Improving activities of daily living performance in an adult with ataxia.

The American Journal of Occupational Therapy 89 This case report describes occupational therapy interventions focused on improving the activities of daily living (ADL) performance of a 31-year-old man with an ataxia syndrome (motor control deficits, visual dysfunction, gait disturbance) secondary to multiple sclerosis. The rehabilitation of clients with ataxia syndrome is a challenge for occupational therapists because of the severity of dysfunction in ADL as well as the limited number of treatment options described in the rehabilitation literature. Various authors have advocated the use of weighted and adaptive ADL equipment (Broadhurst & Stammers, 1990; Schneitzer, 1978; Wyckoff, 1993; Yuen, 1993), weighting of the distal limb (Morgan, 1975), and application of various sensorimotor techniques (i.e., proprioceptive neuromuscular facilitation) (Urbscheit & Oremland, 1995). In addition to these techniques, case reports have advocated the use of relaxation techniques and biofeedback (Guercio, Chittum, & McMorrow, 1997) and the use of weighting in conjunction with elastic bandages (Okajima, Chino, Noda, & Takahashi, 1990). Although “traditional” models of motor control based on reflexive or hierarchical frameworks are not supported in the literature as having appreciable effects on functional performance (Horak, 1991), a contemporary task-oriented approach (Haugen & Mathiowetz, 1995; Horak, 1991; Mathiowetz & Haugen, 1994) was chosen as a theoretical base for this client to guide evaluation and treatment. The occupational therapy treatment techniques described in this case report are based on a current review of the literature focusing on the motor control deficits associated with ataxia that were assumed to be the limiting factor for ADL independence in this client. The contemporary task-oriented approach is based on a systems model of motor control in which the person, task, and environment are considered components of a system that interact to produce movement. This approach to motor control remediation focuses on occupational or role performance, client collaboration to determine problematic tasks, and collection of information regarding the role of the environmental context on performance as well as the interaction of multiple systems and subsystems that contribute to functional deficits (Mathiowetz & Haugen, 1994). Treatment is focused on helping clients find optimal strategies to achieve functional goals, alteration of task requirements, alteration of the environmental context, and the remediation of subsystem deficits that impair performance (Mathiowetz & Haugen, 1994). With this model of motor control, the challenge for the occupational therapist is to identify control parameters that are the most important for the client. Haugen and Mathiowetz (1995) identified control parameters as the following: personal characteristics or environmental factors that constrain movement into specific patterns, factors that