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J. Vertebral Subluxation Res. - JVSR.Com, Oct 4, 2006 1
CASE STUDY
Behavioral and Learning Changes Secondary to Chiropractic Care to Reduce
Subluxations in a Child with Attention Deficit Hyperactivity Disorder: A Case Study
Behavioral and Learning Changes Secondary to
Chiropractic Care to Reduce Subluxations in a Child with
Attention Deficit Hyperactivity Disorder: A Case Study
†Private Practice, Bribie Island, Queensland, Australia
‡Private Practice, Santa Monica, California
Lisa Lovett DC†, Charles L. Blum, DC ‡
Introduction
Anecdotal stories of patients entering chiropractic clinics for
vertebrogenic symptoms and finding pain relief as well as re-
lief from seemingly unrelated problems is commonly accepted.
There is research from the 1920’s by Winsor who linked
diseased organs and spinal deformities and aberrant spinal func-
tion.1 This work was continued by Schmorl, Korr, Sunderland,
Lewitt and others investigating the pathways and consequences
of spinal dysfunction on organ function and in some cases the
effect spinal manipulation might have on certain disease states.2-5
It has been difficult to assess whether or not changes can
occur intellectually and/or behaviorally with spinal adjustments.
It is worthy to note that there is evidence that behavioral changes
can be affected by pain and/or organic dysfunction.6-10 There is
also evidence that behavioral changes occur after a trauma or
head injury.11-14 Postconcussion Syndrome can produce behav-
ioral changes in the form of anxiety, apathy and depression. 15-20
Anyone who has had a headache knows that a headache
affect’s one’s ability to concentrate. Headache sufferers are more
likely to suffer from a psychological disturbance such as de-
pression and anxiety, and psychological disturbances often carry
with it symptoms of a headache.21-22
With children who are learning disabled and/or classified as
Attention Deficit Hyperactivity Disorder (ADHD), it is impor-
tant to determine whether their symptoms are due to chronic
headaches or pain, are their problems purely neurophysiologi-
cal or are they possibly psychological in nature? The most com-
mon allopathic treatment for ADHD is Ritalin.23 However,
Ritalin carries with it many side effects such as growth sup-
pression, rashes, headache, stomachache, psychosis, insomnia
and anorexia.24-26
Because of these side effects, a conservative approach to
treatment of ADHD needs to be pursued. One possible type of
ABSTRACT
Objective: Attention Deficit Hyperactivity Disorder (ADHD)
is extremely subjective in both diagnosis and treatment. No
single cause has yet been determined for this disorder nor has
there been a single treatment plan that is effective in a majority
of cases. This paper proposes a possible etiology for some cases
of ADHD with respect to concentration and hyperactivity along
with a possible positive association with chiropractic adjust-
ments.
Clinical Features: A case history is presented of an 8-year-old
child with many learning and behavioral disorders that are as-
sociated with ADHD and temporally related to a fall incurred
18 months prior to being seen at this office. Physical examina-
tion revealed limited cervical ranges of motion, radiological
examination noted a cervical base angle of 23 degrees, and sacro
occipital technique examination had findings consistent with a
sacroiliac hypermobility syndrome (category 2).
Intervention and Outcome: For the first two months of care
the patient was seen once a week with every adjustment con-
sisting of SOT pelvic blocking procedures and cervical adjust-
ments. While prior to care the child’s symptoms had been stable
for 18 months, following two months of care his mother noted
positive changes in behavior and reduction in his complaints
of headaches and neck pain symptoms. During the two month
period of treatment, reports from his teachers at school remarked
on the positive changes in his behavior and improvements in
academic performance.
Conclusion: There are many causes to ADHD as well as other
learning and behavioral disorders; therefore conclusions can-
not be conclusively drawn by a single case study. A possible
conclusion that can be drawn in this case is that adjusting spi-
nal lesions (e.g., subluxations) appeared to reduce the child’s
pain and discomfort, which allowed him the ability to concen-
trate, learn and “sit still.” Further studies with controls need to
be conducted in this area to determine the effectiveness of chi-
ropractic care in aiding the symptoms of children who are clas-
sified as ADHD.
Key Words: ADD, ADHD, sacro occipital technique, SOT,
Chiropractic, craniosacral, dural function, CSF flow, behav-
ioral disturbances, learning disabilities, subluxation.
