Autism, Asthma, Irritable Bowel Syndrome, Strabismus, and Illness Susceptibility: A Case Study in Chiropractic Management.

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As Published in the Journal Today’s Chiropractic; Vol 27, No 5: 32-47

Autism, Asthma, Irritable Bowel Syndrome, Strabismus, and Illness

Susceptibility: A Case Study in Chiropractic Management.

ABSTRACT

Pathologies of organic origin are commonly thought to be the exclusive

realm of medical treatment and not part of the mainstay of chiropractic

care. The clinical observations of a patient presenting with autism,

asthma, irritable bowel syndrome, strabismus, and illness susceptibility

are reported. Alleviation of symptoms is seen subsequent to corrections of

abnormal biomechanical function of the occipito-atlanto-axial complex. A

relationship between biomechanical faults in the upper cervical spine and

the manifestation of abnormal central neurophysiological processing is

suggested as the genesis of this patient’s symptomatology.

Key words: Autism, Asthma, IBS, Strabismus, Infrared Imaging, Upper

Cervical Spine.

INTRODUCTION

Autism usually manifests itself in the first year of life with onset

rarely later than 30 months of age. The cause of autism is unknown, but

evidence points to a neurological basis. The syndrome is characterized by

extreme aloneness (lack of attachment, failure to cuddle, and avoidance of

eye contact); insistence on sameness (resistance to change, ritual morbid

attachment to familiar objects, and repetitive acts); disordered speech and

language (which varies from total muteness to markedly idiosyncratic use of

language); and uneven intellectual performance. The syndrome tends to

maintain a consistent symptomatic picture throughout development.

Medical treatment, for the most severely impaired children, includes

systematic application of behavior therapy; a technique that can be taught

to parents in order to help manage the child in the home and at school. The

benefits of this therapy vary widely, but may be considerable for these

children who try the patience of the most loving parents and devoted

teachers. Medications provide limited benefit and are used mainly in

controlling the most severe forms of aggressive and self-destructive

behavior. However, they do not resolve the condition (1-3).

Asthma is a lung disease characterized by: airway obstruction that is

reversible (but not completely in some patients), airway inflammation, and

increased airway responsiveness to a variety of stimuli. The airway

obstruction in asthma is due to a combination of factors that include:

smooth muscle spasm of the airways, edema of the airway mucosa, increased

mucus secretion, cellular infiltration of the airway walls, and injury and

desquamation of the airway epithelium. A family history of allergy or

asthma can be elicited in most asthmatics.

Research on the pathophysiology of asthma over the past decade has

focused on the inflammatory cells and their mediators, neurogenic

mechanisms, and vascular abnormalities involved. Recent interest in

neurogenic mechanisms has focused on neuropeptides released from sensory

nerves by an axon reflex pathway. These peptides have vascular permeability

and mucus secretagogue activity, bronchoconstrictor activity, and a

bronchial vascular dilation effect. These sensory nerves also act on the

pulmonary airways and their microvasculature contributing to the special

kind of airway inflammation that is characteristic of asthma.

The medical treatment of asthma may be conveniently considered as

management of the acute attack and day-to-day therapy. Drug therapy focuses

on the two main aspects of the disease: bronchospasm and inflammation.

Sympathomimetic medications cause bronchial smooth muscle relaxation as

their effects mimic those of the sympathetic nervous system. The

inflammatory aspect is managed with corticosteroids. While systemic

corticosteroids are considered exceptionally effective, they are reserved

for more difficult episodes because of their potential for serious adverse

effects (1-3).

Irritable bowel syndrome (IBS) is characterized as a motility

disorder involving the entire hollow GI tract, creating an upper and lower

GI symptom complex. The etiology of IBS is unknown. No anatomic cause can

be found. Two major groups or clinical types of IBS are recognized. In the

spastic colon type, most patients have pain over one or more areas of the

colon associated with periodic constipation or diarrhea. The second group

of IBS patients primarily manifest painless diarrhea, usually urgent,

precipitous diarrhea that occurs immediately upon rising or, more

typically, during or immediately after a meal.

