***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives : The cerebellum is known to play a strong functional role in both motor control and motor learning . Hence , the benefit of physiotherapeutic training remains controversial for patients with cerebellar degeneration . In this study , we examined the effectiveness of a 4-week intensive coordinative training for 16 patients with progressive ataxia due to cerebellar degeneration ( n = 10 ) or degeneration of afferent pathways ( n = 6 ) . Methods : Effects were assessed by clinical ataxia rating scales , individual goal attainment scores , and quantitative movement analysis . Four assessment s were performed : 8 weeks before , immediately before , directly after , and 8 weeks after training . To control for variability in disease progression , we used an intraindividual control design , where performance changes with and without training were compared . Results : Significant improvements in motor performance and reduction of ataxia symptoms were observed in clinical scores after training and were sustained at follow-up assessment . Patients with predominant cerebellar ataxia revealed more distinct improvement than patients with afferent ataxia in several aspects of gait like velocity , lateral sway , and intralimb coordination . Consistently , in patients with cerebellar but without afferent ataxia , the regulation of balance in static and dynamic balance tasks improved significantly . Conclusion : In patients with cerebellar ataxia , coordinative training improves motor performance and reduces ataxia symptoms , enabling them to achieve personally meaningful goals in everyday life . Training effects were more distinct for patients whose afferent pathways were not affected . For both groups , continuous training seems crucial for stabilizing improvements and should become st and ard of care . Level of evidence : This study provides Class III evidence that coordinative training improves motor performance and reduces ataxia symptoms in patients with progressive cerebellar ataxia Occupational therapy ( OT ) is a profession concerned with promoting health and well-being through occupation , by enabling h and icapped people to participate in the activities of everyday life . OT is part of the clinical rehabilitation of progressive genetic neurodegenerative diseases such as spinocerebellar ataxias ; however , its effects have never been determined in these diseases . Our aim was to investigate the effect of OT on both physical disabilities and depressive symptoms of spinocerebellar ataxia type 3 ( SCA3 ) patients . Genomically diagnosed SCA3 patients older than 18 years were invited to participate in the study . Disability , as evaluated by functional independence measurement and Barthel incapacitation score , Hamilton Rating Scale for Depression , and World Health Organization Quality of Life question naire ( WHOQOL-BREF ) , was determined at baseline and after 3 and 6 months of treatment . Twenty-six patients agreed to participate in the study . All were treated because OT prevents blinding of a control group . Fifteen sessions of rehabilitative OT were applied over a period of 6 months . Difficult access to food , clothing , personal hygiene , and leisure were some of the main disabilities focused by these patients . After this treatment , disability scores and quality of life were stable , and the Hamilton scores for depression improved . Since no medication was started up to 6 months before or during OT , this improvement was related to our intervention . No association was found between these endpoints and a CAG tract of the MJD1 gene ( CAGn ) , age , age of onset , or neurological scores at baseline ( Spearman test ) . Although the possibly temporary stabilization of the downhill disabilities as an effect of OT remains to be established , its clear effect on depressive symptoms confirms the recommendation of OT to any patient with SCA3 or spinocerebellar ataxia Locomotor adaptability ranges from the simple and fast-acting to the complex and long-lasting and is a requirement for successful mobility in an unpredictable environment . Several neural structures , including the spinal cord , brainstem , cerebellum , and motor cortex , have been implicated in the control of various types of locomotor adaptation . However , it is not known which structures control which types of adaptation and the specific mechanisms by which the appropriate adjustments are made . Here , we used a splitbelt treadmill  to test cerebellar contributions to two different forms of  locomotor adaptation in humans . We found that cerebellar damage does not impair the ability to make reactive feedback-driven motor adaptations , but significantly disrupts predictive feedforward motor adaptations during splitbelt treadmill locomotion . Our results speak to two important aspects of locomotor control . First , we have demonstrated that different levels of locomotor adaptability are clearly dissociable . Second , the cerebellum seems to play an essential role in predictive but not reactive locomotor adjustments . We postulate that reactive adjustments may instead be predominantly controlled by lower neural centers , such as the spinal cord or brainstem Objective : To investigate the feasibility of a r and omized controlled trial of a home-based balance intervention for people with cerebellar ataxia . Design : A r and omized controlled trial design . Setting : Intervention and assessment took place in the home environment . Participants : A total of 12 people with spinocerebellar ataxia type 6 were r and omized into a therapy or control group . Both groups received identical assessment s at baseline , four and eight weeks . Interventions : Therapy group participants undertook balance exercises in front of optokinetic stimuli during weeks 4–8 , while control group participants received no intervention . Main measures : Test – retest reliability was analysed from outcome measures collected twice at baseline and four weeks later . Feasibility issues were evaluated using daily diaries and end trial exit interviews . Results : The home-based training intervention with opto-kinetic stimuli was feasible for people with pure ataxia , with one drop-out . Test – retest reliability is strong ( intraclass correlation coefficient > 0.7 ) for selected outcome measures evaluating balance at impairment and activity levels . Some measures reveal trends towards improvement for those in the therapy group . Sample size estimations indicate that Bal-SARA scores could detect a clinical ly significant change of 0.8 points in this functional balance score if 80 people per group were analysed in future trials . Conclusions : Home-based targeted training of functional balance for people with pure cerebellar ataxia is feasible and the outcome measures employed are reliable Balance and gait problems in patients with cerebellar degeneration lead to reduced mobility , loss of independence , and frequent falls . It is currently unclear , however , whether balance and gait capacities can be improved by training in this group of patients . Therefore , the aim of this study was to examine the effects of gait adaptability training on obstacle avoidance and