Objective: Ataxic gait can be remarkably improved by a simple method called the “handkerchief guide” involving the patient and caregiver holding opposite ends of a handkerchief and walking together. Our objective was to assess the effect of the handkerchief guide on gait in patients with cerebellar ataxia. Methods: Gait analysis was carried out on seven patients with degenerative cerebellar disease (DCD), seven patients with unilateral cerebellar vascular disease (CVD), and seven healthy control (HC) subjects. All subjects performed two walking tasks: free walking (FW) and handkerchief-guided walking (HGW) on a 10 m pathway. In the HGW condition, each subject walked with the caregiver while maintaining slight tension on the handkerchief. The HCs and patients with DCD held the handkerchief with their right hand, while the patients with unilateral limb ataxia due to CVD grasped it with their affected and unaffected hands in different trials. We measured 10 gait parameters. Results: The HGW attenuated body-sway, lengthened step, and increased gait velocity in patients with cerebellar ataxia. In DCD, the HGW significantly improved seven parameters. In CVD, HGW with the affected hand improved five parameters, and HGW with the unaffected hand improved seven parameters. Conclusions: The HGW stabilized upright posture in patients with cerebellar ataxia during level-ground walking, probably by enabling subconscious postural adjustments to minimize changes in the arm and hand position relative to trunk, and in arm configuration. This led to improvement of gait performance. The handkerchief guide may be useful for walk training in patients with cerebellar ataxia. Abbreviations: COM, center of mass; COG, center of gravity (projection of the COM onto the ground plane); COP, center of pressure; CVD, cerebellar vascular disease; DCD, degenerative cerebellar disease; FW, free walking; HAT, head, arms, and trunk segment; HC, healthy control; HGW, handkerchief-guided walking.
症例は57歳男性．56歳時に胃原発のびまん性大細胞型B細胞性リンパ腫（diffuse large B-cell lymphoma; DLBCL）を発症し，R-CHOP療法により寛解状態であった．左上肢の疼痛と筋力低下で発症し，亜急性に四肢筋力低下が進行し入院した．脊髄造影MRIで上位頸髄から腰仙髄・馬尾まで広範囲に神経根の造影効果をみとめ，髄液検査では糖値の著明な低下と神経伝導検査では正中神経と尺骨神経でF波出現率の低下をみとめた．髄液細胞診をくりかえしneurolymphomatosisをきたしたDLBCLの再発と診断した．高用量メトトレキサート療法を施行したが治療効果に乏しく，完全四肢麻痺へ移行した．DLBCLは広範な脊髄神経根障害を呈して再発することがあり注意が必要である．