Robot-assisted therapy and botulinum toxin for upper limb ataxia: A case report

BACKGROUND: Upper limb ataxia is one of the most common motor disorders associated with cerebellar damage and it might lead to motor impairment and disability. OBJECTIVE: In this study, a subject with disabling upper limb ataxia and intention tremor underwent a six weeks intervention of robot-assisted training combined with Botulinum Toxin Type A (BTX-A). METHODS: Robot-assisted therapy which includes repetitive, goal-directed reaching movements was administered after upperlimb BTX-A injections. Improvements in arm coordination and motor performance were assessed throughout a kinematic analysis and an activity daily living – based questionnaire. RESULTS: After this six weeks training program all spatio-temporal parameters were improved with no additional functional gains. CONCLUSIONS: The positive effects on motor coordination in our subject might help to design clinical trials that combine BTX-A injections and robot-assisted therapy in order to improve upper-limb coordination in subjects with ataxia. Furthermore, if exercises focused on ADLs will be included, they might help to regain a functional use of the arm.