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Parents who have children that suffer from ADHD as well as doctors and therapists who treat these families are well aware that there is a higher rate of difficulty with regard to bladder control for these children. This most times is at night but may also be a problem throughout the day as well. In addition to an obvious sign of delayed development, this also has considerable social stigma attached to it. A recent study in the Journal of Urology confirms and brings into objective evidence what those of us in the field already know. Yes, children who have ADHD are far more likely to have issues with bladder urgency and eneuresis ( bed wetting.) In fact, the higher the child scored on the Connors Parent Rating Scale a psychometric tests for ADHD, the more likely he or she was to have urgency.
In the functional neurology model, this association between ADHD and bladder control makes perfect sense. An under developed cortex or higher brain is going to give one less ability to resist a socially inappropriate urges as well as a lower reflexes such as relating to your bladder. Let’s combine the two situations to make an example. When your bladder fills, you will have the urge two empty your bladder. This is what you do as an infant. It is a reflex. As your higher brain develops you become aware that it is socially inappropriate to empty your bladder whenever it feels full. It is your higher brain which is able to inhibit the bladder reflex to empty your bladder. Thus, if you’re higher brain is not developed sufficiently you will not be able to inhibit the lower bladder reflex and you will have urgency and daytime as well as night time accidents. Now, let’s look a situation in which the child is able to control his bladder during the day but has issues with bed wetting at night. In this situation, your cortex or higher brain is less active at night when you are sleeping. Therefore, you have less ability to inhibit the lower bladder reflex and thus your bladder empties. In the second case, the child’s cortex is sufficiently developed to inhibit the bladder reflex during the day however with decreased cortical activity at night, his ability to inhibit the bladder reflex falls below threshold and he loses his ability to inhibit.
The trick of course is to find the appropriate exercise to stimulate the under functioning area of the brain (the area of dysfunction must be localized) in order to accelerate its development and address both the issue with ADHD and bladder control. This of course is the job of the functional neurology practitioner.
J Urol. 2011 Feb;185(2):663-8. Epub 2010 Dec 18.
Lower urinary tract conditions in children with attention deficit hyperactivity disorder: correlation of symptoms based on validated scoring systems.
Burgu B, Aydogdu O, Gurkan K, Uslu R, Soygur T.
Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
Abstract
PURPOSE: We investigated whether certain voiding problems have a higher incidence in patients with attention deficit disorder with hyperactivity compared to age matched controls.
MATERIALS AND METHODS: We used the Conners Parent Rating Scale-revised for attention deficit disorder with hyperactivity and lower urinary tract symptom score to evaluate voiding problems. A total of 62 children with attention deficit disorder and 124 healthy controls were enrolled. We evaluated uroflowmetry patterns in both groups. Residual urine volumes and Bristol stool scale were noted. We examined the correlation between total Conners Parent Rating Scale-revised and lower urinary tract symptom score in patients with attention deficit disorder. Additionally we analyzed each index of the Conners Parent Rating Scale-revised separately in terms of correlation with symptom subgroups for lower urinary tract symptom scores.
RESULTS: Mean ± SD total lower urinary tract symptom score was 11.1 ± 2.9 in patients with attention deficit disorder with hyperactivity and 3.2 ± 1.3 in controls, a difference that was statistically significantly (p <0.001). With the exception of constipation, mean scores of all lower urinary tract symptom subindices were significantly higher in patients with attention deficit disorder compared to controls. Symptoms evaluated in lower urinary tract symptom score were mostly correlated with attention deficit disorder index of the Conners Parent Rating Scale-revised. If a child with attention deficit disorder has a high index in the Conners Parent Rating Scale-revised, he or she is more likely to have urgency. Also, if a child with attention deficit disorder has a high hyperactivity subscale score, he or she is more likely to have enuresis.
CONCLUSIONS: Voiding problems are more common in children with attention deficit disorder with hyperactivity than in age matched controls. Urgency and enuresis are the outstanding problems in children with attention deficit disorder. Simultaneous use of the Conners Parent Rating Scale-revised and lower urinary tract symptom score questionnaire should be encouraged in patients with attention deficit disorder to allow a structured and quantitative evaluation of these overlapping problems.
Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
PMID: 21172714 [PubMed - in process]
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Our model of autism deals with under functioning areas of the brain as well as difficulty with different areas of the brain communicating with each other. Our treatment approach is based on eliminating issues with fuel delivery to the brain as well as activating the under functioning, under commmunicating pathways, and circuits in order to optimize brain function. This is our general approach to autism as well as many other neurological disorders. We know that the brain is changeable, neuroplasticity, and thus we use this information to stimulate targeted areas of the brain through the senses in order to promote positive changes in the patients nervous system. The stimulation should be targeted and specific to the patients particular area of weakness. I am not a fan of generalized right or left brain stimulation as you can create an imbalance as well as correct one. This is particularly important with regard to children on the autism spectrum as each child is so different even if they have some commonalities. Having established that I prefer specific treatment protocols based on a clinical examination by a functional neurologist, I recognize that I am often asked if there is any general type of stimulation or exercises that a parent that has a child with autism can do at home or by themselves that might be in accordance with the concepts of functional neurology, hemispheric integration and neuroplasticity. Something that I have found that seems to be beneficial in most,but not all cases, is musical training. Obviously, this would depend on where the lesion, problem in the brain, is and what you child’s level of function. Although, in Hemispheric Integration Therapy a great emphasis is placed on balancing the right and left sides of the brain. I again reiterate that there are 2 sets of peripheral nerves, 2 cerebellums, 2 basal ganglias etc and one can not simply stimulate on one side or the other and expect an optimum result. Much of the communication between right and left hemispheres is done through an area know as the corpus callosum which musical training has been shown to increase in size. In addition, musicians have shown larger brain areas for motor, auditory, and visual spatial center of the brain. And I think we have heard it said that musical training improves math skills. This is exactly what neuroplasticity is all about and a good example as to how appropriate stimulation cannot only make a pathway or area more efficient but also make it physically larger. This is exactly what the functional neurologist does with his patient’ s except that the exercises and stimulation are directed toward the area which was found to be deficient on functional neurological examination. Both of my children play the piano. I would say that in general, if you have a child on the autism spectrum, musical training is something you may want to investigate as a way to improve his or her functionality. This is not medical advice as I have not had the opportunity to examine your son or daughter, but simply a suggestion in response to a question that I am often asked. I personally don’t play an instrument, but have it on my list of things to do simply as I like the neurological implications.
J Neurosci. 2003 Oct 8;23(27):9240-5.
Brain structures differ between musicians and non-musicians.
Gaser C, Schlaug G.
Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA.
Abstract
From an early age, musicians learn complex motor and auditory skills (e.g., the translation of visually perceived musical symbols into motor commands with simultaneous auditory monitoring of output), which they practice extensively from childhood throughout their entire careers. Using a voxel-by-voxel morphometric technique, we found gray matter volume differences in motor, auditory, and visual-spatial brain regions when comparing professional musicians (keyboard players) with a matched group of amateur musicians and non-musicians. Although some of these multiregional differences could be attributable to innate predisposition, we believe they may represent structural adaptations in response to long-term skill acquisition and the repetitive rehearsal of those skills. This hypothesis is supported by the strong association we found between structural differences, musician status, and practice intensity, as well as the wealth of supporting animal data showing structural changes in response to long-term motor training. However, only future experiments can determine the relative contribution of predisposition and practice.
PMID: 14534258 [PubMed - indexed for MEDLINE]
Cereb Cortex. 2003 Sep;13(9):943-9.
Cerebellar volume of musicians.
Hutchinson S, Lee LH, Gaab N, Schlaug G.
Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
Abstract
There is evidence that the cerebellum is involved in motor learning and cognitive function in humans. Animal experiments have found structural changes in the cerebellum in response to long-term motor skill activity. We investigated whether professional keyboard players, who learn specialized motor skills early in life and practice them intensely throughout life, have larger cerebellar volumes than matched non-musicians by analyzing high-resolution T(1)-weighted MR images from a large prospectively acquired database (n = 120). Significantly greater absolute (P = 0.018) and relative (P = 0.006) cerebellar volume but not total brain volume was found in male musicians compared to male non-musicians. Lifelong intensity of practice correlated with relative cerebellar volume in the male musician group (r = 0.595, P = 0.001). In the female group, there was no significant difference noted in volume measurements between musicians and non-musicians. The significant main effect for gender on relative cerebellar volume (F = 10.41, P < 0.01), with females having a larger relative cerebellar volume, may mask the effect of musicianship in the female group. We propose that the significantly greater cerebellar volume in male musicians and the positive correlation between relative cerebellar volume and lifelong intensity of practice represents structural adaptation to long-term motor and cognitive functional demands in the human cerebellum.
