Monday, October 19, 2009

Occupational Therapy, Balance, Vision, Sports and People Sense

Occupational therapy with A Total Approach is fun. Typically, we work on Balametrics which is a kind of teeter board where I keep myself balanced for about an hour. While I am on the teeter board, I am also doing Tomatis, a listening program. Tomatis involves wearing a headset and listening to specially filtered Mozart or Gregorian chant. At the same time, we are doing exercises. We  throw bean bags up and down or across the body. Sometimes we do exercises involving fine motor skills such as moving coins around a path. Or, moving numbers  around blocks on top of large pegs in sequence. These exercises involve eye tracking, keeping your eye on the ball as it moves.  Other times we use a kind of skateboard and swivel 90°. Sometimes we swivel 360°. We do these things for an hour. 
The second hour we do creative drawing and then we play games. Drawing has been a big struggle for me. It is very hard for me to express myself. Especially with lousy motor skills. Add to that vision problems and problems in visual motor coordination, that is, hand to eye coordination for the layperson. (I am already starting to talk like a therapist.) My drawings look like a kindergarteners. I did some stick drawings because they are easy. Then I started to graduate to surrealism. Surrealism has been very helpful because I don't have to do any kind of realistic representation. In other words it doesn't have to look like what I am seeing. Or what anybody has seen. I can use relatively simple shapes  and compose a picture. However, I do wonder whether anyone might think that I am a bit psychotic because the split portraits look a little weird. On the other hand that's as much as I can bring myself to draw. Simple shapes flat shapes and this is not very easy. So after about a week of this I do get the choice of playing a game which I am very happy about. We played this game called Labyrinth which involves moving around a pathway. Melissa, my therapist, always wins. Although we have a running joke about following the rules because she didn't know all the rules at the beginning of the game. She had to look them up and found she was wrong on a number of points.

Believe it or not, all of this is rather exhausting. I have to drive down Route 95 from north of Philadelphia past the city of Philadelphia, past the airport south of Philadelphia on Route 95. Some of this is during rush hour. All in all, it is a 1 1/2 hour to two hour trip one way. The therapy is about six days each week. So that is about 25 hours a week. 
This therapy is very interesting and is hitting the problems that I have hearing (Central auditory processing disorder), vision, and balance. I am often a bit queasy from working with Balametrics. We also do work on the balance beam so I'm going back and forth on the balance beam tossing bean bags. Sometimes I am also trying to walk on the balance beam with my eyes closed. Believe it or not walking on the balance beam with your eyes closed takes a high amount of concentration. One thing I noticed about all this therapy is how much I have to move out of the verbal world that I am so accustomed to being in and move into this Zen-like nonverbal, in-the- moment world. It is a world where I have to use my eyes to notice things like balls or bean bags and I can't think in verbal ways. 
I read this book, "The Athletic Eye" which goes  through a lot of the vision training that super athletes use to improve performance. Apparently, athletes like Billy Jean King dwell in the nonverbal world. They focus on the balls, the seams of the ball or other details of the ball. They are one in the moment. They try to track that ball until it hits the racket. When they are really in the zone, they can see the ball hit the racket. Now, that takes some extraordinary amount of eyesight. Another example is Bill Bradley. He had phenomenal peripheral vision. He said that as a kid he used to walk down the street and play game of trying to see what was in the stores as he kept his eyes forward. This gave him a "sense of the court" which is what all basketball stars have. They know where everyone is on the court and what they are doing and how they are moving.
 President Barack Obama also has the same ability that he has derived from his years on the court. He has translated this ability into superb people skills. He knows what everybody in the room is doing. He can “read a room” at an unbelievable level. He understands what is going on with an audience is. Great comedians also have this skill they can meet their audience and they can modulate their delivery to match the audience.  
What these people all have in common, is the ability to track motion whether it is a ball or a person’s facial expressions or body language.

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Saturday, October 17, 2009

Art, Creativity, Lateralization, and Neuroscience

I decide to get a little clever before my next visit to the occupational therapists at A Total Approach. Since they want me to do a self-portrait and all I can do is a very simple composition composed of simple symbols, I decided I was going to learn to draw. So, I ordered a number of art books. One of the books I ordered, "Drawing on the Right Side of the Brain" is very interesting because it integrates the neuroscience of the brain's left and right hemisphere with visual studies.

