Vestibular Rehabilitation

With diplomates in Neurology and fellowships in both Vestibular Rehabilitation and Brain Injury/Concussion diagnosis and rehabilitation, we are the foremost provider in rehab for vertigo and dizziness in the state of Maine, located in Portland. Treatment of Vertigo/dizziness requires specific diagnosis, utilizing proper examination techniques along with sophisticated diagnostics such as Videonystagmography (VNG) and Comprehensive Assessment Posturography System (CAPS) to evaluate eye movements, positional errors and balance/coordination. Once the appropriate diagnosis is made, a treatment plan will be recommended to fully restore normal functioning. These will often consist of Neurological Rehabilitation in the form of Vestibular Rehabilitation, eye movement therapies, repositioning maneuvers, balance/coordination, Physical Therapy, rib manipulation, hyperbaric oxygen therapy, Specific Neurological Chiropractic Adjustments and others. Our success rate is higher as we are able to treat the peripheral vestibular system along with the central connections in the cerebellum and brain stem to restore normal spatial understanding, utilizing principles of Neuroplasticity. 

Functional Neurology/Vestibular Rehabilitation

By evaluating the brain and nervous system in its entirety, we can localize regions that are dysfunctional and misrepresenting sensory information to the brain. Autonomic dysregulation is often seen in neurological patients and we perform careful evaluation of this potential involvement. Oxygen delivery to the brain is an important aspect of brain rehab and is examined thoroughly. We're essentially looking at your brain from an integration perspective, ensuring all regions are sending appropriate afferent information to the brain, including the vestibular system, proprioceptive system, visuomotor system, autonomic system, and oxygenation system. Our core model of care is multi-modal, ensuring that all potential regions that may contribute to your condition are properly assessed to allow for resolution of symptoms. In order to do this, we must reset the Central Integrated State of the dysfunctional neuronal regions of the brain to reduce their resting membrane potential to an appropriate level that is healhy and approximately -65 mV, reducing hyperexcitablity that can cause many of the patient's symptoms. We attempt to achieve this through a specialized program that combines Neurology, Chiropractic, Physical Therapy, Vestibular Rehabilitation, Occupational Therapy and Oxygen. 

Neurology Core Testing Program:

  • Videooculography (VOG, sometimes referred to as VNG) that measure eye movements that relate to specific regions of the brain, brain stem and vestibular system.
  • Sensitive balance and coordination testing of proprioception and brain using Computerized Assessments of Posturography Systems (CAPS) that allow us to measure dysfunctional areas sensory input related to Migraine.
  • Tilt Table Testing
  • Autonomic Assessment
  • Clinical Examination (Neurology, Proprioceptive, Respiration)
  • Gait analysis
  • Oxygen evaluation
  • Metabolic capacity
  • Objective measures
  • Spatial and Temporal Summation (Treatment Plan)

Neurology Core Treatment Program:

  • Tilt Table Treatment (TTT)
  • Non-Invasive Nerve Stimulation (NINS)
  • Vagus Nerve Stimulation (VNS)
  • Oculomotor retraining (eye movement exercises) (OMR)
  • Vestibular Rehabilitation (VR)
  • Occupational Therapy (OT)
  • Rib Manipulation (RM)
  • Cervicovestibular rehabilitation (CVR)
  • Specific Chiropractic Neurological Manipulations for Oxygenation L/S/T (SCNM-O)
  • Mild Hyperbaric Oxygen Therapy (mHBOT)
  • Postural Restoration (PR)
  • Physical Therapy (PT)
  • Functional Neurological Rehabilitation/Neuroplasticity Retraining Exercises (FNR/NRE)
  • Co-treatment (Botox, Medications, etc..) (CT)
  • Migraine dietary recommendations (MDR)

Why so much focus on Neuroplasticity?

Neurons require Activation, Oxygen and Fuel (glucose) to maintain a healthy state of -65 mV and undergo Immediate Early Gene Response to create more cellular contents such as sodium/potassium pumps, mitochondria for ATP formation, axonal and dendritic connections with neighboring cells, etc. The list you saw is how we target the dysfunctional areas with activation, oxygen and carry fuel to those cells. This has to be done in a very graded, careful manner so as to not exceed the metabolic rate of the neurons involved. We observe metabolic capacity for each individual and maintain levels of treatment that stay below those levels so as to keep a steady progression of healthy return to a normal state of function. Neurons respond through Temporal and Spatial Summation, so we can develop treatment plans based on your severity that will allow maximal response and long-term changes. This is known as Neuroplasticity and is at the core of our Concussion Program. I often tell people, I don't know how much I can help you, but in most cases, we're able to improve individuals at least 50% with the understanding that our goal is much higher. Your response depends on multiple factors, including genetics, central sensitization (chronicity), following our treatment plan and so forth. We are very open and honest with our patients and do our best to provide accurate information, but it is a functional issue and it is sometimes difficult to be exacting in our predictions. 

The Portland Chiropractic Neurology approach

Portland Chiropractic Neurology utilizes evidence based treatments in a multi-modal approach, patient centered model that allows individualized diagnosis and treatments by combining Neurology, Hyperbaric Oxygen Medicine (HBOT), Chiropractic, Physical Therapy and Occupational Therapy. It is recommended that evaluation occurs after concussive injuries by a trained professional, such as at PCN. Early intervention is encouraged, but not always necessary. As the leading Chiropractic Neurology office in Maine, the doctors at Portland Chiropractic Neurology (PCN) are highly trained in these areas and have a very successful track record for treatment of Post Concussion Syndrome. Dr. Aaron MacArthur is a Chiropractic Neurologist and has a fellowship in Brain Injury and Rehablitation as well as a fellowship in Vestibular Diagnosis and Rehabilitation. He teaches within the United States on various topics of concussion and migraine care. Dr. Haley Girard is also a Chiropractic Neurologist with extensive training in concussion.