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1 Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
2 Kennedy Krieger Institute, Baltimore, MD, USA; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
* To whom correspondence should be addressed. E-mail: bastian{at}kennedykrieger.org.
Different cerebellar regions participate in balance control and voluntary limb coordination, both of which might be important for normal bipedal walking. We wanted to determine the relative contributions of balance versus leg coordination deficits to cerebellar gait ataxia in humans. We studied 20 subjects with cerebellar damage and 20 control subjects performing three tasks: a lateral weight-shifting task to measure balance, a visually guided stepping task to measure leg coordination, and walking. We recorded 3D joint position data during all tasks, and center of pressure coordinates during weight-shifting. Each cerebellar subject was categorized as having either: no detectable deficits, a balance deficit only, a leg placement deficit only, or both deficits. We then determined the walking abnormalities associated with each of these categories. Five of ten measures of gait ataxia were abnormal in cerebellar subjects with a balance deficit, but only one was abnormal in cerebellar subjects with a leg placement deficit. Furthermore, subjects with a balance deficit performed worse than subjects with a leg placement deficit on nine of the ten gait measures. Finally, performance on the balance task, but not the leg placement task, explained a significant proportion of the variance in walking speed for the entire cerebellar group. We conclude that balance deficits are more closely related to cerebellar gait ataxia than leg placement deficits. Our findings are consistent with animal literature, which has suggested that cerebellar control of balance and gait are interrelated, and dissociable from cerebellar control of voluntary, visually guided limb movements.
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