Abstract: Combining Chiropractic Care with Extinguishing of Primitive Reflexes: A Case Series of 8 Children

Transcription

1 Abstract: Combining Chiropractic Care with Extinguishing of Primitive Reflexes: A Case Series of 8 Children Introduction: The pediatric special needs population is increasing at an alarming rate. More children each year are being diagnosed with disorders ranging from Autism, Attention Deficit Hyperactivity Disorder, and Sensory Processing Disorder than ever before. The additional step of extinguishing primitive reflexes may be of great benefit to children with neurological issues and can easily be added to a pediatric chiropractic protocol. Methods: Results of 8 children with a variety of neurological issues were examined in either a University based chiropractic clinic or a private practitioner s office. The University IRB approved this study. Results: Positive benefits were seen in this case series of 8 special needs children under the care of 5 different chiropractic providers utilizing chiropractic and primitive reflex work. Discussion: The combination of pediatric chiropractic care and extinguishing primitive reflexes may be of great benefit to the increasing population of children with neurological issues. Keywords: Chiropractic, Pediatric, Reflex (abnormal), Child development disorders 1

2 Combining Chiropractic Care with Extinguishing of Primitive Reflexes: A Case Series of 8 Children Introduction: The pediatric special needs population is increasing at an alarming rate (1). More children each year are being diagnosed with neurodevelopmental challenges ranging from Autism, Attention Deficit Hyperactivity Disorder and Sensory Processing Disorder (1-6). The prevalence of children diagnosed with Autism has skyrocketed from 1 in 5000 children in 1975 (2) to the latest statistics showing 1 in 88 children in 2008 (3). ADHD has jumped 16% since 2007, in a CDC study that indicates that almost 10% of children ages 4-17 are diagnosed with this disorder (4). The prevalence of sensory processing disorders is currently at 3.4% of preschool and elementary aged school children (5). The number of children enrolled in special education programs in public schools has risen 30% in the last 10 years (6), and is approximately 13% of all school age kids (7). Research has shown that early intervention is the key to success for this population (8). Waiting until these youngsters are in school before intervening with these children with special needs may be too late (9,10). Chiropractors who take care of a pediatric population may expect an increased number of children with a neurodevelopmental diagnosis to present to their offices. There exists a number of simple yet profoundly impactful steps that can be taken by chiropractors treating special needs children, including exercises 2

3 that can be done in their offices and then replicated at home to build weakened neural pathways (11). The following important authors paved the way for movement therapy in children with special needs. What To Do About Your Brian-Injured Child, written in 1974 by Glenn Doman, stated that there were basic movements that must be accomplished by the infant before other movements could be added successfully (12). In 1996, Sally Blythe Goddard wrote in her book Reflexes, Learning and Behavior, how retention of primitive reflexes past the first year of life can lead to potential difficulties in child development (13). Robert Melillo wrote in a 2009 book and 2011 article illustrating how the extinguishing of these reflexes can lead to an improvement in functioning of impaired children (11,14). Primitive reflexes are found in infants from birth to age 6 months. Their function is to help with survival, by providing immediate response to environmental stimuli. If these reflexes do not appropriately morph into postural reflexes by ages 6 months to 1 year, this indicates potential immaturity of the CNS. These retained reflexes can be extinguished through specific remediation exercises or the use of brushing techniques, such as those described by Goddard (13). Method: Four case studies were examined from patients in a chiropractic university clinic. Each case study involved a child who had been professionally diagnosed with issues ranging from auditory processing disorder to ADHD to cerebral palsy to developmental delays. Student interns were the primary care givers in these four cases, overseen by a university faculty clinician (and author of this paper). 3

4 Student interns also wrote about these patients for a required university research class, and the faculty clinician acknowledges these four students since some of their research and descriptions of their patients make up part of this paper. Four additional case studies were examined from the author s private practice. These four cases studies involve children who were professionally diagnosed with ADHD, Autism, learning disorders, anxiety disorders, and developmental delays. Each of these 8 children had significant positive improvements during care, which was between 1 month and 1 year duration. Every child in this case series has 3 things in common. First, each was diagnosed with a neurodevelopmental issue prior to coming to the university clinic or the private practice. Second, each child received chiropractic care. The final commonality was that each child also received some level of primitive reflex extinguishing exercises. This study was approved by the university IRB. Results: Case study #1: Auditory processing disorder (2nd Author, student intern) A 6-year-old male presented to the university clinic with an auditory processing disorder. The patient was shy with a low self-confidence, due to a lack of coordination and auditory and speech issues. His parents reported that the child often felt different than children his age and did not enjoy playgroups or social interactions. 4

