Thursday, 31 March 2011

Epilepsy.

Epilepsy is a very common problem in brain-injured children.  It is very distressing to watch and can be debilitating for the child.  It is also exceptionally varied, ranging from a few unnatural blinks of the eye through to a ‘whole body’ convulsion.  Just when I think, I have witnessed probably just about every variety of epileptic attack, up pops a child who produces something unique.

 What is epilepsy?
Epilepsy is the tendency of specific brain-cells to misfire.  There are three distinctions of epilepsy to bear in mind in understanding this problem.  The first distinction is that an epileptic episode is either partial or generalised.  The second distinction is that an epileptic episode is either simple or complex. The third distinction is that epileptic seizures are either grand mal or petit mal.  Confused? – Don’t worry, read on and it will all become clear.
 Normally, brain cells fire according to their being excited beyond a certain threshold of stimulation, or they are restrained from firing because they are inhibited from doing so.  Sometimes in epilepsy, these inhibition and excitation thresholds are not applied successfully, causing brain cells to misfire very easily.  When this happens, two things can occur:
1.      The misfiring may be limited to a specific area of the brain, causing a very specific response from the individual such as a short absence or a twitching of one limb. These are known as partial seizures.
2.      The misfiring may form a chain reaction, which spreads to a larger area of the brain, causing a more generalised response from the brain.  Adams & Victor (1981) successfully demonstrated this phenomenon by measuring seizure activity with electrodes placed inside patients’ brains. (In Ropper, et al, 2000).
Partial seizures can be further subdivided by our second distinction of simple and complex.
Simple, partial seizures bring about changes in the level of consciousness, but never involve a loss of consciousness, whereas complex partial seizures do involve a loss of consciousness.
Sometimes, if the focus of the epileptic activity is in one of the temporal lobes of the brain, the child may experience an aura prior to the attack.  This ‘aura’ may be an experience of positive or negative emotions, it may be a hallucination of one or more sensory modality, or the aura may trigger memories or stereotypical movements.
We now come to our third distinction of seizure activity, grand mal and petit mal seizures. Sometimes during a more dramatic ‘complex partial’ seizure, the child’s body may rhythmically shake.  This is known as a grand mal or tonic - clonic seizure.  Although this looks dramatic, it is nothing to be alarmed about and is usually over within a few minutes as a combination of structures in the brain, collectively known as the diencephalon act to suppress the seizure activity.
A petit mal seizure is less dramatic, usually very brief and is sometimes so shallow as to go unnoticed by parents, teachers and doctors.  An example of such a seizure would be an absence, where the child simply stares vacantly for a second or two.  I know a child who used to experience more than fifty such absences an hour and although they sound unobtrusive, when experienced at this magnitude the disruptive effect they can have upon life is easily underestimated.
Finally, and importantly, one aspect of epileptic activity, which it is important to discuss is a phenomenon known as status epilepticus. Usually seizure activity will dissipate within a few minutes and the child will recover with no harm done.  However, rarely the seizure activity either will not stop, or the child emerges from one seizure, quickly to be consumed by another and another.  This is a dangerous and potentially life threatening situation, which needs immediate medical intervention.  In extreme cases such as this, seizures are capable of causing further brain-damage. 
It has been demonstrated that some patients with seizure disorders display injury to a part of the brain called the hippocampus, the amount of damage being closely correlated with the number and severity of seizures, which the patient has experienced.  The damage appears to be caused by the excessive release of a neurochemical called glutamate during the seizure. (Thompson et al, 1996).  It is consequently vital that even if you only suspect your child to be experiencing seizure activity, that this is checked out and treated by a doctor.
  
