El Paso, TX. Chiropractor, Dr. Alexander Jimenez continues with the cerebellum overview. The cerebellum is one of the most identifiable parts of the brain based on its unique shape and location. It is an extremely important part of the brain. It is responsible for being able to perform everyday voluntary tasks likes walking and writing. And it’s essential for being able to keep balance and remain upright. People who have suffered from a damaged cerebellum struggle with balance and maintaining proper muscle coordination.
EVERYTHING PERIPHERAL HAS A CENTRAL CONSEQUENCE!
CASE STUDY
Cerebellar Ataxia
54-YEAR-OLD FEMALE PRESENTED TO OUR CLINIC FOR FEELINGS OF �UNSTEADINESS�
Patient woke up one morning over one year ago with vertigo.
Patient has difficulty with balance and walking. She sometimes resorts to using a cane. Extreme difficulty walking downstairs
Patient has been proactive in her weight loss, however, this has served as a speed bump in her plan of getting back to health.
She has not been able to exercise like she had in the past.
Patient has been to several vestibular rehabilitation clinics to no avail.
PHYSICAL EXAMINATION HIGHLIGHTS
Cranial nerves I-XII WNL
Wide-based gait
Right cerebellar findings
Provocative Romberg testing produced significant sway in the right posterior and left anterior canal position.
Comfortable walking and standing with more narrow- based gait.
Ability to walk down stairs without holding handrail.
CASE STUDY
Meet Aaron & McKayla
**Permission given to use names, images and whatever else needed to spread the word
A 39-year-old retired Explosives Ordinance Disposal Technician who in 2011…
And in 2015…
WHAT CAN FUNCTIONAL NEUROLOGY DO FOR AARON?
HOW CAN WE HELP HIS BALANCE?
IF YOU DON�T USE IT….
WHAT DO YOU SEE?
WHAT DO YOU SEE?
WHAT DO YOU SEE?
WHAT DO YOU SEE?
WHAT DOES IT MEAN?
AFFERENTATION WITH METABOLIC CONSIDERATIONS
A-BETA – MECHANORECEPTORS
Merkel�s disc � slow adapting to pressure and texture. Sharpest resolution for spatial patterning. �steady light pressure�
Meissner�s Corupuscle � superfiicial motion detection. Two point discretion.
Ruffini�s Corpuscle � located in dermis. Steady skin stretch and joint pressure.
Pacinian Corpuscle � rapid adapter, Associated with vibration.
GOLGI TENDON ORGAN IB FIBERS
Responds to muscle tension changes.
1A IIA SOMATOSENSORY
Muscle spindle fiber is the largest fiber in the human body.
Respond to the rate of change in muscle length, as well to change in velocity, rapidly adapting.
This will require the most demands on metabolic capacity.
BACK TO THE CASE
In 2011, Aaron had lost both of his eyes in an IED explosion.
Due to the blast, Aaron also lost his sense of smell and taste.
After several months of rehab, Aaron learned how to �be really good at being blind.�
Although he could not see, balance was no major issue. �I was climbing mountains, running marathons, kayaking…you name it.�
In 2015, a few months after running the Boston Marathon, Aaron was on the phone with Mckayla.
�He said he was not feeling well and was going to go lie down. I was concerned but did not think much of it.�
After a day and a half of waiting for his call, McKayla found out Aaron contracted meningitis and was intubated in the ICU.
Finding out Aaron is completely deaf after meningitis…
The meningitis obliterated his hearing and left him completely deaf for 5 months.
Not only that, the meningitis wreaked havoc on Aaron�s balance centers (his vestibulocerebellum) and he suffered from severe vertigo and difficulty standing and walking.
After recovering from meningitis:
�You can see how he’s walking on the treadmill in the very beginning. It took so much out of him to be able to do that.� � Mckayla
Remember �metabolic capacity?�
Aaron was actually able to get himself back into running shape and ran one of his best times in Ohio, but not without struggle.
