BIOLOGICAL BASIS OF BEHAVIOR
Psychology 321
Spring, 2004
Dr. John M. Morgan MWF, 8am to 9:00 HGH 226
Introduction and Neurosurgeon by:
Stephanie Downing
The cerebellum is a large structure located in the hind brain, containing 10% of the
mass of the brain. The cerebellum means little brain, because like the cerebrum it has
an outer cortex, inner white matter, and deep nuclei below the white matter. The
surface of the cerebellum is highly convoluted much like the cerebral cortex. The
cerebellum contains more neurons than the rest of the brain combined! It is the most
complex neurological structure that is still yet to be fully understood. The cerebellum
is very essential to the motor system, in that it is involved with so many movements.
The cerebellum receives visual, auditory, vestibular, somatosensory, and individual
muscle movement input. It then integrates this information to make smooth and
coordinated movements. Some refer to it like a computer, taking information from
different areas of the brain, decoding it and correcting it to make a precise movement.
Damage to the cerebellum causes an impairment of standing, walking, and
performance of coordinated movements resulting in no or spastic movements and
tremors. The cerebellum is active in not only coordinated movements and balance
such as throwing a ball, or walking with a normal gaint, but more so in refined and or
learned movements such as writing, typing, pointing, clapping, speaking, riding a
bike, or shifting a car. Damage to the cerebellum would very much effect one's
timing, aim, and delay, such as moving your eyes quickly to focus from one point to
another. This is why the cerebellum is extremely large in birds, and almost useless in
a sloth, which hardly moves at all.
As one could tell damage to one's cerebellum means living a disabled life style.
From the prospective of a neurosurgeon, my goal is to correct the damage or try to
stop the degeneration of the brain and it's neurons by performing surgery. The
unfortunate fact still remains that surgery increases the incidence of headaches and
may result in facial paralysis, but the most important factor is your neurosurgeons
experience with the particular approach. One's experience in surgery can far out
weigh the statistics. My newest patient is a 10 year old girl referred to me though a
neurologist. With damage to her cerebellum there are few but some ways to relieve
one's disabling symptoms. If the damage was sustained from a lesion there is the
option of surgically removing the lesion from the cerebellum. This should then heal in
time and behavior should return to normal. To reduce the symptoms of spasticity, a
procedure called Selective Dorsal Root Rhizotomy aims to reduce spasticity in the
legs by reducing the stimulation the legs receive via nerves. The surgeon selectively
locates and severs over active nerves controlling leg muscles. Research suggests this is
successful in for some but not all. Another method is called Chronic Cerebellar
Stimulation. In this technique electrodes are implanted on the surface of the
cerebellum, stimulating certain cerebellar nerves in hopes that there would be an
improvement in motor functioning and a decrease in spasticity. This invasive
procedure has had mixed results. Last but not least is the new (as of 1997)
breakthrough neurological treatment for tremors called deep brain stimulation. This
treatment involves the implantaion of an insulated electrode into the thalamus. The
electrode is connected to a pacemaker like pulse generator that is implanted beneath
the skin of the chest area. This stimulation is either controlled by the doctor or the
patient, using a hand held device to increase or decrease the amount of electrical
pulses that are sent to the wire.
Before any surgical procedures take place there are a number of steps that must
be taken first involving diagnosis, tests, and a detailed account of the patient's
symptoms and health history.
Work Cited:
Kalat, James W., 2000, Biological Psychology, 7th Edition,
Cerebral Palsy- Surgery and Surgical Treatment
www.healing-arts.org/children/cp/cpsurgery.htm
New treatments for Parkinson's Disease
www.theworstpain.com
Carlson, Neil R., 1998, Physiology of behavior, 6th edition
Brooke Michelson
Neurologist
Cerebellum
A neurologist is a physician who specializes in disorders of the brain.
Neurologists diagnose the type of injury and makes recommendations for further
treatment (Fuller, 2000). The cornerstones to a neurological examination are the
patent interview and the physical examination (Weiner, 1999). This is often referred
to as a neurological assessment this is used to rule out other problems or causes. In
the case of a major lesion to the cerebellum this could be discovered during the
patent interview the location of the lesion will be found during the physical
examination. The first step in treatment by a neurologist would be rule out
conditions that might require neurosurgical attention if neurosurgical attention was
needed the patented would be referred to a specialist immediately to prevent further
damage.
During the interview the patent is asked specific questions on any changes in
behavior they have noticed. How much distress is related to these changes is also
noted along with any other information related to their impairment that can be given.
