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The functional neuroanatomy of cerebellar systems has been extensively studied during the past decades by means of experimental animal studies, anatomoclinical studies, as well as structural and functional neuroimaging studies in patients and healthy subjects. Within a system of closed-loop circuits, this wealth of studies identified reciprocal projections between the cerebellar structures and the supratentorial areas subserving sensorimotor, cognitive, and affective function. It has been shown that cerebellar output is mediated by the deep cerebellar nuclei, mainly by the dentate nucleus (DN), which project to the supratentorial cortex via the thalamus (cerebello-thalamo-cortical pathway). In turn, the cortical areas that are the target of cerebellar output project back to the cerebellum via the pons (cortico-ponto-cerebellar pathway). Regions of the cerebellar cortex that receive input from a specific supratentorial area, are the same regions that project back to that supratentorial area, thus forming closed-loop circuits. These projections are largely crossed, connecting the cerebral hemispheres primarily with the contralateral cerebellar hemispheres.

Brain tumour patients with mild language disturbances are typically underdiagnosed due to lack of sensitive tests leading to negative effects in daily communicative and social life. We aim to develop a Dutch standardised test-battery, the Diagnostic Instrument for Mild Aphasia (DIMA) to detect characteristics of mild aphasia at the main linguistic levels phonology, semantics and (morpho-)syntax in production and comprehension. We designed 4 DIMA subtests: 1) repetition (words, non-words, compounds and sentences), 2) semantic odd-picture-out (objects and actions), 3) sentence completion and 4) sentence judgment (accuracy and reaction time). A normative study was carried out in a healthy Dutch-speaking population (N = 211) divided into groups of gender, age and education. Clinical application of DIMA was demonstrated in two brain tumour patients (glioma and meningioma). Standard language tests were also administered: object naming, verbal fluency (category and letter), and Token Test. Performance was at ceiling on all sub-tests, except semantic odd-picture-out actions, with an effect of age and education on most subtests. Clinical application DIMA: repetition was impaired in both cases. Reaction time in the sentence judgment test (phonology and syntax) was impaired (not accuracy) in one patient. Standard language tests: category fluency was impaired in both cases and object naming in one patient. The Token Test was not able to detect language disturbances in both cases. DIMA seems to be sensitive to capture mild aphasic deficits. DIMA is expected to be of great potential for standard assessment of language functions in patients with also other neurological diseases than brain tumours. only published online, no volume/issue number ispartof: Clinical Linguistics & Phonetics vol:36 issue:11 pages:1-25 ispartof: location:England status: Published online

Cerebellar mutism can be considered the hallmark feature of the cerebellar mutism syndrome (CMS), previously also frequently termed the posterior fossa syndrome (PFS). The syndrome consists of specific linguistic, cognitive, behavioral, and affective symptoms following acute posterior fossa damage in children and adults. Although the symptoms have been exceptionally associated with non-tumoral etiologies, CMS usually develops after a brief period of relatively normal functioning in the immediate postoperative phase following posterior fossa tumor surgery. The incidence of CMS in the pediatric population is estimated to range between 7% and 50%. Although similar symptoms have been occasionally reported in adults, CMS is typically viewed as a clinical condition affecting children. An international consensus as to the definition of CMS was recently reached. However, this accepted definition specifically addresses the pediatric variant of the syndrome associated with posterior fossa surgery (postoperative pediatric CMS, POPCMS). In this chapter, the more general term CMS (instead of POPCMS) will be used to denote similar symptoms also occurring in adults, and with non-tumoral etiologies. Although the semiology of CMS has extensively been described, the underlying pathophysiological mechanisms still remain largely unclear. This chapter presents a brief overview of the intriguing semiological combination of transient cerebellar mutism and cognitive, behavioral, and affective alterations following acute posterior fossa lesions. Furthermore, the most important pathophysiological hypotheses and the proposed therapeutic interventions will be briefly discussed.

Semantic processing is a fundamental aspect in human communication. The cortical organization of semantic processing has been exhaustively described, in contrast to inconsistent results on the function of subcortical grey matter structures. Hence, this manuscript reports a systematic review and meta-analysis on the subcortical involvement in verbal semantic comprehension in healthy individuals. The 50 included studies indicate specific contributions by the cerebellum, thalamus and caudate nucleus respectively. In particular, the right posterior cerebellum is proposed to be involved in a semantic executive system and in adequate decision-making. The left thalamus, regulated by the caudate nucleus, might function as a subcortical hub, controlling the access and integration of cortically organized semantic features. Furthermore, a contribution of the cerebellum, thalamus and caudate nucleus in semantic prediction generation and evaluation at sentence level is preliminarily suggested. More research is required to gain insights into the role of the putamen, globus pallidus and subthalamic nucleus.

