The Connection between current brain research and CP research

30 years ago I asked what brain research was being done for my son’s CP. The answer was none. Not only for his type (15% of the CP population) but also for all CP. My son’s doctor at Stanford Children’s Hospital told me that the money was going to go to Parkinson’s, Alzheimer’s, and other adult brain issues. BUT he believed that the discoveries about the brain made in that research would apply to and benefit children with CP.

He was correct. Very little research has been done for CP over the past 30 years. That might be starting to change. Attention is starting to be directed to CP in general but a process of differentiating movement issues in CP, and brain causes, has recently begun. He was also correct that the brain research would inform our knowledge of what causes CP. Today, one of the major missing pieces in CP research is interpretation and application of current brain knowledge to people with movement issues.

Recently, in this process of identifying movement issue and cause, some symptoms of people diagnosed with CP have even become treatable. Dopa-responsive dystonia is an example. B12 deficient dystonia is another. The medical community does not have widespread knowledge of this yet, but dissemination of information on the Internet is happening faster than doctors can keep up with. People are bringing in suggestions for their own diagnosis and new solutions. Medicine is changing dramatically and treatment of CP is/should be changing too. I recently heard of a Dr. in Texas whose sole client base is children with CP. That focus is new, and I expect it will contribute enormously to what we know about movement issues in children.

I feel strongly that there is a medical/biological cause for much of the movement issues children and adults are dealing with. Families of children with Autism are pushing the envelope in the field of Biomedicine – the connection between gut, digestion, metabolism and inflammation and/or brain issues. Due to their diligence with avoiding substances that are not tolerated such as foods, toxins, heavy metals, and chemicals, they have reduced or eliminated inflammation and some or all of the symptoms of autism. They have laid the groundwork for other people to benefit from this knowledge of how to clean up the body, eliminate inflammation and get the digestion and metabolism back on track. They have developed protocols for testing and treating, and there is a network of medical professionals who understand and support this process (MAPS doctors). These doctors are open to seeing children with movement issues as well. There is less anecdotal case information about children with movement issues improving from a biomedical approach, but it is growing and doctors are gaining more experience.

Included in that examination of what is influencing the limitations on a brain function is the study of brain activity and neurochemistry. For years, pathologies such as spasticity have been treated by doing surgeries and therapies onthe, completely anatomically correct, limbs and spine. It is known the issue is in the faulty messaging of the brain, but no solutions for resolving the issue at the brain level were available. Dr. Moshe Feldenkrais changed that. His development of the Feldenkrais Method addressed the brain’s functioning. His method has helped many children and adults improve how their brain operates and therefore how they are able to do what they want to do in life. Other Feldenkrais practitioners have continued Feldenkrais’ work. The best known with children with special needs being Anat Baniel. Many families have discovered that ABM (Anat Baniel Method) can make significant changes for their children.

My son has CP – severe athetoid type, quadriplegic, dystonia, with some spasticity, and strongly retained reflexes. At 30 years old he has developed a life he is very happy with. He has probably had more movement sessions (Feldenkrais and ABM) than most people, and he took the first half of the ABM training program (5 segments of the 10 basic segments). His ability to do what he wishes to in life have increased 100 fold because of this work. His limitations are confined to some major movement issues. The ability of his brain to process, problem solve, empathize, etc. surpasses mine at this point.

We recently tried supplementation to improve his digestion and the availability of nutrients to his cells and saw some significant improvement in head control, reflex hijacking, and spasticity. We also experimented with influencing the neurochemical “soup” in his brain with some good results and some side effects.

I have been looking forward to the development of stem cell therapy as a possible repair for the neurological damage that occurred when he was born. I am beginning to see that the situation is not so simple. There is the original damage, the original response to the trauma that can reset homeostasis to higher levels of glutamate production and lower levels of GABA production in the brain, and there are the consequences of experiencing life in a body that is not functioning as designed.

After reading this article below I am getting a clearer picture of the brain changes that can or have occurred just from living with a condition that constantly creates the feeling of falling, the instability, the drain on nutrition resources, etc. Those are adrenalizing conditions. A chronic state of life endangering adrenaline provoking conditions alters the brain. We see this in PTSD.

This article is primarily about addiction research but in an effort to understand the addictive urge doctors have discovered Dopamine, studied glutamate, identified the “pleasure center”, and more recently begun to understood that “neurons that fire together wire together”, and begun to research whether “neurons that fire apart wire apart” to reverse the process.

