Snowdrop

The more we repeat something, the better we get at it; this much is uncontroversial. But that doesn’t mean it isn’t worth examining. The connection between repeating an action or a skill and then improving because of that repetition is a concept that is so natural and intuitive, so well accepted as common knowledge, that we often fail to appreciate the fascinating mechanics behind the process of skill acquisition. It follows the old adage, 'practice makes perfect!'

On the most basic level, learning a new skill or improving a skill involves changes in the brain. There are a few different ways that our brains adapt to picking up new skills and changing environmental conditions. The first involves a rewiring of the networks of neurons in the brain. Each skill or action that a child performs involves the activation of neural pathways. In Norman Doidge’s book on neuroplasticity, The Brain That Changes Itself, Dr. Alvaro Pascual-Leone has a beautiful little analogy for the way that these pathways relate to skilled performance (Page 209):

"The plastic brain is like a snowy hill in winter. Aspects of that hill–the slope, the rocks, the consistency of the snow–are, like our genes, a given. When we slide down on a sled, we can steer it and will end up at the bottom of the hill by following a path determined both by how we steer and the characteristics of the hill. Where exactly we will end up is hard to predict because there are so many factors in play." “But,” Pascual-Leone says, “what will definitely happen the second time you take the slope down is that you will more likely than not find yourself somewhere or another that is related to the path you took the first time. It won’t be exactly that path, but it will be closer to that one than any other. And if you spend your entire afternoon sledding down, walking up, sledding down, at the end you will have some paths that have been used a lot, some that have been used very little.”

Every action we perform, every new skill we pick up, involves beating down and refining a kind of neural trail. We are making real changes in the brain. And our brains are remarkably efficient to change in response to training. In one study, video game players who played the dark, fast-moving action-based game Call of Duty for 9 weeks were not only better at the game, but were able to see significantly more shades of gray, post-training, than a group who played a simulation strategy game that did not exercise those skills.

Over a longer time span, it is also possible to see significant structural changes in the brain. For example, the brain area associated with motor control of the right index finger in blind subjects who are braille readers has been found to be significantly larger than that of sighted individuals. Similarly, a famous study of london cabbies, famous for their ability to navigate the twisting streets of the city, found that they had greater brain volume in the hippocampus, a structure heavily involved in both memory and spatial navigation, than bus drivers who followed a predefined route every day.

With respect to the brains of children who have developmental disabilities, the brain injuries or abnormalities they suffer might slow that response to training down a little, but the response is still possible.

Evidence for neuroplasticity abounds, - from the structural differences which have been found between experienced athletes and novices, through to the Chinese study of expert divers which found increased gray matter volume in brain areas associated with skilled motor control. Along the same lines, an Australian study of skilled racket-sport players found that brain areas associated with the racket arm were larger than in a matched group of non-athletes. The evidence is irrefutable!

The overarching theme here is that the brain is malleable–it changes with training. It is an interesting concept to keep in mind, especially with respect to brain injured children and it is the overarching principle of the Snowdrop programme.

It’s easy and natural to think about training in terms of muscles, the body and physical skills. But every new skill that a child learns is accompanied also by neural changes that may be harder to see, but are equally important.

If you would like more information about the Snowdrop programme, just visit our main website on http://www.snowdrop.cc - email us at snowdrop_cdc@btinternet.com or call on 01884 38447

A baby's brain has the capacity to grow at a phenomenal rate. At birth it is only one quarter of its adult size, but by three ears of age it will be 80% the size of an adult brain. At birth it is one of the only organs which has not yet fully developed and it is sensory stimulation derived from environmental experience which drives this growth and consequently which drives the development of the child.

Billions of neurons are created throughout the primary stages of foetal development and through birth. Indeed at birth, the only brain structure which is developed to anything like its mature form is the lower brainstem. This part of the brain controls the primitive reflexes and vital functions such as respiration, cardiovascular function, etc. Immediately after birth, baby's higher brain regions begin to make billions of connections between neurons. These connections, called synapses, are used to transmit information based upon sensory experience. Stimulation through the senses of touch, hearing, vision, smell and taste, in addition to vestibular and proprioceptive experience, directly influence these neurons and help in establishing these connections.

