Clinical Method Summary
Hard Lesion: A tumor or some other kind of physical pathology adversely affecting brain or nervous system function.
Soft Lesion: A lack of firing or impulses, in a particular section of the brain.
Two essentials for brain and nervous system health:
Fuel & Activation
Blood Pressure: Blood pressure is taken on both sides of the body, or bilaterally. Normal blood pressure is around 120/80. The side that is measured higher may indicate the side of decreased brain function. The ponto-medullary region lowers the blood pressure, and the mesencephalon, raises blood pressure. When the patient has a decrease in frequency of firing of the brain, the brain will fail to stimulate the ponto-medullary region, which will fail to inhibit or slow the mesencephalon. The increased firing of the mesencephalon causes the patient’s blood pressure to increase. SpO2: Tissue saturation of oxygen is checked bilaterally, and it measures the amount of oxygen in the patient’s system. Sp02, or tissue saturation of oxygen, should ideally measure 98 to 100%. Tissue, especially brain tissue needs oxygen as fuel to survive. Many medical doctors say that a tissue saturation of oxygen about 90% is fine. This is acceptable when examining a patient’s cardiovascular output. However, when observing the neurological stamina of the patient, the optimal saturation of oxygen must be considered. Note: We check a patient’s blood pressure, pulse, and tissue saturation of oxygen before and after each treatment. If I am truly stimulating brain function, the blood pressure and pulse should stay the same or decrease after each treatment because stimulation of the brain will cause increased firing into the lower brainstem.Respiration: Respiration should measure 9 to 12 full breaths per minute. If the respiratory rate is above 12 breaths per minute, the patient is hyperventilating, which may indicate that the brainstem is over firing. A respiratory rate of less than eight breaths per minute may not deliver enough oxygen the body tissue.Pulse: A normal pulse rate should measure between 65 to 75 beats per minute.
Salivary pH: Optimum salivary pH is 7.0. A pH below 7.0 may indicate a decrease in tissue saturation of oxygen.
Chest Expansion: Chest expansion is measured during one complete breath cycle. A minimum chest expansion is 3 inches for females and 4 inches for males. Decreased chest expansion may indicate a decrease in exchange of air due to a decrease in one tidal volume, possible red interference, or lung disease.
Urinalysis & Blood Work: On every patient, I request a urinalysis to check the consistency, content, and color of the urine. A number of different conditions can be detected through urinalysis. I also request a complete blood work-up consisting of a complete blood chemistry, a complete metabolic panel, and a lipid panel. If the patient has these tests performed by a medical doctor within the last three months, I will review the results when I request the patient’s records.
Finger Tip Glucose: Non-fasting finger-tip glucose testing is a screening test to measure levels of glucose in the blood. Glucose and oxygen are the two primary sources of fuel for the brain.
Muscle Stretch Reflexes: Biceps, triceps, brachioradialis and patellar reflexes should be +2 on both sides, meaning that when the doctor taps the reflexes, the arm or leg should bounce. A decrease in reflexes indicates decrease brain function of the opposite brain hemisphere. Hyper reflexes, or too much bounce, may also indicate depressed brain function of the opposite hemisphere.
Vibratory Sensation: Vibratory sensation should be perceived equally on both sides of the body. Vibration tests the back part of the spinal cord, known as the dorsal column. Decreased vibratory sense on one side may indicate decreased brain function of the same or opposite hemisphere, depending on the correlation of other findings.
Pinwheel Sensation: The pinwheel is used to test pain sensation and compare the feeling from side to side. Pinwheel testing on the upper and lower extremities, face or chest tests the front part of the spinal cord. Decreased sensation on one side can indicate decreased brain function of the same or opposite hemisphere, depending on the correlation of other findings
Muscle Strength: Muscle strength is tested to compare strength side to side. Decreased muscle strength on one side may indicate decreased brain function on the same or opposite side, depending on a correlation of other findings.
Weber: A tuning fork is placed on the top of the head; the patient should be a to hear the sound equally in both ears. Sound that occurs louder in one ear than the other (lateralization) may reveal cerumen (ear wax) blocking the year canal or a nerve conduction problem.
Rinne: the tuning fork is held on bone behind the ear (mastoid) until the sound is no longer heard. The tuning fork is then placed in front of the ear canal. At conduction (sound in front of the ear) should be heard after bone conduction (sound of the mastoid) ceases. If the patient cannot hear the sound in front of the ear, hearing many blocked due to wax or nerve damage.
