I've treated many children on the autism spectrum (ASD)and children with ADHD who have struggled with their speech. Many parents have told me that the speech therapy did not work well. Many times, a child with ASD or ADHD also has a right palatal weakness. If the part of the brain that controls tongue movement on the right isn't working, the child will not be able to move the tongue in proper ways. Since it's summertime, parents have more time for therapy with their children. I suggested last week that a mother of a 7 year old boy (who is doing marvelously with neurology treatment) bring him to his speech therapy directly after his treatment here. The speech therapist reported that "it was the best therapy session ever! He was like a different child. They even finished all the treatment for the first time with time left over!" When the brainstem works well, the tongue works well too. Then speech therapy will have even better results. Go, brain, go!
The first time I heard of this disorder, I was confused. The doctor kept saying, "You know, dis-embarkment, like getting off of a boat!". Ok, now it made sense. Some people feel like they are on a boat when they are sitting, standing and/or walking. I examined a man with disembarkment syndrome the first time about 20 years ago, but I didn't know what to call his condition. I recently saw a different man with this syndrome. He said he was looking at his device while on an airplane for about 45 minutes. When he turned it off, he felt terribly sick and nauseated. When he got off the plane, he said he felt like he was walking on 6 foot waves. He said it had been this way for years! In the examination, I found a severe one sided cerebellar deficit, which we started to change right away. Unfortunately, this man did not continue with the treatment plan. However, he was about 50% improved after approximately 2 months of treatment. I also gave him homework so the neurological changes we made would continue to be stable.
Here is an interesting article I just read regarding how certain eye movements are events of certain specific brain areas:
Delineating function and connectivity of optokinetic hubs in the cerebellum and the brainstem.
Optokinetic eye movements are crucial for keeping a stable image on the retina during movements of the head. These eye movements can be differentiated into a cortically generated response (optokinetic look nystagmus) and the highly reflexive optokinetic stare nystagmus, which is controlled by circuits in the brainstem and cerebellum. The contributions of these infratentorial networks and their functional connectivity with the cortical eye fields are still poorly understood in humans. To map ocular motor centres in the cerebellum and brainstem, we studied stare nystagmus using small-field optokinetic stimuli in the horizontal and vertical directions in 22 healthy subjects. We were able to differentiate ocular motor areas of the pontine brainstem and midbrain in vivo for the first time. Direction and velocity-dependent activations were found in the pontine brainstem (nucleus reticularis, tegmenti pontis, and paramedian pontine reticular formation), the uvula, flocculus, and cerebellar tonsils. The ocular motor vermis, on the other hand, responded to constant and accelerating velocity stimulation. Moreover, deactivation patterns depict a governing role for the cerebellar tonsils in ocular motor control. Functional connectivity results of these hubs reveal the close integration of cortico-cerebellar ocular motor and vestibular networks in humans. Adding to the cortical concept of a right-hemispheric predominance for visual-spatial processing, we found a complementary left-sided cerebellar dominance for our ocular motor task. A deeper understanding of the role of the cerebellum and especially the cerebellar tonsils for eye movement control in a clinical context seems vitally important and is now feasible with functional neuroimaging.
5 weeks ago I examined a 9 year old boy on the autism spectrum. He is amazing. He is similar to the Rain Man. He can calculate numbers and birthdates quickly. However, when he walked in my office for the initial 2 hour evaluation and treatment, he walked right up to me, shoved his middle finger in my face and said, "F**K YOU!" I thought, "Finally, an extrovert! I know what to do with this." I told his mom that there was nothing he could do to make me embarrassed or shame her or him. He proceeded to shout, "F**K YOU!" I said, "Say, "Thank you. I love you."" This continued throughout the visit. He said, "I'm going to take you into my van, cut you into a million pieces, and murder you!" I kept saying, "Say thank you. I love you." We actually got through the exam and treatment. On the next visit, his mom said he had an amazing day after the treatment. After cursing at me and his mom during treatment, at the end of the fourth visit, he calmly sat down on the trampoline in the office, and said, "Mom, I'm really sorry for all those terrible things I said." After the 6th visit, his mom texted to tell me that her son was sitting at the dinner table with the family having a conversation (that never happens) and the he was telling her he wanted to buy her a gift! He also was asking his grandma questions about her life. (You need a right cortex to think about others and plan the future). At the seventh visit, the boy had an actual response in his right medial pupil for the first time. When he came in on the next visit, he bounded in and jumped onto the trampoline. As he was jumping, he said, "Aren't you glad I don't say F You anymore?" I said yes. Then he said, "Aren't you glad I don't have a T-shirt on that says F You?" I couldn't stop laughing. He now repeats after me when I tell him to repeat positive affirmations like, "I am a genius applying my wisdom" and "I have perfect brain balance." You know what............he is a genius. He was just trapped by his brain.