The pathophysiology of IBS is based upon motor abnormalities of both

the small and large bowel. When the normal segmentation mechanism of the

sigmoid colon becomes hyperreactive, so-called spastic constipation

results. In contrast, diminished motor function is found in the group

associated with diarrheal episodes. Treatment is basically supportive and

palliative. If offending foods can be identified, diet changes are

suggested. Medical management with drugs are used only as a temporary

expedient to relieve spastic pain (1-3).

Strabismus is characterized as the deviation of one eye from

parallelism with the other. The etiology is either paralytic or

myospasmotic. Paralytic (nonconcomitant) strabismus results from paralysis

of one or more ocular muscles and may be caused by a specific oculomotor

nerve lesion. Nonparalytic (concomitant) strabismus usually results from

unequal ocular muscle tone caused by a supranuclear abnormality within the

CNS. A concomitant strabismus may be convergent (esotropia), divergent

(exotropia), or vertical (hyper- or hypotropia).

The focus of medical treatment is for muscle imbalance. If this alone

is responsible, strabismus is treated early with corrective glasses or

contact lenses, medications, orthoptic training (eg. eye exercises,

patching the normal eye, etc.), or surgical restoration of the muscle

balance. Permanent loss of vision can occur if strabismus and its attendant

amblyopia are not treated before the age of 4 to 6 yrs., with intermittent

follow-up examinations at least until age 10 (1-3).

Considering the above pathophysiology and treatment approach to this

patient’s conditions, it can be understood that the contribution of

chiropractic care in the management of these diseases is considered to be

of no significance to the medical community. However, the body of

literature detailing a possible upper cervical etiology, or at least

contribution, is substantial; and the case made for greater recognition of

the involvement of abnormal upper cervical spine biomechanics is compelling.

CASE REPORT

A 5 year old female was referred to our clinic with the chief

complaint of autism. Her parents advised that the patient had also been

diagnosed with asthma, allergies, irritable bowel syndrome, and left sided

strabismus. The patient’s diagnosis was made through an extensive medical

workup at a specialized autism research institute with the other conditions

diagnosed over time by various medical specialists.

Her mother reported that she had been very susceptible to illnesses

since birth, but had experienced normal development until a viral upper

respiratory illness at 21 months of age. The URI developed into a

complication with asthma necessitating a 5 day regimen of prednisone. The

patient’s mother advised that she was never the same and began to

deteriorate from that point on.

At the time of consultation, the patient had been experiencing 25

violent temper episodes per day with each episode lasting up to 20 minutes.

The episodes consisted of ear piercing screams, combatant behavior, and the

patient throwing herself onto the floor. She also exhibited 3 episodes each

day of self-inflicted violent behavior which included biting her arm,

slapping her head, and repeatedly banging her head against a full length

mirror. Her parents advised that she also expressed at least 1 episode each

day of outward violent behavior which consisted of hitting people,

especially her mother to include slapping the glasses off her face.

The patient’s speech was limited to only a few words such as mama,

dada, milk, and walk. Her fine motor skills were delayed to the extent that

she could only feed herself with her fingers. The patient’s sleep pattern

was considerably disturbed with waking screaming at least twice at night

and once with napping. It was also very difficult to get her back to sleep

once this occurred. The most difficult time was trying to get the patient

to sleep in the evening. Every night consisted of 1-1 1/2 hours of

screaming, comforting, and stories just to get her to sleep.

The irritable bowel syndrome was described by her parents as profuse

loose bowel movements which would occur 4 times a day with the need to

change clothes. They were unable to correlate any food sensitivities or

pattern to the bowel movements. Due to her overall condition she was unable

to be toilet trained. Her parents also noted that she was allergic to dust

and plastics. She had constant eczema behind each ear along with rashes,

redness, and sores which could appear at random anywhere on her body.

Her parents noted that she had continued to be very susceptible to

illnesses. Out of 8-10 months per year, the patient would experience a URI

or flu lasting at least 3 weeks each time. Of these illnesses, 50% would

include asthma attacks necessitating the use of albuteral or a 5 day

regimen of prednisone. Occasionally, she would have to be taken for

in-office nebulizer treatment.

At the time the patient was seen in our clinic, she had been

undergoing various forms of home behavior therapies along with attempted

eye patching with limited results. Her parent’s noted that most of her

symptoms were getting worse in both intensity and frequency.

