背景與目的：物理治療被證實可以改善退化性小腦損傷患者的動作功能。不過，這類研究目前只侷限在 輕微損傷患者，且鮮少提供個別化治療策略。本個案報告目的在探討以動作再學習計畫為基礎的個別化介入， 對嚴重退化性小腦共濟失調個案的臨床效益。方法：一位68 歲男性、散發型小腦共濟失調個案，多年依賴輪 椅移行。根據動作再學習計畫四步驟，找出個案特有動作缺失成分，並提供個別化任務導向訓練。訓練時間共 8 週，每週3 次，每次45 ~ 60 分鐘。以共濟失調等級量表、柏格氏平衡量表、巴氏量表、10 m 行走測試與步 態等評估動作功能。結果：經過8 週訓練，在共濟失調等級量表、柏格氏平衡量表與巴氏量表上，個案進步分 數分別是6 分、16 分與15 分。10 m 行走測試，在使用助行器下，由最大協助進步到接觸保護，且完成時間由 300 秒進步到181 秒。此外，個案行走時重心轉移能力有改善，左腳步伐變大，對跌倒恐懼明顯降低。個案自 覺生活品質有很大改善。結論：依據動作再學習計畫擬定的個別化訓練，有助於嚴重退化性小腦共濟失調患者 之平衡、坐站及行走等動作功能表現。以動作再學習計畫提供個別化訓練是可行且有臨床效益，本個案報告可 提供未來治療嚴重退化性小腦疾病的決策思考方向。

Background and Purpose: Physiotherapy has been shown to improve the motor function of the patients with degenerative cerebellar ataxia. However, the subjects with severe ataxia and the individualized treatment strategies were rarely involved. The purpose of this case study is to investigate the effects of motor relearning program (MRP)-based individualized training on motor function in a subject with severe degenerative cerebellar ataxia. Methods: A 68-yearold male who had a sporadic cerebellar ataxia 6 years prior and wheelchair-bounded for 3 years was included. Based on the four steps of MRP, the subject-specific missing motor components were identified, and then the individualized task-oriented training programs consisted of 45- to 60-min thrice-weekly sessions for 8 weeks were provided. Motor function was assessed by the Scale for the Assessment and Rating of Ataxia (SARA), Berg Balance Scale (BBS), Barthel Index (BI), 10-meter walk test (10MWT) and gait pattern. Results: After 8-week training, the subject had improved scores on SARA, BBS and BI, with 6, 16 and 15 point gains, respectively. In 10MWT, the subject showed improvements in walking time (300 s vs. 181 s) and physical assistance (maximum assistant vs. contact guard). In addition, the symmetry of weight shifting and step length during walking as well as the self-report quality of life had improved. Conclusions: This case report demonstrates individualized training based on MRP can improve balance, sit-to-stand and walking ability in a subject with advanced degenerative cerebellar ataxia. MRP-based individualized training is feasible and effective, which could provide a way to think about the future treatment of the severe degenerative cerebellum ataxia.