A stimulation / inhibition programme aims to give the brain a second ‘chance’ to experience movements that should have been made in the early months of development.
It so creates a bridge between gaps and facilitates more efficient transmission and execution of messages passing between the brain and body.
The programme consists of specific physical stereotyped movements practised for around five to ten minutes per day over a period of nine to twelve months. The movements involved are based upon a detailed knowledge of reflex chronology and normal child development.
All human babies make a series of stereotyped movements during the first year of life, (Nolan 1979)
Many motor training programmes have been around for numerous years. These methods of intervention work from the cortex down towards the brainstem. (Many start at the crawling and creeping stages of development.)These programmes operate by stimulating the development of postural reflexes through vestibular stimulation and general motor training.
Some children make significant gains on these programmes, while for others posture and coordination improve but there is little or no cross-over into improved educational performance.
This can be because the intervention is being aimed at higher development and neurological level than the primary level of dysfunction.
The key to success in any programme of intervention is to begin the intervention from the most basic level of ability, (rather than disability), and to build on it – i.e. to meet the patient where he or she is and use this as the starting point for the programme.
Reflex stimulation and inhibition programmes start from the spinal cord and brainstem and work up towards the cortex to access improved cortical control by providing more efficient pathways.
The reflex programme uses the reflexes as indicators of stages when development may have been temporarily arrested or omitted.
The child (or adult) who has retained early reflexes proceeds to the next development skill apparently without ill effect. Subtle gaps, however, remain in the ‘wiring’ of the Central Nervous System (CNS).
The INPP Programme for Schools has been the subject of a series of studies carried out to assess the reliability of both The INPP Test Battery in identifying children who are under achieving or at risk of underachieving, and of the effectiveness of The Developmental Exercise Programme in improving reflex status, balance, coordination and educational performance.
The first results involving over 810 children in primary schools across the United Kingdom were published in 2005. (Releasing educational potential through movement. Child Care in Practice. 11/4:415-432. Goddard Blythe SA, 2005)
Here at The Kinesis Consultancy, Sheffield, U.K. we maintain that specific movement patterns made in the first months of life contain within them a natural inhibitor to the reflexes, and that if a child has never made these movements in the correct sequence, the primitive reflexes may have remained active as a result.
These active, reflexive involuntary movements may influence and so interfere with a subconscious, learned skill resulting in a supposedly inaccurate or poor pass, putt, control, dribble, run etc.
These primitive reflexes are hard-wired into the brainstem at birth. They are active for the first six months of life, but from the moment of birth, they start a gradual process of inhibition by higher centres in the brain as neurological connections to higher centres develop.
As the primitive reflexes are inhibited, the postural reflexes emerge, which gradually take over many of the functions of the primitive reflexes. Postural reflexes take up to three and a half years of age to be fully developed.
Neuro-Developmental Delay (NDD), ( also referred to as neurological dysfunction), describes the continued presence of a cluster of primitive reflexes in a child above six months of age together with absent or underdeveloped postural reflexes above the age of three and a half.
The presence or absence of primitive and postural reflexes at key stages in development provides evidence of immaturity in the functioning of the CNS and will influence the development and control of posture, balance and motor skill. (Goddard Blythe S 2009: Reflexes, Learning and Behaviour, Fern Ridge Press)
As the CNS begins to mature during the first years of life, there is a gradual transition from primitive to postural reflexes. The maturation is also partly environmentally dependent.
In the early months of life, primitive reflex action provide rudimentary physical training through movement at a time in development before the cortex and connections to the cortex are sufficiently mature to orchestrate a controlled response. So, through the feedback or movement experience of early reflex actions, neurological pathways are developed and strengthened. As connections between higher and lower centres become established primitive reflexes are inhibited to make way for more advanced systems of voluntary movement and postural control.
There are three types of reflexes that develop. The central nervous system (CNS), if it is to function efficiently during development – throughout the embryonic stage into the neonate and up to three and a half years of age and beyond; it has to reveal reflexes that are essentials to its own natural development and efficient orderly growth.
