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Evaluation and Treatment Dear Parents: With passion of heart, mind and soul, you are on a journey guiding your children’s healthy development and learning. Everyday you prove theories of brain growth/neuroplasticity, reflecting your children’s development. You explore spiritual, biological, and environmental avenues developing brain connections that have a profound impact upon your children’s ability to love, grow, and interact with others. You nurture their capacity for feeling and attachment, that are such very necessary steps towards thought and language. Everyday in my practice I am touched by your unyielding passion to embrace your children,empowering their potential and success at home, school, and beyond. Your pursuit of new avenues toward growth truly makes you great explorers of new territory, querying the mapping of 3.1 billion chemical letters that make up human DNA. You challenge what turns genes “on”/”off” and what drives healthy development and learning. Your children’s growth is evidence of the power of brain growth and the power of human potential. Throughout the journey of your children’s growth and development, I wish you continued wonder, excitement, joy and smiles on your children’s faces reflecting loving hearts, peaceful souls, and thoughtful minds. Warmly,
Dr. Val Scaramella-Nowinski: Pediatric Neuropsychology The Pediatric Neuropsychology Diagnostic and Treatment Center creates a very comfortable pediatric setting. We are committed to children, their health, development, and learning and provide evaluation and treatment programs that develop their potential and success. Optimal learning and development requires relaxed alertness and the capacity for feelings and attachment that build upon the development of attention, perception, memory, sensory, motor, speech, language, mood, thought, self direction and social behaviors. Our Center houses three (3) Evaluation and Treatment Programs:
Our Center also houses the Neuroscience Learning Initiative: a program for all children that bridges Brain Science and Education. “The time is now to forge strong alliances between brain science and education to work to inform best practices at home, school and in the community”-Society for Neuroscience Framework Neuropsychological evaluation and treatment at our Center are based upon Systems Biology Theory. This means that the brain is understood as a complex and dynamic SYSTEM. The brain is not just an assembly of interconnections of genes, proteins, structure, chemicals and electrical activity. Understanding these components of the brain system is very important, yet not sufficient enough to understand the complexity of the brain and human development. Systems Theory focuses upon the patterns and relationships among these components and interconnections and how the various brain areas and associated functions interact, change throughout development, and how changes in one part of the system can affect other parts. Neurosystems Evaluation and Neurosystems Treatment, founded upon Systems Biology Theory, have been developed since 1985 by Pediatric Neuropsyschologist, Dr. Val Scaramella Nowinski. Her doctoral work was titled “Systems Analysis-The Cerebral Organization and Psychological Structure of Human Mental Processes”. The brain is certainly the most robust of all biological systems. A major property of any robust system is ADAPTATION. Throughout our lives, we try to adapt and cope with environmental changes and internal biological changes. Neurosystems Evaluation and Treatment reflect a highly specialized understanding of brain organization, the interrelationship among brain pathways and how these pathways are dependent upon both biological and environmental cues. This type of Brain-Behavior analysis provides very specific diagnostic and treatment information that promotes healthy development. It may be helpful to consider a process approach in the following way: Pediatric Neuropsychology Evaluation
Our treatment center is founded upon a “WHOLE-CHILD/WHOLE-BRAIN” framework. Communication with family, health, allied health, and education disciplines is important so as to promote a child’s success at home, school and beyond. Treatment programs within the Center’s 3 divisions address a child’s developing brain as a dynamic system of pathways building upon Attention, Perception, Executive Function/Self-Direction, Memory, Speech, Language, Sensory, Motor, Mood and Social Functions. Specialized treatment programs are developed based upon evaluation results.
