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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):


Ataxia and occupational therapy
[Image credit: 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.


Specialist seating example
Specialist seating example (Rifton 2022; not sponsored)

 

Common occupational therapy interventions



Ataxia, Occupational Therapy
[Image credit: Ataxia Canada, 2022]

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


Rocker knife for ataxia
Rocker knife example

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



Level-access shower for ataxia, adaptations, occupational therapy
Level-access shower example

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



 

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].

3 комментария


Неизвестный пользователь
11 нояб. 2022 г.

Thank you

Лайк

Very informative, thank you!

Лайк

thank you very informative.

Лайк
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