These reflexes are called inter uterine (spinal), primitive and postural, and appear specifically along a chronological line of development.
The intra-uterine (IU) or withdrawal reflexes emerge around five to seven and a half weeks after conception, beginning with responsiveness to touch in the oral region and eventually spreading to the whole body.
The primitive reflexes emerge IU beginning with the Moro Reflex at nine to twelve weeks after conception. The primitive reflexes are fully present at birth in the normal neonate and should gradually be inhibited by the developing brain during the first six to twelve months of life.
Primitive reflexes are mediated at the level of the brainstem.
The postural reflexes emerge after birth, mostly during the first twelve months of life. They should develop together with connections to higher centres in the brain to provide basis for control of posture and movement, beginning with head control.
Postural reflexes largely mediate at the midbrain with the exception of the Oculo-Head Righting Reflex which is directed by the cerebral cortex. The importance of postural reflexes in supporting automatic reactions results in reducing the workload of the cortex so it can deal with important decisions.
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Basically the brain can be divided into two distinct areas: the brain stem, and the cerebral hemispheres. The brain stem is sometimes called the lizard brain because that’s all a lizard has. Its at the bottom of the large bulbous hemispheres just above the spinal cord and is composed of fibres going in and up, sensory nerve fibres, and fibres going down and out, motor nerve fibres.
Nerve cells transmit electricity along the fibre of the nerve, an impulse, and a chemical across from one nerve to another. The brain stem receives impulses from the senses in the head and body; it either reacts directly to those impulses by creating a motor response, or relays the impulse to a higher centre.
None of the reactions within the brain stem are conscious, it is only once the nerve fibre, and so the impulse, reaches the higher levels of the cerebral hemispheres that conscious recognition and response takes place.
Within the conscious brain there are many areas of specialisation which must be in communication with each other. It is within this area that sensory/motor integration takes place. Sensory/motor integration is the recognition and response to the vast and varying number of stimuli that enter the brain. It is what enables us to make sense of our world and where conscious adaptation and learning takes place.
The type of motor response to a sensory input that occurs within the brain stem is always a reflex reaction. A reflex is an automatic response to a stimulus; it is always an unconscious reaction, the sensory nerve in direct connection with a motor nerve, sensory/motor loop.
Reflexes control the vital functions of life, breathing, heart beat, blood pressure control. These reflexes remain all of our lives.
There are also a collection of reflexes called the Primitive Reflexes which develop very early in foetal life and should remain active for the first few months of life only. They are called primitive because they originate in the lower areas of the brain, the first part of the brain to develop.
Movement is an important stimulator of nerve growth but until the baby has a conscious brain no conscious movement is possible. Equally, as our babies are born in a much more immature state than other animals, a great deal of development must take place after birth.
To ascertain that this development does occur, and occurs in the proper sequential manner, the stimulation is programmed into the system. The stimulation is usually a random head movement; each specific head movement generating a specific response. The response being initiated by the Primitive Reflexes.
All babies are tested at birth for the presence of the Primitive Reflexes to determine normal development. These Reflexes should naturally inhibit in sequential order during the first year of life.
Inhibition means that nerve loops do not disappear, rather that stronger loops should emerge within the middle brain stem. These reactions are still reflex, they are still automatic and outside the realm of the conscious brain.
These replacement reflexes are called the Postural Reflexes and control the tiny equilibrating mechanisms for balance and co-ordination once we have learned to sit, stand and move from an upright position. They enable us to live harmoniously with gravity, to maintain a steady visual image even though we or that image is moving, to cut out extraneous non essential sensations creating a more effective focus upon essential stimuli.
Retention of Primitive Reflexes has a fourfold effect:
If a child hasn’t the equipment to behave – if a child is unable to match his abilities to the demands of the environment; the difference will be seen in his behaviour.
A – Attention
B – Balance (sitting still)
C – Coordination
D – Developmental Readiness for (formal)
E – Education
With the under 4’s as part of a programme of normal development.
