Functional Neurological Practice
The Functional Neurology Model
What It Is and What Patients Need to Know
Having said that I can say that Functional Neurology is the most exciting development in primary practitioner education in many years.
Modern traditional medicine has transformed diagnosis and treatment of diseases and injury. In most cases, it is extremely effective. The scientific approach to health and disease has propelled phenomenal developments in recent decades. We currently are living an extra month with each year of life. However, there is still fundamental deficiencies in the accumulated medical knowledge. Today medical science doesn’t always provide the solutions patients want to improve their quality of life, especially when they suffer from not well understood conditions (such as Functional Disorders, Chronic Pain, Fibromyalgia, Migraine, Malaise, a ‘foggy head’, Dizziness or movement disorders). A glaring deficiency in the understanding of health and disease is the puzzle of the Placebo Effect where a 40% effectiveness remains an enigma.
Many patients see doctor after doctor who continuously offer the same pharmaceutical approach. They just can’t seem to help them with the extra improvement they want, this leads to the appeal of alternative medicine.
When exploring Functional Neurology, also known as Chiropractic Neurology in America, the following questions are reasonable to ask.
What is it?
Is it safe?
Is it legitimate?
Depending on who you ask, you can get dramatically different answers.
As a Chiropractor with an interest in this field, I endeavour to diagnose and treat patients with long-lasting signs and symptoms. Sometimes there is not a named disease, condition or syndrome that neatly fits a patients signs and symptoms. People are unique and their problems often are as well. My inclination is to look for the common factors that explain their misery. Usually, within the nervous system there will be a poorly functioning area. This we stimulate in various ways to make it perform as it should.
I do not practice functional neurology as it is practiced in the USA, but I do prefer to base my current treatment on sound evidence based neurological principles. The neuroscience world is rapidly gaining a better understanding of health and disease and novel treatments are being developed constantly.
What Is Functional Neurology?
Functional neurology is a new approach to health and disease for various neurological and systemic disorders. Practitioners using this approach may have subspecialties, but in general, they treat movement disorders (vertigo and dizziness ,Parkinsonism or balance disorders), traumatic brain injury, degenerative disorders (such as dementias), Migraine, Chronic Pain, or other neurological disease or disorder of unknown origin (often something that traditional doctors have not been able to diagnose and treat successfully). Of course many well established diseases can’t be cured leaving the treatment goal to slow or stop the progression of the disease.
The Functional Neurology approach doesn’t include pharmaceuticals or surgery. It uses a combination of Chiropractic manipulation, various Sensory-Motor Therapies, corrective exercises and often recommending lifestyle changes.
An explanation for how functional neurology works is scientifically sound but as yet unproven.There is an ever increasing confirmation of its effectiveness being published in reputable peer reviewed scientific publications throughout the world. To which, I am proud to say, I have contributed.
The Functional Neurology Hypothesis
Functional Neurology considers a patient’s ailments from a neurological perspective as parts of the nervous system failing to work properly — meaning, networks of neurological circuits and pathways aren’t performing well together. This can occur in various locations throughout the central nervous system.
There is much research on this topic and so far it shows that there is a lot more research yet to be done. Generally the brain networks constantly interact with each other and when a pathway is ‘out of sync’ the system mis-performs. The diagnostic puzzle to a Functional Neurologist is to determine which pathways are affected and what has to be stimulated to get the system back to normal.
Functional Neurologists believe the functional aberrations, sometimes called ‘lesions’, come from ‘habituation’. That is, our nervous system is constantly learning and adapting to the environment, which includes the food, exercise, pollutants, stresses, work practices, air quality and mental stimulation that we all experience. The ‘Use It Or Lose It’ rule applies. For example, if we sit too often and don’t use our knees to their full capacity, we habituate to this and start to lose the function of the knees. It looks like someone who cant squat! In many parts of the world people are able to squat for their entire lifetime. This would be considered normal for a human being. In the west where we sit too much, many people lose the ability to bend their knees to their full range of motion. After years of this habituation the knee joints lose their function (cant bend fully). The ‘Use it of lose it’ rule applies and the loss of function quickly develops into pathology like Osteoarthritis.
It is a consequence of our lifestyle, not ‘bad luck’ or ‘genetics’.
