Reabilitação em pacientes com ataxias cerebelares

Chien, Hsin Fen; Zonta, Marise Bueno; Chen, Janini; Diaferia, Giovana; Viana, Celiana Figueiredo; Teive, Hélio Afonso Ghizoni; Pedroso, José Luiz; Barsottini, Orlando Graziani Povoas

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Arquivos de Neuro-Psiquiatria

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View and Review • Arq. Neuro-Psiquiatr. 80 (3) • Mar 2022 • https://doi.org/10.1590/0004-282X-ANP-2021-0065 copiar

Reabilitação em pacientes com ataxias cerebelares

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

As ataxias cerebelares compreendem um grupo heterogêneo de doenças caracterizadas por sintomas motores e não motores, que podem ser adquiridas, degenerativas ou ter uma causa genética, como as ataxias espinocerebelares (AEC). Normalmente, as formas genéticas e neurodegenerativas de ataxias cerebelares apresentam uma piora progressiva e inexorável do quadro clínico e o tratamento com reabilitação é fundamental. O tratamento com reabilitação inclui a fisioterapia, fisioterapia respiratória, fonoterapia, terapia ocupacional e novas tecnologias, como o uso de exergames. O tratamento atual de pacientes com ataxias cerebelares, em particular as formas neurodegenerativas, genéticas ou não, deve incluir essas diferentes formas de reabilitação, com o objetivo principal de melhorar a qualidade de vida dos pacientes.

Palavras-chave:
Ataxia Cerebelar; Reabilitação; Especialidade de Fisioterapia; Fonoterapia; Terapia Ocupacional

