Reduction of Negatives

Sorry, no pretty pictures today. It has been a long hard day. We had our evaluation with Leonid Bylu, the founder of ABR. I’m going to post the transcript of the meeting.

As you read, most of it won’t make much sense. Later on, when I get the video of it, I will post some clips so you can correlate his evaluation with what he was doing in Nathan’s body. And it will make mroe sense that way.

But the main thing that we were told today is that our approach towards Nathan’s development shouldn’t really be about function, it should be about reduction of negatives. At the moment Nathan is one big NEGATIVE. Everything in his structure is wrong. Not only does he have NO control of his body but this lack of control has led to all sorts of structural problems. So the ABR approach is to reduce negatives. For example, my first goal for Nathan is head control. He said before we gain head control we have 8 stages to go to prevent his head from falling backwards. Then there are at least another 8 stages for him to pick up his head etc. So we are looking at 16 stages JUST to get decent head control. Excluding everything else everywhere else in his body.

As you can tell I have had a pretty hard time today. It’s almost like he exposed Nathan in all of his weakness and instability. And yes, this is the same child, I know Nathan is weak and I am the first to know how profoundly weak he is. But it literally felt like I had been looking at him through rosy-colored eyes and today all glasses and all softness was taken away showing us just how long the road ahead of us is going to be.

The good thing is that with a lot of old fashioned hard work we can do something about it. We will be able to reduce some of the negatives and help to improve Nathan’s quality of life. But whether, or how fast, Nathan will make functional progress…seems harder now, and much further away than ever before. I guess ignorance is bliss. By ignoring all the stages required to even hold up his head I had hoped that maybe one day he would just do it. Now I know we have at least 16 stages to go before we can even see that. And we need that before he can sit up, etc.

I think I’m too depressed to continue. Here are the notes from the evaluation:

