Missouri Functional Neurology and Chiropractic, LLC

Near Point of Convergence After a Sport-related Concussion: "Convergence insufficiency (CI) is a common binocular vision deficit after a sport-related concussion (SRC). CI may result in visual discomfort and vision-mediated functional difficulties such as slowed reading and compromised attention, leading to impaired academic, work, and sport performance." "A concussion was defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces and... involving an alteration in mental status with or without loss of consciousness." "Sport-related concussion (SRC) continues to be a significant health concern, affecting as many as 3.8 million athletes each year in the United States. Among the myriad effects of concussions are symptoms (eg, headache, dizziness, nausea) as well as cognitive (eg, memory, reaction time, processing speed), vestibular (balance, saccades, vestibular ocular reflex), and vision or oculomotor impairments. Post-traumatic vision or oculomotor problems are reported in 30% to 65% of patients with a mild traumatic brain injury (TBI)." "Athletes with convergence insufficiency (CI) had worse neuro-cognitive impairment and higher symptom scores than did those with normal near point convergence (NPC). Clinicians should consider routinely screening for NPC as part of a comprehensive concussion evaluation to help inform treatment recommendations, academic accommodations, and referrals for vision therapy." At MFNC we examine and treat for Convergence Insufficiencies (ability to bring your eyes together and see close to your face). If your eyes are unable to move correctly after a concussion your ability to perform cognitively in academics, work, or sports will be impaired. https://www.ncbi.nlm.nih.gov//PMC50671/pdf/nihms822732.pdf

Early Treatment for Concussion May Lead to Faster Recovery "Early clinical treatment may significantly reduce recovery time following a concussion, according to new research led by the University of Pittsburgh Sports Medicine Concussion Program." "A concussion is a mild traumatic brain injury caused by a jolt to the head or body that disrupts the function of the brain. This injury can result in physical, cognitive, emotional and/or sleep-related symptoms that may or may not i...nvolve a loss of consciousness. The symptoms can last from several minutes, to days, weeks, months or longer." "study emphasizes the importance of seeking appropriate, specialized care early on. Delaying clinical care following a concussion leaves patients to deal with symptoms on their own and negates the positive effects of early and targeted interventions" "Early clinical care including behavioral management interventions and targeted exertion, vestibular and oculomotor rehabilitation exercises also may minimize missed time at work, school or sports, helping the patient return to a normal routine sooner" Getting access to specific/targeted vestibular and oculomotor rehabilitation exercises following a concussion shows to speed up your recovery time. https://www.upmc.com//n/010620-kontos-early-treatment-jama

The Intersection Between Ocular and Manual Motor Control: Eye-Hand Coordination in Acquired Brain Injury "Acute and chronic disease processes that lead to cerebral(brain) injury can often be clinically challenging diagnostically, prognostically, and therapeutically." "Neurodegenerative processes are one such elusive diagnostic group, given their often diffuse and indolent nature, creating difficulties in pinpointing specific structural abnormalities that relate to functional ...Continue reading

Single leg balance stability and non-contact lower extremity injury risk: "Postural stability deficits during single-leg stance have been reported in persons with anterior cruciate ligament (ACL) injury, ACL reconstruction, and chronic ankle instability. It remains unclear whether impaired postural stability is a consequence or cause of these injuries."... Methods: "Fifty injury-free female athletes performed a transition task from double-leg stance to single-leg stance with eyes closed." Results: "Six participants sustained a non-contact ACL injury or ankle sprain. Center-of-pressure displacement during the first 3 seconds after the time to a new stability point was significantly increased in the injured." Conclusions: "This preliminary study suggests that postural stability measurements during the single-leg stance phase of the double- to single-leg stance transition task may be a useful predictor of increased risk of non-contact lower extremity injury." At MFNC we evaluate balance in various scenarios with eyes open and eyes closed and provide therapies to improve balance in each situation. https://www.jospt.org/doi/pdf/10.2519/jospt.2016.627

