Effectiveness of pelvis and trunk stabilization exercises over conventional physiotherapy to improve dynamic trunk balance in cerebellar ataxia: a randomized controlled trial

Anam Sasun; Mohammad Irshad Qureshi; Raghumahanti Raghuveer; Pallavi Harjpal

doi:10.12688/f1000research.138131.1

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Study Protocol

Effectiveness of pelvis and trunk stabilization exercises over conventional physiotherapy to improve dynamic trunk balance in cerebellar ataxia: a randomized controlled trial

[version 1; peer review: 3 approved with reservations]

Anam Sasun ¹, Mohammad Irshad Qureshi², Raghumahanti Raghuveer³, Pallavi Harjpal⁴

PUBLISHED 11 Jul 2023

Author details Author details

¹ Neuro-Physiotherapy, First - Year MPT Student, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442004, India
² Head of Department and Professor, Department of Neuro Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research,, Wardha, Maharashtra, 442004, India
³ Professor, Department of Neuro Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442004, India
⁴ Assistant Professor, Department of Neuro Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research,, Wardha, Maharashtra, 442004, India

Anam Sasun
Roles: Conceptualization, Writing – Original Draft Preparation

Mohammad Irshad Qureshi
Roles: Supervision, Validation, Writing – Review & Editing

Raghumahanti Raghuveer
Roles: Supervision, Visualization

Pallavi Harjpal
Roles: Visualization, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Datta Meghe Institute of Higher Education and Research collection.

Abstract

Cerebellar ataxia is caused by several hereditary or acquired aetiologies that eventually lead to abnormalities in the cerebellum. Patients with cerebellar ataxia may experience balance issues, eye movement abnormalities, limb incoordination, gait instability, and speech impairment as a result. The available treatment options for cerebellar ataxia are rather limited, causing many patients to struggle with daily activities. Although the success rate of a range of therapeutic interventions has been determined, evidence-based exercise guidelines for the treatment of balance disorders and associated problems in people with cerebellar ataxia are currently unavailable. Thus, physiotherapists must explore novel approaches to successfully manage the symptoms of ataxia and further improve the quality of life of patients. The current study protocol will provide new insight as no article available to date has looked at trunk and pelvis stabilization exercise programme as an intervention for treating cerebellar ataxia.
We hereby propose a study, which aims to investigate the impact of conventional exercises and trunk and pelvis stabilization exercises along with conventional exercises on subjects with Cerebellar ataxia in a two-arm randomized controlled trial on improving SARA, TIS, BBS, Barthel Index, WHOQOL The total participants will be divided into two-arm parallel groups and the intervention will be given for complete 6 weeks, 5 days in a week. The outcome measure will be evaluated at baseline and the end of 6 weeks. The results will be evaluated after 6 weeks. If the hypothesis of our study proves to be effective, then this physiotherapy intervention could be included in the management of cerebellar ataxia

Keywords

Cerebellar ataxia, Proprioceptive Neuromuscular Facilitation, Balance, Physiotherapy interventions, randomized controlled trial, Quality of life., Trunk impairment scale, Severity of Ataxia Scale

Corresponding author: Anam Sasun

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2023 Sasun A et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Sasun A, Qureshi MI, Raghuveer R and Harjpal P. Effectiveness of pelvis and trunk stabilization exercises over conventional physiotherapy to improve dynamic trunk balance in cerebellar ataxia: a randomized controlled trial [version 1; peer review: 3 approved with reservations]. F1000Research 2023, 12:813 (https://doi.org/10.12688/f1000research.138131.1) First published: 11 Jul 2023, 12:813 (https://doi.org/10.12688/f1000research.138131.1) Latest published: 11 Jul 2023, 12:813 (https://doi.org/10.12688/f1000research.138131.1)

Introduction

Cerebellar ataxia refers to a cluster of movement disorders caused by the vandalization of the cerebellum or its connections. The cerebellum oversees ensuring the precision and uniformity of actions required for centered motor action. The vestibular component of the cerebellum is crucial for coordinated movements. Cerebellar dysfunction is characterized by ataxia, hypotonia, asynergy, dysmetria, nystagmus, dysdiadochokinesia, tremor, and cognitive inability.¹ Hemorrhagic stroke, cerebellar stroke, medications (phenytoin, carbamazepine, lithium), meningitis, and abscesses are examples of acute causes of ataxia. Brain tumors, genetic ataxia, degenerative diseases, cerebellar atrophy, and cerebellar degeneration are examples of subacute and chronic causes. Patients report a significant loss of quality of life and a subsequent decrease in daily living activity performance. Varieties of ataxia are linked to decreased balance. Tumbles caused by impaired balance are common in people with cerebellar ataxia, with more than 70% experiencing at least one fall in the next 12 months.

To date, no effective pharmacological treatments have been available that have worked efficiently in decreasing or slowing the progression of pathology. Physiotherapy-centred rehabilitation exercises play a crucial role in controlling ataxia progression and improving patients’ functions. Rehabilitation strategies can aid in the abolition of balance and gait disorders, the decrease of fear of falling, and the increase of social participation, and independence in daily life activities.² Moreover, to prevent secondary complications and promote the independence of the patient, exercises play a very vital role. Static cycling, biofeedback, treadmill training, gaze stimulation exercises and Opto-kinetic stimuli are known to improve balance and functional independence. Growing gait ataxia frequently results in decreased mobility and the ability to engage in everyday activities, thus negatively impacting the quality of life.

Despite the fact that the trunk is recognized as a significant variable in activity and is frequently affected in dysfunction of cerebellum, it is neglected routinely in rehabilitation. Pelvis is marked as a key structure that works to join the trunk to the lower limbs. The function it performs is to connect the trunk to the lower extremities, support the body’s weight, transferring its load onto the lower limbs, and bears the body’s weight and shifts its load to the lower limbs. Pelvic stability is defined as the ability of the lower trunk and proximal hip muscles to coordinate with their own activity while performing balance and mobility activities in which the pelvis supports dynamic balance in order to allow for effective lower limb mobility.³ A strong trunk allows for more regular movement in the rest of the body. Trunk stabilisation is required to support upper and lower extremity movements, meet loads, and protect the spinal cord. During kinetic chain activities, the trunk muscles act as a corset to provide both a stabilising and a mobilising function.

