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Journal Articles The Cerebellum Year : 2023

Consensus Paper: Ataxic Gait

Pierre Cabaraux
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Sunil Kumar Agrawal
  • Function : Author
Huaying Cai
  • Function : Author
Rocco Salvatore Calabro
Carlo Casali
  • Function : Author
Sarah J. Doss
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Anja Kerstin Ellen Horn
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Winfried Ilg
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Elan Daniel Louis
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Hiroshi Mitoma
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Vito Monaco
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Maria Petracca
Alberto Ranavolo
Ashwini K. Rao
Serena Ruggieri
Tommaso Schirinzi
Mariano Serrao
Susanna Summa
Michael Leo Strupp
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Olivia J. Surgent
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Matthis Synofzik
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Shuai Tao
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Hiroo Terasi
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Diego R. Torres-Russotto
Brittany G. Travers
Jaimie A. Roper
Mario Ubaldo Manto
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Abstract

The aim of this consensus paper is to discuss the roles of the cerebellum in human gait, as well as its assessment and therapy. Cerebellar vermis is critical for postural control. The cerebellum ensures the mapping of sensory information into temporally relevant motor commands. Mental imagery of gait involves intrinsically connected fronto-parietal networks comprising the cerebellum. Muscular activities in cerebellar patients show impaired timing of discharges, affecting the patterning of the synergies subserving locomotion. Ataxia of stance/gait is amongst the first cerebellar deficits in cerebellar disorders such as degenerative ataxias and is a disabling symptom with a high risk of falls. Prolonged discharges and increased muscle coactivation may be related to compensatory mechanisms and enhanced body sway, respectively. Essential tremor is frequently associated with mild gait ataxia. There is growing evidence for an important role of the cerebellar cortex in the pathogenesis of essential tremor. In multiple sclerosis, balance and gait are affected due to cerebellar and spinal cord involvement, as a result of disseminated demyelination and neurodegeneration impairing proprioception. In orthostatic tremor, patients often show mild-to-moderate limb and gait ataxia. The tremor generator is likely located in the posterior fossa. Tandem gait is impaired in the early stages of cerebellar disorders and may be particularly useful in the evaluation of pre-ataxic stages of progressive ataxias. Impaired inter-joint coordination and enhanced variability of gait temporal and kinetic parameters can be grasped by wearable devices such as accelerometers. Kinect is a promising low cost technology to obtain reliable measurements and remote assessments of gait. Deep learning methods are being developed in order to help clinicians in the diagnosis and decision-making process. Locomotor adaptation is impaired in cerebellar patients. Coordinative training aims to improve the coordinative strategy and foot placements across strides, cerebellar patients benefiting from intense rehabilitation therapies. Robotic training is a promising approach to complement conventional rehabilitation and neuromodulation of the cerebellum. Wearable dynamic orthoses represent a potential aid to assist gait. The panel of experts agree that the understanding of the cerebellar contribution to gait control will lead to a better management of cerebellar ataxias in general and will likely contribute to use gait parameters as robust biomarkers of future clinical trials.
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hal-04106332 , version 1 (25-05-2023)

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Pierre Cabaraux, Sunil Kumar Agrawal, Huaying Cai, Rocco Salvatore Calabro, Carlo Casali, et al.. Consensus Paper: Ataxic Gait. The Cerebellum, 2023, 22 (3), pp.394-430. ⟨10.1007/s12311-022-01373-9⟩. ⟨hal-04106332⟩
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