Most of us navigate our way through the world believing that what we see really is “out there” and exists exactly as we perceive it.
This is far from the truth, and, in fact we have no way of knowing, for instance whether even something as basic as our perception of the colour red is in any way comparable to someone else’s perception of the same red object.
We take this for granted, but the distinction between what is perceived and what exists becomes more obvious when we consider various insects who can see colours that are beyond the range of our visual apparatus.
In fact, regardless of whatever reality exists “out there” outside of our heads– we actually know nothing of it.
All that any of us consciously knows is knows is the sum total of all the sensory data presented to our our conscious minds by our sensory apparatus, and integrated and structured into a meaningful whole by our brains. To complicate matters even further there is a process by which the overwhelming majority of sensory data are excluded from conscious awareness by a highly refined subcortical gating process, which occurs especially in the thalami. This process of selection of sensory data relevant to consciousness is termed “sensory integration”.
The neurology of hologrammatic model of consciousness is well understood in neuroscience and is the main subject of the book “Self Comes To Mind” by the neurologist Antonio Damasio. As a curious aside, the same model is clearly referenced in one of the core texts of Mahayana Buddhism- The Heart Sutra.
In this “Self Comes To Mind” Damasio outlines the fact that one of the most important aspects of brain function is the mapping and cross referencing of all the various sorts of sensory data that our brain perceives.
One of the key anatomical structures responsible for the collating and cross referencing of this sensory input is a pair of brainstem nuclei called the superior colliculi.
Ref “Self Comes to Mind” Antonio Damasio
p67: “The superior collicilus is an important provider of those visual maps, and even has the ability to relate those visual maps to auditory and body-based maps”.
Page 83 “The superior colliculus has 7 layers. Layers I -III are the “superficial” layers, while layers IV through VII are called “deep”. All the connections coming into and going out of the superficial layers have to do with vision, and layer II, the main superficial layer, recieves signals from the retina and from the primary visual cortex. These superficial layers assemble a retinotopic map of the contralateral visual field.
The deep layers of the superior colliculus contain, in addition to a map of the visual world, topographical maps of auditory and somatic information, the latter hailing from the spinal cord as well as the hypothalamus. The three varieties of maps- visual, auditory and somatic are in spatial register. This means that they are stacked in such a precise way that the information available for one map for, say vision, corresponds to another map related to hearing or body state. There is no other place in the brain where information available from vision, hearing and multiple aspects of body states is so literally superimposed, offering a prospect of efficient integration. The integration is made all the more significant by the fact that its results can gain access to the motor system (via nearby structures in the periaqueductal gray as well as via the cerebral cortex).
Damasio then goes on to discuss the action that occurs when a lizard flicks out its tongue and catches a passing fly- and the fact that most of the critical relaying and cross referencing of information (including information about the lizard’s hydration and energy status) occurs in the superior colliculus.
Now this model works well if there is a stable one to one relationship between the information entering the brain and the actual source of the information.
The presence of an upper cervical malalignment introduces two difficult elements-
As an example let us assume a minor forwards rotation of the right atlas articular process on the right occipital condyle.
This introduces false information into the brain (effectively informing the affected individual that the right side of his body is pointing to the right and not straight forwards).
This can be demonstrated reasonably straightforwardly by performing a Fukuda test: Instead of being able to march up and down on the spot with eyes shut the individual will drift forwards and to the right. Equally, the affected individual will tend to drift to the right when walking or swimming and sit in the right hand side of the lane when driving. They will also tend to erroneously throw to the right of their target if they can be encouraged to try (many people with this injury will be sufficiently ashamed of their poor co-ordination to refuse even trying to throw a ball).
Now ordinarily our brains can adapt to a distortion in the input information and reconstruct an effective hologram– providing that that distortion remains stable.
A good example of this adaptability of brain function can be seen in this video at about 4 minutes:
(Being Human: Perception and the Brain)
However- in the case of the man throwing the ball at the screen, he has the advantage of being given an acute distortion of his perception (in terms of the prism lenses he was asked to wear and then remove) and he had the added advantage of being told what had been done to him. Given the advantage of being told he actually started correcting his function quite rapidly. It is notable that towards the end of the experiment the prism glasses are removed and the subject has to re-adapt his motor behaviour to cancel out the correction that his brain had started to factor in.
However- the unfortunate individual with an upper cervical malalignment must battle with an unidentified mismatch between body position and proprioceptive input- and associated muscle spasm as the body braces to protect the spinal cord.
This situation is bad enough if that individual acquires an atlas malalignment in later life, but should the injury occur at birth or in infancy the malalignment can impact upon the whole of neuromotor and perceptual development, resulting in the syndromes that the orthopedic surgeon Heiner Biedermannn calls KISS ( Kinematic Instability with Suboccipital Strain) in infants and KIDD (Kiss induced Dyspraxia and Dysgnosia) in schoolage children. KIDD is clinically indistinguishable from ADHD.
(Ref “Manual Therapy in Children” Ed Heiner Biedermann).
