Corticobasal Degeneration( CBD)
CBD presents with an“ alien limb” phenomenon, arms and legs that seem to move on their own. Patients also experience increasingly worse apraxia and contractures. Encourage continual exercise, physical activity and social engagement throughout course of the disease, with appropriate group exercise classes. While the literature on rehabilitation for CBD is limited, it suggests that PT plays a role in managing apraxia, balance and gait and will be needed at various times throughout the course of the disease.
Treatment Strategies
• Patient and caregiver education about the disease
• Aerobic, therapeutic and balance exercises along with fall prevention training
• Encourage use and exercise of affected limb
• PROM, positioning and bracing to prevent contractures
• ADL training, adaptive devices, energy management and fall prevention
• For parkinsonian-type gait, focus on large steps and heel strike
• Teach safe turns, i. e., U-turns in open spaces, avoiding pivot turns or crossing one foot over the other to turn
• Break down tasks into smaller steps
• Appropriate assistive devices; swivel-wheeled rollators with brakes work well only in early stages; apraxia or alien limb often interfere with AD use
• Caregiver training in assistance techniques
• Home modifications and adaptive equipment / devices
• SLP consultation
• OT consultation
• Dystonia and blepharospasms may be helped with Botox
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Research Articles Kawahira K, Noma T, Iiyama J, Etoh S, Ogata A, Shimodozono M. Improvements in limb kinetic apraxia by repetition of a newly designed facilitation exercise in a patient with corticobasal degeneration. Int J Rehabil Res 2009 Jun; 32( 2): 178-83.
Stamenova V, Roy EA, Black SE. A model-based approach to understanding apraxia in Corticobasal Syndrome. Neuropsychol Rev. 2009 Mar; 19( 1): 47-63.