Physiotherapy Approaches in Degenerative Cerebellar Ataxia: A Narrative Review

Background: Degenerative cerebellar ataxia (DCA) comprises progressive neurodegenerative disorders marked by deficits in coordination, gait, balance, and speech due to cerebellar dysfunction. It includes inherited types, such as spinocerebellar ataxias (SCAs), and sporadic variants like multiple system atrophy cerebellar type (MSA-C). Objective: To evaluate existing physiotherapy interventions for DCA, identify current challenges, and propose future directions for evidence-based rehabilitation. Methods: A narrative synthesis of recent clinical studies, meta-analyses, and systematic reviews was conducted focusing on physiotherapeutic strategies. Results: Interventions such as balance training, aerobic exercise, virtual reality, and cueing techniques show modest improvements in ataxia severity and function. However, high heterogeneity in protocols, small sample sizes, brief follow-ups, and inconsistent outcome measures limit generalizability. Additionally, underutilization of wearables, telerehabilitation, and personalized care strategies are key gaps. Conclusion: There is an urgent need for ataxia-specific, standardized rehabilitation protocols. Early intervention, caregiver involvement, and integration of technology may improve adherence and outcomes. Multi-center trials and core outcome sets are essential to inform clinical guidelines and bridge the research-practice gap in DCA rehabilitation.