**4.1 Clients**

256 Learning Disabilities

gravitation he also communicated a spiritual side. In General Scholium, an appendix to the second edition of 'Principia' (1726, p.528), he writes that God "endures forever, and is everywhere present; and, by existing always and everywhere, he constitutes time and space". As healthy humans we take an upright position for granted although defying the gravitational force is a life long struggle. Very soon after birth the infant starts to lift his head up against gravitation. According to Paul Schilder (Hubbard & Wright, 1984) it will take the growing child about 15 years to master the force. However, this struggle might have its rewards as Lin, Woolacott and Jensen (2004) showed that postural control among elderly people was not only linked to age but correlated with functional balance as well. In another study (Carpenter, Adkin, Brawley, & Frank, 2006) it was examined how young adults and older adults with balance problems reacted when balance demands increased. In both groups, increased demands affected both blood pressure, anxiety, and the capacity to handle the body. At the beginning of the 20th century, Joel E. Goldthwait (Goldthwait, Brown, Swaim, & Kuhns, 1937; Oschman, 2000) and his colleagues at Harvard Medical School were trying to attract scientific attention with their research on patients with various chronic disorders all of which were due to faulty 'Body Mechanics'. Goldthwaith stressed the importance of people paying attention to how they moved and held their bodies in relation to gravitation. If posture was correct more energy would be left for use in daily activities and less strain would be put on different body parts and joints. An incorrect posture would be likely to also have unhealthy effects on the viscera of both the thorax and the abdomen. Once again we can hear history speaking to us but unfortunately the trace left from Goldthwait is not to be found within traditional science but has been picked up by

In his sequel to 'Zen and the art of motor cycle maintenance', 'Lila-an inquiry into morals',

 "The law of gravity, for example, is perhaps the most ruthlessly static pattern of order in the universe. So, correspondingly, there is no single living thing that does not thumb its nose at that law day in and day out. One could show that the degree to which an organism disobeys this law is a measure of its degree of evolution. Thus, while the simple protozoa just barely get around their cilia, earthworms manage to control their distance and direction,

Pirsig suggests that man's bodily struggle against the gravitational force has over time contributed to an intelligence good enough to conquer space and by doing so even gravitation itself. Much focus is presently placed on cognition and cognitive development while our neurological heritage seems to have been neglected or even forgotten when it comes to education. So how do we connect the gravitational force to learning disabilities?

I propose that an important connection between the gravitational force and learning disabilities is the maturation of the vestibular system and the integration of

So far, you have been provided with an historical background as to how learning disorders in general have been viewed over the centuries. From there, I moved towards DCD and

birds fly in the sky, and man goes all the way to the moon"(p. 147).

movement therapies and modern body work.

Robert M. Pirsig (1991) wrote:

primitive/primary reflexes.

**3.10 Summary** 

Vestibularis is a private practice using the method Retraining for Balance. Clients are mostly children and youngsters with concentration problems and / or learning disorders. Not all of them are considered clumsy by their parents but notwithstanding this, they will display sensorimotor immaturities on our tests. Adults can also benefit from the training and have completed it with very good results – this has included people who were initially suffering from such diffuse pain and fatigue that it was making them unable to work.

## **4.2 Instruments of assessment**

The initial assessment uses the instruments (Niklasson, *et al.*, 2009) *RB–Physiological Test* (Niklasson & Niklasson, 1999a, 2007a), *Retraining for Balance-Orientation and Balance Test* (Niklasson & Niklasson, 1999b, 2007b) and *Retraining for Balance-Audiometric test*, based on a technique developed by Johansen (1993).

*RB–Physiological Test* consists of 41 different tests which assess sensorimotor (physiological) proficiency (maturity) of clients in terms of primitive/primary reflexes, postural responses, gross motor milestones, and vestibular ability. The tests are divided into six groups;


Each test is scored on a quantitative 5-point scale from 0 – 4 (Field & Blythe, 1989; Niklasson & Niklasson, 1999a, 2007a).