J. Vertebral Subluxation Res. - JVSR.Com, Oct 4, 2006 2Behavioral and Learning Changes Secondary to Chiropractic Care to Reduce
Subluxations in a Child with Attention Deficit Hyperactivity Disorder: A Case Study
conservative approach can be chiropractic therapy. Can chiro-
practic care assist in creating changes in behavioral and learn-
ing function?
The aetiology of ADHD is not clearly understood at this time,
however several theories have been proposed which in-
clude biochemical, sensorimotor, physiological and behavioral
dysfunction.27 The primary signs associated with ADHD are
inattention or difficulty concentrating, impulsivity and hyper-
activity, which are featured as difficulty in staying seated and
in later years is seen as continuous movement of the lower ex-
tremities. Associated signs include difficulty with visual motor
tasks such as printing and copying.
There has not been any consensus regarding particular or-
ganic or neurological indicators for the diagnosis of the spe-
cific condition of ADHD. Some researchers are investigating
a relationship between ADHD and EEG readings.28,29However,
DSM-IV criteria for ADD include nine signs of inattention, six
signs of hyperactivity and three signs of impulsivity. All signs
do not have to be present and should be present in at least two
settings (e.g. at home and school).27 The diagnosis is based
mainly on behavior and history as well as school reports.30 His-
torically ADHD has been referred to as hyperactivity or
minimal brain dysfunction.31
The following is a case history of a child who entered this
chiropractic clinic with many typical signs of inattention, hy-
peractivity and impulsivity. The behavior was displayed at home
and school and was reported by his teachers and parents. A
possible aetiology for some cases of ADHD is suggested with
respect to concentration and hyperactivity, and a rationale as to
why chiropractic adjustments were successful in one case.
Case Description
An 8-year-old patient presented to a chiropractic clinic with
his mother. His mother described his symptoms and related prob-
lems, which included severe headaches, cervical pain and con-
stant “blood shot” eyes, she was unsure as to the reason and she
remarked that the allopathic doctor had no explanation for its
occurrence.
His mother reported he constantly rolled his eyes and moved
his head around. On more specific questioning, other complaints
included stomach pains, an inability to sit still, incoordination,
behavioral problems and learning difficulties. She commented
that he could not read or write properly. She reported that his
teachers complained of him being disruptive in class and inat-
tentive.
The majority of these problems presented following a fall
18 months previously. The boy had fallen from the top of a
slide in a playground, was knocked unconscious and suffered a
concussion. His history also included a car accident at 17 months
old and a series of other falls and accidents where he sustained
head trauma.
Physical examination revealed some decrease in active cer-
vical lateral range of motion, a positive straight cervical fo-
ramina compression produced pain in the mid cervical region.
Upon palpation, the boy reported tenderness over the second
cervical vertebra on the right and third cervical vertebra on the
left. Some swelling was noted over the transverse processes of
C2 on the right and C3 on the left. The triceps and biceps deep
tendon reflexes appeared normal.
Radiological examination consisted of a static A-P and lat-
eral cervical and a bilateral lateral flexion of the cervicals, which
revealed a posterior head posture, based on cervical gravita-
tional analysis.32-33
Following orthopedic and neurological examinations, Sacro
Occipital Technique (SOT) examination and adjusting proce-
dures were chosen as the protocol for therapy. Due to the ap-
prehension of the mother and the patient, it was decided that a
technique that required as little force as possible was indicated.
SOT examination revealed a sprain to the hyaline part of the
sacro-iliac joint, which is referred to as a ‘Category 2’. A cat-
egory 2 has ramifications that can involve the cervical spine
and produce problems in the proprioceptive aspect of the ner-
vous system.34-39
For the first two months of care, the patient was seen once a
week. The adjustments were similar and consisted of SOT block-
ing procedures and cervical adjustments.
At his third appointment, his mother brought in his weekly
spelling tests for the previous three weeks (Figure 1). The ini-
tial spelling test dated February 8, 1991 was just prior to his
first adjustment. The one dated the 15th of February was the
day after his first adjustment and the one dated the 22nd of
February was the day after his second adjustment. His mother
commented that the first spelling test was typical of all previ-
ous examinations for the previous year. As his chiropractic care
progressed his mother continued to comment that his tests were
showing similar results as the third test as shown in Figure 1.
After one month of care the boy’s teachers and family noted
behavioral changes at home and at school. Of particular note
was his ability to “sit still and concentrate without disturbing
the other children.”
Through his first two months of care his mother continued
to note changes in behavior and reduction in the original symp-
toms of headaches and neck pain, the eyes cleared and his stom-
ach problems abated. Reports from his teachers at school re-
marked on change in behavior and improvement in academic
performance.
