Ataxia is the medical term that describes a lack of muscle coordination anywhere in the body. Typically, it can lead to tremors in the arms, legs, head, trunk or eyes and can even affect speech and swallowing. Currently there are no drugs that will get rid of the shaking or tremor that is caused by ataxia. In this article, physiotherapist Wendy Hendrie introduces some ideas that many people with MS have found helpful. Try them out and see if they work for you or, if you prefer, ask for an assessment by a physiotherapist with expertise in MS
People with ataxia tend to walk with their legs apart to try and keep their balance and it can be difficult for them to move their legs smoothly forwards with each step. As a result they can lurch from side to side and this can make balancing very difficult and lead to falls. Many spend their day sitting for long periods as walking feels so precarious. Prolonged sitting, however, can make the condition worse as the muscles will gradual weaken over time and this can make balancing even harder. Here are some tips which may help:
- Keep active and exercise as much as possible to keep the muscles strong. Strong core muscles can help to minimise the effects of ataxia on walking and transferring. Activities which involve using balance muscles, such as yoga, Pilates, Tai Chi or horseriding, may also be helpful as they keep the coordination and balance systems of the body working as well as possible. If you can’t attend these classes, try standing regularly at home with a chair behind you and a table in front, so that you can safely practice balance exercises.
- Using trekking poles instead of walking sticks may help. Putting sand in the shaft of the poles can make them feel more stable.
- Wearing a back-support belt around your middle may help or even Spanx underwear (available for men and women!). If these help, you may find a tailor-made Lycra garment useful. You would need a referral to the orthotic department to be measured for these garments.
- You may feel steadier if there is extra weight going through your body. Try hanging small ankle or wrist weights on a belt around your waist, or put weights in a pocket of your waistcoat or gilet. Start with small weights and gradually increase until you feel more stable.
- Sitting on a wobble cushion or piece of soft foam may help to keep your muscles ‘primed’ when you are sitting. You may find that your balance is better when you first stand up.
- Thinking about and visualising the journey across a room before you do it may help you to perform it more steadily.
- Try using a four wheeled rollator (frame with wheels) for walking. The ones with four wheels are more stable. Some people find it helpful to weigh the frame down. Try putting bags of sugar (or similar) in the basket until the weight feels right for you. Don’t make it too heavy or it will be tiring to push it. Once you have found the right weight, replace the sugar with weights bought from a sports shop.
Using your arms
- Make sure your body is as well supported in the chair as possible before you move your arms. If necessary, put cushions down the side of the chair and roll up a small towel and put in the small of your back. The more stable you are in sitting, the less the tremor will be when you move your arm.
- Keeping everything still and just moving one joint at a time may also help in people with severe tremor. For example, support your arm on a table and just move at the elbow to pick up a cup.
- Small weights fastened around the wrist (available from sports shops or online) may help to dampen down arm tremors. Be careful that the weights don’t make your arms tired. Let a bit of the sand out if they feel too heavy.
- There are many pieces of equipment which may help dampen the tremors when you are eating or drinking: Neater eater; weighted cutlery; Easy 2 drink cup; valved straw; nosey cup; plate guard. You may need an assessment from an occupational therapist.
- Keep cool. Hot muscles don’t work as well so try wrapping a cold, damp scarf or tea towel round your neck for five minutes before you perform a task. Cooling the muscles of the forearm for ten minutes can also help to dampen the tremor and may enable you to eat a meal. A cold wine-bottle sleeve (available from supermarkets) placed on the forearms during a meal may help to calm the tremors.
- Try putting a double layer of size B Tubigrip from your fingers to your armpit (cut out a small slit for the thumb). This can often help to dampen the tremor. If this helps you may find a Lycra garment would be useful.
- Try covering cup handles with scrunched up tin foil. The extra sensation it gives makes the muscles work harder.
- If the tremor gets worse as you get closer to an object, try overshooting the target by a few inches and pick up the object on the way back.
- Try putting the object you want to pick up to one side of you rather than in front. Trying to aim for an object that is directly in front of you can make the tremor worse. Using your peripheral vision may also help to calm the tremors rather than looking directly at the object.
The ideas listed above may help some people with ataxia to function more easily and independently. Sometimes it is worth trying more than one the idea at a time eg put Tubigrip on the arm and use your peripheral vision to pick up a cup. Although these suggestions will not cure ataxia they may help to minimise its effect and enable people with this distressing condition to function more independently.
This article is part of the August 2015 issue of Open Door, the MS Trust’s quarterly newsletter.