Recent research has revealed that the cerebellum plays a critical role in social reasoning and in particular in understanding false beliefs and making trait attributions. One hypothesis is that the cerebellum is responsible for the understanding of sequences of motions and actions, which may be a prerequisite for social understanding. To investigate the role of action sequencing in mentalizing, we tested patients with generalized cerebellar degenerative lesions on tests of social understanding and compared their performance with matched healthy volunteers. The tests involved understanding violations of social norms making trait and causal attributions on the basis of short behavioral sentences and generating the correct chronological order of social actions depicted in cartoons (picture sequencing task). Cerebellar patients showed clear deficits only on the picture sequencing task when generating the correct order of cartoons depicting false belief stories and showed at or close to normal performance for mechanical stories and overlearned social scripts. In addition, they performed marginally worse on trait attributions inferred from verbal behavioral descriptions. We conclude that inferring the mental state of others through understanding the correct sequences of their actions requires the support of the cerebellum., SCOPUS: ar.j, info:eu-repo/semantics/published

Background and objectives: We provide a case analysis for a 28-year-old, native Dutch-speaking lady who developed Foreign Accent Syndrome (FAS), a few weeks after falling down the staircase. In addition to FAS, which gave the impression she spoke with a German accent, German(-like) words and structures occurred. Speech symptoms were aggravated by increased stress, fatigue or emotional pressure, and this triggered jargon speech. It was hypothesized her FAS and jargon developed on a functional basis.Methods: In-depth analyses of the patient's medical background, neuropsychological and neurolinguistic tests and psychodiagnostic exams were done. The patient participated in an fMRI experiment. In a syllable repetition paradigm, motor speech activations were compared to those of healthy individuals, to see whether they were altered, which would be expected in case of a neurological etiology.Results: Medical history disclosed prior traumatic experiences for which she sought help, but no neurological incidents. Repeated neuropsychological and neurolinguistic tests showed deficits in recent memory and executive functioning. The patient demonstrated great difficulties with picture naming. Clinically, language switching and mixing as well as recurring jargon speech was found. Formal psychodiagnostic tests did not identify a clear disorder, but psychodiagnostic interviews were consistent with a DSM-5 conversion disorder. The fMRI study demonstrated that speech network activations corresponded to those found in healthy participants.Conclusion: The clinical neurolinguistic characteristics, outcome of the fMRI experiment, together with the clinical psychodiagnostic findings were strongly indicative for an underlying functional etiology for the FAS and jargon speech, presenting as symptoms of conversion disorder. (C) 2020 Asociacion Universitaria de Zaragoza para el Progreso de la Psiquiatria y la Salud Mental. Published by Elsevier Espana, S.L.U. All rights reserved.

Repetitive thought about oneself, including one's emotions, can lead to both adaptive and maladaptive effects. Construal level of repetitive self-referential thought might moderate this. During interoception, which engages areas such as the insula, the anterior and/or posterior cingulate cortex (PCC) and the somatosensory cortex, concrete low level construal self-referential thought is applied, which has been shown to lead to more positive emotions after upsetting events. Contrarily, during immersion, related to neural activity in the default mode network (DMN), abstract high level construal self-referential thought is applied, which is linked to depression. The current study investigated whether the integration of concrete and abstract self-referential thought by means of embodied mentalization leads to less subjective arousal, decreased DMN activity and increased somatosensory activity as compared to immersion, and to more DMN activity as compared to interoception. In the fMRI scanner, participants imagined stressful events while adopting immersion, interoception or embodied mentalization. After each imagined stressful event, participants rated their subjective arousal and how difficult it was to apply the mode of self-referential thought. Results showed that participants felt that immersion was easier to apply than embodied mentalization. However, no differences in subjective arousal or neural activity were found between immersion, interoception and embodied mentalization. Possible reasons for this lack of significant differences are discussed. ispartof: Frontiers In Behavioral Neuroscience vol:15 pages:1-10 ispartof: location:Switzerland status: published

Background: Until today, there is no satisfying explanation for why one language may recover worse than another in differential bilingual aphasia. One potential explanation that has been largely unexplored is that differential aphasia is the consequence of a loss of language control rather than a loss of linguistic representations. Language control is part of a general control mechanism that also manages non-linguistic cognitive control. If this system is impaired, patients with differential aphasia could still show bilingual language activation, but they may be unable to manage activation in non-target languages, so that performance in another language is hindered. Aims: To investigate whether a loss of cognitive control, rather than the loss of word representations in a particular language, might underlie differential aphasia symptoms. Methods & Procedures: We compared the performance of seven bilinguals with differential and eight bilinguals with parallel aphasia with 19 control bilinguals in a lexical decision and a flanker task to assess bilingual language co-activation and non-linguistic control respectively. Outcomes & Results: We found similar cognate effects in the three groups, indicating similar lexical processing across groups. Additionally, we found a larger non-linguistic control congruency effect only for the patients with differential aphasia. Conclusions & Implications: The present data indicate preserved language co-activation for patients with parallel as well as differential aphasia. Furthermore, the results suggest a general cognitive control dysfunction, specifically for differential aphasia. Taken together, the results of the current study provide further support for the hypothesis of impaired cognitive control abilities in patients with differential aphasia, which has both theoretical and practical implications.

