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Case Report: Use of Applied Kinesiology Protocols on a 12 Year Old Child with Developmental Coordination Disorder.

Dr Genevieve Gagné DC

Introduction:

The foundation of the human nervous system is primitive neonatal reflexes. Stimulation allows newborns to create more connections between the cerebellum and the prefrontal cortex and subsequently, acquire voluntary modulation over these reflexes. Most of these should disappear and be integrated within the first year of life.i Patients diagnosed with Development Coordination Disorder (DCD) are known to have retained some of these primitive reflexes. As such, they have not developed sufficient voluntary control of their motor skills and emotions. Research conducted in 2008 on 177 normal infants revealed that decreased primitive reflex activity was directly correlated to the emergence of motor milestones. ii This suggests that those retained reflexes could be the cause of developmental issues such as DCD.

This type of motor skill disorder affects 5 to 6 percent of all school-aged children in the United States. They typically have normal or above average intellectual abilities. However, their motor coordination difficulties may impact their academic progress, social integration and emotional development. DCD is commonly associated with other developmental conditions including attention deficit disorder (ADD), speechlanguage delay and behavioural issues. There is no known genetic component for this disorder. Early infections, prematurity and foetal alcoholism are generally considered the aetiology of this problem. iii

Allopathic medicine recognizes that there is no cure for this disorder. They recommend a combination of an educational program, physiotherapy treatments and social work to allow the children to evolve and adapt to normal life.

The purpose of this paper is to demonstrate the effectiveness of using Applied Kinesiology Retained Neonatal Reflex™ (RNR) protocols and its associated positive impact on developmental delays such as DCD.

Assessment:

A 12 year old Caucasian male was referred for motor skill delays, slow task execution and generally bad posture. His parents also reported a lack of proprioception and equilibrium. He was anxious, suffered from eczema, bruxism and ADD. His mother additionally described a difficult delivery with fetal distress and the use of a vacuum extractor. He was born 3 weeks before term. In his early development, the patient eschewed the cross-crawl stage in favor of progressing directly to walking. His mother also disclosed an enuresia problem till the age of 9 years old. He had reading problems, appeared to have poor coordination while walking or dancing and classified himself as “a slow runner ». He was unable to ride a bicycle or swim without floating devices. At the age of 12, he still ate using his fingers. He did not have any language or speech delay but he often had difficulty maintaining his train of thought. Additionally, he struggled with mathematic problem solving; however, his mathematic calculation skills were above average. His only prior treatment had been taking Vyvanse® 25mg for 2.5 years; however, his parents ceased medication use a year ago due to lack of significant improvement of his condition.

His evaluation revealed low postural muscle tone while standing and sitting. The Adam’s Forward Bend Test was negative and there were no significant signs of vertebral abnormalities. The Rhomberg’s Test demonstrated a significant coronal and sagittal sway. He required assistance not to fall. The patient was unable to perform the Tredelenburg Test with any measurable parameter as he was too unstable. The musculo-skeletal assessment showed multiple tensions on the vertebral muscles and multiple vertebral subluxations. The patient had difficulty crossing the midline and demonstrated a homolateral walking pattern. The patient also exhibited high levels of anxiety throughout the evaluation and was apprehensive and nervous about each step of the evaluation process.

Primitive reflex retention evaluation using the evaluation procedures of RNR Technique showed signs of a retained Fear Paralysis Reflex (FPR), Moro Reflex, Babkin Response, Asymmetrical Tonic Neck Reflex (ATNR), Lateral Tonic Labyrinthine Reflex (TLR), Symmetrical Tonic Neck Reflex, Stepping and Heel Reflexes, and Spinal Galant Reflex.

Treatment and results:

Throughout all the treatment visits, corrections were performed using applied kinesiology technique RNR which was developed by Dr Keith Keen DC DO and Dr Susan Walker DC. These corrections consist of cranial manipulations and chiropractic HVLA spinal adjustments in a sequence shown to assist the integration of primitive reflexes.

On the patient’s first visit, corrections were focused on the FPR and Moro reflexes. HVLA spinal adjustments were also performed on the patient at T12 -L1.

During the next appointment, 2 weeks later, the patient and his mother reported generally less eczema but significant muscle pain and cramps were felt everywhere on his body. The patient also mentioned that he had felt generally less anxious. On this occasion, corrections were directed toward the Babkin Response and ATNR on the left side only.

Subsequently, an additional 4 weeks later, the patient’s mother reported that he started using his cutlery properly while eating and was less tempted to use his fingers. He felt less leg pain and his eczema was no longer present. Treatment was given on Lateral TLR in the coronal plan and ATNR was showing on the right.

During his next visit, one week after, the Tredelenburg Test was stable on the coronal plan, but the patient was still unstable in the sagittal plan. The Rhomberg’s Test was negative. The patient reported back pain but improvement in focus and reading comprehension. Corrections on this occasion concentrated on Lateral TLR, specifically on the sagittal plane and the Stepping Reflex.

A further 2 weeks later, the patient did not disclose any back pain and his walking pattern was more fluid and straight. He realized that he felt more stable and could run faster. He reported an improvement in athletic performance. Treatments were given toward Heel reflex and STNR in flexion.

During his final visit, 4 weeks later, his mother mentioned with enthusiasm that he was running normally and was generally better in sports. The patient reported no pain during the intervening period. The Spinal Galant reflex was addressed during this visit.

A further 4 weeks later, his mother called to mention that her son was now able to ride his bicycle and his school report card was showing an increase of 16 % in mathematical problem solving.

Discussion:

Patients with DCD are known to have several retained reflexes. Therapies used to correct these reflexes are varied and numerous. Some use manual therapy, while others directly stimulate the pre-frontal cortex with passive or active movements. A comparison of the different approaches could be valuable in determining the effectiveness and the reproducibility of the results on different types of presentations. In this case, the only treatment used was the RNR technique which seemed to impressively integrate his primitive reflexes and subsequently allow his motor milestones to take place.

Conclusion:

This case report illustrates the possibility of using alternative treatments, like RNR, to improve outcomes for those diagnosed with DCD. Traditional treatment protocols are long term prognoses involving years of treatments. However, in this case, the patient showed significant improvement in his general skills, concentration, coordination and vestibular senses in only 5 months. RNR techniques demonstrated concrete results for this patient and should be considered for inclusion in the normal treatment protocol for people with retained primitive reflexes and DCD.

Reference:

i Harald Bloomberg, Moira Dempsey, Movements that Heal, Ed 1, Bookpal, P40-61.

iiDevelopmental Medecine & Children Neurology; November 2008.

iiiPolatajko, H.J., Fox,M.,& Missiuna, C. (1995) An international consensus on children with developmental coordination disorder. Canadian Journal of Occupational Therapy, 62, 3-6.

American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 5th ed, 2013, Washington DC