Mechanical Links to Symptomatic Challenges Associated with CCSVI in Multiple Sclerosis
This title is certainly a mouthful...however, it is appropriate when you consider the complex nature of the topic. This note serves as a follow-up to my previous note (Links to MS and CP) and takes a deeper look into the biomechanical and architectural links to some of the symptomatic difficulties that are sometimes reported in CCSVI. Although the symptoms are quite large and diverse, I will refer to only a few in an effort to maintain clarity and to present these formulations in digestible / absorbable "chunks".
I refer back to my previous note and mention the realities of the characteristic Cervical-Cranial instability. It is this instability that has potential contribution to jaw clenching and other dental dysfunction...however it also has other potentially profound impact on a great many other symptomatic manifestations. In order to effectively convey this hypothesis, I will select 2 very specific symptoms:
1) Reduction of visual acuity
2) Swallowing difficulties
Again, although the symptoms are numerous, these particular manifestations relate most directly to Cervical-Cranial instability...and therefore are the easiest to be linked with an acceptable level of understanding and integration.
Reduction of Visual Acuity
This symptom is perhaps the most elusive when you consider potential mechanical links. For the most part, the reduction of visual acuity is attributed directly to the reduced venous competence (which is quite possible and valid). However, the direct mechanical links are over-looked and also under-appreciated.
The above image is an illustration of the deeper muscles of the posterior neck and the relationship between the cranium and the neck itself. Underneath these muscles lies the Atlas (C1) which articulates with the skull (Occipital bone) and is the source of the profound instability previously mentioned. These muscles, sometimes refered to as "the Sub-occipital Star", are a conglomerate of muscles responsible for fine movement and adjustment of the head in response to positional change. The "pure mechanical" function is easily understood...however, these muscles are intimately linked to autonomic function as well. In other words, they respond to more primitive brain function without our conscious knowledge. For example, perform this simple self-test: 1) place the thumb and index finger of one hand on either side of you neck directly over the sub-occipital star. 2) Close your eyes. 3) Apply gentle pressure with the thumb and index finger and move your eyes left and right with the eyes still closed and while maintaining pressure. If performed correctly, you will feel these muscles react to the movement of the eyes! As you move the eyes in one direction, you will feel the muscles activate under the thumb, then activate under the index finger as you move the eyes in the other direction. This indicates that the stability of the cervical-cranial junction has profound implications on positional understanding and proprioception. In addition, balance and equilibrium are dependant on the ability to maintain an effective "horizon" with the ground. To be precise, the stability of this joint and the proper functioning of the sub-occipital star are necessary to transmit the proper "positional information" to the brain in order for appropriate biomechanical adjustment to be engaged. Therefore, reduced visual acuity can be mechanically attributed to the conflicting sensory information as a result of the profound instability of the cervical-cranial junction and the inability to adequately establish a working "horizon".
Although somewhat more "intuitive" than the reduction of visual acuity, swallowing difficulties can present challenges when searching for "how and why". Again, I refer to the very legitimate potential mechanical links as a valid source of focus and attention.
The above image illustrates the rather complex muscular arrangement of the tongue. Not only is it a very powerful muscle in itself, it has intimate links to sternum and (believe it or not) shoulder blade via the Hyoid bone. This is a rather powerful demonstration of the comprehensive connectivity that exists within the human organism. If you look closely at the illustration, you will notice that there are significant muscle bellies that extend from the mouth itself and attach to the Styloid Process of the Temporal Bone (near the ear on the underside of the Temporal bone). Given the pure "contract / relax" nature of skeletal muscle, the stability of both origin (where it starts from) and insertion (where it attaches) are fundamentally critical to proper function.
The Temporal Bone is in direct contact with the Occipital bone therefore positional instability of the occipital bone has a direct impact on the temporal bone. More importantly, any instability that exists within the cervical-cranial connection will manifest itself in some large or small way in the functioning of the tongue. When you compound this particular challenge with chronic clenching, the resultant swallowing dysfunction becomes less of a mystery.
This is to be considered an "hypothesis" of sorts...however, the architectural links are quite well established and are quite easily reproduced in every case. Further, my experience in the field of Cerebral Palsy clearly shows the significant implications of mechanical instability in this area...and more importantly, demonstrates that a focused strategy to improve this instability has a profound "cascade" effect resulting in measurable improvements in the symptomatic manifestations.
As always, I welcome all comments and feedback...as well as intelligent debate on this subject. I will be presenting some preliminary practical interventions to address this specific challenge and hopefully be able to provide productive tools that will facilitate improvement. Cheers!
The SuperSystem: Perspectives in Rehabilitation
In my continuing examination of the "Pain and Stress" article, I am consistently finding quite a few insightful statements and refreshing confirmations of what I consider the most fundamental consideration in the domain of physical rehabilitation: the human organism is not a collection of seperate systems, rather it is one singular organism with a singular origin that has differentiated parts. As always, these statements are intuitive...but fail to reach the level of common sense when the issue of rehabilitation protocols enters into the equation. If this statement is true, then it should reflect in the implementation of treatment protocols. If these protocols do not serve this over-riding understanding, then they are inadequate and do not serve the fundamental goal of rehabilitation...rather, they simply cleave and trim select elements and address more "symptomatic" manifestations. It is this reality that dictates a more global approach to rehabilitation...hence, the consideration of the human organism as a SuperSystem.
The article eloquently describes the human organism in its true form:
A human being is an open, living, adaptive system that pursues the dual objectives of adaptation to the environment and survival. The term system denotes a set of components constituting a whole within which each component interacts with or is related to at least one other component, and all components serve a common objective. Every system contains nested subsystems that function as component parts. Nervous, endocrine and immune systems are among the subsystems that comprise the body. These subsystems function interdependently.It is important to remember that, although specific sub-systems are mentioned, they all express the same functional appearance: INTERDEPENDANCE. This means that they have a reciprocal relationship. Therefore, formulation of a strategic rehabilitation protocol must respect the SuperSystem philosophy from inception. Whether it is manifest in the strategic periodization of implementation (WHEN certain interventions are put into place), or if it appears within a singular intervention...irritability, connectivity, and plasticity of all sub-systems need to be considered. Further, intensive and focused attention to one particular sub-system has some reciprocal effect on the others...therefore when acute situations and environments demand specific intervention, it's effect from a global perspective must be considered when formulating the post-acute phase.
All adaptive systems have three essential features. The first is irritability: the system is dynamic and responds to perturbations such as tissue injury by moving away from equilibrium to meet the challenge and returning toward equilibrium afterwards. Second, connections and interactions exist among the components of a system; this is its connectivity. Through connectivity patterns form and self-regulating feedback occurs. Consequently, the connectivity of a system is more important than the system components themselves. Third, adaptive systems have plasticity. They change selectively in response to alterations in the environment, and change is often nonlinear. System theorists describe nonlinear transitions as state or phase shifts. For example, the development of allodynia around a focus of injury is a central state shift in sensory processing. A key aspect of system nonlinearity is that small perturbations can produce large system changes while large perturbations often do not. Other features of adaptive systems include emergence, self-organization, and self-regulation.