By knowing the types of movements that promote nerve cell growth Education Kinesis can teach parents and carers to potentiate child development.
Babies are born with one hundred billions brain cells; many more than survive to adult life. At birth, many of these cells, especially in the higher brain, are not connected into pathways or circuits.
The connections are made by “using” each individual nerve cell, as with other tissues the cell fibres grow through stimulation. At about two years of age many of these nerve cells die through lack of use, or involvement into useful circuits or pathways.
The greater the constructive stimulation the greater the number of cells will form useful circuits. Babies who lack a stimulating environment will lose more nerve cells than those born into a stimulating environment; therefore, by using simple movement techniques early enough this can be redressed.
There is available the Johansen Individual Auditory Stimulation (JIAS) programme for individuals or whole classes. This helps with the brain’s auditory development and so interaction and learning.
There is an increasing body of scientific evidence to support the theory that physical skills support academic learning and are involved in emotional regulation and behaviour. INPP has been the pioneer in researching the effects of immature primitive and postural reflexes on learning and behaviour, developing protocols for the assessment of abnormal reflexes and related functions, and has devised a specific method of effective remediation (The INPP Method).
Research over the last 30 years carried out both independently and by INPP has shown that there is a direct link between immature infant reflexes, academic under-achievement and increased anxiety in adult life, and that a remedial programme aimed directly at stimulating and integrating primitive and postural reflexes can effect positive change in these areas.
Developmental readiness for education.
Chronological age and intelligence are not the only criteria for learning success. Developmental readiness for formal education is equally important. Developmental testing of motor skills is carried out regularly in the first year of life, but when responsibly for the young child moves from the domain of medical (midwife, paediatrician and health visitor) to education at the time of school entry, a child’s developmental readiness in terms of physical development is not assessed as a matter of routine. Once a child enters formal education at rising five years of age in the UK, assessment of physical development only take place if problems of a medical nature arise. Assessment within the school system tends to focus on the educational problems or the presenting symptoms rather than on the investigation of underlying causes.
The INPP Method of assessment involves examining the neuro-developmental level of the child and the subsequent physical programme of remedial intervention.
If various reflexes fail to initiate, integrate and inhibit, the system is locked into a developmental holding pattern that prevents natural maturation of neural systems, inevitably leading from mild to severe learning and performance challenges.
Some children fail to gain this control fully in the first six months of life and continue to grow up in a reflexive “no man’s land”, where some of the primitive reflexes remain present and the postural reflexes do not develop fully.
These children are not cerebral palsied, but they do have enormous difficulty with voluntary movement patterns as the body remains under the influence of involuntary response. Retained primitive reflexes will also affect a child’s sensory perceptions, causing it to be hypersensitive in some areas and hypo sensitive in others.
All reflexes must be fully developed, integrated, and then inhibited. If one reflex is still “on”, it is quite certain that other reflexes are “on” as well.
The nervous system develops through several stages. If these stages are never fully finished, the child, and later the adult, will be struggling to cope with an immature system.
The stages of development can be identified as specific stages of reflex development. If early reflexes are present and adult reflexes are not fully developed then the child has a developmental immaturity.
For children, these challenges show up clearly in the classroom, where it is hard for them to keep up with grade level expectations for academics and behaviour. Children most able to cope develop techniques for compensation, and succeed or just get by with great effort.
Those least able to cope often end up in special-education. They are at high risk for behaviour and attitude problems, most often out of years of sheer frustration.
At home you may notice some of the behaviours listed below. Again, please consult a professional on these topics when you believe you identify some of the symptoms with yourself or with your child..
It may be that learning difficulties are more acceptable than they used to be and therefore more accepted. This will inevitably lead to more children being identified but I do not think this is the whole picture. I personally believe that the incidence is on the increase, not simply the recognition.
There are many reasons for the increase; some of these lie within the educational field, others in nutritional and yet others in social and environmental.
Educational causes may stem from the early time that children in the UK start school. I personally believe that at rising 5 some are ready but many are not. This results in a very early experience of frustration and failure.
