11

The CNS Efficiency Model The CNS Efficiency Model of the Chiropractic of the Chiropractic

Subluxation Theory Subluxation Theory

Fred Clary, DC, DIBCNFred Clary, DC, DIBCN

22

Looking Back to Move Looking Back to Move ForwardForward

SubluxationSubluxation Hippocrates 400BCHippocrates 400BC Randall Holme 1688Randall Holme 1688 Hieronymous 1746Hieronymous 1746 Harrison 1821Harrison 1821 Palmers 1910Palmers 1910 Stephenson 1927 Wyke 1967 Whatmore 1968 Korr 1975 Flesia/Faye 1983 Lantz 1990Lantz 1990

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If Fundamentally If Fundamentally You Are the Same as You Are the Same as everyone else…everyone else…

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IF You are thinking outside the IF You are thinking outside the Box…You Still See the box…Box…You Still See the box…

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Neurology Milestones or Dead Neurology Milestones or Dead DogmasDogmas

Before Before late 1990’s, brain tissue can not heal late 1990’s, brain tissue can not heal After 2001, the brain is highly plastic, continually After 2001, the brain is highly plastic, continually

adapting and modifying throughout adult life adapting and modifying throughout adult life BeforeBefore 2002, the thalamus is a midbrain afferent 2002, the thalamus is a midbrain afferent

relay structurerelay structure After 2002, the thalamus regulates the quantity and After 2002, the thalamus regulates the quantity and

quality of information reaching the cortex and quality of information reaching the cortex and modifies the information before its final destination modifies the information before its final destination

BeforeBefore 2000, no adult stem cells exist in the CNS 2000, no adult stem cells exist in the CNS After 2000, adult stems cells found, they are After 2000, adult stems cells found, they are

numerous and act as glia cells when not numerous and act as glia cells when not regenerating circuitsregenerating circuits

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Your World ViewYour World View ParadigmParadigm: : A set of assumptions, concepts, A set of assumptions, concepts,

values, and practices that constitutes values, and practices that constitutes a way of a way of viewing reality …viewing reality …

A scientific paradigm filters :A scientific paradigm filters : what is to be observed and what is to be observed and

scrutinized, scrutinized, the kind of questions that are the kind of questions that are

supposed to be asked and probed supposed to be asked and probed for answers in relation to this for answers in relation to this subject, subject,

how these questions are to be how these questions are to be structured, structured,

how the results of scientific how the results of scientific investigations should be investigations should be interpreted.interpreted.

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Paradigm ShiftParadigm Shift

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Paradigm ShiftParadigm Shift Paradigm ShiftParadigm Shift : Only happens when anomalies or : Only happens when anomalies or

inconsistencies arise within a given paradigm and present inconsistencies arise within a given paradigm and present problems that we are unable to solve within a given problems that we are unable to solve within a given paradigm. paradigm.

Our view of reality must changeOur view of reality must change, as must the way we , as must the way we perceive, think, and value the world. We must take on new perceive, think, and value the world. We must take on new assumptions and expectations that will transform our assumptions and expectations that will transform our theories, traditions, rules, and standards of practice. We theories, traditions, rules, and standards of practice. We must create a new paradigm in which we are able to solve must create a new paradigm in which we are able to solve the insolvablethe insolvable problems of the old paradigm problems of the old paradigm..

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Evolution and the Brain Evolution and the Brain Let us now consider how this general idea (of

evolution through natural selection) could be applied to the nervous system.

Neurons are born and differentiate in ways that are not conditioned by their future functions as elements of neural circuits

Our understanding how functions ... can emerge from these beginnings, … is worth remembering that fundamental attributes of the nervous system such as the circuitry underlying locomotion or escape behavior are probably also present as a rather stereotyped and evolutionarily conserved set of cells and connections.

It is at least possible to envisage that there is a fundamental framework of circuitry just as there is a scaffolding of initial pathways.

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Evolution and the BrainEvolution and the Brain One would imagine that there has been a strong selective

pressure to make «fundamental frameworks of CNS circuitry» as stable and efficient as possible from a developmental point of view.

This involves not only stabilizing the formation of the individual circuits, but also providing for general means to adapt them to unforeseeable perturbations, i.e. general mechanisms of functional plasticity (e.g., learning) and of developmental plasticity

It has been argued that there must also be a mechanism to assess and adjust the functional connectivity of the circuit in order to optimize its performance.

Energy efficiency of processing, interpreting, summation and filtering information must be the mechanism the nervous system uses to assess and adjust the functional connectivity to it's optimize performance.

BATE, M. (1998) Making sense of behavior. Int. J. Dev. Biol. 42: 507-509. GODA, Y. (1995) Memory mechanisms. A common cascade for long-term memory. Curr. Biol. 5: 136-138 FRIEDRICH, M.J. (2000). Research with Drosophila provides clues to enhancing human memory. JAMA 284: 2857-2858

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Inefficient CNS Processing Inefficient CNS Processing involved in ALL Disease involved in ALL Disease

Multiple Sclerosis: Functional connectivity analysis suggests that altered inter-hemispheric interactions between dorsal and lateral prefrontal regions may provide an adaptive mechanism that could limit clinical expression of the disease distinct from recruitment of novel processing regions. Together, these results suggest that therapeutic enhancement of the coherence of interactions between brain regions normally recruited (functional enhancement), as well as recruitment of alternative areas or use of complementary cognitive strategies (both forms of adaptive functional change), may limit expression of cognitive impairments in multiple sclerosis.

Sarah Cader. Reduced brain functional reserve and altered functional connectivity in patients with multiple sclerosis. Brain (2006), 129, 527–537

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Inefficient CNS Processing Inefficient CNS Processing involved in ALL Diseaseinvolved in ALL Disease

Drug AddictionDrug Addiction: …transition to addiction : …transition to addiction results from genetic, developmental, and results from genetic, developmental, and sociological vulnerabilities, combined with sociological vulnerabilities, combined with pharmacologically induced plasticity in pharmacologically induced plasticity in brain circuitrybrain circuitry that strengthens learned that strengthens learned drug-associated behaviors at the expense drug-associated behaviors at the expense of adaptive responding for natural rewards. of adaptive responding for natural rewards. Advances over the last decade have Advances over the last decade have identified the brain circuits most vulnerable identified the brain circuits most vulnerable to drug-induced changes, as well as many to drug-induced changes, as well as many associated molecular and morphological associated molecular and morphological underpinnings. underpinnings. KalivasKalivas PW PW .Drug addiction as a pathology of staged neuroplasticity. .Drug addiction as a pathology of staged neuroplasticity.

