Sensory Integration and Biochemistry

By Ronna Hochbein. OTR/L

Once, in what seems another life to me now, I worked for a plastic hand surgeon. I was responsible for the rehab of all sorts of bizarre diagnoses such as MCP implant arthroplasties, tendon transfers, and amputations. We fabricated splints with moving parts that would impress many who saw them.

I had my children, two at the time, my husband and my dream job. All was well. Then the looming specter of a magazine appeared in my mailbox one day. "Special needs Parenting Magazine." I felt as if I had been kicked in the gut. My children were fine, why in the world did this magazine arrive at our house?

Oddly enough, it was not long after that I was pushed into a new world. The black silence of autism invaded our neat little world, wrecking everything in its path like the destructive whirlwind it can be. So, instead of studying for the surgery the next day…I was reading books about autism. By the time I was finished I lost count. I am thankful I read very quickly.

Before I knew it, I felt I had to switch my focus in therapy. I had to work with children with sensory problems or on the spectrum; keeping up two specialties would prove impossible.

So here I am today….fifteen years as a therapist, eight years into this autism thing. I have had the opportunity over the years to be able to identify sensory issues with their biological origins, based on what I have learned from years of sitting through the physician's science lectures at DAN!.

I intend, if I am permitted, to do a series of posts based on what I see as sensory abnormalities, and provide a biological basis, and then some proposed treatments, based on science and research.

Some people are very good at reading children's cues, and others are not. It is all about who we are, and how our own brains are functioning (read the Molecules of Emotion by Dr. Candace Pert to start).

I would like to start with a much-overlooked property. Motor planning or Dyspraxia. I am always amazed how few therapists understand its far-reaching effects, so here goes, I'll try not to bore you. "Dyspraxia is Impairment of the ability to execute voluntary, purposeful movement."
As defined by 2004 American Heritage Stedman's Medical Dictionary.

There you go, simple enough. Amazing how that one little word can have such horrible, far-reaching implications. Dyspraxia equals difficulty speaking, responding to commands, non-verbally communicating needs, ie difficult to translate my many many thoughts into purposeful action. "I am stuck in my head." Not good.

So we see it as therapists, what do we do? We try to teach signs, until language evolves, if it does. We use what we call physical prompts….kinda like priming the pump as it were…so as you count, you squeeze simultaneously, letting the body prepare for movement…One, (squeeze.) Two, (squeeze.) Three. (You try to get the action, whatever it is, a sign, a jump etc. etc.)

We do hand over hand, allowing the body to feel the passive movements of the desired motions. That is all well and good. BUT -- if your body doesn’t possess the necessary chemicals in order for your nerves to fire, it will make little progress.

Well what can we do? In my experience, Epsom salt baths, based on the research of Susan Owens and Rosemary Waring, have made significant improvements in motor planning based on the concept below.

What seems particularly relevant is that in order for a child to "function," their nerve nets must be abundant and functioning within in the auditory system, the somatosensory system, the vestibular system, the cerebellum, and in almost half of the cranial nerves.  They even seem important for developing trunk strength. Many ASD children have decreased trunk strength.

You may recognize these systems as the parts of the nervous system that are targeted by sensory integration therapy.  Interestingly, the nets won't form properly in the brain without two things happening at the same time: adequate biochemical resources, and continued rapid firing of the relevant nerves.  This argues favorably for coupling biochemical therapies that support this chemistry with the physical and educational approaches that are also known to offer benefits to these systems.

(If you want to know more about the biochemical side of this, you can read a paper written by Susan Owens who has studied the sulfated molecules (called GAGs) for seven years.  Her paper reviewing this area is part of a book that is sold by the Autism Research Unit in Sunderland:  The Proceedings of their 2001 conference in Durham, England.  See http://osiris.sunderland.ac.uk/autism.  If you wish to read the article in its toto, I have sent it to Generation Rescue.)

The Epsom salt bath is number one. Number two is Glutathione supplementaion. From Wikipedia: Glutathione (GSH) is  a tripeptide. It contains an unusual peptide linkage between the amine group of cysteine and the carboxyl group of theglutamate side chain. Glutathione, an anti-oxidant, protects cells from toxins such as free radicals.

Thiol groups are kept in a reduced state within ~5 mmol in animal cells. In effect, glutathione reduces any disulfide bonds formed within cytoplasmic proteins to cysteines by acting as an electron donor. Glutathione is found almost exclusively in its reduced form, since the enzyme which reverts it from its oxidized form (GSSG), glutathione reductase, is constitutively active and inducible upon oxidative stress. In fact, the ratio of reduced to oxidized glutathione within cells is often used scientifically as a measure of cellular toxicity.

Ok, so many studies are done, not necessarily on autism.  We know that some ASD children have Myelin basic protein anti-bodies as seen in Multiple Sclerosis. So researchers have studied effects of alpha lipoic acid, n acetyl cysteine and glutathione in many neurological diseases such as Parkinsons and Diabetic Peripheral Neuropathy.

FROM PUBMED- Diabetes 2000, June 49(6) 1006-15
Effects of DL-alpha-lipoic acid on peripheral nerve conduction, blood flow, energy metabolism, and oxidative stress in experimental diabetic neuropathy.

