When you think of the role of your tongue, you probably immediately think of its role in tasting, talking and swallowing. Did you know the tongue is directly connected to the brain? There is a hub of nerves at the tip of the tongue consisting of about 50-60 nerve branches.1 Picture babies and children in their developing years using their mouths and tongues to explore everything. It is an important learning tool. Have you ever noticed a child coloring with his or her tongue sticking out? How about an athlete focusing in a game?
Researchers hypothesize various theories as to why deep thinking or focusing tasks can lead to engagement of the tongue. The first is something called motor overflow as the network within the brain for language overlaps with the network for fine motor activation of the hands. When the neurons fire for fine motor skills, they may overlap into neighboring tissue for language leading to the use of the mouth and tongue. A second theory is that this process is evolutionary as the hands were first involved in language and through time as early humans started using more complex tools, the hands became occupied leading to the dominant form of communication with the mouth and tongue.2
The tongue-brain connection has been established with such a rich nerve hub as mentioned. Because of this accessible highway to the brain, scientists have looked into ways of accessing the brain through the tongue. Researchers investigated and determined that shocking the tongue may improve brain rehabilitation and repair neural damage in patients with conditions such as multiple sclerosis (MS) and traumatic brain injury (TBI).
Huh? How could shocking the tongue help? The focus and mechanism of this treatment is brain neuroplasticity – the ability of the brain to make new connections and networks. Researchers believe that tongue shocks may be a direct pathway to forming new nerve connections, a necessary repair mechanism for the damaged brain now rampant with bad nerve connections. By shocking the tongue, impulses cruise along the highway from the tongue to the brain, leading to the release of neurotransmitters and the development of new brain pathways.
The healing power of this therapy is thought to come from the induction of neuroplasticity. A device called the Portable Neuromodulation Stimulator (PoNS) provides the electrical stimulation to the tongue. A study demonstrated significant changes in brain wave activity after just one 20-minute PoNS session as well as other findings consistent with neuroplasticity.3 Just last year, the FDA approved marketing for this device for use in MS patients to improve gait.4
The effect of electrical stimulation of the tongue was assessed in MS patients in a 14-week study.5 The study used electrical stimulation in combination with intensive cognitive and physical rehabilitation targeting memory, balance and gait. Brain changes were also assessed in this study via functional MRI. The patients treated with tongue stimulation demonstrated neuroplasticity, greater cognitive improvement and twice the improvement in fluidity and balance compared to the control group. Another study supported these findings, showing significant improvements in balance, walking ability, fatigue and MS impact scores (a measurement of the psychological and physical impact of disease).6
This has become of great interest to the military for use in service members suffering from neurological diseases including the great percentage suffering from TBI. In a study using translingual neurostimulation plus physical therapy among patients with mild to moderate TBI, patients had significant improvements in sleep quality, balance, gait, and had a reduction in headaches and fall frequency.7 In another study among mild to moderate TBI patients, there was demonstrated increased brain volume after treatment as well as improvement in balance, gait, movement and executive function.8
Many TBI patients, like myself, carry on to suffer from chronic tinnitus. Researchers found that electrostimulation to the tongue with a sound program using various frequencies of sound can reduce tinnitus for up to one year after the treatment!9
Electrical stimulation of the tongue holds great promise for many debilitating and disabling conditions. Aside from MS and TBI, this therapy is also being investigated for use in patients with stroke deficits, tinnitus, Parkinson’s and vision loss. Shocking the tongue may be a catalyst for neuroplasticity and re-training the brain.
In February of 2019, four months after sustaining my brain injury, my uncle who lives in Georgia and works in the sports industry called my Mom to tell her about a doctor in Atlanta who was treating concussion with great success, especially with many big-time athletes. My mom and I called the office for a consult. It sounded unlike any treatment I had already tried and seemed promising.
Despite the fact that it sounded promising, I was hesitant and nervous about it. My bills were piling up from all of the treatments I had sought out which had become an additional stressor. I was nervous about traveling and experiencing the busy environment of the airport. I was nervous that the flight would exacerbate my symptoms.
