The cerebellum is a part of the brain vital to coordination. Wrapped up in that one word is a whole lot of anatomical heavy lifting, with standing, walking, use of your hands, judging distance, speaking, and even learning new words involving the cerebellum on some level. In fact, this so-called “little brain” holds more than half of the neurons in your whole body. Needless to say, when part of the cerebellum is damaged, whether through stroke, neurodegeneration, alcohol misuse or drugs, disorders or illnesses, it can be a life-changing ordeal.
Cerebellar Ataxia describes this condition whereby damage to the cerebellum has occurred. Commonly, symptoms include poor muscle control and clumsy or involuntary movements. Other symptoms can involve difficulty with balance, walking, speech, hand movements and coordination, and even swallowing or eye movements. Unsurprisingly, muscular atrophy can occur over time, and pain may be a by-product of the condition as well. Traditional treatments usually involve adaptive devices to make the activities of daily life more achievable, as well as physical or occupational therapy or other treatments based on the original cause for the ataxia.
Where, then, is the role of chiropractic in this brain injury? You could be forgiven for thinking that nervous system care could do very little. However, a recent case report has shown the impacts on one patient who had suffered from cerebellar ataxia for more than fifteen years, and at the time of his presentation to a chiropractic clinic at age 67, he could not perform any ambulatory movement without a walker.
Originally, the condition manifested with tingling in his hands, difficulty gripping a pencil and difficulty navigating his way up and down staircases. Over time, his gait worsened, and he began using a walking stick. Five years after the initial symptoms began, he saw a neurologist who confirmed cerebellar ataxia and began physical therapy. Another five years passed, and he began feeling radiating pain in his right leg while using the walker. By 2017 (12 years after symptom onset), he was having trouble turning by walking and by 2022 he could not perform any ambulatory movement without a walker.
At this point, chiropractic care was sought not for cerebellar ataxia but for right-sided neck and shoulder pain. This isn’t uncommon. Patients often present for neck and back pain but have far more complex health histories manifesting behind the scenes. Thus, thorough histories and examinations are pertinent so we can see their progression as a whole person under care.
In this case, his orthopaedic exams revealed “mildly decreased extension, right rotation, and right lateral flexion with dull, local right-sided pain. Left lateral flexion was decreased with a left-sided stretching pain.” Additionally, the shoulder depression test was positive with right-sided pain.” [3] Neurological examinations were also undertaken (full details can be found in the case report referenced below), resulting in a differential diagnosis of “a cervical sprain/strain, degenerative disc disease and subluxation, accompanied by cerebellar ataxia.” [3]
While his goals for care were simply to reduce the intensity of his pain by about 25% over four months, a long-term goal was established to reduce it by 75% over nine months. The chiropractor noted that this may never be met due to the rapid increase in cerebellar ataxia. However, a care plan commenced with one visit per month, during which Activator methods, Diversified Technique and the Thompson Method were deployed. Anterior drops were also used bilaterally to offer postural support. Home care recommendations for heat and exercise were also given.
Over the course of care, his pain scores decreased significantly. His Quadruple Visual Analogue Scale (a measure of pain and symptoms) decreased from 47 to 30. He also noticed an increase to full strength in his right arm. As the condition is ongoing, some symptomatic escalation is to be expected. However, the positive results in this case report give something to consider.
The first of these is what may have happened in terms of disease progression if chiropractic care was deployed at the outset. Sadly, we will never know. However, the reduction in pain scores and improvement in strength and movement does show that supporting the nervous system may help improve symptoms. Thus, we need to be asking what the reduction of subluxation does in terms of neurorehabilitation in complex cases.
Only more research will tell us what we can claim here. Still, it’s an exciting prospect.
REFERENCES:
1. Staff Writer (2022). “Cerebellum” Cleveland Clinic, https://my.clevelandclinic.org/health/body/23418-cerebellum#:~:text=Your%20cerebellum%20is%20part%20of,system)%20in%20your%20whole%20body.
- Staff Writer (2022). “Cerebellar Ataxia Overview”. Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/ataxia/symptoms-causes/syc-20355652
- Klaus, L., Wells, B., & Durr, S. (2023). TREATING SECONDARY SYMPTOMS OF CEREBELLAR ATAXIA: A CASE REPORT.Journal of Contemporary Chiropractic,6(1), 52–55. Retrieved from https://journal.parker.edu/index.php/jcc/article/view/262
