2.5. The role of the image in Early Modern Age
2.5.1. The new possibilities of the images
Normally an infant is born with a genetically deter
mined specialty for each hemisphere of the brain. This assigns specific dominance to each side of the brain. The dominance must be organized throughout the body for proper function. Doman and Delacat03 present a work
ing hypothesis on the development of the nervous sys
tem through bilateral function and final dominance. They describe the development of the nervous system from infancy where there is reflex action only, to homolateral activity where the two sides of the body function inde
pendently, to use of the two sides of the body together, and finally to cortical hemispheric dominance. Their hy
pothesis indicates that some individuals may not go through the normal stages of development. As a thera
peutic approach, they developed a system of taking an individual back through the stages of crawling and creep
ing to develop homolateral, bilateral, and finally neuro
logic dominance. Their application is to individuals with speech and reading problems, as well as other types of learning disabilities and functional neurologic prob
lems.9,1J,12 In many instances the evaluation and treat
ment procedures extend to children diagnosed as having minimum brain damage.
The concepts presented by Doman and Delacato were actively pursued in the fields of education and re
habilitation in the 1960s, with many excellent results.
There are those in the educational field who now down
grade the importance of their work. Certainly this ap
proach is not a panacea for all reading, speech, and learning difficulties. Their concepts, however, provide many correlative findings with those in applied kinesiol
ogy. The key is to have a method of diagnosing the need for cross patterning, which applied kinesiology appears to supply.
Diagnostic methods, as described by Doman and Delacato, may sometimes indicate a need for a program of crawling and creeping. Applied kinesiology examina
tion and findings may point to some other mechanism interfering with the normal expression of properly
devel-5-9.
oped neurologic function. In these cases, treatment to other factors may restore normal body organization with
out cross patterning. This may shed light on why some individuals who seem to need Doman and Delacato's therapeutic approach do not respond adequately to the procedures; there may be some other aspect interfering with normal function that has not been found and cor
rected.
Delacato hypothesizes that a child goes through five stages of development, beginning with the lower spinal cord and medulla oblongata reflexes that are present at birth to approximately sixteen weeks. Next, homolateral function of the visual and auditory mechanisms devel
ops during the pons level at sixteen weeks to six months.
From six months to one year the midbrain develops, pro
viding the cross-pattern mechanism and using both sides of the body together. This is an important area of devel
opment that prepares the child for function in an upright position. Early cortical function develops within the age range of one to five years. During this stage there is con
tinued bilateral development, and walking begins. Finally, from three to eight years cortical and hemispheric domi
nance develops, giving right- or left-handedness and con
tinued neurologic organization.
Physical activities from infancy through the devel
opment of bilaterality and cortical hemispheric domi
nance are important in developing the nervous system's organization. At the early spinal cord and medulla ob
longata stage, there is no purposeful mobility; it is undu
lating and fish-like in character. As the infant develops into the pons level, sight and sound become important but the eyes and ears are not organized to function together; they function homolaterally, unable to locate sounds or have efficient depth perception. At about six months of age the midbrain stage develops. Here the child develops the ability to use both sides of the body together and coordinate body function, such as the hand with the eye. During this period, the child learns to use his arms and legs together and crawl in a cross-pattern motion.
"Cross pattern" means that he moves his arm and leg into flexion on opposite sides, while the contralateral arm and leg move into extension. This is an important phase of development to complete before moving on to the development of cortical hemispheric dominance.
Early cortical function begins at about one year of age. Bilateral use becomes increasingly efficient. At this stage the child begins to pull himself up on furniture and takes his first few steps in becoming a biped. His arms do not function in a cross pattern; rather, they act as balancing staffs. According to the hypothesis, early cor
tical function should not begin until there is fairly efficient bilateral function. Entering this stage too soon seems to retard the efficient development of bilateral function.
Cortical hemispheric dominance begins to develop at about three years of age. Dominance usually begins
with hand choice, followed by eye, foot, and ear domi
nance. One-sided dominance is unique in man. It is usu
ally fully developed by five to eight years of age.
The same dominance should be developed through
out the body; that is, an individual should be either right
or left-footed, -handed, -eared, and -eyed. A high per
centage of individuals have neurologic disorganization.
A military study of 38,430 personnel found 15% to have mixed dominance. This group required a disproportion
ate amount of orientation and training to achieve the de
sired results in marksmanship and combat training.2
Intrauterine -16 weaks
Spinal cord and medulla oblongata, reflex actions only.
16 weeks -6 months
Pons. Homolateral activity of visual and auditory func
tions.
6 months -1 year
Midbrain. Cross pattern, quadruped crawling, develop
ment of using both sides of the body together, important area of development to prepare child for upright position.
1 year -5 years
Early cortical function, walking, and continued bilateral development.
3 years -8 years
Cortical hemispheric dominance; develops right or left dominance and continued neurologic organization.
5-10.
