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Windows on the Brain

1.1 Introduction

Although all learning ultimately takes place in the brain, it is often forgotten that it is through the body that the brain receives sensory information from the environment and reveals its experience of the environment. Postural control reflects integration of functioning within the central nervous system (CNS) and supports brain-body functioning. Immaturity or conflict in brain-body functioning affects the brain's ability to assimilate and process information and to express itself in an organized way.

One method of assessing maturity and integrity in the functioning of the CNS is through the examination of primitive and postural reflexes. The presence or absence of primitive and postural reflexes at key stages in development provides "windows" into the functioning of the CNS, enabling the trained professional to identify signs of neurological dysfunction or immaturity.

This book, I hope, will give the reader an understanding of why early reflexes are important, their functions in early development, their effects on learning and behavior if retained, and the possible effects on other aspects of development such as posture, balance, and motor skills if they are not integrated at the correct time in development.

Reflexes will be described in detail in subsequent chapters.

There is an increasing body of scientific evidence to support the theory that physical skills support academic learning and are involved in emotional regulation and behavior. Since its foundation in 1975, the Institute for Neuro-Physiological Psychology (INPP) in Chester has been the pioneer in researching the effects of immature primitive and postural reflexes on learning and behavior, developing protocols for the assessment of abnormal reflexes and related functions, and has devised a specific method of effective remediation (the INPP method).

Research carried out both independently and by the institute over the past 30 years has shown that there is a direct link between immature infant reflexes, academic underachievement, and increased anxiety in adult life, and that a remedial program aimed directly at stimulating and integrating primitive and postural reflexes can effect positive change in these areas. This book will outline the underlying theory, mechanisms, developmental markers, and effects of immature reflexes in older children to assist professionals involved in education and child welfare to recognize the signs of neurological dysfunction and their implications.

The book will also explore interdisciplinary shortcomings endemic in the current system for identifying, assessing, and providing effective remedial intervention for learning and behavioral problems. In this context, the book will propose that there is a need within education for a new profession to bridge the present gaps-a neuro-educator-trained specifically to assess children's developmental readiness for education.

1.2 Developmental Readiness for Education

Chronological age and intelligence are not the only criteria for learning success. Developmental readiness for formal education is equally important. Developmental testing of motor skills is carried out regularly in the first year of life, but when responsibility for the young child moves from the domain of medicine (midwife, pediatrician, and health visitor) to education at the time of school admission, a child's developmental readiness in terms of physical development is not assessed as a matter of routine. Once a child enters formal education on reaching five years of age in the UK, assessment of physical development takes place only if medical problems arise. Assessment within the school system tends to focus on educational problems or visible symptoms rather than investigation of underlying causes.

INPP in Chester was set up in 1975 by psychologist Peter Blythe, PhD, with the aim of investigating whether underlying physical factors could play a part in specific learning difficulties and in some phobic disorders. In the 1970s, Peter Blythe and David McGlown devised, first, systems of assessment to identify areas of impaired functioning, and second, physical remediation programs to correct the underlying dysfunctions. These methods of assessment, which involve examining the neurodevelopmental level of the child and the subsequent physical programs of remedial intervention, are now known as the INPP Method of Developmental Training.

By the very nature, symptoms of specific learning difficulties tend to cross diagnostic boundaries, with different categories sharing a number of symptoms in common (comorbidity). This is particularly true of many of the symptoms of dyslexia, developmental coordination disorder (DCD), attention deficit disorder (ADD), and some aspects of autistic spectrum disorders. A number of the symptoms shared in common are a direct result of immaturity in the functioning of the CNS and are sometimes referred to as neurological dysfunction or neurodevelopmental delay.

1.3 What Is Neuromotor Immaturity?

Neuromotor functioning provides one indication of maturity in the functioning of the CNS. It is also linked to functioning of the vestibular, proprioceptive, and postural systems, which cooperatively provide a stable platform for centers involved in oculomotor functioning and subsequently visual perception. Individuals with neuromotor immaturity (NMI) frequently experience difficulties with related skills such as balance, coordination, and visual perception, which can affect behavior and educational performance in children, and manifest as chronic anxiety and emotional sensibility in adults.

One method of identifying signs of NMI is through the use of standard tests to assess retention of primitive reflexes, development of postural reactions, and other tests for "soft signs" of neurological dysfunction. Soft signs, which have previously been dismissed as being too generalized to be useful diagnostic purposes are minor neurological signs, which suggest nonspecific cerebral dysfunction.

The presence or absence of primitive reflexes at key stages in development provide acknowledged signposts of maturity in the functioning of the CNS. Primitive reflexes emerge in utero, are present in the full-term neonate, and are inhibited in the first six months of postnatal life when connections to higher cortical centers and frontal areas develop. Primitive reflexes are also suppressed and integrated into more mature patterns of behavior in the course of normal development as postural reactions and muscle tone develop. Postural reflexes can take up to three and a half years to mature.

Primitive reflexes are retained in certain pathological conditions, such as cerebral palsy. In cerebral palsy, retention of reflexes occurs as a result of damage to the brain or abnormal development which may have occurred prenatally, at birth, or postnatally [1-7]. Damage to the immature brain interferes with the normal process of maturation in a predictable, orderly, developmental sequence resulting in lack of inhibition, demonstrated by prolonged retention of the primitive undifferentiated patterns of movement control characteristic of infancy, accompanied by abnormal muscle tone, development of postural control, impaired patterns of movement, and delayed motor development. Primitive reflexes also re-emerge in degenerative conditions such as multiple sclerosis and Alzheimer's disease, when demyelination results in deterioration of postural reactions, and primitive reflexes are disinhibited. For many years it was assumed that retention of primitive reflexes could not exist to a lesser degree in the absence of identified pathology and therefore primitive reflexes have generally not been the subject of investigation in children with less severe motor delays or children who simply present with signs of a specific learning difficulty.

The term Neuromotor Immaturity (NMI) as used by INPP describes the continued presence of a cluster of primitive reflexes in a child above six months of age together with absent or underdeveloped postural reactions above the age of three and a half years. NMI influences and also provides a reflection of maturity in the development and control of posture, balance, and motor skills.

Neuromotor immaturity (formerly neurodevelopmental delay), sometimes also referred to as neurological dysfunction, is defined by the INPP as (1) the continued presence of a cluster of aberrant primitive reflexes above six months of age and (2) absent or underdeveloped postural reactions above the age of three and a half years.

1.4 What Is the Connection between NMI and Specific Learning Difficulties?

Successful academic learning relies upon adequate mastery of motor skills: reading, for example, involves development and control of smooth eye movements to send an orderly flow of sequential information to the brain; eye movements are a motor skill. In order to write, a child needs to have developed hand-eye coordination, which is also a motor skill. Sitting still and paying attention require postural control, balance, and orientation, in addition to the involvement of cortical centers implicated in the maintenance of attention; aspects of mathematics require spatial skills and communication between the two sides of the cerebral cortex (left and right hemispheres) to cooperate in solving problems in a sequential fashion. Many of these "higher" cognitive...