| Abstract/Notes |
INTRODUCTION:The purpose of this study is to determine the efficacy of six weeks of chiropractic treatment for a 59-year-old male, post-stroke patient with hemiparesis of 18 months duration. CLINICAL FEATURES:A 59-year-old male suffered a stroke on 1/13/04. The patient presented to the clinic on 7/11/05 for rehabilitation and restoration of motor function, strength and proprioception. Cervical radiographs, a consultation with a psycho-neurologist and an MRI were obtained. INTERVENTION:The treatment protocol consisted of full-spine diversified chiropractic manipulative therapy and electrical stimulation (Russian therapy). The functional rehabilitation consisted of proprioceptive neuromuscular facilitation (PNF) patterns, modified Rhomberg’s position, treadmill, and a maze set-up to assess neural task systems. The patient received clinician-supervised chiropractic treatment along with functional rehab 4 to 5 times per week for 6 weeks along with home exercises. Chiropractic treatment included singular applications of judicious cervical spine adjustments in lateral flexion of the middle cervical spine; of the thoracic spine; of the lower extremities (femoral-acetabular, ankle mortise joints and metatarsal interphalangeal joints bilaterally); and of the upper extremity (radial-ulnar, mid-carpal and metacarpalphalangeal joints bilaterally). OUTCOME ASSESSMENTS:Baseline and post-intervention assessments included tandem walk, heel/toe walk, modified Rhomberg’s position, grip strength with a dynamometer, dexterity proprioception, can stacking and PNF patterns. RESULTS:Objective improvements were seen in tandem walk, heel/toe walk. Video analysis revealed the patient’s inability to initiate and terminate movements at baseline, and marked improvement after treatment. Modified Rhomberg’s position was sustained for longer duration. Grip strength of the right hand measured 5 pounds of pressure baseline and improved to 13 pounds.of pressure after treatment. Dexterity proprioception was improved after treatment, demonstrated on video analysis. PNF patterns improved after treatment, with decreased apraxia, increased strength and improved rebound ability. DISCUSSION:Brain reorganization after stroke and determining whether specific rehabilitative techniques can stimulate brain plasticity, thereby improving motor function and decreasing disability, are active areas of scientific research. The restorative processes occurring in the brain after stroke are still not fully understood. This case study may open the door to further research into the influence of chiropractic care on the central nervous system, and ultimately allow chiropractic to emerge as an integral component in the treatment of the hemiparetic stroke patient. Improvement in overall function of this post stroke patient was achieved through full spine chiropractic treatment and functional rehabilitation. The importance of a thorough neurological workup with appropriate referral cannot be overemphasized, as well as a comprehensive physical examination. It is feasible to treat post stroke patients with hemiparesis conservatively with chiropractic full spine adjusting to improve overall function of strength and motor capabilities. The long-term effects of treatment were not assessed. This abstract is reproduced with the permission of the publisher. |
