Augmentation of postural muscle tone induced by the stimulation of the descending fibers in the midline area of the cerebellar white matter in the acute decerebrate cat

Roles of the cerebellar vermis in predictive postural controls against external disturbances

The central nervous system predictively controls posture against external disturbances; however, the detailed mechanisms remain unclear. We tested the hypothesis that the cerebellar vermis plays a substantial role in acquiring predictive postural control by using a standing task with floor disturbances in rats. The intact, lesioned, and sham groups of rats sequentially underwent 70 conditioned floor-tilting trials, and kinematics were recorded. Six days before these recordings, only the lesion group underwent focal suction surgery targeting vermal lobules IV-VIII. In the naïve stage of the sequential trials, the upright postures and fluctuations due to the disturbance were mostly consistent among the groups. Although the pattern of decrease in postural fluctuation due to learning corresponded among the groups, the learning rate estimated from the lumbar displacement was significantly lower in the lesion group than in the intact and sham groups. These results suggest that the cerebellar vermis contributes to predictive postural controls.

Gait-combined closed-loop brain stimulation can improve walking dynamics in Parkinsonian gait disturbances: a randomised-control trial

OBJECTIVE

Gait disturbance lowers activities of daily living in patients with Parkinson's disease (PD) and related disorders. However, the effectiveness of pharmacological, surgical and rehabilitative treatments is limited. We recently developed a novel neuromodulation approach using gait-combined closed-loop transcranial electrical stimulation (tES) for healthy volunteers and patients who are post-stroke, and achieved significant entrainment of gait rhythm and an increase in gait speed. Here, we tested the efficacy of this intervention in patients with Parkinsonian gait disturbances.

METHODS

Twenty-three patients were randomly assigned to a real intervention group using gait-combined closed-loop oscillatory tES over the cerebellum at the frequency of individualised comfortable gait rhythm, and to a sham control group.

RESULTS

Ten intervention sessions were completed for all patients and showed that the gait speed (F (1, 21)=13.0, p=0.002) and stride length (F (1, 21)=8.9, p=0.007) were significantly increased after tES, but not after sham stimulation. Moreover, gait symmetry measured by swing phase time (F (1, 21)=11.9, p=0.002) and subjective feelings about freezing (F (1, 21)=14.9, p=0.001) were significantly improved during gait.

CONCLUSIONS

These findings showed that gait-combined closed-loop tES over the cerebellum improved Parkinsonian gait disturbances, possibly through the modulation of brain networks generating gait rhythms. This new non-pharmacological and non-invasive intervention could be a breakthrough in restoring gait function in patients with PD and related disorders.

Impaired Sensorimotor Processing During Complex Gait Precedes Behavioral Changes in Middle-aged Adults

Gait impairment during complex walking in older adults is thought to result from a progressive failure to compensate for deteriorating peripheral inputs by central neural processes. It is the primary hypothesis of this article that failure of higher cerebral adaptations may already be present in middle-aged adults who do not present observable gait impairments. We, therefore, compared metabolic brain activity during steering of gait (ie, complex locomotion) and straight walking (ie, simple locomotion) in young and middle-aged individuals. Cerebral distribution of [18F]-fluorodeoxyglucose, a marker of brain synaptic activity, was assessed during over ground straight walking and steering of gait using positron emission tomography in seven young adults (aged 24 ± 3) and seven middle-aged adults (aged 59 ± 3). Brain regions involved in steering of gait (posterior parietal cortex, superior frontal gyrus, and cerebellum) are retained in middle age. However, despite similar walking performance, there are age-related differences in the distribution of [18F]-fluorodeoxyglucose during steering: middle-aged adults have (i) increased activation of precentral and fusiform gyri, (ii) reduced deactivation of multisensory cortices (inferior frontal, postcentral, and fusiform gyri), and (iii) reduced activation of the middle frontal gyrus and cuneus. Our results suggest that preclinical decline in central sensorimotor processing in middle age is observable during complex walking.

