A physiological explanation for suspended development
Howard Beardmore DO, May 2008
This paper is an extension of work presented at a Berlin symposium November 2007. At the forthcoming conference we are hosting in Reading Berkshire on 30th November 2008 entitled 'the natural development of health in children' I will present an illustrated documentation of this work with case histories.
I have spent 10 years observing and treating children and young adults in residential care, acknowledged to be some of the most difficult cases of behavioural and developmental failure in the country. It is my conjecture that these cases represent the consequence of development in the sustained sympathetic state. Learning your emotional, communication and mobility skills whilst in an adrenalin dominant state tends to limit and polarise behaviour characteristically as on/off or black/white.
People in this state are usually happy or sad suddenly shifting without obvious reason. The spoken language, if there is any is very one word orientated. The adrenal state does not require complex existence it is primarily a state of emergency survival. Consequently making new relationships is almost irrelevant. It has been observed that people with autistic spectrum disorders have heightened awareness, poor bowel function, malabsorption syndromes; this alone is an acknowledgement of adrenal dominance.
Sustained state of stimulation leads to exhaustion
In any sustained state of stimulation there has to be a point of exhaustion. At this point the stored waste, one consequence of prolonged cortisol secretion; is released and the consequence can be anything from a sudden mood change to a full-blown epileptic fit. So often it is noted that these people have 'their cycle' and without the collapse they are not well the rest of the time. The sleep after a fit is highly restorative.
Indeed children who have their fits suppressed often suffer personality changes and stop developing. Many have atopic pathway illnesses like Asthma, eczema and food allergies further evidence of adrenal involvement and another consequence of symptomatic palliation.
Orthodox approach focus on isolated symptoms or palliation
Orthodox approaches focus on each symptom in isolation and palliates. Depression is lifted, over activity is depressed. Constipation is treated with laxatives, bed wetting with psychoanalysis. Temperatures in any 'cleaning crisis' are suppressed and as these people are often in residential care they will all be vaccinated.
Leaps of development following measles and chickenpox
I have witnessed incredible leaps in development after measles, Rubella and Chickenpox so denying these opportunities is another hurdle. The myth that these 'diseases' are dangerous in Western Europe is not borne out by the facts. Only one unvaccinated child has died in England in the last 15 years from wild measles and he was on immuno suppressant drugs at the time, which puts the issue into context.
Traditional osteopathic approaches focus on each patient
From a traditional osteopathic perspective the treatment of developmental issues such as cerebral palsy and autism spectrum disorders is dictated by the presentation of the patient. The contraction of soft tissue present to varying degrees, depending on the severity of the precipitating cause and length of time before treatment begins; directs the emphasis of the approach. In long standing cases the contraction patterns can lead to contracture, that is a more chronic resistant presentation.
The peripheral lesion patterns of stiffness and rigidity so common in these cases, usually bi lateral and symmetrical, are considered to be a reflex 'default' mode stemming from the initial trauma or precipitating factors. This is a protective bracing by the arms and legs to protect the vulnerable, collapsed spine that in turn protects the cord from damage.
The initial trauma or events leading to the presentation produces the stimulus for chronic sustained sympatheticonia and this is the neuro-endocrine basis for understanding the various clinical presentations. Each case has a unique set of events that 'tip the balance' into sustained sympatheticonia. In a way it is not what caused it but how to identify it and change it that matters.
Trauma induced collapse patterns
In cerebral palsy, the progressive systemic auto intoxication from oxygen starvation at birth forces the body to 'triage' a hierarchy of life important functions with coming first (cerebral cortex) and life necessary areas (medullar) the last to suffer.
This produces a characteristic collapse in the spinal arch relationship, compromising the ability of the spine to self-support as the origins and insertions of all the soft tissue (ligamentous, fascia and musculature) structure loose their mechanical advantage.
This almost always produces a reversal in the dorsal/lumbar arches with contraction on the concavity and tension on the convexity, from an antero/posterior perspective. Various lateral collapses of the spinal arches compound the presentation.
A typical reversed dorso-lumbar arch pattern, common place in many suspended development cases.
The response of this is to produce a reflex, flexor contraction, extensor tension, of the limb tissues to act as a bracing support to the spine. This of course means that the voluntary functions of the limbs are lost, or at least much reduced. Trying to 'train' a limb like this to 'work' in a non postural way is not understanding the physiological 'need' or adaptation. Like wise surgery to address contracture is not always the most intelligent solution.
Reversal of dorsal and lumbar arch patterns and the Consequences physiologically
Because the dorsal and lumbar arch patterns are reversed the ligamentous structures are rendered mechanically incompetent, this leads to compensatory adaptations of contraction in musculature so that the muscles become posturally dominant rather than prime movers. It is not possible to learn to crawl with this pattern and often patients miss out this developmental stage. By not learning the sequential moves required to crawl other sequential activities like speaking are also suspended.
It is my conjecture that missing out of the crawling stage also reflexly affects the ability to construct 'sentences' in speaking. This in turn inhibits the instincts to move towards standing. Very often I see the sudden start of crawling concurrent with the ability to talk in a child that was doing neither before treatment began.
