Types Of Therapy For Cerebellum Brain Injury Recovery
Since cerebellum brain damage can affects each person differently, the treatment required for recovery may vary. However, most individuals following cerebellum brain damage benefit from physical, occupational, and/or speech therapy. The focus of each of these therapies is to activate neuroplasticity to promote recovery.
Position Volume Origin And Arterial Supply
The cerebellum is an integral part of the central nervous system. It is located in the posterior cranial pit and is covered with a duplicate dura mater, which is scientifically called tentorium cerebelli.
Although it only takes up a tenth of the volume of brain tissue, it contains as many as half of the whole number of brain neurons. It is anatomically roughly divided into two hemispheres, vermis, and the flocculonodular lobe.
The cerebellum covers the fourth cerebral chamber and has a close anatomical relationship with the brainstem and the temporal bone pyramids. When it comes to the arterial supply, it sources from the posterior cerebral circulation and the venous drainage is connected to the surrounding sinuses of the dura.
Developmentally, it originates from the posterior brainstem. The cerebral cortex is three-layered and contains the Purkinje cells, which are among the largest human brain cells.
What Are The Signs And Symptoms Of A Cerebellar Disorder
The most common symptom of cerebellar disorders is ataxia or loss of balance. Ataxia happens due to a lack of coordination between the muscle groups. As a result, the person can develop an unsteady gait and appear clumsy. This can be followed by problems in speaking, such as slurred speech.
Other signs and symptoms include:
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Coordinating The Body’s Voluntary Movements
Movement is a complex process that requires a number of different muscle groups working together. Consider how many muscle groups are involved in the process of walking, running, or throwing a ball.
While the cerebellum is not thought to initiate movement, this part of the brain helps organize all of the actions of the muscle groups involved in a particular movement to ensure that the body is able to produce a fluid, coordinated movement. This includes eye movements and movements associated with speaking.
What Is The Cerebellum
The cerebellum is located on the base of the brain, directly behind the brain stem. While the cerebellum makes up only about 10% of the brains mass, it contains anywhere from 50% to 80% of the total number of neurons in the brain.
One of the major responsibilities of the cerebellum is to fine-tune and coordinate voluntary movements. This is essential for maintaining balance, muscle tone, and posture. The cerebellum is also vital in coordinating the movements necessary for walking and other daily activities.
The cerebellum is crucial to several other functions, including cognition, language learning, eye movement, and reflexes. This means that cerebellum brain damage can affect all these functions and many others.
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Cerebellar Connections Are Integrated Into Multiple Brain Networks
The classic view that cerebellar function is restricted to controlling motor coordination has been challenged by recent imaging studies in humans that suggest cerebellar contributions to cognition , emotional behavior , sleep, and even non-somatic, visceral responses . Anatomical studies performed in non-human primates and rodents strongly support the imaging data. Extensive mono- and poly-synaptic pathways connect the cerebellum to the cerebral cortex, hippocampus, amygdala, hypothalamus, periaqueductal gray, basal ganglia, thalamus, brain stem, and spinal cord . Considering such widespread connections between the cerebellum and the forebrain, dozens of brainstem nuclei, and with several major autonomic centers , it seems difficult to imagine that cerebellar circuit dysfunction would interfere only with the ability to perform motor tasks. Still, valid arguments against non-motor contributions of the cerebellum have been presented , and recent data demonstrates that caution should be taken when interpreting for cerebellar non-motor behavior in experimental preparations . Keeping in mind that a lively debate continues as to whether the cerebellum is involved in non-motor function , in the following sections we present recent evidence that has unveiled unexpected roles for the cerebellum in conditions that are historically non-cerebellar .
Table 1. Cerebellar dysfunction contributes to motor and non-motor diseases.
The Biggest Part: The Cerebrum
The biggest part of the brain is the cerebrum. The cerebrum is the thinking part of the brain and it controls your voluntary muscles the ones that move when you want them to. So you need your cerebrum to dance or kick a soccer ball.
You need your cerebrum to solve math problems, figure out a video game, and draw a picture. Your memory lives in the cerebrum both short-term memory and long-term memory . The cerebrum also helps you reason, like when you figure out that you’d better do your homework now because your mom is taking you to a movie later.
The cerebrum has two halves, with one on either side of the head. Scientists think that the right half helps you think about abstract things like music, colors, and shapes. The left half is said to be more analytical, helping you with math, logic, and speech. Scientists do know for sure that the right half of the cerebrum controls the left side of your body, and the left half controls the right side.
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Studies Of The Cerebellum
- Schmahmann & Sherman investigated behavioral changes in patients who had diseases confined to the cerebellum. They found that these patients had impairments in executive functions such as planning, working memory and abstract reasoning.
They also found difficulties in visual and spatial organization and some language deficits.
