Chiropractic care using a functional neurologic approach for idiopathic cervical dystonia in a 59-year-old woman

Abstract

Objective: The purpose of this case report is to describe the care and outcomes of a patient with cervical dystonia who was treated using chiropractic and other alternative medicine interventions. Clinical Features: A 59-year-old woman had an 11-year history of cervical dystonia. She had an uncontrollable 60°leftward head rotation upon shutting her eyes and had spasmodic contractions that caused fatigue. Intervention and Outcome: The management consisted of blue-lensed glasses, vibration stimulation, spinal manipulation, and eye-movement exercises. Within the first week of treatment, she had a reduction in symptoms, which was documented using a functional numeric scale, and improved posture, which was assessed using measurements from her midsternal line to the center of her chin. Conclusion: This patient with cervical dystonia responded to the use of conservative, nonpharmacological treatment procedures that consisted of chiropractic care using a functional neurologic approach aimed at improving her spasmodic contractions and function.

Unravelling functional neurology: a scoping review of theories and clinical applications in a context of chiropractic manual therapy

“…NASympathetic activityLocal application of warmTranscutaneous electrical neural stimulationThese modalities are described to inhibit the sympathetic activity.NACaudate nucleusVisualizing pleasant stimuliIn contrast, amygdala and/or hippocampus may be stimulated by visualizing unpleasant stimuli and “narrative recall” and list learning.Scientific articlesCarrick (1997) [9]Enlarged physiological blind spotCerebral hemisphereSMTIn the articles listed here, the large majority of the therapeutic modalities, i.e. manipulation, vibration therapy, eye exercises, and mirror therapy , are provided or performed depending on the targeted structure(s) and its/their side(s),except in the articles of Pedro (2005) (where this is not mentioned) and of Hirsh (2013) (where this is only mentioned for vibration therapy). b These studies were conducted on healthy subjects who were found with an enlarged blind spot of one of their eyes.Pedro (2005) [41]Landau-Kleffner syndromeLeft hemisphere and right cerebellumManipulationEye movement exercisesVisual, olfactory, auditory, vestibular and somatosensory stimuliInteractive metronomeNutrition therapyThere was no precision of which modalities would alter one of the two targeted structure rather than the other.Daubeny (2010) [57]Enlarged physiological blind spotCerebral hemisphereUpper extremity manipulationsBova (2013) [43]Cervical dystoniaLeft cerebral cortex (frontal lobe)Eye movement exercisesRight cerebellumSMT Vibration therapyRight vestibular systemEye movement exercisesLeft basal gangliaEye movement exercisesVibration therapyBlue-lensed glassesKuhn (2013) [44]Migraines, attention deficit and hyperactivity disorder, obsessive compulsive disorder, and Tourette’s syndromeRight cortical hemisphereSMT Coordination activities associated with eye movementsInteractive metronomeLeft cerebellumSMTCoordination activities associated with eye movementsInteractive metronomeRight basal gangliaSMT Coordination activities associated with eye movementsInteractive metronomeLeft ponsSMT Coordination activities associated with eye movementsHirsh (2013) [46]Attention deficit and hyperactivity disorder, primary nocturnal enuresis and musculoskeletal painRight cortical hemisphere and left cerebellumSMT Blue-lensed-glassesOptokinetic stimulationVibration therapyBalance exercisesVestibular stimulationTiming exercises, including interactive metronome…”

“… Pedro (2005) [ 41 ] Landau-Kleffner syndrome Left hemisphere and right cerebellum Manipulation Eye movement exercises Visual, olfactory, auditory, vestibular and somatosensory stimuli Interactive metronome Nutrition therapy There was no precision of which modalities would alter one of the two targeted structure rather than the other. Daubeny (2010) [ 57 ] Enlarged physiological blind spot Cerebral hemisphere Upper extremity manipulations Bova (2013) [ 43 ] Cervical dystonia Left cerebral cortex (frontal lobe) Eye movement exercises Right cerebellum SMT Vibration therapy Right vestibular system Eye movement exercises Left basal ganglia Eye movement exercises Vibration therapy Blue-lensed glasses Kuhn (2013) [ 44 ] Migraines, attention deficit and hyperactivity disorder, obsessive compulsive disorder, and Tourette’s syndrome Right cortical hemisphere SMT Coordination activities associated with eye movements Interactive metronome Left cerebellum SMT Coordination activities associated with eye movements Interactive metronome Right basal ganglia SMT Coordination activities associated with eye movements Interactive metronome Left pons SMT Coordination activities associated with eye movements Hirsh (2013) [ 46 ] Attention deficit and hyperactivity disorder, primary nocturnal enuresis and musculoskeletal pain Right cortical hemisphere and left cerebellum SMT Blue-lensed-glasses Optokinetic stimulation Vibration therapy Balance exercises Vestibular stimulation Timing exercises, including interactive metronome Home exercises: inhibitory of primitive reflexes, muscles strengthening, and balance exercises. Dietary changes There was no precision of which modalities would alter one of the two targeted structure rather than the other.…”

“… Articles Pedro (2005) [ 41 ] Landau-Kleffner syndrome (case report) At 12 weeks, improvement of language, auditory and motor skills Beck (2009) [ 42 ] Complex regional pain syndrome (case report) At 12 weeks, full recovery of function, but persistence of bouts of pain At 1 year, functional recovery is maintained, episodes of pain are reported. Bova (2013) [ 43 ] Cervical dystonia (case report) Functional improvement, decrease of spasmodic torticollis Kuhn (2013) [ 44 ] Migraines, ADHD, OCD, Tourette’s syndrome (case report) At 19 weeks, migraines were gone, tics and, learning and behavioral capacities were improved Hirsh (2013) [ 46 ] ADHD, primary nocturnal enuresis, and musculoskeletal pain (case report) At 18 weeks, improvement of behavior, confidence, and posture No more difficulty in daytime urinary control At 3 months, occasional bed wetting and improvements in various activities of daily living Esposito (2013) [ 48 ] Symptoms related to traumatic brain injury (case report) At 10 weeks, improvement of balance, cognitive abilities, mood, and anxiety Decrease of the number and severity of physical complaints Bova (2014) [ 45 ] Parkinson’s disease (case report) At 2 months, improvement of posture, function and well-being At 10 months, treatment is continued twice per week for maintenance care with stable results. NB: Relapse was observed when treatment was reduced to once per week.…”

“…We found seven case studies in the literature reporting on: i) Landau-Kleffner syndrome [ 41 ], ii) complex regional pain syndrome [ 42 ], iii) cervical dystonia [ 43 ], iv) migraines, ADHD, OCD and Tourette’s syndrome [ 44 ], v) Parkinson’s disease [ 45 ], vi) idiopathic hemi-paresthesia [ 40 ], and vii) ADHD, primary nocturnal enuresis and musculoskeletal pain [ 46 ]. Two case studies were found that reported on symptoms post-traumatic brain injury [ 47 , 48 ].…”

Dystonic Tremor as an Atypical Presentation of Cervical Radiculopathy

“…The restoration of autonomic nervous function can be achieved following successful cervical rehabilitation [12]. The response to chiropractic treatment, however, exemplifies the potential benefits of conservative management of cervical dystonia [13][14][15]. Daily cervical manipulative therapy, followed by a combination of reduced-frequency therapy and mechanical spinal decompression, resulted in the complete and sustained resolution of his symptoms.…”