learning-connections.org.uk

The Treatment of Neurologically Impaired Children using Patterning

2007-02-27T11:43:00.000Z

The Treatment of Neurologically Impaired Children Using Patterning
Movement Therapy
The submission by the AAP, that, "treatment programmes that offer patterning remain unfounded" needs to be considered thus; the basis of today’s physical therapy movement programmes, is built entirely on the premise, that movement by a therapist, of any part of the human anatomy, on a regular daily basis is in effect "patterning". This movement therapy, practised daily by fully trained, qualified, physiotherapy, and occupational therapists, to rehabilitate stroke victims is accepted worldwide in private, and state medical regimes. The team originally put together by Fay was done so to rehabilitate stroke victims and recipients of traumatic brain injury through accidents.
In effect the AAP critique undermines today’s physio and occupational therapy practitioners those practitioners that the AAP refers to in their web site. www.medicalhomeinfo.org/health/Downloads/EIBrochureF.pdf. to which autistic children should be referred to for therapy as the basis for Early Intervention

The original critique of the AAP in 1968 which led Neman et al, in their paper "Experimental Evaluation of Sensorimotor Patterning used with Mentally Retarded Children", published in American Journal of Mental Deficiency 1974, Vol.79, No.4, 372-384, to quote "The rapid rise to prominence of the Doman-Delacato regimes, the zeal of their followers, and the stories appearing in the popular press telling of remarkable ‘cures’ all served to bring the wrath of the ‘establishment’ to bear upon the Institutes for the Achievement of Human Potential and its methods", was only published 15 years after the establishment of the organisation.

The basis of a movement therapy programme, Sensory Integration Therapy for Neurological Rehabilitation being used in school environments dedicated to the education of special needs children has been established within the Westminster Governments’ Department for Education and Skills.
In their document "Planning, teaching and assessing the curriculum for pupils with learning difficulties", accessible via www.nc.uk.net/ld/index.html they offer the following guidance;
Physical education; Opportunities at Key Stage 1
Much of the programme of study at Key Stage 1 is relevant to pupils with learning difficulties. With modification, it can provide stimulating and challenging learning opportunities. All pupils can contribute in group work with others at their own level of ability.
The document suggests pupils explore basic body movements and actions using different parts of their bodies. To acquire and develope skills, suggesting, crawling, sliding, rolling, moving backwards and forwards. To select and apply skills, tactics and compositional ideas, be helped to follow and respond to simple instructions for example stop and start.
At Key stage 2, the document suggests listening and responding to action words, for example, walking, marching on the spot. Suggesting, as part of games activities, ball games, catching, throwing, on the floor foot skills of passing, dribbling. Throwing and catching bean bags, all as part of hand eye coordination programme, to develop binocular vision.
The Welsh Assembly Government, in their recently published guidance document "Routes for learning", Crown copyright 2006, reference AC/GM/0612, April 2006, affirms that, "This guidance document, written to support the use of the Routes for Learning materials, offers an overview of the main theories and background information, underpinning the effective teaching and assessment of learners with profound, and Multiple Learning Difficulties". In the Additional Guidance section, the document suggests that therapies, including movement therapy, and occupational therapy to address sensory impairment, could be included in the curriculum design. The rationale for this is explained in the premise that inhibiting factors in the student’s ability to learn is irrefutably connected to sensory impairments exhibited by students with learning delay. The document outlines the reasons for the sensory impairments linked to retained inhibitive reflexes. Addressing these inhibitive reflexes being the key to improved learning ability.
It is essential to recognise that the physical exercise components of the DfES document, and movement therapy in the Welsh Document are the core elements of Delacato Therapy, evolved from the ideas of neurologist Dr Temple Fay and propounded in his paper The Origin of Human Movement, presented to the Fourth Annual Institute in Psychiatry and Neurology April 1954 and published in Amer. J. Psychiatry 111:644-652,1955.
In the published work "Using a developmental movement programme to enhance academic skills in grade 1 learners" Fredericks, Kokot, Krog, Teacher Education, University of South Africa, Pretoria, Republic of South Africa, describe the outcomes of a rigorous experimental programme to associate the benefits of physical exercise movement to cognitive learning and academic skills and investigate the efficacy of a movement programme on the academic skills of early learners
In their opinion " The results of the pre-testing and post-testing indicate that the learners of the experimental group showed a significant improvement in spatial development as well as in reading and mathematical skills, compared to the learners in the control group, free-play group and educational toys group".
In support of the rationale behind their experimental programme, the authors cite Summerford, C. (2001). What is the impact of exercise on brain function for academic learning? Teaching Elementary Physical Education, 12(3): 6-8." that physical education is often seen as a frill, and has been discontinued in many South African schools, which might be a misguided kind of thinking "
The authors, drawing on the works of Kephart, (1975). The slow learner in the classroom. Columbus, OH: Merrill, Ayres, (1979). Sensory integration and the child. Los Angeles, CA: Western Psychological Services. Delacato, (1959). The treatment and prevention of reading problems. Springfield, IL: Charles C. Thomas. . (1974). The ultimate stranger, the autistic child. Novato, CA: Academic Therapy, and the recent works, brain research of Pica, (1998). Movement and the brain: moving and learning in early childhood. Teaching Elementary Physical Education, 9(6): 18-19, De Jager, (2001). Breingim. Kaapstad: Human & Rousseau, and others suggest, "in effect, that the body, as a sensory-motor response system, causes the brain to learn and thus to organise itself ".
The premise that movement (physical education programmes) is the sole mechanism for effective remedial action has to be viewed with caution. Feigley, (1990), Should schools eliminate mandating physical education classes? School Administrator, 47(2): 15, 17, 20.proposes that physical education programmes need to more than mere physical fitness regimes. Likewise according Fredericks et al, Corrie and Barratt-Pugh, (1997). Perceptual-motor programs do not facilitate development: why not play? Australian Journal of Early Childhood, 22(1): 30-36, report on studies showing that certain perceptual motor training was not an effective intervention technique for academic cognitive or perceptual-motor variables. The results show little effect in any developmental domain, even on children's gross motor skills. Furthermore, the programmes made little difference to the reading, arithmetic, language or spelling of children with learning difficulties or of normally developing children. However, even though it may initially seem that Corrie and Barratt-Pugh) do not accept the theory that movement leads to learning, they do state that it is not the importance of perceptual-motor development that is disputed, but the way of supporting and facilitating that development that is critical.
According to the authors Fredericks et, al a sensori-motor movement programme should be aimed at the root cause of learning difficulties. On the basis that vestibular, proprioceptive, tactile visual and or auditory systems are dysfunctional, the child will fail in its attempts at academic work. Kokot,S.J. (2003a). Diagnosing and treating learning disabilities in gifted children: a neurodevelopmental perspective. Gifted Education International 17(1): 42-54. The complete document can be viewed at www.ilt.co.za/aricles3.hml.
In May 2006 the American Academy of Pediatrics republished its Policy statement originally published in its journal Pediatrics Vol. 104 no.5 November 1999, pp.1149-1151, http://aappolicy.aappublications.org/cgi/content/full/pediatrics; 104/5/1149.
This in turn was a reiteration of the original statement of 1968 and 1982. The May 2006 statement affirms that "Current information does not support the claims of proponents that this treatment is efficacious, and its use continues to be unwarranted". However nowhere in the References appendage is cited any peer reviewed, journal published work after 1999 which refers to the above mentioned subject matter, to which the article refers, either in support of the argument of the subject matter, or against the subject matter.
Another failure of the AAP, which, is considered to be necessary in balanced scientific commentary, is to ensure that the content of the argumentative discourse at the time of publication contains references to the latest published information from authors of the discussion material pertaining to the subject matter.
To this point, the omission of references to published works of Delacato in 1970, and 1974, "A new start for the child with reading problems" and "The ultimate stranger the autistic child" is to be questioned, as patterning, as defined by the AAP is not referred to in either book.
If the uncommitted reader is to draw a judgement from the argument by the presenters then the reader has to have been given the opportunity to consider a balanced view of the critique.
The reader would then have discovered that the so-called Doman –Delacato therapy was first proposed by Dr Temple Fay MD a neurosurgeon working in Philadelphia, who incidentally, was responsible for the introduction of brain cooling protocol prior to neurosurgery, whose original operational cooling equipment was exhibited at the Smithsonian.
Fay’s paper "The origin of Human Movement" was published in Amer.J. Psychiatry 111: 644-652, 1955.

