Structural differences in the development of the cerebellum in children with spina bifida myelomeningocele are associated with functional deficits in movement, timing, and attention. Furthermore, these structural and functional deficits contribute to uneven development of perception and cognition. Studies are reviewed that provide some understanding of the reason such a mixed pattern of assets and deficits within the same area is seen in these children. Motor learning and adaptation are relative strengths while predictive motor control is not. Upper limb function and visual perception are problematic as is timing and attention. In utero damage to the cerebellum may provide an explanation for this mixed pattern. Early damage can negatively impact the development of cerebellar circuits which could interfere with learning. Clinicians need to be aware of the relative strengths and weaknesses in children with spina bifida myelomeningocele in order to individualize early intervention treatment plans, optimize motor learning, and promote maximal participation in daily life.

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