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Old 02-04-20, 11:18 PM
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Binocular vision in ADH.

Those who know the "old me" will remember my strong interest in the relationship between neck injuries and ADHD- especially birth injuries.

Well, that question has just gotten a lot more interesting. Ive been looking closely at the neurology involved, and finally gotten clear evidence that eye movements and binocular vision disorders are apart of the problem.
In fact the two issues, ADHD and BVD are probably, in many cases, the same problem described by different consultants.

this is worth close attention as it offers an additional approach to us all achieving

This is a very long post on my blog, revised today.
http://wordpress.com/post/atlassublu...dpress.com/526

Here's a significant part of it.
My apologies for the length:
Quote:

The situation is that there is very marked cross over between ADHD and Binocular Vision Disorder (BVD), to the extent that it is probable they are in many cases, the same thing.
These conditions can present simply as ADHD, or as more complex syndromes with neck pain and head tilt, or with very few symptoms, so there is not a full, one to one overlap between them. The incidence

Ophthalmologists classically highlight traumatic brain injury as a cause, and highlight vertical eye misalignment (vertical heterophoria) as the most troublesome variant.
At this point it is worth highlighting some of the main features:
If we are to see the world properly we need to have both eyes looking at exactly the same point. The structure of the retina is in layers, deep to the rods and cones there is a layer of ganglion cells. All rods and cones feed I to only one ganglion cell, so the ganglion cell is the measure of visual field. Each one covers an area about 40 seconds of arc wide. ( A very small distance).

If the images are not matched, the brain will receive 2 images one into each eye.
The neurological response is to suppress one image, and use the other one for sight, but the second image is used for the balance system- which is now receiving asymmetrical information.

The outcomes here are a stress response- all the time (hence much weight gain, irritability, impulsivity) and a failure of muscle tone. If the brain has an orientation issue like this it has difficulty in maintaining upright posture and good muscle tone. Very frequently the patient will develop a persistent head tilt, and hence an upper cervical subluxation, and now we finally see why this is relevant to “Atlas Subluxation and ADHD” In fact these three systems (proprioception, vestibular, and oculomotor) are interlinked and a perturbation in one will disrupt normal function in the others. It is likely then that a wide range of initial insults could initiate this pattern.
We will return to this systems theme and deal with upright posture and attention in a later piece, but for now we will focus on more detail relating to vision..
Working memory is a term often discussed in ADHD. The traditional view has been that we do not have enough of it. I always felt that was wrong. The alternative hypothesis is that we have some “resource hog” wasting all our working memory.
https://www.sciencedirect.com/scienc...28393298000049
Saccadic eye movement and working memory deficits following damage to human prefrontal cortex

In short, saccading as we move along the line reading is a process that demands working memory. The system has to be able to hold in working memory the initial position of the eyeball, and the target position of the eye ball. This is all very well if your system is working efficiently but many ADHD individuals have enormously dysfunctional reading patterns maybe needing 5 times as many eye movements to read the same passage. That consumes a lot more working memory.
The other item consumed is neurotransmitters:

Effects of Dopamine and Norepinephrine on Exercise-induced Oculomotor
Fatigue
Article in Medicine & Science in Sports & Exercise · April 2017
(https://www.researchgate.net/publica...omotor_Fatigue)

This experiment looked at oculomotor fatigue as an item compromising athletes in demanding events. It demonstrated that acute dopamine reuptake inhibitor (Ritalin) and Noradrenaline reuptake inhibitor (reboxitine) prevented fatigue-related impairments in oculomotor control.
This gives us a clear relationship between the current use of stimulants in ADHD, oculomotor fatigue (overdrawn working memory) and dysfunctional oculomotor control, as seen in binocular vision disorder.

Binocular vision disorder is common (about 10% of the population), but its presentation is heterogenous, and many will not present with attention issues. However the idea that it may be a major final common mechanism for ADHD symptoms is strong and well supported.
Finally, the main emphasis in ADHD research has been the fronto- striatal loops in the brain, which are typically underachieve, and the relevant areas of the brain marginally smaller.

It is important to understand that that information about the fronto striatal loops is not at all inconsistent, with this understanding of subcortical contribution to ADHD symptomatology.
the likes explanation is that due to these issues with eyes balance and coordination is perfectly consistent with the information about the fronto striatal region. The basic idea here is that, as a result of the unstable autonomic nervous system (read by our brains as a sign of danger, plus the added burden created by these balance, coordination and eye coordination issues) more decision making becomes automatic/ reflexive and bypasses the fronto striatal process. The fronto striatal system, like all brain parts, requires the stimulus of repeated and diverse activity to grow fully. In this context ADD can be seen not as a "dopamine deficiency disorder" , not as a striata- frontal problem, but more as a particular whole brain issue. However, the old assumptions about behaviour and the coaching and counselling issues become less relevant. A neurologically informed approach to ADHD emotion and behaviour counselling is arguably better directed towards dealing with the underlying neurological issues, but understanding that most of the trouble is driven by stress responses of which we have become unaware. IE If we proceed with a psycho-education approached buffered with at least some basic body mindfulness (I suggest the term diagnostic body scanning- like going to the mechanic), and an understanding that our brittle systems create a situation in which we are more likely to hit overload and "tilt". To me, it seems that we need to focus on stress response prevention, coupled with as much awareness as possible, and the understanding that if we pull back when we are fatiguing (but others are not) we are acting with compassion towards ourselves, and everyone else.

