Current Issue:  Vol. 18, Issue 1 ( 2019)

By Cassandra Fairest, B. Chiro and David Russell, BSc (Psych), BSc (Chiro), Cert TT

Objectives: To present the case of a 7-year-old female previously diagnosed with Attention-Deficit Hyperactivity Disorder (ADHD), and the improvement and management of symptoms under regular chiropractic care, including the integration of a retained asymmetrical tonic neck reflex (ATNR). Methods: Online review of the literature on motor development delay and chiropractic was performed using The Index to Chiropractic Literature, PubMed and Google Scholar. Search terms “ADHD”, “chiropractic” and “spinal manipulation” were used. Clinical features: A 7-year-old female previously diagnosed with ADHD presented with anxiety, sleep disturbances, learning difficulties and behavioral issues. Her mother reported sleep disturbances began at 22-months following a fall onto her forehead. Previous treatments for ADHD, including behavioral therapy, psychotherapy and dietary intervention, had marginal success. A retained ATNR and aberrant H-test (cranial nerves III, IV, and VI) was identified. Direct objective indicators of vertebral subluxation at C1, T2, T4, T9, and sacrum were identified on spinal examination. Intervention and outcomes: Modified Diversified using an Activator instrument as a force application was applied to correct vertebral subluxation. Within the four visits, the child’s behavior, mood and sleep patterns had improved, and the retained ATNR had integrated. Cranial nerve findings had resolved. Direct objective indicators of vertebral subluxation had reduced. Ongoing care continued to improve and manage the presenting behavioral symptoms. Conclusion: Chiropractic care focused on the correction of vertebral subluxation, was associated with improvements in the child’s presenting symptoms associated with ADHD.

Key Words:Attention Deficit Hyperactivity Disorder; ADHD; Chiropractic; Pediatric; Vertebral Subluxation; Chiropractic Spinal Manipulation.

Prognosis of patellofemoral pain in adolescents: a case report

By Heather A. Hanson, D.C., M.Sc

Introduction: Patellofemoral pain is a common condition in adolescents and may significantly impact their activities of daily living. Methods: A literature search was performed using the PubMed database including the terms “knee pain,” “patellofemoral pain syndrome,” “patellofemoral pain,” and “anterior knee pain” combined with “prognosis” and “natural history.” Three relevant articles were identified including individuals aged 13-18 years. Case presentation: An active 14-year old female presented to the chiropractic clinic after being diagnosed with this condition by her general practitioner. The family wanted to know the long-term prognosis of the condition and if anything could be done, as the general practitioner had suggested that the condition would resolve on its own. Intervention: Home exercises were prescribed along with advice to temporarily suspend participation in physical education classes and consider orthotics. Soft tissue therapy and mobilizations of the knee joint were also applied. Outcomes: Despite these efforts, this patient continued to suffer from these complaints, though with reduced intensity, three years after the onset. Discussion: Three prospective studies examining the prognosis of this condition in a young population exist. Though heterogeneous in design, the evidence suggests that the course of patellofemoral pain in adolescents and young adults does not appear to be self-limiting in nature and its prognosis appears to be worse than that of other non-traumatic knee conditions. Conclusion: Early intervention appears to improve the chances of recovery, therefore chiropractors should be aware of this condition’s unfavorable prognosis and the urgency of initiating treatment in a timely manner.

Key Words: Patellofemoral pain syndrome, adolescent, knee pain.

Coping with Crying Babies: A Qualitative Study of Mothers’ Experience

By Joanne Oaten, MChiro, DC, MRCC and Joyce Miller, BA, DC, PhD

Introduction: Excessive crying and fussiness in infants is a complaint commonly presented to healthcare professionals such as chiropractors. Clinicians that gain an understanding of this personal experience will be able to take an effective biopsychosocial approach to the treatment and the management of these cases. Aim: The aim of the study was to explore the personal experiences of parents coping with infants that cry excessively with a goal to further improve the management of these pediatric cases. Method: The study was an explorative study that used a qualitative design. Six mothers who presented to the AECC University College outpatient clinic with their infants, less than 6 months old who cried excessively were interviewed. The chiropractic impression and diagnosis of the cases were similar and there was no other serious diagnosis given alongside the excessive crying in any case. One-to-one semi-structured interviews were conducted with the participating mothers. Tapes of the interviews were transcribed as a dialogue and then thematically analyzed. Results: Four main themes emerged. These were: (1) how the lives of the mothers were disrupted by the crying, (2)the emotional fatigue experienced by the mothers, (3) the sense of failure that was present at some point during the experience and (4) the support that the mothers did or did not receive. Conclusion: This study was able to gain insight into the lived experience of mothers with crying babies. The results show that the whole experience is very difficult and can be quite distressing for those involved. A biopsychosocial approach to the management would be beneficial to the mothers to give them some needed support.

Keywords: Biopsychosocial model/approach, Colic, Excessive crying, Postnatal depression, Qualitative research.

What is the evidence that chiropractic care helps sub-optimal breastfeeding?

By Christina N. Edwards and Joyce Miller, BA, DC, PhD

Breastfeeding is regarded as the optimal method of neonatal and infant nutrition. The long and short term benefits to the mother-infant dyad are well documented; for the mother, breastfeeding has been attributed to a reduction in breast and ovarian cancer and diabetes. The benefits of early initiation of breastfeeding for the neonate is a significant increase in his/her immune response, providing protection against infection and reducing infant mortality. Exclusive breastfeeding for the first six months has been associated with lower rates of gastroenteritis, respiratory tract infections, otitis media, eczema and asthma in infants. Long term, children who are breastfed are less likely to be obese, perform better on intelligence tests at school, and progress to obtain higher income in adult life. A report commissioned by UNICEF UK in 2012 concluded that for just five illnesses, a moderate increase in breastfeeding would save the NHS £40 million, and tens of thousands GP appointments and hospital admissions. Despite growing evidence that breastfeeding improves the health and survival of women and children, and contributes to human capital development, every country in the world fails to meet recommended breastfeeding standards.

Treating infants for suboptimal breastfeeding,is there a difference between chiropractic care versus multidisciplinary care: A pragmatic randomized comparison trial protocol

By Christina N. Edwards and Joyce Miller, BA, DC, PhD

Background: Suboptimal breastfeeding is a problematic concern of mothers of newborns in all societies, with huge economic and sociological ramifications. All professionals support breastfeeding, but some professions have set up special clinics to assist these families. Both chiropractors individually providing care and chiropractors within multi-disciplinary clinics have shown some benefit. Since many resources are involved, we propose a randomized clinical comparison trial that may be able to determine whether there are superior benefits to one approach or the other. Methods: Randomize mothers and babies who consent to participate to two different treatment arms: (1) chiropractic manual therapy along with advice and (2) chiropractic manual therapy along with midwifery care and routine advice. Maternal report will provide the outcomes at the infant’s ages of 6, 12 and 24 weeks. Discussion: The purpose of this trial is to investigate the actual difference in effectiveness of chiropractic care alone versus a multi-disciplinary approach. As such, the results should be helpful to determine what resources should be reserved for this population. The purpose of the proposed publication is to receive recommendations from other professionals to strengthen the protocol.