The more frequently the neuron connections are used, the stronger and more efficient the new connections become, this is a phenomenon known as 'long term potentiation.' If some of the neural pathways are not used, they become weak and are pruned, (this is known as 'long term depression.'). This is why the repetition of the activities within a Snowdrop programme of developmental stimulation are so important.

We know that babies who are born into an impoverished environment do not develop the rich connection between neurons which develop in other babies. Children who are neglected, exposed to stress, trauma, abuse, have negative experiences which can have a detrimental effect upon brain growth and development. It has been shown, that those infants or children who are not exposed to adequate sensory stimuli because of these factors can develop brains which are smaller then those who have had those "good" sensory experiences.

So, you might ask, how does this apply to children who have suffered brain injury? Well, what effect does brain injury have on a child? It acts as a barrier between the child and his environment. It does so because it prevents the child from interacting with his sensory environment. Because he is unable to gain the necessary sensory experience from his environment, due to the 'roadblock' of the injury, or because the injury is acting to distort incoming sensory information in some way, the brain is unable to make the same number, or quality of connection as it would otherwise have done and as a consequence baby's developmental processes are either stopped, slowed, or distorted.

Is there anything which an be done to rectify this situation? Well yes, at Snowdrop we believe there is. We take children who have suffered brain injuries and as a consequence are experiencing developmental difficulties and we provide them with an 'adapted sensory environment.' Where the injury is acting as a barrier between the child and his sensory environment, the adapted environment acts to amplify the sensory stimulation to which the child is exposed, breaking through the barrier and giving the child's brain the opportunity to form connections. Where the injury is acting to distort incoming sensory information, making the child hypersensitive, or unable to selectively tune in, or to mask sensory information, our adapted environment seeks to re-tune the neurological structures which are responsible for this. Again, in this way we encourage the brain to make the appropriate number and quality of connections and to consequently improve the developmental prospects of the child.

This is the basis of a Snowdrop developmental stimulation programme. Anyone interested in learning more about Snowdrop's work should email snowdrop_cdc@btinternet.com

Neuro scientists have pinpointed the brain structure regulating our sense of personal space, possibly opening the way to a better understanding of autism and other disorders.

The structure, the amygdala - a pair of almond-shaped regions located in the brain - was previously known to process strong negative emotions such as anger and fear and is considered the seat of emotion in the brain.  However, it had never been linked rigorously to real-life human social interaction.

The scientists, led by Ralph Adolphs, psychology and neuroscience professor and post-doctoral scholar Daniel P. Kennedy, at the California Institute of Technology

(Caltech), were able to make this link with the help of a unique patient, a 42-year-old woman known as SM, who has extensive damage to the amygdala on both sides of her brain.

"SM is unique, because she is one of only a handful of individuals in the world with such a clear bilateral lesion of the amygdala, which gives us an opportunity to study the role of the amygdala in humans," says Kennedy, who led the study.

SM has difficulty recognising fear in the faces of others, and in judging the trustworthiness of someone, two consequences of amygdala lesions that Adolphs and colleagues published in prior studies.

During his years of studying her, Adolphs also noticed that the very outgoing SM is almost too friendly, to the point of "violating" what others might perceive as their own personal space.

"She is extremely friendly, and she wants to approach people more than normal. It's something that immediately becomes apparent as you interact with her," says Kennedy.

Previous studies of humans never had revealed an association between the amygdala and personal space.

From their knowledge of the literature, however, the researchers knew that monkeys with amygdala lesions preferred to stay closer to other monkeys and humans than did healthy monkeys.

Intrigued by SM's unusual social behaviour, Adolphs, Kennedy, and their colleagues devised a simple experiment to quantify and compare her sense of personal space with that of healthy volunteers.

The experiment used what is known as the stop-distance technique. Among the other subjects, the average preferred distance was .64 metres-roughly two feet.

SM's preferred distance was just .34 meters, or about one foot. Unlike other subjects, who reported feelings of discomfort when the experimenter went closer than their preferred distance, there was no point at which SM became uncomfortable; even nose-to-nose, she was at ease.

Furthermore, her preferred distance didn't change based on who the experimenter was and how well she knew them.

"Respecting someone's space is a critical aspect of human social interaction, and something we do automatically and effortlessly," Kennedy says.

The discovery appeared in the Sunday issue of Nature Neuroscience.