Changes in behavior in things such as learned coordinated motor movements are
noted such as walking riding a bike. Simple tasks that were once mastered
movements are now very difficult if not impossible (Ariniello, 2004). In the case of
this patent she is noted as having major changes in most coordinated movements and
major impairment in her daily activities. These impairments were acquired after
falling from a tree and hitting the back of her head on a rock where the cerebellum is
located.
There are several tests that are run during the physical examination to access
the changes of behavior that the lesion has caused and to pinpoint the part of the
brain that is being affected. There are many ways to conduct the examination I will
start with the checking the upper extremities, The patent is asked to touch her nose
with her eyes open and closed this patent with suspected cerebellum damage is not
able to do this easily and the movement is not smooth, which it would normally be.
Then the finger-finger test that consists of the patent touching her finger to my finger
damage to the cerebellum causes the patent to not do this task smoothly or
accurately. A patting test is also performed the patent is asked to pat her thigh
rapidly this behavior is not performed briskly nor with amplitude or rhythm. A
rebound test is done that checks the patents ability to check movements quickly that
requires coordinated movements that this patent does not have. Pushing her out
stretched arm puts her off balance. Dexterity is assessed in ways such as touching the
thumb to the finger that is difficult for this patent their are also alterations in her
handwriting (Mancall, 1981).
There are several lower extremity tests that are performed to access the behavior
differences. The heel-knee test has the patent lie on their back and the heel of one
foot is placed on the opposite knee then the foot is slid down the shin, this task was
performed very roughly. The patting test is done with the feet, the patent is asked to
stomp her foot while standing the patent is off balance, shaky and uneven. Figure-of-
eight test the patent is asked to lean back put a big toe in the air and draw a figure
eight, which is not done effectively (Mancall, 1981).
The trunk is also tested through several different ways that a person with no lesion
would have no problem performing. The patient is asked first to stand with both feet
close together with the eyes open and closed, then asked to put one foot on top of the
other this takes balance and coordination which this patent does not have. The style
and manner the patent walks is tested by having her walk briskly and turn quickly
with eyes both open and closed, causing a loss of balance. Testing her tandem gate is
then done to see if walking with one foot directly in front of the other causes
difficulties, which caused her a loss in balance. Also her postural behaviors were
noted throughout these tests, because of the damage everything seemed a little off
balance (Mancall, 1981).
A computed tomography is requested because it can evaluate cranial trauma and
other life threatening complications (Weiner, 1999). This was done to assess the
extent of her injury to the cerebellum and her further treatment by a neurosurgeon.
Works Cited
Ariniello, Leah. (2004). What is the
cerebellum? Retrieved April 29, 2004,
from http://www.sfn.org/content/
Publications/BrainBackgrounders/cerebellum
.htm
Fuller, Geraint., & Manford, Mark. (2000).
Neurology: An illustrated color text.
London: Churchill Livingstone.
Mancall, Elliott. (1981) Essentials of the
neurologic examination Ed. 2.
Philadelphia, PA.: F.A. Davis Company.
Weiner, William., Goetz, Christopher.
(1999). Neurology for the non-
neurologist Ed. 4. Philadelphia, PA.:
Lippincott Williams & Wilkins.
Gisela MacCuish
Psychobiology
Dr. J Morgan
Cerebellum tumor
My current patient was diagnosed with a tumor in the cerebellum that is
commonly found in young children. This patient was referred to me by the patient's
neurosurgeon, who completed an operation in hers cerebellum. As the neuron-
psychologist for this young girl, the program that I will write, it will evaluate the
patient's behavior after her recuperation from the surgery. The main focus will be the
assessment of the patient's possible impairments due to damage in the cerebellum.
Since the cerebellum is the "second largest area of the brain" that is responsible for
controls of skilled muscular coordination, including walking (gait) and speech
(articulation)(www.neurosurgery.mgh.harvard.edu, 5), this young girl will present
these side effects through time.
In accordance with the patient's family, there will a team created to help the
patient to cope with the mental deficiencies, such as language impairment, motor
coordination, and social skills at the behavioral level, which she will experience.
The main aspects of this team will be to focus on getting the patient and
family to work with a "therapist to overcome any difficulty of daily living activities,
such as eating, dressing, bathing, and using the toilet" (medicinenet,4).
The rehabilitation process for this patient will involve a great amount of time.
Also, there will be times where the patient and family will experience frustration,
depression, and terrified feelings regarding the patient's new behaviors.