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Last edited by namazu; 02-05-20 at 12:06 AM.. Reason: fixed quote tag
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Old 02-05-20, 03:40 AM
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Re: Binocular vision in ADH.

This makes a lot of sense to me.

-When I was younger I always worked construction labor very physical type jobs, and I always felt to tired to focus.

I now think this is one way I semi controlled my attention deficit and hyperactivity, before being officially diagnosed at age 35. (when started taking methylphenidate).

*Interestingly I could not focus to read a measuring tape until after the age of 35, when I started taking medication.

-I have also noticed a huge reduction in my general motivation for physical exercise, has dramatically reduced since taking medication.

-I also noticed a huge decline in my ability to focus after I worked as a line cook.

(and started smoking pot everyday since the day I started being a line cook)

( I was also more quickly irritated, when I forgot to take medication, or when the medication started waring off.)

(as a line cook, forced to constantly read food order after food order, my top down executive functions where always burnt out, and I was always distressed and really tired, and never had any motivation to read anything) (people told me they think I changed because of the distress of being a line cook)( I was also always worried I was going to miss part of the order, and had to constantly double and triple check)


This happened much less when I was washing dishes.

When I washed dishes, I used to come home and paint for hours. (I also was taking medication) I never smoked any pot , when I was a dish washer.

I am all over the place, but do not want to forget this train of thought, will rewrite tomorrow.

I have lots of questions.

Feels like I am talking to the old you? (feels more like a seasonal, what comes around goes around thing, than an old you verses a new you, to me)

Maybe this is why I like to leave a open space at the bottom of my posts, and space between sentences?

I have a tonne of more things to say.

Feel free to agree or disagree ( am wondering the differences between TBI influencing top down function, verses, neurodevelopmental distress of hypersensitive bottom up function, etc.




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Old 02-05-20, 09:36 PM
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Re: Binocular vision in ADH.

I am wondering if you have have also discovered a link between 3 categories affective response systems and facial expressions?

There are so many perspectives involved in a whole brain perspective.

If I seem to be derailing the thread discussion, that is not my intention.

Trying to find a starting point in a whole brain theory, ideas?


Question

-what are stress responses?

2 types of affective stress?

Affective Distresses and Affective Eustresses

Distresses originate from negative feeling affective response systems?

Eustresses originate from posiitive feeling affective response systems?


Binocular vision disorder: negative feeling auditory-affective response?

Binocular vision disorder like ADHD is normal in early life?


Quote:
Binocular vision: The ability to maintain visual focus on an object with both eyes, creating a single visual image. Lack of binocular vision is normal in infants. Adults without binocular vision experience distortions in depth perception and visual measurement of distance.


















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Old 02-06-20, 03:11 AM
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Re: Binocular vision in ADH.

I think it is better to work this system before going to other issues.
One of the big problems is that "whole of brain" is a very big system to deal meaningfully.


However with regard to "stress", an elevated sympathetic tone from a physical cause can still skew our social perceptions and make us over reactive to situations which it might have been more helpful to ignore.

Even if you do cruise past the risk of over reacting to or over interpreting other people's behaviour, the stress responses can still be unpleasant and disruptive in themselves, and if frequent, will cause a syndrome often called "Sympathetic dominance" with more serious metabolic consequences like weight gain, hypertension, diabetes etc.DOTcom/blog/sympathetic-dominance-low-heart-rate-
variability-and-your-ill-health




Yes, I am sure you are right about your spacing when writing.
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Old 02-06-20, 05:33 AM
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Re: Binocular vision in ADH.

One other point I would make is that this is only one factor in the causation of ADHD symptoms.(though I think a big one)

When i started stimulants I had a huge improvement, including an improvement in vision (not documented).
I had more improvements when I had the initial treatment on my upper neck in late December 2009. Better alertness and energy, better coordination.

When I identified this specialist neurorehabilitation chiropractor in June 2011, though, my eye movements were appalling.

Now there is a lot in that initial report, but the presence of dysfunctional eye movements is very clear:


Quote:

ignificant examination findings were marked Collier's Sign bilaterally, failure to habituate to glabella tapping, very poor vertical and oblique saccades, +ve pointed and parallel rhomberg's tests with bilateral instability. Unstable phasic response to centre of pressure challenges standing was noted, worsening with R eye centrally occluded. Increased sympathetic response to ventral attention system challenges (firing/upregulating into the R hemisphere dominantly) So- a brain based overactive sympathetic nervous system- a great basis for impulsivity using movement in his visual peripheries b/l suggested a relative down-regulation of the dopamine-dependant dorsal attention streams bilaterally though to a greater extent on his L hemisphere. Poor cerebellar tone was demonstrated bilaterally with disadiadokic movements.