Trunk stabilization training intends to enhance the control of the muscles required to brace the trunk against internal as well as external forces. Although all abdominal muscles contribute to vertebral stability, rehabilitation programs have focused on the transversus abdominis muscle, for evaluation and training.⁴ Pelvic proprioceptive neuromuscular facilitation boosts joint proprioception, which enhances pelvic control, which is further important for maintaining control of the trunk, and balance. Techniques such as rhythmic initiation aid in the movement of the limb or body through the desired range of motion, beginning with passive motion and progressing to active resisted movement.⁵ There is a dearth of literature stating the impact of pelvis stabilization exercises and trunk stabilization exercises on achieving dynamic trunk control in patients with cerebral ataxia. Thus, there is a need to conduct a study on the independent effects of the pelvis and trunk stabilization exercises to achieve dynamic trunk balance in patients with cerebral ataxia.

The designed intervention aims to see the impact of the pelvis and trunk stabilization exercises over conventional physiotherapy exercises on dynamic trunk balance in patients with cerebellar ataxia in two-arm parallel/open-label equivalence randomized controlled trial in improving TIS, SARA, BBS, Barthel index, and WHOQOL on marginal difference.

Aim and objectives of the study

Primary objective:

1. To study the effect of pelvis and trunk stabilization over conventional physiotherapy in improving severity of ataxia using the Severity of Ataxia Scale (SARA).
2. To study the effect of pelvis and trunk stabilization over conventional physiotherapy in improving Trunk balance using the Trunk Impairment Scale (TIS).
3. To compare the effects of Pelvis and Trunk stabilization exercises over Conventional Physiotherapy exercises to improve Severity of ataxia, and trunk balance using Severity of ataxia scale and, Trunk impairment scale.

Secondary objective:

1. To study the effect of pelvis and trunk stabilization over conventional physiotherapy in improving balance using Berg Balance Scale.
2. To study the effect of pelvis and trunk stabilization over conventional physiotherapy in improving activity of daily living using the Barthel index.
3. To study the effect of pelvis and trunk stabilization over conventional physiotherapy in improving quality of life using the World health related quality of life.
4. To compare the effects of Pelvis and Trunk stabilization exercises over Conventional Physiotherapy exercises to improve balance, activities of daily living and quality of life using Berg balance scale, Barthel index and World health related quality of life.

Trial design

Single-centric, two arm parallel open label equivalence, randomized controlled trial.

Ethical considerations – Approval was obtained from the Datta Meghe Institute of Higher Education and Research. IEC no. – DMIHER (DU)/IEC/2023/812 IEC approval date – 21/03/2023.

Consent

Patients will be explained about the study procedure in their native language. Informed written consent will be obtained from all study participants.

Methods

This is an interventional study, where participants will be recruited from Physiotherapy OPD of Acharya Vinoba Bhave Rural Hospital Sawangi, Meghe, Wardha, Maharashtra. After receiving an approval from institutional ethics committee of Datta Meghe Institute of Higher Education and Research. Study participants will be divided into Arm-A (Control group) and Arm-B (Interventional-group) with an intent to treat cerebellar ataxic population. A written consent form will be obtained from each patient. Participants will be assessed and screened using inclusion and exclusion criteria of the study.1:1 allocation will be done with an intent to treat the cause. Randomization will be done using computer-generated system. The study is a parallel group-RCT with two arms for subject allocation. Arm-A will receive Conventional Physiotherapy exercises whereas, Arm-B will receive Trunk and pelvis stabilization exercises along-with physiotherapy exercises. The primary and secondary outcome measures used in the study will be quantafied at baseline and at the end of the six-week treatment by a postgraduate resident in neuro-physiotherapy with similar expertise who is aware of the study but blind to the intervention. The design of study is visualized in (Figure 1). The study will be monitored PG guide, HOD, principal and chief advisor of research cell. The final dataset will be uploaded to institutional research website and will be accessible to concerned authorities.

Figure 1. Flowchart of treatment procedure.

Eligibility criteria

Criteria for inclusion of subjects

1. Patient diagnosed as Cerebellar Ataxia by Medical Doctor.
2. Both Male and Female gender.
3. Above 30-60 years of age.
4. Berg Balance Score <20.
5. Those willing to participate in the study.
6. Those having ability to understand and follow instructions.

Criteria for exclusion of subjects

1. Patients having musculoskeletal injury limiting ability to bear weight.
2. Conditions that impact lower limb mobility.
3. Subjects with unstable cardiovascular condition, as determined by the physician.
4. Patients having significant cognitive impairments, limiting ability to give informed consent.
5. Participants enrolled in another clinical trial.

Interventions

Group A (Conventional group): Participants in this group will undergo 60 minutes of conventional therapy. It will include strengthening, sensory stimulation, stretching, mobilising, and teaching functional mobility for the upper and lower limbs. It will be performed for six weeks, five days per week. Identification of weakened muscles will be done. Strengthening exercises for weakened trunk and lower limb at standing, sitting and supine position will be performed. Sensory stimulation will be provided through active ankle mobilisation. Active and functional training will be supplemented with passive mobilisation and stretching. Stretching for lower limb muscles will be done. The hold time for stretching will be 30 seconds with a rest duration of ten seconds. For functional ability, common mat activities will be incorporated.⁶

Group B (Interventional-group): Participants in this group will undergo trunk and pelvic stabilization exercises along-with Conventional physiotherapy exercises. Trunk stabilization exercise will include Trunk Proprioceptive neuromuscular Facilitation (PNF). Trunk PNF will include patterns like, Chopping, Lifting, Bilateral lower extremity flexion with knee flexion for lower trunk flexion, Bilateral lower extremity flexion with knee flexion for lower trunk extension, Trunk Lateral flexion, right lateral flexion with extension. Each exercise will be performed in ten repetition ×1 set with hold time being five to ten seconds and relaxation time being five seconds.⁷ Pelvis Stabilization exercise will include Pelvic Proprioceptive neuromuscular Facilitation (PNF).⁸ Pelvic motions like anterior elevation, posterior depression, posterior elevation, and anterior depression will be performed. Rhythmic initiation technique of PNF will be used to perform patterns with further progression into combinations of isotonics, dynamic reversal, stabilizing reversal followed by contract relax and hold relax technique. Each exercise will be performed for five repetitions, Sessions/Day three times, with a hold time of five seconds, rest time of two seconds.

