As a Speech Language Pathologist (SLP), I am often asked
by parents and interdisciplinary peers how and why I clinically use manual
strategies and neuromuscular reeducation techniques vs more conventional approaches.
My response is simple. When my son was formally diagnosed with Autism, I found
it necessary to learn all I could about the human body. I had to know more
about this condition, and what I could do to help him be part of a world that
was difficult to participate and function in.
How I assess
and treat for function and participation, is based on the synchrony of systems, i.e., digestive, respiratory, fascia and “physics” as it applies to pressure and
alignment, i.e., upright head positioning, postural alignment, jaw
symmetry, foot positioning, points of stability from the feet to the head. Why
do I do this? Well, conditions I assess and treat within my line of work are
primarily not so overt (“obvious”) and tangible (“visible”). For example, let’s
take a common musculoskeletal condition like lateral epicondylitis (Tennis
Elbow). Overt symptoms include pain, decreased range of motion, and loss of
strength. Identifying the underlying factors contributing to lateral epicondylitis
are typically tangible and can be physically assessed. Treatment approaches can
also be tangible and conventionally applied.
But what does Autism “look” like? What
do sensory aversions “look like”? What and where are the overt and tangible regions
to treat? I often joke that I wish I had my son’s “guidebook”. That way, I
could turn to the page that tells me why loud sounds lead to meltdowns, and which
treatment strategies I can incorporate to help address underlying factors that improve noise toleration!
In my line of work etiologies like
“Speech Language Delay”; “Dysphagia”, “Cognitive Communicative Disorders” are
neither overt nor tangible. They also appear to present with
underlying factors associated with afferent processing pathways affecting motor
behavior.
Click here for a diagram that demonstrates the physical
symptoms of an afferent processing pathway (“anxiety”). This gives an idea how
respiration, blood/lymphatic circulation, body temperature, and digestive
functioning can be impacted: http://tophealthnews.net/wp-content/uploads/2016/03/If-You-Have-Panic-Attacks-and-Anxiety-You-Should-Look-for-THIS-Cause.jpg
Professionally, I felt the need to learn manual
strategies and neuromuscular reeducation
techniques as there are neuromusculoskeletal and biomarker components that interplay as relevant co-morbidities, additional pathologies, and
secondary impairments associated with speech, language, hearing, and related disorders like
dysphagia. (Table 1). This list is not all-inclusive, but it
gives you an idea that afferent processing pathways and motor behavior are more
integrated than one thinks! Communication to
motor efferents, blood and lymphatic circulation, digestive functioning, strong
respiration and immune system functioning, core/surface temperature
relationships, and the result of joint alignment, are some of the physiological
factors that influence multi-system interactions.
(image obtained from: http://www.visualsupportsandbeyond.co.uk/images/pyramid.jpg)
I have found neuromusculoskeletal and biomarker components to
be the “overt” and “tangible” areas that can be assessed and treated to improve
motor behavior. They can also be measured objectively to interpret gains associated
with targeted functional outcomes, data collection on co-morbidities, neuromusculoskeletal
alignment, and secondary impairment improvement. In my experience, the
neuromusculoskeletal components have addressed “why” the problem behavior may
be occurring. The physical symptoms of the problem are typically associated
with afferent processing pathways, but still appear to be affecting
musculoskeletal/neuromusculoskeletal performance.
(Click here to see the WHO ICF framework: https://i.pinimg.com/originals/3a/f8/3f/3af83f98d48aaa24cf8ce5ce6363555e.jpg)
This Evolving SLP continues to learn more about the other “brains” of the body, i.e., Central Nervous System, Skin as the “outer brain”, Digestive System, Respiratory System, Immune System and manual techniques using tools and instrumentation. Why? Because literature cites these key points:
➤ In
terms of “cognition”, the word “cognition” is not referenced as “intellect”.
Instead, it is being references as “cognitive factors” (skills associated with
“cognition”).
➤Neuroplasticity
is improved by modalities that use light, sound, vibration, and movement- (Doidge,
2015).
➤Communication to motor efferents, i.e., the strength of
blood and lymphatic movement; digestive, immune, and respiration system
functioning; and the result of joint alignment, are some of the physiological
factors that impact muscle performance. These components can
be found in the skin, spinal pathways, and internal organ systems- (Harvey et al., 2017).
➤The
nervous system does not differentiate between NOR work independently
regarding sensation (generating and processing), function (motor
output), or “cognition” (intention and problem solving)- Von Hofstein,
2007, Developmental Science.
➤Improvement
in one system will promote improvement in all systems- (Adler, Lezlie 2017 from
Combining the Principles of NDT and SI to Gain Function in Children with
Neuromuscular Challenges).
➤Sensory
input drives motor output!!! - (Harvey et al., 2017; Ito and Ostry, 2010).
➤Treatment
methods that do not assess the underlying impairments impacting muscle strength
and coordination neglect an understanding of the relationship of impairments to
function- (Harvey et al., 2017).
➤Postural
stability must be present for movements to control joints effectively. Movement
before stabilization can produce abnormal shear forces both locally and
globally- (Knott and Voss, 1968).
➤Postural
control is influenced by cognitive factors like attention, motivation, memory,
and intent- (Greters et al., 2016).
➤It is important to consider the underlying physiology of
voice production and not just the behaviors that caused the disorder (Stemple,
2017). (I apply this statement to any
problem behavior, not just voice production).
I look forward
to sharing more of this line of work in future blogs. Ever onward!! - J
Disclaimers: Information presented in this blog
is designed to promote ideas and stimulate discussion. The goal of this blog is
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