Brain Advance Access originally published online on October 3, 2008
Brain 2008 131(11):2913-2927; doi:10.1093/brain/awn246
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The influence of focal cerebellar lesions on the control and adaptation of gait
1Section Computational Sensomotorics, Department of Cognitive Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, 2Department of Neuroradiology, 3Department of Neurosurgery and 4Department of Neurology, University of Duisburg-Essen, Germany
Correspondence to: Winfried Ilg, Section Computational Sensomotorics, Department of Cognitive Neurology, Hertie Institute for Clinical Brain Research, Frondsbergstrasse 23, 72076 Tübingen, Germany E-mail: winfried.ilg{at}uni-tuebingen.de
Cerebellar ataxic gait is influenced greatly by balance disorders, most likely caused by lesions of the medial zone of the cerebellum. The contributions of the intermediate and lateral zone to the control of limb dynamics for gait and the adaptation of locomotor patterns are less well understood. In this study, we analysed locomotion and goal-directed leg movements in 12 patients with chronic focal lesions after resection of benign cerebellar tumours. The extent of the cortical lesion and possible involvement of the cerebellar nuclei was determined by 3D-MR imaging. The subjects (age range 13–39 years, mean 20.3; seven female; ICARS score: mean 5.7, SD 6.3) performed three tasks: goal-directed leg placement, walking and walking with additional weights on the shanks. Based on the performance on the first two tasks, patients were categorized as impaired or unimpaired for leg placement and for dynamic balance control in gait. The subgroup with impaired leg placement but not the subgroup with impaired balance showed abnormalities in the adaptation of locomotion to additional loads. A detailed analysis revealed specific abnormalities in the temporal aspects of intra-limb coordination for leg placement and adaptive locomotion. These findings indicate that common neural substrates could be responsible for intra-limb coordination in both tasks. Lesion-based MRI subtraction analysis revealed that the interposed and the adjacent dentate nuclei were more frequently affected in patients with impaired compared to unimpaired leg placement, whereas the fastigial nuclei (and to a lesser degree the interposed nuclei) were more frequently affected in patients with impaired compared with unimpaired dynamic balance control. The intermediate zone appears thus to be of particular importance for multi-joint limb control in both goal-directed leg movements and in locomotion. For locomotion, our results indicate an influence of the intermediate zone on dynamic balance control as well as on the adaptation to changes in limb dynamics.
Key Words: cerebellum; locomotion; adaptation; intra-limb coordination; brain imaging
Abbreviations: CP, patients with cerebellar lesions; HC, healthy controls; IB, impaired balance in gait; ICARS, International Cooperative Ataxia Rating Scale; IL, impaired leg placement; ND, dentate nuclei; NI, interposed nuclei; NIB, unimpaired balance in gait; NIL, unimpaired leg placement; ROI, region of interest
Received December 21, 2007. Revised September 2, 2008. Accepted September 8, 2008.
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