The patient tumor was a mid-grade "brain injury closed," suggesting that there
were diffused tissues from the connection between the cerebellum and the thalamus
(ssgx.com, 3). The examinations done on the patient with MRI and CT scans
indicates that the tumor was a "mid-grade malignant astrocytoma," a very invasive
tumor. (Gazzaniga and Magnun, chap, 11). This kind of tumor will required a
continuous treatment of chemotherapy as to ensure that the astrocytoma will not
spread further after surgery. Thus the patient will be at high risk of "cranial nerve
dysfunction."
Upon the completion of the different evaluations such as a series of test of
cognitive and psychometric assessment, the patient presented deficiency in learning
and memory abilities. Also, the patient was evaluated with the California Verbal
Learning Test (CVLT) to examine the patient verbal skills. The results indicated that
the patient is going to needs a speech therapist (Hand book of neuro-psychology,13).
The patient took the IQ test in which the results where low but the latency of
cognitive development is not lost completely. Therefore, the team's most important
work is to encourage the patient to keep on assisting to her previous school for couple
of hours a day.
There will be a careful evaluation, which will last two years given the patient's
need for a" systematic mental status examination" because the "medical stabilization
does provide a reasonable objective assessment." This is done in order to figure out
the patient's new behavior baseline due to her new life style (handbook of neuro-
psychology, volume 1, 34). In addition, the patient and her family will be assisting to
therapy to learn more about future side effects that the patient will probably
experience.
The following is a diagram of the results of this patient's assessment. The
abilities in which the patient is going to be assisted with are the following:
1. School related and vocational problems: under this category the patients
will try to assist to school, and she will be help with holding pen and
coloring. Also, she will practice with ratios of ten to fifteen minutes to
coordinate her ability of walking and grabbing objects.
2. School interaction with other children: She is going to be part of the
classroom as a regular member.
3. Family difficulties: The family and patient decided they wanted to assist to
family therapy twice a week for the first year, thereafter once a month.
4. Patient will be going to a physical therapist three times a week to maintain
and learn new ways of mobilizing.
5. The patient will be going to a language therapist to exercise speech's
muscles.
6. In addition, the patient will be learning sign language to see if she could
communicate her needs through it.
There will be times when the patient will get depressed, therefore, her mother in
accordance with care provider will be learning ways to cope with it in a helpful
way.
Work Cited
Boller, Grafman and J. Grafman. Hand Book of Neuropsychology. Vol. 1
Boller, Grafman and J. Grafman. Hand Book of Neuropsychology. Vol. 2
Gazzaniga, Richard. Magnun, George. R. Cognitive neuroscience: Biology of the
mind. Second Edition, New York.
Go to:www.ssgx.com.
Go to: www.neurosurgery.mgh.harvard.edu
Go to: www.medicinenet.com
Amanda Logan
Patient
I am a 10 year old girl. I was out playing in the tree one day, climbing, like I
usually do. The limb that I was on broke and I fell out of the tree to the ground
below. I hit the back of my head on a rock below. I was knocked unconscious and
the air knocked out of me. I came to a little bit later. My parents had seen the whole
things so they ran out and called 911. I was already awake and conscious of my
surroundings when they arrived. I went to the emergency room and the doctors
checked me out. I was fine I had a few bumps and bruises. I also had a pretty bad
headache from the fall and the rock.
I had a headache for a while and the emergency room doctor told me to take a
pain killer to help with that and they should go away within a week or so. It has
been a couple months since I fell out of that tree. I wake up in the morning with
awful headaches that don't really go away. It is at the base of my neck where I hit
my head. We have gone back into the doctors and they have checked out my neck,
thinking that it is not severely hurt. My neck always checks out each time and still
these horrible headaches continue. I notice that they are worse in the morning than
any other time. I have also been having dizzy spells, too. We have gone to the
doctors for that, and they gave me a blood test to see if I was becoming anemic. They
really don't know what is going on.
Another month has gone by and the headaches and dizzy spells have gotten
worse. It feels like my head is going to explode at the base. I am really getting
frustrated because it is so bad that I am always late in the morning to school or I
can't go because I am vomiting. My parents are getting worried since I don't
normally throw up almost every morning. I am missing so much school that I am
going to have to go on independent study. I really miss going to school and playing
with my friends and I even miss my teacher. It is so frustrating since my doctor
doesn't seem to know what is going on.
