Visuomotor learning in cerebellar patients

The cerebellum is not necessary for visually driven recalibration of hand proprioception

Decades of research have implicated both cortical and subcortical areas, such as the cerebellum, as playing an important role in motor learning, and even more recently, in predicting the sensory consequences of movement. Still, it is unknown whether the cerebellum also plays a role in recalibrating sensory estimates of hand position following motor learning. To test this, we measured proprioceptive estimates of static hand position in 19 cerebellar patients with local ischemic lesions and 19 healthy controls, both before and after reach training with altered visual feedback of the hand. This altered visual feedback, (30° cursor-rotation) was gradually introduced in order to facilitate reach adaptation in the patient group. We included two different types of training (in separate experiments): the typical visuomotor rotation training where participants had full volition of their hand movements when reaching with the cursor, and sensory exposure training where the direction of participants׳ hand movements were constrained and gradually deviated from the cursor motion (Cressman, E. K., Henriques, D. Y., 2010. Reach adaptation and proprioceptive recalibration following exposure to misaligned sensory input. J. Neurophysiol., vol. 103, pp. 1888-1895). We found that both healthy individuals and patients showed equivalent shifts in their felt hand position following both types of training. Likewise, as expected given that the cursor-rotation was introduced gradually, patients showed comparable reach aftereffects to those of controls in both types of training. The robust change in felt hand position across controls and cerebellar patients suggests that the cerebellum is not involved in proprioceptive recalibration of the hand.

Effect of long-term climbing training on cerebellar ataxia: a case series

Background. Efficient therapy for both limb and gait ataxia is required. Climbing, a complex task for the whole motor system involving balance, body stabilization, and the simultaneous coordination of all 4 limbs, may have therapeutic potential. Objective. To investigate whether long-term climbing training improves motor function in patients with cerebellar ataxia. Methods. Four patients suffering from limb and gait ataxia underwent a 6-week climbing training. Its effect on ataxia was evaluated with validated clinical balance and manual dexterity tests and with a kinematic analysis of multijoint arm and leg pointing movements. Results. The patients increased their movement velocity and achieved a more symmetric movement speed profile in both arm and leg pointing movements. Furthermore, the 2 patients who suffered the most from gait ataxia improved their balance and 2 of the 4 patients improved manual dexterity. Conclusion. Climbing training has the potential to serve as a new rehabilitation method for patients with upper and lower limb ataxia.

Cerebellar ataxia: pathophysiology and rehabilitation

This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is 'The trainee consistently demonstrates a knowledge of management approaches for specific impairments including spasticity, ataxia.'

Force field effects on cerebellar Purkinje cell discharge with implications for internal models

The cerebellum has been hypothesized to provide internal models for limb movement control. If the cerebellum is the site of an inverse dynamics model, then cerebellar neural activity should signal limb dynamics and be coupled to arm muscle activity. To address this, we recorded from 166 task-related Purkinje cells in two monkeys performing circular manual tracking under varying viscous and elastic loads. Hand forces and arm muscle activity increased with the load, and their spatial tuning differed markedly between the viscous and elastic fields. In contrast, the simple spike firing of 91.0% of the Purkinje cells was not significantly modulated by the force nor was their spatial tuning affected. For the 15 cells with a significant force effect, changes were small and isolated. These results do not support the hypothesis that Purkinje cells represent the output of an inverse dynamics model of the arm. Instead these neurons provide a kinematic representation of arm movements.

Motor learning in children with spina bifida: dissociation between performance level and acquisition rate

The cerebellum is part of a neural circuit involved in procedural motor learning. We examined how congenital cerebellar malformations affect mirror drawing performance, a procedural learning task that involves learning to trace the outline of a star while looking at the reflection of the star in a mirror. Participants were 88 children with spina bifida myelomeningocele, a neural tube defect that results in lesions of the spinal cord, dysmorphology of the cerebellum, and requires shunt treatment for hydrocephalus, and 35 typically developing controls. Participants completed 10 trials in the morning and 10 trials following a 3-hr delay. Although children with spina bifida myelomeningocele were initially slower at tracing and made more errors than controls, all participants improved their performance of the task, as demonstrated by increased speed and accuracy across trials. Moreover, degree of cerebellar dysmorphology was not correlated with level of performance, rate of acquisition, or retention of mirror drawing. The results suggest that congenital cerebellar dysmorphology in spina bifida does not impair motor skill learning as measured by acquisition and retention of the mirror drawing task.

Adaptive motor behavior of cerebellar patients during exposure to unfamiliar external forces

The authors investigated adaptation of goal-directed forearm movements to an unknown external viscous force assisting forearm flexion in 6 patients with cerebellar dysfunction and in 6 control participants. Motor performance was generally degraded in cerebellar patients and was markedly reduced under the force condition in both groups. However, patients and controls were able to adapt to the novel force within 8 trials. Only the healthy controls were able to improve motor performance when readapting to a null-force condition. The results indicate that cerebellar patients' motor control system has imprecise estimations of actual limb dynamics at its disposal. Force adaptation may have been preserved because single-joint movements were performed, whereas the negative viscous force alone and no interaction forces had to be compensated.

Task-dependent role of the cerebellum in motor learning

This chapter reviews several findings from our laboratory supporting the hypothesis that the cerebellum's role in motor learning is task-dependent. Namely, its contribution is dependent on the specific task being learned. Several studies are reviewed to demonstrate that the effect of temporary or permanent cerebellar lesions on a specific process such as storage varies depending on the behavior. Furthermore, this task-dependency is reflected also in the modulation of Purkinje cells and nuclear neurons recorded during the learning process. The behavioral correlates of this modulation are very paradigm specific. These observations support the above hypothesis and emphasize the importance of paradigm selection in designing experiments focused on elucidating the cerebellum's role in learning a specific motor behavior.

