Saturday, 26 February 2011

Brain Injured Children. - Tapping the Potential Within.




When I gave up my career as a chemist when my first son, Daniel was born with catastrophic brain – injuries due to medical negligence, little did I know just how my life would change, through the years looking after him and traveling to many ‘alternative’ centres throughout the world for treatment.  I also studied and gained many qualifications based in neuroscience and child development.   However the most important knowledge was that gained through the experience of being a parent to a severely brain injured little boy.

In combining that experience and knowledge, I find I have perhaps a unique insight into the real difficulties faced by families of brain - injured children. In 2008, five years after Daniel died from a series of brainstem strokes, - an accident waiting to happen which no type or amount of therapy could have changed, I established ’Snowdrop' to provide a new type of therapy for brain - injured children. If your child has received a diagnosis of brain – injury, or cerebral palsy, autism, Asperger's syndrome, dyspraxia or any other diagnosis which is a consequence of brain injury, this book is a 'must read.'

At only £4-79 to download it is a snip, providing parents with real knowledge with which to understand what is happening inside their child's brain and giving tips on how to help solve those problems.  To purchase this invaluably helpful book just click here

Monday, 14 February 2011

Problems Associated with Cerebral Palsy. - Breathing.

Breathing is something we all take for granted because it is an automatic function, to which we do not have to pay attention.  Only when something interferes with the smooth function of our respiration, such as exercising, or an adverse reaction to an allergen, or if we develop a respiratory disorder do we become all too aware of it!

Many children who have cerebral palsy, have difficulties with their breathing.  Not many people are aware that the rate and depth of our breathing is subject to the forces of development and that consequently the rate and depth of a babies breathing is simply not comparable to that of an adult.  For instance, the breathing rate of a newborn baby is around 40 breaths per minute, but by the time the child reaches his first birthday, this has dropped to around 35.  By his second birthday the average rate has dropped to 30 and by the time he is 5 years old, it has dropped to around 25.  We then see a slower decline and by the time he is 12 years old it has dropped to around 20, until finally it reaches its adult rate of around 15.

What implications does this have for a child with cerebral palsy?  Well, the brain injury which adversely affects the development of the child in other areas, can also affect the development of the rate of respiration and this can have negative effects.  If a child is growing physically, but his rate of respiration remains stuck at the level of a baby at around 40 shallow breaths per minute, it will create obvious consequences for the ability of that child in terms of his eating, drinking and the development of spoken language. (To test this out, try running up and down stairs until you are out of breath and then try to eat a biscuit or cake or try reciting your favourite poem. – Its difficult isn’t it)?  This is the situation many of our children are faced with constantly.  – Imagine the nightmare of trying to coordinate chewing, swallowing and breathing at such a rate!

Another factor which can be a worry as the child’s growing musculature demands more oxygen from a system which simply cannot provide it, is the creation of a poor physiological environment for the brain.  The brain uses up 25% of all the oxygen we take in and as it develops, it not only demands more oxygen from a respiratory system which cannot deliver it, - with the consequences of brain development being slowed, but the increasing demands being made from a growing physical body provide stiff competition for the limited oxygen which is available.  This can not only have the effects of limiting physical and neurological development, but can cause a child to have seizures.

So what can be done about this situation?  The obvious answer seems to be the direct delivery of Oxygen, such as is seen in hyperbaric oxygen chambers, but this in turn throws up additional problems.  There are sensors in the base of the brain, which are sensitive to the levels of oxygen and carbon dioxide in the bloodstream.  They help regulate the rate of delivery of oxygen to the brain by widening and narrowing the arteries as is necessary.  When they detect higher than normal levels of oxygen in the bloodstream, they act to constrict the arteries so that the brain is not flooded with oxygen.  So in directly delivering extra oxygen, we may actually be depriving the brain of it!  In the more extreme cases this has led to people experiencing a form of stroke known as an ischaemic attack!

So what do we do?  At Snowdrop I find that when a child embarks on a programme of neurological rehabilitation and when we begin to make progress in developmental terms, very often the respiration makes improvements too. 

Anyone who would like more information on this subject, or about Snowdrop’s work in general should visit our website, or simply email us at snowdrop_cdc@btinternet.com.

Sunday, 13 February 2011

A Journey Through the Brain. - The Midbrain.

The midbrain is only a small structure, which lies just above the Pons at the top of the brainstem.  Although it is amongst the smallest structures in the brain, it is packed with important cells.  The midbrain consists of smaller structures as follows;.

  • The tectum
  • The tegmentum 
  • The substantia nigra  
  • The cerebral penduncles 
  • The superior and inferior colliculi 
  • The periaqueductal grey neurons 
  • The red nucleus  


At its top end it is connected to the Thalamus and hypothalamus.

