Use of a Zorb Bumper Ball in rehabilitation of a patient with ataxic multiple sclerosis: A case report

Multiple sclerosis affecting the cerebellum and associated pathways can result in debilitating ataxia. Recent research has shown that reinforcement and goal-based learning may be more effective in improving motor outcomes than error-based motor learning in patients with cerebellar deficits due to decreased intrinsic feedback mechanisms. The case patient initially presented with debilitating ataxia and required a weighted bariatric rollator and Contact Guard Assistance (CGA) for all ambulation. He showed minimal improvement after completing traditional physical therapy which involved compensatory treatment strategies. The patient's rehabilitation goal was to ambulate without an assistive device. After one year of physical therapy treatment, an inflatable Zorb Bumper Ball was purchased for trial use during therapy sessions as a low-cost, versatile alternative to harnessed gait training. The rationale for this novel intervention was to promote maximization of reinforcement learning during balance and gait training, increased patient engagement, and reduced risk of injury during ambulation without upper extremity support. After four sessions (60 minutes per week for four weeks) of utilizing the Zorb Bumper Ball in physical therapy, the patient was able to transition to performing functional outcome measures (25 Foot Walk Test (25FWT), Timed Up and Go (TUG), and 5 Times Sit to Stand (5×STS)) and overground ambulation without an assistive device for the first time in 3 years. During the year following treatment with the Zorb Bumper Ball, average times for the 25FWT, TUG, and 5×STS were not statistically different with and without an assistive device, however, the patient was able to reach his goal of independent ambulation without an assistive device. A Zorb Bumper Ball may be a safe, affordable, and portable means of training unassisted gait in patients with cerebellar ataxia.