Fixation stability as a biomarker after brain injury Eye Fixations: "fixations keep the eye position in a relatively still state to hold the image of a stationary target on the fovea" -The ability to hold your eyes steady on a target... "Depending on the type of eye movement, different brain regions become activated (12). For example, fixations involve specific cerebral and brainstem structures (11). These cerebral structures include the Parietal Eye Field (PEF), the Supplementary Eye Field (SEF), middle temporal and medial superior temporal areas, and the dorsolateral prefrontal cortex (12). Additionally, the Frontal Eye Field (FEF) neurons fire at the beginning of and during fixations (13). The brainstem also impacts fixations and includes the substantia nigra pars reticulata of the basal ganglia and the rostral pole of the Superior Colliculus (SC) (10)." "Examining the neuro-circuitry regulating oculomotor behavior is valuable to understanding both normal functioning and the pathophysiology of diseases and injuries, including concussion" "Impaired fixation stability may indicate dysfunction in brainstem lesions affecting the Nucleus Prepositus Hypoglossi-Medial Vestibular Nucleus Region (NPH-MVN) which is essential for neural integration and vestibular imbalance" RESULTS: "Bivariate Contour Ellipse Area (BCEA) results revealed significant differences between groups with the mTBI group showing a larger gaze spread, indicative of less ability to keep the eyes close to the target without deviating" "Results for Convergence Point and Depth and Disassociated Phoria also proved significant. Such eye movements used to converge, coordinate and hold the eyes while maintaining fusion involve complex neurological processes that may be impacted in persons with TBI. These metrics result in problems with binocularity, reading problems, balance, coordination, and near-work functions." At MFNC we evaluate a person's ability to hold fixation and provide therapies to help improve fixation stability. https://www.tandfonline.com//10.1080/02699052.2020.1865566

POTS: Individualized Treatment Strategies Postural Orthostatic Tachycardia Syndrome (POTS) "POTS is a common disorder of chronic orthostatic intolerance in... children. The disorder is characterized by dizziness, palpations, fatigue, headache, chest tightness, abdominal pain, nausea, and even syncope on standing. Although its symptoms are primarily associated with the upright position, some patients report their persistence when they are sitting or lying down." "POTS predominantly affects females, with the ratio of females to males in adult studies being 4:1" "The symptoms of POTS in children and adolescents vary. Common symptoms of our patients include dizziness (84.00%), fatigue (72.00%), orthostatic faint (62.67%), shortness of breath (55.33%), pallor (51.33%), blurred vision (50.00%), hyperhidrosis (43.33%), gastrointestinal difficulties (40.67%), and fatigue (37.33%). Some authors have reported that 30% of their patients have a variety of symptoms. Female patients often experience a worsening of symptoms during menstruation." "The numerous co-morbidities of POTS in children have attracted the attention of many researchers. These include chronic fatigue syndrome, sleep disorders, migraines, irritable bowel syndrome or functional dyspepsia, cyclic-vomiting syndrome, fibromyalgia, and Ehlers-Danlos syndrome" "Based on the mechanisms of potential pathophysiology of POTS, 3 main clinical subtypes of the syndrome have been established: hypovolemic POTS, neuropathic POTS, and hyperadrenergic POTS (2022). These phenotypes may overlap." Treatments: "Accurate diagnosis is the basis for controlling this disease that excludes true cardiac disorders. The majority of patients with POTS show substantial improvement after proper diagnosis leads to a comprehensive therapeutic regimen being put in place." "Lowered water intake and shorter sleeping time were identified as POTS risk factors in children and adolescents" "Some investigators have found that a regular, short-term progressive physical-exercise program leads to improved symptoms in POTS patients" "Like other researchers, we have found that children with POTS have poor nutrition, including low iron storage (5, 49), vitamin B12 deficiency (50), vitamin B1 deficiency (51), hypovitaminosis D (52), and elevated plasma homocysteine levels (53). Correcting these would be very beneficial to the recovery of patients." https://www.frontiersin.org/articles//fneur.2020.00525/full

