Gait Adaptability Training Improves Gait in Spinocerebellar Ataxia Patients

Spinocerebellar ataxia (SCA) is a rare, genetic neurodegenerative movement disorder primarily affecting the cerebellum. So far, there is no available cure for SCA. However, evidence suggests that neurorehabilitation can alleviate symptoms. The most optimal training protocol has not been established and mechanisms that channel the effects of these interventions are incompletely understood.

This study investigates the disease-specific effects of a gait adaptability training in a SCA cohort compared to healthy controls and explores underlying cerebral mechanisms.

We included 20 early-stage SCA patients and 18 matched healthy controls. A 5-week, C-Mill gait adaptability training protocol was conducted with 10 sessions of 1 h. We evaluated the effects of training on ataxia severity, spatiotemporal gait variables, and functional mobility tests. To identify training-related structural brain changes, two T1w structural MRI scans were acquired within one week before and one week after training.

Following training, the ataxia severity scores did not change, and measures specific to ataxia, such as stride length variability and step width, were unaffected. However, both patients and controls showed improvement in velocity, functional mobility task duration and stride and step length. These behavioral training effects were not accompanied by detectable structural gray matter changes in the brain.

These results suggest that early-stage SCA patients retain the ability to adapt and improve general gait performance when exposed to gait adaptability training, even though ataxia-specific gait measures remain unchanged. The neural substrate mediating this training-induced improvement remains unknown and needs further work.