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Rhythm and the Neurological Plexuses: Better Understanding Autism to Enhance Therapy Interventions; Part 1

Dr. Varleisha D. Gibbs Ph.D., OTD, OTR/L

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Course ObjectivesAs a result of this course, participants will be able to:§ 1) Describe the various neurological structures

related to the 9 senses § 2) Define and describe neuronal oscillations and

their connection to function§ 3) Relate current research on the neuronal

plexuses to function and dysfunction of individuals with Autism

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Autism:aneurodevelopmentaldisorderthatinvolvesdeficitsinsocialinteractionandsocialcommunication,combinedwithrestrictedorrepetitivepatternsofbehaviorandinterests.

Retreivedfrom:https://doi.org/10.3389/fnins.2016.003005

The Spectrum

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1943LeoKanner publishes“AutisticDisturbanceofAffectiveContact”describing11sociallyisolatedchildrenwhoshareanobsessivedesireforsameness.

1950s-1960sAutismwidelyregardedasaformof“childhoodschizophrenia.”Psychoanalystsblameemotionallycoldmothering.

1970sAutismunderstoodasabiologicaldisorderofbraindevelopment.

1980DSM-IIIdistinguishesautismfromchildhoodschizophrenia.

1987DSM-IIIRlaysoutachecklistofcriteriafordiagnosingautism.

1994-2000DSM-IVandDSM-IV-TRexpanddefinitionofautismandincludeAspergersyndrome.

2013DSM-5foldsallsubcategoriesintooneumbrelladiagnosisofautismspectrumdisorder(ASD).Itisdefinedbytwocategories:impairedsocialcommunicationand/orinteractionandrestrictedand/orrepetitivebehaviors.

RetrievedDecember2017,fromAutismSpeaks.org

Timeline

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Howmanysensesdowehave?

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Gyri Review

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Frontal Gyri

§ The superior frontal gyrus: self-awareness, in coordination with the action of the sensory system

§ The middle frontal gyrus: sustaining attention and working memory

§ The left inferior frontal gyrus (IFG), also considered Brodmann Area 44 corresponds to Broca's area

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Pre-FrontalCortexExecutiveFunctioning:

AttentionInhibitionBestChoiceFlexibilityProblemSolvingPlanning,WorkingMemoryMakingsenseofemotions

beingsentfromCingulateGyrus*

Pre-MotorCortexoftheFrontalLobe:Roleinmovement,posture,andunderstandingtheactions

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BrainLateralization

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The Amygdala

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The Emotional Brain

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RAS

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NeuralDynamics

“Neural oscillations are a fundamental mechanism that enables the synchronization of neural activity within and across brain regions and promotes the precise temporal coordination of neural processes underlying cognition, memory, perception, and behavior.”

§ From: The Neurobiology of Schizophrenia, 2016

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Neuronal Oscillations§ Lower Gamma waves; and

Alpha waves correlated to things versus language

§ Waves show a peak with attention to an object versus typically peaking with surprise

§ Children with Autism respond to the familiar not novel objects or experiences

§ Improve with treatment§ We conclude-> Learning must

address the what is familiar first for implicit memory (attending) to occur!

UCLA CART "Autism 2013" Symposium, Feb. 1, 2013Panel II: EEG in ASD: Can Brain Waves Help Us Predict Treatment Response and Outcomes?Shafali Jeste, M.D.

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Research

§ ASD lacked change in Alpha waves with visual distractors

§ Atypical EEG oscillations=atypical arousal levels § Excitatory/inhibitory imbalance.

Keehn,B.,Westerfield,M.,Müller,R.A.,&Townsend,J.(2017).Autism,attention,andalphaoscillations:Anelectrophysiologicalstudyofattentionalcapture.BiologicalPsychiatry:CognitiveNeuroscienceandNeuroimaging,2(6),528-536.

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Asynchrony = Dysfunction § Poor Arousal§ Challenges with Attention§ Emotional Dysregulation§ Memory Difficulty

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Synchronization versus Over Coupling

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Mind-Body connection§ Movement can connect to brain

oscillations§ Rocking can effect brain

patterns§ Calming the body can occur

with rhythmic breathing§ Brain oscillations affected by § Enriched activities, oral motor

activity, and novel stimulation

(Bayer,2011)24

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Oscillations start outside of the brain!