If we get into the point of what , why and how .. these are 3 separate domains… what are the things we’re doing here.. we’re looking at the what… tangible, observable things.. musculoskeletal system in familiar way, what we can see.. the theory as of why, that’s another story. There is the technique, the how.
It’s actually quite simple. First we give you simple thought, everything you heard so far is about the brain and signal and external muscles..spastic, rigid, etc… we’ve been trying to address those problems in one way or another..when we talk about smooth muscles it brings the first bridge, to give you expansion on those original thoughts..not only the external but internal matters as well.
What you’ve seen is obvious..collapse of chest and abdomen. When we talk about maintaining posture, it’s simple, when the internal compartments are too weak, no amount of muscular force from outside can do anything about them. Simple..this is abdomen, very poor compressible abdomen, compared to other children, very different picture. We need to strengthen. B asically every organ has certain wrappings, if u look at cross section everything is divided into sub compartments and divided and bordered and wrapped into connective tissue. Smooth muscles are oversimplification. Of course they are embedded together with other connective tissue. It is generalized under terminology of internal myofascia representing different layers. Wrappings of sub compartments specific of fascia and connective tissue.
Fascia is cheapest tissue existent in human body. Muscles are expensive, connective tissue is cheap, doesn’t cost much to run in terms of metabolism etc. just layers of fabric. So what we’re doing technically is quite simple. You have external elastic muscular layers. You have to find the way to get the response from those internal layers. Once we bypass the resistance of those, we deliver mechanical stimulus to various sub compartments of layers of fascia. As they are being mechanically stimulated there is an electric effect, and that effect, as time goes, causes growth. Under pressure, there are changes in polarity, which changes chemical pathways. When we have compression we can’t control, so this is general. My part is simple. There are external structures, longitudinal, voluntary, etc.. we want to get response from more primitive, deeper, circumferential, layers of fabric wrapping sub compartments within. What we need is to distinguish between 2 types of responses – 1. Elastic rebound from surface. 2. True response. When you see technique from outside it looks strange, but once you are on receiving side, you feel the impact, which is independent on you voluntary perception. Structures of body are multi potential, have diff response depending on types of impact. Difference between wood, predetermined responses, responds or not. Tissues of body respond diff to diff impact. Depending on how we address it we make different responses.
We’re just looking for buoyancy factor to get it floating and then get impact. Idea is simple. Addressing most primitive cheapest structure in the body, which are designed to carry static loads, and the idea is we address those structures so we can free up the more expensive structures which are designed for dynamic performance. Muscles are designed for dynamic performance. In case of CP children, muscles are not bad guys who got into wrong performance. They are good guys but doing a lousy job. Good guys designed to do dynamic job but are forced into position to do hard physical labor which they’re not designed to. And basically that’s what happens. Once they get into static mode they deteriorate. As they deteriorate they can’t perform dynamic properties. Then everyone else tries to fight poor muscles mechanically or poison injections or cutting with knifes or doing nasty things to them.
Our philosophy is the opposite. We talk about the idea that we want to address the structures which are designed primarily for those static loads, deeper connective tissues, and free up muscles for specific jobs. To bring up inexpensive posture and maintenance so that muscles can be free to perform free flowing activities. Structures we’re addressing are not only least expensive, they’re also the silent ones. They don’t shout loud. They don’t have significant electric phenomena, muscles have high electric conductivity. Neurologists who use electricity focus on muscles alone, not much of interest in connective tissue which has low conductivity. The idea is simple, you want to deliver the mechanical stimulus inside. Which is tricky because if you don’t do special tricks it’s all protected from the outside. Only in early months when child is still like jelly there is potential to do this, when they re in jelly fish stage, which actually allows cascade or sequence of effects which causes stimulus to internal structures, during first months of life child doesn’t’ do much dynamic, just breathes and eats. As internal capacity builds up, gradually dynamic component starts getting in. First through static then connections, first weight bearing, then dynamic performance. Static, transitional, weight bearing, dynamic performance.
If addressing internal structures bring something predictable in terms of structures, that’s the only thing that matters. Pictures etc will give comparisons for the future. First thing to show that you’d connect with is that this technique, however strange, it works. It’s multilevel. ABR technique is certain impact designed to deliver micro strengthening, daily micro improvement to those compartments. That’s all we do. We don’t pull or stretch. Transformations happen indirectly. I won’t say that he’ll become normal. You’re looking for things he’s able to do things himself. We can’t impose pluses on top of deep negatives. Reliable interpretation of improvements that you have to look for is strategy of reduction of negatives.
Look at him, what do u see. You want to see symmetric abilities to look up, turn to both sides, etc. what do you have here. Asymmetry in position of head, easier to the right, if he looks left, the right shoulder jumps up a lot higher than the other side. The neutral position is shifted more towards the right. Primary is that what we have this if I try to move head forward, when I try to move his head, the movement of the head translates the movement of the entire body. For instance if I let his head go, it goes down, with acceleration. This is very important. It doesn’t just fall down, it goes down with acceleration. It’s not just weak, there are short muscles that are overstretched by movement of head forward, so when you let go, they snap back. That means he is showing that accelerated movement is there. Next step from accelerated fall is free fall. That is still negative. Still he can’t do anything, but this is transition. That will be the result of the weakness, without the excessive extra muscular shortness. After that looking for development of initial deceleration, he’s still not controlling, but at least makes attempt to slow it down. This is big transition from free fall. From there you go into improvement of deceleration, where he gets controllable decent. Falls w/o head knocking on the ground. After appearance of certain point, where he lets head go, he can control certain individual points. After that, when reverse part has been improved, then from individual dots of holding, you can expect the head to go up on his own. There is just 8 steps to prevent falling down.
In reality if you look truly, that’s not yet the true beginning. The true beginning is lower, he has fish like movement of mouth, as he opens the mouth, the head tilts backward. This is absence of face control, you can’t expect head control if you don’t have face control. If you take front half of face, you need sufficient division of the face, so movement of face doesn’t challenge control of head. Newborn is able to suck, mimic expression, w/o challenge to position of the head. In this case, this twist of the head, rotation, it’s not true rotation it’s an extension of a tilt backwards. If we have this movement backwards but you can only go back as far as that. If he only has range to go backwards, the head derails, his tilt of the head sideways is not true rotational movement, it is tilt backwards plus derail. Practically, means, he can’t handle central position, his point of contact is not occipital, it’s top of the head, we first want to see reduction of twist, and the ability to get point of contact of the head from the crown down to mid occipital level. That will be true count to start going down phases of negative.
