In addition to knowing that if a child were injured at any of the brain stages he would stop progressing at that stage, we also knew that he could not progress beyond that stage even though he was not damaged at higher stages. Therefore, if the child were hurt at midbrain he would not only be unable to creep, but because he was not able to creep he would also not be able to walk, since creeping is necessary before walking can take place, as we had proved in our study of well children.

The team was now faced with the question: Must we accept defeat? If a child were hurt in the midbrain, did it mean that this child could never creep and therefore never walk, or was there something we could do about this? Was it possible, we asked ourselves, to build a bridge, if you like, across this injury? Could we dig a tunnel or beat our way through the injured midbrain? Could we, perhaps, go back to the point at which Nature had accepted defeat and simply intensify those sensory inputs which had clearly fallen short of doing their job but might not have fallen far short?

We knew the lower stages of the pons, the medulla and cord to be intact because we could check the movements they control. Now, was there a way we could check his higher stages beyond midbrain when we had made the decision that it was true that his midbrain was hurt? If his midbrain was hurt, he would not walk; therefore did that mean that we could not check to see if his cortex was intact?

Well, we knew that there were five functions of the cortex, only one of which was walking. Therefore, if we checked the other four in a child who could not walk or creep because he was hurt in the midbrain, would we find that he could nonetheless perform the other four cortical functions? Suppose that he could speak, suppose that he could read, suppose that he could oppose his thumb and forefinger and suppose that he could understand human speech. Did it not seem extremely likely that this child was good in the cortex since four of his five cortical functions were intact? Might it not also be assumed that the fifth, that of walking, was wanting only because he was unable to creep? This did appear to be a logical assumption, and we knew that the only time there might be an exception to this would be if a child had, in addition to the midbrain injury, a highly localized injury confined purely to that area of his cortex that is responsible for walking itself.

Could we now do something about this hurt midbrain? (Of course we knew that we never saw a child who was minus a midbrain; a child could not live without one. We were seeing only children who had hurt midbrains and, obviously, this degree of hurt varied from a little bit of hurt to a great deal.)

Suppose, we finally asked ourselves, we tried to teach his hurt midbrain the functions that it would have performed had it not been hurt?

In the past, we had tried to teach muscles, but the very term muscle re-education was a contradiction in terms, in that it implied that a muscle had the capacity to learn. A muscle is simply a piece of meat and is in every sense uneducable. On the other hand, if we tried to teach the hurt stage of brain its own function rather than to attempt to teach the muscle an exercise . . . was this a possibility? Could we teach the hurt midbrain its function of creeping?

Again we returned to the well children to study carefully the things that the well child did, in order to determine what creeping looked like. Having watched the normal child creep on hands and knees, we carefully recorded the separate functions of each of his bodily parts in the symphonious whole. We could then proceed to try to superimpose this ability on the hurt brain which, because it was hurt, was unable to perform its own function.

Creeping differs from crawling in that it not only rewards coordination but requires it. A creature that drags along on its stomach can move its four legs more or less at random and still make progress. A creature that has lifted its body from the ground must learn, however, not to pick up both right legs or both front legs at the same time - or it will fall. Efficiency requires picking up the right front leg only in combination with the left rear leg, or vice-versa, in a cross-pattern type of coordination. Only creatures with midbrains have this skill.

Temple Fay had long ago used the term cross pattern in his studies of how the lizard or alligator, both midbrain creatures, moved. He had even developed different ways of putting brain-injured children through the same motions, a procedure he called "patterning." This patterning had appeared to help but as applied had not actually succeeded in getting paralyzed children to walk. We decided to try again. We altered his patterns somewhat to represent how a well child moved, in contrast to how a reptile moved, although there were many similarities between the two. We stepped up the frequency of the patternings, remembering how much of his time a well baby spends in going through these motions. We then began the administration of those patterns.

Let me review our logic here. Fay had stated that each creature's brain embraces those capabilities it needs for survival plus those capabilities each creature lower on the evolutionary scale had needed for its survival. The lizard does not reason out the advantages of cross-pattern walking. He is simply endowed with a brain that lets him walk in cross pattern without having to think about it. We, as his descendants, still have that built-in instinct for cross-pattern locomotion. With our "patterning," all we were trying to do was to awaken those inherited instincts.

In a well child, the reflexes produce movement which he can feel. What he feels develops his capacity to feel, and matures the sensory portions of his brain. As the brain matures it begins to appreciate the correlation between motor output and sensory response. It becomes able to initiate voluntarily an action that was originally reflex. Each additional cycle matures both the intake and output portions of the brain.

In the case of a child who had failed, for any reason, to complete this cycle on his own, could we perhaps give him external help? Instead of relying wholly on the random reflexes to teach his brain how motion feels, could we perhaps impose the motions from without and thus give his brain an exposure to the feel of motion that would be even more purposeful and greatly intensified?

We decided to try it. In the case of a child with a midbrain injury, who could not move his arms and legs purposefully when on his belly, we decided to try moving those arms and legs for him - and in the exact pattern that the midbrain was designed for. We decided to "pattern" him.

The patterns were administered by three adults, and were to be performed smoothly and rhythmically. One adult turned the head, while the adult on the side toward which the head was turned flexed the arm and extended the leg. The adult on the opposite side extended the arm and flexed the leg. When the head was turned the other way, the position of the limbs was reversed. Through the years the basic pattern has remained the same, with only slight modifications. We found eventually that when this patterning was done often enough, consistently enough and in a time pattern, which we made more rigid as time went on, then indeed many a child with a hurt midbrain would begin to creep and, indeed, once creeping began, walking followed since it was normal to his well cortex.

We had now answered, at least for those people hurt in the midbrain, a terribly important question. Could we actually treat such people? The answer was yes.

