Stroke is now the second leading cause of death worldwide, with an increased chronic disability in 50% of survivors. Prevalence in Australia is estimated at 154 strokes per 100,000 people and roughly 100 stroke per day. Incidence increases with age, doubling each decade after the age of 55. Stroke rehabilitation is one of the exciting emerging areas of chiropractic research, with recent randomised controlled trials indicating that chiropractic care may have a role in stroke rehabilitation.
It’s an important area of discovery given the widespread complications of stroke and their potential impacts of stroke on quality of life. Common complications are spasticity, weakness, unilateral paralysis, poor coordination, and balance. Thus, stroke rehabilitation is vitally important for survivors.
While the area of chiropractic care post-stroke is still emergent, a few studies do exist. They indicate early post-stroke intervention enhances neural plasticity. Concomitant with that, many case reports identify the benefits of chiropractic for visual disturbance and dizziness. All of this points to a simple indication: Supporting the nervous system through chiropractic may facilitate motor recovery in stroke survivors.
The New Study
In the present study, a retrospective chart review of post-stroke patients who were treated for neck pain between January 2021 and March 2022 was undertaken. The patients were cared for across 37 chiropractic clinics in Hong Kong. To be included in the study, patients had a history of stroke and received chiropractic care for a minimum of six months. During their care, chiropractic care was delivered 2-3 times weekly. All sessions involved rehabilitation exercises, flexion-distraction spinal traction, and spinal manipulation.
X-rays were taken before and after their care plans in order to analyse the cervical gravity line.
Additionally, walking cyclograms were used to track patients’ progress pre and post-care, and surface electromyography (sEMG) was used to investigate muscle activation and fatigue. A Fugl-Meyer Assessment (FMA) scale was used as an index to assess improvements to sensorimotor impairment of the upper and lower extremities. Finally, the World Health Organisation’s Quality of Life Scale (WHOQOL-BREF) was used to record changes in patient quality of life. The WHOQOL-BREF studies domains of quality of life inducing physical health, psych health, social relationships, environmental health, and perception of health.
Results:
In total, seven post-ischemic stroke patients were included in the analysis. Three of them were male, and four were female, and their mean age was 66 years old. Analysis revealed that the average duration of their chiropractic care journey was just under one year.
Overall, there was a 72.8% improvement in upper extremity sensorimotor function and a 71.8% improvement in lower extremity sensorimotor function. All patients showed an 80% improvement in their quality of life. The majority of them reported having an increased sense of support, satisfaction with their health, satisfaction with their ability to perform activities of daily living, satisfaction with access to health services, and decreased negative feelings.
On an individual level, these are significant findings. Taken in tandem, and compared with other stroke studies emerging recently in the literature, the indications seem to be that there is potential for chiropractic to be valuably incorporated into post-stroke rehabilitation and that it may act effectively to avoid long-term complications. The study was small in size, and retrospective in its nature (meaning there is no control group to compare against), however, the findings are notable and may inform larger-scale studies further examining these effects.
It is also notable that recent chiropractic studies have found increases in cortical drive to the muscles post chiropractic care, as well as improvements in sensorimotor function and integration, a reduction in falls risk, as well as neuroplastic changes in the brain.
Multimodal care post-stroke remains best practice. Introducing chiropractic care into this mix just may have the effect of bringing the best of these recent findings into a neurologically important time in a person’s life – that is, right as they are recovering from a stroke.
We can’t wait to see what else emerges.
Reference:
- Ling CW. Changes in gait parameters, muscle tone, and radiographic parameters in post-ischemic stroke patients following chiropractic care. Asia-Pac Chiropr J. 2023;3.4. URL apcj.net/Papers-Issue-3-4/#LingGait
- Navid Muhammad Samran, Niazi Imran Khan, Lelic Dina, Amjad Imran, Kumari Nitika, Shafique Muhammad, Holt Kelly, Rashid Usman, Drewes Asbjørn Mohr, Haavik Heidi (2022). Chiropractic Spinal Adjustment Increases the Cortical Drive to the Lower Limb Muscle in Chronic Stroke Patients , Frontiers in Neurology. 12. https://www.frontiersin.org/article/10.3389/fneur.2021.747261
- Church E, Sieg E, Zalatimo O, Hussain N, Glantz M, Harbaugh R (2016) “Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation,” Penn State Neurosurgery Channel, http://www.cureus.com/articles/4155-systematic-review-and-meta-analysis-of-chiropractic-care-and-cervical-artery-dissection-no-evidence-for-causationretrieved 29 March 2017
- Holt K, Niazi IK, Nedergaar RW, Duehr J, Amjad I, Shafique M, Anwar MN, Ndetan H, Turker KS and Haavik H (2019), “The effects of a single session of chiropractic care on strength, cortical drive, and spinal excitability in stroke patients,” Scientific Reports, 9, Article Numbers: 2673(2019), https://www.nature.com/articles/s41598-019-39577-5retrieved 26 February 2019
- Christiansen, T.L. Niazi, I.K. Holt, K. Nedergaard, R.W. Duehr, J. Allen, K. Marshall, P. Türker, K.S. Hartvigsen, J. Haavik, H. The effects of a single session of spinal manipulation on strength and cortical drive in athletes. Eur. J. Appl. Physiol. 2018. 118;737–749
- Joo S, Lee Y, and Song C, (2018), “Immediate Effects of Thoracic Spinal Manipulation on Pulmonary Function in Stroke Patients: A Preliminary Study,”Journal of Manipulative and Physiological Therapeutics, https://doi.org/10.1016/j.jmpt.2017.12.005
- Holt K, Niazi IK, Amjad I, Kumari N, Rashid U, Duehr J, et al. The Effects of 4 Weeks of Chiropractic Spinal Adjustments on Motor Function in People with Stroke: A Randomized Controlled Trial. Brain Sci. 2021. 11(6):676.
