Tag Archives: neurological rehabilitation

Your 4 year old needs Ritalin

Picture taken by myself of my Adderall prescri...

Unfortunately, your child’s pediatrician might agree.  The American Academy of Pediatrics recently changed the age at which children could be diagnosed with ADHD.  Now children as young as 4 and as old as 18 can be diagnosed with attention deficit hyperactivity disorder.  This diagnosis now also includes the old diagnosis of ADD, a term that is no longer used.

This change has led to fears that with more diagnoses there will be more drug therapies applied and perhaps some of these will be diagnosed incorrectly.  To me, these sound like legitimate fears.

The first problem I have is that the drugs approved for treating ADHD are dangerous and pose serious risks.  On top of that, they have only been approved to be used in children 6 and over.  No one has studied these medications on children younger.  This is a major problem. We cannot possibly know what these powerful stimulants can do to a developing brain.  These stimulants are, after all, a derivative of methamphetamine (basically speed!).

The guidelines are quick to point out that while Ritalin is an effective option, it should only be used once behavior modification has been tried unsuccessfully. The problem with that is I find many pediatricians are already too quick to write a prescription and move on to the next patient.  In a health care environment where most physicians are strapped for time as it is, they are unlikely to take the time to describe how to implement a program of behavioral modification and are much more likely to recommend something quick and easy like Ritalin.

A child that is just 4 years old is still developing.  Their brain is malleable and easily changed.  On one hand this is a good thing.  It means changes in their home life, behavioral modifications and therapeutic exercises have a great chance of working.  On the other hand it means the potential for negative change associated with medications is greater as well.

I see many children in my office for neurobehavioral disorders like ADHD.  I find I can recognize the hard signs in a 4 year of ADHD like breakdown in gait patterns, breakdown in eye movements or the persistence of primitive reflexes.  These are easily corrected with a program of brain rehabilitation and does not require dangerous stimulants.

These guidelines seem to be a way to open a new market for pharmaceutical sales.  As a matter of fact, the chairman of the committee who recommended the new guidelines, physician Mark Wolraich, is a periodic consultant to Eli Lilly,  Shire Plc, and other pharmaceutical companies. Eli Lilly and Shire hold exclusive U.S. patents for atomoxetine (brand name Strattera) and guanfacine (brand name INTUNIV), respectively, both of which the report recommends for treating ADHD in adolescents.

Parents should not be fooled by these recent recommendations.  Parents should seek drug-free alternatives for their children if they believe that they have ADHD. We just don’t know what these medications can do to a young brain.

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What’s that sound?

This is a transaxial slice of the brain of a 5...

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Tinnitus, or ringing in the ears, is an exceptionally common problem.  As many as 2 million Americans experience this on a daily basis.  It can range from very minor to annoying to debilitating.

Tinnitus is often associated with hearing loss.  Prolonged exposure to loud noises is the most common cause of hearing loss.  It is this loss of hearing that is actually causing the tinnitus.  Say what? Hearing loss actually causes people to hear sounds that don’t really exist? Yes!

People often describe tinnitus as ringing in the ears.  However, the list of sounds that are considered tinnitus is very long.  Other sounds that people might perceive include ticking, clicking, whooshing and buzzing to name a few.

Recent research, published online in the journal Proceedings of the National Academy of Sciences, suggest several new approaches to treatment, including retraining the brain, and new avenues for developing drugs to suppress the ringing.

As a chiropractic neurologist the above statement about retraining the brain got my attention.  This is something that is near and dear to the heart of all chiropractic neurologists.  We use techniques that retrain the brain every day.  We use these techniques to help people with a wide variety of conditions ranging from anxiety to muscular imbalances and pain.

Traditionally, patients with tinnitus are told the problem stems from damaged hair cells inside of the ear.  They are told it is these hair cells that are sending the wrong signals into the brain which interprets them as noise. Turns out, this is not true.

Because each hair cell is tuned to a different frequency, damaged or lost cells leave a gap in hearing, typically a specific frequency and anything higher in pitch.  It is this gap which causes problems for the brain.

Chiropractic neurologists have been saying for a very long time that ringing in the ears is actually brain based.  This new research supports this assertion. Below is information from coauthor of the recent study Shaowen Bao, adjunct assistant professor in the Helen Wills Neuroscience Institute at UC Berkeley

Experiments in the past few years have shown that the ringing doesn’t originate in the inner ear, though, but rather in regions of the brain — including the auditory cortex — that receives input from the ear.

Bao’s experiments in rats with induced hearing loss explain why the neurons in the auditory cortex generate these phantom perceptions. They showed that neurons that have lost sensory input from the ear become more excitable and fire spontaneously, primarily because these nerves have “homeostatic” mechanisms to keep their overall firing rate constant no matter what.

