脊髄小脳変性症のニューロリハビリテーション治療：現状と展望

抄録

There is accumulating evidence that intensive neurorehabilitation improves ataxia and activities of daily living in patients with spinocerebellar ataxia. Most rehabilitation programs comprise optimal combination of coordination, balance, and gait exercise according to the principles of motor learning such as repetition of task–oriented practice and increasing balance challenge. There are considerable varieties in the extent and degrees of degeneration in the cerebellar system depending on the type of diseases. For instance, SCA 6 and SCA31 have main lesions in the Purkinje cells that are essential to internal model formation, while SCA 3 has degeneration in the afferent and efferent systems of the cerebellum. These suggest that optimal rehabilitation program need be considered for each type of spinocerebellar ataxia to maximize effect of rehabilitative intervention. Furthermore neuromodulation combined with rehabilitation may facilitate functional gains. There are several clinical trials including non–invasive cerebellar stimulation and neurofeedback for activating the motor related areas.