Another example, the brain, there is heaps of research to show that the mind that is constantly stimulated with new and novel experiences, like learning a language, being involved with social situations, communicating regularly with family and peers, playing Bridge, doing puzzles, learning to dance and staying very active leads to a brain that is less likely to develop dementia. Use it or Lose It. If we habituate a sedentary and un-stimulating lifestyle we will likely lose ‘function’ which leads to pathology.
Functional Neurologists are also interested in ‘fatigability’ which is the ability to consistently maintain a healthy response to a certain stimulus.
With treatment protocols being highly variable, many practitioners stimulate an area of the nervous system enough to engage the brain’s inherent homeostatic mechanisms. That is, the ability of the body to rebuild itself and ignore the previous injuries and conditions.
Homeostasis is a well proven phenomenon and forms the basis of many old and emergent therapies.
Treatment for vestibular disorders (trouble with balance, vertigo, dizziness, nausea etc,) will involve eye exercises and possibly even spinning in a chair to stimulate an underperforming brain area or to stimulate a part of the brain that then feeds into an underperforming area. The Vestibular system connects to nearly all of the neuraxis so it is especially useful for stimulating our nervous system generally, but can also be used to target specific areas as well.
Because functional neurology is such a new field and people present with unique issues the treatments are not yet standardised. Different practitioners may use very different methods for similar problems.
It is always necessary to adjust treatment regimens based on what the patient needs. It is common for practitioners to be willing to try new therapies and borrow what works from other disciplines.
Is Functional Neurology Legitimate?
Many practitioners have satisfied patients and its popularity is rapidly increasing.
From a strictly scientific perspective, there is more work to do for Functional Neurologists to demonstrate:
The detailed scientific explanations for what causes patients ailments.
The extent to which their treatments contribute to patient success.
Establish the boundaries of what Functional Neurology can and cant help.
It would be helpful if the Australian licensing authority adopted the American model.
What Education Does a Functional Neurologist Have?
To become a functional neurologist, there is a post graduate qualification that often takes 2+ years to complete. It is examination based and in the USA there is a professional certification granted by the American Chiropractic Neurology Board and recognised by their various state licensing authorities.
Mostly, practicing Functional Neurologists are Chiropractors. There are an increasing number of other professions like MD’s, Physiotherapists, Occupational Therapists, Optometrists, Dentists and Naturopaths gaining the same knowledge and skills to various levels of competence.
In Australia no one can advertise themselves as a Functional Neurologist. “Functional Neurologist” is not a recognised professional title and was never intended to be a title anyone can grant themselves. The term was first coined by Professor Fredrick Carrick in the 80’s.
Traditional Neurologists are medical doctors whereas Functional Neurologists are not.
The name ‘Functional Neurologist’, can be confusing for some patients.
In Australia practitioner’s do not call themselves Functional Neurologists but rather there are an increasing number of practitioners that practice using the Functional Neurology Model.
What to Expect from a consultation.
1 A comprehensive History taken and discussed in detail.
If you are considering attending here please ask for the History Form, complete it to the best of your ability and return it well prior to your initial appointment.
2 A thorough Examination.
This takes quite a bit of time and depending on the problems and may need to be conducted over several sessions.
It usually involves;
Saccadometry - Precise measurements of eye movements
Force Plate Analysis - An accurate assessment of balance
Pupillometry - Evaluation of the Autonomic Nervous System
Vestibulo-ocular, Optokinetic and Cervical-ocular Reflex assessment. For assessing damage to the processing part of the visual system
Velosity Storage Measurement -An important vestibular measurement
Quantitative Electro Encephalography (QEEG)- 19 Channel Brain Wave analysis, this equipment is used for sensitive measurements. We particularly use it to keep track of treatment progress.
3 Receptor Based Treatments.
These are many and varied. Most nervous systems, by the time they walk through our door, need specific Spinal Adjustments, along with Vestibular and Oculomotor treatments added to more specific and targeted therapies.
4. Exercises - no one is exempt from these.
They will be specific to you and they will be changed as you progress.
5. Lifestyle Recommendations.
These will be common sense, healthy guidelines about diet exercise and attitude. Not too hard but very effective when mastered.