Identification of International Classification of Functioning, Disability and Health categories in a multifaceted rehabilitation program for spinocerebellar degeneration

Identification of International Classification of Functioning, Disability and Health categories in a multifaceted rehabilitation program for spinocerebellar degeneration | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Identification of International Classification of Functioning, Disability and Health categories in a multifaceted rehabilitation program for spinocerebellar degeneration Yuichi Hiramatsu, Hiroaki Fujimoto, Hironori Otomune, Kenji Takamatsu, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7183654/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The optimal dosage and content of effective multifaceted rehabilitation programs for patients with spinocerebellar degeneration (SCD) remain unclear. We aimed to identify the International Classification of Functioning, Disability and Health (ICF) categories targeted by multifaceted SCD rehabilitation programs. Methods A multifaceted, short-term, intensive inpatient rehabilitation program was retrospectively analyzed in 55 patients with SCD, including those with spinocerebellar ataxia types 3, 6, 17, and 31, and dentatorubral-pallidoluysian atrophy, cortical cerebellar atrophy, or unknown types. Therapists in each discipline (physical, occupational, and speech therapies) extracted rehabilitation programs related to functioning (body functions along with activities and participation) and contextual factors (environmental and personal) from medical records. These programs were linked to the ICF and the Deutsche Gesellschaft für Sozialmedizin und Prävention categories based on the ICF linking rules. ICF categories were identified according to ataxia severity, as determined using the Scale for the Assessment and Rating of Ataxia. Results Overall, 1258 rehabilitation programs were linked to 1341 second-level ICF categories: 13 for body functions, 23 for activities and participation, 6 for environmental factors, and 1 for personal factors. Activity and participation categories related to mobility (transfers and standing) and self-care (toileting, dressing, eating, and bathing) were identified according to ataxia severity and varied with disease progression. Conversely, body function programs were linked to similar ICF categories regardless of ataxia severity. Conclusions Multifaceted rehabilitation for SCD is associated with ICF domains, and activity-based interventions vary by ataxia severity, suggesting that multiple components may improve activities of daily living. Spinocerebellar degeneration Rehabilitation program ICF framework ICF code ICF linking Standardization Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Degenerative cerebellar disorders are characterized by progressive ataxia. Rehabilitation programs targeting each component of the International Classification of Functioning, Disability, and Health (ICF) framework have been used to optimize functioning, reduce disability, and improve quality of life (QOL) [ 1 , 2 ]. Short-term intensive rehabilitation treatment has been reported to improve ataxia, balance, gait, and activities of daily living (ADLs) [ 2 – 13 ], with effects sometimes equivalent to 2 years of natural disease progression [ 11 ]. Notably, a systematic review [ 12 ] and meta-analysis [ 13 ] on the effectiveness of rehabilitation programs revealed that the greatest improvements were achieved through coordinated exercise and balance practice for ataxia, and multifaceted rehabilitation for ADLs. However, the heterogeneity of intervention characteristics (content, frequency, intensity, duration, and difficulty) in the rehabilitation programs reported to date is high [ 12 ], and the specificity of efficient intervention content and dosage for functional improvement through multifaceted rehabilitation programs remains unknown. Several considerations are essential when examining the specificity of intervention content and quantity in multifaceted rehabilitation effects [ 2 , 5 , 6 , 8 ]. First, functional improvement achieved through multifaceted rehabilitation is likely attributed to a combination of several rehabilitation programs. It is therefore necessary to verify not only intensive rehabilitation programs for a single functional impairment but also the synergistic effects of combining several rehabilitation programs. Second, multiple rehabilitation programs are often applied simultaneously to address specific functional impairments. For example, coordinated movement, postural control, and functional mobility may all target coordinated movement disorders, which complicates the understanding of the specificity of intervention content and quantity. This complexity may be addressed by organizing information as rehabilitation interventions for functioning and contextual factors using an internationally common standardized language and conceptual framework [ 14 ]. Specifically, the ICF Framework and Classification and its linking rules [ 15 – 17 ] provide such a structure, composed of six components: functioning (body functions [BFs], body structures, and activities and participation [APs]) and contextual factors (environmental [EFs] and personal [PFs]), which functioning and facilitators, as well as disability and inhibiting factors can be positively and negatively identified, respectively, in a comprehensive and standardized language. Additionally, the ICF linking rules enable the linking of information on clinical measures, technical assessments, and interventions in functioning and contextual factors to ICF categories [ 16 ]. Several reports have successfully applied this approach to link rehabilitation interventions to ICF categories [ 18 , 19 ]. However, no systematic framework that encompasses the information on rehabilitation for spinocerebellar degeneration (SCD; symptoms, disability, outcomes, and interventions) has been established. Describing the ICF categories targeted by multifaceted rehabilitation programs allows us to examine the specificity of the content and quantity of interventions required for efficient multifaceted rehabilitation programs in the future. This study, in which we aimed to identify the ICF categories targeted by multifaceted rehabilitation programs for SCD, has practical implications for designing future rehabilitation programs. To this end, we conducted a retrospective study of a short-term intensive inpatient rehabilitation program. Rehabilitation programs were linked to ICF categories related to functioning and contextual factors, providing a practical framework for future interventions. We also identified the ICF categories according to ataxia severity and summarized their frequencies across ICF components. Patients and methods Study design and participants This was a retrospective, cross-sectional study of a short-term, intensive inpatient rehabilitation program for patients with SCD. A total of 55 patients were included, including those with spinocerebellar ataxia types 3 (SCA3; n = 11), 6 (SCA6; n = 11), and 17 (SCA17; n = 1), as well as cortical cerebellar atrophy (CCA; n = 19), dentatorubral-pallidoluysian atrophy (DRPLA; n = 2); and SCA of unknown subtype (n = 11). CCA is characterized by pure cerebellar ataxia [ 20 ] and is also known as sporadic adult-onset ataxia of unknown etiology [ 21 , 22 ] or idiopathic cerebellar ataxia [ 23 , 24 ]. “Unknown” refers to SCA with a family history but without a confirmed subtype. All patients participated in daily physical, occupational, and speech therapy (PT, OT, and ST, respectively) sessions, lasting 60 min each, 6–7 times per week, for approximately 4 weeks. This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Morinomiya Hospital (Approval No. 573). Data collection We conducted a questionnaire survey to obtain information on the short-term, intensive inpatient rehabilitation program, including self-exercise programs (SEPs) prescribed by each patient's therapist. The therapist described the rehabilitation program by classifying based on the components of functioning (BFs, APs) and contextual factors (EFs, PFs) according to the ICF framework. To determine the patients’ clinical characteristics, general items (age, sex, years of illness, length of stay, and disease subtype) and clinical outcome assessment (Scale for the Assessment and Rating of Ataxia [SARA], Functional Independence Measure (FIM)- Motor score [FIM-M], Mini-Mental State Examination [MMSE], Frontal Assessment Battery [FAB]) indices were collected from medical records. Data analysis The collected rehabilitation programs were independently linked to ICF categories by two trained raters (YH and KT) based on the ICF linking rules [ 15 – 17 ]. Cohen's kappa statistic was calculated to assess inter-rater agreement. Any discrepancies were discussed in a consensus meeting involving one rehabilitation physician and representatives from each therapy discipline. Since the ICF does not provide codes for PF, these were classified using the Deutsche Gesellschaft für Sozialmedizin und Prävention (DGSMP) framework [ 25 ]. The frequency of occurrence of the ICF categories for each therapy was calculated. Based on previous reports that patients with SCD require some assistance with ADLs and instrumental ADLs (IADLs) at 12 SARA points and full assistance at 20 points [ 26 ], we identified ICF categories according to ataxia severity using SARA scores as follows: mild (0–14 points), moderate (14.5–20.5 points), and severe (21–31 points). Results Characteristics of participants The demographic and clinical characteristics of the patients are presented in Table 1 . The clinical characteristics of the 55 patients with SCD (SCA3, n = 11, SCA6, n = 11, SCA17, n = 1, CCA, n = 19, DRPLA, n = 2, unknown subtype, n = 11) were as follows: mean SARA total, 18.1 ± 6.2 points (range: 5–31); SARA gait, 5.0 ± 1.6 points (range: 2–8); SARA language, 2.3 ± 0.7 points (range: 0–4); motor FIM, 65.7 ± 16.8 points (range: 13–87); MMSE, 27.7 ± 3.7 points (range: 9–30); FAB, 15.7 ± 2.2 points (range: 8–18); and intervention duration, 39.4 ± 10.2 days (range: 9–80). Patients with SCA17 and DRPLA showed a higher degree of cognitive impairment based on MMSE and FAB scores. We selected rehabilitation programs for 42, 38, and 44 patients in PT, OT, and ST, respectively. Patient characteristics by ataxia severity for each therapy are shown in Supplementary Table 1. Table 1 Demographic and clinical characteristics of patients Physical Therapy (n = 42) Occupational Therapy (n = 38) Speech Therapy (n = 44) ALL (n = 55) Age, years 58.6 (14.8) 58.3 (15.4) 59.4 (14.5) 57.9 (14.6) Female/male 18/24 18/20 19/25 24/31 Disease duration, years 10.5 (5.2) 10.6 (5.7) 10.5 (5.1) 10.8 (5.4) Intervention duration, days 38.7 (7.8) 41.0 (9.9) 38.1 (8.8) 39.4 (10.2) MMSE 27.4 (4.1) 27.4 (4.3) 27.5 (4.0) 27.7 (3.7) FAB 15.8 (2.3) 15.5 (2.3) 15.3 (2.3) 15.7 (2.2) SARA gait score 5.0 (1.4) 5.2 (1.5) 5.0 (1.6) 4.9 (1.6) SARA speech disturbance score 2.3 (0.6) 2.3 (0.8) 2.4 (0.7) 2.3 (0.7) SARA total score 18.3 (5.7) 18.9 (6.6) 18.3 (6.5) 18.1 (6.2) FIM Motor score 66.3 (16.5) 63.1 (18.5) 64.4 (18.5) 65.7 (16.8) SCA3/6/17/CCA/DRPLA/unknown 7/9/1/17/2/6 8/9/1/13/2/5 9/8/1/17/2/7 11/11/1/19/2/11 MMSE, Mini-Mental State Examination; FAB, Frontal Assessment Battery; SARA, Scale for the Assessment and Rating of Ataxia; FIM, Functional Independence Measure; SCA, Spinocerebellar Ataxia; CCA, Cortical Cerebellar Atrophy; DRPLA, Dentatorubral-Pallidoluysian Atrophy Collected rehabilitation programs and linked ICF categories A total of 1258 rehabilitation programs related to functioning and contextual factors (BFs: 511, APs: 358, EFs: 123, SEPs: 266 programs) were collected through the questionnaire survey. These included 487 PT (BFs: 182, APs: 141, EFs: 64, SEPs: 100), 419 OT (BFs: 153, APs: 142, EFs: 57, SEPs: 67), and 352 ST (BFs: 176, APs: 75, EFs: 2, SEPs: 99) programs. All rehabilitation programs were successfully linked to second- or third-level ICF categories, totaling 1341 ICF codes (BFs: 517, APs: 392, EFs: 123, SEPs: 309). Specifically, there were 500 codes for PT (BFs: 182, APs: 154, EFs: 64, SEPs: 100), 441 for OT (BFs: 153, APs: 163, EFs: 57, SEPs: 68), and 400 for ST (BFs: 182, APs: 75, EFs: 2, SEPs: 141). PFs were linked to a single code within the DGSMP. The estimated kappa values ranged from 0.72 to 1.00, indicating substantial to perfect agreement across all disciplines, including PT (BFs: 0.82; APs: 0.86, EFs: 0.89, SEPs: 0.89), OT (BFs: 0.72; APs: 0.76, EFs: 0.95, SEPs: 0.82), and