What the spouse and other family members should do about a patient with 
a tumor or lesion to the cerebellum
By Brenna Kay Sjotvedt


The cerebellum is responsible for motor coordination, balance, and 
there has been evidence recently that it is also involved in speech, 
and memory. 

Damage to the cerebellum can cause impairments to standing, walking, 
and the performance of other coordinated movements. The cerebellum also 
controls how smooth or jerky one's movements are, so damage can also 
cause a jerkiness of movements, and poorly coordinated and exaggerated 
movements. Depending on how severe the damage is, the afflicted person 
may not even be able to stand (Carlson, 2001).

Recent studies have suggested that damage to the cerebellum can cause 
problems with speech, such as being unable to find words while 
speaking, difficulty comprehending the speech of others, and speech 
initiation disturbances (Marien, Engelborghs, Pickut & DeDeyn, 2000). 
Phonation and articulation can also be impaired and language expression 
is monotonous and slow, as well as difficult to understand (Fabbro, 
Moretti & Bava, 2000). These deficits are only occasional for those 
afflicted with cerebellar lesions.

More frequent with cerebellar lesions is memory deficits. Procedural 
memory and verbal short-term memory are mostly affected. Damage to the 
cerebellum can cause problems during the processing and organization of 
sensory information, as well as the inability to remember things by 
rehearsal, because the cerebellum is reported to be involved in 
rehearsal (Silveri & Misciagna, 2000).

The afflicted person may need help getting around because of a loss of 
balance, so it would be important to keep this in mind and have a 
family member or the patient's spouse around whenever possible. There 
may also be times when the patient may knock something over or spill 
something because of the jerkiness of their movements and it is 
important that the spouse and family members remember that this is not 
the patient's fault and hand things to the patient when possible. It is 
also important to remember that the patient is more than likely even 
more frustrated than the family is that s/he cannot do normally the 
things that s/he used to be able to do.

Also, because of the speech problems, there may be times when the 
spouse and other family members of the patient will become impatient 
and annoyed. Again, it is important to remember that the patient is 
very frustrated as well. The speech may be slow and monotonous and the 
family may have a problem understanding what the patient is saying, as 
well as the patient not understanding what the person talking to 
him/her is saying. The family may also get frustrated with the patient 
when s/he cannot find the words to say what s/he wants to say. There is 
language therapy available for those that need it, and it is generally 
very helpful for those that get it.

And because of the memory problems, the family may find that they have 
to repeat themselves often. Because the cerebellum seems to be involved 
in rehearsal of information, the patient may not be able to remember 
for long what is said to them, since they have a hard time keeping 
information in their short-term memory long enough. Also, since 
procedural memory is affected, the patient may no longer be able to 
drive, ride a bike, or do many of the other well practiced habits s/he 
was once able to do. (Keep in mind that even if the patient is able to 
perform those well practiced habits, chances are they are moving 
jerkily and that in itself my impair them from doing those things.)


References

Carlson, N. R. (2001). "Physiology of Behavior." (7th ed.). 
Massachusetts: Allyn and Bacon.

Fabbro, F., Moretti, R., & Bava, A. (2000). "Language impairments in 
patients with cerebellar lesions." Journal of Neurolinguistics. Volume 
13, Issues 2-3. 173-188.

Marien, P., Engelborghs, S., Pickut, B. A., & DeDeyn, P. P. (2000). 
"Aphasia following cerebellar damage: fact or fallacy?" Journal of 
Neurolinguistics. Volume 13, Issues 2-3. 145-171.

Silveri, M. C. & Misciagna, S. (2000). "Language, memory, and the 
cerebellum." Journal of Neurolinguistics. Volume 13, Issues 2-3. 129-
143. 

The Implications Damage to the Cerebellum has for Employers
Kristi Shanoff

Any type of brain damage will inevitably serve as an impairment to the 
one sustaining the damage.  Damage to the cerebellum is no exception.  
Seeing as the cerebellum accounts for 11% of the brain's mass and is 
the second largest part of the brain (Marieb & Mallatt, 2001), it is 
not surprising that many aspects of human behavior are dependent upon a 
fully functioning cerebellum.  Because of this, any damage to the 
cerebellum has significant implications, especially for an employer. 