Objectives: To understand the subjective pain experience of patients, healthcare providers rely heavily on self-reporting. However, to quantify this unique pain experience, objective parameters are not yet available in daily clinical practice. With regard to patients with failed back surgery syndrome (FBSS) treated with spinal cord stimulation (SCS), pain therapists may recover the individual functional information about the patient's posture from the implantable pulse generator (IPG) of the stimulator. The aim of this study is to investigate whether subjective self-reporting is in correlation with the functional capacities of a patient. Materials and Methods: Thirty-nine patients with FBSS, treated with SCS were included. The accelerometer in the IPG detects positional changes and provides an objective output of seven functional positions (lying back, lying prone, lying left, lying right, transition, upright, and upright + mobile). The Oswestry Disability Index (ODI), VAS-diary, and the Pittsburgh Sleep Quality Index (PSQI) were assessed to evaluate physical functioning, pain intensities, and subjective sleep quality. Additionally, 21 patients wore a wearable actigraph device to objectify sleep quality. The agreement and Spearman correlations between objective and subjective parameters were assessed. Results: Spearman rank correlations revealed no significant correlations between the ODI (subscales walking, sitting, standing, and sleeping) and the output of the IPG (percentage upright + mobile, transition, upright, and lying, respectively). Sleep parameters measured with the Actiwatch and the PSQI were not in agreement. Conclusions: This study demonstrated that self-reporting questionnaires do not correlate with the findings of objective measurements. Therefore, we recommend using both subjective and objective parameters when determining treatment options for FBSS patients.

This multi-study analysis (6 fMRI studies; 142 participants) explores the functional activation and connectivity of the cerebellum with the cerebrum during repeated behavioral information uptake informing about personality traits of different persons. The results suggest that trait repetition recruits activity in areas belonging to the mentalizing and executive control networks in the cerebrum, and the executive control areas in the cerebellum. Cerebral activation was observed in the executive control network including the posterior medial frontal cortex (pmFC), the bilateral prefrontal cortex (PFC) and bilateral inferior parietal cortex (IPC), in the mentalizing network including the bilateral middle temporal cortex (MTC) extending to the right superior temporal cortex (STC), as well as in the visual network including the left cuneus (Cun) and the left inferior occipital cortex. Moreover, cerebellar activation was found bilaterally in lobules VI and VII belonging to the executive control network. Importantly, significant patterns of functional connectivity were found linking these cerebellar executive areas with cerebral executive areas in the medial pmFC, the left PFC and the left IPC, and mentalizing areas in the left MTC. In addition, connectivity was found between the cerebral areas in the left hemisphere involved in the executive and mentalizing networks, as well as with their homolog areas in the right hemisphere. The discussion centers on the role of these cerebello-cerebral connections in matching internal predictions generated by the cerebellum with external information from the cerebrum, presumably involving the sequencing of behaviors.

When we feel sad or depressed, our face invariably “drops”. Conversely, when we try to cheer someone up, we might tell them “keep your smile up”, so presupposing that modifying the configuration of their facial muscles will enhance their mood. A crucial assumption that underpins this hypothesis is that mental states are shaped by information originating from the peripheral neuromotor system — a view operationalised as the Facial Feedback Hypothesis. We used botulinum toxin (BoNT-A) injected over the frown area to temporarily paralyse muscles necessary to express anger. Using a pre-post treatment design, we presented participants with gradually changing videos of a face morphing from neutral to full-blown expressions of either anger or happiness and asked them to press a button as soon as they had detected any change in the display. Results indicate that while all participants (control and BoNT-A) improved their reaction times from pre-test to post-test, the BoNT-A group did not when detecting anger in the post-test. We surmise that frown paralysis disadvantaged participants in their ability to improve the detection of anger. Our finding suggests that facial feedback causally affects perceptual awareness of changes in emotion, as well as people’s ability to use perceptual information to learn.

In this analysis we explored the effective connectivity of the cerebellum with the cerebrum in social mentalizing, across five studies (n = 91) involving abstract and complex forms of mentalizing, such as (a) person and group impression formation, based on behavioral descriptions, and (b) constructing personal counterfactual events. Connectivity was analyzed by applying dynamic causal model analysis, which revealed effective connectivity between the mentalizing areas of the cerebellum and cerebrum. The results revealed a significant pattern of bidirectional (closed-loop) connectivity linking the right posterior cerebellum with bilateral temporo-parietal junction (TPJ), associated with behavior understanding. These connections are consistent with known anatomical data on closed loops between the cerebellum and cerebrum, although contralateral closed loops typically dominate. This analysis improves on an earlier psychophysiological interaction analysis of this dataset, which had failed to reveal such evidence of closed loops. Within the cerebrum, there were connections between the bilateral areas of TPJ, as well as connections between bilateral TPJ and the (ventral and dorsal) medial prefrontal cortex. The discussion centers on the function of cerebro-cerebellar connections in generating internal cerebellar "forward" models, potentially serving the automatic understanding, prediction, and error correction of behavioral sequences.

