Autism Therapy: injury

definition of injury: not yet defined.

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Behavior Interventions, by Soares, DA, Vannest KJ, and Harrison J., published in 2009, summarized Dec 16, 2009

Using a computer to keep track of academic success may help reduce self-injury and other unwanted behaviors in children with autism.

This case study described success for one adolescent (13 years old) with Asperger’s syndrome who used a computer as positive reinforcement. The boy kept a record of his own success at completing school tasks. The boy completed more tasks and had less self-injury behavior and fewer tantrums during the weeks that he used the computer system. When researchers stopped his use of the system, he again had tantrums, self-injury, and trouble completing tasks. The authors said that this system is a promising way to offer some independence and would be relatively easy to use in classrooms.


Research in Autism Spectrum Disorders, by Murphy, O., Healy O., and Leader G., published in 2009, summarized Nov 16, 2009

Self-injury behaviors in children with autism may be more intense in children with severe intellectual disability than in other children with autism.

This study asked whether self injury, aggressive, and stereotypy behaviors were more common in some groups of children with autism than others. The researchers tested age, gender, therapy interventions, and intellectual disabilities. Age and gender were not a factor. Children getting applied behavior analysis therapy (ABA) had aggressive behaviors more often than other children, but the authors think that might be because children with behavioral problems are more likely to get therapy. Children with severe intellectual disabilities had more intense self-injury behaviors than other children with autism.


The Journal of Toxicological Sciences, by Ito, T., published in 2009, summarized Sep 25, 2009

Some people with autism may have metabolic disorders that can lead to severe reactions to an anti-cancer drug.

Some people with autism symptoms may lack certain proteins (enzymes) that are required by the body to use food as energy. These genetic deficiencies may also change the way their body uses medications. This study reported that people who have deficiencies in dihydropyrimidine dehydrogenase (DPD) may have severe reactions to an anti-cancer drug called 5-fluorouracil (5-FU). The authors also talked about other metabolic disorders and other medications in this article.


CNS Drugs, by Masi, G., Cosenza A., Millepiedi S., Muratori F., Pari C., and Salvadori F., published in 2009, summarized Aug 25, 2009

Aripiprazole (Abilify®) may be helpful for children and adolescents with autism who have severe behavioral problems.

This article describes a study of 34 autism patients (4-15 years old) who had severe behavioral problems such as aggression, self injury, and hyperactivity. These patients were treated through a psychiatric hospital (inpatient or outpatient) because of their severe behavioral problems. Patients were treated with 3-13 mg/day of aripiprazole for at least 12 weeks. The authors tested skills and behaviors between 4-12 months after the start of treatment. Of all the patients in the study, 37% were much improved or very much improved, and 29% had no change or got worse. Side effects were agitation (27% of patients) and sleep problems (15% of patients).


Suit Therapy is a treatment designed to help people with autism, traumatic brain injury, stroke, and cerebral palsy. Innovative Suit Therapy and Fitness in Louisiana is one of the few certified centers. The treatment consists of putting on a “suit” constructed of resistance bands that help align the body. Then the patient practices exercises using cords and pulleys that concentrate on core muscles. Strengthening these muscles can help with walking and balance.

Read original article: Unique 'Suit Therapy' Helps Neurological Patients


Greg Marischen, who suffered a severe head injury, returned from his therapy determined to use the same therapy methods for children with autism. Robert Melillo, a NY doctor improved on those cognitive and physical therapies to create Hemispheric Integration Therapy (HIT), which lead to the growth of Brain Balance Achievement Centers. Marishen now directs a center in Ohio that helps not only his two sons, but other kids with developmental delays. “The program is all about the plasticity of the brain. After aggressive therapy focused on the weak areas of the brain, it has the ability to rewire itself and make those connections,” said Marischen.

Read original article: Kettering Native Helping Kids wIth Cognitive Health



Please comment on this autism topic.

Responding to self injury

Sep 29, 2010 by Anonymous

You Tube videos under "autism and self-injurious behavior" are very helpful. It shows real autism with real severe self injury and what  one family does to help their child.


This device is cumbersome. Outdated. A more appropriate device would be something you could apply like a defibulator type device, to stop extreme, severe self injury likely to cause serious bodily harm. A device like this is NEVER intended as long term therapy, it's an emergency medical intervention to protect autistic person from extreme self injury and should only be used by persons trained to use it and who have had it used on themselves. See cdfoakley channel on youtube. This family used the device for a while on their child but later stopped using it because device was inconsistently applied due to harsh oppositon from persons who had and still have no idea what severe autism and self injurious behaviors can entail.


Children with autism have temper tantrum problems - also called a meltdown, when it happens, they throw themselves on the floor, crying, screaming and kicking as a means of getting across that things are "not right". Normal kids have temper tantrums too, but it's not so difficult to deal with as autistic children. Here's some tips for parents on how to tame "temper tantrum"-like behaviors of children with autism, which also work for normal kids.

1. Transfer the child's attention. When the child shows signs of a tantrum, try to attract his attention to something else that he would be interested in.

