What Is the Treatment of Friedreich Ataxia When the Patient Is No Longer Ambulant (Wheelchair Dependent)?
When Friedreich ataxia progresses to the point that a person is no longer able to walk and is wheelchair dependent, the rehabilitation approach must be substantially adapted. This population has specific functional needs and limitations that determine which interventions are appropriate.
Clinical scenario: Friedreich ataxia in an individual who is no longer ambulant and is wheelchair dependent. Loss of ambulation defines this group and requires that all physical interventions be individually tailored to their current impairments and functional goals.
Treatment overview
Management in this setting involves a structured, individually tailored physical rehabilitation programme addressing balance, limb strength, and cardio-pulmonary fitness. For those who also present with certain muscle tone and soft tissue complications, targeted adjunctive interventions are included in the regimen. The complete protocol — with the full intervention set, priorities, and specific clinical guidance — is available via the link below.
References
- For individuals with Friedreich ataxia who are no longer ambulant, we conditionally recommend standing and sitting balance exercises over no balance exercises.
- We conditionally recommend lower limb strengthening over no lower limb strengthening for individuals with Friedreich ataxia who are no longer ambulant.
- We recommend upper limb strengthening versus no upper limb strengthening in individuals with Friedreich ataxia who are no longer ambulant.
- We conditionally recommend cardio-pulmonary exercise over no cardio-pulmonary exercise in individuals with Friedreich ataxia who are no longer ambulant.
- We conditionally recommend botulinum toxin injections, stretching, and prescription of ankle–foot orthoses for individuals with Friedreich ataxia who are no longer ambulant and who have spasticity and reduced length of the calf muscles.
DOI: 10.1186/s13023-022-02568-3
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