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Rehabilitation of Balance in Two Patients With Cerebellar Dysfunction

KM Gill-Body, PT, NCS, is Assistant Professor, Graduate Programs in Physical Therapy, MGH Institute of Health Professions, 101 Merrimac St, Boston, MA 02114 (USA) (gill-body.kathleen@mgh.harvard.edu), and Neurologic Clinical Specialist, Physical Therapy Services, Massachusetts General Hospital, Boston, Mass.
RA Popat, PT, NCS, was Supervisor, Physical Therapy Services, Massachusetts General Hospital, and Adjunct Assistant Professor, MGH Institute of Health Professions, at the time this report was written. She is currently a graduate student, University of Massachusetts, Amherst, Mass.
SW Parker, MD, is Chief of Otoneurology, Massachusetts General Hospital, and Assistant Professor of Neurology, Harvard Medical School, Boston, Mass.
DE Krebs, PhD, PT, is Associate Professor, MGH Institute of Health Professions; Director, Massachusetts General Hospital Biomotion Laboratory, Boston, Mass.; Instructor, Harvard Medical School; and Lecturer, Massachusetts Institute of Technology, Cambridge, Mass.

The treatment of two patients with cerebellar dysfunction is described. One patient was a 36-year-old woman with a 7-month history of dizziness and unsteadiness following surgical resection of a recurrent pilocystic astrocytoma located in the cerebellar vermis. The other patient was a 48-year-old man with cerebrotendinous xanthamatosis (CTX) and diffuse cerebellar atrophy, and a 10-year history of progressive gait and balance difficulties. Each patient was treated with a 6-week course of physical therapy that emphasized the practice of activities that challenged stability. The patient with the cerebellar tumor resection also performed eye-head coordination exercises. Each patient had weekly therapy and performed selected balance retraining exercises on a daily basis at home. Measurements taken before and after treatment for each patient included self-perception of symptoms, clinical balance tests, and stability during selected standing and gait activities; for the patient with the cerebellar tumor resection, vestibular function tests and posturography were also performed. Both patients reported improvements in symptoms and demonstrated similar improvements on several kinematic indicators of stability during gait. The patient with the cerebellar tumor resection improved on posturography following treatment, whereas the patient with CTX improved on clinical balance tests. This case report describes two individualized treatment programs and documents functional improvements in two patients with different etiologies, durations, and clinical presentations of cerebellar dysfunction. The outcomes suggest that patients with cerebellar lesions, acute or chronic, may be able to learn to improve their postural stability.

Key Words: Balance • Balance rehabilitation • Cerebellar rehabilitation • Postural control

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