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56 Clinical Functional Topography inCognition
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lesion involving lobules VI, VIIa (Crus I), and IX and the
posterior area of the vermis (Lupo et al. 2018b). In this
patient, a cerebello-cerebral FC analysis detected a pattern of
altered connectivity with specic areas of the prefrontalstriatal- thalamic circuits that are typically altered in bipolar
subjects during the manic state (Lupo et al. 2018c), thus
demonstrating an association between aberrant cerebellocortical FC and the onset of a psychiatric condition.
Structural and functional alterations in the cerebellum
have been reported in neurodevelopmental disorders, especially, in autism spectrum disorder (ASD) (D’Mello and
Stoodley 2015; van der Heijden etal. 2021). According to
the underconnectivity theory (Just et al. 2004), disrupted
connectivity within cerebello-cerebral networks has been
specically implicated in the etiology of ASD.
The study of cerebellar morphometry and FC in adults
with ASD identied a decreased grey matter volume in the
right Crus II that correlates with the degree of autistic traits.
FC was altered between the reduced Crus II and contralateral
frontal and temporal areas (Olivito etal. 2018). It is conceivable that abnormal right Crus II selectively affects
long- distance cerebral regions that are relevant to social processing and accounts for core autistic traits.
56.7 Conclusions
Within this framework, evidence showing that sequencing
is a specic cerebellar impairment and the classical domains
described in the CCAS require additional comments.
Traditionally, sequencing has not been recognized as a discrete cognitive function, and sequencing abilities have been
examined in various elds of cognitive neuroscience, as well
as the neuronal circuits that are involved, namely, frontal/
predictive functions (Bubic etal. 2010), spatial hippocampal
functions (Iglói et al. 2010), and cerebellar processing
(Leggio et al. 2011). It can be dened as a supramodular
function whose relationships with other functions, such as
working memory and timing, remain unknown. With regard
to cerebellar involvement in sequencing, cerebellar damage
impairs sequencing in all modalities, although modality differences are observed in relation to the anatomical distribution of cerebellar damage (Leggio etal. 2008; Molinari etal.
2008). Thus, since sequencing is the most signicantly
affected cognitive function in cerebellar patients (see also
Braitenberg etal. 1997; Tesche and Karhu 2000; Restuccia
et al. 2007; Leggio et al. 2011), this evidence supports a
model in which sequencing is the basic function of the cerebellum (Leggio etal. 2008) and helps dene the cognitive
processes that underlie sequencing (for a deeper discussion
of this issue, see the “Sequencing” chapter by M.Molinari in
this volume).
In patients affected by focal cerebellar damage sequencing,
language, executive function, and visuospatial abilities are
the most adversely affected functions (Schmahmann and
Sherman 1998; Tedesco etal. 2011).
Subjects with lesions in the PICA territory exhibit the
worst cognitive patterns, which are similar to the patterns in
subjects with lesions of the DCN. Furthermore, cerebellar
patients, with the notable exception of those in whom DCNs
are spared, demonstrate the worst performance with regard
to sequencing abilities.
Dysfunctions in cerebellar-cerebral networks may explain
the involvement of different functional domains, as evidenced in patients affected by degenerative cerebellar diseases or in psychiatric populations as well as in individuals
with neurodevelopmental disorders.
Another aspect that has to be taken into account is the
nding that a cerebellar lesion does not eliminate cognitive
function but rather increases suboptimal variability when
motor or mental tasks are performed (Courchesne and Allen
1997). This model is consistent with ndings of low but not
clearly pathological performances in many domains. The
cognitive proles of patients affected by cerebellar lesions
implicate the cerebellum as the “optimization structure”
(Courchesne and Allen 1997) of cognitive operations, indicating the various domains in which cerebellar “dysmetria of
thought” (Schmahmann and Sherman 1998) can be observed.
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Sequencing
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57
Abstract
Sequencing is the fundamental ability of acquiring knowl-
edge of the structure of sequences by acting on a sequence
of events—incidentally through experience or intention-
ally through explicit effort. To acquire sequence knowl-
edge, it must be recognized if stimuli are presented in a
certain order and which are the ordering rules. To this
aim, the information on a single stimulus must be kept
active in a working memory system and compared with
subsequent stimuli. Furthermore, information on time and
space relations among stimuli must be acquired. Once
sequence structure has been identied, it has to be stored
for subsequent use.
