Gait Balance Disorder by Thalamic Infarction with the Disorder of Interstitial Nucleus of Cajal

Abstract

The interstitial nucleus of Cajal (INC) is thought to play an important role in torsional/vertical eye position and head posture, and disorders of the INC induce abnormal ocular movements and head tilt. Our patients with ocular tilt reactions simultaneously also had disturbances in ambulatory balance, yet no reports address the loss of balance control induced by disorders of the INC. We examined the ambulatory disturbances induced by INC lesion. We experienced three patients with ocular movement disorders and abnormal head tilt due to thalamic infarction. We performed ophthalmic examinations on and checked the balance of them. With funduscopy, abnormal cycloduction was seen in the unaffected side and normal cycloduction was observed in the affected side. Nevertheless, Hess charts showed distortions in the visual image of both eyes. They all had disorders of balance control. We tried to treat them using the Bobath approach for improving their ambulatory balance. With subsequent improvements in balance control it was possible for them to take short walks, but it was difficult to make any improvements in their ocular movement. The INC is related to balance control of ambulation and disorders of the INC induce ambulatory disturbances. Cycloduction was only observed in the unaffected side, but Hess charts showed distortions of the visual image in both eyes. Ambulation was briefly improved, but diplopia persisted in these patients.

The Bobath (NDT) concept in adult neurological rehabilitation: what is the state of the knowledge? A scoping review. Part II: intervention studies perspectives

“…Twelve of these studies were experimental designs (RCTs/one prospective parallel group design) [10,[26][27][28][29][30][31][32][33][34][35][36], while five studies used an N-of-1/case report design to describe clinical practice with respect to a specific client/clients, with study design varying from a case report [37,38], to a case series, to a more sophisticated single subject research design (SSRDs) [40,41]. One other paper was a systematic review [11].…”

“…The two SSRD's [40,41] and one of the case reports [37] referenced an up-to-date Bobath theoretical framework. The remaining two studies [38], referenced a wide range of theoretical frameworks from Bobath [42] to Gjelsvik [44].…”

“…Mikołajewska [39] reported the therapists were IBITA Basic or Advanced level. Neither Kurosu et al [37] and Jelica et al [38], nor Ilett [40] reported the demographics of the treating therapists.…”

“…The two SSRD's [40,41] identified client-centered goals, problems and interventions that were referenced to recent Bobath texts [44,45]. The two case reports [37,38] and the case series, did not provide a description of the interventions.…”

“…The two SSRDs [40,41] investigated clients with other neurological diagnoses (multiple sclerosis and muscular dystrophy, respectively), with a specific description of each subject's clinical presentation. The case reports [37,38] and case series, evaluated subjects with stroke, but provided limited information with respect to clinical presentation.…”