ST (BFs: 0.71; APs:1.0, SEPs: 0.78). ICF categories and codes of rehabilitation programs for body functions and structures A total of 511 rehabilitation programs targeting BFs were recorded (PT: 182, OT: 153, ST: 176). The correspondence between the rehabilitation programs and ICF codes is presented in Table 2 . These rehabilitation programs were linked to 517 ICF codes (PT: 182, OT: 153, ST: 182). The first-level ICF categories were “sensory functions and pain (b2),” “voice and speech functions (b3),” “functions of the cardiovascular and respiratory systems (b4),” “functions of the digestive systems (b5),” and “neuromusculoskeletal and movement-related functions (b7).” Figure 1 and Table 3 show the ICF categories linked to each therapy’s rehabilitation program and their frequency of occurrence. In PT (Fig. 1 a), the frequencies of the seven ICF categories were as follows: “control of voluntary movement functions (b760) – 47.2%,” “involuntary movement reaction functions (b755) – 23.6%,” “mobility of joint functions (b710) – 18.1%,” “muscle power functions (b730) – 9.3%,” “exercise tolerance functions (b455) – 0.5%,” “sensations associated with hearing and vestibular function (b240) – 0.5%,” and “sensations of pain (b280) – 0.5%.” In OT (Fig. 1 b), the frequencies of the six ICF categories were as follows: “control of voluntary movement functions (b760) – 60.1%,” “involuntary movement reaction functions (b755) – 16.3%,” “muscle power functions (b730) – 15.0%,” “mobility of joint functions (b710) – 4.6%,” “sensations associated with hearing and vestibular functions (b240) – 2.6%,” and “sensations of pain (b280) – 1.3%.” In ST (Fig. 1 c), the frequencies of the eight ICF categories were as follows: “voice functions (b310) – 22.5%,” “respiration functions (b440) – 17.6%,” “articulation functions (b320) – 16.5%,” “muscle tone functions (b735) – 15.4%,” “fluency and rhythm of speech functions (b330) – 15.4%,” “ingestion functions (b510) – 5.5%,” “muscle power functions (b730) – 3.8%,” and “mobility of joint functions (b710) − 3.3%.” Table 2 Linked ICF of intervention target and rehabilitative intervention. Intervention target Intervention ICF code & category Exercise category Description Coordination b760 Control of voluntary movement functions Postural control Pelvic tilt, trunk rotation, multi-segmental rotation, upright posture control, half kneeling posture, multi-directional stepping, and weight shifting. Coordination and control Bird dog, lunge, supine leg cycling, squat, supine march, bridge, plank, plank rotation, arm reaches, reaching and grasping, raise upper limb, hip-knee extension, up on toes or heels, toe touches or floor, tall kneeling trunk rotation and walking, eye guided hand movement, and trunk rotation with arm reach. Functional mobility Sit to stand to sit, supine log roll, supine to sit, sidelying to sitting, sideways walking, grapevine walking, bimanual activities, and body weight support treadmill training. Balance b755 Involuntary movement reaction functions Static balance Feet apart, feet together, step stance, tandem stance, and single leg stance. Dynamic balance Weight shift, crossover step, stepping, tandem walk, chair leg squat, perturbation correction, catching/ throwing/ bouncing/ kicking ball, and counterbalance squat. Muscle b730 Muscle power functions Muscle strength Resistance training (hand: tabletop, hook fist, digit extension, composite finger flexion, and thumb opposition; trunk-hip: bridge; trunk: prone back extension, Russian twist; lower limb: hip abduction, leg extension; foot: short foot, toe-spread, toe-extension, and towel toe curls), stair climbing, and squatting. b735 Muscle tone functions Muscle tone Progressive muscle relaxation. Joint b710 Mobility of joint functions Contracture and flexibility Mobilization, stretching, and passive movement. Non-speech oral motor Tongue (protrusion, retraction, elevation, wagging, and pressing), lip (protruding, retracting, rounding, and closure), cheek (puffing), jaw (opening, closing), blowing (straw), and oral (massage, brushing). Endurance b455 Exercise tolerance functions General physical endurance Gait training indoors and outdoors, as well as body weight support treadmill training. Vestibular b240 Sensations associated with hearing and vestibular function Dizziness Eye-head/ eye-head-body movement, gaze stability exercise, and walking and turning. Pain b280 Sensation of pain Pain Massage, mobilization, stretching, and passive movement. Respiration b440 Respiration functions Respiratory Breathing (belly, pursed lip, staccato, persistent exhalation, and blowing). Prosody b330 Fluency and rhythm of speech functions Fluency, rhythm, speed, and melody Sentence production (pitch-accent, intonation, rhythm, speed, loudness, and stress), phrasing, and humming. Voice b310 Voice functions Production and quality Sustained vowels and continuous speech, humming, phrasing, speech production (single sound, long sound, vowel, word, sentence, greetings, and formula sequence sound), speech repetition, soft glottal attack, digit span, singing, reading aloud, and voice volume control. Articulation b320 Articulation functions Articulation Place of articulation, vowel production, voice glide, reading aloud and repetition (words and short and long sentences), mora-by-mora finger counting, finger tapping, phrasing conversation, and intelligibility drills. Dysphagia b510 Ingestion functions Swallowing Postural adjustments and feeding strategies. Products and technology e115 Products and technology for personal use in daily living General/assistive products and technology Sofa, bed, chair, table/shower chair, and adaptive eating equipment (spoon, fork, and straw). e120 Products and technology for personal indoor and outdoor mobility and transportation Canes, walkers, wheelchairs, bicycles, carts, handrails, and grab bars. Support and relationships e310 Immediate family Education and counseling About how to assist with activities of daily living (walking, stairs, sit-to-stand, toilet, bathing, preparing meals, eating, and transfer). e315 Extended family e340 Personal care providers and personal assistants Interprofessional communication Rehabilitation program, activities of daily living assistance, and home exercise. e355 Health professionals Behavior patterns i456 Exercise habits Education (exercise habits and lifestyle) Home exercise and active lifestyle (walking, housework, and business). ICF, International Classification of Functioning, Disability, and Health ICF categories and codes of rehabilitation programs for activities and participation A total of 358 rehabilitation programs targeting APs were recorded (PT: 141, OT: 142, ST: 75). The correspondence between the rehabilitation programs and ICF codes is presented in Table 2 . These rehabilitation programs were linked to 392 ICF codes (PT: 154, OT: 163, ST: 75). The first-level ICF categories were “mobility (d4),” “self-care (d5),” “domestic life (d6),” “community life (d9),” “learning and applying knowledge (d1),” and “communication (d3).” Figure 2 and Table 4 show the ICF categories linked to each therapy rehabilitation program and their frequency of occurrence. In PT (Fig. 2 a), the frequencies of the eight ICF categories were as follows: “walking (d450) – 59.7%,” “changing basic body position (d410) − 17.5%,” “going up and down stairs (d451) – 9.7%,” “transferring oneself (d420) – 3.9%,” “toileting (d530) – 3.2%,” “dressing (d540) – 2.6%,” “maintaining a body position (d415) – 1.9%,” and “lifting and carrying objects (d430) – 1.3%.” In OT (Fig. 2 b), the frequencies of the nineteen ICF categories were as follows: “changing basic body position (d410) – 31.3%,” “walking (d450) – 9.2%,” “preparing meals (d630) – 8.6%,” “toileting (d530) – 8.6%,” “doing housework (d640) – 8.0%,” “dressing (d540) – 7.4%,” “washing oneself (d510) – 6.1%,” “recreation and leisure (d920) – 4.9%,” “maintaining a body position (d415) – 4.3%,” “writing (d170) – 3.7%,” “transferring oneself (d420) – 1.8%,” “eating (d550) − 1.2%,” “going up and down stairs (d451) – 1.2%,” “acquisition of goods and services (d620) – 0.6%,” “assisting others (d660) – 0.6%,” “fine hand use (d440),” “lifting and carrying objects (d430),” “moving around (d455),” and “moving around using equipment (d465) − 0.6%.” In ST (Fig. 2 c), the frequencies of the three ICF categories were as follows: “speaking (d330) – 88.0%,” “using communication devices and techniques (d360) – 6.7%,” and “singing (d332) – 5.3%.” ICF categories and codes of rehabilitation programs for environmental factors A total of 123 rehabilitation programs (PT: 64, OT: 57, ST: 2) were EF-related. The correspondence between the rehabilitation programs and ICF codes is presented in Table 2 . These rehabilitation programs were linked to 123 ICF codes (PT: 64, OT: 57, ST: 2). The first-level ICF categories were “products and technology (e1)” and “support and relationships (e3)”. Figure 3 and Table 5 show the ICF categories linked to each therapy rehabilitation program and their frequency of occurrence. In PT (Fig. 3 a), the frequencies of the six ICF categories were as follows: “products and technology for personal indoor and outdoor mobility and transportation (e120) – 57.8%,” “immediate family (e310) – 18.8%,” “products and technology for personal use in daily living (e115) – 9.4%,” “health professionals (e355) – 7.8%,” “personal care providers and personal assistants (e340) – 4.7%,” and “extended family (e315) − 1.6%.” In OT (Fig. 3 b), the frequencies of the three ICF categories were as follows: “products and technology for personal indoor and outdoor mobility and transportation (e120) – 38.6%,” “immediate family (e310) – 36.8%,” and “products and technology for personal use in daily living (e115) – 24.6%.” In ST (Fig. 3 c), the frequency of the one ICF category was 100% for “products and technology for personal indoor and outdoor mobility and transportation (e120).” ICF categories and codes of rehabilitation programs for personal factors All PF-related rehabilitation programs were classified under “exercise habits (i456) – 100%” based on the DGSMP categories, as self-exercise was the only intervention consistently instructed for all patients. There were 266 self-exercise-related rehabilitation programs (PT: 100, OT: 67, ST: 99). The correspondence between the rehabilitation programs and ICF codes is presented in Table 2 . These rehabilitation programs were linked to 309 ICF codes (PT: 100, OT: 68, ST: 141). The first-level ICF categories were “sensory functions and pain (b2),” “voice and speech functions (b3),” “functions of the cardiovascular and respiratory systems (b4),” “functions of the digestive systems (b5),” “neuromusculoskeletal and movement-related functions (b7),” “mobility (d4),” “domestic life (d6),” “learning and applying knowledge (d1),” and “communication (d3).” Figure 4 and Table 6 show the ICF categories linked to each therapy’s rehabilitation program and their frequency of occurrence. In PT (Fig. 4 a), the frequencies of the eight ICF categories were as follows: “control of voluntary movement functions (b760) – 38.0%,” “mobility of joint functions (b710) – 23.0%,” “involuntary movement reaction functions (b755) − 13.0%,” “walking (d450) – 13.0%,” “muscle power functions (b730) – 6.0%,” “changing basic body position (d410) – 4.0%,” “sensations associated with hearing and vestibular function (b240) – 2.0%,” and “moving around in different locations (d460) – 1.0%.” In OT (Fig. 4 b), the frequencies of the nine ICF categories were as follows: “mobility of joint functions (b710) – 36.8%,” “control of voluntary movement functions (b760) – 32.4%,” “involuntary movement reaction functions (b755) – 10.3%,” “muscle power functions (b730) – 8.8%,” “doing housework (d640) – 5.9%,” “changing basic body position (d410) – 1.5%,” “preparing meals (d630) – 1.5%,” “sensations associated with hearing and vestibular function (b240) – 1.5%,” and “writing (d170) – 1.5%.” In ST (Fig. 4 c), the frequencies of the eight ICF categories were as follows: “voice functions (b310) – 38.3%,” “fluency and rhythm of speech functions (b330) – 18.4%,” “articulation functions (b320) – 17.0%,” “respiration functions (b440) – 15.6%,” “speaking (d330) – 7.1%,” “muscle power functions (b730) – 2.1%,” “ingestion functions (b510) – 0.7%,” and “mobility of joint functions (b710) – 0.7%.” ICF categories by ataxia severity No ICF categories for BF related to ataxia severity were identified (Table 7 ). However, specific ICF categories for APs related to mobility (d420: transferring oneself; d415: maintaining a body