Keywords
Cognition · Perception · Behavior
Sequencing is the fundamental ability of acquiring knowledge of the structure of sequences by acting on a sequence of
events—incidentally through experience or intentionally
through explicit effort. To acquire sequence knowledge, it
must be recognized if stimuli are presented in a certain order
and which are the ordering rules. To this aim, the information
on a single stimulus must be kept active in a working memory system and compared with subsequent stimuli.
Furthermore, information on time and space relations among
stimuli must be acquired. Once sequence structure has been
identied, it has to be stored for subsequent use.
In spite of its importance for brain functioning, particularly for feed-forward control in virtually all domains (Pisotta
and Molinari 2014; Van Overwalle etal. 2019; Stoodley and
Tsai 2021), sequencing is not recognized as a discrete cognitive function. Nevertheless, sequencing abilities have been
M. Molinari (*)
Clinical Translational Research, Santa Lucia Foundation,
Rome, Italy
e-mail: m.molinari@hsantalucia.it
examined in various elds of cognitive neuroscience, as have
the neuronal circuits that are involved—for example, frontal/
predictive functions (Bubic etal. 2010), spatial hippocampal
(Igloi et al. 2010) and cerebellar processing (Leggio et al.
2011), and social prediction (Van Overwalle et al. 2019;
Stoodley and Tsai 2021). At present, sequencing can be
dened as a supramodal function whose relationships with
other functions, such as working memory and timing, remain
unknown. As a supramodal function, impairment in sequencing would affect many domains although the decit would be
discrete and functional compensation quite effective. Thus, it
is not surprising that sequencing impairment has never been
described in isolation.
Considering involvement in prediction of sensory events
and the long-standing idea that the cerebellum acts as a comparator, participation of the cerebellum among the brain
structures involved in sequencing is conceivable, and indeed
early in cerebellar research, sequence processing was proposed as the basic functional mechanism of the motor
(Braitenberg et al. 1997) and cognitive (Molinari and
Petrosini 1997) domains. Within this framework, it has been
proposed that comparisons among actual input and preceding stimuli, as well as detection of similarities and discordances between predicted and actual sequences, happen
within the cerebellum (Molinari etal. 2009). Results of this
cerebellar processing would then be funneled to the cortex. If
the incoming stimulus corresponds to the predicted one, cerebellar output would be minimal; if a discrepancy–error signal is detected, then activity in the cerebellum increases and
a large area of the cerebral cortex would be alerted with
enhancing of neuronal excitability.
If the above-described mechanism corresponds to the
basic mode of cerebellar functioning, then sequencing decits should be present in all cerebellar functional domains.
Indeed, sequencing has been reported as the most affected
domain in a large cohort of subjects with focal or degenerative cerebellar damage Tedesco etal. 2011.
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023
D. L. Gruol et al. (eds.), Essentials of Cerebellum and Cerebellar Disorders, https://doi.org/10.1007/978-3-031-15070-8_57
371
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M. Molinari
The relevance of the cortico-striatal-cerebellar networks
in motor sequence learning is well established (Doyon etal.
2003). Within this network, cortico-striatal and cortico-
cerebellar circuits are considered to work in parallel in order
to mediate motor sequence learning. Striatal involvement has
been considered more pronounced in implicit motor sequence
learning (Karabanov et al. 2010), while cerebellar activity
has been related to the computation of prediction errors
which takes place during the early stage of learning but less
when the motor sequence is already established (Doyon etal.
2009). Interestingly, a cerebellar role has been demonstrated
more in sequence detection than in sequence execution in
serial reaction time task (SRTT) in which subjects learn a
sequential pattern of nger presses (Molinari et al. 1997).
This latter evidence highlights the importance of the cerebellum more as a sensory than a motor structure in line with
Bower’s theories (Bower 1997b).The role of the cerebellum
in sensory processing has long been demonstrated (Gao etal.
1996), as has its function in predicting somatosensory events
(Bower 1997a). The importance of the cerebellum in
sequencing incoming sensory inputs has been elegantly
demonstrated more than 20years ago in a magnetoencephalographic study (Tesche and Karhu 2000) and subsequently
conrmed in two mismatch negativity studies (Restuccia
etal. 2007; Moberget etal. 2008). If a random omission is
inserted in a regular train of somatosensory stimuli, thus creating unpredictable omissions, the cerebellum presents much
higher activity when the stimulus is absent than when it is
present. This clearly indicates that the cerebellar activity
codes change in expectancy (Ivry 2000). Reviewing the role
of the cerebellum in sensory processing, Nixon proposed
sensory prediction as a fundamental cerebellar function that
could contribute to many of the behavioral processes with
which the cerebellum has been implicated also outside the
motor- sensory domain (Nixon 2003).
