August 2018

• Improvement in Motor Developmental Speech Delay in Toddler Following Chiropractic Care
• Opioids Given too Easily to Children: Study
• Neck Pain and Hand Numbness Helped by Chiropractic
• Resolution of Bedwetting and Constipation Following Chiropractic Care
• Resolution of Immunodeficiency in a Child Undergoing Chiropractic Care
• Neck Curvature and Autonomic Nervous Function Improved Under Chiropractic Care

The July 2018 issue of the Journal of Clinical Chiropractic Pediatrics published a case study documenting chiropractic care resulting in the improvement of speech and motor development in a toddler. Due to the lack of verbal skills, the child was considered developmentally delayed.

The study begins by noting that, "The World Health Organization defines developmental delay as a child who is not meeting a range of milestones at the expected rate of development.  Developmental delay includes a variety of areas including but not limited to cognitive skills, fine and gross motor skills, speech and language skills and social and emotional skills."

Childhood apraxia of speech (CAS) is a motor speech disorder where a child has difficulty speaking because there is a difficulty in the messages from the brain getting through to the muscles that allow speech. Even though the muscles of speech may not be weak, the child may not be able to organize them into speech, thus reducing the child's vocabulary to simple words. The child may know what they want to say, but can not say it.

The study listed the various ages with the levels of speech a child should achieve. These included;'

• At birth - cries
• At 2-3 months - cries differently in different circumstances; coos in response to parents
• At 6-11 months - babbles in imitation of real speech, with expression
• At 12 months - says 1-2 words; recognizes name; imitates familiar sounds; understands simple instructions
• At 18 months - uses 5-20 words, including names
• 1-2 years - Says 2-word sentences; vocabulary is growing; waves goodbye; makes "sounds" of familiar animals; uses words like "more", to make wants known; understands "no"
• 2-3 years - Identifies body parts; calls self "me" instead of name; combines nouns and verbs; has a 450 word vocabulary; uses short sentences; matches 3-4 colors, knows big and little; likes to hear same story repeated; forms some plurals
• 3-4 years - Can tell a story; sentence length of 4-5 words; vocabulary of about 1000 words; knows last name, name of street, several nursery rhymes

In this case, a 2½-year-old boy with speech delay was brought to the chiropractor. The child had no history of developmental delays except that he had trouble lying face down and could not lift his head upright. If he attempted to push himself up, he would cry and not be able to accomplish the movement.  The boy's speech was way behind what is normal for his age. His total vocabulary only consisted of 5-8 words. He could not repeat or learn new words, he would not try unfamiliar words, and would not try to sound words or syllables.

After a chiropractic examination, and with the consent of the parents, specific chiropractic adjustments to address vertebral subluxations were started. After the first two visits, the boy began making letter sounds without being asked to by his parents. The parents reported that the boy also began babbling differently and more clearly. 

It was reported that after the third adjustment, the boy began to pronounce more syllables and more words. By the sixth visit, the boy's parents reported that their son was beginning to read syllables, and say complicated words from signs he saw in stores. After seven visits, the parents noticed that their son was more engaged with other children at the park and they remarked that their son was becoming more affectionate. They reported that their son was now saying "hi" and "bye", and would blows kisses and gives hugs.

In the discussion the study author noted, "Speech and sound propagation improvements were reported in a 2.5 year old male over the course of 8 weeks of chiropractic care. The child had initially presented with motor speech and sound propagation delay with an inability to sound out words, pronounces syllables and say more than 5-10 words."

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Above is the headline of a July 16, 2018, HealthDay article based upon new research published in August 2018 of the journal, Pediatrics. The HealthDay article begins by saying, "Many children are prescribed powerful opioid painkillers they don't really need, putting them and those around them at risk, a new study shows."

The study referred to in the article and published in the August 2018 journal Pediatrics, explained the reason for the study, "Little is known about opioid prescribing for children without severe conditions. We studied the prevalence of and indications for outpatient opioid prescriptions and the incidence of opioid-related adverse events in this population."

Little data was previously available for the rate of opioid prescriptions for patients under the age of 18. The study did report that the number of doctor visits resulting in a opioid prescription for patients between the ages of 15 and 19 years of age nearly doubled from 1994 to 2007. Additionally, between 1997 and 2012 the number of pediatric hospitalizations attributed to opioid poisoning doubled.

