Primitive Reflexes: Brain Highways Screening for Lower Brain Development

http://theorganizedmindhq.com

Brain Highways has come up with a quick screener which assesses pons development, midbrain development, vestibular processing, proprioception, visual tracking, and eye teaming.  Challenges include "army crawling"/creeping, crawling on hands and knees, answering questions while standing on one foot, touching specific body parts with eyes closed, and following a visual target without moving one's head.  Based on difficulties identified, one can observe which primitive reflexes are not yet integrated, which areas of the brain may be underdeveloped, and what effects this may have on academic achievement.

For example, if a child has not yet integrated the Asymmetrical Tonic Neck Reflex (ATNR) then it may be difficult for he/she to engage in tasks that require bilateral coordination of both upper extremities and lower extremities.  ATNR is the reflex that causes babies to form the "fencing position" shown below.  Sitting at a desk and turning one's head to watch the teacher as she moves about the room may be challenging for a child with ATNR because his/her entire body wants to reposition when the head moves.  It is hard for this child to disassociate head and body movements. Likewise, a child may often be seen lying his head on the table with one arm bent and the other extended.  This is often interpreted as disinterested or unengaged.  However, this may be the most naturally comfortable position for that child due to lack of primitive reflex integration. 

https://s-media-cache-ak0.pinimg.com

Likewise, a child with unintegrated Symmetric Tonic Neck Reflex (STNR) may have difficulty sitting still in a desk because every time the head looks up at the board and then down towards the paper again, his/her arms and legs was to readjust.  Typically with STNR, if the head flexes then the arms flex and the legs extend.  If the head extends then the arms extend and the legs flex.  The baby below is demonstrating significant STNR.  Imagine having STNR and being asked to sit in a desk with your head looking down at your worksheet, your arms bent towards your work, and your knees bent while sitting---it would be nearly impossible and extremely uncomfortable.

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Our pons is primarily developed through creeping ("army crawling") when we are young.  If we don't spend as much time in this position, our brain may not receive the input it needs to fully develop.  The good news is that we can go back and develop those centers of the brain through repetition of specific exercises and physical movements. The Brain Highways program suggests that the pons can be further developed through creeping on one's belly while using bilateral upper and lower extremities to advance, as shown in the top picture below . The midbrain can be further developed through repetitive crawling on hands and knees as shown in the bottom image below.

CREEPING: http://i.ytimg.com

CRAWLING: http://www.freelargeimages.com

These lower centers of the brain are responsible for vestibular processing, proprioception, visual tracking, and eye teaming.  Therefore, a task such as handwriting, which is performed every day within the classroom may be really difficult for a child with unintegrated primitive reflexes and lower brain underdevelopment.  Lack of visual motor integration leads to difficulty with letter formation, spacing, line placement, and sizing of handwriting.  Decreased attention leads to an increase in errors, difficulty following directions, and trouble generating sentences in a given amount of time.  Reading comprehension may also be effected.  Due to deficits in visual tracking, following each line when reading can be tiresome and non-preferred, causing the child to avoid reading or act out when prompted to read in class.  Proprioception, or the awareness of one's body in space, can also be effected.  Deficits in this area can cause a child to run into peers in the hallway, accidentally hurt others when giving a high five or hand shake, or push so hard that the paper rips when writing.  These are just a few ways in which academic performance can be effected by the issues discussed in this post. 

This has been a very brief overview of lower brain underdevelopment and primitive reflexes.  To access the full Brain Highways screener, one must complete the Brain Highways course, which can be accessed at the following link: www.brainhighways.com. 

Potential Effects of Lower Brain Development on Academic Performance

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The academic setting is demanding in many ways.  A child's performance expectations are high and they seem to be continually rising each year.  School curriculum is written with the expectation that each child's brain is fully developed.  However, this is not always the case.  At times,the demands may outweigh a child's developmental capabilities, causing them to struggle within the classroom. 

There are so many areas of our brain functioning at once during any given moment.  Ultimately, the goal is to be able to achieve higher functioning tasks while also completing more automatic tasks (example: standing still without falling over while talking to someone).  In an underdeveloped brain, multi-tasking may be very difficult.  If the brain was already busy working hard at another job, then it has to "drop what it was doing" to come help out with the new challenge.  

