Improvement in a 3½-year-old Autistic Child Following Chiropractic Intervention to Reduce Vertebral Subluxation
Hoffmann and Russell (2008)
Journal of Vertebral Subluxation Research March 24, 2008 (1-4)
Objective: To describe, discuss and track the subjective and objective changes of a 3½ year old autistic girl following chiropractic adjustments over a 10 week period.
Clinical Features: A 3½ year old female child with reduced social interaction and language skills and learning difficulties presented for chiropractic care. The child had been diagnosed with autism 1 year earlier.
Interventions and Outcomes: The child received full spine adjustments where indicated to reduce vertebral subluxation, using the Torque Release Technique protocol and Integrator™ instrument. Strong verbal and physical apprehension to initial care was observed, however no signs of this were present after 5 visits, along with further improvements in social interactions, language skills and increased symmetry in surface EMG and thermal scanning over the 10 weeks of care.
Conclusion: The subjective and objective improvements observed by both practitioner and parents following chiropractic care indicate a link between subluxation and autistic behavioural patterns. Comparable studies have been undertaken previously with similar findings, however further study needs to be conducted to determine the exact relationship between chiropractic care and behavioral changes in autistic children.
Key Words: autism, chiropractic care, Torque Release Technique, Integrator™, subluxation, pediatric, surface EMG, thermal scanning.
Altered sensorimotor integration with cervical spine manipulation
Taylor, H. H., & Murphy, B. (2008)
Journal of manipulative and physiological therapeutics, 31(2), 115-126.
Objective: This study investigates changes in the intrinsic inhibitory and facilitatory interactions within the sensorimotor cortex subsequent to a single session of cervical spine manipulation using single- and paired-pulse transcranial magnetic stimulation protocols.
Method: Twelve subjects with a history of reoccurring neck pain participated in this study. Short interval intracortical inhibition, short interval intracortical facilitation (SICF), motor evoked potentials, and cortical silent periods (CSPs) were recorded from the abductor pollicis brevis and the extensor indices proprios muscles of the dominant limb after single- and paired-pulse transcranial magnetic stimulation of the contralateral motor cortex. The experimental measures were recorded before and after spinal manipulation of dysfunctional cervical joints, and on a different day after passive head movement. To assess spinal excitability, F wave persistence and amplitudes were recorded after median nerve stimulation at the wrist.
Results: After cervical manipulations, there was an increase in SICF, a decrease in short interval intracortical inhibition, and a shortening of the CSP in abductor pollicis brevis. The opposite effect was observed in extensor indices proprios, with a decrease in SICF and a lengthening of the CSP. No motor evoked potentials or F wave response alterations were observed, and no changes were observed after the control condition.
Conclusion: Spinal manipulation of dysfunctional cervical joints may alter specific central corticomotor facilitatory and inhibitory neural processing and cortical motor control of 2 upper limb muscles in a muscle-specific manner. This suggests that spinal manipulation may alter sensorimotor integration. These findings may help elucidate mechanisms responsible for the effective relief of pain and restoration of functional ability documented after spinal manipulation.
Key Indexing Terms: Manipulation; Spinal; Neuronal Plasticity; Transcranial Magnetic Stimulation; Neural Inhibition; Central Nervous System; Chiropractic
Interexaminer reliability of a leg length analysis procedure among novice and experienced practitioners
Holt, K. R., Russell, D. G., Hoffmann, N. J., Bruce, B. I., Bushell, P. M., & Taylor, H. H. (2009)
Journal of manipulative and physiological therapeutics, 32(3), 216-222.
Objective: The purpose of this study was to evaluate the interexaminer reliability of a leg length analysis protocol between an experienced chiropractor and an inexperienced chiropractic student who has undergone an intensive training program.
Methods: Fifty participants, aged from 18 to 55 years, were recruited from the New Zealand College of Chiropractic teaching clinic. An experienced chiropractor and a final-year chiropractic student were the examiners. Participants were examined for leg length inequality in the prone straight leg and flexed knee positions by each of the examiners. The examiners were asked to record which leg appeared shorter in each position. Examiners were blinded to each other’s findings. κ statistics and percent agreement between examiners were used to assess interexaminer reliability.
Results: κ analysis revealed substantial interexaminer reliability in both leg positions and also substantial agreement when straight and flexed knee results were combined for each participant. κ scores ranged from 0.61, with 72% agreement, for the combined positions to 0.70, with 87% agreement, for the extended knee position. All of the κ statistics analyzed surpassed the minimal acceptable standard of 0.40 for a reliability trial such as this.
