What physiotherapy can do for the ataxics ?
Josée Chamberland and Béatrice Delachanal, physiotherapists
Friedreich's ataxia disease involves nervous fibres degeneration which implicated in a control of balance and keep the body in a good position in the space. Friedreich's ataxia generally has a lost, more or less serious of sensibility of the position of their arms in space. That is to say the ataxic must compensate by vision to remember where and how are situated his hands and his legs. This deficiency get impossible normal adjustments movements of the trunk and arms during movements and induce lost of balance and more difficulties to walking and changing positions.
The movement control of the arms may also been affected by gradually apparition of muscular weakness, spasticity (increase of basic muscular tonicity) and involontary shaking during hands movements. Mystagmus (ocular orbital shaking) added to mobility and coordination difficulties. Friedreich's ataxia may be caracterise by neuro-muscular deformations: ark foot exaggeration and cyphoscoliosis (excessive increase of the curvature in the spinal column which may be injured to mobility of balance.
The physiotherapy is an excellent helper to prevent or to improve many problems related to ataxia. Effectively, treatments have objective to maintain the person to maximal fonctionnal level by :
1 . Stretching the stiff muscles, short or spastic of the spinal column and the legs.
2. Strongering the deep musculature of postural muscles to increase body stability.
3. Working the corrections for a good posture, the balance reactions, the coordination, in many positions (sitting, kneeling, lay down, four feet posture)
4. Working the walk-pattern to correct compensations and to improve the efficacity.
The physiotherapy model-treatment for somebody who have Friedreich's ataxia habitually include:
1) stretching exercices and inhibition of the trunk and the legs.
2) strongering muscular exercices fot trunk and arms in controlled movements out of spasticity.
3) exercices to correct posture (sitting, kneeling, lay down, four feet posture) to improve the support on the inferior arms and the extension of the spinal column in these normal curvatures.
4) coordination exercices eye-hand.
5) exercices to improve the general mobility (transfers, change of positions in mattress...)
6) a walking corrections for ambulant people.
One physiotherapy session is normally extend on 60 minutes but it may be shorten or lighten depend of tolerance of each other (especially for persons with cardiac problems.). Exercices are also teach to can practice them at home. This programm regularly doing 2-3 times a week is more increase the efficacity of treatments. If the treatment is doing 1 time a week, it's generally sufficient.