PMID: 12902393 [PubMed - indexed for MEDLINE]Free Article
Clin Med. 2008 Jun;8(3):304-8.
Do musicians have different brains?
Stewart L.
Department of Psychology, Goldsmiths, University of London. l.stewart@gold.ac.uk
Abstract
The search for anatomical correlates of special skills dates from the end of the 19th century, when post-mortem brains of gifted individuals, including musicians, were examined for clues as to origins of their prized abilities. Modern neuroimagingtechniques provide the chance to interrogate the brains of living musicians. Structural and functional specialisations have been demonstrated across several sensory, motor and higher order association areas. These specialisations are often instrument- or effector-specific and correlate with aspects of the training history supporting the view that they are the result, rather than the cause, of skill acquisition. Musicians constitute a model, par excellence, for studying the role of experience in sculpting brain processes. A key challenge for the future will be to develop theoretical frameworks within which musicians and other occupationally specialised groups can be studied in order to investigate the nature, scope and limits of neuroplasticity.
PMID: 18624043 [PubMed - indexed for MEDLINE
Neuropsychologia. 1995 Aug;33(8):1047-55.
Increased corpus callosum size in musicians.
Schlaug G, Jäncke L, Huang Y, Staiger JF, Steinmetz H.
Department of Neurology, Heinrich-Heine University, Düsseldorf, Germany.
Abstract
Using in-vivo magnetic resonance morphometry it was investigated whether the midsagittal area of the corpus callosum (CC) would differ between 30 professional musicians and 30 age-, sex- and handedness-matched controls. Our analyses revealed that the anterior half of the CC was significantly larger in musicians. This difference was due to the larger anterior CC in the subgroup of musicians who had begun musical training before the age of 7. Since anatomic studies have provided evidence for a positive correlation between midsagittal callosal size and the number of fibers crossing through the CC, these data indicate a difference in interhemispheric communication and possibly in hemispheric (a)symmetry of sensorimotor areas. Our results are also compatible withplastic changes of components of the CC during a maturation period within the first decade of human life, similar to those observed in animal studies.
PMID: 8524453 [PubMed - indexed for MEDLINE]
Nat Rev Neurosci. 2002 Jun;3(6):473-8.
The musician’s brain as a model of neuroplasticity.
Münte TF, Altenmüller E, Jäncke L.
Department of Neuropsychology, Otto-von-Guericke University, Universitätsplatz 2, Gebäude 24, 39106 Magdeburg, Germany. thomas.muente@med.uni-magdeburg.de
Abstract
Studies of experience-driven neuroplasticity at the behavioural, ensemble, cellular and molecular levels have shown that the structure and significance of the eliciting stimulus can determine the neural changes that result. Studying such effects in humans is difficult, but professional musicians represent an ideal model in which to investigate plastic changes in the human brain. There are two advantages to studying plasticity in musicians: the complexity of the eliciting stimulus music and the extent of their exposure to this stimulus. Here, we focus on the functional and anatomical differences that have been detected in musicians by modern neuroimaging methods.
PMID: 12042882 [PubMed - indexed for MEDLINE]
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September is literacy month in Florida and I thought I would briefly discuss the connection between functional neurology with regard to reading difficulties. This article will deal more with getting the information into the brain rather than what areas of the brain process different types of information. In order to read properly, there must be coordinated eye movement at a near distance. This means that the right eye must be talking to the left eye with regard to movement. The pupils must also be active, responsive and working together. In addition, there are different areas of the brain that initiate and stop eye movement. This relates to moving from one word to another as well as moving down to the next sentence. For proper reading to take place all these activities must function in synchrony. For example, if one eye does not move in conjunction with the other, the reader will experience double vision or one eye will shut down in order not to confuse the brain. This is all important from a reading standpoint, but realize that the functional neurologist is using this information as a way to assess brain function. It is by addressing deficient or desynchronized brain function that we make the difference to the reader. This means that, not only will the reader be given specific eye exercises in order to facilitate proper eye function and coordination but that other parts of the body may be brought into the treatment in order to smooth and coordinate brain function and thereby help with eye movements when reading. In my office, we have a simple 15 minute test which evaluates eye movements during reading which provides us with considerable information regarding brain function. This is a painless task which requires no preparation and is very much appropriate for children.
