Sunday, August 12, 2012

Implications of Cervical-Cranial Instability in MS: Links to Cerebral Palsy


I have recently been enlightened as to the many challenges associated with Multiple Sclerosis (MS) as well as to the very complex and diverse manifestations.  Although my professional experience and expertise is more deeply rooted in Cerebral Palsy (CP) and general movement dysfunction, my recent investigations and research over the last few months has resulted in some rather interesting links between CP and MS.  These links are note intuitive and have required some analysis to arrive to, however I feel that they are valid concepts to investigate and examine further.
These links are very specific in nature and center around Chronic Cerebrospinal Venous Insufficiency (CCSVI) as well as the presence of cervical-cranial instability (Atlas instability).  My investigation is on-going and therefore relatively "young", however my understadning of this phenomenon is that this Atlas instability (misalignment) transmits compressive forces to the brainstem which in turn may produce venous occlusion resulting in chord ischemia.  This particular manifestation (cervical-cranial instability / misalignment) is quite common and characteristic in individuals with CP.  They manifest profound connective tissue (fascial) weakness that is global in nature...therefore this weakness in the neck is manifest by significant cranial-cervical connections which are typically characterized by complete loss of head control. In addition to this, CP is also characterized by developmental dysfunction...more specifically disrupted establishment of proper bony alignment of the cranium.  This results in sutural deformities and altered bony alignment.  The skeletal distortions contribute to a profound muscular imbalance which further exacerbates the manifestations of the cervical-cranial weakness.

The most interesting finding in my work in CP is that while the structural defficiency remains in place, motor intelligence is still quite actively engaged.  Therefore, there are a number of "intrinsic compensations" that take place.  To use a term from CP expert, Leonid Blyum:  "The instability at this level can be considered as an intrinsic de-capitation".   One of these compansations is the active engagement of the mouth...more specifically the opening of the mouth.  It is very common to observe CP children with their mouth consistently open.  While there are mal-occlusion issues also involved, the most interesting phenomenon occurs when they actively want to stabilize their head or engage in some dynamic performance: They open their mouth very wide and keep it open.  This can be considered as a mechanical "bypass" through which head stability is achieved.  By contracting certain muscles in the jaw, they can artificially stabilize the head and therefore be able to achieve a "quasi-stable" head position which then allows them to improve tracking and proprioceptive performance. This stability is derived from the activation of muscles on the anterior surface of the face /neck to mechanically lock the posterior neck.  In CP, this compensation is also demonstrated by intermitent tongue-thrusting.  This phenomenon draws very interesting links to MS and the focus on dental dysfunction.  My investigation has also revealed that clenching of the jaw is a common occurence that contributes to constant headache and potentially sleep disturbances.  These are physiological stressors that contribute to further exacerbation of the symptomatic challenges in MS.  Although in MS the jaws are clenched and in CP the jaw is held open, it indicates a very tangible link between the cranial-cervical instability and performance of the jaw.  The specific interventions to improve the stability of the cervical-cranial connection in CP has yielded very tangible and measurable reduction in the compensatory actions of the jaw.

In summary, I am aware that my formulations are quite "raw" and my understanding still needs to be populated by more investigation and discussion with experts in the field...however, there is significant precedent to suggest that a focused approach to the cervical cranial instability (without the use of aggressive / invasive procedures) can have very profound positive contribution to improving venous flow, reduction of prevalence of dental dysfunction and associated challenges, and ultimately contribute to a more stable and manageable condition.  I would like to thank my good friend, Jamie Chalmers for introducing me to the MS world with such drive and passion...and I encourage any and all comments and feedback that will help to contribute to the formulation of non-invasive interventions that can be immediately available for the MS community.  I will be continuing my raw investigations and hopefully will be able to share some productive information / demonstration in the very near future!  Best regards, Gavin.

5 comments:

  1. Hi Gavin, this has nothing to do with cranial vaults or such, but I did want to know that I was able to use precut kinesio-tape on my wife's planatar fascitis when she does ABR...it's been a life saver. Will experiment with the pre-cut for Adam's wrists as I am interested in seeing if it effects his contractures of the wrists. I'd be happy with a bit of release...it's my inventor side. Thanks for alerting us to taping...the pre-cut is a god-sent!

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    1. Phil! Great to hear! Indeed, it has some very good effects on plantar fasciitis...good pro-activeness! I have actually had a chance to experiment myself with the tape and contractures. It is very effective with respect to weakness, but contractures are more of a challenge. The way I have formulated is the following: rather than the tape resisting (or working against) the contracture itself, if it is applied with 10-25% stretch (light) it definitely increases proprioceptive feedback. To be more precise, if a join has been contracted for a long period of time (as with Adam's wrists), the representation of the joint in the brain reduces (shrinks)...meaning it is essentially perceived as being "one long forearm" as opposed to being a forearm, joint, and wrist. The tape will stimulate some proprioceptive feedback to the brain and (as it is theorized) potentially help to slow/reverse this shrinking "motor map". I have applied it to contracted wrists recently and am waiting for some feedback. Let me know how your experiment works out...and how it is progressing. Of course, if there is anything I can help you with...just let me know! All the best to you and the family!

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  2. Hi Gavin,(I'm only 'anonymous' because I'm new to commenting and dont know the info for any of the other choices,sorry). I have a genetic connective tissue disorder called Ehlers-Danlos Syndrome (EDS)and arrived here through googling about cervical instability. Both this and CCSVI are currently being researched in the EDS field and people are getting excited about 'The Driscoll Theory' and 'benign' drug treatments that are relieving symptoms. You might already know about that but I thought I'd say just in case its one of those things where information isnt crossing over between patient groups. And MS/pseudo-MS are in EDS literature as both differential and comorbid diagnoses so you might want to look into whether the links between CP and MS extend to EDS as well. I have symptoms of cranial instability and need to engage my jaw and tongue a lot,interesting that could be compensation as my body does a lot of that to get around weaknesses Thanks for this post.

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    1. This is absolutely fabulous information! It opens a whole new perspective on this discussion and, more importantly, reflects the significance of addressing this fundamental area. Your comments are very appreciated and it has stimulated some new thoughts and formulations. I will certainly be expanding into EDS and making more direct links to it in the coming days. You will definitely see something on it very soon. Thanks again for broadening my understanding! I hope you will visit the One Giant Leap facebook page and read the follow up post (Mechanical links to Symptomatic Challenges...). It revolves around MS, but as you have intelligently pointed out, there are direct links to EDS there. Many thanks and keep in touch!

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  3. I am in research of transitional living programs. I guess I could expand my information throught hid post. Thank you.

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