Cerebellar damage impairs automaticity of a recently practiced movement

It has been suggested that the cerebellum plays a critical role in learning to make movements more "automatic" (i.e., requiring less attention to the details of a movement). We hypothesized that cerebellar damage compromises learning of movement automaticity, resulting in increased attentional demands for movement control. The purpose of our study was to determine whether cerebellar damage disrupts the ability to make a practiced movement more automatic. We developed a dual task paradigm using two tasks that did not have overlapping sensory or motor requirements for execution. Our motor task required subjects to maintain an upright posture while performing a figure-8 movement using their arm. This motor task was chosen to simulate requirements of everyday movements (e.g., standing while reaching for objects), but it was novel enough to require practice for improvement. Our secondary task was an auditory vigilance task where subjects listened to letter sequences and were asked to identify the number of times a target letter was heard. We tested controls and people with cerebellar damage as they practiced the movement task alone and then performed it with the auditory task. We recorded 3D position data from the arm, trunk, and leg during the movement task. Errors were recorded for both the movement and the letter tasks. Our results show that cerebellar subjects can improve the movement to a very limited extent with practice. Unlike controls, the motor performance of cerebellar subjects deteriorates to prepractice levels when attention is focused away from the movement during dual task trials. Control subjects' insensitivity to dual task interference after practice was due to learned movement automaticity and was not a reflection of better dual task performance generally. Overall, our findings suggest that the cerebellum may be important for shifting movement performance from an attentionally demanding (unpracticed) state to a more automatic (practiced) state.

Effects of dentate nucleus lesions on spatial and postural sensorimotor learning in rats

The role of the dentate nucleus on spatial orientation, assessed by the Morris water maze test, and on postural sensorimotor performance, assessed by vertical grid, suspended wire, and rotorod tests, was investigated. Bilateral electrolytic lesions of the dentate nucleus slowed down the acquisition of the hidden platform task of the Morris water maze, without affecting long-term retention, the probe trial, and the visuomotor guidance necessary for swimming toward a visible goal. In addition, reversal learning was impaired in the submerged platform condition. The lesions did not affect any of the motor performance scores. The selective impairment seen during acquisition of the hidden platform task is similar to that previously reported in rats with combined lesions of the cerebellar hemispheres and dentate, indicating a specific role for this region in spatial orientation.

Effects of accuracy constraints on reach-to-grasp movements in cerebellar patients

Reach-to-grasp movements of patients with pathology restricted to the cerebellum were compared with those of normal controls. Two types of paradigms with different accuracy constraints were used to examine whether cerebellar impairment disrupts the stereotypic relationship between arm transport and grip aperture and whether the variability of this relationship is altered when greater accuracy is required. The movements were made to either a vertical dowel or to a cross bar of a small cross. All subjects were asked to reach for either target at a fast but comfortable speed, grasp the object between the index finger and thumb, and lift it a short distance off the table. In terms of the relationship between arm transport and grip aperture, the control subjects showed a high consistency in grip aperture and wrist velocity profiles from trial to trial for movements to both the dowel and the cross. The relationship between the maximum velocity of the wrist and the time at which grip aperture was maximal during the reach was highly consistent throughout the experiment. In contrast, the time of maximum grip aperture and maximum wrist velocity of the cerebellar patients was quite variable from trial to trial, and the relationship of these measurements also varied considerably. These abnormalities were present regardless of the accuracy requirement. In addition, the cerebellar patients required a significantly longer time to grasp and lift the objects than the control subjects. Furthermore, the patients exhibited a greater grip aperture during reach than the controls. These data indicate that the cerebellum contributes substantially to the coordination of movements required to perform reach-to-grasp movements. Specifically, the cerebellum is critical for executing this behavior with a consistent, well-timed relationship between the transport and grasp components. This contribution is apparent even when accuracy demands are minimal.

Impaired capacity of cerebellar patients to perceive and learn two-dimensional shapes based on kinesthetic cues

This study addresses the issue of the role of the cerebellum in the processing of sensory information by determining the capability of cerebellar patients to acquire and use kinesthetic cues received via the active or passive tracing of an irregular shape while blindfolded. Patients with cerebellar lesions and age-matched healthy controls were tested on four tasks: (1) learning to discriminate a reference shape from three others through the repeated tracing of the reference template; (2) reproducing the reference shape from memory by drawing blindfolded; (3) performing the same task with vision; and (4) visually recognizing the reference shape. The cues used to acquire and then to recognize the reference shape were generated under four conditions: (1) "active kinesthesia," in which cues were acquired by the blindfolded subject while actively tracing a reference template; (2) "passive kinesthesia," in which the tracing was performed while the hand was guided passively through the template; (3) "sequential vision," in which the shape was visualized by the serial exposure of small segments of its outline; and (4) "full vision," in which the entire shape was visualized. The sequential vision condition was employed to emulate the sequential way in which kinesthetic information is acquired while tracing the reference shape. The results demonstrate a substantial impairment of cerebellar patients in their capability to perceive two-dimensional irregular shapes based only on kinesthetic cues. There also is evidence that this deficit in part relates to a reduced capacity to integrate temporal sequences of sensory cues into a complete image useful for shape discrimination tasks or for reproducing the shape through drawing. Consequently, the cerebellum has an important role in this type of sensory information processing even when it is not directly associated with the execution of movements.