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Ataxia: Overcoming challenges, with occupational therapy
One of many symptoms that can result from physical trauma or injury to the brain, ataxia is a term that encompasses a group of debilitating disorders, primarily affecting co-ordination, balance and speech. This article will explore ways that occupational therapy professionals can support those affected by ataxia.
According to the NHS (2022), any part of the body can be affected by this disorder, but common difficulties arise with balance and walking, speaking and swallowing. Ataxia also compromises tasks that require a high degree of control, such as writing, eating and vision. The graphic below illustrates the physiology and symptoms (ProtoKinetics, 2019):
Symptoms of acquired ataxia are a direct result of trauma, brain injury, brain tumour or a stroke, among other causes. It is important to highlight that there are different types of ataxia; the exact symptoms experienced - and their severity - depend on the form of ataxia a person has.
Appropriate OT assessments and outcome measures?
This is not an exhaustive list...
Assessment of Motor and Process Skills (AMPS)
Goal Attainment Scale (GAS)
Canadian Occupational Performance Measure (COPM)
Self-efficacy tools
Quality of life measures
Literature review: Key findings
Ataxia UK (2016) highlights that a short course of multidisciplinary rehabilitation, including occupational therapy, is beneficial compared to no treatment. The literature identified that client-centred, individually tailored OT programmes can have a positive effect on mood scales. Client-centred goals - along with a theoretical task-orientated approach - may be useful in aiding clinical reasoning.
Compensatory equipment and techniques, that limit the degree of movement and dampened the tremor within specific functional tasks, may improve occupational engagement for the individual.
Specialist seating can have positive and negative affects on posture, but may improve comfort.
This literature review points out that further research into the benefits of occupational therapy is required.
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Common occupational therapy interventions
Occupational therapy intervention should focus on functional goals, that support the person and their carers to address occupational needs, thereby adding to quality of life (Ataxia UK, 2016). Occupational therapists should draw on their core skills to assess and understand the impact of the illness on occupational engagement.
Before exploring interventions, it is worth reviewing this image from Ataxia Canada (2022) as a reminder of impacting symptoms.
What follows are key practical considerations - in occupational categories - as outlined by Ataxia UK. Please note that some suggestions may have more relevance to specific cultures or localities. [N.B. Any links to products or resources below have no affiliation or sponsorship with the Hub]
Computer use
Keyboard and mouse modifications, to adjust the sensitivity and speed of response
Alternatives to a standard mouse, such as a tracker ball
Smaller keyboards, or key guards
Consider the impact of seating and ergonomic set up of the workstation being used
Referral to IT solutions experts; for example, AbilityNet has free advice about IT adaptations for people with ataxia
Control of indoor environment
‘Big button’ telephones
Phones with autodial numbers or voice activation
Telephone with two-way record, to save conversations for replay later and help keep messages
Simple light switches, easily reached from a standing or wheelchair position
Appliance sockets are safest when located off the ground at waist level, to avoid complex bending, squatting and reaching
Driving (car transfers)
Educational approach: Allow the car door to be opened fully; consider the height of the transfer being undertaken
Ensure the person sits their bottom down first, before moving their legs into the car
Insert a swivel transfer mat; if the car seat is low, a firm foam cushion or blanket in a pillowcase
Eating and drinking
Organise work spaces and utensils to reduce clutter and optimise performance
Educational approach: Check for appropriate postural control; use of a lumbar support, to assist optimal eating and drinking posture
Non-slip matting as a placemat, to limit plate or cup movement; for example, Dycem
Plate guards reduce the need to co-ordinate two movements
Rocker knives make cutting food easier, by limiting the degree of movement needed
Use of weighted cutlery
Lidded or insulated cups, or cups with straws, especially when drinking hot liquids
Cups with anti-tremor insert devices; products with a narrow neck and top (to limit spills) and a non slip base (easier to place on a work surface with uncontrolled movements)
