This document provides information on managing ataxia in multiple sclerosis (MS) through a multidisciplinary rehabilitation approach. It discusses the importance of managing ataxia to minimize social isolation and maximize quality of life. Assessment involves evaluating multiple body systems that can contribute to ataxia in MS. Interventions discussed include exercises to challenge balance, activities to improve coordination, strategies to compensate for impairments, and considerations for mobility aids, posture, eating, and cooling techniques. Evidence is presented supporting long-term rehabilitation to maximize potential and slow deterioration.
Practical management of ataxia and balance impairment: Part 2MS Trust
This presentation by Dr Lisa Bunn looks at the practical management of ataxia and balance impairment among people with MS. It includes information on assessing ataxia, the rehabilitation of balance, and relevant research studies.
It was presented at the MS Trust Annual Conference in November 2013.
Practical management of ataxia and balance impairment: Part 2MS Trust
This presentation by Dr Lisa Bunn looks at the practical management of ataxia and balance impairment among people with MS. It includes information on assessing ataxia, the rehabilitation of balance, and relevant research studies.
It was presented at the MS Trust Annual Conference in November 2013.
Ataxia Physiotherapy Presentation - COAP study dayAtaxia UK
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.
The COTSS - Older people Conference keynote presentation by Dr Dawn Skelton PhD Reader in Ageing and Health, HealthQWest, Glasgow Caledonian University coordinator of Prevention of Falls Network Europe Chair, Organising Committee, and World Congress on Active Ageing 2012. COT Annual Conference 2010 (22-25 June 2010)
Ataxia Physiotherapy Presentation - COAP study dayAtaxia UK
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.
The COTSS - Older people Conference keynote presentation by Dr Dawn Skelton PhD Reader in Ageing and Health, HealthQWest, Glasgow Caledonian University coordinator of Prevention of Falls Network Europe Chair, Organising Committee, and World Congress on Active Ageing 2012. COT Annual Conference 2010 (22-25 June 2010)
Neurobalance therapy in elderly populationSurbhiKaura
Aging, geriatric care, Healthy lifestyle# therapies for improving balance. Neuromuscular adaptation. geriatric condition
Fall prevention
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neurobalance therapy for older people
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In modern total knee replacement surgery, only the worn out cartilage surfaces of the joint are replaced.
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Dr. NEERAJ AGGARWAL
MBBS –SMS Medical College, 1999
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Standing 101 is for Physical Therapists, Occupational Therapists, and Assistive Technology Professionals. It covers the history of standing therapy for the disabled, including research studies on standing programs. It also discusses the different types of standing frames including: prone standers, supine standers, and sit to stand standers. It concludes with information on funding and documentation for standing equipment and writing a letter of medical necessity for standing.
http://lifeinmotion.co.in/
We Provide These Services :
Total Knee Replacement,
Revision Joint Replacement Surgery,
Total Hip Replacement
In modern total knee replacement surgery, only the worn out cartilage surfaces of the joint are replaced.
The entire knee is not actually replaced. The operation is basically a resurfacing (or “retread”) procedure. On resurfaced area, hip or knee joints made up of specialized alloy metal and ultra high density polyethylene (UHDP)plastic are placed.
In modern total knee replacement surgery, only the worn out cartilage surfaces of the joint are replaced.The entire knee is not actually replaced. The operation is basically a resurfacing (or “retread”) procedure. On resurfaced area, hip or knee joints made up of specialized alloy metal and ultra high density polyethylene (UHDP) plastic are placed.
Physical activity in people with disabilities and elderly peopleKarel Van Isacker
As presented at the International Workshop on “Qualitative Personal Caring in a European Perspective”, 07 May 2015, Antalya, Turkey
http://mcare-project.eu/
This project (M-Care - 539913-LLP-1-2013-1-TR-LEONARDO-LMP) has been funded with support from the European Commission. This website reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.
http://lifeinmotion.co.in/
We Provide These Services :
Total Knee Replacement,
Revision Joint Replacement Surgery,
Total Hip Replacement
In modern total knee replacement surgery, only the worn out cartilage surfaces of the joint are replaced.
The entire knee is not actually replaced. The operation is basically a resurfacing (or “retread”) procedure. On resurfaced area, hip or knee joints made up of specialized alloy metal and ultra high density polyethylene (UHDP)plastic are placed.
Dr. NEERAJ AGGARWAL
MBBS –SMS Medical College, 1999
MS – SMS Medical College, 2003
Senior Residency KEM Mumbai 2004
Fellowship in Joint Replacement Depuy Fellow, Mumbai 2005
Fellowship Joint Replacement Surgery Germany,
Ranawat Adult Reconstruction Fellow, New York
Mobility Awareness Among Aging PopulationSamOburota
CKCG Health Care Services spotlights mobility impairments and challenges among the aging community. Mobility awareness discussion covers prevention, caregiver assistance for mobility patients, mobility improvement, and mobility topics
Case study on lowback pain using Physioball, yoga And Dietry Measures.iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
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- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
1. Managing ataxia
in MS
MS Trust Conference 2019
Wendy Hendrie
Clinical specialist physiotherapist in MS
Norwich
2. Why is it important?
• “Located illness”
• Minimise exposure
of symptoms in
public; stigma,
shame
• Isolation
• Diminished life
experience
(Cassidy et al, 2011)
6. Just to complicate matters…
• Spasticity/spasms
• Weakness
• Pain
• Fatigue/fatigueability
• Cognitive change
Huge impact on function and quality of life
9. Managing ataxia
Treatment of ataxic patients requires balance
between facilitation of improved control and
the recognition and acceptance of necessary
compensation which is essential for function.
