Tottori J. Clin. Res. 7(2), 155-160, 2016

A patient with SCA6 whose balance ability was improved by outpatient
rehabilitation
Makoto Sawada1)*, Shogo Usui1), Tatsunori Murakami1), Shin-ichi Morioka1),
Shin Nozaki1), Hiroshi Takahashi2)
1) Department of Rehabilitation, NHO Tottori Medical Center2) Department of Neurology, NHO Tottori Medical Center*Correspondence: m_sawada@tottori-iryo.hosp.go.jp
Abstract
We encountered an SCA6 patient whose balance ability was improved by physical therapy at outpatient
rehabilitation. The patient was a male in his 50s with dysarthria and ataxia of the four extremities and trunk, butsymptoms were mild and he was independent in daily life and working. Regarding the physical function,walking ability was relatively retained, but balance ability was reduced to a Berg balance scale (BBS) of 43. Asa physical therapy program, in addition to once-a-week exercise therapy (relaxation and muscle strengthening
and balance trainings), voluntary training (aerobic exercise, relaxation, and muscle strengthening training) wasinstructed. After a 6-month intervention, the BBS scale improved to 55. Tottori J. Clin. Res. 7(2), 155-160,
2016
Key Words: spinocerebellar ataxia (SCA), SCA type 6 (SCA6), outpatient rehabilitation, balance ability, Bergbalance scale (BBS)
Introduction
Spinocerebellar degeneration (SCD) is thecollective name of neurodegenerative diseases
developing ataxia as the main symptom with themain lesions in the cerebellum, brainstem, andspinal cord. The incidence of spinocerebellar ataxia
type 6 (SCA6) is high accounting for about 30% ofhereditary SCD cases in Japan. It mainly develops
in middle age (40-50s) and manifests almost purecerebellar ataxia, such as dysarthria, ataxia of thefour extremities and trunk, and gaze-evokednystagmus1). A rehabilitation effect for SCD has
recently been reported2,3), but it was an effect ofintensive inpatient rehabilitation. In the present case,balance ability was improved despite intervention
being performed at only once a week.

Familial medical history: His mother staggered
during walking from about 50 years old and she
was diagnosed with SCD.
History of present illness: He felt imbalance during
playing tennis in X-3, and gradually becameaware of staggering during walking (particularly
while using the stairs). He visited Hospital A for acomplaint of writing disturbance. SCD wassuspected, and the patient was referred to the
Neurology Department of our hospital.
After diagnosis at our hospital (Fig. 1), drug
therapy (Ceredist 10 mg) was initiated. At thesame time, outpatient rehabilitation was initiated.
Neurological findings: Scanning speech, bilateralslight unskillfulness on an upper limb finger-nose
test, unskillfulness on a heel-knee test, ataxic gait,
inability to perform tandem gait, Mann
Test-positive, Romberg Test-negative, normalreflex, Babinski reflex-negative, no involuntary
movement, no sensory disturbance including deepsensation
Summary: Pure Ataxia
Nutritional status: Ingestion of 3 meals with noproblem with appetite or bowel movement

Case presentation
Patient: Male in his 50s
Diagnosis: SCA6
Chief complaints: Difficulty in walking and thenecessity of a handrail for using the stairs.
Past medical history: lumbar spondylosis(childhood)Occupation: School teacher
1