The key organizing principle in the book is: drawing is the global or "whole" skill requiring only a limited set of basic components. Skills required are not drawing skills, they are perceptual skills: the perception of edges, the perception of spaces, the perception of relationships, the perception of lights and shadows, and the perception of the whole, or gestalt. There are two more basic skills that are required for imaginative, expressive drawing that leads to heart. These are two skills: drawing from memory and drawing from imagination. The final scale, the perception of the whole is neither taught nor learned that seems to emerge as the result of a acquiring the other four skills.

The logical progression for a person starting out in artistic expression is: from line to value to color to painting.

As a side note, facial recognition is a function belonging to the right hemisphere.

The mode of processing used by the right brain is rapid, complex, whole -- pattern, spatial, and perceptual. The mode of the left hemisphere is verbal and analytic, while that of the right is nonverbal and global. Inside each of our skulls we have a double brain with two ways of knowing. In visual mode, we see how things exist in space and how the parts go together to make up the whole. Using the right hemisphere, we understand metaphors, we dream, we create new combinations of five years. Betty Edwards' students report that learning to draw makes them feel more artistic and therefore more creative. The right hemisphere is not good at sequencing.
I am going to see what happens with all of this as my vision improves.
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Eyes, Disorganization, Getting Lost and Getting Found

Tacony-Palmyra bridge, taken from the Philadel...Image via Wikipedia
I went to see Dr. Hertzberg, a developmental optometrist. My trip to see her illustrates how my visual problems and organizational problems impact my life. This time it is a little humorous. At the turnpike, jumped in my car, drove down Route 1 to the turnpike. I got all confused. I wasn't sure whether I should take the fork in the road that goes to New Jersey or continue towards Harrisburg. I've driven down this route a number of times before so I shouldn't be so confused. But I am. And I only have a few seconds to make a decision. I take the fork in the road to the left. I start thinking about something else I forget what but my mind was only partially engaged on my driving. Things start to look a lot less familiar and I am definitely missing familiar landmarks. I start to get a horrible, sinking sensation that I am not where I should be. I continue on. Things are really not looking familiar. And the next thing I know is that a very large bridge looms in front of me. I see a welcome sign for New Jersey. I begin to curse. Then I enter the hell that is New Jersey highways. I can't turn around. There should be a sign, "abandon all hope ye who enter here". You just can't turn around easily in New Jersey. There are these darn Jersey barriers that prohibit left-hand turns. So I keep driving and driving and driving. I notice I'm running late. Finally I find a place to turn around. I turn around and then start pondering what to do next. Should I., should I go? I'm running late but maybe I won't be too late. So I continue on. Back over the bridge. Back on the sharp hike. And I start speeding at 80 miles an hour around the Pennsylvania Turnpike. I'm trying to catch up. I know I'm running late and I start to panic. Maybe I should go home. Maybe I should. I press on. I make Mike exits and turns correctly. And I end up in front of her office 40 minutes late. I start to panic. Maybe her receptionist is going to be really mean. Maybe I'll get yelled at. But I figure while maybe I'll just go when and see if I can reschedule the appointment. Fine. So I go to grab my purse and I realized I forgot my purse. I have been driving not driving a speeding down the New Jersey around the Pennsylvania Turnpike without my purse, without my wallet, without my driver's license. Thank God, no cops stopped me. But here I am in front of the new doctor's office with no checkbook, credit card, or ATM card. I want to have a meltdown like a child. I want to stamp my feet. I want to throw my keys on the ground. If there were a pile of blocks, I would run over and kicked them. But I'm an adult (at least theoretically). So I suck it in. What to do next? I stop. I sit on the bench and ponder my options. I could go home. Or, I could go in and maybe they will be really angry with me for screwing up their schedule.  So, I decided I'll face the music. I'll just go in and reschedule.

So I go in. Fortunately, the optometrist and receptionists are very very kind people. And I explained my story about why I was late. Fortunately, they had a client, a little boy, who had a hard time sitting still so they took him for. I got in the chair and everyone was so nice to me. Dr. Hertzberg heard my story. Normally I would not tell another adult about this thought since it relates to visual problems I told her my story. Well, it turns out that my eyes are truly bad. I have convergence insufficiency, problems with visual tracking, problems with filling out forms, problems with eye teaming, and no 3-D depth perception.

