FAQ

Click on a topic below to view the answer

faqs

Functional neurologists work with neurological disorders without the use of drugs or surgery.

Functional neurologists are trained to assess and intervene in all manner of neurological conditions. Our training consists of postdoctoral education in diagnosis and management of neurological disorders that requires several years to complete. This training generally takes place at extension facilities throughout the country, including chiropractic schools, medical schools, university campuses, and others. A number of different educational institutions train functional neurologists. The largest and longest serving of these is the Carrick Institute for Graduate Studies. The Carrick institute has trained functional neurologists throughout North America, Europe, Asia, and Australia for three decades. The majority of functional neurology practitioners are chiropractors, however many different types of healthcare providers are represented within the functional neurology profession. Medical doctors, Doctors of Osteopathy, and Naturopathic Physicians have completed functional neurology training and become licensed as functional neurologists.

Upon completion of functional neurology training, students become eligible to sit for board examinations that certify them as functional neurologists. Certification is provided through two primary organizations, the American Chiropractic Neurology Board, and the American College of Functional Neurology. The ACNB is itself accredited by the National Commission for Certifying Agencies, the same organization that certifies all medical specialty boards.
Absolutely not. Our care is not intended to be an alternative to treatment by a medical neurologist. Our services are complementary to medical care. We work closely with numerous medical providers, including neurologists, neurosurgeons, physiatrists, internists, and primary care providers. In many circumstances, we require you to be under medical care in order for us to take your case.
No. We cannot cure neurological diseases, or change the ultimate outcome for someone with a degenerative condition. We treat people, not their diseases. Our care is not designed to fix incurable conditions. Rather, our care is designed to improve function in the parts of the nervous system that still work in order to promote the best possible quality of life for our patients.

When you develop a neurodegenerative disorder such as Parkinson’s disease, Alzheimer’s disease, or multiple sclerosis, some nerve cells are unfortunately lost, and some pathways in the nervous system are irreparably damaged. There is nothing we can do to change that. However, when you have such a condition, we can often find ways to influence the remaining working parts of the nervous system to make them work better. We strive to take the pathways that still are healthy and precisely stimulate and exercise them, in order to make them more efficient, increase their endurance, and improve your ability to function in the world.
Our process starts with a comprehensive history. To properly understand the complexities of your case, we need to uncover all of the factors and events in your past that brought you to this point. We follow this with an extremely thorough and detailed neurological examination. Our examination is similar to a medical neurological examination, but differs in a number of important respects.

A traditional medical neurological examination is primarily designed to reveal disease processes and severe neurological dysfunction, as seen with tumors, strokes, nerve injuries, and other pathological conditions. These processes create ablative pathology, which means pools of dead nerve cells. If a reflex is tested during examination, and it appears to work reasonably well, it is generally considered to be normal and free from ablative pathology.

We assess for the same types of pathology in our examination, but we also look deeper to assess for varying levels of neurological function. By looking beyond whether or not a reflex works, but also at how well it works, when it fatigues, and what happens when it fails, we gain much more and deeper information regarding your neurological function. A standard neurology exam may tap the patellar tendon with a reflex hammer, see that the knee moves, grade the reflex, and move on. We do the same thing, but also look at how long it takes to work, the intensity of the response, and how long it takes for the response to fatigue and fail. This gives us far more information, and when correlated with other reflexes, allows us to map out a functional picture of how your well your nervous system works, what happens when it is under stress, and what happens when it fatigues and fails. This provides us with more of what we need to create your unique NeuroRestoration Program.
In the case of brain injuries, pathways involving the eyes, the inner ear, and muscles and joints are often individually or collectively damaged. Our examination allows us to quantify with hard data how well these systems work, and how well they work together. We use cutting-edge diagnostics and gold-standard technologies to evaluate and document how all the different parts of the visual system, the vestibular system, and the proprioceptive systems work together. In conjunction with our neurological examination, this allows us to see what works, what does not, and most importantly, what is not working well with everything else. We can then develop rehabilitation programs that are unique to your own brain and problem. This allows us to speed the recovery process in ways not commonly possible with other traditional forms of rehabilitation.
We use a number of different technologies for this. We start with Computerized Platform Posturography. We put you through a series of balance tests in different types of surfaces, with and without vision, and with a series of different head positions. This allows us to see how well you can stabilize yourself against gravity. It also shows us how your brain uses different types of sensory information to localize itself in space, and how it uses that information in various combinations. It lets us see how well your sensor systems work, and determine how well or poorly the different information they provide matches with each other.

We use VideoNystagmography to assess the function of all of your important visual reflexes. You wear a set of infrared goggles that precisely track your eye position as you follow a series of targets on a screen. This gives us information about a number of important brain regions and circuits, and how well they work together in different situations. The regions we evaluate are not only important for vision, but are involved in a host of cognitive and emotional processes. When they are struggling, not only do we see difficulty with vision, but difficulty with all the mental and emotional functions they also are necessary to perform.