The cerebellum is most commonly known as the part of the brain that 
coordinates body movements as well as maintain an individual's 
equilibrium and posture. In regards to movement, the cerebellum 
receives information regarding the movements being planned by the motor 
cerebral cortex.  The cerebellum then processes the information, 
comparing it to what movements are actually occurring.  Because of 
this, the feedback received from the cerebellum by the motor cerebral 
cortex allows movements to be corrected so that they may be well 
coordinated (Marieb & Mallatt, 2001).  Because of this, when the 
cerebellum is damaged, walking and standing can become difficult tasks.  
Those with extensive cerebral damage aren't even able to stand.  Plus, 
movements may become jerky, poorly coordinated, and/or overly 
exaggerated (Carlson, 2001).

In addition to being partially responsible for movement, there is a 
significant amount of recently conducted research indicating that the 
cerebellum is involved with several other cognitive processes (Silveri 
& Misciagna, 2000), especially because it works in conjunction with 
several other parts of the brain (i.e. the reticular system, 
hypothalamus, limbic system, and associative/neocortical systems).  
Additionally, there's a growing amount of evidence suggesting that the 
cerebellum is also somewhat responsible for an individual's emotional 
health (Schmahmann, 2000).  Because of this, depending on both where 
the cerebral damage occurs and what type of damage as sustained (i.e. 
lesion, tumor, cyst (Fabbro et al., 2000), cerebellar degenerative 
disease (Silveri & Misciagna, 2000) etc.), different behaviors will be 
affected (Fabbro et al., 2000).

There are two cognitive processes the cerebellum has been found to be 
involved with.  One of those cognitive processes is memory, 
specifically phonological short-term memory.  Phonological short-term 
memory is also referred to working memory (Fabbro et al., 2000).  It's 
responsible for the retention of verbal information for short periods 
of time as well as for the rehearsal system.  In regards to procedural 
learning, the cerebellum is specifically involved with motor 
adaptation, as demonstrated by subjects who had sustained cerebral 
damage whose motor adaptation was not as good as those who hadn't 
sustained cerebral damage.  Motor adaptation refers to as "a 
modification in motor performance that does not violate the speed-
accuracy trade-off" (Silveri & Misciagna, 2000).

The fact that the cerebellum is directly involved with phonological 
short-term memory (which is responsible for word repetition, sentence 
comprehension, and new language acquisition) has important implications 
for language, the other cognitive process the cerebellum has been found 
to be involved with (Silveri & Misciagna, 2000).  There are several 
aspects to the effects cerebral damage can have on language, 
particularly in speech production.  These aspects include the 
following: acceleration of orofacial gestures (referring to how quickly 
the mouth is able to move during speech production); timing and 
coordination of complex articulatory sequences (Ackermann & Hertrich, 
2000); word fluency and verb production (This is referring to a study 
done in which subjects who had sustained damage to the right cerebral 
hemisphere were required to generate verbs in response to nouns 
(Petersen et al. as cited in Silveri & Misciagna, 2000)); and sentence 
construction, particularly grammar (Silveri & Misciagna, 2000).  
Additionally, cerebral damage does not only affect an individual's 
speech production, but studies indicate that cerebral damage can also 
affect an individual's verbal comprehension abilities (Fabbro et al., 
2000).  

Because speech production is effected in so many ways by damage to the 
cerebellum, an individual who sustains damage to the cerebellum often 
exhibits both ataxic dysarthria and mutism.  Symptoms of ataxic 
dysarthria include slurred speech, alteration of timing patterns 
(Silveri & Misciagna, 2000), distorted consonant and vowel productions, 
and a slowed speaking rate (Ackermann & Hertrich, 2000).  Mutism refers 
to "impairment of word selection and fluency and syntactic disorders in 
sentence production" (Silveri & Misciagna, 2000).  In addition to 
ataxic dysarthria and mutism, individuals suffering from cerebral 
damage also tend to speak nasally as well as pronounce consonants in an 
"explosive" manner, suggesting that cerebral damage affects phonation 
(the vocalization of sounds) more than articulation in speech 
production (Fabbro et al., 2000).