Link to article – Discovery Magazine – Resetting the Addictive Brain

When I read about neurons firing together in addiction, my thoughts immediately go to the same issue in spasticity and to reflexive triggers that hijack the brain. With these conditions, just as in being ticklish, there is a trigger that causes a large number of neurons to spontaneously fire. That’s what spasticity is – the firing of too many neurons at the same time.  This becomes a pattern that grooves into the brain and becomes built into learned intentional actions as well.  The solution that ABM/Feldenkrais practitioners employ is to differentiate – which means to “fire apart” so that neurons can “wire apart”. Science has validated what Dr Feldenkrais discovered so many years ago.

Being ticklish can be easily resolved when someone has a typical nervous system. Ticklish, spasticity, reflex triggers, are much more difficult to resolve in someone who has had trauma that has altered their nervous system. People who have had hypoxic brain injury, stroke, TBI, Toxic load, nutritional deficiencies, PTSD, all have outward symptoms the give clues to what is going on in the brain. Thank goodness researchers are finally developing a better idea of what that could be.

Resetting the brain changes.  Wow.  That sounds exactly like what is needed.  Refine that idea.  Go with it researchers.  Combine that with more knowledge of what is actually happening in the brain of a person with movement issues.  Right now they are looking at very invasive processes like Deep Brain Stimulation.  That is more refined than previous brain surgical techniques, but subtlety is our friend with the brain.

This study by Eilat Almagor, et al, illustrates the process happening in the brain when a Feldenkrais/ABM practitioner is working.  It examines how the subtle change in directed movement chosen based on the practitioner’s intention to create local connection vs system connection appears as firing in different places in the brain.  Wow.  MRI documentation of the results in the brain of this work as it is happening.

Study: from Frontiers in Human Neuroscience 28, April 2015.

I have confidence that in the future there will be more non-invasive solutions such as Feldenrkais/ABM, and additional ways to help those movement therapies be even more effective through optimizing the systems that have gotten off track. I have talked about the changes from the brain’s response to trauma, the challenge of an atypical neurochemical “soup”, possible digestive and metabolic issues, and the impact of having different movement experiences because of living in a body with different action than it is designed for. Parents drive the differences in perspective and treatment these days.  I encourage families to maximize the ability of the child to learn by researching all of these influences.

Spasticity is not a thing separate from the rest of the body. Spasticity is a response to the experience of the body, brain, nervous system, and even metabolism and digestion. It can cause tissue and bony changes over time, but there is a cause and effect relationship that creates the experience of spasticity. It can be reflexive tightening in response to balance and safety issues, or high tone caused be the neurochemistry in the brain being pre-disposed to exciting of the nerves. 

Some organizing part of the person has defaulted to the spastic holding pattern. It can be driven by connective tissue, motor cortex, brain stem. A permanent way to resolve spasticity would have to go to the source. If someone has lived with spasticity there might be tissue changes involved that are created over time. Learning has definitely revolved around the presence of spasticity. 

The goal of botox, afo’s, and other compensatory supports is to create an environment for a different more useful, comfortable, and typical learning to occur. SPML creates that window of opportunity to learn without the spasticity. One of the reasons that it is more successful than botox is that the window is longer and the doctors have the skill to be extremely precise in the changes they make. 

In ABM practitioners’ experience with botox, the brain didn’t make a change but rather continued to try to produce the spastic holding. When the botox wore off there were new connections plus the old connections and the spasticity was worse. In the case of SPML we are seeing long term or permanent change. Either the spasticity does not come back, or the child learns a different way and does not default to the spastic pattern.

I can’t speak for SDR because I have no experience with it personally or with my clients. I just know that once someone has surgery, whether in their eyes, limbs, spine, it is much more difficult and sometimes impossible for an ABM practitioner to help them learn in that area. The spine is a very foundational part of our structure and learning there is crucial. This is a major reason why we hope that children will not need surgery, and why the minimal impact of SPML is so important.

Surgery is not the end goal – learning to function optimally is. After surgery comes the learning.

NOTE:  Here is a link to a parent’s blog post about her son’s SPML surgery.  The shares all of the research she did before deciding on this procedure.

