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.
摘要：
这篇共识论文的目的是讨论小脑在人类步态中的作用，以及它的评估和治疗。小脑疣对姿势控制至关重要。小脑确保将感觉信息映射到时间相关的运动命令中。步态的心理意象涉及包含小脑的内在联系的额顶叶网络。小脑患者的肌肉活动显示放电时间受损，影响协同作用的模式。姿态/步态共济失调是小脑疾病如退行性共济失调中的第一小脑缺陷之一,并且是具有高跌倒风险的致残症状。长时间的放电和增加的肌肉共激活可能与代偿机制和增强的身体摇摆有关，分别。原发性震颤常伴有轻度步态共济失调。越来越多的证据表明小脑皮层在特发性震颤的发病机理中起着重要作用。在多发性硬化症中，由于小脑和脊髓受累，平衡和步态受到影响，由于播散性脱髓鞘和神经变性损害本体感觉。在直立性震颤中，患者常表现为轻度至中度肢体和步态共济失调。震颤发生器可能位于后颅窝。串联步态在小脑疾病的早期阶段受损，可能在评估进行性共济失调的共济失调前期特别有用。诸如加速度计的可穿戴设备可以掌握步态时间和动力学参数的受损的关节间协调和增强的可变性。Kinect是一种有前途的低成本技术，可以获得可靠的步态测量和远程评估。正在开发深度学习方法，以帮助临床医生进行诊断和决策。小脑患者的运动适应受损。协调培训旨在提高跨步的协调策略和脚部位置，小脑患者受益于强烈的康复治疗。机器人训练是补充小脑常规康复和神经调节的一种有前途的方法。可穿戴动态矫形器代表了辅助步态的潜在辅助。专家小组一致认为，对小脑对步态控制的贡献的理解将导致更好地管理小脑共济失调，并可能有助于将步态参数用作未来临床试验的可靠生物标志物。