We use Vestibular Head Impulse Testing to determine how well the complicated structures in your inner ear are working. You wear another set of goggles that contain an infrared camera and an accelerometer, and we move your head in a number of directions to see how your eyes react. This lets us see how well your vestibulo-ocular reflexes work, which are critical to your recovery and often overlooked. They let you know how your head is moving and how fast. They also help you create your brain’s unconscious concept of where it is located in space. If they are providing the wrong information, the brain does not know where it is accurately when the head moves. This causes it to fire the wrong stabilizing muscles at the wrong time, leading to chronic musculoskeletal problems.
We combine all of this information with your examination findings to create a rehabilitation program that is entirely unique to your brain. Our therapy starts with various types of stimulus, including electrical modalities, laser and light therapies, auditory and visual inputs, and tactile and proprioceptive therapies. We use these to stimulate the deficient parts of your brain and build endurance in your fragile systems. We then use a series of exercises that activate the deficient parts for precise tasks and in very specific orders. We start with fundamental brain reflexes and functions, and build up to more complicated tasks as your brain’s endurance improves. We create exercises that integrate the various regions that are struggling, and train them to work together again. We then create types of exercise that allow us to simulate the contexts in the world where you struggle the most, and help you rebuild your function in real-world contexts.
Our programs take great care to ensure that you exercise your fragile pathways at a rate that does not promote neurological fatigue. By keeping your program within a rate that does not promote failure, you build endurance quicker and recover faster. We believe that if you feel worse during or after a therapy, the therapy is either wrong, provided at the wrong intensity, or with the wrong duration. Our programs account for all of those factors to make sure that you only take steps forward with no steps back.

We also provide you with a thorough evaluation of your metabolic function as a fundamental part of our program. We assess all of the systems that can contribute to impaired neurological function. We start with a series of unique assessment tools that allow us to see how well your various physiological systems are functioning. This gives us insight into blood sugar, oxygenation, hormones, inflammation, digestion, and many other systems that can directly or indirectly influence how well your brain is working. We perform laboratory assessment when necessary, and develop strategies to promote improved function in all of these systems using the best of functional medicine interventions. And when problems we identify are better managed by other providers, we confer with your primary care or provide referrals to other providers to ensure that your metabolic condition cannot interfere with your neurological recovery.

By evaluating and managing you on all of these different levels, we can help you get better faster, with less effort, and fewer symptoms along the way.
In a traumatic brain injury, most of the common symptoms such as headache, dizziness, and brain fog involve the brain being unable to determine where it is in space. The brain needs to be able to make sense of the environment and localize itself within it in order to be able to adapt to the world properly. This requires accurate visual information from the eyes to localize the world, accurate vestibular information from the inner ear to let you know where your head is in relation to gravity and how your head is moving, and accurate proprioceptive feedback from muscles and joints, to let the brain know where the body parts are and what they are doing. These systems need to provide the correct information to the brain and be able to work together for you to make sense of your environment and function well within it.

The pathways that provide this information are almost always impaired to some degree during brain injuries. These pathways come from almost all areas of the brain, and send long, thin fibers to areas of the brainstem where they integrate and work together. This makes them very susceptible to twisting, shearing forces that can damage the sensitive fiber tracts. More importantly, these pathways lose the ability to integrate and work together. When they do not, the consequence is a mismatch between sensory pathways in certain conditions, leading to a failure to adapt to the world in all situations.
There are many forms of therapy that have traditionally been employed to treat these conditions. All are useful and effective in many cases, but none are completely effective on their own. Physical therapy and chiropractic can be helpful to address structural issues that create pain. Vestibular therapy can be helpful to address balance difficulties and dizziness. Vision therapy can be helpful to address problems with double vision and visual focus. But none of these individual types of therapy can fully address the impairment of integration that prevents all of these systems from effectively working together.

If a structural issue such as ongoing neck pain is created by a neurological reflex that the brain is using to compensate for an impaired visual reflex, the neck pain will often continue to return regardless of how many times it is addressed with exercises, therapy modalities, massage, and adjustments. Similarly, if a visual reflex is impaired because an inner ear pathway that moves the eyes is damaged, vision therapy will be incompletely effective. And if dizziness and balance issues exist because the eyes and inner ear are not working well together, rehabilitation of these systems independently will often fail to completely resolve the patient’s symptoms.

This is why we created our NeuroRestoration Program. We stand at the intersection between neurology, physical therapy, vision therapy, vestibular therapy, and physical medicine. We are uniquely equipped to not only evaluate how well visual, vestibular, proprioceptive, and cognitive systems are working, but also to determine how well these systems are working together. Using our comprehensive systems of cutting-edge diagnostics, we can develop programs unique to your own brain and condition to make these systems work well and in harmony with each other once again.
Our program differs from traditional Vestibular Therapy in a number of important respects. We strive to promote correction rather than habituation, and functional restoration rather than compensation wherever possible.

Vestibular Therapy uses treatment known as Habituation Therapy, in order to promote neurological compensation. It seeks to create conditions for the patient that provoke symptoms, and can be a very uncomfortable and provocative process. By repeatedly exposing the brain to challenging stimuli, the brain learns to compensate for the impaired reflexes and build strategies that help it cope in such situations. This also means pushing the patient to the point where symptoms are provoked and beyond during therapy. In essence, habituation therapy is neurological “tough love.” It can be a very challenging and uncomfortable process, and we see many patients that have dropped out of therapy as a result.