If children learned through play for longer, as they do in many other countries, to about age 6 more children would be ready, less would experience failure and academic learning would benefit, not suffer.
Teachers’ lives would be easier as the child is more physically, socially and emotionally ready for separation, independence and academic learning. Teaching is also approached in a primarily left brained approach, verbal, linear, sequential. Many infant and primary teachers are female. It is interesting to note that the vast majority of younger children with learning difficulties are boys.
This may be genetic, it may, however, have some bearing on gender difference in approach and application to learning. It is recognised that boys are more physically active, that they learn more by doing, that their verbal skills are not as advanced at a young age as in girls.
I do not wish in any way to imply criticism of teachers. They do a fantastic job! They have less and less choice in the selection of the syllabus, they have no choice in the age of the child entry to school, more and more academic subjects are squeezing out games and P.E.
Teacher training is almost entirely governed by what and how to teach, rather than how, why, and when children learn.
It would be so beneficial for universities to be aware, understand and appreciate NDD as part of their curriculum. Teachers would be far more prepared to deal with children who have learning and behavioural difficulties in the classroom. Dealing with the root causes of the problems rather than living with the symptoms would be beneficial for all involved.
More and more mothers are working, able to give less time to child development. Most mothers have lost the extended family and have little experience in mothering.
The streets are busy with cars, life outside the home is becoming perceived as more and more dangerous. Children are becoming more and more sedentary, less physically active, stimulating those nerve fibres less and less in a physical way.
Babyhood is becoming more sanitised, more assisted, more mechanised. Babies do not spend the hours on the floor; they sit propped up in buggies, chairs, carriers. They learn to be upright too quickly on bouncers, walkers, they miss out on the vital developmental stages.
They travel in cars, no longer running, skipping, they sit watching television, playing on computers. The mind is stimulated, but the body is not preparing the mind to work with that stimulation.
Many children with ADHD characteristics can be helped by eating slow release carbohydrate foods such as whole grain breads and crackers, potatoes with their skins, beans and legumes, brown rice, oats and whole grain pasta. Fruit is an excellent snack. Eating fruit will sustain energy for longer, for example, than fruit juice, which provides the body with a quick release of fruit sugar into the bloodstream.
Stimulation of the vestibular system can help to settle children down. Have the child stood with arms out from the shoulder, parallel to the floor and slowly turn round for a count of 15 seconds. Then stop with legs together and arms by the side, close eyes and rest for a count of 15 seconds.. repeat the same but going round in the opposite direction.
The eyes being closed is very important, as the majority of the information to the brain for balance comes through the eyes (70%). With the eyes being closed the brain has to rely on proprioceptive and vestibular feedback so helping the systems becoming more acute, receptive and efficient.
Children get on average one and a half hour’s less sleep per night than required for healthy physical and mental development. TV and computer games are cited as the main culprit, speeding up mental processing, creating a state of ‘heightened awareness’ which prevents children from falling asleep naturally (Palmer 2007 ‘Toxic Childhood, How the Modern World is Damaging Our Children’).
Proprioception – taking a balanced approach to sport
If I ask the majority of people, how many senses do we have? The answer usually is five. Well we really have seven! And two very special senses that are very rarely considered unless there is a physical or neurological problem with them are proprioception and balance.
When it comes to sport performance, power, strength and endurance can only take you so far. Whether you’re a footballer dribbling the ball, a gymnast on the bars, a golfer putting or a rugby player diving for the line while fending off tackles, balance is absolutely critical for performance.
Sports Kinesis takes a look at how balance and proprioceptive training and the mechanisms that lie behind this skill can be improved.
Balance in sport involves a complex interplay between numerous factors. A number of these are conscious – such as deciding to move a limb to prevent you falling at the same time as performing a skill e.g. a football shot – while many more are unconscious.
The unconscious element involves the ‘use’ of in-built sensory mechanisms and programmed responses. This is known as ’proprioception’ – awareness of the position of your limbs and body in three-dimensional space.