It has been four months since the accident where I fell out of the tree. I have
not gotten any better I have actually gotten worse. Mom has had to pretty much quit
her job to stay home with me. The new thing is that my walk has changed. I now
take really large, gaits instead of my normal walk and I seem to be loosing my balance
more. We have gone back in to my normal doctor and he has now sent us to a
special doctor called a neurologist. He said that this all could be caused by the fall
and some injury that got overlooked four months ago. This news really upsets my
mother since she feels it could have all been prevented had they done more test
initially when I had fallen. The doctor informed her that most head trauma the
patients usually heal on their own without the help of doctors and with little to no
lasting effects.
So we made the appointment with the neurologist to have some more tests
done. She sent me into have a CAT scan and a MRI. The tests were both pretty cool
because you got to lie down on a table and pushed into a machine. The only down
side was that you had to lie perfectly still for a long time so that the machine could
take an x ray and pictures of my brain. We are so happy to be going to this specialty
doctor because this has put such a strain on the family. I am still getting sick in the
mornings with really bad headaches. My walk has pretty much gone down hill I can
hardly walk without falling down. Plus my steps are so long and miss guided.
The tests came back to show that I have a small blood clot in the back of the
cerebellum that is causing all the problems. It is what is causing there to be so much
pressure in my head. It has been growing since my white blood cells are trying to get
rid of it and they are only adding to the problem. The neurologist says that there is
still time to get it out and there should not be too much lasting damage. She explains
that since the damage is in the cerebellum. She says that is why my gait and balance
has been thrown off. She explains that the cerebellum is in charge of balance and
muscle movement. That is why I have been having a hard time walking. The
headache and vomiting are from the pressure that has been building up in my head.
She refers us to a wonderful neurosurgeon, which will perform the procedure.
When we met with the neurosurgeon, she sent me in for more test. They were
a lot like the ones the neurologist had me do. They took tons of pictures and x rays
of my brain. It has now been five months since my fall out of the tree. I am pretty
much in the same shape I was last month. The neurologist gave me something for the
pain in my head which seems to be working well. After looking at the test results,
she said there are many options for us; also that I should have a pretty good recovery.
She said we could do the procedure within a week or so. She is going to go in and
remove what she can of the blood clot without hurting the brain and then she is
going to stimulate the area that has been under pressure with some electric shock. I
think it sounds painful, but she assures me that I will feel nothing since I will be
asleep when she does it.
So we scheduled the procedure. I made it through with flying colors.
Although they had to shave a little bit on the back of my neck and I get to wear
gauze that looks like a really bad head band. She said I would be in the hospital for a
few days to make sure that everything is OK. I also had to go through some more
tests and pictures of my brain. I am really getting tired of lying down on that table
and lying in the machine. It is a good thing I am not afraid of close spaces. She said
that my walk will improve over time. Until then she suggested that we contact and
see a neuropsychologist, who can help us to understand what to expect.
We went to see the neuropsychologist and she said she was there to help us
understand what is going on. I get to talk with her about how this whole thing has
made me feel. She also works with me and my physical therapist, so that I can
improve my walking. She is a really nice lady and is also really easy to talk to. She
seems to know what I am going through. She says it is because she knows about the
brain and there functions and that is why we came to her instead of a regular
psychologist. She is also helping my parents. She said that it is OK if mom starts
back at her job soon. Mom's boss has been really cool about the whole thing.
It has been a few months since the surgery and I have recovered nicely. My
mom is back to work and I am back in school. I still have to work on walking but I
am getting better every day. I no longer climb trees especially after all the stuff I had
to go through. I no longer am sick or have headaches in the morning. Everything is
all pretty much back to normal.
Works Cited
www.ninds.nh.com National Institute for Neurological Disorders and Surgeries.
Kalat, James. W. Biological Psychology. Thomson Learning, Belmont, Ca. 8th
edition, 2004.
Jennifer Giordano
Family member (mom)
My daughter fell out of a tree yesterday afternoon, and there was massive
damage to her cerebellum. I want everyone to understand how hard it was for me,
and to understand what I have gone through during these past 24 hours. These next
couple years are going to be extremely hard for both my daughter and I.
Due to the fall, my daughter suffers from extreme muscle weakness and speech
problems. There is also a good chance of heart disease because her whole nervous
system has been damaged. One can only imagine how difficult this can make tasks,
such as functioning healthy in school. She has trouble walking to the classroom, due
to her severe muscle weakness, and once seated in the classroom, she remains in her
chair for the remainder of the class period simply because it take too much effort to
lift herself up and out of her desk. The other students even ridicule her; we all know
how cruel 10-year-old kids can sometimes be. It upsets me to know that my daughter
has to deal with this entire traumatic event at such a young as. If only I was outside
with her while she was playing in the tree house, then maybe non-of this would have
happened. Everyday is hard for me. I blame myself day in and day out for my
daughter's traumatic experience, which is going to effect her for life. Often times I
witness her falling or tripping while doing normal everyday simple tasks. Due to the
severe damage she suffers from clumsiness as well as unsteadiness.