What causes epilepsy?
Epilepsy has two causes, one is pathological, and the second is physiological in nature. 
l  Pathology: -When a brain suffers injury, millions of brain cells may die.  Around the area of injury, there may also be cells, which have not been killed, but which are nevertheless injured. In addition, as I have previously alluded, the thresholds of excitation and inhibition, which normally control the firing of these cells, may have been disrupted.  Therefore, these injured cells may not fire according to their normal patterns, but may more or less constantly misfire.  The child in this situation may have more or less constant epileptic activity occurring in his brain.
l  Physiology: - The environment in which the brain operates is by necessity oxygen and nutrient rich.  Although the brain only comprises approximately 2% of the body’s weight, it consumes 25% of the body’s oxygen intake.  When a brain suffers injury, the availability of the oxygen supply can be compromised.  For instance, in many cases of brain-injury, the development of the rate and depth of breathing of the child, does not progress from that of a new-born, which is fast and shallow; - this places difficulties on the optimum levels of oxygen availability, thereby compromising the physiological environment of the brain.  Similarly, uninjured children who are ill and develop a temperature may suffer an epileptic seizure as the temperature rise deprives the brain of oxygen, temporarily creating a poor physiological environment.
The young child with brain-injuries may also have trouble in taking in adequate nutrition, which could cause similar physiological effects.  The brain’s response to this impoverished physiological environment is to produce a seizure reaction. When brain cells struggle to operate normally without the oxygen and the nutrition they need, they begin to misfire.

 What can be done to combat epilepsy?
There are many approaches to combating epilepsy which may improve your child’s situation.  Often a programme of developmental stimulation can reduce seizure activity.  The reason for this is that if developmental gains can be produced in the child, it means the brain is operating at a more mature, efficient level.  This ‘brain development’ can suppress seizure activity.
It is also important that children, who are predisposed towards epilepsy, be given good nutrition.  This will help to maintain the physiological environment of the brain in as optimal a state as possible and hopefully keep seizure activity to a minimum.
There is a wealth of medical technology now available, which can help to combat seizure activity.  Anti-convulsant medication always extracts a price from the child in terms of drowsiness and other side effects, but it is often necessary, if only temporarily to keep epilepsy under control.  As long as the levels of medication are kept to the minimum needed to control the seizure, there is no harm in pursuing this path.
anyone interested in learning more can purchase our book 'Brain Injured Children.' or contact Snowdrop at snowdrop_cdc@btinternet.com

Saturday, 26 March 2011

Problems Associated with Cerebral Palsy (and autism); - Sensory Perception.

This is a huge problem area for many children with cerebral palsy and for children with other developmental disabilities, particularly autism, whose sensory perception can be dulled, distorted or amplified in one or more of the sensory modalities. Children can have a mixture of these problems in different senses, so that a child might for instance have acutely oversensitive hearing and simultaneously be undersensitive in vision. As specific sensory systems supply the information necessary for the efficient operation of motor systems, problems here can have the effect of retarding the development of mobility, hand function, language and communication and socialisation.

Let's consider this.  If for instance, a child's visual development is delayed or stopped, then language development, socialisation, mobility and hand function can be affected. Mobility speaks for itself, if a child cannot see it could be dangerous to move. Language and socialisation development will be affected because the child will not be able to complete the essential developmental stages of making eye – contact, regulating mutual attention and will not be able to see the face of a communicating partner. All of which are vital precursors to the development of language and socialisation.

If a child's auditory development is affected then it is obvious that language and consequently socialisation, which in turn depends so much on language development, will also be affected. The development of spoken language is dependent upon exposure to spoken language and inability to hear spoken language at all, or inability to hear it correctly, is bound to lead to poor, or indeed a complete lack of language production


If tactile development is affected then mobility and hand function will also be problem areas. If you cannot feel where your body, limbs and hands are, then you will have difficulty in the conscious control of them. So we can see how important sensory development is in enabling other developmental functions to operate normally.


Now let's take a look at how brain injury can cause sensory processing difficulties in a child.  There are five different types of sensory processing difficulty I have encountered.  Two are concerned with the modulation of incoming sensory stimuli, whilst the other three I would describe as failures of sensory attention.  Let's briefly review them.


Failures of sensory modulation.