Let’s suppose that the IEP goals were perfect for your child 6 months or 1 year ago, and they are still perfect BUT, very little progress was made.   Should you just say – let’s roll these over to the next year?  If you don’t make changes can you expect a different outcome?  Consider these thoughts.  

FIRST- make really sure that you cannot break this goal or the objectives down to smaller goals and objectives that are more likely to be successful.  Marking success is important for the child and for everyone on the team. There is a huge difference for everyone hearing “no progress was made” vs. “the goals were met”.  Think in terms of tinier steps to take to get there.   If your child can’t write letters think of everything that goes in to writing letters.  

For example:

The understanding of the instruction

The ability to use the tools – paper, pen, etc – hand grasp, pressure, movement

The ability to see – think glasses, CVI etc

The ability to form the pieces

Here’s some questions to ask yourself:  Does he know what you are asking him to do?  Does he know recognize letters?  Does he know how to make the lines and circles that letters consist of?  Does he know how to hold the writing tool?  Can he use the typical desk or slant board, or would another placement be better?  Does he feel the paper when he makes marks?  Should it be textured?  Can he see easily?  Are glasses needed?  Does he need black paper with white chalk?  Yellow paper with Green Felt pens? Backlighting?

Use this idea of breaking down the task to think of the questions you would ask about the specific goals that are set for your child.  If you think of the parts that will be a challenge then that might where changes can be made to help your child be successful.  Notice I did not say that is what the goal should be.  That is where the learning ENVIRONMENT should change to suit your child.

Every accomplishment can be put on a continuum.  Speaking, Writing, Reading, Crawling, Rolling, following instructions etc.  Think of the goals you have set.  Where is your child on the continuum?  Do you need to step back and set a smaller goal?  Should you expect lines and circles instead of complete letters?  Should you expect 10 alphabet words instead of all of them?

NEXT – if you are still convinced the goals are appropriate, it’s time to look at two things.  How is the plan being implemented, and is there a health, medication, behavior issue interfering?

I have seen some ineffectual implementation.  Sometimes time just keep passing and the team doesn’t coordinate what needs to be done.  Evaluation of adapted options, or seats, etc take time.  Equipment funding and ordering takes time.  Sometimes there isn’t the correct staffing in place.  The teacher might be overwhelmed and your child’s needs aren’t deliberately being ignored but implementation is not high enough on the priority list.

I have found the best solution for this is to first ask if there is anything you can help with.  One teacher who moved classrooms at the last minute was so grateful that all the parents showed up to help her move and set up.  Their children’s programs went much more smoothly when she didn’t need to stretch the transition over weeks, and she felt very cared for.  Each family sent one person down, even if they had to take a few hours off work.  That was very heartwarming to hear.

The second thing to do is ask for follow up IEP meeting (s).  You are entitled to ask for them as often as needed.  Sometimes when things are in transition parents have mini meeting weekly or monthly.  It doesn’t have to include the full table of administrators, as the yearly meeting would, unless you see a reason to need them there.  You can plan ahead for this and set the dates in advance or you can submit a request when you see the need.  I think they have a month to respond with possible dates.  Knowing there is a deadline to report on progress can cause things to be at the top of the todo list for those implementing.

ALSO – look at health, medication, and behavior.  

The school has no control of health and medication but you do.  Is your child taking a seizure medicine that interferes with learning?  Are there any medications causing brain fog?  Is there a need to look at nutrition?  

Is the class environment making it difficult for your child to focus, attend, be in learning mode?  You can’t ask the teacher to change what is working for herself and the other students but you CAN ask to see other classes to see if there is a more optimal environment for your child, or in the case of regular education classrooms, speak to the principal about your child’s needs and the available teachers’s teaching styles.

If your child has an IEP you already know that you have responsibilities far beyond what other parents have as they send their child into the care of the teacher and school.  The ideas discussed here will take some thought on your part but it will be so worthwhile in the long term.  You will se your child’s needs and program much more clearly and be ready to do your part to hep them be successful.

Part 1: http://www.andrealbowers.com/what-if-your-child-did-not-meet-iep-goals-part-1/

Related Post:

IEP time – focus on the positive

So you are reading through the evaluations and everything sounds really negative.  Goal after goal is not met.   You immediately tighten up, feel stressed, feel like your child is not measuring up.  

