Why do I feel excited about the cerebellum?
The traditional teaching that the cerebellum is purely a motor control device no longer appears valid, if, indeed, ever it was. There is increasing recognition that the cerebellum contributes to cognitive processing and emotional control in addition to its role in motor coordination. Anatomical and physiological studies reveal that there is a primary sensorimotor region of the cerebellum in the anterior lobe, and a secondary sensorimotor region in the medial aspect of the posterior lobe. In contrast, cerebral association areas that subserve higher order behaviour are linked preferentially with the lateral hemispheres of the cerebellar posterior lobe—in feedforward loops via the nuclei of the basis pontis, and in feedback loops from deep cerebellar nuclei via the thalamus. There are also reciprocal connections between the cerebellum and hypothalamus. These pathways facilitate cerebellar incorporation into the distributed neural circuits governing intellect, emotion and autonomic function in addition to sensorimotor control.
Read the rest of this exciting and insightful article by Jeremy D. Schmahmann, David Caplan: “Cognition, emotion and the cerebellum” DOI: http://brain.oxfordjournals.org/content/129/2/290
As a neuro physiotherapist with many years of experience I recognised that our knowledge of cerebellum has been solely on motor control. Since reading Prof Schmahmann’s papers I have come to realise that involving sensor/motor, visual and cognition together in such a way to make it meaningful to the nervous system will enhance movement and improves motor learning.
I was very excited to read Prof Schmahmann’s papers on the role of Cerebellum on neuro rehabilitation. I recognised that by the process of trial and error, I had been involving motor, visual and cognition and observing changes in the way patients responded to treatment. They seemed to have better motor planning. So the process of enabling a patient to feel something i.e. sitting on an air cushion, had improved their visual processing and therefore balance. I began to connect the dots….!
Cerebellum plays a very important role in Rehabilitation. Its connection to thalamus and sensory/ motor aspect means that as neuro physio we need to be aware of sensory deficit in our patient group and it is no longer enough to say that the patients have neglect on one side of the body. We can work on this issue of neglect with our knowledge of cerebellum. For example involve ocular motor skills: get the patient to sit on an air cushion as this improves their autonomic balance reaction.
Cerebellum’s connection through Pontis, means that prioceptive and sensory feedback is essential in treating stroke, MS, Parkinson and many more neuro conditions such as TM and Gillian Barrie syndrome. They all experience loss of sensation. We use weight and vibratory mat to improve joint preceptors. We also use variety of balance mats which alter sensations. This, together with visually directed body movements, improves balance and coordination.
Cerebellum’s connection to vestibular has an important role in ocular motor skills and visually guided movements. The visually guided movements enable the person to feel safe in walking out side because it improves visual perception.
We have always recognised that cerebellum plays a big role in the balance system.
To find out more about the role of cerebellum in neuro rehabilitation come to our conference on 20-21 June where a host of expert professionals will be speaking on this subject connecting the theory to our everyday experience with our patients. To find out more visit click HERE or click on the image below.