Real‐time use of audio‐biofeedback can improve postural sway in patients with degenerative ataxia

Abstract

Objective Cerebellar ataxia essentially includes deficient postural control. It remains unclear whether augmented sensory information might help cerebellar patients, as the cerebellum underlies processing of various sensory modalities for postural control. Here, we hypothesized that patients with cerebellar degeneration can still exploit audio‐biofeedback ( ABF ) of trunk acceleration as a real‐time assistive signal to compensate for deficient postural control. Methods Effects on postural sway during stance were assessed in an ABF intervention group versus a no‐ ABF disease control group (23 vs. 17 cerebellar patients) in a clinico‐experimental study. A single‐session ABF paradigm of standing plus short exergaming under ABF was applied. Postural sway with eyes open and eyes closed was quantified prior to ABF , under ABF , and post ABF . Results Postural sway in the eyes closed condition was significantly reduced under ABF . Both benefit of ABF and benefit of vision correlated with the extent of postural sway at baseline, and both types of sensory benefits correlated with each other. Patients with strongest postural sway exhibited reduced postural sway also with eyes open, thus benefitting from both vision and ABF . No changes were observed in the no‐ ABF control group. Interpretation Our findings provide proof‐of‐principle evidence that subjects with cerebellar degeneration are still able to integrate additional sensory modalities to compensate for deficient postural control: They can use auditory cues functionally similar to vision in the absence of vision, and additive to vision in the presence of vision (in case of pronounced postural sway). These findings might inform future assistive strategies for cerebellar ataxia.

Might patients with cerebellar ataxia benefit from the Computer Assisted Rehabilitation ENvironment (CAREN)? A pilot study focusing on gait and balance

“…It also has several benefits, such as reducing the energy cost of walking, increasing stride length and speed, and preventing injury or pain in the spine, hips and knees. According to Fleszar et al ( Fleszar et al, 2018 ), acoustic cues, which are also provided by VR rehabilitation training, could compensate for postural sway and imbalances. This aspect could suggest that VR treatment has led to a better balance during gait.…”

Rehabilitation in patients with cerebellar ataxias

“…A sensor captures trunk acceleration and sends this information to a smartphone that plays an acoustic feedback during exergame training period. Although the effects of long-term training outcomes are not yet known, the preliminary study shows that acoustic sensory information could compensate for the impairment in proprioceptive and vestibular signals to reduce postural sway 33 .…”

Local Dynamic Stability of Trunk During Gait is Responsive to Rehabilitation in Subjects with Primary Degenerative Cerebellar Ataxia

“…Nonetheless, approximately 85% of swCA experience injurious falls. Intensive and repetitive rehabilitation focusing on balance, gait, and activities of daily living has proved to be effective in improving motor performance of swCA [19][20][21][22][23][24][25][26][27]. Particularly, truncal ataxia and trunk-limb coordination were shown to be effective targets for rehabilitation [19,20,22,28].…”