Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association.

Background: Uncompensated vestibular hypofunction can result in symptoms of dizziness, imbalance, and/or oscillopsia, gaze and gait instability, and impaired navigation and spatial orientation; thus, may negatively impact an individual's quality of life, ability to perform activities of daily living, drive, and work. It is estimated that one-third of adults in the United States have vestibular dysfunction and the incidence increases with age. There is strong evidence supporting vestibular physical therapy for reducing symptoms, improving gaze and postural stability, and improving function in individuals with vestibular hypofunction.

Motor Neuron Excitability Attenuation as a Sequel to Lumbosacral Manipulation in Subacute Low Back Pain Patients and Asymptomatic Adults: A Cross-Sectional H-Reflex Study.

Objective: The purpose of the study was to compare a time series of tibial nerve H-reflex trials between patients with subacute low back pain (LBP) and asymptomatic adults using pre and post high-velocity, low-amplitude (HVLA) spinal manipulation (SM) and control procedures.

Methods: Asymptomatic adults (n = 66) and patients with subacute LBP (n = 45) were randomized into 3 lumbosacral procedures: side-posture positioning, joint preloading with no thrust, and HVLA SM. A time series of 40 H/M ratios at a rate of 0.

Understanding inhibitory mechanisms of lumbar spinal manipulation using H-reflex and F-wave responses: a methodological approach.

The purpose of this research was to characterize unique neurophysiologic events following a high velocity, low amplitude (HVLA) spinal manipulation (SM) procedure. Descriptive time series analysis techniques of time plots, outlier detection and autocorrelation functions were applied to time series of tibial nerve H-reflexes that were evoked at 10-s intervals from 100 s before the event until 100 s after three distinct events L5-S1 HVLA SM, or a L5-S1 joint pre-loading procedure, or the control condition. Sixty-six subjects were randomly assigned to three procedures, i.

Motor-evoked potentials recorded from lumbar erector spinae muscles: a study of corticospinal excitability changes associated with spinal manipulation.

Objective: The purpose of this study was to determine if high-velocity, low-amplitude spinal manipulation (SM) altered the effects of corticospinal excitability on motoneuron activity innervating the paraspinal muscles. In a previous study using transcranial magnetic stimulation (TMS), augmentation of motor-evoked potentials (MEPs) from the gastrocnemius muscle after lumbar SM was reported. To date, there is no known report of the effect of SM on paraspinal muscle excitability.

A pilot study comparing two manual therapy interventions for carpal tunnel syndrome.

Objective: The purpose of this study was to determine the clinical efficacy of manual therapy interventions for relieving the signs and symptoms of carpal tunnel syndrome (CTS) by comparing 2 forms of manual therapy techniques: Graston Instrument-assisted soft tissue mobilization (GISTM) and STM administered with the clinician hands.

Methods: The study was a prospective comparative research design in the setting of a research laboratory. Volunteers were recruited with symptoms suggestive of CTS based upon a phone interview and confirmed by electrodiagnostic study findings, symptom characteristics, and physical examination findings during an initial screening visit.

Evaluation of the effect of postural perturbation on motoneuronal activity following various methods of lumbar spinal manipulation.

Background And Context: One basic physiologic response to spinal manipulation (SM) is a transient decrease in motoneuronal activity, as assessed by the Hoffmann reflex (H-reflex) technique. However, questions of appropriate control procedures when using the H-reflex technique to study the basic physiologic mechanisms of SM still exist. The identification of appropriate control procedures may allow us to better differentiate among the specific and nonspecific aspects of SM.

Spinal manipulation postepidural injection for lumbar and cervical radiculopathy: a retrospective case series.

Objective: To describe the safety and potential therapeutic benefit of spinal manipulation postepidural injection in the nonsurgical treatment of patients with cervical and lumbar radiculopathy.

Methods: The study design was a retrospective review of outcomes of 20 cervical and 60 lumbar radiculopathy patients who underwent spinal manipulation postepidural injection in a hospital setting. Patients received either fluoroscopically guided or computed tomography (CT)-guided epidural injection of a combination of lidocaine and Depo-Medrol.