position) and self-care (d530: toileting; d540: dressing; d550: eating; d510: washing oneself) were identified in severe cases (Table 8 ). Discussion This is the first study where the ICF categories and codes associated with multifaceted inpatient rehabilitation programs for SCD were investigated. These programs were classified using ICF components: functioning (BFs, APs) and contextual factors (EFs, PFs). The findings are consistent with established definitions of rehabilitation, which is described as a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions by addressing their interactions with their environment [ 1 , 2 ]. The following subsections discuss the relevance of the identified ICF categories in the context of rehabilitation programs. Body functions and structures The rehabilitation programs targeting BF were primarily linked to ICF categories related to coordination, balance, muscle strength, joint range of motion, exercise tolerance, vestibular function, pain, respiratory function, prosody, voice function, articulation, and swallowing. These ICF categories closely correspond to the key intervention targets previously reported in studies on intensive or multi-faceted rehabilitation programs [ 2 – 13 ]. Previous studies on multifaceted rehabilitation have addressed not only rehabilitation for primary symptoms such as coordination, balance, ocular movement, and speech disorders [ 27 ], which are characteristic of cerebellar ataxia, but also rehabilitation programs for secondary symptoms such as exercise tolerance, muscle strength, joint range of motion, and immobility-induced pain [ 2 , 3 , 5 , 6 , 8 – 12 , 28 ]. Approximately 90% of the rehabilitation programs conducted during PT and OT within this study consisted of coordination, balance training, muscle-strengthening, and range-of-motion exercises. These rehabilitation programs are commonly included in most multidisciplinary rehabilitation approaches for cerebellar ataxia [ 2 – 13 ]. However, most reports on multidisciplinary rehabilitation do not specify the duration of each rehabilitation program, making it unclear which programs receive greater emphasis. Notably, the only report providing detailed descriptions of the time allocation for each rehabilitation program revealed that approximately 50% of a 4-hour daily PT session in multidisciplinary rehabilitation was dedicated to coordination exercises, balance training, and gait training [ 5 ]. In the present study, we did not investigate the duration of each rehabilitation program; however, approximately 70% of the rehabilitation programs involved coordination and balance training, indicating that coordination and balance exercises play pivotal roles in the implementation of multidisciplinary rehabilitation for patients with SCD. Notably, the specificity of the rehabilitation programs targeting BFs according to disease severity could not be confirmed. Participants in this study were not in the asymptomatic (SARA 0) or prodromal (SARA 0–2) stages, but rather in the ataxic stage (SARA ≥ 3) and thus presented with a wide range of clinical symptoms [ 29 ]. This suggests that similar rehabilitation programs may have been implemented in response to overlapping symptoms regardless of disease severity. However, given that the severity of individual symptoms tends to worsen with disease duration, it is possible that the dosage or intensity of each rehabilitation program varies accordingly. Activities and participation Consistent with previous reports, goal-oriented rehabilitation using the Goal Attainment Scale was implemented for patients with SCD in the present study [ 2 , 6 , 9 , 10 ]. Accordingly, rehabilitation programs were linked to ICF codes related to mobility, self-care, domestic life, communication, and community life, reflecting the participants’ primary complaints and needs. Previous studies, in which factors that impact daily life in individuals with SCD were investigated, have reported that impaired coordination, balance disturbances, gait disorders, speech impairments, limitations in ADLs, and falls significantly affect both daily functioning and QOL [ 28 , 30 – 32 ]. These needs were mainly encompassed using the ICF categories associated with the rehabilitation programs analyzed in this study. Moreover, in PT and OT, a substantial number of rehabilitation programs were related to mobility (such as walking, maintaining a standing posture, and transfers), self-care, and domestic life (such as cooking, housekeeping, toileting, dressing, and bathing), whereas in ST, many programs were focused on communication. These findings suggest that goal-oriented rehabilitation interventions can address the specific needs of individuals with SCD. In the present study, we demonstrated that rehabilitation programs targeting mobility (including transfers, stair climbing, and hand use), self-care (such as toileting, dressing, bathing, and eating), and domestic activities (including shopping, cooking, and cleaning) were widely implemented. In patients with SCD, assistance with ADLs, as measured using the FIM, and IADLs, as assessed using the Lawton IADL scale, becomes necessary at a SARA score of 12, and full assistance across all items is required at a score of 20 [ 26 ]. As ataxia severity progresses, difficulties in ADLs tend to arise in the following order: communication, mobility, self-care, toileting, social cognition, and transfer. For IADLs, difficulties appear in shopping, non-ambulatory mobility, household tasks, medication management, financial management, meal preparation, and telephone use [ 26 ]. Furthermore, previous studies have reported that patients who experience difficulty walking often struggle with self-care and fine motor tasks. Given these findings, the identification of ICF categories related to mobility (such as transfers and standing) and self-care (including toileting, dressing, eating, and bathing) in this study suggests that rehabilitation programs tailored to ataxia severity are necessary to support ADL performance in individuals with SCD. Environmental factors Rehabilitation programs targeting EFs were linked to ICF codes related to products and technology, support and relationships, and services, systems, and policies. These programs were designed to address fall prevention and promote independence (including walking, eating, and bathing) in patients with cerebellar degenerative disorders, encompassing physical, interpersonal, and social dimensions. Many patients with SCD disorders, whose primary symptoms include gait and balance disturbances, have a history of falls [ 33 – 35 ]. In such cases, the use of assistive devices (including mobility aids and self-help tools) and environmental modifications represents effective strategies for fall prevention and fostering independence by immediately stabilizing movement. Educational interventions focused on ADLs (such as walking, toileting, eating, bathing, and stair climbing) and home-based exercises are aimed at supporting family members, friends, and healthcare professionals in the home setting by enhancing their understanding of patients’ physical capabilities and appropriate caregiving techniques. These efforts are intended to optimize ADL assistance and prevent disuse syndromes by promoting appropriate levels of physical activity. After discharge, patients can access suitable assistive devices and medical services based on their disability status through the national social insurance system. Self-exercise Rehabilitation programs related to self-directed (home-based or independent) exercises were linked to ICF codes that encompass functioning, including BFs and body structures, and APs. Previous studies have similarly reported that most self-directed exercises are aimed at improving BFs [ 9 , 10 , 36 ], and in the present study, over 80% of the collected self-directed rehabilitation programs were focused on this category. Since self-directed exercises are performed without direct supervision, safety considerations are paramount, often resulting in programs designed to be conducted in bed or at the bedside, with a primary focus on BFs. Nevertheless, rehabilitation programs aimed at practicing essential ADL tasks tailored to individual needs were also identified in this study. In the context of rehabilitation for cerebellar degenerative disorders, personalized programs emphasizing meaningful activities and participation are indispensable for enhancing QOL. Such programs should be optimized to support not only BF but also engagement in personally relevant and socially significant activities. Limitations Some unresolved limitations exist in clarifying the ICF categories targeted by multidisciplinary rehabilitation programs. First, as this study was a retrospective survey of multidisciplinary rehabilitation programs, there is a possibility that specific rehabilitation interventions were not reported because of the respondents' cognitive bias. Second, items addressing the specific objectives of each rehabilitation program were not included in the survey, which may have resulted in some interventions not being accurately linked to appropriate ICF categories. Nevertheless, respondents were instructed to consult medical records and treatment plans when completing the survey. The process of linking interventions to ICF categories was discussed among multiple reviewers, supporting the overall validity of the categorization. Third, the interpretation of this study was based on the frequency of ICF categories associated with the reported rehabilitation programs rather than on the dosage of multidisciplinary rehabilitation. Accordingly, the analysis of disease severity was limited to a comparison of the types of categories identified, without reflecting the intensity or volume of interventions. Fourth, only a limited range of disease subtypes were included in the study, and it remains possible that rehabilitation programs may vary according to disease subtype. Conclusion The multifaceted rehabilitation program for SCD was associated with ICF categories encompassing BFs, APs, EFs, and PFs. Furthermore, ataxia severity was found to influence the selection and adaptation of rehabilitation programs targeting APs. These findings suggest that multiple intervention components may contribute to improving ADLs through rehabilitation therapy. In the future, a more detailed ICF-based framework may help identify optimal combinations of intervention characteristics, such as content, frequency, intensity, duration, and complexity, to enhance therapeutic outcomes in SCD. Declarations Acknowledgements Editorial support in the form of medical writing, assembling tables, creating high-resolution images based on detailed directions, collating author comments, copy editing, fact-checking, and referencing was provided by Editage. Author contributions Y.H., H.F., H.O., K.T. (Kenji Takamatsu), M.H., H.Y., and I.M. contributed to the conception and design of the study, statistical analysis, drafting of the text, and preparation of the figures. Data collection and analysis were performed by Y.H., K.T. (Kenji Takamatsu), H.S., K.T. (Koji Takahashi), and H.F. All authors read and approved the final manuscript. Funding This work was supported by a Grant-in-Aid from the Research Committee of Ataxia through the Health and Labor Sciences Research Grants program of the Ministry of Health, Labor, and Welfare, Japan, under grant number 23FC1010 (to IM). Data availability No datasets were generated or analyzed during the current study. Ethics approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Morinomiya Hospital (Approval No. 573). Competing interests The authors have no competing interests to declare that are relevant to the content of this article. Consent to participate This retrospective study was conducted using an opt-out approach, as approved by the Institutional Review Board of Morinomiya Hospital. Study information was made publicly available, and potential participants were given the opportunity to decline inclusion. Accordingly, the requirement for informed consent was waived. Consent to publish Not applicable, as no identifying information or images are included in the article. References World Health Organization; 2024. Rehabilitation. https://www.who.int/news-room/fact-sheets/detail/rehabilitation. Accessed 18 Mar 2025 Milne SC, Roberts M, Williams S, Chua J, Grootendorst AC, Agostinelli G, et al. Goal-directed rehabilitation versus standard care for individuals with hereditary cerebellar ataxia: a multicenter, single-blind, randomized controlled superiority trial. Ann Neurol. 