Neuropsychopharmacology. 2008 Jan;33(1):166-80. Epub 2007 Sep 5.Neuropsychopharmacology. 2008 Jan;33(1):166-80. Epub 2007 Sep 5.

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Inefficient CNS Processing Inefficient CNS Processing involved in ALL Diseaseinvolved in ALL Disease

DepressionDepression: In contrast to the null findings : In contrast to the null findings for behavioral data, pretreatment, for behavioral data, pretreatment, depressed patients showed depressed patients showed diminished diminished activityactivity in the dorsolateral prefrontal cortex in the dorsolateral prefrontal cortex and diminished and diminished functional connectivityfunctional connectivity between the dorsolateral prefrontal cortex between the dorsolateral prefrontal cortex and dorsal anterior cingulate cortex. and dorsal anterior cingulate cortex. The The altered functional connectivityaltered functional connectivity appears appears to be persistent. Further, at least some of to be persistent. Further, at least some of the prefrontal hypoactivity seems to be an the prefrontal hypoactivity seems to be an episodic characteristic of acute depression episodic characteristic of acute depression amenable to treatment. amenable to treatment.

AizensteinAizenstein HJ HJ .Am J Geriatr Psychiatry. 2009 Jan;17(1):30-42. .Am J Geriatr Psychiatry. 2009 Jan;17(1):30-42. Altered functioning of the executive control circuit in late-life depression: episodic and persistent phenomena.

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Inefficient CNS Processing Inefficient CNS Processing involved in ALL Diseaseinvolved in ALL Disease Autism: These findings suggest that the

neural basis of altered cognition in autism entails a lower degree of integration of information across certain cortical areas resulting from reduced intracortical connectivity. The results add support to a new theory of cortical functional underconnectivity in autism, which suggest a deficit in integration of information at the neural and cognitive levels

Marcel Adam Just. Functional and Anatomical Cortical Underconnectivity in Autism: Evidence from an fMRI Study of an Executive Function Task and Corpus Callosum Morphometry. Cerebral Cortex April 2007;17:951--961

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Inefficient CNS Processing Inefficient CNS Processing involved in ALL Diseaseinvolved in ALL Disease

Pain & Awareness: Thalamus and thalamo-cortical pathways seem to be linked to the hypnotic effects of anesthesia and deep sedation. Connectivity studies also confirm this….….

RamaniRamani R R,, Understanding anesthesia through functional imaging.Understanding anesthesia through functional imaging.Curr Opin anaesthesiol. 2008 Curr Opin anaesthesiol. 2008 Oct;21(5):530-6.Oct;21(5):530-6.

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Inefficient CNS Processing Inefficient CNS Processing involved in ALL Diseaseinvolved in ALL Disease

Alzheimer’sAlzheimer’s: We have been : We have been able to show that in mildly able to show that in mildly demented Alzheimer's disease demented Alzheimer's disease patients the breakdown in patients the breakdown in memory for unfamiliar faces is memory for unfamiliar faces is due, at least in part, to a due, at least in part, to a reduction in reduction in functional functional connectivity… connectivity…

Cheryl L. Grady .Altered brain functional connectivity and impaired short-term memory in Alzheimer's disease. Brain, Apr 2001; 124: 739 - 756.

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Inefficient CNS Processing Inefficient CNS Processing involved in ALL Diseaseinvolved in ALL Disease

Headache:Headache: Until recently, primary headache Until recently, primary headache disorders, such as migraine and cluster headache disorders, such as migraine and cluster headache were considered to be vascular in origin. However, were considered to be vascular in origin. However, advances in neuroimaging techniques, such as advances in neuroimaging techniques, such as positron emission tomography, single photon positron emission tomography, single photon emission computed tomography and functional emission computed tomography and functional magnetic resonance imaging have augmented the magnetic resonance imaging have augmented the growing clinical evidence that these headaches growing clinical evidence that these headaches are primarily driven from the brainare primarily driven from the brain. . Brain Brain functional circuitry, signaling and connectivity. functional circuitry, signaling and connectivity.

Connectivity is the functional relationships and Connectivity is the functional relationships and communication between different regions of the communication between different regions of the CNS. CNS.

Cohen ASCohen AS . Functional neuroimaging of primary headache disorders. Expert Rev Neurother. 2006 . Functional neuroimaging of primary headache disorders. Expert Rev Neurother. 2006 Aug;6(8):1159-71.Aug;6(8):1159-71.

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Inefficient CNS Processing Inefficient CNS Processing involved in ALL Diseaseinvolved in ALL Disease

Heart Disease:Heart Disease: That the brain may That the brain may be involved in cardiovascular be involved in cardiovascular regulation has been acknowledged regulation has been acknowledged for over a century. for over a century. That cardiac That cardiac arrhythmias may result from arrhythmias may result from cortical derangement has been cortical derangement has been less well recognized.less well recognized.

Oppenheimer SOppenheimer S. Cerebrogenic cardiac arrhythmias: cortical lateralization and clinical significance. . Cerebrogenic cardiac arrhythmias: cortical lateralization and clinical significance. Clin Auton Res. 2006 Feb;16(1):6-11.Clin Auton Res. 2006 Feb;16(1):6-11.

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Inefficient CNS Processing Inefficient CNS Processing involved in ALL Diseaseinvolved in ALL Disease

Heart Function: There is extraordinary neuroplasticity of the sympathetic nervous system in adulthood, a structural and functional neuronal ebb and flow according to the demands placed on it.

