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When Clumsiness, Slurred Speech Are a Problem, Therapy Can Help

November 17, 2023

If you’re acting drunk -- with slurred speech and an unsteady gait -- but haven’t had a drop of alcohol, you might be suffering from damage to the cerebellum, the part of the brain responsible for coordinating movement.

These symptoms, collectively called “ataxia,” indicate a loss of balance and motor coordination that can also lead to depression, low self-esteem, social withdrawal and loneliness.

Alcohol misuse causes temporary ataxia, and so can some medications, environmental toxins and vitamin deficiencies or excesses. Ataxia also may occur in some hereditary and non-hereditary diseases — including tumors, stroke and multiple sclerosis — or following traumas that damage the cerebellum.

If you have ataxia, speech, physical and occupational therapy can help you recover or maintain motor skills, develop workarounds and learn to cope in social settings with any remaining symptoms to avoid the isolation and depression that ataxia could provoke.

How Ataxia Is Diagnosed and Treated

Your doctors will use a variety of strategies to diagnose what is causing your symptoms. They will take a complete family and medical history and perform both physical and neurological exams to evaluate your vision, balance, coordination and reflexes. Blood tests may be performed to identify treatable disorders. Imaging studies like an MRI may be needed to help with diagnosis. Your doctor also may recommend genetic testing to determine if your ataxia is hereditary.

In some cases — a vitamin deficiency, for example — treating the underlying cause of ataxia will improve symptoms or at least prevent them from getting worse without further treatment. But even when the underlying cause is untreatable, most people with ataxia can partially overcome impaired motor function with an intensive rehabilitation program, research shows.

The goal is to train other parts of the brain to take over for the damaged cerebellum. The ability of the brain to shift functions from one area to another is a form of “neuroplasticity,” and it is achieved by repeating therapeutic exercises again and again.

Depending on your symptoms, you could be referred for physical, occupational or speech therapy — or a combination of those —to improve your balance, coordination, speech and cognitive skills.

Physical Therapy

Because movement is essential to retrain the brain, you likely will be referred to physical therapy even if your symptoms are mild.

You will work with your physical therapist on exercises that may include grabbing, bending and reaching. If tremors are an issue, wrist or ankle weights or weighted utensils can help. But the No. 1 exercise you will be asked to perform is walking. While individual needs vary, most therapists recommend walking at least 10 minutes two to three times a day – the more, the better.

Such coordinated, regular training improves motor performance and reduces ataxia symptoms, which improves your quality of life.

For motivation, join a local Y, a gym or a walking club. Even if it’s difficult at first, repeated movement will retrain your brain, and your symptoms will get better.

Speech Therapy

If you have slurred speech (dysarthria), a common ataxia symptom, a speech therapist will help you speak more clearly with techniques like these

  • Changes in breathing patterns
  • Changes in posture
  • Exercises to strengthen vocal muscles
  • Emphasis on each word as you speak slowly

In extreme cases, speech therapists also may recommend speech-assistive technology, such as a laptop computer connected to a voice synthesizer, and teach you how to use them.

Trouble swallowing (dysphagia) is another ataxia symptom your speech therapist can address. You may need treatment if you have these signs:

  • Drooling, coughing or choking while eating or drinking
  • Difficulty chewing food
  • A sensation that food is stuck in your throat or chest

Treatment could include exercises to stimulate nerves that trigger the swallowing reflex. Dietary changes to make swallowing easier may also be recommended, but the ultimate goal is for you to return to your original diet.

Occupational Therapy

Controlled, coordinated movement of the upper body is essential to most daily functions, from brushing your teeth to bringing food to your mouth to driving a car. When ataxia disrupts your ability to perform the most routine tasks, an occupational therapist steps in to help you recover lost skills or develop work-arounds when that’s not possible, sometimes using assistive technology to work on a computer or drive a car, for example.

Research shows conventional OT can improve balance and coordination in ataxia patients, especially when used in combination with physical therapy.

What To Expect

In most cases, ataxia often cannot be cured in the traditional sense, but therapy can improve the symptoms by training different parts of the brain to take over tasks once performed by the damaged cerebellum.

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