Pediatric Cerebellar Ataxia

Pediatric Cerebellar Ataxia: Connecting the divide between current research and school-based PT

Britt Tatum

The idea for this project was inspired from my clinical affiliation with the Alamance-Burlington school-system. During this time, I encountered several children with diagnoses involving the cerebellum, which subsequently affected functioning in their school environment. Many had trouble playing with peers on the playground, classroom navigation, going up/down steps and curbs as well as safety awareness. The school system provides a different opportunity to provide therapy, unlike outpatient clinics and hospitals. As this was my first time in the school system, I found myself wondering “What is the best way to approach therapy with these children to maximize function”. I found myself wondering “What is the (or is there one) protocol for treating children with cerebellar ataxia”.  This project attempts to link the evidence between pediatric cerebellar ataxia and school-based therapy.

What is cerebellar ataxia?

Cerebellar  ataxia can result as any damage to the cerebellum and input/output pathways. Likewise, causes can be hereditary or acquired and degenerative or non-progressive! With that said, it is no surprise from the variety of causes each child presents a little differently! To provide a small picture of how cerebellar ataxia may clinically present take a look at Ethan!! From 52 seconds – 2 minutes you will be able to develop a tiny picture of how functional Ethan is in his environment. Ethan has cerebellar hypoplasia.

Common Clinical Presentations of Cerebellar Ataxia (Marsden, 2011)

From this information I developed an Outcome Measures Table, with relevant and applicable measures/tests to be implemented in the school system. Not all measures were tested specifically for children with cerebellar ataxia, but instead may measure components affected by ataxia such as dynamic balance, static balance,gait, flexibility and functional mobility. My goal for developing this table was to provide a quick and easy resource school physical therapists can utilize day-to-day.

Evidence Tables

My school-based evidence table highlights the effectiveness of school-based therapy,intensity recommendations, considerations for goals and services, and the role of the school PT (and how it has changed over the years). I find these articles are particularly important for those who are less familiar with school-based therapy in order to understand how this will then affect treatment of children with cerebellar ataxia.

A Few Facts about School-Based PT

• School PT’s affect change by collaborating and interviewing teachers, families and students to optimize the education experience(Leverdure, 2009).
• School PT’s are often afforded the ability to follow the student through their entire educational experience.
• Goals need to be context specific, focus on life skills/ academic tasks, and include objective measurements (McConglogue, 2009). 
• School-based PT’s tend to use a variety of approaches in therapy (direct, consultative) based on the family-centered approach to therapy (King, 1999).

Is my child appropriate for school PT? Indications for school therapy are (NCDPI):

• Student has a disability
• PT service is educationally relevant and clear in purpose
• PT service is necessary in order for the student to benefit from the IEP
• There is reason to believe the student will not have access to an appropriate educational setting
• There is reason to believe the student will not experience the appropriate educational benefits.

The student would not be appropriate for school PT if (Giangcreco, 2001):

• If the students needs can be addressed appropriately by the special education teacher or classroom teacher
• If the students needs can be addressed through the core school faculty or staff (school nurse, guidance counselor, librarian, teachers, administrators, bus drivers, cafeteria staff).
• If the student could benefit from his/her educational program without the service.
• If the need of the student could be met outside of the educational setting (non-school hours).
• If unnecessary gaps are present in the students educational setting while obtaining PT services.

Considering the implications for school-based PT, lets think about how children with cerebellar ataxia may receive therapy services in this setting. My Cerebellar ataxia evidence table addresses current research intervention to improve function, gait and balance. This evidence table was developed in EBP II with the PICO question In school-aged children with cerebellar ataxia is balance training more beneficial than gait training to improve functional independence. Over the course of this project I edited and updated the table to provide the most relevant research.

As a student, I was expecting to find all of my answers in research. However, I quickly learned there is limited research for pediatric cerebellar ataxia. This theme is also apparent in school-based therapy evidence. I quickly learned utilizing my resources would be key to success in this project. For students in the future, I highly recommend you do the same! Using the evidence I had, my survey results, and utilizing the expertise of pediatric physical therapists I developed a Pediatric Cerebellar Presentation! Want to see how much you know about pediatric cerebellar ataxia? Before you look at the presentation take the Pre-test and afterwards the Post-test/Evaluation !!!

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Feedback: I presented this information to the school-based PT’s in Alamance-Burlington School System (4 PTS, 1 OT, 1 SPT). Overall the feedback I received from was positive (finding the content and presenter very effective). They appreciated the handouts I provided them with (OM table, survey results, list of resources, power pointt). The presentation was very interactive which I enjoyed because I left not only feeling like I was able to share the information I knew, but having learned a lot from them about clinical experience/professional opinions. One change I will consider for future presentations is making sure I have videos directly downloaded to my computer. Since I presented at the school, the school has limited access to certain website (youtube, etc), so I was not able to share the video during the presentation.

List of references: Additional References

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NC School-Based Physical Therapy website:

This presentation and corresponding materials will also be made available in the near future on NC School-Based Physical Therapy website (developed by Laurie Ray, PT consultant for DPI). For NC physical therapists, I am working diligently to  allow completion of my presentation module (voice-thread with corresponding pre/post/evaluation) to count as approved CEU time. For more information please contact me @ tjbritt@med.unc.edu

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THANK YOU!!!

I  would like to give many thanks to  Susan Attermeier, Sonny Gasaway, Charlotte Hughes,Karen McCulloch,and Laurie Ray. I am also very appreciative of all the NC pediatric PT’s who participated in my survey. Without the help from all of you, the completion of this project would not have been possible!