“With the loss of hearing, you have phantom sounds,” said Bao, who himself has tinnitus. In this respect, tinnitus resembles phantom limb pain experienced by many amputees. (From sciencedaily.com)

The neurons that have lost sensory input in the brain are the neurons that are responsible for the perceived noise that people hear.  These neurons have undergone a process called transneural degeneration.  To stabilize these neurons they need more input.  But because they cannot receive it from the hair cells in the ear that are damaged, other areas of the auditory cortex must take over.  This retraining of the brain takes time, but if performed diligently, the results can be phenomenal.

We know this is a possibility because the brain is plastic.  That is, it changes in response to the stress and environmental input it receives. When a finger is amputated, for example, the region of the brain receiving input from that finger may start handling input from neighboring fingers.

Drug therapy is aimed at increasing the levels of the neurotransmitter GABA in the brain.  GABA is the primary inhibitory neurotransmitter.  In order to slow down the firing rate of these over excited cells, we must increase the levels of this inhibitory neurotransmitter.  The good news is there are lots of natural therapies that work to raise GABA levels or drive GABA receptors in the brain.

One way is to use the amino acid taurine.  I use it frequently.  Another is a product called phenibut (Phen-i-bute).  It is a natural GABA derivative that crosses the blood brain barrier and binds to GABA receptors.  I also use this frequently in my practice. These supplements, however, I believe are temporary solutions.  The permanent solution is to retrain the brain.

Tinnitus is a complicated and elusive condition, but we appear to be headed in the right direction in terms of research.  Always remember, the brain holds the key!

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1 in 100 Children have Autism…Find Out Why

My recent studies have focused very much on vitamin D and all of its wonderful benefits.  A quick perusal of the other articles on our blog will confirm this!  Recently, I came across information that was too good not to share with all of you.  A link between Autism and vitamin D deficiency has been established.  As some of you know, we see many children at The Vreeland Clinic for interventions with autism.  We provide nutritional and neurological rehabilitation programs to further assist in the development of the brains of these children.  In this article I would like to share with you groundbreaking information regarding vitamin D and autism.

Autism now affects 1 in 100 children in the U.S.

Autism statistics are staggering.  Twenty-five years ago an autism diagnosis was a 1 in 10,000 chance.  Today, 1 in 100 children will be diagnosed with autism.  Many researchers point to the increase in diagnosis as nothing more than more accurate methods and increased awareness.  They believe that the number was always about 1 in 100, but it was not reported.  Although there is some truth to more accurate diagnosis, it does not account for such a meteoric rise.  What’s more likely is that there has been some change in our environment over the last 20 to 25 years that, in combination with a more accurate system of diagnosis, has caused the number of autistic children to rise to epidemic proportions.

Autism involves poor social and verbal functioning accompanied by a host of other issues that range from poor digestion to fixed and repetitive behaviors.  Also included in the Autistic Spectrum Disorders is a series of problems with fine or gross motor control, all of which can have a devastating effect on a family.  The range is so broad in fact that many scientists and healthcare professionals often do not agree on a diagnosis.  What is presently known is that this condition can cause subtle developmental delays or profound issues that can require long-term care is specialized facilities.  The dichotomy is obvious, but there seems to be a link between the two.  This link is vitamin D.

There are many proposed causes of autism.  Most agree that there is some genetic predisposition.  This has been suggested because of the increased frequency of autism that tends to occur in families and in studies of identical twins.  Although there is a genetic link, it is also accepted that some environmental trigger must occur to cause autism.  The majority of scientists have come to a consensus that identifies both genetic and environmental factors as being relevant in the cause of autism.  Many theories have focused on environmental toxins, especially heavy metals, as a culprit in autism.  Another theory is low levels of vitamin D during pregnancy and infancy.

Many times when speaking about autism people are very confused by the recent rise in autism diagnoses.  Most times,

A link between Autism and vitamin D deficiency has been found

people rightly point out that a purely genetic theory makes no sense because our genes certainly are not any different than they were 20 years ago.  They also make the point that our environment, while different, is not significantly different than it was 20 years ago.  If both of these previous statements are true, and I believe they are, then what could possibly be causing the rise in the diagnosis of autism?  Dr. John Cannell, a leading researcher in vitamin D has a theory.  He agrees that genetically we are the same today as we were 20 years ago and that the environment, while altered, is not so significantly altered to cause an epidemic of autism.  He argues that our behavior with regard to our environment has changed.  He states that these changes have had an effect on our nervous systems that can and does account for a rapid rise in autism diagnoses.

