esmac 2012

‘Negative contribution’ of automatic postural control on development of

child with brain lesion. By

Rajul Vasa [India]for

ESMAC in SWEDEN

ELEPHANT BABY walks after birth

Baby with mother.

Baby’s COM supported by mother.

Safety of COM•We all know that safety of

COM is a priority of all living beings.•we also know that human

baby at birth is not equipped with automatic control on COM safety like animal baby.

GravityFrom No Control on COM at birth,

to complete control on COM safety

automaticallyis the journey

we all have made as infants to get connected to the gravity.

Inlaying anticipatory controlDifferent developmental postural milestones unfolded during this journey we made as infants to get connected to the gravity. Resultant effect of our journey is we developed automatic control on safety of our COM with inlaying of anticipatory postural connectivity among distant postural centers of our brain.

Exploiting gravity• Exploiting gravity and

experiencing disequilibrium and re-equilibrium from within by raising COM in different developmental postures is critical to inlaying of anticipatory postural control post birth for automatic safety of COM.

Central axis• Poor control on

central axis; ‘The head neck and trunk’ results into disequilibrium and fall unless passively supported by parents or devices.

Brain - Equipped with anticipatory control!

Limbs provide safety to COM.

Lesion in the brain• Baby with brain lesion and paretic

muscles is unable to exploit gravity for its development and gets into disequilibrium from gravitational force that threatens safety of COM making gravity a liability unlike TD children who can exploit gravity for their growth and development.

Degrees of freedom• Fluidity in movement of COM

with slightest movement of flail linked segments + increased degrees of freedom from paresis + flail weak muscles unable to generate force becomes huge threat to safety of COM.

Raising COM in different postures.

• Baby with poor control on head neck and central axis + paretic muscles + constant disequilibrium from gravity finds it hard to raise COM without threatening COM safety.

Problem Solving • Constant threat to COM safety, makes Self-

organizing brain to take inability to raise COM with paretic body

as an opportunity ‘to solve disequilibrium problem’ by not raising COM high above the support surface for an indirect safety from within. This results into more delay in development.

Optimal economic solutionDelaying motor milestone and not raising COM above the support surface actively is an optimal and most economic solution in terms of energy cost by self-organizing brain with lesion.

Fluid character of COM Movement • Besides delaying postural milestone

so that COM does not rise above the support surface, brain also begins to make extra provisions

against fluid character of COM movement for more safety.

Safety measures are automatic.• Safety of COM is automatic for a

brain with lesion or without lesion. Only difference is brain with lesion uses different tools from within when paretic muscles cannot generate force to combat gravity.

‘Defensive’ as against ‘In control’ • Self-organizing brain when

cannot control and restore COM to safety it turns..

highly defensive with special measures of safety from within.

Log • Self-organizing brain works towards

restricting fluid change in movement of COM with morphological changes in tissues which are available in abundance throughout the body and can restrict or freeze linked segments into a log like structure so that COM movement can be frozen or it gets highly restricted.

Sensory processing • Self-organizing brain works optimally.

With freezing of COM movement it also takes benefit of reducing, sensory chaos with reduced afferent inflow from log like body unable to move by itself

thereby economizing on energy on sensory processing.

Tools within • Self-organizing brain exploits

tools from within like fascia and connective tissue available in abundance which connects entire body with one another to make multi linked body work as ‘one whole integrated unit’.

Contracture •Morphological changes in

fascia and connective tissue results into Contracture that helps reduce degrees of freedom in linked segments thus provide indirect safety.

Homeostasis • Contracture in connective tissue

within and around paretic muscles that make up 40 % of body mass helps develop some force within to bring in homeostasis of forces

within and outside.

Negative contribution of automatic postural control

• Automatic safety measures like delaying postural milestone, not raising COM, inlaying anticipatory control of freezing and restricting COM movement with morphological changes for a log like body from contracture in self defense contribute negatively in the growth and development of child unless one is able to therapeutically prioritize safety of COM automatically with ‘Re-reorganization’ of self-organized brain.

Dark side of automatic safety of COM.

Automatic control on safety of COM is a major contributing factor behind delay in postural development in children with brain lesion.

Solution of the MillenniumVasa Concept is the solution of the millennium.

