The spinal cord and brain make up the central nervous system while the spinal nerves that branch to the spinal cord and cranial nerves that branch to the brain makes up the peripheral nervous system.
There are thirty-one sets of nerves that extend out of the spinal cord and are connected to it by the nerve root. Each nerve branches out about a half inch from the spinal cord before dividing into smaller branches. The dorsal rami are on the posterior side of the branch while the larger ventral rami are on the anterior side.
The dorsal rami provide nerve function for the skin of the trunk and posterior muscles. The ventral rami from T1 to T12 provide nerve function to the skin of the trunk as well as the lateral and anterior muscles. The anterior divisions that remain for plexuses, networks that provide nerve function to the body. Each plexus has specific areas on the body for skin sensitivity as well as certain muscles. Their point where they exit the spine determines how they are numbered. The four primary plexuses are:
Cervical plexus, C1 � C4, innervates the diaphragm, shoulder, and neck
Brachial plexus, C5 � T1, innervates the upper limbs
Lumbar plexus, T12/L1 � L4, innervates the thigh
Sacral plexus, L4 � S4, innervates the leg and foot.
These spinal nerves have two sets of fibers: motor and sensory. Motor fibers facilitate movement and provide nerve function to the muscles. Sensory fibers facilitate sensitivities to touch, temperature and other stimuli. They provide nerve function to the skin.
What are Myotomes and Dermatomes?
A group of muscles that are innervated by the motor fibers that stem from a specific nerve root is called a myotome. An area of the skin that is innervated by the sensory fibers that stem from a specific nerve root is called a dermatome. These patterns of myotome and dermatome are almost always identical from person to person. There are occasionally variances, but that is rare.
This consistency allows doctors to treat nerve pain in patients. If a specific area is hurting, they know that it is attributed to a certain myotome or dermatome, whichever the case may be, and its corresponding nerve root. Problems with nerve damage are often the result of stretching the nerve or compressing it.
When the nerves are injured in specific areas like the lumbosacral or brachial plexus, it presents as sensory and motor deficits in the limbs that correspond to them. Myotomes and dermatomes are used to assess the extent of the damage.
How are Myotomes and Dermatomes used to Assess Nerve Damage?
When a doctor tests for nerve root damage in a patient, he or she will often test the myotomes or dermatomes for the nerves assigned to that location. A dermatome is examined for abnormal sensation, such as hypersensitivity or lack of sensitivity.
This is done by using stimulus inducing tools such as a pen, paper clip, pinwheel, fingernails, cotton ball, or pads of the fingers. The patient is instructed to provide feedback regarding their response. Some of the abnormal sensation responses include:
A myotome is tested for nerve damage in the muscles which presents as muscle weakness. This grading scale, which assigns a rating to the degree of muscle weakness, is often used:
5 � Normal � Complete range of motion against gravity with full resistance
4 � Good � Complete range of motion against gravity with some resistance
3 � Fair � Complete range of motion against gravity with no resistance, active ROM
2 � Poor � Complete range of motion with some assistance and gravity eliminated
1 � Trace � Evidence of slight muscular contraction, no joint motion evident
0 � Zero � No evidence of muscle contraction
During a typical chiropractic exam, your chiropractor will assess both dermatomes and myotomes for potential neurological problems. This gives them additional insight on how to treat your condition, whether it’s related to a subluxation of vertebral bodies or other, other disease processes.
Many headaches that people classify as migraines are actually not migraines at all. Two of the most common headaches confused with migraines are sinus headaches and occipital neuralgia.
The condition can be debilitating but there are treatments, including chiropractic, that are very effective. Understanding occipital neuralgia can help patients better manage it so they can minimize the pain and symptoms of the condition.
What Is Occipital Neuralgia?
Occipital neuralgia is a neurological condition that affects the occipital nerves which run from the top portion of the spinal cord, through the scalp, transmitting messages to and from the brain. There are two greater occipital nerves, one on each side of the head, from between the vertebrae located in the upper neck through the muscles that are located at the base of the skull and back of the head.
While they do not cover the areas on or near the ears or over the face, they can extend over the scalp as far as the forehead. When those nerves are injured or become inflamed, occipital neuralgia is the result. A person with this condition may experience pain at the base of their skull or the back of their head.
What Are The Symptoms Of Occipital Neuralgia?
Pain is the prevalent symptom of occipital neuralgia. It often mimics the pain of migraine headaches or cluster headaches and is described as throbbing, burning, and aching.
There may also be intermittent shooting or shocking pain. Typically, the pain begins at the base of the skull but may radiate along the side of the scalp or in the back of the head. Other symptoms include:
Pain is experienced on one side (but sometimes both sides)
Pain behind the eye of the side that is affected
Tenderness in the scalp
Sensitivity to light
Pain triggered by neck movement
What Causes Occipital Neuralgia?