Significant relief to his postural discomfort was recently obtained with a C1 repositioning treatment.

This pattern implies a soft lesion in the pre-tectum ( a soft pre-tectal syndrome pattern) with consequent diaschisis predominantly into his L hem. This suggests Andrew is experiencing two problems concomitantly.

Given the above pattern of cerebellar driven asymmetry of eye movement with consequent down-regulation of mid-line vestibulo-spinal integration, particularly in the sub occipital muscles on the right I have suggested a combination of vestibular exercises via two sets of afferents. These are 1) the para-spinal muscles, one of the great proprioceptive inputs to the cerebellum and the 2) dorsal attention system activation aimed at the L hemisphere's vision pathways both cortical and subcortical. This combination of cortically and sub-cortically led exercises has been applied consistently.
So, at that point I had significant problems with eye movement regulation, among other things.
Yesterday I had an eye check and there was only a minimal binocular vision issue.
My main problem, and brain fog- but is now rapidly resolving.

I will come back to some of these other issues in later threads, but for now the main points are the multiple issues and complex causation of my ADHD, and the very pleasing one that these are now resolving fast.

So if you can take it in you can see that this functional neurology is remarkably helpful.

No conventional doctor could come close to reversing that mess..


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Old 02-06-20, 06:46 PM
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Re: Binocular vision in ADH.

Quote:
Bifocal lenses help to make it easier on the eyes to focus by providing the lens power needed to see comfortably both up close and in the distance.

Other conditions for which bifocals may be prescribed for children include binocular vision disorders and visual problems associated with desk or computer work.

http://cdn.ymaws.com/www.covd.org/re...r_children.pdf

The link above does not discuss attention disorders, but the internet does have research about binocular vision disorder and binocular vision disorder is very very common in people who have AD(H)D.

Neck pain is also very common in people who have binocular vision disorder in the articles I read.

So it seems your perspectives based on your experiences are very valid.

I found one article, if i understood correctly concluded that medication did not help improve binocular vision disorder, in children with AD(H)D?

(I presently only found one article) but the differences in the medication effects, when experiencing TBI verses AD(H)D, in regard to improving (or not) binocular vision needs more inquiry)

(I am not sure about research that studies the same students, on and off medication, due to the effects of sensitization and desensitization,etc)(much better to study people who have AD(H)D who do not take medication, verses, people who have AD(H)D who do take medication.)

Overall, i find the discussion topics to be very motivating, and I greatly appreciate the help.






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Old 02-06-20, 07:10 PM
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Re: Binocular vision in ADH.

I think, due to inherited epigenetic factors, and/or, adverse early childhood experiences, we are born with even more sensitive distress response systems than typical.

Making your "resource hog" distress theory, and the value of your compassionate self-compassion treatment approach, even more likely.










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Old 02-06-20, 10:05 PM
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Re: Binocular vision in ADH.

Quote:
Originally Posted by mildadhd View Post
The link above does not discuss attention disorders, but the internet does have research about binocular vision disorder and binocular vision disorder is very very common in people who have AD(H)D.

Neck pain is also very common in people who have binocular vision disorder in the articles I read.

So it seems your perspectives based on your experiences are very valid.

I found one article, if i understood correctly concluded that medication did not help improve binocular vision disorder, in children with AD(H)D?
Overall response rate to stimulants is about 70%, maybe 80 % if all options are tried.
The sense that I am getting is that BVD is a significant portion of ADHD ad that addressing it will minimise ADHD symptoms without medication.


Now if that is right it may settle symptoms in a large portion of ADHD individuals as opposed to palliate them with stimulants.



That also fits with the neurorehab approach to ADHD,
See this YouTube- it is addressing vision rehab, though not specifically binocular.


This one also addresses the eye- neck- balance triad:
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Old 02-06-20, 11:53 PM
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Re: Binocular vision in ADH.

Quote:
Originally Posted by mildadhd View Post
I am wondering if you have have also discovered a link between 3 categories affective response systems and facial expressions?

There are so many perspectives involved in a whole brain perspective.

If I seem to be derailing the thread discussion, that is not my intention.

Trying to find a starting point in a whole brain theory, ideas?


Question

-what are stress responses?

A stress response is an adaptive response of the autonomic nervous system aimed at directing resources towards an expected physical challenge-be that fun and games or a more dangerous challenge.
I think that the "eustress/distress" model is less useful when talking in these terms.
IE - If I need to stand up, I must make certain adjustments to my blood flow to effect that change in posture. That is not an affective or a non affective response- it is a practical one.



Quote:

2 types of affective stress?

Affective Distresses and Affective Eustresses

Distresses originate from negative feeling affective response systems?

Eustresses originate from posiitive feeling affective response systems?


Binocular vision disorder: negative feeling auditory-affective response?

Binocular vision disorder like ADHD is normal in early life?

Well actually, lack of binocular vision is normal in early life (and babies are remarkably disorderly )- so the term "binocular vision disorder" cannot be meaningfully applied!

One of the things i am picking up on more and more- especially in psychiatry, is sloppy use of the English language generating meaningless propositions.


Call me old fashioned.






















m[/quote]
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