Multi-Sensory Awareness, Modulation, and Attention Regulation: This program focuses upon modulating alertness and multisensory attention in the brain and easing sensory pathways. Wake states, sleep states and what a child does inbetween wake and sleep relies on brain pathways associated with sense organs. Every time your child hears, sees, touches, tastes and smells, sensory pathways in the brain and body are charged. Children having developmental difficulties often experience an overexcitation (too many ‘switch-ons’) and/or overinhibition (too many ‘switch- offs’) among multiple pathways that disrupt their sensory contact with their environment. Inefficient sensory ‘switch-ons’ or ‘switch-offs’ throughout the brain can also affect other body pathways. This is also one reason why some children can experience heightened food/airborne sensitivities, immune/gastrointestinal symptoms, among other metabolic symptoms. When a child’s sensory system is overwhelmed, stress hormones are also alerted and anxiety increases. Efficient modulation of a child’s sensory system lessens sensory storms and behavioral meltdowns. This program addresses sensory modulation throughout the body. The body is a vehicle for brain development. Knowledge is acquired through our senses. No sensory system develops in isolation. Each system reinforces, modifies, and influences the other. All of our senses pass through the body’s vestibular system. This is a system located in the inner ear that adjusts to head-body movement. It is the first system to be fully developed with onset at approximately 16-weeks in-utero. It provides the fetus with direction. At birth, it allows us to relate with gravity. Hearing is related to energy through motion and vibration. Efficient vibration through sensory modulation passes through the entire body-entire sensory vestibular system. Efficient modulation of sound results in relaxed alertness and promotes learning and development. The vestibular system is also highly connected with the visual system. The auditory vestibular impact discussed above is also closely related to the eye-motor system. Eye movement and eye contact are reliable indicators of brain development and sensory input. Each eye sees different images. It is the brain that fuses the images. The eyes need to team and fix to certain points. Eyes need to accommodate so as to sharpen focus and adjust to near and far. Eyes need to track so as to scan from point-to-point. Eye movement controls directional awareness. It is like a compass that can give a sense of center so as to move up-down-right-left. This is one of the ways that the eye/brain understands the difference between similar images such as b-d; p-q; on-no. It is one of the first signs of a child’s visual attention to his/her environment. As children grow, eye movement becomes more smooth and targeted to specific stimuli including sound and touch. Touch is one of our first contacts with the outer world. All senses are closely related to the tactile/touch system. Even at 5-weeks in-utero, stimulation to the fetus’s upper lip results in movement. During the second and third trimesters, tactile awareness matures to produce reflexes needed at birth that allow for feeding, comfort, and exploration of the world. The infant can grab a mother’s finger, suck to be nurtured, and rock to be soothed. This is why touch in infancy, especially to the cheek/face, results in a calming of hand movements that is highly related to lip pursing and sucking so the infant can be nurtured. Infant massage and tactile sensory modulation ease sensory sensitivity and/or sensory seeking behaviors. Taste and smell are very significant in early years when the mouth and face are the major sources of information from the environment. An infant’s mouth sensation is highly related to movement through the tongue associated with taste and chewing. Taste is also very connected to smell. Taste and smell are highly related to memory, especially in early years. Nerves of the nasal passages are routed through areas closely connected to the hypothalamus, a major memory center in the brain. Sensory information from our sense organs transferring to brain connections enables our body to adjust in space and develop our sensory awareness with the environment. This is called proprioception. Proprioception is a coordinated dance among all sensory systems. Efficient timing of the dance results in an efficient coordinated dance. Our Center’s Multisensory Awareness, Modulation, and Attention Regulation program uses comfortable eye movement technology aiding visual attention and processing. Comfortable advanced technologies/specialized cameras can be used for eye movement training focusing upon facial recognition, object recognition and the development of visual attention, visual perception, visual memory, expression and social relatedness. Parents are also given visual graphs demonstrating their child’s eye movement and tracking progress. The Center also uses comfortable auditory training technology, including Therapeutic Listening Programs with air conduction and bone conduction. Sound travels much faster through bone than air. Headphones that have sensors on the mastoid bone (behind the ear), skull bone or sensory centers of the hand, for example, ease and modulate vibration throughout the body resulting in relaxed alertness and auditory attention, reception, memory, processing, and integration. Modulating tactile awareness is also an important part of the program. Sensory/movement therapies, including infant massage, breathing techniques, vestibular-sensory awareness and brain-based sleep patterns needed for sounder sleep are integrated within this program.
