Rehabilitation of Executive Functioning After Focal Damage to the Cerebellum

Abstract

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.

Transfer effects of errorless Goal Management Training on cognitive function and quality of life in brain-injured persons

“…In general, patients reported better executive function in daily living after both treatments, whereas proxies reported a decrease in executive behavioral problems. This is in agreement with the results of previous studies, which also showed that proxies (Miotto, Evans, de Lucia, & Scaff, 2009;Schweizer et al, 2008;Spikman, Boelen, Lamberts, Brouwer, & Fasotti, 2010) and therapists (Spikman et al, 2012) reported less complaints after GMT. However, in our study post-treatment improvements were not found on all subjective cognitive measures.…”

Response to Goal Management Training in Veterans with blast-related mild traumatic brain injury

“…Neither study demonstrated a significant difference between the GMT group and the comparative treatment group. Nor did Schweitzer et al report a significant improvement in their case study which used the total achievement score of the D-KEFS subtest TOL [37].…”

The Cognitive Face of Cerebellum; Implications for Extended Research

“…Numerous neuroanatomical and neuroimaging studies have proposed the relationship between the cerebellum and executive functions (16,48,49). Cerebellum is now identified as a non-motor center playing a significant role in controlling of executive function such as language, visuo-spatial organization, emotional response, personality, reasoning, planning and sequencing (48).…”

“…Tasks demanding working memory activate both prefrontal cortex and cerebellum (48). Clinical reports have explained the executive dysfunction fallowed cerebellar damage (49). The classic executive dysfunctions are common and include impairments in set-shifting, planning, abstract-reasoning, verbal-fluency and working memory (16,42,53,54).…”

“…Executive function disorders are complicated and their management is challenging (48). Schweizer et al described the use of a cognitive rehabilitation technique, Goal Management Training (a rehabilitation approach which relies on the verbally-mediated, metacognitive strategies to systematically target disorganized behavior resulting from executive and attentional impairment), in a patient with persisting executive dysfunction after right cerebellar hemorrhage (49,55).…”