I was seeing this child Rimzim who is seven years old and who was diagnosed with learning disability and had a significant discrepancy in the verbal and the performance IQ. In the draw the person test- the results showed that she is very anxious and believes in fantasy rather than reality satisfaction and also had feelings of inadequacy and dependency. There was also a lot of restlessness and hyperactivity. Her visual motor age was 5 years.
She came across as a very small tiny bony girl who didn’t make eye contact and wanted to just hide behind her mom. I wanted to discuss about the concerns with the mother but not in front of her. She was very very shy and extremely compliant. We gave her a puzzle and asked her to play in the room outside. Rimzim had changed two schools in two years because she was not able to cope with academics and used to get easily frustrated and angry in the class. She was receiving counselling at school for a year and help for academics from a special educator but behaviour was worsening with each day. Mother also said that she cannot copy from the board and also made a lot of spelling mistakes. The major complaint that the mother had was that Rimzim would hit all her classmates and did not make friends. She had a lot of motion sickness even while traveling in auto rickshaw. Even though she is seven, she still did bed wetting every single night.We called Rimzim inside and she was still shy and anxious about what I would ask her. We just had a general conversation and evaluated her.
- Sensory processing disorder
- Poor Vestibular tolerance and also had
- Presence of Primitive Reflexes -TLR (Tonic labyrinthine Reflex), ATNR ( Assymetric Tonic Neck Reflex), SGR(Spinal Galant Reflex) and STNR (Symmetric Tonic Neck Reflex)
Some reasoning in Rimzim:-
- The presence of TLR affected her eye movements and did not give her a stable visual field. Presence of TLR is also an indication of immature vestibular system.
- The cerebellum coordinates the signals from the vestibular and the visual systems and because of the immature vestibular system,TLR and ATNR, the messages given to the cerebellum and those received by the body did not match. This resulted in motion sickness and visual perceptual problems.
- The presence of SGR affected her sitting and she constantly changed her position and wriggled in the classroom which coupled with TLR and eye movements made it difficult for her to focus on the blackboard. The presence of SGR also resulted in bed wetting and difficulties with auditory processing.
- Auditory processing affected her ability to blend,discriminate and sequence sounds and thus her spellings suffered and reading comprehension was also slow.
- The presence of ATNR affected her planning and bilateral integration skills.She had difficulties in crossing the midline which made handwriting very difficult- her eye tracking was also laboroius when it involved crossing midline. Because the entire task of copying from the blackboard was not automatic, and completely done by the cerebral cortex, the ability to comprehend slowed down because of overload on the cortex.
- Presence of STNR affected her posture because the tone of the upper and the lower body were dependent on the position of the head. It also affected her speed of accomodation which affected copying from blackboard. (accomodation in simple words is the automatic ability to converge and diverge for near and far objects). She avoided eating by herself because it is messy in the presence of active STNR.
- The cerebellum uses the postural reflexes to acheive smooth coordinated movements and when the above mentioned primtive reflexes were present, they didn’t allow the access to postural reflexes. Thus there was a general slowness and clumsiness in everything that Rimzim did.
- Rimzim had a very intelligent brain which was compensating for the above mentioned challenges but at the cost of falling grades . Since she is intelligent and can see the effort she was putting and the results that were coming out, she had temper tantrums and hyperactivity and undesirable behaviours.
- Rimzim also stammered at times which is because of the immature functioning of the cerebellum. The cerebellum coordinates the speed of the thought and the speech which if uncoordinated led to stammering in Rimzim.
So, we started with
- Sensory integration
- Astronaut training to work on her vestibular system.
- Therapeutic Listening to manage her sensory processing issues
- RMT to integrate the presence of active primitive reflexes.
- Behavior therapy- we added token economy and ensured that she was praised for all her efforts and not for the end results.
She came for sessions twice a week and the mother did RMT every day at home.
She met me in March after a month and there was no difference in her at all. I was really sad and was wondering what is going wrong. Her mom was also quite upset with no difference. Then we changed her therapy targets but worked along the same systems as above. She took a break for the month of April because of exams and was out of town in May for a few days because of which the therapy was irregular. I was very sure that the meeting in June would also be the same as March and it was actually what I predicted. Now, we decided to really continue for just a month and see if things get better or we decide the course of action and also changed some of the therapy targets.
I met Rimzim today and saw the posture of the mother, it was upright and straight and she looked at me with a tinkle in her eyes. I sensed that something good has happened and was really curious to know what it was. We started filling the follow up form and here is what she said
- Rimzim has started sleeping well and has sound sleep because of which she can focus better (earlier she had disturbed sleep)
- She had started eating on her own completely whereas earlier she was fed by her mom.
- Her temper tantrums and impulsive behavior had reduced by 50-60%.
- Her motion sickness has gone away which they noticed when they took her out of town and had to travel in cars and buses. In fact, she also sat on the merry go round which was initially something that her would not even dream of.
- Her books are complete; she has started copying from the black board. She has started writing fast. She has stopped hitting her class mates and not just that-she has made friends!!
- Her stammering which was seen when she was angry has reduced by 60%.
- Self regulation or in simple words –controlling her own behaviour which used to take 30 minutes earlier- now happens in just 2-5 minutes.
She still makes spelling mistakes and we are working on auditory processing but we have come a long way in just three months. Bed wetting is less but still there.
I have been feeling happy after meeting them and floating around like a happy balloon and also feeling extremely satisfied and blessed!!! Brain is neuro-plastic and we can change the way it functions-feeling really optimistic!!!