Kreusser MM, Haass M, Buss SJ, Hardt SE, Gerber SH, Kinscherf R, Katus HA, Backs J. Injection of nerve growth factor into stellate ganglia improves norepinephrine re-uptake into failing hearts. Hypertension 2006;47:209 –215

The connectivity and neural drive to the heart varies according to efficiency and neuroplasticity tenets. Demands for the circuit and efficiency of that circuit control resource use and thus its functional performance.

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Inefficient CNS Processing Inefficient CNS Processing involved in ALL Diseaseinvolved in ALL Disease

Immune System: The brain and the immune system are the Immune System: The brain and the immune system are the two major adaptive systems of the body. During an immune two major adaptive systems of the body. During an immune response the brain and the immune system "talk to each response the brain and the immune system "talk to each other" and this process is essential for maintaining other" and this process is essential for maintaining homeostasis. Two major pathway systems are involved in homeostasis. Two major pathway systems are involved in this cross-talk: the hypothalamic-pituitary-adrenal (HPA) this cross-talk: the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS) …the role of axis and the sympathetic nervous system (SNS) …the role of SNS are also discussed in the context of their clinical SNS are also discussed in the context of their clinical implication in certain infections, major injury and sepsis, implication in certain infections, major injury and sepsis, autoimmunity, chronic pain and fatigue syndromes, and autoimmunity, chronic pain and fatigue syndromes, and tumor growth.tumor growth.

Elenkov IJ . .The sympathetic nerve--an integrative interface between two supersystems: the brain and the immune system. Pharmacol Rev. 2000 Dec;52(4):595-638.

The brain and the immune system, or the "supersystems", a term recently coined by Tada (1997) , are the two major adaptive systems of the body. Although the immune system has been often regarded as autonomous, the last two to three decades provided strong evidence that the central nervous system (CNS) receives messages from the immune system and vice versa messages from the brain modulate immune functions. Thus, the brain and the immune system are involved in functionally relevant cross-talk, whose main function is to maintain homeostasis

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Inefficient CNS Processing Inefficient CNS Processing involved in ALL Diseaseinvolved in ALL Disease

IBS/GI DisturbancesIBS/GI Disturbances: According, : According, positron emission tomography (PET) positron emission tomography (PET) and functional magnetic resonance and functional magnetic resonance imaging (fMRI) have been widely imaging (fMRI) have been widely used to study used to study neural mechanisms neural mechanisms underlying visceral sensationsunderlying visceral sensations. . IBS and other GI disease display IBS and other GI disease display altered connectivity and functional altered connectivity and functional changes in the brain compared to changes in the brain compared to healthy volunteers. healthy volunteers.

Rapps N. Brain imaging of visceral functions in healthy volunteers and IBS patients. J Psychosom Res. 2008 Jun;64(6):599-604

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Disease and Dysponesis Disease and Dysponesis

DysponesisDysponesis is defined as a reversible is defined as a reversible physiological state consisting of unnoticed, physiological state consisting of unnoticed, misdirected neuro-physical reactions (e.g. misdirected neuro-physical reactions (e.g. abnormal muscle activity) to various agents abnormal muscle activity) to various agents (environmental events, bodily sensations, (environmental events, bodily sensations, emotions, and thoughts) and the emotions, and thoughts) and the repercussions of these reactions repercussions of these reactions throughout the organism. These errors in throughout the organism. These errors in energy expenditure that are capable of energy expenditure that are capable of producing functional disorders consist producing functional disorders consist mainly of covert errors in action, potential mainly of covert errors in action, potential output from the motor and pre-motor areas output from the motor and pre-motor areas of the cortex, and consequences of that of the cortex, and consequences of that output.output.

Whatmore, GB. (1968) Dysponesis: A Neurophysiological Factor in Functional Disorders. Whatmore, GB. (1968) Dysponesis: A Neurophysiological Factor in Functional Disorders. Behavioral Science, Vo. 13, p.102

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Disease and DysponesisDisease and Dysponesis

Dysponesis (inefficient efferent output due to inefficient Dysponesis (inefficient efferent output due to inefficient processing) is capable of producing a variety of processing) is capable of producing a variety of physiological disturbances within the organism. By physiological disturbances within the organism. By affecting nervous system function, it can alter regulation affecting nervous system function, it can alter regulation and thereby alter organ function of any system of the and thereby alter organ function of any system of the body. body.

If one only treats the structural or psychological issues in If one only treats the structural or psychological issues in a patient, results will be disappointing, as dysponesis is a a patient, results will be disappointing, as dysponesis is a neurophysiologic response pattern (CNS program) that neurophysiologic response pattern (CNS program) that will survive structural and behavior therapy. The will survive structural and behavior therapy. The Neurophysiological response must be changed. The Neurophysiological response must be changed. The program must be changed. The connectivity and program must be changed. The connectivity and functional signaling between areas of the CNS must be functional signaling between areas of the CNS must be changed to have a long-term successful outcome.changed to have a long-term successful outcome.

Dysponesis plays a role in the resultant neurophysiologic Dysponesis plays a role in the resultant neurophysiologic sequela.sequela.

Dysfunctional disorders produce neuropathologic Dysfunctional disorders produce neuropathologic signaling errors within the CNS circuitry and vice versa.signaling errors within the CNS circuitry and vice versa.

Whatmore, G.B. & Kohli, D.R.: The Physiopathology and Treatment of Functional Disorders. Grune & Stratton, New York, 1974

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Disease and DysponesisDisease and Dysponesis

Dysponesis embodies the tenets of Dysponesis embodies the tenets of traditional chiropractic philosophy traditional chiropractic philosophy and the technology of the 21st and the technology of the 21st century. Acknowledging the century. Acknowledging the devastating effects of the vertebral devastating effects of the vertebral subluxation upon human health, the subluxation upon human health, the chiropractor now has the clinical and chiropractor now has the clinical and intellectual tools to effectively lead intellectual tools to effectively lead humanity into a healthful and fulfilling humanity into a healthful and fulfilling 21st century. 21st century.

