Shaping the Mind through the Body: an Integrative Neurobiological Approach

RUTH TROUGHTON,

CLINICAL LEADER, PHYSIOTHERAPY,

SPECIALIST MENTAL HEALTH SERVICE, CDHB

7 NOVEMBER 2017

DR BRUCE PERRY 2015

Complexity Plasticity dyadic relationship

Neuro-sequential model: sequential and hierarchical

‘stress’

Key brain structures, roles, connections

Vestibular system

Lopex, (2013); Mast et al (2014); Edoctoronline.com,

What do we see?Effect of Trauma– psychological /physicaloPosture

oBreathing pattern dysfunctions

o physical injuries, dysfunctions, limitations

Neurological soft signs and sensorimotor dysfunctionoDevelopmental dysfunctions and retained reflexes

oAbnormalities of tone, movement

obalance

Neurological soft signs & motor dysfunction

Excess of NSS in 1st episode psychosisoMotor coordination/sequencing

oSensory integration

oDevelopmental reflexes

Study NSS prevalence 20-97.1% 1st episode psychosis

NSS presence in general population ↑ likelihood of adult onset

schizophrenia or affective psychotic disorders

Patel, N, Jankovic, Prof J, Hallet, Prof M (2014); Dazzan, P. & Murray, R. (2002); Filatova et al 2017

Mittal et al (2013)

Current paradigmsIn addition to pharmacologic/ metabolic/ genetic/ nutritional/ psychosocial factors, research in the last 25 years appears to support underlying neurobiological contributing factors: oTrauma

oneurodevelopmental

oNeural Connectivity

Neurobiological Paradigms informing therapy interventions

Neuroplasticity and neurogenesis

Bi-directional connection and influence between body and brain

Sense of ‘safety’ - ‘Window of tolerance’

Interoception is the basis of emotion

The ‘state’ of the body affects personal resource

Shaping the mind: ‘Safety first’Calming the ‘smoke detector’

◦ Oxytocin - neurotransmitter of connection ◦ social engagement, ◦ ‘Good’ touch, warmth, pleasant activities, Support/positioning

◦ Autonomy and predictability

◦ Removing limitations, restoring function ◦ pain◦ Joint restriction

Shaping the mind: Regulating Neurophysiology

Autonomic nervous system◦ Muscle tension release

◦ Breathing pattern dysfunction

Interoception◦ Mindful attention to sensory/body/movement

Afferent and efferent systems - Sensorimotor processing

◦ vestibular system

◦ muscle activation

◦ posture

◦ ‘tone’

Synchrony and attunement – rhythmic movements

Physical activity…!

Shaping the mind: integration

Vancampfort et al 2015

Not Psychotherapy …. but psychotherapeutic

Sense of Safety – regulation of survival ’state’

Increase capacity by reducing dysfunction, inefficiency and effort:

Work with the body, retrain the brain and central nervous system

Increase capacity and resource for self, for connection, for life

Conclusion

Clinical presentation indicative of underlying neurobiological dysfunction

Physiotherapy interventions enhance neurobiological integration…to increase capacity and resource

….for self, for connection, for life

Bernard, J. & Mittal, V. (2015) Updating the research domain criteria: the utility of a motor dimension. Psychological Medicine

Catts et al. (2013). Rethinking schizophrenia in the context of normal neurodevelopment Frontiers in Cellular Neuroscience. Volume 7 | Article 60

Dazzan, P. & Murray, R. (2002). Neurological soft signs in first episode psychosis: a systematic review. British Journal of Psychiatry (BJP).

Filatova, S Koivumaa-Honkanen H, Hirvonen, N, Freeman, A, Ivandic, I, Hurtig, T, Khandaker GM, Jones, PB Moilanen, K, Miettunen J (2017) Early motor developmental milestones and schizophrenia: A systematic review and meta-analysis Schizophrenia Research 188 13–20

Gaskill & Perry, B. (2014). The Neurobiological Power of Play Using the Neurosequential Model of Therapeutics to Guide Play in the Healing Process.

