Rehabilitation of High-Level Dynamic Balance Skills in an Individual With Significant Nonprogressive Cerebellar Atrophy: Case Report.

A 46-year-old man received a course of quinolone-family antibiotics for puncture wound-related cellulitis. Cerebellar symptoms developed within 3 weeks of treatment, progressed over 6 months, and then became static. Seven years later, he received an individualized 12-week-long course of physical therapy to challenge his balance with high-level fall-inducing but safe dynamic activities. Outcome measures included the International Cooperative Ataxia Rating Scale, modified Dynamic Gait Index, instrumented gait analysis, and posturography. The total modified dynamic gait index score improved 4 points. Gait velocity increased and reached a meaningful clinically important difference threshold. Step length increased, and step width and toeing out decreased. Reaction times, movement velocities, and center of gravity excursions improved on the limits of stability test. He increased frontal and sagittal speed on the rhythmic weight shift test and became able to jump vertically and run with hand support on a treadmill. The results highlight the benefits of an individualized physical therapy program for a patient with chronic nonprogressive cerebellar deficits years after the original insult. Factors that may have contributed to the success of this case are the nonprogressive nature of the disorder, a harness system that allowed for sufficiently challenging repetitions, and the patient's physically fit and disciplined characteristics.