Upon examination, the patient presented in constant motion with

running on her toes while loosely flapping her hands and arms. Her gait

included a bilateral toe-in with a marked increase on the right. She was

uncommunicative, uncooperative, and prone to screaming violent outbursts.

Vital signs, ear, nose, and throat examinations were unremarkable with the

exception of bilateral posterior auricular eczema.

Orthopedic examination revealed significant palpatory hypertonicity

of the paraspinal musculature from the occiput to C3 bilaterally with a

marked increase on the right. A combination of screaming, arched cervical

extension, and outward violence suggested tenderness in the same areas. The

patient demonstrated a reduction in passive cervical extension and right

lateral flexion. Her lumbosacral evaluation was unremarkable.

Figure 1

Gross neurologic examination was also found to be unremarkable. A

moderate left esotropia was noted along with a mild right. A paraspinal

digital infrared imaging analysis was performed in accordance with

thermographic protocol (4-6). Due to the patient’s violent behavior, she

had to be restrained by both parents and the doctor in order to take the

scan. A continuous paraspinal scan consisting of approximately 300 infrared

samples was taken from the level of S1 to the occiput (Fig. 1).

The data was analyzed against established normal values and found to

contain wide thermal asymmetries indicating abnormal autonomic regulation

or neuropathophysiology (7-10) (Figs. 2 and 3).

Figure 2

Figure 3

Since the cervical spine displayed highly abnormal thermal asymmetries, a

focused scan was performed with approximately 75 infrared samples taken

from T1 to the occiput (Figs. 4 and 5).

Figure 4

Figure 5

The full spine scans also displayed an abnormal central hypothermia of

the spine, which suggests long standing nervous system dysfunction (Figs. 2

and 6).

Figure 2

Figure 6

The above information yielded a high suspicion of abnormal upper

cervical arthrokinematics. Consequently, a precision upper cervical

radiographic series was performed for an accurate analysis of specific

segmental biomechanics (11). Since positioning chairs and head clamps

cannot be used with infants or uncooperative children, supine table films

were taken using an on-patient laser-optic alignment system to precisely

align the patient to the central ray. With this system, maintenance of

precision patient alignment can be facilitated without a head clamp system

due to the laser being aligned to the source of the X-ray beam rather than

the bucky. However, with children who are old enough to sit on their own,

weight-bearing laser-optic alignment is preferred (Figs. 7 and 8).

Figure 7

Figure 8

An analytical radiographic method consisting of mensuration combined

with arthrokinematics was performed (11). Biomechanical abnormalities were

noted at the atlanto-occipital and atlanto-axial articulations.

CHIROPRACTIC MANAGEMENT

Correction of the atlanto-occipital subluxation was chosen as the

first to be adjusted from the accumulated degree of aberrant biomechanics

noted at this level. Before treatment was rendered, the parents were

counseled that they may expect exacerbations in symptomatology as part of

the normal response to care due to the global impact of neural reintegration.

To correct the subluxation, the patient was placed on a specially

designed knee-chest table with the posterior arch of atlas as the contact

point. An adjusting force was introduced using a specialized upper cervical

adjusting procedure (12). The patient was then placed in a post-adjustment

recuperation suite for 15 minutes as per thermographic protocol (4-6).

Correction of the subluxation was determined from the post-adjustment

cervical infrared scan noting resolution of the patient’s presenting

neuropathophysiology (Figs. 9 and 10).

Figure 9

Figure 10

All subsequent office visits included an initial cervical infrared

scan; and if care was rendered, another scan was performed to determine if

normal neurophysiology was restored. Since the focus of the patient’s care

was in the upper cervical spine, infrared scans were made in this region

only during normal treatment visits with full spine scans performed at

30-day re-evaluation intervals.

The patient was adjusted twice during the first week of care. After

the first adjustment, the patient’s mother noted that she had her first

good night sleep since she could remember. By the end of the week, she

reported that the patient’s violent temper episodes had reduced to 15 per

day along with a substantial decreased in intensity. She noted that

reasoning with the patient could stop them now. The patient’s

self-inflicted violent behavior was also decreasing in frequency. Her

speech had suddenly improved with an increase in vocabulary with the

ability to expressing feelings (saying hungry, tired, mad). Her sleep

pattern also changed to waking only once at night along with longer napping

times. The patient’s mother reported that she was running less and walking

more flat footed. Performing thermal scans had also become much easier as

she was now able to sit on her own without restraint.