The tegmentum,  which includes dopamine manufacturing neurons is closely enmeshed with the front, upward continuation of the reticular formation.  The rear part of the tegmentum  sees downward moving cortical nerve fibres.

The most obvious structure of the midbrain is the pinkish colored "red nucleus", which receives descending motor fibers from the frontal lobe and gives rise to the rubrospinal tract which facilitates flexor muscle tone.

If you had to summarise the function of the midbrain in one sentence, you would say that it acts as a sort of relay station for auditory and visual information.  However it does much more than this.  It is involved in eye movement and voluntary motor function. So when you see me staring into your child’s face, one of the things I am noticing is his / her ability to move the eyes in all directions.  The midbrain also has input to the regulation of autonomic functions and awareness and also motor coordination.

Also located within the midbrain is the periaqueductal grey, a set of brain cells which have extensive connections to the amygdala and other limbic system structures which are implicated in the motoric-vocal aspects of emotional expression.  For example, stimulation of the periaqueductal grey can trigger the production of a variety of sounds that are suggestive of exceedingly negative moods.  So, it is possible to infer from listening to the sounds a child makes, whether this part of the brain is injured

Specifically, the periaqueductal grey coordinates the activity of the laryngeal, oral-facial, and principal and accessory muscles of respiration.  The coordinated activity of these tissues enables an individual to laugh, cry, or howl, even if the rest of the brain (excepting the brainstem) were dead and there was no evidence of consciousness.  So, your child’s ability to laugh and cry are dependent on the functional integrity of the periaqueductal grey.
It then appears that rather than a centre for emotional vocalisations, the midbrain periaqueductal grey instead appears to be the site where particular vocalisation motor patterns are stored. Hence, when the periaqueductal grey is activated by impulses received from the limbic system or neocortex, it activates the appropriate motor program and then organises and coordinates the oral-laryngeal and respiratory muscles so that the appropriate sounds can be produced.  This is why I listen to the sounds your child makes and also listen to his breathing. 

The tectum, which includes the superior (visual) and inferior (auditory) colliculi is located between and below the dopamine producing tegmentum and the substantia nigra which also manufactures dopamine. Dopamine is believed to play a dominant role in cognition and motor functioning, and disturbances in the dopamine transmitter systems are closely related to the development of Parkinson's disease and some types of athetosis.  Dopamine also has crucial input to the brain’s reward and desire systems, which makes it a major player in the addictive process.

The superior colliculi can be further functionally divided into superficial and deep layers which are responsible for different functions.  For example, the superficial layers receive considerable input from the retina as well as temporal and visual cortex, and respond to moving stimuli.

By contrast, the intermediate and deeper layers receive converging motor, somesthetic, auditory, visual and reticular input, and in fact serves as an extension of the reticular formation, and maintains interconnections with the caudal medulla and those cranial nerves associated with movement of the head. Hence, these layers serve as a multi-modal assimilation area which is concerned with orienting toward external stimuli and movement; particularly movements of the head and eyes during gaze shifts.  This again is the reason why I pay so much attention to your child’s face and head positioning.

The inferior colliculus (IC) is predominantly concerned with detecting and analysing auditory stimuli, and in fact is tonotopically organised; i.e. neurons are arranged in a laminar pattern which represents different auditory frequency bands.   The IC can also respond to sounds arriving from either ear. This enables the IC to analyse and localise the source of various sounds and to correlate them with their various spatiotemporal characteristics. In this manner, sounds can be identified as coming from a certain direction and from a specific source.  This is why I am so keen to ascertain whether your child can localise sound effectively and whether he / she has problems with specific frequencies of sound.

The IC also acts to relay auditory signals received from the lateral lemniscus to the medial (auditory) geniculate of the thalamus, and in this regard it serves not only to analyse and orient toward auditory stimuli, but as a major auditory relay nucleus.

Other common symptoms of a midbrain lesion are as follows. 

  • Facial palsy 
  • Weakening of nerve and motor functions 
  • Poor functioning of limbs, most particularly the arms.  
  • Abnormally shaped pupils. 
  • Resting tremor (due to injury to dopamine producing cells) 
  • Extreme rigidity, such as decerebrate rigidity, (as opposed to spasticity)  
  • Auditory disturbances Coma (if there is injury to the tegmentum).


Anyone who would like more information about brain injury and Snowdrop’s rehabilitation programmes can email snowdrop_cdc@btinternet.com



Wednesday, 9 February 2011

Question from a parent about different types of cerebral palsy.

This is a recent question which I received by email from a parent who had been totally confused about the diagnosis she had received from a doctor concerning her son.

