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Your Hemispheric Sensory Assessment Briefing
Each hemisphere has separate circuits and centers that control various sensory and motor functions. What you will be doing is isolating the specific functions that are the weakest. As you do the assessment tests, it will become obvious that your child's strong functions are specific to one side of the brain and his or her weakest functions are specific to the opposite side. You will be assessing your child in ten areas: Mother and Child Health History Developmental Milestones History Sensory-Motor Skills Vestibular (Balance) Skills Auditory (Hearing) Skills Vision Skills Proprioception Skills Tactile (Touch) Skills Olfactory (Smell) Skills Prior to starting most of these assessments, you will fill out a ten-question checklist and rate your child on a scale of 1 to 10. A 1 means "does not apply", a 5 is "this sounds somewhat" like my child, and a 10 is "almost always"- this sounds exactly like my child. After you've completed all the checklists and assessments, I will show you how to tally them up and determine if your child has a left brain or right brain deficiency. Then I will teach you how to correct it.
BASIC RULES You should not attempt to do these assessments all in one day. Do them over the course of three to four days, or even a week. Review and fill out the checklist before you do each assessment. It is important that you answer these questions accurately, so consult with others- teachers, day care workers, babysitters, whoever is necessary. The tests can be done with only one parent participating. However, it is best for both parents to confer and agree on the answers. If both parents want to be involved, fill them out separately then compare notes. It is important that you and the child be in the right frame of mind. For example, if you're in a bad mood or your child is being fussy, then postpone the assessment to another time. Most children with FDS are very bright, so you want to explain everything you are doing but not necessarily the reason you are doing it – that is, you don't want to say you are trying to find out what is wrong with him or her. Rather, make it appear more like a game. I've done these assessments with children thousands of times, and for the most part, they really enjoy them and will get engaged as long as they feel like it is fun and they do not feel threatened. Do not comment on what you are seeing or discovering. Encourage your child all the time and give a lot of positive feedback. If the child seems uncomfortable or scared at any time, stop. You can always redo the test at another time. Most likely, your child will enjoy all the attention and like spending the time with you. Do the assessments in a location that is familiar to the child and is also comfortable, quiet, away from distraction, and has plenty of light. If your child is sensitive to light, make sure to adjust for it. For these tests you will need certain tools, which you should make sure you have, borrow, or purchase before you begin. These tools are: Penlight or small flashlight Tuning fork, preferably a C-128 Two small unused paintbrushes A straight chair A chair with arms that spins around A mat or soft surface for lying on the floor Several empty film canisters Essential oils of aromas familiar to your child, such as orange or lemon Some children may be too small or too low-functioning to do these assessments. It is also possible that some of the results you get will not be very clear or you may not be able to determine a specific level. In these instances you can depend on the results you get from the symptoms checklist in each section. At the end I will show you how to use they symptom checklists along with the Master Hemispheric Checklist to determine the side and level of dysfunction in each sensory and motor area. Each sensory-motor test is broken down, when possible, to three functional levels: Level 1: the lowest functional level Level 2: mid-level Level 3: the highest functional level (this is the ultimate goal) Here is one other important message before you begin. These checklists and assessments do not constitute a formal neurological or physical exam, or a professional diagnosis. This can only be done by a professional. These checklists and assessments are simply a guide to help you evaluate your child. If you find this difficult or your child does not respond, then you may need a more complete professional evaluation and/or your child would benefit best from an individualized program, such as we provide at a Brain Balance Center. You should try to find a local Brain Balance Center or a professional who has been trained in Hemispheric Integration Therapy or Functional Neurology. ABOUT THE ASSESSMENTS You will begin developing your corrective home program by evaluation your child's sensory-motor functions. Sensory-motor activities, which you will get to in the next chapter, form the most important part of the Brain Balance Program. As you now know, the foundation of baseline brain activity and balance comes from sensory and motor stimulation to the brain. Also, the most common symptoms that we see in children with FDS involve the muscles- lack of coordination, low muscle tone, clumsiness, bad posture, an awkward gait, and so on. Sensory stimulation is what drives brain development and activity, but it is the motor system that drives the sensory system. I have never seen a child who has just one sensory deficit, so you should not be looking for just one. Likewise, we never see a child with only gross (large muscle) or fine (small muscle) motor problems. It is usually a combination of both, although they usually have more of a problem with one for the other. In addition, it is impossible, unless the child has a specific brain injury, to have sensory deficits without various emotional, cognitive, immune, autonomic, and academic issues. However, the combination of these problems is different in each child. This is why these evaluations are so important. Relying on a list of symptoms alone is not the best way to identify what your child's specific problems are, or what activities the child must do to resolve these problems. Symptoms can be misleading but functions don't lie. Before you start, however, I want you to go back in time and review some things that will help you understand how your child got to this point. MOTHER AND CHILD HEALTH HISTORY Studies show a link between learning and behavior disorders and the early health history of either mother or child. Signs of a brain deficiency can show up early- in some children even before they are born. This is especially true of a right brain deficiency. Many clues can be found when looking back at your child's development history and your own health history and pregnancy- go through these lists. You don't have to write anything down or keep a tally. It is just one more assessment that will help you determine if your child has FDS and if it is due to a left or a right brain delay. Ø Mother's Health Profile PREGNANCY Difficulty getting pregnant, one or more miscarriages, or complications during pregnancies Fertility drug use
PRENATAL History of allergies and immune deficiencies, chronic fatigue, or fibromyalgia Gestational diabetes Thyroid dysfunction and possibly exposed to toxic chemicals or pesticides
BIRTH Breech presentation Forceps delivery Oxygen Deprivation Bruising or swelling about head and neck Induced labor
BIRTH TO AGE ONE Colic and other digestive problems Alternate chronic constipation and diarrhea Spitting up (reflux) or projectile vomiting Pyloric stenosis (stomach obstruction) Allergies and/or asthma Thrush (yeast infection) Eczema at birth that got worse Chronic ear infections that were aggressively treated with antibiotics Reactions to immunization Sleep disturbances Hypotonia (low muscle tone) Possible sensory deprivation prior to adoption
AGES ONE TO TWO Allergic symptoms: constant runny nose, red ears, puffy eyes White bumps on skin Increasing hyperactivity Strabismus (lazy eye), possibly nystagmus (involuntary shaking of the eyes side to side) Regression in milestones around age two
DIET Increasing limited diet due to strong likes and dislikes Preference for foods containing wheat and dairy Preference for milk and cereal or a bagel with cream cheese for breakfast Preference for grilled cheese sandwiches for lunch Preference for pizza or pasta for dinner or secondarily chicken nuggets Snacks on raw carrots Loves eating French fries
AGES TWO TO THREE Delayed or abnormal crawling or skipped stages of crawling before walking Clumsy or floppy movements Toe-in foot or knock-kneed Lisp in speech
Ø Normal Vital Signs As the child grows, the first areas of the brain that develop are those that control reflexes. An area called the medulla controls the automatic reflexes, such as breathing and heartbeat, that are necessary for basic survival. That's why they are called vital signs. There are basic values for heart rate, breathing rate, and blood pressure as a child matures. When a child is first born, the heart rate and respiratory rate are very rapid and blood pressure is relatively high. As higher areas of the brain develop, heart rate and breathing slow down and blood pressure drops. Once a child starts to stand and walk, heart rate and respiration get slower. If your child's brain is progressing normally, heart rate, respiratory rate, and blood pressure should match what is considered normal for certain age levels. By age three, the cerebral cortex should be taking over and inhibiting the primitive system that has been supporting vital functions since birth. If it is still too rapid at age three, it is an indication that the brain is immature for his or her chronological age. Some parents keep baby books that call for these entries. If you don't have one, ask your pediatrician's office to get you a copy. Compare them to this table.
Age Avg. Heart Rate Avg. Respiratory Rate Avg. Blood Pressure
Newborn 140 30-75 1-6 months 130 6-12 months 115 22-31 1-2 years 110 17-23 96/60-112/78 (2 yrs) 2-6 years 103 16-25 (2-4 yrs) 98/64-116/80 (6 yrs) 6-10 years 95 13-23 (4-10 yrs) 106/68-126/84 (9 yrs) 10-14 years 85 13-19 14-18 years 82 same as adult 112/74-136/88 (12 yrs)
Most likely you'll find that your child's record is off the chart. Most likely it still is. Brain Balance can improve this. Throughout the program you will keep track of your child's heart rate, breathing rate, and blood pressure. Do this once a week if possible. You can start tracking it now. Take your child's heart rate by counting the beats per minute at the wrist. You can easily measure their breathing rate by watching and recording how often your child's chest rises and falls in a ten-second period then multiply that by 6 to get their breaths per minute. You must do this when the child is not aware of it. Ask your pediatrician to check your child's blood pressure on both arms (they should be relatively equal). If there is a significant difference (more than 10 points) in any of the numbers, this is usually caused by a brain imbalance. The higher number is usually on the same side as the weaker hemisphere. As your child progresses through the program, you will see a change in vital signs.