  1. Sensory over-amplification. -  The world is a very bright, or noisy, or physically oppressive place for this child, whose immature sensory system is overwhelmed by stimulation from the environment.  This is the child who hates bright lights, or the child who screams in agony at certain noises and may make a constant noise himself in order to drown out noises from the environment. (I once had a child vomit in response to a sound).  This is the child who avoids physical contact and might detest certain fabrics.  To these children the world is a very threatening place. (Mulleners et al, 2001).
  2. Sensory under-amplification. - This is where not enough of the visual, auditory and / or tactile message is being processed by the brain.  This child either appears not to notice the light at all, or is strongly attracted to it. These children will sometimes flap their hands in front of their eyes in an attempt to self stimulate the contrast between light and dark which their visual system needs.  This is the child who appears not to notice some, or all sounds, or is fascinated and amused by loud noises.  This is the child who bumps into things and appears not to notice the pain, or the child who bites himself, pulls his own hair or who craves physical contact.  To these children, the world has not quite arrived and they are separated from it by a sensory system which dampens down incoming sensory information

Failures of sensory attention.

  1. Narrowly focussed sensory attention. - These are the children who seem obsessed with one particular toy, or with one particular feature of the environment.  They are the children whose attention you cannot attract, they are so focussed on what they are doing, or listening to.  They cannot expand their attention to accommodate more than one feature of the environment at a time.  Rizzo and Robin, (1990) describe this situation perfectly speaking about children's ability to 'mask' other features of the environment apart from the one to which they are attending, is too efficient.
  2. Unfocussed sensory attention. - these are the children who do not 'mask' at all, as you or I would.  You can focus upon reading this text and if a car passes outside, you might not notice, - your brain has masked it.  Children with this problem cannot do this, they cannot single out salient features of the environment upon which they can focus attention.  Consequently, everything within their visual, auditory or tactile environment is competing for attention at the same time!  Children who have this problem, whether it be solely with vision, hearing, tactility, or all senses, live in a world of unimaginable chaos and can display high anxiety.  Often these are the children who withdraw into themselves, shunning contact with their environment. (Bruno 2006)
  3. Inwardly focussed sensory attention. - In the same way that a migraine can produce a visual display which blocks the vision of the sufferer, or the person who has tinnitus is driven insane by the noise produced by his auditory system, or the person who suffers constant parasthesia has a constant tingling sensation in the limbs, the brain injuries our children suffer can produce these effects.  This causes their sensory attention to be diverted towards the stimulus produced by their own sensory systems.  This is the child who stares into the mid-distance, appearing to be looking at something which you cannot see.  This is the child who appears to be listening to something which you cannot hear.  These children live in their own world of internal chaos from which it is difficult to retrieve them. Beck and Guthrie were reporting this phenomena as early as 1956! 
It is now proven that many of the aberrant behaviours which I have described above and which we see in children with sensory processing problems are indeed a consequence of those problems. (Wiggins et al, 2009).

What causes these problems of sensory modulation and sensory attention?
In the case of sensory modulation problems we can be pretty sure that it is a structure in the brain called the 'thalamus.' which is at fault.  Part of the role of the thalamus is to act as a 'sensory switchboard.' - It routes incoming sensory stimulation to the appropriate part of the cortex for further processing.  However, what the thalamus also does is to 'excite' that particular area of cortex, so that it is properly tuned in to the information which is being sent to it (Carlson 2007).  What is happening in the case of the child experiencing sensory under-amplification is that the thalamus is not exciting the cortex sufficiently, therefore the cortex is not properly tuned into the stimulus being received.  the effect of this is that the child is unaware, or under-aware of the particular stimulus and fails to see, hear, or feel it adequately.   In the situation where the child is experiencing sensory over-amplification, the cortex is being hyper-excited by the thalamus and the child experiences stimulation as too bright, too loud or too harsh.

In the case of sensory attention problems, we know that a structure which wraps itself around the brainstem called the 'reticular activating system' which is causing the problems the child is experiencing.  An important part of the role of the reticular activating system is in directing our attention.  It is the structure which wakes you in the night when you hear your baby make a noise; - it is the structure which enables you to focus your attention upon reading this text, despite the children making a noise and playing in the next room; - it is the structure that, if someone were to say your name in a crowded, noisy room, would enable you to home in on the person who said it.  It is also the structure, which for instance, when you are due to go to the dentist, makes you notice that suddenly all the advertisements on TV are for toothpaste!

If we think of attention as a searchlight, then in the case of narrowly focussed sensory attention, the child has a small searchlight and is over - focussed upon certain features of his visual, auditory, or, tactile environment, (or all three) and may have difficulty in switching his attention away from what he is focussed on.  His reticular system is mis-tuned.