Efficient multi sensory modulation results in efficient sensory attention and regulation. Efficient TIMING of sensory brain pathways allows a child to more efficiently feel peaceful rhythms physiologically throughout the brain-body. Children can better focus attention, sustain attention, and switch attention to necessary input from the environment in order to grow, learn and develop. Sensory Processing and Movement: Our Center’s Sensory Processing and Movement program focuses upon health and the relationship between movement, increased awareness, attention and learning. Movement is an integral part of any learning process. During sensory movement sessions, children often express feelings of relaxation and more ease. They breathe more freely, their thoughts have more clarity and they have more body control. Their wake/sleep cycles are eased without artificial means. This process also empowers their esteem and development. Children learn techniques to improve their health through organized modulation/timing of sensory connections and movement. Optimal learning requires relaxed alertness. I am reminded of a 5-year old boy who at the end of a sensory movement session commented, “this is like a piece of heaven”. Your child’s sensory development and movement rely on some of the very first pathways developed in the brain. Occupational Therapy and Physical Therapy are interventions that address sensory development and movement. Our program also utilizes internationally recognized Feldenkrais® Method of Somatic Education and related “Awareness Through Movement” programs. These programs promote “mindfulness of the body”. Comfortable kinetic lessons, using gentle movements, and verbal directives guide speed and timing of sensory-receptor and motor-expression impulses throughout the body. Therapy develops communication among these brain pathways through sensory modulation and movement. This enables movement input to flow freely throughout the brain/body. Children can attend to their movements, including right/left, head/neck movement and upper/lower body coordination. Children become aware of the PROCESS of sensory awareness and movement aiding postural control throughout the body. Learning to move with less effort makes daily life easier. Other sensory pathways throughout the brain/body build upon this sensory motor framework. Information found under Sensory Attention, Modulation, and Attention Regulation also describes materials used in this Sensory Processing and Movement program. This connection underscores our Center’s Systems Biology Framework: all brain pathways are integrated.
MULTI SENSORY MEMORY TRAINING Learning cannot occur without memory. How well a child’s sensory systems are regulated has much to do with a child’s memory and learning. When the sensory system is overwhelmed, “too many switch-ons and/or switch-offs” stress hormones are alerted and anxiety increases. This is one reason why heightened anxiety impedes memory consolidation. The more efficiently sensory information is received and processed (from the environment and biologically) the more efficiently memory is developed. When children, especially those having developmental difficulties, become sensorially overwhelmed, information from the sensory input is inefficiently consolidated in memory. This can result in information always seeming novel and can impede learning. Much repetition may be needed due to poor recall from memory. Inefficient memory pathways influence internal speech and internal sensory memories needed for self-direction and self- regulation. Children may require behavior plans using tremendous repetition so as to aid their recollection and reflection of how to control their behaviors. Memory training incorporates multi sensory programs using repetition, recollection, and reflection exercises based on the child’s level of development and as documented by formal evaluation results. Multiple aspects of memory are addressed including visual memory, auditory memory, tactile memory, rote memory, short-term memory, working memory, and long term memory. Memory consolidation is necessary for the continued development of attention, receptive and expressive brain pathways/behaviors. Memory facilitates self-talk, self-regulation, planning, and organizational skills that guide our behaviors and allow us to learn and adapt with the environment. This is the basis of a well known behavioral program founded upon repetitive trial learning with positive reinforcement-Applied Behavioral Analysis (“ABA”). As behaviors are consolidated in memory through repetitive ABA exercises, a child can better regulate the particular behavior being worked on. Consistent recollection and reflection exercises following repetitive exercises aid in increased regulation of behavior. The behavior becomes less novel to the child and promotes his/her learning of the behavior. Home, school and therapeutic-based memory programs that foster and build upon sensory regulation and verbal/ non-verbal