Gait ataxia in humans: vestibular and cerebellar control of dynamic stability
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During human locomotion, vestibular feedback control is fundamental for maintaining dynamic stability and adapting the gait pattern to external circumstances. Within the supraspinal locomotor network, the cerebellum represents the key site for the integration of vestibular feedback information. The cerebellum is further important for the fine-tuning and coordination of limb movements during walking. The aim of this review article is to highlight the shared structural and functional sensorimotor principles in vestibular and cerebellar locomotion control. Vestibular feedback for the maintenance of dynamic stability is integrated into the locomotor pattern via midline, caudal cerebellar structures (vermis, flocculonodular lobe). Hemispheric regions of the cerebellum facilitate feed-forward control of multi-joint coordination and higher locomotor functions. Characteristic features of the gait disorder in patients with vestibular deficits or cerebellar ataxia are increased levels of spatiotemporal gait variability in the fore-aft and the medio-lateral gait dimension. In the fore-aft dimension, pathologic increases of gait fluctuations critically depend on the locomotion speed and predominantly manifest during slow walking velocities. This feature is associated with an increased risk of falls in both patients with vestibular hypofunction as well as patients with cerebellar ataxia. Pharmacological approaches for the treatment of vestibular or cerebellar gait ataxia are currently not available. However, new promising options are currently tested in randomized, controlled trials (fampridine/FACEG; acetyl-dl-leucine/ALCAT).
KeywordsVestibular system Vestibulopathy Cerebellar ataxia Gait Falls Fall-related injury Gait speed
The work was supported by Federal Ministry for Education and Science (BMBF, IFB 01EO1401) of Germany.
Compliance with ethical standards
Conflict of interest
Roman Schniepp declares that there are no financial disclosures or conflicts of interest. Ken Möhwald declares that there are no financial disclosures or conflicts of interest. Max Wuehr declares that there are no financial disclosures or conflicts of interest.
Funding sources for the study
The work was supported by the Federal Ministry for Education and Science (BMBF, Nr. 80121000-49) of Germany.
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