The sad thing about all this is that the therapy to correct these problems has  existed since the 1960s.
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Music, Audiology, Rhythm, and me

AudiogramImage by schoschie via Flickr
I met with the audiologist, Maxine Young, today. I am amazed at the wonderful intelligent people I am meeting on this journey and she is one of them.  Maxine Young is not only an audiologist but a singer.  She used to sing with the Pittsburgh Symphony Choir.  She is also a collaborator with the notable neuroscientist, Mezernich.
Maxine Young went over my hearing tests and my hearing is definitely impacted. On the first test, I scored 72% than the norm is 85%. On the second test,dichotic hearing, I passed but she could tell that it was a definite strain for me. For most people, this is a test that can be done pretty effortlessly. But I had my eyes closed and I was highly focused. It wasn't easy. The third test, tapping, I failed completely. I didn't get a single question right.

So, her recommendations are that I continue with the Tomatis method with A Total Approach. After I finish with them, I should do the Brain Fitness program by Posit Science. Additionally, I should arrive at meetings early and get a seat at the front of the room. I should try and set between three and 5 feet from a speaker. In larger meetings, it would be good to get a notetaker or use an FM transmitter.

Maxine Young is very optimistic about me. She is amazed at how much I've done with myself. She says I've been carrying at a house on one hand and three cars on another. A lot of people with less on their plate don't do half as much. So here's to you, my dear executive lobes, who have borne the brunt of all this. She thinks I'll be doing great in about six months and wants me to call her. I intend to do just that.

We talked about music. I asked her if I should just give up with music given that my hearing is so crummy. She told me to never give up with music. Maxine Young used to sing with the Pittsburgh Symphony chorus. She believes passionately in the power of music. She doesn't think that I could ever perform, but neither do I. I would just like to play well enough for friends and family to enjoy.

That night when I went home, I cried a little bit about not being able to hear all the things that everyone else can hear. But, I sat and thought about it. You know, death people can learn to play music. Beethoven was deaf, wasn't he? Well, I am no Beethoven bot I should be able to make the most of what I have. Maxine Young did recommend active listening. And I do believe that using whatever I have the fullest is going to bring it back as much as it can be brought back. So, I got my fingers tapping and searched on the Internet for teaching the deaf music. I found the teacher who is now at the Episcopal Academy on the Main line. He used to live in Bucks County so maybe he knows someone local here who would be a bit more patient than the average music teacher. I have just taken a piano class at Bucks County community college. My poor teacher was trying so hard to drum into me the basics of rhythm. 123, 123, 123. It was really frustrating for both of us. I explained I was having some neurological problem and he was kind to me with his grading.  But, I never really go rhythm… But Maybe after we do the Interactive Metronome with A Total Approach, rhythm will come to me.
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Rock Climbing Despite Being Spastic and Afraid of Heights

10-0119 Ralph Stover State Park 03Image by clocksforseeing via Flickr
I did all kinds of stuff to overcome fear as a young adult.  One of them was rock climbing.  How I did it with the amount of Motor Apraxia (really lousy coordination and physical skills) and Visual problems, I'll never know.
I remember rock climbing in college with a bunch of friends. We were part of an outdoor club that did many activities, one of which was rock climbing. I really never liked rock climbing but I did it to be part of the group. Why didn't I like rock climbing? It was hard on the body. My arms ached and ached and ached. As did my shoulders my calves and my thighs. I'm scared of heights and even though I was well harnessed to the climbing ropes I was afraid of falling. Going up the wall and figuring out the strategies to get me to the top was brutal. You put your fingers on very small protrusions or crevices. You put your toes or feet on very very small supports an expected this to support your body weight. The rocks hurt my hands. When I slipped and fell, I scraped the rocks tearing skin off and drawing blood. I learned quickly not to look down because it would frighten me even more. I remember the pit feeling in my stomach as I stared at the earth. I could only feel better by concentrating on the wall and where I could go next. When I fell, the rope would jerk into my chest and pull into my groin.

At the beginning, it was hard to read the wall. I couldn't understand the mapping of the crevices and ledges. I couldn't trace a route to the top that would support my weight and would be within my reach every step of the way. Often times, I would back myself into a corner and then have to crawl back down to a lower ledge and plot a new course.