0: No deviation, 1: Small remainder of a primitive/primary reflex or minor difficulty completing a specific feature, 2: Remainder of a primary reflex or partial absence of a postural response or difficulty completing an item, 3: Almost intact primary reflex or almost

Could Motor Development Be an Emergent Property of Vestibular Stimulation

concept of replication, together with three concomitant theories:

other, together with continued CNS development… 3. There is a **sequence** and pattern to reflex inhibition" (pp.12-13).

completed the job it was designed to do.

as Goddard (1990) wrote;

nothing else has worked" (p.15).

between vestibular disorder and learning impairment.

and Primary Reflex Inhibition? A Tentative Approach to Sensorimotor Therapy 259

The basic theory behind the training was formulated by Blythe in 1980 (Goddard, 1990), "the innate mechanistic processes involved in the inhibition, modification and transformation are observable, and more importantly are **replicable** at any age, to assist in the rehabilitation of impairment" (p.12). Goddard (1990) continues, "… it is possible to give the brain a second chance to **register** the inhibitory movement patterns which should have been made at the appropriate stage of development, or, to recapitulate a stage of development which may have been omitted, or incompletely worked through, for one reason or another, during intra-uterine life or infancy. The remediation of aberrant reflexes is based on the primary

1. Every reflex has a purpose, and will not be fully suppressed unless it has successfully

2. All human babies make certain stereotyped movements during the first year of life, (Thelan, 1979). These movements contain within them the natural antedote to the appropriate reflex at that stage in development, thus facilitating inhibition of a primitive reflex on the one hand, and the subsequent release of a postural reflex on the

As explained above, Vestibularis had identified a need to bring coherence and continuity to the different exercises. One reason for this was that different physiological and psychological regressions emerged when certain exercises and vestibular stimulation were used, a phenomenon not mentioned by Blythe. When an exercise was used long enough the regressions faded and physiological and/or psychological behavior seemed to be transformed to a more mature level. Instead of breaking the apparent 'flow' by being too mechanical, Vestibularis aimed at creating a smooth succession of exercises, thereby achieving a maximal 'squeeze' from each one. Through continuous supervision from Professor Matti Bergström, Vestibularis came to understand the significance of regressions from a developmental point of view. As an expert on the brain and coming from a research tradition with an interest in sensory and motor behavior, Bergström (1964) was well acquainted with the concept. Another reason for the re-construction undertaken by Vestibularis was that vestibular stimulation seemed to be effective with all clients when used as a complement to fetal and neonatal movements. This view was not shared by INPP

"In certain cases where there is severe impairment in all sensory channels, and this impairment goes beyond the area of dysfunction into suggested damage, vestibular stimulation and rotation appear to open the gateway to further remediation, where formerly

In a randomized, double-blind, controlled study McPhilips *et al.* (2000) used stereotypical neonatal movements similar to those developed by INPP, but no vestibular stimulation, on children with specific reading difficulties. After training, the experiment group showed significant results both regarding reflex inhibition and reading improvements. A recent study by Brookes, Tinkler, Nicholson, and Fawcett (2010) concludes "that there is a significant incidence of balance difficulties in children and adults with dyslexia, even for those without comorbid attention deficit". Comparing under achieving children with well performing children, Franco and Panhoca (2008) found a statistically significant relationship

a total absence of a postural response or a marked difficulty completing a particular item, and 4: Intact primary reflex or a total absence of a postural response or an inability to complete or execute a specific item.

*Retraining for Balance-Orientation and Balance Test*. This test (Field & Blythe, 1989; Niklasson & Niklasson, 1999b, 2007b) consists of a standing balance assessment (Rodnitzky, 1988; Cherng, Chen, & Su, 2001; Geuze, 2005) done on two occasions (the Romberg test), a vestibular test (rotating on a chair) (Vose, 1986; Guyton, 1991; Niklasson et.al., 1999, 2007), and two tests of orientation (body-space perception, perception of time).

Each test is assessed according to whether there is either "no deviation from normal ageappropriate behavior" or "deviation from normal age-appropriate behavior".

*Retraining for Balance-Audiometric test* with the aim to determine whether the client has right or left ear dominance or whether dominance is lacking. Right ear dominance facilitates a more rapid processing of speech sounds (Sininger & Cone-Wesson, 2004). The tests' rationale for importance of right-ear dominance was validated by Tallal, Miller, and Holly Fitch (1993) and by Okamoto, Stracke, Ross, Kakigi, & Pantev (2007).

#### **4.3 Training**

The decision as to whether to start the training or not is taken with respect to the scoring on each test and with respect to the child's developmental history as described by its parents. However strange it may sound, low scoring does not necessarily imply that the client would not benefit from the training. This is especially relevant for those older children or adolescents who may be able to compensate for their difficulties. If this is the case, the history as described by parents is of particular interest. When the decision has been made to start the training, the client trains at home with his parents. The fact that the parents themselves are 'solving' a problem together with their child is a methodological asset. An association between the development of movement and emotion has been argued by Schilder (1964, 1971) and Erikson (1987) and they also emphasize importance of the parents in this process. The estimated time needed for training is about 15 minutes/day although it often takes longer because of obstinacy which seems to be a part of the regressive behavior which emerges during training. The child with its parents returns to Vestibularis every 8th week for re-assessment and in order to get new exercises. During a re-assessment, appropriate primitive/primary reflexes, postural reactions, vestibular function and gross motor milestones are checked and suitable new exercises are introduced. Generally fifteen sessions are needed to complete the program.