They concluded that the cerebellum plays a big part in the areas of language and cognition.
They also found that language was associated with the right-hand side of the cerebellum, whereas the left side of the cerebellum was associated with spatial awareness.
What Is The Cerebellum And What Does It Do
Although the cerebellum is involved in a number of brain functions, it is best known for its part in the modulation of movement. When we make a voluntary movement, the signal to initiate that movement originates in the motor cortices. Before the signal is sent to our muscles, however, it is sent to the cerebellum.
In addition to receiving information about the planned movement from the cortex, the cerebellum also gets information about the position of the body from the spinal cord. It uses this information to coordinate the movement and allow us to make it in a smooth manner, while maintaining our balance and equilibrium.
For example, imagine you are standing up and there is a piece of cake on the table in front of you. A plan to reach for the cake originates in the motor cortex. But, in order for that plan to result in a fluid movement, a number of things have to happen. For example, the movement must be executed with the current position of the body in mind. If you are standing stably on two feet, the action would require a different motor plan than if you were trying to balance on one foot. Also, muscles that oppose the movement must be inhibited otherwise your attempt to extend your arm might be negated by the muscles whose role is to flex your arm. When the cerebellum receives information about the motor plan from the motor cortex, it incorporates what it knows about the position of the body and muscles then it sends the plan back to the cortex to put it into action.
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Ventricles And Cerebrospinal Fluid
The brain has hollow fluid-filled cavities called ventricles . Inside the ventricles is a ribbon-like structure called the choroid plexus that makes clear colorless cerebrospinal fluid . CSF flows within and around the brain and spinal cord to help cushion it from injury. This circulating fluid is constantly being absorbed and replenished.
There are two ventricles deep within the cerebral hemispheres called the lateral ventricles. They both connect with the third ventricle through a separate opening called the foramen of Monro. The third ventricle connects with the fourth ventricle through a long narrow tube called the aqueduct of Sylvius. From the fourth ventricle, CSF flows into the subarachnoid space where it bathes and cushions the brain. CSF is recycled by special structures in the superior sagittal sinus called arachnoid villi.
A balance is maintained between the amount of CSF that is absorbed and the amount that is produced. A disruption or blockage in the system can cause a build up of CSF, which can cause enlargement of the ventricles or cause a collection of fluid in the spinal cord .
What Is The Gray Matter And White Matter
Gray and white matter are two different regions of the central nervous system. In the brain, gray matter refers to the darker, outer portion, while white matter describes the lighter, inner section underneath. In the spinal cord, this order is reversed: The white matter is on the outside, and the gray matter sits within.
Gray matter is primarily composed of neuron somas , and white matter is mostly made of axons wrapped in myelin . The different composition of neuron parts is why the two appear as separate shades on certain scans.
Each region serves a different role. Gray matter is primarily responsible for processing and interpreting information, while white matter transmits that information to other parts of the nervous system.
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Cognitive Deficits In Autosomal Dominant Ataxias: What Did We Learn
The prevalence of cognitive deficits varies considerably . Table 3 summarizes the deficits reported in the literature for the SCAs which have been studied in detail. Executive dysfunction is common. In SCA6, which is considered as one of the pure cerebellar forms amongst SCAs, and which is characterized by neuropathological changes nearly restricted to the cerebellar cortex, the majority of reports point out the lack of cognitive impairment, although verbal memory may be slightly defective. Noticeably, attention and fronto-executive functions are spared. In SCA17, which is one of the SCAs with prominent psychiatric/behavioural manifestations, correlations with the psychiatric course show gray matter degeneration patterns in the frontal and temporal lobes, the cuneus and the cingulum, and there is a clear correlation between the MMSE score and the atrophy of the nucleus accumbens, likely accounting for neuropsychiatric manifestations . In SCA17, the contribution of cerebellar atrophy per se in the constellation of behavioural/psychiatric symptoms remains a matter of debate.
Symptoms Of A Damaged Cerebellum
On the surface, the cerebellum is primarily in charge of the movement. Damage to that area usually correlates to muscle control-related problems.
Individuals with cerebellar damage tend to sway and stagger when walking.
The most common form of cerebellum disorder is known as ataxia.
Ataxia, the loss of muscle control and coordination, is most often seen as a result of cerebellum-related health problems. It can also be genetic or occur as a result of stroke, head injuries, or cerebral palsy.
Your brain is susceptible to the effects of toxins, and the cerebellum is no exception.
Prolonged exposure to solvents like paint thinners or heavy metals can cause ataxia. This also applies to certain prescription drugs and alcohol.
Other symptoms that stem from ataxia
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Right Brain Left Brain
The cerebrum is divided into two halves: the right and left hemispheres They are joined by a bundle of fibers called the corpus callosum that transmits messages from one side to the other. Each hemisphere controls the opposite side of the body. If a stroke occurs on the right side of the brain, your left arm or leg may be weak or paralyzed.