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What these researchers do not allude to is that just because the amygdala may be wired in a specific way in people who have autism, this does not mean that the situation is unchangeable. We know that the brain possesses a high degree of plasticity and can and does restructure it's functional organisation in response to the environment in which it finds itself. Therefore if we provide the appropriate neuro-developmental environment, we give people who face difficulties on the autistic spectrum every opportunity for their brain to reorganise itself. This is exactly what a Snowdrop programme entails.

Breathing is something we all take for granted because it is an automatic function, to which we do not have to pay attention. Only when something interferes with the smooth function of our respiration, such as exercising, or an adverse reaction to an allergen, or if we develop a respiratory disorder do we become all too aware of it!

Many children who have cerebral palsy, have difficulties with their breathing. Not many people are aware that the rate and depth of our breathing is subject to the forces of development and that consequently the rate and depth of a babies breathing is simply not comparable to that of an adult. For instance, the breathing rate of a newborn baby is around 40 breaths per minute, but by the time the child reaches his first birthday, this has dropped to around 35. By his second birthday the average rate has dropped to 30 and by the time he is 5 years old, it has dropped to around 25. We then see a slower decline and by the time he is 12 years old it has dropped to around 20, until finally it reaches its adult rate of around 15.

What implications does this have for a child with cerebral palsy? Well, the brain injury which adversely affects the development of the child in other areas, can also affect the development of the rate of respiration and this can have negative effects. If a child is growing physically, but his rate of respiration remains stuck at the level of a baby at around 40 shallow breaths per minute, it will create obvious consequences for the ability of that child in terms of his eating, drinking and the development of spoken language. (To test this out, try running up and down stairs until you are out of breath and then try to eat a biscuit or cake or try reciting your favourite poem. – Its difficult isn’t it)? This is the situation many of our children are faced with constantly. – Imagine the nightmare of trying to coordinate chewing, swallowing and breathing at such a rate!

Another factor which can be a worry as the child’s growing musculature demands more oxygen from a system which simply cannot provide it, is the creation of a poor physiological environment for the brain. The brain uses up 25% of all the oxygen we take in and as it develops, it not only demands more oxygen from a respiratory system which cannot deliver it, - with the consequences of brain development being slowed, but the increasing demands being made from a growing physical body provide stiff competition for the limited oxygen which is available. This can not only have the effects of limiting physical and neurological development, but can cause a child to have seizures.

So what can be done about this situation? The obvious answer seems to be the direct delivery of Oxygen, such as is seen in hyperbaric oxygen chambers, but this in turn throws up additional problems. There are sensors in the base of the brain, which are sensitive to the levels of oxygen and carbon dioxide in the bloodstream. They help regulate the rate of delivery of oxygen to the brain by widening and narrowing the arteries as is necessary. When they detect higher than normal levels of oxygen in the bloodstream, they act to constrict the arteries so that the brain is not flooded with oxygen. So in directly delivering extra oxygen, we may actually be depriving the brain of it! In the more extreme cases this has led to people experiencing a form of stroke known as an ischaemic attack!

So what do we do? At Snowdrop I find that when a child embarks on a programme of neurological rehabilitation and when we begin to make progress in developmental terms, very often the respiration makes improvements too.

Anxiety isn't a problem that you would automatically think to associate with cerebral palsy, but some children really do suffer quite badly with it. This can be due to many reasons. One reason is the discomfort produced by stiff musculature. A high muscle tone can be uncomfortable for a child and having to cope with this constantly is bound to have an anxiety raising effect.

Another possible cause can be the overproduction of norepinephrine in the brain, leaving the child on a hyper-anxiety inducing adrenaline 'high.'

Yet another cause can be sensory over-sensitivity. - A child who is unable to mask extraneous incoming sensory stimulation, but who sees, feels and / or hears too much, or whose sensory system over-amplifies incoming stimulation is likely to experience anxiety.

Another factor can be lack of sleep. Many children who have cerebral palsy have a poor sleeping pattern. We all know how we feel if we lose a night's sleep, tired, overstressed and anxious.  So for many children, anxiety can simply be part of their every day existence.

There are techniques, which Snowdrop employs within some of its programmes, which are designed to help relieve this situation, but in the most severe cases intervention can be necessary with anti – anxiety medications.