Functional Neuroanatomy for Posture and Gait Control

Here we argue functional neuroanatomy for posture-gait control. Multi-sensory information such as somatosensory, visual and vestibular sensation act on various areas of the brain so that adaptable posture-gait control can be achieved. Automatic process of gait, which is steady-state stepping movements associating with postural reflexes including headeye coordination accompanied by appropriate alignment of body segments and optimal level of postural muscle tone, is mediated by the descending pathways from the brainstem to the spinal cord. Particularly, reticulospinal pathways arising from the lateral part of the mesopontine tegmentum and spinal locomotor network contribute to this process. On the other hand, walking in unfamiliar circumstance requires cognitive process of postural control, which depends on knowledges of self-body, such as body schema and body motion in space. The cognitive information is produced at the temporoparietal association cortex, and is fundamental to sustention of vertical posture and construction of motor programs. The programs in the motor cortical areas run to execute anticipatory postural adjustment that is optimal for achievement of goal-directed movements. The basal ganglia and cerebellum may affect both the automatic and cognitive processes of posturegait control through reciprocal connections with the brainstem and cerebral cortex, respectively. Consequently, impairments in cognitive function by damages in the cerebral cortex, basal ganglia and cerebellum may disturb posture-gait control, resulting in falling.

Brainstem control of locomotion and muscle tone with special reference to the role of the mesopontine tegmentum and medullary reticulospinal systems

The lateral part of the mesopontine tegmentum contains functionally important structures involved in the control of posture and gait. Specifically, the mesencephalic locomotor region, which may consist of the cuneiform nucleus and pedunculopontine tegmental nucleus (PPN), occupies the interest with respect to the pathophysiology of posture-gait disorders. The purpose of this article is to review the mechanisms involved in the control of postural muscle tone and locomotion by the mesopontine tegmentum and the pontomedullary reticulospinal system. To make interpretation and discussion more robust, the above issue is considered largely based on our findings in the experiments using decerebrate cat preparations in addition to the results in animal experimentations and clinical investigations in other laboratories. Our investigations revealed the presence of functional topographical organizations with respect to the regulation of postural muscle tone and locomotion in both the mesopontine tegmentum and the pontomedullary reticulospinal system. These organizations were modified by neurotransmitter systems, particularly the cholinergic PPN projection to the pontine reticular formation. Because efferents from the forebrain structures as well as the cerebellum converge to the mesencephalic and pontomedullary reticular formation, changes in these organizations may be involved in the appropriate regulation of posture-gait synergy depending on the behavioral context. On the other hand, abnormal signals from the higher motor centers may produce dysfunction of the mesencephalic-reticulospinal system. Here we highlight the significance of elucidating the mechanisms of the mesencephalic-reticulospinal control of posture and locomotion so that thorough understanding of the pathophysiological mechanisms of posture-gait disorders can be made.

Adaptation and aftereffects of split-belt walking in cerebellar lesion patients

To walk efficiently and stably on different surfaces under various constrained conditions, humans need to adapt their gait pattern substantially. Although the mechanisms behind locomotor adaptation are still not fully understood, the cerebellum is thought to play an important role. In this study we aimed to address the specific localization of cerebellar involvement in split-belt adaptation by comparing performance in patients with stable focal lesions after cerebellar tumor resection and in healthy controls. We observed that changes in symmetry of those parameters that were most closely related to interlimb coordination (such as step length and relative double stance time) were similar between healthy controls and cerebellar patients during and after split-belt walking. In contrast, relative stance times (proportions of stance in the gait cycle) were more asymmetric for the patient group than for the control group during the early phase of the post-split-belt condition. Patients who walked with more asymmetric relative stance times were more likely to demonstrate lesions in vermal lobules VI and Crus II. These results confirm that deficits in gait adaptation vary with ataxia severity and between patients with different types of cerebellar damage.

What triggers the continuous muscle activity during upright standing?

The ankle extensors play a dominant role in controlling the equilibrium during bipedal quiet standing. Their primary role is to resist the gravity toppling torque that pulls the body forward. The purpose of this study was to investigate whether the continuous muscle activity of the anti-gravity muscles during standing is triggered by the joint torque requirement for opposing the gravity toppling torque, rather than by the vertical load on the lower limbs. Healthy adults subjects stood on a force plate. The ankle torque, ankle angle, and electromyograms from the right lower leg muscles were measured. A ground-fixed support device was used to support the subject at his/her knees, without changing the posture from the free standing one. During the supported condition, which eliminates the ankle torque requirement while maintaining both the vertical load on the lower limbs and the natural upright standing posture, the plantarflexor activity was attenuated to the resting level. Also, this attenuated plantarflexor activity was found only in one side when the ipsilateral leg was supported. Our results suggest that the vertical load on the lower limb is not determinant for inducing the continuous muscle activity in the anti-gravity muscles, but that it depends on the required joint torque to oppose the gravity toppling torque.