Outcome measures

Primary outcome measures

1. Change in Trunk impairment scale (TIS) Score⁹
The trunk impairment scale totals the scores for static and dynamic sitting balance, as well as coordination. It is a 17-point scale. Its continued use in clinical practice and research is supported. To rate the quality of trunk movement, the scale can be used as a treatment guideline. The highest score is 23, the lowest is 0, and the total inter-observer reliability is 0.99.
2. Severity of Ataxia Scale (SARA) Score¹⁰
Schmitz-Hibusch developed this scale as a clinical assessment tool for calculating the severity of ataxia. It evaluates upper and lower limb ataxia, gait, and balance. It is divided into 8 categories, with a score ranging from 0 (no ataxia) to 40 (the most severe ataxia).

Secondary outcome measures

1. Change in Berg Balance Scale Score¹¹
It is a performance tool that is based on balance. It is a 5-point scale, with each task scored between 0 and 4. The highest possible score is 56. It includes 14 tasks that are scored between 0 and 4. A participant’s maximum total score is 56.
2. Change in Barthel Index Score
It is a 10-item assessment scale used to measure the performance of daily living activities. A lower score denotes more dependency.
3. Change in World health-related quality of Life (WHO-QOL) score
It is a self-reported questionnaire consisting of 26 questions on patients’ health and well-being.

Sample size calculation

This study protocol will be an independent two-group study investigating the efficacy of trunk and pelvis stabilization exercises over conventional physiotherapy exercises to improve dynamic trunk balance in cerebellar ataxia. G. Power 3.15 software was used to determine the total participants.

Formula using mean difference

n 1 = n 2 = 2 \frac{{(Z_{α} + Z_{β})}^{2} σ^{2}}{{(δ)}^{2}}

Primary variable (Trunk Impairment Scale)

Mean ± SD. (Pre) result on Trunk Impairment Scale for experimental group = 5.17 (1.26)

Mean ± SD. (Post) result on Trunk impairment Scale for experimental group = 9.13 (1.72)

Difference = 3.96 (3.27 to 5.05). (As per reference Article)

Pooled standard deviation. = (1.26 + 1.72)/2 = 1.49

Clinically relevant superiority = 30% = (3.96 *30)/100 = 1.188

As per reference articles.

N1 = 2^{*} [{(1.64 + 0.84)}^{2} {(1.49)}^{2}] / {(1.188)}^{2} = 19.34 = 20

Total samples required = 20 per Group.

Considering 10% dropout = 2

Total samples required (n1 = n2 = 20 per group)

The total sample size required (N) = 2*20 = 40

Notations:

Z_{α} = 1.64

α = Type I error at 5 %

Z_{β} = 0.84 (1 - β) = Power at 80 %

σ = std . dev

Reference Article: Effects of Pelvic Stability Training on Movement, Control, Hip Muscles Strength, Walking Speed, and Daily Activities after Stroke: A Randomized Controlled Trial.³

Discussion

People suffering from ataxia might regard physiotherapy as their “sole faith”. We intended to investigate the impact of the pelvis and trunk-stabilization exercises over conventional physiotherapy exercises on dynamic trunk balance in individuals suffering from cerebellar ataxia. Further, the study’s objective is to study the effect of pelvis and trunk stabilization over conventional physiotherapy in improving balance using the SARA, BBS, TIS, Barthel Index, and WHOQOL as outcome measures. The results of the study will be assessed at baseline and after 6 weeks of study. Mohammad Elshafey et al. (2022), carried out a study, to determine the impact of a core stability exercise program on coordination and balance in children with cerebellar ataxia.¹² Winser et al. (2022), published a systematic review – meta-analysis to study the implications of therapeutic exercise on the severity of disease, balance, and functional independence in cerebellar ataxia patients.¹³

Further, Dubey et al. (2018), published an RCT concluding the positive impact of pelvis exercise on movement, and muscle strength of walking in stroke patients. Patients with cerebellar ataxia show greater trunk movements which reflect a lack of coordination between the segments of the body which impacts the spatiotemporal variables of gait local stability.¹⁴ According to Marimuthu et al (2022), trunk and neck-specific PNF exercises proved to be a useful intervention in improving balance and trunk control among patients.¹⁵ Cerebellar ataxia is associated with cerebellar dysfunction and various balance disorders.¹⁶ Further, Poor predictive control has been known to negatively impact the feed-forward part of the movement, which has been associated with the motor symptoms of cerebellar damage.¹⁷

The current study protocol will provide new insight as no article available to date has looked at trunk and pelvis stabilization exercise programs as an intervention for treating cerebellar ataxia.