Cervicogenic (neck) Dizziness "Cervicogenic dizziness (CGD) is a clinical syndrome characterized by the presence of dizziness and associated neck pain." "Cervicogenic dizziness is characterized by the presence of imbalance, unsteadiness, disorientation, neck pain, limited cervical range of motion (ROM), and may be accompanied by a headache"... "Although the etiology remains unknown, many cases of CGD have been diagnosed post whiplash injury" "It has been proposed that a disruption of the normal afferent signals from the upper cervical proprioceptors to the vestibular nucleus results in an inaccurate depiction of head and neck orientation in space" "Once vestibular pathologies have been ruled out, the clinician should examine the cervical spine, followed by the cervical neck torsion test and cervical relocation test to help confirm or exclude the diagnosis of CGD." At MFNC we evaluate how your brain responds to different head movements that can cause dizziness and provide therapies to assist in recovery. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759906/

Chronic Pain And Brain Plasticity "Homeostatic plasticity is an essential form of plasticity in the human brain that ensures neuronal activity is maintained within a stable physiological range" "Impaired homeostatic plasticity may contribute to maladaptive synaptic plasticity and symptom persistence in chronic musculoskeletal pain."... "In the healthy brain, homeostatic plasticity mechanisms enforce stability and maintain brain excitability within a normal range by shifting the threshold for LTP(long term potentiation or increased excitability) and LTD(long term depression or decreased excitability) based on the history of synaptic activity." "Although precise mechanisms remain unclear, structural and functional reorganization of the sensorimotor cortex has been identified in cLBP(chronic low back pain), and is associated with pain severity, pain duration and movement dysfunction" "These unique data suggest a disruption of synaptic homeostasis in individuals with cLBP that manifests as an inability to counter excessive increases in corticomotor excitability." "Failure to regulate synaptic plasticity in individuals with cLBP could lead to a disproportionately high rate of synaptic strengthening that in turn, produces abnormally high cortical excitability and maladaptive reorganisation of brain regions." "Indeed, studies have shown increased cortical excitability, reduced GABAergic inhibition, and enlarged representations of the back muscles that are posteriorly shifted and show greater overlap in cLBP when compared with those of healthy controls. These cortical changes are associated with pain severity, impaired postural control and reduced coordination of trunk muscles" Conclusions: "These data indicate impaired homeostatic plasticity in the primary motor(movement) cortex of individuals with cLBP." At MFNC we look for the different brain areas that are affected when someone is experiencing pain and provide therapies to assist in the recovery. https://www.sciencedirect.com//artic/pii/S138824571830083X

Measuring Eye Movements in ADHD, and Reading Disability "Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most commonly diagnosed disorders in children with prevalence rates in the general population ranging... from 3-7%" "Reading Disability (RD) is also commonly diagnosed with prevalence rates of approximately 4% among school-aged children in the general population" "Furthermore, there is a strong link between child behavior difficulties and underachievement in reading. For example, Nelson, Benner, Lane, and Smith (2004) found that 83% of students classified with emotional and behavioral disorders performed in the below average range on a standardized measure of reading skills" "To reduce the likelihood of misdiagnosis and more clearly differentiate between ADHD and RD, an objective assessment measure is needed. One such instrument may be eye movement tracking." "Eye movement tracking is a potentially useful method of assessment because it allows for objectivity and provides quantitative data on reading process and visual and attentional abilities" Reading Disability (RD) "Previous research has demonstrated that children with RD exhibit different patterns of eye movement on reading tasks as compared to normal readers. While normal readers can read about 250 words per minute, the reading speed of children with RD tends to be much slower because they make longer fixations, more frequent fixations, shorter saccades, and more regressions than normal readers." ADHD "Results indicated that participants with ADHD displayed longer reaction times, more variability, and slower saccades in the prosaccade task compared to participants in the Control group." In the antisaccade task, participants with ADHD had more difficulty inhibiting automatic saccades, displayed longer reaction times, and greater variability" At MFNC we examine all the different types of eye movements and provide therapies to assist in improving the function of those areas of the brain. https://www.scirp.org/pdf/Psych.20100400002_90960101.pdf