Physiological effects of sustained sympatheticonia
These can be listed as effects from the prolonged secretion of adrenalin and cortisol and from a traditional osteopathic perspective and go a long way to explain why development is suspended rather than just arrested because sympatheticonia is a reversible state.
So prolonged sympatheticonia under the hormonal action of adrenalin and cortisol manifests physiologically as:
Peripheral tension and contraction patterns contrasting to central flaccidity, diminished digestive activity, malaise, lack of endurance, nervous instability, loss of weight, increased pulse rate, night sweats, anaemia, leucocytosis, depressed urine secretion.Pottinger symptoms of visceral disease 'toxaemia'
This view also helps to explain the constitutional nature of the condition rather than listing the presenting musculoskeletal symptoms as isolated phenomena. Sometimes the patient presents with a history of epilepsy, which I would interpret as the body's way of releasing the often-prolonged body tension in the limbs. From this perspective suppressing the fits with medication whilst addressing the need for them could be seen as a hindrance to development.
Evidence that patients do respond to the traditional osteopathic approach can be seen in that the tension in the limbs is often reduced in the periphery, concurrent with improvements in the ability to self-support and start crawling on all fours. Digestive activity improves, so does communication and interaction.
Difficulty of co coordinating older patients due to 'lesion layering'
It is always more difficult to coordinate the developmental stages with the mix of developmental suspension that is often present in older patients. For example in the usual run of events when the spinal arches are not reversed one learns to roll over, crawl flat, teeth start coming through, speech becomes more recognisable, then crawling on all fours, sit, stand walk. The stability of sitting, then standing should precursor movements like walking. Sometimes an awkward walking gait can be traced to this order not following on. These patients tend to revert for a short period to the sitting, standing and crawling stages after treatment as if the body knows that these stages were missing in the development. Regression followed by dramatic improvement is a common reaction to treatment and is always better than trying to force a child or adult to walk with orthopaedic supports when the developmental stage is not ready for it.
Indeed, if the spinal arch pattern is not optimal from the beginning some of these stages are not completed or in some cases even begun. This makes the development become fractionated and consequently development tends to become less and less until a plateau of stasis is reached.
Signs of suspended development, no teeth
I very often see patients with no teeth, collapsed arches and all the contracture and tension patterns as above. The first sign is usually all the teeth come through, then attempts at speaking begin with a simultaneous improvement in limb coordination, in a sense the instinctive development picks up where the gaps are, as you address the first consequential lesion pattern of reversed spinal arches.
Signs of 'restarts' to development, a consequence of traditional osteopathic treatment
These 'restarts' to development occur in an overlapping fashion, a sudden teeth spurt may slow the spinal development and vise versa. It's as if the same parts of the brain involved in sentence construction syntax are also involved in sequencing the multiple movements involved in walking. Often you see the speaking comes first before the attempts at standing and walking, as communication is more important and safer to get wrong; whereas attempting to walk or stand and falling over is more risky.
Epilepsy improves as the tension reduces during treatment
I am used to seeing patients with epilepsy have less fits as the spinal arch mechanics become more competent. This maybe because high muscle tension demands high blood sugar levels, as this is continual in CP the only relief is affording by fitting and the sleep afterwards is deeply restorative. As patients become more relaxed at rest through treatment this cycle can be aborted.
The effects of fitting in uric acid retention are well known (Lesch Nyhans). It is not inconceivable to see a link between the high adrenal tone in CP (cerebral palsy) and a relationship to fitting patterns. General osteopathic treatment seeks to address the high adrenal tone by coordinating the spinal arch patterns using long levers thus gradually rendering the compensations of contraction and tension in the limbs unnecessary.
Successful treatment avoids the need for operations or Botox to 'release contracture'
This is a gradual process and to date in the ten years I have been doing this not one child has had to have the predicted operations or botox program to address the condition. All of the children I have seen have been able to walk without callipers. It is important that no specific muscle relaxing programmes or drugs are used in isolation to treat the patterns or the coordinating effect of the treatment is lost. As a point of note Botox is not licensed for use on children with cerebral palsy so any patient offered this approach should be made fully aware of this fact.
Treatment protocols for conditions are valueless, it is the patient who needs assessing, not the pathology!
The biggest drawback to the traditional osteopathic approach is that is takes time to unravel the chaos and in the older the patient the more work this takes. The ideal period for treatment is weekly to begin with until the development starts up again. Each patient is then assessed individually to space this out. Over treatment is as bad as not enough, it is this critical balance that require constant audit and practitionership to achieve. It is impossible to write a prescriptive treatment protocol for a condition as this is multi- variant in every patient, attempting to do this does not demonstrate intelligence on the part of the practitioner!
None of these conditions are 'abnormal' they are natural and normal consequences
I have never considered CP cases to be abnormal development more suspended development under the action of sustained sympatheticonia (prolonged adaptive stress response). This means that the usual development stages are influenced by the stress response so the communication, mobility and cognitive awareness presentations are all a normal reaction to this state.
Form this perspective inhibiting the adrenal tone through general osteopathic treatment, re coordinating reflexes and alkaline dietary changes (to cope with the acid waste releases that come from chronic contractures during well managed healing crisis), in many cases has assisted the restarting of the developmental reflexes.
Howard Beardmore DO