Individuals with an acquired rotatory malalignment of the upper cervical spine have their situation complicated by spasm and guarding of the upper cervical joints, resulting in a fixed hyperextension of the C0-1 joint, a tendency to a sitting posture with thoracic kyphosis and forward head posture
(the orthopedic and autonomic consequences of which will be discussed in another post). However, of direct relevance to the theme of this article, the persistent forward head posture vastly reduces mobility of the facet joints in the upper cervical spine. Proprioceptive input from these facet joints and related musculature is one of the major sources of the stimulus that drives the operation of consciousness. In particular the resting tension of the suboccipital musculature is especially important. Suboccipital spasm causes an inhibitory post synaptic output from the cerebellum- which is forwarded back to these muscles and forward to the contralateral frontal lobe. Thus individuals with a right atlanto-occipital malalignment will suffer chronic suppression of left frontal lobe activity and be more prone to being right hemisphere dominant in their function. In itself this is one of the major drivers of the dysregulated impulsive emotionality of the ADHD individual.
Again as an aside from the main theme, the relative immobility of the upper cervical facet joints leads (via reduced proprioceptive input) to a decrease in endorphin production, upregulating the individual’s sensitivity to pain.
So it can be seen that upper cervical malalignments can directly lead to a series of serious consequences impacting upon perception, attention and motor output.
Firstly there is a subtle balance impairment. This balance impairment (in conjunction with motor impairment) can be seen in the subtle clumsiness of most ADHD individuals (who are very prone to bumping into solid objects like doorways and the corner of tables), though some individuals manage to master particular tasks, and can make very fine, though injury prone, athletes. Often though these individuals will retain subtle clumsiness inother domains of function. The balance impairment will also often show up in a fear of heights and in falling dreams. It can be demonstrated by testing for Romberg’s sign, and by assessing heel toe gait with eyes open and closed. (The worse gait with eyes closed clearly illustrates an underfunctioning vestibulocerebellar system and over reliance on vision to navigate through the world). These problems represent a direct and severe drain on working memory- an acknowledged problem in ADHD.
Secondly, there are perceptual issues as well- such as difficulty with 3 dimensional orientation, and confusion between left and right. Dyslexia may well be an expression of this problem. Individuals with significant malalignment issues also have great difficulty in mirroring activity when being taught new movements. This can be seen very well in activities that require high attention to detail- such as Tai Chi. I would argue that the great capacity of us ADHD individuals to lose things is, in part related to these perceptual issues, as is our notably higher risk of car accidents.
I would argue that in the presence of upper cervical instability the individual is presented with an ever changing variability in the correspondence of body position, proprioceptive information reaching the brain stem, balance information from the vestibular apparatus and visual input. The problem is made more complex by the tendency of affected individuals to hold the head tilted, further increasing the complexity of processing required to maintain the coherent “reality hologram” required to act asa template for motor output.
In this context the issues of sensory integration seen in ADHD (and in other psych disorders) become more comprehensible. It is arguable that much of the intolerance of many ADHD individuals for noisy or chatoic environments or for certain tactile, taste or odour stimuli simply reflects the functioning of a system struggling to integrate mismatched sensory information.
At this point it may be worth reporting my personal experience with my unstable upper cervical spine. When the spine is out of alignment for any period of time, I will develop a cluster of predictable symptoms- a predictable pattern of right sided muscular spasm and body pain, dysarthria, difficulty in challenging motor tasks such as reverse parking my car, and blurred vision in the right eye. I also will rapidly develop sensory integration issues- such as intolerance of noisy environments or tight fitting clothing.The blurred vision is particularly interesting, as with ongoing meditation practice I have developed the capacity to see directly that what I am seeing is a distortion of visual input- such that upright objects in my right visual field appear distorted – with their upper parts pushed to the right. This distortion is reversible in real time if I loosen, unlock and straighten my upper cervical spine, which I can now usually manage without the assistance of a manual therapist, thanks to my Qi Gong / Tai Chi training.
[The issue of reporting personal experience in a blog that aims to focus on scientifically verifiable data is a thorny one- but I hope that the readers will forgive me putting this observation “out there” in the hope that someone can point me in the direction of some already completed scientific research data on this subject. However, the intermittent dysarthria has been verified by my own physician].
The improvement in perceptuo-motor function following adjustment to the upper cervical spine is clearly demonstrated in Heiner Biedermann’s book Manual Therapy in Children on page 170, which illustrates improvement in drawing ability in a 6 year old child over a 5 week period following a single adjustment to the upper cervical spine.
I note also recent work in which the issue of unstable gaze in ADHD (usually improved by stimulants) is discussed and proposed as a part of a diagnostic work up for ADHD.
ref: ADHD subjects fail to suppress eye blinks and microsaccades while anticipating visual stimuli but recover with medication
Moshe Fried a, Eteri Tsitsiashvili a, Yoram S. Bonneh b, Anna Sterkin a, Tamara Wygnanski-Jaffe c,d, Tamir Epstein e, Uri Polat a,⇑
Volume 101, August 2014, Pages 62–72
This phenomenon would certainly be at least partially explicable in the light of the issue of mismatching information being fed into the superior colliculi- which play a major role in regulating eye movement.
A further clinical observation relevant to the improvement in function on stimulants may be the simple one that individuals on stimulants and quietly engaged in an interesting task tend to hold a more upright posture- and so would tend to have unstable joints settle into place and reduce the mismatch of information entering the brainstem. Again, this is speculative, but it may well provide a further mechanism for the function of these medications.
Finally, I would note that where present, such cervical malalignments would also provide a very clar cut explanation for the dyspraxia/ Developmental Coordination Delay seen in about ½ of all ADHD individuals, and the lesser degrees of problems with co-ordination seen ain many others.