Fall risk profile and quality-of-life status of older chiropractic patients
Holt, K. R., Noone, P. L., Short, K., Elley, C. R., & Haavik, H. (2011)
Journal of manipulative and physiological therapeutics, 34(2), 78-87.
Objectives: The primary aim of this study was to estimate the prevalence of fall risk factors in older chiropractic patients. The secondary aim was to investigate the quality-of-life status of older chiropractic patients and to see whether a history of falling was related to quality-of-life status. Methods: A cross-sectional study was conducted at 12 chiropractic practices throughout Auckland, New Zealand, and Melbourne, Australia. The study involved gaining a profile of health status, fall history, and fall risk from active chiropractic patients who were 65 years or older.
Results: One hundred ten older chiropractic patients were approached, and 101 agreed to participate in this study (response rate, 91.8%). Thirty-five percent of participants had experienced at least 1 fall in the previous 12 months. Of those that had fallen, 80% had at least a minor injury, with 37% of fallers requiring medical attention and 6% suffering a serious injury. The prevalence of most fall risk factors was consistent with published data for community dwelling older adults. Quality of life of older chiropractic patients appeared to be good, but fallers reported a lower physical component summary score compared with no fallers (P = .04).
Conclusions: A portion of the older chiropractic patients sampled in this study had a substantial risk of falling. This risk could be assessed on a regular basis for the presence of modifiable fall risk factors, and appropriate advice, given when fall risks are identified
Key Indexing Terms: Chiropractic; Accidental Falls; Aged; Risk Factors; Postural Balance; Quality of Life
Subclinical neck pain and the effects of cervical manipulation on elbow joint position sense
Haavik, H., & Murphy, B. (2011)
Journal of manipulative and physiological therapeutics, 34(2), 88-97.
Objective: The objectives of this study were to investigate whether elbow joint position sense (JPS) accuracy differs between participants with a history of subclinical neck pain (SCNP) and those with no neck complaints and to determine whether adjusting dysfunctional cervical segments in the SCNP group improves their JPS accuracy.
Method: Twenty-five SCNP participants and 18 control participants took part in this pre-post experimental study. Elbow JPS was measured using an electrogoniometer (MLTS700, ADInstruments, New Zealand). Participants reproduced a previously presented angle of the elbow joint with their neck in 4 positions: neutral, flexion, rotation, and combined flexion/rotation. The experimental intervention was high-velocity, low-amplitude cervical adjustments, and the control intervention was a 5-minute rest period. Group JPS data were compared, and it was assessed pre and post interventions using 3 parameters: absolute, constant, and variable errors.
Results: At baseline, the control group was significantly better at reproducing the elbow target angle. The SCNP group’s absolute error significantly improved after the cervical adjustments when the participants’ heads were in the neutral and left-rotation positions. They displayed a significant overall decrease in variable error after the cervical adjustments. The control group participants’ JPS accuracy was worse after the control intervention, with a significant overall effect in absolute and variable errors. No other significant effects were detected.
Conclusion: These results suggest that asymptomatic people with a history of SCNP have reduced elbow JPS accuracy compared to those with no history of any neck complaints. Furthermore, the results suggest that adjusting dysfunctional cervical segments in people with SCNP can improve their upper limb JPS accuracy.
Key Indexing Terms: Proprioception; Upper Extremity; Manipulation, Spinal; Central Nervous System; Posture; Chiropractic
Osteochondritis Dissecans of the Knee in a 10 year old Female Gymnast: A Radiology Case Report
Rhodes, C., & Drovandi, S. (2011)
Chiropractic Journal of Australia 41(2):64-66
Objective: To discuss the clinical presentation and diagnostic imaging appearance of osteochondritis dissecans of the knee in a 10 year old competitive female gymnast.
Clinical features: The patient presented with a 4-month history of knee pain that was aggravated by activity and relieved with rest.
Outcome: The patient was referred to her general practitioner and subsequent orthopedist for consultation. Diagnostic imaging studies of the knee including plain film and MRI revealed findings consistent with osteochondritis dissecans. The patient was placed on complete rest from activity for eight weeks and has since returned to competitive gymnastics.