Further more the uninformed reader would have discovered that Delacato and Robert Doman had left the Institutes by 1973 creating the centre for neurological rehabilitation, and later, Delacato alone continued his work to develop a new therapy which relied less heavily on the "patterning" concept first laid down by Fay.
The submission by the authors for a need for several persons to perform exercises to the head and extremities for several hours a day, no longer applies to today’s Delacato Therapy, except on individuals with no movement ability, and then only for very short periods.
The omission of these pertinent points by the AAP, is a serious misjudgment by the AAP to construct a valid balanced argument, necessary to have credence in the cause of scientific discourse, which makes their published critique appear to be more of personal issue, rather than a scientific one. This can be argued due to the fact that other individuals were working on the same principles around the same period as the Doman’s and Delacato, Kephart (1975), Cratty (1972,1973) and only the Doman-Delacato work is primarily referred to in text and References.
In 1970, Carl Delacato (17) proposed a new revolutionary concept together with a new curative therapy, outlined in his book, " A New Start for the Child with Reading Problems".
In his book Delacato describes his work as being hard in as much as it presented a new approach to reading problems; reading problems were the result of lack of development of the nervous system, especially in the development of complete one-sidedness.
Delacato notes that the previous book relating reading to brain function was written in 1923 by Dr Samuel Orton, and now he was to resurrect and add fuel to that old fire in educational circles.
Dr Orton, a clinician and prominent dyslexia researcher, hypothesised that normally developing readers suppress the visual images reported by the right hemisphere of the brain because these images could potentially interfere with input from the left.
Using functional magnetic resonance imaging to study brain activity in children, researchers led by Dr Guinevere Eden (18) at Georgetown University Medical Center confirmed part of an eighty year old theory on the neurobiological basis of reading disability, and shed new light on brain regions that change as children become accomplished readers. Advanced technology allowed the researchers to discover that children do in fact turn off the right side of their visual parts of the brain, as they become accomplished readers. This confirms an aspect of Ortons’ work - borne out of observations of individuals with reading disability - is correct.
To put this theory into its simplest terms, systems of reading and language difficulty, show up where there is conflict between one side of the brain and the other to gain language dominance.
In the human brain the language area is usually located in either, the left, or right side of the brain. Likewise, man is usually left- handed or right- handed.
Normally, dominance in the brain begins as soon as baby learns to speak, total dominance achieved around 7 to 8 years of age. Theoretically, a missing of any stage of development between crawling, creeping, walking, seeing, talking and writing creates problems in reading.
In November 2003 researchers led by Dr Mark Wallace (19), report that Dyslexia may stem from how the brain processes sight and sound together rather than simply a problem decoding the written word. They go on to suggest "For the first time, there is evidence that dyslexia is a multi- sensory disorder. It is not solely a problem with visual processing or with language"," our study suggests that it is actually a problem combining visual information with auditory information. "Early reading involves matching what you see with what you hear. The sights and sounds of words are inappropriately matched. So, while the average person very quickly matches the written word "dog" with the sound "dog", a child with dyslexia may have much more difficulty".
Turning again to the text of the body of the critique, there is a precis of the theory of neurological organisation underpinning patterning. "According to this theory" the authors consider that, "the majority of cases of mental retardation, learning problems, and behaviour disorders are caused by brain damage or improper neurologic organisation. Current information does not support these contentions".
On this issue alone has the AAP ignored or completely missed the plethora of peer reviewed, journal published, investigative research papers, suggesting, by brain scanning autistic subjects, with the latest high definition MRI, CAT, and PET scanners, and identifying lesions in various parts of the autism forming brain.
The submission by the AAP, that "treatment programmes that offer patterning remain unfounded" needs to be considered thus; the basis of today’s physical therapy movement programmes, is built entirely on the premise that movement by a therapist, of any part of the human anatomy, on a regular daily basis is in effect "patterning". This movement therapy, practised daily by fully trained, qualified, physiotherapy, and occupational therapists, to rehabilitate stroke victims is accepted worldwide in private, and state medical regimes. The team originally put together by Fay was done so to rehabilitate stroke victims and recipients of traumatic brain injury through accidents.
In effect the AAP critique undermines today’s physio and occupational therapy practitioners those practitioners that the AAP refers to in their web site. www.medicalhomeinfo.org/health/Downloads/EIBrochureF.pdf. to which autistic children should be referred to for therapy as the basis for Early Intervention