Irritation or pressure to the occipital nerves are what actually cause the pain. This may be due to tight muscles in the neck that squeeze or trap the nerves, injury, or inflammation.
However, much of the time doctors are unable to determine the cause. There are several medical conditions linked to occipital neuralgia:
Tight neck muscles
Diabetes
Trauma or injury to the back of the head
Gout
Tension in the neck muscles
Whiplash
Inflammation of the blood vessels in and around the neck
Infection
Neck tumors
Cervical disc disease
Osteoarthritis
What Are The Treatments For Occipital Neuralgia?
Occipital neuralgia treatment focuses on pain relief. It often begins with conservative treatments that include:
In more severe cases the patient may be prescribed a stronger anti-inflammatory medication, muscle relaxants or in some cases an anticonvulsant medication.
If these therapies are not effective or do not bring about the desired level of pain relief, then doctors may recommend percutaneous nerve blocks and steroids. Sometimes surgery is recommended in cases where the pain is severe, chronic, and is unresponsive to more conservative treatments.
Chiropractic For Occipital Neuralgia
Chiropractic was once considered an �alternative� treatment for occipital neuralgia, but now it is often a regular part of recommended patient care. The advantage of chiropractic over medication or surgery is that chiropractic does not come with the side effects of drugs or the risks of surgery.
Another advantage is that chiropractic seeks to correct the root of the problem, not just manage the pain like other treatments.
Chiropractic treatment for occipital neuralgia may include lift adjustments, heat, massage, and traction. This will bring the body back into proper alignment and take the pressure off of the nerves as it loosens the neck muscles.
The patient stands a better chance of staying pain free when taking this treatment route.
Injury Medical Clinic: Doctor Of Chiropractic Near Me
Human Cranial nerves are a set of 12 paired nerves that come directly from the brain. The first two (olfactory and optic) come from the cerebrum, with the remaining ten come from the brain stem. The names of the these nerves relate to what function they perform and are also numerically identified in roman numerals (I-XII).�The�nerves serve in functions of smell, sight, eye movement, and feeling in the face. These�nerves also control balance, hearing, and swallowing.
As with all nerves, symptoms describe the location of the lesion
Lesion in the lingual nerve will result in loss of taste, general sensation in tongue & salivary secretion
Lesion proximal to the branching of the chorda tympani such as in the facial canal will result in the same symptoms without the loss of general sensation of the tongue (because V3 has not yet joined the CN VII)
Corticobulbar innervation is asymmetric to the upper and lower parts of the Facial Motor Nucleus
If there is an UMN lesion (lesion to the corticobulbar fibers) the patient will have paralysis of the muscles of facial expression in the contralateral lower quadrant
If there is a LMN lesion (lesion to the facial nerve itself) the patient will have paralysis of the muscles of facial expression in the ipsilateral half of the face
Bell�s Palsy
Testing Cranial Nerve CN VII
Ask the patient to mimic you or follow instructions to make certain facial expressions
Be sure to assess all four quadrants of the face
Raise eyebrows
Puff cheeks
Smile
Close eyes tightly
Check for strength of the buccinator muscle against resistance
Ask patient to hold air in their cheeks as you press gently from the outside
Patient should be able to hold air in against resistance
Cranial Nerve VIII – Vestibulocochlear
Cranial Nerve VIII Clinically
Changes in hearing alone are most often due to
Infections (otitis media)
Skull fracture
The most common lesion to this nerve is caused by an acoustic neuroma
This affects CN VII and CNVIII (cochlear AND vestibular divisions) due to proximity in the internal auditory meatus
Symptoms include nausea, vomiting, dizziness, hearing loss, tinnitus, and bell�s palsy etc.
Testing Cranial Nerve CN VIII
Otoscopic Exam
Scratch Test
Can the patient hear equally on both sides?
Weber Test
Tests for lateralization
256 Hz tuning fork placed on top of the patient�s head in the center, is it louder on one side than the other?
Rinne Test
Compares air conduction to bone conduction
Normally, air conduction should last 1.5-2 as long as bone conduction
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
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.�
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CN I Clinically
Cranial Nerve II Clinically
Cranial Nerve III Clinically
Testing Cranial Nerve CN II & III
Cranial Nerve IV Clinically
Cranial Nerve VI Clinically
Cranial Nerve V Clinically
Cranial Nerve VII Clinically
Cranial Nerve VIII Clinically
Cranial Nerve IX Clinically
Cranial Nerve X Clinically
Cranial Nerve XI Clinically
Cranial Nerve XII Clinically
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!