This child is reported by his mother to have had normal de-
velopment, activity and learning skills until an accident from a
slide. It was not until this accident that the child in this study
began to show behavioral changes and changes in learning abil-
ity. Because it was suggested that he had experienced chronic
headaches, he was unable to recognize this as abnormal. The pa-
tient was adjusted weekly for 2 months. By October, time be-
tween treatments had increased to once per month and in No-
vember he was referred to a chiropractor closer to home.
Discussion
This particular case is interesting because the symptoms be-
gan after a fall 18 months prior to commencing treatment. While
Post Concussion Syndrome has symptoms including headaches
and difficulty in concentration, it also includes apathy, depres-
sion and anxiety. This patient did not exhibit those latter types
of psychological disturbances.
Inattention is described as difficulty concentrating, or sus-
taining attention in work or play. Can the result of pain and/or
subclinical symptoms influence behavior, performance and con-
centration? There is a wealth of evidence to prove that pain
does affect behavior and performance. The ability to concentrate
J. Vertebral Subluxation Res. - JVSR.Com, Oct 4, 2006 3Behavioral and Learning Changes Secondary to Chiropractic Care to Reduce
Subluxations in a Child with Attention Deficit Hyperactivity Disorder: A Case Study
Figure 1 - Spelling Test Results after three weeks of Chiropractic care
J. Vertebral Subluxation Res. - JVSR.Com, Oct 4, 2006 4Behavioral and Learning Changes Secondary to Chiropractic Care to Reduce
Subluxations in a Child with Attention Deficit Hyperactivity Disorder: A Case Study
can also be affected due to aberrant neurological input such as
elevated levels of pain.40-44 Is it possible that some children clas-
sified as ADHD are functioning in some level of pain or are
experiencing subclinical spinal dysfunction prior to the diag-
nosis of ADHD? If a child has had chronic pain and/or discom-
fort, do they recognize it as abnormal? Some articles recognize
that the aetiology for learning disorders can include perinatal
injury.45-48 It can be postulated therefore that perinatal injuries
could be responsible for some low grade, consistent headaches
or other subclinical symptom that may subsequently mimic
symptoms of ADHD.
In this particular case, one possible conclusion might be that
headaches and neck pain were the main reason for his inability
to concentrate. Once his pain was relieved, his ability to con-
centrate improved. There is sufficient reason to believe that this
boy's ability to concentrate was affected by his headaches. As
his headaches subsided his ability to concentrate and his ability
to function at school improved. Further research is needed to
determine if ADHD may have a subclinical component, which
cannot be detected through normal clinical findings. In veteri-
nary practice, behavior is utilized as a measure of level of pain.49
Children who are unable to report their subjective symptoms
clearly might not be able to function as accurate historians and
it is possible that all the doctor has for the diagnosis are clinical
findings and behavior.
In this case, the radiological and physical examinations were
suggestive of trauma-induced headaches, which appeared to
have a vertebrogenic component.50 Recent findings of connec-
tive tissue bridges between the posterior muscles of the upper
cervical spine and the dura further confirm that many head-
aches can have a vertebrogenic origin.51-53
ADHD is a “persistent and frequent pattern of developmen-
tally inappropriate inattention and impulsivity, with or without
hyperacvity."27 While organic factors may play a role in the di-
agnosis of ADHD, there is little evidence that children with
ADHD have any real organic clinical findings since evalua-
tions usually focus on brain function. The major factors in di-
agnosis are behavioral and visual-motor tasks.53 The child’s
writing in the spelling tests in figure 1, suggests improved vi-
sual motor skills. This improvement began following treatment
and was sustained during the duration of his care.
Impulsivity is an important aspect of ADHD. It is described
as constant shifting from one activity to another, interrupting or
intruding on others.27 This patient exhibited destructive behav-
ior as described by his teachers. His mother and teachers no-
ticed that he repeatedly shifted from one activity to another and
was unable to maintain a continued focused attention. Both
parents and teachers noted significant changes in this area of
his behavior after care was started.
Another sign of ADHD is hyperactivity, which is described
as difficulty staying seated, or fidgeting or squirming. A theo-
retical rationale for this squirming or fidgeting might be due to
a subjects desire to find an antalgic position due to sacral and/
or sacroiliac dysfunction.