Reading and the Autistic child

2006-12-05T11:08:00.000Z

Reading and the Autistic Child

The basis of a movement therapy programme, Sensory Integration Therapy for Neurological Rehabilitation being used in school environments dedicated to the education of special needs children has been established within the Westminster Governments’ Department for Education and Skills. (1)
In their document "Planning, teaching and assessing the curriculum for pupils with learning difficulties", accessible via www.nc.uk.net/ld/index.html they offer the following guidance;
Physical education; Opportunities at Key Stage 1
Much of the programme of study at Key Stage 1 is relevant to pupils with learning difficulties. With modification, it can provide stimulating and challenging learning opportunities. All pupils can contribute in group work with others at their own level of ability.
The document suggests pupils explore basic body movements and actions using different parts of their bodies. To acquire and develope skills, suggesting, crawling, sliding, rolling, moving backwards and forwards. To select and apply skills, tactics and compositional ideas, be helped to follow and respond to simple instructions for example stop and start.
At Key stage 2, the document suggests listening and responding to action words, for example, walking, marching on the spot. Suggesting, as part of games activities, ball games, catching, throwing, on the floor foot skills of passing, dribbling. Throwing and catching bean bags, all as part of hand eye coordination programme, to develop binocular vision.
The Welsh Assembly Government, in their recently published guidance document (2)"Routes for learning", affirms that, "This guidance document, written to support the use of the Routes for Learning materials, offers an overview of the main theories and background information, underpinning the effective teaching and assessment of learners with profound, and Multiple Learning Difficulties". In the Additional Guidance section, the document suggests that therapies, including movement therapy, and occupational therapy to address sensory impairment, could be included in the curriculum design. The rationale for this is explained in the premise that inhibiting factors in the student’s ability to learn is irrefutably connected to sensory impairments exhibited by students with learning delay. The document outlines the reasons for the sensory impairments linked to retained inhibitive reflexes. Addressing these inhibitive reflexes being the key to improved learning ability.
It is essential to recognise that the physical exercise components of the DfES document, and movement therapy in the Welsh Document are the core elements of Delacato Therapy, evolved from the ideas of neurologist Dr Temple Fay (3).
In the published work (4)"Using a developmental movement programme to enhance academic skills in grade 1 learners" Fredericks, Kokot, Krog, describe a rigorous experimental programme to associate the benefits of physical exercise movement to cognitive learning and academic skills and investigate the efficacy of a movement programme on the academic skills of early learners
In their opinion " The results of the pre-testing and post-testing indicate that the learners of the experimental group showed a significant improvement in spatial development as well as in reading and mathematical skills, compared to the learners in the control group, free-play group and educational toys group".
In support of the rationale behind their experimental programme, the authors cite Summerford, (5) , that physical education is often seen as a frill, and has been discontinued in many South African schools, which might be a misguided kind of thinking
The authors, drawing on the works of Kephart (6), Ayres (7), Delacato (8,9), and the recent works, brain research of Pica (10), De Jager (11), suggest, "in effect, that the body, as a sensory-motor response system, causes the brain to learn and thus to organise itself.
The premise that movement (physical education programmes) is the sole mechanism for effective remedial action has to be viewed with caution. Feigley (12), (1990), proposes that physical education programmes need to more than mere physical fitness regimes. Likewise according to Corrie and Barratt-Pugh, (13), report on studies showing that certain perceptual motor training was not an effective intervention technique for academic cognitive or perceptual-motor variables. The results show little effect in any developmental domain, even on children's gross motor skills. Furthermore, the programmes made little difference to the reading, arithmetic, language or spelling of children with learning difficulties or of normally developing children. However, even though it may initially seem that Corrie and Barratt-Pugh do not accept the theory that movement leads to learning, they do state that it is not the importance of perceptual-motor development that is disputed, but the way of supporting and facilitating that development that is critical.
According to the authors Fredericks et, al a sensori-motor movement programme should be aimed at the root cause of learning difficulties. On the basis that vestibular, proprioceptive, tactile visual and or auditory systems are dysfunctional, the child will fail in its attempts at academic work. Kokot, S.J. (14)
For decades, it has been well established that one child in five has serious reading difficulties. Many systems of special teaching have been tried.
In his paper "Ontogeny of Reading Problems"(15) presented to Claremont Reading Conference in 1963, Dr Carl Delacato, Ed.D reasoned that "the process by which one attains the ability to read – the ability to learn to express oneself starts at birth. If the child is not afforded the opportunity to develop total neurological organisation, the child cannot become totally "human", and as a result cannot communicate at the level at which the child might have been able to, had neurological organisation been completed."
The 1963 paper, and his book in 1970, both stem from original research. (16)
In this paper the principles of Sensory Integration Therapy are proposed.
In 1970, Carl Delacato (17) proposed a new revolutionary concept together with a new curative therapy, outlined in his book, " A New Start for the Child with Reading Problems".
In his book Delacato describes his work as being hard in as much as it presented a new approach to reading problems; reading problems were the result of lack of development of the nervous system, especially in the development of complete one-sidedness.
Delacato notes that the previous book relating reading to brain function was written in 1923 by Dr Samuel Orton, and now he was to resurrect and add fuel to that old fire in educational circles.
Dr Orton, a clinician and prominent dyslexia researcher, hypothesised that normally developing readers suppress the visual images reported by the right hemisphere of the brain because these images could potentially interfere with input from the left.
Using functional magnetic resonance imaging to study brain activity in children, researchers led by Dr Guinevere Eden (18) at Georgetown University Medical Center confirmed part of an eighty year old theory on the neurobiological basis of reading disability, and shed new light on brain regions that change as children become accomplished readers. Advanced technology allowed the researchers to discover that children do in fact turn off the right side of their visual parts of the brain, as they become accomplished readers. This confirms an aspect of Ortons’ work - borne out of observations of individuals with reading disability - is correct.
To put this theory into its simplest terms, systems of reading and language difficulty, show up where there is conflict between one side of the brain and the other to gain language dominance.
In the human brain the language area is usually located in either, the left, or right side of the brain. Likewise, man is usually left- handed or right- handed.
Normally, dominance in the brain begins as soon as baby learns to speak, total dominance achieved around 7 to 8 years of age. Theoretically, a missing of any stage of development between crawling, creeping, walking, seeing, talking and writing creates problems in reading.
In November 2003 researchers led by Dr Mark Wallace (19), report that Dyslexia may stem from how the brain processes sight and sound together rather than simply a problem decoding the written word. They go on to suggest "For the first time, there is evidence that dyslexia is a multi- sensory disorder. It is not solely a problem with visual processing or with language"," our study suggests that it is actually a problem combining visual information with auditory information. "Early reading involves matching what you see with what you hear. The sights and sounds of words are inappropriately matched. So, while the average person very quickly matches the written word "dog" with the sound "dog", a child with dyslexia may have much more difficulty".
Man is unique in the fact that the species is the only life form that has developed a written form of communication, which developed from his ability to communicate orally in the form of speech. Having established this premise it has to be cautioned that the ability to read and write is not dependent on the ability of the individual to use coherent speech. This is true of many autistic children with little or no vocabulary being taught to read and write and autistic children with coherent language not being able to read and write. One thing however is certain that that both cohorts of children are capable of being taught reading and writing by developing the conditions that enable written language to be both taught and learnt.
A spoken and written language is the result of having sideness and uniqueness of a brain, which contains an upper portion divided into two halves, the cortex. The uniquely human characteristic of sideness developed in man has one half of the cortex becoming the dominant, language-controlling hemisphere, and the other becoming sub-dominant.
The ability of a child born without the encumbrance of a traumatic birth process and incident free pregnancy, to develop a written language is a precise process, any part of that process being missed or not totally developed compromises the process and inhibits the end result of written language and the ability to read written language.
To understand the reasons why the compromised process inhibits reading and writing is firstly to understand the precise developmental processes, which lead to reading and writing, and only then, can we understand why children, born with a traumatic birth procedure after a problem pregnancy, are unable to read and write. Only by this understanding can intervention be applied to correct these inadequacies.
In his paper "Ontogeny of Reading Problems" presented to Claremont Reading Conference in 1963, Dr Carl Delacato, ED. D reasoned that the process by which one attains the ability to learn to read - the ability to learn to express oneself starts at birth .If the child is not afforded the opportunity to develop total neurological organization, the child cannot become totally " human ", and as a result cannot communicate at the level at which the child might have been able to, had neurological organization been completed.
Based on the rationale of neurological reorganization, prevention of communication dysfunction and, as well, the development of meaningful communication is very possible. It must be based, however, on the premise that there are significant development stages of neurological organization which cannot be bypassed, and as the child reaches each stage chronologically, it must be given every opportunity to master the functional neurological activities at that level before moving on to the next. With such a logical approach to child development, we could become able to deal with the problems that face us today, by seeing that every child is given the opportunity to develop wholly and completely in terms of functional neurological organization.
