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Andrew M. Ball, MS, PT -> Re: ataxia and valid, reliable PT or OT interventions (November 21, 2000 6:43:00 PM)
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Great question! I'll answer it partially, but in the spirit of Plato, I've got some questions for ya'll. I'm sure that David will encourage ya'll to participate in an on-line discussion regarding the additional questions that I've posed.
David has ya jumping huh? I'm sure he's had you look through MEDLINE to get a few suggestions, but if not, take a look at:
[URL=http://www.ncbi.nlm.nih.gov/PubMed/]http://www.ncbi.nlm.nih.gov/PubMed/[/URL]
Try the following search string
Ataxia and treatment and "physical therapy"
You will generate 14 hits
Zelnik N, Gale AD, Shelburne SA Jr. Multiple sclerosis in black children.
J Child Neurol. 1991 Jan;6(1):53-7.
Hanks SB. Motor disabilities in the Rett syndrome and physical therapy strategies.
Brain Dev. 1990;12(1):157-61.
Hanks SB. The role of therapy in Rett syndrome. Am J Med Genet Suppl. 1986;1:247-52.
Ganz SB, Levine DB, Axelrod FB, Kahanovitz N. Physical therapy management of familial dysautonomia. Phys Ther. 1983 Jul;63(7):1121-4.
Feldkamp M. [Motor goals of therapeutic horseback riding for cerebral palsied children]. Rehabilitation (Stuttg). 1979 May;18(2):56-61. German.
Saywell SY. Riding and ataxia.
Physiotherapy. 1975 Nov;61(11):334-5.
Morgan MH. Ataxia and weights.
Physiotherapy. 1975 Nov;61(11):332-4.
Surtees OB. Springboards as an aid to treatment of children with abnormal motor development. Physiotherapy. 1972 May;58(5):175-6.
Berger H. [Early management of cerebral movement disorders]. Wien Med Wochenschr. 1968 Jul 13;118(27):610-2. German.
Wolff E de. [Early treatment of cerebral motor dysfunctions. 5 years of activity at the Notre Dame de Loudes a Sierre Center].
Schweiz Arch Neurol Neurochir Psychiatr. 1968;102(2):355-70. French.
You'll note a few things, first of all, you may need to have a few articles translated. Besides that, there are only a small fraction of articles dealing with ataxia AND CP. There are other kinds of ataxia. Should treatment for ataxia be identical regardless of etiology? Why or why not? I see a lot of Ataxia in the lower toned kids, rather than the higher toned ones. Think about what kind of conditions produce kids with low-tone. Add into that list VATER association and spinocerebellar ataxia.
What area of the brain should be suspected in cases of ataxia? Is this the same area compromised in kids with CP? Would you expect ataxia in CP? If yes, why? If no, then what other conditions (given the neurologic structures associated with ataxia) would you expect to see problems?
I'm a big fan of PWB-GT for kids with athetoid CP, which is close to, but not the same thing as ataxia. Given the clinical neurology associated with PWB-GT, what is the reasoning for using this technique in kids with athetosis OR ataxia? Am I justified in my proclimations that for individuals with athetoid CP or ataxia, PWB-GT is the most effective tool that we have in our bag of tricks? Why or why not?
Another hint . . . Patricia Montgomery, PhD, PT has written a lot of late about working with children with ataxia. Not all of her stuff is available through MEDLINE. I suggest that one of you contact her directly, or order a copy of her lecture at PT'99 from the APTA . . . the audio tape should be about $7. She's very evidence-based and her lecture is chock full of leads for your assignment.
Drew
[This message has been edited by Andrew M. Ball, MS, PT (edited November 22, 2000).]
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