Extensor coxae brevis: treatment strategies for the deep lateral rotators in pelvic tilt

The group of myofascial units known as the deep lateral rotators are considered in light of their role as postural hip extensors, resulting functional and palpatory assessments of pelvic neutral are presented, and treatment strategies for anterior and posterior pelvic tilt are discussed.

Nervous mechanisms controlling body posture

This paper briefly summarizes the studies of nervous mechanisms controlling the body posture, which were performed in the Department of Neuroscience of the Karolinska Institute during the last decade. Postural mechanisms were investigated in "animal models" of different complexity--the mollusk, lamprey, rabbit, and cat. The following problems were addressed: (1) functional organization of the postural system; (2) localization of postural functions in the mammalian CNS; (3) postural networks; (4) impairment of postural control caused by vestibular deficit. These studies have significantly expanded our knowledge of how the postural control system operates, how the stabilized body orientation can be changed, and how the postural functions are distributed within different parts of the CNS. For simpler animal models (mollusk, lamprey), the neuronal networks responsible for the control of body posture have been analyzed in considerable detail, with identification of the main cell types and their interactions. Also, alterations in the activity of postural mechanisms caused by the vestibular deficit were investigated to better understand the process of recovery of postural function.

The cerebellar fastigial nucleus contributes to CO2-H+ ventilatory sensitivity in awake goats

The purpose of this study was to test the hypothesis that an intact cerebellar fastigial nucleus (CFN) is an important determinant of CO(2)-H(+) sensitivity during wakefulness. Bilateral, stainless steel microtubules were implanted into the CFN (N=9) for injection (0.5-10 microl) of the neurotoxin ibotenic acid. Two or more weeks after implantation of the microtubules, eupneic breathing and CO(2)-H(+) sensitivity did not differ significantly (P>0.10) from pre-implantation conditions. Injection of ibotenic acid (50 mM) did not significantly alter eupneic Pa(CO2) (P>0.10). The coefficient of variation of eupneic Pa(CO2) was 4.0+/-0.6 and 3.7+/-0.4% over the 2 weeks before and after the lesion, respectively. CO(2)-H(+) sensitivity expressed as inspired ventilation/Pa(CO2) decreased from 2.15+/-0.17 pre-lesion to 1.58+/-0.26 l/(min mmHg) 3-6 days post-lesion (P<0.02, -27%). There was no significant (P>0.10) recovery of sensitivity between 7 and 10 days post-lesion. The lesion also increased (P<0.05) the day-to-day variability of this index by nearly 100%. When CO(2) sensitivity was expressed as elevated inspired CO(2)/room air V (I), values at 7%, but not 3 and 5% inspired CO(2), were reduced and more variable (P<0.05) after the ibotenic acid injections. We conclude that during wakefulness, the CFN contributes relatively more to overall ventilatory drive at high relative to low levels of hypercapnia.

Neural bases of postural control

The body posture during standing and walking is maintained due to the activity of a closed-loop control system. In the review, we consider different aspects of postural control: its functional organization, the distribution of postural functions in different parts of the central nervous system, and the activity of neuronal networks controlling posture.

Lesions in the cerebellar fastigial nucleus have a small effect on the hyperpnea needed to meet the gas exchange requirements of submaximal exercise

The purpose of this study was to test the hypothesis that an intact cerebellar fastigial nucleus (CFN) is necessary for the hyperpnea to meet the gas exchange needs of submaximal exercise. Bilateral stainless steel microtubules were implanted in the cerebellum inside (n = 12) or outside (n = 2) the CFN for injection (0.5 to 10 microl) of the neurotoxin ibotenic acid. All goats had difficulty maintaining normal posture and walking for up to 1 mo after the implantation of the microtubules and again for hours or days after the neurotoxin was injected. Postmortem histology indicated there were 55% fewer living neurons (P < 0.001, n = 9, 3,720 +/- 553 vs. 1,670 +/- 192) in the CFN of the experimental goats compared with a control group of goats. As is typical for goats before implantation of the microtubules, the decrease in arterial Pco(2) from rest during mild and moderate treadmill exercise was 2.0 +/- 0.39 and 3.5 +/- 0.45 Torr, respectively. Implantation of the microtubules did not significantly change this exercise hyperventilation. However, neurotoxic lesioning with 10 mul ibotenic acid significantly (P < 0.05) attenuated the decrease in arterial Pco(2) by 1.3 and 2.8 Torr at the first and second workload, respectively. The modest attenuation of the exercise hypocapnia at both workloads in CFN-lesioned goats suggests that the CFN is part of the control system that enables the ventilatory response to meet the gas exchange requirements of submaximal exercise.