When goals and objectives are not met the traditional thing to do is look at the child’s failures.  That is NOT what an IEP is about.  Individual Education Plans are intended to identify your child’s strengths so the team can develop a program custom tailored for their success.  That gets lost in all the testing.

Take a couple of deep breaths.  Read below and design the NEXT IEP for your child’s success.  First possibility – the wrong goals and objectives were set.  Here’s an example:

This child has difficulty using their hands for fine motors so these 2 goals are set.

Goal 1: Child will sit upright with feet on floor and legs at 90 degrees

Goal 2: Child will write his alphabet letters with 90% accuracy

These goals focus on the motor skills that the child has difficulty with. They do not break the task down into the ingredients for success that they uniquely will use.  If these goals are the focus of the IEP then there will be limited time to show all the other wonderful things the child can achieve and demonstrate in class.

Note:  none of the other children are sitting with their feet flat and their legs at 90 degrees.  I guarantee it.  Children need to move all the time.  Your child does too.

See how the REVISED goals are about meeting the child where they are and providing the means for them to learn and succeed.  You might add some OT or PT or ABM goals to support those listed below and stipulate whether they are provided outside the class, or provided by the parent at home.

REVISED GOAL 1: Child will have supports in place to achieve more ease with fine motors

Objective:  Child will be able to to grasp and release many differently shaped objects easily

Objective 2: Child will be able to draw circles, straight lines, wavy lines and dots with ease.

Implementation – Trial of a number of chairs with varying level of support to determine what is needed.

REVISED GOAL 2:  Child show understanding of alphabet letters and sounds through reading and writing.

Objective 1:  Child will form letters through tracing, putting shapes together, and writing with an adapted or unadapted implement.

Objective 2: Child will select correct letter when given the name or sound from a  field of 8.

Implementation:  OT to test adapted implements including hand straps, built up handles, variety of shapes etc.  Teach and OT to adapt assignment by providing cut paper, iPad app, alphabet cards as appropriate.

These new goals and objectives make it clear that the child is doing fine and the task is for the professionals to design the environment that will work for the child.

Part 2 – http://www.andrealbowers.com/so-the-iep-goals-were-not-met-part-2/

Related post:

IEP time – focus on the positive

The tests are in, you have a meeting scheduled and you are dreading it.  I know how you feel.  The IEP season is  so tough for parents to get through when it’s all about what your child can NOT do.  

Here’s the message you and I might want to send:

Guess what professionals?  I live with my child every day – I know very well what his limitations are.  Let’s get over that and talk about how we are going to build on his strengths!

I just received a business article about what successful companies do to get the most from their employees, to have happy employees, and to have employees who want to stick around long term!!

What they DON’T do is work on their employees’ weaknesses.  Big surprise right?  It’s now clear in the business world that if they focus on their employees’ strengths, the reasons they actually HIRED them, the employees contribute more and are happier.  Working on weaknesses and trying to turn everyone into well rounded employees brings down their quality, productivity and moral.

Well guess how this applies to kids, and ESPECIALLY special needs children?  Exactly the same.  It doesn’t mean we ignore the need to keep make gains in areas that are delayed.  But the focus should always be on the strengths.  When the goal is to show that the material is understood go to strengths.  

Encourage flexible ways of demonstrating knowledge.  Can’t use scissors?  Teacher cuts up shapes and the student selects the appropriate one to show they KNOW THEIR SHAPES.  Can’t write alphabet letters clearly? How about selecting scrabble letters, iPad letters, or flash cards to show knowledge and understanding.  

If the focus is on not being able to use scissors or pen, then all of the time will be spent on learning the thing that is the very hardest for your child.  If they could do it easily they would already be doing it.  Your child won’t have the chance to show how artistic, funny, creative, compassionate, or fun they really are.  They will feel like life is a struggle, like they are a failure, and like they are different from the other children.  They are the same in so many more ways than they are different.

if your IEP is about what KNOWLEDGE your child needs to demonstrate in class then the challenge is put squarely with the professionals to figure out how to use your child’s strengths so they can show what they know.

Focus on the positive.

 Related posts

What if your child did not meet IEP goals? Part 1

So the IEP Goals were not met….Part 2

Children or people with disabilities don’t have something equivalent to the “man up” phrase that boys and men encounter.  It is more subtle and the message is  “Don’t be different”.  Parents never intend to make “different” seem wrong, but, isn’t that what we are battling when we go to therapy, buy equipment, encourage our child to sit up, stop drooling, sit still, fix your foot.  We want our kids to have a typical childhood.  How do parents find the accepting, loving, message to send to their child at the same time they are trying to help their child with special needs?  How does society say “we value you the way you are” or not?  Why is being accepted the way they are so important for our children?