2. Ignore the tantrum. For a preschooler, ignore his tantrum but stay where he can see you; for a older child, tell him to return to his own room after he calms down.

3. Control yourself. Set a good example for your child, even in a tantrum, the child is learning from you.

4. Avoiding injury is the top priority during a meltdown. If the child starts to hurt himself or others, you must intervene and move the child to an safer place.

5. Describe the tantrum behavior to your child with "you lost control", not "you are too bad".

6. Find chances to give lavish praise for the appropriate behaviors. Once the child stops the tantrum, praise him for the next appropriate behavior.

7. You can comfort the child, but don't satisfy any unreasonable demands of them.

8. Avoid meltdowns in public places, people who don't know that your child is on autism spetrum will make presumptions about your parenting skills.

Hope these tips are helpful for controlling temper tantrums of autistic children.

Take care,

Sneh

My Favorite Links:
For discounted blood and labwork, MRI, etc: http://tinyurl.com/6fxdjm 

What not to eat: http://www.feingold.org/

Different alternative treatments [most comprehensive- pl. read carefully]: www.quickdoctors.com  

CST: http://www.iahp.com/pages/search/index.php
Neurofeedback Therapyhttp://www.neuropathways.com/index.html 

Yoga-Meditationhttp://www.divyayoga.com/freePranayamTraning.htm


Neurofeedback

Dec 28, 2007 by Anonymous

www.neurofeedback.org

What is Neurofeedback? (taken with permission from http://www.thebrainlabs.com/neurofeedback.shtml)

Neurofeedback uses sophisticated computer technology to train the brain. While there are different forms of neurofeedback (as discussed below), the most traditional form is known as EEG Biofeedback. In EEG Biofeedback, a child plays video/computer games with his/her brainwaves. During a typical session, EEG electrodes are placed on the scalp and/or ear lobe(s). These sensors only measure a child's brainwaves; no electrical current enters the brain. The information/brainwaves that are read by these sensors are fed to a computer that converts this information into gamelike (pacman game) displays that include visual and auditory feedback. An example of a typical set up is displayed below in Figure 1.

Figure 1

As a child learns to control and improve upon their brainwave patterns, their game score increases and they progress. The only way to succeed at the games is for a child to improve their brain and how it functions. Further examples are included below, including the game computer that the client sees in Figure 2 and the therapist computer that monitors the clients brain wave patterns in Figure 3.

Figure 2
Figure 3

As this is done over various sessions, a child's brain improves and their symptoms or problems reduce. There is also every reason to believe that if this is done over a long enough period of time that the changes that occur will be enduring. In addition to its' long-lasting effects, the other major advantage is the lack of significant side effects.

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What can Neurofeedback help?

Given that this therapy helps people to control and change their brainwaves, EEG biofeedback can potentially help with any problems that can be influenced by brainwaves. This would include almost anything controlled by the brain including thinking abilities, motoric responses, behavioral, emotional, and social difficulties.

Table 1 shows the types of conditions/diagnoses for which Neurofeedback has been shown to be helpful. The number of research studies verifying its' impact is also presented.

Table 1

A simple review of the data in Table 1 shows that Neurofeedback is considered effective for some Seizure Disorders and Attention Deficit Hyperactivity Disorder. In fact, at least three research studies (Fuchs et al., 2003; Monastra et al., 2002; Rossiter & LaVaque, 1995) have now shown that EEG biofeedback is equivalent in its' effectiveness as compared to stimulant medications for the treatment of ADHD symptoms, but without the side effects and with a greater duration of lasting effects.

While Neurofeedback has also been shown to be effective for other conditions observed in children, such as Traumatic Brain Injury, there are clearly conditions in which much more work and research is needed. These would include Learning Disabilities, Stroke and especially Tourette's Syndrome and Autistic Disorders.

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What are the different types of Neurofeedback?

There are three major forms of Neurofeedback. These are:

  1. EEG Biofeedback (monopolar, bipolar, coherence training)
  2. Stimulation-Driven EEG Biofeedback (Roshi, LENS)
  3. Hemoencephalography (nirHEG, pirHEG)

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What is EEG Biofeedback?

Clearly, the most well known and first form of Neurofeedback is EEG Biofeedback. It was first discovered in the late 1960's and early 1970's that individuals could learn to control their own brain waves when provided feedback about them and that this information could be used to minimize or control seizures. It was later found that EEG Biofeedback could be used to treat Attention Deficit Hyperactivity Disorder and other developmental conditions or problems.

The typical EEG Biofeedback session has been described and shown above. Typically, EEG Biofeedback is done with three electrodes arranged in a monopolar pattern. This means that one electrodes is placed on the scalp at a clinically significant location and the other two are placed at relatively neutral sites (e.g., earlobes). With these electrodes in place various EEG frequencies are rewarded and others inhibited. This occurs via the visual and/or auditory feedback received, often via a computer screen and image. For example, it is common to reward low beta frequencies (often associated with focused, calm thought processes) and inhibit lower frequency ranges (delta, theta), which are often associated with distraction, fatigue, etc. When these conditions are met, for example, the pacman will move rapidly through a maze. Following similar processes, brainwave patterns are shaped over time toward a client's therapeutic improvement.