2025;97:409–24. https://doi.org/10.1002/ana.27130 Bando K, Kondo Y, Miyazaki Y, Hara T, Takahashi Y. Differences in the impact of intensive rehabilitation on hereditary ataxias and the cerebellar subtype of multiple system atrophy. Cerebellum. 2024;23:2447–56. https://doi.org/10.1007/s12311-024-01744-4 Barbuto S, Kuo SH, Winterbottom L, Lee S, Stern Y, O’Dell M, et al. Home aerobic training for cerebellar degenerative diseases: a randomized controlled trial. 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Neurorehabil Neural Repair. 2017;31:609–22. https://doi.org/10.1177/1545968317712469 Matsugi A, Bando K, Kondo Y, Kikuchi Y, Miyata K, Hiramatsu Y, et al. Effects of physiotherapy on degenerative cerebellar ataxia: a systematic review and meta-analysis. Front Neurol. 2024;15:1491142. https://doi.org/10.3389/fneur.2024.1491142 World Health Organization. International classification of functioning, disability and health (ICF); n.d. https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health. Accessed 18 Mar 2025 Cieza A, Geyh S, Chatterji S, Kostanjsek N, Ustün B, Stucki G. ICF linking rules: an update based on lessons learned. J Rehabil Med. 2005;37:212–8. https://doi.org/10.1080/16501970510040263 Cieza A, Brockow T, Ewert T, Amman E, Kollerits B, Chatterji S, et al. Linking health-status measurements to the International Classification of Functioning, Disability and Health. J Rehabil Med. 2002;34:205–10. https://doi.org/10.1080/165019702760279189 Cieza A, Fayed N, Bickenbach J, Prodinger B. Refinements of the ICF Linking Rules to strengthen their potential for establishing comparability of health information. Disabil Rehabil. 2019;41:574–83. https://doi.org/10.3109/09638288.2016.1145258 Mueller M, Boldt C, Grill E, Strobl R, Stucki G. Identification of ICF categories relevant for nursing in the situation of acute and early post-acute rehabilitation. BMC Nurs. 2008;7:3. https://doi.org/10.1186/1472-6955-7-3 Lustenberger NA, Prodinger B, Dorjbal D, Rubinelli S, Schmitt K, Scheel-Sailer A. Compiling standardized information from clinical practice: using content analysis and ICF Linking Rules in a goal-oriented youth rehabilitation program. Disabil Rehabil. 2019;41:613–21. https://doi.org/10.1080/09638288.2017.1380718 Yoshida K, Kuwabara S, Nakamura K, Abe R, Matsushima A, Beppu M, et al. Idiopathic cerebellar ataxia (IDCA): diagnostic criteria and clinical analyses of 63 Japanese patients. J Neurol Sci. 2018;384:30–5. https://doi.org/10.1016/j.jns.2017.11.008 Abele M, Minnerop M, Urbach H, Specht K, Klockgether T. Sporadic adult onset ataxia of unknown etiology: a clinical, electrophysiological and imaging study. J Neurol. 2007;254:1384–9. https://doi.org/10.1007/s00415-007-0556-1 Abele M, Bürk K, Schöls L, Schwartz S, Besenthal I, Dichgans J, et al. The aetiology of sporadic adult-onset ataxia. Brain. 2002;125:961–8. https://doi.org/10.1093/brain/awf107 Bürk K, Bühring U, Schulz JB, Zühlke C, Hellenbroich Y, Dichgans J. Clinical and magnetic resonance imaging characteristics of sporadic cerebellar ataxia. Arch Neurol. 2005;62:981–5. https://doi.org/10.1001/archneur.62.6.981 Burk K, Globas C, Wahl T, Bühring U, Dietz K, Zuhlke C, et al. MRI-based volumetric differentiation of sporadic cerebellar ataxia. Brain. 2004;127:175–81. https://doi.org/10.1093/brain/awh013 Grotkamp SL, Cibis WM, Nüchtern EAM, von Mittelstaedt G, Seger WKF. Personal factors in the international classification of functioning, disability and health: prospective evidence. Aust J Rehabil Couns. 2012;18:1–24. https://doi.org/10.1017/jrc.2012.4 Cruz GCD, Zonta MB, Munhoz RP, Mello NM, Meira AT, Nunes MCA, et al. Functionality and disease severity in spinocerebellar ataxias. Arq Neuro Psiquiatr. 2022;80:137–44. https://doi.org/10.1590/0004-282X-ANP-2020-0580 Klockgether T, Mariotti C, Paulson HL. Spinocerebellar ataxia. Nat Rev Dis Primers. 2019;5:24. https://doi.org/10.1038/s41572-019-0074-3 Haruyama K, Kawakami M, Miyai I, Nojiri S, Fujiwara T. Impact of rehabilitation on quality of life in patients with degenerative cerebellar ataxias using structural equation modeling. Sci Rep. 2025;15:21997. https://www.nature.com/articles/s41598-025-01990-4 Velázquez-Pérez LC, Rodríguez-Labrada R, Fernandez-Ruiz J. Spinocerebellar ataxia Type 2: clinicogenetic aspects, mechanistic insights, and management approaches. Front Neurol. 2017;8:472. https://doi.org/10.3389/fneur.2017.00472 Rönnefarth M, Hanisch N, Brandt AU, Mähler A, Endres M, Paul F, et al. Dysphagia affecting quality of life in cerebellar ataxia-a large survey. Cerebellum. 2020;19:437–45. https://doi.org/10.1007/s12311-020-01122-w Seabury J, Alexandrou D, Dilek N, Cohen B, Heatwole J, Larkindale J, et al. Patient-reported impact of symptoms in Friedreich ataxia. Neurology. 2023;100:e808–21. https://doi.org/10.1212/WNL.0000000000201598 Kondo Y, Matsugi A, Bando K, Kikuchi Y, Maruyama H, Miyazaki Y, et al. What are the key challenges faced by spinocerebellar degeneration and multiple system atrophy patients in daily life? Insights from a comprehensive questionnaire survey in Japan. Cerebellum. 2025;24:78. https://doi.org/10.1007/s12311-025-01831-0 Fonteyn EM, Schmitz-Hübsch T, Verstappen CC, Baliko L, Bloem BR, Boesch S, et al. Prospective analysis of falls in dominant ataxias. Eur Neurol. 2013;69:53–7. https://doi.org/10.1159/000342907 Fonteyn EMR, Schmitz-Hübsch T, Verstappen CC, Baliko L, Bloem BR, Boesch S, et al. Falls in spinocerebellar ataxias: results of the EuroSCA Fall Study. Cerebellum. 2010;9:232–9. https://doi.org/10.1007/s12311-010-0155-z van de Warrenburg BPC, Steijns JAG, Munneke M, Kremer BPH, Bloem BR. Falls in degenerative cerebellar ataxias. Mov Disord. 2005;20:497–500. https://doi.org/10.1002/mds.20375 Lessard I, Gagnon C, Tremblay M, Girard-Côté L, Côté I, Aubertin-Leheudre M, et al. A tailored home-based training program improved ataxia severity and participation in adults with ARSACS. Cerebellum. 2025;24:63. https://doi.org/10.1007/s12311-025-01816-z Tables Tables 3 to 8 are available in the Supplementary Files section. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7183654","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":489672145,"identity":"d887cd15-7adb-4c00-a588-1faaa9d14d4b","order_by":0,"name":"Yuichi 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for body functions.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7183654/v1/f85bc374c3678032df2c8ca7.png"},{"id":87605725,"identity":"dac199db-ffdc-4601-a546-b5f4f4942c6f","added_by":"auto","created_at":"2025-07-25 18:13:10","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":158183,"visible":true,"origin":"","legend":"\u003cp\u003eThe frequency of occurrence of the second-level ICF categories for activities and participation.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7183654/v1/be7835b8d061bec243dfcfb5.png"},{"id":87605721,"identity":"5f2073cd-8b02-4963-aad0-d6b234ad327c","added_by":"auto","created_at":"2025-07-25 18:13:09","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":110637,"visible":true,"origin":"","legend":"\u003cp\u003eThe frequency of occurrence of the second-level ICF categories for environmental factors.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7183654/v1/2b51a8cdd792207613952391.png"},{"id":87606554,"identity":"bf7062e6-f76f-47e5-9ae8-2c41bf4dbf30","added_by":"auto","created_at":"2025-07-25 18:29:10","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":171066,"visible":true,"origin":"","legend":"\u003cp\u003eThe frequency of occurrence of the second-level ICF categories for self-exercise rehabilitation programs.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7183654/v1/78bbe3d9149c2769ce20b9b3.png"},{"id":90312757,"identity":"4a3148d1-d340-48c3-8bde-40013ed9176c","added_by":"auto","created_at":"2025-09-01 10:02:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1634792,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7183654/v1/19950997-e0d7-477d-9859-148ed54dc7f9.pdf"},{"id":87605720,"identity":"9d7e8fbc-ad8d-458e-a06b-7c6b41ce674d","added_by":"auto","created_at":"2025-07-25 18:13:09","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":39303,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-7183654/v1/9a1f610f66fda17f1fb6afc1.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Identification of International Classification of Functioning, Disability and Health categories in a multifaceted rehabilitation program for spinocerebellar degeneration","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDegenerative cerebellar disorders are characterized by progressive ataxia. Rehabilitation programs targeting each component of the International Classification of Functioning, Disability, and Health (ICF) framework have been used to optimize functioning, reduce disability, and improve quality of life (QOL) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Short-term intensive rehabilitation treatment has been reported to improve ataxia, balance, gait, and activities of daily living (ADLs) [\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e–\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], with effects sometimes equivalent to 2 years of natural disease progression [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Notably, a systematic review [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and meta-analysis [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] on the effectiveness of rehabilitation programs revealed that the greatest improvements were achieved through coordinated exercise and balance practice for ataxia, and multifaceted rehabilitation for ADLs. However, the heterogeneity of intervention characteristics (content, frequency, intensity, duration, and difficulty) in the rehabilitation programs reported to date is high [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], and the specificity of efficient intervention content and dosage for functional improvement through multifaceted rehabilitation programs remains unknown.\u003c/p\u003e\u003cp\u003eSeveral considerations are essential when examining the specificity of intervention content and quantity in multifaceted rehabilitation effects [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. First, functional improvement achieved through multifaceted rehabilitation is likely attributed to a combination of several rehabilitation programs. It is therefore necessary to verify not only intensive rehabilitation programs for a single functional impairment but also the synergistic effects of combining several rehabilitation programs. Second, multiple rehabilitation programs are often applied simultaneously to address specific functional impairments. For example, coordinated movement, postural control, and functional mobility may all target coordinated movement disorders, which complicates the understanding of the specificity of intervention content and quantity.\u003c/p\u003e\u003cp\u003eThis complexity may be addressed by organizing information as rehabilitation interventions for functioning and contextual factors using an internationally common standardized language and conceptual framework [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Specifically, the ICF Framework and Classification and its linking rules [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e–\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] provide such a structure, composed of six components: functioning (body functions [BFs], body structures, and activities and participation [APs]) and contextual factors (environmental [EFs] and personal [PFs]), which functioning and facilitators, as well as disability and inhibiting factors can be positively and negatively identified, respectively, in a comprehensive and standardized language. Additionally, the ICF linking rules enable the linking of information on clinical measures, technical assessments, and interventions in functioning and contextual factors to ICF categories [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Several reports have successfully applied this approach to link rehabilitation interventions to ICF categories [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, no systematic framework that encompasses the information on rehabilitation for spinocerebellar degeneration (SCD; symptoms, disability, outcomes, and interventions) has been established.