DEVELOPMENTAL MILESTONES ASSESSMENT
During the first year of life, a baby grows at an amazing speed. Weight doubles by five or six months and triples by the first birthday. A baby is constantly learning. Major achievements, called developmental milestones, including rolling over, sitting up, standing, walking, and saying those first words. No two children are exactly alike. Most babies reach certain milestones at similar ages. However, it's not unusual for a healthy, "normal" baby to fall behind in some areas or race ahead of others. If your child was born prematurely (before thirty-seven weeks of pregnancy), you need to look at the milestone guidelines a little differently. The age at which a child is expected to reach various milestones is based on the due date, not the birthday. So if your child was born two months early, then you should add two months to each milestone. Compare your child's development to the table below. Make note if your child was early or late. Either one can be a sign that a child's underlying problem may have existed at birth. Again you don't have to write anything down or keep a tally. This table is the standard used by the American Academy of Pediatrics. I have found, however, that the real time frames are much shorter. For instance, according to the AAP, it is considered normal for a child to start walking between eleven and sixteen months of age. However, I have found that if the child starts to walk after thirteen or fourteen months, it is a sign of developmental delay. Many parents are delighted to see their child walk earlier than expected. They see it as a good sign. This isn't necessarily the case. I have found that is a child starts to walk before ten or eleven months, it is also a sign of a developmental problem. In order for the nervous system to develop properly, a child must crawl for at least two to four months before starting to walk.
ü HINT: In my experience, most parents are excellent at remembering if their child was early or missed a major milestone. If you can't remember some of these details, it is probably because there was nothing out of the ordinary. Ø Milestones By the end of their first month, most babies:
Make jerky, quivering arm movements Bring hands near face Keep hands in tight fists Move head from side to side while lying on stomach Focus on objects 8 to 12 inches away Prefer human faces over other shapes Prefer black-and-white or high-contrast Hear very well Recognize some sounds, including parents' voices
By the end of their third month, most babies:
Raise head and chest when lying on stomach Support upper body with arms when lying on stomach Stretch legs out and kick when lying on stomach or back Push down on legs when feet are placed on firm surface Open and shut hands Bring hands to mouth Grab and shake hand toys Follow moving objects with eyes Watch faces closely Recognize familiar objects and people at a distance Start using hands and eyes in coordination Begin to babble and to imitate some sounds Smile at the sound of parents' voices Enjoy playing with other people May cry when playing stops
By the end of their seventh month, most babies:
Roll over both ways (stomach to back and back to stomach) Sit up Reach for objects with hand Transfer objects from one hand to the other Support whole weight on legs when held upright Develop full-color vision and mature distance vision Use voice to express joy and displeasure Respond to own name Babble chains of consonants (ba-ba-ba-ba) Distinguish emotions by tone of voice Explore objects with hands and mouth Struggle to get objects that are out of reach Enjoy playing peek-a-boo Show an interest in mirror images Crawl
By their first birthday, most babies:
Sit without assistance Get into hands-and-knees position Pull self up to stand Walk holding on to furniture, and possibly a few steps without support Use pincer grasp (thumb and forefinger) Say "dada" and "mama" Use exclamations, such as "uh-oh!" Try to imitate words Respond to "no" and simple verbal requests Use simple gestures, such as shaking head "no" and waving bye-bye Explore objects in many ways (shaking, banging, dropping) Begin to use objects correctly (drinking from cup, brushing hair) Find hidden objects easily Look at correct picture when object is named
By their second birthday, most children:
Walk alone Pull toys behind them when walking Carry large toy or several toys while walking Begin to run Kick a ball Climb on and off furniture without help Walk up and down stairs while holding on for support Scribble with crayon Build tower of four blocks or more Recognize names of familiar people, objects, and body parts Say several single words (by fifteen to eighteen months) Use simple phrases (by eighteen to twenty-four months) Use two- to four-word sentences ("want snack") Follow simple instructions Begin to sort objects by shapes and colors Begin to play make-believe Imitate behavior of others Show growing independence
Source: Adapted from American Academy of Pediatrics, Caring for your Baby and Young Child; Birth to Age 5, Fourth Edition (Bantam Books, 2005)
MIXED DOMINANCE ASSESSMENT
Ideally, children should have a dominant side when it comes to using their hand, foot, eye, and ear. If they do not, it most often is a sign that the brain is not developing or maturing properly. A child's mixed dominance can be changed and the natural dominance released through the Brain Balance Program. We see it happen all the time. This does not mean that all children who are left-handed should be right-handed, but they should favor one side from head to toe. Here is how to find out. Here you will be determining your child's laterality. You are checking to find out if he favors left or right for:
Foot Eye Ear
If you find that your child's dominance is mixed, repeat this test each week, as you go through the Brain Balance Program. Seeing a change is a good sign, but it doesn't have to happen for all children.
Ø Hand You likely already know if your child is left- or right- handed, but do this test anyway. Record your finding in the space provided. Do this test outdoors. Find a ball, such as a baseball, that is small enough for your child to catch with one hand. Stand a few feet away from y our child and start tossing the ball back and forth. Little kids have a tendency to play catch with two hands, so you'll have to instruct your child to try to catch it with only one hand.
Hand used__________
Which hand does the child use to draw, crayon, or write?
Hand used__________
Which hand does the child use to brush their teeth?
Hand used__________
Ask the child if he is left-handed, right handed, or has mixed dominance. The answer is:
__________
Ø Foot
This exercise will tell you which foot is dominant, as foot preference is not something that is taught, such as handwriting in which a child is often urged to use the right hand. Ask the child to kick a very light ball across the room. If this is not available, bunch up some newspaper into a ball. Do this three times.
1. L_____ R_____ 2. L_____ R_____ 3. L_____ R_____
Ask the child to take off her shoes and, while standing, write her name on the floor with her toes. She doesn't have to actually finish this task. You want to find out which foot she uses. Do this on three different occasions.
1. L_____ R_____ 2. L_____ R_____ 3. L_____ R_____
Ø Eye
NEAR VISION Hand the child a kaleidoscope or magnifying glass and ask him to look through it. Which eye does he use?
L_____ R_____
FAR VISION Take a tube, such as one from a roll of paper towels. Select a small stationary object, such as a doorknob or light switch, and ask the child to focus on the object with one eye by looking through the tube. Hand the child the tube, pointing it at the center of his body. Tell him to take the tube with both hands, hold it at arm's length, and slowly bring it toward the eye. Note which eye he uses to focus on the object. Do this three times with different objects. Make sure that you aim at the center of the body when you hand the tube to the child and that the child grasps it with both hands before you let go.
Object 1. R_____ L_____ Object 2. R_____ L_____ Object 3. R_____ L_____
Ø Ear
Ideally you should use a tuning fork for this test. A C-128 is preferable. Demonstrate this task before asking the child to do it. Make sure you turn your head and put one ear to the tuning fork when demonstrating. If you don't have a tuning fork, you can use a cell phone. Hit the tuning fork and aim it to the middle of the child's face. Ask the child to turn his head without touching the tuning fork and listen to the sound. If using a cell phone, pick up the phone and tell the child that someone (a grandparent or friend) is on the phone and wants to say something. Do not let the child grab the phone. Aim it at the middle of the child's body so he will turn his head to listen. If this does not work, walk into a different room with the child and shut the door. Say you think someone is calling his name. Tell him to put his head up against the door and listen. Hold the door, so that the child doesn't choose to open the door instead. Do this exercise three times but not in a row and note which ear the child uses.
Exercise 1. L_____ R_____ Exercise 2. L_____ R_____ Exercise 3. L_____ R_____
Ø Dominance Profile
Use this area to log your discovery. If the child used the right in some tasks and the left for others for the same body part, there is no dominance. Check off "Mixed" for ambidextrous.