Prior to the presentation of this paper at the Claremont reading Conference, Carl Delacato had spent over 10 years developing the theories on which his paper was based; studying cultures around the world and working with and studying children and adolescents with varying degrees of communication and development delay problems. This research led to his premise that all the affected individuals studied, had either an incomplete neurological development, or had received, or been subjected to an event which interrupted the natural sequence of development leading to complete neurological development. His two books published in the period up to 1963 outline his rationale and treatment regime, which leads to neurological completion and thus to the individual to achieving meaningful communication.
The remainder of the presentation goes on to outline the rationale of his premise, by presenting the etiology of brain injury, which leads to the development of sensory problems, and the retention of inhibitive reflexes, which hinder the natural development sequence, and create lost opportunities, such as, failing to crawl on hands and knees, before walking.
I have discussed elsewhere "Making Sense of the Senses"(19,20) the subject of sensory dysfunction of the autistic child as well as the subject of retained inhibitive reflexes, (acquaintance with the work of Sally Goddard on the reflexes is recommended).
Delacato goes on to say "Let us look at the significant stages of development to see how the lack of opportunity for complete neurological organization at each successive stage of neurological development relates to the ontogeny of a reading problem. For our purposes, let look at the successive stages receptively in terms of audition, vision and expressively in terms of movement.
As the child who has had a non-traumatic birth arrives at 3 to 20 weeks of age we find that his mobility consists of creeping on his stomach in a homolateral pattern. That is, the child moves forward with the arm and leg on the same side of the body extended and the arm and leg on the opposite side of the body flexed. His head turns toward the flexed side and as he moves, this body position is reversed. The mobility is aimed in a two-dimensional world toward seeking vital and basically crude comfort. If we view the child at this age from a visual point of view, we note that this body position places eyes in such a position that the child is binocular in visual performance. That is, as the right arm and leg come up, the right eye looks at the right hand, the left eye does not. It remains somewhat strabismic. As the position is reversed, the left eye looks at the left hand and the right eye has no part in the visual process. At this stage the child operates visually binocularly, using only one eye at a time just as one side of the body at a time in the homolateral pattern.
The same is true in audition. At this stage the child cannot place sound in space simply because auditorially the child receives the stimulus from one ear or the other. This total performance lies performance lies in terms of neurological organization at the level of the Pons. This is basically a one-sided level of function. Mobility is homolateral, or one side used for propulsion at a time, vision is binocular, and audition is binaural.
When the child moves on to the level of the mid – brain at the age of 7-9 months, we find a whole new area of function arising. The child, in terms of mobility, adds the third dimension to movement. The child now crawls on hands and knees and the stomach is no longer in contact with the floor. Significantly, as the child moves now, the opposite appendages are used for propulsion. In other words as the child moves, the right hand and left knee are used at one time and then the left hand and right knee are used for propulsion. The child has become a cross- patterned organism. The child no longer one-sided, but now is distinctly two -sided. The child has become a bilateral human being.
In vision, at this stage, the child begins to use eyes in concert. The child no longer uses one eye at a time in a monocular fashion. Instead, the child uses the two eyes in concert and here is the beginning of binocularity. Those children who present to us later in the developmental picture a lack of good binocularity are children who have not been given adequate opportunity to develop binocularity at this stage of development, which is the responsibility of the mid-brain. Such children, who are not given adequate opportunities for creeping, later develop problems for which binocularity is a variable.
In audition the same phenomenon takes place at the level of mid-brain. During the 7 to 9 month development levels the child learns to place a sound in space. The child becomes binaural, that is, tends to use two ears in concert. The stimuli are mediated and the child can place a sound in space.
We have all seen these children to whom we could not teach phonetics, no matter how hard we tried. In our investigations we find that those children are lacking in this very basic binaural skill, which is a function of mid-brain and not of the cortex, as we had assumed in the past. Children who are not afforded the opportunities for development at the level of mid-brain in the area of vision, mobility and audition at the ages of 7 to 9 months are beginning to develop significant problems in communication. If they lack binocularity, binaural function and mid-brain overall responsiveness we have started them on their way toward a disability in language.
As children reach one year of age they become cortical creatures and they move from bilateral activity, binocular and binaural, to a new level of function, that is stereo or depth within their receptive and expressive mobilities. Children from the age of one on begin to develop stereopsis in vision. This must be superimposed upon strong binocularity. They begin to develop stereophonic abilities in hearing which must be superimposed upon strong binaural activities. They begin to develop true cross –patterned walking which must be superimposed upon the more elemental mid-brain cross-pattern crawling. Indeed at this time in the other areas of receptiveness they have developed from the level of the Pons, at which they were able to receptively discriminate between very painful and very strong stimuli along to the point at the level of the cortex wherein they have developed complete stereagnosis receptively.
In a few short years from birth the child has moved from being one-sided to being two-sided and now must move on to the final human level, that of developing or superimposing upon this developmental continuum cortical hemispheric dominance. Here is where man is unique in neurological terms. Man is the only creature who has developed one hemisphere, which is dominant over the other hemisphere. As a result man is the only creature who has a symbolic language.
As a child begins to make early choices of sidedness, the culture must give opportunities to reinforce this sidedness so that the child develops complete unilaterality, which results in one-sidedness, the child can begin the process of becoming completely human in terms of his receptive and expressive abilities.
This sequential continuum, called neurological organization, ends at about the age of six, or about the age when generally we begin the formal teaching of reading. To recap, the whole process of development of readiness to read begins at birth. It goes on to the level of Pons, which functions in an alternating one-sidedness, to the level of the mid-brain which is two-sidedness, to the level of the cortex, which encompasses stereo functions, to the level of the development of complete cortical hemispheric dominance. This continuum forms the basis of human perceptual abilities.
Perception is a fundamental process. We learn to see in varying stages and in varying ways; we learn to move in varying stages and varying ways; we learn to hear in varying stages and varying ways; we learn to feel in varying stages and varying ways. There are no shortcuts to these developmental processes in any of the sensory modalities, sequentially, logically and according to the development of the human nervous system. Only by going through the process as nature intended it to be can we form good perceptual abilities.
Superimposed upon the development of perceptual abilities are the apperception’s which we build from our experiences which, in turn, result in conceptualization and the ultimate in reading, which is human conceptual comprehension. The ability to learn to read and the ability to learn to express oneself starts from birth on. If one is not afforded the opportunity to develop this total neurological organization, they cannot become totally human, and as a result, cannot communicate at the level at which they might have been able to, had the neurological organization been complete.
To diagnose our language problems, therefore, we must start at the age at which we first see the child, but we must look back developmentally to the original area of the dysfunction. As a result, it may be that in terms of the diagnosis, some of our children are not well developed at the level of the Pons, some at the level of the mid- brain, some at the level of the cortex and some at the level at cortical hemispheric dominance. If we are to diagnose validly and reliably, we must go through each succeeding stage to assess the mastery of function at each stage.
Treatment must also follow this sequence. In treatment we must go back to the original point of departure from development norms and we must re-create for that brain level and that chronological level, those functions so that the child can go through the proper developmental stages and begin to move on to the establishment of complete neurological organization .In, we must start at the lowest level at which there appears to be a lack of neurological organization and we must give the child the opportunity to master the activities and functions of that level and of each succeeding level until we have mastered complete cortical hemispheric dominance.
Here is now outlined a beginner’s guide to the causes, recognition of, and description of how to overcome the child’s difficulty.
There is an increased risk of mild diffuse brain injury, leading to reading difficulty and learning delay, from, difficult pregnancy, difficult birth procedures, including emergency and elective Caesarian section delivery, and early post natal period up to 6 months.
The child who misses a stage of development i.e. crawling and creeping increases the risk of reading problems and learning delay.
In the event that the parent believes that such an event, like viral or bacterial infections, risk of miscarriage during pregnancy, premature birth, a birth procedure longer than 12 hours or less than 2 hours, has occurred, should be aware of increased risk to the normal development of the child. A Caesarean Section birth, increases risk as this is invariably less than 2 hours.
The next critical stage is at approximately 5 months when the child should start to creep on hands
and knees. In the event that the child wants to start to walk without creeping, the parent should ignore this wish, and encourage the child to creeps on hands and knees for at least 4 months. After which, walking erect is then allowed.
Should you now recognise that you have a problem with your child, then the following rehabilitation can be practised.
For children over the age of 2-3 years and up to the age of 5 years, the following exercises can be carried out.
Each exercise to be carried at least twice a day, for a duration of 2 minutes each exercise, for a minimum of 4 months until you believe your child has improved to your satisfaction
Creeping on hands and knees for at least 4 months.
Rolling the child on a well-carpeted floor or alternatively on the bed up and down. You do the rolling, do not allow the child to do it itself.
Slow controlled spinning in a revolving chair, alternatively rotating 3 times to right and 3 times to left. You spin the child, remember that children spinning and rolling themselves are self-stimulation, you spinning the child is therapy.
Catching and throwing balls, rolling balls, catching after one bounce, catching balloons, chasing bubbles, kicking balls.