\u003c/p\u003e\u003cp\u003eDescribing the ICF categories targeted by multifaceted rehabilitation programs allows us to examine the specificity of the content and quantity of interventions required for efficient multifaceted rehabilitation programs in the future. This study, in which we aimed to identify the ICF categories targeted by multifaceted rehabilitation programs for SCD, has practical implications for designing future rehabilitation programs. To this end, we conducted a retrospective study of a short-term intensive inpatient rehabilitation program. Rehabilitation programs were linked to ICF categories related to functioning and contextual factors, providing a practical framework for future interventions. We also identified the ICF categories according to ataxia severity and summarized their frequencies across ICF components.\u003c/p\u003e"},{"header":"Patients and methods","content":"\u003cp\u003e\u003cb\u003eStudy design and participants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis was a retrospective, cross-sectional study of a short-term, intensive inpatient rehabilitation program for patients with SCD. A total of 55 patients were included, including those with spinocerebellar ataxia types 3 (SCA3; n = 11), 6 (SCA6; n = 11), and 17 (SCA17; n = 1), as well as cortical cerebellar atrophy (CCA; n = 19), dentatorubral-pallidoluysian atrophy (DRPLA; n = 2); and SCA of unknown subtype (n = 11). CCA is characterized by pure cerebellar ataxia [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and is also known as sporadic adult-onset ataxia of unknown etiology [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] or idiopathic cerebellar ataxia [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. “Unknown” refers to SCA with a family history but without a confirmed subtype. All patients participated in daily physical, occupational, and speech therapy (PT, OT, and ST, respectively) sessions, lasting 60 min each, 6–7 times per week, for approximately 4 weeks. This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Morinomiya Hospital (Approval No. 573).\u003c/p\u003e\u003cp\u003e\u003cb\u003eData collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWe conducted a questionnaire survey to obtain information on the short-term, intensive inpatient rehabilitation program, including self-exercise programs (SEPs) prescribed by each patient's therapist. The therapist described the rehabilitation program by classifying based on the components of functioning (BFs, APs) and contextual factors (EFs, PFs) according to the ICF framework. To determine the patients’ clinical characteristics, general items (age, sex, years of illness, length of stay, and disease subtype) and clinical outcome assessment (Scale for the Assessment and Rating of Ataxia [SARA], Functional Independence Measure (FIM)- Motor score [FIM-M], Mini-Mental State Examination [MMSE], Frontal Assessment Battery [FAB]) indices were collected from medical records.\u003c/p\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eThe collected rehabilitation programs were independently linked to ICF categories by two trained raters (YH and KT) based on the ICF linking rules [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e–\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Cohen's kappa statistic was calculated to assess inter-rater agreement. Any discrepancies were discussed in a consensus meeting involving one rehabilitation physician and representatives from each therapy discipline. Since the ICF does not provide codes for PF, these were classified using the Deutsche Gesellschaft für Sozialmedizin und Prävention (DGSMP) framework [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The frequency of occurrence of the ICF categories for each therapy was calculated. Based on previous reports that patients with SCD require some assistance with ADLs and instrumental ADLs (IADLs) at 12 SARA points and full assistance at 20 points [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], we identified ICF categories according to ataxia severity using SARA scores as follows: mild (0–14 points), moderate (14.5–20.5 points), and severe (21–31 points).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eCharacteristics of participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe demographic and clinical characteristics of the patients are presented in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. The clinical characteristics of the 55 patients with SCD (SCA3, n\u0026thinsp;=\u0026thinsp;11, SCA6, n\u0026thinsp;=\u0026thinsp;11, SCA17, n\u0026thinsp;=\u0026thinsp;1, CCA, n\u0026thinsp;=\u0026thinsp;19, DRPLA, n\u0026thinsp;=\u0026thinsp;2, unknown subtype, n\u0026thinsp;=\u0026thinsp;11) were as follows: mean SARA total, 18.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2 points (range: 5\u0026ndash;31); SARA gait, 5.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 points (range: 2\u0026ndash;8); SARA language, 2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 points (range: 0\u0026ndash;4); motor FIM, 65.7\u0026thinsp;\u0026plusmn;\u0026thinsp;16.8 points (range: 13\u0026ndash;87); MMSE, 27.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7 points (range: 9\u0026ndash;30); FAB, 15.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2 points (range: 8\u0026ndash;18); and intervention duration, 39.4\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2 days (range: 9\u0026ndash;80). Patients with SCA17 and DRPLA showed a higher degree of cognitive impairment based on MMSE and FAB scores. We selected rehabilitation programs for 42, 38, and 44 patients in PT, OT, and ST, respectively. Patient characteristics by ataxia severity for each therapy are shown in Supplementary Table\u0026nbsp;1.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographic and clinical characteristics of patients\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePhysical Therapy\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOccupational Therapy\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSpeech Therapy\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eALL\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.6 (14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.3 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.4 (14.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.9 (14.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale/male\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18/24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18/20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19/25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24/31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisease duration, years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.5 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.6 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.5 (5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.8 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention duration, days\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.7 (7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.0 (9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.1 (8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.4 (10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMMSE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.4 (4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.4 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.5 (4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.7 (3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFAB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.8 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.5 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.3 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.7 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSARA gait score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.0 (1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.2 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.0 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.9 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSARA speech disturbance score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.3 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.3 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.4 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.3 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSARA total score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.3 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.9 (6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.3 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.1 (6.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIM Motor score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66.3 (16.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.1 (18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.4 (18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65.7 (16.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSCA3/6/17/CCA/DRPLA/unknown\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7/9/1/17/2/6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8/9/1/13/2/5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9/8/1/17/2/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11/11/1/19/2/11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eMMSE, Mini-Mental State Examination; FAB, Frontal Assessment Battery; SARA, Scale for the Assessment and Rating of Ataxia; FIM, Functional Independence Measure; SCA, Spinocerebellar Ataxia; CCA, Cortical Cerebellar Atrophy; DRPLA, Dentatorubral-Pallidoluysian Atrophy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCollected rehabilitation programs and linked ICF categories\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 1258 rehabilitation programs related to functioning and contextual factors (BFs: 511, APs: 358, EFs: 123, SEPs: 266 programs) were collected through the questionnaire survey. These included 487 PT (BFs: 182, APs: 141, EFs: 64, SEPs: 100), 419 OT (BFs: 153, APs: 142, EFs: 57, SEPs: 67), and 352 ST (BFs: 176, APs: 75, EFs: 2, SEPs: 99) programs.\u003c/p\u003e\n\u003cp\u003eAll rehabilitation programs were successfully linked to second- or third-level ICF categories, totaling 1341 ICF codes (BFs: 517, APs: 392, EFs: 123, SEPs: 309). Specifically, there were 500 codes for PT (BFs: 182, APs: 154, EFs: 64, SEPs: 100), 441 for OT (BFs: 153, APs: 163, EFs: 57, SEPs: 68), and 400 for ST (BFs: 182, APs: 75, EFs: 2, SEPs: 141). PFs were linked to a single code within the DGSMP.\u003c/p\u003e\n\u003cp\u003eThe estimated kappa values ranged from 0.72 to 1.00, indicating substantial to perfect agreement across all disciplines, including PT (BFs: 0.82; APs: 0.86, EFs: 0.89, SEPs: 0.89), OT (BFs: 0.72; APs: 0.76, EFs: 0.95, SEPs: 0.82), and ST (BFs: 0.71; APs:1.0, SEPs: 0.78).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eICF categories and codes of rehabilitation programs for body functions and structures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 511 rehabilitation programs targeting BFs were recorded (PT: 182, OT: 153, ST: 176). The correspondence between the rehabilitation programs and ICF codes is presented in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. These rehabilitation programs were linked to 517 ICF codes (PT: 182, OT: 153, ST: 182). The first-level ICF categories were \u0026ldquo;sensory functions and pain (b2),\u0026rdquo; \u0026ldquo;voice and speech functions (b3),\u0026rdquo; \u0026ldquo;functions of the cardiovascular and respiratory systems (b4),\u0026rdquo; \u0026ldquo;functions of the digestive systems (b5),\u0026rdquo; and \u0026ldquo;neuromusculoskeletal and movement-related functions (b7).\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e and Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e show the ICF categories linked to each therapy\u0026rsquo;s rehabilitation program and their frequency of occurrence. In PT (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003ea), the frequencies of the seven ICF categories were as follows: \u0026ldquo;control of voluntary movement functions (b760) \u0026ndash; 47.2%,\u0026rdquo; \u0026ldquo;involuntary movement reaction functions (b755) \u0026ndash; 23.6%,\u0026rdquo; \u0026ldquo;mobility of joint functions (b710) \u0026ndash; 18.1%,\u0026rdquo; \u0026ldquo;muscle power functions (b730) \u0026ndash; 9.3%,\u0026rdquo; \u0026ldquo;exercise tolerance functions (b455) \u0026ndash; 0.5%,\u0026rdquo; \u0026ldquo;sensations associated with hearing and vestibular function (b240) \u0026ndash; 0.5%,\u0026rdquo; and \u0026ldquo;sensations of pain (b280) \u0026ndash; 0.5%.