This study looked at the record for children between the ages of 2 and 17, who were on Medicaid in Tennessee, and were given a prescription between the years 1999 and 2014. The study also looked for adverse events due to opioids in this patient population. The criteria for including an adverse event was strict, requiring documentation of a direct relationship between opioid usage and the negative event. The study defined such events as, "An opioid-related adverse event was defined as an emergency department (ED) visit, hospital admission, or death related to an opioid adverse effect"

The results of the study showed that for the 401,972 children enrolled in TennCare who did not have severe conditions or who were not diagnosed with substance abuse disorders, there were a total of 1,362,503 filled outpatient prescriptions for opioids. The age breakdown for those prescriptions showed that 269 602 (19.8%) were for children 2 to 5 years of age, 377,823 (27.7%) were for children 6 to 11, and 715,078 (52.5%) were for children and adolescents 12 to 17. 

In the study discussion, the authors noted the high rate of opioid prescriptions given to children. "During the study period, 15% of children in the qualifying Medicaid population had a filled outpatient opioid prescription annually, including ˃10% of children 2 to 5 years of age."

Dr. Elliot Krane, a professor of anesthesiology and a pain management specialist at Stanford University commented in the HealthDay article, "A huge chunk of the opioids out there come from dentists," she continued, "A dentist will remove a child's wisdom teeth and then give them a week's worth of Vicodin. Opioids are not even the best medicine for oral pain, and after a wisdom tooth extraction you need analgesics for a couple or three days, but not necessarily for a whole week."

The authors of the study summed up their findings by stating in the conclusion, "In this cohort of children enrolled in Medicaid without severe conditions, 15% of children filled outpatient opioid analgesic prescriptions annually for acute, self-limited conditions. One of every 2611 study opioid prescriptions was followed by an opioid-related ED visit, hospitalization, or death; more than two-thirds of these were related to therapeutic use of the prescribed opioid."

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The Journal of Upper Cervical Chiropractic Research published the results of a case study on July 9, 2018, documenting the improvement under chiropractic care of a woman who was suffering with neck pain and numbness in hands.

This study begins by noting that neck pain is common. Statistics show that 37.2% of the population will experience neck pain lasting over one year's duration. Over 50% of the population suffers some form of neck pain in their lifetime. Additionally, neck pain is the fourth leading cause of years lost to disability.  Women more commonly suffer with neck pain then men.

In this case, a 46-year-old woman with chronic neck pain and left-hand numbness presented herself to a chiropractic clinic. The neck pain was long-term, and the woman could not recall when and how the problem first started. The numbness she was experiencing in her left hand was intermittent with no defined pattern or timing. She had not seen any other type of doctor for these conditions prior to her visit to the chiropractor.

She described the pain as achy and stiff. She initially rated the pain as a 4 out of 10 initially on a scale of 0 to 10 where 0 is no pain. She noted that her pain worsened after working long hours or traveling for work. However, she reported that none of her daily activities were affected. Massages did give her some short-term relief for the pain.

In addition to her primary complaint of neck pain and hand numbness, she also reported that she experienced low back pain and tingling, and numbness into the toes. She had previously been diagnosed with lumbar disc herniation and was treated by a physical therapist.

A chiropractic examination was performed which included spinal palpation, range of motion, relevant orthopedic and neurological exams, thermographic heat scans, and a postural analysis. Spinal x-rays of her neck were also performed. The x-rays showed moderate degeneration of mid-neck area.

Based upon the examination and x-rays, specific chiropractic care was started. She was initially seen twice per week and adjusted based upon an evaluation performed each visit. After two months of chiropractic care the patient reported a total resolution of her neck pain and the numbness she was experiencing in her left hand. 

Neck pain is one of the more common conditions for which people seek chiropractic care. The authors of the study noted, "Chiropractic care has been used to manage numerous musculoskeletal conditions including neck pain. Neck pain accounts for 25% of the initial consultations and examinations rendered at chiropractic offices."

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On  June 25, 2018, the Journal of Pediatric, Maternal & Family Health published the results of a case study showing the resolution of bedwetting and constipation after chiropractic care. The clinical name for bedwetting is enuresis.