Conclusion: This study revealed good interexaminer reliability of all aspects of the leg length analysis protocol used in this study
Key Indexing Terms: Leg Length Inequality; Chiropractic; Observer Variation; Reproducibility of Results
Practice Characteristics of Chiropractors in New Zealand
Holt, K., Kelly, B., & Taylor, H. H. (2009)
Chiropractic Journal of Australia, 39(3):103-9.
Objective: To summarise the key findings of the 2007 New Zealand College of Chiropractic Stakeholders Advisory Committee survey of the New Zealand chiropractic profession.
Method: The survey questionnaire comprised 50 questions divided into 5 sections: the chiropractic practitioner, the chiropractic practice professional functions and referrals, accident compensation and the chiropractic patient. Hard copy surveys were mailed to all 306 chiropractors with a New Zealand postal address who were issued with an Annual Practicing Certificate during the 2005/2006 year. Chiropractors were invited to either complete the hard copy survey or complete the survey online using an electronic version.
Summary: 152 chiropractors responded to the survey. The results indicate there is a desire amongst the profession to increase the number of chiropractors in New Zealand. They also suggest that, despite the lack of mandate by the New Zealand Chiropractic Board for a set minimum number of continuing education hours, most New Zealand chiropractors appear to be engaging in a satisfactory level of continuing education.
Process versus outcome: challenges of the chiropractic wellness paradigm
Russell, Eric G. (2009)
Journal of chiropractic humanities 16.1 (2009): 50-53.
Objective: The purpose of this article is to discuss the term wellness in the context of the philosophy of chiropractic.
Discussion: PubMed and Index to Chiropractic Literature show an upward trend in use of the term wellness. Wellness may be used differently depending upon the profession and may be considered a process by some and an outcome by others.
Conclusion: There appears to be no consensus on the definition of wellness or how it is being used. Wellness is not exclusive to chiropractic, and wellness is not synonymous with health, although is often used that way. Wellness is a societal trend, and chiropractic as a health care profession may be a good fit for this concept.
Key indexing terms: Wellness; Chiropractic; Philosophy; Vitalism
Altered central integration of dual somatosensory input after cervical spine manipulation
Taylor, H. H., & Murphy, B. (2010)
Journal of manipulative and physiological therapeutics, 33(3), 178-188.
Objective: The aim of the current study was to investigate changes in the intrinsic inhibitory interactions within the somatosensory system subsequent to a session of spinal manipulation of dysfunctional cervical joints.
Method: Dual peripheral nerve stimulation somatosensory evoked potential (SEP) ratio technique was used in 13 subjects with a history of reoccurring neck stiffness and/or neck pain but no acute symptoms at the time of the study. Somatosensory evoked potentials were recorded after median and ulnar nerve stimulation at the wrist (1 millisecond square wave pulse, 2.47 Hz, 1 × motor threshold). The SEP ratios were calculated for the N9, N11, N13, P14-18, N20-P25, and P22-N30 peak complexes from SEP amplitudes obtained from simultaneous median and ulnar (MU) stimulation divided by the arithmetic sum of SEPs obtained from individual stimulation of the median (M) and ulnar (U) nerves.
Results: There was a significant decrease in the MU/M + U ratio for the cortical P22-N30 SEP component after chiropractic manipulation of the cervical spine. The P22-N30 cortical ratio change appears to be due to an increased ability to suppress the dual input as there was also a significant decrease in the amplitude of the MU recordings for the same cortical SEP peak (P22-N30) after the manipulations. No changes were observed after a control intervention.
Conclusion: This study suggests that cervical spine manipulation may alter cortical integration of dual somatosensory input. These findings may help to elucidate the mechanisms responsible for the effective relief of pain and restoration of functional ability documented after spinal manipulation treatment.
Key Indexing Terms: Somatosensory Evoked Potentials; Neuronal Plasticity; Spinal Manipulation; Sensory Filtering; Sensorimotor Integration; Chiropractic
The effects of spinal manipulation on central integration of dual somatosensory input observed after motor training: a crossover study
Taylor, H. H., & Murphy, B. (2010)
Journal of manipulative and physiological therapeutics, 33(4), 261-272.
Objective: This study sought to investigate the influence of spinal dysfunction and spinal manipulation on the response of the central nervous system to a motor training task.