Record the preference of which hand the child uses to pick up objects and holds a pencil. If the predominance is right hand, then you will create the brain dominance on the left side of the brain, left-hand preference creates right hand side dominance of the brain.
For the child older than 5 years of age the encouragement of the use of hand, eye, foot, and hearing on one side of the body only, is necessary to create the condition for effective reading and writing.
When you have determined which hand your child prefers to use you can then reinforce this preference to fix the handedness and make your child all one-sided, and achieve hemispherical dominance.
This you can do by ensuring he always uses his preferred hand to write, pick up objects, throw and catch balls.
Next ensure that when he starts to walk from a standing or sitting position, he starts to walk always using his leg which is on the same side as his preferred hand. With ball games roll the ball to the foot you want your child to kick back to you with.
A good exercise for footedness is to stand the child at the bottom of the stairs and have the child place the preferred foot on the first step and then return to normal standing position. Repeat the exercise until this becomes a natural instinct.
To ensure he only uses the correct eye we can use the effect of red/red or red/green filters when the child is writing or reading.
When writing with a red/orange pen/crayon/pencil the words disappear when viewed through a red lens.
Putting a green filter on a page of a book, the words disappear when viewed through red lenses.
To enable the child to use the correct eye, we cover the other eye with a red lens.
The child uses the red lens for 2 minutes twice a day for reading and writing exercises. These exercises continue until you the parent are satisfied that your child has successfully mastered reading and writing.
To complete the handedness and create one- sided dominance in the brain, hearing needs to be addressed. Spend two, five – minute periods each day talking or reading to your child. While sitting on the right side, ask your child to cover the left ear while listening to you. If left- handed, sit on the left side and cover the right ear during listening.
When your child is all one-sided, using eye, ear, hand and foot, on one side of the body only, neurological organisation is complete.
References
1. Department for Education and Skills. "Planning, teaching and assessing the curriculum for pupils with learning difficulties", accessible via www.nc.uk.net/ld/index.html
2."Routes for learning", Crown copyright 2006, reference AC/GM/0612, April 2006,
3.The Origin of Human Movement, presented to the Fourth Annual Institute in Psychiatry and Neurology April 1954 and published in Amer. J. Psychiatry 111:644-652,1955.
4."Using a developmental movement programme to enhance academic skills in grade 1 learners" Fredericks, Kokot, Krog, Teacher Education, University of South Africa, Pretoria, Republic of South Africa. www.ilt.co.za/articles3.html.
5.Summerford, (4) C. (2001). What is the impact of exercise on brain function for academic learning? Teaching Elementary Physical Education, 12(3): 6-8."
6. Kephart (6) (1975), The slow learner in the classroom. Columbus, OH: Merrill,
7 Ayres, (1979). Sensory integration and the child. Los Angeles, CA: Western Psychological Services.
8. Delacato (1959). The treatment and prevention of reading problems. Springfield, IL: Charles C. Thomas.
9.Delacato (1974). The ultimate stranger, the autistic child. Novato, CA: Academic Therapy.
10.Pica (1998). Movement and the brain: moving and learning in early childhood. Teaching Elementary Physical Education, 9(6): 18-19,
11.De Jager, (2001). Breingim. Kaapstad.
12. Feigley (1990), Should schools eliminate mandating physical education classes? School Administrator, 47(2): 15, 17, 20.
13. Corrie, Barratt-Pugh, (1997). Perceptual-motor programs do not facilitate development: why not play? Australian Journal of Early Childhood, 22(1): 30-36.
14. Kokot,S.J.(2003a). Diagnosing and treating learning disabilities in gifted children: a neurodevelopmental perspective. Gifted Education International 17(1): 42-54.
15.Delacato,Carl Ed.D Ontogeny of Reading Problems, Claremont Reading Conference 1963.
16. Delacato, Doman, Doman "Behaviour, Learning and Mobility, cause and effect of Rehabilitation". Institute of Physical Medical and Rehabilitation, New York in 1953,
17. Carl Delacato" A New Start for the Child with Reading Problems". 1992 Morton Books
18. Dr Guinevere Eden, Georgetown University Medical Center, May 18th on line publication of the journal Nature Neuroscience. www.sciencedaily.com/releases/2003/05/030519083450.htm accessed 19/11/06
19. Dr Mark Wallace Wake Forest University Baptist Medical Centre at the annual meeting of Society for Neuroscience in New Orleans, November 2003 www.sciencedaily.com/releases/2003/11/031110054404.htm accessed 19/11/06
20."Making Sense of the Senses"www.learning-connections.org.uk
21 Retained Inhibitive Reflexes, www.learning-connections.co.uk/2005/12/inhibition-of-primitive-reflexes-to_02.html.
Robin Burn
The Autism Centre
November 2006

