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Letters   |    
The Role of Cerebellar Rehabilitation in Improvement of ADHD Imbalance
Mona Delavarian, M.D.; Shahriar Gharibzadeh, M.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2011;23:E34-E34. doi:10.1176/appi.neuropsych.23.4.e34
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Biomedical Engineering Faculty, Amirkabir University of Technology, Tehran, Iran

Correspondence: gharibzadeh@aut.ac.ir

To the Editor: Attention deficit hyperactivity disorder (ADHD) is a relatively common neurobehavioral disorder.1 Children with ADHD have continuous symptoms of inattention, hyperactivity, and/or impulsivity in more than one setting, such as at home, school, and work.2,3 Several studies have focused on ADHD balance dysfunction, which affects many gross and fine motor activities, and most of these studies attribute it to inattentiveness4,5 and even have suggested attention exercises to improve the problem.5 On the other hand, SPECT studies in ADHD have identified some decreased activities in different parts of the CNS, including the cerebellum.7 Also, many MRI morphologic studies have identified some differences between the cerebellum of normal-control children and those with ADHD.1

On the basis of the above-mentioned points, we hypothesize that cerebellar disturbances are probably involved in ADHD balance dysfunction. It is worth noting that the cerebellum has a dual effect in this area: not only is it involved directly in equilibrium, but there is also strong evidence for the role of the cerebellum in cognitive functions including attention.8 We have observed in a preliminary small clinical trial that “cerebellar rehabilitation exercises,” which are typically used in ataxia rehabilitation, improve ADHD balance dysfunction. These exercises involve proprioceptive, vestibular, and visual systems, all of which are in close relationship with the cerebellum.9 We suggest that cerebellar rehabilitation will improve both balance and attention in these children. Of course, for confirming this hypothesis, larger clinical trials are needed.

Voeuer Kytja  KS:  Attention-deficit hyperactivity disorder (ADHD).  J Child Neurol 2004; 19:798–814
[PubMed]
 
Sadock  BJ;  Sadock  VA:  Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th Edition.  Lippincott Williams & Wilkins, 2007
 
Delavarian  M;  Towhidkhah  F;  Dibajnia  P  et al:  Designing a decision-support system for distinguishing ADHD from similar child behavioral disorders.  J Med Systems 2010;  Sept.; E-pub ahead of print
 
Aranha  KM:  A Comparison of Postural Control: Typical Developing Children vs. Children With ADHD.  A Thesis in Exercise and Sport Science , 2006
 
Leitner  Y;  Barak  R;  Giladi  N  et al:  Gait in attention-deficit hyperactivity disorder: effects of methylphenidate and dual-tasking.  J Neurol 2007; 254:1330–1338
[CrossRef] | [PubMed]
 
Ghanizadeh  A:  Predictors of postural stability in children with ADHD.  J Attention Disord 2011; 15:604–610
[CrossRef]
 
Dunn  S;  Sharman  J:  Understanding ADHD.  MIND 1998; 1:16
 
Baldaçara  L;  Borgio  JGF;  de Lacerda  ALT  et al:  Cerebellum and psychiatric disorders.  Rev Bras Psiquiatr 2008; 30:281–289
[CrossRef] | [PubMed]
 
Armutlu  K:  Ataxia: physical therapy and rehabilitation applications for ataxic patients.  Int Encyclopedia of Rehabilitation ,  State University of New York at Buffalo, Center for International Rehabilitation Research and Exchange (CIRRIE), 2010; 1:19
 
References Container
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References

Voeuer Kytja  KS:  Attention-deficit hyperactivity disorder (ADHD).  J Child Neurol 2004; 19:798–814
[PubMed]
 
Sadock  BJ;  Sadock  VA:  Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th Edition.  Lippincott Williams & Wilkins, 2007
 
Delavarian  M;  Towhidkhah  F;  Dibajnia  P  et al:  Designing a decision-support system for distinguishing ADHD from similar child behavioral disorders.  J Med Systems 2010;  Sept.; E-pub ahead of print
 
Aranha  KM:  A Comparison of Postural Control: Typical Developing Children vs. Children With ADHD.  A Thesis in Exercise and Sport Science , 2006
 
Leitner  Y;  Barak  R;  Giladi  N  et al:  Gait in attention-deficit hyperactivity disorder: effects of methylphenidate and dual-tasking.  J Neurol 2007; 254:1330–1338
[CrossRef] | [PubMed]
 
Ghanizadeh  A:  Predictors of postural stability in children with ADHD.  J Attention Disord 2011; 15:604–610
[CrossRef]
 
Dunn  S;  Sharman  J:  Understanding ADHD.  MIND 1998; 1:16
 
Baldaçara  L;  Borgio  JGF;  de Lacerda  ALT  et al:  Cerebellum and psychiatric disorders.  Rev Bras Psiquiatr 2008; 30:281–289
[CrossRef] | [PubMed]
 
Armutlu  K:  Ataxia: physical therapy and rehabilitation applications for ataxic patients.  Int Encyclopedia of Rehabilitation ,  State University of New York at Buffalo, Center for International Rehabilitation Research and Exchange (CIRRIE), 2010; 1:19
 
References Container
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