- - Christopher Kent, D.C., FCCIChristopher Kent, D.C., FCCI

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The Importance of Metabolic The Importance of Metabolic Efficiency in Neural ProcessingEfficiency in Neural Processing

Brains are animal’s evolutionary responses Brains are animal’s evolutionary responses to demands that are as basic to life as the to demands that are as basic to life as the requirement for energy and the need to requirement for energy and the need to collect , transmit, process and store collect , transmit, process and store information. Because nervous systems are information. Because nervous systems are specialized for speed, efficiency and wide specialized for speed, efficiency and wide scale integration, some of the molecular and scale integration, some of the molecular and cellar constraints that determine signaling cellar constraints that determine signaling and computation in complex systems will be and computation in complex systems will be obvious, i.e. resources like ATP and signing obvious, i.e. resources like ATP and signing molecules. molecules.

Laughlin,SB. (2001).Efficency and complexity in neural coding. Laughlin,SB. (2001).Efficency and complexity in neural coding. Novartis Foundation Novartis Foundation

Symposium 239. p177-192Symposium 239. p177-192. .

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The Importance of Metabolic The Importance of Metabolic Efficiency in Neural Processing Efficiency in Neural Processing

The Metabolic Cost of Neural The Metabolic Cost of Neural Informational processing and Informational processing and signaling has often been signaling has often been neglected by theorists neglected by theorists attempting to understand the attempting to understand the basic mechanisms of brain basic mechanisms of brain function. function.

Allman, JM (1990). The Origin of the NeoCortex. Seminars in Neurosciences 2. 257-62Allman, JM (1990). The Origin of the NeoCortex. Seminars in Neurosciences 2. 257-62

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The Importance of Metabolic The Importance of Metabolic Efficiency in Neural ProcessingEfficiency in Neural Processing

The central theory of biology is evolution The central theory of biology is evolution through natural selection. Information through natural selection. Information processing , signaling, summation and processing , signaling, summation and integration by the nervous system is integration by the nervous system is extremely metabolically expensive. The extremely metabolically expensive. The human brain is the product of optimization human brain is the product of optimization and efficiency over million of years of and efficiency over million of years of improvements towards adaptations to the improvements towards adaptations to the internal and external environment and internal and external environment and phylogenetic functional prioritizations. phylogenetic functional prioritizations.

The metabolic cost and energy expense The metabolic cost and energy expense of information processing is the most of information processing is the most important constraint in the evolution of important constraint in the evolution of the nervous system. the nervous system.

Gotts, S. (2003). Mechanisms underlying enhanced processing efficiency in Neural systems. Gotts, S. (2003). Mechanisms underlying enhanced processing efficiency in Neural systems. A A dissertation presented to the Department of Psychology-Carnegie Mellon University dissertation presented to the Department of Psychology-Carnegie Mellon University

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The Importance of Metabolic The Importance of Metabolic Efficiency in Neural ProcessingEfficiency in Neural Processing

Energy usage is tightly coupled to neural Energy usage is tightly coupled to neural performance. performance.

The high metabolic rate of the CNS is The high metabolic rate of the CNS is product of neural activity. product of neural activity.

Every signaling event uses energy, and Every signaling event uses energy, and neurons are constantly active and densely neurons are constantly active and densely packed. packed.

Laughlin,SB (2001). Energy as a constraint on the coding and processing of sensory information. Laughlin,SB (2001). Energy as a constraint on the coding and processing of sensory information. Current Current Opinion in Neurobiology 11:475-480. Opinion in Neurobiology 11:475-480.

Metabolic efficiency will only be an important determinant of the evolution and design of signaling systems when metabolic costs impose a significant penalty on the parent organism.

Laughlin, S. The metabolic cost of neural information. Nature Neuroscience. Vol.1 no. 1 May 1998, page 36

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The Importance of Metabolic The Importance of Metabolic Efficiency in Neural ProcessingEfficiency in Neural Processing

The adult brain accounts for 20% of The adult brain accounts for 20% of the adult body’s resting metabolic the adult body’s resting metabolic energy use while it accounts for only energy use while it accounts for only 2% of the total body mass. 80% of 2% of the total body mass. 80% of the mammalian brain’s energy use is the mammalian brain’s energy use is accounted by neural signing and accounted by neural signing and processing. The child spends 50% of processing. The child spends 50% of all metabolic expense on CNS all metabolic expense on CNS processing. processing.

Attwell, D. (2001)An energy budget for signaling in in the grey matter of the brain. Attwell, D. (2001)An energy budget for signaling in in the grey matter of the brain. Journal of Cerebral Blood Flow and MetabolismJournal of Cerebral Blood Flow and Metabolism. 21(10),1133-45. . 21(10),1133-45.

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The Importance of Metabolic The Importance of Metabolic Efficiency in Neural ProcessingEfficiency in Neural Processing

The brain is finite and the moment to moment The brain is finite and the moment to moment energy supply is finite despite the ‘requests’ of the energy supply is finite despite the ‘requests’ of the CNS to process and run numerous programs. CNS to process and run numerous programs. Demand always outweighs supply. Demand always outweighs supply.

Energy Metabolism is central to life because cells Energy Metabolism is central to life because cells cannot exist without an adequate supply of ATP. cannot exist without an adequate supply of ATP. The CNS is particularly sensitive to any disturbance The CNS is particularly sensitive to any disturbance in energy supply. in energy supply.

Erecinska, M. (2004) Energy metabolism in mammalian brain development. Erecinska, M. (2004) Energy metabolism in mammalian brain development.

Energy limitation is a major factor in shaping the Energy limitation is a major factor in shaping the normal operation of the brain’s circuitry. normal operation of the brain’s circuitry. Management of Resources is the Management of Resources is the primary and superseding impact on primary and superseding impact on CNS functionCNS function

Ames, A. (2000). CNS energy metabolism as related to function. Ames, A. (2000). CNS energy metabolism as related to function. Brain Research Reviews 34:42-68Brain Research Reviews 34:42-68

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Thalamic neuron theoryThalamic neuron theoryThalamic neuron theory: theoretical basis Thalamic neuron theory: theoretical basis

for the role played by the central for the role played by the central nervous system (CNS) in the causes nervous system (CNS) in the causes

and cures of all diseases.and cures of all diseases. Lee. TN. Med-Hypotheses. 1994 Nov; 43(5): 285-302 Lee. TN. Med-Hypotheses. 1994 Nov; 43(5): 285-302

The Mid Brain is older and more protected than the Cortex and takes metabolic priority.