Spinal reflex excitability changes after cervical and lumbar spinal manipulation: a comparative study.

Background Context: Spinal manipulation (SM) is a commonly employed nonoperative treatment modality in the management of patients with neck, low back or pelvic pain. One basic physiologic response to SM is a transient decrease in motoneuron activity as assessed using the Hoffmann reflex (H-reflex) technique. Previous research from our laboratory indicates that both SM with a high-velocity, low-amplitude thrust and mobilization without thrust produced a profound but transient attenuation of motoneuronal activity of the lumbosacral spine in asymptomatic subjects.

Spinal reflex excitability changes after lumbar spine passive flexion mobilization.

Background: Flexion distraction has gained increased credibility as a therapeutic modality for treatment of low back pain. Although important work in the area has elucidated the intradiskal pressure profiles during flexion distraction, the accompanying neural responses have yet to be described.

Objective: The purpose of this pilot study was to assess neural reflex responses to motion with 3 degrees of freedom applied to the lumbar spine and to evaluate H-reflex responses of the soleus.

Comparison of tibial nerve H-reflex excitability after cervical and lumbar spine manipulation.

Background: Previous investigations indicate that spinal manipulation leads to short-term attenuation of alpha-motoneuron excitability, when assessed by means of the Hoffmann reflex. Past studies, however, are limited to regional effects, such as lumbar manipulation effects on lumbar alpha-motoneuron activity.

Objective: This study compared and contrasted the effects of cervical and lumbar spine manipulation on the excitability of the lumbar alpha-motoneuronal pool in human subjects without low back pain, and compared the effects of cervical (nonregional) and lumbar (regional) spinal manipulation on lumbar alpha-motoneuron pool excitability in healthy subjects.

The effect of chiropractic manipulation on salivary cortisol levels.

Background: The stress response in humans is a healthy response and is necessary for life. The effects of chiropractic manipulation (CM), if any, on stress are ill-defined. Cortisol has been used as an accurate measure of the stress response system in humans.

First Prize: Central motor excitability changes after spinal manipulation: a transcranial magnetic stimulation study.

Background: The physiologic mechanism by which spinal manipulation may reduce pain and muscular spasm is not fully understood. One such mechanistic theory proposed is that spinal manipulation may intervene in the cycle of pain and spasm by affecting the resting excitability of the motoneuron pool in the spinal cord. Previous data from our laboratory indicate that spinal manipulation leads to attenuation of the excitability of the motor neuron pool when assessed by means of peripheral nerve Ia-afferent stimulation (Hoffmann reflex).

Comparison of effects of spinal manipulation and massage on motoneuron excitability.

The purpose of this study was to compare the magnitude and duration of motoneuron inhibition occurring as a sequel to spinal manipulation or paraspinal and limb massage. The physiologic mechanisms involved in spinal manipulative therapy and massage therapy are largely unknown. One possible hypothesis is based upon the theory that these two distinct and different modalities may attenuate the activity of alpha motoneurons.

Spinal reflex attenuation associated with spinal manipulation.

Study Design: This study evaluated the effect of lumbosacral spinal manipulation with thrust and spinal mobilization without thrust on the excitability of the alpha motoneuronal pool in human subjects without low back pain.

Objectives: To investigate the effect of high velocity, low amplitude thrust, or mobilization without thrust on the excitability of the alpha motoneuron pool, and to elucidate potential mechanisms in which manual procedures may affect back muscle activity.

Summary Of Background Data: The physiologic mechanisms of spinal manipulation are largely unknown.

Electrodermal indices of public offending and recidivism.

Three hypotheses based on the relationship between electrodermal activity and 'psychopathic' behaviour were investigated. These hypotheses are that 'psychopathic' behaviour relates to frequency of spontaneous fluctuations (Schalling, 1978), orienting response recovery time (Mednick, 1975) and orienting response amplitude (Siddle, Nicol and Foggitt, 1973). Non-recidivistic domestic offenders and highly recidivistic public offenders were compared on two test sessions.