Proprioception has been called the ‘sixth sense’ and is basically a mechanism (or, more accurately, a series of mechanisms) that keeps track and control of muscle tensions and movement in the body.
When you consciously make movements or are subjected to external forces, your muscles, ligaments and joints will be making their own ‘judgments’, based on the information that they receive from their own sources.
These judgments are then used to invoke mechanisms to control movement. These mechanisms are known as sensorimotor processes, and scientists have been investigating how the senses consciously and subconsciously react with one another to control movement (known as sensorimotor research). Sports scientists now believe that sensorimotor ability and proprioception can be enhanced by specific practices.
Mechanics of proprioception
Proprioception is achieved through muscles, ligaments and joint actions using messages that are continuously sent through the central nervous system (CNS). The CNS then relays information to the rest of the body literally ‘telling’ it how to react and with what amount of tension/action.
Some of these instructions go to the brain, where more often than not they are acted on unconsciously, whilst others go to the spinal cord, where they are acted on automatically.
Proprioceptors are basically ‘sensors’ that reside within muscles, joints and ligaments. These respond to pressure, stretch and tension and are key in initiating what is known as the ‘stretch/reflex’.
You will probably be familiar with the stretch/reflex as a mechanism in the everyday sporting context when trying to stretch a muscle beyond its static point – a point will be reached when the muscle will not want to stretch any further. This is the result of the stretch/reflex mechanism kicking in and trying to prevent the muscle from being stretched further.
Although not so readily apparent, the stretch/reflex also provides control over other functions e.g. your postural muscles, which maintain the balance of the body against gravity. This makes it an overall as well as specific site muscle mechanism.
An example of this is if you were holding a weight in your outstretched hand and then had more added; the stretch/reflex would attempt to make the adjustments necessary to allow you to continue to hold the added load by ‘tweaking’ all the supporting muscles and influencing your posture.
Injury can impair proprioception
Injury can reduce the effectiveness of an athlete’s proprioception, something that the athlete and coach may not be fully aware of even when rehabilitation seems complete.
Specificity and proprioception
The rule of training specificity states that the greatest sports improvement gains will be derived from the most sport specific exercises for that sport. So for example, a sprint athlete will get greater returns from plyometric training, in comparison with weight training. However, it is possible that even these specific training means may not fully develop proprioceptive ability.
A focus on speed and power exercises, with their emphasis on fast-twitch muscle fibre may in fact disrupt proprioceptive ability. Fast-twitch muscle fibre is less adept at monitoring and controlling muscle tension when compared with slow-twitch fibre because of the quicker speed of neural impulses being sent and interpreted through muscle spindles and spinal motor neurons.
So it is argued that balance type exercises need to be performed at slower paces to optimally enhance proprioception. These allow postural stabilizer muscles, with their greater predominance of slow-twitch muscle fibre, to supply enhanced movement control. An example of a stabilizing muscle is the soleus muscle of the lower leg, while the other major calf muscle (the gastrocnemius) is the ‘fast-twitch fibre rich prime mover’.
Balance type drills are seen to improve not only proprioception, reducing potential injury, but also the ability of an athlete to express power. To explain this, think of a high jumper planting off their curved approach to leap dynamically upward. The forces going through the athlete’s prime mover leg muscles need to be controlled by the stabilizing muscles.
The more effective these muscles are, the more effective the power output will be from the prime movers. This is akin to the fine-tuning of a race car’s suspension (which can be equated to the stabilizing muscles), where small tweaks can greatly enhance the geometry of the car and therefore the speed produced by its prime mover – the engine.
To counter the thoughts of those who might still advocate faster movements for the development of proprioception, it is necessary to differentiate between proprioception and kinaesthetic awareness. Kinaesthetic awareness is about the ability of an athlete to perform a dynamic sporting skill, perhaps from an unstable position, and involves the conscious control of the body in space and time in order to affect a sports skill. This differs from the more automatic nature of proprioception responses.