Coupling between feline cerebellum (fastigial neurons) and motoneurons innervating hindlimb muscles

The aims of the study were twofold: (1) to verify the hypothesis that neurons in the fastigial nucleus excite and inhibit hindlimb alpha-motoneurons and (2) to determine both the supraspinal and spinal relays of these actions. Axons of fastigial neurons were stimulated at the level of their decussation in the cerebellum, within the hook bundle of Russell, in deeply anesthetized cats with only the right side of the spinal cord intact. The resulting excitatory postsynaptic potentials and inhibitory postsynaptic potentials were analyzed in motoneurons on the left side of the lumbar enlargement. Postsynaptic potentials evoked by the first effective stimulus were induced at latencies <2 ms from descending volleys and <1 ms from interneuronally relayed volleys, indicating a trisynaptic coupling between the fastigial neurons and alpha-motoneurons, via commissural interneurons on the right side. Cerebellar stimulation facilitated the synaptic actions of both vestibulospinal and reticulospinal tract fibers. However, the study leads to the conclusion that trisynaptic fastigial actions are mediated via vestibulospinal rather than reticulospinal tract fibers [stimulated within the lateral vestibular nucleus (LVN) and the medial longitudinal fascicle (MLF), respectively]. This is indicated firstly by collision between descending volleys induced by cerebellar stimulation and volleys evoked by LVN stimuli but not by MLF stimuli. Second, similar cerebellar actions were evoked before and after a transection of MLF. Mutual facilitation between the fastigial and reticulospinal, as well as between the fastigial and vestibulospinal actions, could be due to the previously reported integration of descending vestibulospinal and reticulospinal commands by spinal commissural interneurons.

Integration of multiple motor segments for the elaboration of locomotion: role of the fastigial nucleus of the cerebellum

This chapter provides a conceptual overview of the role and operation of higher structures of the central nervous system (CNS) in the control of posture and locomotion in the mammal, including the nonhuman primate and the human. Both quadrupedal and bipedal locomotion require the integrated neural control of multiple body segments against gravity. During development, and in selected instances in the adult, motor learning is required, particularly for merging anticipatory and reactive CNS processes, the latter being necessary after tripping and stumbling. We have recently found that the fastigial nucleus (FN) of the cerebellum in the cat plays a particularly important role in the control of locomotion, by virtue of its critical position in uniting the cerebro-cerebellar and the spino-cerebellar loops of neural activity that participate in the integrated control of multiple body segments. Further understanding of the CNS structures that achieve this integration has come from our recent study of an intact nonhuman primate, the Japanese monkey, Macaca fuscata, as it learns to elaborate bipedal locomotion rather than its normal quadrupedal fashion. Based on findings from these two animal species, we now present a model of the overall integrated control of posture and locomotion that features the combined operation of parallel and distributed neural circuitry throughout the CNS.

Comparative neurobiology of postural control

In recent years, studies of nervous mechanisms for the control of body posture have been performed on animal models of different complexity - cat, rabbit, lamprey and the mollusc Clione. These studies have greatly expanded our knowledge of how the control system operates, how the system can change the stabilized body orientation and how the postural functions are distributed within different parts of the CNS. For simpler animal models, the postural network has been analyzed in considerable detail and main cell types and their interactions have been identified.

Mechanisms underlying gait disturbance in Parkinson's disease: a single photon emission computed tomography study

Single photon emission computed tomography was used to evaluate regional cerebral blood flow changes during gait on a treadmill in 10 patients with Parkinson's disease and 10 age-matched controls. The subjects were injected with [99mTc]hexamethyl-propyleneamine oxime twice: while walking on the treadmill, which moved at a steady speed, and while lying on a bed with their eyes open. On the treadmill, all subjects walked at the same speed with their preferred stride length. The patients showed typical hypokinetic gait with higher cadence and smaller stride length than the controls. In the controls, a gait-induced increase in brain activity was observed in the medial and lateral premotor areas, primary sensorimotor areas, anterior cingulate contex, superior parietal cortex, visual cortex, dorsal brainstem, basal ganglia and cerebellum. The Parkinson's disease patients revealed relative underactivation in the left medial frontal area, right precuneus and left cerebellar hemisphere, whereas they showed relative overactivity in the left temporal cortex, right insula, left cingulate cortex and cerebellar vermis. This is the first experimental study showing that the dorsal brainstem, which corresponds to the brainstem locomotor region in experimental animals, is active during human bipedal gait. The reduced brain activity in the medial frontal motor areas is a basic abnormality in motor performance in Parkinson's disease. The underactivity in the left cerebellar hemisphere, in contrast to the overactivity in the vermis, could be associated with a loss of lateral gravity shift in parkinsonian gait.