Analysis

R studio software 4.3 version will be used to calculate the results. Descriptive statistics will be calculated on the quantitative assessment over the parameters for mean, standard deviation, maximum, minimum, and median for the variables (age, gender, hand dominance). For qualitative assessment frequency and percentage will be calculated over the variables (gender, hand dominance). All the results for the inferential statistics will be tabulated and tested for significance at a 5% level of significance (P= <0.05). The outcome variables (Primary variables: Trunk impairment scale for dynamic trunk balance, Severity of ataxia scale for calculating ataxia severity, and, Secondary variables: Berg balance scale for calculating balance, Barthel index for evaluating independence in activities of daily living and World health-related quality of life for evaluating the quality of life) will be evaluated for testing pre and post result using paired t-test. The outcome variables will be initially tested for normality using Kolmogorov-Smirnov Test for data testing. If data fails to follow normality will be attempted to transform in normal distribution using mathematical algorithm tests like Log Function, Inverse Function, Exponential function, or Boxcox transformation. If data persists with non-normal distribution then, Alternative non-parametric test will be used for the parametric test result. For the paired-t test, an alternative Wilcoxon sign t-test will be used. An unpaired t-test will be used to find significant differences over the mean for both primary and secondary variables between the control and interventional group. Alternate non-parametric Mann-Whitney will be used. Association analysis for finding sig for the unpaired t-test. The significance of cofounding parameters will be evaluated by using the Chi-squared test or Fisher’s exact test or by using multi-variant analysis.

Study status

Not started.

Dissemination

Planning to present my study protocol at the conference preceding.

Data availability

Not applicable as it’s a study protocol.

Reporting guidelines

Zenodo: SPIRIT_checklist.docx. DOI: https://doi.org/10.5281/zenodo.8013885

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

References

1. Mukhtar T, Afzal Pt A, Hussain S, et al.: Effects of Gaze Stability Exercises with Proprioception Training to Improve Gait and Functional Independence in Cerebellar Ataxic Patients. Pak. J. Med. Health Sci. 2021; 15: 3467–3469. Publisher Full Text
2. Zesiewicz TA, Wilmot G, Kuo S-H, et al.: Comprehensive systematic review summary: Treatment of cerebellar motor dysfunction and ataxia. Neurology. 2018; 90: 464–471. PubMed Abstract | Publisher Full Text | Free Full Text
3. Dubey L, Karthikbabu S, Mohan D: Effects of pelvic stability training on movement control, hip muscles strength, walking speed, and daily activities after stroke: a randomized controlled trial. Ann. Neurosci. 2018; 25: 80–89. PubMed Abstract | Publisher Full Text | Free Full Text
4. Freund JE, Stetts DM: Use of trunk stabilization and locomotor training in an adult with cerebellar ataxia: A single system design. Physiother. Theory Pract. 2010; 26: 447–458. PubMed Abstract | Publisher Full Text
5. Beckers D, Buck M: PNF in Practice: An Illustrated Guide. Berlin, Heidelberg: Springer Berlin Heidelberg; 2021. Publisher Full Text
6. Milne SC, Corben LA, Roberts M, et al.: Rehabilitation for ataxia study: protocol for a randorandomizedrolled trial of an outpatient and supported home-based physiotherapy programme for people with hereditary cerebellar ataxia. BMJ Open. 2020; 10: e040230. PubMed Abstract | Publisher Full Text | Free Full Text
7. Bae SH, Lee HG, Kim YE, et al.: Effects of Trunk Stabilization Exercises on Different Support Surfaces on the Cross-sectional Area of the Trunk Muscles and Balance Ability. J. Phys. Ther. Sci. 2013; 25: 741–745. PubMed Abstract | Publisher Full Text | Free Full Text
8. Boob MA, Kovela RK Jr MAB, Sr RKK: Effectiveness of Pelvic Proprioceptive Neuromuscular Facilitation Techniques on Balance and Gait Parameters in Chronic Stroke Patients: A Randomized Clinical Trial. Cureus. 2022; 14: e30630. PubMed Abstract | Publisher Full Text | Free Full Text
9. Samal SN, Samal SS: Neha Ingale Chaudhary, Sachin Chaudhary, Vasant Gawande: Efficacy Of Core Strengthening Exercises On Swissball Versus Conventional Exercises For Improving Trunk Balance In Hemiplegic Patients Following Stroke. Int. J. Res. Pharm. Sci. 2021; 12: 889–893. Publisher Full Text
10. Schmitz-Hübsch T, du Montcel ST , Baliko L, et al.: Scale for the assessment and rating of ataxia: development of a new clinical scale. Neurology. 2006; 66: 1717–1720. PubMed Abstract | Publisher Full Text
11. Winser SJ, Smith CM, Hale LA, et al.: Clinical assessment of balance using BBS and SARAbal in cerebellar ataxia: Synthesis of findings of a psychometric property analysis. Hong Kong Physiother. J. 2018; 38: 53–61. PubMed Abstract | Publisher Full Text | Free Full Text
12. Elshafey MA, Abdrabo MS, Elnaggar RK: Effects of a core stability exercise program on balance and coordination in children with cerebellar ataxic cerebral palsy. J. Musculoskelet. Neuronal Interact. 2022; 22: 172–178. PubMed Abstract
13. Winser S, Chan HK, Chen WK, et al.: Effects of therapeutic exercise on disease severity, balance, and functional Independence among individuals with cerebellar ataxia: A systematic review with meta-analysis. Physiother. Theory Pract. 2022; 39: 1355–1375. PubMed Abstract | Publisher Full Text
14. Chini G, Ranavolo A, Draicchio F, et al.: Local Stability of the Trunk in Patients with Degenerative Cerebellar Ataxia During Walking. Cerebellum. 2017; 16: 26–33. PubMed Abstract | Publisher Full Text
15. Dinesh M, Thenmozhi P, KalaBarathi S: Proprioceptive Neuromuscular Facilitation Neck Pattern and Trunk Specific Exercise on Trunk Control and Balance—an Experimental Study. Int. J. Ther. Massage Bodyw. 2022; 15: 9–17. PubMed Abstract | Publisher Full Text | Free Full Text
16. Pathan A, Telang P: A Review Article on Assistive and Rehabilitation Technology in Cerebellar Ataxia. J. Pharm. Negat. Results. 2022; 3012–3016. Publisher Full Text
17. Nawkhare AV, Shamal S, Udhoji SP, et al.: Convalescence after physiotherapy intervention in a classic rare case of cerebellar bleed: A case report. Med. Sci. 2023; 27. Publisher Full Text

