The wide-based gait — cerebellar ataxia, honestly

Degenerative cerebellar ataxia is where the honest version of physiotherapy lives. The Romberg is read as a sensory probe and stays essentially negative — the comparator, not the input, is broken — and the SARA grades the severity the training is judged against. Ilg’s intensive coordinative training trial showed performance improves even as the disease advances, and the consensus paper recommends the training; what it does not show is cure, so the plan pairs the training with compensation — the rollator, the home, the backward-fall engineering — and re-measures so improvement and progression are both on the record. What you do with it: differentiate the ataxia at the bedside, prescribe the coordinative work at a real dose, fit the device before the next backward fall rather than after, and write goals that a progressive disease can honestly meet.

• Any step-change in the gait or a new focal sign — progression here is slow; a jump is a new event and goes back to neurology
• Backward falls with head-strike potential — the environment and the device are urgent, not reviewable

• Can’t feel the floor — neuropathy, foam and the RombergTier 2
• Worse after the hot shower — Uhthoff’s and the INOTier 2

This page carries the case’s first decision. The full sequence — every decision, the examination by domain, and the debrief that grades you — is in the drill, and the library is included with membership.