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Brain Based Therapy: BBT
BBT is a revolutionary treatment based on the work by the countries leading Chiropractic Neurologist Dr. Fredrick Carrick. The therapy is neurologically based and the treatments have been clinically proven to help patients with chronic pain and dizziness.
Occular Light Therapy
Eyelight therapy has been shown to target the weaker functioning hemisphere of the brain via the non-dominant eye. Research has shown that light projections into the eye can have a profound effect on the hormonal system, emotions, stress levels, sleep, brain function and the patient's biochemistry. One study showed a remarkable change in the concentration of neurotransmitters in the cerebro-spinal fluid. I utilize eyelights to treat learning disorders in children and different neurological conditions.
Ocular light therapy is a method of therapeutically sending light through the eyes in order to stimulate brain function. Light through the eyes enables us to open up neurological pathways into specific brain structures, significantly affecting the brain and every cell of the body. Although we live on air, water, and food as nourishment, we are energy and light, and we are affected and nourished by light. Light is the second most important environmental input, after food, in controlling bodily functions. Studies have shown that application of light can affect the entire blood stream through circulation and elimination of toxins.
Research suggests that our nervous system, like our vascular system, may have two functions. It not only puts out and receives nerve impulses, but also may be a channel for the streaming of energy. Light ignites cellular metabolism. It enters the eye and goes to the body's power distribution center, the hypothalamus, where it is converted into electro-chemical impulses that are sent to important endocrine glands such as the pituitary and the pineal. These glands, in turn, distribute the hormonal messages via the body's nervous system to virtually every cell in the body.[1]
Interactive Metronome (IM)
A Revolution in Neurological and Motor Rehabilitation
What is the IM?
The interactive metronome (IM) is a computerized brain-based rehabilitation assessment and training program developed to directly improve the processing abilities that effect attention, motor planning, and sequencing. This in turn strengthens motor skills, including mobility and gross motor function, and many fundamental cognitive capacities such as planning, organizing, and language. The IM literally re-programs your brain.
How Does the IM Work?
The IM program provides a structured, goal-oriented training process that challenges the patient to precisely match a computer generated beat. Participants are instructed to synchronize various hand and foot exercises to a reference tone heard through head phones. The patient attempts to match the rhythmic beat with repetitive motor actions such as tapping his/her toes on a floor sensor mat or hand clapping while wearing an IM glove with palm trigger. A patented audio or audio and visual guidance system provides immediate feedback. The difference between the patient’s performance and the computer generated beat is measured in milliseconds. The score provided indicates timing accuracy.
More than a decade of clinical research and case studies on IM demonstrates that gains in motor planning, rhythm city, timing and sequencing lead to improvements in…
Attention and concentration
Language Processing
Behavior ( Aggression & Impulsivity )
Fine/ Gross Motor Skills
Balance & Gait
Strength & Endurance
Coordination
Motor skills for independent living
Independence with Prosthetic limbs
Who can Benefit?
Individuals with motor planning and sequencing problems, speech and language delays, motor and sensory disorders, learning disabilities, and various cognitive and physical deficits may benefit from the IM program. Adult and pediatric patients who have benefited from IM include those with:
#1: Traumatic Brain Injury (TBI)
#2: Cerebral Vascular Accident (CVA or Stroke)
#3: Balance Disorders
#4: Parkinson’s Disease
#5: Multiple Sclerosis
#6: Incomplete Spinal Cord Injury
#7: Decline in Function
#8: Developmental Disorders
#9: Chronic pain syndromes
#10: Epilepsy
#11: Limb Amputation
Why Use the IM?
We are applying IM in conjunction with traditional multidisciplinary treatment to inpatient and outpatient adults and children. IM training has expedited our clients’ transition from intensive inpatient therapy to a less intensive outpatient program. We have seen significant improvements in gait and coordination as well as attention and mental processing.”
Cheryl Miller-Scott, OTR/L, National Director of clinical services, HealthSouth Hospitals
“ I was particularly interested in IM because, like some of the other intensive modalities with which I work, IM can help to drive changes in the brain. The result is that children can make excellent progress in short periods of time.”
Aditi Silverstein, M.A., CCC-SLP, President of Center for Rehabilitation and Development, Inc., Roanoke,VA
“ I have found Interactive Metronome to be a useful modality to improve bilateral integration skills and to increase single limb stance time. The patients displayed increased tolerance to engage in tasks which were longer in duration and more complex.”