Hand Left_____ Right_____ Mixed_____ Foot Left_____ Right_____ Mixed_____ Eye Left_____ Right_____ Mixed_____ Ear Left_____ Right_____ Mixed_____
PRIMITIVE REFLEXES
Primitive reflexes are the basic necessities of survival that are housed in the central nervous system. The development of the central nervous system begins at conception and develops in a regular sequence. Parts of this sequence are identified by the movement patterns that occur at each stage. These are called reflexes. Each reflex plays a part in the necessary growth of the fetus and infant. Each reflex also prepares the way for the next stage of development. These primitive reflexes should disappear by the age of one. If they don't, it indicates a developmental delay. I have found that as you balance the brain, these primitive reflexes will naturally disappear. If your child seems to get "stuck" or does not improve while doing the At-Home Brain Balance Program, you should have your child professionally evaluated. A trained professional can devise a specific exercise program to correct the problem. This is also true for mixed dominance.
POSTURAL ASSESSMENT
Ø Head Tilt
Here you are going to determine if the head tilts right or left. Ask your child to sit straight but dono't ask him to hold his head straight. The side of the tilt is usually the side of the weaker hemisphere. Have your child sit facing you, preferably at eye level. You want him to sit straight and remain still; however, he needs to be in a natural position so he feels comfortable. Check for a head tilt by observing the bottom of the ear. Record which side is lower.
Right_____ Left_____
Ø Eye Balance
Here you are going to assess for an eye imbalance. Gently position the child's head so that it is level or straight. The head is level when the bottoms of the ears are level facing you. This will bring out any imbalances in their eyes more. Ask the child to look straight ahead, either at you or the wall behind you. Look at your child's eyes and observe if one is wider than the other. To detect this, look at the distance between the iris (the colored part of the eye) of each eye and the lower eyelid. Record the eye with the larger distance. The eye that seems to be larger will usually be on the side of the weak hemisphere.
Right_____ Left_____
Ø Fixation
Some children with right hemisphere deficits are not able to fix their eyes on an object without blinking or moving their eyes for more than 3 seconds. The ability for a child to hold his eyes still and focus on an object or person is known as fixation. It is very important and is almost always lacking in a child with a right hemisphere weakness. Point to an object or pick up an object and position it no closer than 18 inches in front of the child's face. Ask the child to stare at the object. Count to three. Indicate below if the child was able to fixate.
Fixation No_____ Yes_____
Ø Pupils
Now you are going to check your child's pupils. You do not want your child to be focusing on something close when you do this. Have the child focus on a spot on the wall behind you, so it is easier to keep the eyes still. Look to see if one of their pupils is larger than the other. You may have to look back and forth several times to see any difference. The larger pupil is usually seen on the side of hemispheric weakness.
Larger Pupil R_____ L_____
Ø Facial Muscles
Here you will be checking for facial muscle weakness. The best way to do this is to look at the nasolabial folds. These are the faint lines (in children) that go from the bottom of the nose to the corner of the mouth (in adults these are often called "laugh lines"). When you look closely, these two lines should be equally visible or absent in a child. You may see that one of the creases looks deeper than the other. If there is a noticeable crease, the side where there is no crease or a more shallow crease is usually the side of the weak hemisphere. If you cannot find the fold, do this: Look at the child's closed mouth when she is neither smiling nor frowning. You may see that one side is slightly lower than the other. Note the side. This and the fainter or absent crease indicate a hemispheric weakness on the same side.
Right_____ Left_____
Ø Soft Palate
You will need a penlight or a flashlight for this assessment. Actually, most children are good at this as long as you don't use a tongue depressor. If the child's tongue gets in the way, use a Q-tip to hold down the front of the tongue. Don't put it toward the back or it will make the child gag. Have the child open her mouth and say "Ahhhh". Tilt her head back slightly or crouch down, so you can get a look at the soft palette, or the back roof of the mouth. Have her continue to say "Ahh". Observe the little white stripe that goes from the front to the back of the soft palate that divides it in two. As the child says "Ahh", you will see that the soft palette goes up as the muscles contract. Both sides of the soft palette should go up at the same speed and same distance. You are checking to see if the white stripe in the middle is drawn more to one side or the other. The side that the white stripe moves toward is usually away from the side of the brain that is weak. Record the side that the stripe is moving away from.
Right_____ Left_____
Ø Tongue Deviation
Ask the child to open her mouth slightly and stick out her tongue as far as possible. Look to see if the tongue points to the left or right. Opposite of what is seen with the soft palette, the tongue will usually point toward the weak hemisphere. Record the side that the tongue is moving toward.
Right_____ Left_____
Ø Standing Body Tilt
You want to be able to see the child's body in this assessment, so have her wear shorts and a T-shirt. Have the child stand straight in front of you. Bend or sit to observe the child at shoulder height. Note if one shoulder is lower than the other. You can also observe this by looking at the child from the back . note the side of the shoulder tilt. This usually indicates the side of weakness. A shoulder tilt can also indicate scoliosis (curvature of the spine), so you should have this checked by your child's pediatrician or chiropractor.
Right_____ Left_____
Ø Elbow Bend
Ask the child to stand up straight in a relaxed natural position, with his arms at his sides. Check for a bend in the elbow and note which elbow is bent more. The side with the more pronounced bend will usually be on the side of hemispheric weakness.
Right_____ Left_____
Ø Hand Placement
Ask the child to stand up straight in a relaxed natural position, with his arms at his sides and hands relaxed. The thumbs will naturally face forward toward you. You should not see the back of either hand facing you. If they do, this indicates that the arm is rotated in toward the body on that side, signaling an imbalance between the muscles in the front and back of the arm. This is usually seen with brain imbalance. Check to see if you can see the back of one hand more than the other. Note the side. This is usually on the side of hemispheric weakness.
Right_____ Left_____
Ø Thumb Strength
You can do this one thumb at a time, though doing both together will give you a better comparison. Ask the child to stand up straight in a relaxed natural position. Ask him to make a fist with both hands and stick the thumbs up in the air as straight as possible. Place your thumbs on top of his thumbs, instructing that he not let you push his thumbs down. Gently increase pressure on his thumbs until the muscle fails. Take note if one thumb is weaker than the other. The side of the weaker thumb is usually on the side of the weaker hemisphere.
Right_____ Left_____
If this didn't work, you can try this instead. You may want to repeat this a few times to get an accurate gauge. Ask the child to bring the thumb and pinky finger of one hand together on the same hand and hold the position tightly. Say you are going to try to pull the fingers apart buy you want him to resist. Gently try to pull the fingers apart until they separate. Do the same with the other hand. The side on which the fingers are the strongest is usually opposite of the side of hemisphere weakness.
Right_____ Left_____
Ø Big Toe
Have the child sit in a chair barefooted and raise one leg straight out. Ask the child to move the big toe in toward her body as far as possible. Tell her to resist as you gently try to push the toe down toward you. Repeat with the other leg and toe. Record the side with the weaker toe. This is the side of hemispheric weakness.
Right_____ Left_____
Ø Postural Assessment Results
Transfer the postural assessment results here. You should see that most, if not all, are either left or right. This correlates to a brain deficiency of the same side.
Head Tilt Right_____ Left_____ Eye balance Right_____ Left_____ Fixation Right_____ Left_____ Pupils Right_____ Left_____ Facial muscles Right_____ Left_____ Soft palate Right_____ Left_____ Tongue deviation Right_____ Left_____ Standing body tilt Right_____ Left_____ Elbow bend Right_____ Left_____ Hand placement Right_____ Left_____ Thumb strength Right_____ Left_____ Big toe Right_____ Left_____ Total Right_____ Left_____
VESTIBULAR FUNCTION CHECKLIST
The vestibular system is all about balance and spatial awareness. These are signs of a problem in this area. Read each of the following symptoms and rate each item that most closely describes your child. A 1 indicates "doesn't apply at all", and a 10 is "almost always". Add up the numbers and record the total. (The lowest possible score is 10, and highest is 100.)
