Tuesday, 23 May 2017

4th Assessment for a Little Girl with Cerebral Palsy through Bilateral Haemorrage.

Today we welcomed back a 4 year old little girl and her family today for her 4th assessment. She had suffered a bilateral haemorrhage, leading to cerebral palsy.  She had suffered the bleeds shortly after birth and the doctors had told mum and dad that 'if she survived' and they did not expect her to, she did not have a bright future and would most likely have severe disabilities.  However, she is doing very well indeed. 

At four years of age she is now top of the developmental ladder in visual development being able to read via both sight recognition and through phonological building of a word from it's constituent graphemes / phonemes.  Auditory development which was plagued by sensitivity around 2.6 Khz is now also at the top of the developmental profile.  The sensitivity issue is important because although human hearing goes right up to 20,000 Hz, the 43 speech sounds of the English sound system are compressed within a frequency range of 450Hz - 4,500Hz.  A sensitivity at 2, 500HZ, which is right in the middle of speech sound frequencies is likely to cause problems in processing speech sounds and therefore in producing those speech sounds in the form of language.  The sensitivity has been dealt with by the activities of the Snowdrop programme and she now understands language in advance of her age and produces perfect, grammatically correct language.

Yes she has some problems with visual acuity but when there is also a retinal bleed that is almost inevitable. Gross motor development has progressed from 18 months to the 36 month level, which considering she has been on programme for 16 months, is phenomenal progress, although we have to work on quality of movement. A very intelligent little girl here, who will go a long way!

Monday, 22 May 2017

Today's Assessment, 22nd May 17. West Syndrome and CVI

Today we welcomed back a 3 year old little boy and his family for his 4th assessment. He has West Syndrome and CVI and has been on the Snowdrop programme for 15 months.

 West Syndrome consists of group of symptoms characterized by epileptic/infantile spasms, abnormal brain wave patterns called hypsarrhythmia and intellectual disability. The spasms that occur may range from violent jackknife or "salaam" movements where the whole body bends in half, or they may be no more than a mild twitching of the shoulder or eye changes. These spasms usually begin in the early months after birth and can be difficult to control, requiring steriod treatment.

Cortical visual impairment, (CVI) is a form of visual impairment caused by the brain not being able to process information from the eyes passing along the visual pathways in the brain.  In my observation there are varying forms of CVI, caused for instance by the thalamus not exciting the cortex sufficiently to process visual stimuli, to actual injury to the occipital cortices.  Another possibility is that vision becomes 'de-automated!'  Vision is something which just happens to us, we cannot help but see, - it is an automated programme, however I see children who have to be reminded to 'use their eyes!' - It comes in many forms.

With today's little boy we saw clear improvements in the use of vision, which is now 'switched on' for much of the time. He is also understanding more language, responding to simple instructions and his former auditory sensitivity is now gone. His tactile processing problems are resolved and he is now 'high kneeling' and his upper body control is good enough for us to begin working towards developing a standing balance. He also demonstrated that he now has 2 words of speech. He is though, very busy and we have to work further on slowing him down a little. His biggest change in my eyes is in sociability, he now really tries hard to interact. Well done to his parents who work so hard with him. It was great to see you again.

Sunday, 21 May 2017

Autism Symptoms Improved by Vitamin D Supplementation.

This is encouraging and could feed directly into the treatment of children with autism who are part of the Snowdrop programme

"This study is the first double-blinded RCT proving the efficacy of vitamin D3 in ASD patients. Depending on the parameters measured in the study, oral vitamin D supplementation may safely improve signs and symptoms of ASD and could be recommended for children with ASD. At this stage, this study is a single RCT with a small number of patients, and a great deal of additional wide-scale studies are needed to critically validate the efficacy of vitamin D in ASD."

With thanks to Wiley online library and the Journal of Child Psychology and Psychiatry.