Otoscopic Ear Examination: The external ear canal should be clear with no wax or redness observed. The eardrum (tympanic membrane) should be pearly gray in color and reflect light. Infections of the inner or middle ear can cause a change in the eardrum color or size.
Eye Exam: The eyes are inspected for equal size, shape, overall appearance and position. Differences from side to side may indicate decreased brain function when correlated with other findings.
Corneal Reflex: Checking the corneal reflex cranial # 5 (sensation) and cranial nerve # 7 (eye closure). The patient is asked to move the eye to one side and look up. A puff of air or piece of tissue touches the eye. The eye should blink reflexively and the sensation should be perceived equally in both eyes. If the eye doesn’t blink equally, cranial nerve #7 may have decreased output on that side. Decreased sensation may indicate decreased function of cranial nerve #5 on that same side.
Corneal Light Reflection: The corneal light reflection is tested by shining a light at the bridge of the nose and observing the reflection. The eyes should remain neutral, not deviating in or out from neutral. If one eye deviates from the midline, it may indicate decreased brain function when correlated with other findings.
Pupillary Reflex – Cranial Nerve #3: The pupillary reflex is tested by shining a light into the eye and observing the pupil becoming smaller. A slow response or even bouncing (hippos) may indicate decreased brain function. When the light is removed, that pupil should become larger.
Accommodation – Cranial Nerve #3: The patient is told to watch an object as it is brought in towards the nose. The eyes should converge toward the nose. If one eye moves out, this may indicate decreased brain function on that same side.
Pupil Size – Cranial Nerve #3: Pupil size should be equal side to side. A large pupil (corectasia) may indicate decreased brain function on that same side.
Rapid Eye Movement Between Two Specific Points: The patient looks from one finger at midline to finger in the periphery as quick as possible. Decreased speed or coordination when moving to one side may indicate decreased cerebellar function on the opposite side or decreased brain function on same side.
Cover/Uncover Test: The patient fixates gaze on a distant point, and vision in one eye is blocked by holding thumb over one pupil and taking away quickly. The eyes are observed for any deviation from normal position. Abnormal motion of either can indicate decreased brain function on that side.
Ocular Motion – Cranial Nerves #3, 4 and 6: Ocular motion is checked while the eyes follow an object through different visual fields. Muscle weakness or vibration of the eye is noted. Any decreased ocular motion may indicate decreased brain function on that side. Eye braking, or termination of movement, is also considered at the end of each visual field. Decreased braking may indicate decreased cerebellar function.
Peripheral Vision: A patient’s peripheral vision is compared side to side. Differences from side to side can involve decrease brain function on either side when compared with other findings.
V/A Ratio: V/A ratio stands for the vein to artery ratio in the eye. The ratio should be 1:1 in each eye. A higher vein to artery ratio of one eye, may indicate higher blood pressure on that side, indicating decreased brain function.
Optokinetic Tape: The patient follows a red and white tape with his eyes. Decreased movement on one side indicates decreased function of the parietal and frontal lobes of the brain (on that side) or decreased cerebellar function of the opposite side, depending on eye movement.
Blind Spot Mapping: The patient is asked to cover one eye and observe the red tip on a white pencil with his peripheral vision. The pencil is moved from the black dot, and when the red tip disappears from view, the area is marked. Once all areas are outlined, a comparison is made side to side, for similarity in shape (no irregularities), size (smaller than a quarter) and regularity from top to bottom. Differences in characteristics indicate decreased brain function on the opposite side.
Olfactory Testing – Cranial Nerve #1: Olfactory testing is the difference in the ability to smell from side to side. Decreased smell on one side indicates decreased brain function on that side. Facial
Muscles – Cranial Nerve #7: All facial muscles should look the same on both sides, while smiling, wrinkling the forehead, biting down and frowning. A decreased tone on one side of the face indicates decreased brain function on the same side or opposite side, depending on other findings.
Cranial Nerve #11: The cranial nerve #11 allows the patient to move his head from side to side and shrug his shoulders. Differences side to side can indicate a lesion in cranial nerve #11.
Cranial Nerve #12: When testing the cranial nerve #12, the tongue should protrude in the midline. A tremor or deviation to one side, they indicate a problem with the 12th cranial nerve.
Testing the Cerebellum
Rhomberg’s Sign: The patient stands with both feet together, and his eyes closed. The patient should stand tall without sway. Swaying back and forth or falling to one side indicates decreased cerebellar function.