Making Sense of the Senses

2006-11-15T09:22:00.000Z

Making Sense of the Senses
"If we do not try to express any psychological or behavioral theory
in terms of neurons, we are unlikely to get to the bottom of the problem."
G.M.EDELMAN
Most autistic children are highly sensitive to changes in the volume of noise. The louder the noise, the harder it gets for the child to tolerate, until the child bursts into tears.
This is caused by a faulty mechanism by which sound is input at the level of the hearing cortex. The first layer of the hearing system in the cerebral cortex consists of neurons that are sensitive to variations in noise levels. The same neurons also distinguish one tone of voice from another: calm or angry. An anatomical or chemical injury to this layer can cause serious disturbances making it difficult to adapt to high frequency sounds.
Human beings can hear sounds between 16 and 16,000 Hz. Clearly as the sound approaches one or other of these extremes it becomes more difficult to listen to the sound, which is either extremely dull or very acute. Brain injured children, including autistic children, have a very low tolerance for high frequency sounds, particularly if the noise is also loud.
Autistic children do not tolerate high frequency sounds but love low sounds, like whispering.
A very quiet and unruffled environment can put a stop to a whole range of strange behavior, such as hiding under the table, staying under water for long periods, sleeping with a blanket over the head, fingers in the ears, making a continuous even sound, staying in the corner of the room. Many autistic children like the corners of rooms because they feel protected against sounds.
The cheek color of autistic children changes very often. Sometimes in the course of a single day they can go from a healthy red to pale gray, particularly around the eyes. This is a symptom of great suffering.
The color changes when the noise level becomes intolerable, but this level is very low for autistic children, since they are hypersensitive to sounds. When the noise level is intolerable the child begins to behave in one of the ways described earlier (hiding under the table, fingers in the ears, etc.). If the level of intolerability is very high the child uses a different mechanism that is even more effective: he becomes pale and cuts himself off from the rest of the world. Even very loud noises no longer penetrate. Call him and nothing happens. It is as though he has suddenly gone deaf. The only way to get the child to come back into the world is to whisper something in his ear. The sound is very low, so there is no need for the nervous system to maintain a high level of defense. A low sound allows the child to lower his defenses and enables him to let sounds back in.
If the child is the source of the sound, or knows that the sound will come, the nervous system gets itself ready and copes with the noise, but if the noise comes suddenly and unexpectedly the child cannot cope and, as it were, shuts down.
A child screaming also makes perfect sense. Often autistic children react in this way to show their suffering or try to use their own voice, an instrument with which they are familiar.
Switching on the TV or staring at the washing machine as it turns and tumbles are familiar traits of behavior in autistic children with an impaired sound pathway. They use this sound, which they themselves provoke, to focus on and drown out all other noises.
For many years very little hope was held out for autistic children in terms of speech ability. But nowadays we know much more about the neurological basis of speech abilities.
Antonio and Hanna Damasio have carried out very interesting studies in this area. They and their team have investigated three different neural structures related to speech. The first structure consists of a large number of neurons in both the right and left hemispheres; these neurons process sensorial inputs. The second structure consists of a numerically smaller number of neurons located mainly in the left hemisphere; these neurons are used for the recognition of phonemes, the combination of phonemes and an understanding of syntax. The neurons of the third structure are also in the left hemisphere; these mediate between the other two. For example, if you want to say a color, the neurons of the third structure place the neurons of the other two structures in communication. The first structure contains the visual sensation of the color and the second the phonemes to pronounce the word. In other words, the memory must contain the correct phonemes and the correct sensory experience. If someone does not have the visual apparatus to perceive colors, forms or movements correctly, the concept of color, form and motion will be lacking, and hence the words relating to these things will also be lacking.
Defective perception becomes defective language and unfortunately autistic children are seriously affected by defects in sight, hearing, touch, taste and smell.
If we just think back to the example of a child hyper auditory, it is not difficult to understand the problems the child has in acquiring the proper use of language.
We know that the first layer of the hearing cortex controls the volume of sounds. The second layer is used to distinguish a series of sounds, their pitch and rhythm.
The second layer enables us to understand speech. Every spoken word has two elements: volume and rhythm. The first layer of the cortex receives the sound of the word and distinguishes the volume; the second captures the rhythm. The result is that the word can be memorized and learned. The pathway is obligatory from the first to the second layer. The first layer filters sounds, especially volume, that reach the second layer and hence influences its structure. If the first layer does not carry out its filtering function properly, the second layer slows its activity and is unable to distinguish the rhythm of words and hence to distinguish and understand spoken words.
Autistic children are often unable to control the volume of the sounds they hear, although there are many different forms of this disability. In some cases the difficulty is so severe that no sounds reach the second layer; the child is "acting deaf." In such cases the second layer is deprived of information and proper linguistic abilities are impossible. If the sensitivity to differences in volume is less pronounced, sounds do reach the second layer and hence the child is able to make certain distinctions between words. Speech is by no means perfect but the child is often able to repeat some words or to make sounds that are similar to words. If the dysfunction is quite small, the second layer is able to carry out its functions properly and in this case the autistic child acquires superior language abilities compared to the norm. If impairment of a sensory pathway is only slight, the child develops special mechanisms to offset the disturbance, and may be able, for example, to learn an entire telephone book by heart, finish a complicated jigsaw puzzle in a few minutes or reproduce a drawing at sight, and so on. Sometimes these abilities reach extraordinary heights but the other disabilities of the child are generally so severe that the child is not independent.
Children are able to juggle objects, defy gravity. But what was most astonishing is the fact that they seemed to pay no attention whatsoever to what he was doing during these moments. Their eyes are elsewhere. Children spend hours in this way, sometimes throwing things across the room or from the balcony, or leaving them neatly arranged at the edge of the table.
It is amazing the deceptive nature of the behavior of autistic children. That way of looking askance at things was not a sign of lack of interest, but the only way children could actually see things. By looking out of the corner of their eyes they perceived the object. The juggling act was actually a way of focusing on it, seeing it better.
For many autistic children the only way they can see is to move their heads sideways and look out of the corner of the eye.
The visual apparatus of human beings is quite complex: essentially it involves breaking elements down into separate entities and then recomposing the picture as it was. Of course we are not aware that this is what we do. Every time we look at an object, a person, the scenery, a group of people, neurons analyze color, form, depth and motion. The neurons that recognize color are all located in one area of the brain, and so on, for other functions.
There are five such vision areas in the brain that for simplicity’s sake we can call V1, V2, V3, V4 and V5.
The first area, V1, is also known as the layered or primary area. This area receives the images falling on the retina. These images are then passed to V2, which links up to the other areas making up the area of associative vision, or the pre-layered cortex.
Area V3 receives information from V1 and V2 concerning form. Areas V4 and V5 also receive information from V1 and V2, but V4 concerns form and color. While V5 concerns depth and movement.
Once V3, V4 and V5 have done their jobs, the message is sent back to V1 and V2 along pathways that integrate the information, so the image is recomposed.
It is as if the elements of a picture were poured into a funnel. Everything goes through the neck of the funnel and mixes together: color, form, depth and movement.
In order to see the world normally these areas must be perfectly balanced; any imbalance can cause distorted vision.
Serious damage in the V1 and V2 areas causes total blindness while damage in the pre-layered area (V3, V4 and V5) causes difficulties in perceiving form.
One of the world’s leading experts on vision in human beings, Semir Zeki, has noticed that people with brain injury in the pre-layered area, who therefore have difficulty identifying forms, tend to rotate their heads in order to create movement, or prefer objects which move such as objects seen on television.
Typical behavior of autistic children is to tilt the head in order to look at things out of the corner of the eye. Another is to frenetically rock or rotate an object, or to watch television programs featuring things in rapid motion, such as the list of characters, actors and crew at the end of a film. They also like to see the same scene of a cartoon over and over again, or watch quiz shows like "The Price is Right" or "Wheel of Fortune."
A lot of evidence concerning autistic children points to injury of the pre-layered cortex. This is not necessarily wrong, but there is also evidence of other types of disturbance such as the inability to distinguish between similar images, or to see small things on an object’s surface or to remember a visual experience such as scenery or the route along a road.
It is therefore more correct to say that autistic children process visual inputs differently. This different perception may be associated with injury in the occipital lobe (the area related to vision) and may involve one or more areas of vision.
A slight but widespread injury at an early age may not have serious immediate consequences but certainly alters the neurological organization of the central nervous system. To make things simpler we could say that the brain of a newborn child is like a building site where the engineer is running things. An injury is like a construction event that won’t change the scaffolding but causes all of the engineer’s orders to be carried out slightly wrong, with consequences that may make the building unsteady or unusable. It is as if the engineer were speaking a slightly different language from the builders following his orders. The inputs are skewed, making the building out of shape. The neurons—the builders in our metaphor—simply carry out orders as best they can, building things the way they seem to have been told. The result in autistic children is a series of neurological maps that don’t correspond with the real world, giving rise to antisocial and unusual behavior.
In the case of vision, only V1 has an efficient neurological organization at birth. This means that the baby uses this area immediately in order to see. But it also means that this area is the most exposed to injury during pregnancy.
In addition, the primary visual cortex is just like the engineer on the building site: all other areas of vision are organized by V1 despite the fact that the messages go through V2. If the orders coming from V1 are in this rather odd language the rest of the visual apparatus is built wrong.
Lack of perception of color could be caused by injury to the specific area dealing with color perception (V4) or to the primary visual cortex (V1) failing to give the right messages to V4. If the only defect in vision were the perception of color, it would probably be correct to assume the injury has occurred in V4. But autistic children generally have many defects of vision, so it is far more likely that V1 has been injured and the entire language of the engineer is off-cue. Usually V4 is unlikely to be injured since autistic children generally receive injury during pregnancy or in the first few months of life, and V4 practically does not exist at this time.
So the hypothesis is that autistic children receive injury to V1 before or just after birth. Now we need to explain how this determines their behavior.
Let us recap what we know about the primary visual cortex: first, it works from birth. Second, it receives all visual inputs. Third, it communicates with all other areas. Fourth, serious injury causes total blindness.
Now we can go backward over these points. Autistic children are very rarely blind Usually their injury is not severe. The layered visual cortex (V1) sends information to all other areas, determining the way in which these areas develop. In order to do this, the neurons in V1 must be able to recognize each visual input and understand where to send it. The nerve cells in V1 that recognize a stimulus are contained in the layer. Nerve cells responding to movement are found in sub-layer IV c a , the cells recognizing forms in sub-layer IV c b and other cells responding to color and spatial orientation in layers II and III.
The presence of nerve cells responding to all types of visual stimulus in, V1 means, this area of the brain is independent. In other words, with this area alone we can perceive forms, colors and movement. But this does not make for proper vision. We would find it difficult to focus on nearby objects, would see few differences in color and would only be able to see the outline of an object by moving it. We would see like a newborn child who only has the V1 area of the brain available for seeing. But in the case of a newborn child, vision improves as the functions of the pre-layered cortex come into play.
The pre-layered cortex receives its orders from V1, which is organized in layers, each one responding to a particular stimulus and each transmitting input to other areas. The nerve cells in these areas activate a series of synapses that excite and inhibit, forming a kind of circuitry.
One of the circuits called the magnocellular circuit, transports information concerning depth and movement. Another called the parvicellular circuit, transports information concerning form and color.
The magnocellular circuit starts with some rather large ganglial cells (hence the name) connected to cells on the retina that recognize movement. The signal is then projected onto the V1 sub-layer IV Cc a , where spiny star-shaped nerve cells respond to the stimulus, activating an exciter synapse. The message processed by these cells is then transmitted via V2 to V5 where specialist neurons further analyze the message.
The parvicellular circuit starts with some rather small ganglial cells (hence the name) connected to cells on the retina that recognize form and color. The signal related to form is projected to the sub-layer of V1, IV c b , and to some cells in layers II and III where the remaining cells respond only to color. The messages processed by these sub-layers are sent to V3 and V4 respectively.
The cells contained in sub-layer IVC b are exciters, but those in layers II and III excite a group of cells contained in layer VI of V1—smooth star-shaped nerve cells—which inhibit and modulate the effect of exciter cells. Two observations can be made at this point. The first is that the pathway carrying messages about movement and the pathway carrying a message about color and form are completely separate. The second observation concerns the nature of some cells in V1: they are generally exciter cells but are regulated by inhibitor cells. The message that is finally sent back to V1 is the result of the balance between these two types of cells.
If the pathways are separate, one may be injured without affecting the other. For example the parvicellular circuit may be damaged but the magnocellular circuit may be intact.
This is probably what occurs in autistic children.
The magnocellular circuit is the first to develop; the receptors or rods at the edge of the retina develop and detect movement. The ganglial cells creating the magnocellular circuit start from there. Autistic children seem to be able to detect movement perfectly well, almost too well. So it is unlikely that this circuit has been damaged. It is more probable that the processing of the image in the parvicellular circuit is affected.
The balance between inhibitor and exciter cells is very delicate. A slight injury to the visual cortex can have serious consequences. For example, if these cells are not perfectly balanced, the information processed in sub-layer IV c b and in layers II and III concerning the form and outline of objects, affects perception. The alteration is transmitted to V3, which then works on faulty input. It may be that V3 receives excessively detailed information about parts of an object, without providing the outline, so that the child is bombarded with information about single parts of objects without perceiving them as wholes. Autistic children with this vision defect recognize people not from their faces but by the shape of their ears or their shoes. They are also able to notice tiny changes in two almost identical figures and to reproduce images effortlessly. They can do jigsaw puzzles at a very astonishing speed and notice a tiny crumb on the floor.
Conversely, the effect of imbalance between inhibitor and exciter cells in the parvicellular circuit, may also send too little information to V3, so shapes are indefinite. Autistic children of this sort need to use special strategies to distinguish shapes.
It is well known that to distinguish the outline of an object motion is helpful. Autistic children are masters of this. Similarly, a child may place things along the edge of a table in order to make the edge clearer or touch things with the tips of the fingers. Another method is to create strong color contrasts. The way children played with saliva in front of the window was a way of creating light contrasts. With hands shade is created that fell over the eyes; the saliva had a prismatic effect, separating colors.
The way children continuously move their hands is a torment for parents. Even if they kept hands relatively still, they continue playing with things around him—a pen, a piece of paper, a leaf, to rock in front of their eyes.