Some researchers have theorized that sacroiliac function or
craniosacral function is involved with driving cerebral spinal
fluid (CSF) around the brain and spinal cord.55-56 The CSF is
important for the regulation of the extracellular environment of
the neurons to the brain and central nervous system.57 The CSF
is also important for nutrition and waste removal and contains
hormones, neurotransmitters and other bioactive substances.
Without proper CSF flow through the central nervous system,
aberrant neurological function is possible.There have been sev-
eral studies documenting impaired CSF flow which cause head-
aches and other neurological symptoms such as tinnitus, ver-
tigo, vestibulocochlear dysfunction and Chiari deformation.58-63
Where there is no obvious cause of CSF hypotension or de-
creased CSF circulation, the resultant hypotension and its’ com-
plications is referred to as spontaneous. Interestingly, CSF hy-
potension has also been reported in cases of head injury.64 In
this case study, the subject had suffered several head injuries
with concussion that occurred 18 months prior to beginning
treatment at this office and was believed to precipitate his symp-
tomatology.
It has been demonstrated that the A-P diameter and shape
and movement of the dural sac changes with anteroflexion and
retroflexion of the lumbosacral spine. This change is compared
to a neutral position, which can be evaluated both qualitatively
and quantitatively.65-66 CSF circulation is aided by respiratory
and postural pressure changes.67 These postural changes affect
the diameter and shape of the dura that contains the CSF.
Changes in the dura, brought on by posture and respiration af-
fect flow of CSF around the spinal cord and is theorized to act
in a similar manner to the way the heart pumps blood around
the body. Pacchioni, who devoted his research to the structure
and function of the dura, compared the function of the dura to
cardiac muscle,68 in that the cardiac muscle drives blood around
the body the same way the dura, through periods of tension and
relaxation, drives the CSF around the brain and spinal cord.
The patient presented with findings of a category 2 or poste-
rior sacroiliac sprain which persisted for 2 months. Sacroiliac
joint dysfunction is implicated to have an effect on the cranium
and effect the coupled motion between the cranium and sacrum
or craniosacral motion.69-74 Impaired sacroiliac function or cran-
iosacral function is also postulated to affect CSF flow.75-78 Sac-
ral motion is described as being nutational with the axis rotat-
ing around the second sacral tubercle, the point at where the
strongest terminal aspect of the dura mater attaches. Motion of
the sacrum is affected by flexion and extension of the trunk,
(which also affects the diameter and shape of the dural sac) and
is also affected by respiration, as is the dura.
It should be noted that CSF circulation is important to proper
nervous system function, that balanced dural tensions are im-
portant to CSF flow, and that craniosacral function can affect
the dura and consequent CSF flow. Therefore, it can be sug-
gested that the inability of some ADHD children to sit still might
be related to an inherent need of the body to drive CSF around
the central nervous system and cope with the possibility of lo-
calized or generalized CSF hypotension.
It is of interest to consider whether an ADHD child’s need to
constantly move might also be a reflex action to increase mo-
tion of an impaired or subluxated sacroiliac joint. It is under-
standable that a child with a sacroiliac subluxation would find
sitting for any length of time difficult.
J. Vertebral Subluxation Res. - JVSR.Com, Oct 4, 2006 5Behavioral and Learning Changes Secondary to Chiropractic Care to Reduce
Subluxations in a Child with Attention Deficit Hyperactivity Disorder: A Case Study
Conclusion
In this single case study, the only care given was SOT and
cervical chiropractic adjustments. Other than “over the counter”
analgesics used, as reported by the mother, the child did not
take any prescribed medication. There was no extra tutorial at
school or at home. Initially the mother was very dubious that
chiropractic care could have any effect but she was, as she de-
scribed “at her wits end” and prepared to try anything. She ini-
tially commented that she “did not believe in chiropractic care”.
The reduction in neck pain, headaches, stomach discomfort
and eye irritation provided objective case history evidence but
is of peripheral interest compared to the behavioral and learn-
ing changes. Ironically however, the headaches and neck pain
prompted the mother to bring her son in for chiropractic care.
The child was adjusted using SOT methodology and indica-
tors, and range of motion studies and orthopedic tests were found
to normalize over the course of care. As greater mechanical and
behavioral function was restored the child reported being free
of pain, better able to concentrate, and learn similarly to his
capacity prior to the accident he had sustained 18 months be-
fore he presented to the office. Restoring normal sacroiliac func-
tion, improved his level of activity and this is believed to aid
his ability to sit still.