It happened fairly quickly and the next day, with a push from my Mom, we were booking flights to Georgia for a week for an intensive neurorehabilitation program at Innova Brain Rehabilitation, now called Plasticity Centers.
I had looked into the treatment further which had received a lot of press over the past several years after Sidney Crosby of the Pittsburgh Penguins credited his concussion recovery success to Dr. Carrick, the founder of the Carrick Institute, which trains providers in clinical neuroscience and rehabilitation such as the doctors I would work with at Innova. Crosby had suffered several concussions and missed nearly a year of hockey as a result and in that time period, he had received treatment with Dr. Carrick who founded the field of functional neurology, also referred to as chiropractic neurology. Many other NHL players and professional athletes have had success with this treatment for their concussions.
What Is Functional Neurology?
Viewed by some as controversial or unorthodox, functional neurology combines neurology with chiropractic care. Functional neurology is a holistic approach, focused on the rehabilitation of the nervous system by identifying specific areas of miscommunication and dysfunction in the brain and treating those areas with a rehabilitation program. This treatment is deeply rooted in the process of neuroplasticity.
Neuroplasticity is the brain’s ability to reconnect dysfunctional communication systems or form new neural networks. This involves an in depth evaluation of the various systems of the brain. By using repetition exercises of the dysfunctional areas, the goal is to either strengthen or grow new networks within the brain. This is similar to exercise and using repetition to increase the strength of a muscle. In order to get bigger muscles, you must use and train them. The same concept flows into neuroplasticity and with repetition and exercises, the areas in the brain that may be weak or not communicating properly can strengthen connections and begin to work effectively again. This is the same concept used in neuro-optometric rehab.
The Carrick Institute is a postdoctoral education program where Dr. Carrick’s method of brain rehabilitation is taught. This is an additional three years of studies beyond chiropractic school completion. While many chiropractors go through this program, it is available for other providers too. This extra specialization allows a deeper understanding of the nervous system and how to treat problems that may arise. The goal of this treatment is to get the systems working together again. This involves waking up the deficient parts of the brain and also strengthening the communicating parts of the brain to make them more efficient, increasing endurance and then getting them to work in harmony again.
Using various tools and types of stimuli, these areas of the brain are strengthened. These tools include but are not limited to: whole-body gyroscope (GyroStim), which is a rotating chair that spins in various directions to stimulate the brain (picture and video of this later), electrical stimuli, laser therapies, light therapies, visual input, proprioceptive therapy, balance exercises and multi-tasking.
Touch Down in Atlanta
After an exhausting and symptom-provoking airport and flight experience, we made it to Georgia. I knew day one was going to be long and draining. I caught up with family which was wonderful. I was and am still so grateful I had a very welcoming place to stay. I got to bed early in anticipation of day one. It was nerve-wracking.
The familiar questions before new treatments scattered through my mind. Could they help? What if this is another dead end? Would it be worth the expense? At the end of the day, I was so desperate for something, anything, to work. The smallest chance that this could help was enough to propel me forward.
Innova Brain Rehabilitation
From the start, we were met with open arms. Literally. I received a big hug from Leslie, the care coordinator. She definitely made up for my lack of energy, in a good way. I then met Dr. Duffy and Dr. Patterson. I knew we would have a special bond and this group would soon feel like family.
I had to fill out forms including a symptom checklist with a scoring system of 0 (none) to 6 with 5-6 being severe. My severe symptoms included: headaches, pressure in head, dizziness, sensitivity to light, feeling slowed down, feeling in a fog, don’t feel right, fatigue or low energy, more emotional, sadness, trouble staying asleep, eye pressure, tinnitus, jaw pain. Moderate symptoms included: neck pain, nausea or vomiting, blurred vision, difficulty concentrating, irritability.
We wasted no time and got to work. I sat down with Dr. Duffy in an exam room where we went over my injury, symptoms, imaging results and treatment modalities tried up until that point. This was the first time the reality of the situation started to settle in. He was the first provider to tell me that I absolutely could not afford even one more hit to my brain. I think somewhere within me I knew this was the case but I wasn’t willing to accept it just yet.