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Version 1

VERSION 1 PUBLISHED 11 Jul 2023

Author details Author details

¹ Neuro-Physiotherapy, First - Year MPT Student, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442004, India
² Head of Department and Professor, Department of Neuro Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research,, Wardha, Maharashtra, 442004, India
³ Professor, Department of Neuro Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442004, India
⁴ Assistant Professor, Department of Neuro Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research,, Wardha, Maharashtra, 442004, India

Anam Sasun
Roles: Conceptualization, Writing – Original Draft Preparation

Mohammad Irshad Qureshi
Roles: Supervision, Validation, Writing – Review & Editing

Raghumahanti Raghuveer
Roles: Supervision, Visualization

Pallavi Harjpal
Roles: Visualization, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (1)

version 1

Published: 11 Jul 2023, 12:813

https://doi.org/10.12688/f1000research.138131.1

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© 2023 Sasun A et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Sasun A, Qureshi MI, Raghuveer R and Harjpal P. Effectiveness of pelvis and trunk stabilization exercises over conventional physiotherapy to improve dynamic trunk balance in cerebellar ataxia: a randomized controlled trial [version 1; peer review: 3 approved with reservations]. F1000Research 2023, 12:813 (https://doi.org/10.12688/f1000research.138131.1)

NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.

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Key to Reviewer Statuses VIEW HIDE

ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions

Version 1

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PUBLISHED 11 Jul 2023

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Reviewer Report 16 Nov 2023

Sarah Milne, Murdoch Children's Research Institute,, Parkvile, Australia

Approved with Reservations

https://doi.org/10.5256/f1000research.151308.r219285

This is a randomised controlled trial protocol examining the efficacy of additional trunk and pelvic stabilisation exercises compared to a conventional rehabilitation program in individuals with cerebellar ataxia. This is an appropriate intervention targeting the postural instability in individuals with ... Continue reading

This is a randomised controlled trial protocol examining the efficacy of additional trunk and pelvic stabilisation exercises compared to a conventional rehabilitation program in individuals with cerebellar ataxia. This is an appropriate intervention targeting the postural instability in individuals with ataxia, that has yet to be explored. I have a few comments and suggestions for strengthening the protocol.

Abstract:

“Evidence-guidelines for treatment of balance disorders… are currently unavailable” – this is an incorrect statement. Refer to Friedreich's Ataxia Research Alliance - Clinical Care Guidelines (curefa.org) and Medical Guidelines - Ataxia UK

“No article available to date has looked at trunk and pelvis stabilization exercise program” – is incorrect also. Please refer to: Tabbassum, KN et al. (2013) Core Stability Training with Conventional Balance Training Improves Dynamic Balance in Progressive Degenerative Cerebellar Ataxia. Indian Journal of Physiotherapy and Occupational Therapy 7(1): 136-140.

Please spell out outcome measures in full first time used in the abstract.

Introduction:

Paragraph 2: Please find references for the following sentence: “Static cycling, biofeedback, treadmill training, gaze stimulation exercises and Opto-kinetic stimuli are known to improve balance and functional independence.”

Method:

Could you please provide further detail on how you are going to recruit participants? Are they inpatients or outpatients? Where will you ask them to participate?

Please indicate if allocation will be concealed from the enrolling investigator.

Group B – Intervnetional group – could you please clarify if participants will receive 60 minutes of conventional physiotherapy as well as the stabilisation exercises and therefore how long they will receive each day. This will give an indication of dosage to allow comparison across both groups.

Could you consider using the TIDieR checklist to describe your intervention in more detail. This will be important if your results demonstrate significant improvement with the additional trunk and pelvis exercises.

Could you please confirm your primary outcome measure. Is it the TIS? Or the SARA?

Could you please clarify your sample size estimation – it appears to state that you need 20 participants per group and to factor in a 10% drop out (n=2). Does this mean your sample size should be 22 per group?

Are you going to record any adverse events?

Please indicate what demographic and disease characteristics you are going to collect. This will be very important as it appears you will include both progressive and non-progressive ataxia diagnoses, which may influence your results.

Discussion

You mention three prior studies in the discussion but don’t explain further about how the findings from this study will build on these studies.

Analysis

“For qualitative assessment frequency and percentage will be calculated over the variables (gender, hand dominance).” I am not sure you mean ‘qualitative’ here as gender and hand dominance are quantitative data. You have repeated hand dominance after both assessments.

With the between group analysis chosen, how will you account for any differences at baseline?

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Rehabilitation, physiotherapy, cerebellar ataxia, neurological rehabilitation

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Reviewer Report 14 Nov 2023

Helen Hartley, Alder Hey Children's NHS Foundation Trust, Liverpool, UK

Approved with Reservations

https://doi.org/10.5256/f1000research.151308.r219289

The authors are presenting a protocol for a RCT examining the effectiveness of pelvis and trunk stabilization compared with conventional physiotherapy in cerebellar ataxia. There is a place for further research in this area as interventions specific to cerebellar ataxia ... Continue reading

The authors are presenting a protocol for a RCT examining the effectiveness of pelvis and trunk stabilization compared with conventional physiotherapy in cerebellar ataxia. There is a place for further research in this area as interventions specific to cerebellar ataxia are not well described however, there are a number of areas where the rationale for this study could be enhanced.

Comments as below;

Abstract
Add sentence on data analysis

Introduction
Generally this section is under referenced.

Would suggest rewording in the first paragraph where 'vandalization' is used.

Please reference the comments on falls (end of first paragraph) and the comments on types of interventions that improve balance (end of second paragraph).

There is further scope to refer to the systematic reviews that have been published on ataxia interventions in adults - and draw from this the need for further research.

Trunk stabilisation training should be clearly defined and differences between this and core control or (proximal control exercises) should be clearly stated

Please add in full the outcome measures prior to abbreviating e.g, TIS, SARA

Not clear why the primary objectives have been chosen i.e. over the secondary objectives - can you clarify why SARA and TIS have been chosen as primary.
Not sure what no 3 primary objective is? - is it 1 and 2 repeated (similarly number 4 in the secondary objective)

Methods
Can you confirm will the participants potentially have cerebellar ataxia from an acute or genetic origin?