Gait, Balance, Posture in Mental Illnesses "Mental disorders are among the most common health issues worldwide. Changes in psychomotor behavior can be observed in gross motor skills. Gait is an example of behavior that reflects various levels of nervous system function." ... "In psychiatric conditions, gait disturbances are thought to reflect defective brain function. Patients who suffer from gait disturbances tend to develop balance disorders as well as impaired body posture." "Our review indicates that patients suffering from mental disorders have a unique physical profile that is in keeping with the clinical diagnosis (schizophrenia, depression and anxiety)" "the physical profile of patients with schizophrenia is characterized by a slow gait and decreased stride length, patients suffering from anxiety disorders are characterized by balance disorders, and those suffering from depression - by a slow gait and slumped posture." Conclusions: "We would propose that when seeking to create an evaluation and treatment program for patients with mental illness, specific elements such as balance, gait patterns and posture, should also be taken into consideration." At MFNC we evaluate our patients balance, gait, and posture. Did the chicken or the egg happen first.. did the mental illness cause the neurologic signs with balance, gait, and posture or did the loss/lack of balance, gait, and/or posture cause the mental illness... Gait, Balance and Posture in Major Mental Illnesses: Depression, Anxiety and Schizophrenia - Schreiber, F. et al. 2020

Treatment Outcomes of mTBI's Published July 28, 2020 Objectives: ... "Mild traumatic brain injury (mTBI) is a controversial and under-researched area, despite most traumatic brain injuries being classed as mild. Our objective was to review the evidence underpinning these approaches to treat mTBI including educational, psychological, rehabilitative and pharmacological approaches and discuss their efficacy." Conclusions: "Traditional education and reassurance can no longer be recommended as having the best evidence base for efficacy as compared to psychological and rehabilitative approaches, and guidelines should begin to reflect this." "Mild traumatic brain injury (mTBI) occurs in the absence of readily detectable neurological damage. It accounts for 7090% of brain injuries and is a common complaint in patients attending Accident and Emergency departments, where patients may present with a complicated pattern of symptoms" https://www.tandfonline.com//10.1080/02699052.2020.1797168

Impact of Position of the Head on Function of the Human Body "The head is an important element of the biokinetic chain. Due to its location and the fact that it constitutes approximately 6% of the total body weight" "The findings of the current studies indicate that the head... moving forward activates a number of compensation mechanisms involving many structures." "Failure of the head to align with the vertical axis of the body, among others, causes disturbances in the 3-dimensional chest shape and its respiratory movements, decreases their respiratory movements of the lower chest, and increases the amplitude of respiratory movements of the upper tract(use of accessory breathing muscles such as scalenes and SCMs)" "They confirm that changes of the head position lead to accessory muscle recruitment with increased, among others, SCM and anterior scalene muscle activity causing rib cage elevation and reducing thoracoabdominal mobility. Therefore, it seems that the logical consequence of this series of events would be cervical spine(neck) overload syndromes. Alteration in the head posture, muscular imbalance has been observed in the neck pain population." "Due to the large number of proprioreceptors located in the neck area, the head position also has a significant relationship with balance. Additionally, as the head moves forward, COG(center of gravity) shifts. According to many authors, it is the reason for body position disorders and worse balance among people with FHP(forward head posture)." Conclusions: "In people with FHP, abnormalities in the breathing movements of the chest as well as in respiratory functions, especially FVC (forced vital capacity) and FEV1 (forced expiratory volume) can be observed. Changes in muscle activity caused by a chronic abnormal head position negatively affect proprioception and the stability of the body. Changes in muscle activity caused by a chronic abnormal head position result in an increased occurrence of neck pain" Chronic poor posture can play a big role in how someone's brain perceives the world causing a multitude of issues, not just neck pain but issues with breathing and balance too. https://pubmed.ncbi.nlm.nih.gov/32713947/