Thanks to 'Scienceblog' for this report, which again clearly demonstrates just how plastic the brain actually is. It is this inherent plasticity that Snowdrop aims to direct in our programmes of rehabilitation for brain injured children

Visually impaired people appear to be fearless, navigating busy sidewalks and crosswalks, safely finding their way using nothing more than a cane as a guide. The reason they can do this, researchers suggest, is that in at least some circumstances, blindness can heighten other senses, helping individuals adapt.

Now scientists from the UCLA Department of Neurology have confirmed that blindness causes structural changes in the brain, indicating that the brain may reorganize itself functionally in order to adapt to a loss in sensory input.

Reporting in the January issue of the journal NeuroImage (currently online), Natasha Leporé, a postgraduate researcher at UCLA's Laboratory of Neuro Imaging, and colleagues found that visual regions of the brain were smaller in volume in blind individuals than in sighted ones. However, for non-visual areas, the trend was reversed -- they grew larger in the blind. This, the researchers say, suggests that the brains of blind individuals are compensating for the reduced volume in areas normally devoted to vision.

"This study shows the exceptional plasticity of the brain and its ability to reorganize itself after a major input -- in this case, vision -- is lost," said Leporé. "In other words, it appears the brain will attempt to compensate for the fact that a person can no longer see, and this is particularly true for those who are blind since early infancy, a developmental period in which the brain is much more plastic and modifiable than it is in adulthood."

Researchers used an extremely sensitive type of brain imaging called tensor-based morphometry, which can detect very subtle changes in brain volume, to examine the brains of three different groups: those who lost their sight before the age of 5; those who lost their sight after 14; and a control group of sighted individuals. Comparing the two groups of blind individuals, the researchers found that loss and gain of brain matter depended heavily on when the blindness occurred.

Only the early-blind group differed significantly from the control group in an area of the brain's corpus callosum that aids in the transmission of visual information between the two hemispheres of the brain. The researchers suggest this may be because of the reduced amount of myelination in the absence of visual input. Myelin, the fatty sheaf that surrounds nerves and allows for fast communication, develops rapidly in the very young. When the onset of blindness occurs in adolescence or later, the growth of myelin is already relatively complete, so the structure of the corpus callosum may not be strongly influenced by the loss of visual input.

In both blind groups, however, the researchers found significant enlargement in areas of the brain not responsible for vision. For example, the frontal lobes, which are involved with, among other things, working memory, were found to be abnormally enlarged, perhaps offering an anatomical foundation for some of blind individuals' enhanced skills.

Previous studies have found that when walking down a corridor with windows, the blind are adept at detecting the windows' presence because they can feel subtle changes in temperature and distinguish between the auditory echoes caused by walls and windows.

Leporé noted that scientists and others have long been curious about whether or not blind individuals compensated for their lack of vision by developing greater abilities in their remaining senses. For example, the 18th-century French philosopher Denis Diderot wrote of his amazement with some of the abilities shown by blind individuals, in particular a blind mathematician who could distinguish real from fake coins just by touching them.

But it wasn't until the early 1990s that the suspicions of science began to be confirmed with the development of neuroimaging tools.

"That allowed researchers to probe inside the brain in a non-invasive manner, yielding insights into the impressive adaptive capacity of the brain to reorganize itself following injury or sensory deprivation," Leporé said.

Other authors included Caroline Brun, Yi-Yu Chou, Agatha D. Lee, Sarah K. Madsen, Arthur W. Toga and Paul M. Thompson, all of UCLA, and Franco Leporé, Madeleine Fortin, Frédéric Gougoux, Maryse Lassonde and Patrice Voss, of the University of Montreal.

This study was supported by the Canadian Institutes of Health Research, the Canada Research Chairs Program, the National Institute on Aging, the National Library of Medicine, the National Institute of Biomedical Imaging and Bioengineering, the National Center for Research Resources, the National Institute for Child Health and Development, and a grant from the National Institutes of Health.

The researchers report no conflicts of interest.

The UCLA Laboratory of Neuro Imaging, which seeks to improve understanding of the brain in health and disease, is a leader in the development of advanced computational algorithms and scientific approaches for the comprehensive and quantitative mapping of brain structure and function. The laboratory is part of the UCLA Department of Neurology, which encompasses more than a dozen research, clinical and teaching programs. The department has ranked No. 1 among its peers nationwide in National Institutes of Health funding for the last seven years

What is Absence of the Septum Pellucidum?