Sample size calculation - please reference this section

Do Group B receive the trunk stabilisation exercises in addition to the conventional therapy? I.e., is the amount of intervention therefore different between the two groups?
If so, need to clearly state this and justify this design and acknowledge this may impact on outcome

Discussion
This section doesn't flow well as it is before the analysis. Some elements of the discussion could be used in the introduction to increase the rationale for the study.
I am not sure of the purpose of the discussion here?

Data analysis
Please can you provide information as to why you will try and transform the data into normal distribution and the rationale for this
And reference choice of statistical testing

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Neuro Oncology, Rehabilitation, Ataxia

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Reviewer Report 25 Sep 2023

Ragab K. Elnaggar, Cairo University, Giza, Giza Governorate, Egypt; Prince Sattam bin Abdulaziz University, Al Kharj, Riyadh Province, Saudi Arabia

Approved with Reservations

https://doi.org/10.5256/f1000research.151308.r195453

This is a protocol for a prospective, open-label clinical trial that will study the effectiveness of trunk and pelvic stabilization exercises on dynamic trunk balance in patients with cerebellar ataxia. I have some major/minor concerns that the authors need to ... Continue reading

This is a protocol for a prospective, open-label clinical trial that will study the effectiveness of trunk and pelvic stabilization exercises on dynamic trunk balance in patients with cerebellar ataxia. I have some major/minor concerns that the authors need to address before considering the study appropriate. These are as follows:

Abstract

Abbreviations should be spoked out the first time they are mentioned (SARA, TIS, BBS, and WHOQOL)
The data analysis plan as has been stated in the abstract is not clear. Revise for clarity.
A synopsis of the potential clinical implications should be provided in the conclusion subsection of the abstract.

Introduction

The authors used the term “trunk and pelvic stabilization” exercise. What is the difference between your intended study approach and the commonly known “Core stability” exercise? This is critical to clarify.
I have a major concern regarding the novelty of the intended study. There exist plenty of published articles that explore the role of “trunk and pelvic stabilization” for different postural control outcomes. However, I am open to changing my point of view if the authors pinpointed the research gap appropriately (in light of the related literature) and made it clear what drove them to conduct the study
The introduction does not provide the proper context about the topic. The logical flow of the idea is lacking. Authors need to provide further context and background information about the role of trunk and pelvic stabilization exercises in patients with cerebellar ataxia or other conditions sharing similar symptoms.
The significance of the study is not clear. Please, provide a justification of the importance of the intended study, highlight the impact it would have on the research field, define its contribution to new knowledge, and explain how others will benefit from it.
In other words, the connection between the background and the research question should be made clear.
Why did you split the study's primary/secondary objectives into several statements? They are redundant and could be compiled in two statements (one primary and one secondary objective).

Methods

There is a potential risk of open-label design. I think this could be partially addressed if the authors considered blinding the outcome assessor.
A detailed description of the study design is needed. This should include information about recruitment, blinding, and randomization procedures.
You conducted a priori power analysis to determine the appropriate sample size. Please, provide proper credit to the source of the information you employed for the analysis.
The intended treatment (i.e., the core stability training) needs a clear description. As I attempted to envision how exercises would be done, I couldn't quite get it. So, a detailed description of the exercise program (exercise description, instruction for performance, volume, intensity,….. etc.) is imperatively needed to help other researchers replicate it.
Also, a further description of the outcome measures (i.e., measurement procedures) should be provided.
The training volume and frequency as proposed are different. This could affect the study results. Training should be equated for both groups.
Have you registered the protocol in any of the WHO clinical trial registration repositories? If yes, give the registration details.

Data analysis

Given the many outcome measures in the study, I would not recommend a t-test or the non-parametric equivalent for the data analysis. I would suggest mixed-model ANOVA to calculate the pre-to-post change differences.

Discussion

The discussion requires additional development. Authors should discuss in-depth focusing on the relevance of the study, and outlining the potential implications for practice

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Physical Therapy and Health Rehabilitation

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

CITE

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Version 1

VERSION 1 PUBLISHED 11 Jul 2023

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Version 1 11 Jul 23	read	read	read

Ragab K. Elnaggar, Cairo University, Giza, Egypt; Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia
Helen Hartley, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
Sarah Milne, Murdoch Children's Research Institute,, Parkvile, Australia

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16 Nov 2023 | for Version 1

Sarah Milne, Murdoch Children's Research Institute,, Parkvile, Australia

17 Views Cite this report Responses(0)

Approved With Reservations

This is a randomised controlled trial protocol examining the efficacy of additional trunk and pelvic stabilisation exercises compared to a conventional rehabilitation program in individuals with cerebellar ataxia. This is an appropriate intervention targeting the postural instability in individuals with ataxia, that has yet to be explored. I have a few comments and suggestions for strengthening the protocol.

Abstract:

“Evidence-guidelines for treatment of balance disorders… are currently unavailable” – this is an incorrect statement. Refer to Friedreich's Ataxia Research Alliance - Clinical Care Guidelines (curefa.org) and Medical Guidelines - Ataxia UK

“No article available to date has looked at trunk and pelvis stabilization exercise program” – is incorrect also. Please refer to: Tabbassum, KN et al. (2013) Core Stability Training with Conventional Balance Training Improves Dynamic Balance in Progressive Degenerative Cerebellar Ataxia. Indian Journal of Physiotherapy and Occupational Therapy 7(1): 136-140.

Please spell out outcome measures in full first time used in the abstract.

Introduction:

Paragraph 2: Please find references for the following sentence: “Static cycling, biofeedback, treadmill training, gaze stimulation exercises and Opto-kinetic stimuli are known to improve balance and functional independence.”

Method:

Could you please provide further detail on how you are going to recruit participants? Are they inpatients or outpatients? Where will you ask them to participate?

Please indicate if allocation will be concealed from the enrolling investigator.