Imagine if you were trying to load the dishwasher and your child bumped his elbow.  He is crying and requires your full attention to put a bandaid on his wound, give him a hug, and comfort him.  Meanwhile, the dishwasher has not loaded itself and all of the dirty dishes remain where you left them.  An underdeveloped brain can resemble this scenario.  A child who is focusing really hard on sitting still in her desk and then gets called on in class, now has to divert her attention to answering the question and she may slouch or lean over in her chair.  This change in posture may lead the teacher to believe that the student is "lazy" or "disinterested" when really it is just her brain's way of compensating. 

I have been completing an online course as part of my professional rotation which looks at some of the possible physical explanations for why it may be difficulty for some children to pay attention in the classroom.  Attributes of decreased attention may include retained primitive reflexes, incomplete pons and midbrain development (lower centers of the brain), or poor sensory processing.  Some children may have underdevelopment in multiple areas of the brain, making it difficulty for them to respond appropriately when you ask them to "pay attention".  Tasks that require bilateral coordination, fine motor control, visual motor integration, visual perception, visual tracking, eye teaming, proprioception, and vestibular processing may be difficult if the lower brain is not fully developed.  Within an academic setting, deficits in these areas can impact handwriting, pencil grasp, reading, attention, gross motor skills, and much more.  

This video from Brain Highways provides teachers with student feedback regarding individual brain processing: https://www.youtube.com/watch?v=lTMLzXzgB_s

For more information related to the Brain Highways online program, please visit www.brainhighways.com. 

Stay tuned to this blog for more specific information regarding the Brain Highways screener and what detected deficits may tell us about areas of academic difficulty. 

Very Brief Examples of Sign Language (Videos and Pictures) :-)

I have included videos and picture of some of the most frequently used signs from the school based setting below!  Please enjoy :-) 

 

Even within American Sign Language (ASL), there are sometimes multiple sign for the same language.  Similar to the spoken English language, one word may also have multiple meanings.  There may be different sign for the same word, depending on the meaning.  Using facial expression and body posture is also very important when signing.  In a way, these elements act as the user's "tone of voice" so that the other person better understands the sentiment or mood behind the message. When working with children, it is important to note that some may use alternate signs because they do not have the fine motor skills or isolated finger movements necessary to perform some hand shapes.  Children can understand and use sign language before they are even one year old, well before they are expected to have developed isolated finger movements. Therefore, the signs that a child uses may be slightly altered from the original gesture. I have attached the following videos to demonstrate:
 

Check out these videos:

• https://www.youtube.com/watch?v=Fha8ZsdxupI (Boy reads to his little brother using sign).
• https://www.youtube.com/watch?v=_-f1My_8OFE (Children signing animals).
• https://www.youtube.com/watch?v=FDGqqVecHGo (Adult signing animals at the zoo).
• https://www.youtube.com/watch?v=w48yGQ2B6fk (Children signing colors). 
• https://www.youtube.com/watch?v=GfpaHQD9WYc (Adults signing emotions). 
• https://www.youtube.com/watch?v=9M1ky9_nm4Y(Adults & Children signing the Alphabet).

Here are just a few very basic signs that one might see used frequently when working with children: 

           
          
                                                                                       

Sign Language in the School Setting

As part of my professional rotation, I am receiving one-on-one sign language instruction from a private tutor.  I am so blessed to be learning from such a knowledgeable individual!  I have chosen to begin learning about terms that are commonly used among children as I can immediately apply this information during my current rotation.  I will then address some terms and phrases more commonly used among adults. I am really looking forward to this brief yet broad introduction to sign language, as this has always been an interest of mine.  I have met so many wonderful people who I may have been able to communicate with more effectively if I had known sign language.  What a great opportunity this is!

My instructor advised me to purchase the book referenced below, as she has used it when teaching sign languages courses previously and has always found it to be user friendly, especially for beginners. 

Humphries, T., Padden, C., & O'Rourke, T. (1994).  A basic course in American sign language.  T.J. Publishers, Inc. (Second Edition).