Cognitive sequencing functions are often analyzed by
processing behavioral sequences. Different terms, such as
action script or semantic sequencing, have been used indiscriminately to refer to such a function. Script sequencing can
be dened as the process that allows for recognition of correct spatial and temporal relations among behaviorally relevant actions. Script sequencing has been considered to be
sustained by the frontal lobe and basal ganglia circuits, and it
requires the ability to plan (Tinaz etal. 2006).
Card-sequencing tasks, as for instance the Picture
Arrangement (PA) subtest of the Wechsler Adult Intelligence
Scale Revised (WAIS-R), require examination of visual or
verbal material to understand spatial, temporal, and/or
semantic relationships and to reconstruct the strings in logical sequences. In other words, subjects have to extract elements to predict the next card in the sequence from a complex
array of sensory information. We reported decits in cardsequencing tasks after cerebellar damage either in the PA or
in newly developed test with material-controlled contents
(Leggio etal. 2008). In the PA test, patients with degenerative or focal cerebellar pathologies generally score within the
normal range. Nevertheless, if performances are carefully
analyzed, impairments can be identied. Cerebellar patients
only rearrange small string fragments, and their performance
differs signicantly from that of matched controls. The
sequencing impairment became more apparent when using
the new test, which allows to evaluate the sequencing performance according to the material used: verbal-script, pictorialscript, or spatial-abstract. Script sequencing requires the use
of both spatial and temporal information, while abstract
sequencing can rely exclusively on spatial information.
Subjects with cerebellar lesions are impaired with all testing
materials. Nevertheless, differences emerge considering the
etiology and lesion topography. While cerebellar degenerative disorders uniformly affect performance throughout
modalities, focal lesions evoke different proles depending
on the affected side. Patients with lesions of the left hemicerebellum perform poorly on script sequences, based on pictorial material, and patients with lesions of the right
hemicerebellum fail to generate script sequences that require
verbal elaboration.
Sequencing is required for a number of language functions and sequencing decits reported in different language
pathologies either of developmental (Peter et al. 2013;
Stoodley and Stein 2013) or of adult onset (Robinson 2013).
Cerebellar dependent language impairments have been
reported since early 1990s (Silveri etal. 1994) and are a matter of debate (Späth et al. 2022; Marien etal. 2014). Among
cerebellar language decits, verbal uency impairment is the
most commonly reported (Tedesco etal. 2011).
Verbal uency is routinely studied using tasks which
measure the ability to generate words through different word
searching methods, i.e., associative processes—phonological or semantic—and strategic abilities (Abwender et al.
2001). Production of words in a specic semantic category
(e.g., birds, furniture) tests semantic association. Production
of words that begin with a specic letter (e.g., F, A) tests
phonemic association. In retrieving words from a lexicon
under forced conditions, peak performance requires the ability to organize words strategically into a burst of words (clusters) that can be semantically or phonemically related. In
phonemic and semantic uency tasks, both semantic and
phonemic clusters can be produced, with more phonemic
than semantic clusters produced in phonemic uency tasks
and vice versa in the semantic uency tasks. Cerebellar
patients can show impairments in their ability to generate
lists of words according to the phonemic but not semantic
rule. This modality-specic decit is also present in clustering; that is, cerebellar damage selectively impairs phonological clustering (Leggio etal. 2000; Stoodley and Schmahmann
2009). The selective phonological impairment indicates that
cerebellar uency impairment is due to a decit in sequencing. Differences between semantic and phonological associ-
57 Sequencing
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373
ation strategies are attributed to differences in lexical
representation and retrieval cue properties (Rosser and
Hodges 1994; Troster etal. 1995). The semantic system contains knowledge of the physical and functional properties of
objects, and the activation of an initial and usually highly
prototypical exemplar effects the automatic activation of
closely related semantic neighbors. Letter uency relies on
the phonological level of word representation, without reference to meaning; the mechanism is less automatic, and it represents an unusual means of word searching and requires to
form novel category neighbors (Martin etal. 1994; Rosser
and Hodges 1994). Thus, while semantic rule is based on a
well-learned automatic strategy, the phonemic rule requires a
novel strategy. The acquisition of a novel word retrieval
strategy requires similar steps as those for the acquisition of
sequence knowledge. To obtain a correct phonemic cluster, a
subject has to sequentially couple the last word with the new
ones, i.e., to keep the prototypical sound active within the
working memory system and to recognize the last word
sound–next word sound phonemic correspondence.