Depending on the level of damage, habituation strategies to build compensations may be necessary to a degree. However, it is important to distinguish between an impairment in capacity and the reflexes that impair the capacity. If a neurological reflex is damaged, and this leads to an impaired functional capacity, habituation therapy involves repetitively performing the challenging task. This may make it easier to perform over time and decrease some of the associated symptoms, but this will not repair the damaged reflex that created the problem in the first place. Our therapies seek to identify the problem reflexes and rebuild them, rather than to simply train strategies to compensate for the damage.

For example, if the vestibular reflex that is fired by moving the head back and to the right does not integrate well with the reflex that is fired when rolling the right ear toward the right shoulder, no amount of balance therapy will correct that specific impairment. You may see your general balance improve with therapy, but you will still likely develop dizziness, vertigo, nausea, light-headedness, and imbalance when looking over your right shoulder. Worse, if these vestibular reflexes do not integrate well with visual systems, your brain may do worse when visual stimulus is involved, such as when shoulder checking when driving, or when moving through grocery stores. Habituation therapy to force you to repeat similar tasks over and over may help reduce the symptoms to a point, but the reflexes will remain damaged, and at some point the compensation will usually fail.

If NeuroRestoration strategies are employed first, in order to repair and reintegrate the reflexes that are creating the problem, most if not all symptoms usually resolve, and habituation therapies become unnecessary. And in cases where we cannot completely get rid of symptoms, the amount of time necessary to train compensations is generally much shorter.
Brain injury survivors often seek vision therapy to help them address problems with visual focus, double vision, light sensitivity, and headaches and fatigue during reading. This is often very helpful. However, the visual symptoms that develop from traumatic brain injuries are very commonly not problems with the eyes themselves. They are instead the result of neurological injuries, and need to be treated as such to completely resolve.

Some of the most common problems seen in brain injuries involve the ability to move the eyes quickly, smoothly, accurately, and in unison. Even more fundamentally, one of the most basic functions that is commonly damaged is the ability to hold the eyes still. These problems are not based on damage to the eyes. They are problems with the neurological systems and pathways that move the eyes. A failure to activate a particular eye muscle properly during a movement can be a problem with the muscle itself, a problem with the nerve driving the muscle, or more commonly, a problem with one or more of the many different neurological reflexes that activate the nerve. These can involve inputs from different parts of the inner ear, several different parts of the brainstem, the frontal lobe, the parietal lobe, and many other parts of the brain. All of these different regions and reflexes will create different versions of the same problem, and all of them need to be rehabilitated differently for maximum effect.

The comprehensive neurological examination and neurodiagnostics involved in the NeuroRestoration Program allow us to determine exactly which parts of the system need to be rehabilitated, both prior to and during eye movement therapy. This allows us to have much faster gains through therapy, and resolve issues that do not respond well or fully to traditional vision therapy. In cases where vision therapy remains necessary, we refer to and work with the best vision therapy professionals to combine our therapies for maximum benefit.

And as before, visual habituation therapy progresses much faster after NeuroRestoration therapy.
Traditional physical therapy is commonly employed to address the structural injuries associated with a traumatic brain injury. This can be very useful in helping patients reduce pain, headaches, muscle spasms, and heal their tissue damage. In cases where a patient injures a joint or muscle where there is no neurological injury or central neurological disorder, such therapy is perfectly appropriate. But when the brain is injured, often the structural problems seen on physical examination are consequences of the brain injury, rather than associated structural problems. Successful treatment requires the ability to determine whether this is the case and create treatment protocols that address both the structural and neurological issues simultaneously.

As an example, if you damage central neurological pathways that move the eyes to the left, the eyes will deviate to the right. These pathways can be from the frontal lobe, the cerebellum, the brainstem, the vestibular system, and several other structures, either alone or in combination. When your eyes are deviated to the right, the brain will engage a reflex that turns your head to the left in order to see straight ahead. It does this by contracting muscles at the base of your skull. These can become chronically tight and painful, and often promote headaches. Your brain doesn’t care if doing this creates headaches, it just wants to make sure that you can see where the world is and don’t fall down. A therapist may determine that the tight muscles are the source of your headaches, and use a number of techniques, modalities and exercises to reduce the muscle tension. This may help the headaches and neck pain. Unfortunately, the brain needs this muscle tone to compensate for the impaired visual reflexes, and the therapy takes the compensation away. This may reduce the headache, but it will usually come back shortly after treatment. More importantly, taking the compensation away makes it harder for the brain to determine where it is in space, and it thus takes longer for the brain to heal and stabilize.

Our solutions involve determining the exact regions of the brain that are creating the impaired reflex compensations, and designing specific programs to rehabilitate these before engaging in structural therapies. In this way we can greatly shorten the time necessary for your system to heal. We address the root cause to get you better faster, with less effort and fewer symptoms along the way.