Conclusion: Osteochondritis dissecans of the knee is a prevalent disorder in young high level atheletes. It is characterised by a subchondral osseous fragment that can separate from the underlying bone. Diagnosis and management must be implemented quickly and with patient compliance to allow for a positive outcome. Successful resolution of OCD at the knee in young high level athletes can often be achieved with conservative management to include; rest, ice and bracing. Chiropractic care is helpful in the management of associated back, knee, hip and ankle complaints induced by altered gait and weight bearing.
Improvement in autistic behaviors following chiropractic care: A case series
Cleave J, Alcantara J, Holt K. (2011)
Journal of Pediatric, Maternal & Family Health – Chiropractic 2011(4), 125-131
Objective: To describe two cases of individuals diagnosed with autism undergoing chiropractic care.
Clinical features: Case one involves a 20 year old autistic male who displays aggressive behavior towards others. Case two is a 17-year-old autistic female who abuses herself.
Intervention and outcome: Both patients received a trial of chiropractic care for 5 and 4 months respectively with visit frequency of once per week. Both patients responded favorably to chiropractic care with the male patient decreasing in aggressive behavior and the female patient decreasing in self-abuse and improved socialization.
Conclusion: Two cases of individuals who suffered from autism are presented. Each had favorable results after undergoing chiropractic care. This case series provides supporting evidence that individuals with autism may benefit from chiropractic care. More research is warranted in this area.
Key indexing terms: autism, autistic disorder, autistic spectrum disorder, chiropractic, vertebral subluxation.
The effects of manual therapy on balance and falls: a systematic review
Holt, K. R., Haavik, H., & Elley, C. R. (2012)
Journal of manipulative and physiological therapeutics, 35(3), 227-234.
Objective: The purpose of this study was to review the scientific literature on the effects of manual therapy interventions on falls and balance.
Methods: This systematic review included randomized and quasi-randomized controlled trials that investigated the effects of manual therapy interventions on falls or balance. Outcomes of interest were rate of falls, number of fallers reported, and measures of postural stability. Data sources included searches through June 2011 of Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, PsycINFO, Allied and Complimentary Medicine, Current Controlled Trials, Manual Alternative and Natural Therapy Index System, Index to the Chiropractic Literature, National Institutes of Health (USA), and Google Scholar.
Results: Eleven trials were identified that met the inclusion criteria. Most trials had poor to fair methodological quality. All included trials reported outcomes of functional balance tests or tests that used a computerized balance platform. Nine of the 11 trials reported some statistically significant improvements relating to balance after an intervention that included a manual therapy component. The ability to draw conclusions from a number of the studies was limited by poor methodological quality or very low participant numbers. A meta-analysis was not performed due to heterogeneity of interventions and outcomes. Only 2 small trials included falls as an outcome measure, but as a feasibility study and a pilot study, no meaningful conclusions could be drawn about the effects of the intervention on falls.
Conclusion: A limited amount of research has been published that supports a role for manual therapy in improving postural stability and balance. More well-designed controlled trials with sufficient participant numbers are required to draw meaningful clinical conclusions about the role that manual therapies may play in preventing falls or improving postural stability and balance.
Key Indexing Terms: Accidental Falls; Postural Balance; Manual Therapy; Systematic Review; Chiropractic.
The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control
Haavik, H., & Murphy, B. (2012)
Journal of Electromyography and Kinesiology, 22(5), 768-776.
This review provides an overview of some of the growing body of research on the effects of spinal manipulation on sensory processing, motor output, functional performance and sensorimotor integration. It describes a body of work using somatosensory evoked potentials (SEPs), transcranial magnetic nerve stimulation, and electromyographic techniques to demonstrate neurophysiological changes following spinal manipulation. This work contributes to the understanding of how an initial episode(s) of back or neck pain may lead to ongoing changes in input from the spine which over time lead to altered sensorimotor integration of input from the spine and limbs.
Chiropractic Care in New Zealand: Theories, Practice and Research
Holt KR, Haavik H. (2012)
New Zealand Journal of Natural Medicine, Issue 6 Aug-Nov.