It was a great relief to get to the top. The ordeal was over.
Rappelling was much easier once I got going. Although the beginning was also quite scary. There are two types of rappelling. The first most common type begins by leaning backwards; the second, by leaning forwards. I felt like I was throwing my life away as I tilted into position. I can feel the vertigo in my stomach and the shaking in my hands and legs and the sweatiness in my palms. After I got used to breaking myself by throwing my hand behind my back, I did enjoy jumping down the wall. But leaning back into position was always tough. Using the second technique, leaning forward, was always tough. Because I had to look down. Looking down was scary. Although I did manage to train myself not to look straight down. Going forward with like running straight down the cliff and throwing myself off it.
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How this All Started

NewYork-Presbyterian Hospital / Columbia campus.Image via Wikipedia
At the beginning of 2009, I started to notice some things seem very off in very small ways, that in and of themselves, didn't seem important, but, when you add them up seemed to be a lot. So, I made the appointment with neurologist at Columbia Presbyterian Hospital. The evaluation didn't show anything but I did get a referral to a neuropsychiatrist. I saw the psychiatrists in June 2009 four a comprehensive narrow psychiatric workup. I took a wide variety of tasks and got the diagnosis of a nonverbal learning disorder. The doctor felt that there was a subtle difference in the tests that warranted that diagnosis.

I was very upset by that diagnosis and cried a lot for three days afterwards. At the time, I felt like I was being graded unfairly, and that the neuropsychiatrist had concentrated on my deficits. I talked to someone else who had seen his share of neuro psychiatrists, and he felt the same way after seeing his doctors. So, I felt a little better. You know misery loves company. I talked to both a psychologist and my ophthalmologist and they both seem to think that the diagnosis was a bit of a garbage can for multiple symptoms. In fact, the psychologist isn't completely sure about that diagnosis.

I didn't receive much a referral from Columbia so I was left to my own devices. I posted something to the gifted and talented e-mail list and got a recommendation for a bunch of occupational therapist over at the total approach. This made me feel a lot better because I was really hoping for a plan of action from Columbia detailing the different specialists that would be needed.  The folks over at A Total Approach seemed to have everyone under their roof. They have the auditory, motor, vision, speech, etc. services and have a good network of referrals. They are on the other side of Philadelphia unfortunately.

The occupational therapists report was very revealing. There is a 99.9% chance of a genetic link. When I think about my mother and father, I think this is true. Both of them had many problems with manual dexterity organization, dealing with other people, etc. If the activation of therapists feels that I have led a life of compensating and coping. She feels that carried many fears throughout life. I need to use the lot of compensation to get where other people go automatically.

There is a link between motor, neural, timing, and organizational skills and the temporal lobes.  She thinks I probably tend to be a perfectionist.  When I'm in high gear everything works; when I'm in low gear it doesn't.

As for auditory problems, this happened very very early in life. The inner year is formed in the one a baby can hear a mother down through her spinal cord and into the womb as the mother speaks. The audio develops then the tactile end next level the visual. In the first nine months, with an incident has a heightened sense of auditory. However, this sense usually settles down. But for me it never did and i.e. their overcoat or I shut down. All this coping takes a toll on security and emotions. Innately, there is a bit of a sense of multiple speak. In order to deal with me well, it'd people need to look at me straight and repeat. The occupational therapists feel so I fit the profile of central auditory processing disorder.

My sensory profile shows our registration problem of low registration. I tend to also want to seek in that I know I'm missing something otherwise I wouldn't be seeking to! I have problems with some bone hearing. But years just start yelling: selectivity open year.

The course of treatment that is propose will start with the auditory and then move towards remedying visual spatial deficits. The first step would be Tomatis therapy for about three months. This therapy would use a mental health counselor, as well. It would include vocal work on tonal quality. It would be Monday through Friday two hours a day for 15 days with one-week break the second. What involve vocal work. Or I could select the home oxygen this therapy would involve 60 hours at this time they will also look at sleeping and eating habits very there will be a retest. After completing the tomatoes therapy, we will work on the interactive metronome. We may add more to modest therapy if the years aren't there. We will be need to leave the brain alone for consolidation. We will have to work against coping strategies. We may ask for vision therapy could be done simultaneously with the audio. The auditory function is not far from limbic function. If I'm doing home therapy, I am not allowed to use computing electronics. Expect to feel a lot of opera groping and overstressing which may lead to ain't anxiety or thestraight to the limbic system. Since I have a limited sense of smell, the neural pathways may have shut down the messages to thought what a mixed system. I have a hyper censor a profile. Sometimes during the course of therapy, smell does normalize. I have the sense of taste so there is some sense of smell. In order to deal with fears, they will use a number protective techniques. As far as dealing with social learning disorders we'll not focus on the social until I'm finished. There is a group for adults at Temple University. It is important to do this in order. This therapy is constructed around a child's development.