The ability to read is important in order for children to succeed in school as well as in life. In school a child who is frustrated with an inability to read may begin to have behavioral issues as his peers start to label him as “dumb.” In addition, if he cannot read and do the work then he may become bored and inattentive. This may lead to a miss diagnosis of ADHD and even perhaps a child being placed on medication that is unnecessary. As these children become older and progress through life their rates of juvenile delinquency may increase. One study revealed that 90% of the juvenile delinquents participating could not read. Thus, simple but many times undetected functional reading problems may come at great cost to you and your child but also a greater cost to society. Thus, before you place your child on ADHD medication please be sure to discuss the issue of near point coordinated eye movement with your doctor.
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This is the case of a six-year-old child who presented with a diagnosis of Asperger’s syndrome. He is also hyperactive. He has tantrums and can become aggressive. He has difficulty with social situations. He can be very intelligent in particular with regard to things that he enjoys such as dinosaurs and maps. He is a picky eater. He has some sensitivity to sounds and dysgraphia.
Incidentally noted was a misalignment of the eyes. But was this misalignment of the eyes really just an incidental finding or was it really a great clue as to where this child’s functional lesion originated from. We know that the number one comorbidity associated with autism spectrum disorders is in coordination. We know that the cerebellar and vestibular systems are intimately involved with balance and coordination. We see that many children on the autism spectrum in fact do have functional vestibular lesions as part of their problem and presentation.
So we can evaluate the child’s neurologic system as well as his vestibular system? Here are some things that we might look for . Are his eyes misaligned at rest? Is there any change in the alignment of his eyes with eye movement? Is there any involuntary movement of his eyes? Are his eye movements smooth and not ratchet like? Is his head tilted or rotated? Does the tilt and/or rotation improve when he closes his eyes? Does the child get dizzy easily? If you spin him in various directions, does he have an appropriate vestibular response?
By assessing function and determining where the issue lies, we can begin to formulate a treatment plan that will stimulate that pathway that is under functioning using the concepts of neural plasticity. In this case, we determined that the muscle was functionally short. We determined that there was an issue with the neurologic feedback system and the neurologic control of the length of the muscle. There was an issue with all the neurologic inputs to the muscle that help determine what it’s normal resting length should be. By addressing this functional vestibular lesion as well as other associated neurological dysfunction that we were able to pick up on his examination, the child has made other improvements which are more in line with what his parents brought him in for. So we know that the eye misalignment was not his primary complaint or what was a the greatest concern to his parents. However, it is an interesting and observable window into the physiologic changes that can be made with the appropriate functional treatment of his nervous system. That is to say, we cannot see the strengthening connections from his vestibular nucleus to his cerebellum for example but we can see the alignment of his eyes improving. This is what functional neurology is all about, observation, understanding, application and observation again. There was another clue in this child’s history that made it apparent that this was a functional lesion. This child had had three surgeries to correct the misalignment of his eyes. That is, they would operate to address the length of the eye muscle. The misalignment would correct temporarily and then return. This occurred three times. This is a simple clue to the functional neurology practitioner that indicates that the misalignment was not in fact a structurally short eye muscle but a functionally short eye muscle. That is, that the muscle was shortened due to faulty neurologic integration.
What else are we seeing with this child? His hyperactivity has improved, his temper tantrums have improved and he has not had a bowel or bladder accident in several weeks. His teacher relates that this past week was the first time that the child was able to do his writing work at school. He wrote seven words. The teacher states that he is having improved attention. He also played ball with his father for the first time in his life.
To explain how the vestibular system may be interrelated with issues such as hyperactivity, tantrums and social deficiencies is beyond the scope of this article. However, you can be aware that vestibular issues are common in children with autism spectrum disorders. Manifestations of vestibular malfunctions such as misalignment of the eyes may be related neurologically to symptoms being expressed as autism spectrum disorder and not an unrelated incidental finding. And now hopefully this is something you are aware of and can observe.
