Cerebellar patients have intact feedback control that can be leveraged to improve reaching

It is thought that the brain does not simply react to sensory feedback, but rather uses an internal model of the body to predict the consequences of motor commands before sensory feedback arrives. Time-delayed sensory feedback can then be used to correct for the unexpected—perturbations, motor noise, or a moving target. The cerebellum has been implicated in this predictive control process. Here, we show that the feedback gain in patients with cerebellar ataxia matches that of healthy subjects, but that patients exhibit substantially more phase lag. This difference is captured by a computational model incorporating a Smith predictor in healthy subjects that is missing in patients, supporting the predictive role of the cerebellum in feedback control. Lastly, we improve cerebellar patients’ movement control by altering (phase advancing) the visual feedback they receive from their own self movement in a simplified virtual reality setup.