Boys becoming men.  The pressure is huge to be something that fits an “image” instead of being who you are.   Here are two videos a friend just pointed me to about being told to “man up”.  They have such a clear message.  We can learn from their power.  Substitute an image of your child with special needs receiving the message they are NOT ok, every time they say “man up” and imagine what that does, how they would feel.

http://www.upworthy.com/if-you-tell-this-dude-to-man-up-you-better-be-prepared-to-learn-why-what-you-said-is-awful?c=cur1

http://distractify.com/culture/whats-the-worst-thing-you-could-say-to-a-little-boy-you-might-be-shocked-by-this/

There you go. Not so long ago “man up” was perfectly acceptable.  What are the messages your child is receiving about not being typical? How does it feel to not have access?  to be told to do things to be socially acceptable when they aren’t possible? 

My son’s 3rd grade teacher partnered him with a boy who was on his way to becoming a bully.  His parents were in jail.  He had been kept back so he was one of the bigger kids in the class.  He tended towards anger.  I think he was part of the “man up” experience.  Don’t fall apart, be stoic, don’t show vulnerability.  During that time that he was my son’s class buddy he transformed.  He transformed to the point that he was even willing to join my son in a silly bear costume for a talent show in front of the school.   How vulnerable did that make him?  I think knowing my son changed the course of his life.  My theory?  My son was totally non threatening.  He had nothing to prove to my son.  This boy was able to be compassionate and make a difference for someone else.  He was able to get away from “man up” and have another experience.

What experience do you want for your child?  I think this is the highest priority a parent can have.  We are not perfect.  Our anxiety for our child’s wellbeing can interfere with this goal.  Realize you slipped.  You made fitting in, or being closer to typical, more important than being “ok the way you are” – and recommit.  Insist that others be as committed.  It is the foundation of what we want for ourselves, our children, and everyone else – to be accepted for who we are.

Andrea L Bowers

I have been continuing to research how we can use Gut Brain connection information to help our children and ourselves.  It’s an ongoing project because of the complexity, but, here’s an update.

I highly recommend 23andMe.com for the nutrigenomic testing.  I have had blood testing done through my doctor.  These blood tests were done at my local lab and based on the information UCDavis developed.  I followed with the 23andMe saliva testing.  The results are identical for me.  Everyone I have talked to is very happy with the saliva test results and many doctors are agreeing.  Blood tests are more expensive and more difficult for children to do.

23andMe has a great system.  You go online to 23andMe to order your kit (s).  There is a special that you get the first kit for $100 and additional kits for $75.  They arrive and you go back online to register each kit’s number.  Open them – supply 1/2 teaspoon of saliva – then recap and replace tube back into the box.  It’s set to go.  Return postage and address are already on the box.  All you do is drop it in a mailbox.  One week later they email you that they have received it and about 4 weeks after that all results are online on your own private home page on their site.

The information that might make the most difference right away is in the two genes that influence the MTHFR enzyme production.  Elinor Silverstein and I have written in previous articles about how significant the Methyl enzyme is for so many systems in the body.  Critical for neurology and movement are the detox systems and the B vitamin conversion systems.  Once you know if your results show any potential for methyl deficiency you can determine the next steps to take to make sure all systems are functioning optimally.

Raw data from 23andMe can be downloaded and put into geneticgenie.com for free or a voluntary donation.  They produce a great graph that makes it very clear which genes have +/+, +/- etc.  The red are double mutations, the yellow are single (one part of the pair is a plus) and the green are good to go – both minus (-/-).  

Originally, I recommended going onto the B Vitamins which were already methylated – they are ready to move right into the cells.  There are some gene situations which would cause the initial boost from methyl b vitamins to be less effective in the long term.  These situations influence the health of the gut and some other parts of the metabolic cycles.  I’m studying up on those issues and will report here once I have a good understanding of what they are and what action can be taken.