Absence of the septum pellucidum (ASP) is a rare disorder, (occuring in an estimated 2 to 3 individuals per 1 00,000 people in the general population). It is characterised by abnormal development of a thin membrane located at the midline of the brain. It runs down from the corpus callosum, the structure which connects the two cerebral hemispheres of the brain and effectively acts as a separator for the two hemispheres. The disorder usually occurs with other neurological abnormalities such as agenesis / dysgenesis of the corpus callosum.

Individuals with ASP may experience vision impairment or blindness. They may also have coordination problems and hormone deficiencies that result in short stature. Intelligence is usually affected and learning disabilities are common. The disorder usually manifests early in life, often as a consequence of discovering the other neurological abnormalities, such as corpus callosum abnormalities or septo – optic dysplasia. Symptoms include involuntary eye movements, a wasting of a part or parts of the body, and short stature. Seizures and inappropriate behaviour, such as displays of 'sham rage' may also occur. The cause of ASP is currently unknown.

What is the prognosis?

The prognosis of ASP varies depending on the severity of co-occurring abnormalities. Many cranial abnormalities are life threatening, but alone ASP is not a life-threatening disorder.

Can ASP be treated?

When a part of the brain is actually missing, - having not developed at all, then obviously no amount of treatment is going to be able to restore that missing neurology. What we can strive to do is to enable the neurology which is present to function at maximum efficiency and therefore give the child the opportunity to achieve his / her maximum potential. We believe that that at Snowdrop, we teach parents how to provide an appropriately stimulating developmental environment for this to happen

The Pons is located in the lower brainstem, directly above the Medulla Oblongata. The word 'pons' means 'bridge' and this is an apt description as it acts as a bridge which connects the cerebellum to higher brain structures. It's involvement with the cerebellum makes it an important player in the coordination of movement and posture.

The Pons is also involved in sensory analysis... for example, information from the ear first enters the brain in the pons at the level of the Eighth cranial nerve. It is therefore easy to imagine how many of the distortions of sensory processing experienced by our children can be produced by injury here!  It has parts that are important for regulating our level of consciousness and for sleep, which fits in nicely with the fact that the raphe nuclei are serotonin producing neurons. Injury to the Pons can cause coma. The pons contains the raphe nuclei which contain serotonin, a type neurotransmitter which is instrumental in mediating mood and sleep. The pons is also involved in our ability to perceive pain. Regulation of specific direction of gaze is also controlled at the pons and so a good indicator of injury to this structure is the absence of a pupillary light reflex.

Another important set of nuclei in the pons is the Locus Coereleus. This area of the brain is intimately involved in REM (dream) sleep. It is these nuclei which are responsible for many stress reactions, including 'post traumatic stress disorder.' The locus ceruleus is activated by stress, and will respond by producing a neurotransmitter called 'norepinephrine,' - a form of adrenaline. Injury here is why some of our children are hyper-anxious and oversensitive in sensory terms. Norepinephrine also increases cognitive function and motivation.

So injury to the Pons is capable of producing coma, causing sleep disturbances, sensory disturbances, lack of pupillary response, dysfunction in levels of arousal and attention and increases in levels of stress and anxiety. How many of our children who suffer conditions such as cerebral palsy and autism have injuries to this structure? I would suggest it is more than one would imagine.

Can an injury to the Pons be treated?

Yes! We know that the brain has a high degree of plasticity, - the ability to reorganise it's structure and functioning according to the demands of the environment in which the individual finds himself. We also know that if we can gain an improvement in functioning in one part of the brain, then we can expect 'knock - on' effects, - improvements in other parts of the brain due to the rich connectivity between all areas of the brain. What we do at Snowdrop is to provide children (and adults) with an envionment which is designed to stimulate their development by encouraging this plasticity and improved functioning.

The Medulla Oblongata lies right at the bottom of the brainstem. It's functions are to control respiration, heart rate, swallowing, vomiting, blood pressure and coughing. It also acts as a relay station for nerve fibres, which are descending from the cortex, which cross over at the level of the medulla. This ensures that the right cortical hemisphere controls the left hand limbs of the body and vice versa.