The thalamus influences a wide variety of sensory and motor processes in the telencephalon, including gating of sensory information

Melissa J. Coleman. Thalamic Gating of Auditory Responses in Telencephalic Song Control Nuclei. The Journal of Neuroscience, September 12, 2007 • 27(37):10024

The thalamus regulates the quantity and quality of information reaching the cortex and modifies the information before its final destination

R. W. Guillery, S. M. Sherman. The role of the thalamus in the flow of information to the cortex. Phil. Trans. R. Soc. Lond. B 2002 357, 1695-1708

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Thalamic neuron theoryThalamic neuron theory

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The Thalamic Neuron Theory The Thalamic Neuron Theory

The Thalamic Neuron Theory (TNT) The Thalamic Neuron Theory (TNT) postulates that the central nervous system postulates that the central nervous system (CNS) is involved in all disease processes, (CNS) is involved in all disease processes, as the CNS not only processes incoming as the CNS not only processes incoming physical and chemical information from the physical and chemical information from the periphery, it also sends out physiological periphery, it also sends out physiological commands to the periphery in order to commands to the periphery in order to maintain homeostasis for the entire body. maintain homeostasis for the entire body. Inherent in its capacity to learn and adapt Inherent in its capacity to learn and adapt (i.e. to habituate) is the CNS' ability to learn (i.e. to habituate) is the CNS' ability to learn to be sick (pathological habituation) by to be sick (pathological habituation) by looking in certain deranged central neural looking in certain deranged central neural circuitries, leading to chronic disease states circuitries, leading to chronic disease states

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The Thalamic Neuron TheoryThe Thalamic Neuron Theory

Uncontrolled flow of information Uncontrolled flow of information into the cortex (thalamic filtering into the cortex (thalamic filtering and integration dysfunction) and integration dysfunction) leads to mental health disorders leads to mental health disorders and other systemic dis-eases. and other systemic dis-eases.

Kornhuber, J. The Etiopathogenesis of Schizophrenias. Pharmoco-psychiatry 2004;S103-S112.Kornhuber, J. The Etiopathogenesis of Schizophrenias. Pharmoco-psychiatry 2004;S103-S112.

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The Thalamic Neuron TheoryThe Thalamic Neuron Theory

The unique characteristic actions of the The unique characteristic actions of the thalamus allow the thalamus to modify all thalamus allow the thalamus to modify all of the messages passing through the of the messages passing through the thalamus for perceptual processing. It is thalamus for perceptual processing. It is important to recognize that ALL copies of important to recognize that ALL copies of motor instructions pass through the motor instructions pass through the thalamus. These instructions are subject to thalamus. These instructions are subject to rich modulatory influences That come rich modulatory influences That come intrinsically from the thalamus and from intrinsically from the thalamus and from every are of the brain. The output is very every are of the brain. The output is very modified in and out of the midbrain!modified in and out of the midbrain!

Guillery, RW. Branching Thalamic Afferents link Action and Perception. Guillery, RW. Branching Thalamic Afferents link Action and Perception. Journal of Neurophysiology. Vol. Journal of Neurophysiology. Vol.

90. August 2003. p.539.90. August 2003. p.539.

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Neuroplasticity and Pain Neuroplasticity and Pain

We now know that not only modulation but also plastic changes may take place at the level of peripheral receptors, at the spinal cord, or at higher cerebral centers….changes can be of short duration, last days, months, or may potentially be irreversible .

Steen Petersen-Felixa. Neuroplasticity – an important factor in acute and chronic pain. SWISS MED WKLY 2002;132:273–278

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Neuroplasticity Neuroplasticity

Brain plasticity refers to the brain’s ability to undergo functional and structural alterations in response to internal and external environmental changes

A. May. Structural Brain Alterations following 5 Days of Intervention: Dynamic Aspects of Neuroplasticity. Cerebral Cortex January 2007;17:205--210

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NeuroplasticityNeuroplasticity

The main thing to know is that even the adult The main thing to know is that even the adult brain is not "brain is not "hard-wiredhard-wired" with fixed and " with fixed and immutable immutable neuronal circuitsneuronal circuits. Many people have . Many people have been taught to believe that once a brain injury been taught to believe that once a brain injury occurs, there is little to do to repair the damage. occurs, there is little to do to repair the damage. This is simply not the case and there is no fixed This is simply not the case and there is no fixed period of time after which "plasticity" is blocked period of time after which "plasticity" is blocked or lost. We simply do not know all of the or lost. We simply do not know all of the conditions that can enhance neuronal plasticity conditions that can enhance neuronal plasticity in the intact and damaged brain, but new in the intact and damaged brain, but new discoveries are being made all of the time.discoveries are being made all of the time. There There are many instances of cortical and are many instances of cortical and subcorticalsubcortical (thalamic!) rewiring of neuronal circuits in response (thalamic!) rewiring of neuronal circuits in response to training as well as in response to injury. to training as well as in response to injury.

There is solid evidence that There is solid evidence that neurogenesisneurogenesis, the , the formation of new nerve cells, occurs in the adult, formation of new nerve cells, occurs in the adult, mammalian brain--and such changes can persist mammalian brain--and such changes can persist well into old age. well into old age.

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NeuroplasticityNeuroplasticity To review, To review, plasticity is the selective elimination of axons, plasticity is the selective elimination of axons,

dendrites, axon and dendrite branches, and synapses, dendrites, axon and dendrite branches, and synapses, without loss of the parent neurons, which occurs during without loss of the parent neurons, which occurs during normal development of the nervous system, as well as in normal development of the nervous system, as well as in response to injury or disease. response to injury or disease. The widespread The widespread developmental phenomena of exuberant axonal developmental phenomena of exuberant axonal projections and synaptic connections require both small-projections and synaptic connections require both small-scale and large-scale axon pruning to generate precise scale and large-scale axon pruning to generate precise efficient connectivity. This pruning provides a mechanism efficient connectivity. This pruning provides a mechanism for for neural plasticityneural plasticity in the developing and adult nervous in the developing and adult nervous system, as well as a mechanism to evolve differences system, as well as a mechanism to evolve differences between species in a projection system.between species in a projection system.