	Study population/ Sample size	Type of study	Intervention/ Tecnhique	Authors
Physiotherapy	Progressive ataxia (N=16)	Experimental study	Intensive coordinative training improves motor performance	Ilg et al., 200966. Ilg W, Synofzik M, Brötz D, Burkard S, Giese MA, Schöls L. Intensive coordinative training improves motor performance in degenerative cerebellar disease. Neurology. 2009 Dec 1;73(22):1823-30. https://doi.org/10.1212/WNL.0b013e3181c33adf https://doi.org/10.1212/WNL.0b013e3181c3...
	Degenerative ataxia or multiple sclerosis	Systematic review	Intensive rehabilitation improves postural capacity and motor coordination	Marquer et al., 201477. Marquer A, Barbieri G, Pérennou D. The assessment and treatment of postural disorders in cerebellar ataxia: a systematic review. Ann Phys Rehabil Med. 2014 Mar;57(2):67-78. https://doi.org/10.1016/j.rehab.2014.01.002 https://doi.org/10.1016/j.rehab.2014.01....
	Degenerative ataxia	Review article	Intensive rehabilitation improves stability and motor coordination	Synofzik and Ilg, 201488. Synofzik M, Ilg W. Motor training in degenerative spinocerebellar disease: ataxia-specific improvements by intensive physiotherapy and exergames. Biomed Res Int. 2014;2014:583507. https://doi.org/10.1155/2014/583507 https://doi.org/10.1155/2014/583507...
	Genetic degenerative ataxia	Systematic review	Coordination and balance training, multifaceted inpatient rehabilitation, cycling, balance exercises with technology assisted biofeedback, respiratory muscle training, and treadmill	Milne et al., 201799. Milne SC, Corben LA, Georgiou-Karistianis N, Delatycki MB, Yiu EM. Rehabilitation for individuals with genetic degenerative ataxia: a systematic review. Neurorehabil Neural Repair. 2017 Jul 1;31(7):609-22. https://doi.org/10.1177/1545968317712469 https://doi.org/10.1177/1545968317712469...
	Children with ataxia	Systematic review	Insufficient data to support or refute effectiveness of exercise and physical therapy for children with ataxia	Hartley et al., 20191212. Hartley H, Cassidy E, Bunn L, Kumar R, Pizer B, Lane S, et al. Exercise and Physical Therapy Interventions for Children with Ataxia: A Systematic Review. Cerebellum. 2019 Oct;18(5):951-68. https://doi.org/10.1007/s12311-019-01063-z https://doi.org/10.1007/s12311-019-01063...
Outcome measures and clinical scales	Cerebellar ataxia	Validation	Scale for the Assessment and Rating of Ataxia (SARA)	Trouillas et al.,19971717. Trouillas P, Takayanagi T, Hallett M, Currier RD, Subramony SH, Wessel K, et al. International Cooperative Ataxia Rating Scale for pharmacological assessment of the cerebellar syndrome. The Ataxia Neuropharmacology Committe e of the World Federation of Neurology. J NeurolSci. 1997 Feb 12;145(2):205-11. https://doi.org/10.1016/S0022-510X(96)00231-6 https://doi.org/10.1016/S0022-510X(96)00...
	Spinocerebellar degeneration (N=27), Spinocerebellar subtypes (N=91)	Validation	International Cooperative Ataxia Rating Scale (ICARS)	Yabe et al., 20081414. Yabe I, Matsushima M, Soma H, Basri R, Sasaki H. Usefulness of the Scale for Assessment and Rating of Ataxia (SARA). J Neurol Sci. 2008 Mar 15;266(1-2):164-6. https://doi.org/10.1016/j.jns.2007.09.021 https://doi.org/10.1016/j.jns.2007.09.02...
	SCA3	Validation	The Neurological Examination Score for Spinocerebellar Ataxias (NESSCA)	Kieling et al.,20082020. Kieling C, Rieder CRM, Silva ACF, Saute JAM, Cecchin CR, Monte TL, et al. A neurological examination score for the assessment of spinocerebellar ataxia 3 (SCA3). Eur J Neurol. 2008 Apr;15(4):371-6. https://doi.org/10.1111/j.1468-1331.2008.02078.x https://doi.org/10.1111/j.1468-1331.2008...
	SCA	Validation	SCA Functional Index (SCAFI)	Schmitz-Hübsch et al., 20082222. Schmitz-Hübsch T, Giunti P, Stephenson DA, Globas C, Baliko L, Saccà F, et al. SCA Functional Index: a useful compound performance measure for spinocerebellar ataxia. Neurology. 2008 Aug 12;71(7):486-92. https://doi.org/10.1212/01.wnl.0000324863.76290.19 https://doi.org/10.1212/01.wnl.000032486...
	Autosomal dominant cerebellar ataxia Autosomal dominant spastic paraplegia	Validation	Composite cerebellar functional severity score (CCFS)	du Montcel et al., 20082424. Du Montcel ST, Charles P, Ribai P, Goizet C, Le Bayon A, Labauge P, et al. Composite cerebellar functional severity score: validation of a quantitative score of cerebellar impairment. Brain. 2008 May;131(5):1352-61. https://doi.org/10.1093/brain/awn059 https://doi.org/10.1093/brain/awn059...
	Cerebellar ataxia	Observational study	Recommended outcome measures for postural disorders severity screening (BBS and TUG)	Winser et al., 20152525. Winser SJ, Smith C, Hale LA, Claydon LS, Whitney SL. Balance outcome measures in cerebellar ataxia: a Delphi survey. Disabil Rehabil. 2015;37(2):165-70. https://doi.org/10.3109/09638288.2014.913709 https://doi.org/10.3109/09638288.2014.91...
Exergame and New Technologies	Cerebellar ataxia	Review	Exergame for SCA rehabilitation	Lanza et al., 20192828. Lanza G, Casabona JA, Bellomo M, Cantone M, Fisicaro F, Bella R, et al. Update on intensive motor training in spinocerebellar ataxia: time to move a step forward? J Int Med Res. 2020 Feb;48(2):300060519854626. https://doi.org/10.1177/0300060519854626 https://doi.org/10.1177/0300060519854626...
Exergame and New Technologies	Friedreich’s Ataxia (N=14)	Observational study	Robotic devices for clinical measures and ataxia rehabilitation	Germanotta et al., 20173939. Germanotta M, Vasco G, Petrarca M, Rossi S, Carniel S, Bertini E, et al. Robotic and clinical evaluation of upper limb motor performance in patients with Friedreich's Ataxia: an observational study. J Neuroeng Rehabil. 2015 Apr 23;12:41. https://doi.org/10.1186/s12984-015-0032-6 https://doi.org/10.1186/s12984-015-0032-...
Respiratory Rehabilitation	Ataxia Telangectasia (N=11)	Experimental study	Inspiratory muscle training	Felix et al., 20144242. Félix E, Gimenes AC, Costa-Carvalho BT. Effects of inspiratory muscle training on lung volumes, respiratory muscle strength, and quality of life in patients with ataxia telangiectasia. Pediatr Pulmonol. 2014 Mar;49(3):238-44. https://doi.org/10.1002/ppul.22828 https://doi.org/10.1002/ppul.22828...
Respiratory Rehabilitation	Spinocerebellar ataxias (N=30)	Experimental study	SCA may present restrictive pulmonary dysfunction and upper airway obstruction.	Sriranjini et al., 20104343. Sriranjini SJ, Pal PK, Krishna N, Sathyaprabha TN. Subclinical pulmonary dysfunction in spinocerebellar ataxias 1, 2 and 3. Acta Neurol Scand. 2010 Nov;122(5):323-8. https://doi.org/10.1111/j.1600-0404.2009.01306.x https://doi.org/10.1111/j.1600-0404.2009...
Speech language therapy	SCA 3 (N= 33)	Observational study	Early intervention for oral motor control, changing food viscosity and bolus volume	Wolf 20085252. Wolf AE. Aspectos clínicos da deglutição, da fonoarticulação e suas correlações genéticas na doença de Machado-Joseph [Dissertation]. [Campinas (SP)]: Faculdade de Ciências Médicas; 2008.
Occupational therapy	Degenerative ataxia	Systematic review	For balance and coordination	He et al., 20205656. He M, Zhang H-N, Tang Z-C, Gao S-G. Balance and coordination training for patients with genetic degenerative ataxia: a systematic review. J Neurol. 2021 Oct;268(10):3690-705. https://doi.org/10.1007/s00415-020-09938-6 https://doi.org/10.1007/s00415-020-09938...
Occupational therapy	Spinocerebellar ataxia type 3 (N=26)	Experimental study	Mood improvement	Silva et al., 20105757. Silva RCR, Saute JAM, Silva ACF, Coutinho ACO, Saraiva-Pereira ML, Jardim LB. Occupational therapy in spinocerebellar ataxia type 3: an open-label trial. Braz J Med Biol Res. 2010 Jun;43(6):537-42. https://doi.org/10.1590/s0100-879x2010005000009 https://doi.org/10.1590/s0100-879x201000...

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[1] Correspondence:
José Luiz Pedroso; Email: jlpedroso.neuro@gmail.com.