Gurvich, C., Maller, J., Lithgow., Haghgooie., & Kulkarni, J. (2013). Vestibular insights into cognition and psychiatry. Brain research.

Hitier, M., Besnard, S,. & Smith, P. (2014). Vestibular pathways involved in cognition. Frontiers in integrative neuroscience, 8, 1-15

Javitt, D., & Freedman, R. (2015). Sensory Processing Dysfunction in the Personal Experience and Neuronal Machinery of Schizophrenia. American Journal of Psychiatry.

Kaufmann T et al (2015) Disintegration of Sensorimotor Brain Networks in Schizophrenia Schizophrenia Bulletin, Volume 41, Issue 6, Pages 1326–1335,2015 doi:10.1093/schbul/sbv060

Lopez, C (2013) A neuroscientific account of how vestibular disorders impair bodily self-consciousness Front. Integr. Neurosci., https://doi.org/10.3389/fnint.2013.00091

McEwen BS Bowles NP Gray JD Hill MN. Hunter RG Karatsoreos IN Nasca C (2015) Mechanisms of stress in the brain Nature Neuroscience. 18(10): 1353–1363. doi:10.1038/nn.4086.

References

ReferencesMast, FW, Preuss, N, Harmann, M, Grabhen, L (2014) Spatial cognition, body representation and affective process: the role of vestibular information beyond ocular reflexes and control of posture, Frontiers in integrative neuroscience

Matsuura Y, Fujino, H, Hashimoto, R, Yasuda, Y, Yamamori, H, Ohi, K, Takeda, M, Imura O (2015) Standing postural instability in patients with schizophrenia: Relationships with psychiatric symptoms, anxiety, and the use of neuroleptic medications, Gait & Posture 41 847–851

Mittal, V. et al. (2013). Neurological Soft Signs Predict Abnormal Cerebellar-Thalamic Tract Development and Negative Symptoms in Adolescents at High Risk for Psychosis: A Longitudinal Perspective. Schizophrenia Bulletin.

Morita, T , Asada, M, Naito, E (2016) Contribution of Neuroimaging Studies to Understanding Development of Human Cognitive Brain Functions Front Hum Neurosci. 2016; 10: 464 doi: 10.3389/fnhum.2016.00464

Niklasson, M,Rasmussen, P, Niklasson, I, and Norlander T (2015) Adults with sensorimotor disorders: enhanced physiological and psychological development following specific sensorimotor training Frontiers in Psycholology, 6 (480) https://doi.org/10.3389/fpsyg.2015.00480

Patel, N, Jankovic, Prof J, Hallet, Prof M (2014) Sensory aspects of movement disorders Lancet Neurology 13(1): 100-112

Perry, Bruce. & Hambrick, E. (2008). Introduction to the neurosequential model of therapeutics (NMT): A neurodevelopmentally informed approach to clinical work with maltreated children. The Child Trauma Academy.

Read, J, Fosse R, Moskowitz A & Perry B (2014) The traumagenic neurodevelopmental model of psychosis revisited Neuropsychiatry 4(1), 65–79

Van Damme, T Fransen ,E. Simons, J, van West, D. Sabbe, B (2015) Motor impairment among different psychiatric disorders: Can patterns be identified? Human Movement Science 44 317–326

Vancampfort, D, De Hertb,M, Myin-Germeysc, I, van Winkel, R, Firth,J Van Dammea,T, Probst M (2017) Lower cardiorespiratory fitness is associated with more time spent sedentary in first episode psychosis: A pilot study Psychiatry Research 253 13–17

Te Tinana – the bodySystems to support life

◦ 11 major organ systems – include Circulatory, respiratory, excretory, digestive, nervous, endocrine, immune, integumentary (skin) reproductive, and musculoskeletal …

◦ Maintaining balance - homeostasis

◦ adjusting to demands- allostasis

Vehicle for ‘self’◦ inner sensations, perceptions, desires, fears…

◦ Outer world…

connection with others◦ non verbal language is up to 90 % of all communication

◦ Posture, movement and physiology