An individual's hand dominance is most easily rec
ognized. Sometimes an individual will have mixed domi
nance of hand function, writing with the right hand and performing sports activities with the left. Observation of an individual's writing should be supplemented by obser
vation of physical activities such as hammering, catch
ing a ball, and other ordinary activities. When asked to cross the arms, the typical reaction is to place the domi
nant one on top.2
The most common clinical observance of crossed dominance is failure of hand and eye dominance to be the same. There are several methods for determining near
and far-point eye dominance. To determine far-point bin
ocular dominance, give the individual a tube to hold in both hands at arm's length and have him look at a dis
tant target. The examiner observes which eye the indi
vidual uses in lining up the tube to observe the target. A monocular far-sighted test is done by giving the individual a sheet of paper with a half-inch hole cut in it. The sub
ject is asked to line up the distant target in the hole and bring the paper to his face, maintaining visual contact with the target. The opening in the paper will be brought to the dominant eye.
Evaluating near-point sight is similar to evaluating far-point. The individual being tested is seated at a desk and given a tube 3" to 5" in length, with an opening of about 3/4". On the desk is a sheet of paper with an "x"
marked on it. He is asked to look at the x through the tube and bring the tube slowly back to the eye, without losing sight of the x. The eye to which the tube is brought is the dominant eye.
Another method of near-point sighting is for the examiner to hold his finger approximately 36" from the patient's face. The patient is then asked to align his in
dex finger with the examiner's finger. The patient's finger should be approximately halfway between the examiner's face and his own. The patient's index finger will line up with the dominant eye.
Each of these sighting tests should be done three times. It is best to alternate them so that a practice or habit pattern does not develop.
Foot dominance is determined by observing which foot the individual uses in kicking and doing intricate activities, such as picking up marbles. Pedal dominance can be observed by having the individual step up on a chair or a step. Since approaching the object and then stepping on it may predetermine the foot used, the indi
vidual should be placed directly in front of the object and the activity begun from a standing position. The individual will typically use his dominant foot to step on the object.2 To determine ear dominance, give the individual a watch or something else with a low sound, but not a musical one. It will usually be held to the dominant ear.
The clicking sound is best interpreted by the logical math
ematical left brain in the average individual, while the musical sound is best interpreted by the tonal right brain.
Each side of the brain receives input from both ears. The crossed connections are stronger than the uncrossed ones. 10
5-11. Normal cross crawling of child develops bi
laterality.
Disturbed Development
The child's development from early cord and me
dulla stages through pons, midbrain, early cortex and, finally, through cortical hemispheric dominance can be interfered with in many ways. During development the child can have a brain injury, severe febrile disease, or any other disease that interferes with normal nerve func
tion. Since freedom of activity is very important in devel
oping through the different stages, restriction can cause lack of normal development. Adults often cause the re
striction by confining children in plastic carrying baskets, playpens, and walkers. Heavy clothing, if worn frequently, is also restrictive.
Normally, when a child breast-feeds, one eye and arm are alternately restricted as the mother uses the op
posite breast on subsequent feedings. The bottle-fed baby is usually held with the mother's left arm while she holds the bottle with her right hand. Consistently feeding the baby in the same direction restricts one arm and often an eye, retarding bilateral development. The bottle-fed baby should be held in alternating arms from feeding to feeding.
5-12. Constantly holding child in same position restricts the use of the limbs and eyes bilaterally. The child should be held alternately in the right and left arms from feed
ing to feeding.
When the baby begins eating solid food, there is a tendency for an adult to place the child in a restrictive high chair and encourage the use of a spoon. During the development of the midbrain and early cortical stage, bilateral function is enhanced by eating with both hands.
Using a spoon at this stage forces the child into unilat
eral dominance prior to readiness.
Adults tend to force a child to stand and walk too rapidly. Parents take pride in a child's early walking and early self-feeding. Actually, this often forces the child into advanced development for which he is not ready. Profi
cient development of cortical hemispheric dominance may be interfered with or delayed. Children develop at
5-13. Use of eating utensils begins development of unilaterality and dominance. Observe that this child's eyes are not functioning together, an indication that bilateral
ity has not yet been developed. The child is not ready for unilateral dominance development.
different rates and should be allowed to go through the stages of development at their own speed.
Adults should not attempt to change a normally developing left-dominant child to a right-dominant one.
If the genetic code is present for left dominance it should
5-14. 5-15.
Children should not be forced into early walking.
5-16. When the child is ready to start walking he will first pull himself up into a biped position, then begin tak
ing steps on his own.
develop normally, even though the left-dominant indi
vidual will have more problems than the right-dominant one. It is recognized that it is very difficult for a left-domi
nant person to live in a right-dominant world, but it is worse to have poor neurologic organization.
