John, how many sessions have you worked with this patient? I am a strong believer of the motor learning principle, hence, intensive task training. There isn't any strong evidence on effective treatment for ataxia, but from what I've seen in the literature, intensity of practice seem to help. My thought would be to keep your patient on 45% BWS and practice walking repetitively, when he can reach a fairly normal speed then start decrease the % of body weight slowly. Maybe you've done all of the above....ataxia is very challenging....Doris
Does anyone have thoughts on a treatment progression for treating severe motor ataxia using the LiteGait in an adult with a chronic TBI?
He ambulates independently, but must hyperextend his knees during the entire stance phase to provide enough stability to overcome the severe motor tremors/ataxia. This has caused him severe knee pain, and he wishes to ambulate with a more normal pattern, with less pain.
In the LiteGait with about 45% BWS, he ambulates over the TM with very flexed hips and knees with a significant reduction in ataxia. Decreasing BWS causes him to either hyperextend his knees in stance, or sit in the harness, and flex even more. He is a large man and the extensor moment is so great during stance without a LOT of BWS, I am unable to manually control it. After training on the LG, he attempts to decrease his hyperextension in stance, but is unable to walk independently due to the extreme increase in tremors/ataxia.