57.1 Cerebellar Damage andLearning
ofSearching Sequences
One of the earliest models to experimentally address cerebellar cognitive abilities is the analysis of spatial functions in rodents. Different research groups have
demonstrated spatial processing impairments linked to
cerebellar abnormalities (Botez 1993; Molinari and
Petrosini 1997) [see for Rev (Molinari and Leggio 2007)].
From those initial observations, the interest of the scientic community on the topic has increased and cellular
mechanisms of cerebellar spatial functions were elucidated (Babayan etal. 2017; Watson etal. 2019). Also, for
spatial processing, sequencing appears to be the cerebellar operational modality (Molinari etal. 2004), and behavioral sequences can be singled out when testing rodents in
maze tasks, such as the Morris water maze (MWM)
(Morris 1984; Leggio etal. 1999). To solve MWM, rats
have to learn different searching strategies to be used in
sequence. Acquisition of correct procedures can be
achieved either by experience or by observation (Leggio
etal. 1999). MWM behavior has been analyzed in depth,
and different behaviors have been characterized (D’Hooge
and De Deyn 2001). Quite relevant, for clinical considerations, is the experimental evidence that cerebellar lesion
impairs sequence acquisition but not sequence execution.
Naïve rats placed in MWM solve the test initially using
inefcient routes. As sessions progress, solving strategies
change quickly, and progressively more efcient search
routes are implemented. Quite rapidly, animals learn to
swim directly to the correct location. When the cerebellum is lesioned, search strategy freezes with no progres-
sion to more efcient procedures. Notably, if training
occurs before the cerebellar lesion, MWM is performed
efciently also in spite of cerebellar damage. Overall,
MWM experiments in rodents highlight the importance of
cerebellar processing for the acquisition of the procedural
competences to develop the correct sequences needed to
search environment (Petrosini etal. 1998).
At present, cerebellar sequencing processing has been
demonstrated to support predicative abilities in quite different domains, and further evidence can be expected in the
near future involving behavior and mental illness areas (Van
Overwalle etal. 2019). An interesting area receiving quite a
broad interest is the cerebellar role in the developmental disorders such as autism, dyslexia, and attention-decit/hyperactivity disorder (ADHD) (Clausi et al. 2021). In this
framework, interesting suggestions may derive from early
studies in cognitive learning paradigms in animal models of
cerebellar damage (Molinari et al. 2013) [see also CHPR
“Lesions of the Cerebellum,” this volume].
In the last 20 years, data from disparate elds of neuroscience have highlighted the importance of cerebellar processing in several non-motor domains, such as cognition,
emotion, and affective processing (Koziol etal. 2014). In
turn, this revolution has necessitated a complete reconsideration of the mechanisms through which the cerebellum
exerts its inuence on the cerebral cortex. Among different theories, a role for the cerebellum in sequencing
incoming sensory patterns and outgoing responses has
been proposed (Leggio etal. 2011), underscoring the central position of cerebellar circuits in sequence processing
regardless of whether the material that is processed is sensory (Bower 1997a), motor (Thach etal. 1992), or behavioral (Molinari etal. 2008). Overall, cerebellar sequencing
can be viewed as the basic functional mechanism that
allows optimization of brain functions, and it can explain
on the one hand the complexity of the motor and cognitive
cerebellar prole and on the other the discreteness of cerebellar cognitive impairments.
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PeterMariën andKimvan Dun
58
Abstract
The traditional view of the cerebellum as the sole coordinator of sensorimotor function has been substantially
redened during the past decades. Neuroanatomical, neuroimaging, and clinical studies have extended the role of
the cerebellum to the modulation of cognitive, affective,
and social processing. Neuroanatomical studies have
demonstrated cerebellar connectivity with the supratentorial association areas involved in higher cognitive, affective, and social functioning, while functional neuroimaging
and clinical studies have provided evidence of cerebellar
involvement in a variety of cognitive, affective, and social
tasks. This chapter provides an overview of the recently
acknowledged role of the cerebellum in speech and language processing.