Group B – Intervnetional group – could you please clarify if participants will receive 60 minutes of conventional physiotherapy as well as the stabilisation exercises and therefore how long they will receive each day. This will give an indication of dosage to allow comparison across both groups.

Could you consider using the TIDieR checklist to describe your intervention in more detail. This will be important if your results demonstrate significant improvement with the additional trunk and pelvis exercises.

Could you please confirm your primary outcome measure. Is it the TIS? Or the SARA?

Could you please clarify your sample size estimation – it appears to state that you need 20 participants per group and to factor in a 10% drop out (n=2). Does this mean your sample size should be 22 per group?

Are you going to record any adverse events?

Please indicate what demographic and disease characteristics you are going to collect. This will be very important as it appears you will include both progressive and non-progressive ataxia diagnoses, which may influence your results.

Discussion

You mention three prior studies in the discussion but don’t explain further about how the findings from this study will build on these studies.

Analysis

“For qualitative assessment frequency and percentage will be calculated over the variables (gender, hand dominance).” I am not sure you mean ‘qualitative’ here as gender and hand dominance are quantitative data. You have repeated hand dominance after both assessments.

With the between group analysis chosen, how will you account for any differences at baseline?

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Rehabilitation, physiotherapy, cerebellar ataxia, neurological rehabilitation

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Respond to this report

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Reviewer Report

9 Views

14 Nov 2023 | for Version 1

Helen Hartley, Alder Hey Children's NHS Foundation Trust, Liverpool, UK

9 Views Cite this report Responses(0)

Approved With Reservations

The authors are presenting a protocol for a RCT examining the effectiveness of pelvis and trunk stabilization compared with conventional physiotherapy in cerebellar ataxia. There is a place for further research in this area as interventions specific to cerebellar ataxia are not well described however, there are a number of areas where the rationale for this study could be enhanced.

Comments as below;

Abstract
Add sentence on data analysis

Introduction
Generally this section is under referenced.

Would suggest rewording in the first paragraph where 'vandalization' is used.

Please reference the comments on falls (end of first paragraph) and the comments on types of interventions that improve balance (end of second paragraph).

There is further scope to refer to the systematic reviews that have been published on ataxia interventions in adults - and draw from this the need for further research.

Trunk stabilisation training should be clearly defined and differences between this and core control or (proximal control exercises) should be clearly stated

Please add in full the outcome measures prior to abbreviating e.g, TIS, SARA

Not clear why the primary objectives have been chosen i.e. over the secondary objectives - can you clarify why SARA and TIS have been chosen as primary.
Not sure what no 3 primary objective is? - is it 1 and 2 repeated (similarly number 4 in the secondary objective)

Methods
Can you confirm will the participants potentially have cerebellar ataxia from an acute or genetic origin?

Sample size calculation - please reference this section

Do Group B receive the trunk stabilisation exercises in addition to the conventional therapy? I.e., is the amount of intervention therefore different between the two groups?
If so, need to clearly state this and justify this design and acknowledge this may impact on outcome

Discussion
This section doesn't flow well as it is before the analysis. Some elements of the discussion could be used in the introduction to increase the rationale for the study.
I am not sure of the purpose of the discussion here?

Data analysis
Please can you provide information as to why you will try and transform the data into normal distribution and the rationale for this
And reference choice of statistical testing

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Neuro Oncology, Rehabilitation, Ataxia

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Respond to this report

Responses (0)

Back to all reports

Reviewer Report

22 Views

25 Sep 2023 | for Version 1

Ragab K. Elnaggar, Cairo University, Giza, Giza Governorate, Egypt; Prince Sattam bin Abdulaziz University, Al Kharj, Riyadh Province, Saudi Arabia

22 Views Cite this report Responses(0)

Approved With Reservations

This is a protocol for a prospective, open-label clinical trial that will study the effectiveness of trunk and pelvic stabilization exercises on dynamic trunk balance in patients with cerebellar ataxia. I have some major/minor concerns that the authors need to address before considering the study appropriate. These are as follows:

Abstract

Abbreviations should be spoked out the first time they are mentioned (SARA, TIS, BBS, and WHOQOL)
The data analysis plan as has been stated in the abstract is not clear. Revise for clarity.
A synopsis of the potential clinical implications should be provided in the conclusion subsection of the abstract.

Introduction

The authors used the term “trunk and pelvic stabilization” exercise. What is the difference between your intended study approach and the commonly known “Core stability” exercise? This is critical to clarify.
I have a major concern regarding the novelty of the intended study. There exist plenty of published articles that explore the role of “trunk and pelvic stabilization” for different postural control outcomes. However, I am open to changing my point of view if the authors pinpointed the research gap appropriately (in light of the related literature) and made it clear what drove them to conduct the study
The introduction does not provide the proper context about the topic. The logical flow of the idea is lacking. Authors need to provide further context and background information about the role of trunk and pelvic stabilization exercises in patients with cerebellar ataxia or other conditions sharing similar symptoms.
The significance of the study is not clear. Please, provide a justification of the importance of the intended study, highlight the impact it would have on the research field, define its contribution to new knowledge, and explain how others will benefit from it.
In other words, the connection between the background and the research question should be made clear.
Why did you split the study's primary/secondary objectives into several statements? They are redundant and could be compiled in two statements (one primary and one secondary objective).

Methods

There is a potential risk of open-label design. I think this could be partially addressed if the authors considered blinding the outcome assessor.
A detailed description of the study design is needed. This should include information about recruitment, blinding, and randomization procedures.
You conducted a priori power analysis to determine the appropriate sample size. Please, provide proper credit to the source of the information you employed for the analysis.
The intended treatment (i.e., the core stability training) needs a clear description. As I attempted to envision how exercises would be done, I couldn't quite get it. So, a detailed description of the exercise program (exercise description, instruction for performance, volume, intensity,….. etc.) is imperatively needed to help other researchers replicate it.
Also, a further description of the outcome measures (i.e., measurement procedures) should be provided.
The training volume and frequency as proposed are different. This could affect the study results. Training should be equated for both groups.
Have you registered the protocol in any of the WHO clinical trial registration repositories? If yes, give the registration details.

