Ataxia Physiotherapy Presentation - COAP study day


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This is a presentation given by Anita Watson, Lecturer in Physiotherapy, at the Care of Ataxia Patients (COAP) study day on 18 November 2011 in Manchester. It is an overview of physiotherapy treatment options for people with ataxia.

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Ataxia Physiotherapy Presentation - COAP study day

  1. 1. Physiotherapy treatment options for people with ataxia Anita Watson Lecturer in Physiotherapy [email_address]
  2. 2. Contents <ul><li>Neurological Physiotherapy </li></ul><ul><li>Ataxia UK Physiotherapy Guidelines </li></ul><ul><li>Salford Activity Limitation Score for Ataxia (SALSA) Outcome Measure </li></ul>
  3. 3. Neurological Physiotherapy <ul><ul><li>What do we do: </li></ul></ul><ul><ul><ul><li>Work to maximise quality of life by restoring, maintaining and improving function and movement. </li></ul></ul></ul><ul><ul><li>Where do we work: </li></ul></ul><ul><ul><ul><li>In-patient, out patient and community </li></ul></ul></ul><ul><ul><ul><li>Independently and as part of multi-disciplinary teams. </li></ul></ul></ul>The CSP Code of Professional Values, 2011
  4. 4. Neurological Physiotherapy <ul><li>How to find us: </li></ul><ul><ul><li>Referral by a GP, Consultant, Allied Healthcare Professional or self referral. </li></ul></ul><ul><ul><li>Private - look up neurological physiotherapy (yellow pages or Google)or access Physio2u on the CSP website. </li></ul></ul><ul><ul><li> </li></ul></ul>
  5. 5. What do we do? <ul><li>Assess your problems </li></ul><ul><li>Identify a treatment plan </li></ul><ul><li>Monitor progress using outcome measures </li></ul>Edwards, 2002
  6. 6. Ataxia UK Guidelines-Physiotherapy <ul><li>Produced by Betty Cassidy, Cherry Kilbride and Ann Hollands (2009). </li></ul><ul><li>Review of rehabilitation approaches and physiotherapy interventions in children and adults with ataxia (1980-2009). </li></ul><ul><li> </li></ul>
  7. 7. <ul><li>Treadmill Training </li></ul><ul><li>Balance and Mobility Aids </li></ul><ul><li>Weighting </li></ul><ul><li>Visual Feedback </li></ul><ul><li>Lycra Garments </li></ul><ul><li>Cold Therapy </li></ul><ul><li>Exercise </li></ul>Ataxia UK Guidelines-Physiotherapy
  8. 8. Treadmill Training <ul><ul><li>Encouraging results </li></ul></ul><ul><ul><ul><li>But intensity and duration of training needs further investigation. </li></ul></ul></ul>
  9. 9. Balance and Mobility Aids <ul><li>Light touch as a balance aid may help postural stability. </li></ul><ul><li>Careful assessment needed as walking pattern can deteriorate. </li></ul>
  10. 10. Weighting <ul><li>No evidence for walking. </li></ul><ul><li>Weighted wrist cuffs or cutlery may help. </li></ul><ul><li>But could be too tiring or cumbersome for some. </li></ul>
  11. 11. Visual Feedback <ul><li>Visual rehearsal of stepping and reaching might improve performance and safety but is short lived in nature. </li></ul>
  12. 12. Lycra Garments <ul><li>Insufficient data to support the use of lycra garments </li></ul><ul><li>Recently project by Ataxia UK showed inconclusive results. </li></ul>
  13. 13. Cold Therapy <ul><li>Cooling of the arm can temporarily reduce tremor, aiding functional activities. </li></ul><ul><li>Further studies are warranted. </li></ul>
  14. 14. Exercise <ul><li>Aerobic/endurance training could be a means of promoting activity and reducing deconditioning. </li></ul><ul><li>But very little evidence to date. </li></ul>
  15. 15. Take home messages <ul><li>Exercise that increases movement practice shows positive outcomes-treadmill training, auditory cuing, targeted balance training, robot training and constraint induced movement therapy. </li></ul><ul><li>But further work needed about intensity and duration. </li></ul>
  16. 16. Take home messages <ul><li>Visual rehearsal of a movement can be used as a short term strategy to improve performance. </li></ul><ul><li>Walking aids and weighting to be assessed on a case by case basis. </li></ul><ul><li>More studies looking at lycra garments and cooling. </li></ul>
  17. 17. Limitations of ataxia research in physiotherapy <ul><li>Further research is needed to establish: </li></ul><ul><ul><li>Which interventions are most effective. </li></ul></ul><ul><ul><li>How much and how often. </li></ul></ul><ul><ul><li>The underlying mechanisms of ataxia. </li></ul></ul><ul><ul><li>Robust and sensitive outcome measures. </li></ul></ul>
  18. 18. SALSA-questionnaire development <ul><li>Item generation. </li></ul><ul><li>Items grouped, themed and reworded. </li></ul><ul><li>Questionnaire scale added-Likert. </li></ul><ul><li>Reviewed by people with ataxia (6) to ensure face and content validity </li></ul><ul><ul><li>does it look like it will measure what it says?? </li></ul></ul>
  19. 19. SALSA-Themes <ul><li>Getting around </li></ul><ul><li>Travelling </li></ul><ul><li>Wheelchair use </li></ul><ul><li>Falls </li></ul><ul><li>Getting ready </li></ul><ul><li>Cooking </li></ul><ul><li>Eating and Drinking </li></ul><ul><li>Shopping </li></ul><ul><li>Arm and Hand activities </li></ul><ul><li>Housework </li></ul><ul><li>Gardening </li></ul><ul><li>Leisure </li></ul>
  20. 20. Example of SALSA
  21. 21. What next?? <ul><li>Questionnaire is now being completed by a larger sample to collect further data for validity, sensitivity and stability testing. </li></ul><ul><li>Finding will be analysed to quantify patient’s problems. </li></ul><ul><li>Even larger numbers are needed-any volunteers? </li></ul>
  22. 22. Acknowledgements <ul><li>Ataxia UK - helping with recruiting participants. </li></ul><ul><li>Dr Ealing, Dr Tyrell and their teams. </li></ul><ul><li>Salford Royal and Greater Manchester Physiotherapists. </li></ul><ul><li>All people with ataxia who have taken part so far. </li></ul><ul><li>Professor Sarah Tyson and Dr Richard Jones, University of Salford </li></ul>