Methods: The dual peripheral nerve stimulation somatosensory evoked potential (SEP) ratio technique was used in 11 subjects before and after a 20-minute typing task and again when the typing task was preceded with cervical spine manipulation. Somatosensory evoked potentials were recorded after median and ulnar nerve stimulation at the wrist (1 millisecond square wave pulse, 2.47 Hz, 1× motor threshold). The SEP ratios were calculated for the N9, N11, N13, P14-18, N20-P25, and P22-N30 peak complexes from SEP amplitudes obtained from simultaneous median and ulnar (MU) stimulation divided by the arithmetic sum of SEPs obtained from individual stimulation of the median (M) and ulnar (U) nerves.
Results: There was a significant increase in the MU/M+U ratio for both cortical (ie, N20-P25 and P22-N30) SEP components after the 20-minute repetitive contraction task. This did not occur when the motor training task was preceded with spinal manipulation. Instead, there was a significant decrease in the MU/M+U ratio for the cortical P22-N30 SEP component. The ratio changes appear to be due to changes in the ability to suppress the dual input as concurrent changes in the MU amplitudes were observed.
Discussion: This study suggests that cervical spine manipulation not only alters cortical integration of dual somatosensory input but also alters the way the central nervous system responds to subsequent motor training tasks.
Conclusion: These findings may help to clarify the mechanisms responsible for the effective relief of pain and restoration of functional ability documented after spinal manipulation and the mechanism involved in the initiation of overuse injuries.
Key Indexing Terms: Somatosensory Evoked Potentials; Neuronal Plasticity; Spinal Manipulation; Sensory Filtering; Sensorimotor Integration; Chiropractic
The effect of spinal manipulation on the efficacy of a rehabilitation protocol for patients with chronic neck pain: a pilot study
Murphy, B., Taylor, H. H., & Marshall, P. (2010)
Journal of manipulative and physiological therapeutics, 33(3), 168-177.
Objective: This pilot study sought to (1) determine whether a 4-week period of chiropractic care improved the ability of chronic neck pain patients to respond to an 8-week period of exercise rehabilitation and (2) determine effect sizes to use in sample size calculations for future studies.
Methods: Twenty male and female participants (age, 43 ± 12 years; body mass index, 27 ± 4.5 [mean ± SD]) with chronic nonspecific neck pain were randomized into either a chiropractic care combined with exercise or an exercise only group. Group 1 received 4 weeks of chiropractic care, and group 2 waited 4 weeks before both groups participated in an 8-week exercise intervention. The following outcome measures were assessed in week 1 (baseline), week 4, and at week 12: Neck Disability Index (NDI); Visual Analogue Scale (VAS), both now and worst; neck flexion-relaxation response; and feed-forward activation (FFA) times. A repeated-measures analysis of variance was used to evaluate the changes in the NDI and VAS over time. Effect sizes were calculated for changes in neuromuscular parameters.
Results: There were significant decreases in the NDI score (P < .001) and VAS in (P < .005) in both groups with no significant differences between the groups. Effect sizes (ESs) were as follows: NDI (.293); VAS now (.175); VAS worst (.392); flexion-relaxation (.636); FFA times: sternocleidomastoid (.1321), anterior scalene (.195). This lead to sample size estimates as follows: flexion-relaxation response, 64 subjects per group; NDI, 145 subjects per group; VAS, 166 subjects per group.
Conclusions: Chiropractic care combined with exercise and exercise alone are both effective at reducing functional disability and pain in chronic nonspecific neck pain patients. Future studies will need at least 64 subjects per group to determine if there are differences between the groups and if these differences are attributable to changes in neuromuscular measures.
Key Indexing Terms: Manipulation, Spinal; Exercise; Neck Pain; Electromyography; Chiropractic
The cervical flexion-relaxation ratio: reproducibility and comparison between chronic neck pain patients and controls
Murphy, B. A., Marshall, P. W., & Taylor, H. H. (2010)
Spine, 35(24), 2103-2108.
Study Design: Reliability study.
Objective: To determine the reproducibility of the cervical flexion-relaxation ratio (FRR) measured 4 weeks apart in a group of chronic neck pain patients and healthy control group and to compare the FRR between the 2 groups.
Summary of Background Data: The cervical FRR measures the ability of the neck extensor muscles to relax during forward flexion, similar to the lumbar FRR. Its reliability and ability to discriminate neck pain patients from controls has not been investigated.