In the case of unfocussed, or perhaps more accurately, 'widely focussed' sensory attention, the searchlight is too wide and the attentional system is overwhelmed by having to try to deal with too much incoming information at any one time.

In the case of inwardly focussed sensory attention, the searchlight just is not shining on the outside environment at all and the child seems unaware of his visual, auditory and / or tactile environment.

What can be done to encourage these systems to operate more normally?
When a baby is born into this world, it comes from an environment in the womb, which is dampened in sensory terms, into a world full of brightness, colour, noise and physical sensations.  Not surprisingly, this is a shock to an immature sensory system.  So what does baby do to re-tune these two systems which have been used to the dempened sensory environment within the womb?  The answer is sleep!  A newborn baby will sleep for 18 hours out of 24!  By 3 months of age, this is down to 15 hours sleep out of 24!  How does this help?  It gives the neural structures which are responsible for processing sensory information time to readjust to this comparatively bright, busy new world.  It introduces baby to this bustling new environment gradually, - slowly building up the time awake and consequently the stimulation received as the system can handle it.

Now consider what a brain injury, or if you prefer, a brain dysfunction does to a child and then we can apply the lessons which a newborn baby teaches us, to the treatment of the problems we see.  A brain injury stops, slows or distorts the development of the child.  In the case of the traumatic brain injury of an older child, it regresses the developmental abilities already attained to lower levels of development.  So the sensory system of a child who has suffered brain injury, or for some reason of genetics is wired differently to normal is likely to be at a more immature stage of development compared to that child's uninjured peers. In addition, the dysfunctioning system might be causing one or more of the sensory processing / attentional difficulties spoken of above.  So what do we do about this?  The answer is that we observe nature and copy her!

In the case of ''sensory over-amplification' and unfocussed sensory tuning, we take our lead from the newborn baby who sleeps for a great deal of the time.  Now we can't force our children to dull their sensory systems by sleeping when we want them to, (although wouldn't that be wonderful sometimes?), but what we can do is to create an adapted sensory environment which is tantamount to an 'external womb' where we can take them to allow their sensory systems to calm and to re-tune.  Obviously, we cannot place them in this environment for 18 hours per day - the length of time a newborn sleeps in 24 hours, but we can give them regular breaks from the bright, noisy, bustling world and we can make their time outside this artificial womb as calm and understimulating as possible.  Over time, as they adjust, we can then begin to introduce stimuli in a more controlled, structured way to enable them to build their tolerance to it.  the fact that these sensory systems can be re-tuned has recent evidence to support it. (Sham 2011)

So what can we do to help the children who in effect are under-sensitive to normal external stimulation, - the children who exhibit sensory under- amplification, or narrowly focussed sensory attention, or inwardly focussed sensory attention?  In these cases, what in effect has happened is that the brain injury has placed a barrier between the environment and the child, so that the child cannot experience and interact with the environment in a normal way.  The effect of the environment is dulled and as the development of the child is dependent upon interaction with the environment and in particular on sensory stimulation, the child's development is stopped, slowed or distorted.

So what do we do?  We have to increase the effect of the environment!  As I have just said, the environment creates a demand upon the developing child, in terms of his sensory experience and motor output.  In cases where the brain injury has created a barrier between the child and his environment, we have to overwhelm that barrier by creating an adapted sensory environment which is so compelling that it breaks through the under-amplification, - that it diverts the child away from his narrow focus of attention, - that it creates a bigger attraction for the sensory attention of the child who is internally focussed.  In short, we are following, but amplifying nature!  

This is the basis of Snowdrop's philosophy of treating the sensory problems which present themselves with cerebral palsy, autism and other developmental disabilities.  If you would like to learn more please contact us at snowdrop_cdc@btinternet.com.


References.

Beck, A. T., and Guthrie, T. (1956).  Psychological significance of visual auras: Study of three cases with brain damage and seizures. Psychosomatic Medicin, Vol XVIII, no 2, 


Bruno, L.  (2006).  Conscious Living: How a Brain Injury Changed the Way I Make Decisions. http://www.internationalrenaissancecoaching.com/s_140.asp

Carlson, N. R. (2007).  Physiology of Behavior. London.  Allyn and Bacon.