Our understanding of what vitamin D does in our body has exploded in recent years.  Although most physicians know that vitamin D is critical for healthy bones, most do not know about its other benefits.  Vitamin D is critical for a healthy heart.  It has been shown that it is critical in preventing many forms of cancer.  We know that it regulates the immune system by keeping it prepared but also keeping it from overreacting.  Vitamin D is a potent anti-inflammatory.  It has also been shown that the active form of vitamin D, called calcitriol, is an important neurosteroid hormone.  A neurosteroid hormone is a compound that is extremely important for brain development and behavior.  Calcitriol is a potent neurosteroid that controls brain cell growth and acts on brain cells from the time of conception.  Recent research has suggested that vitamin D offers “neuroprotection, antiepileptic effects [antiseizure effects], immunomodulation, impact on several brain neurotransmitter systems and hormones as well as regulation of behaviors.”  The last statement makes it very obvious that vitamin D is critical for pregnant mothers, newborns and children alike.

The question remains, however.  What could have possibly changed so greatly in the past 20 years that it would account for the rapid rise in autistic cases?  Dr. Cannell believes it is a simple answer.  He believes that in an effort to reduce our risk for skin cancer we have created a very serious deficiency in vitamin D.  Remember, it is through the sun’s UV rays that most of our vitamin D is produced in the body.  By lathering up with sunscreen every time we go out side, we block those UV rays from ever reaching our skin, thus preventing synthesis of the all important vitamin D.  Dr. Cannell also believes that because we have become a much more sedentary society that we do not get outside nearly as much as we used to.  And is this so hard to believe?  Twenty years ago marks the real beginning of home video game systems.  Cable television was still in its infancy 20 years ago.  The iPod did not exist and hand held electronic games were not nearly as popular and complex as they are today.  So this, in combination with sunscreen, creates a dangerous, yet easily overlooked scenario.

Our unfounded fear of the sun has lead to an epidemic of low vitamin D levels - even in sunny climates.

So what evidence links autism with vitamin D deficiency?  Is it more that just a coincidence?  Calcitriol acts as a molecular switch in brain tissue that turns on favorable genes that facilitate brain development.  In fact, there are about 1,000 genes already known that are targets of calcitriol.  Vitamin D is unique in that is it the only vitamin that relies on the sun for its production rather than dietary intake.  Because pregnant women are getting into the sun less and less they require more and more to be taken orally.  Unfortunately, the prenatal vitamins that most women take are far too low in vitamin D to be of any benefit.  From an evolutionary perspective, our bodies are not used to getting the majority of our vitamin D from a pill.  It is used to getting massive amount from the sun.  The skin’s production of vitamin D is far more effective than ingesting it orally.  Take the following into consideration; in just 10-40 minutes of sunbathing by a fair skinned adult about 20,000 IUs of vitamin D will be produced over the next 24 hours.  It is important to note that the FDA claims 400 IUs per day through diet is sufficient for health.  There is quite a difference between 20,000 and 400.  Now consider this; in order to get 20,000 IUs from diet, one would have to drink 200 glasses of milk or take 50 prenatal multivitamins.  Obviously neither of those is a viable option.

Dr. Cannell points out that people have been avoiding the sun for the past 20 years.  It is exactly in the last 20 years that we have noticed a rapid rise in the diagnosis of autism.  Now, just because the rise in autism parallels a decrease in sun exposure in industrialized nations does not necessarily mean it is a cause and effect relationship.  There are other astounding biochemical reasons this theory makes sense.  A very large amount of animal studies have shown just how crucial calcitriol is to brain health.  In rats, it has been shown that the offspring of vitamin D deficient mothers had abnormal cell growth, structure and functions in their brains and alterations in learning and memory.  A group of French researchers found that 36 important brain proteins are disrupted when vitamin D is deficient during fetal development.  We discussed earlier that vitamin D is a potent anti-inflammatory.  Often in autism, children have problems with immune function similar to those affected by vitamin D – including increased inflammatory cytokine levels.  These high levels of inflammatory cytokines cause oxidative stress in the brain and are known to cause cognitive impairment.  Vitamin D reduces this oxidative stress on the brain.  Calcitriol also helps increase levels of glutathione in the brain.  Glutathione is a critical antioxidant for detoxification.  This may explain the link between heavy metals and autism.  Without the calcitriol, children cannot actively detoxify the small amounts of heavy metals that accumulate in their body on a daily basis.  In time, this results in a toxic load that retards brain development.  As we can see, there are many reasons why vitamin D is important for proper brain function.  It serves to regulate nerve cell growth, it regulates protein structure, it regulates the immune system and it regulates oxidative stress that may damage brain cells.

So now the question is, how much vitamin D do I need?  This is a good question.  Most people cannot obtain enough vitamin D through diet.  Ideally, a good blood level of vitamin D is 50-60 ng/mL.  This can be measured through a simple test.  In order to get to that number most people will have to supplement their diet with a quality form of vitamin D.  Generally speaking, we start adults on at least 2,000 – 4,000 IUs per day and recheck the levels in 2-3 months.  Recent research indicates that even that might not be enough (remember we are told the standard for Americans for adequate health is 400 IUs).  Children over 1 year of age can safely take at least 1,000 IUs but we usually start at 800 IUs and check the levels in 2-3 months.  Vitamin D is very safe to take and as a matter of fact, the risk of not having enough far out weighs the risk of vitamin D toxicity.  In fact, if vitamin D is taken responsibly, the risk of toxicity is virtually zero.  Should you have any questions regarding vitamin D supplementation, please contact you health care professional and talk to them about vitamin D.

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Vision Therapy For ADHD.

I recently came across an article in the NY Times that speaks of using vision therapy to correct problems in children like learning disabilities and ADHD.  The article explores the divide that exists between what mainstream medical practitioners think and optometrists think when it comes to vision therapy.  Most of the health practitioners who practice vision therapy for leaning disabilities happen to be optometrists.

Behavioral optometry, as it is called when optometrists focus on these types of conditions, is a growing field within optometry.  This is similar to my own chiropractic profession in which regulated subspecialties like neurology, radiology and nutrition have emerged over the last 20 years or so.  Behavioral optometrists use eye exercises to improve conditions such as ADHD, Autism, learning disabilities and even neck pain.

Mainstream medicine, of course, finds this abhorrently offensive because it does not fit into their own paradigm of drug therapy.  To them, everything that can be known is known and anything ‘outside the box’ is without a doubt wrong and probably dangerous.  As a matter of fact, they will often tell you if you seek these treatments the practitioners offering it are ‘quacks’ and are out to steal your money.  This may sound harsh, but it is not an exaggeration.  I have heard it many times from my patients who were unsuccessfully lobbied by their primary care doctors to stop seeing me for their treatments.

Eye exercises along with other modalities is something that we use with regularity to treat children with a range of conditions that includes ADHD, Autism and other learning disabilities.  It is extremely successful.  Many doctors will say that there is no scientific research that shows it works.  Takes this quote for instance.

“It has no validity,” says Marshall Keys, a Rockville, Md., pediatric and adolescent ophthalmologist who is an outspoken critic of vision therapy.

Dr. Keys clearly has not picked up a neurology text in a very long time. The fact that they eyes and the brain act as virtually one entity is well known.  If they eyes do not work properly the brain cannot process information correctly.  If the brain is not working properly it cannot control the eyes.  The connection is easy to understand.  Try this simple demostration:

Stand up and put your feet together and with your eyes open look up at the ceiling and roll your head in several circles.  Now repeat this with your eyes closed.  It was much easier to stand and roll your head in circles with your eyes open wasn’t it?  You felt more stable with your eyes open.  Why?  Because you depend very heavily on your eyes for your sense of balance.  When you close your eyes you rely solely on the information coming from your inner ear and the receptors in the joints of your legs and spine.  Without the input from your eyes, your brain finds it slightly more difficult to process information.  Now extrapolate this to reading, writing, attention, etc.  Is it not easy to see that if you had an issue with your eyes or your brain that these tasks might be difficult to perform?

I do take exception to one thing in behavioral optometry.  They tend to attribute everything to a problem with the eyes.  While this is the case many times, just as many cases are problems in the brain.  I have seen many children with learning disabilities and sometimes the problem is with the eyes and sometimes it’s in the brain.  The treatments, however, are similar.  You must retrain the eyes or the brain.  To do so eye exercises, light therapy, sound therapy, vestibular therapy, cognitive visualization and balance exercises are applied to name a few.  This, when applied correctly and specifically, corrects the underlying issue.  It is really very amazing.

The brain is an amazing environment, but it is not perfect.  It makes mistakes and can under function just like other parts of the body.  When this happens it needs to be rehabilitated.  This rehabilitation is a simple process, but often requires months to be effective.  This is because of the very nature of the brain.  While it is malleable, it resists change.  A perfect example is trying to master a new skill.  You can’t master it overnight.  It takes many hours of repetition before the skill has been mastered.  Rehabilitating the brain is similar.  Exercises must be done over and over again in order to reap the rewards and see benefit in the end.  People are often frustrated at the pace of therapy, but are extremely pleased with the overall results.  You wouldn’t expect to be able to run a marathon after training for a month would you? The brain is very similar to a muscle.  It must be trained and maintained to function at its very best.  When it isn’t working well, training is the only way to fix it.

If you have a child that is having trouble in school have someone who is trained in functional neurology examine them.  A great website with a list of doctors is www.acnb.org.  They have a doctor locator in which you can put your address and zip code in and find all of the doctors within a defined radius.  If you ask your pediatrician for advice, your child will end up on drugs that have dangerous, even lethal side effects with no prospect of producing any permanent benefits.  Functional brain rehabilitation is the only way to permanently change the function of a child’s brain.

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