A Brief Overview of the History and Principles of Neurological Organization Therapy

By Bette Lamont, M.A., D.M.T.
Developmental Movement Center
12351 Lake City Way NE, Ste 102
Seattle, WA 98125
(206) 525-8038
dmc@developmentalmovement.org

Neurological Organization Therapy and Developmental Movement are two names for a rehabilitation therapy for the brain injured that has its roots in the work of Temple Fay, MD, Glen Doman, Carl Delacato, and later, Florence Scott, AN. Various doctors who have helped advance the work, but whose names are not as strongly associated with this methodology, include Evan Thomas, MD, Edward LeWinn, MD, and Neil Harvey, MD, among others. This treatment method continues with an unbroken record of over 50 years of rehabilitating children and adults with non-progressive brain injuries and learning disabilities.

The work has been found to have great effect in addressing the problems of cerebral palsy, autism, epilepsy, mental retardation, learning disabilities, strokes, and all other non-progressive brain injuries whether acquired before, during, or at any age after birth. The youngest person treated successfully by this program began treatment as a newborn. The oldest successfully treated began the program after suffering a stroke at age 90.
Believing that most non-progressive brain injuries are irreversible, medicine in the past has been content to diagnose and treat brain-injured children and adults on the basis of symptoms with little or no reference to the brain. This perspective has discouraged the search for more accurate knowledge about the injured brain. It has also prevented attempts to devise and assess treatment programs designed to improve the functioning of an injured brain. There is increasing evidence that activating early reflexes can alter the structure and functioning of the brain, but with few exceptions, medical practice has largely ignored the implication of this evidence. Instead, as a rule it has been taken for granted that the treatment of the brain-injured must be symptomatic.
To our knowledge, the first people to take issue with the symptomatic treatment of non-progressive brain injury were those named in the group above. These individuals became dissatisfied with the results of physical therapy and the overuse and wrong use of braces in the management of cerebral-palsied children. In the late 1940s they decided to seek ways of treating the brain injured.

This group of pioneers recognized that phylogenetically and ontogenetically, the human brain comprises a hierarchy of developmental levels with ultimate control in the cerebral cortex. They were aware that, deprived of appropriate sensory input, the brain fails to develop normal functions. From this knowledge they reasoned that it might be possible to organize or reorganize neuronal systems in an injured brain. In order to accomplish this in brain-injured children, they devised treatment programs that recapitulated, as far as this was possible, the sensory and motor experiences they believed were essential for the development of brain functions during infancy.

Principles on Which This Treatment Is Based
The brain is a hierarchy. The human brain develops from the lowest level upwards recapitulating in part the phylogenetic development of the fetus, infant and child. Function determines structure. Genes initially determine structure, but embryonic cells in the development of the embryo differentiate for functional purposes. In the early stages of development, function can determine how the embryonic cells develop. Also, the functional use of nerves and muscles increases the size and efficiency of these structures, while disuse causes atrophy.
Sensory input and motor activities are essential for the development of learning as a manifestation of functional neurological organization. Learning is a sensory process that must be reinforced by motor functioning. As stated by Doman and Scott: if input is nonexistent, limited or confused, the sensory pathways will be similarly undeveloped, underdeveloped, or incorrectly developed, and learning will not exist, will be incomplete, or will be incorrect to the same degree.
By increasing the duration, frequency, and intensity of sensory and motor activity appropriate for the development of neurological organization from birth onward, the neurological organization of injured brains can be improved. Treatment programs are therefore based on increased stimulation in six sensory and motor areas: visual competence, auditory competence, tactile competence, mobility, language, and manual skills. To influence the organization or reorganization of injured brains, it is necessary to make a fresh start beginning with activities and sensory inputs that have proved beneficial in promoting effective neurological organization from early infancy on. In other words, it is necessary to retrace steps in the normal process of neurological organization going back as far as possible.
The greatest possible unlimited opportunity for bodily movements is essential in the treatment of brain-injured children who have mobility problems. Further, movement activities increase stimulation to injured brains that impact all functions of that brain area. Thus, a child who crawls increases his capacity to accurately perceive pain and develop sophisticated horizontal visual-motor patterns.
The floor best provides opportunities for body movement for brain-injured children and adults. The restrictive effects of lying in a bed or on a couch, or sitting in a wheelchair during most of the day must be avoided in all cases, unless contraindicated by illness. "The floor is the athletic field of the child."

Neurological Issues in Therapy

Despite all of our scientific, educational, and social progress, most experts readily admit that we can clearly identify the causes of neurological handicaps in only about one of five cases. For this reason, many of the symptoms are not treated as neurological impairments interfering with learning and development, but are treated at the level of the symptoms, often with frustratingly poor results.
Developmental Movement programs help bypass barriers to learning and normal development that exist in the brains of some children. Developmental Movement treats the brain, not the symptoms, with formalized exercises - including creeping and crawling - that stimulate the child's neurological organization, that is, the step-by-step development of the central nervous system.
Many health care providers and teachers see the concept of neurological organization as a means of improving the minds and bodies of neurologically impaired children. This treatment has been recognized and used by schools, health care providers, and the British government, which has done a documentary about Developmental Movement.
Beyond the category of specific brain injury, there are millions of children in our private and public schools who are unable to read. A good many of them may have some flaw in their perceptual processes that hampers them in transferring printed or written words to the brain.

Many mysteries remain about exactly how the brain "learns". However, Developmental Movement theory recognizes that the stages by which a child's nervous system normally develops provide a key. This key facilitates diagnosis and treatment of brain injury, developmental delays, and learning problems. Developmental Movement proposes that the nervous system of each new human being must go through a specific series of developmental stages before the brain can operate at its full potential. As the baby grows, it goes through a process that is somewhat like programming a computer. The baby "programs" its motor-perceptual equipment, nerves, and brain cells by using its whole body and all of the senses.
When there is an impairment resulting from brain injury or lack of opportunity, phases in this developmental sequence will be skipped, causing problems at higher levels. Since the upper brain works through the lower brain to function, impairments at lower levels disrupt the full functioning at the highest level of the brain, where skills such as reading, writing, speech, and mathematics are learned.
Developmental Movement programs are based on the concept that academics, social, and emotional functioning depend on the integrity of each level in the brain hierarchy, beginning at the lowest levels. So children on these programs will repeat activities that stimulate the brain level that has a gap in functioning. These children may be asked to do creeping, crawling, and other developmental activities.
As the child masters all of these stages, their intellectual academic functioning is enhanced. In addition, striking personality and behavioral changes are often seen in, for example, the withdrawn, apathetic child with high distractibility and short attention span. Frequently families and teachers report children becoming outgoing, well-adjusted individuals. Although these reported and observed changes are not measured on any profile by the Developmental Movement Center, they demonstrate the holistic character of this treatment of neurological impairments, learning disabilities, and brain injury.
How can we know if a learning disabled, hyperactive, or otherwise challenged child is dealing with a neurological impairment? The Developmental Profile (Kestenberg), used by the Developmental Movement Center, gives us an excellent window into the child's functional neurological skills. It tests sensory and motor skills at seven developmental levels. If there is a gap at any of these levels, and if that gap is reflective of reported learning or behavior problems, we can assume some neurological involvement and begin a stimulation program to support associated intellectual and psychological capabilities.
You can do a lot of work now and see your child becoming more competent, or you can forever work to simply get them through life."