Sports bottle or camel pack, for severe ataxia
Neater-eater, or similar device, with a dampening hydraulic mechanism, aiding independent spoon or fork feeding
Falls management
Ensure clothing is not too long and shoes are well fitted, to reduce falls risk
Educational approach: Teach falls recovery techniques
Community care alarms and telecare; inclusion of techniques to avoid further injury, such as pressure sores, while waiting for help
Food preparation
Kettle tipper devices or hot water dispensers, making hot drinks safer
Travel mug with a lid, to assist carrying a drink
Waist-height ovens; sliding food to a level surface
Full-length oven gloves
Microwave as safer alternative to standard ovens
Chopping boards with an attached cutting blade
Food processor, for slicing or chopping vegetables
Ergonomic grip knives, to limit the degree of movement needed to chop
Rocker knives make cutting food easier, by limiting the degree of movement needed
Handwriting
Educational approach: Work spaces and seating set-up, to improve support and posture
Educational approach: Review type of pen nib and pressure applied; fatigue can affect sustained grip
Dictaphones or voice-activated computer software, to compensate for deficits
Weighted pens and thick barrelled pens; N.B. there is limited supporting evidence for this
Household management
Trolleys to transport items, especially food, drinks and heavy items
One-handed trays can help with item transportation
Educational approach: Recommend removal of items, such as scatter rugs and loose electrical cables (risks to mobility)
Good lighting, to optimise performance of tasks and avoid potential hazards
Leisure
Rubber thimble to help turn pages, if with fine motor coordination deficit
Download books online; use of zoom text where vision is reduced
Talking books; the UK's RNIB charity can be a useful support service
Electronic page-turners; these can be costly and take up space
Outdoor and community mobility
Shop-mobility, taxi card schemes, mobility buses, dial-a-ride services
Public transport and rail providers offer subsidised fares for people with a disability
Meet and greet service/access assistance
Motorised scooters or wheelchairs, to maximise independence; consider transfer safety
Self-care and toileting
Educational approach: Recommend sitting to bathe or shower
Consider seating with back and arm support
Thermo-regulation devices on taps, as safety consideration
Lever taps may be easier to use than standard taps
Level-access showers, if bath transfers become unsafe
Dressing: Provide small aids, such as ‘zip pulls’ and button hooks
Dressing: Replace fastenings with Velcro, to increase independence
Automatic washing and drying toilets may help with hygiene
Toilet rails; ideally fixed, to minimise accident risk
Adjust toilet seat height if required
Hygiene wipes and alcohol gel, to maintain hygiene when away from home
Register with RADAR, for key access to public toilets
Transfers - from bed, chair and toilet
Bed, chair and toilet height - and location within room - for efficient and safe transfers
Bed lever, to aid rolling and rising in bed
Mattress variators, or profiling beds
Firmer mattresses, to aid bed mobility
Consider pressure care needs if bed mobility is restricted
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End note: Points to acknowledge...
We hope the ideas and recommendations outlined in this article prove helpful for individuals with ataxia, supported by occupational therapists and occupational therapy assistants.
Guidance provided is mostly based on practice consensus, rather than research.
The literature review, highlighted by Ataxia UK (2016), only identified a small number of case studies and case series designs focused on occupational therapy intervention in ataxia.
Most of the studies reviewed describe multidisciplinary intervention. It is therefore difficult to separate the effects of occupational therapy specifically.
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References
Ataxia Canada (2022) Ataxias > Symptoms (online). Available from: https://lacaf.org/en/ataxias/symptoms/ [Accessed 12 April 2022].
Ataxia UK (2016) Ataxia - Management of the ataxias towards best clinical practice. pp.61-71. 3rd ed. July 2016. Available from: https://www.ataxia.org.uk/research-news/latest-research-news-july-and-august-2016 [Accessed 12 April 2022].
NHS (2022) Health A to Z > Ataxia. Available from: https://www.nhs.uk/conditions/ataxia [Accessed 12 April 2022].
ProtoKinetics (2019) Common Gait Deviations: Ataxic Gait (online). Available from: https://www.protokinetics.com/common-gait-deviations-ataxic-gait/ [Accessed 12 April 2022].
Rifton (2022) Activity chair (image). Available from: https://www.rifton.com/products/special-needs-chairs/rifton-activity-chairs [Accessed 13 April 2022].