Autistic children have problems perceiving depth. Every time they come close to a carpet they seem to raise their feet as though they were about to climb onto a step A lack of depth perception, i.e. the inability to see how far away things are, creates enormous difficulties. It is like walking in mid-air, without having any idea of how far away the floor or the wall is. It makes stairs difficult to climb and the ceiling appearing to fall. Children with this difficulty often trip over colors and designs.
One of the consequences of this problem is that in large open spaces autistic children often scream in order to receive an echo and calculate the distance to the walls. Or they throw things to see when they impact with the wall.
Our sense of depth is a complex process that requires the combination of information from both eyes. The information is sent from V1 to V5 but it would be mistaken to think that V5 is the area where the information is definitively processed. Depth information has nothing to do with objects in motion. On the contrary, it often requires the use of a distant, stationary object. An injury to the primary visual area means that all information coming from this area may be erroneous, particularly if the sensory input comes from a stationary object. Therefore the correct sense of depth is one of the most common difficulties.
Mothers try to hug her child and the child moves away as if irritated. Over the years many psychologists have investigated this problem and have come up with a number of theories, none of them satisfactory. These theories are usually based on a conflicted relationship between mother and child and have never had any scientific basis. For years, mistaken diagnoses were made on the basis of these theories and treatments often damaged the child and parents more than the illness itself.
This was happening to children and families at the same time that the world’s libraries were filling up with books dedicated to the physiology of the nervous system and the processes of responding to sensory stimuli. It would have been sufficient to read practically any one of them to come to a different conclusion. For any human being the sense of touch is intimately associated with survival. Hence the neurological organization governing the sensory pathway for touch is particularly sophisticated.
This neurological organization helps us to distinguish between light touches and harder contacts, and to feel heat. This is made possible by an inhibitory system for tactile sensations, that filter some out. It is like turning on a radio and looking for a particular station. When you first switch the radio on you cannot distinguish between all the messages arriving; it’s just noise. By turning the tuning knob one message emerges stronger than the others and then entirely replaces the previous noise. This is how the neurological organization of tactile inputs works, by choosing one sensation and removing others. Every day we are bombarded with tactile sensation—the touch of clothes against the skin, the feel of a wristwatch, and so on. All of these signals would lead to total confusion if we were not able to "tune in" to one sensation or another. The inhibitory system is exactly this form of tuning in to one signal. We use it to gain tactile information about the world around us.
Tactile information travels along pathways—nerve fibers—that go from the extremities to the center and vice versa. The nerve fibers that carry information about light touches do not carry information about heat or harder contacts; these are carried by other nerve fibers. It is like a three-lane highway where the traffic moves in parallel to the same destination.
In order to enable us to distinguish between one type of tactile sensation and another, groups of receptors on the skin carry out different activities. Some receptors are excited only by very light touches, others only by heat and still others only by deeper contacts.
When we are affected by heat, our heat receptors pick up the information but other receptors are not stimulated since they cannot read this type of input. In other words each type of receptor only picks up signals of a certain type, and is unaffected by other types of signals. We can see that the receptors are specialists, making the tactile sensory pathway extremely efficient.
When the light-touch receptor picks up information it transmits the stimulus along the correct pathway, heat receptors along the heat pathway and so on. The three types of nerve fiber carry only one type of information.
Draw a circle on the palm of your hand then try to stimulate the center of the circle with a paintbrush. In this way you are stimulating only the sensors of light touch. All the other receptors in the circle have been inactive because they cannot read the stimulus. If you then take a pin and prick the center of the circle, the receptors of harsh sensation come into play and the sensors of light touch remain inactive. If you then touch the palm of your hand with an ice cube the receptors of heat will be excited but no others.
The three pathways transmit only one type of information to the cortex, which does not accept the signal as it is, but tends to modify it. The basic function of the cerebral cortex is to receive all inputs from the outside world and to put them together into one message. To do this it inhibits certain inputs, as in the example above.
Inhibition of tactile messages takes place in the bulb and thalamus where exciter and inhibitor neurons are distributed—as in the case of all sensory pathways—with exciter neurons at the center and the inhibitor neurons at the extremities of these brain areas. The part of the input that reaches the center is transmitted to the next nucleus. The part that hits the edge is inhibited. The closer to the edge the impulse is received, the stronger the inhibition. The next nucleus receives only the portion of the input that hits the center. The pathway hands on the message from nucleus to nucleus in this way until the input finally reaches the cerebral cortex.
All sensorial pathways—sight, sound, touch, taste and smell—have inhibitors. In the case of touch there are three types of inhibitors because there are three pathways and three types of input: light touch, deep contact and heat.
If the cerebral cortex controls the inhibition process properly, there is no problem. But if the cerebral cortex has been injured, this control function is impaired and the balance between exciter and inhibitor receptors is thrown askew. Essentially three types of dysfunction result: the nucleus may transmit too much information to the next nucleus by not inhibiting the input at the edge. This nucleus in turn passes on too much information so it finally reaches the cerebral cortex in too intense a form. This is called hyperactivity. Alternatively the nucleus may inhibit too much of the stimulus at the edge and in the center. In this case the stimulus is overinhibited, leading to hypoactivity.
The third type of dysfunction is called "white noise" and involves the addition of impurities in the input. Inputs are regulated by exciter and inhibitor receptors. White noise occurs when the inhibitor receptors, instead of filtering out an input, actually contribute to it so the message that reaches the cerebral cortex is not a message derived entirely from the outside world but has been polluted along the way by inhibitor receptors.
Autistic children can be diagnosed for hyper or hypo vision, hearing, touch, taste and smell or for white noise in any of these sensory pathways.
For the tactile pathway things are a little more complicated. To say that an autistic child has hyper or hypo tactile activity or white noise in the tactile pathway means nothing at all. If the type of pathway is not specified, the statement makes no sense. It may be that the child has hyperactivity of light touch, and/or hypo activity of deep touch. In other words the diagnosis is meaningful only if related to one or more of the three tactile pathways.
For example, how can you understand which tactile pathway is affected? Why does behavior often seem contradictory? Why does a child not like to be hugged but then go off and bite his own hand?
I managed to reply that close observation of an autistic child shows what the child constantly refuses and what he or she constantly looks for. The analysis of this behavior leads to a correct diagnosis of tactile disorders.
The search for strong stimuli such as beating the knees against the floor or the head against a wall, or biting the hand, would seem to indicate hypo activity of deep tactile feeling. Conversely, the inability to accept a caress or hug, or the touch of clothes on the skin (particularly socks, shoes, caps and glasses), or difficulty taking a shower, brushing one’s teeth, or combing one’s hair, suggest hyperactivity of light touch.
Hypoactivity at the deep tactile level combined with hyperactivity at the surface level occurs in 90% of cases of autism; this means the child has areas of the body, such as the soles of the feet, which are hypersensitive but at a deep level virtually insensitive. A child with this disturbance often walks barefoot or on the tips of the toes to reduce contact with the floor. But if he is forced to wear rather rigid shoes or to walk over a cobbled surface he cannot walk on tiptoes or go barefoot so he marches, slamming his feet down onto the surface in order to look for deep tactile feeling.
Hypo tactile children bite their wrists. The way to stop them biting their wrist was to massage it very firmly, replacing the search for deep tactile feeling with another stimulus. But the problem is not just hyposensitivity of the wrist. The pressure of teeth also fails to stimulate sensation, so there is a problem of hypoactivity in the mouth too.
There are other signs of this hypoactivity, children, they can eat almost the entire packet of biscuits in one mouthful. This is common in children who suffer from hypotactile sensitivity inside the mouth. Not only do they bite themselves and things in their grasp, they often eat in this way because it is the only way that they can feel what they are eating. Conversely, a child who finds it difficult to eat even soft foods, or is very sensitive to the temperature of food, or prefers eating very small mouthfuls has the opposite problem: hypersensitivity.
If the choice is based on a tactile experience (soft, crunchy) then the problem is one of feeling; if the choice is based on taste (sweet, sour, acidic, salty) then the problem is based on taste. The stronger the taste, including detergents, soil, stools and other inedible substances, the more likely the child is to be suffering from hypo taste. Hyper taste tends to lead to a choice of almost tasteless food.
But smell also plays a part in the choice of food. A disturbance to the sense of smell also determines other types of behavior, such as the child dirtying himself with excrement or rubbing saliva over his body or over things around him in order to produce an acrid smell that he can recognize.
Hyper smell can cause the child to vomit every time he smells something strong; he may also have trouble urinating or defecating because of the smell.
The control of the sphincter requires a separate discussion. A disturbed sense of smell clearly plays an important role, but other elements come into play. First of all, tactile sensation is important since these activities involve the sense of feeling. Urinating and defecating stimulate a large number of tactile sensations and a child with hyperactive surface feeling may actually feel pain and therefore not want to go to the bathroom. But not only surface feeling is involved. The toilet seat is often colder than the body temperature so a child with hyperactive feeling in relation to temperature may be disturbed. This type of child will have difficulty with potty training and will want to use nappies to maintain the temperature of the genitals.
Another factor contributing to problems urinating and defecating is related to sight. Boys often find it difficult to judge the distance and depth of the toilet and are afraid they might fall in.
Children often can’t reach the floor when they sit on a toilet and this for autistic children can cause a loss of balance that terrifies them. Sometimes it is sufficient to place something under the child’s feet—even a pile of books—to overcome this problem.
A child with hypoactive activity in the area of deep sensation tries to stimulate deep feeling with harsh impacts, such as falling, or by biting or touching parts of the body in contact with mucous, such as the nostrils, ears, eyes and genitals. They are not trying to find sexual pleasure but sensation pure and simple.
Axons (extensions of neurons) are located at the level of joints, muscles and tendons. They communicate the slightest muscle or tendon contraction and the slightest change in the angle of the joint. This enables us to understand where we are in relation to space. In other words, part of our perception of the world is our perception of ourselves within it. The inputs from muscles, tendons and joints travel along neural pathways that are adjacent to those of deep tactile sensation, so an injury impairing one pathway may also produce a dysfunction in the adjacent pathway.
Hypo tactile children have an imprecise notion of themselves in the deep feeling pathway. If you ask them to touch their nose they may touch their ears. Body contortions are quite common. An imprecise notion of one’s body means it is difficult for the autistic child to draw the human body. Autistic children generally draw the human body with massive distortions between the body and legs or the hands and head. The size of the hands or head in the drawing often corresponds to the perception the child has of that part of his body. All tests related to the interpretation of drawings should bear this in mind; otherwise the results would have no scientific foundation.
Emotions are influenced by environmental and cultural factors.
A man raised in a mountain district finds the peaks of mountains more breathtaking than the view of the sea. A sailor has a different relation to the sea than others, who have not been to sea. Their emotions are influenced by their experience. Education also has a bearing on feelings. An opera lover does not respond to jazz in the same way that a jazz fan does. The environment, culture, and education are all strong factors in our everyday emotions. But they are nothing if the perception of the outside world is incorrect.
How would we experience a sunset if we suddenly went color-blind? Our sense of the importance of color would change. Our relationship to beauty would no longer be the same. And if we had never perceived colors huge parts of popular culture related to sunsets would be lost on us.
What if we had no sense of smell? Any defect in sensory perception changes emotional capability.
But how is this possible? Aren’t emotions intimate and unique, the product of the individual mind? How can they just be the result of perception?"
Maybe the thought is not comforting, but the fact remains that they are the result of perception. Human beings are culturally inclined to think of emotions as inscrutable and private. Religion, some philosophical thought, and some psychology tend to encourage this view. But it is based on erroneous thinking. Human emotions are the product of culture, tradition and the environment because they are transformed into sensory inputs; they are perceptions. A faulty sensory mechanism precludes the proper development of emotions. This might seem rather cold, but neuroscience has proven this conclusion, and other religious and psychosocial theories—which we might feel drawn to for a number of reasons—have proven to have no scientific basis..
If the sensory mechanisms could be retrained and corrected, behavior would improve and the emotions would evolve.
Nothing is worse for a parent than to be told that nothing can be done, that it would be better to put their energies into their other children or, worse, to seek psychiatric help.