Lastly, it has been recently postulated that damage to the cerebellum 
has a direct influence on emotional health.  This postulation has been 
supported by numerous case studies.  In one case, a group of people had 
electrodes implanted into the cerebellum in order to help reduce the 
occurrence of epileptic seizures.  In addition to seizure reduction, 
the group reported improvements in aggression, anxiety, and depression 
(Riklan et al. as cited in Schmahmann, 2000).  (However, it should be 
noted that those improvements in health could also be because of the 
reduction in seizures.)  In another case study, 11 patients who were 
institutionalized for emotional dyscontrol had electrodes implanted in 
a particular region of the cerebellum.  After their surgeries, they 
exhibited "extraordinary" improvements.  Because of the extent of their 
improvements, they were allowed to be "released to the community and 
live essentially normal lives."  In addition to these case studies, 
there's evidence that damage to the cerebellum can influence the 
occurrence of the following emotional disorders because of the 
cerebellum's association with all the different parts of the brain: 
schizophrenia; depression, specifically bipolar disorder; and autism in 
children (Schmahmann, 2000).

As can be seen, damage to the cerebellum can manifest itself in many 
different ways, and each manifestation poses a unique challenge for the 
individual affected.  It is likely that these challenges can be 
overwhelming at times as well as relative incapacitating to the 
individual.  Undoubtedly, an individual who has sustained some type of 
cerebral damage will have a harder time functioning as a successful 
citizen in today's society, especially when it comes to seeking 
employment.  (It should be noted, though, that there is hope for these 
individuals because of the seemingly rapid recovery rate in individuals 
who have undergone surgery in order to correct the cerebral damage 
they've sustained (Fabbro et al., 2000).)

Employers working with an individual who has sustained cerebral damage 
have to keep several things in mind.  First of all, the speech problems 
individuals with cerebral damage experience could cause significant 
complications which could frustrate employers.  This is because 
communication could potentially be extremely difficult; not only could 
the individual with cerebral damage have a hard time speaking in a way 
which is understandable, but the individual may also have a hard time 
comprehending what the employer.  In the case of the employer, not 
being able to understand what the employee is saying combined with not 
being able describe to the employee successfully the tasks that the 
employee is expected to perform would cause significant frustration.  
The employer would probably give the employee tasks requiring little 
verbal communication as well as explanation.  Although this seems like 
a satisfactory solution, this could prove frustrating for the disabled 
employee.  Despite all the communication deficits cerebral damage 
causes, the affected individual's IQ is not any lower than others'.  
Thus, the affected individual is just as smart as anyone else, but has 
trouble proving it (Fabbro et al., 2000).

The motor impairments experienced by individuals who've sustained 
cerebral damage also poses a significant challenge in an employment 
setting.  Most jobs require at least good control over fine motor 
skills.  However, those with cerebral damage (even if the damage isn't 
that extensive) have often lost the ability to execute fine motor 
movements smoothly (Carlson, 2001).  This means that the impaired 
individual would have to have a task requiring little motor skills in 
order to keep his/her job.  For an employer, this means having an 
employee with very little versatility.  Most the time, such an employee 
is either never hired or when hired, doesn't have the opportunities to 
advance.

Lastly, the emotional problems those with cerebral damage face would 
also cause them problems in a job setting.  One set of reported mood 
alterations in 26 children with cerebral damage were the following: an 
increase in aggression; an increase in irritability; the tendency to 
avoid physical and eye contact; and a decreased ability to tolerate the 
company of others (Schmahmann, 2000).  Although these symptoms were 
recorded in children, this doesn't mean that the same symptoms couldn't 
appear in adults who have sustained the same amount of cerebral damage.  
Any adult exhibiting any of the characteristics described above would 
be a difficult person to work with, let alone be around.  This would 
make it hard for employers.  Nobody wants an employee who's going to 
tell off customers or avoid any sort of contact with his coworkers.  
Because of this, the only types of jobs available for people exhibiting 
characteristics above are the low-paying, solitary, menial jobs that no 
one else wants.  This is unfortunate for the impaired individual; not 
only is the impaired individual's intelligence undermined in such jobs, 
but because the individual is more likely to be depressed because of 
the fact that he/she is overqualified for the job (Johnson & Johnson, 
1996), the impaired individual will in turn be more likely to exhibit 
the emotional characteristics that earned him/her the menial job in the 
first place.