*Retraining for Balance –Methods* (Niklasson, *et al.,* 1999, 2007) describes 48 exercises which comprise the training and which in many ways are the same as those used at INPP (Goddard, 2002) although modified and in some cases further developed. The exercises are divided into the following seven categories:

1) Fetal movements and neonatal movements 2) Vestibular stimulation 3) Auditory perceptual stimulation 4) Tactile stimulation 5) Basic gross motor movements or milestones 6) Sports-related gross motor skills 7) Complementary play exercises.

For further description of the categories see Niklasson, *et.al.,*(2009).

a total absence of a postural response or a marked difficulty completing a particular item, and 4: Intact primary reflex or a total absence of a postural response or an inability to

*Retraining for Balance-Orientation and Balance Test*. This test (Field & Blythe, 1989; Niklasson & Niklasson, 1999b, 2007b) consists of a standing balance assessment (Rodnitzky, 1988; Cherng, Chen, & Su, 2001; Geuze, 2005) done on two occasions (the Romberg test), a vestibular test (rotating on a chair) (Vose, 1986; Guyton, 1991; Niklasson et.al., 1999, 2007),

Each test is assessed according to whether there is either "no deviation from normal age-

*Retraining for Balance-Audiometric test* with the aim to determine whether the client has right or left ear dominance or whether dominance is lacking. Right ear dominance facilitates a more rapid processing of speech sounds (Sininger & Cone-Wesson, 2004). The tests' rationale for importance of right-ear dominance was validated by Tallal, Miller, and Holly

The decision as to whether to start the training or not is taken with respect to the scoring on each test and with respect to the child's developmental history as described by its parents. However strange it may sound, low scoring does not necessarily imply that the client would not benefit from the training. This is especially relevant for those older children or adolescents who may be able to compensate for their difficulties. If this is the case, the history as described by parents is of particular interest. When the decision has been made to start the training, the client trains at home with his parents. The fact that the parents themselves are 'solving' a problem together with their child is a methodological asset. An association between the development of movement and emotion has been argued by Schilder (1964, 1971) and Erikson (1987) and they also emphasize importance of the parents in this process. The estimated time needed for training is about 15 minutes/day although it often takes longer because of obstinacy which seems to be a part of the regressive behavior which emerges during training. The child with its parents returns to Vestibularis every 8th week for re-assessment and in order to get new exercises. During a re-assessment, appropriate primitive/primary reflexes, postural reactions, vestibular function and gross motor milestones are checked and suitable new exercises are introduced. Generally fifteen

*Retraining for Balance –Methods* (Niklasson, *et al.,* 1999, 2007) describes 48 exercises which comprise the training and which in many ways are the same as those used at INPP (Goddard, 2002) although modified and in some cases further developed. The exercises are

1) Fetal movements and neonatal movements 2) Vestibular stimulation 3) Auditory perceptual stimulation 4) Tactile stimulation 5) Basic gross motor movements or milestones

6) Sports-related gross motor skills 7) Complementary play exercises. For further description of the categories see Niklasson, *et.al.,*(2009).

and two tests of orientation (body-space perception, perception of time).

Fitch (1993) and by Okamoto, Stracke, Ross, Kakigi, & Pantev (2007).

sessions are needed to complete the program.

divided into the following seven categories:

appropriate behavior" or "deviation from normal age-appropriate behavior".

complete or execute a specific item.

**4.3 Training** 

The basic theory behind the training was formulated by Blythe in 1980 (Goddard, 1990), "the innate mechanistic processes involved in the inhibition, modification and transformation are observable, and more importantly are **replicable** at any age, to assist in the rehabilitation of impairment" (p.12). Goddard (1990) continues, "… it is possible to give the brain a second chance to **register** the inhibitory movement patterns which should have been made at the appropriate stage of development, or, to recapitulate a stage of development which may have been omitted, or incompletely worked through, for one reason or another, during intra-uterine life or infancy. The remediation of aberrant reflexes is based on the primary concept of replication, together with three concomitant theories:


