Cerebellar Ataxia Case Study | Virtual Reality Improves Motor Control

ABSTRACT

Cerebellar Ataxia is a movement disorder that is caused by degeneration of nerve cells in the cerebellum. Symptoms can include impair coordination of limbs and torso, unsafe gait, frequent loss of balance, slurred speech, and a greater burden of care. Therapy typically consists of regular physical therapy treatment and pharmacological efforts. This case involves a patient with “Undiagnosed Cerebellar Ataxia” who performed Virtual Reality exercises regularly during their physical therapy sessions. This case study documents the patient’s progress from initial utilization of VR, then integrated into their physical therapy sessions over the course of 10 months.

INTRODUCTION

The patient is a 56 year old female and presents with “Undiagnosed Cerebellar Ataxia”. This has caused decreased overall function and increased burden of care as time went by. Patient was wheelchair bound and could ambulate less than 30 feet with a rolling walker and moderate to maximum assistance to safely ambulate. Patient was admitted to physical therapy at the Neurological Recovery Center in Fort Worth, Texas December 27, 2017. During therapy her exercises would include, but not limited to, robotic gait training using the Hocoma Lokomat, rhythmic auditory stimulation, and aquatic therapy. Beginning in May of 2018 the patient began to receive Virtual Reality exercises using Neuro Rehab VR’s XR Therapy System. The VR routines consisted of 30 minutes of Virtual Reality exercises during or after her therapy session 3x a week.

CLIENT CHARACTERISTICS

Patient is a white female 56 years old and reports her symptoms began in 1991. The patient and her husband were referred to therapy at the Neurological Recovery Center due to the increased burden of care of the patient. Patient was motivated “to walk again” and “be able to play with my grandchildren” and was eager to begin physical therapy. Before onset of symptoms, the patient enjoyed traveling, going to concerts, and spending time outside with her family without issues. She was examined and under the care of William Pittmon PT, DPT and Arik Yates, PTA.

EXAMINATION FINDINGS

Patient was tested April 18, 2018 using the Scale for the Assessment and Rating of Ataxia (SARA) and had goals for walking greater than 30 feet using a rolling walker, standing balance for greater than 30 seconds, and to demonstrate ability to unscrew 5 screws in under 5 minutes using wooden adaptive screw driver and screws. During patient’s evaluation prior to using Virtual reality, she was given a SARA score of 20 (23 is maximal dependence), could ambulate 30 feet with a 20 pound rolling walker, standing for less than 30 seconds before losing balance and unscrewing 5 screws in 5 minutes. Throughout her sessions the patient sustained a positive attitude and remained focused and motivated for completing therapy despite the challenge of performing coordination, balance, and walking.

INTERVENTIONS

The administered VR exercises were Retail Therapy which required the patient to grocery shop within a virtual grocery story, picking up items on various shelf levels with both upper extremities, and a Rhythmic Auditory Stimulation activity requiring the patient to strike color coded blocks coming towards the patient with bilateral upper extremity movements. Both of these exercises were performed in each session 15 minutes each with intermittent breaks in between. The exercises were administered with slight increase in challenge based on level completion within the virtual reality exercises and would perform these activities two times a week.

OUTCOME

During patients re-evaluation May 22, 2019 the patient demonstrated improvements in each of her personal goals and supervising therapist goals. She achieved a score of 14 (14.25 is moderate dependence) on SARA, she demonstrated the ability to ambulate 210ft using a 10lb pound rolling walker, she sustained standing balance for 2 min and 30 seconds, and was able to unscrew 5 screws in 4 minutes and 45 seconds.

DISCUSSION/CLOSING

Through the inclusion of Virtual Reality exercises using Neuro Rehab VR’s XR Therapy System patient showed great improvements during the trial period between May 1, 2018 and May 22, 2019. As a result the burden of care on her husband and caregivers had decreased and a more “hands off approach” could be put forth during activities of daily living and during travel. While normal physical therapy contributed, the inclusion of VR exercises expedited achievement of patient and therapist goals.