Case of cerebellar ataxia successfully treated by virtual reality-guided rehabilitation

Abstract

A male patient in his 40s was transferred to our hospital for rehabilitation of ataxia after right cerebellar and brainstem infarction. After 3 weeks of conventional physical therapy, his activities of daily life successfully improved with an increase in the functional impedance measure from 101 to 124. However, he still fell short of gaining a higher level of balance function, which was necessary for his job as a standup forklift driver. We introduced virtual reality-guided balance training. The training was performed for approximately 40 min on weekdays for 2 weeks. As a result, the Scale for the Assessment and Rating of Ataxia score decreased from 5 to 1, Functional Balance Scale score improved from 48 to 56, and Mini-Balance Evaluation Systems Test score increased from 20 to 28. The trunk sway disappeared clinically. He regained confidence and returned to work after an additional 2 weeks of physical therapy.

Keywords: brain stem / cerebellum; physiotherapy (rehabilitation); rehabilitation medicine; virtual rehabilitation.

Figure 1

Diffusion-weighted cranial MRI at stroke onset. Hyperintensities are visible in the right cerebral peduncle and the ventral right cerebellar hemisphere in the area of the right anterior inferior cerebellar artery (A-C). The patient is diagnosed with right cerebellar/brainstem infarction.

Figure 2

Visualisation of mediVR KAGURA in use: a medical device for VR-guided rehabilitation. The patient is being trained to make smooth adjustments to his centre of balance as he moves to make contact with objects falling downward in the virtual space, directly in front of his left hand, and then diagonally in front of his right hand using controllers held in the respective hand (sequence depicted from left to right). Blue and red objects must be ‘caught’ with the left and right hand, respectively. VR, virtual reality.

Figure 3

The computer control screen for mediVR KAGURA (in use). The speed, size, location and number of falling objects can be adjusted using the controls on the left half of the screen. Part of the rendered VR space seen by the patient is displayed on the right half of the screen. VR, virtual reality.