�Every little change in pace and every little movement was a huge calibration for me and it took a lot out of me.�
�I still have a lot of work to do…�
CHALLENGE ACCEPTED
Sooooo….back to the basics!
We utilized different surfaces to challenge his balance system (foam pads, wobble boards, etc….
We also had him do most of his therapies barefoot to increase afferentation to the somatosensory cortex
Updates from McKayla:
�Pace is a 7:30 and he’s doing 6 miles. Completed core work too.�
Typically in the OVARD we would spin Aaron in specific directions and he would tell us which direction he was spinning in.
At first this was very difficult and he could not perceive the movement, however it was not long until he was sensing each direction of his spin.
We let him have a little fun in this particular video….
I asked Aaron and McKayla how they felt therapy was going.
They responded �great, but we won�t really know until he goes for a run outside…�
So we went on a seven mile run at an 8 minute pace.
Here we are working on turns.
Cured!
Aaron is back home in Florida continuing his training for Boston in two weeks.
He is continuing at-home exercises and vestibular rehab with specialists
He and I are running a half marathon together in the not-so-distant future
SOME SIMPLE CEREBELLAR THERAPIES
GENERAL CEREBELLAR EXERCISES
Spinning in desk chair will stimulate ipsilateral cerebellum
Passive muscle stretch will stimulate ipsilateral cerebellum
Squeezing tennis ball will stimulate ipsilateral cerebellum
Passive or active non-linear complex movements will stimulate ipsilateral cerebellum
Finger to nose pointing will stimulate ipsilateral cerebellum
Vermal & Paravermal Exercises
Passive and active gaze stabilization exercises with central fixation
Wobble board/unsteady surface exercises
Balance beam exercises and tandem walking
Bouncing a ball against the ground or throwing it against the wall
Core exercises such as planks, sit-ups and yoga
Learning how to balance on a bicycle
Supine cross crawl activity
Lateral Cerebellum Exercises
Cognitive processes
Learning a musical instrument
Tracing a maze
Playing �catch�
Tapping fingers/hand or toes/feet to the beat of a metronome
Although the cerebellum has many responsibilities, its central function is to coordinate and handle motor activities. Balance, coordination, posture, equilibrium and eye motion are controlled in part by the cerebellum. Additionally, it works to calibrate motor actions in order for our movements to have a smooth, flowing nature to them. The cerebellum receives data from various other structures, like the inner ear and the vestibular system, and fine-tunes incoming sensorimotor information to achieve naturally smooth movements.
Cerebellum Exercises
Many cerebellum exercises are available which help the cerebellum enhance the operation of its neurons. Essentially, neurons want stimulation to be able to function accordingly. When neurons do not get enough stimulation, they become unstable, which can lead to a lot of behavioral difficulties, such as the ones connected with ADHD, among others. But, exercising the cerebellum can increase operation as well as decrease negative symptoms.
Exercises that require focused attention are demonstrated to help cerebellar development. Deliberate and purposeful physical movements, such as balancing on a balance board or working with a rehabilitation ball, will help neurons get the stimulation they need to maximize their functioning. Because there’s a substantial connection between physical activity and mental functioning, pairing physical tasks with psychological exercises is also very beneficial towards enhancing cerebellar functioning. By way of instance, a child diagnosed with ADHD may be requested to keep their balance on a balance board whilst simultaneously reciting the alphabet.
If a child or individual demonstrates weak cerebellar development in one quadrant, doing physical exercises between the legs and arms on the exact same side of the body is able to help that portion of the cerebellum “catch up” to the level of development of it’s other half. These exercises might involve arm or leg stretches or complex motions that include the hands, wrists, elbows and shoulders. Vestibular-based actions, such as catching and throwing a ball or performing balance exercises such as standing on one leg, are also great cerebellum exercises that ease the stabilization, growth and development of neurons.
Cerebellar rehabilitation programs incorporate each of these exercises into an extensive regimen for tapping into the brain’s neuroplasticity. The exercises involved require patients to perform tasks that involve balance, spatial judgments, and motor actions, all which enhance cerebellar functioning and operation. Basically, since the brain’s neural networks arrange the incoming sensory information, they improve their functioning and become more effective.