Of significance are the changes in his learning ability based
on the form of weekly spelling tests. It is important to note the
change in his writing as well as his spelling. This change in
writing is indicative of his improved visual motor tasks. The
improvement in spelling is also indicative of his improved learn-
ing skills as well as his improved ability to concentrate.
There may be many causes of ADHD as well as other learn-
ing and behavioral disorders. While conclusions cannot be
drawn by a single case study, the results in this particular case
indicate the need for further studies. It is suggested that by ad-
justing spinal lesions (i.e. subluxations) the child’s pain and
discomfort were reduced and this allowed him to better con-
centrate, learn and “sit still.” This improved behavior resulted
in better grades and a more attentive attitude. There are some
recorded cases of chiropractic care aiding in the symptoms of
ADHD 29,79-94 however, further studies with controls need to
be conducted in this area to determine the effectiveness of chi-
ropractic care in aiding the symptoms of children who are clas-
sified as ADHD.
Acknowledgements
My thanks go to Dr. Marc Pick for his initial help, to Dr.
Rob English for critically evaluating my first draft and to Dr.
Charles Blum for constant continued support and helping me
with completing this paper by supplying me with guidance.
Acknowledgements should also go to SOTO Australasia and
SOTO-USA
References
1. Winsor H. Sympathetic segmental disturbances-II. The Medical Times
Nov. 1921.
2. Schmorl G. Junghans, H. The human spine in health and disease. (1st Am.
Ed., translated by Wilk and Goin ).New York: Grune and Stratton; 1957.
3. Peterson B, ed. The collected papers of Dr. Irwin Korr. American Academy
of Osteopathy 1979.
4. Sunderland S. Traumatised nerves, roots and ganglia: musculoskeletal
factors and neuropathological consequences. The neurobiological
mechanisms in manipulative therapy 1978. New York, NY: Plenum Press
5. Lewitt K. The contribution of clinical observation to neurobiological
mechanisms in manipulative therapy. The neurobiological mechanisms in
manipulative therapy 1978. New York, NY: Plenum Press
6. Oberklaid F, Amos D, Liu C, Jarman F, Sanson A, Prior M. “Growing
pains”: clinical and behavioural correlates in a community sample. J Dev
Behav Pediatr 1997 Apr; 18:2: 102-6.
7. Mikkelsson M, Sourander A, Piha J, Salminen JJ. Psychiatric symptoms
in preadolescents with musculoskeletal pain and fibromyalgia. Pediatrics
1997 Aug; 100:2 Pt 1: 220-7.
8. Suhr J, Tranel D, Wefel J, Barrash J. Memory performance after head
injury: contributions of malingering, litigation status, psychological factors,
and medication use. J Clin Exp Neuropsychol 1997 Aug; 19:4: 500-14.
9. Powell AL, Yudd A, Zee P, Mandelbaum DE. Attention deficit hyperactivity
disorder associated with orbitofrontal epilepsy in a father and a son.
Neuropsychiatry Neurosychol Behav Neurol 1997 Apr; 10:2: 151-4.
10. Michiels V, Cluydts R, Fischler B J. Attention and verbal learning in
patients with chronic fatigue syndrome. J Int. Neuropsychol Soc 1998
Sep; 4:5: 456-66.
11. Hills EC, Geldmacher DS. The effect of character and array type on visual
spatial search quality following traumatic brain injury. Brain Inj 1998 Jan;
12:1: 69-76.
12. Max JE, Lindgren SD, Knutson C, Pearson CS, Ihrig D, Welborn A. Child
and adolescent traumatic brain injury correlates of disruptive behaviour
disorders. Brain Inj 1998 Jan; 12:1: 41-52.
13. McDowell S, Whyte J, Desposito M. Working memory impairments in
traumatic brain injury: evidence from a dual task-task paradigm.
Neuropsychologia 1997 Oct; 35:10: 1341-53.
14. Max JE, et al. Attention-deficit hyperactivity symptomatology after
traumatic brain injury: a prospective study. J Am Acad Child Adolesc
Psychiatry 1998 Aug; 37:8: 841-7.
15. Atkinson L, Jull G, Treleaven J. Cervical Musculoskeletal Dysfunction in
Post-Concussional Headache. Cephalgia. 1994; 14:273-9.
16. Massey W, Scherokman B, Post-Traumatic Headaches, Neurologic Clinics.
1983; 1:457.
17. Strauss R, Mild Head Trauma Can Cause Big Problems, Physician and
Sports Medicine. 1993 Apr; 21(4):3.
