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

Rehabilitation for Functional Dystonia: Cases and Review of the Literature

BACKGROUND

Functional dystonia (FD) is a common subtype of functional movement disorder. FD can be readily diagnosed based on positive signs and is potentially treatable with rehabilitation. Despite this, clinical outcomes remain variable and a gold standard approach to treatment is lacking.

CASES

Here we present four cases of axial and limb functional dystonia who were treated with integrated rehabilitation and improved. The therapy approach and clinical outcomes are described, including videos.

LITERATURE REVIEW

A literature review evaluated the published treatment strategies for the treatment of functional dystonia. Out of 338 articles, 25 were eligible for review and included mainly case reports and case series. Most patients received more than one treatment modality. Non-invasive therapies, commonly physiotherapy and psychological approaches were mostly associated with positive outcomes. Multiple treatments commonly used in dystonia were used, including botulinum toxin injections, pharmacotherapy and surgery, leading to variable outcomes.

CONCLUSION

Therapy should be personalized to the clinical presentation. In challenging cases, initiation of a multidisciplinary approach may provide benefit regardless of etiology. Pharmacotherapy should be used judiciously, and surgical therapy should be avoided.

Dystonic Tremor as an Atypical Presentation of Cervical Radiculopathy

Cervical radiculopathy often presents with neck pain, sensory disturbances, or motor weakness. This case report describes an atypical presentation of cervical radiculopathy manifesting as dystonic tremor and brachialgia, which has been documented only once previously. A 46-year-old, right-handed, male delivery worker presented with severe neck pain that gradually evolved into a dystonic tremor and sharp aching pain across his right shoulder. Despite medical intervention, his symptoms persisted, leading him to seek chiropractic care. Physical examination and diagnostic tests revealed degenerative osteophytes, causing bilateral foraminal impingement and narrowing. As orthopedic interventions only provide temporary relief, the patient opted for conservative chiropractic management, which led to a remarkable reduction in pain and complete resolution of the dystonic tremor and brachialgia. This case demonstrates that cervical disc prolapse may manifest with dystonic tremor due to excruciating radiculopathy. Additionally, it emphasizes the potential benefits of chiropractic care in managing such atypical presentations and underscores the need for further research on the mechanisms and management of such cases.

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

BACKGROUND

Functional Neurology (FN), a seemingly attractive treatment approach used by some chiropractors, proposes to have an effect on a multitude of conditions but some of its concepts are controversial.

OBJECTIVES AND DESIGN

A scoping review was performed to describe, in the context of chiropractic manual therapy, 1) the FN theories, and 2) its clinical applications (i.e. its indications, examination procedures, treatment modalities, treatment plans, and clinical outcomes) using four sources: i) one key textbook, ii) the scientific peer-reviewed literature, iii) websites from chiropractors using FN, and iv) semi-structured interviews of chiropractors using FN.

METHODS

The scientific literature was searched in PubMed, PsycINFO, and SPORTDiscus, completed by a hand search in the journal Functional Neurology, Rehabilitation and Ergonomics (November 2016 and March 2017, respectively). The only textbook on the topic we found was included and articles were chosen if they had an element of manual therapy. There was no restriction for study design but discussion papers were excluded. Websites were found in Google using the search term "Functional Neurology". Chiropractors, known to use FN, were invited based on their geographical location. Theories were mainly uncovered in the textbook as were all aspects of the clinical applications except treatment plans. The other three sources were used for the five aspects of clinical applications. Results were summarized and reported extensively in tables.

RESULTS

Eleven articles were included, five websites scrutinized, and four semi-structured interviews performed. FN is based on the belief that reversible lesions in the nervous system are the cause of a multitude of conditions and that specific clusters of neurons can be positively affected by manipulative therapy, but also by many other stimuli. Diagnostic procedures include both conventional and unusual tests, with an interpretation specific to FN. Initial treatment is intense and clinical outcomes reported as positive.

CONCLUSION

FN gives the impression to be a complex alternative to the old variant of the chiropractic subluxation model, in which the vertebral subluxation is replaced by "physiological lesions" of the brain, and the treatment, spinal adjustments, are complemented by various neurological stimuli. Both models purport to treat not the symptoms but the cause. We conclude there is a need for more scientific documentation on the validity of FN.

Chiropractic management of an 81-year-old man with Parkinson disease signs and symptoms

OBJECTIVE

The purpose of this case report is to describe the chiropractic management of a patient with Parkinson disease.

CLINICAL FEATURES

An 81-year-old male with a 12-year history of Parkinson disease sought chiropractic care. He had a stooped posture and a shuffling gait. He was not able to ambulate comfortably without the guidance of his walker. The patient had a resting tremor, most notably in his right hand. Outcome measures were documented using the Parkinson's Disease Questionaire-39 (PDQ-39) and patient subjective reports.

INTERVENTION AND OUTCOME

The patient was treated with blue-lensed glasses, vibration stimulation therapy, spinal manipulation, and eye-movement exercises. Within the first week of treatment, there was a reduction in symptoms, improvement in ambulation, and tremor.

CONCLUSION

For this particular patient, the use of alternative treatment procedures appeared to help his Parkinson disease signs and symptoms.