CASE STUDY |
(The client's name has been changed to honor the family's request for confidentiality. All other details of the case are factual.)
Jason Becker
A ten year old boy with learning disabilities and
speech and language difficulties due to birth trauma
Jason, a good-natured boy with a delightful sense of humor, was first seen at The HANDLE Institute in August 1999. Academic concerns, lingering despite intensive tutoring and previous therapies, motivated Jason’s mother to seek help from HANDLE. Jason was about a year behind grade level in reading. Sequencing, memory and writing were all challenges for him. Jason, primarily, wanted to improve his eye/hand coordination so he could play ball sports.
Three weeks late, Jason came into the world via emergency C-section when doctors discovered the umbilical cord wrapped around his neck following days of labor. Despite his weighing in at a whopping twelve pounds, his APGAR at one minute was only four and his blood oxygen level was dangerously low. Following seven nights in the hospital, several of which were spent in intensive care, Jason’s family was finally able to bring him home.
Jason’s mother recalls Jason as an “easy baby” who breastfed well for a year and a half. His progression through most of the basic gross motor developmental milestones was on target. His teeth came in very early and the teething period was rough on the entire family. He was a "mouther," putting almost everything within his grasp into his mouth.
Speech challenges as a youngster prompted extensive speech therapy to help him master nine sounds that he had not been able to produce. Jason attended a small private school and worked regularly with tutors. In first grade, Jason received additional therapy for the "r" sound at school. He was in a special class that employed Lindamood-Bell techniques, which emphasize the “feel” of sounds as produced by the mouth to promote phonemic awareness.
Prior to seeking help from The HANDLE Institute, his family utilized several other therapies to help Jason through his challenges. In second grade, Jason received vision therapy and also underwent a naturopathic treatment (NAET) to eliminate his many allergies. Although the application of these disparate therapies and learning strategies brought about progress for Jason, deficits remained. At HANDLE, Jason’s problems began to be treated holistically, building support for weak foundational systems from the bottom up.
Ten years following his traumatic birth, Jason presented at The HANDLE Institute with a variety of learning challenges. During the evaluation, Jason entered willingly into the spirit of playfulness and competition. An understanding of the root causes of his academic difficulties emerged.
Despite vision therapy, Jason did not have good visual tracking skills. His eyes tended to jump while tracking an object, and he needed a fair amount of help to discern differences on a picture completion task. Additionally, Jason had not achieved dependable binocular function; with red/blue glasses on, he saw red and blue halves on white paper indicating that his eyes were not working well together.
On a task called finger tapping, where the client copies a simple pattern of touching the thumb to each finger in order, Jason first completed the pattern in reverse. When changed to a skip-finger pattern, he had more difficulty with the sequence, and even demonstrated some trouble finding the fingers themselves. On an ear/nose touching task, which involved midline crossing, he also had trouble locating his body parts.
Throughout the assessment, Jason’s speech was slow and deliberate, as if he needed to consciously conceive the sounds before he spoke them. Repeating a string of nonsense syllables on an auditory task proved very challenging for Jason. He elicited correct responses for three and four syllable sequences, but only attained accuracy on five syllables with repetition. When asked to repeat a twelve-word sentence with simple structure, he retained the general meaning, but lost some detail.
Jason also demonstrated a considerable amount of “overflow” movement. That is, when asked to track an object with his eyes, his head moved too. When performing a finger tapping exercise with one hand, the other did not remain still. His whole body moved as he wrote on the chalkboard with both hands at the same time. On another chalkboard task, which involves drawing circles and triangles with closed eyes, interpretation of Jason’s efforts indicated that he drew the circles with his right hemisphere leading and his triangles with his left hemisphere leading. The circles were not the same size or shape, an indicator of weak synchrony between the two cerebral hemispheres.
Lastly, multi-tracking, or doing more than one thing at a time, proved difficult for Jason. Trying to engage him in conversation while he was performing a task that requires strong connections between the two sides of the brain (interhemispheric integration) tended to stop one or the other.
At a foundational level, Jason’s learning was compromised by a weak vestibular system (inner ear). Among other things, the vestibular system supports the dynamic use of our eyes and muscle tone. The fine muscle control necessary for Jason’s eyes to work together (binocularity) was lacking and his eyes were sensitive to bright light. This, together with poor visual tracking, helps explain why he often skipped small words while reading. Without first strengthening his vestibular system, Jason was not able to fully realize the benefits of his previous vision therapy program, and so his reading problems persisted.
Sensation of the body in space, called proprioception, is also supported by the vestibular system. Difficulty locating body parts on specific assessments validates proprioceptive irregularities. If the brain does not know where a specific body part is, it cannot move appropriately without monitoring the movement through conscious and cognitive means. Poor proprioception in the body parts required for articulation can interfere with a person's inherent ability to enunciate and this difficulty was evident in Jason’s speech difficulties. Additionally, reports of thrashing in his sleep, falling out of bed and needing to listen to tapes to fall asleep supported the findings of a weak proprioceptive sense.
One factor in good language function is good auditory function. Adding to Jason’s speech and reading problems was a deficit in auditory sequencing, as evidenced by his trouble reproducing nonsense syllables. Again, the abilities to filter and focus sound, sustain auditory attention, and process auditory input are all functions regulated by the vestibular system.
Jason demonstrated other irregularities, too, among them, an immaturity of differentiation. That is, the ability to move only the specific body part we mean to move, inhibiting overflow movements. Differentiation is a precursor to establishing a controlling hemisphere of the brain, and in turn, to efficient communication between the two sides of the brain. Weakness in the integration of the brain hemispheres can negatively affect multi-tracking, and academics at all levels. Jason's left hemispheric functioning, particularly sequencing, needed strengthening.
From a holistic and developmental perspective, weak aspects of Jason’s nervous system needed development, to allow lower-level functions to become automatic, thus freeing mental energy for higher-level functions such as reading, writing and speaking. Carefully selected activities, such as drinking through a crazy straw, catching a suspended glow ball, hula hoop games and a specific massage technique, were part of Jason’s individualized program. Vestibular functioning, interhemispheric integration, proprioception, differentiation and binocularity were all targeted for enhancement.
At a one-week follow-up session designed to ensure that the activities were being performed correctly, Jason reported that he was becoming more skilled with the exercises. An interhemispheric writing drill, games to enhance math comprehension, and an exercise to further develop differentiation were added to supplement his basic program. An additional recommendation for cranio-sacral therapy, as an adjunct to his HANDLE work, was made to help alleviate the extreme sensitivity of his face and scalp.
Throughout the first month of his program, Jason began to reap the benefits of his effort. His fine motor control and printing became noticeably better. Refinements in his visual functioning surfaced; he could sustain his visual activities for longer periods of time and reading comprehension improved. The exercises were happening more automatically. Jason completed his cranio-sacral treatments, during which tensions in his skull shifted dramatically.
Positive gains continued. According to a school test, in the first four months of Jason’s HANDLE program, he had made reading progress equivalent to one year. His fine motor ability continued to improve and his memory flourished. He was seemingly more aware of the things going on around him and organization was less of a problem. His mother reported being pleased at his enhanced ability to clean his room.
For Jason, his gleeful self-report of “I can catch a ball!” said it all. His new-found ability to kick the soccer ball opened up opportunities to play positions other than goalie. Not only was Jason able to fulfill his desire to play basketball, he even participated in exhibition game at the Key Arena!
His skill at throwing and catching a baseball surprised everyone, as this was something he and everyone who knew him had previously considered dangerous. So now, Jason and his dad enjoy playing catch together, and Jason plans to join a team next year.
