Impertinent solutions? Ergonomic rehabilitation after attempted limb amputation. A case study

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Introduction

This case study presents a full recovery following functional neurological rehabilitation. A 25 year old female soldier (EB) suffered a knife attack and needed to be resuscitated several times with surgery to her left arm. Amputation was offered, but surgery proved successful but sensation was absent. Her left arm was in contracted state and painful to move. Four weeks from surgery, applying functional neurological care involving brain based stimulation she made a complete recovery and was able to return to active military duty, (figs.1-3).

Methods

An evaluation was interpreted from a functional neurological perspective [1-3]. These included complete absence of sensation in the left arm to pinwheel test vibration. Reflexes were not attempted. Oxygen perfusion in the four limbs was 98%, [3&4]. The left blind-spot [80mmØ] was enlarged, but the right was reduced [25mmØ], suggestive of uneven cortical function. Interpreting the neurological findings, concepts common in artificial neural networking [4-6 & 8] were used. In this approach, systems (e.g. human nervous system) have protective responses, guarding from complete failure when sudden impacts present. Such responses can result in a new systemic status away from original homeostasis due to a so-called aberrant emergent behaviour known as “fail-code condition” [7]. A new non-homeostatic state of contracture and sensory neglect results in protective brain-based responses [9 & 10]. This creates altered feedback which can be considered as “signal noise” interfering with operational efficiency with aberrant emergent behaviour. In neurological terms this relates to the dark side of neuroplasticity [11]. Chiropractors would refer to this phenomenon as maladaptive compensation.
To reduce the signal noise and enhance central nervous system operational efficiency treatment focused on improving inhibitory control mechanisms by exciting the left neocortical areas to reduce exaggerated motor output, i.e. contracture in flexor position (figs. 5&6). Specific exercises for the contralateral cerebellum were performed (figs. 7&8). Thus, treatment involved right sided limb activation using several simple modalities while prohibiting activation of the left limb. Exactly opposite of a “regular” treatment approach.

Results

With fast stretch of the right elbow (low grade input to golgi tendon organ = hormesis [15]), sensation immediately returned to the left arm (confirmed by normal pinwheel & vibration tests). By stimulating the opposite (right) foot [9-12], the left hand gradually straightened. Six treatment visits with self-help exercises produced a full recovery in just four weeks after surgery, EB was able to return to active field duty.

Conclusions

Traumatic insults promote aberrant emergent behaviour [13-15] from altered signalling – distal “neural network noise” or induced temporary functional diaschisis [16], resulting in maladaptation or “fail-code condition”. Inhibition induced by hormetic minor noise enhances appropriate feedback that is essential to restore homeostasis (the reverse of diaschisis). Comprehension by the practitioner of changing the neural loops that maintain the “fail-code condition” may facilitate healing [15]. In these scenarios and potentially many others, it may be crucial to work on the unaffected site to enhance contralateral inhibitory (noise reducing) control of the injured site. Further research is needed into this aspect of neural behaviour.

Date & time

7-8 June 2016

NCTL Learning and Conference Centre, Nottingham

What is a Complex System?

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