Unfortunately, I have found very little in the literature as far as treatment goes that would be applicable and yet specific to this patient.
I’ve found some evidence that gait training with a metronome could help decrease ataxia in the cerebellar stroke population. My case was non-ambulatory, so that doesn’t apply. We were aiming at goals a lot lower than that. Metronome Cueing of Walking Reduces Gait Variability after Cerebellar Stroke. Frontiers in Neurology. 2016.
I’ve found TONS of evidence for transcranial stimulation. There’s even a case specific to cerebellar stroke! However, this intervention is yet to be approved by the FDA. It is also yet to be determined if this intervention falls in the scope of physical therapy practice. So, unfortunately, was not and still is not a treatment option for this or any other cerebellar stroke patient. Soon I hope! Deep Brain Stimulation of the Dentate Nucleus Improves Cerebellar Ataxia After Cerebellar Stroke. Neurology. 2015.; Optogenetic neuronal stimulation of the lateral cerebellar nucleus promotes persistent functional recover after stroke. Nature. 2017.; Understanding and Modulating Motor Learning with Cerebellar Stimulation. Cerebellum. 2015.; Cerebellar theta burst stimulation in stroke patients with ataxia. Functional Neurology. 2014.; Modulating locomotor adaptation with cerebellar stimulation. Journal of Neurophysiology, 2012.; Non-invasive Cerebellar Stimulation– a Consensus Paper. Cerebellum. 2014.
I DID find something useful. I found 2 articles that supported the use of “postural training” and “a classical physiotherapy after stroke according to the Bobath concept.” These interventions showed improved postural control, which in turn helped reduce the disability caused by ataxia. BUT these articles were VERY vague. Those two quotes are literally, exactly the extent of the description of the intervention. So those interventions could basically be almost anything and the intervention is not reproduceable by me or any other therapist really. So I didn’t really learn anything of use there, except how to NOT write a journal article. Recovery of Cerebellar Disorders in the Elderly. Science, Movement and Health. 2013.; Functional recovery and rehabilitation of postural impairment and gait ataxia in patients with acute cerebellar stroke. Gait and Posture. 2014.
So I believe I acted according to the literature at the time of the treatment and chose more generalized treatments focusing on functional transfer and bed mobility practice and habituation of the central vestibular system. You could literally pull any general neurologic physical therapy textbook off the shelf you wanted since the profession began to find support for functional practice, so I won’t bore you there. I’ll discuss the generalized articles I used to support my treatment of the vestibular system next time.