Hidden Functions of the Cerebellum

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What functions support our body’s ability to effortlessly or clumsily move through space? To anticipate our next movements before we know we are about to make them? What structures allow for the hidden nuances of everyday body language and a feeling of synchronicity to ourselves and others without intentional thought? 

 

As PTs, OTs, and SLPs we are constantly trying to uncover the intricacies that make our patients tick. We all understand the importance of the human brain and yet often overlook the complexities of its structures. The following is a brief synopsis of some of the functions of the cerebellum and why understanding its major roles can provide crucial insights into effective therapeutic interventions. Neuroatypical and /or neurodivergent clients can particularly benefit from activation and modulation of the cerebellum in an attempt to obtain an increased level of homeostasis in whatever capacity that might be for that individual. This article will briefly go over the anatomy of the cerebellum, roles/functions, and how to tailor treatment to target these areas. 

Basic Anatomy 

 

Most therapists have at minimum a brief understanding of brain anatomy. Yet often emphasis is placed on the cerebral cortex and its role with higher level cognitive functions such as executive function, decision making, etc. While many interventions are tailored to this area of the brain, an older part of our anatomy also craves attention.  

 

The cerebellum is responsible for a vast array of functions including but not limited to: movement, coordination, balance, timing, and anticipation of motor movements. It is broken down into three major parts: The Anterior Lobe, Posterior Lobe, and Flocculondurlar lobe (this is the oldest part of the brain in terms of evolution and is primarily concerned with balance and spatial orientation, however, it is also responsible for many visual and sensory inputs/processes).  

 

Roles/functions/importance:  

 

The cerebellum is focused on making the perfect plan for the body before we even have conscious awareness of our movement. Another name for this process is called neural sharpening. Studies have shown that cerebellar size is smaller in the autism population, causing this process of neural sharpening to be less fine-tuned when compared to the neurotypical population.  

 

In addition, many gestures (how we talk with our hands, etc) are implicitly learned and often originate in the cerebellum. It has also been studied that an increase in gestures is a predictor of language, and language by preschool can be a predictor of academic success (Kuhn et al., 2014). A child should have sixteen gestures by 16 months and a wonderful resource for this can be found here: https://ambiki.com/resources/16-gestures-by-16-months

 

The cerebellum also helps our sense of equilibrium, provides an internal timing of our movement system, and allows us to be in rhythm and synchronicity with others. When we think of some of the challenges neurodivergent and neuroatypical populations face, we can appreciate the role the cerebellum plays if it is not functioning optimally. Without the modulation of the cerebellum, a vast array of disconnections can occur. Providing techniques that can help modulate the cerebellum can assist a client in gaining some internal regulation of their own body.  

 

Treatment interventions:  

 

Activation of the cerebellum and teletherapy tie-ins:  

 

Balance activities: such as single leg stance, toe walking, heel walking, standing on a bosu (or inflatable cushion) and tossing a ball back and forth. 

 

Vestibular activities: swinging, taking away the visual component to any of the above. 

 

Anticipatory Postural Activities (APAs): activities that allow a child or client to anticipate and predict movements and postural control. Examples of this can include tug of war, opening a drawer while sitting or standing, providing verbal cues/scenarios to allow a client to prepare for the movement ( ie: I am going to try to push you, be extra strong and do not let me push you” before gently pushing the client, allowing anticipatory responses to kick in).  

 

Clapping patterns: producing clapping patterns and having a child/client mimic back to you can help promote sequencing, rhythm, and motor planning. This can easily be scaled to become harder or easier and are a wonderful way to activate the cerebellum over teletherapy.  

 

Singing a song or playing a video with motions attached: singing a song such as “I’m a little teapot” / ‘wheels on the bus’ which have corresponding motor movements can work on activation and prediction of movements to home in on smoother transitions. This is also a technique that can easily be implemented over teletherapy.  

Tying it all together 

 

A white paper published by Harvard Medical School found there to be high efficacy in treating ADHD (ages 8- 14 years of age) with brain/balance exercises (Teicher, 2020). As therapists focused on so many types of interventions and anatomical structures, it can be easy to overlook the nuances of the cerebellum and its hidden correlations to the underpinnings of our everyday rhythms.  

 

At Ambiki, we aim to make our platform a place where therapists can come together and share evidence-based practice approaches as well as their own experiences of what has and has not worked well with their clients. It is also our hope that our highly interactive teletherapy platform will empower rather than limit therapists to continue to provide highly effective and evidence-based interventions virtually. We invite you to come try our 1-month free trial  (no credit card information required) and begin an experience tailored to your individual therapy goals.  

 

Editor's note: In addition to being an OTR/L, Bethany Ayer is also a Certified Brain Injury Specialist (CBIS).

 

References:

Kuhn, L. J., Willoughby, M. T., Wilbourn, M. P., Vernon-Feagans, L., & Blair, C. B. (2014). Early communicative gestures prospectively predict language development and executive function in early childhood. Child Development. https://doi.org/10.1111/cdev.12249

 

Rogers, T. D., McKimm, E., Dickson, P. E., Goldowitz, D., Blaha, C. D., & Mittleman, G. (2013). Is autism a disease of the cerebellum? an integration of clinical and pre-clinical research. Frontiers in Systems Neuroscience, 7. https://doi.org/10.3389/fnsys.2013.00015

 

Roostaei, T., Nazeri, A., Sahraian, M. A., & Minagar, A. (2014). The human cerebellum. Neurologic Clinics, 32(4), 859–869. https://doi.org/10.1016/j.ncl.2014.07.013

 

Teicher, M. (2020). Final White Paper: Effects of Brain Balance Exercises and Interactive Metronome on Children with Attention Deficit Hyperactivity Disorder are Similar to the Effects of Stimulant Medication. Harvard Medical School.