Background Although language deficits after awake brain surgery are usually milder than post-stroke, postoperative language assessments are needed to identify these. Follow-up of brain tumor patients in certain geographical regions can be difficult when most patients are not local and come from afar. We developed a short telephone-based test for pre- and postoperative language assessments. Methods The development of the TeleLanguage Test was based on the Dutch Linguistic Intraoperative Protocol and existing standardized English batteries. Two parallel versions were composed and tested in healthy native English speakers. Subsequently, the TeleLanguage Test was administered in a group of 14 tumor patients before surgery and at 1 week, 1 month, and 3 months after surgery. The test includes auditory comprehension, repetition, semantic selection, sentence or story completion, verbal naming, and fluency tests. It takes less than 20 minutes to administer. Results Healthy participants had no difficulty performing any of the language tests via the phone, attesting to the feasibility of a phone assessment. In the patient group, all TeleLanguage test scores significantly declined shortly after surgery with a recovery to preoperative levels at 3 months postsurgery for naming and fluency tasks and a recovery to normal levels for the other language tasks. Analysis of the in-person language assessments (until 1 month) revealed a similar profile. Conclusion The use of the TeleLanguage battery to conduct language assessments from afar can provide convenience, might optimize patient care, and enables longitudinal clinical research. The TeleLanguage is a valid tool for various clinical and scientific purposes.

This multi-study connectivity analysis explores the functional connectivity of the cerebellum with the cerebrum in social mentalizing, that is, understanding the mind of another person. The analysis covers 5 studies ( n = 92) involving abstract and complex forms of social mentalizing such as (a) person and group impression formation based on behavioral descriptions and (b) constructing personal counterfactual events (i.e., how the past could have turned out better). The results suggest that cerebellar activity during these social processes reflects a domain-specific mentalizing functionality that is strongly connected with a corresponding mentalizing network in the cerebrum. A significant pattern of connectivity was found linking the dorsal medial prefrontal cortex (mPFC) and the right temporo-parietal junction (TPJ) with the right posterior cerebellum, and linking the latter with the left TPJ. In addition, in the cerebrum, further connectivity was found through links of the bilateral TPJ with the dorsal mPFC, orbitofrontal cortex and between right and left TPJ. The discussion centers on the role of these cerebro-cerebellar connections in matching external information from the cerebrum with internal predictions generated by the cerebellum. These internal predictions might involve the sequencing of the person's behaviors.

BACKGROUND: Extraforaminal lumbar disc herniation (EFLDH) accounts for 7%-12% of all lumbar disc herniations. We report on a surgical technique for EFLDH, which requires only minimal resection of the facet joint and also allows access to the preforaminal space, if necessary. METHODS: The medical records of 61 consecutive patients treated with disc fragment herniectomy through a facet joint quadrantectomy for EFLDH at the Universitair Ziekenhuis Brussel were critically evaluated with respect to preoperative clinical signs and symptoms, surgery-related complications and outcome at 6 weeks after intervention. Patient satisfaction after the surgery was evaluated using the MacNab classification. RESULTS: The prevalence of leg pain decreased from 100% before the intervention to 19.7% at follow-up. Only 9 patients (14.8%) suffered from residual motor deficit at follow-up, compared with 37 patients (60.7%) in the preoperative situation. The postoperative improvement was highly significant for all parameters (P < 0.0001) and this evolution is also reflected in the MacNab classification showing 62.3% excellent, 23.0% good, 13.1% fair, and only 1.6% poor satisfaction. Using logistic regression analysis, only the presence of a preoperative sensory deficit was found to be an independent predictor for excellent patient satisfaction on the MacNab classification. CONCLUSIONS: Disc fragment herniectomy through a facet joint quadrantectomy for EFLDH is a safe and minimal invasive technique resulting in very satisfactory results. Preservation of facet joint stability and the possibility to convert to a classic approach to reach for preforaminal components, if necessary, are major advantages of this technique.

During the past decades neuroanatomic, neuroimaging, and clinical studies have substantially changed the long-standing view of the role of the cerebellum as a sole coordinator of sensorimotor function. Currently, the cerebellum is considered to be crucially implicated in a variety of cognitive, affective, social, and behavioral processes as well. In this chapter we aim to summarize a number of critical insights from different research areas (neuroanatomy, functional neuroimaging, clinical practice) that provide evidence for a role of the cerebellum in motor speech and nonmotor language processing in both adults and children. Neuroanatomic studies have provided a robust basis for the development of new insights in the modulatory role of the cerebellum in neurocognition, including nonmotor language processing by means of identifying a dense network of crossed reciprocal connections between the cerebellum and the supratentorial association areas. A topologic distinction has been established between the "motor" cerebellum, projecting to the cortical motor areas, and the "cognitive/affective" cerebellum, connected with the cortical and limbic association areas. Neuroimaging studies have demonstrated cerebellar involvement in several different language tasks, even after controlling for motor aspects. In addition, several clinical studies have identified a variety of nonmotor linguistic deficits after cerebellar disease in both children and adults, implying a prominent role for the cerebellum in linguistic processes. Functional neuroimaging has confirmed the functional impact of cerebellar lesions on remote, structurally intact cortical regions via crossed cerebellocerebral diaschisis. Overall, evidence from neuroanatomic, neuroimaging, and clinical studies shows a (strongly lateralized) involvement of the cerebellum in a broad spectrum of nonmotor language functions through a dense network of crossed and reciprocal cerebellocerebral connections. It is argued that the cerebellum is involved in language in a similar manner as it is involved in motor functions: through monitoring/coordinating cortical functions via timing and sequencing mechanisms.