As can be seen, with the emotional, physical, and cognitive impairments 
combined, those sustaining cerebral damage have a tough road to travel.  
Luckily, as mentioned before, those who are able to undergo surgery to 
repair the damage they've received experience a relatively thorough 
recovery (Fabbro et al., 2000) (Schmahmann, 2000).  However, this does 
not help those who are unable to undergo such a surgery.  Hopefully, 
with the ever-increasing amount of improvements being made within the 
sciences, cerebral damage will become fully understood and curable, 
thus making the lives of those impaired and those faced with attempting 
to employ the impaired more livable.

References

Ackermann, H., Hertrich, I.  (2000).  The contribution of the 
cerebellum to speech processing.  The Journal of Neurolinguistics, 
13(2-3), 95-116.

Amato, C.J.  (1998). The World's Easiest Guide to Using the APA: A 
User-Friendly Manual for Formatting Research Papers According to the 
American Psychological Association Style Guide  (2nd ed.).  
Westminster:  Stargazer Publishing Company.

Carlson, N.R. (2001).  Physiology of Behavior.  (7th ed.)  Boston: 
Allyn and Bacon.

Fabbro, F., Moretti, R., Bava, A.  (2000). Language impairments in 
patients with cerebellar lesions. Journal of Neurolinguistics, 13(2-3), 
173-188.

Johnson, G.J., Johnson, W.R.  (1996). Perceived over qualification and 
psychological well-being. The Journal of Social Psychology, 136(4), 
435-445.

Marieb, E.N., Mallatt, J.  (2001). Human Anatomy.  (3rd Ed.)  San 
Francisco: Benjamin Cummings.

Schmahmann, J.D.  (2000). The role of the cerebellum in affect and 
psychosis.  Journal of Neurolinguistics, 13(2-3), 189-214.

Silveri, M.C., Misciagna, S.  (2000). Language, memory, and cerebellum.  
Journal of Neurolinguistics, 13(2-3), 129-143.