All of those are true. Not in textbook. These are opportunities, these are clear cut, tangible, mechanical things. I don’t ask how bad is brain injury. For cheap structures, response is automatic, that’s beauty of primitive connective level. They run on such little brain power, that they just need enough brain power to eat and digest, they have enough to respond. I can give you those landmarks and milestones with a lot of precision, these are steps that you cannot bypass. You have to understand that for everything, there are B, c, d, e, f etc.. and most of them still belong to negatives. So we start by reducing negatives.
ABR works by delivering elementary changes. You need to understand chest is weak. I can assure you that 200 hours into chest, it will become stronger and hold better. Same with abdomen. 200 hours on abdomen, sooner you’ll see the response, difference in abdominal tone. 200 hours onto shoulders, he’ll get broader, stability will improve, etc. those are elementary. Yes it is possible to address structural levels. But if you ask me for timeline from accelerated to freefall – I can’t give, too many components, have to see dynamics, etc. I can give you roadmap, landmarks, but if there’s a highway or country road or a jungle, impossible to know. The younger the child, the better they respond. If child has better intellectual capacity, that’s a good sign for other things. If the child eats and feeds and bowel movement these are good signs. But 200 hours per area will show you significant tangible visible changes. But how, and what , and when, hard to know. How large the change is, I don’t know.
Structural Observations of Nathan’s body:
Derailing is in midneck region, much worse when the derailing happens at the cervical cranial transition. That’s one of the things we see with Doman individuals. They get patterning and derailments are mind boggling.
(Nathan on his tummy weight bearing on shoulder girdles) – as he’s supported by the chest he should hold his weight. As response you see penguin position. Once you get into landing pose, elbow is straight, and he’s not weight bearing on his arms, and what happens as he tries to hold his weight, the shoulder blade slides upwards, doesn’t’ really hold. If we try to have him prop himself up on his belly with his arms, the arm rolls under. We want to see transition from penguin into beginnings of an eagle. The first thing is he’ll get into elbow contact position. When elbow is in contact we want to see elementary cone of support. One position of contact for the elbow. But for that you have to be able to come out go in go forwards backwards. So generally it’s inverted ice cream cone.
Secret of transition from static to dynamic is the inverted cones. You put down the elbow, and then the shoulder moves around and needs to be supported, so makes inverted cone. This is foundation of dynamic movement. You’re looking for transition for those elements of structures and that functional transitional thing. Anything you have in terms of grasping, reaching, those are bonus. Pure unpredictable bonuses. What we want to see is reliable things such as reduction of negatives and gradual improvement of weight bearing components. It’s not crawling that’s the goal, the goal is to build the divisions between the neck and the shoulder girdle. As that goal is being fulfilled it can be traced by the development of weight bearing.
These are opportunities. If you look at shoulder blade, you want to see it go down. You want to see it getting stable, not sliding around. Reaction force – if weight contacts the ground, reaction force appears, weight directed other way around. Every time you touch the ground, reaction force emerging. To complete story of prone position, what you’re seeing here because of all deficiencies, what happens if I try to move him by one arm, the whole thing moves, we cannot make selective movement of single arm. We understand its happening because he has such conflict between clavicle and neck. Going to reduction of negatives – gives another key understanding. Wrong place wrong movement between clavicle and neck and stiffness of trapeze muscles. This creates situation that if you help him he can get on elbows and hold his head. This is a fake because it’s based on stiffness of muscles which ascend from the shoulder upwards not the proper strength of the neck. If you look the clavicle to the neck and tighten up the trapeze, it keeps the head from dropping down. Once we get release of area you’ll see he’s going to drop, you’ll see an improvement, because underneath rigidity there is weakness. It’s called reduction of weakness. Mobility without strength is a step forward, better than mobility with stiffness.
Legs – posterior muscles are too strong in response to anterior, you can’t strengthen anterior. And that’s what you need. Anything he can do himself won’t help him. We are opposing athletic training. If you build it under the premise of strength building this is wrong premise. But the right premise is to give him variety of movement experiences and as certain development of movement pleasure and movement intelligence. If likes certain things, do them, but bring in variety. Anything when they come in with playing and engage him, that’s fine. But understand that you should not have many expectations from it as it won’t work. With such a profound structure limitation, no matter how much of movement intelligence he has, it’s not going to help him to do much. As you work on structural improvements, you’re welcome to continue fun work or anything that promotes motor intelligence. As longs as you know priorities. It’s all about balance and priorities.
Everything with suspension is bad idea. Suspension gait trainers challenge structure.
Scissoring is reflection of alignment. Scissoring shouldn’t worry. You should be concerned is fact that legs aren’t reacting, no weight bearing at all. If he gets excited he tightens up through spine. Scissoring is reflection of alignment. Alignment comes last. How can you judge position of the leg if you don’t know where the leg ends and the spine starts. For his legs priority is not to fight with scissoring, straightening is miles away from us. We want to see mobility. Today its moving way out there, today it’s not moving with the pelvis, etc etc. be ready to see legs are far from aligned. You can’t expect to improve movements before you’ve arrived at the right place.
You can see how collapsible his chest is, you can press it all the way in. When you bring him to the floor he can’t use his hands/arms to protect himself, falls face down. If you bring his shoulders together they can almost touch.
ATNR – not infant reflexes. Those are just because the clavicle goes up, so the arm comes up. Infant reflexes invented by lazy people who didn’t study real people. Lazy electricians dominate neurological world.
Side sitting and supporting himself with his hands is not real weight bearing, he holds himself based on stiffness. Not real.
In sitting, even with maximum support, no balancing at all, even with max support, if you move him, his entire body moves in unison with his legs. If you shift support lower to mid chest, he collapses under his own weight. If you lift his head, it’s stiffness of trapezes muscles, not strength. If I move support lower, folds down even more. Here you can see the extreme of the diaphragm bulge (on his back when he’s leaning forward). The diaphragm has to be a dome sitting underneath the border of the rib cage. If compressionally we have such a bulge, its wrong territory and reflection of profound weakness. Again giving him one arm for support, and he cannot hold himself at all. If you tilt head and let it go, the body collapses.
He commands a lot of respect for the way he carries himself.
If you do too much, you get tired, and stop enjoying, give up. You want consistent rate of progress without sacrificing. Very important to find the pleasures and happiness today not having it to a deferred life plan, nothing more destructive than that. People who fall into that get themselves burnt out. They chase rainbows.