The reality was hard for me to accept but I was somewhat relieved to hear a strong perspective on the issue that was tormenting my mind. At this point, I was still holding on to the thought that somehow it would be worth it for me to play hockey again. The truth is, I really wanted one of my providers to make the decision for me so I could be done with it. I wanted them to make it for me because I wanted to be reckless. And really, I had been reckless for the majority of my hockey career. It was as if I needed protection from myself. This was a start, though I continued living in denial for quite a bit longer. It still seems silly in retrospect that I held on to that idea for so long even though I was never even close to having the opportunity to play again.
I have come to realize that sometimes the idea of something is so much more appealing than the reality. I had come to love the idea but not the reality. And this was a hard truth I had to grow to recognize on my own. I wrote this in my journal during my recovery:
When will reality become better than my dreams?
I took the recommendation from Dr. Duffy where it would marinate for quite some time and we moved along.
Comprehensive Testing and Results
The exam was long and grueling. While I summarize a lot of it here, there was so much more conducted and assessed that I have not included. We first started with my vital signs – blood pressure and heart rate. My gait was then assessed. I walked down a long hallway and then making things a bit more complicated, he had me complete random tasks such as saying the alphabet, then saying the alphabet backwards while walking. I didn’t realize this could be such a difficult task.
My gait demonstrated no left arm swing. Arm swing during normal walking can indicate how well the brain is functioning. By adding dual tasking or asking me to say the alphabet while walking, the doctor assesses for any change in arm swing. This is a useful assessment for persons with neurological disease.
Luria’s test is a test that assesses frontal lobe damage or dysfunction. It involves the performance of three different hand motions. My result showed the movements were decomposed on both sides, suggesting I suffered frontal lobe damage of my brain.
Perfusion index is a measure of blood flow to peripheral tissues and can give a look into the autonomic nervous system. This is measured with a sensor on the fingertip similar to that of a pulse oximeter which measures heart rate and blood oxygen levels. It is supposed to be between the ranges 1.5-4. My PI was 0.32, suggesting dysautonomia, along with many other findings. As a reminder, dysautonomia is a dysfunction of the autonomic nervous system.
A bruit is a vascular sound heard through a stethoscope that is a result of turbulent blood flow. Bruits were present over the left subclavian and both carotid arteries, suggesting dysautonomia.
The pupillary reflex is a look into the function of cranial nerve III. The findings suggested decreased brain function. My left pupil was fast to fire and fail. The right pupil demonstrated hippus, which means the pupil constricts and dilates back and forth. Interestingly, this term is rooted in Greek origins from the word hippos which means horse so it has been suggested the name was given as the fluctuating movements of the pupil resemble that of a galloping horse. This fluctuation in the pupil reflects varying signals from the nerves responsible for autonomic functions. Again, this points to dysautonomia and an imbalance of the sympathetic and parasympathetic nervous systems.
Several movements were performed and assessed which evaluated fine motor skills and function of the cerebellum. Rapid alternating movements of the arms were slower on the right, suggesting decreased cerebellar function on the left. Finger-thumb tapping showed sluggish action on both sides.
The Maddox rod test is a test used to evaluate the diplopic function of the eyes, or the eyes functioning together on a target. One eye visualizes a line while the other visualizes a light. In normal functioning of the eyes, the line and light should overlap. When I did this test, the line was many inches away from the light. What they found on exam was exodeviation or the deviation of the eye outward. They also found hypotropia which means one eye drifts downward. The result of this is each eye is seeing a target at different points in space which can lead to double vision and other visual symptoms.
Convergence testing which measures how the eyes come together to focus on a target at near showed failure at 9 inches with both eyes shifting to the right. For reference, normal convergence in healthy eyes should be around 3 inches.
Further assessment of the cranial nerves showed a low hanging palate on the right, representing dysfunction of cranial nerves IX and X. My balance was tested which actually wasn’t too bad.
Then things started getting complicated. By complicated, I mean exceptionally difficult and draining. Visual eye tracking via video-oculography was performed, assessing eye reflexes and movements. Sitting in the chair not focusing on any target in pure darkness, my eyes demonstrated right beating nystagmus. Nystagmus is an involuntary, quick rhythmic movement of the eyes.