\u0026rdquo; In OT (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003eb), the frequencies of the six ICF categories were as follows: \u0026ldquo;control of voluntary movement functions (b760) \u0026ndash; 60.1%,\u0026rdquo; \u0026ldquo;involuntary movement reaction functions (b755) \u0026ndash; 16.3%,\u0026rdquo; \u0026ldquo;muscle power functions (b730) \u0026ndash; 15.0%,\u0026rdquo; \u0026ldquo;mobility of joint functions (b710) \u0026ndash; 4.6%,\u0026rdquo; \u0026ldquo;sensations associated with hearing and vestibular functions (b240) \u0026ndash; 2.6%,\u0026rdquo; and \u0026ldquo;sensations of pain (b280) \u0026ndash; 1.3%.\u0026rdquo; In ST (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003ec), the frequencies of the eight ICF categories were as follows: \u0026ldquo;voice functions (b310) \u0026ndash; 22.5%,\u0026rdquo; \u0026ldquo;respiration functions (b440) \u0026ndash; 17.6%,\u0026rdquo; \u0026ldquo;articulation functions (b320) \u0026ndash; 16.5%,\u0026rdquo; \u0026ldquo;muscle tone functions (b735) \u0026ndash; 15.4%,\u0026rdquo; \u0026ldquo;fluency and rhythm of speech functions (b330) \u0026ndash; 15.4%,\u0026rdquo; \u0026ldquo;ingestion functions (b510) \u0026ndash; 5.5%,\u0026rdquo; \u0026ldquo;muscle power functions (b730) \u0026ndash; 3.8%,\u0026rdquo; and \u0026ldquo;mobility of joint functions (b710) \u0026minus;\u0026thinsp;3.3%.\u0026rdquo;\u003c/p\u003e\n\u003cdiv align=\"\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eLinked ICF of intervention target and rehabilitative intervention.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIntervention target\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eICF code \u0026amp; category\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eExercise category\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDescription\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eCoordination\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eb760 Control of voluntary movement functions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePostural control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePelvic tilt, trunk rotation, multi-segmental rotation, upright posture control, half kneeling posture, multi-directional stepping, and weight shifting.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCoordination and control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBird dog, lunge, supine leg cycling, squat, supine march, bridge, plank, plank rotation, arm reaches, reaching and grasping, raise upper limb, hip-knee extension, up on toes or heels, toe touches or floor, tall kneeling trunk rotation and walking, eye guided hand movement, and trunk rotation with arm reach.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFunctional mobility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSit to stand to sit, supine log roll, supine to sit, sidelying to sitting, sideways walking, grapevine walking, bimanual activities, and body weight support treadmill training.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eBalance\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eb755 Involuntary movement reaction functions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStatic balance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFeet apart, feet together, step stance, tandem stance, and single leg stance.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDynamic balance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWeight shift, crossover step, stepping, tandem walk, chair leg squat, perturbation correction, catching/ throwing/ bouncing/ kicking ball, and counterbalance squat.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eMuscle\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eb730 Muscle power functions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMuscle strength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eResistance training (hand: tabletop, hook fist, digit extension, composite finger flexion, and thumb opposition; trunk-hip: bridge; trunk: prone back extension, Russian twist; lower limb: hip abduction, leg extension; foot: short foot, toe-spread, toe-extension, and towel toe curls), stair climbing, and squatting.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eb735 Muscle tone functions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMuscle tone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProgressive muscle relaxation.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eJoint\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eb710 Mobility of joint functions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eContracture and flexibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMobilization, stretching, and passive movement.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNon-speech oral motor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTongue (protrusion, retraction, elevation, wagging, and pressing), lip (protruding, retracting, rounding, and closure), cheek (puffing), jaw (opening, closing), blowing (straw), and oral (massage, brushing).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eEndurance\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eb455 Exercise tolerance functions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGeneral physical endurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGait training indoors and outdoors, as well as body weight support treadmill training.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eVestibular\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eb240 Sensations associated with hearing and vestibular function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDizziness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEye-head/ eye-head-body movement, gaze stability exercise, and walking and turning.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003ePain\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eb280 Sensation of pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMassage, mobilization, stretching, and passive movement.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eRespiration\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eb440 Respiration functions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRespiratory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBreathing (belly, pursed lip, staccato, persistent exhalation, and blowing).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eProsody\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eb330 Fluency and rhythm of speech functions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFluency, rhythm, speed, and melody\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSentence production (pitch-accent, intonation, rhythm, speed, loudness, and stress), phrasing, and humming.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eVoice\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eb310 Voice functions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProduction and quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSustained vowels and continuous speech, humming, phrasing, speech production (single sound, long sound, vowel, word, sentence, greetings, and formula sequence sound), speech repetition, soft glottal attack, digit span, singing, reading aloud, and voice volume control.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eArticulation\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eb320 Articulation functions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eArticulation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePlace of articulation, vowel production, voice glide, reading aloud and repetition (words and short and long sentences), mora-by-mora finger counting, finger tapping, phrasing conversation, and intelligibility drills.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eDysphagia\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eb510 Ingestion functions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSwallowing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePostural adjustments and feeding strategies.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eProducts and technology\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ee115 Products and technology for personal use in daily living\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGeneral/assistive products and technology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSofa, bed, chair, table/shower chair, and adaptive eating equipment (spoon, fork, and straw).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ee120 Products and technology for personal indoor and outdoor mobility and transportation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCanes, walkers, wheelchairs, bicycles, carts, handrails, and grab bars.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eSupport and relationships\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ee310 Immediate family\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducation and counseling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbout how to assist with activities of daily living (walking, stairs, sit-to-stand, toilet, bathing, preparing meals, eating, and transfer).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ee315 Extended family\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ee340 Personal care providers and personal assistants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInterprofessional communication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRehabilitation program, activities of daily living assistance, and home exercise.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ee355 Health professionals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eBehavior patterns\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei456 Exercise habits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducation (exercise habits and lifestyle)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHome exercise and active lifestyle (walking, housework, and business).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eICF, International Classification of Functioning, Disability, and Health\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eICF categories and codes of rehabilitation programs for activities and participation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 358 rehabilitation programs targeting APs were recorded (PT: 141, OT: 142, ST: 75). The correspondence between the rehabilitation programs and ICF codes is presented in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. These rehabilitation programs were linked to 392 ICF codes (PT: 154, OT: 163, ST: 75). The first-level ICF categories were \u0026ldquo;mobility (d4),\u0026rdquo; \u0026ldquo;self-care (d5),\u0026rdquo; \u0026ldquo;domestic life (d6),\u0026rdquo; \u0026ldquo;community life (d9),\u0026rdquo; \u0026ldquo;learning and applying knowledge (d1),\u0026rdquo; and \u0026ldquo;communication (d3).\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e and Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e show the ICF categories linked to each therapy rehabilitation program and their frequency of occurrence. In PT (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003ea), the frequencies of the eight ICF categories were as follows: \u0026ldquo;walking (d450) \u0026ndash; 59.7%,\u0026rdquo; \u0026ldquo;changing basic body position (d410) \u0026minus;\u0026thinsp;17.5%,\u0026rdquo; \u0026ldquo;going up and down stairs (d451) \u0026ndash; 9.7%,\u0026rdquo; \u0026ldquo;transferring oneself (d420) \u0026ndash; 3.9%,\u0026rdquo; \u0026ldquo;toileting (d530) \u0026ndash; 3.2%,\u0026rdquo; \u0026ldquo;dressing (d540) \u0026ndash; 2.6%,\u0026rdquo; \u0026ldquo;maintaining a body position (d415) \u0026ndash; 1.9%,\u0026rdquo; and \u0026ldquo;lifting and carrying objects (d430) \u0026ndash; 1.3%.\u0026rdquo; In OT (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eb), the frequencies of the nineteen ICF categories were as follows: \u0026ldquo;changing basic body position (d410) \u0026ndash; 31.3%,\u0026rdquo; \u0026ldquo;walking (d450) \u0026ndash; 9.2%,\u0026rdquo; \u0026ldquo;preparing meals (d630) \u0026ndash; 8.6%,\u0026rdquo; \u0026ldquo;toileting (d530) \u0026ndash; 8.6%,\u0026rdquo; \u0026ldquo;doing housework (d640) \u0026ndash; 8.0%,\u0026rdquo; \u0026ldquo;dressing (d540) \u0026ndash; 7.4%,\u0026rdquo; \u0026ldquo;washing oneself (d510) \u0026ndash; 6.1%,\u0026rdquo; \u0026ldquo;recreation and leisure (d920) \u0026ndash; 4.9%,\u0026rdquo; \u0026ldquo;maintaining a body position (d415) \u0026ndash; 4.3%,\u0026rdquo; \u0026ldquo;writing (d170) \u0026ndash; 3.7%,\u0026rdquo; \u0026ldquo;transferring oneself (d420) \u0026ndash; 1.8%,\u0026rdquo; \u0026ldquo;eating (d550) \u0026minus;\u0026thinsp;1.2%,\u0026rdquo; \u0026ldquo;going up and down stairs (d451) \u0026ndash; 1.2%,\u0026rdquo; \u0026ldquo;acquisition of goods and services (d620) \u0026ndash; 0.6%,\u0026rdquo; \u0026ldquo;assisting others (d660) \u0026ndash; 0.6%,\u0026rdquo; \u0026ldquo;fine hand use (d440),\u0026rdquo; \u0026ldquo;lifting and carrying objects (d430),\u0026rdquo; \u0026ldquo;moving around (d455),\u0026rdquo; and \u0026ldquo;moving around using equipment (d465) \u0026minus;\u0026thinsp;0.6%.