Dr. Alex Jimenez’s Insight
Cerebellar ataxia is a disorder which affects the normal functioning of the brain and the nervous system by decreasing balance and coordination, most commonly in the back, arms and legs. Cerebellar rehabilitation exercises are often utilized to help alleviate the symptoms associated with cerebellar ataxia. Cerebellar exercises can also be recommended by a chiropractor or physical therapist for children and individuals in order to stimulate the brain and help with cerebellar development. Participating in cerebellar exercises has been demonstrated to improve balance, coordination and posture as well as promote more natural and smooth motor activities.
Many cerebellar exercises can be utilized in order to help stimulate specific regions of the brain, particularly the cerebellum. Each zone of the cerebellum is in charge of performing essential functions, therefore, enhancing these different regions is fundamental towards ultimate function and operation. Below, a series of exercises have been divided to enhance specific zones of the cerebellum.
General Cerebellar Exercises
Spinning in a desk seat can stimulate the ipsilateral cerebellum
Vertical muscle stretch can stimulate the ipsilateral cerebellum
Squeezing a tennis ball can stimulate the ipsilateral cerebellum
Passive or active non-linear complex movements can stimulate the ipsilateral cerebellum
Finger to nose extending can stimulate the ipsilateral cerebellum
Vermal and Paravermal Exercises
Passive and active gaze stabilization exercises using central fixation
Wobble board/unsteady surface exercises
Balance beam exercises and tandem walking
Bouncing a ball against the floor or throwing it against the wall
Core exercises, such as planks, sit-ups and yoga
Learning how to balance on a bicycle
Supine cross crawl action
Lateral Cerebellum Exercises
Cognitive procedures
Learning a musical instrument
Tracing a maze
Playing “catch”
Tapping fingers/hand or toes/feet to the beat of a metronome
Seeking to compose with eyes shut
Strategic board games
Cerebellar Rehabilitation Exercises for Cerebellum Dysfunction
When the cerebellum is damaged or not fully developed, individuals can display erratic or slow movements, demonstrate an inability to judge distance, have difficulty performing rapid moves, and walk with an unnatural gait. Dysfunction from the cerebellum have also been linked to symptoms of ADHD and other behavioral disorders. Cerebellar rehabilitation exercises can be helpful towards enhancing the indications of cerebellum dysfunction, most commonly, cerebellar ataxia.
Cerebellar ataxia is a disease which originates from the cerebellum. Cerebellar ataxia can happen as a result of several ailments and presents with symptoms of an inability to coordinate balance, gait, upper/lower extremity and eye motions. Healthcare professionals frequently use visual monitoring of people performing motor tasks so as to look for signs of ataxia. Research studies have shown that cerebellar rehabilitation exercises can be helpful towards improving symptoms related to cerebellum dysfunction.
Treatment of cerebellar ataxia generally involves treating the underlying illness in addition to the symptoms. Cerebellar rehabilitation exercises are used to improve balance and increase the independence of the patient using methods focusing on balance, posture and coordination control. Stabilizing the back and proximal muscles ought to begin with mat activities, like moving onto the forearms out of a lying face down position and crawling/moving onto the knees into a sitting posture. Gait training should also be performed, since it’s an excellent indicator of balance and insertion.
Cerebellar rehabilitation exercises for cerebellum dysfunction can also improve proprioception. Proprioception is controlled by the cerebellum and involves knowing which body parts are situated in space and in connection with each other. Treatment entails plyometric exercises, balance board and mini trampoline exercises. Vibration and match treatment can also be utilized to enhance proprioception, posture and movement. Yoga and other body-awareness exercises might also be included in the treatment plan to increase proprioception.