Stimulation of a restricted region in the midline cerebellar white matter evokes coordinated quadrupedal locomotion in the decerebrate cat

In the reflexively standing acute decerebrate cat, we have previously shown that pulse train microstimulation of the hook bundle of Russel in the midline of the cerebellar white matter, through which crossed fastigiofugal fibers decussate, augments the postural tone of neck, trunk, fore-, and hindlimb extensor muscles. In the present study we examined the possible role of such stimulation in evoking locomotion as the animal is supported by a rubber hammock with its feet contacting the moving surface of a treadmill. We were able to provoke well-coordinated, bilaterally symmetrical, fore- and hindlimb movements, whose cycle time and pattern were controlled by appropriate changes in stimulus intensity and treadmill speed. We carefully and systematically mapped this cerebellar locomotor region (CLR) through repeated dorsoventral penetrations with a glass-coated tungsten microelectrode in a single animal and between animals. We found that the optimal locus for evoking locomotion was centered on the midline, at Horsley-Clarke coordinates H0 and P7.0, and extended over a rostrocaudal and dorsolateral range of approximately 0.5 mm. The lowest effective stimulus intensity at the optimal site was in the range of 5-8 microA. Along penetration tracks to left or right of the midline, effective stimulus intensity increased and evoked locomotor patterns were no longer symmetrical, but rather shifted toward the contralateral limbs. In the same animals, controlled locomotion was evoked by stimulating the mesencephalic locomotor region (MLR). With concomitant stimulation of the optimal sites in the CLR and the MLR, each at subthreshold strength, locomotor movements identical to those seen with suprathreshold stimulation of each site alone were evoked. With concomitant stimulation at suprathreshold strength for each site, locomotion became vigorous, with a shortened cycle time. After making ablative lesions at either the CLR or MLR (unilateral or bilateral), controlled locomotion was still evoked at the prior stimulus strength by stimulating the remaining site. Together, these results demonstrate that selective stimulation of the hook bundle of Russel in the midsagittal plane of the cerebellar white matter evokes "controlled" locomotion identical to that evoked by stimulating the MLR. We have shown that the fastigial nucleus is one of the supraspinal locomotion inducing sites and that it can independently and simultaneously trigger brain stem and spinal locomotor subprograms formerly believed to be the domain of various brain stem regions including the MLR and the subthalamic locomotor region.

Cerebellar-induced locomotion: reticulospinal control of spinal rhythm generating mechanism in cats

In a decerebrate cat (locomotor preparation), stimulation of a restricted region along the midline cerebellar white matter has been found to evoke generalized augmentation of postural muscle tone on a stationary surface (Asanome et al. 1998. Neurosci. Res. 30: 257-269) and "controlled" locomotion on the surface of a moving treadmill. Characteristics of cerebellar-evoked locomotion were similar to those of mesencephalic locomotor region-evoked "controlled" locomotion on the same animal. Microinjection of a neural tracer (CTb-HRP) into the lesioned stimulus site of the cerebellar white matter resulted in both retrograde labelling of cells in the fastigial nuclei, bilaterally, and anterograde labeling of fibers descending to the brain stem. These results indicated that the effective cerebellar stimulus site (cerebellar locomotor region) corresponded to the midline region of the hook bundle of Russell (Rasmussen, A. T., 1933. J. Comp. Neurol. 57: 165-197), through which crossed fastigioreticular, fastigiovestibular, and fastigiospinal fibers pass. In this study, contribution of reticulospinal systems to the control of cerebellar-evoked locomotion was extensively studied. By stimulating the cerebellar locomotor region and the MLR in the same animal, a majority of antidromically identified pontomedullary reticulospinal cells were synaptically activated. The results of the present study demonstrated that fastigial cells with crossed fastigioreticular fibers and reticulospinal fibers play a crucial role in the control of posture and locomotion in the locomotor preparation.