Abstract
Math and Physics-Based Treatments
Force travels from areas of lowest mobility and greatest density to areas of greatest mobility and lowest density. Thus, the upper cervical spine (UCS), due to its size, lack of osseous locking boundaries, its tremendous joint mobility, and its function in supporting the human head, is highly susceptible to trauma. Countless forces can result in upper cervical joint dysfunction, including trauma during the process of birth. 1 Subtle disruption to upper cervical soft tissue structures results in dysfunctional joint mechanics, which has significant neurological implications with numerous long-term consequences.
Conventional Western medicine neither considers nor attempts to address the UCS, in absence of fracture, dislocation, anomalies, and gross pathology. Concussion protocols are woefully neglectful in consideration of the conduit between the brain and body. Even within chiropractic circles, the UCS may not be sufficiently addressed. Specific upper cervical techniques were introduced in the early 1930s by the profession's developer Dr. B.J. Palmer (1881–1961). His research at his Iowa facility concluded that the UCS should be the first consideration for most spinal treatments. This sparked future development of several outstanding techniques (Kale, Atlas Orthogonal (AO), Orthospinology, Advanced Orthogonal, Blair, NUCCA, Laney, etc.). For decades, these methods have produced beneficial results for cases intractable to both conventional and alternative medical interventions. Chiropractors who are postdoctorate certified (in upper cervical specialties) and their patients can attest to this with the conviction that this expertly delivered type of care is still one of the most underutilized aspects of health care worldwide.
Millions of people suffer from neck injury in motor vehicle accidents. However, despite treatment from many different medical specialties, poor outcomes are significant, and long-term disability is common. 2 In my practice, I use the AO procedure developed by Dr. Roy W. Sweat (1927–present). A sophisticated mathematical X-ray analysis reveals the relative alignment of the head and neck for the patient. It is analogous to deciphering the combination to a lock. Such calculations dictate the reproducible, precise, and patient-specific corrective treatment. The AO percussion-adjusting instrument is calibrated to deliver an imperceptible single-pulse percussion wave vibration to the atlas vertebra (C1). This improves spinal alignment, joint mechanics, and body balance, which supports better neurological function. A 2006 study confirming AO's effectiveness was published in the Journal of Whiplash & Related Disorders. 2 Remarkable success in resolving chronic cases of painful consequences of collision-related injury was documented.
AO procedures support functional healing by addressing altered biomechanics of the UCS due to trauma. Low-level light therapy (cold laser) greatly complements treatment of the spine (and other injured areas) on a cellular level. 3 Furthermore, three-phase auricular therapy administered by means of electrical stimulation and acupuncture needles is supportive on an energetic plane. Auricular projection zones are scanned in search of electrically active and treatable points that correlate with injured structures. Drug-free support for pain modulation is accomplished by addressing auricular projections of the brain associated with pain modulation, including the frontal and prefrontal cortex, cerebellum, cingulate gyrus, basal ganglia, and amygdala. 4 Patients recover naturally from injury by means of math and physics-based treatments rather than a chemical pharmaceutical approach.
References
Gutmann G. Blocked atlantal nerve syndrome in infants and small children. Manuelle Medizin 1987;25:5–10.
Carleton J, Hammond R, Obebe J, et al. Resolution of cervical complications secondary to motor vehicle accidents by the application of Stereotactic Cervical Alignment (SCALE) methods: Statistical review of 54 patients. J Whiplash Related Disord 2006;5:15–24.
Rochel G, Murphy D, Berry T, Shanks S. Low-level laser therapy for the treatment of chronic neck and shoulder pain. Funct Neurol Rehabil Ergon 2016;6:97–104.
Soliman N. Soliman's Auricular Therapy Textbook: New Localizations and Evidence Based Therapeutic Approaches. Bloomington, IN: Author House, 2008.
The Liebell Clinic
Virginia Beach, VA
Art Therapy as Part of an Integrative Treatment Plan for Traumatic Brain Injury
Cognitive impairments, motor skill dysfunction, and behavioral changes are common in people who experience traumatic brain injury (TBI). As a result, people who experience a significant TBI may also experience changes in their physical, emotional, social, work, and home aspects of living, and a feeling of chaos may ensue, along with a loss of identity. As one part of a comprehensive and integrative treatment plan, emerging research suggests that art therapy may help individuals with TBI in a unique way.
