Rehabilitation of Executive Functioning After Focal Damage to the Cerebellum
Tom A. Schweizer, PhD*,
Brian Levine, PhD1,
Dmytro Rewilak, PhD2,
Charlene O'Connor, MA1,
Gary Turner, MA1,
Michael P. Alexander, MD3,
Michael Cusimano, MD, PhD4,
Tom Manly, PhD5,
Ian H. Robertson, PhD6,
and
Donald T. Stuss, PhD7
1 Rotman Research Institute, Baycrest, Toronto, ON, Canada
2 Department of Psychology, Baycrest, Toronto, ON, Canada
3 Rotman Research Institute, Baycrest, Toronto, ON, Canada, and Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
4 Department of Neurosurgery, St. Michael’s Hospital, Toronto, ON, Canada
5 Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
6 Department of Psychology, Trinity College Dublin, Ireland
7 Rotman Research Institute, Baycrest, Toronto, ON, Canada, and Department of Psychology, Baycrest, Toronto, ON, Canada
* To whom correspondence should be addressed. E-mail: tschweizer{at}rotman-baycrest.on.ca.
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Abstract |
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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.
