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More Falls in Cerebellar Ataxia When Standing on a Slow Up-Moving Tilt of the Support Surface

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Abstract

We investigated how subjects with cerebellar ataxia (CA) adapt their postural stability and alignment to a slow and small tilt of the support surface allowing for online postural corrections. Eight subjects with CA and eight age- and gender-matched healthy control subjects participated in the study. Subjects stood eyes closed for 1 min after which the support surface was tilted 5° toes-up at a ramp velocity of 1°/s. The toes-up position was held for 2.5 min after which the surface rotated back down to level with identical tilt characteristics. As reflected by the large number of falls, subjects with CA had marked difficulty adapting their posture to the up-moving incline in contrast to control subjects. Subjects with CA who lost their balance had faster trunk velocity and excessive backward trunk reorientation beginning within the first second after onset of the tilting surface. In contrast, the down-moving tilt to level did not result in instability in CA subjects. These results suggest that instability and falls associated with CA derive from an inability to maintain trunk orientation to vertical while standing on a slow-moving or unstable surface. This study underscores the importance of the cerebellum in the online sensory control of the upper body orientation during small amplitude and slow velocity movements of the support surface.

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Abbreviations

ABC:

Activities-specific Balance Confidence scale

BESTest:

Balance Evaluation Systems Test

CA:

Cerebellar ataxia

COM:

Center of mass

COP:

Center of pressure

DTR:

Deep tendon reflex

LOB:

Loss of balance

MSA-C:

Multiple system atrophy cerebellar dysfunction subtype

SAOA:

Sporadic adult-onset ataxia

SARA:

Scale for the assessment and rating of ataxia

SCA:

Spinocerebellar ataxia

References

  1. van de Warrenburg BP, Steijns JA, Munneke M, Kremer BP, Bloem BR. Falls in degenerative cerebellar ataxias. Mov Disord. 2005;20:497–500.

    Article  PubMed  Google Scholar 

  2. Fonteyn EM, Schmitz-Hubsch T, Verstappen CC, Baliko L, Bloem BR, Boesch S, et al. Falls in spinocerebellar ataxias: Results of the EuroSCA Fall Study. Cerebellum. 2010;9:232–9.

    Article  PubMed  Google Scholar 

  3. Baloh RW, Jacobson KM, Beykirch K, Honrubia V. Static and dynamic posturography in patients with vestibular and cerebellar lesions. Arch Neurol. 1998;55:649–54.

    Article  CAS  PubMed  Google Scholar 

  4. Bakker M, Allum JH, Visser JE, Gruneberg C, van de Warrenburg BP, Kremer BH, et al. Postural responses to multidirectional stance perturbations in cerebellar ataxia. Exp Neurol. 2006;202:21–35.

    Article  PubMed  Google Scholar 

  5. Kung UM, Horlings CG, Honegger F, Kremer HP, Bloem BR, van De Warrenburg BP, et al. Postural instability in cerebellar ataxia: correlations of knee, arm and trunk movements to center of mass velocity. Neuroscience. 2009;159:390–404.

    Article  CAS  PubMed  Google Scholar 

  6. Oude Nijhuis LB, Hegeman J, Bakker M, Van Meel M, Bloem BR, Allum JH. The influence of knee rigidity on balance corrections: a comparison with responses of cerebellar ataxia patients. Exp Brain Res. 2008;187:181–91.

    Article  CAS  PubMed  Google Scholar 

  7. Horak FB, Diener HC. Cerebellar control of postural scaling and central set in stance. J Neurophysiol. 1994;72:479–93.

    CAS  PubMed  Google Scholar 

  8. Diener HC, Dichgans J, Bacher M, Guschlbauer B. Characteristic alterations of long-loop "reflexes" in patients with Friedreich's disease and late atrophy of the cerebellar anterior lobe. J Neurol Neurosurg Psychiatry. 1984;47:679–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Kawato M. Internal models for motor control and trajectory planning. Curr Opin Neurobiol. 1999;9:718–27.

    Article  CAS  PubMed  Google Scholar 

  10. Wolpert DM, Ghahramani Z, Jordan MI. An internal model for sensorimotor integration. Science. 1995;269:1880–2.

    Article  CAS  PubMed  Google Scholar 

  11. Day BL, Thompson PD, Harding AE, Marsden CD. Influence of vision on upper limb reaching movements in patients with cerebellar ataxia. Brain. 1998;121(Pt 2):357–72.