Mulleners, W. M., Chronicle, E. P., Palmer, J, E., Koehler, P. J., and Vredeveld, J. W. (2001), Suppression of perception in migraine: Evidence for reduced inhibition in the visual cortex, Neurology, January 23, 2001; 56(2): 178 - 183.

Rizzo, M. and Robin, D. A. (1990).  Simultanagnosia:  A defect of sustained attention yields insights on visual information processing.  Neurology, 40, 447-455.

Sham, L. (2011) in  Medical News Today.  Shedding Light On The Dynamics Of Sensory Recalibrations Has Implications For Brain Injuries, Robotics.  http://www.medicalnewstoday.com/articles/220047.php

Wiggins, L. D. et al (2009).  Sensory Abnormalities as Distinguishing Symptoms of Autism Spectrum Disorders in Young Children. Journal of Autism and Developmental Disorders, Vol 39 (7) 1087 - 1091

Thursday, 17 March 2011

Language Development in Children with Cerebral Palsy, Autism and other Developmental Disabilities.

This article was first published by Andrew Brereton in the July / August 2010 edition of  'Special Education Needs' magazine.

When Words Fail!

It is normal for parents not only to want their child to be able to understand them, but to be able to communicate with them too. Interaction is fundamental to humanity and in a way I feel it defines who and what we are. Naturally then, when a child cannot use language, it can cause parents immense distress. So why does the language and communication development of children with cerebral palsy and other neurodevelopmental problems so often fail? Let's examine some of the major reasons.

Many difficulties with the development of language and communication begin very early on, when the parents bring their child home after birth, or after the child has received the diagnosis. Naturally the parents are often weighed down by the worry and crippling stress of having to cope with their child's unexpected problems. I have been in this situation myself and can testify that it is so. Often they are reeling from the shock of the diagnosis their child has just received.

What frequently occurs then is that parents do not interact with their child as they would have done had they had an uninjured baby. They may miss the communicative signals given out by the child and consequently may not supply their child with input which is appropriate to the development of language. This is no fault of the parents, who are invariably doing an heroic job in simply caring for their child's needs and helping them survive despite sometimes overwhelming difficulties - This can often be a 48 hour per day task in itself! The situation is merely a result of a set of circumstances produced by the extremely stressful situation in which the parents find themselves.

So, having missed the early communicative opportunities provided by normal parent / child interactions, the child's early communicative skills fail to develop. Instead, the child sometimes completely fails to develop a communicative understanding with Mum and Dad, with the consequence that the understanding of language is impaired, or even non existent! In the absence of understanding of language, the child fails to produce language. In other cases where some appropriate but incomplete interaction has taken place between parents and child, a partial understanding of language develops, with little or no production of language.

A second reason for the failure of language to develop, is when the child experiences 'distortions of sensory processing.' The brain abnormalities and dysfunctions which produce neurodevelopmental problems like cerebral palsy and autism, can adversely affect the functioning of several key structures in the brain, which are responsible for the processing of incoming sensory information from the environment. Obviously, we all know that successful development of spoken language is largely dependent upon successful auditory development; - Essentially, if the child's ability to process the sounds which make up the sound system of the English language is poor, - then their ability to reproduce those sounds as language will be poor. If their ability to process those sounds is non existent, their development of spoken language is likely to be non existent. It is simply a matter of successful sensory reception leading to successful motor output. (Language after all, is an output skill). In other words, this is a sensory - motor loop, the successful development of the motor part of the loop, being dependent upon the successful development of the sensory part of the loop. So, if we have a child who hears nothing, we are likely to have a 'NINO' situation, (nothing in - nothing out). If we have a child who is experiencing sensory distortions, whose hearing is hyposensitive or hypersensitive, or who is experiencing difficulties in regulating their auditory attention, we will probably be facing a CICO situation, (Chaos in - chaos out).

Other factors which can influence language development are difficulties with maintaining eye contact, reluctance to look at faces and the lack of ability to share attention with a communicating partner. These are all vital precursor skills to language development and form their own sensory - motor loops to support the development of communicative skills.