How?

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O’Brien, M. (2015)

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Enteric Nervous System

§ Over 30 different neurotransmitters utilized

§ Resembles and Acts similar to the CNS

§ More than 90% of the body's serotonin is made within the gut

§ More than 50% of the body's dopamine

§ Can mediate behavior

§ Communicates bi-directionally withCNS

BrainGutConnection!

CNX

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Plexus of the ANS§ Myenteric§ Celiac§ Submocus

§ PNS and SNS responses§ Sensory, Motor, and Inter- Neurons§ Sensory includes “taste” receptors; detects

glucose similar to taste buds§ Interneurons integrate sensory information

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Challenges with: § Sleeping§ Eating§ Digestion§ Muscle tone

The child may:§ Be sensitive to light§ Dislike certain textures and touch§ Avoid or prefer specific foods§ Present socially awkward§ Are aggressive at times§ May have gastrointestinal dysfunction as in constipation or diarrhea§ Stress on the body may lead to frequent illness such as respiratory

infections

DecreasedPNSandIncreasedSNS

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Celiac “Solar” Plexus

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Anatomy

§ Located behind the stomach near the diaphragm§ Level of L1§ Around the Aorta§ Carries “Pain”§ Largest of the Sympathetic-ANS and innervates

the gut§ A Branch of CN X; Parasympathetic§ “Knocking the Wind Out of You”= Diaphragmatic

spasms

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Myenteric plexus§ Has Motor and Enteric Sensory Neurons§ From Vagus Nerve; CN X§ Sympathetic and Parasympathetic § From the Medulla to the Gut (muscles of the esophagus, stomach, and

intestines)§ SNS decreases motoric activity= constipation§ Also known as :Auerbach's plexus, together with Submucosal plexus

Costa,M;Brookes,S.J.;Hennig,G.W.(2000

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Connection to ASD§ 3-4 x more likely to have Gastrointestinal

Dysfunction

§ Encopresis

§ Maybe not just a co-morbidity

§ Research revealed a substantial reduction in the spatial density of intestines and increased interganglionic space

(Colins et.al,2014;Rao,M&Gershon,2016)

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Connection of the ANS

§ Vagus, Vagus, Vagus!

§ Longest CN in the Body

§ Sensory and Motor

§ Vagovagal reflex

§ Has both Parasympathetic and Sympathetic divisions

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Innervation§ Organs

§ Pulmonary Plexus§ Esophageal Plexus§ Cardiac§ Stomach§ Gall Bladder§ Pancreas§ Small Intestine§ External Ear§ Part of the brain meninges§ Connection to extraocular motor

muscles via connection to the trigeminal nerve; oculocardiac reflex

§ Muscles

§ Cricothyroid muscle: Tensor muscle of pharynx for phonation

§ Levator veli palatini muscle: Elevates soft palate to prevent food in pharynx

§ Salpingopharyngeus muscle§ Palatoglossus muscle: Muscle of the

tongue; not Hypoglossal but Vagus nerve

§ Palatopharyngeus muscle: Pull up pharynx to cover food while eating

§ Superior, middle and inferior pharyngeal constrictors

§ Muscles of the larynx: Speech

(Dutschmann,Bautist,Mörschel,&Dick,2014)

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Vagal Maneuvers § Bearing Down: Valsalva maneuver, closed

glottis; occluded straws/whistles

§ Coughing: similar to bearing down; easier

§ Cold Stimulus to the Face: Divers reflex; ice pack or cold cloth to face about 10 secs.

§ Gagging: The gag reflex stimulates the Vagus nerve.

§ Additional techniques in Course 2....WakeForestBaptistHealth.VagalManeuversforaFastHeartRate.http://www.wakehealth.edu/Health-Encyclopedia/Health-Topics/Vagal-Maneuvers-For-A-Fast-Heart-Rate.htm#ps1283-secAccessedAugust2014.