Rehabilitation goals include enhancing balance and posture against external stimuli, increasing joint stabilization as well as creating independent, practical gait to promote independence. Training principles include progressing from simple to complicated exercises and providing support with home exercise and sports activities. Cerebellar rehabilitation exercises should be prescribed by a healthcare professional who specializes in cerebellum dysfunction, such as a chiropractor or physical therapists. The language of the brain is repetition, and rehabilitation can enhance brain function. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
Knee Injuries: Alex Jimenez was a wrestler for 15 years when he suffered an ACL tear. Once diagnosis confirmed his knee injury, Alex Jimenez began an extensive care regimen, consisting of chiropractic care with Dr. Alex Jimenez and crossfit rehabilitation, in order to help him recover. Now that Alex Jimenez dedicates himself to health and fitness, he’s always mindful of engaging in the proper exercises to avoid suffering another sports injury. With a positive mentality, Alex Jimenez was able to find his life plan when his ACL tear healed completely.
Chiropractic Care For Knee Injuries
The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments of the knee. The prevalence of ACL injury is higher in athletes who take part in sports, such as basketball, soccer, skiing, and football. Roughly half of ACL injuries occur together with injury to the meniscus, articular cartilage, or other ligaments. Furthermore, patients may have lumps of the bone beneath the cartilage surface. These might be seen on a magnetic resonance imaging (MRI) scan and might indicate injury to the overlying articular cartilage.
We are blessed to present to you�El Paso�s Premier Wellness & Injury Care Clinic.
As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
If you have enjoyed this video and/or we have helped you in any way please feel free to subscribe and share us.
El Paso, TX. Chiropractor Dr. Alexander Jimenez presents an introduction to the cerebellum. The brain is a complex structure that has billions of nerve cells. The basic anatomy is easily understandable. But there is one part of the brain, the cerebellum, which is involved in virtually all movement. This is the part of the brain that helps a person drive, throw a ball, or walk across the street.
Problems with the cerebellum are uncommon and mostly involve movement and coordination difficulties. This article will give an overview of the anatomy, purpose, and disorders of the cerebellum, as well as, how to keep the brain healthy.
FAGIOLINI ET AL. EPIGENETIC INFLUENCES ON BRAIN DEVELOPMENT AND PLASTICITY CURR OPIN NEUROBIOL, 2009
�Enhancing plasticity in the adult brain is an exciting prospect and there is certainly evidence emerging that suggest the possible use of epigenetic factors to induce a �younger� brain.�
�Recent findings support a key role of epigenetic factors in mediating the effects of sensory experience on site-specific gene expression, synaptic transmission, and behavioral phenotypes.�
TAYLOR ET AL. CUTTING YOUR NERVE CHANGES YOUR BRAIN BRAIN, 2009
�Animal studies have established that plasticity within the somatosensory cortex begins immediately following peripheral nerve transection, and that 1 year after complete nerve transection and surgical repair, cortical maps contain patchy, noncontinuous representations of the transected and adjacent nerves.�
�Here, we have demonstrated for the first time that there is functional plasticity and both grey and white matter structural abnormalities in several cortical areas following upper limb peripheral nerve transection and surgical repair.�
THE CEREBELLUM
IMPORTANT FUNCTIONAL AREAS OF THE CEREBELLUM
Spinocerebellum
Vestibulocerebellum
Cerebrocerebellum
SPINOCEREBELLUM
Responsibilities:
Regulation of muscle tone for posture and locomotion
Example: piano playing, finger taping, finger to nose, etc.
TAYLOR ET AL. CUTTING YOUR NERVE CHANGES YOUR BRAIN BRAIN, 2009
�Animal studies have established that plasticity within the somatosensory cortex begins immediately following peripheral nerve transection, and that 1 year after complete nerve transection and surgical repair, cortical maps contain patchy, noncontinuous representations of the transected and adjacent nerves.�
�Here, we have demonstrated for the first time that there is functional plasticity and both grey and white matter structural abnormalities in several cortical areas following upper limb peripheral nerve transection and surgical repair.�
Benign paroxysmal positional vertigo is a common type of vertigo, a sensation of spinning or whirling and loss of balance, which has been reported to account for as many as 17 percent of all cases of dizziness. Benign paroxysmal positional vertigo, or BPPV, is believed to be caused by a health issue in the inner ear. While it is typically associated with aging, head injuries have also been found to cause BPPV.