After we finished the valuation, my husband and I needed time to decompress. So we went over to Borders and had some coffee and poked around that some books and talk things over. We both fell a very enlightened and basically optimistic about this therapy solving problems. I just feel a bit whiny and I don't want to do the work and there is better things in life to do than therapy. I feel like a therapy junkie. I'd really rather not devote so much time to therapy but I certainly can see the costs of continuing to do business as usual. I talked about this to my psychotherapist then she suggested a hero metaphor. However, I am really a profile in non-courage. Rather than riding off into the sunset with sword in hand, I feel like I've hauled my sorry tail onto a very mangy mare and am painfully galumphing along.

Dealing with fears is going to get interesting. I read a presentation on the web from Carnegie Mellon that quoted an autistic person, Sean Barrow:
my autism brought me much misery and unhappiness, and in essence brought me of a childhood. I was born with the pervasive fear that never seemed to diminish, so I spent most of my earliest years devising ways to lessen the unrelenting terror, if not get rid of the chronic dread completely. To that end, I try to find ways to look at and take in the world that would make sense to me and be less overwhelming, while at the same time, provide a measure of comfort control balance and security -- all of which were missing from my life, isolating and manipulating objects while tuning out people; fixating on repetitive motions; asking the same questions over and over; and focusing to an extreme degree on one item or event to the exclusion of every thing else were among the ways I've found some control and security, while temporarily sidestepping my fears.
If this brings back memories of playing with balls when I was a child. I remember playing softball and seeing the ball high in the sky come hurtling at me. If it was a frightening object because I couldn't orient myself to it. I wasn't sure I could get out of the way. I knew it would hit me hard if I let it. Even catching it could be painful. I could put my hands up in the air to catch at but I was never quite sure where lots. The ball would travel I would see it. But some time before impact the bowl disappeared. If I were lucky when I put my hands out I could catch the ball. I is never knew that I was going to catch the ball until I caught it. Not, more often than not even know my hands were outstretched I couldn't catch the ball. The ball would fall to the your theory and I might here is something as it did. I'd see it balance and bounds and bounce and then it rolled away. I wasn't completely sure the balls pass on the ground as it was coming down. And it was very confusing to see it fall to the ground and it was hard to figure out where I needed to be, how fast they needed to run in order to pick up the ball. Catching the ball was not always pleasant to my nose. The mitts were smelly with the sweat of other people. The mitts I used to belong to the school and were well used. Getting up the bat was not much fun either. The pitcher would pitch the ball. I keep my eye on the ball like I was told. Then the ball with this pair when it came close to me I could never see the ball as I was trying to to hit it with the bat often times eight slaying. The bat with circle around me and silence. Strike one. The pitcher would pitch again. Strike two. Again. Strike three. You're out. The few times I would connect with the bat, the ball usually didn't go far and I was an easy out. I couldn't run fast and I would huff and puff my way to first base. I remember being caught and frustrated. I was chosen last.

When I remember this, I have feelings in my legs and my heat, in my groin and my shoulders and in my head. I have some feelings in my stomach. Ceilings are kind of lead and feelings feelings all walked in and feelings from my last sign and they crossed into the middle and my stomach. I hear ringing in my years. And the tenseness of my jaw and in my neck. I feel my shoulders having some tension. I feel my throat in the base of my throat. I feel this sense of unease just moving through my body might goes through my throat mostly on the left side.

Basketball was another uncomfortable time. Again a large ball hurtling at you. Coming high and falling on you. People were swirling around. They were running quickly and busily. They were running all around. Once you thought you had them figured out they changed. They were moving faster than you I was very very out of sync. I'd run and jump after the ball if it bounced up out of the net are through the hope but I didn't know where the ball was going next. I couldn't figure out these patterns of people moving and changing. I was very disoriented. I stopped growing really some time in junior high school or and there were many tall people. So I couldn't shoot over them. It was hard to shoot around them. What is just scary. People wanted me to do things I couldn't do. No one understood why I wasn't fast record made it her graceful. I remember jumping jumping the ball and missing missing this but I did try very hard. I remember people pushing on the court. I thought I had my position established but I still got pushed and the referee didn't call foul. I remember some girls pull my hair and pushing me. They were strange girls. They will really weren't accepted. And they were mean. I really didn't want to go near them.

When I think of basketball I feel a sharpness of my stomach. I feel my left leg's very heavy. I feel my thigh very very heavy and I feel an energy running up my left leg and around into my stomach I feel my chest my shoulder blades I feel my new ones I feel my third guy. I feel back of my throat. I swallow. I feel a lump to my throat. Again from my last side to my middle.

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