Such pruning is also required to remove damaged axonal Such pruning is also required to remove damaged axonal connections or those that are perceived by local connections or those that are perceived by local mechanisms as mechanisms as not being efficient for the required circuitnot being efficient for the required circuit, , to stabilize the affected neural circuits, and to initiate their to stabilize the affected neural circuits, and to initiate their maturation or repair. Pruning occurs through retraction, maturation or repair. Pruning occurs through retraction, degeneration or functional degradation.degeneration or functional degradation.

To maintain energy efficiency (whether the program is To maintain energy efficiency (whether the program is physiological or not), the CNS, through neuroplasticity, physiological or not), the CNS, through neuroplasticity, will actually change the cells themselves!will actually change the cells themselves!

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Neuroplasticity: SummaryNeuroplasticity: Summary Cellular mechanisms:Cellular mechanisms:

Changes in synaptic strengthChanges in synaptic strength Structural changes:Structural changes:

SynaptogenesisSynaptogenesis Axon sproutingAxon sprouting

Cortical and SubCortical reorganization:Cortical and SubCortical reorganization: Constant changes based on useConstant changes based on use Remapping after injury: adjacent areas take Remapping after injury: adjacent areas take

overover Rehabilitation helps preserve mapRehabilitation helps preserve map Rehabilitation helps strengthen secondary Rehabilitation helps strengthen secondary

connectionsconnections

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Its Biology (Evolutionary Its Biology (Evolutionary Biology). Not Opinions…Biology). Not Opinions…

Not all neural plasticity is beneficialNot all neural plasticity is beneficial The brain is driven by efficiency, so if a bad The brain is driven by efficiency, so if a bad

(e.g. Pain) program continues to run the (e.g. Pain) program continues to run the brain simply becomes plastic and saves brain simply becomes plastic and saves resources. The Pain program becomes resources. The Pain program becomes efficient. Less input is requires to get the efficient. Less input is requires to get the same output (result) whether its same output (result) whether its physiological or pathological…physiological or pathological…

Chronic Pain, LBP, HA may be a result of Chronic Pain, LBP, HA may be a result of efficiency driven neuroplasticity and not efficiency driven neuroplasticity and not simply Atlas Right…simply Atlas Right…

The brain is only concerned with the now…The brain is only concerned with the now…

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Neuroplasticity RefsNeuroplasticity Refs

Gross CGGross CG.. Nat Rev Neurosci. 2000 Oct;1(1):67-73.Nat Rev Neurosci. 2000 Oct;1(1):67-73. Neurogenesis in the adult Neurogenesis in the adult brain: death of a dogma.brain: death of a dogma.

TurlejskiTurlejski K K . .Prog Brain Res. 2002;136:39-65.Prog Brain Res. 2002;136:39-65. Life-long stability of neurons: a Life-long stability of neurons: a century of research on neurogenesis, neuronal death and neuron quantification century of research on neurogenesis, neuronal death and neuron quantification in adult CNS.in adult CNS.

KempermannKempermann G G.. Ernst Schering Res Found Workshop. 2002;(35):17-28.Ernst Schering Res Found Workshop. 2002;(35):17-28. Neuronal Neuronal stem cells and adult neurogenesis.stem cells and adult neurogenesis.

Helen E. ScharfmanHelen E. Scharfman . .Is More Neurogenesis Always Better?Is More Neurogenesis Always Better? Science. 2007 January 19; 315(5810): 336–338. Science. 2007 January 19; 315(5810): 336–338.

TaupinTaupin P P.. Adult neurogenesis, neuroinflammation and therapeutic potential of Adult neurogenesis, neuroinflammation and therapeutic potential of adult neural stem cells. Int J Med Sci. 2008 Jun 5;5(3):127-32.adult neural stem cells. Int J Med Sci. 2008 Jun 5;5(3):127-32.

TaupinTaupin P P.. Adult neurogenesis pharmacology in neurological diseases and Adult neurogenesis pharmacology in neurological diseases and disorders. Expert Rev Neurother. 2008 Feb;8(2):311-20.disorders. Expert Rev Neurother. 2008 Feb;8(2):311-20.

Taupin P.Taupin P. Neurogenesis in the adult central nervous system. C R Biol. 2006 Neurogenesis in the adult central nervous system. C R Biol. 2006 Jul;329(7):465-75. Epub 2006 May 26.Jul;329(7):465-75. Epub 2006 May 26.

Taupin P.Taupin P. Adult neurogenesis in the mammalian central nervous system: Adult neurogenesis in the mammalian central nervous system: functionality and potential clinical interest. Med Sci Monit. 2005 Jul;11(7):RA247-functionality and potential clinical interest. Med Sci Monit. 2005 Jul;11(7):RA247-252. Epub 2005 Jun 29.252. Epub 2005 Jun 29.

Ma DK,Ma DK, Adult neural stem cells in the mammalian central nervous system. Cell Adult neural stem cells in the mammalian central nervous system. Cell

Res. 2009 Jun;19(6):672-82.Res. 2009 Jun;19(6):672-82.

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PhysiopathologyPhysiopathology

Physiopathology – Physiopathology – clinicians have long been clinicians have long been aware of structural pathology and the ability of aware of structural pathology and the ability of these anatomical or biochemical abnormalities to these anatomical or biochemical abnormalities to produce malfunction. Malfunctions produced in this produce malfunction. Malfunctions produced in this manner are termed pathophysiology by the health manner are termed pathophysiology by the health care community.care community.

Malfunction resulting from processing or signaling Malfunction resulting from processing or signaling errors within the circuitry of nervous system is errors within the circuitry of nervous system is termed termed physiopathologyphysiopathology.. Because of the presence Because of the presence of both inborn and acquired CNS neuronal of both inborn and acquired CNS neuronal interconnections (acquired because of efficiency interconnections (acquired because of efficiency driven neuroplasticity)driven neuroplasticity), , processing and signaling processing and signaling errors can be produced and errors can be produced and maintained maintained

Arnsten AF. Stress signaling pathways that impair prefrontal cortex structure and function. Arnsten AF. Stress signaling pathways that impair prefrontal cortex structure and function. Nat Rev

Neurosci. 2009 Jun;10(6):410-22.

