1It is thought that the brain does not simply react to sensory feedback, but rather uses an 2 internal model of the body to predict the consequences of motor commands before sensory 3 feedback arrives. Time-delayed sensory feedback can then be used to correct for the 4 unexpected-perturbations, motor noise, or a moving target. The cerebellum has been implicated 5 in this predictive control process. Here we show that the feedback gain in patients with cerebellar 6 ataxia matches that of healthy subjects, but that patients exhibit substantially more phase lag. 7 This difference is captured by a computational model incorporating a Smith predictor in healthy 8 subjects that is missing in patients, supporting the predictive role of the cerebellum in feedback 9 control. Lastly, we improve cerebellar patients' movement control by altering (phase advancing) 10 the visual feedback they receive from their own self movement in a simplified virtual reality 11 setup.12 16 slow movements accurately. However, feedback is time delayed, and thus it never represents the 17 current state of the body during movement. Because of this, it is thought that we depend on 18 internal models of the body that are built based on prior experience. These models can be rapidly 19 accessed and thus provide a fast internal prediction system to estimate how a movement will 20 unfold, enabling us to better understand where our limbs are at any given moment. This allows 21 us to make fast and accurate movements despite long-latency feedback.
22People with cerebellar damage show a characteristic pattern of incoordination during 24 movement that is referred to as ataxia. When reaching, they make curved movements that miss 25 intended targets and require multiple corrections. This pattern of over-and undershooting a 26 target (dysmetria) and oscillatory corrections (intention tremor) are hallmarks of cerebellar 27 ataxia. One hypothesis that might explain ataxia is that the predictive estimation and control 28 provided by cerebellar circuits is dysfunctional or lost (Wolpert, Miall, and Kawato 1998; R. 29 Chris Miall et al. 2007).30 31 Normally, the estimation of limb state (i.e., position and velocity) benefits from 32 integrating proprioceptive measurements with an internal predictive control model during a 33 movement (Paillard and Brouchon 1974; Adamovich et al. 1998; Fuentes and Bastian 2010).
34However, patients with cerebellar damage do not seem to receive this benefit (N. H. Bhanpuri, 35 Okamura, and Bastian 2013; Weeks, Therrien, and Bastian 2017). Worse, it is possible that their 36 predictive model actually conveys incorrect state information during active movements, which 37 could corrupt rather than enhance proprioceptive estimation of limb state. This difficulty of 38 predicting the future state of limbs during active movement leads to movements that are poorly 39 directed and scaled, requiring ongoing corrections to reach a goal location.
41Patients with cerebellar ataxia may rely more heavily on visual feedback to correct 42 dysmet...