Keywords
Cerebellum · Language · Speech · Cognition · Affect
58.1 Introduction
Clinical and experimental research on the cerebellum has been
overshadowed for more than two centuries by an overwhelming interest in the role of the cerebellum in sensorimotor control (Manto et al. 2012; Mariën et al. 2014). A wealth of
experimental and clinical evidence supports the view that the
cerebellum coordinates movement, resulting in various cerebellar ataxic syndromes in cases where the motor zones of the
cerebellum sustain neurological damage. However, during the
past decades, the long-standing view of the cerebellum as a
pure coordinator of sensorimotor function has been modied.
From the late 1970s onwards, major advances have been made
in elucidating the many functional neuroanatomical connections of the cerebellum with the supratentorial association cortices that subserve nonmotor language, cognition, and affect
(Fig.58.1). In addition, neuroimaging studies in healthy subjects and neurophysiological and neuropsychological research
in patients showed that the cerebellum is critically implicated
†PeterMariën was deceased at the time of publication.
P. Mariën
Department of Neurology and Memory Clinic,
ZNA Middelheim Hospital, Antwerp, Belgium
Department of Clinical Neurolinguistics (CLIN),
Vrije Universiteit Brussel, Brussels, Belgium
K. van Dun (*)
Department of Clinical Neurolinguistics (CLIN),
Vrije Universiteit Brussel, Brussels, Belgium
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023
D. L. Gruol et al. (eds.), Essentials of Cerebellum and Cerebellar Disorders, https://doi.org/10.1007/978-3-031-15070-8_58
375
376
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P. Mariën and K. van Dun
CEREBELLUM
MOTOR
PREMOTOR
‘MOTOR’ NUCLEI
ncl. ventralis anterior
ncl. ventralis intermedius
SUPPLEMENT. MOTOR AREA
SUPERIOR TEMPORAL
POSTERIOR PARIETAL
ncl. dentatus
ncl. interpositus
ncl. fastigius
THALAMUS
CORTEX
PREFRONTAL
PONTINE
NUCLEI
‘NON-MOTOR’ NUCLEI
intralaminar nuclei
ncl. medialis
CINGULATE GYRUS
PARAHIPPOCAMPAL
GYRUS
LIMBIC CORTICES
Fig. 58.1 Diagram depicting the cerebello-cerebral connectivity network underlying cognitive and affective processes. The feedback or
efferent loop originates from the deep nuclei of the cerebellum that
project to the motor (grey arrows) and nonmotor (blue arrows) nuclei of
the thalamus. In turn, the motor nuclei of the thalamus (ncl. ventralis
anterior and intermedius) project not only to motor and premotor cortices (grey arrows) but also to nonmotor areas among which the prefron-
in a large spectrum of cognitive and affective impairments. As
a result, converging evidence derived from these different
strands of research substantially extended the sensorimotor
role of the cerebellum to include that of a crucial modulator of
cognitive and affective processes.
58.2 Motor Speech Production: Planning
andCoordination ofArticulatory
Movements
At the beginning of the twentieth century, Gordon Holmes put
forward the view that the cerebellum plays a crucial role in
motor speech production. Ataxic dysarthria is a typical cerebellar motor speech disorder characterized by distorted articulation
and prosody (Spencer and Slocomb 2007). Ataxic dysarthria
tal cortex, the supplementary motor area, the superior temporal, and
posterior parietal regions (blue arrows). The nonmotor nuclei of the
thalamus project to the cingulate gyrus, the parahippocampal region,
and the limbic cortices (blue arrows). The feedforward or afferent system of the cerebello-cerebral circuit is composed of corticopontine and
pontocerebellar mossy ber pathways (red arrows) (After Schmahmann
and Pandya (1997) and from Mariën etal. (2013))
shares a number of characteristics with apraxia of speech, a
motor speech planning and coordination disorder that typically
follows from injury to the language- dominant motor speech
regions. These similarities led some researchers to believe that
both conditions are related phenomena resulting from disruption of the motor speech planning and coordinating network
subserved by the motor speech areas of the language dominant
hemisphere and the cerebellum (Mariën etal. 2006).
58.3 Verbal Fluency andLexical/Semantic
Retrieval
The right lateral cerebellum has been consistently implicated
in word generation tasks. Papathanassiou etal. (2000) used
positron emission tomography (PET) to show activation in
58 Speech andLanguage
https://t.me/medicina_free
377
the right cerebellum during a covert verb generation task.
Silveri etal. 1998 found verbal short- term memory decits
after surgical removal of the right cerebellar hemisphere in
an 18-year-old patient. They identied the functional locus
of the decit at the level of the phonological output buffer.