EEG biofeedback can be performed in a monopolar fashion at any of at least 19 electrode sites. Alternatively, some therapists chose to use bipolar montage or arrangement. In such a pattern, there are now two electrodes placed on the scalp and one on one ear. Now, brainwave patterns are shaped between theses two electrode sites or so it is theorized. Possible electrode placements and sites are expansive given that there are at least 19 locations and two electrode pairing combinations.

Lastly, there is an advanced form of EEG biofeedback referred to as coherence training. Coherence training is done with two separate channels of EEG (3 electrodes times 2 for a total of 6 electrodes). Each electrode grouping is arranged in a monopolar fashion. There are then two electrodes on each earlobe and two electrodes on the scalp. The purpose of coherence training is to facilitate "communication" between two specific brain regions.

EEG biofeedback conducted with either monopolar or bipolar setups seeks to focus on the amplitude or magnitude of various EEG frequencies, encouraging some and discouraging others. Monopolar arrangements seek such changes over one particular location, while bipolar setups seek changes between two sites (theoretically speaking). The training of specific locations and EEG frequencies then becomes of critical importance. EEG frequencies are described in cycles per second and reflect the speed of processing at a particular brain region. The following table is a representation of common frequency ranges, their names and associated features.

Typically, EEG biofeedback seeks to encourage some frequency ranges and discourage others. As a result, the neurofeedback therapist is left to choose the type of training, where on the brain to train and what frequency ranges to reward or inhibit. Discussed below are some issues related to these choices and approaches to neurofeedback.

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What is Stimulation-Driven EEG Biofeedback?

The two most popular forms of enhanced or stimulation-driven neurofeedback are LENS and the Roshi. LENS, or Low Energy Neurofeedback System, uses a very low power electromagnetic field to carry feedback to the person receiving it. This signal seeks to change this persons' brainwaves in subtle ways. The goal is often to alter to dominant brainwave frequency so as to make it more powerful. The result may be increased self-regulation and skills.

The Roshi is also an enhanced form of neurofeedback. In its' many incarnations, Roshi involved light stimulation that emulates a normally fluctuating EEG signal and its' many frequency variations. This tends to "push" the person more towards normalcy than they would be otherwise.

There is some evidence to suggest that these forms of enhanced neurofeedback can be helpful, especially in complex cases.

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What is Hemoencephalography?

Hemoencephalography or HEG refers to brain blood flow, its' measurement, and use as a neurofeedback application. This is a completely unique form of neurofeedback that is separate and different than EEG Biofeedback.

The originator of this technique, Hershel Toomim, developed a technology referred to as Near Infrared HEG or nirHEG. This measurement and biofeedback device is housed in a headband, which contains a light source and two optodes. Infrared lights are flickered alternating between 660 and 850 nm. The absorption of these lights, and a ratio of the same, received at the optodes is a calculation of cerebral oxygenation. This is used in the form of feedback to allow the client to enhance their brain's functions.

Another form of HEG has also been developed by Jeffrey Carmen. This form, entitled Passive Infrared HEG or pirHEG, uses an infrared lense that serves as a brain thermometer and measures temperature and inferred cerebral metabolism. This may also be used as a form of neurofeedback to aide in the enhancement and regulation of brain functions.

HEG is somewhat limited in that it doesn't see through hair. However, it has the advantage of being insensitive to artifacts such as muscle tension or eye blinks which may interfere with EEG biofeedback. As a result, HEG may be particularly useful of neurofeedback of frontal lobe or system dysfunction.

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What types of assessments can help Neurofeedback?

Now that we know there are various form of Neurofeedback that could be applied to many different problems and brain regions, how does one decide what to do and where? Believe it or not, there are some within the field that believe that all people can be treated the same way or with the same protocol. This is not our approach. In our clinical practice, we individually tailor and Neurofeedback protocol to an individual's particular problems or symptoms and, importantly, the identifiable regions of brain dysfunction that related to these symptoms.

The following is a possible list of ways in which Neurofeedback could be tailored for an individual:

  1. Based on symptom presentation with an understanding of brain regions that mediate these functions or skills.
  2. Protocols for particular problems or "tricks of the trade." For example, the most common protocol for ADHD is EEG biofeedback done over the top of brain (Cz, C4-C3) rewarding SMR and inhibiting theta and high beta activity.
  3. Using psychological assessment information such as parent ratings scales and tests of attention such as TOVA or IVA.
  4. Use of more complex neuropsychological tests to diagnose regions of brain dysfunction and treatment plan accordingly.
  5. Use of direct neurophysiological measurement to determine brain dysfunction and treatment plan accordingly. This is often done with something called a QEEG or Quantitative Encephalogram or EEG.


Please comment on injury or other autism therapy topics.

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