BPPV occurs when several of the small crystals found in the inner ear, known as otoconia, become loose and wind up in one or more of the three fluid-filled semicircular canals of the ear. Whenever these crystals move around the inner ear, they can cause the fluid in the semicircular canals to become displaced. This ultimately results in a spinning or whirling sensation, otherwise referred to as vertigo. The symptoms of BPPV can often come on suddenly when an individual with benign paroxysmal positional vertigo moves their head in a certain position. By way of instance, symptoms may trigger when turning over in bed during night time. Symptoms of BPPV can last anywhere from several seconds to several minutes, and may include:
Dizziness;
A feeling that surroundings are spinning or moving (vertigo);
A loss of equilibrium or balance;
Nausea; and
Vomiting.
BPPV Treatment
Although many healthcare professionals often prescribe drugs and/or medications for BPPV, there is not enough evidence to support their use as treatment for this condition. In other, very rare cases, surgical interventions are considered. However, in the majority of instances, BPPV can safely and effectively be adjusted mechanically.
Once a healthcare professional specializing in vestibular disorders, such as a vestibular rehabilitation therapist, a chiropractor, a specially trained physical therapist, an occupational therapist or audiologist, or an ENT (ear, nose & throat specialist who specializes on vestibular disorders), has properly diagnosed the individual’s type of benign paroxysmal positional vertigo by performing tests like the Dix-Hallpike Test, then they’ll have the ability to understand which of the semicircular canal(s) the crystals are in, and whether it is canalithiasis, where the loose crystals can move freely in the fluid of the tube, or cupulolithiasis, where the crystals are believed to be ‘hung up’ on the bundle of nerves that feel the fluid motion, then they can recommend you the appropriate therapy maneuver.
Other Auditory & Vestibular Function Tests
The Dix-Hallpike Test is commonly used to diagnose BPPV, however, if the diagnosis is negative, healthcare professionals may utilize a variety of other auditory and vestibular function tests in order to properly diagnose the patient’s source of their symptoms.
The most common treatment for benign paroxysmal positional vertigo, or BPPV, is called the Epley maneuver. The Epley maneuver, sometimes referred to as canalith repositioning, is a procedure which involves a succession of head movements, normally performed by a healthcare professional who is qualified and experienced in the treatment of vestibular disorders, in order to relieve the symptoms associated with BPPV.
Research studies have demonstrated that the Epley maneuver is a safe and effective treatment for the condition, offering both immediate and long-term relief. The Epley maneuver, named after Dr. John Epley, has been named the canalith repositioning maneuver because it�helps reposition the small crystals in a individual’s ear, which may be causing the sensation of dizziness. Repositioning these small crystals, also known as otoconia, ultimately helps to relieve BPPV symptoms.
The Epley maneuver is performed by placing the patient’s head at an angle from where gravity can help alleviate the symptoms. Tilting the head can move the crystals from the semicircular canals of the inner ear. This means that they will stop displacing the fluid, relieving the dizziness and nausea they may have been causing. In this way, the Epley maneuver alleviates the symptoms of BPPV. But, it may need to be repeated more than once, as occasionally, some head movements can once again displace the small crystals of the inner ear, once they had already been repositions after the initial treatment.
When a healthcare professional carries out the Epley maneuver, they’ll perform the following measures:
Ask the patient to sit upright in an examination table, completely extending their legs out in front of them.
Rotate the patient’s head in a 45-degree angle to the side they’re experiencing the worst vertigo.
Instantly push the patient back, so they are lying with their shoulders touching the table. The patient’s head is retained facing the side most negatively affected by vertigo but at a 30-degree angle, so that it is lifted slightly off the table. The healthcare professional holds the patient in this position for between 30 seconds and two minutes, until their symptoms stop.
