Join renowned chiropractor and researcher Dr. Carlo Rinaudo as he explores the connection between the body, brain and our vestibular system and our capacity for neuroplasticity with our ambassador, Dr. Damian Kristof. Proprioception, the vestibular system and the senses inform the brain of the context of the body and Dr. Carlo shares with Damian the importance of change and challenge for the brain to encourage neuroplasticity and neurorehabilitation.
Carlo shares the research on how to engage in neurorehabilitation particularly for a sympathetic dominated nervous system through contextual, titrated and targeted therapy and emphasises the importance of specific diet and lifestyle modifications to promote brain and nervous system health.
COVERED IN THIS EPISODE
[00:30] Welcoming Dr. Carlo Rinaudo
[01:56] What is proprioception
[04:33] Proprioception as a fundamental component of neuroplasticity
[09:30] Context specificity and how to “change it up”
[17:44] How the brain maps different senses
[26:17] The role of the vestibular system and how it develops
[31:10] How developmental milestones in children rely on the vestibular system
[35:01] Preventing the decline of cognitive function by engaging the vestibular system
[39:25] Optimising the health of the vestibular system
[43:59] Thanking Carlo and closing remarks
- Muscles have a strong sensory function and provide proprioception feedback to the brain
- Neuroplasticity requires engagement, gradual increase, variety, novelty and challenges to the brain
- Physical activity and stretching muscles, ligaments and spine help to support the nervous system, however variety is important for neuroplasticity
- Context specificity – we do better at rehab or therapy when they are done specific to the context of which the movements were originally done to support neurorehabilitation
- Incremental increases of therapy to support neuroplasticity of the brain in 5-10% increments to prevent an emotional response leading to SNS dominance in neurorehabilitiation – important for anxiety, depression, hypervigilance conditions particular in chronic neurological condition – applies to nutritional, exercise, therapy
- The brain isnt linear, it is full of variables in connections and experiences that can impact an experience or response
- Body maps in the brain that give an awareness of the surrounding using sensory input. Mismatch of the maps between perception of experience and actual experience can lead to spinal, peripheral joint and anxiety problems are often the result of these body map problems. Spinal adjustments, nutritional, vestibular, eye moment therapies are aimed at recalibrating maps.
- Somatosensory maps
- Motor maps that control body parts
- Retinotopic maps = movement of eyes in specific direction as brain maps the visual world.
- Tonotopic maps – sound related maps associated with sounds and direction
- Vestibular maps – brain recognition of movement in space without other sensory input
- Vestibular system development in utero is complete to full adult size by 25 weeks gestation suggesting importance of it in terms of neurodevelopment. After birth, the vestibular system responds to the environment – important for variation, graded, progressive, novel environments in infancy to support development
- Support for the nervous system includes lifestyle, nutrition, sleep, life purpose, relationships, emotional support in addition to rehab of the vestibular system and connections between the front lobe (cognitive, executive function, attention and focus, decision making)
- Gut health is important for nervous and vestibular system health, macronutrients, micronutrients, gut health – neurotransmitters are produced within the gut and the connection between gut and brain via vagus nerve, inflammation and autoimmunity need to be brought down using turmeric, huperzine, resveratrol, medicinal mushrooms to shift from SNS dominant to PSNS state, support blood glucose levels and low iron levels to ensure blood glucose regulation to support brain health, past history of concussions, thyroid health, essential fatty acids intake to support neuron health phosphatidylserine and phosphatidylcholine
RESOURCES DISCUSSED IN THIS EPISODE
|Carlo’s website: Brain Hub|
|Brain Hub Academia|
|Book: The Brain that Changes Itself by Dr. Norman Diodge|
Damian: This is FX Medicine, bringing you the latest in evidence-based, integrative, functional, and complementary medicine. I’m Dr. Damian Kristof, a Melbourne-based chiropractor and naturopath, and joining us today is Dr. Carlo Rinaudo.
He’s a registered chiropractor, researcher, and educator. He’s the clinic director and founder of Brain Hub, a multi-disciplined clinic that focuses on complex neurological conditions, including post-concussion syndrome, vertigo, migraine, and paediatric neurodevelopment.
He’s completed a PhD in vestibular rehabilitation at the University of New South Wales, and is currently involved in further research in vestibular neuro-rehabilitation. Dr. Rinaudo frequently presents and teaches practitioners across the globe on similar topics.
Carlo, thank you so much for joining us.
Carlo: Thank you, Damian, and thanks to the listeners for taking the time to hear what we have to say and talk about.
Damian: It’s going to be such a great podcast, and I’m really grateful for your time, Carlo, because your wisdom… I went to one of your seminars many years ago, the one that you presented with our great friend, Paul Bergamo, and it really was one of the great seminars that I’ve ever attended and it just blew my mind. And I’ve always been hungry to share to the public, I suppose, or to the professions at large, your knowledge because I think it’s outstanding, and I think a lot of people will get a lot from what we’re going to be talking about today.
Carlo: Great. Thank you. Let’s…all the pressure’s on.
Damian: No pressure, no pressure.
Carlo, I want to ask you a couple of questions just to kick us off. The first question – and I’m going to dovetail these questions and put them in the same sentence – but the first question is what is proprioception? And then, how changeable is the brain?
