Surface EMG- and coordination dynamics measurements-assisted cerebellar diagnosis in a patient with cerebellar injury

Cerebellar diagnostic was performed in a patient who had suffered severe cerebellar injury, using kinesiologic (coordination dynamics) and electrophysiologic (surface EMG (sEMG)) means. Since the right cerebellum had been completely destroyed, significant coordination problems (especially on the right side) were expected to be found in addition to balance problems. As compared to a healthy person, coordination between arms and legs was 80% up to 300% worse. Unexpectedly, no pronounced impairment of coordination of the right arm and right leg was found (with respect to the remaining limbs) as a result of the lost right cerebellum. The values of coordination dynamics measured for the right arm and the right leg for exercising in the forward and backward direction were as good as or even better than those obtained for the left side. However, sEMG disclosed a strong impairment of antagonistic muscle activation (spinocerebellum) between the tibialis anterior and the gastrocnemius muscles on the right side upon exercising the legs only on the special coordination dynamics therapy device (similar to a stationary bicycle). The muscles of the right-sided leg worked worse than those of the left-sided leg. But upon exercising both legs and arms on the special device (more integratively), the antagonistic muscle activation improved in the poor right leg by 36% in the short-term memory but not in the good left leg (symmetry improvement). These kinesiological and electrophysiological measurements show that there was no clear ipsilateral correlation between the cerebellum and the laterality of body functions. For different kinds of supported walking sEMG motor programs worsened with the reduction of the support. Probably the damaged vestibulocerebellum could not sufficiently coordinate balance any more with walking When swinging and jumping on the springboard, sEMG motor programs were best for jumping in anti-phase, where maybe more inhibition is activated. It is concluded that coordination measurements and sEMG are powerful tools to evaluate the outcome of cerebellar injury and to provide a diagnostic tool to quantify improvements in the CNS functioning as a result of the coordination dynamics therapy.