If treatment implies actually changing illness itself, then indeed this was our first true treatment method, as opposed to merely giving normal opportunity, which we accomplished when we put the children on the floor, important as that might be.

Now it remained to be determined whether we could develop like procedures for the other brain areas, by imitating precisely the things a well child did as he went through each of these stages. With this question in mind, we now moved back down the scale to determine whether there was a method that we could use to superimpose the normal crawling methods on the brain of the pons-injured child.

Again we examined carefully the well child, this time as he went through the pons stage or crawling stage (usually at around five months of age). Again, after many attempts and many failures, we developed a method that was very similar to the method used by Fay, whose brilliant conclusions regarding the amphibians we now paralleled with the normal movements of well children. This pattern of activity he had long ago called homolateral patterning, and this appeared to us to be a good name.

This pattern was also administered by three adults. One adult turned the head, while the adult on the side to which the head was turned flexed the arm and leg. The adult on the opposite side extended both limbs. As the head was turned, the flexed limbs extended while the extended limbs flexed. We found that when this pattern was administered rigidly enough and frequently enough, in a timed pattern, many of the children hurt in the pons began to crawl. When they became able to crawl, if their midbrain and cortex were uninjured, they would rapidly move through creeping to walking and do well. (It is interesting to note that of all the methods of patterning that had been described by Temple Fay in his study of the growth of the race, the homolateral pattern is the only one which has remained almost exactly as he described it in his original work.)

Now there remained only the bottom and the top - the medulla and cord, and the cortex. We turned our attention first to the medulla and cord, the lowest stage of brain, which controlled the very basic first movements of arms and legs that precede crawling.

As has been said earlier, if a well infant, in the days immediately following birth, is placed on its face instead of on its back, one can observe the normal movement of arms and legs. Though these movements do not result in crawling at this stage of the game, they are synchronous movements of both trunk and limbs which aim in the direction of crawling. Here again we devised a pattern of movement. We called it truncal movement. Again the head was turned by one adult while an adult worked on each side of the body. When the head was turned to the left, the left shoulder and hip were lifted a few inches off the table. When the head was turned to the right, the right shoulder and hip were lifted and the left shoulder and hip were brought to rest on the table.

Again success was achieved in many children.

Now there remained only the question of whether or not we could reproduce the final stage of walking in children hurt in the cortex. It seemed strange to us, initially, that this was the most difficult of all the problems to solve, although as time went by the reasons became increasingly apparent.

We had studied walking in the well baby in intricate detail - in particular those things that had followed creeping but preceded normal walking. The well baby, in between creeping and totally well walking, did many things. Among these was getting onto his knees and walking for brief periods of time on his knees. He also pulled himself up by holding onto furniture and walked holding onto furniture. He also experimented by getting up in the middle of the floor all by himself in a position, not of hands and knees, but of hands and feet in a sort of inverted "U" and from there attempted to stand unsupported. This last stage Fay had described as elephant walking, and he had felt this was useful since it was a stage that occurred in man's phylogenetic growth. Although we tried this repeatedly as a technique to precede walking, we did not get useful results even though we saw well children do this frequently. We did find, however, that walking on the knees could sometimes be a helpful prelude to walking itself, and that the device of pulling himself erect on something stable such as furniture and walking holding on was also a useful technique.

Two other techniques used by the well baby also proved useful - walking with arms held above the horizontal as a balancing device, and walking with arms held below the horizontal and used as pistons to pull the body forward.

Finally, the pattern of reproducing "normal" in a child hurt in the cortex took shape as follows. We found it wise to delay the process of walking as long as possible when the child had once reached the level of perfect cross-pattern creeping, since we found that the more he crept, the better his synchronous movements became and the easier it then was to introduce him to walking. When walking had been delayed as long as possible the child was then permitted, when he insisted on doing so, to pull himself up into the cruising position on furniture or to walk on his knees if this suited him better. When the child then began to take his first faltering steps without holding on to anything, the team therapy was then directed at making the walking good.

It must be noted here that sometimes the child who is hurt in the cortex is hurt in only one cortex, and man has two cortices - a right and a left cortex. This is of vital importance to man. When a child is hurt in only one side of the cortex, this results in a paralysis of only one side of his body. We found that the longer such a child could be kept creeping, the more likely it was that he would achieve good control of the paralyzed side of his body, whether through maturation of the damaged cortex or even through a transfer of the responsibility for the missing function to the undamaged cortex. (There are many cases on record where an entire hemisphere of the brain has had to be removed surgically - and yet the remaining hemisphere has learned to take over its functions.)

When the child had arrived at the point of being able to take independent steps, even though these steps were poor in nature, then and only then did we begin to prescribe what is now called cross-pattern walking. In this method, the child was encouraged to keep his feet a few inches apart, to turn his toes slightly outward, and as he put his left leg forward to bring his right arm forward at the same time and to turn his head slightly to the left. The body is bent laterally at the waist, then as the right leg comes forward, the left arm is also brought forward and at the same time the head is turned slightly to the right.

It seems prudent to point out that this method of walking can hardly be called either the method of Temple Fay or of the team itself. Nor can any of these methods be so described because, as Fay had pointed out long before, they were hardly his methods but instead those of the Good Lord himself. We had simply decided to imitate nature as best we could and to perform these motions as had been intended by nature herself.

We had found that if these patterns were applied rigorously, on a specific schedule, and done with a religious zeal, brain-injured kids improved. If all these things were accomplished and additional central approaches, still to be described, were added, virtually all but the most severely involved youngsters showed marked improvement. We had observed nature and had acted as her Boswell in writing down what we had observed. The approach had paid off.

from:
What To Do About Your Brain-Injured Child
by Glenn Doman
© Copyright 1974