Arm Slap: The patient stands with both feet together, and his eyes closed. His hands are straight and outstretched. The examiner pushes the arm toward the floor. The patient’s arm should return quickly to its initial position. Overshooting the original position can indicate decreased cerebellum function on the same side.
Past Pointing: The patient stands with feet together, his eyes closed, and his hands out in front. He should be able to touch his finger to his nose without difficulty. Missing the nose or ratchety motion when moving toward the nose, may indicate decreased cerebellar function on that same side.
Piano: The patient is asked to play the piano with his arms straight out in front of him. Rapid and equal motion should be present in both hands. Decreased motion in one hand, may indicate decreased cerebellar function on that side.
Supination / Pronation: The patient quickly turns his hand up (supination) and down (pronation). Speed and coordination should be equal in both hands. Decreased speed or coordination in one hand, may indicate decreased cerebellar function on that side.
Heel Tap: The patient places one heel on the other shin and taps the shin with the heel as rapidly as possible on the same spot. Uncoordinated tapping may indicate decreased cerebellar function on the same side.
Heel to Toe Walk: The patient walks in the straight-line with the heel touching the toe on every step. Unsteadiness in gait may indicate decreased function on one side.
Running Heel Down Shin: beginning at the knee and moving down to the ankle, the patient moves the heel down the opposite shin. The motion should be smooth and coordinated with both feet. Ratchety motion on one side can indicate a problem with the outside of the cerebellum on that same side.
Windshield Wiper Blades: The lower extremities are tested by moving both feet in a windshield wiper pattern. The pattern should be smooth and at the same speed on both sides of the body. Decreased speed and on foot can indicate decreased outside cerebellar function on that side.
Repeat Numbers: The patient should be able to repeat seven numbers back to the examiner. The inability to repeat the numbers spoken in a monotone voice indicates decreased left temporal lobe function, and the inability to repeat numbers spoken in a rhythmic variation indicates decreased right temporal lobe function.
Parietal Sway: The patient stands with his feet together, eyes closed, and hands straight out in front. If one arm drifts away from original position, a parietal lobe soft lesion should be suspected.
Two-Point Discrimination: Two-point discrimination should be distinguishable between two separate areas of the body, including the left side from the right, while the patient’s eyes are closed.
Heart Exam: A heart exam is performed by listening to the patient’s heart for any abnormal signs such as clicks or gallops. Rhythm is also noted in the form of normal rhythm (sinus rhythm) or uneven rhythm (arrhythmia). Uneven rhythm may indicate a decreased left brain function. Heart rate is also noted. A normal heart rate is measured at 60 to 100 beats per minute. Fast heartbeats (over 100) equal tachycardia, while slow heartbeats (under 60) equal bradycardia. Either tachycardia or bradycardia indicate a decreased right brain function.
Abdominal Exam: The exam is performed by listening to bowel sounds in the four different areas or quadrants of the abdomen. Bowel sounds should be heard in each area within 10 seconds. Decreased bowel sounds could indicate a bowel obstruction and further testing is warranted. Pressure is applied to the same for areas of the abdomen looking for pain lumps or bumps. Tapping over all four quadrants is also performed with any difference in sound noted. Aerophasia (the swallowing of air) can be heard as a hollow sound. Over one or more of the four quadrants.
Bruits: The examiner listens to the blood vessels in the head, neck, and abdomen for blood vessel narrowing.
Orthopedic Exams: Several orthopedic exams are performed on each patient. The purpose of orthopedic tests is to identify problems within certain areas of the body. Groups of tests focus on diagnosis for different regions of body. The areas are divided into neck (cervical), mid-back (thoracic), and low back (lumbo-pelvic) and extremity.
ROM: Range of motion is performed in different areas of the spine. Cervical, thoracic, lumbar and pelvic areas are all considered. Baseline degrees of motion are expected in decreased motion in one or more can indicate joint fixation, sprain-strain, or other pathology.
Posture: The patient’s overall posture is observed. A high shoulder, head tilt, high hip or weight-bearing are noted. Gait is also analyzed. Patterns of movement during walking may be observed. Movement can give clues to assess overall brain function.
Re-Examination: A re-exam will be performed at specific interim points of care. This re-exam will check whether progress has been made to date, and identify areas needing more work.
HOW TO TELL WHICH SIDE TO STIMULATE
Unilateral Chiropractic Adjustments: Joint manipulation is only performed on one side of the body to increase brain function of the opposite cortex (brain) and ipsilateral, or same side cerebellum. Lower frequency modalities, including an Activator or Arthrostim may be used. With a lower frequency modality instrument, the practitioner can administer a very low force adjustment to a particular vertebra. The activator is very beneficial to people suffering from migraine headaches, fibromyalgia, and dizziness.