Another factor which will affect the development of spoken language is direct injury to the left hemisphere of the cortex, around the regions of Wernicke's area and Broca's area. These areas are respectively responsible for our ability to understand and produce spoken language. The connotations of direct injury here are obvious.

Another factor to consider is that when a child has a brain dysfunction or injury, the ability of their brain to process information is slowed down. As a consequence they might not be able to process the content or meaning of interaction quickly enough and even if they can, they might be unable to respond quickly enough. The development of such conversational turn taking is a vital precursor to the development of spoken language. If the child keeps missing its turn in the interaction because his speed of processing information has been slowed, this can be very frustrating for the child who desperately wants to interact. This frustration at constant failure might lead them to simply stop trying!

The question is then, what can we do to assist the language development of our children? What I do at Snowdrop is to treat these causal factors logically and methodically.

First we need to take parents and their child back to the point where the interactive processes broke down. This can often mean going back to the beginning to the initial patterns of interaction, which have been missed. We need to teach parents to look for communicative signals given by their child and to foster meaning in the child's signals. Very often, these simple procedures can 'kick start' language development and we can then guide both parents and child through the next stages.

We also need to address any distortions of sensory processing which the child may be experiencing. This might mean the temporary construction of an adapted developmental environment in order to attempt to retrain parts of the brain which are responsible for sensory processing to re-tune their activity to a more normal level. - This is entirely possible and can often provide a massive boost to language development.

The next problem, which involves direct injury to the areas of the brain involved with language comprehension and production can be problematic, but depending upon the extent of the injury, is certainly not hopeless. The reason those areas of the brain are not functioning correctly is the fact that out of the millions of neural networks involved with these functions, many have lost cells due to injury. Therefore many networks are operating with their cell complement depleted. The effect of this is that they operate less efficiently and language comprehension and production are constrained. We can however use stimulatory techniques to train these networks to operate more efficiently, which encourages 'sprouting' (dendrites forming new synaptic connections, thereby increasing network efficiency). This neuroplasticity is the basis of recovery of function.

The final problem, relating to slower speed of processing, is perhaps most easily addressed. Quite simply, children must be given more time to process information, more time to plan a response and more time to execute that response. In this way they will not miss their turn and will not be tempted to withdraw from us in frustration at their perceived failure.

So whilst the difficulties faced by our children might seem great, indeed from my own experience, sometimes I know they seem insurmountable, - parents should not lose hope. If we can take children back through those vital early stages of language development, stages which they might have missed, then it is surprising what sometimes can be achieved.

If you want to learn more about Snowdrop's approach to developing language and communication in children who have developmental disabilities, simply visit our website at http://www.snowdrop.cc or email us at snowdrop_cdc@btinternet.com

Sunday, 13 March 2011

A promise. - One of the reasons Snowdrop exists.

For decades, the treatment of children’s neuro - developmental problems, - difficulties including cerebral palsy, autism, PDD, AD(H)D and associated problems such as learning difficulties--- has focused upon either controlling symptoms or upon behavioural principles. In an age which understood little about the brain, where medicine considered that once a brain was damaged, there was nothing which could be done, this was understandable. In an age where professionals could not even imagine how a brain responds to it's environment, it's inherent plasticity, it's ability to create new connections and to discard unused ones, what more could be expected? Consequently, for the millions of children who suffered neuro-developmental problems in this age, the future was bleak. At worst it meant life in an institution, away from the family, with no hope at all and sometimes treatment was harsh. My heart cries out to these lost children because I remember my visit to one in 1988. It was Cranage Hall in Cheshire in the UK and it was the shock of my life. I was already the father to a baby who had been diagnosed with cerebral palsy and I was at university studying neuroscience, child development and special educational needs.

Cranage was a dinosaur of a place and the new government philosophy at the time of 'care in the community,' meant that thankfully, places like it were closing. I think the objective of our lecturer in taking us there was to shock. - He succeeeded because I have never forgotten! During my visit I got to see some sad cases of desperately disabled children who had grown into young adults, who had been placed in there by their family simply because they could not cope and the services were not available as they are today, to support the family at home. I remember holding the hand of a young man in a wheelchair, who had cerebral palsy. He could not speak but he clearly understood some of what I said. As I kneeled beside him, seeing parallels between him and my own young son I swore to him that I would do something about this, that I would fight to see that children like him were helped. Little did I know at the time how I would end up fulfilling that oath!

