Introduction
Autism
spectrum disorder (ASD) is characterized by persistent deficits in
social communication and social interaction across multiple contexts
and restricted, repetitive patterns of behavior, interests, or
activities.1
The causes of ASD are
currently unknown.1
Current research suggests that ASD is genetic as is observed with
twins, in 9 out of 10 sets of twins if one is observed to be ASD the
other is as well. Currently diagnosis is based on clinical
observations using a set of criteria established in the Diagnostic
and Statistical Manual of Mental Disorders, 5th
edition.2There is very limited research on adults with ASD as it is a condition that is recommended to be diagnosed and treated early in life. The NIH has information on how care for adults with ASD and it is only recommended that they live on their own if they have gone through proper adaptive rehabilitation in order to deal with their own finances and interface with persons of law enforcement.1 Previous case studies have shown improvement in the behavior and associated symptoms of children with ASD through reduction of vertebral subluxations, however no information was found on chiropractic in adults with ASD.3-6
Case
Report
History
The
patient was a thirty-one year old female who had originally sought
chiropractic care for headaches 3 years prior to receiving care in
this office. Before chiropractic care she would experience
cervicogenic headaches on a daily basis. She said she knows it is
time to be checked by the chiropractor when she gets a headache
which, at the time of starting in this office had been reduced to
less than once a month with an HDI of 26%.
When
she was in the second grade she was brought to a neurologist who
determined through brain scans that she had Asperger's which has
since been redefined as Autistic Spectrum Disorder. Several different
medications were given during high school and they were not good
because they made her feel several emotions at the same time. She
described her condition as a brain fog that prevents her from having
the ability to concentrate. Phone consultation with previous
chiropractor confirmed that patient would experience a noticeable
difference in personality from pre to post adjustment.
Chiropractic
Examination
An
initial examination included cervical x-rays, thermographic scanning,
prone leg check, supine leg check, static palpation and muscle
palpation in order to specifically locate and analyze this patient's
subluxation pattern. Upper Cervical X-Rays included: lateral
cervical, nasium and vertex views.
A
thermal scan was obtained from the posterior cervical region of the
patient with a Tytron C-3000. The Tytron contains infrared probes
that glide paraspinally from the 1 st thoracic vertebra to the base
of the occiput. The autonomic nervous system controls cutaneous body
temperature via the arteriole system and is activated by centers
located in the spinal cord, brain stem, and hypothalamus.7
The infrared technology of the Tytron detects skin temperature
superficially to measure the integrity of the nervous system.
Uematsu8
states that these heat differentials can be used to determine if
dysfunction of the autonomic nervous system is present. A study has
shown that aberrant thermal temperature can decrease one’s physical
health perception, as seen on an SF-12.9
In this case a pattern analysis was established in order to determine
when the patient was showing a stress reading of similar qualities
indicating that there was compromise to the integrity of the nervous
system thus indicating upper cervical subluxation.
Based
on Grostic’s Dentate Ligament – Cord Distortion theory, a
misalignment of the upper cervical vertebrae via the dentate ligament
results in spinal cord tension and irritation, thus affecting the
muscles of the pelvic girdle and lower extremities, prompting
contracture of the muscles and causing the appearance of a short
leg.10
The measurement of supine leg length differentials is considered to
be of high inter- and intraexaminer reliability.11
Chiropractic
Intervention
The x-ray views previously
mentioned were analyzed using the Grostic protocal in order to obtain
a specific misalignment for this patient's upper cervical subluxation
complex. L(R1
A3)I1.5/M
was the listing obtained from the films. L indicates that the
headpiece should be set 1 inch lowered from neutral. This headpiece
placement in combination with an inferior torque component in the
adjustment were used in order to correct the lower cervical angle of
1.5. Information inside the brackets indicates that the adjustment is
to be given using a specific line of drive vector where the
chiroprator's pisiform contacts the atlas transverse process and
directs their episternal notch to 1 inch above and 3 inches anterior
to their contact point. The M gives an indication that the upper
angle (head tilt) and lower angle (lower cervicals) are ipsilateral
and there is no need to angle the headpiece to accommodate for a kink
of angles.
On
the first visit thermographic pattern was established having 3 scans,
taken 15-20 minutes apart, with similar deviation patterns. Prone leg
check revealed the right leg to be 1/2” short, supine leg check
revealed the
right leg to be 1/4” short, static and muscle palpatory findings
revealed a scoliosis of unmeasured degree in the mid thoracic region
and subluxations of sacrum apex posterior as well as atlas with right
laterality and anteriority.
