Monday, 21 November 2016

Global Developmental Delay, (but catching up)!

This morning, amid all the flooding and in an ever decreasing dry area at Snowdrop as the water spread across the floor, we welcomed back a 2 year old little boy who has global developmental delay. However, that delay is gradually decreasing and he is a different little boy than the one I met three assessments and almost a year ago to the day. In the last twelve months, his visual development has increased by 12 months, his auditory development has increased by 11 months and his hearing has improved to the point where he needs the sensitivity of his hearing aids reducing. His tactile sensitivities have disappeared and consequently he has gross motor development has improved from the 5 month level, - not being able to sit or crawl, to the 12 month level, - being able to sit, crawl on all fours, pull himself to stand and to stand albeit very briefly alone! In language development he has gone from simple vocal play to triangulation and is bordering 'scribble talk' and his hand function, especially left hand function is improved dramatically, to the point where the left hand which was really lagging behind, now seems to be his dominant hand at times. Socially he is a bright, interactive, playful little soul. A joy to see, especially amid the despair of the rising flood!

Sunday, 20 November 2016

Injury to the Pons

The Pons is located in the lower brainstem, directly above the Medulla Oblongata. The word 'pons' means 'bridge' and this is an apt description as it acts as a bridge which connects the cerebellum to higher brain structures. It's involvement with the cerebellum makes it an important player in the coordination of movement and posture.

The Pons is also involved in sensory analysis... for example, information from the ear first enters the brain in the pons at the level of the Eighth cranial nerve. It is therefore easy to imagine how many of the distortions of sensory processing experienced by our children are produced by injury here!

It has parts that are important for regulating our level of consciousness and for sleep, which fits in nicely with the fact that the raphe nuclei are serotonin producing neurons. Injury to the Pons can cause coma. The pons contains the raphe nuclei which release serotonin, a type neurotransmitter which is instrumental in mediating mood and sleep. The pons is also involved in our ability to perceive pain. Regulation of specific direction of gaze is also controlled at the pons and so a good indicator of injury to this structure is the absence of a pupillary light reflex.

Another important set of nuclei in the pons is the Locus Coereleus. This area of the brain is intimately involved in REM (dream) sleep. It is these nuclei which are responsible for many stress reactions, including 'post traumatic stress disorder.' The locus ceruleus is activated by stress, and will respond by producing a neurotransmitter called 'norepinephrine,' - a form of adrenaline. Injury here is why some of our children are hyper-anxious and oversensitive in sensory terms. Norepinephrine also increases cognitive function and motivation

So injury to the Pons is capable of producing coma, causing sleep disturbances, sensory disturbances, lack of pupillary response, dysfunction in levels of arousal and attention and increases in levels of stress and anxiety. How many of our children who suffer conditions such as cerebral palsy and autism have injuries to this structure? I would suggest it is more than one would imagine.

Can an injury to the Pons be treated?

Yes! We know that the brain has a high degree of plasticity, - the ability to reorganise it's structure and functioning according to the demands of the environment in which the individual finds himself. We also know that if we can gain an improvement in functioning in one part of the brain, then we can expect 'knock - on' effects, - improvements in other parts of the brain due to the rich connectivity between all areas of the brain. What we do at Snowdrop is to provide children (and adults) with an envionment which is designed to stimulate their development by encouraging this plasticity and improved functioning.

If you are interested in learning more about Snowdrop develeopmental stimulation programmes, go to our websiteor email us at