As explained above, Vestibularis had identified a need to bring coherence and continuity to the different exercises. One reason for this was that different physiological and psychological regressions emerged when certain exercises and vestibular stimulation were used, a phenomenon not mentioned by Blythe. When an exercise was used long enough the regressions faded and physiological and/or psychological behavior seemed to be transformed to a more mature level. Instead of breaking the apparent 'flow' by being too mechanical, Vestibularis aimed at creating a smooth succession of exercises, thereby achieving a maximal 'squeeze' from each one. Through continuous supervision from Professor Matti Bergström, Vestibularis came to understand the significance of regressions from a developmental point of view. As an expert on the brain and coming from a research tradition with an interest in sensory and motor behavior, Bergström (1964) was well acquainted with the concept. Another reason for the re-construction undertaken by Vestibularis was that vestibular stimulation seemed to be effective with all clients when used as a complement to fetal and neonatal movements. This view was not shared by INPP as Goddard (1990) wrote;

"In certain cases where there is severe impairment in all sensory channels, and this impairment goes beyond the area of dysfunction into suggested damage, vestibular stimulation and rotation appear to open the gateway to further remediation, where formerly nothing else has worked" (p.15).

In a randomized, double-blind, controlled study McPhilips *et al.* (2000) used stereotypical neonatal movements similar to those developed by INPP, but no vestibular stimulation, on children with specific reading difficulties. After training, the experiment group showed significant results both regarding reflex inhibition and reading improvements. A recent study by Brookes, Tinkler, Nicholson, and Fawcett (2010) concludes "that there is a significant incidence of balance difficulties in children and adults with dyslexia, even for those without comorbid attention deficit". Comparing under achieving children with well performing children, Franco and Panhoca (2008) found a statistically significant relationship between vestibular disorder and learning impairment.

Could Motor Development Be an Emergent Property of Vestibular Stimulation

force?

**6. Emergence** 

**6.1 A possible driving force** 

and Primary Reflex Inhibition? A Tentative Approach to Sensorimotor Therapy 261

hindrance in the learning process. Goddard Blythe (2009) is recommended as a learned companion when it comes to a more detailed description of how these phenomena can affect a child's possibilities at school and in its social life. Our quantitative naturalistic study (Niklasson, *et al.*, 2009) showed a significant increase in the physical and sensorimotor maturity of participants after completion of the training. The findings also suggested that problems of concentration and attention should be viewed as connected to sensorimotor difficulties. After training, participants generally performed better at school in reading, writing and physical education although with some children difficulties with mathematics persisted. Regarding improvements in the area of reading and writing, we suggested that not only is the integration of primitive/primary reflexes of importance but also the maturation of the vestibular system due to there being a close connection (Simon, Aminoff, & Greenberg, 1989; Goddard, 2002) between the vestibular apparatus and horizontal tracking required for these skills. As a reminder of this chapter's heading, it is of significant interest that physiological improvements in participants were the results of development which had not previously taken place. By this I mean that participants in the study developed as a child would in its early years of life (as explained in **3.6**) despite them being much older. Results from the qualitative study (Niklasson, *et al.*, 2010) showed psychological improvements shaped as regressions and transformations. Viewed in the totality of the training, the phenomena (of regressions and transformations) were complementary and were labeled as either negative or positive developments. The study identified three periods of regression (negative developments) all of which were followed by transformations (positive developments). Using the concept 'negative development' for regression does not necessarily imply something bad. In this context and in accordance with Kris (1952) who distinguished a regression where the ego itself is in charge, a 'regression in the service of the ego', we suggested the opposite. Regression and progression (Werner, 1957; Loewald, 1981) are complementary and of great importance concerning both organization on the psychological level and physical development (McGraw, 1995). The qualitative study was able to show, for the first time as far as we know, both physical and psychological regressions and transformations in connection with sensorimotor training. But what might be the driving

In **3.8** we learned that Papaseit, *et al.* (2000) were advised not to conduct their study because the gravitational force was considered to be too weak to make any physiological difference. Still, they got unexpected results pointing in another direction. When Vestibularis, during training, placed great emphasis upon vestibular stimulation our studies as well showed unexpected results, especially within the psychological domain. My suggestion is that the gravitational force is an important and hitherto neglected factor in human development. Holger Hydén (1961) famous for his research on RNA and memory wrote; "One unchanging stimulus, for example, is the force of gravity, which maintains a high activity in the gravityresponding brain centers throughout the life cycle" (p.33). Before him D. and K. Stanley-Jones (1960) considered that, "The force of gravity is the most unchanging, and therefore the most reliable physical fact on the surface of the earth, whether by sea or on land or air. It is therefore on the gravity-receptors, with their unchanging response to an unchanging stimulus,

Empirically, over the years, Vestibularis has experienced very good results practicing a combination of stereotypical movements and vestibular stimulation. As a first step in studying whether RB could be successful as a complement to regular treatment of DCD, Specific Learning Difficulties (SLD), and ADHD, one quantitative naturalistic study and one qualitative study were conducted.
