Mechanisms underlying training-related motor improvement in cerebellar ataxia.

小脑共济失调的运动症状的治疗仍然是一个主要的挑战。到目前为止，唯一的选择是物理治疗。直到最近几年，控制良好的研究才提供了明确的证据，证明小脑共济失调患者受益于运动训练。然而，我们还不知道哪种形式的训练对不同类型的小脑患者最有帮助，也不知道是否有方法可以提高训练的效果。我们的主要目标是发起一个研究项目来解决这一差距。我们将使用三种基本方法：达到适应的现代方法，结构成像和病理学与行为缺陷的相关性，以及使用非侵入性脑刺激来改善缺陷。更具体地说，我们的目标是证实最近的发现，即在小脑疾病中可能保留了缓慢的适应过程，并调查这种缓慢的学习是否被保留。如果是这样，激活慢适应可能特别有助于小脑共济失调的康复。此外，我们研究了非侵入性小脑或大脑感觉运动刺激（经颅直流电刺激，tDCS）是否能增强小脑变性患者的学习能力。最后，我们假设改善取决于病变部位。特别是，我们将验证保留小脑深部核的患者保留更多的慢适应和更强的保留的假设。这项研究的目的是了解小脑共济失调中训练相关运动改善的基本原理，并确定这种训练最有可能有效的患者。信息将有助于设计未来的康复方案量身定制的小脑患者的具体需要。

Treatment of motor symptoms of cerebellar ataxia remains a major challenge. As yet, the only option is physiotherapy. Only in recent years, well-controlled studies have provided unequivocal proof that patients with cerebellar ataxia benefit from motor training. However, we do not yet know what form of training helps most for different classes of cerebellar patients, and whether there are methods that could enhance the effects of training. Our main goal is to initiate a research program that addresses this gap. We will use three basic methodologies: modern approaches to reaching adaptation, structural imaging and correlation of pathology with behavioral deficit, and the use of non-invasive brain stimulation to ameliorate deficit. More specifically, we aim to substantiate the recent finding that slow adaptation processes may be preserved in cerebellar disease, and to investigate whether such slow learning is retained. If so, activation of slow adaptation could be of particular help in rehabilitation of cerebellar ataxia. Furthermore, we investigate whether non-invasive cerebellar or cerebral sensorimotor stimulation (transcranial direct current stimulation, tDCS) enhances learning in patients with cerebellar degeneration. Finally, we hypothesize that improvements depend on lesion site. In particular, we will test the hypothesis that patients with preserved deep cerebellar nuclei have more preserved slow adaptation and stronger retention. The aim of the study is to understand the fundamentals of training-related motor improvement in cerebellar ataxia, and to identify those patients for whom this kind of training is most likely to be effective. Information will help to design future rehabilitation programs tailored to the specific needs of cerebellar patients.