Cross-Pattern Treatment
Cross-crawl patterning was introduced into applied kinesiology by Goodheart. 41t is a modification of Doman and Delacato's creeping pattern. 3 Creeping, in Doman and Delacato's work, is the cross-pattern hands and knees crawl in quadruped fashion. This is called crawling in applied kinesiology. Early in applied kinesiology nearly everyone who was neurologically disorganized was put on a cross-patterning exercise. With the methods of finding the cause and correcting the neurologic disorganization described previously, cross patterning is not needed as often. It is prescribed when there is evidence of improper development. This may be the result of restrictive child
hood actions, described previously. The child may have had a prolonged restriction, such as a leg or an arm cast as a result of bone fracture. Severe health problems dur
ing the neurologic developmental stages may have inter
fered with normal progression.
Crossed dominance and general disorganization are indications for cross patterning. One should first evalu
ate for neurologic disorganization and correct its cause.
When there is recurrent neurologic disorganization or dif
ficulty in obtaining correction, cross patteming often helps obtain correction and better organization.
Patterning is usually done with the patient supine.
His opposite arm and leg are flexed to the maximum and then returned to the table. To complete one cycle, the other arm and leg are then fully flexed. The therapeutic effect of the cross patterning is enhanced by turning the head to one side during half the cycle. The patient is considered patterned to a particular side when the head is turned to the side of shoulder flexion; the head is main
tained in a neutral position when the opposite shoulder is flexed. The direction in which the patient is patterned does not necessarily correlate with the dominant hemi
sphere or any aspect of bilateral brain function. The pa
tient may require patteming to either side, but not to both.
The side to which the patient is to be patterned can gen
erally be determined by testing internal thigh rotation. The examine\ grasps the patient's ankles and internally rotates both legs. The side of greatest internal thigh rotation is usually the side toward which the patient should turn his head when that arm flexes. The greater internal thigh rotation usually relates to relative weakness of the psoas and piriformis. Greater weakness of muscles on one side of the body also indicates the need for cross patterning and the side toward which to pattern.
Although the thigh rotation test generally shows the appropriate side for patterning the patient, it is absolutely necessary to use a therapeutic trial to determine if this
5-17. Leg internal rotation test showing right leg with more available medial rotation, indicating a probable right cross-crawl pattern.
direction enhances muscle function. This is accomplished by having the patient perform the procedure for approxi
mately six cycles, then testing previously weak muscles to determine if function has improved. An important se
quential test that should always follow is to have the patient pattern in the opposite direction; the muscles should again test weak. This is extremely important be
cause improper application of cross patterning not only fails to help the patient, it can potentially harm him.
There is a type of patterning that differs significantly from the cross pattern described here. It is called a "ho
molateral" crawl pattern, which GoodheartS associates with schizophrenia. A homolateral pattern refers to flex
ion of the ipsilateral arm and leg, first on one side and then on the other. An individual organized in a homolat
eral pattern will test weak throughout the body for a short time after doing cross-pattern activity. Cross-pattern ac
tivity administered to an individual who is in homolat
eral organization can cause significant exacerbation of symptoms.
Homolateral organization requires a specific thera
peutic approach. Cross patterning should not be admin
istered to an individual with this type of organization. (This is further discussed on page 438.) This is one reason it is absolutely necessary to do a therapeutic trial whenever cross patterning is prescribed for a patient.
Some types of exercise apply an improper neuro
logic pattern and cause recurrent neurologic disorganiza
tion. An example is a rope and pulley arrangement where the individual pulls the leg into hip flexion with homolat
eral arm flexion.14 The same type of exercise, but done on a cross pattern, will probably cause no harm.
Many individuals who require cross patterning are neurologically disorganized. They often fail to understand instructions properly, and it is quite possible that the pro
cedure may be done improperly at home. It is advisable, especially with children, to have another individual
5-18. Right cross pattern. Head turns to the right as right arm and left leg flex.
5-19. Right cross pattern. Head stays straight as left arm and right leg flex.
5-20. Right homolateral pattern. Head turns right as right arm and leg flex.
5-21. Right homolateral pattern. Head stays straight as left arm and leg flex.
ob serve the procedure and note the instructions for do
ing it. One should also write down the instructions so the patient has the correct information to refer to at home.
It is important to re-evaluate the patterning as treat
ment proceeds. Neurologic organization may change. The individual may need patterning to the opposite side, or he may no longer need patterning.
Thirty cycles a day are usually sufficient for estab
lishing neurologic organization. In some severe cases it may be necessary to do thirty repetitions three times a day. If the individual engages in some activity, such as swimming or running, it may be advisable to do the pro
cedure immediately before and after the activity. The length of time the procedure must be performed varies from several weeks to many months, depending on the condition's severity. If the activity is still needed several months after diligent patterning, some other factor is prob
ably causing the neurologic disorganization. The patient should be thoroughly re-evaluated for its cause, as indi
cated previously in this chapter.
There should be mind-body integration with the cross-patterning activity. Sometimes when one has done the cross patterning for a few weeks it becomes almost automatic, needing little or no thought. In this case weak muscles will fail to test strong after the patterning. Sim
ply have the patient think through the process, repeating
ply have the patient think through the process, repeating