Rotate the patient’s head 90 degrees from the opposite direction, stopping when the other ear is 30 degrees away from the table. Again, the doctor holds the patient in this position for between 30 minutes and two minutes, until their symptoms cease.
Next, the healthcare professional will roll the patient in precisely the same direction that they are facing, onto their side. The moment they encounter the worst vertigo on will be facing upward. The physician holds the patient in this position for between 30 minutes and 2 minutes, until their symptoms stop.
Eventually, the healthcare professional will bring the patient back up into a sitting position.
The whole process is repeated up to three times, until the patients’s symptoms have been completely relieved.
A healthcare professional specializing in vestibular disorders, such as a chiropractor or physical therapist, will utilize the Epley maneuver to help alleviate an individual’s dizziness and nausea, among other symptoms, when they have decided that BPPV is the cause. As mentioned before, the Epley maneuver isn’t suitable to treat vertigo brought on by another health issue aside from BPPV. If the individual is unsure of what is causing their vertigo, they ought to talk to a doctor and ask to be properly diagnosed. Other causes of vertigo may include:
Migraine headaches
Ear infections
Anemia
Cerebellar stroke
After performing the Epley maneuver, a doctor will advise the patient who has BPPV to prevent specific movements that may dislodge the crystals. These movements include:
Bending quickly
Lying down fast
Leaning the head
Moving the head back and forth
Many research studies have been done on the safety and effectiveness of therapy maneuvers for BPPV, such as the Epley maneuver, together with results and outcome measures demonstrating that the rates of recovery are well into the 90 percent range by 1 to 3 treatments. The more infrequent cupulolithiasis, or ‘hung-up’ version of BPPV, can be a little more stubborn to resolve, as this type of BPPV is generally the consequence of trauma or injury.
Dr. Alex Jimenez’s Insight
If you’ve ever experienced a sudden spinning or whirling sensation, dizziness and nausea when you make certain head movements, especially while rolling over in bed at night or when getting out of bed in the morning, you may be suffering from a common condition called benign paroxysmal positional vertigo, or BPPV. This type of vertigo can be frustrating to deal with and it can tremendously affect an individual’s quality of life. A healthcare professional who specializes in vestibular disorders, including chiropractors and physical therapists, frequently diagnose BPPV using the Dix-Hallpike Test before following up treatment for benign paroxysmal positional vertigo using the Epley maneuver.
Benign Paroxysmal Positional Vertigo, or BPPV, is a frequent health issue, and will be encountered more and more as our population ages. The effect can vary from a mild annoyance to a highly debilitating condition, and can affect function and safety as well as increase the risk of falls. Fortunately, symptoms tend to decrease in intensity over time as the brain gradually adjusts to the strange signals it is receiving, or as the condition resolves on its own. However, with a healthcare professional who’s suitably qualified and experienced in the diagnosis and treatment of BPPV, most patients will find overall relief of their problem once it readily corrected and their world stops spinning or whirling. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
Skateboarding: Javier Mata has entrusted Dr. Alex Jimenez for many years now, receiving trustworthy chiropractic care after experiencing several low back pain injuries throughout his life. Javier Mata first considered the non-surgical treatment choice following his own father’s recommendation to seek chiropractic care after he himself received treatment with Dr. Alex Jimenez. Javier Mata has found tremendous relief through spinal adjustments and manual manipulations and he highly recommends chiropractic care with Dr. Alex Jimenez.
Skateboarding Injury Treatment
Skateboarding is a popular recreational activity among children and teenagers. Although it is an enjoyable and exciting activity, skateboarding carries with it a serious risk for injury. Roughly 70,000 injuries requiring a trip to the emergency department occur each year. There are many things that parents and children can do to help prevent skateboarding injuries, such as carefully selecting safe places to ride and wearing protective gear, especially helmets. Many accidents happen when a child loses balance, falls off the skateboard and lands on an outstretched arm. Skateboarding accidents often involve the wrist, ankle, or face and sprains or strains may occur.
We are blessed to present to you�El Paso�s Premier Wellness & Injury Care Clinic.