18. Flanagan S, Physiatric Management of Mild Traumatic Brain Injury,
Headache: Abstracts from other Journals. 2000 Jan; 40(1): 152-59
19. Butler R, Mood Disorders After Neurologic Injury, Topics in Geriatric
Rehabilitation. 1994 Dec; 10(2): 70-81
20. Kanoff R, Traumatic Alterations Of Consciousness, Osteopathic Annals.
1981 Feb; 9(2): 29-43
21. Curl DD, Shapiro S. Head/neck pain: the need to identify the patient with
acute vs. chronic pain. J Chirop Tech 1989; 1:101-105.
22. Moss ML, Salentijin L. The primary role of functional matrices in facial
growth. Am J Orthod 1969; 55: 56-57.
23. Archer J. Bad medicine: Is the health care system letting you down. NSW:
Simon & Schuster; 1995: 79.
24. MIMS annual 23rd ed. NSW: C.R. Wills; 1999. 311.
25. Inselman P S. Is There Any Other Way Besides Ritalin? Am Chiro May/
Jun 1998; 3(20): 24-25.
26. Blessing SJ. What You Should Know About Ritalin. Chiro Peds Apr 1994;
1(1): 16-17.
27. Merck manual of diagnosis and therapy. 17th Ed. Merck Research
Laboratories; N.J 1999. 2255-6.
28. Tinius TP, Tinius KA. Changes After EEG Biofeedback and Cognitive
Retraining in Adults with Mild Traumatic Brain Injury and Attention Deficit
Hyperactivity Disorder. Journal of Neurotherapy 2000; 4(2): 27-41.
29. Hospers L. EEG and CEEG Studies Before and After Upper Cervical or
SOT Category II Adjustment in Children After Head Trauma, in Epilepsy
and in “Hyperactivity”. Proceedings of the National Conference on
Chiropractic; 1992 Nov: 84-139.
30. Mulligan S. Classroom Strategies Used By Teachers of Students with
Attention Deficit Hyperactivity Disorder. Physical & Occupational Therapy
in Pediatrics. 2001; 20(4): 25-44.
31. Dorlands medical dictionary. 27th ed. W.B. Saunders Co; Philadelphia:
1988. 495.
32. Erhardt R. Chiropractic Reference of Clinical Radiographic Studies.
Privately published, 1984. 245.
33. Aragona RJ. Applied Spinal Biomechanical Engineering. Fundamental
Principles and Practise of ASBE. Privately published. Revised edition
1987; 99.
34. De Jarnette MB. Sacro Occipital Technic. Privately Published, Nebraska
City, Nebraska, 1984: 2,9.
35. Blum CL. Chiropractic and Pilates Therapy for the Treatment of Adult
Scoliosis. JMPT May 2002; 25(4).
J. Vertebral Subluxation Res. - JVSR.Com, Oct 4, 2006 6Behavioral and Learning Changes Secondary to Chiropractic Care to Reduce
Subluxations in a Child with Attention Deficit Hyperactivity Disorder: A Case Study
37. Blum CL. Spinal/Cranial Manipulative Therapy and Tinnitus: A Case
History, Chiropractic Technique Nov 1998; 10(4): 163-8.
38. Hochman JI. Analysis of the Cervical Spine, Todays Chiropractic, Jul/
Aug 1992; 21(4):15-20.
39. Gregory TM. Temporomandibular Disorder Associated with Sacroiliac
Sprain, JMPT May 1993; 16(4): 256-65.
40. Curl DD, Shapiro S, Head/neck pain: the need to identify the patient with
acute vs. Chronic pain. J Chirop Tech 1989; 1:101-105.
41. Crombez G, Eccleston C, Baeyens F, Eelen P. Habituation and the
interference of pain with task performance. Pain 1997 Apr; 70:2-3, 149-54.
42. Eccleston C, Crombez G. Pain demands attention: a cognitive-affective
model of the interruptive function of pain. Psychol Bull 1999 May; 125:3,
356-66.
43. Eccleston C, Crombez G, Aldrich S, Stannard C. Attention and somatic
awareness in chronic pain. Pain 1997 Aug; 72:1-2, 209-15.
44. Hansen B. Through a glass darkly: using behavior to assess pain. Semin
Vet Med Surg (Small Anim) 1997 May; 12:2, 61-74.
45. Milberger S, Biederman J, Faraone SV, Guite J, Tsuang MT. Pregnancy,
delivery and infancy complications and attention deficit hyperactivity
disorder: issues of gene-environment interaction. Biol Psychiatry 1997
Jan; 41:1: 65-75.