Lesions in the cerebellum
The Neuropsychologist
Annie Topolewski



	The cerebellum, known as the "little brain" is made up of the two 
smaller hemispheres located at the back of the cerebrum.  The 
cerebellum plays an important role in the coordination of voluntary 
movements by fine-tuning commands from the motor cortex in the 
cerebrum.  All motor activity, from hitting a golf ball to playing a 
musical instrument, is dependent on the cerebellum (Encarta, 1999).  
Lesions to the cerebellum can cause problems with standing, walking, 
and performance of coordinated movements.  The movements become jerky 
and erratic.  The symptoms from lesions in the cerebellum change 
depending on what part of the cerebellum is damaged.  For example, if 
the vermis is damaged there may be disturbances in posture and balance, 
while damage to the intermediate zone can cause limb rigidity (Carlson, 
1998).  
An evaluation by a neuropsychologist can be critical in 
determining if there is some sort of brain injury, and if there is 
injury, which brain functions are impaired and which remain intact.  
The neuropsychologist is also involved in monitoring recovery and 
determining the effectiveness of the rehabilitation 
(www.neuropsychologycentral.com).
When there is any change in behavior following some sort of brain 
injury that effects memory, learning, or the ability to function, it is 
important for the patient to seek a neuropsychological evaluation.  
However, the patient should first rule out any medical causes of the 
symptoms prior to seeing the neuropsychologist 
(www.neuropsychologycentral.com).    
The neuropsychologist may have some sort of behavior checklist 
that they use.  One such list, the neuropsychological interview form, 
requires much detail about the physical functioning of the patient.  
The interview form requests information on vision, hearing, touch, 
smell, taste, pain, balance, motor abilities, walking, memory, speech, 
and attention, among many other areas.  The neuropsychologist will 
examine the patient, checking for signs of brain injury.  A blow to the 
head may result in headache, dizziness, paralysis, convulsion, or 
temporary blindness, depending on the area of the brain affected.  It 
is the job of the neuropsychologist doing the examination to determine 
which area of the brain has been damaged based on the symptoms that the 
patient presents with.  Since the cerebellum helps to coordinate 
movement, a patient with a lesion in the cerebellum may stumble, have 
an irregular gait, or have difficulties writing (Wickelgren, 1998).  
The patient may present with dysmetria, which is when the limb may 
undershoot, or hypermetria, when the limb overshoots an intended 
target.  Speech can also be affected.  Damage to the cerebellum can 
cause abnormal transitions from consonants to vowels, slower speech, 
and reduced speech movement acceleration (Schulz, 1999).
The neuropsychologist will test the patient's coordination by 
asking them to touch their finger to their nose, and also by using the 
heel-to-shin test.  They also check the patient for clumsiness and 
slowness.  They are looking for changes in behavior.  There are 
numerous other motor signs of damage, such as, rigidity, ballism, 
dystonia, akinesia, tremor, and chorea, which is characterized by 
involuntary, purposeless, spasmodic movements of the entire body. 
Spasticity is reduced movement due to stiffness of the muscles and 
exaggerated reflexes.  Ataxia is loss or impairment of muscular 
coordination, characterized by involuntary trembling of parts of the 
body when performing voluntary movements, difficulty in performing 
precise movements, and disturbance in balancing the body (Cytowic, 
1996).
Lalonde and Marquard (2000) found that patients with damage to 
the cerebellum show some impairment in test of visuospatial 
organization, selective attention, working memory, frontal lobe-
sensitive behaviors and associative learning.  They used a variety of 
existing measures to test for impairment in these areas.  For example, 
to test visuospatial organization they used block design and object 
assembly subtest of the Wechsler's Adult Intelligence Scale and the 
Raven Standard Progressive Matrices.  In measuring short-term or 
working memory they used the digit span subtest of the Wechsler Adult 
Intelligence Scale.
The prognosis for recovery is dependent on many factors.  "Of 
stroke survivors, 70-80% will have mild or no functional deficit, 20% 
will be moderately disabled, and fewer than 10% will be severely 
disabled"(Anderson, 1994).


References:

Anderson, R.M. (1994). Practitioner's guide to clinical 
neuropsychology. New York: Plenum press.

Carlson, N.R. (1998). Physiology of Behavior. Boston: Allyn and Bacon.

Cytowic, R.E. (1996). The neurological side of Neuropsychology. 
Cambridge, Mass.: The MIT press.

Encarta Encyclopedia. (1999). Redmond, Washington: Microsoft.

Lalonde, R. and Botez-Marquard, T. (2000). Neuropsychological deficits 
of patients with chronic or acute cerebellar lesions. Journal of 
Neurolinguistics, 13, 117-128.

Schulz, G.M. and Dingwall, W.O. (1999). Speech and oral motor learning 
in individuals with cerebellar atropy. Journal of Speech, Language and 
Hearing Research, 42, 1157-1176.

Wickelgren, I. (1998). The cerebellum: The brain's engine of agility. 
Science, 281, 1588-1591.