There are two types of enuresis.  Nocturnal enuresis is bed-wetting at night and is the more common type of elimination disorder. Daytime wetting is called diurnal enuresis, and can occur by itself or in conjunction with nighttime bedwetting. Clinically, both nocturnal enuresis and diurnal enuresis are only considered to be a diagnosis if there is no other underlying organic disease, and after a child is five years of age.

The study points out that enuresis and constipation are very common conditions for children. Nocturnal enuresis is thought to affect up to 20% of children up to the age of seven. About 15% of the cases seem to correct themselves each year. Daytime, or diurnal enuresis is less common but commonly seen with the nighttime condition as well.

Constipation is defined as two or fewer bowel movements per week. It is the most common digestive symptom of the general population. Approximately 3 to 5% of all pediatric office visits are for child for constipation problems. The study notes that about 28% of adults in the United States suffer from constipation. Children are also commonly affected, with around 9-13% of pediatric cases that suffer from constipation being also associated with bladder symptoms, such as enuresis.

In this case, a 9-year-old girl was brought to a chiropractor for an evaluation and possible care. She was suffering with diurnal enuresis, nocturnal enuresis and chronic constipation. The history revealed that the girl was intolerant to red dye and suffered from digestive issues. She regularly experienced infrequent bowel movements that were difficult to pass.

An examination was performed which included a postural analysis and bilateral weight scales. Range of motion of her spine was evaluated. Additionally, palpation of the spine and adjacent musculature was performed. Thermography studies were also conducted to determine heat differences along the spine. Surface Electromyography (sEMG) studies were used as an assessment tool to measure the electrical activity of the girl's paraspinal muscles. From these tests, subluxations were determined to be present and specific forms of chiropractic adjustments were started. 

The results of the chiropractic care were almost immediate. It was reported that after the girl's first adjustment, she experienced several bowel movements and remained dry for three consecutive nights.  Four weeks after starting chiropractic care, the first re-assessment was performed to evaluate the girl's progress. At that time, she reported having only one wet night in the past week. During the second re-assessment, it was reported that the girl had not had either a daytime or nighttime leakage of urine and was having regular bowel movements about twice per day.

In their discussion, the authors of the study explained how subluxations could have created problems such as enuresis, as well as how correction would allow the body to heal itself. "The nervous system controls and regulates every organ, gland and tissue of the body and controls all bodily functions to maintain a proper bodily homeostasis.31 This regulation is done through direct nerve innervation to all organ systems of the body. When there is malposition of a vertebra in the spinal column there can be negative effects on the neurological signal of the nerve in the involved area, which is called a vertebral subluxation.

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The Journal of Pediatric, Maternal & Family Health published a study on July 5, 2018, documenting the case of a child who was suffering with a compromised immune system being helped by chiropractic. Having a compromised immune system means that the body does not fight off bacteria and viruses, leaving the person more susceptible to infectious disease and illness.

The authors of the study begin by explaining the function, and importance of the immune system. "It is understood that as we develop and throughout life our bodies will need to be overcome immune challenges. Every day we are exposed to innumerable microorganisms that have the potential to cause illness. The immune system is primarily responsible for keeping us well and for attacking microbial invaders when necessary. Getting infections when we are young primes our immune system to deal with future instances of infection more efficiently and more rapidly than the first time."

In this case, a 5-year-old girl who was suffering with recurrent respiratory illnesses related to dysfunction of the immune system, was brought to the chiropractor.  The girl's mother reported that since her birth, her daughter had repeated episodes of coughing every 2-4 weeks during the winter months with frequent pneumonia often occurring three times per year. The girl was currently suffering with congestion for the past two weeks before her visit to the chiropractor. She had been prescribed a variety of medications, mainly antibiotics, for her problems, in addition to other daily medications for allergies and asthma.

The girl's history showed that she was regularly on antibiotics since birth, A prior full blood work-up determined that she was borderline immuno-deficient. As a baby, she had suffered with constipation and constant ear infections which eventually led to surgery to have tubes placed into her ears.

A chiropractic examination along with spinal x-rays of the girl's neck were performed. The x-rays showed that the girl had a severe decrease in what should be the normal forward curve of the neck. From these procedures, it was determined that multiple areas of vertebral subluxation were present in the girl's spine. With this information, specific forms of chiropractic adjustments were started.