Not all functions of the hemispheres are shared. In general, the left hemisphere controls speech, comprehension, arithmetic, and writing. The right hemisphere controls creativity, spatial ability, artistic, and musical skills. The left hemisphere is dominant in hand use and language in about 92% of people.
Combining Baddeley Et Al With Imamizu Et Al
When applied to Baddeley et al.’s conclusion that the phonological loop evolved to learn new sound patterns, Imamizu et al.’s findings can be interpreted to mean that an enormous number of sound forms of new words were adaptively mixed or blended with an equally enormous number of newly decomposed/re-composed visualspatial contexts or moments. That is, as new moments of visualspatial working memory were gradually fractioned, and tagged , an enormous number of new, rapidly learned and, later, rapidly accessible cause-and-effect strategies became available.
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History Of The Cerebellum
The distinct appearance of the cerebellum was first described thousands of years ago by philosophers. The Roman physician Galen gave the earliest written surviving descriptions of this part of the brain.
It was not until the early 19th-century, however, that physicians and researchers began to learn more about the functions of this region of the brain. Experimental work that involved ablating portions of the cerebellum in animals revealed that this part of the brain is important in the coordination of movement.
How Big Is The Cerebellum
Named for the Latin term for “little brain,” and hanging off the back of the main brain, the adorable sounding anatomical feature packs a major punch for its diminutive size. “The brain weighs about 3 pounds and the cerebellum makes up about 10 percent of that,” says Janice Wiesman, M.D., clinical associate professor in the department of neurology at the NYU School of Medicine, in an email interview. “It’s made up of three lobes, the vermis in the center , and a cerebellar hemisphere on each side of that.”
“It weighs about 5 ounces ,” adds Pediatric Neurophysiology Fellow at Nationwide Children’s Hospital, Daniel Freedman, D.O., in an email. “It’s the coordination center of the brain and receives a large amount of sensory input from the spinal cord and brain regarding the body’s movements and position. It uses this information to maintain smooth coordinated movements.”
We’ll get to how the cerebellum translates all that input into action in a second, but let’s go deeper on the brain structure’s super distinctive appearance. “It has a beautiful branched appearance which is very unique,” says Parneet Grewal, a fellow at RUSH University Medical Center, in an email interview. “It has a complex circuitry and is divided into midline vermis and two cerebellar hemispheres on either side of the vermis.”
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Dystonia Pathogenesis Provides New Insights Into Cerebellar Connectivity
Table 2. Animal models and human data that implicate the cerebellum in dystonia.
On the one hand, genetically altering Purkinje cells has revealed an unexpected requirement for the cerebellum in dystonia, yet on the other hand, it may not be entirely surprising that altering Purkinje cell function would produce complex motor deficits. In fact, one has to wonder whether defective Purkinje cell communication could also, and perhaps simultaneously, influence non-motor behavior. This logic was recently put to the test in experiments that sought to determine whether the cerebellum is linked to ASD.
Ataxia The Classic Case Of Cerebellar Dysfunction
As a symptom, ataxia refers to uncoordinated movement and as a disorder it refers to a family of neurological diseases that typically involve neurodegeneration. Ataxia-related defects can also be acquired, and develop as a result of stroke, multiple sclerosis, tumors, alcoholism, peripheral neuropathy, metabolic disorders, and vitamin deficiencies . Ataxia can also arise sporadically . Patients with ataxia have poor muscle control, and when they have limb movement problems the lack of balance and coordination ultimately disturbs their gait, a symptom often associated with cerebellar defects.
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What Happens If The Cerebellum Is Damaged
With all this responsibility, you can’t help but wonder what might happen if the cerebellum were to suffer any kind of damage.
“The primary symptom of a damaged cerebellum is ‘ataxia’ or uncoordinated movement,” Freedman says. “Permanent damage to the cerebellum can come from stroke, tumors, infection, or alcohol use. Ataxia can also be temporary as seen in alcohol intoxication. When police officers conduct a roadside sobriety test, they are checking cerebellar function by having you touch finger to nose or walk a straight line.”
“Symptoms and signs of cerebellar disease include difficulty coordinating movements, such as walking, moving the arms, and coordinating the muscles of swallowing and speech into a smooth pattern,” Wiesman says. “People can have trouble with balance, moving the arms and hands in the way they want, swallowing and coordinating the voice when they speak and the speech can sound slurred. Cerebellar damage can cause a tremor of the limbs, trunk, or voice.”
Because the cerebellum also regulates smooth movements of the eyes, people with cerebellar damage may also experience double vision or abnormal eye movements. And because the cerebellum is apparently a player in cognitive and emotional function, researchers believe damage could contribute to mental illnesses like schizophrenia.