Methods: Fourteen participants with chronic neck pain and a control group of 14 individuals with no neck pain were recruited via advertisement and word of mouth. The cervical FRR was determined at baseline and 4 weeks later using standardized electromyographic data collection and analysis procedures.
Results: The mean FRR value for the combined left and right side data for the neck pain groups was 1.93 ± 0.8, and 1.73 ± 0.61 at 4-week follow-up. The intraclass correlation coefficient (ICC) was 0.83 (95% CI = 0.67–0.92). Three participants in the control group developed neck pain in the 4 weeks and their data were not included in the reliability calculation. For the control group, the combined (left and right side) mean FRR value was 4.09 ± 1.58 at baseline and 4.27 ± 1.71 on retest 4 weeks later. The ICC (intraclass r) was 0.89 (95% confidence interval = 0.76–0.95). The overall ICC for the combined groups was 0.92 (95% confidence interval = 0.86–0.95). An independent 2 group t test revealed a significant difference in the baseline FRR data between the control group and the neck pain group (P < 0.001).
Conclusion: The cervical extensor muscles exhibit a consistent flexion-relaxation phenomenon in healthy control subjects and the measurement is highly reproducible when measured 4 weeks apart in both controls and chronic neck pain patients. The FRR in neck pain patients is significantly higher than in control subjects suggesting that this measure may be a useful marker of altered neuromuscular function.
Changes in asthma symptoms and bedwetting in a four year old child receiving chiropractic care: a case report
Postles, A., Taylor, H. H., & Holt, K. (2010)
Chiropractic Journal of Australia 40(1), 34-36.
Objective: This article describes and discusses changes in asthma, bedwetting and allergy symptoms in a four-year-old child receiving chiropractic care.
Clinical features: A four-year-old child diagnosed with asthma and a history of allergies, bedwetting and disrupted sleep presented for chiropractic care.
Intervention and outcome: The child received spinal and cranial adjustments based on Sacro Occipital Technique (SOT) protocol. After 32 weeks of chiropractic care the child no longer has asthma symptoms, bedwetting had ceased and a positive change in other presenting symptoms was noted.
Conclusion: There are a growing number of case reports that describe improvements in childhood problems such as asthma and nocturnal enuresis in children receiving chiropractic care. Thus far clinical trials have failed to provide sufficient evidence to support the potential link between in these childhood problems and chiropractic care. Further study is required to investigate the role chiropractors may play in caring for children with these disorders.
Index terms: Asthma, chiropractic, case reports (publication type), nocturnal enuresis
Exploring the neuromodulatory effects of the vertebral subluxation and chiropractic care
Taylor, H. H., Holt, K., & Murphy, B. (2010)
Chiropr J Aust, 40, 37-44.
The elusive vertebral subluxation is the central defining clinical principle of the chiropractic profession. After almost 115 years of discussion there is still little consensus regarding the nature of the vertebral subluxation or its potential associated neurological manifestations. Some authors even deny that the subluxation exists. In this paper a model is presented that assumes that the putative vertebral subluxation represents a state of altered afferent input which is responsible for ongoing maladaptive central plastic changes that over time can lead to dysfunction, pain and other symptoms. A growing body of research that investigates the neuromodulatory effects of chiropractic care supports this model. This paper explores this research and discusses it in light of the vitalistic principles upon which chiropractic was founded. The model outlined in this paper may go some way to explain some of the beneficial effects of chiropractic care on nonmusculoskeletal conditions previously reported in the literature.
Index terms: MeSH: chiropractic; central nervous system; manipulation, spinal; proprioception; posture; evoked potentials, somatosensory; (other): sensorimotor integration; feed forward; vitalism.
Improvement in quality of life in a patient with depression undergoing chiropractic care using Torque Release Technique: a case study
Mahanidis, T., & Russell, D. (2010)
J Vert Sublux Res, 31.
Objective: To report on a female patient who presented for chiropractic care with depression. Clinical Features: 49 year old female who presented with a history of depression, asthma, high stress, mood and gastrointestinal changes.
