Stroke Rehabilitation and The Positive Effects of Chiropractic on the Response to the Central Nervous System and Motor Training Tasks
By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
Whithall, McCombe Waller, Silver, and Macko (2000) reported, “Stroke is the third leading cause of death in the United States and the leading cause of adult disability. Annually, approximately 750,000 Americans suffer a stroke. Although incidence rates have remained constant over the last 3 decades, mortality has declined, leaving an increasing number of patients requiring rehabilitation. Approximately two thirds of stroke survivors have residual neurological deficits that persistently impair function. Specifically, dysfunction from upper extremity (UE) hemiparesis [weakness on one side of the body] impairs performance of many daily activities such as dressing, bathing, self-care, and writing, thus reducing functional independence. In fact, only 5% of adults regain full arm function after stroke, and 20% regain no functional use. Hence, alternative strategies are needed to reduce the long-term disability and functional impairment from UE hemiparesis [weakness on one side of the body]” (p. 2390).
According to Kleim and Jones (2008), neuroscientists (specialists who study how the brain and nervous systems work) are often asked about specific therapies that should be included in clinical treatment programs. They go on to report that the data points to brain cells possessing the ability to alter their structure and function in response to a variety of internal and external pressures and is called “neural plasticity.” They go on to say that, “Neural plasticity is believed to be the basis for both learning in the intact brain and relearning in the damaged brain that occurs through physical rehabilitation. Neuroscience research has made significant advances in understanding experience-dependent neural plasticity, and these findings are beginning to be integrated with research on the degenerative and regenerative effects of brain damage” (Kleim & Jones, 2008, p. S225). When you any type of brain damage, the goal is to limit additional damage and help restore as much function as possible.
Whithall et al. (2000) reported that, “ Traditionally, methods of stroke rehabilitation have been focused on the first 3 months after stroke and consist largely of passive (nonspecific) movement approaches or compensatory training of the nonparetic [non affected] arm.
This time window is consistent with natural history studies of stroke recovery that show a plateau after 3 months. Recently, both the paradigms for rehabilitation interventions and the time frame for possible UE motor recovery have been challenged. Experiments demonstrate that functional gains and possible neural plasticity can occur, via active practice, long after spontaneous recovery would be expected to end. For example, monkey models of chronic stroke demonstrate functional recovery as well as cortical reorganization after being forced to use their paretic limb. On the basis of this ‘forced-use’ paradigm, Taub, Wolf, and colleagues constrained the nonparetic [non affected] arm of patients with chronic stroke and forced the use of the paretic arm in task-specific activities in an intensive 2-week protocol” (p. 2390).
The goal of rehabilitation is to create new pathways for the brain to express itself in the form of movement and function to enable the stroke victim to regain as much function as possible. This allows the individual to live as normal a life as he/she can without care and support from aides, devices and specialists, rendering a level of physical and resultant emotional independence.
Taylor and Murphy reported in 2010 that when motor activity is followed by a chiropractic spinal manipulation/adjustment, it altered the way in which the central nervous system responded to motor training tasks. In both the patient with and without recurring neck pain, it positively affected the process of use-dependant neural plastic changes. The research went on to report that spinal manipulation/adjusting alone leads to improved function. However, spinal manipulation/adjusting in combination with motor training tasks “…not only results in altered sensorimotor integration but also alters the way the CNS responds to a functional task…” (Taylor & Murphy, 2010, p. 268). Taylor goes on to report, “The results of this study suggests that this is possible, as an improved ability to filter somatosensory information in sensorimotor integration circuits was observed after the same 20-minute motor training task, when this was preceded with spinal manipulation of the subjects’ dysfunctional cervical joints. This finding was similar to what has been previously observed after spinal manipulation alone and indicates that spinal manipulation improves gating or filtering of sensory information, an ability the CNS retains even after the motor training intervention” (Taylor & Murphy, 2010, p. 269). While no one suggests that manipulation/adjusting should replace motor training or skill acquisition, the results indicate that manipulation should significantly improve the outcomes of rehabilitation with stroke victims.
References:
1. Whithall, J., McCombe Waller, S., Silver, K. H. C., & Macko, R. F. (2000). Repetitive bilateral arm training with rhythmic auditory cueing improves motor function in chronic hemiparetic stroke.Stroke, 31 (10), 2390-2395.
2. Kleim, J. A., & Jones, T. A. (2008) Principles of experience-dependant neural plasticity: Implications for rehabilitation after brain damage, Journal of Speech, Language, and Hearing Research, 51(Suppl. Neuroplasticity), S225-S239.
3. Haavik Taylor, H., & Murphy, B. (2010). The effects of spinal manipulation on central integration of dual somatosensory input observed after motor training: A crossover study.Journal of Manipulative and Physiological Therapeutics, 33(4), 261-272.