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Physiopathology detected by Physiopathology detected by fMRI fMRI

To our knowledge, this is the first study to use fMRI to differentiate pain processing in patients with PTSD compared with trauma controls. Compared with controls, veterans with PTSD revealed an analgesic response when subjected to heat stimuli. Patients with PTSD showed altered pain processing in brain areas associated with affective and cognitive pain processing, such as the insula, hippocampus, amygdala, and ventrolateral PFC. We propose that the neural pattern with decreased activity in the right amygdala and the bilateral ventrolateral PFC reflects altered pain regulation mechanisms in patients with PTSD.

Gueze, E. Altered Pain Processing in Veterans With Posttraumatic Stress Disorder. Arch Gen Psychiatry. 2007;64:76-85

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What is the Chiropractic What is the Chiropractic Subluxation ComplexSubluxation Complex

The CNS is the most expensive metabolic tissue The CNS is the most expensive metabolic tissue The Evolutionary constraint on the organism is CNS The Evolutionary constraint on the organism is CNS

energy efficiency energy efficiency The CNS attempts to be efficient in its signaling, The CNS attempts to be efficient in its signaling,

connectivity and processing connectivity and processing The CNS chooses the highest priority programs to run first The CNS chooses the highest priority programs to run first

with its finite resources and energy supplywith its finite resources and energy supply Neuroplasticity is activated as programs Neuroplasticity is activated as programs

(connections/signaling) continue to run over time. This (connections/signaling) continue to run over time. This neuroplasticity drives the program to run with lower neuroplasticity drives the program to run with lower resource utilization resource utilization

The brain become “efficient” at a dysfunctional program, The brain become “efficient” at a dysfunctional program, because it has saved resources in the short term.because it has saved resources in the short term.

Pain, Symptoms, Dis-ease and Disability arise if a non-Pain, Symptoms, Dis-ease and Disability arise if a non-physiological program is “reinforced” or if other physiological program is “reinforced” or if other physiological programs are neglected because of lack of physiological programs are neglected because of lack of resources. resources.

The “Interference” in the nerve system was between your The “Interference” in the nerve system was between your ears…ears…

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What is the Chiropractic What is the Chiropractic Subluxation ComplexSubluxation Complex

Subtle rotations in the spine may be physiologic or pathologic Subtle rotations in the spine may be physiologic or pathologic adaptations…Evolutionary pruning would have removed non-adaptations…Evolutionary pruning would have removed non-advantageous traits over millions of years of selection. After advantageous traits over millions of years of selection. After millions of years of adaptation, only traits that don’t have a millions of years of adaptation, only traits that don’t have a negative value are left behind.negative value are left behind.

Pure Symmetry is NOT part of the normal evolution, efficiency Pure Symmetry is NOT part of the normal evolution, efficiency and biological fitness are a part of normal evolutionary and the and biological fitness are a part of normal evolutionary and the natural selection historical evidentiary pool for humansnatural selection historical evidentiary pool for humans

When a human adapts for functional movement that program When a human adapts for functional movement that program must not only take into account vertebral geography, but must not only take into account vertebral geography, but musculature tension, facial tension, anticipated pre & post musculature tension, facial tension, anticipated pre & post motor activity states, available instantaneously resources motor activity states, available instantaneously resources including global and individual musculature constraints, energy including global and individual musculature constraints, energy and metabolic efficiency. Subtle vertebral body rotations may and metabolic efficiency. Subtle vertebral body rotations may be the best instantaneous physiological decision for the be the best instantaneous physiological decision for the human. human.

If we HEDO, thump a high spot, we should ask, “…did that If we HEDO, thump a high spot, we should ask, “…did that body want that high spot because that small local fixation body want that high spot because that small local fixation saved the greatest amount of resources globally and made saved the greatest amount of resources globally and made them as efficient as possible in the short term?...”them as efficient as possible in the short term?...”

Do we work against what the brain is trying to do…Do we work against what the brain is trying to do…

4747

Big Words…Big ConceptsBig Words…Big Concepts Neurophysiological Partitioning: Neurophysiological Partitioning: since the CNS controls and since the CNS controls and

regulates all physiological processes of the human body, regulates all physiological processes of the human body, optimizations must occur at the microscopic cellular level in the optimizations must occur at the microscopic cellular level in the nervous system first.nervous system first.

All these changes can be explained by considering the process All these changes can be explained by considering the process of energy efficiency of neural communication and neural of energy efficiency of neural communication and neural processing. Energy (available ATP) is finite. It is reasonable to processing. Energy (available ATP) is finite. It is reasonable to assume that the limiting factor for this energy efficiency assume that the limiting factor for this energy efficiency optimization process is the use of available ATP. Thus, to optimization process is the use of available ATP. Thus, to optimize neurological programs, the CNS will shunt and optimize neurological programs, the CNS will shunt and mobilize ATP to the areas of greatest physiological need in the mobilize ATP to the areas of greatest physiological need in the CNS. CNS.

Synergistic Neurophysiological Efficiency: Synergistic Neurophysiological Efficiency: Over time, all Over time, all neural processing moves to the most energy efficient state. neural processing moves to the most energy efficient state. Neuroplasticity is driven by long term efficiency of the Neuroplasticity is driven by long term efficiency of the information processing NOT the long term survival needs of the information processing NOT the long term survival needs of the individual. (Survival is ‘weeded’ out by natural selection) individual. (Survival is ‘weeded’ out by natural selection)

Neuronal communication and computation are efficient when Neuronal communication and computation are efficient when considered in the dual (synergistic) context of energy considered in the dual (synergistic) context of energy andand information rather the either context aloneinformation rather the either context alone. .

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Where is the “Subluxation”Where is the “Subluxation”

CNS Integration and Summation CNS Integration and Summation

or Bone Out of Place?or Bone Out of Place?

Epigenetically unfolding our Epigenetically unfolding our potential as a species or Bone potential as a species or Bone Out of Place? Out of Place?

