Benjamin Shield, Ph.D.
Craniosacral Therapy Approaches with Conditions of
Down Syndrome, Autism and Cerebral Palsy
The intention of this article is discussion of Down syndrome, autism and cerebral palsy and how I view and treat these conditions in my practice. It is meant as a personal discussion and not intended as a scientific research study.
I have been a Craniosacral therapist for 35 years. In these years, numerous cases of Down syndrome, autism and cerebral palsy have been presented. These individuals have aided me in the knowledge and refinement of my work as much as my treatment may have benefited them.
Down Syndrome:
Down syndrome (also referred to as Down’s syndrome) is caused by extra genetic material (trisomy) on chromosome 21. The effect of this condition causes the slowing of development between the sixth and twelfth week of intrauterine life. It is the effect on this stage of intrauterine life that is responsible for many of the features associated with Down syndrome.
Cranially, these features include the under-development and shortening of the cranial base. This results in the cranial base being straight and having a very steep (45 degree) angle. It is this steep angle that decreases the volume of the mouth and causes the tongue to characteristically protrude.
As the sphenoid bone is affected, the sphenoid sinus is absent. This causes the presentation of a flat forehead and the decreased anterior/posterior dimension. The growth of the ethmoid, nasal bones, maxillae and mandible are also affected.
Because of the deficiencies in this area of the cranium, and along with the angle of the hard palate extruding the tongue, the individual often has great difficulty breathing through the nose. They also can exhibit apnea during sleep hours because of the tongue obstruction. This can result in an overall lack of oxygen (hypoxia), and it is this hypoxia that can be the cause of many significant postnatal conditions.
The goal of Craniosacral Therapy for individuals with Down syndrome would be to work with the bones of the cranial base, the hard palate, the nasal, ethmoid, zygoma and frontal bones to maximize the ability to breathe. In treatment, we respect that this condition affects the stability of the second cervical vertebra, it causes a thinning of the cranial vault, and there is often a significant separation of the cranial sutures, particularly the sagittal suture between the parietal bones. In these instances, Craniosacral Therapy works with the intention of enhanced breathing, greater comfort, and to effect the progression of conditions caused by reduced oxygenation to the tissue and nerves.
Autism:
It is challenging to discuss autism as a particular condition, as there are as many presentations as there are cases. It is my belief that autism is a spectrum disorder that is a delicate and unique interaction between internal and external influences. However, we often see certain anatomical, physiological and behavioral similarities.
Of particular interest for Craniosacral Therapy is the how the brain in certain conditions of autism is wired. We can think of the brain as being similar to a phone company. There is local service and long distance service. In many cases, the local areas tend to be over connected and the long distance connections (between more distant regions of the brain) are weak. The over connectedness of the local areas can possibly result in the hyperfocus on details and obsessive behavior. The poor connections of the hemispheres and distal areas of the brain may account for the difficulty in analytical, motor and sensory integration.
In terms of brain development, it is often discovered that the frontal lobes are greatly enlarged, mainly due to excess white matter (myelinated axons). It is not unusual for a child to have excess axons in the frontal lobes, but there is a ‘pruning’ process that normally occurs that helps to organize thought and movement. With autism, often this pruning process is absent.
The corpus callosum links the two hemispheres of the brain. With autism, this is often undersized and underdeveloped, and the hemispheres of the brain can be poorly connected.
The amygdala, which plays a role in emotional and social behavior and in determining danger, can be enlarged in the individual with autism. This may be a reason for an elevated level of anxiety.
The hippocampus has to do with storage of memory. This is often enlarged, and one theory is that, with poor connection throughout the brain, the individual must rely on memorizing activities in a particular way.
The goal of Craniosacral Therapy with individual who have autism is to attempt to assist in the connectivity of the brain. The goal is also to down-regulate the levels of anxiety and to assist the individual achieve the greatest degree of social integration.
Cerebral Palsy:
Cerebral palsy is due to an injury to the brain, most often associated with the birthing process. It is most commonly caused by a lack of oxygen to a distinct area of brain cells. Because the damage is to a distinct area, it is considered ‘non-progressing’, in that the damage does not increase. However, the injury may appear more severe depending on the developmental stage of the child. The injury usually involves the motor system.
There are several presentations of cerebral palsy, mostly dependent on what part of the brain was affected. Spasticity is the most common symptom. Difficulties with speech, balance, and motor control of the arms and legs may be present.
There can be a condition referred to as ‘pseudo’ cerebral palsy in which there are many of the symptoms of cerebral palsy, but without damage to the brain. This is often associated with cranial bone dysfunction, and often due to cranial bones overlapping at their sutures. This is most common if the parietal and frontal bones overlap at the coronal suture. A Craniosacral therapist can aid in the normalization of these bones, particularly in infants.
My thoughts for the hope of cerebral palsy individuals are similar to the hope one has for victims of stroke. With stroke, there is an injury to a distinct area of the brain. It may be do to hemorrhage, but most commonly due to blockage of a blood vessel preventing oxygen from reaching the brain cells. There may be primary damage, followed by secondary damage around the primary site, but it is distinct.
What one can consider is that approximately one-third of stroke victims, even without the aid of therapy, recover fully. Approximately one-third will have partial recovery, and another third will show little improvement. The question is…what occurs in the one-third that fully recovers? It is an injury and damage to a distinct part of the brain, similar to injury and damage to the brain in cerebral palsy. If these victims of stroke can recover, why not those individuals suffering from cerebral palsy?
It would be the goal of Craniosacral therapy to help entrain the health of the brain. It is not likely that those cells that have died due to anoxia will come back to life. However, we can work with the goal of the healthy tissue to uptake some of the functions of the damaged tissue, as the brain may accomplish in recovery from stroke.