Exhibits poor balance_____ Had delayed crawling, standing, and/or walking_____ Poor muscle tone_____ Experiences motion sickness_____ Dislikes heights, swings, carousels, escalators, elevators_____ Easily disoriented and/or a poor sense of direction_____ Clumsy_____ Difficulty remaining still; may actively seek movement such as spinning/rocking_____ Difficulties with space perception_____ Walks or walked on toes_____
TOTAL_____
VESTIBULAR BALANCE ASSESSMENT
The term Disconnected Kids is a direct reference to a malfunction of the vestibular or inner ear, system. The vestibular system is one of the main systems that helps children orient themselves in the earth's gravitational pull. It helps them maintain proper posture and balance. The inner ear balance system, along with the proprioceptive (spatial awareness) system and the oculomotor (eye muscle) system, make up the majority of all stimulus to the brain. The vestibular system works closely with the visual and auditory systems to help with the spatial awareness and movement. A child who has an underactive vestibular system will be kind of clumsy and may never seem to get dizzy when spinning. A child with an overly active vestibular system gets dizzy easily. This is the child who gets motion sickness in the car. What you will be looking for in this assessment is balance between the right and the left vestibular system. If one side is overactive, it will make the other side underactive. The vestibular system on one side sends its signal to the opposite side of the brain. When a child turns in one direction, it activates the vestibular system on the same side. So if a child spins to the right (clockwise), it turns on the vestibular system in the right ear, and vice versa. This is what you are going to do in these tests. It is called post-rotational nystagmus and its is the best way to assess balance of the vestibular system. Nystagmus is the term used to describe quick involuntary movements of the eyes that occur when the body spins or the head moves quickly. This is what gives us the sensation of vertigo or that the earth is spinning, even if we are still. The primary vestibular area in the brain that processes vestibular information resides in the right side of the brain and lies very close to the part of the brain that controls the digestive system and the sense of taste or smell, the right frontal insula cortex. This is why you feel nauseous when you are dizzy. These tests will help determine if your child has a weakness of the right or the left vestibular system. The weak hemisphere will be opposite the weak side of the vestibular system. For all these tests, you will need a chair with arms that spins easily. The arms are important for the safety of the child so make sure that you only use a chair with arms.
Ø Post-Rotational (Nystagmus) Tests
SLOW SPIN
Have the child sit straight in the chair with the head bent slightly forward and in the middle. Legs must be off the floor and on the chair, either tucked in or Indian style. Instruct the child to keep the head still during the exercise. Start spinning the chair slowly to make sure the child can tolerate the test. You only need to do this for a few seconds. Ask the child to close his eyes and very slowly spin the chair in one direction. It should take 60 seconds to do one full rotation. While you are spinning, instruct the child to point a finger in the direction he is spinning. Also, tell him to let you know when you've stopped spinning the chair. Slowly bring th chair to a stop. Ask the child if he is still spinning. If he says yes, then ask him to tell you when he stops. Once the child says the spinning stopped, have him open his eyes. Ask if he feels dizzy or sick. Then repeat the same exercise in the opposite direction. Note if the child could correctly identify the direction of motion, when he said the chair stopped spinning, and if he felt dizzy when he opened his eyes. Record the results of both scores.
LEFT SPIN Direction of spin L_____ R_____ Accurate stopping Yes_____ No_____ Dizziness Yes_____ No_____
RIGHT SPIN Direction of spin L_____ R_____ Accurate stopping Yes_____ No_____ Dizziness Yes_____ No______
FAST SPIN
If the child can tolerate slow spinning, you are going to speed it up to make the child get dizzy. Start from the same position as above. With the child's eyes open, spin the chair in one direction ten times. Each full rotation should take 2 seconds. After the tenth rotation stop the child so she is facing you. Tell the child not to look directly at you but up towards the ceiling. You may want to gently grab her head so she doesn't move it around. Quickly check the child's eyes. Both eyes should be moving quickly back and forth. Count how long this continues. Note it in the space below. When the eyes stop moving, the child should stop feeling dizzy. Make sure the eyes have stopped moving and there is not dizziness before repeating in the other direction. If the eyes are not moving after they stop, this shows a very underactive vestibular system. Normal eye movement after spinning is 12 to 14 seconds. Less than 12 seconds is considered under active. Longer than 14 seconds is considered overactive. The underactive side indicates the underactive hemisphere.
Right spin (clockwise) _____ seconds Left spin (counterclockwise) _____ seconds
LEVEL 1 Feels dizzy after slow spin or can't accurately tell direction of slow spin. No movement of eyes after fast spin.
LEVEL 2 Movement of eyes for less than 6 seconds after fast spin.
LEVEL 3 Movement of eyes for 12 to 14 seconds.
Ø Vestibular Ocular Reflex
When we walk, the head bobs up and down in a kind of figure 8 movement. If the eyes moved with the head, the world would be blurry. So we have a reflex that keeps the eyes still and level to the horizon when we walk, run, or move our head. This reflex is called the vestibular ocular reflex. When the head moves in one direction, the vestibular system signals the eyes to move in the opposite direction at the exact same speed the head is moving. This keeps the eyes still even though the head is moving. If there is an imbalance in the vestibular system, the cerebellum, or the neck and postural muscles, it can affect how well all this works. A sensitivity on one side means there will be an undersensitivity on the other. The undersensitive side can make a child clumsy and bang into things. If overactive, the child will get dizzy and may get motion sick. Here is how you are going to test this reflex. Have the child sit opposite you in a stationary chair. Hold up your index finger about 18 inches from the front of her nose. Have the child focus both eyes on your finger and tell her to slowly turn her head to one side only as far and as fast as she can while she can still see your finger, then ask her to turn her head back to the middle and stop. Do this ten times to the same side without stopping. The child should be able to keep her eyes fixed on your finger the whole time. If her eyes turn away toward her head motion, this is abnormal. Count how many times the eyes turned away from your finger and toward the direction of the head movement. The more the eye turns away from the finger, the more the reflex is underactive. If the child is able to maintain contact with the finger but gets dizzy afterward, it is a sign that the reflex is overactive on that side. The underactive reflex will be on the opposite side of the underactive hemisphere. If it is underactive and overactive on both sides equally, this is rare but it is a sign of a general vestibular dysfunction.
LEVEL 1 Eye turns 6 to 10 times.
LEVEL 2 Eye turns 1 to 5 times.
LEVEL 3 No eye turns and no dizziness.
UNDERACTIVITY R (L hemisphere) _____ L (R hemisphere) _____ Equal _____
Ø Vestibular Balance Results
Record the results of the tests here. If the results favor one side, there is a weakness in the opposite direction.
Slow Spin (clockwise) R_____ L_____ Slow Spin (counterclockwise) R_____ L_____ Fast Spin (clockwise) R_____ L_____ Fast Spin (counterclockwise) R_____ L_____ TOTAL R_____ L_____
AUDITORY FUNCTION CHECKLIST
These are the symptoms of a problem with the auditory sensory system. Read each of the following symptoms and rate each item as it most closely resembles your child. A 1 indicates "doesn't apply at all", and a 10 is "almost always". Add up the numbers are record the total. (The lowest possible score is 10 and the highest is 100.)
Concern about hearing as an infant _____ Inability to sing in tune_____ Hypersensitive to sounds_____ Misinterprets questions_____ Confuses similar-sounding words; frequently needs to have words repeated_____ Inability to follow sequential directions_____ Flat and monotonous voice_____ Hesitant speech_____ Small vocabulary_____
Total_____
AUDITORY ASSESSMENT
Many of the children we work with in our clinics have some type of auditory problem. Almost all have hearing that tests normal, yet they don't seem to react to sound in a normal way. Some are undersensitive to sound. In fact, many parents tell me that they thought their child was deaf as an infant. Many parents of children diagnosed with attention and reading problems have also been diagnosed with some type of auditory processing problem, also referred to as central auditory processing disorder. What most people are unaware of is that auditory processing, like most sensory detection and processing, is different in the right and the left hemispheres. It is not enough to say the child has a hearing or auditory processing deficit. It must also be determined if it is a right or left deficiency. This is important because the problems associated with such a disorder show up differently, and they require different approaches. No sensory function words in isolation. All the senses are dependent on other sensory functions, which are dependent on a baseline level of brain activity. Most people assume that if a child doesn't respond well to sound, or if he doesn't process sound properly, there must be something wrong with his ears or with his hearing mechanism. In most instances that we see, this is not the case. The hearing pathway and the ears are perfectly normal; the brain is not responding to the sound because brain activity is under threshold. If brain activity is not pulsing at the right speed, it can't keep up with the input of sound. It does not reach a conscious level of awareness. The baseline level of brain activity comes mainly from the constant flow of input from gravity- that is, input from postural muscles and other tendon, joint, and skin receptors. This is why auditory stimulants alone is not enough to make the brain word as a whole. The big muscles must be worked as well. The best way to test hearing and auditory processing is through formal testing with an audiologist. If your child has had a hearing test, find out if there was a hearing difference in the two ears. If one ear is hearing less, even if both ears are within normal limits, this may signify and imbalance in the brain. The audiologist, however, may not look at this. There are simple tests you can perform to see if your child has decreased or unbalanced hearing and processing. Of course, before doing these tests, make sure your child doesn't have an ear infection or fluid or wax in his ears at the time of the testing. Get your child's ears checked and have a formal hearing test performed as well.