The next few years saw me on a journey of discovery and led me to various treatment centres all over the world, a few of them good, most of them bad. Some of them were clearly motivated by finance, whilst some of them were staffed by people who were clearly under-qualified to be doing what they were doing. During those years however, I did amass a vast amount of knowledge concerning neurodevelopment, which led me to being involved in various projects including the construction of connectionist models designed to replicate the cognitive functions of children and designing strategies to build communication in and language in children who displayed such problems. Allied to this I went on to study at various universities, first obtaining a degree based in neuroscience and child development and later gaining qualifications in ‘language and communication impairments in children’ and finally an MSc based in child development and cognitive neuroscience.

In 2008, six years after the death of my own son from a series of brainstem strokes, I fulfilled my oath to that young man and to my own son when I formed Snowdrop, - a small enterprise dedicated to focussing all of the knowledge and experience I have gained and applying it to the treatment of children’s neurodevelopmental problems. Snowdrop’s approach is called neuro-cognitive therapy and is neurodevelopmental in its foundation.

Neuro-cognitive therapy recognises that often, brain injury or dysfunction is likely to impinge upon the child’s ability to process sensory information coming into the brain from the outside world. In turn, these ‘distortions of sensory processing' will inevitably affect the way in which the child relates to the world and reacts to it. The consequences of these sensory processing deficits express themselves in the output functions of the child, - namely the development of mobility, hand function, language, socialisation, etc.

So, one part of the wide ranging approach of neuro - cognitive therapy focuses upon attempting to train the brain to process incoming sensory stimulation in a more normal manner and consists of providing structured sensory information, within an environment which has been adapted to take account of the child’s sensory processing difficulties.

Another prong of neuro - cognitive therapy is informed by Vygotskian psychology and involves an assessment of the current level of the child’s cognitive functioning and then building upon these abilities in a logical step - by - step manner. The approach focuses upon the way in which children learn naturally in their early years and applies this to stimulating the cognitive development of children with developmental difficulties. It recognises that early learning is a social phenomena which is concentrated within the interactions between the child and more skilled partners (parents, siblings, etc) and that over time and with repetition the child begins to not only take the lead in the learning process, but internalises the learning task into his own developmental capability.

Snowdrop now treats children from all over the world and has some incredible success stories to it's name, which can be read about in my new book, Brain Injured Children: - Tapping the Potential Within.
Anyone who requires more information about Snowdrop's work should visit the website or email snowdrop_cdc@btinternet.com  or call 01884 38447

Tuesday, 8 March 2011

Vitamin C critical to early brain development

A recent study by Swedish researchers warns that vitamin C deficiency early in life can lead to significant impairment in brain development.

Researchers with the University of Copenhagen tested guinea pigs and found that those subjected to even moderate vitamin C deficiency had 30 percent less hippocampal neurons and noticeably worse spatial memory than guinea pigs on a normal, healthy diet. The hippocampus is strongly implicated in learning and memory.

Lead author Jens Lykkesfeldt said that like guinea pigs, humans depend on getting enough vitamin C through their diets.

The researchers said that the brains of newborns are more vulnerable than other tissue to even a slight lowering of vitamin C levels.
This will be translated into treatment in Snowdrop's programme


Tuesday, 1 March 2011

Parts of the brain can switch function.

Thanks to MIT for this groundbreaking research, which gives hope to all children who have neurodevelopmental disabilities.

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Cambridge, MASS- When your brain encounters sensory stimuli, such as the scent of your morning coffee or the sound of a honking car, that input gets shuttled to the appropriate brain region for analysis. The coffee aroma goes to the olfactory cortex, while sounds are processed in the auditory cortex.

That division of labor suggests that the brain's structure follows a predetermined, genetic blueprint. However, evidence is mounting that brain regions can take over functions they were not genetically destined to perform. In a landmark 1996 study of people blinded early in life, neuroscientists showed that the visual cortex could participate in a nonvisual function — reading Braille.