(Marsden and Harris, 2011)
11. Assessment – ask about….
• Medication – especially anti-spasticity tabs
• Percentage of day sitting
• Use of walking aids
• Things they have found useful
• Their expectation of what you can do
• Beliefs about the future
• Family / carer concerns
• Attitude to exercise / activity
15. Outcome measures for ataxia
• SARA (Scale for Assessment and Rating of
Ataxia)
• ICARS – International Cooperative Ataxia
Rating Scale
• Kurtze Functional Systems Score
• SF 36 (v2) for quality of life
• VAS - 0 - 10cm scale “How difficult is it to…”
• Canadian Occupational Performance Measure
16. Balance and gait outcomes
• Functional Reach (modified)
• TUG
• Single leg stance
• Berg balance
• ABC (Activities-specific Balance Confidence
scale)
• Balance – SARA
• Timed 10m walk; 6 minute walk
17. Tests of coordination
• 9 hole peg test – can dishearten if repeatedly
fails
• Figure of 8 drawing or spiral (A4 page)
20. RCT evidence for rehab in MS?
• Cochrane review – 2007 (Mills et al)
• NICE Guidelines for MS 2014
– Armutlu et al 2001
– Keser et al 2013
21. Evidence for rehab in ataxias
Physiotherapy can improve:
• Mobility
• Balance
• Trunk control
(Gill-Body et al 1997; Marsden and Harris, 2011; Miyai et al 2012, Ataxia
UK Guidelines 2016)
22. Approaches to rehabilitation
• Dynamic task practice – challenge stability,
reduce UL weight bearing (Armutlu et al 2001)
• Balance retraining (challenging) (Keller & Bastian 2014)
• Priming/rehearsing task visually (Crowdy et al, 2002)
23. Approaches to rehabilitation
• Strengthening and treadmill training (Vaz et al 2006)
• Biofeedback + computer game (Betker et al, 2006; Bunn
et al 2015)
• Frenkel’s exercises – visual feedback to control
movement(Armultlu et al 2001)
24. Rehabilitation
• More training, better outcomes – prolonged
intervention 3-12 months
• Better outcomes in mild ataxia
• Carry-over not usually assessed
25. Deconditioning
• People with ataxia tend to sit for long periods
– change patterns of movement e.g. push up
with arms
• Deconditioning reversible
27. Standing
• Improves motor function
• Feasible to use at home
• People enjoy standing safely upright
(Freeman et al 2019)
Standing frame website (results and resources):
www.plymouth.ac.uk/research/sums
28. Tailoring activity to the person
• Yoga
• T’ai Chi
• Pilates
• Horse riding
• Climbing wall
The importance of challenge!
31. Rollators
May be dangerous
as lateral side-steps
to aid balance is
impeded (Bateni 2004)
May find added
weight improves
stability
32. Mobility Aids
• Trekking / Nordic poles – light tough contact,
reduce UL weight bearing (Jekka 1997; Balliet 1987)
• Difficult placing sticks / poles if person has
dysmetria or tremor
• Can weight hollow mobility aids with sand /
ball-bearings or use weights (graded to
person)
36. Torso weighting – vest or belt
• Use weight to increase
proprioception
• Increases feelings of
steadiness
• To counteract forward
or backward lean
• Reaching activities in
sitting
(Gibson-Horn, 2008; Widener et al,
2009)
37. Visual and verbal cues
• Visual cues using virtual reality (walking along
virtual tiles) (Baram and Miller, 2006)
• Verbal cues delivered through ear piece (tick
on stepping) increased speed and stride
length (Baram and Miller 2007)
38. Strategies for the upper limb
• Manipulation of visual information (Haggard et al
1994, Pope 2007)
• Tremor and dysmetria may improve if
movement not visually guided (Pope, 2007)
• Can work well in people with intention tremor
• Find the ‘quiet arc’ of movement
39. Central vs. Peripheral vision
• Central pick-up may increase tremor
• Locate object then use peripheral vision
• Place object to one side
40. Lycra garments
• Increases sensation/proprioception
• Some success with UL (Watson et al, 2007; Betts 2015)
41. Lycra garments
• May help with functional tasks
• Can be hot
• Can be difficult to put on
• Assess with two layers of Size B tubigrip
46. Wrist weighting
• Grade weight until
tremor diminished
enough for function
• Beware of making
tremor, instability,
weakness, fatigue or
rebound worse
• Up to 4lbs (Gillen 2000)
50. More ideas…..
• Overshoot and pick
up on return
• Easy target
• Improve sensation –
visual / touch
• Bag of different
objects / textures
51. Single joint move
• Simplify movement
• Avoid rapid, multi-joint movements
• Reduce number of moving joints
• Stabilise
• Slow movement down
(Bastian 1997)
56. Medical interventions
• Medication may not be helpful
• Botulinum toxin Type A – two randomised
placebo controlled trials reporting benefit in
tremor reduction and improved writing ability.
However – no improvement in QoL and
increased weakness
(Alusi et al 2000; Brin et al 2001)
57. Medical interventions
• Review drugs which may effect ataxia e.g.
anti-spasticity medication
• Essential to monitor effects of these drugs
• Gabapentin – possibly effective but
insufficient evidence to confirm or refute
58. Medical interventions
• Stereotactic thalamotomy and Deep Brain
Stimulation (DBS)
– Initial tremor suppression in 94% (thalamotomy)
and 96% (DBS)
– 63% had tremor suppression at 12 months
– Adverse effects: hemiparesis, dysarthria,
dysphagia
(Yap et al 2007)
59. In summary
• Balance exercises should challenge base of
support!
• May need to use a variety of compensatory
interventions
• Check medication (especially anti-spasticity)
as muscle weakness may be contributing to
ataxia
60. In summary
• Deconditioning makes everything worse
• Support long-term activity
• Talk about expectations and the importance of
doing a bit to keep as good as possible
61. Management of the ataxias:
towards best clinical practice 2016
www.ataxia.org.uk
63. References
1. Marsden J. Harris CM. (2011) Cerebellar ataxia: Pathophysiology and rehabilitation
Clinical Rehabilitation 25:195-216
2. Management of the ataxias: towards best clinical practice 3rd Ed July 2016 Ataxia
UK – www.ataxia.org.uk
3. Mills, RJ et al (2007) Treatment for ataxia in multiple sclerosis. Cochrane database of
systematic reviews. Issue 1 Art.No.:CD005029.DOI:10.1002/14651858.CD005029.pub2
4. Keller JL and Bastian AJ (2014) A home balance exercise program improves walking
in people with cerebellar ataxia Neurorehabilitation and Neural Repair 28(8):770-778
5. Davis, AE. Lee RG (1980) EMG feedback in patients with motor disorders: an aid for
co-ordinating activity in antagonistic muscles groups. Can J Neurosci 7:199-206
6. Guercio JM et al (2001) Increasing functional communication through relaxation
training and neuromuscular feedback Brain Inj 15:1073-82
64. References
7. Betker et al (2006) Video game-based exercises for balance rehabilitation: a single-
subject design Arch Phys Med Rehabil 87:1141-49
8. Bastian, AJ (1997) Mechanisms of ataxia. Phys Ther 77:672-675
9. Armutlu K et al (2001) Physiotherapy approached in the treatment of ataxic multiple
sclerosis: a pilot study. Neurorehabil and Neural Repair 15: 203-211
10. Balliet R et al (1987) Retraining of functional gait through the reduction of upper
extremity weight-bearing in chronic cerebellar ataxia. Int Rehabil Med 8:148-153
11. Vaz, DV et al (2008) Treadmill training for ataxic patients: a single subject
experimental design. Clin Rehab 22:234-241
12. Gill-Body, KM et al (1997) Rehabilitation of balance in two patients with cerebellar
dysfunction. Phys Ther 77:534-552
13. Miyai, I et al (2012) Cerebellar ataxia rehabilitation trial in degenerative cerebellar
disease. Neurorehabil Neural Repair 26:515-522
14. Yap, L et al (2007) Stereotactic neurosurgery for disabling tremor in multiple
sclerosis: thalamotomy or deep brain stimulation? British Journal of Neurosurgery
21(4):349-354
65. References
15. Crowdy, KA et al (2002) Rehearsal by eye movement improves visuomotor
performance in cerebellar patients. Exp. Brain Res. Exp Hirnforsch Experimentation
Cerebrale 146:244-247
16. Jekka, JJ (1997) Light touch contact as a balance aid. Phys Ther 77:476-487
17. Bateni, H. et al (2004) Can use of walkers or canes impede lateral compensatory
stepping movements? Gait Posture 20: 74-83
18. Cassidy, E et al (2011) Using interpretive phenomenological analysis to inform
physiotherapy practice: An introduction with reference to the lived experience of
cerebellar ataxia. Physiother Theory Pract. 27:263-277
19. Bunn, L et al (2015) Training balance with opto-kinetic stimuli in the home: a
randomised controlled feasibility study in people with pure cerebellar disease. Clinical
Rehabilitation 29(2):143-153
20. Freeman, J. et al (2019) Assessment of a home-based standing frame programme
in people with progressive multiple sclerosis (SUMS): a pragmatic, multi-centre,
randomised, controlled trial and cost-effectiveness analysis. Lancet Neurology 18 736-
747
66. References
21. Gibson-Horn, C. (2008) Balance-based torso-weighting in a patient with ataxia and
multiple sclerosis: a case report. Journal of Neurologic Physical Therapy 32(3):139-146
22. Widener, GL et al (2009) Randomised clinical trial of balance-based torso weighting
for improving upright mobility in people with multiple sclerosis. Neurorehab and
Neural Repair 23(8):784-791