During the second week of care the patient was adjusted only once.

Her mother reported that by the end of the week the temper episodes had

decreased to only 5 per day with a further decrease in intensity. She also

noted that she was able to stop them quickly. The patient’s left strabismus

had improved to the point that her mother noticed it only twice since the

week before. She advised that the right eye showed no signs of strabismus

since treatment began. The patient’s mother was elated to report that she

had been increasingly vocal this week and began speaking in sentences for

the first time. She was also able to nap now without waking and woke only

once per night this week with the ability to go back to sleep on her own.

Her toe in gait continued to decrease with more flat-footed walking. Her

mother reported a marked decrease in hyperactivity along with wanting to be

touched and hugged now.

The patient was adjusted once during the third week of care. By the

end of the week, the patient’s violent temper episodes had decreased to

only twice per day with a continued decrease in intensity. Her mother noted

that she continued to speak using more sentences and vocalizing

disappointment, anger, hunger, tiredness, and other feelings. The patient’s

strabismus was now showing up in the left eye only when tired. Her gait was

absent of toe-in by this time. Her mother advised that there was very

little running or hyperactivity now. She had also ceased to display any

self or outward violent behavior. The patient’s mother also noted that her

IBS had improved to the point of 1-2 loose bowel movements per day with

only an occasional need to change clothes. She noted that the patient was

now beginning to recognize bowel and bladder functions on her own. Because

she was doing so well, they decided to go to a friend’s house as a family

for the first time. The patient’s social behavior was excellent; she played

with their dog, used the stairs without falling, and came home and asked to

go to bed because she was tired.

No adjustments were necessary during the fourth week of care. The

patient’s mother reported that by the end of this week all temper episodes,

hyperactivity, self and outward violent behavior had stopped. She was now

napping and sleeping through the night perfectly. The patient was also

walking more and more, running less, and showed no signs of toe-in. Her

mother advised that there were no signs of any strabismus by this time. The

IBS continued to improve with only one loose bowel movement per day at the

most and only a rare clothing change. Her mother also noted that the eczema

behind her ears had cleared up and that her allergic skin reactions had

stopped.

Before entering our clinic for care, an appointment had been made at a

special autism, occupational therapy, and speech center to evaluate the

patient for specialized therapy. Her parents decided to keep the

appointment due to the difficulty in getting one in the first place and to

see what if anything could further the patient’s development. The patient

underwent one hour of observation and evaluation by two therapists. Upon

conferring their findings they both reported that the patient did not have

autism and that there must have been a misdiagnosis. The patient’s mother

was pleasantly amused and elated by this and proceeded to explain in detail

the patient’s behavior four weeks previously. Upon hearing this, the

therapists agreed that the original diagnosis was autism, but that the

patient was not currently exhibiting this disorder. They reported that due

to her current level of behavior that she would not need in-center therapy

and that they would give the parents work for her to do at home. Their

report also noted that at her current rate of improvement she would be able

to function in society.

A re-evaluation was also performed in our center at this time. The

examination revealed: no signs of posterior auricular eczema, normal

cervical muscle tone, cervical PROMs WNL, lack of toe-in gait, and

bilateral central positioning of the eyes. A full spine paraspinal infrared

scan was performed at this time noting near total resolution of the

patient’s presenting neuropathophysiology along with a return of normal

central spinal heat (Figs. 11, 12, and 13).

Figure 11

Figure 12

Figure 13

Having the patient in the office had become a pleasure by now. She

would hold my hand while walking down the hall, position herself with her

back to the examining chair while allowing me to lift her up to sit, and

finally holding her own hair out of the way for me to perform an infrared

scan.

