Monday, July 27, 2015

Brain Exercises for Cerebral Palsy: Sensory Body Mapping

One of the biggest (if not THE biggest) mysteries of mankind if the human brain.  It has been said that we only truly understand about 2% of how the brain works...which begs the question as to what (if anything) can we really do about improving or "re-training" it.  Despite the odds being stacked against us, we certainly have windows of opportunity to confidently work within the parameters of this 2%.

Most of my work within the Fascia Therapy context revolves around the biomechanical and systemic manifestations of injury and / or neurodevelopmental disorder, but this does not imply that there aren't any simple and user-friendly things that can be done to extract the maximum best-case scenario by tapping into a resource that has an infinite amount of influence and potential.

"It's all in your head."

A common expression, however from a formal perspective it is paradoxically quite accurate.  Things such as pain perception have long been studied and identified as something that can actually be controlled via some form of training.  More relevant to the context of this blog, I will use the example of a more familiar phenomenon called Phantom Limb to set the groundwork towards understanding the mechanism of Sensory Body Mapping.

Phantom Limb is a phenomenon characterized by a person with a recently amputated limb continuing to perceive their lost limb as still being attached.  In other words, they still continue to "receive" sensory input to the brain which often times is characterized by severe pain.  There have been many (largely inconclusive) theories on how this happens...but the prevailing opinion is that the severed nerve ending in the stump are irritated and therefore increase afferent (sensory) signals to the brain.  The reason as to "why" it would be interpreted by the brain as an entire limb (which is no longer there) is the real mystery...however, there have been some interesting studies in the last 5-8 years regarding the brains way of "mapping" the body which can be (at the very least) extrapolated into a working theory or model.

The brain essentially keeps and registers a "blueprint" of the entire body so that when any kind of sensory stimulus enters into the system (hot / cold, texture, sound, etc...) the brain can identify where it is coming from or where this stimulus is being applied.  For example, if you place both hands behind your back (so that you don't see them) and touch both index fingers together, your brain will immediately register some pressure being applied to the fingertips.  This is a generic demonstration of afferent (sensory information TOWARDS the brain) pathways being opened and used.  In healthy individuals, the "map" of the body (in this case, map of the entire hand) is well developed...therefore we are able to receive sensory information, process it, and engage in fine motor skills via efferent (motor instructions LEAVING the brain) pathways.  In general, coordinated movement is a formal "loop"...starting with sensory information going to the brain and resulting in programmed movement being generated by motor instructions going to the body.

The "Shrunken" Map

This relates quite heavily to the phenomenon of Phantom Limb...which is essentially a representation of the brain's "body map" remaining in place while the limb is no longer there.  My theory with respect to neurodevelopmental disorders can be considered as the "reverse" situation...a situation whereby the body map was never fully developed due to limited or lack of use.  What does this mean in practical terms?  According to these recents studies, when a limb (hand / foot / etc...) is contracted and goes unused over time, the representation of that particular limb is reduced considerably in the brain.  In other words, a hand that is consistently closed with no use of the fingers will formally be registered in the brain as a "club or stump".  When this "shrunken body map" scenario takes hold, a significant (if not all) amount of motor function will be manifested with the "neurological intent" of using a club...not a hand.  In practical terms, movement will be characterized by more gross motor patterns (swinging, swatting) and very little (if any) fine motor skill.

This is a dilemma for most because the subjective impression is that they either do not know how to use their hands or do not WANT to use their hands...but in alot of cases, it is simply a question of the brain not having a proper body map established.  To compound this scenario, persistent and chronic non-use of the limb results in sensory (afferent) pathways going unopened and unused for years...essentially becoming dormant.  Beyond the progressive deterioration that can be accompanied with growth and development, this reducing sensory challenge only serves to aggravate the situation.

"Re-drawing the map"

Sensory Body Mapping is therefore the formal adjunct "technique" that is designed with the following objectives:

1. Re-awaken dormant sensory (afferent) pathways
2."Re-draw" the body map that was previously reduced or non-existent via sensory pathways
3. Potentiate gradual improvement in motor skill (particularly fine motor skill)
4. Facilitate an environment that potentiates further coordination and function

Simple Steps:

This pattern is generally repeated for a few minutes at a time which can then be followed by some active / unstructured play using toys or various textured objects.  This tpye of activity is more functional and will serve to potentiate the stimulus now travelling through the re-opened sensory pathways.

If the hands are in a closed position, this can also be done on the dorsum (back) of the hand in a similar fashion.  The back of the hand contains less soft tissue, therefore the stokes may be done by using a softer implement such as a small paintbrush.  Additionally, this form of "mappping" can be done in different areas of the body...all of which require a specific framework (or grid).

The strategy is to use this type of mechanism as a complement to the larger rehabilitation plan in an effort to extract the best possible result.  Coordinated and productive movement / function is the net result of a reciprocal relationship between sensory and motor function...therefore potentiating and improving sensory integrity is an essential component to developing (or re-establishing) better motor control and function.

More specifics on how it looks to come on the FT YouTube page.
Try it out!