\u0026rdquo; In ST (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003ec), the frequencies of the three ICF categories were as follows: \u0026ldquo;speaking (d330) \u0026ndash; 88.0%,\u0026rdquo; \u0026ldquo;using communication devices and techniques (d360) \u0026ndash; 6.7%,\u0026rdquo; and \u0026ldquo;singing (d332) \u0026ndash; 5.3%.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eICF categories and codes of rehabilitation programs for environmental factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 123 rehabilitation programs (PT: 64, OT: 57, ST: 2) were EF-related. The correspondence between the rehabilitation programs and ICF codes is presented in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. These rehabilitation programs were linked to 123 ICF codes (PT: 64, OT: 57, ST: 2). The first-level ICF categories were \u0026ldquo;products and technology (e1)\u0026rdquo; and \u0026ldquo;support and relationships (e3)\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e and Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e show the ICF categories linked to each therapy rehabilitation program and their frequency of occurrence. In PT (Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003ea), the frequencies of the six ICF categories were as follows: \u0026ldquo;products and technology for personal indoor and outdoor mobility and transportation (e120) \u0026ndash; 57.8%,\u0026rdquo; \u0026ldquo;immediate family (e310) \u0026ndash; 18.8%,\u0026rdquo; \u0026ldquo;products and technology for personal use in daily living (e115) \u0026ndash; 9.4%,\u0026rdquo; \u0026ldquo;health professionals (e355) \u0026ndash; 7.8%,\u0026rdquo; \u0026ldquo;personal care providers and personal assistants (e340) \u0026ndash; 4.7%,\u0026rdquo; and \u0026ldquo;extended family (e315) \u0026minus;\u0026thinsp;1.6%.\u0026rdquo; In OT (Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003eb), the frequencies of the three ICF categories were as follows: \u0026ldquo;products and technology for personal indoor and outdoor mobility and transportation (e120) \u0026ndash; 38.6%,\u0026rdquo; \u0026ldquo;immediate family (e310) \u0026ndash; 36.8%,\u0026rdquo; and \u0026ldquo;products and technology for personal use in daily living (e115) \u0026ndash; 24.6%.\u0026rdquo; In ST (Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003ec), the frequency of the one ICF category was 100% for \u0026ldquo;products and technology for personal indoor and outdoor mobility and transportation (e120).\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eICF categories and codes of rehabilitation programs for personal factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll PF-related rehabilitation programs were classified under \u0026ldquo;exercise habits (i456) \u0026ndash; 100%\u0026rdquo; based on the DGSMP categories, as self-exercise was the only intervention consistently instructed for all patients. There were 266 self-exercise-related rehabilitation programs (PT: 100, OT: 67, ST: 99). The correspondence between the rehabilitation programs and ICF codes is presented in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. These rehabilitation programs were linked to 309 ICF codes (PT: 100, OT: 68, ST: 141). The first-level ICF categories were \u0026ldquo;sensory functions and pain (b2),\u0026rdquo; \u0026ldquo;voice and speech functions (b3),\u0026rdquo; \u0026ldquo;functions of the cardiovascular and respiratory systems (b4),\u0026rdquo; \u0026ldquo;functions of the digestive systems (b5),\u0026rdquo; \u0026ldquo;neuromusculoskeletal and movement-related functions (b7),\u0026rdquo; \u0026ldquo;mobility (d4),\u0026rdquo; \u0026ldquo;domestic life (d6),\u0026rdquo; \u0026ldquo;learning and applying knowledge (d1),\u0026rdquo; and \u0026ldquo;communication (d3).\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e and Table \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e show the ICF categories linked to each therapy\u0026rsquo;s rehabilitation program and their frequency of occurrence. In PT (Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003ea), the frequencies of the eight ICF categories were as follows: \u0026ldquo;control of voluntary movement functions (b760) \u0026ndash; 38.0%,\u0026rdquo; \u0026ldquo;mobility of joint functions (b710) \u0026ndash; 23.0%,\u0026rdquo; \u0026ldquo;involuntary movement reaction functions (b755) \u0026minus;\u0026thinsp;13.0%,\u0026rdquo; \u0026ldquo;walking (d450) \u0026ndash; 13.0%,\u0026rdquo; \u0026ldquo;muscle power functions (b730) \u0026ndash; 6.0%,\u0026rdquo; \u0026ldquo;changing basic body position (d410) \u0026ndash; 4.0%,\u0026rdquo; \u0026ldquo;sensations associated with hearing and vestibular function (b240) \u0026ndash; 2.0%,\u0026rdquo; and \u0026ldquo;moving around in different locations (d460) \u0026ndash; 1.0%.\u0026rdquo; In OT (Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003eb), the frequencies of the nine ICF categories were as follows: \u0026ldquo;mobility of joint functions (b710) \u0026ndash; 36.8%,\u0026rdquo; \u0026ldquo;control of voluntary movement functions (b760) \u0026ndash; 32.4%,\u0026rdquo; \u0026ldquo;involuntary movement reaction functions (b755) \u0026ndash; 10.3%,\u0026rdquo; \u0026ldquo;muscle power functions (b730) \u0026ndash; 8.8%,\u0026rdquo; \u0026ldquo;doing housework (d640) \u0026ndash; 5.9%,\u0026rdquo; \u0026ldquo;changing basic body position (d410) \u0026ndash; 1.5%,\u0026rdquo; \u0026ldquo;preparing meals (d630) \u0026ndash; 1.5%,\u0026rdquo; \u0026ldquo;sensations associated with hearing and vestibular function (b240) \u0026ndash; 1.5%,\u0026rdquo; and \u0026ldquo;writing (d170) \u0026ndash; 1.5%.\u0026rdquo; In ST (Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003ec), the frequencies of the eight ICF categories were as follows: \u0026ldquo;voice functions (b310) \u0026ndash; 38.3%,\u0026rdquo; \u0026ldquo;fluency and rhythm of speech functions (b330) \u0026ndash; 18.4%,\u0026rdquo; \u0026ldquo;articulation functions (b320) \u0026ndash; 17.0%,\u0026rdquo; \u0026ldquo;respiration functions (b440) \u0026ndash; 15.6%,\u0026rdquo; \u0026ldquo;speaking (d330) \u0026ndash; 7.1%,\u0026rdquo; \u0026ldquo;muscle power functions (b730) \u0026ndash; 2.1%,\u0026rdquo; \u0026ldquo;ingestion functions (b510) \u0026ndash; 0.7%,\u0026rdquo; and \u0026ldquo;mobility of joint functions (b710) \u0026ndash; 0.7%.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eICF categories by ataxia severity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo ICF categories for BF related to ataxia severity were identified (Table \u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e). However, specific ICF categories for APs related to mobility (d420: transferring oneself; d415: maintaining a body position) and self-care (d530: toileting; d540: dressing; d550: eating; d510: washing oneself) were identified in severe cases (Table \u003cspan class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis is the first study where the ICF categories and codes associated with multifaceted inpatient rehabilitation programs for SCD were investigated. These programs were classified using ICF components: functioning (BFs, APs) and contextual factors (EFs, PFs). The findings are consistent with established definitions of rehabilitation, which is described as a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions by addressing their interactions with their environment [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The following subsections discuss the relevance of the identified ICF categories in the context of rehabilitation programs.\u003c/p\u003e\u003cp\u003e\u003cb\u003eBody functions and structures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe rehabilitation programs targeting BF were primarily linked to ICF categories related to coordination, balance, muscle strength, joint range of motion, exercise tolerance, vestibular function, pain, respiratory function, prosody, voice function, articulation, and swallowing. These ICF categories closely correspond to the key intervention targets previously reported in studies on intensive or multi-faceted rehabilitation programs [\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Previous studies on multifaceted rehabilitation have addressed not only rehabilitation for primary symptoms such as coordination, balance, ocular movement, and speech disorders [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], which are characteristic of cerebellar ataxia, but also rehabilitation programs for secondary symptoms such as exercise tolerance, muscle strength, joint range of motion, and immobility-induced pain [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9 CR10 CR11\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eApproximately 90% of the rehabilitation programs conducted during PT and OT within this study consisted of coordination, balance training, muscle-strengthening, and range-of-motion exercises. These rehabilitation programs are commonly included in most multidisciplinary rehabilitation approaches for cerebellar ataxia [\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, most reports on multidisciplinary rehabilitation do not specify the duration of each rehabilitation program, making it unclear which programs receive greater emphasis. Notably, the only report providing detailed descriptions of the time allocation for each rehabilitation program revealed that approximately 50% of a 4-hour daily PT session in multidisciplinary rehabilitation was dedicated to coordination exercises, balance training, and gait training [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In the present study, we did not investigate the duration of each rehabilitation program; however, approximately 70% of the rehabilitation programs involved coordination and balance training, indicating that coordination and balance exercises play pivotal roles in the implementation of multidisciplinary rehabilitation for patients with SCD.\u003c/p\u003e\u003cp\u003eNotably, the specificity of the rehabilitation programs targeting BFs according to disease severity could not be confirmed. Participants in this study were not in the asymptomatic (SARA 0) or prodromal (SARA 0\u0026ndash;2) stages, but rather in the ataxic stage (SARA\u0026thinsp;\u0026ge;\u0026thinsp;3) and thus presented with a wide range of clinical symptoms [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This suggests that similar rehabilitation programs may have been implemented in response to overlapping symptoms regardless of disease severity. However, given that the severity of individual symptoms tends to worsen with disease duration, it is possible that the dosage or intensity of each rehabilitation program varies accordingly.\u003c/p\u003e\u003cp\u003e\u003cb\u003eActivities and participation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eConsistent with previous reports, goal-oriented rehabilitation using the Goal Attainment Scale was implemented for patients with SCD in the present study [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Accordingly, rehabilitation programs were linked to ICF codes related to mobility, self-care, domestic life, communication, and community life, reflecting the participants\u0026rsquo; primary complaints and needs. Previous studies, in which factors that impact daily life in individuals with SCD were investigated, have reported that impaired coordination, balance disturbances, gait disorders, speech impairments, limitations in ADLs, and falls significantly affect both daily functioning and QOL [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. These needs were mainly encompassed using the ICF categories associated with the rehabilitation programs analyzed in this study. Moreover, in PT and OT, a substantial number of rehabilitation programs were related to mobility (such as walking, maintaining a standing posture, and transfers), self-care, and domestic life (such as cooking, housekeeping, toileting, dressing, and bathing), whereas in ST, many programs were focused on communication. These findings suggest that goal-oriented rehabilitation interventions can address the specific needs of individuals with SCD.