    Article  PubMed  Google Scholar 

  12. Kluzik J, Horak FB, Peterka RJ. Differences in preferred reference frames for postural orientation shown by after-effects of stance on an inclined surface. Exp Brain Res. 2005;162:474–89.

    Article  PubMed  Google Scholar 

  13. Schmitz-Hubsch T, du Montcel ST, Baliko L, Berciano J, Boesch S, Depondt C, et al. Scale for the assessment and rating of ataxia: development of a new clinical scale. Neurology. 2006;66:1717–20.

    Article  CAS  PubMed  Google Scholar 

  14. Allum JH, Honegger F, Pfaltz CR. The role of stretch and vestibulo-spinal reflexes in the generation of human equilibrating reactions. Prog Brain Res. 1989;80:399–409.

    Article  CAS  PubMed  Google Scholar 

  15. Beckley DJ, Bloem BR, Remler MP, Roos RA, Van Dijk JG. Long latency postural responses are functionally modified by cognitive set. Electroencephalogr Clin Neurophysiol. 1991;81:353–8.

    Article  CAS  PubMed  Google Scholar 

  16. Diener HC, Horak FB, Nashner LM. Influence of stimulus parameters on human postural responses. J Neurophysiol. 1988;59:1888–905.

    CAS  PubMed  Google Scholar 

  17. Henry SM, Fung J, Horak FB. Control of stance during lateral and anterior/posterior surface translations. IEEE Trans Rehabil Eng. 1998;6:32–42.

    Article  CAS  PubMed  Google Scholar 

  18. Nashner LM. Fixed patterns of rapid postural responses among leg muscles during stance. Exp Brain Res. 1977;30:13–24.

    Article  CAS  PubMed  Google Scholar 

  19. Horak FB, Nashner LM. Central programming of postural movements: adaptation to altered support-surface configurations. J Neurophysiol. 1986;55:1369–81.

    CAS  PubMed  Google Scholar 

  20. Soucie JM, Wang C, Forsyth A, Funk S, Denny M, Roach KE, et al. Range of motion measurements: reference values and a database for comparison studies. Haemophilia. 2011;17:500–7.

    Article  CAS  PubMed  Google Scholar 

  21. Jonsson E, Henriksson M, Hirschfeld H. Does the functional reach test reflect stability limits in elderly people? J Rehabil Med. 2003;35:26–30.

    Article  PubMed  Google Scholar 

  22. Welch TD, Ting LH. A feedback model explains the differential scaling of human postural responses to perturbation acceleration and velocity. J Neurophysiol. 2009;101:3294–309.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Earhart GM, Bastian AJ. Selection and coordination of human locomotor forms following cerebellar damage. J Neurophysiol. 2001;85:759–69.

    CAS  PubMed  Google Scholar 

  24. Van de Warrenburg BP, Bakker M, Kremer BP, Bloem BR, Allum JH. Trunk sway in patients with spinocerebellar ataxia. Mov Disord. 2005;20:1006–13.

    Article  PubMed  Google Scholar 

  25. Diener HC, Dichgans J, Bacher M, Gompf B. Quantification of postural sway in normals and patients with cerebellar diseases. Electroencephalogr Clin Neurophysiol. 1984;57:134–42.

    Article  CAS  PubMed  Google Scholar 

  26. Mauritz KH, Schmitt C, Dichgans J. Delayed and enhanced long latency reflexes as the possible cause of postural tremor in late cerebellar atrophy. Brain. 1981;104:97–116.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors thank Cristiane Zampieri and Kelly Bartow for their help with data collection as well as Triana Nagel for her help in the subject recruitment and data collection. This research was supported by the NIH R01-DC004082 and NIH R37-AG006457.

Conflict of interest

None of the authors have any financial and personal relationships that might bias the work presented in the current manuscript.

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Authors and Affiliations

  1. Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada

    Caroline Paquette

  2. Balance Disorders Laboratory, Department of Neurology, Oregon Health and Science University, Portland, OR, USA

    Caroline Paquette, Erika Franzén & Fay B. Horak

  3. Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden

    Erika Franzén

  4. Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden

    Erika Franzén

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  1. Caroline Paquette
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  2. Erika Franzén
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Correspondence to Caroline Paquette.

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Paquette, C., Franzén, E. & Horak, F.B. More Falls in Cerebellar Ataxia When Standing on a Slow Up-Moving Tilt of the Support Surface. Cerebellum 15, 336–342 (2016). https://doi.org/10.1007/s12311-015-0704-6

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  • DOI: https://doi.org/10.1007/s12311-015-0704-6

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