assessment and symptoms

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   <h2 id='how-alcohol-damages-cerebellum'>How does Alcohol damage your Cerebellum?</h2>
 
   <p>Alcohol consumption has a detrimental effect on the motor functions of the cerebellum, in particular postural control and coordination. Damage to the cerebellum can also cause speech control problems and poor muscle coordination. For example, it is very common for patrol officers to check the driver’s ability to perform counting or walking exercises. This is why it is extremely dangerous to drive under the influence of alcohol since it could severely affect your visual and motor skills. </p>
-  <p>Brain imaging technology like computed tomography and magnetic resonance imaging (MRI) showed that heavy alcohol abuse is correlated to brain tissue shrinkage (significant loss of nerve cells) that could increase the risk of having a stroke. Moreover, long-term alcohol abuse can damage nerve signals that can result in permanent functional deficits in cognitive reasoning and mental balance. For instance, chronic alcoholics might no longer recover their ability to perform smooth and rapid movements as a result of motor control deficits. Abstinence from alcohol may show significant signs of improvement although it depends on how reversible their brain tissue injury is.</p>
+  <p>Brain imaging technology like computed tomography and magnetic resonance imaging (MRI) showed that heavy alcohol abuse is correlated to brain tissue shrinkage (significant loss of nerve cells) that could increase the risk of having a stroke. Moreover, long-term alcohol abuse can damage nerve signals that can result in permanent functional deficits in cognitive reasoning and mental balance. [<a href='#ref-7'>7</a>] For instance, chronic alcoholics might no longer recover their ability to perform smooth and rapid movements as a result of motor control deficits. Abstinence from alcohol may show significant signs of improvement although it depends on how reversible their brain tissue injury is.</p>
   <p>Past research shows how alcoholics perform poorly in visual and cognitive tasks that involve organizing information in the right temporal order. Lack of coordination between visual and motor skills could increase the danger of head injuries and accidental falls. Cerebellar degeneration can provoke severe adaptation issues to changes in visuospatial perception that makes them unable to walk straight or in the dark with their eyes closed.  It can also have a significant impact in the cognitive control of self-movement and sense of position.</p>
   <p>It is still unclear whether instability arising from alcohol abuse is directly caused from cerebellum dysfunction or from deficiency of the peripheral nervous system in body position and motor balance. Hence, more research is still needed to understand whether the cerebellar damage represents the prime cause of certain functional deficits in alcoholics. “New research must be conducted to determine if alcohol-related imbalance results from cerebellar pathology or from poor functioning of the peripheral nervous system in the body’s extremities, such as the hands and feet. Peripheral neuropathy can occur in alcoholics, resulting in decreased sensation that may lead to imbalance ” [<a href='#ref-7'>7</a>]. Knowledge of this kind would be crucial for quickening recovery processes.</p>
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-  <h2 id='how-cerebellum-damage-affects-you'>How does damage to Cerebellum affect you?</h2>
-  <p>Loss of balance, dizziness, ...</p>
+  <h2 id='how-cerebellum-damage-affects-you'>How does damage and dysfunction of Cerebellum affect you?</h2>
+  <p>Damage to the cerebellum can cause a broad spectrum of motor and cognitive disturbances. It causes impairments in motor coordination and balance which lead to symptoms of clumsiness, irregular walking and feelings of dizziness. [1] Smooth and purposeful movements become difficult for subjects with cerebellar damage. [3]</p>
+<p>Signs and symptoms can include a wide-based, uncoordinated walk; a back and forth tremor in the trunk of the body; uncoordinated movements of the arms and legs; slow and slurred speech and uncontrolled eye movements. This lack of coordination of motor movements is often referred to as Ataxia. [4] Subjects with left cerebellar damage report attention deficits while right cerebellar damage can lead to disrupted language skills. [1] </p>
+
+  <p>Since the cerebellum plays a role in cognition and emotion, cerebellar dysfunction also contributes to non-motor conditions such as certain neurodevelopmental disorders e.g. autism spectrum disorders. [3] Cerebellar abnormalities have been found in patients with ADHD, which is characterized by inattention, hyperactivity and impulsivity. Moreover neuroimaging studies show cerebellar differences in subjects with dyslexia. Dyslexic subjects have also shown a poorer performance on a variety of cerebellar motor tasks, which leads to the proposal that cerebellar dysfunction is a core neurobiological underpinning of dyslexia. It was found that early cerebellar damage leads to poorer outcomes than cerebellar damage in adulthood, which suggests that the cerebellum is important during development. [2]</p>
+
+  <p>Cerebellar damage caused by alcoholism specifically is one of the most common acquired forms of cerebellar ataxia.  [5]  The developing cerebellum is very sensitive to the toxic effects of alcohol.  Children with fetal alcohol spectrum disorder, a group of conditions occurring when the mother consumed alcohol during pregnancy show many symptoms of cerebellar dysfunction. [6]</p>
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   <h2 id='assessment'>How to assess your Cerebellum function?</h2>
-  <p>Loss of balance, dizziness, ...</p>
+
+  <h4>Neuropsychological and Medical Tests</h4>
+  <p>Since damage to the cerebellum impairs the ability to control motor movements clinical signs can be detected that occur throughout the body. In an examination of a patient the gait, posture and speech of the patient would be observed. [1] Patients with damage to the cerebellum may have abnormal posture and a broad-based gait. When scanning the speech an enunciation of individual syllables may occur. Nystagmus, abnormal eye movements can be detected by asking the patient to follow the movement of the examiner's finger. [2]</p>
+
+  <p>In the ‘Finger to nose & finger to finger test’ the patient is first asked to fully extend the arm and then touch their nose and secondly asked to touch the examiner's finger and then their nose. The difficulty of this test can be increased by adding resistance to the patient's movements. Checking for rapid alternating movements is another way of detecting cerebellum damage. In this task the patient is asked to place one hand over the next and have them flip one hand back and forth as fast as possible. Patients with cerebellar damage show abnormalities in this task. The ‘Rebound phenomenon’ (of Stewart & Holmes) is a test where the patient pulls on the examiner’s hand until they slip the hand out of their grasp. Normally the muscles would contract and stop their arm from moving further. Patients with cerebellar damage are unable to quickly stop their arm from moving in the desired direction. 
