This time of year lends itself to reflection, and as we have been reviewing all of the fantastic case reports that have been submitted through the ASRF Case Report Projects over the past two years, recurrent themes have been emerging. We have repeatedly spoken about the beauty of the case report, in its ability to effectively document and communicate the journey of one individual, with their individual care plan and lifestyle. Another incredibly valuable aspect of publishing case reports is the observation and identification of trends – albeit before larger studies can come in and confirm or explain the mechanisms behind them.
Sometimes these recurrent themes are obvious, such as a change in a primary symptom across multiple cases. Other times, it is the secondary factors that are more easily missed that form an undercurrent in research. One such factor is the focus of today’s blog: mental clarity. In 2023, we published four case reports that all include an aspect of improved mental function.
The most recent was released in the October edition of the Asia-Pacific Chiropractic Journal. A 63-year-old female presented for chiropractic care with symptoms related to poor gait, balance issues, and difficulty walking. Her secondary concerns included back pain, digestive problems, allergies, and brain fog.  The patient reported previous episodes of gallbladder issues, tendonitis, and orthotics prescribed by a previous chiropractor. She also noted whiplash and back pain stemming from prior motor-vehicle accidents, horse-riding injuries, and falls.
The aims of care were to correct the identified subluxations, hopefully resulting in improved balance, corrected digestive issues, and improved mobility and pain. Following the first 12 visits, significant changes were observed. She could now move better and with increased energy, her balance and coordination improved, and there was a decrease in musculoskeletal pain.
But a novel, unexpected improvement she attributed to her care was an improvement in her mental health and a resolution of her brain fog. Her improved mental clarity had been ‘life-changing’ as she was now more clear-headed and able to function better.
A similar outcome was noted in another case report.  A 74-year-old male presented for chiropractic care with the primary complaints of low back pain, headaches, and reflux. Following a 15 week course of care, the patient noted improvements in his predominant concerns, but also the speed at which he could process information. He reported that his ability to think quickly and strategically increased to a level competitive with those around him who were younger and more educated. Despite his ever-increasing workload, he reported his productivity was still up, and he could fit more into the time he had.
An important aspect that influences mental clarity is overall mental health. Two separate case reports reporting the care journey of a 51-year-old male and a 42-year-old male, both reported an improvement in mental health outcomes. One case reported a reduction and stabilisation of antidepressant use.  The other followed the changes in mental coping and health in an individual with a terminal cancer diagnosis. 
While seeing changes in outcomes related to mental health and clarity is exciting, most of the changes are identified through subjective self-reporting. To increase the validity and reliability of this trend in emerging research, studies incorporating objective and quantifiable measures need to be published. This would also allow us to gain some insight into how the improvements may have occurred. Is it because the nervous system, including the brain, just works better when it is free of interference? Is brain fog a symptom of a dysregulated nervous system? These and more are questions we can answer in time.
But for the moment what we know is this: case report data is beginning to indicate that individuals under chiropractic care have (in at least two cases) experienced an increase in mental clarity. Many more chiropractors may remember people reporting anecdotally that they feel or think better when they are under care. Case reports simply capture these moments.
- Steinberg B, Clodgo-Gorden K, Postlethwaite R, McIvor C. Improved mental clarity, balance, and digestive function, and normalised gait in 63-year-old female under chiropractic care: A case report. Asia-Pac Chiropr J. 2023;4.2. URL apcj.net/papers-issue-4-2/#SteinbergAdaptability
- Seaman R, Postlethwaite R, McIver C. Improvement in self-reported Mental Processing and Quality of Life in a 74-year old male concomitant with Chiropractic care for LBP: A case report. Asia-Pac Chiropr J. 2023;3.4. URL apcj.net/Papers-Issue-3-4/#SeamanMentalProcessing
- Croke O, Postlethwaite R, McIver C. Improvement in Forward-Head posture, Mental Health and Erectile Function in a 42-Year-Old Male under Chiropractic care: A case report. Asia-Pac Chiropr J. 2023;3.4. URL apcj.net/Papers-Issue-3-4/#CrokeErectileDysfunction
- Seaman R, Postlethwaite R, McIver C. Improved Mental Health and Quality of Life in a 51-Year-Old Male under Chiropractic care: A Case Report. Asia-Pac Chiropr J. 2023;3.4. URL apcj.net/Papers-Issue-3-4/#SeamanMentalHealth