Ø Tuning Fork Test
You will be using a tuning fork for this assessment. Demonstrate what you are going to do on yourself several times, so you are familiar with the procedure. Also, tell the child exactly what you are going to do and what you want him to do during the process. Quick movements often make a child jump, so you'll actually want to demonstrate without sounding the tuning fork. You want the child to sit still and not move his head or try to grab the instrument. Explain that you will be hitting the fork and it will make a ping sound followed by a low and steady hmmmmmm sound. Tell the child to let you know when he doesn't hear the sound anymore. Now, hit the tuning fork and put it about 2 to 3 inches from the right ear. Use a stop watch or count in your head the number of seconds that go by before you get the signal that the sound has stopped. Record the elapsed time. Do this at least two or three times to be certain the results are accurate. The elapsed time should be the same for both ears. Also ask the child if it sounded louder in one ear than the other. Typically, the sound should be audible for about 60 seconds, depending how hard you hit the tuning fork. Less than 60 seconds indicates reduced sensitivity to sound, either because of poor attention or reduced processing of sound in the brain. This is usually opposite the side of hemispheric weakness. So, note in the space below the side of the brain opposite of the reduced hearing. Another way you can do this exercise is with vibrations. This will make your results even more accurate. As you strike the tuning fork, you will feel the vibration in your fingers. As you count, take note how many seconds after the vibration stops that the child stops hearing the sound. The child should hear the sound for 10 to 20 seconds after you stop feeling the vibrations in your fingers. It should be equally as long on both sides.
Side opposite weak hearing ear R_____ L_____
Ø Simultaneous Sound (Dichoric Listening) Test
This test should be done with the eyes closed. If the child is too distracted to do this, you will need to cover her eyes so she can concentrate on what she is hearing. Again, this test may take some practice, so try it on yourself or your spouse first to make sure you are doing it correctly. The idea of this test is to present the exact same sound to both ears at the exact same time. You will be checking to see if the child hears the sound first in one ear before the other. You want to be eye level, so you should kneel in front of the child or have the child stand on a steady chair. Stand or kneel facing the child. Extend your arms so your hands are 18 inches from both your child's ears. Rub your thumbs against your fingers and ask the child if she can hear the sound. If not, slowly move your hands closer to the ears at the same speed and distance, and ask the child to signal you when she hears the sound. Ask if she heard it in both ears or just one. If it is just one, continue to get closer until she hears the sound. Sound heard first in only one ear indicates a weakness on the opposite side of the brain of the ear that was slower in hearing. Note the sound opposite from where the sound was first detected. Note the side of decreased hearing.
Sound in both ears at the same time_____
Side opposite the ear where the sound was detected L_____ R_____
LEVEL 1 Child hears sound for less than 30 seconds in either or both ears or has a significant or large difference between the two ears on either test.
LEVEL 2 Child hears sound for less than 45 seconds in either or both ears or has a moderate difference between the two ears on either test.
LEVEL 3 Child hears the sound for 60 seconds in both ears and has no difference between the two ears.
Ø Auditory Dysfunction Results
Transfer the results here.
Tuning Fork Test R_____ L_____ Simultaneous Sound Test R_____ L_____ Total R_____ L_____
VISUAL DYSFUNCTION CHECKLIST
This checklist focuses on symptoms that make reading difficult. If you are not sure, talk to your child's teacher or go through some reading exercises with your child. Read each of the following symptoms and rate them as they most closely describe your child. A 1 indicates "does not apply" and a 10 is "almost always". Add up the numbers and record.
Misreads words_____ Misses or repeats words or lines_____ Reads slowly_____ Needs to use fingers or marker as a pointer_____ Inability to remember what was read_____ Poor concentration_____ Poor focus while reading, i.e., letters move or jump around on the page_____ Crooked or sloped handwriting_____ Letters appear out of balance with one eye covered or when trying to read sideways_____ Sensitivity to light_____
Total_____
VISUAL ASSESSMENT
Vision is the most complex sense to test, for several reasons:
· It is the only sense that is directly dependent on the movement of muscles. · Eyes have to detect both light and movement. · Sometimes eyes must move in perfect concert, as in tracking something slowly or reading a book, but they sometimes must move in the opposite direction, such as when looking at a schoolbook and watching the blackboard. · Some eye movements are voluntary but most movements are involuntary. · The muscles of the pupils of the eyes need to contract and relax smoothly to help the eye focus close and far away.
On page 35, I described that there are two different visual systems- the where and the what. The where system is not sensitive to color, sees things faster, and is more interested in the big picture. It's the right brain system. The what system is very sensitive to color, sees things more slowly, and focuses on details. It is the left brain system. The muscles of the eye are also proprioceptive, meaning they help us feel ourselves in space. Studies show that if we place very small vibrators around the eyes, we can alter individual's perceptions of their bodies in space or make them feel as if they are moving in a particular direction. This tricks the brain into thinking the body is moving. This illustrates that they eye muscles are powerful messengers and can even override what the person is actually seeing. All of these factors are separate from 20/20 vision. People think that 20/20 vision is all that matters, but in fact, it is probably the least important function of the eye and the visual system. Some children are born with a weak eye muscle. Their eye may be turned in or out on one side. This is called strabismus. We have all had the experience of talking to someone whose one eye is focused on you but the other eye is somewhat "off". Though this has traditionally been looked at as an eye problem, we can now see that the issue may have more to do with the brain. For proper vision, both eyes must work in perfect concert. When one eye is weak or "lazy", it means a child can only see with one eye at a time. Obviously, this interferes with good vision. Only the child does not recognize this. Each eye can see when the other is shut, but when both eyes are open, the brain ignores the images in the one eye and only sees out of the good eye. At one time, doctors believed this was caused by a weak eye, but now we know that it is caused by the brain being out of rhythm. Vision comes from the occipital lobe. The right lobe gets vision from the left half of both eyes. If one eye is blind, the occipital lobe will take over both sides. If the two hemispheres of the brain are not in sync, however, the occipital lobes are desynchronized. The brain gets two completely different visions of the world. The brain can't fuse the images together, but instead of seeing double, it ignores the bad eye and focuses only on what it sees out of the good eye. When the problem is sight, vision can adjust and compensate. However, the worse the problem, the worse the symptoms will be.
Ø Light Sensitivity Test
Using a penlight or small flashlight on the lowest setting, focus the beam in the outside corner of one eye. Count how long it takes for the pupil to constrict and enlarge completely back to its original size. Depending on how bright the light is, the pupils should normally stay constricted for about 10 seconds. If the pupil constricts quickly and dilates right away, this usually shows a weakness in the brain on the opposite side. Also note if the child's eyes tear or if they are so hypersensitive to the light that you can't perform the exercise. The weak hemisphere is usually opposite the eye that dilates first.
Right eye_____ seconds Tearing Y_____ N_____ Sensitivity Y_____ N_____ Left eye_____ seconds Tearing Y_____ N_____ Sensitivity Y_____ N_____
LEVEL 1 The child turns away from the light or closes her eyes
LEVEL 2 The child's eye constricts then dilates quickly. It takes less than 10 seconds to dilate.
LEVEL 3 The child's pupil constricts and then returns to fully dilated in 10 to 15 seconds.
Ø Fast Tracking (Saccades) Test
Fast tracking is a very important vision function. It is critical in reading, for example, when the eye jumps from one line to the next. Many children with FDS have great difficulty in doing this and may overshoot or undershoot the target. This makes reading difficult and very slow. This testing will allow you to determine which side of the brain is underactive, slower, and underconnected. Sit directly in front of your child at eye level. The child should sit tall with head straight. If you detect a head tilt, try to gently straighten the head. Hold your pointer fingers about 12 inches from your child's face and about 30 degrees out to the side. Tell the child to stare at your face. Say you are going to wiggle your finger and tell the child to turn her eyes to the finger without moving her head as soon as she detects it. Watch her eyes carefully to see if she overshoots when she turns to focus on your finger. When you say okay, the child should turn her eyes back and stare at your nose. Repeat by wiggling your fingers in a random pattern so the child cannot predict where to start or stop. Do this a total of five times. Repeat on the other side. The side of the brain opposite the direction of the eyes that overshoots will be the side of the weak hemisphere.