Now, a study from MIT neuroscientists shows that in individuals born blind, parts of the visual cortex are recruited for language processing. The finding suggests that the visual cortex can dramatically change its function — from visual processing to language — and it also appears to overturn the idea that language processing can only occur in highly specialized brain regions that are genetically programmed for language tasks.

"Your brain is not a prepackaged kind of thing. It doesn't develop along a fixed trajectory, rather, it's a self-building toolkit. The building process is profoundly influenced by the experiences you have during your development," says Marina Bedny, an MIT postdoctoral associate in the Department of Brain and Cognitive Sciences and lead author of the study, which appears in the Proceedings of the National Academy of Sciences the week of Feb. 28.


Flexible connections

For more than a century, neuroscientists have known that two specialized brain regions — called Broca's area and Wernicke's area — are necessary to produce and understand language, respectively. Those areas are thought to have intrinsic properties, such as specific internal arrangement of cells and connectivity with other brain regions, which make them uniquely suited to process language.
Other functions — including vision and hearing — also have distinct processing centers in the sensory cortices. However, there appears to be some flexibility in assigning brain functions. Previous studies in animals (in the laboratory of Mriganka Sur, MIT professor of brain and cognitive sciences) have shown that sensory brain regions can process information from a different sense if input is rewired to them surgically early in life. For example, connecting the eyes to the auditory cortex can provoke that brain region to process images instead of sounds.

Until now, no such evidence existed for flexibility in language processing. Previous studies of congenitally blind people had shown some activity in the left visual cortex of blind subjects during some verbal tasks, such as reading Braille, but no one had shown that this might indicate full-fledged language processing.

Bedny and her colleagues, including senior author Rebecca Saxe, assistant professor of brain and cognitive sciences, and Alvaro Pascual-Leone, professor of neurology at Harvard Medical School, set out to investigate whether visual brain regions in blind people might be involved in more complex language tasks, such as processing sentence structure and analyzing word meanings.

To do that, the researchers scanned blind subjects (using functional magnetic resonance imaging) as they performed a sentence comprehension task. The researchers hypothesized that if the visual cortex was involved in language processing, those brain areas should show the same sensitivity to linguistic information as classic language areas such as Broca's and Wernicke's areas.

They found that was indeed the case — visual brain regions were sensitive to sentence structure and word meanings in the same way as classic language regions, Bedny says. "The idea that these brain regions could go from vision to language is just crazy," she says. "It suggests that the intrinsic function of a brain area is constrained only loosely, and that experience can have really a big impact on the function of a piece of brain tissue."

Bedny notes that the research does not refute the idea that the human brain needs Broca's and Wernicke's areas for language. "We haven't shown that every possible part of language can be supported by this part of the brain [the visual cortex]. It just suggests that a part of the brain can participate in language processing without having evolved to do so," she says.


Redistribution

One unanswered question is why the visual cortex would be recruited for language processing, when the language processing areas of blind people already function normally. According to Bedny, it may be the result of a natural redistribution of tasks during brain development.

"As these brain functions are getting parceled out, the visual cortex isn't getting its typical function, which is to do vision. And so it enters this competitive game of who's going to do what. The whole developmental dynamic has changed," she says.

This study, combined with other studies of blind people, suggest that different parts of the visual cortex get divvied up for different functions during development, Bedny says. A subset of (left-brain) visual areas appears to be involved in language, including the left primary visual cortex.

It's possible that this redistribution gives blind people an advantage in language processing. The researchers are planning follow-up work in which they will study whether blind people perform better than sighted people in complex language tasks such as parsing complicated sentences or performing language tests while being distracted.

The researchers are also working to pinpoint more precisely the visual cortex's role in language processing, and they are studying blind children to figure out when during development the visual cortex starts processing language.
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This research has profound, positive implications for all our children.  It is our contention that this research supports the principles of the Snowdrop programme in creating an enriched developmental environment for brain injured children.  In this way, we are creating the 'competitive demand; which encourages the brain to enter what the researchers call the "competitive game" of deciding which brain region is going to take over what function! This then helps to change the 'developmental dynamics' spoken of in the study.