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Rehabilitation of Executive Functioning After Focal Damage to the Cerebellum

Rotman Research Institute, Baycrest, Toronto, ON, Canada, tschweizer{at}rotman-baycrest.on.ca

Brian Levine, PhD

Rotman Research Institute, Baycrest, Toronto, ON, Canada, University of Toronto, Toronto, ON, Canada

Dmytro Rewilak, PhD

Department of Psychology, Baycrest, Toronto, ON, Canada

Charlene O'Connor, MA

Rotman Research Institute, Baycrest, Toronto, ON, Canada

Gary Turner, MA

Rotman Research Institute, Baycrest, Toronto, ON, Canada

Michael P. Alexander, MD

Rotman Research Institute, Baycrest, Toronto, ON, Canada, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA

Michael Cusimano, MD, PhD

University of Toronto, Toronto, ON, Canada, Department of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada

Tom Manly, PhD

Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK

Ian H. Robertson, PhD

Department of Psychology, Trinity College Dublin, Ireland

Donald T. Stuss, PhD

Rotman Research Institute, Baycrest, Toronto, ON, Canada, Department of Psychology, Baycrest, Toronto, ON, Canada

Executive dysfunction accounts for significant disability in patients with many types of brain injury in many locations. Clinical reports have described impaired executive functioning after damage to the cerebellum, and anatomical and neuroimaging studies have identified the likely basis for this effect: a cortico—ponto—cerebellar network through which the cerebellum is densely connected to areas of frontal cortex. The patterns of executive impairment attributable to cerebellar damage have been extensively described in the past 15 years, but there has been no assessment of the efficacy of rehabilitation in this patient population. Here, the use of a cognitive rehabilitation technique, Goal Management Training, in a patient with persisting executive dysfunction after a right cerebellar hemorrhage is described. The patient made and maintained modest gains on measures of sustained attention, planning, and organization that translated into significant improvement in real-life functioning. This is the first report on the rehabilitation of impaired executive functioning following focal damage to the cerebellum and in the presence of intact frontal cortex.

Key Words: Neuropsychology • Cognition • Attention • Strategy application • Goal neglect

This version was published on February 1, 2008

Neurorehabilitation and Neural Repair, Vol. 22, No. 1, 72-77 (2008)
DOI: 10.1177/1545968307305303


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