Sign language can help to facilitate both expressive and receptive language for students within the school based setting.  For those who have difficulty producing the vocabulary needed to interact with peers, learning an alternate way of communicating can be a real game changer.  Many children demonstrate a decrease in behaviors and appear less frustrated when they have a reliable means of communication.  For some, sign language not only allows them to more readily communicate their basic wants and needs, but also decreases social isolation and encourages interactive play.  Within the academic setting, staff members always want to ensure that the child's cognitive capacity is being accurately represented and that no physical limitation is prohibiting the student from communicating effectively.  Sign language can be a great resource for some students who may otherwise have difficulty communicating all of their unique desires, thoughts, and ideas!

Below is a list of some commonly used signs within the school setting, all of which I have had a chance to learn and review with my sign language instructor.

• animals (zebra, horse, cow, bird, duck, chicken, sheep, pig, turkey, bear, elephant, giraffe, tiger, lion, rabbit, owl, mouse, Mickey Mouse, caterpillar, bug, spider, nothing, monkey, fish). 
• colors (brown, black, grey, orange, pink, red, blue, green, yellow, white purple).
• numbers (1-20)
• emotions (angry, happy, sad, surprised, tired, bored). 
• interesting 
• smart, clever
• more 
• no 
• yes 
• stop 
• please 
• thank you 
• want 
• don't want 
• schedule, list 
• snack, eat 
• hungry 
• thirsty 
• bathroom, toilet 
• walk 
• swing 
• run 
• jump
• work
• play 
• look 
• read 
• book
• sit 
• toy
• first 
• then 
• school 
• home 
• pay attention, focus 
• listen 
• clean up 
• draw 
• study 
• test 
• know 
• don't know 
• understand

Look for a future post with instructional pictures related to some of the signs listed above! :-)

Sample Goals for School Based OT

Below are some potential goals for a student in the school base setting.  For the purposes of this example, we will refer to the student as Jeanette.  As shown here, sometimes the occupational therapist may choose to create a general overarching goal related to academic achievement and then list more measurable objectives within that goal. 

Jeanette will improve the accuracy and legibility of her handwriting to help facilitate success with academic tasks.

1. Jeanette will copy the uppercase alphabet with an average of 80% accuracy for letter formation on targeted trials.
2. Jeanette will copy the lowercase alphabet with an average of 80% accuracy for letter formation on targeted trials. 
3. Jeanette will be able to write her name independently, using case specific letters, with accurate letter formation in 80% of documented trials.  

Jeanette will improve her motor coordination skills to increase functional independence within her educational environment. 

1. Jeanette will independently manipulate snaps on her own body in 80% of targeted trials. 
2. Jeanette will be able to independently manipulate buttons on her own body, without requiring verbal cues for alignment or error correction in 80% of targeted trials. 
3. Jeanette will complete the first step of shoe tying by independently crossing laces and tying a knot in 5/5 trials; advancing to being able to tie her shoes. 

Jeanette will improve her fine motor capabilities in order to increase independence and promote success across academic settings.

1. Jeanette will use a functional tripod/quadrapod grasp on her writing utensil during 80% of targeted writing attempts.
2. Jeanette will use isolated finger movements to complete fine motor activities, requiring no more than two verbal prompts for finger isolation in 80% of targeted trials.  

Personally, I have been very impressed with the interprofessionalism and teach based approach that is consistently implemented in the school based setting.  Rather than making recommendations based solely on data gathered during an OT evaluation, the therapist must rely on reports and data gathered across academic settings.  This helps the therapist to gain a more accurate picture of how that child is performing throughout his/her day.  The team generally consists of the child's parent(s)/guardian(s), administration such a the principle or vice principle, a special education coordinator, psychologist, social worker, speech therapist, physical therapist, and occupational therapist.  Only those services which are needed in order to support the child's educational experience will be represented on the team.  For example, if a child does not have any gross motor delays and is able to functionally access all areas of the school, he/she may not require physical therapy services.  Additionally, parents/guardians may invite outside representatives such as a behavioral analyst or an early intervention therapist to the individualized education plan (IEP).  All team members must agree on all goals and objectives during the IEP meetings.