dynamic stability during adaptive gait . Ten patients with degenerative cerebellar ataxia received 10 protocol ized gait adaptability training sessions of 1 h each during 5 weeks . Training was performed on a treadmill with visual stepping targets and obstacles projected on the belt 's surface . As the primary outcome , we used an  obstacle avoidance task  while walking on a treadmill . We determined avoidance success rates , as well as dynamic stability during the avoidance manoeuvre . Clinical ratings included the scale for the assessment of ataxia ( SARA ) , 10 m walking test , timed up- and -go test , berg balance scale , and the obstacle subtask of the emory functional ambulation profile ( EFAP ) . Following the intervention , success rates on the obstacle avoidance task had significantly improved compared to pre-intervention . For successful avoidance , participants allowed themselves smaller stability margins in the sagittal plane in the ( shortened ) pre-crossing step . However , in the subsequent steps they returned to baseline stability values more effectively than before training . SARA scores and the EFAP obstacle subtask improved significantly as well . This pilot study provides preliminary evidence of a beneficial effect of gait adaptability training on obstacle avoidance capacity and dynamic stability in patients with cerebellar degeneration Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists Objective . To investigate short- and long-term effects of intensive rehabilitation on ataxia , gait , and activities of daily living ( ADLs ) in patients with degenerative cerebellar disease . Methods . A total of 42 patients with pure cerebellar degeneration were r and omly assigned to the immediate group or the delayed-entry control group . The immediate group received 2 hours of inpatient physical and occupational therapy , focusing on coordination , balance , and ADLs , on weekdays and 1 hour on weekends for 4 weeks . The control group received the same intervention after a 4-week delay . Short-term outcome was compared between the immediate and control groups . Long-term evaluation was done in both groups at 4 , 12 , and 24 weeks after the intervention . Outcome measures included the assessment and rating of ataxia , Functional Independence Measure , gait speed , cadence , functional ambulation category , and number of falls . Results . The immediate group showed significantly greater functional gains in ataxia , gait speed , and ADLs than the control group . Improvement of truncal ataxia was more prominent than limb ataxia . The gains in ataxia and gait were sustained at 12 weeks and 24 weeks , respectively . At least 1 measure was better than at baseline at 24 weeks in 22 patients . Conclusions . Short-term benefit of intensive rehabilitation was evident in patients with degenerative cerebellar diseases . Although functional status tended to decline to the baseline level within 24 weeks , gains were maintained in more than half of the participants Exercise therapy ( ET ) can be beneficial in disabled multiple sclerosis ( MS ) patients .  Intermittent transcranial magnetic theta burst stimulation ( iTBS ) induces long-term excitability changes of the cerebral cortex and may ameliorate spasticity in MS . We investigated whether the combination of iTBS and a program of ET can improve motor disability in MS patients . In a double-blind , sham-controlled trial , 30 participants were r and omized to three different interventions : iTBS plus ET , sham stimulation plus ET , and iTBS alone . Before and after 2 weeks of treatment , measures of spasticity through the modified Ashworth scale ( MAS ) and the 88 items Multiple Sclerosis Spasticity Score question naire ( MSSS-88 ) , fatigue through the Fatigue Severity Scale ( FSS ) , daily living activities ( ADL ) through the Barthel index and health-related quality of life ( HRQoL ) through the 54 items Multiple Sclerosis Quality of life inventory ( MSQoL-54 ) were collected . iTBS plus ET  reduced MAS , MSSS-88 , FSS scores , while in the Barthel index and MSQoL-54 , physical composite scores were increased . iTBS alone caused a reduction of the MAS score , while none of the measured scales showed significant changes after sham iTBS plus ET . iTBS associated with ET is a promising tool for motor rehabilitation of MS patients Friedreich ’s ataxia results in morbidity because of many factors ; progressive equinovarus deformity is one of these . We studied the risk factors and incidence of this deformity . We sought to assess whether surgical management of fixed equinovarus deformity leads to functional improvement .  Thirty-six patients with Friedrich ’s ataxia were assessed for this deformity . These patients were treated by splinting , botulinum toxin Type A injection , and surgery , as indicated by the severity , followed by an ongoing rehabilitation program . The effect of surgery was assessed using subscales of the Barthel index and functional independence measure . Severe foot deformities in which either surgery or botulinum toxin injection was recommended correlated with current age , years since disease onset , and years that the patient required a wheelchair for mobility , but not with the GAA repeat size or age at disease onset . Function and mobility were improved after surgery compared with a similar period before surgery . Three of seven patients who had surgery had significant complications . Aggressive management of foot deformities should be considered , and active measures to prevent permanent foot deformities should be pursued to maximize quality of life and independence of patients with Friedreich ’s ataxia . Level of Evidence : Therapeutic study , Level IV ( case series-no , or historical control group Few clinical studies have evaluated physiotherapeutic interventions for patients with degenerative cerebellar disease . In particular , evidence for long-term effects and transfer to activities of daily life is rare . We have recently shown that coordinative training leads to short-term improvements in motor performance . To evaluate long-term benefits and translation to real world function , we here assessed motor performance and achievements in activities of daily life 1 year after a 4 week intensive coordinative training , which was followed by a home training program . Effects were assessed by clinical rating scales , a goal attainment score and quantitative movement analysis . Despite gradual decline of motor performance and gradual increase of ataxia symptoms due to progression of disease after 1 year , improvements in motor performance and achievements in activities of daily life persisted . Thus , also in patients with degenerative cerebellar disease , continuous coordinative training leads to long-term improvements , which translate to real world function Recent research indicates that physiotherapy can improve motor performance of patients with cerebellar degeneration . Given the known contributions of the cerebellum to motor learning , it remains unclear whether such observable changes in performance are mediated by the 
    Output:
    
There is consistent evidence that rehabilitation improves function , mobility , ataxia , and balance in genetic degenerative ataxia