There is no evidence for effects of gait training in spinocerebellar degeneration (SCD) of SCD severity level IV. Here we report the effect of gait training in a 42-year-old man diagnosed with SCD severity level IV. At the beginning of physical therapy (day X), his Scale for Assessment and Rating of Ataxia (SARA) score was 20 and his Berg Balance Scale (BBS) score was 27. The patient required two people to assist him in walking because of his high risk of falling due to ataxia, which caused the lower limbs to step out in unexpected directions. His Functional Ambulation Categories (FAC) score was 0. Regular standing and balance function exercises failed to improve his condition, and he was switched to physical therapy focusing on gait training using a walker with a saddle (OG Giken Safety Walker GB-500), which improved his SARA score to 15 and BBS score to 35 at day X+24. He became able to walk with the assistance of one person, and with the use of handrails, his 10 m walking speed was 12 s and his continuous walking distance was 60 m. His FAC score also improved to 2, and he was transferred to another hospital to continue his rehabilitation. Even in this patient with SCD severity level IV, intensive gait training using a walker with saddle resulted in improved walking ability.

Background: and Purpose Differences in measurement of the extent of acute ischemic stroke using the Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) by non-contrast computed tomography (CT-ASPECTS stratum) and diffusion-weighted imaging (DWI-ASPECTS stratum) may impact the efficacy of endovascular therapy (EVT) in patients with a large ischemic core. Methods: The RESCUE-Japan LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan–Large IscheMIc core Trial) was a multicenter, open-label, randomized clinical trial that evaluated the efficacy and safety of EVT in patients with ASPECTS of 3–5. CT-ASPECTS was prioritized when both CT-ASPECTS and DWI-ASPECTS were measured. The effects of EVT on the modified Rankin Scale (mRS) score at 90 days were assessed separately for each stratum. Results: Among 183 patients, 112 (EVT group, 53; No-EVT group, 59) were in the CT-ASPECTS stratum and 71 (EVT group, 40; No-EVT group, 31) in the DWI-ASPECTS stratum. The common odds ratio (OR) (95% confidence interval) of the EVT group for one scale shift of the mRS score toward 0 was 1.29 (0.65–2.54) compared to the No-EVT group in CT-ASPECTS stratum, and 6.15 (2.46–16.3) in DWI-ASPECTS stratum with significant interaction between treatment assignment and mode of imaging study (P=0.002). There were significant interactions in the improvement of the National Institutes of Health Stroke Scale score at 48 hours (CT-ASPECTS stratum: OR, 1.95; DWIASPECTS stratum: OR, 14.5; interaction P=0.035) and mortality at 90 days (CT-ASPECTS stratum: OR, 2.07; DWI-ASPECTS stratum: OR, 0.23; interaction P=0.008). Conclusion Patients with ASPECTS of 3–5 on MRI benefitted more from EVT than those with ASPECTS of 3–5 on CT.