As an emerging therapy for TBI, art therapy can help directly by improving cognitive abilities, motor skills, and communication and social skills and, ultimately, may help reduce feelings of anxiety and depression as well as boost self-esteem. It is critical, however, that people with TBI engage in this modality only with art therapy professionals who are trained to work with trauma patients, so that the client is not unnecessarily retraumatized.
As one example of how art therapy can help, McGuinness and Schnur discussed the use of art therapy to help with self-regulation of emotions and behavior in people with TBI. 1 These authors explained how art therapy exercises were able to help a client deal with feelings of frustration. Frustration can be a normal experience in the art making process, and being able to increase tolerance from frustration using art therapy helped the client engage in increasingly complex projects, according to the authors. Of course, this skill then becomes quite applicable to the frustrations of daily living with TBI. The authors commented, “Our hope is that additional art therapy, research-based studies using measurable outcomes will allow clients diagnosed with TBI to accept deficits, focus on strengths and reestablish identity.” 1
Bitonte and De Santo point out that art therapy is a significantly underutilized complementary therapy in general and yet can be very effective for people with chronic illness, physical challenges, or cancer in both adult and pediatric populations. 2 In their article, they report on a small pilot study utilizing art therapy for TBI with results showing that half or more of the participants improved in feelings of depression, anxiety, and stress.
Further research is needed in the specific area of art therapy for TBI. However, art therapy professionals are already on the frontlines working with accident victims, military personnel, and athletes with TBI to creatively help them heal both physically and emotionally.
References
McGuinness MM, Schnur KJ. Art therapy, creative apperception and rehabilitation from traumatic brain injury. In: Malchiodi C, ed. Art Therapy and Health Care. New York: The Guilford Press, 2014.
Bitonte RA, De Santo M. Art therapy: An underutilized, yet effective tool. Mental Illness 2014;6:5354.
Case Western Reserve University School of Medicine
Cleveland, OH
Yoga as an Adjunct Therapy for Traumatic Brain Injury
Yoga is one of the most common forms of complementary and alternative medicine therapies, with its popularity increasing significantly worldwide. Yoga has been proven effective in treating an array of neuropsychiatric disorders and many chronic diseases such as depression, cancer, asthma, diabetes, arthritis, fibromyalgia, cardiac problems, and stroke. 1 A systematic review on yoga therapy for stroke patients reported improvements in cognition, mood, balance, and reductions in stress. 2,3 Previous studies show that yoga improves physical pain, functional strength, balance, and quality of life in multiple sclerosis patients. 4,5 Yoga intervention was observed to be beneficial in reducing sadness and other post-traumatic symptoms compared with controls in post-traumatic stress disorder patients. 6 High-quality studies exploring the potential of yoga as an adjunct therapy in patients suffering from TBI are lacking. A single case study was found demonstrating improvements in balance by 36%, confidence by 39%, lower extremity strength by 100%, and endurance by 105% at the end of eight weeks of yoga intervention. 7
Considering the need for a feasible yoga module for TBI patients, a 45-minute yoga module has been designed. Based on the available scientific evidence and our clinical experience of >10 years in treating patients suffering from neuropsychiatric disorders, the following yoga module may be useful as an adjunct therapy in enhancing cognition and recovery of patients with mild-to-moderate TBI who do not require surgery.
