Book to be released August 1!

Book to be released August 1!
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Friday, February 11, 2011

Cross about the Cross-Crawl

The myth of the cross-crawl has been with us for at least 50 years now, and I for one am tired of the claims that are made about it. This belief, initially (as far as I know) promulgated by Glen Doman and Carl Delacato, a physical therapist and an educational psychologist respectively, assumes that when an older child or adult imitates the typical movement patterns of a young infant, his or her brain is in some way restructured and begins to function more effectively. There is, however, no evidence to suggest that this is anything but a myth.

Doman and Delacato put great emphasis on repetition of infantile movement patterns like those of the asymmetrical tonic neck reflex, in which head, arms, and legs all move predictably and reciprocally. The arm and leg movements of this reflex are to some extent repeated as a baby begins to crawl on the stomach and to creep on all fours; the right arm and left leg move forward together as the left arm and right leg are extended, and vice versa. In ordinary movement, this movement pattern has the great advantage of stabilizing the baby’s posture while allowing forward motion, because to move both arm and leg forward on the same side would throw weight to one side, a difficult situation for a child too young to shift weight to maintain balance.

The “cross-crawl” movement, with movement of legs and arms as described above, is an activity that older children and adults can do for themselves. As such, it has been recommended by unconventional therapists as a way to achieve better communication between brain hemispheres and to “rebuild” compromised brain functions. Now, such practitioners are suggesting that the “cross-crawl”-like movements of a trotting horse will have the same function as cross-crawling (a function which, by the way, has yet to be established on any evidentiary foundation).

Examples of these claims can be seen at http://www.hoofbeatstohealing.com/, which states that the method is “Based on the theory of cross hemispheric integration. Which is if a child didn’t crawl correctly their brain may not be mapped correctly” (punctuation sic). The method is said to be effective for the following: Reactive Attachment Disorder, visual impairment, hearing impairment, spina bifida, emotional disabilities, and other problems. In a 2006 article in Western Horseman, to be found at http://tswf.org/Happy-Trotting.pdf, the reporter tells the story of a child riding a horse with a particular gait for the first time. The instructor noticed that the child’s pupils were dilated, but rather than interpreting this as a sign of pleasure and approval, she “could tell there was something going on in his brain neurologically. The dilation meant that his brain was downloading the patterning of the horse’s gait”, the instructor later said, and she continued, “Downloading that patterning can reveal the rider’s emotional, physical and neurological issues, making it seem like the rider’s getting worse, not better.”

Having fun and good physical exercise, and learning to communicate with a large animal, are all great things for children to be doing. For children who have handicapping conditions that limit muscle strength and movement, the physical stretching associated with horseback riding can be very beneficial. But this whole business about the cross-crawl, about downloading the horse’s gait, and so on, is the purest nonsense.

An injury to a developing brain does not mean that the brain stops or gets “stuck” in its development. Uninjured parts of the nervous system continue to grow and form connections with other uninjured parts. Typical functions may appear, even though the connections that cause them are not themselves typical. Re-enacting early behavior patterns affects the brain through the sensory systems, but it does not drive the brain back through early development; the brain is no longer at that early stage, has different structures than it did, and can no longer act as it used to act. In any case, the problems listed as treatable by horseback riding would all have occurred at different points in development.

I should also point out that the reciprocal crawling pattern does not cause brain development. This is clear because although that crawl pattern is typical of human infants, and although it is “average” (statistically most common), it is not the only normal developmental pattern—that is, a pattern that leads to good later development. Many babies use this crawl pattern and develop very well. Some babies use the crawl pattern and do not develop very well. Some babies just sit around for months or scoot on their bottoms to where they want to go, and then one day stand up and walk. It’s true that when a baby’s crawl is one-sided, developmental problems are more likely than when both sides are used. However, a typical crawl does not necessarily predict good development, nor does a failure to crawl at all predict developmental problems. If crawling caused early brain development, we would see big differences between those who crawled before walking and those who did not.

Here’s an interesting further piece of evidence. In some parts of the world (for instance, traditional Bali), babies were not allowed to crawl. They were considered to have come straight from Heaven and it would be shocking to let them go on all fours like animals, so they were carried until ready to walk. Yet no unusual number of developmental problems were to be seen.