thinking strengthen memory consolidation, executive function and self-direction. Speech/Language Development and the Listening Center: Your child’s speech and language development involves connections among multiple brain pathways. Multiple sensory attention, reception, memory and expression pathways interrelate. The auditory cortex (sound brain) is strongly connected with pathways in the sensory motor brain cortex (sensory-movement brain), the visual cortex (seeing brain) and the limbic subcortex (mood and sensory-memory brain) and executive function/planning/self-regulation brain (frontal brain). The vestibular nerve/system (sensory-balance brain) influences vibration movement throughout the body. All of these pathways and their connections govern the development of a child’s speech/language. Decades of clinical research among multiple professions involving neuropsychology, medicine, acoustics, physiology, music therapy, education, etc. have increased our knowledge of speech/language development. Children having developmental difficulties often experience an ear-brain connection problem. Hearing is not usually the problem. It is the ear-brain connection that experiences delays. Sound travels through the auditory canal to the eardrum vibrating the middle ear bones. The inner ear takes this vibration energy and converts it to electro-chemical messages and carries them through auditory pathways to the brain. The brain interprets these messages as sound. When auditory perception is distorted, a child’s attention, emotional, cognitive, social and academic development becomes difficult. Formal speech/language therapies and listening programs including music-based auditory modulation through air and bone conduction programs and sensory-vibration modulation programs train brain areas to process sound. Comfortable headphones using air conduction and/or bone conduction programs transmit modulated vibration and modulated sound. Home-based auditory training programs are also provided. Auditory related pathways throughout the brain and body influence not only speech/language but increase a child’s attention, perception, memory, sensory, motor, mood and self-regulatory executive function skills. Language reception (understanding language), memory, and expression (speaking, singing, signing) occur when the brain recognizes and interprets the sound through vibration, movement, visuals, touch, music and multi sensory stimuli. Our Center’s Speech/Language Program and the Listening Center incorporates nationally and internationally developed acoustic/auditory-based training programs building upon speech/language development. Evaluating the multiple brain pathways and relationship among the pathways needed to develop speech/language aids in providing specialized treatment programs. Treatment targets the PROCESS. Speech/language development must embrace the inter-relationship among all sensory systems, their attention, reception and expression. These are necessary steps toward the advanced development of thought, self-direction/executive function, and language. This process is fundamental for all human behavior. Home-based listening programs can also be developed. Our Center also use home-based auditory training programs developed by Advanced Brain Technologies LLC. The scientists at our Center show you and your child how to use the programs at home and monitor progress throughout the program. Home-based programs are often used in conjunction with therapeutic listening programs. Pre-and post-testing documenting progress is also available. MOOD AND SOCIAL SKILLS: Fundamental to all learning is the ability to relate and adapt within the environment. Regulatory behaviors including sleep/wake cycles, appetite cycles, respiration, digestion and other metabolic processes are vital processes of development. Sensory regulation of stimuli from our environment and regulation of mood also aid in global development, learning, and adaptation. Healthy social adaptation and healthy social networking necessitate efficient development of attention, perception, memory, speech, language, sensory, motor, mood and executive function/self-direction. Children having developmental difficulties can be sensorially overwhelmed, often affecting mood regulation. This can impede social skills and social relationships. Specialized behavior programs (therapeutic, home, and school-based) are developed according to your child’s evaluation results. Family support is a very important part of this program. The behavioral programs help to relax and calm you child and guide healthy thoughts and behaviors. Our Center offers Individual and Group behavioral/social development sessions. Parent Information Groups are also available:
Researchers are also involved in developing brain training programs and test materials regarding child development and learning. We especially focus upon the development of early childhood, learning and intelligence. |
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