Tracy Cueli-Dutil, DPT, Miami Children’s Hospital/ Dan Marino Center, Miami, FL
Clinical Results
Spinal Cord Injury
A 32-year-old male with paraparesis underwent IM rehabilitation training after demonstrating significant impairments with hip and ankle equilibrium reactions. Prior to IM, his heels were not able to touch the floor during ambulation and he could only tolerate the treadmill for 2 minutes at 0.5 mph. A total of 19 IM training sessions were conducted. After training, he was able to sit, then stand independently, walk on a treadmill for over 30 minutes at 1.2 mph, and ambulate 130 feet with only minimal contact guard assistance.
Cerebral Vascular Accident (CVA)
A 46 year-old mortgage manager sustained a Cerebral Vascular Accident and presented with a vestibular disorder. He suffered from severe dizziness with head and eye movement, mild problem solving difficulties, pronounced ataxic gait, poor coordination, jumping difficulties, and loss balance. After 11 sessions with the Interactive Metronome, the man performed all advanced balance skills with improved coordination. He could jump and perform jumping jacks without loss of balance, and dizziness decreased to 20% of the time. He was independent with executive level problem solving skills.
Traumatic Brain Injury (TBI)
D.S. suffered a traumatic brain injury (TBI) in a motor vehicle accident when he was 19 years old. Before IM, D.S. displayed very jerky motions, an unstable waddle-like gait, and a severe speech stutter. In the years following his injury, he had been able to regain primary gross motor and speech functions. D.S. was 38 years old when he underwent IM training. By the time D.S. had completed his 6th IM therapy session, he had significantly improved precise gross motor control of his arms. Upon completing IM training, D.S. demonstrated symmetrical gait and improved speech.
Interactive metronome was developed in the early 1990s and immediately proved of great benefit to children diagnosed with learning and developmental disorders. Backed by years of clinical research and supported by prominent medical leaders in the industry, IM soon gained national attention as a breakthrough intervention to help those patients increase attention & concentration, motor control & coordination, language processing and control of impulsivity.
In recent years, innovative therapists have discovered the positive effects that IM can have on patients with acquired neurological and motor deficits. Rehabilitation hospitals and clinics now use IM in much the same way as their learning and developmental colleagues, to care for patients diagnosed with Stroke, Brain injury, Balance Disorders, Chronic pain syndromes, and Parkinson’s.
Interactive Metronome’s application is so broad because it measures and improves motor planning and sequencing, a critical part of the central nervous system. IM’s Rehabilitation Technologies Division (RTD) was formed to enhance traditional approaches to rehabilitation.
Today, there are more than 2,500 certified IM providers in over 1,700 clinics, hospitals and universities throughout the United States and Canada. Each day our community of providers continues to grow. IM has received an abundance of media recognition including the CBS Early Show, CNN News and World Report, as well as various segments that have aired on hundreds of TV affiliates, radio stations and national publications.
WWW.INTERACTIVEMETRONOME.COM
The Cerebellum and Central Dysdiadokokinesia
By Edgar Romero, DC, DACNB
One of the more interesting things I have learned during my practice and application of chiropractic neurology is the neurophysiological basis for spinal stability. The intrinsic spinal muscles, unlike other muscles associated with the striated voluntary muscle groups, are involuntary in nature.
Proper treatment to promote spinal stability, therefore, must be cerebellar in nature for the patient who happens to be in chronic, unremitting pain secondary to instability.
The cerebellum; where do I start? The cerebellum may very well be one of the most misunderstood areas of a very misunderstood brain. It is at once one of the oldest areas of the brain (fish have a vestibulo-cerebellar cortex that allows them to swim in a balanced manner), and one of the more complex and "new" areas of the human brain. Some researchers feel, in fact, that it is the development of the cerebellum that is responsible for the growth spurt of the rest of the brain; in essence, that it was the cerebellum which made us human.
The cerebellum is made up of a whole host of different neuronal cells: purkinje cells, granular cells, molecular cells, etc. It also has many major nerve centers within it that control a good many functions, such as balance and motor control. It is a very neuron-dense area, such that it is estimated there are more synaptic connections in the cerebellum than there are stars in the universe! Just like any electrical output generator, it can be understood that the cerebellum can be a great generator of "electricity," and electricity is what makes all our engines run.
Because of its concentrated neuronal density, however, the cerebellum is also very blood-dependent, meaning that any loss of oxygenation will affect the cerebellum profoundly, and any toxins taken into the bloodstream will have a high probability of producing a cerebellar consequence. The reasons for these changes into the cerebellum can be numerous.