5 At assessment, multiple retained primitive reflexes were observed, such as Asymmetric Tonic Neck Reflex (ATNR), Palmar, Gallant, Rooting, and Babinski. In addition to chiropractic adjustments, the patient was given cross crawl integration exercises to improve left/right brain communication and primitive reflex remediation exercises to extinguish the ATNR. Brushing techniques were used to extinguish the other retained primitive reflexes (Rooting, Palmar, Gallant, and Babinski). By the 14 th visit in 3 months, the patient exhibited signs of independence, an increase in self-confidence, and marked improvements in coordination. Case Study # 2: ADHD (3rd author, student intern) An 11-year-old female presented to the university clinic with ADHD, diagnosed by her pediatrician. At age 3, she experienced emotional distress around others. By school age, she had difficulties with reading comprehension, handwriting, and mathematics. Persistent primitive reflexes that were retained included ATNR, Rooting reflex, Palmar Grasp and Babinski s. The patient began a course of chiropractic adjustments and reduction of primitive reflexes with remediation exercises and brushing. Since beginning chiropractic care, the child's social interaction and emotional state improved, with the largest advance seen in the child s school environment. At visit number twenty-three, the mother stated that the child s progress report, which listed deficiencies, was now in the A range. The parents 5

6 were informed that the patient was now selected to be tested for the honors program. Case Study #3: Developmental delays in Crawling and Walking (4th author, student intern) A 13-month-old female presented to the clinic because she was not reaching appropriate developmental milestones. The mother described the child s crawling as a scooting motion since the patient s buttocks remained in contact with the ground. The patient was also not standing on her own or trying to walk. The patient's evaluation showed a positive retained Babinski and Gallant reflexes. The patient was shown cross-crawl exercises in which one arm is lifted with the opposite leg, as the patient is supine, then visa-versa. The patient s mother was also given brushing exercises to diminish the retained Babinski and Gallant reflexes. After 4 adjustments, the patient was crawling normally, had taken four steps unassisted, and had not performed the scooting motion since the second visit. Case Study # 4: 2 year old male with Cerebral Palsy (5th author, student intern) A two-year-old male presented to the university clinic with a diagnosis of Cerebral Palsy. He was non-ambulatory, non-verbal, still wearing diapers, and had no meanginful use of his hands. All primitive reflexes tested were positive: Rooting, Palmer, Gallant, Babinski, ATNR. The patient had 31 adjustments in 7 months. The parents were compliant in performing the réflex extinguishing 6

7 exercises, and reported the following gains: the patient was able to take things from his hand to his mouth, performed a modified commando crawl, made eye contact when his name was called, and started mumbling vocal sounds and saying hi. Case History # 5 & 6: Sisters with anxiety and speech delays (1st author) Two sisters presented to the author s clinic, ages 2 and 4, with chief complaints of anxiety and speech delays, respectively. The youngest was constantly upset, creating significant disruption to the household, and the older sibling had serious speech and communication delays, which affected her socialization at preschool and daycare. Both girls had positive retained reflexes including Rooting, Palmer and Babinski, and had a diet with high amounts of dairy. They were given brushing and remediation exercises, and eliminated all dairy products. After 8 months of care, the younger sister s anxiety was dramatically reduced, enough so that she could now attend daycare, and the 4 year old no longer needed speech therapy and was accepted into a prestigious preschool program. Case Study #7: Reading issues and multiple concussions in a 6 year old (1st author) A 6-year-old girl had a 2-year history of blacking out in which she would fall and hit her head, even with a mild trauma such as falling backward on her bed. Her concussion-like syndrome continued to occur with regularity even with 7

