Heim, Drake, & Millar: Cerebellar Ataxia, PART 1

Heim, Drake, & Millar: Cerebellar Ataxia, PART 1

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OVERVIEW:

Meredith: The brain stimulation program that we’re doing at Hopkins is we’re applying transcranial direct current stimulation to people who’ve had multiple types of brain injuries. The most common population that we see are strokes. The concept of this non-invasive brain stimulation is that it promotes neuroplasticity and so we combine it with intensive therapies. You come every day for 3 weeks and we’re trying to do this really intensive therapy plus the non-invasive brain stimulation so we’re hoping it’s like a double whammy of neuroplasticity and that we’re really trying to get the brain to get excited…excite those cortical tissues and get them to start re-organizing and healing themselves.

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Brain Injury Recovery Simplified, Pete and Deb talk with physical therapists Jennifer Millar and Meredith Drake from Johns Hopkins Ataxia Center in Baltimore, MD, and cerebellar stroke survivor Stephen Heim. We uncovered the following:

• Cerebellum is latin for “little brain.” It coordinates coordination. The cerebellum is where movement coordination and motor learning mostly occurs. The role of the cerebellum is to predict and smooth out our movements in response to sensory stimuli. It is a complicated structure.
• An impaired cerebellum is very debilitating to the body. Damage impacts motor learning and motor planning, which means traditional therapy is ineffective.
• The cerebellum works ipsilaterally with the other brain structures to produce movement.
• Dual task engagement is not effective for people with cerebellar damage. Using a new device such as a rolling walker adds another aspect to a task. Walking and talking should not occur together.
• Parkinson’s treatment principles do not merge well with interventions to treat cerebellar ataxia.
• Therapy for cerebellar ataxa focuses on balance, dynamic challenges and weight shifting rather than strength training. Most people with cerebellar ataxia have good strength. Practice and repetition are key for recovery. Tai Chi, yoga and swimming are effective interventions for ataxia.
• Dysmetria is a challenge for Stephen, whether he under shoots or overcorrects – he still has trouble. He finds it annoying despite knowing the challenge exists. He uses a wheelchair for mobility and finds this conserves energy.
• We learned compensatory strategies and devices that may help with dysmetria and ambulation when ataxia is present.
• The origin of the Johns Hopkins Ataxia center and services provided. The brain stimulation program promotes neuroplasticity with intensive therapy…It doesn’t cure but does advance outcomes beyond those that occur without using brain stimulation as an intervention.

We hope you find value in Part 1 of our conversation!

• LifeGlider Hands-free, upright, "fall-safe" mobility.
• National Ataxia Foundation
• OT Strategies for Improving Daily Living Independence
• Educational webinars about Ataxia

As always, we want to hear your top takeaways! Please email us at NogginsAndNeurons@gmail.com.

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Pete’s blog, book, Stronger After Stroke, and talks.

• • Pete's Seminars
    • Stroke and TBI Recovery - Three Part Series
    • The Neuroplastic Model of Spasticity Reduction
  • Blog
  • Consultation with Pete
  • Book: Stronger After Stroke, 3rd edition

Deb's OT Resources:

• Deb's OT resources
• The OT’s Guide to Mirror Therapy
• Tri-Fold Mirror (US address only)
• Occupational Therapy Intervention: Scavenger Hunt Visual Scanning for Adults

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