General Management of Cerebellar Disorders: An Overview
Cerebellar disorders primarily effect motor functions and can lead to significant and serious restrictions in activities of daily living. Possibilities for medical interventions are rare and limited to specific diseases and symptoms. Furthermore, motor re
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Winfried Ilg and Dagmar Timmann
Abstract
Cerebellar disorders primarily effect motor functions and can lead to significant and serious restrictions in activities of daily living. Possibilities for medical interventions are rare and limited to specific diseases and symptoms. Furthermore, motor rehabilitation for patients suffering from cerebellar damage is challenging, since the cerebellum is known to play an important role for the execution as well as for the (re)learning of precise movements. This chapter reviews the state of the art in medical intervention and rehabilitation, focusing on presenting new results on motor rehabilitation in cerebellar disease. Recent studies indicate that even in the case of degenerative cerebellar diseases intensive and continuous motor training can reduce ataxia symptoms and increase motor performance relevant to daily living. In addition, current studies in the area of motor learning – in combination with modern imaging techniques – in cerebellar disease are described. These results offer promising perspectives for a deeper understanding of remaining motor learning capacities in cerebellar disease, and thus might help in the future to optimize motor rehabilitation for individual patients.
W. Ilg (*) Section Computational Sensomotorics, Department of Cognitive Neurology, Hertie Institute for Clinical Brain Research, Centre for Integrative Neuroscience, University of T€ ubingen, Frondsbergstrasse 23, 72070 T€ ubingen, Germany e-mail: [email protected] D. Timmann Department of Neurology, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany e-mail: [email protected] M. Manto, D.L. Gruol, J.D. Schmahmann, N. Koibuchi, F. Rossi (eds.), 2349 Handbook of the Cerebellum and Cerebellar Disorders, DOI 10.1007/978-94-007-1333-8_105, # Springer Science+Business Media Dordrecht 2013
2350
W. Ilg and D. Timmann
Introduction Cerebellar dysfunction can induce a variety of motor impairments including upper and lower limb movement, oculomotor control, balance, and walking (Bastian 1997, 2011; Diener and Dichgans 1996; Holmes 1939). Causes for cerebellar impairments can be various, including stroke, cerebellar tumors, multiple sclerosis, and degenerative disease. Functional recovery heavily depends on the cause and site of the lesion. Within this spectrum, degenerative cerebellar diseases are especially hard to treat, since – despite greatly improved understanding of the genetic underpinnings (Klockgether 2011; Sch€ ols et al. 2004) – no cure or drug treatments to ameliorate ataxia or decelerate disease progression are yet available. Furthermore, motor rehabilitation is also challenging for this patient population, since the cerebellum is known to play a functional role in motor learning. Therefore, poor recovery or low benefit of physiotherapeutic training may be a consequence of damaging structures critically involved in the relearning of motor skills (Bastian 2006; Thach and Bastian 2004). However, recent results deliver pieces of e
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