Foreign accent syndrome (FAS) is a relatively rare speech motor disorder in which the pronunciation of an affected speaker is perceived as distinctly foreign by listeners of the same language community. Because of various close semiological resemblances with apraxia of speech, FAS has been hypothesized to be an apraxia subtype. In 2009 two cases of developmental FAS (dFAS) were described in whom the disorder was detected in an early stage of their speech-language development in the absence of brain damage or mental illness. In the present study, two listening panels consisting of 30 native speakers of two regiolects, Dutch and Flemish, evaluate the spontaneous speech of two native Flemish-speaking boys with suspected dFAS, three native Flemish-speaking children diagnosed with developmental apraxia of speech (dAoS), two bilingual children (L1 = Flemish, L2 = French or English), and six native Flemish-speaking children with typical speech-language development. Whereas the Dutch panellists were not able to distinguish the different groups, the Flemish listeners accurately identified the children with dFAS and the bilingual children. None of the listeners were able to discern between dFAS and dAoS. The latter finding supports the assumption that the two speech disorders not only share similar semiological and perceptual characteristics but also a common pathophysiological substrate. Although it is not always identified by listeners of the same language community but is by speakers of the same regiolect, in addition to FAS resulting from brain damage or a psychological disorder, dFAS appears a distinct form of apraxia of speech resulting from developmental deficits.

Foreign Accent Syndrome (FAS) is an intriguing motor speech disorder which has captured the interest of the scientific community and media for decades. At the moment, there is no comprehensive model which can account for the pathophysiology of this disorder. This paper presents a review of 112 FAS cases published between 1907 and October 2016: these were analyzed with respect to demographic characteristics, lesion location, associated neurocognitive symptoms, and comorbid speech and language disorders. The analysis revealed that organic-neurogenic FAS is more frequent in women than in men. In organic-neurogenic FAS over half of the patients acquired the foreign accent after a stroke. Their lesions are typically located in the left supratentorial regions of the brain, and generally involve the primary motor cortex and premotor cortex (BA 4 and 6), and/or the basal ganglia. Although neurocognitive data are not consistently reported, vascular FAS patients regularly suffer frontal executive dysfunctions. On the basis of a careful comparison of the cognitive and theoretical accounts of FAS, AoS and ataxic dysarthria, it is concluded that FAS should be regarded a dual component motor speech disorder in which both planning and motor execution of speech may be affected.

Foreign accent syndrome (FAS) is een zeldzame motorische spraakstoornis waarbij de uitspraak van de patiënt door luisteraars wordt opgevat als een buitenlands accent. Meestal is de aandoening het gevolg van een CVA in de taaldominante hemisfeer, maar in enkele gevallen werd FAS als een spraakontwikkelingsstoornis beschreven. In dit artikel wordt een 17-jarige, Nederlandstalige jongen besproken die met een buitenlands accent begon te spreken vanaf zijn taalontwikkeling. Een neurologisch onderzoek, inclusief een SPECT scan, toonde aan dat de patiënt FAS vertoonde, gecombineerd met een verbale en een visuoconstructieve dyspraxie in het kader van een verstoring van het cerebro-cerebellaire netwerk. FAS is a rare motor speech disorder which causes patients to be perceived as non-native speakers. Usually the condition occurs after a stroke in the language-dominant hemisphere. However, a few cases of FAS have been reported showing that FAS may occur on a developmental basis. In this article a 17-year-old Dutch-speaking Belgian boy is presented who developed a French accent as of the beginning of his language development. Neurological investigations, including a SPECT scan, revealed that the patient presented with FAS in combination with developmental apraxia of speech and a visuo-constructive dyspraxia. The combination of these (planning) disorders may be caused by a disruption of the cerebro-cerebellar network.

During the past 3 decades numerous neurophysiological, neuroimaging, experimental and clinical studies have evidenced a crucial role for the cerebellum in cognitive, affective and behavioral functions. As a result of the acknowledged modulatory role of the cerebellum upon remote structures such as the cerebral cortex, cerebellar injury may give rise to a constellation of behavioral, affective and cognitive symptoms (Schmahmann's Syndrome). In sharp contrast to the wide range of therapeutic interventions to treat cognitive and affective disorders following cerebral cortical lesions and despite the consequences of Schmahmann's syndrome upon daily life activities, the literature is surprisingly only scantly documented with studies investigating the impact of cognitive therapies on cerebellar induced cognitive and affective disorders. This survey aims to present an overview of the therapeutic interventions available in the literature as a possible treatment for Schmahmann's Syndrome after cerebellar injury, afterposterior fossa surgery in children, and in children with neurodevelopmental disorders. Although systematical studies are clearly warranted, available evidence suggests that cerebellar-induced cognitive and affective disorders should be treated in a specific way. Approaches where the patients are explicitly made aware of their deficits and are considered to act as an "external cerebellum" are the most promising. The study of the anatomical connectivity of the cerebellar microcomplexes involved in cognitive/affective deficits is likely to play a major-role in the future.