Q. What is the difference between mild cerebral palsy (hemiplegia / hemiparesis), with ataxia or dystonia.

A.  There are four patterns of brain injury, which cause four types of cerebral palsy. Those four types are 'spastic cerebral palsy,' 'athetoid cerebral palsy,' 'ataxic cerebral palsy,' and 'mixed cerebral palsy. Let's focus on the two types you have mentioned.


Athetoid Cerebral Palsy. (This is the type where dystonia can occur).

This type of cerebral palsy is caused by injury to a structure below the cortex called the 'basal ganglia.' The basal ganglia plays a role in motor function, cognitive processes, emotional processes and our ability to learn. It also acts as a 'braking' mechanism on the thalamus, a part of the brain which mediates our sensory experiences. So, without this inhibitory role, one can imagine a thalamus in effect operating without its 'braking system' which might produce many of the sensory distortions we see in some children who have cerebral palsy. It also acts as a 'braking system' for movement, which enables us for instance, to sit still. In order to sit still a 'brake' has to be placed on all other movements. Consequently injury at this level hampers the 'braking system' and we see children who cannot sit still and are in constant movement and children whose sensory perception is distorted. Injury to this part of the brain also exhibits itself in many children by retention of the primitive postural reflexes, as it is the role of the basal ganglia to suppress these in order to enable the child to move.

Children with basal ganglia injury are also more likely to have hypotonia, (floppy muscle tone) and persistently impaired balance and ambulation performance.


Ataxic Cerebral Palsy.

Children who have this type of cerebral palsy are usually injured in a structure right at the back of the brain called the 'cerebellum.' The word 'cerebellum' actually means 'little brain' and it is not without justification, as at first sight it does look like a smaller version of the brain. It is located behind the brainstem and it forms massive connections with this structure and with the cerebral cortex. It is the only structure within the brain which is not fully formed at birth, taking a further two years to develop to it's full complement of neurons.

The proper functioning of the cerebellum ensures that any movements we make are smooth and well coordinated. It seems that the motor cortex supplies commands to the body musculature, which are then refined by the cerebellum to ensure smooth coordination. Feedback on the success of the movement is then supplied from the cerebellum back to the motor cortex where the original movement command can be refined if the movement has been unsuccessful.

One might imagine then that an injury to the cerebellum will interfere with these functions. Movement can become slow and uncoordinated, the child may display problems with balance and equilibrium, the child might experience an 'intention tremor' - (a tremor which is made worse when the child tries to move). Injury to this part of the brain causes 'Ataxia' – this is where the muscle tone is hypotonic (floppy).

Higher cognitive functions, like language and visual processing, have long been thought to reside primarily in the brain's cortex, however recent research involving premature infants is documenting an important role for the cerebellum -- previously thought to be principally involved in motor coordination and shows that cerebellar injury can have far-reaching developmental consequences. This work also demonstrates that the cortex and cerebellum are tightly interconnected. Sophisticated MRI imaging of 74 pre-term infants' brains revealed that when there was injury to the cortex, the cerebellum failed to grow to a normal size. This means that our children with spastic cerebral palsy will usually also experience some of the difficulties associated with injury to the cerebellum.

When the injury to the cortex was confined to one side, it was the opposite cerebellar hemisphere that failed to grow normally. The reverse was also true: when injury occurred in one cerebellar hemisphere, the opposite cerebral hemisphere was smaller than normal. So, there seems to be an important developmental link between the cortex and the cerebellum, - it seems that the two structures modulate each others growth and development. So it appears that the way the brain forms connections between structures may be as important as a direct injury to a brain structure itself.

The cerebellum has also been implicated in the development of some types of literacy problems, including dyslexia.

If you have any questions concerning your child's development you can email Snowdrop at snowdrop_cdc@btinternet.com

Saturday, 5 February 2011

Problems Associated with Cerebral Palsy. - Anxiety.

Anxiety isn't a problem that you would automatically think to associate with cerebral palsy, but some children really do suffer quite badly with it. This can be due to many reasons.  One reason is the discomfort produced by stiff musculature.  A high muscle tone can be uncomfortable for a child and having to cope with this constantly is bound to have an anxiety raising effect. 


Another possible cause can be the overproduction of norepinephrine in the brain, leaving the child on a hyper-anxiety inducing adrenaline 'high.' 


Yet another cause can be sensory over-sensitivity. - A child who is unable to mask extraneous incoming sensory stimulation, but who sees, feels and / or hears too much, or whose sensory system over-amplifies incoming stimulation is likely to experience anxiety.


Another factor can be lack of sleep.  Many children who have cerebral palsy have a poor sleeping pattern.  We all know how we feel if we lose a night's sleep, tired, overstressed and anxious.


So for many children, anxiety can simply be part of their every day existence.


There are techniques, which Snowdrop employs within some of its programmes, which are designed to help relieve this situation, but in the most severe cases intervention can be necessary with anti – anxiety medications.

