The incredible capability of the brain to quickly alter performance in response to ever-changing environment is rooted in the process of adaptation. The core aspect of adaptation is to fit an existing motor program to altered conditions. Adaptation to a visuomotor rotation or an external force has been well established as tools to study the mechanisms underlying sensorimotor adaptation. In this mini-review, we summarize recent findings from the field of visuomotor adaptation. We focus on the idea that the cerebellum plays a central role in the process of visuomotor adaptation and that interactions with cortical structures, in particular, the premotor cortex and the parietal cortex, may be crucial for this process. To this end, we cover a range of methodologies used in the literature that link cerebellar functions and visuomotor adaptation; behavioral studies in cerebellar lesion patients, neuroimaging and non-invasive stimulation approaches. The mini-review is organized as follows: first, we provide evidence that sensory prediction errors (SPE) in visuomotor adaptation rely on the cerebellum based on behavioral studies in cerebellar patients. Second, we summarize structural and functional imaging studies that provide insight into spatial localization as well as visuomotor adaptation dynamics in the cerebellum. Third, we discuss premotor — cerebellar interactions and how these may underlie visuomotor adaptation. And finally, we provide evidence from transcranial direct current and magnetic stimulation studies that link cerebellar activity, beyond correlational relationships, to visuomotor adaptation .

Visuomotor adaptation (VMA) is a form of motor learning essential for performing day to day routines. Theoretical models and empirical evidence suggest a specific cortico-striato-cerebellar loop that mediates early and late learning in VMA. Here, we investigated dynamic changes in neural activity and connectivity when learning a novel visuomotor rotation using fMRI. We found that motor cortical regions, parietal cortex and cerebellum are recruited in the early phase of VMA, gradually reduce their activity as learning reaches plateau and rebound when the visuomotor rotation is removed. At this phase, dubbed de-adaptation, individual performance correlated with activity in motor and parietal cortex such that stronger activity was associated with better performance. Theory suggests that VMA is governed by the cortico-striato-cerebellar network during the early phase of learning and by the cortico-cerebellar loop at later stages. We tested this hypothesis using dynamic causal modelling and found distinct modulation of a cerebellar to dorsal premotor cortex (dPMC) loop. Specifically, the cerebellar to dPMC connection was modulated during adaptation, suggesting a release of inhibition and net excitatory effect of cerebellum on dPMC. The modulation of cerebellar to dPMC connection during de-adaptation was specifically related to behavioral learning parameter: stronger release of inhibition of the cerebellar to dPMC connection was associated with better de-adaptation. We interpret these findings to reflect dynamic interactions between representation of movement in cerebellum and visuomotor integration in dPMC.

Non-invasive transcranial stimulation of cerebellum and primary motor cortex (M1) has been shown to enhance motor learning. However, the mechanisms by which stimulation improves learning remain largely unknown. Here, we sought to shed light on the neural correlates of transcranial direct current stimulation (tDCS) during motor learning by simultaneously recording functional magnetic resonance imaging (fMRI). We found that right cerebellar tDCS, but not left M1 tDCS, led to enhanced sequence learning in the serial reaction time task. Performance was also improved following cerebellar tDCS compared to sham in a sequence production task, reflecting superior training effects persisting into the post-training period. These behavioral effects were accompanied by increased learning-specific activity in right M1, left cerebellum lobule VI, left inferior frontal gyrus and right inferior parietal lobule during cerebellar tDCS compared to sham. Despite the lack of group-level changes comparing left M1 tDCS to sham, activity increase in right M1, supplementary motor area, and bilateral middle frontal cortex, under M1 tDCS, was associated with better sequence performance. This suggests that lack of group effects in M1 tDCS relate to inter-individual variability in learning-related activation patterns. We further investigated how tDCS modulates effective connectivity in the cortico-striato-cerebellar learning network. Using dynamic causal modelling, we found altered connectivity patterns during both M1 and cerebellar tDCS when compared to sham. Specifically, during cerebellar tDCS, negative modulation of a connection from putamen to cerebellum was decreased for sequence learning only, effectively leading to decreased inhibition of the cerebellum. These results show specific effects of cerebellar tDCS on functional activity and connectivity in the motor learning network and may facilitate the optimization of motor rehabilitation involving cerebellar non-invasive stimulation.