Leggio et al. (1995, 2000) studied patients with focal or
degenerative left and right cerebellar lesions and showed that
cerebellar damage specically affects phonological uency.
These ndings were conrmed by Schweizer et al. (2010)
who also showed that patients with right cerebellar lesions
were signicantly more impaired than patients with left cerebellar lesions.
58.4 Syntax Impairment
Agrammatism has been repeatedly observed in patients with
focal cerebellar lesions. Silveri et al. (1994) described a
patient who, following ischemic damage of the right cerebellum, presented with expressive agrammatism. Single-photon
emission-computed tomography (SPECT) showed a relative
hypoperfusion (cerebellocerebral diaschisis) in the entire left
cerebral hemisphere (Silveri etal. 1994). Several other studies subsequently showed that the right cerebellar hemisphere
is embedded within a distinct neural network devoted to the
processing of grammar, together with the basal ganglia and
the language dominant left prefrontal, temporal, and parietal
cortex (Mariën etal. 2001).
58.5 Aphasia
The co-occurrence of decits affecting different linguistic
levels may give rise to cerebellar-induced aphasia (Mariën
etal. 1996). Mariën etal. (1996) described a 73-year-old,
right-handed patient with a dynamic aphasia-like language
disorder after an ischemic lesion in the vascular territory of
the right superior cerebellar artery. SPECT revealed a signicant hypoperfusion in the anatomoclinically suspected
prefrontal language region of the left hemisphere.
Impairment of linguistic functions after cerebellar lesions
may therefore result from a decrease of excitatory impulses
through the cerebello-ponto-thalamo-cortical pathways
causing functional depression of the supratentorial regions
subserving linguistic functions (cerebellocerebral diaschisis). Other cases have been published of adult patients who
suffered from various aphasic symptoms (Mariën et al.
2009; Baillieux etal. 2010). A more skeptical opinion on
the role of the cerebellum in linguistic processing has been
advanced by Timmann and co-workers who address the
limitations of lesion studies and negative ndings in
patients with cerebellar lesions in a number of studies (e.g.,
Frank etal. 2007).
58.6 Acquired andDevelopmental
Dyslexia
Acquired dyslexia (alexia) following cerebellar lesions is
typically related to non-linguistic disturbances such as
imperfect oculomotor control (nystagmus) (Moretti et al.
2002) or functional disruption of the cerebellar-encephalic
projections involved in attentional and alerting mechanisms
(Mariën etal. 2009; Moretti etal. 2002).
However, Nicolson etal. (1995, 2001) included the cerebellum in the pathogenesis of dyslexia. They introduced the
“cerebellar decit hypothesis” to explain dyslexia as a disruption of the automatization of learned skills such as articulation, reading, spelling, and phonological abilities, caused
by cerebellar dysfunction. Several neuroimaging studies of
dyslexic subjects have demonstrated abnormal cerebellar
function in a range of cognitive and linguistic tasks (Brown
etal. 2001; Rae etal. 2002; Nicolson et al. 1999; Baillieux
etal. 2009).
58.7 Peripheral andCentral Agraphia
Cerebellar damage might induce motor writing disorders
such as afferent dysgraphia and macrographia (Silveri etal.
1997). However, central agraphias may be observed follow-
ing cerebellar damage as well. The patient of Mariën etal.
2009 presented with surface dysgraphia after a right superior
cerebellar artery infarction. Supported by SPECT ndings,
they hypothesized that the writing decits resulted from
functional disruption of the cerebellar-encephalic pathways
connecting the cerebellum to the frontal supratentorial areas,
which subserve attentional and planning processes. Clinical
evidence suggests involvement of the cerebellum in the neural network of graphomotor planning. Distortion of the spatiotemporal features of handwriting (apraxic agraphia) has
been observed after disruption of the cerebello-cerebral network subserving the planning and execution of skilled motor
actions (Mariën etal. 2007; De Smet etal. 2011).
58.8 Conclusion
Clinical and experimental evidence shows that different neuroanatomic parts of the cerebellum are critically implicated
in a variety of speech and language functions. The neuroanatomical substrate subserving the role of the cerebellum in
nonmotor language processing is a dense and reciprocal network of crossed cerebro-cerebellar pathways that establish a
close connection between the cerebellum and the supratentorial autonomic, limbic, and association cortices. In addition,
the majority of anatomoclinical studies of patients with linguistic impairments following focal cerebellar lesions and
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