Dorsal Spine Adjustment: Thoracic adjustment to activate dorsal column pathways, to increased tidal volume of lungs, and to improve oxygenation.
Upper Extremity Adjustment: Utilizing muscle spindle afferents in the wrist and elbow to stimulate the cuneo-cerebellar tract that activates the fastigium within the ipsilateral cerebellum, then is a feed-forward mechanism to the opposite brain.
Lower Extremity Adjustment: Utilizing muscle spindle afferents in the ankle and lateral knee to stimulate the spineo-cerebellar tract to activate the fastigium within the ipsilateral cerebellum, then is a feed-forward mechanism to the opposite brain.
Overview: auditory stimulation in one ear is utilized increase the firing or impulses of the opposite cortex via the inferior colliculus of the mesencephalon. Blood pressure, pulse, and other neurological findings before and after treatment determine the type and length of treatment at each visit. Auditory stimulation will vary from 1 to 20 minutes per treatment.
Metronome: The metronome works well when both the cerebellum and the brain need to be stimulated with a low metabolic demand. The metronome beats can range from 40 beats per minute to 74 beats per minute, but the rate should not exceed the patient’s heart rate.
Rain/thunderstorm: Nature sounds stimulate the opposite cortex and usually work well in patients with hypertension.
Mozart: Mozart and the major key stimulates the opposite cortex. The major key has a higher metabolic demand than other forms of auditory stimulation, and it should therefore be used judiciously. à Have them listen monophonic – with a radio shack earpiece.
Checkerboard Pattern: Watching a checkerboard pattern can increase brain function when viewed in only one-half or one-quarter of a patient’s visual field. Visual stimulation coming from the left visual field crosses through the superior colliculus in the upper brainstem, which increases activation in the cerebral cortex or right brain. Increased activity of the brain should lower the blood pressure and pulse via the ponto-medullary stimulation. The intensity of treatment can be very by using different color combinations. Frequency varies by rate of color in the various checkerboard patterns. Color frequencies from lowest to highest are red/black, red/green, blue/black, and light blue/dark blue. Frequency (speed of movement) can range from 2 to 8 Hz.
Red or Green Light: Are red or green light may be shown in the nasal aspect of the right or left eye. This increases the activity of the superior colliculus of the opposite mesencephalon to reduce the activation of the mesencephalic reticular activating system. Remember that the mesencephalic reticular activating system is simply the brain firing to lower brainstem.
Faces: The act of viewing pictures of faces increases brain function via the feed-forward mechanism through the cerebellum to the cortex. Faces stimulate the amygdala, which lies deep in the temporal lobe. Familiar faces will stimulate the left amygdala and unfamiliar faces was stimulate the right.
Eye Exercises: Eye exercises will increase activation into the cerebellum. The lateral cortex of the cerebellum will be activated in will improve connections to the contralateral frontal cortex.
Mazes / Word Searches: Mazes will activate the right parietal lobe, and word searches will activate the left parietal lobe.
Large Letters Made of Small Letters: observing only the large letters will stimulate the right hemisphere or right brain. Observing only the small letters will stimulate the left hemisphere or left brain.
Physical Therapy Modalities
TENS: TENS stands for trans-electrical nerve stimulation. Electrical stimulation is used at a sub-threshold level (the patient cannot feel it) to decrease pain sensation, and increase the function of the opposite hemisphere (brain) and the same side cerebellum. Since the right brain controls the left side of the body and the left brain controls the right side of the body, TENS should be administered to the opposite brain area (left side for right brain). Normal brain frequency is 8 to 13 Hz, so that TENS frequency is set in this range.
Heat: Heat therapy is used to promote and increase metabolic and healing rate to the involved tissue. Increased heat increases the activation to the brain. Heat has an immediate soothing effect, decreasing joint stiffness and muscle spasms, by increasing the frequency of firing of the cerebellum and brain. Ice decreases frequency of firing or impulses to the brain.
Ultrasound: Ultrasound is utilized to provide a deep muscular vibratory sensation to increase the vascular supply to the involved tissue.
Intersegmental Traction: Intersegmental traction is performed on a mechanical table, and it increases vibration into the dorsal column, the back part of the spinal cord. This form of vibration activates the patients proprioceptive system (tells the brain where the body is in space). The dorsal column fires up to the cerebellum, increasing the cerebellar frequency of firing.
