Balint’s syndrome is a rare inability to perceive one’s visual surroundings as a whole. This causes a loss in the sense of “whereness”; that is, in the relation of oneself to one’s environment.  Acquired cases are usually the result of a stroke that affects, most often, both parietal lobes of the brain.   In children, the symptoms are usually confused with those of other neurodevelopmental conditions.  Parents describe their children as clumsy and careless.  Visuospatial difficulties causes them to lose the fluidity of motor movements, such as, when reaching out to put on their socks.  Teachers invariably report difficulties in both reading and copying text. Indeed, they are poor performers at school  where they seem to have difficulties in adapting to the overwhelming stimulating environment of our educational facilities.

Patients with Balint’s syndrome also have difficulties in recognizing objects when they are presented simultaneously but not when they are presented individually.  The syndrome provides for awkward sensations as when the patient struggles to figure out where a wall ends or when attempting to locate the cutlery on a dining room table.  Indeed, although patients with Balint’s syndrome are attentive, they are perplexed by an environment that they seemingly fail to understand.  This causes the patient to become anxious, fearful, and to strive for continuity in routines.

I have often wondered whether autistic individuals have a type of Balint’s syndrome. Autistic individuals have an attention tunnel (monotropism) that only allows them to focus their attention on one aspect of sensation at a time.  At the beach, grains of sand sifting through their fingers can elicit an awkward sensation as their attention solely focuses on the scattered sparkles of light that they reflect. In the meanwhile, other sensations, like the texture of the sand (whether coarse or fine) and, even trying to predict where the grains may fall, are lost to some patients.

Temple Grandin has said that she has difficulties conceptualizing why two different species of dogs are related. When presented individually, she can recognize a Chihuahua as a dog and a Dalmatian as a dog.  Getting them together and making comparisons poses difficulties for Temple.   From her perspective, if the dogs stand side by side, the physical attributes of the animals no longer fit the defining criteria of a singular species.  Objects in Temple’s mind are kept in a memory vault within her brain.  This vault contains many drawers, each one of them storing the visual prototype of what she considers to be a dog, hat, bridge, chair or table.  You could say that Temple and other autistic have a preferential visual memory, but the same is highly selective for what they envision as representative objects.

Tito Mukhopadhyay is a gifted poet who has described many of his experiences as an autistic person.  In his book, “How can I talk if my lips don’t move?”, Tito relates his problems in learning to play badminton.  Forcing himself to pay simultaneous attention to different parts of his body, the ball, and the immediate environment would make him feel dizzy.  The awkward sensation would invariably prompt him to move indoors to the comfort of familiar surroundings. Sometimes having mirrors around him would help to calm him down.

Many of these difficulties in discernment appear to be related to an inability of the brain to “bind” together different aspects of perception. Usually the brain binds together the different parts of a whole by having cortical areas work at the same voltage frequency when captured by an electroencephalogram (EEG).  Thus, if areas of the occipital and parietal lobe are both working at a frequency of 40 cycles per second, we would surmise that they are working on the same thing. Usually this binding occurs only within the highest bandwidth of the brain which we call gamma frequencies.  It is therefore important to note that abnormalities in the coherence of gamma frequencies appear to be universal in autism.  This forces patients to look at individual features of an object while missing characteristics of the whole (Gestalt).  In some cases, the autistic individual ends up looking at the lips or nose of a person making it difficult to identify who he/she may be.

The literature on rehabilitation in Balint’s syndrome is rather sparse. I have recommended aquatherapy as a way of centering the body for some of these patients.  The pressure imposed by the water allows the sensations of the body to come together naturally. Aquatherapy also has the benefit of taking weight off from the joints and preventing blood from pooling in the lower extremities while exercising. In the case of autistic individuals aquatherapy has the added advantage of being performed in a group setting which may lead to enhanced social skills. Patient’s with Balint’s syndrome also enjoy benefits from visuospatial exercises.  Similarly, Mel Kaplan has been a major proponent of visuomotor exercises for autistic individuals. The simple and progressively more complex exercises that he promotes have led not only to benefits in visuospatial orientation but also to the emotional well-being of his patients.

References

Casanova MF. Autism Updated: Symptoms, Treatments, and Controversies. Amazon publishing, 2019

Casanova MF. The body plan in autism: stiffness and anxiety. CorticalChauvinism, 2014.

Casanova MF. Autism: What is the buzz about gamma? CorticalChauvinism, 2013.