Weeks six and eight were punctuated by a mild return of symptoms. The

patient’s mother advised that the temper episodes had returned at

approximately once per day along with her left strabismus, but that both

were very mild in intensity. Concomitantly, her infrared scans noted a

return of her presenting neuropathophysiology necessitating an adjustment

once during each week. All of her other conditions continued to improve at

a steady rate. Her mother reported that she was climbing, exploring, and

doing things she would never do before. A re-examination was performed at

eight weeks with no remarkable findings.

Figure 14

No adjustments were needed during the ninth through twelfth weeks of

care. The patient’s mother continued to report improvements with no temper

episodes, self or outward violent behavior, or strabismus (Fig. 14). Her

sleeping habits remained undisturbed. The patient’s hyperactivity continued

to decrease along with an increased frequency of a heel-toe gait. Her

speech continued to improve with more and more sentence use. The IBS had

almost completely resolved with no episodes needing a change of clothes.

The patient continued to improve over the next 8 months. Adjustments

were rendered very infrequently. Her mother reports that the patient

currently exhibits the type of anger in intensity and frequency that normal

children have when not getting their way, etc. The patient may rarely show

some self-violent behavior with slapping her own head if she is over

stimulated or very tired. Any outward violent behavior, if ever seen, is

described by her mother as usual childhood behavior as when mad with a

sibling. Her sleep pattern continues to be undisturbed. She continues to

improve in her speech development with increased use of complex structured

sentences. Her gross motor skills have improved to the point of performing

somersaults and playing catch, while her fine motor skills include work

with holding pencils correctly, using keys, and the ability to feed herself

(even soup) using utensils.

Her IBS has almost completely resolved with possibly one loose bowel

movement a week with no clothing changes. To her mother’s delight she is

now toilet training. Her left strabismus is a rare occurrence, hardly

noticeable, and only when she is extremely tired. The patient’s mother

reports that her allergies and eczema never returned. She has also never

had another asthma attack. Over the past eleven months of care, the patient

has experienced only three minor colds lasting at the most five days.

Considering the amount of developmental delay, learning disabilities, and

immune dysfunction seen in this patient, it is amazing how much progress

she made in such a short amount of time. However, even though improvements

continue day-by-day, she still has a long way to go.

NEUROBIOLOGICAL MECHANISMS

There are two extensively studied neurophysiological mechanisms which

may explain the profound changes seen in this patient. The first is CNS

facilitation (13-17). This condition arises from an initiating trauma

(birth, falling, etc.) which causes entrapment of intra-articular

meniscoids resulting in segmental hypomobility and finally compensatory

hypermobility. Consequently, hyperexcitation of intra and periarticular

mechanoreceptors and nociceptors occurs. Over time, this bombardment of the

central nervous system can cause facilitation. Facilitation results in an

exponential rise in afferent signals to the cord and/or brain. This may

cause a loss of central neural integration due to direct excitation, or a

lack of normal inhibition, of pathways or nuclei at the level of the cord,

brainstem, and/or higher brain centers. The upper cervical spine is

uniquely suited to this condition as it possesses inherently poor

biomechanical stability along with the greatest concentration of spinal

mechanoreceptors.

The second mechanism is cerebral penumbra or brain cell hibernation

(18-24). Previous research held that the neuron had two basic states of

existence: function and dysfunction. However, a third state was uncovered

which may explain the rapid and profound changes seen in some cases. When a

certain threshold of ischemia is reached, the neuronal state of hibernation

occurs; the cell remains alive, but ceases to perform its designated

purpose. Entire functional areas of the cerebral cortex or cerebellum may

be affected. The mechanism of hyperafferancy, as mentioned above, plays an

initiating role. Hyperafferant activation of the central regulating center

for sympathetic function in the brain may cause differing levels of

cerebral ischemia. A second route via the superior cervical sympathetic

ganglia, may also cause higher center ischemia.

These recent advances in neurophysiological research correlate well

with the pathophysiology currently proposed in the presented conditions

(1-3). Normalization of frontal lobe and limbic system physiology would

account for this patient’s drastic personality and behavior changes (1-3).

Cerebral penumbra may hold the greatest explanation for the changes seen in

autism with specialized upper cervical chiropractic care.