During the past decades neuroanatomic, neuroimaging, and clinical studies have substantially changed the long-standing view of the role of the cerebellum as a sole coordinator of sensorimotor function. Currently, the cerebellum is considered to be crucially implicated in a variety of cognitive, affective, social, and behavioral processes as well. In this chapter we aim to summarize a number of critical insights from different research areas (neuroanatomy, functional neuroimaging, clinical practice) that provide evidence for a role of the cerebellum in motor speech and nonmotor language processing in both adults and children. Neuroanatomic studies have provided a robust basis for the development of new insights in the modulatory role of the cerebellum in neurocognition, including nonmotor language processing by means of identifying a dense network of crossed reciprocal connections between the cerebellum and the supratentorial association areas. A topologic distinction has been established between the “motor” cerebellum, projecting to the cortical motor areas, and the “cognitive/affective” cerebellum, connected with the cortical and limbic association areas. Neuroimaging studies have demonstrated cerebellar involvement in several different language tasks, even after controlling for motor aspects. In addition, several clinical studies have identified a variety of nonmotor linguistic deficits after cerebellar disease in both children and adults, implying a prominent role for the cerebellum in linguistic processes. Functional neuroimaging has confirmed the functional impact of cerebellar lesions on remote, structurally intact cortical regions via crossed cerebellocerebral diaschisis. Overall, evidence from neuroanatomic, neuroimaging, and clinical studies shows a (strongly lateralized) involvement of the cerebellum in a broad spectrum of nonmotor language functions through a dense network of crossed and reciprocal cerebellocerebral connections. It is argued that the cerebellum is involved in language in a similar manner as it is involved in motor functions: through monitoring/coordinating cortical functions via timing and sequencing mechanisms.

Apraxic agraphia (AA) is a so-called peripheral writing disorder following disruption of the skilled movement plans of writing while the central processes that subserve spelling are intact. It has been observed in a variety of etiologically heterogeneous neurological disorders typically associated with lesions located in the language dominant parietal and frontal region. The condition is characterized by a hesitant, incomplete, imprecise or even illegible graphomotor output. Letter formation cannot be attributed to sensorimotor, extrapyramidal or cerebellar dysfunction affecting the writing limb. Detailed clinical, neurocognitive, neurolinguistic and (functional) neuroimaging characteristics of three unique cases are reported that developed AA following a thalamic stroke. In marked contrast to impaired handwriting, non-handwriting skills, such as oral spelling, were hardly impaired. Quantified Tc-99m ECD SPECT consistently showed a decreased perfusion in the anatomoclinically suspected prefrontal regions. The findings suggest crucial involvement of the anterior (and medial) portion of the left thalamus within the neural network subserving the graphomotor system. Functional neuroimaging findings seem to indicate that AA after focal thalamic damage represents a diaschisis phenomenon.

Objective The authors compared the effectiveness of 2 intensive therapy methods: Constraint-Induced Aphasia Therapy (CIAT; Pulvermüller et al., 2001) and semantic therapy (BOX; Visch-Brink & Bajema, 2001). Method Nine patients with chronic fluent aphasia participated in a therapy program to establish behavioral treatment outcomes. Participants were randomly assigned to one of two groups (CIAT or BOX). Results Intensive therapy significantly improved verbal communication. However, BOX treatment showed a more pronounced improvement on two communication—namely, a standardized assessment for verbal communication, the Amsterdam Nijmegen Everyday Language Test (Blomert, Koster, & Kean, 1995), and a subjective rating scale, the Communicative Effectiveness Index (Lomas et al., 1989). All participants significantly improved on one (or more) subtests of the Aachen Aphasia Test (Graetz, de Bleser, & Willmes, 1992), an impairment-focused assessment. There was a treatment-specific effect. BOX treatment had a significant effect on language comprehension and semantics, whereas CIAT treatment affected language production and phonology. Conclusion The findings indicate that in patients with fluent aphasia, (a) intensive treatment has a significant effect on language and verbal communication, (b) intensive therapy results in selective treatment effects, and (c) an intensive semantic treatment shows a more striking mean improvement on verbal communication in comparison with communication-based CIAT treatment.

BackgroundAwake craniotomy is currently considered the gold standard to maximise the extent of resection and to minimise postoperative deficits in patients with supratentorial tumours near eloquent areas. In addition to direct electrical stimulation (DES) of the cortex, intraoperative subcortical mapping is increasingly used as it optimises the benefit-to-risk ratio by decreasing (permanent) postoperative neurological deficits. However, only little attention has been paid to subcortical mapping procedures and especially the tasks to be used.MethodsIn this article, language and non-language testing at the subcortical level is described and discussed by means of three right-handed cases with a glioma in the left hemisphere. To assess subcortical functions, a multimodal test named the Quick Mixed Test was developed (QMT). Pre-, intra- and postoperative test results are described and discussed in detail.ResultsBased on the analysis of these preliminary observations, a number of clinical recommendations for intraoperative subcortical mapping may be made: (1) the selection of a set of language and non-language tests needs to be tailored according to the functional corticosubcortical regions affected by the tumoral lesion and the patient’s characteristics (job/hobby/daily life activities); (2) language and non-language tests should be presented in a multimodal and alternating way during subcortical stimulation since this approach enables screening various functions simultaneously or in a very short period of time and (3) spontaneous speech is a useful adjunct to standardised tests since it most resembles daily life conversation.ConclusionAdministration of multimodal tests during subcortical DES such as the experimental QMT may facilitate identification of eloquent pathways leading to avoidance of permanent neurological impairments.