As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
If you have enjoyed this video and/or we have helped you in any way please feel free to subscribe and share us.
Benign Paroxysmal Positional Vertigo, or BPPV, is the most common vestibular disorder and it is by far the most common cause of vertigo, a false sensation of rotational movement or spinning. BPPV isn’t life-threatening, it can come in unexpectedly in brief spells and it can trigger with certain head positions or motions. This might frequently occur when you tip your head down or up, when you lie down, or when you flip over or sit up in bed.
BPPV is a mechanical problem in the inner ear. It occurs when some of the calcium carbonate crystals, known as otoconia, that are typically embedded in gel at the utricle, become dislodged and migrate into at least one of the 3 fluid-filled semicircular canals, in which they are not supposed to be. When enough of these particles collect among the canals, they interfere with the fluid movement that these canals use to sense head motion, causing the internal ear to send false signals to the brain.
Fluid from the canals does not normally respond to gravity. On the other hand, the crystals do interact with gravity, thereby shifting the fluid when it normally would remain still. After the fluid moves, nerve endings in the canal are triggered and send a message to the brain that the head is moving, even though it is not. This false information does not match what the other ear may be sensing, together with what the eyes are seeing, or using what the muscles and joints do, and this mismatched information is sensed by the brain as a spinning sensation, or vertigo, which normally lasts less than one minute. Between vertigo spells some people may feel symptom-free, while others feel a mild sense of imbalance or disequilibrium.
Symptoms of BPPV
The signs and symptoms of benign paroxysmal positional vertigo, or BPPV, may include:
Dizziness
A feeling that you or your surroundings are spinning or moving (vertigo)
A loss of equilibrium or balance
Nausea
Vomiting
The signs and symptoms of BPPV can come and go, with these generally lasting less than one minute. Episodes of benign paroxysmal positional vertigo can disappear for a while and then return. Activities that cause the signs and symptoms of BPPV may vary from person to person, but are nearly always brought on by a change in the placement of the head. Some people also feel out of balance when standing or walking. Abnormal rhythmic eye movements, known as nystagmus, usually follow the outward signs of benign paroxysmal positional vertigo, or BPPV.
It’s essential, however, to understand that BPPV will not give you continuous dizziness that is unaffected by motion or even a change in position. Also, it will not affect your hearing or produce fainting, headache or neurological signs, such as numbness, a sensation of “pins and needles,” difficulty speaking or difficulty coordinating your movements. If you have one or more of these additional symptoms, tell a healthcare professional immediately. Other disorders could be originally misdiagnosed as BPPV. By alerting a healthcare professional about any signs and symptoms you may be experiencing along with vertigo, they could reevaluate your illness and think about whether you might have another kind of disorder, instead of or in addition to BPPV.
BPPV is rather common, with an estimated prevalence of 107 per 100,000 annually plus a lifetime prevalence of 2.4 percent. It is thought to be quite rare in children but can affect adults of any age, particularly seniors. The wide majority of cases happen for no apparent reason, with many individuals describing how they simply went to get out of bed and the room began to spin. Nevertheless, associations have been made with injury, migraine headaches, inner ear infection or disease, diabetes, osteoporosis, intubation, presumably due to protracted time lying in bed, and reduced blood flow. There might also be a correlation with a person’s favorite sleeping side.
Diagnosis for BPPV
General practitioners normally refer patients to a healthcare professional specifically trained to take care of vestibular disorders, most commonly a vestibular rehabilitation therapist, such as a chiropractor, a specially trained physical therapist, or sometimes an occupational therapist or audiologist. An ENT (ear, nose & throat specialist) who specializes on vestibular disorders can also diagnose BPPV.
Normal medical imaging (e.g. an MRI) isn’t effective in diagnosing BPPV, because it doesn’t show the crystals that have moved to the semi-circular canals. However, when someone with BPPV has their own head moved into a position that makes the dislodged crystals go within a canal, the error signals have been known to cause the eyes to move in a very specific pattern, known as “nystagmus”.
