Learning Difficulties, Chronic Pain and Physiotherapy
by Sean GT Gibbons BSc (Hons) P.T., MSc Ergonomics, MCPA

What are Learning Disabilities?

Learning disabilities are conditions of the brain that affect a person’s ability to take in, process or express information. There is a disorder in one or more of the processes
involved in understanding or in using language, spoken or written, which may manifest itself in an imperfect ability to listen, think, speak, read, write, spell or to do math. There are four main categories of learning disabilities: reading disorders, mathematics disorders, disorders of written expression and learning disorders not otherwise specified. As many as twenty percent of school age
children may be affected by learning disabilities, however the exact amount is not known. Without intervention, these children may carry their learning problems into adulthood.

Relationship between Learning
Disabilities and Substance Abuse

There are many possible causes and contributing factors related to learning disabilities. A genetic link has been found with certain types of learning disabilities. As well, there appears to be environmental and developmental
associations such as: a low birth weight, complications with pregnancy, absence of breast feeding, exposure to
alcohol, tobacco and illicit drugs in the womb and
dysfunctions of child development (i.e. exposure to toxic chemicals, experiencing high amounts of stress and anxiety). There is evidence of a link between learning difficulties and substance abuse, however the mechanism is unclear. Learning disabilities are associated with social rejection, low self esteem and depression. It has been proposed that drugs or alcohol are used to counteract these psychological effects, while a second theory suggests that people with learning difficulties may use drugs or alcohol to attempt to treat their own problem.

Physiotherapy and Learning Disabilities

Some physical problems associated with learning disabilities include problems with balance, coordination, aspects of vision, and primitive reflexes. Primitive reflexes are survival reflexes that emerge during development in the womb and during the first year of life. For example, the rooting and sucking reflexes ensure the baby can breathe and feed. The persistence of primitive reflexes beyond their normal time span can interfere with normal development. The presence of physical problems with learning disabilities creates a mechanism by which exercise may improve some of these deficits.

Implications for Chronic Pain

Several things consistently change in the body when pain is occurring. Some muscles do not work properly; other muscles must then compensate; normal movement
patterns change; breathing patterns change; there is a loss of some aspects of balance. Some people may experience stress, anxiety and a reluctance to try activities. After pain is present for a long time other changes occur; muscle endurance decreases, sensations of fatigue increase, there is reduced concentration, memory and attention; primitive reflexes appear and there is an alteration in some senses (i.e. vision and touch).
There are some striking similarities between chronic pain and learning disabilities in some people. The presence of chronic pain may lead to a type of learning disability or a
person with a mild learning disability may be more likely to experience chronic pain. While research is ongoing in this area, it seems logical that a program to help a person
with pain would address all the physical and mental problems that appear to change during a chronic pain episode.

The Brain, Stability and Learning

Your brain is constantly sampling the environment you are in for information to keep you safe and stable. The brain gets this information about where you are from several sources including vision, hearing, touch, inner ear (vestibular system), smell, joint and skin stretch, muscle position and muscle contractions. More importance is given to information from the feet, hands, touch, vision and the upper neck. Ideally, the information from one place would tell the brain the same thing as another (i.e. the eyes are telling the brain the same thing as the muscles). When these are different a mis-match occurs. These mis-matches can occur for a variety of reasons (i.e. injury, pain, disuse, disease).

The brain processes information about learning (and how we think), a little differently from the information about safety and stability. They compete in the brain for processing space. Normally, the brain deals with this and allows both to occur, however when there is a mis-match, there is greater competition for brain function and the brain has to work harder to achieve the goal of keeping you stable or in learning information. Often something is sacrificed – either learning or stability. When there is a mis-match of information, there are a variety of possible symptoms that occur such as reduced balance, poor coordination, clumsiness, dizziness, nausea, confusion, memory loss, poor attention or concentration, fatigue, and unexplained pain symptoms. This can have a secondary effect of creating anxiety or fear.

Rehabilitation is aimed at teaching you to use sensory information you have with exercises for balance, coordination, vision and retraining the primitive reflexes. Research
is growing to support the use of specific exercise for some types of learning disabilities in children as well as memory, concentration and attention in adults, and many chronic pain problems.

Summary
Many factors may contribute to learning disabilities. Various physical problems occur with learning disabilities and certain learning disabilities can be helped with specific exercise. Some chronic pain shows similar characteristics to learning disabilities along with other problems. Rehabilitation should address the specific problems that are present rather than a one size fits all approach.

A full reference list is available
from Sean Gibbons
stabilityphysio@gmail.com

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