The Role of Cerebellar Rehabilitation in Improvement of ADHD Imbalance

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 inattentiveness^4,5 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.