Wednesday, 5 April 2017

Hypoglycemic brain Injury

Yesterday we welcomed back a family with a 5 month old little boy for their first Snowdrop reassessment. We first saw this little one when he was just 5 weeks old and he had suffered hypoglycemic brain injuries. I was so pleased today to see that he was doing so well. In 5 areas out of 7 he was age appropriate, (better than his age level in 2 areas). Such a vibrant, vigorous little man who has come a long way in a few months.  His progress shows just what can be achieved through stimulating the plasticity of the brain and leading that plasticity down the developmental pathway.

Today, Wednesday the 5th of April, we met a lovely family with a great little boy of 18 months who has acute brain injuries. He is a terrific character and a playful little chap who feel has a great deal inside of him waiting to come out. Such a friendly playful little guy. Can't wait to get him started.

Monday, 3 April 2017

Treating Global Developmental Delay.

Today we welcomed back a 2.5 year old little boy for his fourth assessment. He had developmental delay in many areas prior to starting the Snowdrop programme, but now he is age appropriate in visual development in that he is able to recognise familiar people in photographs and recognise himself in a mirror.  He is also age appropriate in social development where he is understanding the emotions of those around him, throwing age appropriate tantrums and beginning to cross over from 'parallel play' into joined play with other children.  He is not far behind in auditory development, following instructions and clearly understanding more complex sentences and more and more vocabulary. He is also on the verge of walking, it is just a matter of confidence and time. Hand function has also improved dramatically. - His left hand was only half as able developmentally as the right, but now it is difficult to separate the two hands. A very different little boy to the one I met a year and a half ago.

Thursday, 16 March 2017

Autism and ADHD in the same child.

Today we welcomed a new family to the programme with a 5 year old little boy with a dual diagnosis of autism and ADHD. The poor little one literally could not keep still and was in a world of his own, but occasionally he would rise to the surface and there would be moments of lucidity where you could see his intelligence. Currently he is lost in a sea of hyper-activity and consequent lack of attentional control.

His world must be turmoil and I watched as he would try to do three different things at once.  Visually he liked to watch moving objects, particularly objects which can be indicative of the under-activity of the visual magnocellular pathway, which enables us to detect movement.  This is why many children with autism are fascinated with looking at their fingers in front of their eyes or with flapping their hands, or with opening and closing doors, - it is to create movement, - a desperate attempt to feed a pathway which is under-active.  Fortunately, we know how to activate this pathway, - it is with exposure to yellow filtered light! (Ray, N. J. et al, (2005). Yellow Filters Can Improve Magnocellular Function, Motion Sensitivity, Convergence, Accommodation and Reading. Annals of the New York Academy of Sciences. 1039, 283 – 293.

Tuesday, 14 March 2017

Infantile Spasms

Today we welcomed a 20 month old little boy who has suffered with infantile spasms back for his first reassessment.  He has now been on the Snowdrop programme for 6 months.  During that time he has made some nice progress in some areas, most notably in gross motor development where he has developed a sitting balance and has sufficient 'cephalo-caudal development' to warrant us beginning to work on a standing balance.  Visually his eyes are straighter and he is making more sustained eye contact and auditorially he is now more in tune with the human voice and is paying attention to the conversations going on around him.  In terms of fine motor development he has gone from not using his hands at all, to the 4 month level of trying to reach and bringing his hands into the midline and intertwining his fingers.  So there is some nice progress to be seen, well done to a hardworking mum and dad.

Problems do remain however in that visually a great deal of his time is taken up in self stimulation of either the magnocellular pathway, (which enables us to detect movement), by waving his fingers in front of his eyes, or of the visuo - vestibular pathway, where he is constantly swinging his head from side to side.  He is also very fidgety, always on the go, which is detracting from his ability to use his attention consistently to engage with his environment and the people in it.  Instead, he is largely living in a world of self - stimulation and internal 'activity and agitation' and this is our next challenge with this little one, to normalise the sensory systems which are keeping him in a world of his own and to take his level of internal arousal down a peg or two.  Only then will we see him beginning to engage with and to make sense of his world.

Onwards and upwards.