8 simple traumas. She had a positive ATNR plus tracking, pursuit, and accommodation issues, which caused some moderate reading issues. She was given remediation exercises as well as eye exercises. After 1 year of care, there have been no reported fainting spells, even though she did have several falls including one with a direct blow to the head, plus her reading abilities showed dramatic improvement. Case study #8: ADHD (1st author) A 7-year-old boy presented with ADHD so severe that both their teacher and pediatrician recommended Ritalin. He also presented with low affect, was reserved and shy. He had positive ATNR, Rooting and Gallant retained primitive reflexes. He was given remediation and brushing exercises. Within 30 adjustments, he no longer received negative comments on his report card and had all A s or grades of Satisfactory, and his teachers no longer talked to his parent s about needing Ritalin. Summary of Results: Each child had impressive results while under chiropractic care and simultaneously extinguishing their primitive reflexes. Seven out of eight showed improvement that drastically reduced or discontinued one or more other services that they had been a weekly part of their care. The only child whose progress was mild (although he did have good results with reducing his primitive reflexes) was the child with CP (case #4), who had significant additional impairments. 8

9 Discussion: The addition of primitive reflex reduction in conjunction with pediatric chiropractic care provided a marked level of improvement to children who had mild to severe symptoms. Younger children who had trouble talking showed improved communicative. Elementary aged children and pre-teens that were socially uncomfortable displayed attempts at forming friendships for the first time in their lives. Children who had trouble focusing showed improved focus, noticed not only by their parents but also by their teachers. There are several limitations to this study. First, the sample size was small (8 children). However, having 5 unique providers may eliminate the possibility that it was a provider effect phenomenon. Another limitation is that this was a retrospective study, which only dealt with 8 successful candidates and did not address a cohort of children who started treatment around the same time and then recording the results after a specific amount of time had lapsed. This study also did not use assessment tools to measure pre and post findings. Future research would benefit from parents filling out pre and post questionnaires such as the pediatric SF-10. Conclusion: The combination of pediatric chiropractic care and extinguishing primitive reflexes may be of great benefit to the increasing population of children with neurological issues (11, 14). With this population growing at a rate of almost 17% per decade, by 2023 we might see 20 million children having 9

10 neurodevelopmental issues such as those addressed (15). The average chiropractor may not be equipped for such children unless they look into extinguishing primitive reflexes as a possible additional therapy that needs to be addressed. This population will probably continue to increase and will not stabilize in its growth in the foreseeable future. It is important for chiropractors that work with such children to prepare themselves for this population. 10

11 References 1. Centers for Disease Control and Prevention [homepage on the internet]. Workshop on U.S. Data to Evaluate Changes in the Prevalence of Autistic Spectrum Disorders (ASD). February 1, Available at: ummary.pdf 2. Weintraub K. Autism Counts: The Prevalence Puzzle. Nature : Available at: 3. Centers for Disease Control and Prevention [homepage on the internet]. Baio J. Prevalence of Autism Spectrum Disorders: Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, Available at: 4. Centers for Disease Control and Prevention [homepage on the internet]. Attention Deficit/ Hyperactivity Disorder (ADHD): Data and Statistics. Available at: 5. Gouze KR, Hopkins J, LeBailly S, Lavigne JV. Re-examining the Epidemiology of Sensory Regulation Dysfunction and Comorbid Psychopathology. J Ab Child Psyc (8): National Education Association [homepage on the internet]. IDEA/Special Education. Available at: 7. Scull J & Winkler AM. Shifting Trends in Special Education. Thomas B Fordam Institute May Available at: 8. Glicksman E. Catching Autism Earlier. American Psychology Association Monitor (9): Dawson G, Rogers S, Munson J, Smith M et al. Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model. Pediatrics (1): Fountain C, Winter AS, Bearman PS. Six Developmental Trajectories Characterize Children with Autism. Pediatrics (5): Melillo R. Primitive Reflexes and Their Relationship to Delayed Cortical Maturation, Under Connectivity, and Functional Disconnection In Childhood Neurobehavioral Disorders. J Func Neuro, Rehab & Ergo (2):

12 12. Doman G. What To Do About Your Brain-Injured Child. Doubleday & Company, New York City, New York, Goddard S. Reflexes, Learning and Behavior. Fern Ridge Press, Eugene, Oregon, Melillo R & Leisman G. Neurobehavioral Disorders of Childhood: An Evolutionary Perspective. Springer, New York City, New York Boyle CA, Boulet S, Schieve LA, Cohen RA et al. Trends in the Prevalence of Developmental Disabilities in US Children, Pediatrics (6):