Data analysis

Given the many outcome measures in the study, I would not recommend a t-test or the non-parametric equivalent for the data analysis. I would suggest mixed-model ANOVA to calculate the pre-to-post change differences.

Discussion

The discussion requires additional development. Authors should discuss in-depth focusing on the relevance of the study, and outlining the potential implications for practice

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Physical Therapy and Health Rehabilitation

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Respond to this report

Responses (0)

[1] 1. Mukhtar T, Afzal Pt A, Hussain S, et al.: Effects of Gaze Stability Exercises with Proprioception Training to Improve Gait and Functional Independence in Cerebellar Ataxic Patients. Pak. J. Med. Health Sci. 2021; 15: 3467–3469. Publisher Full Text

[2] 2. Zesiewicz TA, Wilmot G, Kuo S-H, et al.: Comprehensive systematic review summary: Treatment of cerebellar motor dysfunction and ataxia. Neurology. 2018; 90: 464–471. PubMed Abstract | Publisher Full Text | Free Full Text

[3] 3. Dubey L, Karthikbabu S, Mohan D: Effects of pelvic stability training on movement control, hip muscles strength, walking speed, and daily activities after stroke: a randomized controlled trial. Ann. Neurosci. 2018; 25: 80–89. PubMed Abstract | Publisher Full Text | Free Full Text

[4] 4. Freund JE, Stetts DM: Use of trunk stabilization and locomotor training in an adult with cerebellar ataxia: A single system design. Physiother. Theory Pract. 2010; 26: 447–458. PubMed Abstract | Publisher Full Text

[5] 5. Beckers D, Buck M: PNF in Practice: An Illustrated Guide. Berlin, Heidelberg: Springer Berlin Heidelberg; 2021. Publisher Full Text

[6] 6. Milne SC, Corben LA, Roberts M, et al.: Rehabilitation for ataxia study: protocol for a randorandomizedrolled trial of an outpatient and supported home-based physiotherapy programme for people with hereditary cerebellar ataxia. BMJ Open. 2020; 10: e040230. PubMed Abstract | Publisher Full Text | Free Full Text

[7] 7. Bae SH, Lee HG, Kim YE, et al.: Effects of Trunk Stabilization Exercises on Different Support Surfaces on the Cross-sectional Area of the Trunk Muscles and Balance Ability. J. Phys. Ther. Sci. 2013; 25: 741–745. PubMed Abstract | Publisher Full Text | Free Full Text

[8] 8. Boob MA, Kovela RK Jr MAB, Sr RKK: Effectiveness of Pelvic Proprioceptive Neuromuscular Facilitation Techniques on Balance and Gait Parameters in Chronic Stroke Patients: A Randomized Clinical Trial. Cureus. 2022; 14: e30630. PubMed Abstract | Publisher Full Text | Free Full Text

[9] 9. Samal SN, Samal SS: Neha Ingale Chaudhary, Sachin Chaudhary, Vasant Gawande: Efficacy Of Core Strengthening Exercises On Swissball Versus Conventional Exercises For Improving Trunk Balance In Hemiplegic Patients Following Stroke. Int. J. Res. Pharm. Sci. 2021; 12: 889–893. Publisher Full Text

[10] 10. Schmitz-Hübsch T, du Montcel ST , Baliko L, et al.: Scale for the assessment and rating of ataxia: development of a new clinical scale. Neurology. 2006; 66: 1717–1720. PubMed Abstract | Publisher Full Text

[11] 11. Winser SJ, Smith CM, Hale LA, et al.: Clinical assessment of balance using BBS and SARAbal in cerebellar ataxia: Synthesis of findings of a psychometric property analysis. Hong Kong Physiother. J. 2018; 38: 53–61. PubMed Abstract | Publisher Full Text | Free Full Text

[12] 12. Elshafey MA, Abdrabo MS, Elnaggar RK: Effects of a core stability exercise program on balance and coordination in children with cerebellar ataxic cerebral palsy. J. Musculoskelet. Neuronal Interact. 2022; 22: 172–178. PubMed Abstract

[13] 13. Winser S, Chan HK, Chen WK, et al.: Effects of therapeutic exercise on disease severity, balance, and functional Independence among individuals with cerebellar ataxia: A systematic review with meta-analysis. Physiother. Theory Pract. 2022; 39: 1355–1375. PubMed Abstract | Publisher Full Text

[14] 14. Chini G, Ranavolo A, Draicchio F, et al.: Local Stability of the Trunk in Patients with Degenerative Cerebellar Ataxia During Walking. Cerebellum. 2017; 16: 26–33. PubMed Abstract | Publisher Full Text

[15] 15. Dinesh M, Thenmozhi P, KalaBarathi S: Proprioceptive Neuromuscular Facilitation Neck Pattern and Trunk Specific Exercise on Trunk Control and Balance—an Experimental Study. Int. J. Ther. Massage Bodyw. 2022; 15: 9–17. PubMed Abstract | Publisher Full Text | Free Full Text

[16] 16. Pathan A, Telang P: A Review Article on Assistive and Rehabilitation Technology in Cerebellar Ataxia. J. Pharm. Negat. Results. 2022; 3012–3016. Publisher Full Text

[17] 17. Nawkhare AV, Shamal S, Udhoji SP, et al.: Convalescence after physiotherapy intervention in a classic rare case of cerebellar bleed: A case report. Med. Sci. 2023; 27. Publisher Full Text

Effectiveness of pelvis and trunk stabilization exercises over conventional physiotherapy to improve dynamic trunk balance in cerebellar ataxia: a randomized controlled trial

Abstract

Keywords

Introduction

Aim and objectives of the study

Trial design

Consent

Methods

Figure 1. Flowchart of treatment procedure.

Eligibility criteria

Interventions

Outcome measures

Sample size calculation

Primary variable (Trunk Impairment Scale)

Discussion

Analysis

Study status

Dissemination

Data availability

Reporting guidelines

References

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