BackgroundAphasia is characterized by difficulties in connected speech/writing. AimsTo explore the differences between the oral and written description of a picture in individuals with chronic aphasia (IWA) and healthy controls. Descriptions were controlled for productivity, efficiency, grammatical organization, substitution behaviour and discourse organization. Methods & ProceduresFifty IWA and 50 healthy controls matched for age, gender and education provided an oral and written description of a black-and-white situational drawing from the Dutch version of the Comprehensive Aphasia Test. Between- and within-group analyses were carried out and the reliability of the test instrument was assessed. Outcomes & ResultsThe language samples of the healthy controls were more elaborate, more efficient, syntactically richer, more coherent, and consisted of fewer spoken and written language errors than the samples of the IWA. Within-group comparisons showed that connected writing is more sensitive than connected speech to capture aphasic symptoms. Conclusions & ImplicationsThe analysis of both modalities (speech and writing) at the discourse level allows one to assess simultaneously micro- and macro-linguistic skills and their potential interrelations in a given IWA. Connected writing appears to be more sensitive in discriminating IWA from healthy controls than connected speech. This method for analyzing language samples should, however, be used in conjunction with other assessment tools.

International audience; Abstract : Background: The thumb plays a critical role for manual tasks during the activities of daily life and the incidence of neurological or musculoskeletal disorders affecting the voluntary movements of the thumb is high in the elderly. There is currently no tool to assess repetitive motor sequencing of the thumb during ageing.Objectives: To report a novel procedure (the Click Test) assessing the effects of ageing on fast motor sequencing of the thumb.Methods : Healthy subjects (n = 252; mean age +/- SD: 49.76 +/- 19.97 years; range: 19-89 years; F/M: 151/101) were asked to perform fast repeated flexion/extension movements of the thumb using a mechanical counter.Results: Motor performances (assessed by the number of clicks during 3 time periods: 15, 30 and 45 sec), significantly decreased as a function of age for both the dominant (age effect; p< 0.0001 for 15, 30 and 45 sec) and the non-dominant hand (p

Foreign accent syndrome is a rare motor speech disorder that causes patients to speak their language with a non-native accent. In the neurogenic condition, the disorder develops after lesions in the language dominant hemisphere, often affecting Broca's area, the insula, the supplementary motor area and the primary motor cortex. Here, we present two new cases of FAS after posterior fossa lesions. The first case is a 44-year-old, right-handed, Dutch-speaking man who suffered motor speech disturbances and a left hemiplegia after a pontine infarction. Quantified SPECT showed a bilateral hypoperfusion in the inferior lateral prefrontal and medial inferior frontal regions as well as a significant left cerebellar hypoperfusion. Further clinical investigations led to an additional diagnosis of brainstem cognitive affective syndrome which closely relates to Schmahmann's syndrome. The second patient was a 72-year-old right-handed polyglot English man who suffered a stroke in the vascular territory of the left posterior inferior cerebellar artery (PICA) and developed a foreign accent in his mother tongue (English) and in a later learnt language (Dutch). In this paper, we discuss how the occurrence of this peculiar motor speech disorder can be related to a lesion affecting the posterior fossa structures.

Background & Objective: During the past 3 decades, numerous neurophysiological, neuroimaging, experimental and clinical studies have evidenced a crucial role for the cerebellum in cognitive, affective and behavioral functions. As a result of the acknowledged modulatory role of the cerebellum upon remote structures such as the cerebral cortex, cerebellar injury may give rise to a constellation of behavioral, affective and cognitive symptoms (Schmahmann's Syndrome). In sharp contrast to the wide range of therapeutic interventions to treat cognitive and affective disorders following cerebral cortical lesions and despite the consequences of Schmahmann’s syndrome upon daily life activities, the literature is surprisingly only scantly documented with studies investigating the impact of cognitive therapies on cerebellar induced cognitive and affective disorders. This survey aims to present an overview of the therapeutic interventions available in the literature as a possible treatment for Schmahmann’s Syndrome after cerebellar injury, after posterior fossa surgery in children, and in children with neurodevelopmental disorders. Although systematical studies are clearly warranted, available evidence suggests that cerebellar-induced cognitive and affective disorders should be treated in a specific way. Approaches where the patients are explicitly made aware of their deficits and are considered to act as an “external cerebellum” are the most promising. Conclusion: The study of the anatomical connectivity of the cerebellar microcomplexes involved in cognitive/affective deficits is likely to play a major-role in the future.

Until today, there is no satisfying explanation for why one language may recover worse than another in differential bilingual aphasia. One potential explanation that has been largely unexplored is that differential aphasia is the consequence of a loss of language control rather than a loss of linguistic representations. Language control is part of a general control mechanism that also manages non-linguistic cognitive control. If this system is impaired, patients with differential aphasia could still show bilingual language activation, but they may be unable to manage activation in non-target languages, so that performance in another language is hindered.To investigate whether a loss of cognitive control, rather than the loss of word representations in a particular language, might underlie differential aphasia symptoms.We compared the performance of seven bilinguals with differential and eight bilinguals with parallel aphasia with 19 control bilinguals in a lexical decision and a flanker task to assess bilingual language co-activation and non-linguistic control respectively.We found similar cognate effects in the three groups, indicating similar lexical processing across groups. Additionally, we found a larger non-linguistic control congruency effect only for the patients with differential aphasia.The present data indicate preserved language co-activation for patients with parallel as well as differential aphasia. Furthermore, the results suggest a general cognitive control dysfunction, specifically for differential aphasia. Taken together, the results of the current study provide further support for the hypothesis of impaired cognitive control abilities in patients with differential aphasia, which has both theoretical and practical implications.