Head and Neck Trauma Causing Underlying Vestibular Disorders "We believe this to be a very important topic, since vestibular complaints in traumatic patients often remain undiagnosed or underestimated in clinical practice. This review article aims to suggest directions for additional research and to provide guidance to both the scientific and clinical practice communities." "The many published studies on traumatic brain injury indicate that post-traumatic dizziness or vertigo...Continue reading

Convergence (ability to bring the eyes close together) Insufficiency and Concussions "Convergence insufficiency (CI) is a common binocular vision disorder that often results in visual symptoms including headaches, eyestrain, blurred vision, loss of place while reading, and diplopia during near visual activities." "A recent study of the prevalence of concussion-related vision problems in children and adolescents found that 49% of the sample had CI."... "This high prevalence of CI in both the general and the mTBI populations has led to an interest in studying the effectiveness of treatment for CI." "In this pilot study, we found significant changes in symptoms and both clinical and objective measures of disparity vergence after completion of OBVT(office based vision therapy)." "these findings are encouraging and suggest that even though the underlying etiology(cause) of the CI is likely different in concussion-related CI, OBVT seems to be an effective treatment approach." At MFNC we evaluate for Convergence Insufficiency's that can be causing different symptoms depending on the patient. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5182092/

Concussions and Lower Extremity(legs) Injury Odds Background: "Previous studies have identified abnormalities in brain and motor functioning after concussion that persist well beyond observed clinical recovery. Recent work suggests subtle deficits in neuro-cognition may impair neuromuscular control and thus potentially increase risk of lower extremity musculoskeletal injury after concussion."... Results: "The incidence of acute lower extremity musculoskeletal injury was higher among recently concussed athletes (15/87; 17%) compared with matched controls (17/182; 9%). The odds of sustaining an acute lower extremity musculoskeletal injury during the 90-day period after return to play were 2.48 times higher in concussed athletes than controls" "Concussed athletes have increased odds of sustaining an acute lower extremity musculoskeletal injury after return to play than their non-concussed teammates. The study results suggest further investigation of neuro-cognitive and motor control deficits may be warranted beyond the acute injury phase to decrease risk for subsequent injury." It is important following a concussion to get an appropriate Neuro-Muscular examination done in order to help decrease the risk of another injury. https://www.ncbi.nlm.nih.gov/pubmed/26786903

Key Functions of the Fastigial Nucleus in the Brain "Fastigial nucleus (FN) is the phylogenetically oldest nucleus in the cerebellum, a classical subcortical motor coordinator" "Compared with the other cerebellar nuclei, the FN is located nearest to the middle line at the anterior end of the superior vermis"... "the FN contributes to the axial (spine), proximal and ocular motor (eye) control." "the FN also actively participates in various non-somatic functions, such as feeding control, cardiovascular and respiratory regulation, defecation and micturition, immune, as well as emotions." "Dysfunction or lesion of FN may result in not only ataxias and oculomotor deficits, but also non-motor symptoms involving cardiovascular, respiratory and emotional disorders." At MFNC during our examination we evaluate the function of your fastigial nucleus through balance and eye movements. Had your Fastigial Nucleus checked lately? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853849/

Saccadic (fast) Eye Movements and Postural (balance) Control In Older Adults Introduction "Postural control is fundamental for performing numerous daily activities. The main behavioral goals involved in the control of posture are postural equilibrium (related to the balance of forces that act on the body) and postural orientation (related to the positioning of body segments relative to each other and the environment. To achieve... such purposes, the postural control system must obtain and integrate sensory cues that are provided by visual, vestibular, and somatosensory channels and use them as a basis for the production of motor activity involved in balance control." "Saccades are very fast eye movements that are performed to bring a new region of the visual scene to the fovea, which allows following objects in the environment and acquiring visual cues that might be used for the production of motor activity." "Elderly individuals also demonstrate impaired performance in eye-movement tasks compared with young adults. Generally, older adults have slower saccadic RTs (Moschner & Baloh, 1994) and reduced accuracy of saccadic eye movements (Warren, Thurtell, Carroll, & Wall, 2013). Paquette and Fung (2011) showed that older adults performed less accurate saccades compared with young adults under both unperturbed and perturbed standing conditions, which was attributed to subtle declines in sensorimotor integration. Conclusions "In summary, the present results demonstrates that saccadic eye movements affected posture in older adults similarly to young adults by decreasing body sway magnitude compared with fixation." "We suggest that future studies examine the relationship between eye movements and postural control in older adults in more natural situations to asses and possibly provide a means to prevent risks of falls during daily activities that involve the search for visual information." At MFNC we examine Saccadic eye movements looking for latency (reaction time/speed) and accuracy. A specific eye movement training program is then developed to each patient to improve latency and accuracy. https://www.researchgate.net//276311745_Effects_of_saccadi

