We have been keenly awaiting the latest instalment in the stroke research emerging from the New Zealand College of Chiropractic. Dr Kelly Holt’s exciting work on the topic was first published in 2019, following collaboration with colleagues as far as Pakistan. The ground-breaking study looked at plantar muscle strength in stroke patients before and after one session of chiropractic adjustments. They found that “Plantar muscle strength increased in chronic stroke patients after a single session of chiropractic care. An increase in V-wave amplitude combined with no significant changes in H-reflex parameters suggests this increased strength is likely modulated at a supraspinal level.” Essentially, this study indicated that the changes were likely happening at the brain level and not the spinal level. It was an exciting finding indeed.
It was the latest in a line of research from the NZCC examining things like cortical drive to the muscles post-chiropractic care, and was truly a breakthrough in chiropractic stroke research. It was, however, limited to just one session of chiropractic care. What would this look like if it stretched out beyond that initial, single session of care?
We know that stroke can impact many areas of life and lead to long term disability and diminished quality of life. Therefore, rehabilitating motor function is imperative to post-stroke recovery. Often this recovery is limited though, so research is always looking toward new techniques and approaches. We know chiropractic care influences the Central Nervous System and we know that the chiropractic adjustment can change the structure and function of the brain. What if chiropractic care could be a meaningful part of stroke rehabilitation?
The latest study advances our knowledge on this topic. The study examined participants who had experienced a stroke at least 12 weeks prior to enrolment. They had also previously completed a rehabilitation program at the Railway General Hospital. These patients are referred to as having subacute or chronic stroke. They were included in the study if they had scored less than 80 on a combined upper and lower extremity Fugl-Meyer Assessment of motor function. This test is designed to assess motor impairment and a score of 80 would indicate significant impairment.
Exclusion criteria was applied so to ensure the validity of the study, and participants were broken up into two (randomised) groups: Chiropractic care plus Physical Therapy, or sham plus Physical Therapy. The course of care was four weeks in duration for both. It is important to note that, in order to pass ethics approval, Physical Therapy could not be eliminated in order to present chiropractic alone as a treatment, as Physical Therapy is known to be effective post-stroke and those first weeks are important in a patient’s recovery. Therefore, chiropractic care was simply added to the mix and the difference between groups measured.
The intervention group received either manual high velocity, low amplitude thrusts or instrument-assisted thrusts to the spine or pelvic joints. Each appointment lasted approximately fifteen minutes and the primary outcomes were measured according to the Fugl-Meyer Assessment (FMA) for motor function for the combined upper and lower limbs.
Secondary outcomes included in the study were: stroke specific quality of life scale, the timed up and go test, the Modified Rankin Scale, and the five-repetition sit-to-stand test.
All outcomes were measured at baseline (pre-intervention), 4 weeks (post-intervention), and 8 weeks (follow up to assess retention effects).
Both groups showed improvement in FMA scores at the end of the 4-week intervention. Most remained at a similar score at the follow up (although scores did vary somewhat either way). Excitingly, there was a larger effect in the chiropractic care plus Physical Therapy group when compared to the sham intervention plus physical therapy group. This was true on combined FMA (upper and lower extremity) and FMA-lower extremity at the 4-week follow up. There was a statistically significant difference between groups and the authors of the study reported a successful blinding. That is, 95% of participants across the two groups believed they had received the active chiropractic care.
This is an encouraging finding in an important area of healthcare, and we congratulate Dr Kelly Holt and the team on another wonderful study. No doubt there is more to come.
References:
- Holt, K.; Niazi, I.K.; Nedergaard, R.W.; Duehr, J.; Amjad, I.; Shafique, M.; Anwar, M.N.; Ndetan, H.; Turker, K.S.; Haavik, H. The effects of a single session of chiropractic care on strength, cortical drive, and spinal excitability in stroke patients. Sci. Rep. 2019. 9;2673.
- 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
- Navid, M.S. Niazi, I.K. Lelic, D. Nedergaard, R.B. Holt, K. Amjad, I. Drewes, A.M. Haavik, H. Investigating the Effects of Chiropractic Spinal Manipulation on EEG in Stroke Patients. Brain Sci. 2020. 10;253
- Suter, E. McMorland, G. Herzog, W. Bray, R. Decrease in quadriceps inhibition after sacroiliac joint manipulation in patients with anterior knee pain. J. Manip. Physiol. Ther. 1999. 22;149–153
- Haavik, H. Özyurt, M.G. Niazi, I.K. Holt, K. Nedergaard, R.W. Yilmaz, G. Türker, K.S. Chiropractic Manipulation Increases Maximal Bite Force in Healthy Individuals. Brain Sci. 2018. 8;76
- Niazi, I.K. Türker, K.S. Flavel, S. Kinget, M. Duehr, J. Haavik, H. Changes in H-reflex and V-waves following spinal manipulation. Exp. Brain Res. 2015, 233, 1165–1173
- 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.