Side opposite the overshoot R_____ L_____
LEVEL 1 The child cannot do the activity or she overshoots every time in either direction, or she has a significant difference between the speed of movement of both eyes.
LEVEL 2 The child overshoots two times in either direction or she has a significant difference between the speed of movement of both eyes.
LEVEL 3 There is no overshooting, and speed of movement is equal on both sides.
Ø Slow Tracking (Pursuit) Test
Only humans and the highest level of primates can perform conscious voluntary slow tracking movements with the eyes. Obviously this means this has something to do with having a more sophisticated brain. Therefore, measuring this ability in children is very important. If a child can perform smooth, slow tracking movements while following a target both left and right, it is a good sign of brain development. This is also very easy to assess. This child's head needs to remain still during the exercise. If the head moves, put your hand on top of the head to hold it in place. Have the child seated in front of you so that you are face-to-face. Tell the child to sit straight with the head level and still. Place your index finger at eye level and to the left of the child's head. Tell the child to turn her eyes and follow your finger as you move it slowly to the right and as far as the eyes can follow. It should take about 6 seconds to get from one side to the next. Reverse the direction. If the child has trouble, or if the eyes are moving more slowly or if they are jumping back and forth more following your finger to one side, it is a sign of a hemispheric deficiency in the same side. If she cannot follow your finger in either direction, it shows poor fixation ability, which is a right hemispheric weakness.
R_____ L_____ No fixation_____
LEVEL 1 The child cannot follow the finger or has significant jumping of eyes or slowness in either direction or has a significant imbalance in speed and accuracy of tracking between the two sides.
LEVEL 2 The child can follow the finger but has significant jumping of eyes in either direction or has a significant imbalance in speed and accuracy of tracking between the two sides.
LEVEL 3 The child can track the finger smoothly to both sides with no jumping and has no difference in speed in either direction.
Ø Crossing Eyes (Convergence/Divergence) Test
The ability to bring both eyes toward the nose at the same time, or crossing the eyes, is known as convergence. This is another skill that we assume children can do but it is no guarantee. Between 30 and 50 percent of all children diagnosed with ADHD cannot cross their eyes. I have found this is also true with most children with a right hemisphere weakness. If the child cannot cross his eyes smoothly, it affects close-range reading. It also makes it difficult to copy from a blackboard. If the eyes can't work together, then it is likely that the two hemispheres are not working together as well. Have the child sit straight with the head straight. Face the child at eye level. Raise your index finger about 18 inches in front of his nose. Tell him to follow your finger with both eyes as you slowly move it in toward his nose. Ask him how many fingers he sees. If the answer is two fingers, it is an indication that the eyes are not aligned and they may have a more severe muscle weakness. You should be able to get 1 to 2 inches in front of the nose before he sees two fingers. Move your finger back till he says he sees only one finger. Check the child's eyes to see if one is turned out. The eye that is turned out is the weak eye and usually indicates a hemispheric weakness on the same side. If he cannot cross his eyes at all, it shows a right hemispheric weakness. If the child can successfully do the exercise, repeat it five to ten times and observe if one eye fatigues and turns out. If one tires and turns out early, it can also indicate a brain weakness on the same side. Record the results below.
R_____ L_____ Cannot cross eyes_____
LEVEL 1 Cannot cross eyes closer than 12 inches from nose without seeing double.
LEVEL 2 Cannot cross eyes closer than 6 inches from nose without seeing double.
LEVEL 3 Can cross eyes equally up to 2 inches from nose without seeing double.
Ø Vision Assessment Results
Transfer the vision assessment results here. If the results weigh heavily to one side, it indicates an imbalance on that side of the brain.
Light Sensitivity Test R_____ L_____ Fast Track Test R_____ L_____ Slow Track Test R_____ L_____ Cross Eyes Test R_____ L_____ Total_____
PROPRIOCEPTIVE FUNCTION CHECKLIST
This checklist will help judge how well your child feels his or her body in space. Read each of the following symptoms and rate them as they most closely describe your child. A 1 indicates "does not apply" and a 10 is "almost always".
Poor Posture_____ Constant fidgeting or moving_____ Excessive desire to be held_____ Provokes fights_____ Hooks feet around legs of desk for support_____ Problem identifying body parts in space_____ Bumps into things often_____ Poor balance_____ Rocks body or bangs head_____ Does not like heights_____ Total_____
PROPRIOCEPTIVE ASSESSMENT
Proprioception is the ability to know where one's body is in space relative to gravity and where it is relative to itself and other people or objects. I consider the proprioceptive system the most important influence on other sensory systems and the brain as a whole. Other doctors believe the vestibular system is more important, but I disagree. Research has proven that a person can compensate fairly well for a vestibular loss but can never compensate for a severe proprioceptive loss.
The funny thing about the proprioceptive sense is that when it is diminished or lost, no one- parents or child- realizes it because it is the one sense that is mostly subconscious. We are much more familiar and consciously aware of the other senses such as vision, hearing, smell, taste, and touch. Proprioception, however, is more essential to the brain because it is the only sense that is constant. It works closely with the vestibular system, which also is mostly subconscious.
When children first start to move and walk, they have to actively think about their movements. This makes it hard for the brain to concentrate and learn anything else. If a child doesn't get it- if he is clumsy and walks oddly- it is hard for him to move on to other skills because his brain is so preoccupied with trying to control movements. When a child learns to walk and move naturally, however, the brain no longer has to think about these things. Movement becomes subconscious.
Muscle tone is also a good indicator of proprioception. If the child has low muscle tone, then the muscles and tendons and joints will be undersensitive to movement because the body has to move a lot more before the brain reacts to that movement. This is what makes movements appear clumsy, slow, and uncoordinated.
Ø Standing Balance (Rhomberg) Test
Have your child stand facing you in a relaxed position and barefoot. Ask him to move his feet together so the ankles touch. Note if he remains straight or sways to one side or the other. Stand close enough so you can catch him if he falls. If he can stay balanced, ask him to close his eyes. Again, look for a sway. A sway or fall indicates a hemispheric weakness in the opposite direction of the sway. Record the side of the brain that is opposite the sway.
L_____ R_____ No sway_____
Ø One Foot in Front of the Other (Manns) Test
If your child did fine on the previous test, these two tests will be more challenging. Have the child stand straight, barefoot, and relaxed with feet together. Tell the child to put one foot directly in front of the other. Note if he sways to one side. Be close to catch him in case he falls. As he keeps the pose, ask him to close his eyes. A sway to one side indicates a hemispheric weakness on the opposite side of the sway. Record the side opposite the sway.
Eyes open L_____ R_____ Eyes closed L_____ R_____
Ø One Leg Stand
Have the child stand barefoot in front of you. Ask him to lift one leg bent at the knee. Use a stop watch or count silently the seconds the child can remain upright without swaying or needing to grab on to something. She should be able to maintain the position for 30 seconds. If successful, ask her to repeat the exercise with eyes closed. She should be able to do this for 10 seconds. Repeat with the opposite leg. Repeat the test three times to verify your counting. A sway or fall on one side indicates a hemispheric deficiency on the opposite side of the sway. The side of the shorter balancing time indicates a deficiency on the opposite side of the brain. Record the side opposite the sway.
Longer balancing time L_____ R_____ Shorter balancing time L_____ R_____
LEVEL 1 Stand with one foot in front of the other. Eyes open without falling for 30 seconds.
LEVEL 2 One leg stand with eyes open for 30 seconds without falling or putting foot down.
LEVEL 3 One leg stand with eyes closed for 30 seconds without falling or putting foot down.
Ø Core Stability Test
The core muscles are mainly in the trunk and abdomen. Weakness and poor muscle tone in these muscles are usually due to or can cause poor proprioceptive awareness. Because these muscles are mainly under subconscious control, exercises cannot be done consciously. The left brain controls most conscious or voluntary movements, especially of small muscles of the hands and feet. Lifting weights, for example, are voluntary muscle movements. The muscles that stabilize the body contract involuntary. This is why conscious exercise won't strengthen these muscles.
The key to stability is a balance of the muscles in the front, back, and sides of the trunk. Normally, the spinal muscles in the back should be 30 to 50 percent stronger than the abdominal muscles. The muscles on the left side of the spine should have about the same strength and endurance as the muscles on the right. This balance, plus overall strength, is critical to stability and balance.
A child may appear to have weak leg and arm muscles when, in fact, it is the stabilizing big muscles of the spine that are weak. If the foundation is weak, the arm and leg muscles will appear weak. Sitting inactivates these muscles and will make them weak or lead to delayed development of muscle tone. This is another reason why TV and video games are bad for your child.
