Patricia Meier

Background/Objectives: In consideration of the significance of the pursuit of training-induced neuroplastic changes in the stroke population, who are reliant on neurorehabilitation treatment for the restoration of neuronal function, the objectives of this trial were to investigate fMRI paradigms for acute stroke patients with ataxic symptoms, to follow up on changes in motor function and balance due to recovery and rehabilitation, and to investigate the different effects of two treatment methods on neuronal plasticity. Methods: Therefore, fMRI-paradigms foot tapping and the motor imagery (MI) of a balancing task (tandem walking) were employed. Results: The paradigms investigated were suitable for ataxic stroke patients to monitor changes in neuroplasticity while revealing increased activity in the primary motor cortex (M1) and the cerebellum over 3 months of treatment. Furthermore, analysis of the more complex balance task revealed augmented activation of association areas due to training. Coordination exercises, constituting a specific treatment of ataxic symptoms, indicate more consolidated brain activations, corresponding to a faster motor learning process. Activation within Brodmann Area 7 has been prominent among all paradigms, indicating a special importance of this region for coordinative functions. Conclusions: Further studies are needed to confirm our results in larger patient groups. Clinical Trial Registration: German Clinical Trials Registry (drks.de). Identifier: DRKS00020825. Registered 16.07.2020.

In view of the frequent use of the portable balance board (Tymo^®, Tyromotion, Graz, Austria) in neurorehabilitation, the objective of this study is to assess its posturographic validity and reliability in comparison to a floor-embedded force platform (AMTI, Watertown, MA, USA), as well as its clinical validity in stroke patients. To evaluate posturographic validity, thirty healthy participants were tested in four different measurement conditions (M1–M4: standing with/without a balance pad, eyes open/closed) while simultaneously measuring with both devices placed on top of each other. Clinical validity is obtained by correlating stroke patients’ Tymo^® outcome variables (path length and ellipse) of M1–M4 with Berg Balance Scale (BBS) results. Reliability is determined by correlating repeated measurements. The Center of pressure (COP) paths of both force plates show a very strong correlation. The repeated measurement reliability of both force plates is comparable. Tymo^® outcome variables exhibit moderate to strong correlation with the BBS and demonstrated repeated measurement reliability analogous to healthy participants. Therefore, the Tymo^® device demonstrates measurement accuracy comparable to a gold-standard device while offering the advantages of portability and user-friendly software. Tymo^® is suitable for assessing balance in stroke patients, though protocol adaptations and averaging repeated measurements are recommended to enhance feasibility and reliability.

Introduction: Posterior circulation stroke can lead to ataxia, manifesting in a loss of coordination and balance. Patients experience difficulty in activities of daily living and an increased risk of falling, both profoundly affecting quality of life. In individuals with neurodegenerative diseases, coordination exercises have been shown to lead to a reduction in ataxic symptoms. There is, however, limited evidence on the effect of physical therapy, specifically coordination exercises in patients with stroke-related ataxia. We therefore present a study protocol for a prospective trial.Methods: The purpose of this trial is to investigate the effects of coordination exercises compared to standard physiotherapy on balance and walking in ataxic stroke patients. Therefore, a prospective, single-blinded randomized controlled trial is currently ongoing at the Clinical Department of Neurology, Medical University of Innsbruck, Austria, in collaboration with two local rehabilitation facilities in Austria, Hochzirl Hospital and the Clinic for Rehabilitation Münster. Balance is the primary outcome of the study as assessed using the Berg Balance Scale. Secondary outcomes are concerned with walking, risk and number of falls, independence in daily life, and quality of life, rated using appropriate scales and scores. Patients are allocated applying a 1:1 ratio and a stratified block randomization. In both groups recruited individuals undergo five 45-min treatment sessions per week, totaling 20 sessions of coordination exercises (IG) or standard physiotherapy (CG) over the course of 4 weeks. Data is collected at the baseline (T0), after the 4-week supervised practice (T1), and after another 8 weeks of independent home-based training (T2).Discussion: This is the first randomized controlled trial investigating the effects of coordination exercises on balance and walking in people with stroke-related ataxia. As stroke guidelines emphasize the limited evidence of treatment for ataxic symptoms, this study aims to contribute further knowledge regarding tailored interventions for these patients.Clinical Trial Registration: German Clinical Trials Registry (drks.de). Identifier: DRKS00020825.