Since recent research has elucidated neurogenic mechanisms which

cause bronchoconstriction, mucus secretion, and airway inflammation in

asthmatics (1-3), normalization of neural function could correct the

condition. In the treatment of asthma, sympathomimetic drugs are used to

mimic the normal activity of the sympathetic system (1-3). Why not return

function to this system rather than prescribing drugs that mimic it.

Normalization of pathological central sympathetic regulation due to

cerebral penumbra, and/or direct pathophysiological spinal pathway

integration to the bronchial tree, may explain our effects.

In the case of strabismus, supranuclear abnormalities within the CNS

or direct occulomotor nerve dysfunction can cause unequal ocular muscle

tone (1-3). Correction of cerebral penumbra and/or facilitated pathways

could explain the return of normal central ocular positioning in this patient.

Motor nerve abnormalities which cause the bowel motility dysfunction

seen in irritable bowel syndrome (1-3), may arise from either pathologies

of central motor regulation due to cerebral penumbra or loss of direct

pathway controls. Normalization of motor nerve function would cause a

return of regular bowel motility.

The role that the sympathetic nervous system plays in the regulation

of immune function is substantial (1-3). Dysregulation of this system can

result in sympathetically mediated immune dysfunction and thus,

susceptibility to illnesses. Correction of pathological central sympathetic

regulation resulting from cerebral penumbra and/or facilitation would lead

to a return of normal immune function.

CONCLUSION

The most important factor in this case was our ability to objectively

monitor the adjustment’s affects on the patient’s neurophysiology. Many

different types of tests are used in our profession such as leg length,

cervical challenge, motion and static palpation, and others. However, these

tests lack objectivity, posses inherent errors, and have no literature

confirmation of their ability to monitor neurophysiology (25-28). Digital

infrared imaging, however, has been researched for over 30 years compiling

almost 9,000 peer-reviewed and indexed articles confirming its use as an

objective measure of neurophysiology. By using this technology, our clinic

has been able to consistently determine the correct adjustive procedures

that produce reproducible and dramatic positive neurophysiological

improvements in our patients.

If the foundation of our profession stands on the principle that

homeostasis is dependent upon coordinated neurophysiology, then we must

directly and objectively monitor this system as an outcome measure to our

care. But not any way of monitoring this system will suffice. We need to

measure the autonomic nervous system if we are to monitor the global

systemic aspect of the nervous system’s control. Paraspinal digital

infrared imaging fulfills this need by objectively measuring the autonomic

changes of all 32 spinal nerves as they exit to effect deep visceral

function. Since testing does not involve patient compliance, such as

movement or a verbal response, paraspinal infrared imaging becomes as

objective a test of neurophysiology as we can get.

To what magnitude the upper cervical spine is involved in the genesis

of organic conditions remains to be seen. In an atmosphere where much of

the public see our profession as useful for neck and back pain treatment at

most, patients with complex disorders are left unaware of the possible

benefits of care. The body of literature detailing a possible upper

cervical etiology, or at least contribution, to organic disorders is

substantial. Further research into this area of the spine, combined with

objective monitoring of neurophysiology, may reveal that chiropractic does

indeed offer consistent conservative management of complex visceral disorders.

ACKNOWLEDGMENTS

The authors would like to gratefully acknowledge the Titronics

Corporation. For without their design of the TyTron C-3000 Paraspinal

Digital Infrared Scanner, we would not have been able to monitor this

patient’s neurophysiology.

REFERENCES

1.) Schroeder, S., Krupp, M., Tierney, L. Current Medical Diagnosis and

Treatment. Norwalk, CT: Appleton & Lang; 1988.

2.) Berkow, R., Beers, M., et al. Manual of Diagnosis and Therapy. Merk &

Co.; 16th ed. 1992.

3.) Andreoli, T., Carpenter, C., Plum, F. Essentials of Medicine. 2nd ed.

Philadelphia: W.B. Saunders; 1990.

4.) Thermography Protocols - International Thermographic Society 1997.

5.) Thermography Protocols - American Academy of Thermology 1984.

6.) Thermography Protocols - American Academy of Medical Infrared Imaging

1997.

7.) Uematsu, S., Edwin, D., et al. Quantification of Thermal Asymmetry.

Part 1: Normal Values and Reproducibility. J Neurosurg 1988;69:552-555.

