Functional Neurology (or Chiropractic Neurology)
Functional Neurology may help to address cognitive and physical deficits that occur after a concussion. Instead of treating a patient’s symptoms separately, functional neurologists return to the origin of those symptoms: damage to specific areas in the brain. Patients will receive a personalized regimen of mental and physical tasks, plus additional types of treatment, to help retrain the areas of their brain that are injured.
What is functional neurology?
Functional neurology is a relatively new treatment with increasing numbers of practitioners and clinics. Several high-profile NHL and NFL athletes have been treated at functional neurology clinics.
Most of the functional neurology practitioners are chiropractors with additional functional neurology training and certification, and so the term chiropractic neurology is sometimes used. Functional neurology is not primarily about chiropractic adjustment, however, and chiropractic adjustment may or may not be part of a patient’s treatment plan.
What is the evidence behind functional neurology?
There is a significant amount of anecdotal patient evidence. Concussion Alliance has chosen to write about functional neurology after hearing numerous stories of substantial improvements with functional neurology from healthcare professionals who have referred their patients for this treatment, as well as patients who have been treated at functional neurology centers.
The research backing up this treatment modality, however, is scant. A critical review of clinical research articles through 2017 concluded: “Due to design and methodological issues, no acceptable scientific evidence was found in relation to effect or benefit of various functional neurology interventions.” A 2017 scoping review concludes “there is a need for more scientific documentation on the validity of functional neurology,” although it notes “nevertheless, the potential ability to change the quality of life for people suffering from poorly understood and/or chronic disorders makes this concept attractive for both clinicians and patients.”
There is some evidence from research associated with the Carrick Institute, although the authors of the studies acknowledge that they are not controlled/randomized studies. Also, Carrick has a vested stake in the success of his treatment so doing a retrospective study of his own work on people who come to him believing or hoping for a cure means the potential for placebo effect and bias, intentional or unintentional, is relatively large.
What effect the bias has is up to interpretation.
Functional neurology, neuroplasticity, and rehabilitation
The concepts behind applying neuroplasticity retraining for the body and brain after a concussion are well supported.
Neuroplasticity is a well researched, scientifically supported idea.
Many institutions, such as the Center for Disease Control, and research studies have recently published articles in support of the concept that the best treatment for concussions involves mental and physical rehabilitation instead of isolation and rest.
Concussion Alliance is inclined to believe that functional neurology methods are effective because vestibular therapy has been shown to be effective, but ideally, there would be clinical research to validate this treatment modality.
What symptoms can functional neurology address, and how does it work?
Functional neurology has been reported, anecdotally and with limited research, to improve balance, mood, “fogginess,” and many sensory/motor deficits. Functional neurology has the potential to help concussions symptoms long after the initial injury, and to help with more severe cases, such as repeated concussions and persistent post-concussion symptoms.
The central concept behind functional neurology is neuroplasticity. Neuroplasticity is the idea that your brain can form/strengthen connections between neurons in your brain which can improve how well you can complete mental/physical/sensory tasks. Neuroplasticity has formed the basis for new treatments for stroke, phantom limbs, and addiction.
Functional neurology in the news: articles about NHL player and 2x Stanley Cup winner Daniel Carcillo, Concussion Advocate Amy Zellmer, and NHL superstar Sidney Crosby.
How to find a functional neurologist
Find a specialist certified in functional neurology by using the doctor search tool below, provided by the American Chiropractic Neurology Board.
Concussion Alliance has been keeping a list of functional neurology clinics recommended by patients and healthcare practitioners that we know. Also, Dr. Ash, Concussion Alliance Advisory Board Member, is familiar with peers in his field, and he has contributed to this list. You can find this list on our blog post Finding a Functional Neurologist.
Diagnosis and treatment: what to expect
A visit to a functional neurologist would include a full history, a comprehensive musculoskeletal and neurological examination, specific tests (tests of vision, balance, etc.), and an individually tailored treatment plan to reconnect or strengthen weak or damaged areas of the brain.
Often functional neurology clinics use more advanced diagnostic tools compared to those commonly found in concussion clinics. For example, in addition to a neurological assessment, Dr. Ashkan Jalili may use these diagnostic tools:
Computerized Neuro-cognitive Baseline Test (ImPACT Test)
C3Logix Concussion Management System
Micromedical Binocular Video Goggles
EQ Brain Tracking Technology
Brain Science Testing
RightEye assessment tool.
The Brain Plasticity Centers has photos and explanations about each of their diagnostic and therapeutic technologies.
Additional diagnostic tests may also include images studies, nerve conductions tests, neurotransmitter tests, blood glucose tests, or hormone tests.
Treatments that require patients active participation: mental/physical tasks, and cardio/aerobic therapy
Each patient is given an individualized treatment plan with specific mental and physical tasks, often involving high-tech equipment, which they do with the assistance of the doctor or staff therapists. Many of these tasks involve balance and eye tracking to develop integration somatic, vestibular, and ocular systems.
For example, some of the tasks address dizziness and strengthen the vestibular system which deals with the body’s spatial relations and balance. Several of the elements of functional neurology overlap with Vision and Vestibular Therapy.
In addition, a patient’s treatment plan may include guided cardio/aerobic therapy.
