Todd Lloyd, DC
Background
The concept of neuroplasticity is fundamental to both the natural recovery and physician guided recovery from central nervous system injury or stroke . One of the most challenging objectives for neurological rehabilitation is the return of fine neurological control of the muscles of gait and upper extremity control. Further, with these outwardly apparent objectives of extremity rehabilitation, the proper coordination and strength of the spinal and other postural muscles may be neglected.
The coordination of the intrinsic spinal muscles is critical to the central integrated state (CIS) of the cerebellum. An upright posture is important to the development of the cerebellum both phylogenically and during individual development . Spinal mechanoreceptors in the muscles, joint capsules, discs, and ligaments of the spine receive a constant force from gravity. This force gets transduced to the nervous system and provides background information for posture and all motor control. It has been proposed that the upright posture of humans lead to an advanced enlargement of the cerebellum and the neocortex of the cerebrum beyond other mammals.
Strength and coordination of the spinal muscles is critical for good function of the upper and lower extremities. As an arm moves with sustained, fine, or ballistic movements, the spinal muscles respond with a counterforce by bracing for the movement. When there is dysfunction of the control of spinal muscles, the nervous system will reflexively inhibit the motor output to the proximal extremity muscles to prevent an overexertion of movement that may cause injury to the involved joint.
After a stroke, the brain undergoes cortical reorganization to adapt to functional loss of the affected area. For example, when an arm is affected in a stroke, putting a restraint on the good arm will force the patient to use the paralyzed or paretic arm. At the prefrontal cortex, the intact neurons will fill the void where there is the loss of function in an otherwise intact neurological pathway. Neurons involved with shoulder abduction may migrate to form collateral connections for supination or pronation of the forearm.
More subtly, a patient may have altered gait patterns months or years after a stroke merely because the pattern of neurological commands for the proper muscles groups co-contracting is lost in the basal ganglia, cerebellum, or spinal cord. Neuroplasticity can fill this void with conscious effort, then, unconscious repatterning.
The LPG® Spine Force rehabilitation device uses an oscillating platform on which a patient stands, providing a dynamic change of forces on the joints and muscles of gravitational pull. It also incorporates twin force transducers to precisely measure the force applied with the patient’s upper extremities. The feedback to the spine with gravitational changes and upper extremity forces allow for a three-dimensional range of sensorimotor rehabilitation.
5th Street Spine Treatment Protocols
5th Street Spine uses the Spine Force equipment for their protocols for stroke rehabilitation . Typically, patients are treated with an aggressive three-visits-per-week frequency for two to eight weeks, depending on their neurological integrity. Gradually, the frequency of visits is tapered down to a level where the nervous system indicators are stabilized. The new function gained is reinforced with the stabilization phase of treatment, then the patient is dismissed for self-care with home-based exercises.
Along with the Spine Force equipment, 5th Street Spine uses various forms of “low-tech” rehabilitation such as Swiss Ball protocols, wobble board and Theraband strengthening. Low Level Laser Therapy (LLLT) is available when indicated. A typical visit lasts between ten and thirty minutes.
Patients are evaluated on every visit with a self-scored outcome assessment. On each visit, patients meet with the treating doctor to maintain congruency in care and to reinforce proper rehabilitation instruction. Patients are also assessed periodically to monitor neurological markers such as various cerebellum tests, vestibular function, extraocular eye muscles, other cranial nerves, and various neurological tests.
Results of Care
Patients have reported with a wide variety of improvements. Many report that their fluidity of the gait cycles has improved with just a few visits. Many still remark that their overall balance has become more stabile in a variety of settings their activities of daily living. Some patients note that their “decorticate posture” of rolled-in upper extremity or pronated/inverted foot and ankle has straightened out.
While there hasn’t been 100% resolution of signs and symptoms of stroke, the impact on quality of life is generally improved with these protocols where patient satisfaction is very high.
There isn’t a profession more misunderstood than Chiropractic. Most people, when asked, think a Chiropractor is a “back doctor”. While this is true in part, there’s a whole lot more to the art and science of Chiropractic.