Patient
presented on the first visit with a headache and cognitive
“fogginess”. having made a move from Georgia to South Carolina
over the past month she had been very stressed and had not seen a
chiropractor for 2 months. She had been under chiropractic care for 3
years prior to her first visit and reported having improved cognitive
function under care. Phone consultation with previous chiropractor
confirmed that when the patient was in a subluxated state she would
be noticeably distant, less responsive and report that she was having
“brain fog”, post adjustment there was noticeable alertness.
As
this patient came to the office having already established a pattern
and plan of care with a previous practitioner the new plan of care
based on history and current findings started with once every 2
weeks. Over the course of 10 months the patient was seen 20 times.
The same analysis protocol was applied on each visit as was described
for the first visit. She received a specific C1 adjustment using the
Grostic protocol on visits when her thermographic pattern was present
and supine leg check revealed the right leg to be 1/4” or greater
short. C1 was adjusted on a total of 10 visits. Due to the patient's
scoliosis and the limitations of matter, Thompson protocol was used
when the prone leg check indicated that sacrum ought to be addressed.
Sacrum was found to be apex posterior and adjusted on 12 visits.
Outcomes
Patient
reported fogginess on the majority of visits where she was found to
have a C1 subluxation. On these visits the practitioner also noted
patient had difficulty focusingon
one topic and reduced reaction time to instructions even though the
same procedural steps were used on every visit. After adjustment to
the C1 vertebra the patient had noticeable change in alertness and
subjectively reported improved cognitive function. The patient only
reported having a headache on the first visit. Her HDI did not reduce
significantly as it started at 26% and reduced to 22% however, it is
believed that her headaches did not return because she was consistent
with her plan of care.
Discussion
In
their review, Schroeder et al.12 examined three possible
models based on the core characteristics of ASD, which revealed a
link to joint complex dysfunctions altering circuitry, thus
aberrantly affecting the structure and function of the cerebellum and
the frontal lobe.6 Hoffmann and Russell describe the
impact that a subluxation has on the cerebrum and cerebellum by
suggesting that as a result of “altered biomechanics of thespine,
a subluxation can lead to an imbalance in sensory input into both the
cerebrum and the cerebellum.”6 They further stated that
“this sensory dysafferentation then leads to alteration in the
central state of the neuronal cells involved with initiating the
response to the environmental stimuli.”6
Conclusion
This
case study explores the possible link between the objective reduction
of a vertebral subluxation and the subjective improvement in the
behavioral patterns and cognitive function of an adult diagnosed with
Autistic Spectrum Disorder. There has been similar cases reported in
children, however
there continues to be a limited amount of evidence supporting the
efficacy of chiropractic care for either children or adults with ASD.
Further research is warranted in both.
1)
National Institute of Mental Health. Autism Spectrum Disorders.
http://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml
2)
American Psychiatric Association (APA). Diagnostic and statistical
Manual of Mental Disorders, 5th edn. American Psychiatric
Association, Washington, DC, 2013.
3) Cohn A. Improvement in Autism Spectrum Disorder Following Vertebral Subluxation Reduction: A Case Study. J. Pediatric, Maternal & Family Health, 2011; 87-91 4) Cleave J, Alcantara J, Holt K. Improvement in Autistic Behaviors Following Chiropractic Care: A Case Series. Pediatric, Maternal & Family Health, 2011; 125-131 5) Noriega A, Chung J, Brown J. Improvement in a 6 year-old Child with Autistic Spectrum Disorder and Nocturnal Enuresis under Upper Cervical Chiropractic Care. J. Upper Cervical Chiropractic Research, 2012; 1-8 6) Hoffmann N, Russell D. Improvement in a 3 ½ -year-old autistic child following chiropractic intervention to reduce a vertebral subluxation. J Vert Sublux Res. 2008 Mar 24:1-4. 7) Guyton AC, Hall JE. Textbook of Medical Physiology. 10 th ed. Pennsylvania: W.B. Saunders Company; 2000. 8) Uematsu S, Edwin DH, Jankel WR, et. al. Quantification of Thermal Asymmetry, Part 1: Normal Values and Reproducibility. J Neurosurg, 1988;69(4):552-555. 9) Hart J, Omolo B, Boone WR. Thermal patterns and health perceptions. J Can Chiropr Assoc. 2007;51(2):106-111. 10) Grostic JD. Dentate Ligament –Cord Distortion Hypothesis. Chiropr Res J. 1988; 1(1):47-55. 11) Hinson R, Brown S. Supine leg length differential estimation: an inter- and intra-examiner reliability study. Chiropr Res J, 1998; 6(1):17-22. 12) Schroeder JH, Derocher M, Bebko JM, Cappadocia MC. The neurobiology of autism: theoretical applications. Research in Autism Spectrum Disorders 4. (2010) 555-564.
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