Treatments applied by the practitioner
Based on the individualized treatment plan and what a particular clinic has to offer, the patient may be given:
Transcranial Direct Current Stimulation, or Transcranial Magnetic Stimulation (rTMS)
Cold Laser or Low-intensity Laser Therapy
Vagus and trigeminal nerve stimulation
Tongue Nerve Stimulation Device (approved by Health Canada for traumatic brain injuries)
Photobiomodulation with various LED light therapy devices, including the Vielight devices
Tone Pacer Sound of different vibrations (for the vestibular system)
Hyperbaric Oxygen Therapy (HBOT)
Touch and specific adjustment to joints
Some functional neurology clinics also address metabolic deficiencies in the brain that show up in blood glucose, neurotransmitter, or hormone tests. This aspect of a concussion may be treated by specialists within the functional neurology clinic, or patients may be referred to a naturopathic doctor or a functional medicine doctor that the clinic collaborates with.
These deficiencies may be addressed with dietary changes, or with vitamins and minerals, sometimes given intravenously. Some functional neurology doctors find that a significant number of their patients have these imbalances and that they respond to treatment.
Functional Neurologists differentiate between functional imbalances and more serious hormonal deficits, for which they refer patients to endocrinologists. See our page on Hormone Therapy.
Frequency of treatments and costs: what to expect
Functional neurology clinics can range from a single talented practitioner within an affordable fee schedule to large, expensive clinics which have a big staff and the most expensive state of the art technology.
Three of the largest clinics have the GyroStim Vestibular/Rotational Therapy, while other clinics have chosen to forgo the GyroStim to keep their fees more affordable. Some clinics offer neuro-metabolic testing and treatment, and others do not.
Regarding timing, a patient may see their local functional practitioner on a weekly basis for several months, or travel to a clinic for one or two-week intensives, usually with three treatment sessions per day.
Some or all of the fees may not be covered by insurance, and practitioners may provide patients with an invoice that can be submitted to insurance for reimbursement. There are also some clinics which will defer costs while a patient pursues their legal case for injuries due to a motor vehicle accident, for example, ImagineX.
Depending on the clinic, patients may be quoted a flat fee for an “intensive" treatment, whereas other clinics invoice separately for specific component treatments, particularly the neuro-metabolic interventions.
Examples of some fees, as of 2019:
Brain Plasticity Centers $7,500 for a five day intensive
Minnesota Functional Neurology, $5,500 for a five day intensive
Dr. Jalili at Equinox Integrative Wellness Center, $3250 (Canadian) for a five day intensive
Who are functional neurologists?
Any functional neurologist should be certified by the American Chiropractic Neurology Board (ACNB) or the American College of Functional Neurology (ACFN). The certification follows 300 post-doctoral hours of coursework in functional neurology (also called clinical neuroscience), with the most prominent training program being the Carrick Institute.
Most functional neurologists are Doctors of Chiropractic (DC) who have taken the additional training. Some of these DCs will do manipulation in conjunction with functional neurology treatments, but not all. Functional neurology is also called chiropractic neurology depending on whether the practitioner is certified by the ACNB or ACFN.
The ACNB and ACFN also certify PTs (physiotherapists) and NDs (naturopathic doctors) in addition to MDs (doctor of medicine) and DOs (doctor of osteopathy). Physiotherapists need a bachelor and masters in physical therapy. Naturopathic doctors go through a 4-year post-graduate degree but are only licensed to practice in 17 of 50 American states.
What is the theory behind functional neurology?
The theory behind functional neurology is that concussions cause lesions (damage or abnormal change)* to the brain. These lesions create small groups of neurons where the function is impaired resulting in a sensory/motor deficit.
The lesions may be isolated to either the left or right brain hemisphere, or sometimes are in multiple areas of the brain on both sides, which means that they can be detected by finding which side of the body has a sensory/motor deficit. Once the deficiency is identified, targeted training can be used to “strengthen” the brain.**
For example, the patient is given balance and eye movement tasks to strengthen the vestibular system, which deals with the body’s spatial relations and balance.***
This strengthening is a function of neuroplasticity because the brain makes new connections (synapses) and gets better at tasks when they are repeatedly practiced. The functional neurologist works to re-connect the patient’s dysfunctional pathways through specific stimuli to improve the brain's functionality and reduce persistent post-concussion symptoms.
One theory is that with reactivation of the vestibular system via specific Head-Eye-Vestibular movement coordination, the blood flow to the areas of dysfunction increases and allows the brain to create new connections vital to improving mental function. Dizziness, a dysfunction of the vestibular system, is a symptom that is associated with a protracted recovery from a concussion.
* Standard CT and MRI scans do not show any damage to the brain with a concussion, but researchers are able to see damage from a concussion using tests not available in clinics.
** The “concept in functional neurology that ‘minor’ asymmetries are clinically relevant makes up one of the big differences between functional and classical medical neurology.”
*** This training of the vestibular system (Head-Eye Vestibular Motion Therapy) seems to contribute to increasing function and decreasing symptoms of persistent post-concussion symptoms, even though many of the symptoms are not traditionally classified as vestibular. The exact mechanism through which it improves symptoms not related to balance and spatial relations is not known.