Cerebellar Atrophy
by Karen Shuler, PT, DPT, Lifestyle Physical Therapy, Lake Wylie, SC INTRODUCTION
Patient is a 65 y.o. female with a long history of seizures and declining balance over the past 3 years. Her MRI revealed cerebel ar atrophy due to prolonged use of seizure medication. The patient has fal en once over the past year due to her Functional Gait Assessment 26/40 at week 4.
balance deficits and not her seizures. Her balance improved and her seizures stabilized with a change in her medication, but her balance did not return to her previous level of function. TREATMENT
Prior to experiencing changes in her balance the patient AlterG Anti-gravity Treadmill training was implemented was independent with household and community walking, during the second week of physical therapy. See progression negotiating stairs, and performing household chores. She is now experiencing moderate difficulty with al activities. She has to sit on a bench while showering, is unable to walk her dogs, Physical Therapy treatment for this patient also included a has to support herself to bend over and feed her dogs, and progressive dynamic balance retraining program on and off uses a handrail to negotiate stairs. She has no confidence in the AlterG, low level laser therapy, core and lower extremity strengthening with a power plate, and neurological re-education. CONSIDERATIONS
Pt. to be independent with dynamic sitting balance activities Pt. has the following co-morbidities: chronic neck pain, Pt. to increase single limb balance to 10 seconds without UE headaches, hand tremors, occasional blurred vision with difficulty focusing, chronic Tegretol and Dilantin therapy, previous history of breast cancer, pain and stiffness in left knee from left total knee replacement 6 years ago, and side effects to keppra which include decreased balance and energy.
Pt. able to negotiate 10 steps without handrail, step over step independently with no loss of balance Pt. to restore Berg Balance Score to 51/56 to restore her The AlterG was extremely motivating for this patient. She Pt. to increase her Dynamic Gait Index to 24/24 so she can looked forward to coming to therapy and walking distances turn and talk to someone while walking without falling and that she has not been able to walk in over a year. She felt very safe and confident in the AlterG which allowed her to challenge Pt. to be able to take moderate perturbations in static her balance early on. She has benefited greatly from treatment standing without loss of balance so she can walk in a crowd and progressed at a good pace. At discharge she presents with a reciprocal gait pattern with proper base of support and Pt. to perform tandem walking 8’ with no loss of balance to arm swing on various surfaces, significantly reduced her risk restore her ability to walk in narrow spaces of falling, ability to bend forward and feed her dogs without loss of balance, ability to stand and shave her legs while HISTORY/PROGRESSION
showering with no loss of balance, ascends and descends 3 stairs with independence and no use of handrail. Berg balance Pt. has difficulty performing sit to stand transfers secondary score improved from 45/56 to 55/56. Dynamic Gait Index score improved from 17/24 to 24/24. Functional gait assessment score increased from 26/30 to 28/30 at discharge.
Pt. had a left knee replacement in 2005 which continues to be limited in mobility Pt. ambulates with a narrow base of support with a reciprocal gait pattern. Loss of balance reported when going around corners PROGRESSION TABLE
Freq (per week)
Total Time Walking


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