Making Sense of the Senses based on extract from publication "Children who do not look you in the eye, The Secrets of Autistic Behaviour"
Authors Dr. Antonio Parisi MD and Anna Lisa Buonomo.
With kind permission of the authors.

Robin Burn
The Autism Centre
May 2006

The Treatment of Neurologically Impaired Children Using Patterning

2006-10-22T11:24:00.000+01:00

The Treatment of Neurologically Impaired Children Using Patterning
Movement Therapy
Sensory Integration Therapy for Neurological Rehabilitation using Movement Therapy in the school environment.
The basis of a movement therapy programme being used in school environments dedicated to the education of special needs children has been established within the Westminster Governments’ Department for Education and Skills.
In their document "Planning, teaching and assessing the curriculum for pupils with learning difficulties", accessible via www.nc.uk.net/ld/index.html they offer the following guidance;
Physical education; Opportunities at Key Stage 1
Much of the programme of study at Key Stage 1 is relevant to pupils with learning difficulties. With modification, it can provide stimulating and challenging learning opportunities. All pupils can contribute in group work with others at their own level of ability.
The document suggests pupils explore basic body movements and actions using different parts of their bodies. To acquire and develope skills, suggesting, crawling, sliding, rolling, moving backwards and forwards. To select and apply skills, tactics and compositional ideas, be helped to follow and respond to simple instructions for example stop and start.
At Key stage 2, the document suggests listening and responding to action words, for example, walking, marching on the spot. Suggesting, as part of games activities, ball games, catching, throwing, on the floor foot skills of passing, dribbling. Throwing and catching bean bags, all as part of hand eye coordination programme, to develop binocular vision.
The Welsh Assembly Government, in their recently published guidance document "Routes for learning", Crown copyright 2006, reference AC/GM/0612, April 2006, affirms that, "This guidance document, written to support the use of the Routes for Learning materials, offers an overview of the main theories and background information, underpinning the effective teaching and assessment of learners with profound, and Multiple Learning Difficulties". In the Additional Guidance section, the document suggests that therapies, including movement therapy, and occupational therapy to address sensory impairment, could be included in the curriculum design. The rationale for this is explained in the premise that inhibiting factors in the student’s ability to learn is irrefutably connected to sensory impairments exhibited by students with learning delay. The document outlines the reasons for the sensory impairments linked to retained inhibitive reflexes. Addressing these inhibitive reflexes being the key to improved learning ability.
It is essential to recognise that the physical exercise components of the DfES document, and movement therapy in the Welsh Document are the core elements of Delacato Therapy, evolved from the ideas of neurologist Dr Temple Fay and propounded in his paper The Origin of Human Movement, presented to the Fourth Annual Institute in Psychiatry and Neurology April 1954 and published in Amer. J. Psychiatry 111:644-652,1955.
In the published work "Using a developmental movement programme to enhance academic skills in grade 1 learners" Fredericks, Kokot, Krog, Teacher Education, University of South Africa, Pretoria, Republic of South Africa, describe the outcomes of a rigorous experimental programme to associate the benefits of physical exercise movement to cognitive learning and academic skills and investigate the efficacy of a movement programme on the academic skills of early learners
In their opinion " The results of the pre-testing and post-testing indicate that the learners of the experimental group showed a significant improvement in spatial development as well as in reading and mathematical skills, compared to the learners in the control group, free-play group and educational toys group".
In support of the rationale behind their experimental programme, the authors cite Summerford, C. (2001). What is the impact of exercise on brain function for academic learning? Teaching Elementary Physical Education, 12(3): 6-8." that physical education is often seen as a frill, and has been discontinued in many South African schools, which might be a misguided kind of thinking "
The authors, drawing on the works of Kephart, (1975). The slow learner in the classroom. Columbus, OH: Merrill, Ayres, (1979). Sensory integration and the child. Los Angeles, CA: Western Psychological Services. Delacato, (1959). The treatment and prevention of reading problems. Springfield, IL: Charles C. Thomas. . (1974). The ultimate stranger, the autistic child. Novato, CA: Academic Therapy, and the recent works, brain research of Pica, (1998). Movement and the brain: moving and learning in early childhood. Teaching Elementary Physical Education, 9(6): 18-19, De Jager, (2001). Breingim. Kaapstad: Human & Rousseau, and others suggest, "in effect, that the body, as a sensory-motor response system, causes the brain to learn and thus to organise itself ".
The premise that movement (physical education programmes) is the sole mechanism for effective remedial action has to be viewed with caution. Feigley, (1990), Should schools eliminate mandating physical education classes? School Administrator, 47(2): 15, 17, 20.proposes that physical education programmes need to more than mere physical fitness regimes. Likewise according Fredericks et al, Corrie and Barratt-Pugh, (1997). Perceptual-motor programs do not facilitate development: why not play? Australian Journal of Early Childhood, 22(1): 30-36, report on studies showing that certain perceptual motor training was not an effective intervention technique for academic cognitive or perceptual-motor variables. The results show little effect in any developmental domain, even on children's gross motor skills. Furthermore, the programmes made little difference to the reading, arithmetic, language or spelling of children with learning difficulties or of normally developing children. However, even though it may initially seem that Corrie and Barratt-Pugh) do not accept the theory that movement leads to learning, they do state that it is not the importance of perceptual-motor development that is disputed, but the way of supporting and facilitating that development that is critical.
According to the authors Fredericks et, al a sensori-motor movement programme should be aimed at the root cause of learning difficulties. On the basis that vestibular, proprioceptive, tactile visual and or auditory systems are dysfunctional, the child will fail in its attempts at academic work. Kokot,S.J. (2003a). Diagnosing and treating learning disabilities in gifted children: a neurodevelopmental perspective. Gifted Education International 17(1): 42-54.
To read the full transcript of the study carried out by the University of South Africa, visit web site www.ilt.co.za/articles3.html.