46. Perils and pitfalls on the path to normal potential: The role of impaired
attention. Homage to Herbert G Birch. J Clin Exp Neuropsychol 1995
Aug; 17(4):481-98.
47. Schatz J, Craft S, Koby M, Park TS. Associative learning in children with
perinatal brain injury. J Int Neuropsychol Soc 1997 Nov; 3:6: 521-7.
48. ltemus KL, Almli CR. Neonatal hippocampal damage in rats: long-term
spatial memory deficits and associations with magnitude of hippocampal
damage. Hippocampus 1997; 7:4: 403-15.
49. Hansen B. Through a glass darkly: using behavior to assess pain. Semin
Vet Med Surg (Small Anim) 1997 May; 12:2, 61-74.
50. Curl, DD. Chiropractic approach to head pain. Maryland: Williams &
Wilkins; 1994.
51. Hack GD, Koritzer RT, et al. Anatomic relation between the rectus capitus
posterior minor muscle and the dura mater. Spine; 20(23):2484-2486.
52. Mitchell B, Humphreys BK, O’Sullivan E. Attachments of the ligamentum
nuchae to cervical posterior spinal dura and the lateral part of the occipital
bone. JMPT 1998 Mar/April; 21(3).
53. Alix ME, Bates DK. A proposed etiology of cervicogenic headache: the
neurophysiologic basis and anatomic relationship between the dura mater
and the rectus posterior capitus minor muscle. Physiol Ther 1999; 22:534-9.
54. Farmer JA, Blum CL. Dural Port Therapy, Journal of Chiropractic
Medicine. Jun 2002; 1(2):54-61.
55. Page-Echols W, Retzlaff E, Mitchell F Jr. Respiratory Kinematics of Ribs
and Sacrum: Natural History and Physical Diagnosis Interrater Reliability,
J Am Osteopathic Assoc, 1982; 82:112.
56. Zankis MF, Dimeo J, Madonna S, Morgan M, Dasby E. Objective
Measurement of the CRI with Manipulation and Palpation of the Sacrum
(abstract), J Am Osteopath Association, 1996; 96(9): 551.
57. Berne RM, Levy MN. Physiology, 3rd Ed. Mosby Year Book Inc; 1993: 96.
58. Wang LP, Schmidt JF. Central nervous side effects after lumbar puncture.
A review of the possible pathogenesis of the syndrome of postdural
puncture headache and associated symptoms. Dan Med Bull 1997 Feb;
44:1, 79-81.
59. Rabin BM, Roychowdhury S, Meyer JR, Cohen BA, LaPat KD, Russell
EJ. Spontaneous intracranial hypotension: Spinal MR findings. Am J
Neuroradiol, 1998 Jun, 19:6, 1034 -9.
60. Atkinson JL, Weinshenker BG, Miller GM, Piepgras DG, Mokri B.
Acquired Chiari I malformation secondary to spontaneous spinal
cerebrospinal fluid leakage and chronic intracranial hypotension syndrome
in seven cases. J Neurosurg 1998 Feb; 88:2, 237-42.
61. Rando TA, Fishman RA. Spontaneous intracranial hypotension: report of
two cases and review of the literature. Neurology 1992 Mar; 42:3 Pt 1,
481-7.
62. Kasner SE, Rosenfeld J, Farber RE. Spontaneous intracranial hypotension:
headache with a reversible Arnold-Chiari malformation. Headache 1995
Oct; 35:9, 557-9.
63. Bakouche P. Intracranial hypotension. Presse Med 1998 Sep; 27:25,
1296-301.
64. Ludianskii EA. Dissociated symptoms of the progressive course of brain
injury. Zh Nevropatol Psikhiatr Im S S Korsakova 1990; 90:7, 53-5.
65. Mihale J, Bartko D, Turcani P, Novakova Z. Specific aspects of mobility
and changes in the shape of the dural sac in functional lumbosacral
myelography. Cesk Neurol Neurochir 1990 Jul; 53(4):257-63.
66. Dai LY, Xu YK, Zhang WM, Zhou ZH. Influence of flexion-extension
motion of lumbar spine on lumbosacral dural sac. An experimental study.
Chin Med J (Engl) 1991 Jun; 104:6, 498-502.
67. Vander A, Sherman J, Luciano D. Human Physiology, The Mechanisms
of Body Function. 6th Ed. McGraw-Hill Inc; 1994. 230.