\u003c/p\u003e\u003cp\u003eIn the present study, we demonstrated that rehabilitation programs targeting mobility (including transfers, stair climbing, and hand use), self-care (such as toileting, dressing, bathing, and eating), and domestic activities (including shopping, cooking, and cleaning) were widely implemented. In patients with SCD, assistance with ADLs, as measured using the FIM, and IADLs, as assessed using the Lawton IADL scale, becomes necessary at a SARA score of 12, and full assistance across all items is required at a score of 20 [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. As ataxia severity progresses, difficulties in ADLs tend to arise in the following order: communication, mobility, self-care, toileting, social cognition, and transfer. For IADLs, difficulties appear in shopping, non-ambulatory mobility, household tasks, medication management, financial management, meal preparation, and telephone use [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Furthermore, previous studies have reported that patients who experience difficulty walking often struggle with self-care and fine motor tasks. Given these findings, the identification of ICF categories related to mobility (such as transfers and standing) and self-care (including toileting, dressing, eating, and bathing) in this study suggests that rehabilitation programs tailored to ataxia severity are necessary to support ADL performance in individuals with SCD.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEnvironmental factors\u003c/b\u003e\u003c/p\u003e\u003cp\u003eRehabilitation programs targeting EFs were linked to ICF codes related to products and technology, support and relationships, and services, systems, and policies. These programs were designed to address fall prevention and promote independence (including walking, eating, and bathing) in patients with cerebellar degenerative disorders, encompassing physical, interpersonal, and social dimensions. Many patients with SCD disorders, whose primary symptoms include gait and balance disturbances, have a history of falls [\u003cspan additionalcitationids=\"CR34\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. In such cases, the use of assistive devices (including mobility aids and self-help tools) and environmental modifications represents effective strategies for fall prevention and fostering independence by immediately stabilizing movement. Educational interventions focused on ADLs (such as walking, toileting, eating, bathing, and stair climbing) and home-based exercises are aimed at supporting family members, friends, and healthcare professionals in the home setting by enhancing their understanding of patients\u0026rsquo; physical capabilities and appropriate caregiving techniques. These efforts are intended to optimize ADL assistance and prevent disuse syndromes by promoting appropriate levels of physical activity. After discharge, patients can access suitable assistive devices and medical services based on their disability status through the national social insurance system.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSelf-exercise\u003c/b\u003e\u003c/p\u003e\u003cp\u003eRehabilitation programs related to self-directed (home-based or independent) exercises were linked to ICF codes that encompass functioning, including BFs and body structures, and APs. Previous studies have similarly reported that most self-directed exercises are aimed at improving BFs [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], and in the present study, over 80% of the collected self-directed rehabilitation programs were focused on this category. Since self-directed exercises are performed without direct supervision, safety considerations are paramount, often resulting in programs designed to be conducted in bed or at the bedside, with a primary focus on BFs. Nevertheless, rehabilitation programs aimed at practicing essential ADL tasks tailored to individual needs were also identified in this study. In the context of rehabilitation for cerebellar degenerative disorders, personalized programs emphasizing meaningful activities and participation are indispensable for enhancing QOL. Such programs should be optimized to support not only BF but also engagement in personally relevant and socially significant activities.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSome unresolved limitations exist in clarifying the ICF categories targeted by multidisciplinary rehabilitation programs. First, as this study was a retrospective survey of multidisciplinary rehabilitation programs, there is a possibility that specific rehabilitation interventions were not reported because of the respondents' cognitive bias. Second, items addressing the specific objectives of each rehabilitation program were not included in the survey, which may have resulted in some interventions not being accurately linked to appropriate ICF categories. Nevertheless, respondents were instructed to consult medical records and treatment plans when completing the survey. The process of linking interventions to ICF categories was discussed among multiple reviewers, supporting the overall validity of the categorization. Third, the interpretation of this study was based on the frequency of ICF categories associated with the reported rehabilitation programs rather than on the dosage of multidisciplinary rehabilitation. Accordingly, the analysis of disease severity was limited to a comparison of the types of categories identified, without reflecting the intensity or volume of interventions. Fourth, only a limited range of disease subtypes were included in the study, and it remains possible that rehabilitation programs may vary according to disease subtype.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe multifaceted rehabilitation program for SCD was associated with ICF categories encompassing BFs, APs, EFs, and PFs. Furthermore, ataxia severity was found to influence the selection and adaptation of rehabilitation programs targeting APs. These findings suggest that multiple intervention components may contribute to improving ADLs through rehabilitation therapy. In the future, a more detailed ICF-based framework may help identify optimal combinations of intervention characteristics, such as content, frequency, intensity, duration, and complexity, to enhance therapeutic outcomes in SCD.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEditorial support in the form of medical writing, assembling tables, creating high-resolution images based on detailed directions, collating author comments, copy editing, fact-checking, and referencing was provided by Editage.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthor contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eY.H., H.F., H.O., K.T. (Kenji Takamatsu), M.H., H.Y., and I.M. contributed to the conception and design of the study, statistical analysis, drafting of the text, and preparation of the figures. Data collection and analysis were performed by Y.H., K.T. (Kenji Takamatsu), H.S., K.T. (Koji Takahashi), and H.F. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by a Grant-in-Aid from the Research Committee of Ataxia through the Health and Labor Sciences Research Grants program of the Ministry of Health, Labor, and Welfare, Japan, under grant number 23FC1010 (to IM).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData availability\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analyzed during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki.\u0026nbsp;Approval was granted by the Ethics Committee of Morinomiya Hospital (Approval No. 573).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests to declare that are relevant to the content of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective study was conducted using an opt-out approach, as approved by the Institutional Review Board of Morinomiya Hospital. Study information was made publicly available, and potential participants were given the opportunity to decline inclusion. Accordingly, the requirement for informed consent was waived.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent to publish\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable, as no identifying information or images are included in the article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization; 2024. Rehabilitation. https://www.who.int/news-room/fact-sheets/detail/rehabilitation. Accessed 18 Mar 2025\u003c/li\u003e\n\u003cli\u003eMilne SC, Roberts M, Williams S, Chua J, Grootendorst AC, Agostinelli G, et al. Goal-directed rehabilitation versus standard care for individuals with hereditary cerebellar ataxia: a multicenter, single-blind, randomized controlled superiority trial. 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Mov Disord. 2005;20:497\u0026ndash;500. https://doi.org/10.1002/mds.20375\u003c/li\u003e\n\u003cli\u003eLessard I, Gagnon C, Tremblay M, Girard-C\u0026ocirc;t\u0026eacute; L, C\u0026ocirc;t\u0026eacute; I, Aubertin-Leheudre M, et al. A tailored home-based training program improved ataxia severity and participation in adults with ARSACS. Cerebellum. 2025;24:63. https://doi.org/10.1007/s12311-025-01816-z\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 3 to 8 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Spinocerebellar degeneration, Rehabilitation program, ICF framework, ICF code, ICF linking, Standardization","lastPublishedDoi":"10.21203/rs.3.rs-7183654/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7183654/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe optimal dosage and content of effective multifaceted rehabilitation programs for patients with spinocerebellar degeneration (SCD) remain unclear. We aimed to identify the International Classification of Functioning, Disability and Health (ICF) categories targeted by multifaceted SCD rehabilitation programs.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA multifaceted, short-term, intensive inpatient rehabilitation program was retrospectively analyzed in 55 patients with SCD, including those with spinocerebellar ataxia types 3, 6, 17, and 31, and dentatorubral-pallidoluysian atrophy, cortical cerebellar atrophy, or unknown types. Therapists in each discipline (physical, occupational, and speech therapies) extracted rehabilitation programs related to functioning (body functions along with activities and participation) and contextual factors (environmental and personal) from medical records. These programs were linked to the ICF and the Deutsche Gesellschaft f\u0026uuml;r Sozialmedizin und Pr\u0026auml;vention categories based on the ICF linking rules. ICF categories were identified according to ataxia severity, as determined using the Scale for the Assessment and Rating of Ataxia.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOverall, 1258 rehabilitation programs were linked to 1341 second-level ICF categories: 13 for body functions, 23 for activities and participation, 6 for environmental factors, and 1 for personal factors. Activity and participation categories related to mobility (transfers and standing) and self-care (toileting, dressing, eating, and bathing) were identified according to ataxia severity and varied with disease progression. Conversely, body function programs were linked to similar ICF categories regardless of ataxia severity.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eMultifaceted rehabilitation for SCD is associated with ICF domains, and activity-based interventions vary by ataxia severity, suggesting that multiple components may improve activities of daily living.\u003c/p\u003e","manuscriptTitle":"Identification of International Classification of Functioning, Disability and Health categories in a multifaceted rehabilitation program for spinocerebellar degeneration","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-25 18:13:05","doi":"10.21203/rs.3.rs-7183654/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"186e712b-00f6-48c4-b0a3-1c4ce4ce7a59","owner":[],"postedDate":"July 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-01T09:54:05+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-25 18:13:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7183654","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7183654","identity":"rs-7183654","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}