My poor daughter can't even enjoy her childhood, doing normal child-like
things such as running around, playing jump rope, playing tag, and any other
cardiovascular activity, because she suffers from chest pain, shortness of breath, and
heart palpitations. The doctor tells me that it is very possible that 10 years from
now, my daughter will be in a wheelchair. I want to talk to her and boost her self-
esteem by telling her that she is just like everyone else, and should be treated exactly
like all of the other kids on the playground, but in order to support her, I need to get
support for myself. These last couples of days have been filled with depression for
me, just having to witness the problems that my helpless daughter faces each day.
I am here to let you all know that the best thing to do if you or someone close
to you is suffering like my daughter due to severe injury to the cerebellum, is to seek
out some kind of psychological counseling and support groups for everyone being
effected. This will indeed help your family cope with any problems that arise, and it
always helps to talk to other individuals who are trying to cope with these same
difficulties. It's important for the patient to have friends she can talk to, who know
exactly what she is going through, and who can identify with her feelings. Outside
support is the most important in the healthy development and success of a child
suffering from something as serious as my daughter.
It's also difficult for me to explain to my other children what happened to their
big sister and why all of a sudden is she acting completely different. The hardest part
was telling my son, Johnny, that his big sister couldn't walk with him and the other
children to the park, the reason being that she would never make it that far. She
would have collapsed before they even made it half way. She is not strong enough to
do those kinds of things, and because of it, she is suffering, she is in misery, and I feel
helpless because there's nothing that I can do to help her overcome this. She will
probably remain in this terrible state for the rest of her life. What kind of life is this
for my young and innocent
daughter? Why did this have to happen to her? What did she ever do to deserve
this? I often ask myself these kinds of questions, although I know that the answer is
that it is nobody's fault and that these kinds of things just happen; it's part of life.
I have lost my job because of this. I am a single parent who can't even work
part time anymore because it is necessary that I stay home and look after my injured
daughter. Who will get up and get her some water when she is sick? Who will carry
her to bed and tuck her in? Who will help her stand up in the shower every morning,
and pick her up off the ground when she collapses due to no muscle strength.
Yesterday my daughter came to me and asked me, "mommy, why am I so different
than all the other kids at school. Why can't I play kick ball out on the playground at
recess, and why can't I get up out of my chair to walk over and say hello to my
friend?" It's questions like these that bring tears to my eyes, just hearing about how
my daughter is suffering and how she is too young to really know and understand
what is happening to her body. The muscle aches, the muscle weakness, the short
breaths, and the inability to move around quickly, the inability to play on the
playground with the rest of the kids at school. All of these privileges people take for
granted, and here my daughter is at home in bed because she is too sick to get up and
play.
Today is the first day of physical therapy for my daughter. Who really knows
if this will help her in the long run, but at this point, anything is worth a try.
Hopefully she will be able to gain some muscle strength back, although this is not
usually possible. Most effects of damage to the cerebellum are long term, and cannot
be helped. She will always have weak muscles, will always have high risk for heart
attacks, and will always have trouble completing everyday, simple tasks. My
daughter will probably never be able to live alone. She will be dependent on someone
for the majority of her life, and this is not healthy.
I hope that someday doctors will find a way to reduce the effects of such a
traumatic lesion to certain parts of the brain, in my daughter's case, the cerebellum.
I also hope that someday my daughter will be just like everyone else, and be able to
play with the other kids. It hurts me to see my child stuck in the house all day, and
being so restricted from the outside world like she is. It's important to me that all
you parents be careful and watch out for your children. Don't leave them alone in
the background for even a min, while you are cleaning up inside. Never leave them
unattended, or else you will risk them unintentionally damaging themselves, whether
its falling off the swing, or falling out of a tree. These are serious issues that have
serious consequences.
I am currently in the process of setting up a support group for other kids like
my daughter. This way she will have other people to talk to. And the parents of
these children who are suffering will have outside support from other parents dealing
with the same thing. If only you people knew how much this has changed my
daughter's life, as well as shifted my own life.
References
Kalat, J. Biological Psychology. Thomson Learning, Inc. 2004 (8th ed.).
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Copyright © 2004, Dr. John M. Morgan, All rights
reserved - This page last edited May 3, 2004
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