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Reaching Farther Program:

Neurophysiology of Learning Disorders and Developmental Dysfunctions

Reaching Farther -  An Overview of Neurophysiology as Related to Learning Disorders and Developmental Dysfunctions

Learning disorders, developmental dysfunctions, and childhood psychological diagnosis are the fastest growing problems facing parents today. Therefore, there has been an increase in the demands on chiropractic physicians to give parents treatment and management options without the use of medication.

In the spectrum of learning disorders as well as psychological problems, there is often no diagnostic (anatomic or physiologic) evidence, (i.e. MRI, CT) that will identify the problem in the brain. However these are very definitively brain-based problems, with involvement of specific areas. These are termed 'functional' problems and may be caused by underactivity or lack of development in certain neurological pathways. As a result, the child often will have corresponding changes in neurolgic function. For example, they may have changes in sensory function, such as intolerance to many environmental stimuli.

Children also may experience changes in motor function, and/or incoordination in their ocular, gross motor, or fine motor abilities. Other changes are also present, such as changes in the balance centers (vestibular) and the areas that control muscle tone as well as functions such as digestion and respiration. By addressing the changes in neurologic function, by rehabilitating dysfunctional pathways we can subsequently affect the brain.

Overview of Neurophysiology 

Historically, the brain has often been described as a static organ system. Within the past ten to fifteen years, much of what we previously knew about the brain has changed. The current view is that the brain is functions more like a muscle, very dynamically changing in not only months or weeks, but literally at the speed of light. The cellular metabolic activity of the brain -- or its frequency of firing -- determines much of our cognitive, emotional and higher conscious thought.

The functional unit of brain activity is the neuron. The primary functional activity of neurons is to survive by firing to other neurons and through gene coding expression. To survive, neurons need two things: fuel and activation. Fuel is oxygen and glucose; Activation is stimulation from the environment, (i.e. light, sound, touch, taste, smell, and sense of position (proprioception). Changes in either fuel or activation affects the neurons of the brain, making them more fatigable -- decreasing function or causing spontaneous firing . Factors that affect fuel delivery would be birth anoxia, dietary problems, and breathing difficulties.

On the topic of activation, we know that the environment influences our brain, and is brought into the brain by receptors -- light receptors in the eyes, sound in the ears, taste in the mouth, smell in the nose, touch in the skin. Propioception, or sense of position, is found in the muscles and joints of the body. It is the sense that we are least aware of but that has the most powerful influence because it is constant.

Proprioceptive receptors are found most in the muscles and joints of the spine, specifically of the cervical spine. Proprioception and spinal attitudes are a reflection of the cortical activity of the child. That is why we see such profound postural changes in these children. After the receptor the stimulus is relayed to thalamus, and then to other brain areas) except smell). Propioceptive afferents not only project to the thalamus but also relays to the cerebellum, then on to higher brain areas.

The brain itself is made of several key areas as follows: /p>

• Cortex (subdivided into lobes)
  • Frontal
  • Parietal
  • Temporal
  • Occipital
• Cerebellum
• Basal Ganglia
• Brainstem
• Thalamus
  

Briefly speaking, the areas that are of most concern in our children is the cerebellum, the contralateral frontal lobe, and the basal ganglia. These areas develop and function in concert with one another. Therefore changes in the developing system most profoundly affect these areas. 

So What is the Problem?

The frontal lobe is subdivided into four main functional areas; we will cover this in general. In examining the function of the frontal cortex, it seems that each side of the frontal cortex is responsible for certain characteristic functions. For example, the left side of the brain is primarily responsible for positive emotions, language, math, reading, and details, approach behavior. The right side seems to associated with negative emotions, nonverbal communication, attention, new learning, timing, and withdrawal behavior.

Specifically in our children, as mentioned we see lack of development, or underactivity in neurons centrally in this area, and other areas as well. In general right frontal cortical problems can be associated with attentional and autistic spectrum behaviors. Loss of normal right side functions causes a loss of attention, an inability to interpret social cues and emotions, a lack of fear, motor planning problems, lack of boundaries etc.

On the contrary, left frontal cortical decreases will cause dyslexia, language problems, depression etc. Now children do not all fit these models exactly, however this is the general accepted view of spectrum disorders.

Subsequently the frontal cortex fires into the basal ganglia, which is a floodgate for motor and emotional activity. The basal ganglia is comprised of several relay nuclei that function to facilitate these functions. When the frontal areas decrease their bombardment of the basal ganglia, the neurons in these areas are subsequently affected.

Functional problems in the basal ganglia are associated with Tourette's S, OCD, tics, hemiballismus etc. The basal ganglia symptoms subsequently become part of the spectrum of signs that the child may present with. The cerebellum is another functional area that is of concern.

The role of the cerebellum is to receive incoming afferent feedback from muscles and joints and project to the contralateral brain.

Secondly, the cerebellum works to smooth out motor functions descending from the cortex out to the soma.

Thirdly, the cerebellum is involved with learning by working with the contralateral frontal cortex for learned cognitive thought.

Lastly the cerebellum is involved with the vestibular or balance functions by controlling posture in a gravitational field and matching that with eye, head and body control. Lesions in the cerebellum are involved with hypotonia, motion sickness, eye movement breakdown, gross motor dysfunction etc.

What are the Causes of these Problems?

The causes of these problems are multi-factorial. Obviously there are arguments pitting genetics versus environment. We accept theories from both arenas. Typically there are certain patterns in the history that are consistent.

Many times the patterns are set forth even before the child is born. Maternal stresses have been identified as a causative factor causing hormonal changes in brain development. Birth trauma or anoxia at birth is common.

Early ear infections and colic are common presentations, as well as poor vaccine reactions and multiple antibiotic rounds. Early history of motor delay in the body, or the eyes is common. Gastrointestinal dysfunction, skin problems, changes in tone, the list goes on.

Another factor is diet and activity of the child. Many speculate that the rise in attentional problems mirrors that of the rise in obesity in children, that they are less active. We will take a comprehensive history of your child to identify any causative factors. The goal is however to localize the child’s current function based on their neurologic exam, remove causative factors and start to rehabilitate them. 

It is clear that much of the problems facing are children are of a neurologic origin. Although the outward appearance may be behavioral or a learning problem, the underlying dysfunction is in the nervous system. We focus on rehabilitating these problems using feedback from muscles and joints, vestibular influences, eye movements, gross motor movements, to specifically affect hypo-functioning areas of the nervous system.  

Take an in-depth look at Reaching Farther, A Novel Approach to Childhood Neurological Disorders

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