Dear Editor, Severe kyphoscoliosis is a deformity with fixed spinal vertebrae that does not allow traction, suspension, or side bending of the spine [1]. Treatment of rigid scoliosis in adults involves correction of complex three-dimensional deformities and restoring balance to the spine but is challenging due to a high rate of associated neurological complications [2]. Spinal cord stimulation (SCS) involves a minimally invasive procedure and might be an alternative pain-relieving therapeutic option with lower risks than spinal correction surgery, especially in patients with increased preoperative risk factors [3]. SCS delivered at 10kHz (HF10) may be preferable over conventional SCS for treatment of back pain [4], but studies examining its use in patients with kyphoscoliosis are lacking. We describe a patient with severe kyphoscoliosis who suffered from back pain for many years but refused spinal correction surgery. A treatment with high-frequency SCS diminished the burden of pain, and the patient was able to return to work. To our knowledge, this is the first report of an “unoperated back” patient who was efficiently treated with high-frequency SCS. A woman age 57 years presented with severe idiopathic kyphoscoliosis and progressive therapy-resistant back pain …

Research has shown that linguistic functions in the bilingual brain are subserved by similar neural circuits as in monolinguals, but with extra-activity associated with cognitive and attentional control. Although a role for the right cerebellum in multilingual language processing has recently been acknowledged, a potential role of the left cerebellum remains largely unexplored.This paper reports the clinical and fMRI findings in a strongly right-handed (late) multilingual patient who developed differential polyglot aphasia, ataxic dysarthria and a selective decrease in executive function due to an ischemic stroke in the left cerebellum. fMRI revealed that lexical-semantic retrieval in the unaffected L1 was predominantly associated with activations in the left cortical areas (left prefrontal area and left postcentral gyrus), while naming in two affected non-native languages recruited a significantly larger bilateral functional network, including the cerebellum. It is hypothesized that the left cerebellar insult resulted in decreased right prefrontal hemisphere functioning due to a loss of cerebellar impulses through the cerebello-cerebral pathways.

At the beginning of the twentieth century, several authors defined the role of the cerebellum as a modulator of motor functions including diadochokinesia, tonus, coordination, and motor speech production (Babinski 1902; Luciani 1891; Holmes 1922). Although from time to time clinical case descriptions and experimental evidence from animal studies dating back to the early part of the nineteenth century suggested an association between cerebellar pathology and a variety of nonmotor cognitive and affective dysfunctions, a causal relationship remained unexplored and was dismissed for several decades. During the past three decades converging evidence from a wealth of neuroanatomical, neuroimaging, and clinical studies has unambiguously demonstrated that the cerebellum is also involved in cognitive, affective and linguistic processing. Neuroanatomical studies revealed that the cerebellum is closely linked in a reciprocal way to the autonomic, limbic, and associative regions of the supratentorial cortex (for a review, see Schmahmann 2004). In addition, cortical areas send information to the cerebellum via the basilar pons (Schmahmann and Pandyat 1997), and deep cerebellar nuclei send information back to the cortical association areas through dentatothalamic pathways (Middleton and Strick 1997) (Fig. 9.1).

Background: Cerebellar mutism syndrome (CMS) or posterior fossa syndrome (PFS) consists of a constellation of neuropsychiatric, neuropsychological and neurogenic speech and language deficits. It is most commonly observed in children after posterior fossa tumor surgery. The most prominent feature of CMS is mutism, which generally starts after a few days after the operation, has a limited duration and is typically followed by motor speech deficits. However, the core speech disorder subserving CMS is still unclear. Case presentation: This study investigates the speech and language symptoms following posterior fossa medulloblastoma surgery in a 12-year-old right-handed boy. An extensive battery of formal speech (DIAS = Diagnostic Instrument Apraxia of Speech) and language tests were administered during a follow-up of 6 weeks after surgery. Although the neurological and neuropsychological (affective, cognitive) symptoms of this patient are consistent with Schmahmann's syndrome, the speech and language symptoms were markedly different from what is typically described in the literature. In-depth analyses of speech production revealed features consistent with a diagnosis of apraxia of speech (AoS) while ataxic dysarthria was completely absent. In addition, language assessments showed genuine aphasic deficits as reflected by distorted language production and perception, wordfinding difficulties, grammatical disturbances and verbal fluency deficits. Conclusion: To the best of our knowledge this case might be the first example that clearly demonstrates that a higher level motor planning disorder (apraxia) may be the origin of disrupted speech in CMS. In addition, identification of non-motor linguistic disturbances during follow-up add to the view that the cerebellum not only plays a crucial role in the planning and execution of speech but also in linguistic processing. Whether the cerebellum has a direct or indirect role in motor speech planning needs to be further investigated., SCOPUS: ar.j, info:eu-repo/semantics/published