Focusing on a stable, non-moving target in various gaze positions, my eyes showed square wave jerks. These jerks are also involuntary movements of the eyes but consist of an initial sudden movement from the intended fixed target followed by a second quick movement in the opposite direction. On the video and graph result of my eyes, it looked like tiny, spastic movements that I named tiny eye earthquakes.
Pursuits were assessed, which are large fluid movements of the eyes to track a moving object. Again, with these movements, I experienced the tiny eye earthquakes. This threw off my tracking of the object and I was left feeling dizzy, nauseous, off balance and with an increased headache.
Quick eye movements between targets called saccades showed a prolonged latency, which is the measure of time it takes for the nervous system to trigger this movement. My latency was prolonged, which is a typical finding after brain trauma or neurological conditions.
The hardest part of the testing was when we got to the optokinetic reflex (OPK). The OPK is the reflex that allows us to follow objects in motion while our heads remain stable. An example of this is when you are driving down a tree-lined street or a construction zone with orange cone after cone. As you pass each tree or cone, this reflex allows you to stabilize the image and still allow you to recognize where you are at in space by the quick adjustment of the eye as the tree or cone moves out of your field of vision. In a healthy pair of eyes, they will quickly jump back to the original location of target. My OPK was egregiously off as shown by my results but also the test itself left me so dizzy, nauseated and almost to the point of vomiting. This would explain my issues with tracking moving objects, sickness in the car and inability to scroll on my phone.
The vestibular ocular reflex (VOR) was also deficient. This reflex is used to stabilize your gaze while moving the head due to activation of the vestibular system which allows you to maintain balance and equilibrium if working properly. This gives you an idea of how the visual system is working with the vestibular system. As a matter of demonstrating why the OPK and VOR can give such an indication of brain function is how many areas it takes to stimulate these reflexes. Both reflexes are stimulated by neurons located diffusely in the brain.
The results I received made me feel validated. Having no objective data of my deficits leading up to this point was difficult for me to understand. I struggled to understand my brain and body and having nothing to show why I was feeling the way I did left me feeling invisible.
In short, my results showed major short circuiting in various areas of my brain. My eyes were the most troubling. My autonomic nervous system was in a state of fight or flight. I could not hold a stable gaze on a target that was not moving and my eyes were spastic even when not focusing on any target. How would we get all of this to start functioning properly again?
My rehab was intense and grueling, with each day being eat, sleep, rehab, repeat. Rehab consisted of starting with the basics and fundamentals which was gaze stabilization and getting the eyes to be able to focus on a non-moving target. As time went on, we added movement of my body while my eyes continued to focus on the target.
Chiropractic manipulation was used to not only get my body in balance but to also give my brain good positive reinforcement and feedback. Proprioceptive feedback is important for the brain and body because it allows you to sense your position in space. My brain needed repeated positive feedback because it was constantly out of equilibrium. It was determined that my first left rib was stuck which improved with manipulation. Interestingly, my left jaw had begun popping and clicking since my injury and this was the first time it was suggested that the neck should be looked at more closely as that was most likely where it was originating from. My shoulder was a mess from my surgery just two months prior due to failure of rehab, so manipulation of the shoulder was also done.
Electrical stimulation was used to stimulate the second branch of cranial nerve V. This would stimulate the nuclei located in the pons, the largest part of the brainstem that houses a group of nerves. This is important for sensory and motor communication in the brain.
The GyroStim machine became my best friend. I felt like I was preparing for a NASA takeoff to outer space. The GyroStim is a multi-axis rotational chair, invented by an engineer in his basement, desperate to find a way to help his daughter who had suffered from cerebral palsy. The movements of the chair were theorized to stimulate the vestibular system, motor control areas in the brain and wake up dormant neural networks. When he noticed major improvements in his daughter, this device slowly made it into the medical community. Interestingly, the first sale of this chair was to the Air Force Academy.