UBE: The UBE, or upper body ergometer is like an exercise bike for the arms. The UBE will increase the firing of the posterior muscle groups, neck, and arms to fire the cuneo-cerebellar tract bilaterally to the cerebellum, increasing its activation. The UBE will also activate the muscles of posture. The arms (cuneo-cerebellar tract) fire much more powerfully to the cerebellum, then the legs (spino-cerebellar tract). For this reason, I always recommend exercising with the UBE over the treadmill.
Oxygen: Supplemental oxygen will be given to patients to increase the vascular supply, or fuel, to brain tissues. Oxygen is fuel for the brain, who, the brainstem, and especially the cerebellum. The cerebellum is the most oxygen-dependent organ in the body. The brain requires two things to survive: fuel, in the form of oxygen and glucose, and activation. The normal inspiration/expiration ratio of an individual should be 1:2, meaning it you should breed out twice as long as you breathe in.
Warm and Cold Calorics: Placing warm water or air in the ear stimulates the cerebellum on the same side via the semicircular canal of the ear and the vestibular nerve. The warm water stimulates the semicircular canals by increasing the flow of the endolymph. Endolymph is a gelatinous material that resembles Jell-O. Everyone knows that when you warm up Jell-O, it liquefies. When the endolymph is warmed to a higher temperature, the endolymph becomes liquefied and stimulates hair cells in the semicircular canals called stereocillia and kinocillia. This stereocillia and kinocillia fire, or excite the vestibular nerve back to the cerebellum, and they therefore increase the frequency of firing, or impulses, to the same side cerebellum. Cold or ice calorics may be used to diagnose a particular condition. When ice water is placed in the ear, the exact opposite effect of a warm caloric is initiated. The endolymph would be more gelatinous and would fail to stimulate the stereocillia and kinocillia. The same side cerebellum would have a decreased frequency of firing, allowing the practitioner to test the neuro-plasticity, or function of the opposite cerebellum. Calorics are very helpful in the treatment of vertigo/dizziness.
Olfactory Stimulation: Olfactory stimulation (stimulating smell) through one nostril is used to increase the frequency of firing of impulses to the temporal lobe of the same-side brain.
Visual Imagery: Visual imagery entails imagining one’s body going through certain motions. Depending on head position, this will stimulate the semicircular canals of the ear and will activate brain function.
Eye Exercises: Eye exercises (slow to the right) will engage the parietal cortex with a fast saccade back to the left, engaging the right frontal cortex and the contralateral (or left cerebellum) terminates the eye movement.
Mirror Imagery: The patient observes one-half of the body in the mirror. This half will be moved to project that the opposite side of the body, the side that is not working, is also moving. Mirror imagery increases the frequency of firing of the brain via activation of the somato-topic map. Mirror imaging is especially helpful in stroke rehabilitation where the patient has lost the use of one side of the body.
Spin Therapy: Spinning a patient in a slow to moderate rate in a clockwise or counter-clockwise direction stimulates the semicircular canals in much the same way as a caloric by increasing the flow of the endolymph. The endolymph excites this stereocillia and kinocillia that excite the vestibular nerve and increase the frequency of firing of the same side cerebellum. Spinning to the right increases the impulses to the right cerebellum, and spinning to the left increases the impulses to the left cerebellum.
Ultimate Eye Filters: A decreased frequency of firing from the brain down to the lower brainstem, or ponto-medullary area causes an increase in the frequency of firing of the upper brainstem, the mesencephalon. As a result of a high frequency of firing of the upper brainstem, the patient’s pupil will dilate and the patient will experience some or all of the following symptoms: light sensitivity, increased perspiration, rapid heart rate, increased warmth and chronic pain syndromes. The symptoms are created when the mesencephalon drives down the spinal cord, causing a release of pain producing chemicals. Light and sound are the two most powerful stimulants to the upper brainstem. I developed the ultimate eye filters to decrease the wavelength of light entering the patient’s brainstem. Ultimate eye filters are patented technology that decreases the wavelength of light entering the upper brainstem or mesencephalon. By slowing down the firing of the upper brainstem and increasing the firing of a lower brainstem, they pupil will become smaller, and the upper brainstem will decrease in the frequency of firing. A decrease in the frequency of firing of the upper brainstem will cause a constriction of the blood vessels in the brain. And this in turn will help relieve a patient’s migraine headaches, light sensitivity, and overall firing into the upper brainstem.
Yours in Health,
John Lieurance, D.C.