One way to make sense of its sensitivity is this: When one has had a few too many drinks at the bar and is dumb enough to drive (a dumbed-down cerebellum means a dumbed-down frontal cortex, which will most likely lead to dumb decisions), the state trooper will put you through a series of sobriety tests. These tests are actually called cerebellar tests. Finger to nose, walking in a straight line, standing on one leg; these are all things controlled by the cerebellum. When alcohol has shut down the cerebellum, one cannot perform these functions properly. Take it a step further, and you may very well see those same symptoms in someone with vertigo, muscle weakness or a visual disorder. And thus, of course, it would make sense that the cerebellum is involved in each of these (and more).
A correlate to this thought process, then, is that stress, sickness and toxins in the body can all have central manifestations, such that we may present with cerebellar dysfunction and thus, increased likelihood of low back pain.
The cerebellum has two lobes, with the left cerebellum stimulating the right cortex and the right cerebellum stimulating the left cortex. The cerebellum has nuclei within it that control a number of functions related to balance, motor function and visual controls. Hence, a dysfunctional cerebellum is linked to many chronic pain syndromes and disorders such as vertigo, Parkinson's disease/dystonia (reflexogenic muscle contractions), and major muscle weaknesses. Most recently, the cerebellum has been linked to sensory functions, such that we now realize it is the cerebellum that senses where we are in our environment on a constant basis and guides our control of movements through feedback mechanisms.
Regardless, the nuclei in the cerebellum fire into the area acoustica in the pons. As the name might imply, this is also the area that receives direct stimulation from the ear pathways that are so integrally involved in our balance state. The vestibular nuclei fire into the ascending and descending medial longitudinal fasciculus; the ascending portion fires into the motor eye centers, which is why our eyes are so integral to balance, and the descending portion fires into the ventral spinal cord, where we see a reflexogenic spinal muscle response to whatever movements we have made. In essence, the cerebellum senses movement through vestibular and muscle-related reflexogenic afferents, and then sends an efferent response to our eyes and muscles to make sure we maintain balance and do not fall over. This is a much-oversimplified explanation for the moment, but it is all we really need to get where we want to go with this discussion.
Dysdiadokokinesia, is the ratchety movement associated with a misfiring motor system, specifically a misfiring cerebellum. The traditional board question involved running the heel of the foot from the knee to the shin, and we needed to observe a breakdown in movement that would signify some central cerebellar disorder. This is, in fact, a valuable test that I often use to differentiate areas of cerebellar involvement.
Central dysdiadokokinesia occurs when we see this same breakdown in movement in the intrinsic spinal muscles. Think of it: The same motor systems that show instability with a misfiring cerebellum will likely produce spinal dysfunction. This being the case, you can see how spinal treatment for low back pain that does not enhance spinal stabilizing mechanisms is more likely to fail.
If the patient lacks spinal stability as evidenced by this positive finding, the likelihood of their holding an adjustment is significantly decreased due to the simple fact that they have no reflexogenic muscle control. This patient may very well re-subluxate by just walking around the office. These patients often become (or are) chronic, and they tend to feel relief for a day or two after a good adjustment, and then are right back where they were again.
The ability to increase spinal stability and help these patients hold their adjustment must be a "central-based" treatment, or a cerebellar specific approach to their care. The interesting thing here is that the cerebellum receives many, many afferents from the spinal joints. Thus, a good adjustment will increase the frequency of firing of the cerebellar integrative state and increase the likelihood that the patient will do well.
Remember, the eyes and ears are also involved in this area for stability of spinal muscles. What I do many times in the office is integrate eye movement with the preferential side of needed adjustment, assuming that the patient's neurological state can support the treatment. For example, if their left cerebellum is weak, I may have them look to the right at the same time as I adjust their left cervical spine in a coupled movement, thus increasing the integration of the descending medial longitudinal fasciculus and increasing the likelihood that the adjustment will have greater motor stabilizing effects. I may have them listen to music or a metronome at the time of the adjustment to maximize central effects. I then immediately re-check for the signs related to the instability.
If there is an immediate stability change seen, then I know we are on the right track and it becomes an individual approach as to how long it will take to bring the patient to full stability and function. Some will respond in one adjustment, and some chronic patients may take up to six weeks to allow for muscle firing and strengthening to occur.
Dr. Edgar Romero practices in Miami. He is a diplomate of the American Chiropractic Neurology Board.
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