If failure to crawl doesn’t really cause problems, what are the chances that the cross-crawl movement, self- or horse-produced, can solve them? (And what would happen if someone drove a pacer, which moves the legs on the same side together?)

14 comments:

  1. "A horse is a horse, of course, of course, and noone can talk to a horse, of course
    Unless of course the talking horse
    Is the famous Mr. Ed

    Go right to the source and ask the horse
    He'll give you the answer that you endorse..."

    Don't think Mr. Ed is around any more. What bullshit! I am all in favor of equestrian therapy and pet therapy for kids with problems, to let them relate to a non-judgmental animal and have a sense of accomplishment, but using animals this way defeats that whole purpose.

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  2. Yes,it all makes me think of the optimistic child who said as he shoveled,"There must be a pony in here somewhere!"

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  3. I find this and your last post very interesting.
    Way back in the 1980’s, when I was in a group home I had “horseback riding therapy”, which in my humble opinion was just horseback riding lessons. I loved it! I loved grooming and interacting with the horses. And yes they do seem somehow wise with their big eyes and gentle natures. Do I think it was more than a good experience and a chance for a foster kid to do something special and interesting? I’m not so sure about that, but I certainly don’t think it HURT anything. Then again the horse trainer did not fancy herself a therapist who had me do her dishes.

    I have wondered about any advantage of getting “horseback riding therapy” for my almost 3 year-old who has mild global dyspraxia /CP. (Isn’t there something about the righting reflex and the sway of the horse?) She never crossed crawled as a baby, she had a lopsided scoot, and she walked at 19 months. We continued to encourage her to learn to crawl (which she did…kind of), hoping that it would force her to use and strengthen both sides of her body, and maybe even hopefully help rewire that activity to another part of her brain that isn't dammaged. Maybe not but, can you blame a mom for trying?

    I always appreciate your insight; you always give us a lot to think about.

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  4. Well, of course you encouraged her to crawl, and to do everything else she tried, I'm sure. And I didn't mean to suggest that that's a mistake.

    I think your point about strengthening the weaker side of her body is an essential one. Many people get so involved with the idea of brain "rewiring" that they forget the various other factors that are important for voluntary movement. This would include muscle strength, balance, weight, body proportions, and motivation to do something difficult (what you helped to encourage). Even the flexibility of the torso, which develops as a preschooler's ribs move to a more adult position during breathing, makes a difference to whether you can counter-rotate the shoulders to imoprove balance in walking.

    The later Esther Thelen, a developmental psychologist, did some fascinating work with Down syndrome infants, setting up a baby "treadmill" to help exercise and strengthen their leg muscles, and they walked earlier than untreated Down children do. No "rewiring", just stronger muscles.

    I wouldn't dream of saying horseback riding is unhelpful in cases where muscle strength, flexibility, balance, and so on need work. It's fun and therefore highly motivating, so what can be bad? I'm just pointing out that the helpfulness of that kind of activity for muscle and balance problems where often there is nervous system damage too, does not mean that every nervous system problem benefits. And just because it's now popular to call emotional disturbance a "brain disease", there's still no reason to think that riding is more psychotherapeutic than any other enjoyable social activity that gives an experience of mastery.

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    1. Strength gains in the first 4-6 weeks of any new physical training program are primarily due to neuromuscular adaptions. Your brain is constantly pruning unused connections and making new/strengthening existing connections that are used. That could be referred to as "rewiring". You can't isolate and strengthen muscles without neuromuscular adaptions.

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    2. "The later Esther Thelen, a developmental psychologist, did some fascinating work with Down syndrome infants, setting up a baby "treadmill" to help exercise and strengthen their leg muscles, and they walked earlier than untreated Down children do. No "rewiring", just stronger muscles."

      That just doesn't make sense. Your muscles don't get stronger independently of your brain. Strength gains in the first 4-6 weeks of a training programming are primarily due to neuromuscular adaptions, not increases in muscle strength or size alone. This is common knowledge.