After chiropractic adjustments had been started, the girl's mother commented that her daughter had remained symptom-free for the majority of her time since starting chiropractic. According to the girl's mother, this represented the longest time her daughter had gone without getting sick since birth.  It was also reported that the girl was also able to get off all of her medications with the exception of her inhaler for allergies and asthma, which she only rarely used at night.

It was reported by the mother that the girl missed very few days of school, was able to concentrate more efficiently, slept better, was behaving better both at home and at school, and she noted an increase in energy levels. Four months after starting chiropractic, a follow-up set of neck x-rays showed that the girl's neck curve had improved from severely decreased to only mildly decreased.

In explaining the premise of how chiropractic could have a positive effect on the immune system the authors wrote, "Chiropractors often contend that many adult conditions originate in the childhood years due to nervous system interference and resulting aberrations of physiology. Previous research has identified chiropractic care as an effective treatment option for childhood conditions, including but not limited to respiratory illnesses, which are directly related to the functioning of the immune system. Thus, it is reasonable to conclude that chiropractic intervention has the potential to benefit cases of childhood immuno-deficiency."

In their conclusion, the authors summed up this case by saying, "This case study provides supporting evidence on the benefits of chiropractic care in increasing immune system function in the pediatric population. By identifying the vertebral subluxation complex and correcting it through chiropractic adjustments, neurological function may be improved which can effectively restore balance to the immune system."

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The Annals of Vertebral Subluxation Research published a case study on June 28, 2018, documenting the long-term improvement of neck curvature and the improvement of autonomic nerve system function in a patient undergoing chiropractic care. The purpose of this study was to examine changes to the neck curvature because of chiropractic care and the resulting changes to autonomic nerve system function.  

The study begins with an explanation of the importance between proper biomechanical structure and body function. "The normal alignment of the spine and its complex biomechanics have been subject to investigation in the past decades. There is now a large body of evidence suggesting that the disruption of its alignment has both physiological and anatomical consequences in the human organism."

A normal upright human spine should have four curves when viewed from the side on x-rays. These curves include a forward curve in the neck, and curve backward in the upper mid spine, and inward forward curve in the lower back, and a forward curve of the base and tail section at the bottom of the spine.  An x-ray from the front or back of the spine should show a spine that is straight with little or no deviation to either side.

The curve that seems to be the most susceptible to change and has drawn the most attention in chiropractic is the neck curvature. According to the study, neck curvature loss has been associated with conditions such as ADHD, otitis media, respiratory conditions, neck and upper back pain, low back pain, sinus infections, vertigo, nausea as well as vascular, migraine and tension headaches.

For the purposes of this research, only the objective biomechanical and functional results were reported in this case study. In this case, a 26-year-old man presented himself to the chiropractor for a several musculoskeletal complaints. No previous surgical interventions or medications were reported. Upon meeting the criteria for inclusion of this study, the man underwent a case history interview as well as chiropractic examination using video-fluoroscopy, static film x-rays as well as infrared thermography heat studies.

The static x-rays of the man's neck showed a reversal of the cervical curvature with an abnormal forward tilting of the man's top neck bone, called the atlas. Video-fluoroscopy, also known as motion x-rays, of the man's neck showed multiple locking-type areas of restricted or reduced movement. These two types of x-ray findings verified a structural problem within the man's spine.

Infrared paraspinal thermography was also performed to record heat variations along the spine from side to side as well as one spinal level to the next. The variations present, along with a consistent pattern of the variation in this man's spine, demonstrate an effect on the autonomic nervous system which controls heat levels by varying body surface blood supply.

After a period of time of specific forms of chiropractic care being rendered, motion and static x-rays were performed and compared to the initial studies. Periodic infrared paraspinal thermography scans were also performed and compared to the earlier studies.

The results of these follow-up procedures showed improvements in the curvature of the man's neck to where it changed from a reversed curvature to a slight forward curvature. Additionally, the motion x-rays showed improvement in segmental motion. These x-ray findings document and confirm an improvement in the biomechanical structure of this man's spine.

The follow-up thermography scans no longer showed an abnormal pattern, and overall showed a reduction toward normal of heat variations. This demonstrated a positive change in the man's autonomic nerve system function.   

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