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PubMed\/MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane CENTRAL were searched from inception to April 16, 2025. Randomized and nonrandomized interventional studies evaluating rehabilitation, speech therapy, noninvasive neuromodulation (repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation [tDCS]), virtual reality, vibration therapy, biofeedback\u2010based, assistive devices, and complementary approaches were included. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklists. Given substantial clinical and methodological heterogeneity, findings were consolidated narratively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 100 studies met inclusion criteria. Structured physical therapy, rTMS, and tDCS demonstrated statistically significant short\u2010term reductions in ataxia severity (measured using Scale for the Assessment and Rating of Ataxia [SARA] or International Cooperative Ataxia Rating Scale [ICARS]). Improvements were most consistent in axial domains, including gait and postural control. Limited mechanistic studies reported restoration of cerebellar inhibitory modulation, increased cerebellar\u2013frontal connectivity, and enhanced regional perfusion following tDCS. Evidence for speech therapy, virtual reality\u2013based rehabilitation, vibration therapy and complementary approaches was limited. Across all modalities, durability beyond the short\u2010term remained unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>NPI may confer short\u2010term symptomatic and functional benefits in degenerative cerebellar ataxia, particularly in axial motor domains, supported by the largest evidence for structured rehabilitation followed by neuromodulation, although heterogeneous. Future multicenter, biomarker\u2010informed trials are required to define optimal dosing, durability and stage\u2010specific therapeutic strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mdc3.70880","type":"journal-article","created":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:57:08Z","timestamp":1792810628000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nonpharmacological Interventions in Degenerative Cerebellar Ataxia: A Systematic Review"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0532-3370","authenticated-orcid":false,"given":"Divyani","family":"Garg","sequence":"first","affiliation":[{"name":"Department of Neurology All India Institute of Medical Sciences  New Delhi 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