Thursday, 3 February 2011

What can I do to get my 18 month old to sleep all night?

This is a recent question from an exasperated parent.  Sleeping problems are the most common problems I encounter in children with brain injuries and the problem can drive the parents to total exhaustion.


Q.  What can I do to get my 18 month old to sleep all night?  He doesn't have a problem going to sleep its staying asleep we have tried everything from benadryl to music letting him cry nothing seems to help him sleep and he wont take naps during the day either.

A. Hi. The regulation of the sleeping pattern is one of the most problematic aspects of child development, (at least it is for parents who are deprived of sleep). There are several things you can do to work alongside the brains natural rhythm and so to encourage sleep. I will list them here'...

(1). Raise the core temperature of the body just before bedtime. When we go to sleep the body temperature cools and this sends signals to the brain that it is time for sleep. You do this by giving a nice warm bath just prior to bedtime and then making sure that the bedroom is cool.

(2) Exposure to early morning light. Exposure to early morning light, helps to set the brain's clock which deals with the sleep - wake cycle, by influencing a set of neurons called the suprachiasmatic nuclei.

(3). Make sure the final meal is steeped towards containing foods which are high in tryptophan, - a list of which can be found here. http://www.nutritional-supplements-healt… Tryptophan is converted into a substance called 5-Hydroxytryptamine in the bloodstream, which is then used by the brain to make serotonin and consequently melatonin, which helps us sleep. The meal should also be high in carbohydrates as this facilitates the absorption of tryptophan.

(4). As dark a bedroom as possible. This can also send signals to the brain to produce melatonin.


If you would like to ask a question of Snowdrop concerning any aspect of your child's development, simply email snowdrop_cdc@btinternet.com  Please mark your email as 'blog question' in the subject line of your mail.

Wednesday, 2 February 2011

Does your child grind their teeth?

This is a question I was asked recently.  You might be surprised at the answer.

Q. My son is almost 4. He has cerebral palsy and ever since he has had molars he grinds his teeth!  The dentist isn't too concerned, he just says he will likely grow out of it. But the sound is terrible and I worry he might break his tooth or wear them down. Does your child have this habit?  Did they ever out grow it? 

    He has been doing this for over a yr!  I don't see him out growing it anytime soon, it also may be related to his brain damage and constant spasm in muscles, or maybe it is just soothing for him, he seems to like the input it gives him. He is in speech therapy etc.
    A.  Many children who have cerebral palsy also have this problem.  If it is related to his brain damage then he is unlikely to grow out of it without correct treatment to resolve the cause.  
    What is the Cause? - teeth grinding can be a sign of injury to the brain's vestibular apparatus, as is the over-production of saliva, constipation, nystagmus in addition to other symptoms.
    What can be done about it? - You need to address the cause, - the malfunctioning vestibular nuclei in the brainstem, which have connections to the cerebellum. Snowdrop provide programmes of treatment which can help by providing the correct stimulation to the vestibular system.
    If you have a question you would like answered concerning your child's developmental disabilities, email snowdrop_cdc@btinternet.com and have that question answered here.  Label the subject line of your email as 'blog question.'

Tuesday, 1 February 2011

Do we use only a small part of the brain?

This is a question I answered not long ago, - it went like this.

Q. - "If humans used every part of the brain what more would we know or be able to do?"


A. - The idea that we only use 10% of our brains is probably such an enduring myth because it's comforting to think we have spare capacity. The 'unused' 90% could take up the slack after brain injury or offer the possibility for miraculous self-improvement. This flexible factoid has been used not only to sell products to enhance our brain's performance, but also by certain psychics like to explain mystical cutlery bending powers.

Unfortunately the boring, tedious, but unavoidable facts point to this merely being a desirable myth.

Unfortunately there's four good reasons it is false (Beyerstein, 1999):

1. If we only use 10% of our brains then damage to some parts of our brains should have no effect on us. As any neurologist will tell you, this is patently not true.

2. From an evolutionary perspective it is highly unlikely we developed a resource-guzzling organ, of which we only use 10%.

3. Brain imaging such as CAT, PET and fMRI shows that even while asleep there aren't any areas of our brain that completely 'switch off'.

4. Parts of the body that aren't used soon shrivel and die. We know this is also true of the brain, - any neurons we weren't using would soon shrivel and die. This is a process called 'long term depression."

The structure of the brain and its metabolic processes have also been carefully examined, along with the diseases that afflict it. None of this work has suggested there is a hidden 90% that we're not using. Unfortunately.

Anyone who still maintains we only use 10% of our brains after this fusillade of fact has to come up with a counter-argument for each one of these. I see no valid argument to refute these facts!


If anyone would like to pose questions to Snowdrop concerning their children's developmental disabilities, then feel free to write in to snowdrop_cdc@btinternet.com