Assessment and tailored physical rehabilitation approaches in persons with cerebellar impairments targeting mobility and walking according to the International Classification of Functioning: a systematic review of case-reports and case-series

Abstract

Purpose

Cerebellar impairment (CI) manifests from different etiologies resulting in a heterogenic clinical presentation affecting walking and mobility. Case-reports were reviewed to provide an analytical clinical picture of persons with CI (PwCI) to differentiate cerebellar and non-cerebellar impairments and to identify interventions and assessments used to quantify impact on walking and mobility according to the International Classification of Functioning, Disability and Health (ICF).

Materials and Methods

Literature was searched in PubMed, Web Of Science and Scopus. Case-reports conducting physical rehabilitation and reporting at least one outcome measure of ataxia, gait pattern, walking or mobility were included.

Results

28 articles with a total of 38 different patients were included. Etiologies were clustered to: spinocerebellar degenerations, traumatic brain injuries, cerebellar tumors, stroke and miscellaneous. The interventions applied were activity-based, including gait and balance training. Participation based activities such as tai chi, climbing and dance-based therapy had positive outcomes on mobility. Outcomes on body function such as ataxia and gait pattern were only reported in 22% of the patients.

Conclusions

A comprehensive test battery to encompass the key features of a PwCI on different levels of the ICF is needed to manage heterogeneity. Measures on body function level should be included in interventions.

IMPLICATIONS FOR REHABILITATION

• This review reports on 38 cerebellar cases from 14 different aetiologies.

• Distinguishing cerebellar and non-cerebellar symptoms and categorising patients within the three cerebellar syndromes can assist with heterogeneity.

• Reporting of assessment on the body function level of ICF in terms of ataxia and gait pattern was only present in a minority of reports and thus increased reporting is encouraged.

• Multimodal and patient-tailored strategies are promising for targeting walking and mobility in persons with cerebellar impairment.

Keywords:

• Cerebellar impairment
• assessment
• physical rehabilitation
• walking
• mobility
• International Classification of Functioning
• case reports

Disclosure statement

No potential conflict of interest was reported by the authors.

Author contributions

A.B., F.R, P.C, P.F., and L.M. contributed to the conceptualization of aims of the systematic review and defining the search strategy. A.B. and F.R. screened articles for inclusion and completed the data extraction L.M. contributed as the third reviewer and resolved discrepancies. A.B., F.R, P.C, P.F., and L.M. contributed to the writing and revising the manuscript.

Additional information

Funding

Fonds Wetenschappelijk Onderzoek (FWO) project obtained by Prof. Peter Feys, grant number G082021N; Fonds Wetenschappelijk Onderzoek (FWO) project obtained by dr. Lousin Moumdjian, grant number 1295923 N; Stiftelsen Promobilia grant obtained by dr. Lousin Moumdjian, grant number 20110.