Whole body joint loosening with mindfulness and breath synchronization (five minutes): feet, ankles, knees, hips, fingers, wrists, elbows, shoulders, and neck in sitting
Preparatory breathing practices in standing (five minutes): twisting, side bending, hands in and out breathing, tiger breathing
Instant relaxation technique in supine pose (five minutes): quick tightening of all body parts from toes to head followed by letting go and relaxation (two rounds)
Āsanas (physical postures)—First five rounds without holding the pose; sixth round hold the pose for 10 breaths (15 minutes): Prone: Bhujangasana (cobra pose), Naukasana (boat pose in prone position), Makarasana stretch (crocodile pose) Supine: Utthita Padasana (alternate straight leg rising), Navasana (boat pose in supine position), Pavanmuktasana kriya (wind releasing pose), Setubandhasana (bridge pose), Shavasana (corpse pose)
Prānāyāma (yogic controlled breath) in sitting meditative pose (10 minutes):
Nadishuddi prānāyāma (alternate nostril breathing)—(three minutes)
Bhramari in Shanmukhi Mudra (humming bee breath) (two minutes)
Nadanusandhana (chanting of sounds—AAA, UUU, MMM, and AUM six rounds each and feeling the vibrations in the body)
Relaxation in Shavasana (corpse pose) (five minutes): Deep abdominal breathing with prolonged exhalation in Shavasana (corpse pose) (the duration of inhalation and exhalation for each respiratory cycle should be maintained at a 1:3 ratio, respectively) for three minutes Part by part relaxation of the body from head to toes for two minutes
Acknowledgments
We acknowledge Department of Science and Technology, Science And Technology of Yoga and Meditation (DST-SATYAM), Government of India, New Delhi for the financial support.
References
Meyer HB, Katsman A, Sones AC, et al. Yoga as an ancillary treatment for neurological and psychiatric disorders: A review. J Neuropsychiatry Clin Neurosci 2012;24:152–164.
Immink MA, Hillier S, Petkov J. Randomized controlled trial of yoga for chronic poststroke hemiparesis: Motor function, mental health, and quality of life outcomes. Top Stroke Rehabil 2014;21:256–271.
Lazaridou A, Philbrook P, Tzika AA. Yoga and mindfulness as therapeutic interventions for stroke rehabilitation: A systematic review. Evid Based Complement Alternat Med 2013;2013:357108.
Salgado BC, Jones M, Ilgun S, et al. Effects of a 4-month Ananda yoga program on physical and mental health outcomes for persons with multiple sclerosis. Int J Yoga Therap 2013;23:27–38.
Doulatabad SN, Nooreyan K, Doulatabad AN, et al. The effects of pranayama, hatha and raja yoga on physical pain and the quality of life of women with multiple sclerosis. Afr J Tradit Complement Altern Med 2013;10:49–52.
Telles S, Singh N, Joshi M, Balkrishna A. Post traumatic stress symptoms and heart rate variability in Bihar flood survivors following yoga: A randomized controlled study. BMC Psychiatry 2010;10:18.
Schmid AA, Miller KK, Van Puymbroeck M, Schalk N. Feasibility and results of a case study of yoga to improve physical functioning in people with chronic traumatic brain injury. Disabil Rehabil 2016;38:914–920.
Department of Psychiatry
NIMHANS Integrated Centre for Yoga
Bangalore, India
Integrated Approach for Sports-Related Injury
Sports and recreation-related injuries are common physical trauma presentations. Body locomotion is the result of the integrated work of muscles. Therefore, considering muscles or muscle groups as isolated structures fails to answer complex treatment questions related to sports injuries. Instead, dealing with muscles aligned in the same direction as members of a particular functional subsystem would allow for analyzing movement patterns and identifying the reason for chronic post-traumatic muscle pain in sports.
The posterior oblique subsystem (POS) is a key muscle arrangement, participating in many body movements. 1 For example, handball throwing is a particular movement pattern specifically engaging the POS. Weakness of prime body stabilizers (i.e., the transversus abdominis and multifidi muscles) will overload the left gluteus maximus (as a secondary stabilizer) during flexion–rotation of jump throwing in handball and lead to compensatory shortness of the right latissimus dorsi muscle. The latter will destabilize the right shoulder area, which will cause shoulder pain during throwing. Consequently, sport-specific shoulder pain treatment of handball players in clinical practice cannot be effective without addressing core body muscles and the POS.
Reference
Clark MA, Lucett SC. Chapter 2: Introduction to human movement science. In: Clark MA, Lucett SC. NASM Essentials of Corrective Exercise Training, 1st ed. Philadelphia: Lippincott W&W/Wolters Kluwer, 2011:26–27.
School of Health Sciences
Cyprus Health and Social Sciences University
Kutlu Adali Bulvari, Turkey
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