Gait and Cerebellar ataxia:The gait in persons with ataxia consists of stumbling, lurching to one side and

falls.The patients walk at a slower speed. This is inturn because of a reduced step

length and slower cadence. The kinetic abnormality associated with this pattern is a prolongation of EMG burst patterns required for movement. The psychological reason is a compensation of the patient for balance and a bargain for accuracy in exchange to speed. Hick’s Speed accuracy trade off.

The percent of time spent in stance is increased there is delayed rotation of ankle and Knee. Reduced flexion of the knee in stance and reduced ankle range of rotation.

Some studies with videography have failed to show a increased width of base which seem to be a major clinical observation. The reason for this might be that wide base is of less value during walking than during standing.

There are relative delays between joints. There is a relative delay of plantar flexion as compared to knee flexion at the end of stance and a relative delay of knee flexion to hip flexion at the onset of swing. This is because of dyssynergia.

The foot will hit the floor on some occasions leading to a fall.

Clinical Reason:A. Increased width of base –The increased width helps to reduce the fall in these patients who are having a reduced amount of balance as an compensation.1

B.A variable step length – There is a reduced amount of balance because of which the patient tries to compensate by taking a reactive step and this in turn is an adaptation of an inability to control the C.O.G. , within the constantly varying base with each step.

C. Alteration in pattern of gait: The impairment of alteration in the triphasic pattern of coordination among the joints of the lower limb.

D. Nystagmus: Loss of smooth pursuit and abnormal corrective movements on saccades prevents the patient from looking properly on where the leg is placed.3.

E. Overcoming obstacles: The visual problems make it difficult for the patients to fixate the eyes on the stationary objects as the head is constantly in motion and hence the amount to which the leg should be moved in order to overcome the obstacle and hence leads to a trip or a fall.

Management: Not all of these problems are amenable to correction by exercises.However, improvement of the primary problems of vision and balance can be used to improve the gait pattern to a large extent.

1. Vision: The patients can be improved either by reducing the usage of vision by making them walk on a foam surface with the eyes closed or by wearing cooling glasses or by

training the smooth pursuit by following slowly moving objects and saccades by fixating eyes on objects placed little apart.

2. Balance can be improved by first finding the major cause for loss of balance and correcting them. Some of the means are a. Making the patients walk on a foamy surfaceb. Making the patients walk with the eyes closedc. Making them to walk on a foamy surface and with the eyes closedd. Giving pushes to them from different directions when they are walking e. Making them to walk on a narrow pathwayf. Making them walk with resisting their movements e.g walking through waterg. Walking with slippers or shoesh. Walking on sandy and slippery surfacesi. Walking over obstacles of different sizes and placed at different intervalsj.Moving obstacles suddenly across their pathk. walking in circles or altering the directions of their walkingWalking at varying speeds.