Immediate Resolution of Constipation in an Infant Following Chiropractic Care: A Case Report & Selective Review of the Literature
Kim I, Hammond K, Alcantara J, Holt K. (2012)
Journal of Pediatric, Maternal & Family Health – Chiropractic, 2012(2), 61-65
Objective: To describe the history, treatment, and the positive outcome of chiropractic care in an infant with constipation.
Clinical features: A 3-week-old boy was presented by his mother with complaints of constipation since birth.
Intervention and outcome: The patient received chiropractic adjustments (Diversified Technique) to address subluxations at the atlas, thoracic spine, and sacrum. The patient’s mother reported an immediate, dramatic improvement in the patient’s bowel function following the first chiropractic adjustment. Consistent normal bowel function after each feeding was reported thereafter.
Conclusion: This case report suggests that further research is required to better understand if chiropractic care may be beneficial for infants suffering from constipation.
Key words: Constipation, chiropractic, infant, pediatric, vertebral subluxation
Alterations in cortical and cerebellar motor processing in subclinical neck pain patients following spinal manipulation
Daligadu, J., Haavik, H., Yielder, P. C., Baarbe, J., & Murphy, B. (2013)
Journal of manipulative and physiological therapeutics, 36(8), 527-537.
Objective: The purpose of this study was investigate whether there are alterations in cerebellar output in a subclinical neck pain (SCNP) group and whether spinal manipulation before motor sequence learning might restore the baseline functional relationship between the cerebellum and motor cortex.
Methods: Ten volunteers were tested with SCNP using transcranial magnetic stimulation before and after a combined intervention of spinal manipulation and motor sequence learning. In a separate experiment, we tested 10 healthy controls using the same measures before and after motor sequence learning. Our transcranial magnetic stimulation measurements included short-interval intracortical inhibition, long-interval intracortical inhibition, and cerebellar inhibition (CBI).
Results: The SCNP group showed a significant improvement in task performance as indicated by a 19% decrease in mean reaction time (P b .0001), which occurred concurrently with a decrease in CBI following the combined spinal manipulation and motor sequence learning intervention (F1,6 = 7.92, P b .05). The control group also showed an improvement in task performance as indicated by a 25% increase in reaction time (P b .001) with no changes to CBI.
Conclusions: Subclinical neck pain patients have altered CBI when compared with healthy controls, and spinal manipulation before a motor sequence learning task changes the CBI pattern to one similar to healthy controls.
Key Indexing Terms: Manipulation, Spinal; Transcranial Magnetic Stimulation; Cerebellum; Learning
Detection and classification of movement-related cortical potentials associated with task force and speed
Jochumsen, M., Niazi, I. K., Mrachacz-Kersting, N., Farina, D., & Dremstrup, K. (2013)
Journal of neural engineering, 10(5), 056015.
Objective: In this study, the objective was to detect movement intentions and extract different levels of force and speed of the intended movement from scalp electroencephalography (EEG). We then estimated the performance of the closed loop system.
Approach: Cued movements were detected from continuous EEG recordings using a template of the initial phase of the movement-related cortical potential in 12 healthy subjects. The temporal features, extracted from the movement intention, were classified with an optimized support vector machine. The system performance was evaluated when combining detection with classification. Main results. The system detected 81% of the movements and correctly classified 75 ± 9% and 80 ± 10% of these at the point of detection when varying the force and speed, respectively. When the detector was combined with the classifier, the system detected and correctly classified 64 ± 13% and 67 ± 13% of these movements. The system detected and incorrectly classified 21 ± 7% and 16 ± 9% of the movements. The movements were detected 317 ± 73 ms before the movement onset. Significance. The results indicate that it is possible to detect movement intentions with limited latencies, and extract and classify different levels of force and speed, which may be combined with assistive technologies for patient-driven neurorehabilitation.
Selective changes in cerebellar-cortical processing following motor training
Haavik, H., & Murphy, B. A. (2013)
Experimental brain research, 231(4), 397-403.