Ø Supine Bridge Core Test
LEVEL 1 Have the child lie on the floor, hands by the side for stability and legs shoulder-width apart. Ask the child to lift his trunk off the floor so the spine is straight. You can put your hands under his backside to help him lift but don't keep it there. Have him hold this position still for as long as possible. Use a stop watch or count to yourself how long he can hold the position. If he starts to shake, bend, or collapse, encourage him once to keep going, but if he can't correct this, stop counting. A small child should be able to maintain this position for at least 30 seconds; an older child should hold this for 60 seconds.
Time:_____
LEVEL 2 If the child achieved Level 1, give him a 10-second rest and have him do this exercise. It eliminates some of the stability and adds resistance to the muscles, making the exercise harder to do.
While still lying on the floor, have the child put his knees together and cross his arms over his chest. Ask him again to lift his trunk off the floor and hold the same spine-straight position. Count the number of seconds he can hold the position. Record it below. A child who can do Level 2 should be able to hold this position for 60 seconds.
Time:_____
LEVEL 3 If the child achieves Level 2 without a problem, have him do this exercise. This takes away even more stability and adds more resistance.
Assume the same position as Level 1. Have him lift one leg off the floor about an inch. Count how long he can steadily hold this position and record it below. Switch legs and repeat. A child should be able to hold the position in each leg for 30 seconds. Record it below.
Time:_____ Ø Prone Bridge Core Stability Test
LEVEL 1 Have the child lie belly down on the floor with arms stretched out next to the head, which should be down and in the middle. Ask the child to raise his head and one arm off the floor, keeping his arm perfectly straight. Ask him to hold this position for as long as possible up to 15 seconds. Stop counting if he drops or bends his arm at all or drops his head. Count how long he can hold this position and record it below. Repeat this with all four limbs separately while lifting the head. Stop counting as soon as any part of the position lets go.
Right arm time _____seconds Left arm time _____seconds Right leg time _____seconds Left leg time _____seconds
LEVEL 2
If he is able to hold all four limbs separately for 15 seconds, advance to the Level 2 position. Have the child assume the same position and ask him to lift his head, one arm, and the opposite leg off the floor. Count how long he can keep the position. Relax for 10 seconds. Switch arm and leg and repeat. If he drops arm, head, or leg or bends arm or leg, stop counting. He should be able to de each exercise for 30 seconds on each side. If he fails on either side, he has failed this assessment.
Right arm and left leg time _____ seconds Left arm and right leg time _____ seconds
LEVEL 3
If the child can maintain Level 2 for 30 seconds, have him do this exercise. Assume the same starting position and ask the child to lift all four limbs off the floor in a Superman position. Ask him to keep this position for as long as possible up to 60 seconds.
Time _____ seconds
Ø Curl Ups
Have the child lie on a flat cushioned and clean surface with knees bent and feet about 12 inches from his backside. Put your hands over his feet for support. Ask him to cross his arms and place his palms on his shoulders. Now ask him to raise his trunk and curl up until his elbows touch his thighs. Ask him to lie back down so the shoulder blades touch the color, for one curl-up. Continue to do this for 1 minute while counting aloud. The goal is to do as many as possible fluidly without error in 1 minute. He should be able to do the number that matches his age and sex below.
LEVEL 1 GOALS FOR BOYS AND GIRLS Ages 4-7: 15 curl-ups Ages 8-12: 25 curl-ups Ages 13-17: 35 curl-ups
LEVEL 2 GOALS FOR BOYS Ages 4-7: 25 curl-ups Ages 8-12: 35 curl-ups Ages 13-17: 45 curl-ups
GOALS FOR GIRLS Ages 4-7: 25 curl-ups Ages 8-12: 35 curl-ups Ages 13-17: 40 curl-ups
LEVEL 3 GOALS FOR BOYS Ages 4-7: 35 curl-ups Ages 8-12: 45 curl-ups Ages 13-17: 55 curl-ups
GOALS FOR GIRLS Ages 4-7: 35 curl-ups Ages 8-12: 45 curl-ups Ages 13-17: 50 curl-ups
Ø Right Angle Push-Ups
Have the child lie facedown on the floor in the classic push-up position: hands under shoulders, fingers straight, parallel, and slightly apart with the toes supporting the feet. Ask the child to push up, keeping the back and knees straight and then lower the body until there is a 90-degree angle at the elbows. Place your hands on the child's hands so his shoulders touch your hands when he goes back to the floor. The entire exercise should take 3 seconds. Keep track of the number. He should be able to do the number that matches his age and sex below.
LEVEL 1 GOALS FOR BOYS Ages 4-7: 5 push-ups Ages 8-12: 10 push-ups Ages 13-17: 15 push-ups
GOALS FOR GIRLS Ages 4-7: 5 push-ups Ages 8-12: 10 push-ups Ages 13-17: 15 push-ups
LEVEL 2 GOALS FOR BOYS Ages 4-7: 5 push-ups Ages 8-12: 15 push-ups Ages 13-17: 30 push-ups
GOALS FOR GIRLS Ages 4-7: 5 push-ups Ages 8-12: 10 push-ups Ages 13-17: 15 push-ups
LEVEL 3
GOALS FOR BOYS Ages 4-7: 15 push-ups Ages 8-12: 25 push-ups Ages 13-17: 45 push-ups
GOALS FOR GIRLS Ages 4-7: 15 push-ups Ages 8-12: 20 push-ups Ages 13-17 push-ups
Ø Proprioception Assessment Results
Record the results of the assessments here. If the results lean heavily to one side, it is an indication of a deficiency in the other side.
Standing Balance Test R_____ L_____ One Foot in Front of the Other R_____ L_____ One Leg Stand R_____ L_____ Core Stability Test R_____ L_____ Supine Bridge Test R_____ L_____
Prone Bridge Core Stability Test
Level 1 R_____ L_____ Level 2 R_____ L_____ Level 3 R_____ L_____
Curl-ups
Level 1 R_____ L_____ Level 2 R_____ L_____ Level 3 R_____ L_____
Right angle Push Ups
Level 1 R_____ L_____ Level 2 R_____ L_____ Level 3 R_____ L_____
Total R_____ L_____
TACTILE FUNCTION CHECKLIST
These symptoms indicated either under or oversensitiviy to touch. Read each of the following symptoms and rate them as they most closely describes your child. A 1 indicates "doesn't apply", and 10 indicates "almost always".
Hypotactile (Undersensitivity) Symptoms
Hypotactile to most things _____ Doesn't notice or respond when cut_____ High threshold for pain_____ Doesn't sense the feeling of cold or hot_____ Craves contact sports_____ Doesn't notice when sits down on object_____ Provokes roughness or fighting_____ Is not ticklish_____ Compulsively touches_____ Acts like a bull in a china shop_____
Hypertactile (Oversensitivity) Symptoms
Seems hypersensitive all the time_____ Dislikes playing sports_____ Dislikes being touched_____ Hates tags on clothes_____ Has allergic skin reactions_____ Hates makeup and/or jewelry_____ Has poor body temperature control_____ Does not like clothing on arms_____ Has low pain threshold_____ Doesn't like touching_____
Total_____
TACTILE ASSESSMENT
Tactile awareness is the ability to feel touch. Many children with FDS have an abnormal sense of touch. The skin contains receptors for both light and deep touch. This, along with the vestibular and proprioceptive senses, is important for the ability to feel oneself in space. If a child does sense touch, it affects her in a number of ways. Tactile awareness, especially of the feet, is very important for the body in her brain. Receptors in the left brain regulate the sense of touch on the opposite side of the body. The receptors in the right brain mostly control touch of the left side of the body. This has to do with the right brain's job of seeing the"big picture".
Both undersensitivity and hypersensitivity to touch are signs of underactivity in the brain, especially the right side. Many parents think their child is a little touchy because he didn't cry when he got hurt. However, it is really a sign that the child doesn't have a normal feeling for pain and touch.
Hypersensitivity is also due to underactivity of the brain but it is better than undersensitivity. This is the child that hates to be touched or is hypersensitive to the feeling of tags on shirts or particular types of clothing.
Tactile awareness is important also from a hemispheric perspective. Most often, children are undersensitive to touch but they are much more undersensitive on one side of the body than the other. The undersensitive side of the body is usually opposite the slower, more underactive side of the brain.