Intervention and Outcome: Over a period of 7 months, a specific, conservative chiropractic adjustment regimen for the correction of vertebral subluxation was administered to the patient. The care plan was altered in accordance to outcome measures and over this time period the patient exhibited a considerable decrease in presenting symptomology alongside a substantial increase in self rated quality of life. Self-rated health/wellness (SRHW) surveys were taken prior to care and at subsequent progress visits assessing four domains of health (Physical state, Emotional/Mental state, Stress and Life Enjoyment) as well as Overall Quality of Life. Static and Thermal EMG were performed using the Chiropractic Leadership Alliance (CLA) Insight™ surface EMG and thermal scanning technology. Improvements were noted in SRHW and surface EMG and thermal scanning over the 7 months of care. Conclusions: While under chiropractic care subjective and objective improvements in physical, mental and social wellbeing were documented in a patient with a history of depression, asthma, high stress, mood and gastrointestinal changes.
Keywords: Chiropractic, subluxation, depression, quality of life, Stress, Torque Release Technique (TRT), Insight™ surface EMG and thermal scanning
Reflex effects of a spinal adjustment on blood pressure
Holt, K., Beck, R., Sexton, S., & Taylor, H. H. (2010)
Chiropractic Journal of Australia Volume 40 Issue 3 (Sep 2010)
Objective: To investigate whether an adjustment to any segment in the spine resulted in a blood pressure change and to see whether the direction of any potential blood pressure changes were dependent on the region of the spine adjusted.
Methods: Participants included 70 patients attending the New Zealand College of Chiropractic Student Health Centre. Blood pressure was recorded by a blinded examiner before and after either a single Diversified type chiropractic adjustment or an adjustment set-up with no thrust. Participants were randomly allocated to groups. Each trial was allocated to a subgroup based on the spinal region involved. Some participants were involved in more than one trial session with a total of 118 trials included in the study.
Results: Multifactorial repeated measures ANOVA assessing for any effect from the adjustment revealed a significant overall interactive effect for the factors TIME (pre / post) and GROUP (adjustment / control) [F (1,103)=4.23, p=0.042] for systolic blood pressure. Further analysis of the adjustment group revealed a significant overall effect [F (1,49)=10.89, p=0.002] with systolic blood pressure decreasing significantly (-3.9 +/- 10.3mmHg) following an adjustment. No other significant differences were found in the adjustment or control groups.
Conclusion: An adjustment to any segment in the spine resulted in a statistically significant average decrease in systolic blood pressure of 3.9 mmHg. The direction of blood pressure change that was observed was not dependent on the region of the spine adjusted. However, visual analysis suggests cervical and lumbopelvic adjustments had a greater influence on systolic blood pressure than thoracic adjustments. Diastolic blood pressure remained relatively constant. Average changes in blood pressure were unlikely to be clinically significant. However, in individual participants some blood pressure changes were considered to be clinically relevant following an adjustment.
Resolution of vertigo, migraines and neck pain in a 12-year-old boy receiving chiropractic care-a case study
Kelly, D. D., & Holt, K. (2010)
Journal of Pediatric, Maternal & Family Health–Chiropractic, 4, 150-153.
Objective: This article describes and discusses changes in vertigo, migraine and neck pain symptoms in a 12 year old boy receiving chiropractic care.
Clinical Features: A twelve year old boy with a long history of routine, recurrent dizziness, chronic neck pain and migraines presented for chiropractic care. These symptoms resulted in him being absent from school more than half of the time for the previous seven years Intervention and Outcome: The patient received high velocity low amplitude thrust chiropractic adjustments for the reduction of vertebral subluxations over a twelve month period. The C2 and C6 spinal segments were regularly adjusted over this timeframe, as well as mid-thoracic vertebrae and the sacrum. The initial frequency of care was three chiropractic visits per week for four weeks. Visit frequency was then gradually reduced over the next 12 months to one visit per month. Besides the chiropractic adjustments the patient was also advised to perform cervical stretches (lateral flexion, rotation and flexion/extension) twice daily. After the first week of chiropractic care the patient reported a cessation of his headaches and neck ache. His vertigo attacks decreased in frequency and became less severe, then ceased altogether. His attendance improved dramatically at school and dropped from 223 half days absent the previous year to 56 half days absent for the 12 months after beginning chiropractic care.
Conclusion: This case report describes a child who reported a cessation in symptoms of vertigo, neck pain and headaches after beginning chiropractic care. There are a growing number of case reports that suggest chiropractic care may be beneficial for patients suffering from vertigo. Further study is required to investigate the role chiropractors may play in caring for people with vertigo.
Key Words: Vertigo; Chiropractic; Migraine; Case Reports; Manipulation, Chiropractic; Vertebral Subluxation; Adjustment