Cerebellar damage disrupts movement coordination. Actions ranging from walking to reaching become inaccurate and difficult to control, resulting in poor functional movements. Therapeutic approaches for cerebellar motor disorders, or 'ataxia,'rely heavily on rehabilitation since there are no medications that systematically improve movement coordination. Rehabilitation is limited by the fact that cerebellar damage dramatically disrupts motor learning (i.e. the ability to learn movements through trial-and-error practice). Recently, we discovered that people with cerebellar damage can show motor learning, but only when the errors driving learning are small and gradual. It is also known that non-invasive stimulation of the brain can improve motor learning in healthy subjects. In this project, we will work to understand whether use of gradual learning strategies and non-invasive brain stimulation can improve learning of movement coordination of people with cerebellar damage. We will study both reaching and walking movements.
In aim 1, we will test whether (a) the learning benefit associated with gradual learning is due to the small error size or due to the subject's lack of explicit awareness of error;(b) whether we can use gradual learning to teach people with cerebellar damage to correct their specific reaching deficits, and (c) whether gradual learning benefits extend to walking, which would imply a general brain mechanism for this type of learning.
In aim 2 we will use transcranial magnetic stimulation (TMS) to test whether gradual motor learning is more associated with increased excitability in primary motor cortex, whereas learning from large and abrupt errors is more associated with increased excitability in the cerebellum.
In aim 3, we will determine whether non-invasive, transcranial direct current stimulation (tDCS) of different brain regions can augment motor learning in people with cerebellar damage. In sum, an increased understanding of the mechanisms of motor learning could lead to important changes in rehabilitation treatments for people with ataxia from cerebellar damage. Our overarching goal is to provide a scientific foundation for devising new rehabilitation strategies.

Public Health Relevance

Cerebellar damage causes poor movement control and an ability to learn to improve movement. We will work to understand whether use of gradual learning strategies and non-invasive brain stimulation can improve motor learning and thus, coordination of people with cerebellar damage. If true, these approaches could be translated into novel and effective rehabilitation strategies.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Motor Function, Speech and Rehabilitation Study Section (MFSR)
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Nitkin, Ralph M
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Hugo W. Moser Research Institute Kennedy Krieger
United States
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Bhanpuri, Nasir H; Okamura, Allison M; Bastian, Amy J (2014) Predicting and correcting ataxia using a model of cerebellar function. Brain 137:1931-44
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