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Case Review

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Summary§ 9 or more senses

§ Connection to our sensory motor experiences and neuronal oscillations

§ Brain waves can be affected by our actions

§ Enteric Nervous System similarity to the CNS

§ Connecting to ENS via the Vagus nerve could influence PNS and behavior

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What’s in Part II?§ New method to categorizing children based on

these findings (The Self-Regulation and Mindfulness 7-level Hierarchy)

§ The CSI Method for Contextual Intervention§ Techniques to address the brain oscillations and

neuronal plexus

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visit me at LinkedIn, Twitter and FacebookDrVarleisha

Email: info@drvgibbs.com

Website: https://www.drvgibbs.com/

Questions?

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References§ Laurence Bayer, Irina Constantinescu, Stephen Perrig, Julie Vienne, Pierre-Paul Vidal, Michel Mühlethaler, Sophie Schwartz, Rocking

synchronizes brain waves during a short nap, In Current Biology, Volume 21, Issue 12, 2011, Pages R461-R462, ISSN 0960-9822, https://doi.org/10.1016/j.cub.2011.05.012.

§ Human Anatomy and Physiology, Marieb & Hoehn, seventh edition[Handbook of Experimental Pharmacology, Vol. 194: Sensory Nerves, Brendan J. Canning, Domenico Spina. Springer. Page 341.

§ J. Collins, R. Borojevic, E. Verdu, J. Huizinga, E. Ratcliffe. Intestinal microbiota influence the early postnatal development of the enteric nervous system. Neurogastroenterol. Motil., 26 (2014), pp. 98-107

§ Costa, M; Brookes, S. J.; Hennig, G. W. (2000). "Anatomy and physiology of the enteric nervous system". Gut. 47 (90004): iv15–9; discussion iv26. doi:10.1136/gut.47.suppl_4.iv15. PMC 1766806 Freely accessible. PMID 11076898.

§ Dutschmann, M., Bautista, T. G., Mörschel, M., & Dick, T. E. (2014). Learning to breathe: Habituation of Hering–Breuer inflation reflex emerges with postnatal brainstem maturation. Respiratory Physiology & Neurobiology, 195, 44–49. http://doi.org/10.1016/j.resp.2014.02.009

§ Jeste, S. UCLA CART "Autism 2013" Symposium, Feb. 1, 2013Panel II: EEG in ASD: Can Brain Waves Help Us Predict Treatment Response and Outcomes?

§ Keehn, B., Westerfield, M., Müller, R. A., & Townsend, J. (2017). Autism, attention, and alpha oscillations: An electrophysiological study of attentional capture. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 2(6), 528-536.

§ Mazzuoli, Gemma; Schemann, Michael (2012). "Mechanosensitive Enteric Neurons in the Myenteric Plexus of the Mouse Intestine". PLoS ONE. 7 (7): e39887. Bibcode:2012PLoSO...739887M. doi:10.1371/journal.pone.0039887. PMC 3388088 Freely accessible. PMID 22768317.

§ Stach, W (1979). "Differentiated vascularization of Dogiel's cell types and the preferred vascularization of type I/2 cells within plexus myentericus (Auerbach) ganglia of the pig (author's transl)". Anatomischer Anzeiger. 145 (5): 464–73. PMID 507375.

§ Rao, M., & Gershon, M. D. (2016). The bowel and beyond: the enteric nervous system in neurological disorders. Nature Reviews. Gastroenterology & Hepatology, 13(9), 517–528. http://doi.org/10.1038/nrgastro.2016.107

§ Fujita, Shin; Nakanisi, Yukihiro; Taniguchi, Hirokazu; Yamamoto, Seiichiro; Akasu, Takayuki; Moriya, Yoshihiro; Shimoda, Tadakazu(2007). "Cancer Invasion to Auerbachʼs Plexus is an Important Prognostic Factor in Patients with pT3-pT4 Colorectal Cancer". Diseases of the Colon & Rectum. 50 (11): 1860–6. doi:10.1007/s10350-007-9072-8. PMID 17899273.

§ Pasricha, Pankaj Jay. "Stanford Hospital: Brain in the Gut - Your Health".41