The aim of this study was to investigate the effect of varying stimulation rate and the effects of a repetitive typing task on the amplitude of somatosensory evoked potential (SEP) peaks thought to relate to cerebellar processing. SEPs (2,000 sweep averages) were recorded following median nerve stimulation at the wrist at frequencies of 2.47, 4.98, and 9.90 Hz from 12 subjects before and after a 20-min repetitive typing task.
Typing and error rate were recorded 2-min pre- and post-typing task. Effect of stimulation rate was analysed with ANOVA followed by pairwise comparisons (paired t tests). Typing effects were analysed by performing two-tailed paired t tests. Increasing stimulation frequency significantly decreased the N30 SEP peak amplitude (p < 0.02). Both the 4.98 and 9.90 Hz rates lead to significantly smaller N30 peak amplitudes compared to the 2.47 Hz (p ≤ 0.01). The N24 amplitude significantly increased following the typing task for both 4.98 and 2.47 Hz (p ≤ 0.025). In contrast, there was a highly significant decrease (p < 0.001) in the N18 peak amplitude post-typing at all frequencies. Typing rate increased (p < 0.001) and error rate decreased (p < 0.05) following the typing task.
The results suggest that the N24 SEP peak amplitude is best recorded at 4.98 Hz since the N30 amplitude decreases and no longer contaminates the N24 peak, making the N24 visible and easier to measure, while still enabling changes due to repetitive activity to be measured. The decrease in N18 amplitude along with an increase in N24 amplitude with no change in N20 amplitude may be explained by the intervention reducing inhibition at the level of the cuneate nucleus and/or interior olives leading to alterations in cerebellar-cortical processing.
Keywords: Cerebellum, Cortical plasticity, Repetitive movement, Somatosensory evoked potentials, Human
Effectiveness of chiropractic care in improving sensorimotor function associated with falls risk in older people
Holt, K. R. (2014)
Doctoral dissertation, ResearchSpace@ Auckland
This thesis assessed whether chiropractic care was effective in improving sensorimotor function that is related to fall risk in community-dwelling older adults over a 12 week period. A pragmatic randomised controlled trial was conducted that compared the effect of chiropractic care to a ‘usual care’ control on proprioception (joint position sense), postural stability (static posturography), a broad measure of sensorimotor function (choice stepping reaction time), multisensory integration (the sound-induced flash illusion), and health-related quality of life (SF-36). Outcomes were assessed at four weeks and 12 weeks after a baseline assessment. Participants in the trial included 60 community dwelling older adults from the Auckland region. Of potential participants screened for eligibility, 92% were eligible. Chiropractic care was provided by 12 chiropractic practices from across Auckland in their usual practice setting, following an approach tailored to the participants’ individual clinical needs.
The key findings from the study were that the chiropractic group improved compared to the usual care control group in ankle joint position sense (p=0.045, mean difference across four and 12 week assessments 0.20˚, 95% CI 0.01-0.39˚), and choice stepping reaction time (p=0.01, mean difference at 12 week assessment 118ms, 95% CI 24 to 212ms), and they were also less susceptible to the sound-induced flash illusion (p=0.01, mean difference at 12 week assessment 13.5%, 95% CI 2.9 to 24.0%). Between group differences were also observed in the physical component of health-related quality of life with the chiropractic group improving compared to the control group between the four and 12 week assessments (p=0.047, mean difference 2.4, 95% CI 0.04 to 4.8).
Further research is now required to understand the potential mechanisms of action associated with the improvements that were observed in sensorimotor function, multisensory integration, and the physical component of quality of life in the chiropractic group. Future studies are also required to investigate whether chiropractic care may play a role in preventing falls in older people.
The Reality Check: A quest to understand chiropractic from the inside out
A novel protocol to investigate motor training-induced plasticity and sensorimotor integration in the cerebellum and motor cortex
Baarbé, J., Yielder, P., Daligadu, J., Behbahani, H., Haavik, H., & Murphy, B. (2014)
Journal of neurophysiology, 111(4), 715-721.