Lifestyle Choices and Brain Health "this article aims to provide an overview of evidence from current literature and expert opinion on key elements known to be relevant in preserving brain health as people age." Brain Health and Mental Well-Being...Continue reading

Exercise and Mental Health "Lifestyle modifications can assume especially great importance in individuals with serious mental illness. Many of these individuals are at a high risk of chronic diseases associated with sedentary behavior and medication side effects, including diabetes, hyperlipidemia, and cardiovascular disease." "An essential component of lifestyle modification is exercise. The importance of exercise is not adequately understood or appreciated by patients and m...ental health professionals alike. Evidence has suggested that exercise may be an often-neglected intervention in mental health care" "Aerobic exercises, including jogging, swimming, cycling, walking, gardening, and dancing, have been proved to reduce anxiety and depression." "This physiologic influence is probably mediated by the communication of the HPA axis with several regions of the brain, including the limbic system, which controls motivation and mood; the amygdala, which generates fear in response to stress; and the hippocampus, which plays an important part in memory formation as well as in mood and motivation." Conclusions: "Exercise improves mental health by reducing anxiety, depression, and negative mood and by improving self-esteem and cognitive function. Exercise has also been found to alleviate symptoms such as low self-esteem and social withdrawal." "Thirty minutes of exercise of moderate intensity, such as brisk walking for 3 days a week, is sufficient for these health benefits. Moreover, these 30 minutes need not to be continuous; three 10-minute walks are believed to be as equally useful as one 30-minute walk." "Health benefits from regular exercise that should be emphasized and reinforced by every mental health professional to their patients include the following: Improved sleep Increased interest in sex Better endurance Stress relief Improvement in mood Increased energy and stamina Reduced tiredness that can increase mental alertness Weight reduction Reduced cholesterol and improved cardiovascular fitness" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470658/

The Eyes and Brain Health "Many studies show that eye movements are closely linked to cognitive processes such as attention, memory, and decision-making. Eye movements not only reflect certain aspects of brain function, providing information about our thoughts and desires to others, but might also influence and actively participate in them." "The eyes also provide a glimpse into the aging and diseased brain. We now know that changes in eye movements accompany the changes that... occur in the brain as a result of both normal aging and neuro-degeneration." "Eye movements are controlled by a diverse network of brain stem and cerebral cortical structures that are susceptible to degenerative processes; eye movement abnormalities therefore accompany the pathological changes underlying many neurodegenerative diseases." "An intriguing new study shows that eye movements can help to compensate for age-related cognitive decline, providing another potential way in which examination of eye movements could be of benefit in the clinic." "There are four basic types of eye movements. Vestibulo-ocular movements are reflexes that stabilize our eyes relative to the outside world to compensate for head movements; Vergence movements simultaneously rotate the eyes in opposite directions to align the fovea (the most sensitive part of the retina) of each eye to a near or distant object; Smooth pursuit movements are slow tracking moves that keep a moving object on the fovea. The fourth type, called saccades, seems to tell us the most about brain function and dysfunction. Saccades are rapid eye movements that quickly change our point of fixation. They can be initiated both voluntarily and reflexively." At MFNC we evaluate all the different types of eye movements that relate to different areas of brain health and come up with an individualized treatment plan to improve those areas of the brain. https://dana.org/artic/the-eyes-are-windows-into-the-brain/