4949

Life is all about choices…Life is all about choices… In all of its functions, In all of its functions, the brain seeks the brain seeks

optimum efficiencyoptimum efficiency, or the path of , or the path of least resistance. If one particular least resistance. If one particular function is not accessible, the brain function is not accessible, the brain will automatically go on to the next will automatically go on to the next most efficient process for doing that most efficient process for doing that particular task. If the second task is particular task. If the second task is not available, it will go on to the third not available, it will go on to the third or the fourth most efficient way. or the fourth most efficient way. Because each alternative process is Because each alternative process is less efficient, it becomes more less efficient, it becomes more stressful and energy expensive.stressful and energy expensive.

5050

The TruthThe Truth

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The TruthThe Truth EpigeneticsEpigenetics: Epigenetics is defined as the study of Changes in : Epigenetics is defined as the study of Changes in

gene expression which occur in organisms with differentiated gene expression which occur in organisms with differentiated cells, Epigenetic factors that can influence the behavior of genes cells, Epigenetic factors that can influence the behavior of genes include:include:

1. Chromatin structure – how DNA is packed1. Chromatin structure – how DNA is packed2. DNA methylation – turning genes off2. DNA methylation – turning genes off3. Small RNAs – made from DNA and can influence gene 3. Small RNAs – made from DNA and can influence gene behavior in many waysbehavior in many ways

Once triggered, a group of molecules called a methyl group Once triggered, a group of molecules called a methyl group attaches itself to the control centre of a gene, permanently attaches itself to the control centre of a gene, permanently switching on or off the manufacture of proteins that are switching on or off the manufacture of proteins that are essential to the workings of every cell in our body. In most essential to the workings of every cell in our body. In most tumors, this DNA methylation pattern has been knocked awry, tumors, this DNA methylation pattern has been knocked awry, leading to a gene being completely deactivated or triggered to leading to a gene being completely deactivated or triggered to abnormally high activity.abnormally high activity.

Our genetic code, the actual sequential structure of our DNA, Our genetic code, the actual sequential structure of our DNA, can pretty much shrug off the influence of any external can pretty much shrug off the influence of any external environmental factors, short of massive radiation. environmental factors, short of massive radiation.

However, the expression of individual genes within that However, the expression of individual genes within that sequence can be permanently altered by such seemingly sequence can be permanently altered by such seemingly innocuous influences as diet, exercise, sensory input, innocuous influences as diet, exercise, sensory input, lifestyle or how others treat us (socialization)lifestyle or how others treat us (socialization)..

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The TruthThe Truth Now, scientific evidence is emerging that these Now, scientific evidence is emerging that these

externally driven changes in the behavior of our genes externally driven changes in the behavior of our genes might be passed down through the generations. For might be passed down through the generations. For example, recent research has demonstrated that the example, recent research has demonstrated that the sons of men who began smoking before puberty were sons of men who began smoking before puberty were more prone to obesity. more prone to obesity.

All of a sudden, we're staring personal All of a sudden, we're staring personal responsibility in the faceresponsibility in the face. Not only can our bad . Not only can our bad habits or noble attempts at clean living habits or noble attempts at clean living permanentlypermanently change the way our genes act within us, they could change the way our genes act within us, they could very well have a significant impact on the very well have a significant impact on the quality of quality of our children's livesour children's lives. . If DNA is the hardware of If DNA is the hardware of inheritance, the epigenetic operating system is the inheritance, the epigenetic operating system is the software, controlling the 30,000 genes that carry software, controlling the 30,000 genes that carry instructions for the proteins that make up our bodies instructions for the proteins that make up our bodies and keep them running.and keep them running.

If left alone, the epigenetic changes that bad or good If left alone, the epigenetic changes that bad or good behaviors (sensory input) causes in research animals behaviors (sensory input) causes in research animals not only lasted a lifetime but wasnot only lasted a lifetime but was inherited inherited..

5353

The TruthThe Truth

The traditional idea that we are the passive The traditional idea that we are the passive carriers of our genes is being challenged by carriers of our genes is being challenged by the notion that we are their custodians. the notion that we are their custodians. Our Our lifestyles, What we believe…OUR lifestyles, What we believe…OUR PARADIGMS— what we eat, what drugs PARADIGMS— what we eat, what drugs we ingest, how we utilize chiropractic we ingest, how we utilize chiropractic care, how much we exercise, whether care, how much we exercise, whether we smoke — plays a role in a chemical we smoke — plays a role in a chemical switching system that activates or switching system that activates or deactivates our genes. There are signs deactivates our genes. There are signs that our behavior may program sections that our behavior may program sections of our children's DNA, and that how we of our children's DNA, and that how we live may even affect our live may even affect our grandchildren's grandchildren's genesgenes..

5454

What is Chiropractic for?What is Chiropractic for? • To increase ROM?To increase ROM?

• To remove a disc wedge?To remove a disc wedge?

• To remove pain?To remove pain?

• Rehabilitate? Palliative? Supportive? Rehabilitate? Palliative? Supportive?

• To Treat or Adjust?To Treat or Adjust?

• Or to Epigenetically advance Or to Epigenetically advance humans so we can fulfill our humans so we can fulfill our absolute destiny as a species…to absolute destiny as a species…to efficiently push our natural selection efficiently push our natural selection and evolution as a person, and evolution as a person, community, society, nation, worldcommunity, society, nation, world

5555

THE GREATEST ADDICTION IS NOT THE GREATEST ADDICTION IS NOT DRUGS OR ALCOHOL, BUT THE DRUGS OR ALCOHOL, BUT THE

ADDICTION TO OTHER PEOPLE’S ADDICTION TO OTHER PEOPLE’S LIMITED OPINIONS ABOUT YOU AND LIMITED OPINIONS ABOUT YOU AND

YOUR LIFEYOUR LIFE

56

YOU CAN’T CHANGE WHAT IS GOING ON AROUND YOU,

UNTIL YOU CHANGE WHAT IS GOING ON WITHIN YOU.

WHEN YOU START CHANGING HOW YOU THINK, ACT, AND TREAT OTHERS,

LIFE WILL START RESPONDING TO YOU