Ataxia

Ataxia means lack of balance and coordination especially in anti-gravity postures. Postural tone is usually
below normal. If the child is rested with support, then dys-coordinated movements are not so visible. But
in anti-gravity posture these jerky movements become very strong. Following are some common
problems which we see in most ataxic patients.
Main Problems:
i) Lack of abdominal co-activation.
ii) Low tone (just below normal) of trunk and neck.
iii) Abnormal use of extensors of back.
iv) Compensation of balance by over use of arms.
v) Nystagmus (to & fro movements of eye ball) is common.
vi) Occurrence of tremors when movement is going to be completed.

Rx Concept:
A) Young child who is unable to sit:
Most ataxic initially are floppy children. So improve the tone via bottom up exercises; bridging,
turning over and weight bearing on arms in prone position may be used.

i. Bottom up exercise

ii. Bridging exercise

iii. Prove on elbow

iv. Turning over facilitation

When the tone is little bit improved, then try to make sitting position of the child.
B) Child who is able to sit:
When ataxic child sits, he uses both arms for support because he can’t sit unsupported due to lack
of balance. Continuous use of both hands for support restricts child to use hands for activities of
daily life. So our target should be to increase trunk stability so that child can spare his hands for
function. If trunk stability will increase then child will have a chance to use both hands for
function.
NOTE: Never use roller or ball for sitting purpose in ataxic patients because these introduce
instability. Always use solid, firm and stable base as BOS. In order to increase trunk stability a
special technique is used known as compression release technique.
This technique is shown here.
Technique
Child is sitting on bench/chair. P.T is standing behind the child. PT places both hands on shoulders of
child. Slowly compresses down both shoulders and suddenly releases the pressure. By this compression
trunk stability can be improved.

Arrows are showing direction of compression.

In second stage crossed compression technique is used i.e. compress down right shoulder and shift body
weight towards left side.

Most ataxic children have very poor abdominal contractions. So it becomes very important to facilitate
abdominals. A child in sitting position holding some bar in front in order to keep protraction of shoulders.
In this position manual facilitation of abdominals with hands or brush can be tried. (See fig A)
A B C

Fig A to C shows process of progressive standing facilitation .

C) Child who is able to stand (Rx Concept)

Some ataxics are able to walk using “Higa” Posture i.e. they keep both arms elevated in sideways
position. If in early stage, head control can improve than chances of walking for ataxics are bright in
future. Following are some situations which can be used to improve knee, hip and ankle control.
1. Stand in ring. Pick up some object from the floor. As the child will bend down, his jerky
movements of legs will decrease because it promotes grading at knees. After picking object from
the floor, place it right or left side.
2. Weight bearing on a low table in front. Hip and knee should be in slight flexion. In this position
abdominals gets facilitation. Maintaining this posture for some time.
3. Best walking style is ‘Monkey Walking’ i.e, walking with hip and knee mild flexion with lowered
centre of gravity.
4. Pushing heavy objects or wall with flexion at hip and knee will be good position to increase
stability of lower trunk.
5. Walking with weight in both hands. Initially with wide base. Gradually this base is made closer.
E.g. walking on two parallel lines somewhat separated. Gradually distance between lines is
reduced.

Standing with low table in front: