thesis, learning disabilities osteopathic relation to cervical and thoracic spine, by france...

7/23/2019 Thesis, Learning Disabilities Osteopathic Relation to Cervical and Thoracic Spine, by France Champagne

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Osteopathy and Learning Disabilities i

DO YOUTH DIAGNOSED WITH LEARNING DISABILITY HAVE SIMILARDYSFUNCTION IN THE CERVICAL AND UPPER THORACIC SPINE

By

France Champagne

Thesis submitted in partial fulfilment of

the requirements for the diploma of,

Master of Osteopathic Manipulative

Science

The Canadian Academy of Osteopathy &

Holistic Health Sciences

2012

Approved by: Brandon Stevens, DDO-MTP, M.OMSc, MICO.

Chairperson of the Supervisory Committee: Professor

Program Authorized To Offer Diploma,

The Canadian Academy of Osteopathy & Holistic Health Sciences, Inc.

Date March 15, 2012


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Osteopathy and Learning Disabilities ii

DO YOUTH DIAGNOSED WITH LEARNING DISABILITY HAVE SIMILAR

DYSFUNCTION IN THE CERVICAL AND UPPER THORACIC SPINE

By

France Champagne

Chairperson of the Supervisory Committee: Professor Brandon Stevens, DDO-MTP, M.OMSc.,

MICO.

Department of Osteopathic Principles & Practices

ABSTRACT

The purpose of this paper is to determine whether youth diagnosed with Learning Disability have

common cervical and upper thoracic vertebral dysfunctions, to document any observed

dysfunctions, and, with an Osteopathic approach, to explore the correlation between any

observed dysfunction and Learning Disability.


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Osteopathy and Learning Disabilities iii

TABLE OF CONTENTS

Title page .. i

Abstract .. ii

Table of Contents. iii

List of Figures... iv

Acknowledgements .. v

Glossary. Vi

Preface .. 1

Thesis Question 1

Introduction .. 2

Understanding Learning Disabilities ... 3

The Anatomy and Physiology of Learning Disabilities 5

Agraphia .. 8

Dyslexia .. 11

Dyscalculia. 13

Working memory 14

Attention Deficit and Hyperactivity Disorder 16

The well-functioning brain and its supporting structures 18

The dural venous sinus .. 23

The vertebral vein and the inter-vertebral venous plexus .. 25

The cervical spine .. 27

The superior cervical ganglion 28

In early osteopathy .. 32


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Osteopathy and Learning Disabilities iv

The research project .. 34

Analysis results 38

Limitations 39

Conclusions 40

Appendix 48


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Osteopathy and Learning Disabilities iv

LIST OF FIGURE

Figure Page

1 Neurons, dendrites and synaptic connections.................................... 6

2 Arcuate fasciculus. .. 7

3 Hearing spoken language and reading written language......... 8

4 Brocas, Wernickesarea and perisylvian area..................... 9

5 Agraphia cognitive information processing model of spelling and writing...................... 10

6 Thalamus projections to cerebral cortex . 12

7 The relationship between the procedures involved in reading... 13

8 Presence of new brain cells, in the hippocampus 14

9 Thalamus nucleus. 16

10 Midbrain, the hemispheres, corpus callosum... 19

11 Dural venous sinus flow ... 21

12 Dural venous sinus... 22

13 Areas of the brain used in reading, listening, processing and generating words.... 24

14 Suboccipital cavernous sinus.... 25

15 Vertebral veins and internal jugular veins . 26

16 Superior Cervical Ganglion, Posterior neck dissection.... 28

17 Cerebral arteries.... 29

18 Carotid sinus and carotid canal. 30

19 Watershed areas, thoracic head .anchor. 32

20 The common compensatory pattern: origin and relationship to the postural mode. 33

21 Osteopathic Structural Diagnostic (OSD) assessment.. 35


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Osteopathy and Learning Disabilities v

ACKLOWLEDGEMENTS

The author wishes to thank the Canadian Academy of Osteopathy and Holistic Health Sciences,

for keeping the integrity of Osteopathy and teaching Osteopathy with the same integrity. I would

also like to thank Donna Champagne, my sister in law, for all the guidance she provided during

the writing of this research paper.


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Osteopathy and Learning Disabilities vi

GLOSSARY

Acalculia Math disabilities resulting from a brain injury

Agraphia Disorder of spelling and writing caused by neurological damage. Some variation

include: Lecxical Agraphia- eg. oshen vs. ocean; Phonological Agraphia-

eg. stair vs.stare; Semantic Agraphia- eg. daysvs. week. Also known as

Dyscalculia

Corpus callosum Connects the left and right hemisphere

Cyngulate gyrus Above the corpus callosum, connecting the hemispheres

Dyscalculia Innate difficulty in learning or comprehending arithmetic

Dyslexia An impairment in reading with associated deficit in oral language acquisition

(dysphasia) writing (dysgrphya) mathematic (dyscalculus) motor coordination

(dyspraxia), temporal orientation (dyschronia), visuospacial abilities

(developmental right-hemisphere syndrome)and attentional abilities

(hyperactivity and attention deficit disorder) . Aspect of dyslexia :

deep dyslexia eg. bicycle vs tandem, single vs. singal, visual dyslexia eg

land vs lend, phonologic dyslexia eg. comb vs. cobe, surface dyslexia eg

flude vs.flood , stake vs. meat, attentional dyslexia eg but, big hut vs.

pot, big,hut

Glia Nerve cells that dont carry nerve impulses. Glia meaning glue perform many

important functions related to homeostasis, form myelin, provide support and

nutrition and more. Glia cells makes up to 90 % of brains cells . Also known

as Glial or Neuroglia


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Osteopathy and Learning Disabilities vii

Graphemic

buffer

Working memory system that temporarily stores abstract orthographic

representations while they are being converted into codes appropriate for various

output modalities ( i.e. writing, oral spelling, typing, or spelling with anagram

letters)

Learning

Disability

Learning disability refers to a number of disorders which may affect the

acquisition, organization, retention, understanding or use of verbal or nonverbal

information. These disorders affect learning in individuals who otherwise

demonstrate at least average abilities essential for thinking and/or reasoning. As

such, learning disabilities are distinct from global intellectual deficiency.

Long term

potentiation

(LTP)

LTP is a enhancement in signal transmission between two neurons that results

from stimulating them synchronously. One of several phenomena underlying

synaptic plasticity( the ability of chemical synapses to change their strength)

Major cellular mechanism of learning and memory

Magnocellular

cell ( M-cells_

Neurons located within the magnocellular layer of the lateral geniculate nucleus

of the thalamus. The cells are part of the visual system, concerned mostly with

movement detection. The nerve endings at the back of the retina relay to the M-

cells of the Thalamus.

Neuroplasticity Synaptic plasticity, the property of a neuron or synapse to change its internal

parameters in response to its history, permits learning

Suboccipital

cavernous sinus

Also known as atlanto occipital joint membrane

Synaptic Pruning Refers to neurological regulatory processes, which facilitate a change in neural

structure by reducing the overall number of neurons and synapses leaving more

efficient synaptic configurations.


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Osteopathy and Learning Disabilities viii

Synaptic

plasticity

Ability of chemical synapses to change their strength, involved in learning and

memory


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Osteopathy and Learning Disabilities 1

Preface

Prior to beginning studies in Osteopathy I had worked for 20 years with families and children at risk of

developmental delay. During that time I observed that some of the children who had the most difficulties

were those who appeared to have a good or above average intellect, yet some rudimentary concepts

seemed to evade them. Throughout my journey into Osteopathy, my interest in youth remained strong,

specifically for those youth with learning disabilities (LD). One day a patient left me the following

message: my eyesight is down, I dont hear as good and my brain is foggy, my neck must be crooked

again, can I get in for a treatment?

Understanding the body as a dynamic unit functioning in concert with all its parts is an important

principal of Osteopathy. The necks relationship to sight, hearing and clear thinking enticed me to

ponder an observation of LD youth I had treated in my practice, considering the presence of somatic

dysfunction. A somatic dysfunction is an impaired or altered function of related components of the

body. These two events catalyzed my interest in the potential link between cervical and thoracic

dysfunction and learning disabilities (LD), particularly in youth.

Thesis Question

Do youth diagnosed with Learning Disability have a similar somatic dysfunction in the cervical and

upper thoracic spine?


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Introduction

Osteopathy is a drugless manipulative medicine. It was developed, in the late 1800s, by Andrew T Still.

In early 1900, there was a 2 year influenza pandemic (1918-1919); more than 28% of the population

died of the disease. The United States medical hospital reported a 30 to 40% mortality compared to

.25% mortality in the Osteopathic hospital (Magoun H. I Jr, 2004). This is a difference of from 29.75-

39.75% less mortality, which is significant and cannot possibly be linked to chance. Surprisingly,

despite this remarkable statistic, Osteopathy has since been largely forgotten and not well understood by

the general public; although its premise that a well aligned body structure will permit immunity and self-

healing had been so strongly supported by these disparate catastrophic events. Osteopathy benefits may

be very widespread in keeping the body aligned and well-functioning. An exploration of conditions that

are neither well understood nor treated, together with whether mal-alignment is a contributing factor,

could benefit society overall. One example of a condition that costs society and individuals throughout a

lifetime is known as learning disability.


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Understanding Learning Disabilities

Learning disabilities are not visible. An individual with learning disabilities may have average or above

average intelligence, yet a 2006 statistical study showed over 40% of those diagnosed with LD were not

in the labour force in that year. The same study found that 120,000 children aged 5-14 were diagnosed

with LD in 2006 (Bernnan S., 2006).This represented over 3% of all children in that age group in

Canada, and most of these children were enrolled in school. As students show disabilities in school

related learning, their general performance is questioned, and an assessment plan is establish. Sometimes

this plan includes independent professional psychological assessment. In the event that a student did not

have an assessment, The Canadian Study Grant acknowledged the extent of the problem and includes a

one-time only $1,200 grant to cover a learning assessment for students enrolled in post-secondary

education (National Education Association of Disabled Students, 2000). This clearly speaks to the high

numbers of students who struggle with learning challenges and its overall costs to society.

A substantial number of students with LD drop out of school; over half of those diagnosed with learning

impairments were found to have no more than a high school education. Study subjects reported that their

disabilities influenced their choice of course, choice of careers, time it takes to finish their education and

their needs for additional support. Employment was reported to be restricted in the 15 to 64 year age

group and over four in ten reported not being in the labour force (Brennan S., 2006).

The cost of LD is substantial. It is estimated that the simple incremental cost of LD from birth to

retirement is $455,208 per person. Individuals with LD and their families shoulder about 60% of the cost

and public programs carry the remainder (The Roeher Institute, 2007) .

Presently the services offered to students with learning disabilities are mainly of strategic learning

techniques and training, also known as cognitive training or cognitive behavioural therapy. An


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adjunctive support to this cognitive training could be the use of integrative manual therapy such as

Osteopathy.

This research project targeted a specific search for presence or absence of structural dysfunction in

students diagnosed with learning disabilities. Subjects were recruited through health practitioners and

personal referral. Seven students aged 6 to 14 diagnosed with learning disabilities were assessed

following the Osteopathic Structural Diagnostic (OSD) method of evaluation; they received a

subsequent treatment to address their somatic dysfunctions. All the subjects revealed asymmetry, tissue

texture changes, restriction of motion, and sensorial changes in the occipital and first cervical vertebra,

mid-cervical and upper thoracic spine, and lower lumbar and sacrum.


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The Anatomy and Physiology of Learning Disabilities

At birth our brain is wired in a network of neuron cells that transmit nerve impulses, and glia, from a

word meaning glue, which support these cells. Together these form the two main components of the

brain (Harun K.M Yusuf, 1992). Glia do not carry nerve impulses, yet they communicate with other

glial cells (Fields D.,Stevens-Graham B., 2002) and can affect neuronal activity, that is, excitability and

communication between cells, or synaptic transmission. While neurons peak in numbers during

gestation, their numbers and size change as their cable-like projections, known as axons, thicken, and as

their body cells branch forming dendrites. This increase in dendrite numbers and synaptic connections

continues to undergo changes through development. (See figure 1) Over time as neurons are not used

there is a reduction in their numbers after birth. The structural changes in neuron size are determined by

the dynamic relationship between glial cell, decreased numbers of neurons and the increase in size of the

remaining neurons. At time of birth, mammalian neurological development includes a structural

regulator that functions by reducing the overall numbers of neurons and synapses to make way for more

efficient synaptic configurations. This synaptic pruning is complete by the time of sexual maturation in

humans (Iglesias J, 2005) and is thought to be regulated by hormones and nutritional factors

(P.Vanderhaeghen et al., 2010) . The ability of the neuron to change the efficiency of its synaptic

transmission, known as neuroplasticity, permits a network of information to be sorted and retrieved

using pathways established and modified according to the function and the structure of the neurons.

Information storage and retrieval are essentially the components of learning and reclaiming or sharing

what has been stored, or learned. Without retrieval, the information stored is trapped. This describes the

essential brain activity related to learning without which the environment for learning is diminished,

inaccessible or impossible.


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Figure 1 Neurons, dendrites and synaptic connections

Learning changes the neural pathways in the brain. For example, when learning a new language or new

words, neurons are recruited from the visual centers to recognize spelling, in the auditory centers to

distinguish sound, and in the association centers to relate words with existing knowledge. It is by

repeating new words or new learning over and over that the strength of the connection is established

over various circuits of the cortex.

The establishment of those association pathways and their strength may depend on several factors. One

of these factors is long-term potentiation(LTP). LTP is a process in which synapses are strengthened

between two neurons that are simultaneously stimulated; or it can be the activity of several neurons

converging onto a single neuron strengthening the synapses. LTP occurrence is the chief player in the

great deal of plasticity observed in the hippocampus and its relationship with memory (Dubuc). (See

figure 2)


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Figure 2 Arcuate fasciculus, Diffusion Tensor imaging showing right and left arcuate fasciculus

New information learned is perceived through the senses as processed by different responsible parts of

the brain. Visual input is transmitted from the eyes to the midbrain, to the thalamus then transferred to

the primary receiving area in the neocortex of the occipital lobe. Auditory input is transmitted from the

inner ears to the brainstem, midbrain, and thalamus, and then transferred to the primary auditory

receiving area within the neocortex of the temporal lobe. From the primary areas these signals are then

transferred to the `association centre where simple precepts become more complex by affiliation. The

frontal lobe is the senior executive, or manager, of the brain. It is where executive functions involving

the ability to reason, to plan, to solve problem, to modulate emotion, move voluntarily, and a small

region in the left frontal lobe converts thoughts into words. The primary auditory cortex is located in the

temporal lobe and is important in processing meaning of both speech and vision. The temporal lobe also

contains the hippocampus that plays a key role in the formation of memory and learning. It is in the

parietal lobe where information is integrated from different sensory stimuli such as taste, temperature,

and pain. The parietal lobes are responsible for auditory and visual association with memory to give the

signals meaning. The parietal lobes permit language comprehension while the occipital lobes mainly

decode visual information; a visual processing center associating visual perceptions with remembered

images to identify and recognize objects. Together these would work thus: you are walking in a field,


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you see (visual input from eyes to midbrain to visual cortex) a flower (visual cortex to hippocampus and

association center) you decide to pick a bouquet of flowers (frontal lobe higher cognitive function

process, to motor neuron so your hand can pick the flowers) and the whole process together permits

learning. Any gap in this process may interfere with the ability to learn. (See figure 3) While these gaps

are all specified as different learning disorders, the facts of missing linkages in this process shared.

Figure 3 Hearing spoken language and reading written language

Learning disability refers to a number of disorders which may affect the acquisition, organization,

retention, understanding or use of verbal or nonverbal information. These disorders affect learning in

individuals who otherwise demonstrate at least average abilities essential for thinking and/or reasoning.

As such, learning disabilities are distinct from global intellectual deficiency (Official Definition of

Learning Disabilities, 2002).

Difficulty with spelling and writing words, Agraphia, is related to the function of the left temporo-

parietal-occipital junction. The involved site overlaps the angular gyrus (Hinshelwood J., 1900), left

posterior parietal cortex, temporal gyrus, the perisylvian language zone, including Wernickes area, the

supramarginal gyrus and in some cases Brocas area. Some areas may be spared depending upon the

form of agraphia (M.L.Henry et al., 2008). (See figure 4)


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Figure 4 Brocas, Wernickesarea and perisylvian area

The verbal working memory system seems to play an important role in all aspects of agraphia as it

activates a phonological loop between the Brocas and the Wernickes. Studies suggest it is located

below the frontotemporoparietal area with spatial attention (S. M. Szczepanski, et al., 2010) . (See

figure 5)


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Figure 5 Agraphia cognitive information processing model of spelling and writing

Some studies have postulated that visual spatial memory is associated with a region of the occipital

cortex. The memory is related to the hippocampus where its neurons have the ability to remodel

themselves due to their high plasticity (long term potentiation). From the hippocampus it loops to other

areas involved with language. This is where neurons create new connections of association for new

knowledge; somewhat like connecting the dots to create a new picture. Agraphia is defined by a

Acousticanalysis

AuditoryInputlexicon

PhonologicalOutputLexicon

Phonologicalbuffer

Sementicsystem

GraphemicOutputLexicon

Phoneme-Grapheme

conversion

GraphemicBuffer

AllographicMemoryStore

GrapgicMotorPrograms

GraphicInventoryPatterns

Oral SpellingTypingAnagram Letters

AllographicConversion

Auditory input

Speech

Writing

A

C

BBD

Temporoparietal occipital junctionAngular gyrus, Brodman area 39,posterior middle and inferio temproa gyrus are 37Perisylvian language zone, Wernicke's some time Broca


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difficulty with producing written words, with the phonological loop playing a significant role in this

particular learning impairment, as it does in dyslexia. While there are many brain dysfunctions that

impair learning, dyslexia is one that most people have some knowledge or understanding of. Yet it is

still not well understood. Dyslexia is an impairment of cognitive function involved in the process of

reading. Studies have shown that the impairment stems from the cortical areas involved in reading,

object naming and verbal working memory. Researchers define the phonological processing system as

spanning multiple cortical and subcortical regions, including the temporoparietal junction, the insula and

the inferior frontal gyrus (Eden G. F. and Zeffiron T. A., 1998) . There is growing evidence that

dysfunction in magnocellular (M cell) pathways are responsible for visual motion detection difficulties

in Dyslexics and some forms of learning disabilities as demonstrated by a number of studies(Duff,

2009). These M cells are located in the magnocellular layer of the lateral geniculate nucleus of the

thalamus and are part of the visual system which is directly connected by the optic radiation to the

primary visual cortex. Impairments of these areas may mean interference in how the brain processes the

visual appearance of words or letters, the catalyst of learning disabilities in Dyslexia. Dysfunctions of

the visual word system are located in the left inferior occipital, the left inferior temporo-occipital and the

inferior parietal cortical cortex (angular gyrus and supramarginal gyrus area)(Eden G. F. and Zeffiron T.

A., 1998). The left occipital cortex is responsible for the analysis of visual stimuli as is the lateral

geniculate nucleus of the thalamus (M cells) and the white matter including the callosal fibers (corpus

callosum). Both these structures provide input to vision and its associated regions of the brain. (See

figure 6)


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Figure 6 Thalamus projections to cerebral cortex

In Dyslexia, there is a disconnection between the visual information presented to the right hemisphere

and the left angular gyrus that is assumed to be a critical part of recognition of words. There may also be

interference from the left occipital cortex responsible for the analysis of visual stimuli (H. Branch

Coslett, 2002). (See figure 7) It is believed that Dyslexia results from either a block of direct visual

1- Thalamus,2- Anterior thalamic radiation to frontal lobe

3- Superior thalamic radiation to parietal lobe,4- Posterior thalamic radiation to occipital lobe-- Inferior thalamic radiation to temporal lobe26- Cut corpus callosum


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input to the mechanism that processes printed word in the left hemisphere or a disruption of the visual

word system. Dyslexia is very often the umbrella term used by the general public to refer to reading,

writing, and even arithmetic difficulties, the latter of which is a separate learning disability in and of

itself.

Figure 7 The relationship between the procedures involved in reading

The inability to perform number related tasks can be as devastating to an individual as the impaired

function of reading. Dyscalculia, akin to dyslexia, is the difficulty to understand numbers, how to

Visual Analysis

Visual WordForm System

PhonologicalOutput Lexicon

Cognitive SystemPrint to SoundConverstion

Written Word

Speech

Superio temrporal gyrusLateral sulcus of parietal lobe


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manipulate numbers, mathematics and a number of related symptoms such as difficulties with spatial

reasoning. Scientists suggest Dyscalculia manifest in the supramarginal and angular gyri at the junction

between the temporal and inferior parietal lobule of the cerebral cortex (Maye E.r et al., 1999). Folks

affected with Dyscalculia may have difficulties with arithmetic, reading analog clocks, mentally

estimating measurement, or distance, or judging time. The ability to manipulate numbers and time

require the use of many areas including a well-functioning working memory, as the different aspects of

learning implies juggling particles of information and comparing it to what we already have stored away

in our memory.

Figure 8 The figure shows the presence of new brain cells, labeled with GFP (green), among older ones

(red) in the hippocampus (Scellig S. D. Stone)

The mammalian brain requires the use of special functions managed by distinct structures, including an

effective working memory. Working memory is manifested in recruiting several modalities such as the


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amygdala, the cingulate gyrus and the hippocampus which are all parts of the limbic lobe and together

they play a significant role in the acquisition of language. The amygdala and the hippocampus display

synaptic plasticity and dendritic proliferation, and will grow additional dendritic spine in response to

new learning (Engert F, Bonhoeffer T., 1999). (See figure 8) This long term potentiation (LTP) is how

we form new memory. Another special structure involved in juggling of information is the central hub.

The thalamus is the center of neurological input, receiving information from the senses, and then

relaying that information to different processing areas of the brain, made possible due to its division into

sub sections related to specific sections of the cerebral cortex. Various subdivisions of the thalamus,

such as the lateral geniculate nucleus (LGM), the medial geniculate nucleus (MGN) and the dorsal

medial nucleus (DMN) play a significant role in learning by transmitting the sensory input to the proper

cortical region. (See figure 9) Straddling the thalamus is the caudate nuclei, important to the brains

attention, learning and memory systems. The caudate nuclei is innervated by dopamine neurons and

input from various association cortex. Dopamine is essential to the normal functioning of the central

nervous system. A reduction in its concentration within the brain is associated with Parkinsons disease

while high dopaminergic activities are seen in individuals with Attention Deficit with Hyperactivity

Disorder.


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Figure 9 Thalamus nucleus

The American Psychiatric Association defines Attention Deficit and Hyperactivity Disorder (ADHD)

(American Psychiatric Association, DSM-5 Development, 2010) as characterized by age inappropriate

symptoms of inattention and/or hyperactivity or impulsivity which occur for at least six months in at

least two domains of life and begin prior to the age of seven. Functional imaging studies have provided a

strong foundation for a network or several networks of neurobiological abnormalities resulting in

1- Thalamus,2- Anterior thalamic radiation to frontal lobe

3- Superior thalamic radiation to parietal lobe,4- Posterior thalamic radiation to occipital lobe-- Inferior thalamic radiation to temporal lobe26- Cut corpus callosum


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ADHD symptomatology. The imbalance in noradrenergic and dopaminergic systems, ideal targets for

pharmacological treatments of ADHD symptoms, are showing the right caudate nucleus of the basal

ganglia, which is highly innervated by dopamine, as being involved in ADHD. Studies have revealed

structural abnormalities in those with ADHD in the posterior vermis of the cerebellum, the splenium of

the corpus callosum, right caudate nucleus and various prefrontal regions (Eve M. Valera, et al., 2007).

People with ADHD also seem to be afflicted by additional learning disabilities such as those associated

with the language center. The dynamic between the brains function and its structure is an important

component to understanding when we are contemplating finding ways to facilitate learning in people

with LD. It is this complexity of learning and gaps in learning that has inspired the current research

project.


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The well-functioning brain and its supporting structures

Osteopathy views the anatomy and physiology of the body in a similar, yet somewhat different fashion

than does traditional medicine. While both acknowledge the interplay between the bodys parts and how

they support one another, in traditional medicine there is a practice of treating one part of the body, or its

ailments, separately from the rest. This may mean with pharmaceutical or it may be with surgery,

physiotherapy or other interventions. In Osteopathy, the principle is that a body is a dynamic unit of

function so that an ailment is then seen as a dysfunctional symptom. In a well-functioning body, the

structure supports appropriate function, and appropriate function maintains an appropriate structure. In

other words, any changes in the structure will impose a change in the function and any changes in the

function will reciprocally change the structure. The structure is required to have a free flow of

movement in order to maintain its proper function; if the structure is inadequate, the function will be

impaired. But we might wonder how important and exacting must the structure be for optimum

function? We all know of people who have very disabled bodies that function at a surprisingly high

level. Yet which of us would ever presume that these same bodies, if rendered whole in structure would

not function even more highly? The same is true for the brain as an entity.

Perhaps a brief look at how the brain functions can illustrate some specific areas that may impair a brain

from, for the purpose of this paper, its full learning function. The brain is a network of neurons

receiving, processing, storing and analysing information acknowledged through our senses. It is divided

into two hemispheres. Each hemisphere is further divided into four lobes; the frontal, parietal, temporal

and occipital lobes. The hemispheres are interconnected to each other by corpus callosum which is made

of white matter. (See figure 10) The hemispheres are linked to the spinal cord through the midbrain, the

pons, and the brain stem. The midbrain contains the thalamus, the hippocampus and many other

structures.


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Figure 10, Midbrain, the hemispheres, corpus callosum

A closer review of the brain demonstrates that these parts of the brain need nourishment and cleansing in

order to function just as any other part of the body does. The brain is nourished, cleansed and cooled

through the venous system, or through the arterial blood supply taking nutrients and oxygen to the brain,

and through the veins returning waste for disposal from the brain. If this drainage is impaired, there are

consequences. The venous channel must be free of impediments so its flow may be constant and its

function of picking up just enough metabolic waste and carrying it back to the heart and lung to be

oxygenated may be fulfilled. The intense neuronal activity within the brain when we learn creates an

increase in arterial flow which in turn creates an increase in metabolic waste to be transported out and

drained, which is of utmost importance to brain function. The dual role of the brains venous system

would be to cool the brain and drain its waste so the neurons can function adequately. In this way the

flow in the brain is maintained within very narrow parameters. There is little room for excess or paucity.

This intracranial circulatory flow is controlled through two mechanisms, one through the venous system,


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the other through the arterial. The venous system controls its pressure by releasing venous blood through

the inter-vertebral venous plexus (slow release) and the internal jugular vein (rapid release) connected to

the dural venous sinus. This function is very precarious; the venous system in the brain and spinal cord

has no valves, so venous blood can travel up or down. Conversely the arteries have the ability to change

by increasing up to 4 times in diameter when needed, providing a second way of auto-regulating

intracranial flow. However, when the brain is very active this regulation is challenged since arterial

blood flow can elevate by from 30-50%. (Schmidt F., 1999)

Intracranial circulation requires a stable acid-base balance, otherwise known as pH level; the measure of

acidity or alkalinity of a substance. When blood flow is obstructed, it slows down, decreasing the venous

pH level of blood which remains in the veins longer, allowing acidic metabolic waste to be in contact

with surrounding tissue for longer periods, increasing the excitatory environment for the nerve cells,

which in effect impacts their action potential either by decreasing the threshold potential and/or the

refractory period (Zhao H, et al., 2011). With respect to learning disabilities, this excitatory

environment can be an additional burden on the already altered neuronal communication network.

Clearly, sufficient drainage of the brain is crucial to optimal functioning. This may be even truer for the

person who struggles to learn because of the increased activity for someone whoslearning processes

may require extra energy because of gaps in learning links.

The venous system stores between 65-75% of the bodys blood volume, acting as a reservoir. Venous

walls distend and contract in response to the amount of blood available in the circulation. However, the

function of the cerebral veins differs slightly in this regard in that they provide cooling for the brain and,

contrary to the rest of the body, drainage in the brain and spine occurs from deep to superficial. In the

brain, the dural venous sinuses take over the function of venous drainage. These sinuses are channels

found within the layers of the dura mater in the brain. They receive blood from the internal and external


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veins of the brain and cerebrospinal fluid from the arachnoid space, and ultimately drain into the internal

jugular vein. (See figure 11) With respect to learning disabilities, some dural sinuses are more important

due to their anatomical position and function. In order to understand their pathways, it is helpful to

review the dural sinuses as a whole. (See figure 11-12)

Figure 11 Dural venous sinus flow

Sup. Sagital sinus

Inf. Sagital sinus

Cavernous sinus

Straight sinusInf. Sagital sinus Transverse sinus

Suo. Petrosal sinus

Sigmoid sinus

Inf.. Petrosal sinus

Internal Jugular vein

Sphenoparietal sinus


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Figure 12 Dural venous sinus


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The dural venous sinus contains the superior and inferior sagittal sinus, the cavernous, the straight,

transverse and the sigmoid sinuses. The superior sagittal sinus drains the frontal lobes, the lateral aspect

of the anterior cerebral hemispheres and the cerebrospinal fluid to the confluence of sinuses, and has

been seen in neuroangiogram studies to be increased in size together with a dominant cavernous sinus,

usually indicating an increment of drainage from the deep structures that feed into the cavernous sinus

(M. Shapiro, 2010). These areas refer to the language center.

The inferior sagittal sinus is responsible for collecting fluid from the tributaries of the corpus callosum

and cingluate gyrus regions which it then drains into the straight sinus. The corpus callosum and the

cingulate gyrus receive input from the thalamus and project to the higher function in the cerebral cortex,

therefore playing an important role in the neuronal communication of learning, and enhancing drainage

which in turn aids pH balance and proper function.

Somewhat more complex is the cavernous sinus, made up of a collection of thin-walled veins creating a

nook bounded by the temporal and sphenoid bones, whose volume of drainage may influence the size of

the superior sagittal sinus and its tributaries: the superior & inferior ophthalmic veins, the sphenoparietal

sinus, and the superficial middle cerebral veins it drains. The influence on these four tributaries comes

from the structures they drain; for instance the sphenoparietal sinus collects blood from the sylvian

veins, which collect blood over the area of the sylvian fissure including the perisylvian area containing

the planum temporale, the inferior frontal gyrus, the posterior supramarginal gyrus and the angular

gyrus. These areas, in the left hemisphere, are otherwise known as the language center. It is possible to

extrapolate that an increase in neuronal activity in those centres, as when one is struggling to

comprehend a concept, would have a similar physiological response to any other area of the body by

providing more blood to an area of high activity, thereby implying an increase in metabolic waste and

drainage.


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Conversely, the transverse sinuses run laterally in a groove along the inferior surface of the occipital

bone, passing forward of the petrous portion of the temporal bone where it attaches to the tentorium

cerebelli and drains into the sigmoid sinuses originating beneath the temporal bone, following a tortuous

course to the jugular foramen, at which point the sinus becomes the internal jugular vein. (See figure 13)

Figure 13 Areas of the brain used in, reading, listening, processing, generating words


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The slower drainage process of the vertebral vein and the inter-vertebral venous plexus also has a dual

role of drainage and cooling. The circulatory system of the brain drains into two principal venous

outlets, through the internal jugular veins and through the vertebral venous plexus. The vertebral venous

plexus is an immense network of small size valveless veins located within the spinal canal and extending

from both the proximal and distal ends of the spinal cord. This system drains waste from the superficial

layer of the head and face and is connected to the dural venous system via the suboccipital cavernous

sinus, also known as the atlantooccipital membrane, located just outside the skull between the first

cervical vertebra and the occipital bone. Although outside the skull, it is part of the intracranial dural

sinuses since it has similar construction and functions of drainage and cooling. The vertebral vein

originates in the suboccipital cavernous sinus, formed of the small branches which spring from the

internal vertebral venous plexuses. (See figure 14)

Figure 14 Suboccipital cavernous sinus

The vertebral veins unite with small veins from the deep muscles at the upper part of the back of the

neck, and form a vessel which enters the foramen in the transverse process of the atlas, and descends,


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forming a dense plexus around the vertebral artery, in the canal formed by the transverse foramen of the

cervical vertebrae. This vessel ends in a single trunk, emerging from the transverse foramen of the sixth

cervical vertebra, opening at the root of the neck into the brachiocephalic vein near its origin, its mouth

being guarded by a pair of valves. The trajectory of the vertebral vein within the transverse foramen of

the cervical vertebral becomes obstructed when a vertebra subluxates, meaning a vertebral segment

becomes limited in its palpable motion. The internal jugular vein, originating in the posterior

compartment of the jugular foramen at the base of the skull runs laterally down to the neck where it

connects with the common, internal, and carotid arteries by the carotid sheath composed of three major

fascial layers of connective tissue in the neck. The prevertebral layer of the carotid sheath encloses the

sympathetic trunk. The internal jugular vein unites at the root of the neck with the subclavian veins. (See

figure 15)

Figure 15 Vertebral veins and internal jugular veins

One can see from the preceding description of the route of the venous system the significance of

constant drainage for optimal brain function. This whole drainage process is enhanced by movement of


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the skeleton and muscles which act as a pump for the valveless venous system. Conversely, lack of

sufficient movement, or alteration of structural movement, subluxation, will restrict or reduce drainage

of the venous system from the brain. Stagnation or decrease in venous flow creates a vicious cycle;

sluggish drainage decreasing the pH level, which in turn generates excitatory stimuli to the surrounding

neurons, in turn producing a surge of activity, subsequently increasing the metabolic waste and

intensifying heat created by the residual activity of the excited brain neurons. This entire process can

begin, quite simply, with a subluxation of a cervical vertebra, detrimentally affecting the brains venous

drainage. A similar notion of cerebrospinal venous insufficiency and its effect on neurological function

is currently being investigated in Multiple Sclerosis, although the experimental surgical treatment plan

remains controversial(Zamboni P et al., 2008).

The cervical spine can be anatomically divided into two levels, the upper, C1 and C2 and the lower, C3-

C7. The third and fourth cervical vertebrae have a similar physiological impact. The third cervical

vertebra, possibly due to its fragility compared to others, is the most common subluxation where it is

either forced forward, backward, or in torsion and both its superior and inferior facets are involved. This

is the only vertebra seen to have both upper and lower facets involved in a subluxation (Marion E. Clark,

1906). A subluxation of the third cervical vertebra would create changes in many tissues. The ligaments

would become thicker and tender; this would move the vertebra closer, showing a visible change in the

structure of that part of the neck. These structural changes would produce a functional variation in the

neurological feedback loop. The muscles, in response to this variation in neurological communication

would contract; the contraction further limiting the communication flow of the nerves, arteries, and

veins, circulation thereby decreasing nutrient feed to those structures. The third cervical vertebra is in

very close proximity to the superior cervical vertebra ganglion. Compressing the area of a sympathetic

ganglion tends to create excitatory results.


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Figure 16 Superior Cervical Ganglion, Posterior neck dissection (Stanford school of Medicine)

The superior cervical ganglion (SCG), just behind at the angle of the jaw, is in proximity to the third

cervical vertebra. (See figure 16) The superior cervical ganglion is part of the sympathetic nervous

system (SNS). This system is responsible for the fight or flight response, controlling hormonal and

physiological responses to perceived threats from the environment. This response results in respiratory

rate increases, blood shunting from the digestive tract to muscles and limbs, increased awareness, sight,

energy and other series of responses to prepare the body to fight an enemy/threat or flee from it. This

response is important in learning, particularly when the threat may be a perceived fear of interpreting

and understanding data. The SCG receives fibers from the first four cervical vertebral nerves and cranial

nerves nine, ten and twelve. It exerts a vasoconstriction on the arteries of the head and neck(Tasker D.

D. , 1913). The constrictor influence of the superior cervical ganglion comes from the second, third and

fourth dorsal sympathetic chain ganglion. The sympathetic nervous system has a plexus surrounding the

1

2

1

3

11

46

789

1

10

11

12

13

14

15

1-superior cervicalganglion

2- spinal ganglioncervical nerve VI

3- trapezius musclecut

4- internal jugular v. 6- articular surfaceT-1

7- spinal cord 8- C-7 arch cut 9- semispinal iscevicis m, &multifidus m.

10- C-3 arch cut 11- internal jugularv

12- levator scapulamuscle

13- C-4 body 14- splenius capitis 15- anterior marginof foramenmagnum


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carotid arteries and exerts its control through the -1 adrenergic receptors. SNS stimulation produces

vasoconstriction and increased vascular resistance, thereby increasing the blood pressure in the carotid

arteries. The excitatory stimulus travels, with the carotid arteries, along its sinuous journey. The carotid

arteries originate from the common carotid artery at the level of the third cervical vertebra where it

bifurcates in the external and internal carotid. At its origin, a dilation named the carotid sinus, through

its role as a baroreceptor, helps to maintain proper blood pressure. The internal carotid, via the neck,

enters the skull through the carotid sinuous canal and travels through the cavernous sinus where it gives

rise to the ophthalmic segment, and the communicating segment. The communicating segment branches

contain the posterior communicating arteries, the anterior choroidal arteries and anterior & middle

cerebral artery; the latter two serving the area of the temporal and parietal lobes related to languages

processing. (See figure 16) A subluxation of the third vertebra would cause a compressive force on the

superior cervical ganglion. In most cases this would stimulate the sympathetic tone of the internal

carotid arteries causing a decrease in the size of the arteries (vasoconstriction) which in turn would

decrease the flow of blood to the language center, which in turn would decrease nutrient availability to

the neurons subsequently decreasing the function of the neurons in the language processing center.

Figure 17 Cerebral arteries

From the brain, through the neck, the circulation flows into the spinal cord, where blood vessels are

valveless and blood can flow either upward or downward freely. Proper motion of the vertebra is


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essential to facilitate adequate circulation, through its pump-like action. When a body part is either feed

or drained by two vessels, this area is called watershed. When this area is compressed either by

contracted musculature or due to a restriction in motion or any physiological impediment, the blood

circulation to this area will be restricted, making the area more susceptible to ischemia. In reference to

the spine, decreased motion would reduce the blood supply to an area, reducing oxygen and nutrient

supply to the surrounding tissues such as muscles, ligaments, connective tissue, vessels, nerves and

lymph nodes within those tissues. Subsequently, contracture would settle in the area, further limiting the

circulation. In the spine these watershed areas are found in the cervical vertebra upper thoracic and

lower thoracic regions (C4-T3-T4, and T8-T9). (See figure 17)

Figure 18, Carotid sinus and carotid canal

Some parts of the spine are anatomically prone to alter blood supplies. Because blood can flow either

upward or downward in the anterior and posterior spinal arteries, the tissues at greatest risk of blood

Carotid canalCarotid sinus


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flow variation are those at border zones between the distributions of two adjacent supplying arteries.

Since any variation in the motion of the vertebrae can infringe on those arterial vessels, the tissues they

supply would be malnourished, perpetuating the vicious cycle that maintains subluxation. (See figure

18) A decrease of vertebral motion in these areas, C4, T3-4, and T8-9, increases the chances of venous

congestion and subsequent arterial starvation of the surrounding tissues. These watershed areas correlate

with anatomical zones under higher structural stress. For instance, the third and fourth thoracic vertebrae

anchor the head and neck; when the head is carried in a forward manner, muscles attached to the base of

the skull pull on the attached vertebral body. As a result, the third and fourth thoracic vertebrae are

closely related to neck dynamics. An altered motion in this area changes the blood circulation impact by

twofold due to its watershed region being supplied by joining arteries. (See figure 18)

Figure 19 Watersheds area, thoracic head anchor


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In early osteopathy, the third and fourth thoracic spinal segments were identified as the origin of many

disorders, partly due to their neurological influence on organs such as the lungs and heart in addition to

their fibrous contribution to the superior cervical ganglion. John Martin Littlejohn referred to the area of

the second and fourth thoracic vertebrae as a physiological center for superficial circulation (CAO-HHS,

207-2012). Marion Clark described these same two vertebrae as having an effect upon nutrition of the

whole body due to their control of the circulation to the heart, oxygenation of the blood and influence on

absorption from ingested food (Marion C., 1906). Tasker supported the importance of this area in that he

said that the upper cervical ganglion receives fibers from the second, third and fourth thoracic

sympathetic chain ganglion (Tasker D., 1913). Osteopathys adage that it is necessary to treat the whole

body from the bottom up and middle out is still very relevant as subluxation of the third cervical

vertebra could have its origin in the fourth thoracic vertebra. The latter dysfunction could be influenced

by a lower thoracic compression, which in turn would be a response of a deviation of the thoracolumbar

region, which ultimately would be consequent to a distortion of the pelvis, articulating the importance of

detail of the dynamics between each vertebrae and their relationship to each other and to their group

dynamic. All of which speaks to the significance of the body constantly compensating to maintain health

and wellness. These fundamental principles are still relevant today; from them we can hypothesise that a

change in function of the third cervical vertebra and fourth thoracic vertebra can ultimately have an

impact on neurological function of the brain and influence the conditions of learning.( See on figure 19)


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Figure 20 The common compensatory pattern: origin and relationship to the postural mode , (Ross E.

Pope)

Dural venous system


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The research project

Seven male students, aged from 6 to 14 and diagnosed with learning disabilities, were recruited for this

project. All were assessed using the Osteopathic Structural Diagnostic (OSD) method, looking

specifically for somatic dysfunction. A somatic dysfunction is an impaired or altered function of related

components of the bodys somatic system which includes the skeletal, arthrodial, fascial, vascular,

visceral, lymphatic and neural elements. (Bezilla T, 2007-2011) Any presence or absence of somatic

dysfunction was recorded and the students received an osteopathic integrative treatment.

The OSD of these seven students showed similarities in somatic dysfunction at the level of the occiput

on the atlas, the third and fourth cervical vertebrae, the upper thoracic vertebra, mid lumbar spine and

the sacrum. There was a commonality in the anterior curves, with the third and fourth vertebrae having

similar dysfunction in the cervical and the lumbar spine. Asymmetry, tissue texture change, restriction in

motion and sensorial changes, commonly known as somatic dysfunction, are the key component of

osteopathic diagnostic assessment and treatments. (See figure 21)


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Figure 21 Osteopathic Structural Diagnostic (OSD) assessment

Age Diagnostic Rhythm &Cranium

Occipital/Atlas Cervical Thoracic Ribs Lumbar Sacrum

OB- 10 Gifted/ LD/dysgraphia

E R torsion SlRr C3-7 SlRlC3-4

(A/E)TTC B

T-3 RrT-8 Rr

T-12 E

R rib 6exhaled

Lowerlumbar

SrRl

Counternutate

L/L

J -12 ADHD/LD F rSR SlRr C 3-4(A/E) SlRl

T3 SlRrT7 FSlT9 ESr

R rib 4exhale

L3 EL4-5 F

CounternutateL/L

J-10 LD/ Dyslexia F lSR Extended C4-5 SlC3 TTC B

T1 SrRl,T2 SlRrT5-8 FRlcompressT12 Rl

L & R ribdysfunctionT-5-8

L1 SlRr Nutate L/L

M-10 LD//ADHD/AspergerSyndrome

F lSRTemporal Sl

SlRrlTTC B

AA- Rr

C-5-7 SlRlC3-4(A/E)TTC B

T4E BL rib 4dysfunction

L 3-4compress

Nutate L/L/

J -6 LD/ADD E BL parietalbonecompression

E SlRr C4 Sl(A/E)C 3-7 Sl

T1-2-3 Rr R rib 1-2-3inhale

L4compress

Counternutate L/L

Z-14 LD/ Dyslexia F superiorvertical shear

E SlAA Rr

C 4-7SlRl,C3 Rr(P/F)

T1-2-3SrRlT5 F SrT7-6 FT8 F Sl

L rib 1 inhaleR rib 2 inexhaleL rib 4-5-6 inehale

L3 SlL1-5 Sr

RUnilateralflexion(shear)

S 9 LD/Gifted/sensoryintegration

E R torsionRighttemproal ininferiorrotation

SrRl C-4-7 SlRlC3-Sl(A/E)

T1 SlRrT 2-3 SrRlT4 E

L rib 1inhaleBL rib 4inhale

Lower LSrRl

CounternutateL\L

ADHD; attention deficit disorder with hyperactivity, LD; learning disabilities, AA: atlas and axis complex, (A/E) :anterior/extend, (P/F) posterior/flex R; rotated, S side bend, E : extended, F: flex, r: right , l: left, L/L left rotation

on a left axis,SRr : right side bending with rotation , TTC B: tissue texture changes bogginess

Osteopathic Structural Diagnostic results


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Analysis of the results demonstrated a common dysfunction of the occipital bone on the atlas, with all

but one subject displaying a side bend left and rotation right. The third cervical vertebra showed either

an anterior or posterior translation (flexion or extension) with or without tissue texture changes

(congestion/bogginess) in all but one subject. One out of the seven subjects showed somatic dysfunction

at the level of fourth cervical vertebra. Every subject showed somatic dysfunction in the upper thoracic

vertebra and upper ribs. Five had some dysfunction of the third thoracic vertebra while four showed

dysfunction at the third or fourth lumbar vertebrae. All but one student had a left rotated sacrum on a left

axis.

In this research project, six out of seven subjects demonstrated some degree of somatic dysfunction at

the mid cervical vertebrae. The third cervical vertebra was identified as being slightly different from its

counterparts, four to seven of the cervical spine. In this research project, it was observed that all but one

subject had a subluxation of the third vertebra and almost half of these subluxations were accompanied

by bogginess, no doubt due to congestion with all but one subject showing somatic dysfunction in the

area of fourth thoracic.

These findings demonstrate compensation in the patterns of dysfunction in the subjects. This is

indicative of a natural tendency of the body to adapt, although by adaptation the structures of the body

may create restriction in areas, increasing the chances of generating predisposed genetic or structural

impediments ( such as learning disabilities, diabetes, high blood pressure, etc.) In adapting, the body

will always find the weakest link and there express symptoms. In people with LD, a normal structural

adaptation of the body could decrease enough of the nutritional supplies and drainage to the brain to

action the predisposed neurological challenges.


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There are few researchers who have examined youth diagnosed with LD with a view toward osteopathy

as a treatment. Of those available, most are simply case studies much like what has been undertaken in

this thesis. For Example, Viola Freeman pioneered cranio-sacral treatment in affected children and

documented academic improvements as a marker of successful treatments (Frymann V., 1976). One

study showed the effect of osteopathic treatments on orthographic skills (Knzig M. et al, 2006).

Chiropractic research has shown success in manipulative treatment of the cranial bone and the atlanto-

occipital complex (M.D. Thomas et al., 1992). The research undertaken for this paper considered

subjects holistically with a view toward finding physiological impediments to optimum learning

function.

As Dr Still, the grandfather of osteopathy wrote in the 1800s Healthy action of brain with its

magnetic and electrical forces to the vital parts which sustain life, memory and reason, depend directly

and wholly upon unlimited freedom of the circulatory systems of nerves, blood, and cerebral fluidNot

much has changed in the reasoning of this 19th century physician.


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Limitations

For the scope of this research project, a small, non-randomized review of patients served the study

purpose. However, a well conducted study would include significantly more subjects of both sexes, and

random ages, who would be chosen by an outside agent, and would include a random sample of

individuals, including some with learning disabilities. These individualsdiagnostics and learning

abilities would be blinded to the researcher until the study had been concluded. There would be an

opportunity to add in full osteopathic therapy together with learning and social indicators through a

third, also blinded research partner so that the effects of osteopathic treatment on learning disabilities,

inclusive of both academic and social indicators could be documented and found credible. The field,

while very exciting and with potential for significant societal impact, is not well studied and the future

of study is open to an innovative team.


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Conclusions

In conclusion, this research reviewed the potential for osteopathy to offer a drugless intervention to the

many people who suffer from learning disabilities, particularly those in whom somatic dysfunction is

identified. While early osteopathy studies indicated the power potential of this alternative intervention, it

has not been widely uptaken in our society.

Learning disabilities have been identified as linked mainly to the left hemisphere of the brain, where the

language center is situated. Proper communication between the communicating neurons of the brain is

essential to a well-functioning system. Adequate feed and drainage to the brain is closely linked to

optimal function, with these functions being supported by the anatomy and physiology of the structures,

without which learning becomes more challenged.

This study provides a preliminary finding to influence future studies in the area of somatic dysfunction,

its osteopathic interventions, and the potential effects on learning.

Given that if the structures of the neck and thorax are altered, any somatic dysfunction involving tissues

texture changes, asymmetry, restriction of motion and sensory changes, would have an impact on the

spinal segment producing a cascade of events restricting the nerves, veins, arteries and lymph vessels.

These constraints in turn create contracture in the muscles and further restrict the nutritional supplies to

the area thus impairing the nutrient exchange route to and from the brain. The subjects of the research

demonstrated some structural impairment of the neck and thorax which may be linked with nutrient

deficiency to the brain, contributing to learning disabilities. It will be interesting in the future to examine

whether osteopathic manual integrative treatments will have an effect on learning capacity for

individuals who have been diagnosed with learning disabilities.


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APPENDICES

Appendix A 44

Appendix B ...48

Appendix C ... 49

Appendix E ... 50


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APPENDIX A


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APPENDIX A


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APPENDIX A


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APPENDIX A


57/60


APPENDIX B


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APPENDIX C


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APPENDIX D

Learning Disability definition:

Learning disorder / Learning Disabilities or Specific Learning Disability is a group of disorders

characterized by difficulties in learning basic academic skills, that are not consistent with the person's

chronological age, educational opportunities, or intellectual abilities. Basic academic skills refer to

accurate and fluent reading, writing, and arithmetic. (DSM-5 development proposed revision)1

Learning disabilities: World Health Organization 2

'' a state of arrested or incomplete development of mind''

Learning disability is a diagnosis, but it is not a disease, nor is it a physical or mental illness,

Unlike the latter, so far as we know it is not treatable.

Internationally three criteria are regarded as requiring to be met before learning disabilities can

be identified:

intellectual impairments ( mild: 50-70, moderate : 35-50, severe :20-35, profound :

below 20 IQ)

social or adaptive dysfunctions early onsetWorld Health Organization3 refers to ''Disorder of Psychological Development

F81 - Specific developmental disorder of scholastic skills

F81.0 specific reading disorder

F81.1 specific spelling disorder

F81.2 specific disorder of arithmetical skills

F81.3 mixed disorder of scholastic skills

F81.8 other developmental disorders of scholastic skills

F81.9 developmental disorder of scholastic, unspecified

F82 Specific developmental disorder of motor function

1http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=429#2British Institute of Learning Disabilities http://www.bild.org.uk/docs/05faqs/Factsheet%20Learning%20Disabilities.pdf

3The ICD-10 Classification of Mental and Behavioural Disorders. Clinical description and diagnostic guidelines , WorldHealth Organization


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F83 Mixed specific developmental disorders

F84.0-1-2-3-4-5-6-7-8-9 Pervasive development disorders

F88 Other disorders of psychological development

F90-F98 Behavioural and emotional disorders with onset usually occurring in childhood and

adolescence

F90- Hyperkinetic disorder (as ADD- ADH)

F99 - Unspecified mental disorder

thesis, learning disabilities osteopathic relation to cervical and thoracic spine, by france...

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