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Author Notes:

Correspondence: Madeleine E. Hackney madeleine.hackney@gmail.com Present Address: K. Sathian, Department of Neurology, Milton S. Hershey Medical Center and Penn State College of Medicine, Hershey, PA, United States

Author Contributions: The research project concept was defined by MH, KS, BC, DC, SW, JD, and ME. MH, KM, VK, and KG organized the project.

The research project was executed by MH, JD, KM, AB, AH, and ME. MH, JD, VK, KM, and LK designed the statistical analysis plan.

The statistical analysis plan was executed by JD and MH and received critiques from KS, BC, VK, SW, DC, KG, and ME. J

D and MH wrote the first draft of the manuscript.

KS, BC, VK, SW, DC, KG, AH, and ME reviewed and critiqued the manuscript.

Acknowledgments: We would like to thank the participants.

Conflict of Interest Statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Research Funding:

Department of Veterans Affairs R&D Service Career Development Award IK2RX000870 supported this work and ME Hackney.

The National Science Foundation Emerging Frontiers in Research Initiatives (EFRI) award number 1137229 and the Atlanta Center for Visual and Neurocognitive Rehabilitation supported JD.

Support for KS contribution to this work was provided by the Atlanta VAMC.

We acknowledge the Emory Center for Health in Aging and the Emory University Center for Systems Imaging. Supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002378.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

This work was supported in part by funding from a Shared Instrumentation Grant (S10) grant 1S10OD016413-01 to the Emory University Center for Systems Imaging Core and by the National Center for Advancing Translational Sciences, National Institutes of Health Award UL1TR000454.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Clinical Neurology
  • Neurosciences
  • Neurosciences & Neurology
  • Parkinson's
  • putamen
  • cerebellum
  • lower limb
  • internally guided
  • externally guided
  • striatum
  • fMRI
  • FMRI
  • GAIT

Internally Guided Lower Limb Movement Recruits Compensatory Cerebellar Activity in People With Parkinson's Disease

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Journal Title:

Frontiers in Neurology


Volume 10


, Pages 537-537

Type of Work:

Article | Final Publisher PDF


Background: Externally guided (EG) and internally guided (IG) movements are postulated to recruit two parallel neural circuits, in which motor cortical neurons interact with either the cerebellum or striatum via distinct thalamic nuclei. Research suggests EG movements rely more heavily on the cerebello-thalamo-cortical circuit, whereas IG movements rely more on the striato-pallido-thalamo-cortical circuit (1). Because Parkinson's (PD) involves striatal dysfunction, individuals with PD have difficulty generating IG movements (2). Objectives: Determine whether individuals with PD would employ a compensatory mechanism favoring the cerebellum over the striatum during IG lower limb movements. Methods: 22 older adults with mild-moderate PD, who had abstained at least 12 h from anti-PD medications, and 19 age-matched controls performed EG and IG rhythmic foot-tapping during functional magnetic resonance imaging. Participants with PD tapped with their right (more affected) foot. External guidance was paced by a researcher tapping participants' ipsilateral 3rd metacarpal in a pattern with 0.5 to 1 s intervals, while internal guidance was based on pre-scan training in the same pattern. BOLD activation was compared between tasks (EG vs. IG) and groups (PD vs. control). Results: Both groups recruited the putamen and cerebellar regions. The PD group demonstrated less activation in the striatum and motor cortex than controls. A task (EG vs. IG) by group (PD vs. control) interaction was observed in the cerebellum with increased activation for the IG condition in the PD group. Conclusions: These findings support the hypothesized compensatory shift in which the dysfunctional striatum is assisted by the less affected cerebellum to accomplish IG lower limb movement in individuals with mild-moderate PD. These findings are of relevance for temporal gait dysfunction and freezing of gait problems frequently noted in many people with PD and may have implications for future therapeutic application.

Copyright information:

© 2019 Drucker, Sathian, Crosson, Krishnamurthy, McGregor, Bozzorg, Gopinath, Krishnamurthy, Wolf, Hart, Evatt, Corcos and Hackney.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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