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    3. Dear Anon-- I am assuming that these two comments are from the same person-- aren't you conflating neuromuscular events (muscles,peripheral motor nerves, and maybe spinal nerves) with brain events? Would you expect a "body-builder" to have a brain that's different from, say, that of a ballet dancer,or from that of a sedentary person? If so,what differences would you predict?

      And, to go back to the original post, would you say that any of these differences would be related to Reactive Attachment Disorder or to hearing impairment?

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  5. Yes, my feelings exactly. Any child who wants to learning to ride can certainly benefit in many ways from that good experience with a beautiful, powerful animal. Me, I'd be terrified to get on a horse, even though I admire them, but for a kid, even overcoming that kind of fear could be liberating.

    This really annoys me because I love animals of all kinds and think they really can be useful in therapy, but not as therapists! Just give the child a good time, good exercise, strengthen some muscles and increase confidence. Isn't that enough benefit for anyone?

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  6. Apparently not. It's gotta rewire your brain or it's not worth doing! Also, I suppose an issue is who will pay for it.

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  7. You do realize cross patterning is not only about crawling/walking movements don't you? My son has yet to master any cross patterning activities at all he is nearly 3 which means his window to learn and secure the skills is beginning to close. If he doesn't begin to acquire some cross patterning skills soon we will find it near futile to teach him to walk,talk,see with both eyes looking the same direction, do activities that require both hands to be used independently and many more simple tasks that people do every day without thinking. cross patterning is the ability to switch from left to right brain thinking and vice versa when doing anything not just crawling but crawling is the most basic activity for a toddler to do that will holistically reinforce the neuro pathways required for cross patterning so that is why it is encouraged in that age group. The Balinese may not prefer crawling but you can guarantee that there are other cross patterning activities happening in their lives. I agree that it is silly to get adults or older children to crawl in hopes of rewiring the brain as by that time the pathways are either there or not there is no maybe but please don't tell people to forget about crawling altogether.

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  8. What you call "cross patterning" seems to me to be coordination of the two sides of the brain, not switching back and forth. Both sides are working at all times, but doing different tasks with respect to motor signals. For example, when humans crawl, the left arm and right leg move together, while the right arm and left leg also move together-- like the trot rather than the pace of a horse. But this coordination comes from normal very early development, not from experience. Newborns show coordination of the two sides in their reflexive "crawling" and "stepping" movements, as well as in the tonic neck reflex. As muscle strength and control by the nervous system advance, these movements become more obviously coordinated and make it possible for the child to move independently. When walking begins, the toddler's stiff trunk makes it hard to see that there is coordination of the whole body, but as the ribs become more mobile you see the shoulder girdle counter-rotate to balance the stepping movement, and swinging of the arms shows how the two sides coordinate, just as the horse's trot does. This is not a matter of reinforcing neural pathways because it is not actually a matter of learning, except for fine details.

    The important research Esther Thelen demonstrated that Down syndrome toddlers could be helped to walk earlier by exercising them on treadmills, but this was due to strengthening of muscles, not neural pathways.

    If your child is sadly so much delayed developmentally as you describe, any social and physical activity will be more helpful than none. However, there is no window of the kind you mention for motor development.

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    1. I really am trying to understand this but it just makes no sense to me. Strength gains don't happen without neuromuscular adaption. You can't activate more motor units for a movement without the appropriate adaptions. You can't move without brain activity.

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  9. funny how you all use ideas fathered by glenn doman (RIP) while denying their efficacy and ridiculing their originator. all these now common beliefs (first ridicule then angry denunciation then quiet acceptance), that the brain grows by use, that there is a relationship between movement and brain development, are all products of doman's work or at least of the controversies that his research produced such that these discussions could even occur. Give credit where credit is due.

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    1. I'm not sure who "you all" is, but if you read what I said you'll see that I am contradicting Doman's claims. The brain grows through genetically-determined maturational factors (assuming health and nutrition are adequate), but some aspects of its structure and functioning are shaped by experience-- especially those that have to do with binocular vision and sound localization. Doman's view was in fact more likely to be accepted in the '60s, when a strong environmentalist perspective on development was still in fashion (cf. Kanner and John Money), and is met with ridicule today, as it deserves to be.

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