www.neuropsychologycentral.com


Waridi Parsons
Psych 321
May 4,2001
	About a week ago, I began to feel a ringing kinda buzzing sound 
in my ear.  I also felt dizzy for no reason at all.  I decided to go in 
to the doctor to see what was wrong.  I did not know what to expect 
nothing like this had ever happened to me.  I remember my Uncle Tory 
died a few years before from a brain tumor.  My uncle got sick he 
waited a while until he got help.  He began to experience headaches, 
vomiting.  The fluid in his brain was unable to circulate which caused 
Increased Interacranial Pressure.  The doctors told me then that I 
should be aware of these symptoms if they ever occurred.  
	The next week I had an appointment with Dr. Parsons and she 
explained that she was going to give me a neurological examination.  I 
wasn't sure what the exam was about, but she assured me that it would 
not hurt.
 NEUROLOGICAL EXAMINATION 
A basic neurological examination includes the following: 
Eye movement, pupil reaction, and eye reflex tests. Hearing tests using 
a ticking watch or tuning fork. Reflex tests using a rubber hammer.  
Balance and coordination tests. Heel-to-toe walking. Heel-to-shin 
movements. Balance with feet together and eyes closed. Rapid 
alternating movements such as touching the finger to the nose with eyes 
closed. 
Sense of touch tests using a pinpoint and cotton ball. 
Sense of smell tests using various odors. Facial muscle tests--smiling, 
grimacing. Tongue movement, gag reflex tests. Head movement tests. 
Mental status tests. Asking for the current time and date. Asking who 
is President. Abstract thinking test. Asking for the meaning of "a 
stitch in time saves nine. "Memory tests. Asking to have a list of 
objects repeated. Asking for a description of the food eaten at 
breakfast yesterday. Asking for a description of the events of last 
Thanksgiving. 
   	A few days after the examination Dr. Parsons called to set up a 
follow-up appointment.  She said I needed more tests, maybe a CAT scan 
(Computerized Axial Tomography).  Dr. Parsons explained that a CAT scan 
would be able to see past the bone in my brain.  She explained that I 
would get an injection of a special dye to detect the abnormal tissue 
that may be in my brain.  About two weeks after the Cat scan test came 
back. The doctors were sure that they had found a malignant brain 
tumor.  The doctors explained to me that because my tumor was malignant 
it was life- threatening.  The exact location of the cancer was in my 
cerebellum, the doctor told me that it was a small mass and that I had 
to have surgery.
	I decided to do some investigations and find out just what was 
going on in my brain.  First I wanted to know what was my cerebellum 
and what it did.  I found that the cerebellum receives visual, 
auditory, vastibular, and somatosensory information.  It is the most 
important part of the motor system.  It also receives information about 
individual muscle movements being directed by the brain.  If my cancer 
was not treated I would eventually began to experience symptoms.  These 
symptoms would include jerky, poorly coordinated, exaggerated 
movements.  I learned that the cerebral area of my brain was very 
important and that this surgery was serious.  The doctor told me that 
Surgery is the treatment of choice for accessible brain tumors. 
Accessible tumors are those which can be surgically removed without 
causing severe neurological damage. Tumors located in gray matter or 
deep within the brain may be inaccessible. 
 	I knew I needed this surgery because without in I might not be 
able to walk someday if the cancer started to spread. I just wanted to 
get rid of the cancer at one time. I knew that the surrey was not the 
end of the road I still might have to have additional treatments if the 
cancer was not completely removed. Even if it were completely removed I 
still would have to be careful to make sure it never comes back.
The goal of surgery was to remove all visible tumor. Many benign 
tumors are treated only by surgery. Most malignant tumors require 
additional treatment. Malignant tumors lack distinct borders. They 
often invade nearby normal brain tissue. Tumor cells may also spread 
throughout the brain and spine by way of the cerebrospinal fluid. But, 
even partial tumor removal is beneficial. 
The purpose of surgery is: 
To remove as much tumor as possible. Partial removal (debulking) of a 
tumor provides relief of symptoms, improved quality of life, and a 
smaller tumor burden for other treatment modalities. To help establish 
an exact diagnosis removal of a sample of tumor to be examined under a 
microscope in the laboratory provides an exact diagnosis to determine 
the extent of the tumor. The neurosurgeon sees the actual tumor in the 
brain to provide access for other treatments, such as newer forms of 
radiation during surgery, implants may be placed or radiation may be 
delivered.
	After this ordeal was over the cancer was removed and I had a 
couple of sessions with the Chemotherapy and I have not seen the cancer 
since.

References
Carlson, N. R. (2001). "Physiology of Behavior." (7th ed.). 
Massachusetts: Allyn and Bacon.

Copyright © 2001, Dr. John M. Morgan, All rights reserved - This page last edited 7 - May, 2001
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