Computational Sensomotorics Section, Department of Cognitive Neurology, Hertie Institute for Clinical Brain Research, and Centre for Integrative Neuroscience, University of Tübingen, Tübingen, Germany.
Mov Disord. 2013 Sep 15;28(11):1566-75. doi: 10.1002/mds.25558.
It is well known that the cerebellum is important for movement control and plays a critical role in balance and locomotion. As such, one of the most characteristic and sensitive signs of cerebellar damage is gait ataxia. However, characterizing ataxic gait is no easy task, because gait patterns are highly variable. This variability seems to result from the interaction of different factors, namely, (1) the primary motor deficits in balance control and multi-joint coordination and oculomotor dysfunction, (2) the safety strategies used, and (3) inaccurate adjustments in patients with loss of balance. In this report, we review different approaches to analyzing ataxic gait and studies to identify and quantify the different factors contributing to this movement disorder. We also discuss the influence of the cerebellum in adaptive locomotor control, the interaction between cognitive load and gait in dual-task paradigms, and the recent advances in rehabilitation of gait and posture for patients with cerebellar degeneration. In the second part, we discuss open questions concerning cerebellar mechanisms in multi-joint coordination during different walking conditions. Furthermore, we point out potential future directions in motor rehabilitation, with the objective of identifying predictors of rehabilitation outcome and the development of individualized training programs that potentially involve rehabilitation technology.
众所周知，小脑对于运动控制非常重要，在平衡和运动中起着关键作用。因此，小脑损伤最典型和敏感的标志之一是步态共济失调。然而，描述共济失调步态并非易事，因为步态模式变化多样。这种可变性似乎源于多种因素的相互作用，即（1）平衡控制和多关节协调以及眼球运动功能障碍的主要运动缺陷，（2）使用的安全策略，以及（3）平衡丧失患者的不准确调整。在本报告中，我们回顾了分析共济失调步态的不同方法以及研究确定和量化导致这种运动障碍的不同因素的研究。我们还讨论了小脑在适应性运动控制中的影响、认知负荷与双任务范式中步态的相互作用，以及针对小脑退行性变患者步态和姿势康复的最新进展。在第二部分中，我们讨论了有关小脑在不同行走条件下多关节协调中的机制的一些悬而未决的问题。此外，我们指出了运动康复的潜在未来方向，目的是确定康复结果的预测因素，并制定可能涉及康复技术的个体化训练计划。
