Over the past 20 years research has illustrated incredible reductions in chronic pain and the return of functions to limbs and joints through the use of mirror visual feedback (MVF). The treatment works on the foundations that constant streams of sensory input represent a learned pattern of our own bodies and how we perceive them. When a structure is damaged and the peripheral link between the limb and the brain is lost, there is a disconnect between the intention of the brain to move and the resulting feedback, or lack thereof. The consequence is a learned paralysis (in phantom limb phenomenon) or learned pain (as is complex regional pain syndrome). By providing a visual input (the mirror image of the asymptomatic limb) a sensory input will match the motor intention. Click here to see Dr. VS Ramachandran beautifully explain the principles behind this life changing treatment.
I wanted to take a moment and describe the goal of our practice and how the discipline of chiropractic neurology fits into the health care spectrum. Beyond the doctoral degree, a chiropractor can specialize in a variety of health subsets by the completion of a diplomat program and subsequent board certification. My diplomat’s governing body is the International Academy of Chiropractic Neurology (IACN); they oversee the 20-month program and board testing. This additional post-graduate training increases my depth of knowledge of the nervous system and allows for greater diagnostic and treatment specialization. In turn, this broadens the scope of practice to include care to patients with traumatic brain injuries, demyelinating diseases, learning and developmental pathologies, Parkinsonian symptoms, post-stroke patients, and many other conditions. Common diagnostic procedures include ophthalmoscopy, electrodiagnosis, and video-nystagmography; all non-invasive methods of evaluating the central and peripheral nervous system. As a Chiropractic Neurologist, I still treat the chiropractic “big 3” (low back pain, headaches, and neck pain) and perform manual therapy and rehabilitation on all sorts of musculoskeletal injuries; tendinitis, bursitis, fasciitis, etcetera. Don’t forget, Doctors of Chiropractic have physician status in the state in which they hold a license, and therefore function as portal-of-entry care, visit us (chiropractors) as you would any other doctor and appropriate treatment and referrals will take place when needed. With respect to all bodily functions, neurology is king, nothing takes place without its intervention. The diagnosis and treatment of most pathologies should consider the effects on the nervous system itself, and how the perturbation of it may aid in recovery or propagate disease progression. Neurology’s unanimous involvement in health is why I strive to become an expert in this area and build a practice around the most integral body system.
Transcranial direct current stimulation (tDCS), simply put, is an electrical stimulus applied to the exterior of a patient’s skull. This therapy was first used almost 2000 years ago when someone with a bad headache placed an electric ray on their head. Since then, the techniques and instrumentation have evolved and now in the present day we have small battery powered devices used to treat an array of conditions such as depression, anxiety, migraines, addiction, and even schizophrenia.
How is this possible?
The electric stimulation (which is only 1-2 milliamps) is applied through electrode pads which are polarized, one positive and one negative. With our advanced understanding of the brain’s functional anatomy, the electrode placement can be arranged to increase or decrease stimulation to specific regions, and thus functions of the brain. The desired effects are achieved by altering the brain’s resting membrane potential.¹ For example, if a region of the brain is desired to be “turned on” a positive stimulus to that area will heighten the resting membrane potential, requiring less input from the person themselves to activate that area. The same can be said for the reverse situation, an area of the brain whose function is desired to be decreased, when given a negative stimulus, will in-turn be more difficult to activate.
This treatment is incredibly safe. In clinical trials and reviews the only side effect recorded is occasional itching and tingling of the scalp where the electrodes are placed.²
This treatment is proven effective. Because of the ease in which a “sham” treatment can be done (leaving the machine turned off) randomized clinical trials are simple to perform and have demonstrated some great results, particularly with depression, anxiety, mild traumatic brain injuries (concussions), and patients who has suffered a stroke.³
Personally, in our office, we use 2 different brands of tDCS, “Brain Stimulator” and “Fisher Wallace” (full disclosure, I have no stake in either of these companies). The reasons for using 2 different models is because the “Fisher Wallace” has an alternating current, which seems to be more comfortable for a patient who is sensitive to the itchy, tingling scalp described earlier. It should be noted that a couple of studies show a superior outcome when using a direct current, used by the “Brain Stimulator”.
Please sent us a message or give us a call if you have any questions about the therapy or to schedule a consultation appointment.
1. Wilcox T, Hirshkowitz A. NIH Public Access. 2015;85(0 1):1-27. doi:10.1016/j.neuroimage.2013.08.045.The
2. Poreisz C, Boros K, Antal A, Paulus W. Safety aspects of transcranial direct current stimulation concerning healthy subjects and patients. Brain Res Bull. 2007;72(4-6):208-214. doi:10.1016/j.brainresbull.2007.01.004
3. G. S, V. R, D. N. Transcranial direct current stimulation in stroke recovery. Arch Neurol. 2008;65(12):1571-1576. http://archneur.ama-assn.org/cgi/reprint/65/12/1571http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed8&NEWS=N&AN=2009108270.
A young female patient presented with lightheadedness, dizziness, and near-syncope during exercises of varying extensional activity. These symptoms have been presents for years and she has previously exhausted many forms of medical investigation; internists, cardiologists, stress-testing, cortisol levels, and even neurotransmitter blood testing. Even after these interventions a blood pressure related issue was resulting in transient decreases in cerebral blood prefusion.
During history and examination, it was learned that her symptoms could be brought about with cervical, shoulder, and upper limp positioning and manipulation. In previous case studies it has been noted that carotid baroreceptor stimulation (e.g., mechanical forces such as may occur with turning of the neck or looking upward) results in vagal activation and/or sympathetic inhibition. (1) Historically, this phenomenon is seen in older males with sclerotic carotid arteries and accompanied by a diagnosis of carotid sinus syndrome (CSS). (1) In this patient’s case, it may indicate Carotid Sinus Hypersensitivity (CSH). (1) Whereas the muscle activation, head and neck positioning, and physical compression is enough of an adequate stimulus to trigger an unwanted carotid reflex.
Carotid massage has been a classic diagnostic tool for the differentiation of ventricular tachycardias. To a lesser degree it has been used in cases such as this one to recreate patient symptoms. This is an uncommon situation; however, it should be noted that an unintended carotid massage could take place during many manipulative and soft tissue procedures. Caution should be taken during spinal manipulative therapies (SMT) and instrument assisted soft tissue mobilization (IASTM) of structures in and around the carotid triangle (SCM, upper traps, and scalene musculature).
In moving forward with this patient… some guidelines for CSH have been established. They are, however, difficult to test and do not imperially yield a diagnosis. Most importantly a carotid massage (intentional of otherwise) has the ability to create an embolism and should only be performed buy trained medical professionals.
- Benditt, David, and Brian C Downey. “Carotid Sinus Hypersensitivity and Carotid Sinus Syndrome.” Edited by Peter Kowey, UpToDate, 16 Jan. 2019, www.uptodate.com/contents/carotid-sinus-hypersensitivity-and-carotid-sinus-syndrome.
On February 2nd, from 10am to 2pm, R&R with be hosting an open house along side Passion Chiropractic and Innate Fitness to celebrate our clinic and the patients that we care for. This will be a great opportunity to tour the facility, meet the doctors and trainers, and see what our clinic has to offer the community. There will be door prizes and free barbeque! See you there.