THE EFFECT OF FRENKEL’S EXERCISE ON BALANCE DISORDERS, ATAXIA AND THEIR RELATED IMPAIRMENTS: A META-ANALYSIS AND SYSTEMATIC REVIEW

A. Mohamed¹, R. Ahmad¹, E. Elsayed¹, A. Magdi¹, M. Al Jarrah¹, S. Mysore¹

¹Fatima College of Health Sciences, Physiotherapy, Abu Dhabi, United Arab Emirates

Background: Balance impairments and ataxia are not clinical diagnoses, they are related to the interruption of different parts of the nervous system, that’s why they usually exist with other associated signs and symptoms, depending on the underlying aetiology. Patients with these impairments may experience frequent falling, reduced functional mobility, and fatigue. Balance impairments and ataxia can be managed pharmacologically through disease-modifying therapy, surgically, or through physiotherapy symptomology interventions such as Frenkel’s exercise, which is a coordination and proprioception exercise designed to improve ataxia symptoms.

Purpose: To investigate the effect of Frenkel’s exercise compared to alternative physiotherapy interventions on balance disorders, ataxia and their related impairments.

Methods: The search was conducted in six databases: Medline, CINAHL, Cochrane, PubMed, OVID and PEDro. In addition to manual search in Google Scholar, PDF locator, and reference lists of the included studies. Randomized control trials (RCTs) that compare the effects of Frenkel’s exercise in compared to other interventions on balance, ataxia, gait, fatigue, falls, and proprioception outcomes were included according to the eligibility criteria.

Results: Nine RCTs were included with a total of 374 participants diagnosed with different ataxia and balance disorders etiologies which were degeneration and ageing, Multiple Sclerosis (MS), Type II diabetic neuropathy, visual impairment (blindness), cerebellar dysfunction, and stroke. The overall result revealed that Frenkel’s exercise has a non-significant effect on balance disorders, ataxia and their related impairments (MD of -0.22 (95% CI, -0.88,0.44; P=0.51)). However, falls and proprioception were not measured in any of the included studies, therefore there is no meta-analysis for them.

Conclusions: Overall, Frenkel’s exercise has a non-significant effect on the enhancement of balance disorders & ataxia and their related impairments. Therefore, Frenkel’s exercise is preferred to be applied adjunctively to a comprehensive treatment program that may include pharmacological and alternative physiotherapy interventions to enhance its efficacy. More studies, investigating the effectiveness of Frenkel’s exercise on ataxia, proprioception and fall risk, are recommended.

Implications: The review findings suggested that Frenkel's exercise provides small improvements on balance disorders, ataxia, and their related impairments, Therefore, physiotherapists are encouraged to integrate other physiotherapy approaches in the management of ataxia and balance disorders as an adjunct to Frenkel's exercise to enhance the efficiency of the outcomes of treatment programs.

Funding acknowledgements: None

Keywords:
Exercise
Balance
Ataxia

Topics:
Neurology

Did this work require ethics approval? No

Reason: Since this research is based on secondary research, approval was not required. However, all ethical considerations were given in handling the published data.