8.) Feldman, F., Nickoloff, E. Normal Thermographic Standards in the

Cervical Spine and Upper Extremities. Skeletal Radiol 1984;12:235-249.

9.) RP. Human Skin Temperature and its Relevance in Physiology and

Clinical Assessment. In: Francis E, Ring J, B, et al, Recent

Advances in Medical Thermology, New York: Plenum Press, 1984:5-15.

10.) Uematsu S. Symmetry of Skin Temperature Comparing One Side of the Body

to the Other. Thermology 1985;1:4-7.

11.) Amalu, W., Tiscareno, L., et al. Precision Radiology: Module 1 and 5

-- Applied Upper Cervical Biomechanics Course. International Upper Cervical

Chiropractic Association, 1993.

12.) Amalu, W., Tiscareno, L., et al. Precision Multivector Adjusting:

Module 3 and 7 -- Applied Upper Cervical Biomechanics Course. International

Upper Cervical Chiropractic Association, 1993.

13.) Gardner, E. Pathways to the Cerebral Cortex for Nerve Impulses from

Joints. Acta Anat 1969;56:203-216.

14.) Wyke, B. The Neurology of Joints: A Review of General Principles. Clin

Rheum Dis 1981;7:223-239.

15.) Coote, J. Somatic Sources of Afferent Input as Factors in Aberrant

Autonomic, Sensory, and Motor Function. In: Korr, I., ed. The Neurobiologic

Mechanisms in Manipulative Therapy. New York: Plenum, 1978:91-127.

16.) Denslow, J., Korr, I., Krems, A. Quantitative Studies of Chronic

Facilitation in Human Motorneuron Pools. Am J Physiol 1987;150:229-238

17.) Korr, I. Proprioceptors and the Behavior of Lesioned Segments. In:

Stark, E. ed. Osteopathic Medicine. Acton, Mass.: Publication Sciences

Group, 1975:183-199.

18.) Heiss, W., Hayakawa, T., Waltz, A., Cortical Neuronal Function During

Ischeamia. Arch Neurol 1976;33:813-20

19.) Astrup, J., Siesjo, B., Symon, L. Thresholds in Cerebral Ischemia --

The Ischemic Penumbra. Stroke 1981;12:723-5

20.) Roski, R., Spetzler, R., Owen, M., et al. Reversal of Seven Year Old

Visual Field Defect with Extracranial-Intracranial Anastomosis. Surg Neurol

1978;10:267-8

21.) Mathew, R., Meyer, J., et al. Cerebral Blood Flow in Depression.

Lancet 1980;1(818):1308

22.) Mathew, R., Weinmann, M., Barr, D. Personality and Regional Cerebral

Blood Flow. Br J Psychiatry 1984;144:529-32

23.) Jacques, S. Garner, J. Reversal of Aphasia with Superficial Temporal

Artery to Middle Cerebral Artery Anastomosis. Surg Neurol 1976;5:143-5

24.) Lee, M., Ausman, J., et al. Superficial Temporal to Middle Cerebral

Artery Anastomosis. Clinical Outcome in Patients with Ischemia of

Infarction in Internal Carotid Artery Distribution. Arch Neurol 1979;36:1-4

25.) DeBoer, K., Harmon, R., et al. Inter- and Intra-examiner Reliability

of Leg Length Differential Measurement: A Preliminary Study. J Manipulative

Physiol Therap 1983;6:61-66

26.) Falltrick, D., Pierson, S. Precise Measurement of Functional Leg

Length Inequality and Changes Due To Cervical Spine Rotation in Pain-Free

Students. J Manipulative Physiol Therap 1989;12:364-368

27.) Keating, J. Inter-examiner Reliability of Motion Palpation of the

Lumbar Spine: A Review of Quantitative Literature. Am J Chiro Med

1989;2:107-110

28.) Nansel, D., Peneff, A., Jansen, R., et al. Interexaminer Concordance

in Detecting Joint-Play Asymmetries in the Cervical Spines of Otherwise

Asymptomatic Subjects. J Manipulative Physiol Therap 1989;12:428-433

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Sheri Nakken, R.N., MA, Classical Homeopath

http://www.nccn.net/~wwithin/vaccine.htm