Ø Tactile Sensitivity
Cover the child's eyes. Using a soft paintbrush, lightly stroke the inside of one forearm and then the other forearm. If you don't have a paintbrush, you can use your fingertips. Ask the child if it felt the same on both arms. If the answer is no, ask on which arm the feeling was the strongest. Repeat three times. Record the arm with the strongest sensation.
L_____ R_____ Both the same_____
Repeat the same exercise on the leg above the knees. Repeat three times. Record the leg on which the child felt the strongest sensation.
L_____ R_____ Both the same_____
Ø Simultaneous Touch (Extinction) Test
With two brushes or your fingers, gently stroke both forearms at the same time. Make sure you press down equally. As you are stroking, ask him if the feeling is more noticeable on one arm. Repeat three times. Record the side of most intensity. Do the same exercise on the top of the leg. Repeat three times. Record the side of most intensity.
R_____ L_____ Both the same_____
Ø Number Tracing (Graphestesia) Test
This test also should be performed with the eyes closed. Explain what you will be doing and demonstrate it first so he can watch.
With eyes covered, have the child sit with arms outstretched and palms up. With the eraser end of a pencil, trace a digit from 0 to 9 on one arm and ask him to identify the number. Write the number in the child's style as if he were writing the number so he will recognize it. Do this a total of three times with three different numbers. Repeat on the other side. The side opposite the side of the most inaccuracies indicate the deficient side. Note this side.
Deficient Side R_____ L_____
Use the symptom checklist to determine the level.
Ø Tactile Assessment Test
Transfer the results here. The side with the highest total indicates a deficiency in the opposite side of the brain.
Tactile Sensitivity R_____ L_____ Simultaneous Touch (Extinction) R_____ L_____ Number Tracing (Graphestesia) R_____ L_____
Total R_____ L_____
OLFACTORY FUNCTION CHECKLIST
These two checklists will help you ascertain if your child has a deficiency in the senses of smell and taste. One list checks for oversensitivity and the other undersensitivity. Read each of the symptoms and rate them as they most closely resemble your child. A 1 indicates "doesn't apply at all", and a 10 is "almost always".
Ø Hypersensitive Smell and Taste Checklist
Exhibits increased sensitivity to taste and smell_____ Gags at the smell of certain foods_____ Avoids going to the bathroom at the risk of wetting pants because the smell is repugnant_____ Prefers bland foods_____ Avoids children with dirty or smelly clothes_____ Complains about others' bad breath_____ Misbehaves after house is cleaned with solvents_____ Is sensitive to smoke_____ Avoids places and foods with strong cooking smells_____ Sniffs everything_____
Ø Hyposensitive Smell Checklist
Never comments on strong smells_____ Never notices baking smells, such as cookies_____ Overfills mouth_____ Avoids foods because of the way it looks_____ Never sniffs_____ Hates to eat, even sweets_____ Chews on objects like pens_____ Does not notice strong smells like something burning_____ Eats indiscriminately, will reach for anything, even toxic household products_____ Is an extremely picky eater_____
Total_____
OLFACTORY ASSESSMENT
Smell is the sense most people take for granted but it is more important than most parents think. When our tests confirm that a child has a problematic sense of smell, it often surprises the parents. But the truth is that if your child can't smell, you will almost never realize that on your own. It is hard to tell if a child's sense of smell is diminished or absent, especially if a child never had a good sense of smell to begin with. It is easier to know if your child is hypersensitive to smell, because your child will sniff at and comment on anything.
Most children with FDS have something abnormal with their sense of smell. Ask yourself a few questions. Does your child ever comment on cooking smells, for example? Does he react to strong smells like something burning? Or does your child overreact to smells and complain about them all the time?
Smell and taste are virtually inseparable. Of the two, however, smell is more important. We've all experienced the lack of taste from a snuffy nose cold. Without smell, there is not much interest in taste. Also, without a sense of smell, a child is not able to recognize a smell that signals danger, such as smoke.
However, when it comes to the developing brain, a problem with smell is more significant than missing out on the pleasure of food. The sense of smell involves the higher processing centers of the brain, so if this area of the brain is not developing properly, a child most likely will also have trouble with other important facets of life that are controlled in this part of the brain. This can show up as poor emotional awareness, socialization problems, immune and digestive problems, an inability to pay attention, and possibly even impulsive obsessive behaviors. However, when we bring out a child's sense of smell, we see a correction in these troubles as well.
Children with a poor sense of smell are, no surprise, picky eaters. And in most cases, it is because they have a very poor sense of both smell and taste. They rely more on how food looks and how it feels in the mouth.
As with the other senses, there is a hemispheric relationship to smell. The right half is more sensitive to bad smells and the left is more sensitive to pleasant smells. I worked with one child with Asperger's who told me he could detect good smells but he didn't recognize bad smells that others in his family could detect.
Ø Sense of Smell Test
When testing your child's sense of smell, you'll want to measure the ability to detect smell in general but also the smell sensitivity in one nostril versus the other. To assess the sense of smell accurately, you will need three things: essential oils, cotton balls, and several empty film canisters. You may already have them in your house. If not, essential oils are available at most health stores and many department stores. You can get empty film canisters at a photo store. They usually just get thrown out, so they are usually happy to give them away. If you cannot get film canisters, find containers that are small, clean, look the same, and that a child cannot see in. children are very clever and you want to make sure that they can't identify any canister with a specific aroma. The idea is to put a few drops of the aromatic oil on a cotton ball and deposit it in the canister. Do this with several different aromas. Choose something familiar that your child will recognize such as lemon, orange, apply, strawberry, or peppermint. Instead of essential oils, you can use anything with a strong scent, such as coffee or chocolate. Do not make the canisters, you want them all to look the same.
Before you do this test, practice it on your child. Make it like a game so the child gets involved. I always tell children that we are going to do a "smell game". They end up really enjoying it- and you get valuable information. Smell is the only sense that does not cross over to the opposite side of the brain.
Ask the child to close his eyes (or blindfold him) and close one nostril with his finger. Hold the canister about 12 inches from his nose. Ask him to breathe in and ask if he smells anything. Start bringing it closer to the nose, inch by inch, and ask him to tell you when he smells something. When he detects the smell, ask him to identify it. Note how far from the nose detection occurred and if the identification was correct. Repeat with the other nostril and tell him the smell may or may not be the same. It is part of the game. A child should be able to detect a strong, familiar smell at a distance of 8 to 10 inches. The side of the decreased smell is on the same side as the weak hemisphere.
Smell distance (Detection) R_____ inches L_____ inches Unable to identify smell (Identification R_____ inches L_____ inches
Use the symptom checklist to determine the level.
Ø Olfactory Assessment Results
Transfer the results here. The checked side indicates a weakness in the same hemisphere.
Sense of Smell Test R_____ L_____
HEMISPHERIC ASSESSMENT IDENTIFICATION
The assessment tests you just performed should correspond with the results of the Master Hemispheric Checklist in determining the side of the functional weakness. These assessments, however, have now helped you determine the brain function that is causing the imbalance. In the first column of the following table, record whether the assessment indicated a left or right imbalance.
FUNCTIONAL WEAKNESS IDENTIFICATION
ASSESSMENT Left Right Side of Level of brain score brain score weakness severity
Postural _________ _________ _________ _________ Vestibular _________ _________ _________ _________ Auditory _________ _________ _________ _________ Visual _________ _________ _________ _________ Proprioception _________ _________ _________ _________ Tactile _________ _________ _________ _________ Olfactory _________ _________ _________ _________
Next, add up the totals from your seven checklists and put them in the appropriate column. In olfactory and tactile, there is one checklist for hypersensitive and one for hyposensitive. If either of these checklists falls into abnormal range, then use the lowest number as your guide.
For each list, the lowest possible score is 10 and the highest is 100. This is what determines the level of severity. The higher the score, the greater the weakness.
A score of 11-40 is Level 3, and a child should start doing exercises at this level.
A score of 41-70 is Level 2.
A score of 71-100 is Level 3.
If the total score in each individual checklist is less than 10, it means that your child most likely does not have a problem in this functional area. He or she will require or benefit from exercises for this function.
Ideally the Master Hemispheric Checklist, the individual sensory-motor checklists, and the functional assessments should coordinate with one another. If they are not clear-cut, use the Master Hemispheric Checklist to determine the side of the weakness and the individual checklist for each function to determine severity.
The results of the Functional Weakness Identification will be your guide in selective the type of exercises you will do as a part of the Brain Balance Program. Brain Balancing is from the Book, "Disconnected Kids" by Dr. Robert Melillo
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