The association between the internal ears and the eye muscles are what generally permit us to remain focused on our environment while the head is moving. Since the dislodged crystals make the brain think a person is moving when they are not, it causes the eyes to move, making it seem like the room is spinning. The eye movement is the indication that something is happening automatically in order to move the fluid in the inner ear canals when it shouldn’t be.
The nystagmus will have different characteristics that allow a healthcare professional to recognize which ear the displaced crystals are inside, as well as which canal(s) they have moved into. Evaluations like the Dix-Hallpike test involves moving the head into specific orientations, allowing gravity to move the dislodged crystals and activate the vertigo while the healthcare professional watches for the recognizable eye movements, or nystagmus.
Dix-Hallpike Test for BPPV
Healthcare professionals, such as chiropractors specializing in vestibular diseases, typically utilize the Dix-Hallpike test, sometimes called the Dix-Hallpike maneuver, to test for benign paroxysmal positional vertigo, or BPPV. To execute the Dix-Hallpike test, your doctor will ask you to sit on the test table with your legs stretched out. He’ll turn your head 45 degrees to one side, which contrasts the right posterior semicircular canal with the sagittal plane of the body, then they are going to allow you to lie back quickly, while the eyes are open, so that your head hangs slightly over the edge of the desk.
This motion may cause the loose crystals to move inside your semicircular canals. The healthcare professional will ask if you are feeling symptoms of vertigo and observe your eyes to find out how they move. As soon as you’ve got a few minutes to recover, your doctor may do the test on the opposite side of your head.
The latency, length and direction of nystagmus, if present, along with the latency and duration of vertigo, if present, should be noted. If the test is negative, it will demonstrate that�benign paroxysmal positional vertigo is a less probable diagnosis and central nervous system involvement ought to be considered. There are two sorts of BPPV: One at which loose crystals can move freely in the fluid of the canal (canalithiasis), and, more infrequently, one where the crystals are believed to be ‘wrapped up’ on the bundle of nerves that feel the fluid motion, or cupulolithiasis.
With canalithiasis, it requires less than a moment for those crystals to stop moving after a particular change in head position has triggered a twist. Once the crystals quit shifting, the fluid motion settles and the nystagmus and vertigo cease. With cupulolithiasis, the crystals trapped on the package of sensory nerves will make the nystagmus and vertigo last longer, until the head is moved out of the offending position. It is necessary to make the proper diagnosis, since the treatment is different for every variant. BPPV can be treated using various treatment methods, one of the most common being the Epley Maneuver.
Dr. Alex Jimenez’s Insight
Chiropractic care is an alternative treatment option commonly utilized to help treat a variety of injuries and conditions associated with the proper alignment of the spine. Occasionally, a spinal misalignment, or subluxation, can develop into numerous health issues, causing a wide array of symptoms if left untreated for an extended period of time. However, many chiropractors can treat many other ailments not closely associated with the spine. In a clinical setting, chiropractic care has been used for the management of benign paroxysmal positional vertigo, or BPPV. Chiropractors will utilize the Dix-Hallpike test to diagnose a patient followed by the Epley maneuver to help treat patients with BPPV. Many patients have reported a reduction in symptoms.
The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
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Cranial nerves I-XII WNL
Right Posterior Canal Repositioning Maneuver.
Marked improvement in balance.
WHAT DO YOU SEE?
WHAT DO YOU SEE?
AFFERENTATION WITH METABOLIC CONSIDERATIONS
In 2011, Aaron had lost both of his eyes in an IED explosion.
After recovering from meningitis:
CHALLENGE ACCEPTED
Updates from McKayla:
SOME SIMPLE CEREBELLAR THERAPIES
Responsibilities:
WHAT CAN YOU DO?
Have the patient perform balance exercises:
EYE MOVEMENT REVIEW
WHAT CAN YOU DO?
Have the patient perform gaze stability exercises:
WHAT CAN YOU DO?
Have the patient perform coordinated movements!