Division of Endocrinology and Metabolism, University of Michigan, Ann Arbor 48109-0678, USA.

"Experimental diabetic peripheral neuropathy (DPN) is marked by impaired nerve conduction velocity (NCV), reduced nerve blood flow (NBF), and a variety of metabolic abnormalities in peripheral nerve that have been variously ascribed to hyperglycemia, abnormal fatty acid metabolism, ischemic hypoxia, and/or oxidative stress. Some investigators propose that NCV slowing in experimental DPN can be explained entirely on the basis of nerve energy depletion secondary to reduced NBF.

This article reports highly selective effects of administration of the antioxidant DL-alpha-lipoic acid (LA) to streptozotocin-injected diabetic rats.    LA improved digital sensory but not sciatic-tibial motor NCV, corrected endoneurial nutritive but not composite NBF, increased the mitochondrial oxidative state without correcting nerve energy depletion, and enhanced the accumulation of polyol pathway intermediates without worsening myo-inositol or taurine depletion.

These studies implicate oxidative stress as an important pathophysiological factor in experimental DPN. They reveal complex interrelationships among nerve perfusion, energy metabolism, osmolyte content, conduction velocity, and oxidative stress that may reflect the heterogeneous and compartmentalized composition of peripheral nerve."

We have to increase the nerve conduction speed, and provide the nerve nets with the sulfur they need, in order for our kid to respond, and say, "Yes, mommy I want to go to the park", or respond by picking up his toy,when he is directed to do so.

There's a lot to the treatment world, but much, much, much of it works, no matter what you read elsewhere. So how do you get an OT who is knowledgeable in Sensory Integration? I have a few suggestions.

In my experience, most therapists who are certified in Therapeutic Listening (a form of auditory integration training) are knowledgeable in S.I. Here is a list (http://www.vitallinks.net) of therapists who have attended these trainings in all of America, and are listed by state and email address, so you could see if they are available to you. Sensory Integration International (http://www.sensoryint.com/) is our mother organization for therapists to be educated.Here’s Another great site (http://www.pdppro.com) to show your OT's to further their education.

As for books and resources- My book, Come What May (http://www.amazon.com/Come-What-May-Comprehensive-Non-traditional/dp/1591138485) has many sensory/biological issues discussed in it.

And the standard book everyone should read is The Out Of Sync Child (http://www.amazon.com/Out-Sync-Child-Recognizing-Processing/dp/0399531653) which explains sensory symptoms in clear easy to read terms, and is great for teachers as well.

Many Thanks, and yours in the fight.

Ronna Hochbein, OTR/L

Ronna Hochbein has been a practicing Occupational Therapist for 15 years, is certified in Therapeutic Listening, Advanced Listening and Level one Samonas Sound Therapy. She has over 400 hours in continuing education devoted to autism, is the author of Come What May, A Comprehensive Guide to Traditional and Non-Traditional Treatments for the Autism Spectrum. She guest lectures at colleges for teachers and therapists on the topics of Autism and Sensory Integration, and all over her state of Pennsylvania. Most importantly, she is the mother of three sons, one of whom has recovered from full-blown autism to Asperger's syndrome through standard and biological interventions.

Comments

[Angela C]

Thanks for your info and please give us more! I have a son with SPD, not autism, but have seen drastic behavior improvement with taurine and Alpha lipioc acid. I am trying to learn about the biochemical connections and what else to try and how best to do it. Please continue with more on this subject!

[Stagmom]

Ah yes, Kennedy Krieger... dear friends of Autism Speaks. The dismissal of our kids by docs in most specialites is astounding. Autism? Write that kid off and tell Mom she's a nutjob. Meanwhile, Michelle, your daughter is soaring with her success yes? It's discouraging to know how many docs are against our kids' success unless it conforms to their narrow definition (drugged.)

When I asked an ENT if antiobiotic overuse could lead to seizures (by trashing the gut) and told him our nutritionist had suggested the idea to me (this was MANY years ago) he said, "No. When you're a hammer everything looks like a nail." as a way of denigrating the nutritionist. Meanwhile, no matter WHAT we had walked into his office with, I'd have left with an Rx for antibiotics of increasing strength. When I checked the literature for the antibiotic he'd prescribed it DID reference seizures....

We have to trust ourselves and learn to pick and choose which docs we allow the PRIVILEGE of working with our kids.

[Michelle O'Neil]

After being dismissed by three pediatricians, an OT was the first to offer us any clue about what might be going on inside our highly sensory defensive child's world.

When I took this information to Kennedy Krieger in Baltimore, the doc was more concerned that an OT dare diagnose, than he was about figuring out what was wrong with our child.

I said, "She has sensory integration dysfunction."

He got all swaggery and puffy, "And WHO made that diagnosis?"

He never did help us in the least.

OT did.

P.S. Epsom salt baths are good for moms too!

[Kent Heckenlively]

Dear Ronna:

Welcome to Rescue Post!

I look forward to your articles. As the husband of a speech therapist and one who's been fighting the autism wars for about as long as you have I'm pleased to welcome such a well-informed and well-educated parent.

We will get our kids back someday!

All the best,
Kent Heckenlively

[Jakesmom]

If only school OT's had any training or a clue. Most of them don't even know what SI is, they're too busy teaching the kids how to hold a pencil.