+Hypotonia is a condition that can be observed when checking the knee reflex. When the leg keeps swinging after the knee reflex is tested for more than 4 times this suggests damage to the cerebellum. [2]</p>
+
+  <h4>Assessment through Neuroimaging</h4>
+  <p>Magnetic resonance imaging is another way of detecting cerebellar damage. Alcoholic cerebellar degeneration is a cause for cerebellar atrophy which is a reduction of cerebellar volume and connections. [3] This cerebellar volume loss can be detected with neuroimaging techniques and can occur even in the absence of clinical signals such as ataxia. Cerebellar shrinkage occurs mostly for older alcoholics with at least a 10-year duration of alcoholism. [4]</p>
+
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 <section class='column col-12'>
   <h2 id='assessment'>How to assess your Cerebellum function?</h2>
-  <p>Loss of balance, dizziness, ...</p>
+
+  <h4>Neuropsychological and Medical Tests</h4>
+  <p>Since damage to the cerebellum impairs the ability to control motor movements clinical signs can be detected that occur throughout the body. In an examination of a patient the gait, posture and speech of the patient would be observed. [1] Patients with damage to the cerebellum may have abnormal posture and a broad-based gait. When scanning the speech an enunciation of individual syllables may occur. Nystagmus, abnormal eye movements can be detected by asking the patient to follow the movement of the examiner's finger. [2]</p>
+
+  <p>In the ‘Finger to nose & finger to finger test’ the patient is first asked to fully extend the arm and then touch their nose and secondly asked to touch the examiner's finger and then their nose. The difficulty of this test can be increased by adding resistance to the patient's movements. Checking for rapid alternating movements is another way of detecting cerebellum damage. In this task the patient is asked to place one hand over the next and have them flip one hand back and forth as fast as possible. Patients with cerebellar damage show abnormalities in this task. The ‘Rebound phenomenon’ (of Stewart & Holmes) is a test where the patient pulls on the examiner’s hand until they slip the hand out of their grasp. Normally the muscles would contract and stop their arm from moving further. Patients with cerebellar damage are unable to quickly stop their arm from moving in the desired direction. 
+Hypotonia is a condition that can be observed when checking the knee reflex. When the leg keeps swinging after the knee reflex is tested for more than 4 times this suggests damage to the cerebellum. [2]</p>
+
+  <h4>Assessment through Neuroimaging</h4>
+  <p>Magnetic resonance imaging is another way of detecting cerebellar damage. Alcoholic cerebellar degeneration is a cause for cerebellar atrophy which is a reduction of cerebellar volume and connections. [3] This cerebellar volume loss can be detected with neuroimaging techniques and can occur even in the absence of clinical signals such as ataxia. Cerebellar shrinkage occurs mostly for older alcoholics with at least a 10-year duration of alcoholism. [4]</p>
+
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 <section class='column col-12'>
-  <h2 id='how-cerebellum-damage-affects-you'>How does damage to Cerebellum affect you?</h2>
+  <h2 id='how-cerebellum-damage-affects-you'>How does damage and dysfunction of Cerebellum affect you?</h2>
   <p>Damage to the cerebellum can cause a broad spectrum of motor and cognitive disturbances. It causes impairments in motor coordination and balance which lead to symptoms of clumsiness, irregular walking and feelings of dizziness. [1] Smooth and purposeful movements become difficult for subjects with cerebellar damage. [3]</p>
 <p>Signs and symptoms can include a wide-based, uncoordinated walk; a back and forth tremor in the trunk of the body; uncoordinated movements of the arms and legs; slow and slurred speech and uncontrolled eye movements. This lack of coordination of motor movements is often referred to as Ataxia. [4] Subjects with left cerebellar damage report attention deficits while right cerebellar damage can lead to disrupted language skills. [1] </p>