Because of the functions which are the responsibility of the medulla, injury to this part of the brain often proves fatal. Because several cranial nerves carrying sensory information from the environment enter the brain at the level of the medulla, injury can cause many sensory complications. For instance, injury here can cause numbness and paralysis of the palate and throat, difficulty swallowing, leading to excessive drooling and disturbances of taste. It can also cause 'acid reflux,' gagging and inability to rotate the head. There are obvious implications amongst these problems for the development of language and communication.

Despite the high fatality rates for injuries to this part of the brain, I do occasionally see children who are displaying obvious signs of the involvement of the medulla in their injuries. They include children with both cerebral palsy and autism.

Can an Injury to the Medulla be successfully treated?

The brain is highly plastic and any part of our neurological structure is capable of making new connections if we can create the right environment for it to do so. What is the 'right environment?' Well that depends upon to particular pattern of injury experienced by the individual, but an environment which comprises the appropriate level of stimulation can improve the functioning of all areas of the brain. This is what a Snowdrop programme is tailored to acheive.

This is a very interesting study, with one elementary mistake! It was thought for years that the dopaminergic system was responsible for reward, - it isn't, but people, including scientists who should know better keep calling it so! The mesocorticolimbic system, which is a primary dopamine pathway, involving the stratium and the accumbens produces dopamine, but that dopamine does not produce 'reward' it produces 'desire' or what we would term 'craving.' - This 'desire' is the basis of addiction. What happens when this pathway is stimulated is that associated systems which produce opioids, - the brain's own heroin are triggered to release those opioids, which is where the 'reward' comes in. However after a while, opioid production begins to fall and so we have desire without pleasure or reward! This is why addicts need more and more of a drug to feel the reward - in order to release the opioids! It is also why many addicts feel the craving to take drugs, but don't get pleasure from it!  Anyway, it seems that this system might be undersensitive in some children who have ADHD and this research might lead to more effective treatments.

Indeed at Snowdrop, we use several techniques with children who have ADHD, which directly target these neural systems.

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The underlying causes of Attention Deficit Hyperactivity Disorder (ADHD) have yet to be well characterized. But a new study utilizing brain imaging has found an abnormality in the pathway responsible for the motivation/reward system in patients with ADHD. The finding may lead to more effective treatments for the condition as well as a greater understanding of ADHD behavior.

A hallmark of ADHD is lack of attention. Especially seen in the classroom, both children and adults with the disorder lack the ability to focus for extended periods of time. Scientists suspected the symptom was due to a deficit in motivation and reward system--a process which can hone focus with the understanding that a reward (or at least not a punishment) will be given if successful.

Studying that pathway is a difficult task. It relies on the chemical dopamine, which can be easily affected by ADHD treatment or drug abuse which is common in adult ADHD sufferers. Tests to this point have been relatively small, but a push by lead author Nora Volkow, Director of the National Institute on Drug Abuse, finally saw a sizable cohort of participants investigated.

53 adults with ADHD who had never received treatment were subjected to a PET scan along with 44 healthy controls. Researchers looked at both ends of the dopamine pathway--"dopamine receptors, to which the chemical messenger binds to propagate the "reward" signal, and dopamine transporters, which take up and recycle excess dopamine after the signal is sent."

The study showed those with ADHD had lower levels of both receptors and transporters. This was especially clear in the acumbens and midbrain, both of which are regions important to the motivation/reward process.

Understanding the deficit in dopamine can help change the way ADHD patients interact with the world. Volkow stated, "[The pathway's] involvement in ADHD supports the use of interventions to enhance the appeal and relevance of school and work tasks to improve performance."

Though the dopamine problems have not been a solid fact until this moment, the medication that has been used for decades were on the right track. "Our results also support the continued use of stimulant medications — the most common pharmacological treatment for ADHD — which have been shown to increase attention to cognitive tasks by elevating brain dopamine," Volkow said.

The team also hopes that this study will help adults with ADHD who tend towards drug abuse and obesity. The lack of dopamine makes the rewards system difficult to trigger, so overeating and over use of stimulant drugs may be seen as a dangerous form of compensation, an unconscious move to help bolster the feeling of reward. Developing therapies that help attenuate the need for drugs and binge eating will greatly improve quality of life. Thanks to the examiner