Vasa Concept

1. To Re-reorganize the self-organized brain of the child with lesion by capitalizing on speedy growth of CNS post birth before body and brain succumb to gravity with negative plasticity and adaptability.

2. To promote COM movement in all the 3 axis by prioritizing safety of COM in different mechanically stable postures to promote development from within.

Vasa Concept

1. To prevent CNS from turning defensive against gravity with inlaying of negative solution like not raising COM with delay in development and freezing and restricting COM movement with contracture.

2. To convert disadvantage into an advantage by capitalizing on affected CNS, MSS, and gravity to make them work in tandem with one another for growth and development.

Vasa Concept

1. To prevent negative contribution of automatic postural control from taking control of the child with contracture, stiffness and delay in development that disturbs inlaying, pruning, amplification, integration of major physiological systems with poor general condition making controller the CNS get controlled by periphery the PNS and MSS.

Exploit & Promote resources within.

• Vasa Concept exploits gravity, brain and body as the best tools as against manmade tools.

• Vasa Concept exploits Spino-spinal circuits with inter limb knowledge and inter limb sensation and all major sensory receptors for different afferent inflow to influence the motor outflow for development of milestones.

Exploit & Promote resources within.

• Vasa Concept promotes disequilibrium and re-equilibrium from within and not externally induced.

• Vasa Concept promotes non muscular forces like GRF, inertia of body, body mass for stability, inter-segmental forces to approximate joints for extra stability

Philosophy behind Vasa Concept

• VASA CONCEPT is based on influencing; the influencer “the affected CNS”.

Philosophy behind Vasa Concept

• CNS is an invisible internal controller of COM “the invisible”, to be controlled.

• Posture is an external visible controller of COM.

• Position of COM influences both the controller; “CNS and posture”.

Philosophy behind Vasa Concept

• Characteristics of invisible COM is its fluid character. COM is always unstable and ready to find new position.

• Exploit it to our advantage as Unstable COM is the most essential ingredient to make CNS to respond instantly motorically before controller; ‘the CNS’ gets controlled by ‘the MSS’ with contracture that freezes and restricts COM.

What to do?• Introduce the sub cortical stability to COM

wherein the COM rises above the ground automatically, safely with development of strength in muscular links enabling different configuration of posture to influence the growing CNS to grow normally & also develop the postural programme that connect COM movement, instantly with internal CNS connections to influence the MSS, an instant tool to stabilize the COM

Channelize before brain self-organizes negatively.

• One can channelize self-organizing brain to exploit its highest plastic time period post birth for optimal perceptual cognitive intellectual development and prevent child from getting label of mentally retarded and physically handicapped.

What not to do

• Do not allow the self-organizing brain to become defensive and restrict degrees of freedom of flail MSS by freezing COM with passive tissue contracture for; safety is always a priority.

‘U’ turnIf, one can take care of disequilibrium and threat to safety by building anticipatory postural circuits in the brain one can take a U turn from palliative approach for CP to solution based approach with desirable growth.

Vicious Circle

• VASA CONCEPT recognizes that weak muscle links & tight muscle links becomes the hindrance in achieving the stable posture. Unstable posture poses threat and affects CNS safety. This makes CNS react instinctively in self defense by choosing any possible motor strategy that helps restrict the COM movement. This affects the growth of MSS, that sets in never ending vicious circle.

VASA CONCEPT

• Is to exploit the affected brain itself as the best tool for its growth and development. [convert disadvantage into advantage]

• Is to exploit gravitational force as most powerful tool to develop brain. [gravity is available for free]

• Is to exploit multi-linked body itself to develop milestone. [convert disadvantage into advantage]

VASA CONCEPT contd.

• Is to promote control on global center of mass [COM] to make muscles grow and develop without letting any passive tissue contractures to develop at all. [Keeps secondary tertiary complications always at bay, this will save time of orthopedic surgeons for other more satisfying surgeries, energy of child and parents, money for parents, state and insurance companies will save big money as well, MULTIPLE BENEFITS ]

• To promote restoration of COM from within with development of brain for long term memory of automatic spatiotemporally effective postural control. [This makes physical dependence become history for the child and tag of CP becomes obsolete].