The definition of functional neurology, according to the Functional Neurology Society, is the following: “Functional neurology is based on the principles of neuroplasticity. The various parts of your nervous system can be altered to work more efficiently and even regenerate. The goal of a Functional Neurologist is to optimize this remarkable ability.”
Neuroplasticity is the nervous system’s ability to reorganize itself by forming new connections between neurons throughout life. This is the mechanism by which Functional Neurology stands for.
The gold standard of imaging is the MRI, which offers endless amounts of information. However, it is mainly used for looking at the neuroanatomy and observing if there are any abnormalities such as lesions, plaques, tumors, etc. This is why a lot of our patients with neurological conditions or symptoms are told that everything is “normal” after they have imaging and a standard neurological exam that is negative or within normal limits.
The one thing it cannot offer is the ability to test the function of a certain area of the nervous system. One of the only ways, and best ways, to test the function of the nervous system, is to perform a very comprehensive functional neurological examination.
In a detailed functional neurological examination, we look at multiple areas of the nervous system. After taking a detailed history, we then correlate that information with our exam, which looks at the nervous system at the level of the receptors, peripheral nerves, cerebellum, spinal cord, brainstem, basal ganglia and the cerebral cortex. The big difference in a functional neuro exam is that we look for subtle changes and always compare to the opposite side of the body. For example, if a patient was performing the Finger-to-Nose test and is able to successfully touch the tip of their finger to the tip of their nose, which is considered within normal limits (WNL). What if the patient had a much tougher time locating their nose with their right hand when compared to their left? What if they had a small tremor or breakdown in movement before they hit their nose? These are the subtleties we look for with any test. The tests incorporate everything from vitals, balance, gait, reflexes, motor testing, sensory testing, coordination testing, cranial nerve exam, eye movements, vestibular-ocular reflexes (VOR), and much more.
After completing the exam, we then put the findings together and try to develop a plan for the INDIVIDUAL patient. If ten patients came in with a headache, there could be a different mechanism in every patient that is causing their INDIVIDUAL set of symptoms. The human body is very complex, which is why it’s important to look at every patient on a personalized level. This is our approach.
We determine the course of action by applying different forms of sensory input into the nervous system and retesting parts of the exam that we found were not functioning to their capacity. The procedures and modalities that we use include light, sound, vibration, manipulations (extremity and spine), complex movements of extremities, specific eye movements, balancing exercises, and much more. We need to be specific and activate the areas of the nervous system that aren’t doing enough and also inhibit or decrease the amount of activation in the areas that are doing too much. Each patient will likely have different exercises and different amount of sets, reps, etc. The reason for this is that each patient can tolerate different amounts of stimulation and we’re not going to work on areas of the nervous system that are already doing their job and functioning well. We also do not want to push a patient past their metabolic capacity.
Metabolic capacity is a term used to describe how much stimulation a patient can take before their nervous system or body fatigues. For instance, if a patient’s eye movements start to lose their smoothness and get worse after four repetitions, their metabolic capacity for that exercise is four reps. We can take advantage of this and have the patient do three reps at a time, which we know won’t fatigue them, and they should be able to see improvement at a faster rate. If we push them past their capacity, the progress could plateau, the patient could develop symptoms or the patient could potentially get worse. This is why every patient will likely have different exercises, different amounts of the sets/reps and no one is just put into a category and given a “protocol” for a given condition.
Our goal is to create synchrony and harmony throughout the nervous system. If that occurs, the nervous system should be able to communicate effortlessly and be able to receive and transmit information without an issue.
We have seen positive outcomes in the following conditions:
- Mild Traumatic Brain Injury (mTBI)
- Migraine Headaches
- Tension Headaches
- Occipital Neuralgia
- Trigeminal Neuralgia
- Balance Disorders
- Parkinson’s Disease (PD)
- Neck pain
- Back pain
To schedule an free initial phone call with Dr. Paul Deglmann, call our office at (952) 479-7801 or send us an email at [email protected]