68. Brunori A, Vagnozzi R, Giuffrè R. Antonio Pacchioni (1665-1726): pioneer
studies on the dura mater. Ann Ital Chir 1992 Sep; 63:5, 579-85,
discussion 586.
69. DeJarnette MB. Sacro Occipital Technic. Privately Published, Nebraska
City, Nebraska, 1982: 8, 109.
70. Retzlaff EW. Structural and functional concepts of craniosacral
mechanisms. Concepts and mechanisms of neuromuscular functions.
Berlin, Heidelberg, New York: Springer – Verlag; 1980. 111-28.
71. Upledger J, et al. The reproducibility of craniosacral examination findings:
A statistical analysis. J Am Osteopathic Assoc 1977; 76: 67-76.
72. Mitchel FL. Voluntary and involuntary respiration and the craniosacral
mechanism. Osteopathic Annals 1977; 5: 52-9.
73. Frymann V. Relation of disturbances of craniosacral mechanisms to
symptomatology of the newborn: Study of 1,250 infants. J Am Osteopathic
Assoc 1966 June; 65: 51-67.
74. Hanten WP, et al. Craniosacral rhythm: reliability and relationships with
cardiac and respiratory rates. J Orthop Sports Phys Ther 1998 Mar.
75. Peterson K. A Review of cranial mobility, sacral mobility and cerebrospinal
fluid. JACA; 12:3, 7-14.
76. Flanagan M. The relationship between CSF and fluid dynamics in the
neural canal. JMPT Dec 1988; 11(6): 489-92.
77. Blum CL. Biodynamics of the cranium: A survey. The J of Cranio-
mandibular Practice. 1985 Mar/May; 3(2): 164-71.
78. Retzlaff E, Michael D, Roppel R. Cranial bone mobility. J Am Osteopathic
Assoc 1975 May; 869-873.
79. Barnes T. Attention deficit hyperactivity disorder and the triad of health. J
of Clinical Chiropractic Pediatrics 1996; 1(2): 59-65.
80. Phillips C. Case study: The effect of utilizing spinal manipulation and
craniosacral therapy as the treatment approach for attention deficit-
hyperactivity disorder. Proceedings of the national conference on
chiropractic and pediatrics 1991 Nov; 57-74.
82. Schetchikova NV, Children with ADHD: Medical vs. Chiropractic
Perspective and Theory – Part 2, J of American Chiro Assoc; Aug 2002:
34-44.
83. Kidd PM, Attention Deficit/Hyperactivity Disorder (ADHD) in Children:
Rationale for Its Integrative Management, Alternative Medicine Review
2000 Oct; 5(5): 402-28.
84. O’Shea T, Attention Deficit Disorder: A Designer Disease (Part 1) Todays
Chiropractic Jan/Feb 2000; 1(29): 42-48.
85. O’Shea T, Attention Deficit Disorder: A Designer Disease (Part 2) Todays
Chiropractic Mar/Apr 2000; 2(29): 14-15.
86. Liesman NJ, A Case Study of ADHD, International Review of Chiropractic
1998 Oct; 54(5): 54-61.
87. Peet P, Child with Chronic Illness: Respiratory Infections, ADHD and
Fatigue: Response to Chiropractic Care, Chiro Peds Jun 1997; 1(3): 12-13.
88. Peet JB, Adjusting the Hyperactive ADD pediatric Patient, Chiro Peds
Jan 1997; 4(2): 12-13.
89. Barnes T, A Multi-Faceted Chiropractic Approach to Attention Deficit
Hyperactivity Disorder: A Case Report International Review of
Chiropractic 1995 Jan/Feb: 41-3.
90. Holder JM, Blume K, Attention Deficit Disorders (ADD) Biogenic Aspects,
Chiro Peds Aug 1994; 2(1): 21-23.
91. Langley C, Epileptic Seizures, Nocturnal Enuresis, ADD, Chiro Peds Apr
1994; 1(1): 22.
92. Anderson CD, Partridge JE, Seizures Plus Attention Deficit Hyperactivity
Disorder: A Case Report, ICA Review Jul/Aug 1993; 4(49): 35-37
93. Devinney RB, Diagnosis of Attention-Deficit Disorder, Todays Chiro May/
Jun 1993; 1(22): 34-37.
94. Sprieser PT, Learning Disabilities – Part II, Dig Chiro Econ Nov/Dec
1987; 3(30): 20.