Our group set out to develop a sensitive technique, capable of detecting output changes from the posterior fossa following a motor acquisition task. Transcranial magnetic stimulation (TMS) was applied over the right cerebellar cortex 5 ms in advance of test stimuli over the left cerebral motor cortex (M1), suppressing test motor-evoked potentials (MEPs) recorded in a distal hand muscle. Ten participants typed the letters Z, D, F, and P in randomized 8-letter sequences for ∼15 min, and 10 participants took part in the control condition. Cerebellar-M1 recruitment curves were established before and after the motor acquisition task. Cerebellar inhibition at 50% (CBI50) was defined as the intensity of cerebellar-M1 stimulations that produced MEPs that were 50% of the initial test MEP. Collection also occurred at stimulator intensities 5 and 10% above CBI50. A significant interaction effect of group (experimental and control) vs. time (pre- and postintervention) was observed [F(1,18) = 4.617, P = 0.046]. Post hoc tests showed a significant effect for the learning task in the experimental group [F(1,9) = 10.28, P = 0.01]. Further analysis showed specific disinhibition at CBI50 (P = 0.04), CBI50+5% (P = 0.008), and CBI50+10% (P = 0.01) for the experimental group only. Reaction time (P < 0.001) and accuracy (P = 0.006) improved significantly following practice, implying that disinhibition coincides with motor learning. No changes, however, were seen in the control condition. We conclude that this protocol is a sensitive technique that may be used to study cerebellar disinhibition with motor acquisition in vivo.
Resolution of Nocturnal Enuresis in a 10-year-old Child Following Chiropractic Care to Reduce Vertebral Subluxation: A Case Report
Luscombe, S., Alcantara, J., Holmes, S., Holt, K. (2014)
J. Pediatric, Maternal & Family Health, 2014(3) 55-59
Objective: To describe the chiropractic care of a 10-year-old boy experiencing frequent nocturnal enuresis (NE), otherwise known as “bedwetting”.
Clinical Features: The child suffered from long-term regular bedwetting.
Intervention and Outcome: The child received instrument assisted and drop table technique adjustments over a two month period. After four weeks of chiropractic care the child’s bedwetting ceased.
Conclusion: This case study adds to the growing body of literature that supports a possible link between chiropractic care and improvements in NE. Further research in this field is required to investigate this potential link.
Keywords: Enuresis, nocturnal, bedwetting, child, chiropractic, vertebral subluxation
Induction of long-term depression-like plasticity by pairings of motor imagination and peripheral electrical stimulation
Jochumsen M, Signal N, Nedergaard RW, Taylor D, Haavik H and Niazi IK (2015)
Front. Hum. Neurosci. 9:644
Long-term depression (LTD) and long-term potentiation (LTP)-like plasticity are models of synaptic plasticity which have been associated with memory and learning. The induction of LTD and LTP-like plasticity, using different stimulation protocols, has been proposed as a means of addressing abnormalities in cortical excitability associated with conditions such as focal hand dystonia and stroke. The aim of this study was to investigate whether the excitability of the cortical projections to the tibialis anterior muscle could be decreased when dorsiflexion of the ankle joint was imagined and paired with peripheral electrical stimulation of the nerve supplying the antagonist soleus muscle. The effect of stimulus timing was evaluated by comparing paired stimulation timed to reach the cortex before, at and after the onset of imagined movement. Fourteen healthy subjects participated in six experimental sessions held on non-consecutive days. The timing of stimulation delivery was determined offline based on the contingent negative variation (CNV) of electroencephalography (EEG) brain data obtained during imagined dorsiflexion. Afferent stimulation was provided via a single pulse electrical stimulation to the peripheral nerve paired, based on the CNV, with motor imagination of ankle dorsiflexion. A significant decrease (P=0.001) in the excitability of the cortical projection of tibialis anterior was observed when the afferent volley from the electrical stimulation of the tibial nerve (TN) reached the cortex at the onset of motor imagination based on the CNV. When TN stimulation was delivered before (P=0.62), or after (P=0.23) imagined movement onset there was no significant effect. Nor was a significant effect found when electrical stimulation of the TN was applied independent of imagined movement (P=0.45). Therefore, the excitability of the cortical projection to a muscle can be inhibited when electrical stimulation of the nerve supplying the antagonist muscle is precisely paired with the onset of imagined movement.