Chiropractic Vestibular Rehabilitation
By Marc J, Lamantia, D.C., DACNB << Back to Scoliosissystems Home Page
Although the literature reports a significant labyrinthine dominance on the side of thoracic convexity in the thoracic spine, and the concavity of the lumbar spine, a thorough vestibular examination should be performed on the scoliosis population. Therapy should then be appropriate to the diagnosis. Further study of the vestibular and oculomotor connections to the central nervous system are required for a more complete understand of the vestibular mechanisms associated with Idiopathic Scoliosis. Below are a few brief concepts;
Chiropractic Vestibular TherapyŠ (CVR):
Chiropractic Vestibular Rehabilitation (CVR) incorporates the clinical evaluation of brainstem function through the use of advanced neurodiagnostic testing procedures including Video Electronystagmography (ENG) and Posturography. ENG is accepted by the American Academy of Neurology as a standard test to assess midline brainstem function and mild neurological imbalances as evidenced by caloric, postural and oculomotor testing. A Review of the literature identifies ENG as being sensitive to CNS disturbances even when other neurological testing may be negative. The technique is safe non-invasive and can be performed on infants, children and adults.
Non-Specific chiropractic techniques utilizing movement strategies, repetative head positioning, natural spin, gaze with adjusting, and other neuro-rehabilitative techniques are applied in a manner consistent with current understandings of CNS neuro-rehabilitation.
A review of the literature identifies oculomotor exercises as well as evocation of optokinetic reflexes as an effective form of neuro-rehabilitation. Relying on the plasticity of the nervous system, chiropractic spinal adjustic procedures, balance and oculomotor activities can be coupled into specialized treatment protocols to further influence central neural integration.
Further review of the literature identifies vestibular rehabilitation as being most effective when specific exercises and activities are developed based upon the findings associated with ENG analysis. Research also has shown that sensory stimulations are effective in improving motoric activities in a neuro-rehabilitation setting. These concepts become important to the Doctor of Chiropractic interested in restoring balanced brainstem activity.
The nature of the vestibular system is such that it is sensitive to very subtle neural imbalance due to the tonic activity of the vestibular nuclei in a gravitational environment. The Vestibular nuclei are directly responsible for extensor tone of the axial musculature, and are commonly the cause of head tilts and chronic upper cervical spinal misalignment. Strong vestibular connections to the lumbar spine musculature as well as connections to the extra-ocular musculature create the neural controls of posture and dynamic balance in motion. Both vestibulo-spinal and vestibulo-ocular reflexes provide a window to the neural integrity of the brainstem structures both before and after appropriate chiropractic care.
A working knowledge of cortical, cerebellar, and brainstem neurology will allow the Doctor of Chiropractic to identify specific imbalances which will serve to direct appropriate use of chiropractic care as a neuro-rehabilitative technique. ENG testing of eye movements may uncover CNS dysfunctions secondary to imbalances or dysfunction in the basal ganglia, parietal, frontal and temporal brain, cerebellum, brainstem, cranial nerves and peripheral receptors of the inner ear.
Radiographic techniques of the spine can be utilized by the Doctor of Chiropractic to assess the potentiality of using the cervical spine as a sensory modality to induce plastic changes in the CNS. Through the use of coupled reduction of the cervical spine, including special considerations when attempting to manipulate the upper cervical vertebrae, the Doctor of Chiropractic can offer the patient a unique approach to neuro-rehabilitation. Due to the cervical spine afferent integration into the central system, upper cervical spine activities represent a potential avenue of rehabilitation regardless of the presence of cervical spine disease or subluxation. A review of the literature identifies chiropractic care as an appropriate intervention for the patient with MeniereÕs disease, vertigo and abnormal nystgamus; all which are symptoms of vestibular brainstem imbalances.
Vestibular and oculomotor imbalances have been identified in patients with learning disabilities, difficulty reading, dyslexia, vertigo, anxiety, migrainous syndromes, head injury, balance disturbances, cerebellar disease, brainstem disease, cortical disease, dystonia and scoliosis. Although ENG can be utilized with patients with these conditions, ENG findings are not diagnostic for each particular condition
The peripheral vestibular receptor is responsible for conveying information about angular acceleration of the head, linear acceleration of the head, and gravity. Through central pathways, the vestibular nuclei influence extensor tone ipsilaterally and flexor tone contralterally via the Vestibulospinal reflex. Ascending projections from this same system control ocular reflexes in response to head perturbations. Aberrancies have long been identified in the scoliosis population.
Advanced diagnostic testing by the chiropractor should include Video Electronystagmogrphy or VNG testing. Both caloric testing and active head rotation testing of the VOR is recommended. In the event Video Electronystagmography and caloric testing is not available; natural vestibular stimulations can be used opposite of the major convexity as a rule. Be aware that this will be inappropriate for thirty percent (30%) of you patient population. All therapy should be conducted with the aid of a pulse oximeter. In the event of a tachycardic or bradycardic event, the treatment should be halted. Plastic changes in the nervous system will take place within a three month period.