The chair even does flips! No flips for me, though. Flips did eventually occur later that year when I completed another intensive rehab program in functional neurology, but that’s another story. During this treatment at Innova, I moved slowly left to right in the machine as I fixated my eyes on a little smiley face sticker. It was difficult for my eyes at first but became easier each time and my autonomic nervous system seemed to love it too. My perfusion index which again is supposed to fall between 1.5-4 improved to 1.8 from a whopping 0.32. It continued to rise the more we did it, maxing out at 2.3. Attached at the end is a video showing this futuristic device.
Passive figure 8 movements called complex proximal joint movements of the right leg and arm were done in opposite directions to stimulate the left cerebellum. Attached at the end is a video showing this.
The last day consisted of repeat testing, one last hoorah in the GyroStim and education on my home exercise program.
Major Improvements and Home Assignments
By the end of the week, I was feeling improvement which was amazing. I remember being so happy to feel some relief, I couldn’t help but cry. While I was still far from “normal,” I was sleeping better, my pain had decreased and many of my other symptoms had improved too. The initial symptom checklist I had filled out showed many of my symptoms decreasing to the mild or moderate range rather than severe.
Home assignments were given. With the repetition of the exercises, this was supposed to stimulate my brain to make new connections. This was also supposed to help stabilize my vision which was so terribly wrecked at this point. The improvements and gains I made in Georgia came home with me.
Very religiously each morning, my Mom or Dad would assist me with my home exercise program. Two of the exercises were called sinusoidal pitch movements which were to mimic the same movements in the GyroStim. My parents would push me in a rocking chair, slowly forward and back as I stared at a sticker on the wall to stabilize my gaze. We would then move over to an office chair, where I would be rotated slowly side to side as I stared at a sticker on the wall.
We were to continue the complex proximal joint movements or figure 8 movements at home. Lastly, I was also given breathing exercises and stretching exercises to open up my chest. All of these exercises would be repeated and done twice a day.
The Inevitable Decline
As I continued the home exercise program, I was feeling hopeful but after about two weeks of being home, things started to reverse. Despite religiously doing the assigned exercises, all of my symptoms came flooding back to the intensity they were prior to my trip. I was disheartened, devastated, hopeless, and again could feel myself being drawn back into the dark place I had become so familiar with.
It was hard for me because I again took it as a reflection of me. I was trying my hardest with the exercises and it still wasn’t good enough. Why couldn’t I make it stick? I decided maybe if I just increased the exercises and did them three times a day instead, the gains would come back. They didn’t. I lost them. I could not understand why.
I understand now. While they did a deep investigation of identifying the areas of my brain that were not functioning properly and assigned the rehab exercises for those specific areas, it was not sustainable. It was not sustainable because of the underlying problem of rampant inflammation and neurosteroid imbalance. My brain could not hold on to the gains because it was simply not prepared to receive or keep them.
I’ve discussed previously that maybe the timing of a treatment is just as important as the treatment itself. I truly believe there is major benefit to functional neurology, but I don’t believe I was at a point where my brain was ready to receive it and hold on to it. How could those improvements thrive in a brain riddled with inflammation? And one without the proper levels of neurosteroids, potent regulators of neuroinflammation.
It was a safe space for my brain that made it feel good. But once I left that space, my brain faced that familiar reality – the perception that everything was a threat and inundated with inflammation. The intensive positive input I received day in and day out from rehab was gone and so those connections became weak and lax, falling victim to the diffuse inflammation throughout my brain. There was nothing to combat it.
While at Innova, I thought, this is the missing puzzle piece. This is the thing that will get me better. While it didn’t turn out to be that, it did bring me a little hope to keep going and it brought me a reprieve from my symptoms for even a brief moment, which was more valuable to me than anything leading up to that point. It also opened my eyes to the deeper issues within my brain and my vision, which ultimately led me to find a neuro-optometrist which has been a huge, much needed resource. It also led me to explore the role of my neck in my recovery which had been neglected up until that point. I truly believe functional neurology can help patients whose brains are ready to receive the benefits and hold on to them.
By the end of day one, the Innova staff felt like they were family. We still keep in touch to this day. They treated me with kindness and care and brought me much needed hope. That is something that I will be forever grateful for.
Chiropractic Functional Neurology: An Introduction, 2017. PMID: 30881237.