If you wish to research for yourself – my resources are:

MTHFRsupport.com

23andMe.com,

scribd.com/doc/132017201/Dr-Amy-s-Simplified-Road-Map-to-Health

http://www.heartfixer.com/AMRI-Nutrigenomics.htm#Methyl%20Cycle%20Genomic%20Testing%20and%20Treatment%20-%20What%20you%20Can%20and%20Cannot%20Expect%20from%20Us

http://www.dramyyasko.com/wp-content/files_flutter/1327512160_9_1_1_8_pdf_02_file.pdf

www.dramyyasko.com

My son with CP loves crowds and was always up for going to a school dance as he was growing up.  He now listens to music and does an amazing job editing music into his video productions.  He doesn’t sing, or keep the beat of music.  He has trouble doing slow rhythmic movements when weight training and has trouble with timing his movements in general.  The connection between his motor limitations and these rhythm skills is clear.

This article that Anat Baniel has highlighted about workout music and the action of the supplementary motor cortex in movement timing gives me ideas about the potential to help children with motor issues using beat and rhythm.  All young children’s classrooms encourage music and clapping but it seems like more is better when there are motor challenges.  This is an area that is worth pursuing even when it is not easily evoked.

Tom Stafford says: The benefits of music are largest for self-paced exercise – in other words those sports where some of the work involved is in deciding when to act, as well as how to act. This means all paced exercises, like rowing or running, rather than un-paced exercises like judo or football. My speculation is that music helps us perform by taking over a vital piece of the task of moving, the rhythm travels in through our ears and down our auditory pathways to the supplementary motor area……The signals to move the muscles start in an area of the brain called, unsurprisingly, the motor cortex. It’s in the middle near the top. Part of this motor area is known as the supplementary motor cortex. Originally thought to be involved in more complex movements, this area has since been shown to be particularly active at the point we’re planning to make a movement, and especially crucial for the timing of these actions. So, this specific part of the brain does a very important job during exercise, it is responsible for deciding exactly when to act. 

In this Psychology Today article Henkjan Honing, Ph.D, a Professor in Music Cognition at the University of Amsterdam, studied “a cognitive skill called beat induction, which most of us think of as trivial (e.g., being able to tap your foot to the beat), is active so early in life. It can be seen as additional support for the idea that, beat perception contributed to the origins of music since it enabling such actions as clapping, making music together and dancing to a rhythm. Next to being music-specific, beat induction is also considered to be uniquely human.”

He was able to conduct tests in two day old babies which showed this skill was acquired before birth.

Furthermore, the results challenge some earlier assumptions that beat induction is learned in the first few months of life, for example by parents rocking the infant. Our study suggests that beat perception must be either innate or learned in the womb — as the auditory system is at least partly functional as of approximately three month before birth.

When you consider that birth trauma and/or hypoxia is often the cause of CP you realize that most children with CP had a pre-birth opportunity to have this auditory experience.  Perhaps this recognition of beat is something that can be brought forward through early experience?

I have been introduced to TaKeTiNa by fellow practitioner Heidi Lawson and had conversations with her about the impact of rhythm on the brain and motor skills.  Taketina is a rhythm development program.  Masters in rhythm can maintain many rhythms with different parts of themselves simultaneously.  They use shifting weight, hands, feet, vocalizations etc to produce the rhythms.  It is usually practiced by adults who do not have motor limitations, but the research that has been done with this group shows the impact a rhythm practice on the EKG – more evidence of the correlation between beat, rhythm and our brains.  Learning basic rhythm and beat will make a difference for our children.

Tapping and rhythm are sometimes used as a tool in ABM lessons but the focus of lessons can be in so many areas of neuromovement learning that lessons are not an ideal place to create this experience for children. Perhaps your practitioner can help with the action of tapping, patting, etc and introduce the idea of rhythm, but fun opportunities and encouragement to practice will be essential.  Knowing about the potential benefits of rhythm, beat, and music for the functioning of the supplemental motor cortex, and motor timing seems like a wonderful opportunity for parents and teachers to emphasize this in their interactions with children with motor challenges.

Consider all these places you encounter rhythm and beat during your day: music, marching, counting, walking, crawling, songs, rhymes, swinging, bouncing, your heartbeat, horseback riding.  You can find beat and rhythm in many places.  Make it important and noticeable.  Think of “marking” it for your child.  You can tap your child along to the music, vocalize to the song, noise, or movement.  What you notice and participate in your child will take note of.  

Here’s a google search for “creating rhythm in special needs children” which may give you  more ideas!