Direct visualisation of gaze and hypometric saccades in cerebellar patients during visually guided stepping.

Four patients suffering from primary cerebellar degeneration and healthy matched controls undertook a test of functional mobility that demanded precise foot placement at each step. Vertical and horizontal eye movements were measured (using a head mounted eye tracking system) together with footfall patterns. Healthy subjects stepped accurately onto all targets and produced a clear pattern of saccadic eye movements, fixating each target in the sequence just prior to footlift. Still video frames, showing direction of gaze while walking, provide direct visual confirmation that these saccades serve to transfer gaze between successive targets in the walkway sequence. The planning of the saccade to the next target probably provides the locomotor control system with information useful for planning the corresponding (and shortly following) step. Cerebellar patients showed characteristic locomotor and oculomotor deficits. Dysmetric saccades to fixate footfall targets were seen in 39% of steps. Analysis confirms that these multi-saccadic eye movements include an initial hypometric saccade, which undershoots the target, followed by one or more additional saccades in the same direction. Direct visualisation of gaze at the end of a saccadic sequence confirms that these additional saccades are indeed corrective resulting in a foveal image of the footfall target.