Carlo: Two great questions, and one that I have interest in. And I guess as practitioners, as a chiropractor, it’s one that I think dovetails really well into our practice and our teaching. Proprioception, I guess, if I had to look at a definition, would be, really, the connection between the muscles and ligaments and the brain, and that feedback mechanism.
We have embedded in our muscles and ligaments and joints, these sensory organs that give our brain and body an awareness of where we are. And interestingly, we think of muscles as being a contractor, and something that we shorten or gives us power or strength. But a good part, or a good portion of muscle function is actually sensory function.
So you have all these sensors and all these proprioceptors that are embedded in these muscles and ligaments. And as we move, they tell the brain where we are, and what we are doing, and the brain talks to our muscles and says, “Okay, well, that’s not where I expected to be,” or, “We’re going too fast or too slow,” or, “We’re going to miss that ball.”
And so, it refines and adjusts that output, and the brain then talks to the body and says, “Okay, is that a better copy of what you want?” And the brain says, “Well, we’re getting closer to it. The wind’s blowing from the left to the right. Well, we need to adjust to it.” So, that interaction between the environment and our brain is, really, pathed through our proprioceptors, and we’ve got so any of them. And as chiropractors, why we take such an interest in it, is that the spine, in particular the upper cervical spine, is heavily innovated or densely populated, I should say, with these proprioceptors, far more compared to any other part of the body.
So it’s one that we know when there’s a problem with it, it has a big bearing on our brain. But also we can, by affecting the spine through our therapy or any adjunctive work that relates to the spine, we can have a profound impact on resetting these proprioceptors and then resetting the body’s connection with the environment. So, proprioceptors, it’s a real niche, it’s a real entry point that gives us that aspect of understanding the communication between the body and brain.
I guess going to your second question about how changeable is the body, or the brain? Extraordinarily. And one of the ways in which it is, is through proprioception and proprioceptors. So we know that the body is very malleable and changeable, and we love the word neuroplastic, that ability to change. And we know that if we give it the right nutrients, and nutrients is not necessarily just food or drink or whatever it might be, but stimulation and environmental triggers, then we know that the brain can adapt.
It’s a double-edged sword. It works both ways. We can help it, but also someone’s negative thoughts or negative actions can also create bad changes or bad neuroplasticity, so to speak.
Damian: Great answer, and what a great way to intro this. I love the idea that in the cervical spine there’s so many proprioceptors. And the reason why I asked those two questions together is because there is a lot of discussion around proprioception, neuroplasticity, etc., etc. And I think that the understanding that neuroplasticity exists, a lot of people think that neuroplasticity stops when you’re little or stops when you’re young. But if you think about the work of say, Norman Doidge, where he wrote a great book, The Brain That Changes Itself, that really highlighted that whole neuroplasticity space.
If you’re practising something… And I’ve just started playing golf. And I don’t know if many of the listeners know that I love playing golf, I’m sure they do by now. But I’ve just started playing golf in the last 5 years, and I feel like my game’s getting better, and I’m nearly 50. And so, I continue to remember that.
I interviewed a guy on my podcast, 100 Not Out, and his name was Stephen Jepson. At the age of 72 years old, he started to learn how to do walking on a slack-line, and then taught himself how to juggle and pick up marbles with his left foot crossed over his right foot. And he was doing all these sorts of things, and that highlighted, at different various ages, there’s still the ability of the body to retrain and to, I suppose, harness neuroplasticity. And so, the reason why I put that together is because proprioception really is a fundamental component of this neuroplasticity component or the subject that we talk about.
Carlo: Certainly. I guess going back to your point about ages and neuroplasticity and that it continues through the span of life, I certainly couldn’t agree with you more on that. I guess what has to happen, and one that becomes a bit more challenging as we get older, is you need couple of key ingredients for neuroplasticity. You need to be engaged, so you need to have someone that is willing to be involved and willing to change. It needs to be progressive, so your therapy or what you do needs to change and be graded based upon the level that they’re at, and always there’s like a 5% or 10% amount that you want to go a bit over and above where you are at, because the brain relishes that opportunity to change. It certainly doesn’t like doing the same thing over and over. So your therapies or your treatments or your exercise, there needs to be that progressive aspect to it.
And the final thing, novelty. There needs to be something that the brain goes, “Ooh, this is different. How do I navigate around that? How do I learn that? What resources do I need to pull in my brain to be able to accomplish that task?” So, those things, as long as you have them, and that’s not age-dependent. We just seem to find that obviously, as we get older, they tend not to be as dominant, but they’re required. And as long as you have those key ingredients, I’m confident that no matter what age you’re at, you have the capacity to change, or you have that neuroplasticity capacity to change and to move you to that next level.
So, there’s got to be that buy-in, there’s got to be that what’s in it for me? There’s got to be that drive. There’s got to be that reward of, “Wow, I’ve got to that next level,” Or, “Maybe I can get to the…” I’ll go back to your analogy of golf, “Well, maybe I could get into the seniors.” Because, obviously, you’re at that age, Damian, that seniors is probably… I’m just joking.
Damian: That’s very hard to swallow. It’s so true, but it’s very hard to swallow, I got to tell you.
Carlo: So, if there’s a task or a target that you’re working towards, and obviously, you need to have the substrate, you need to have the good nutrition, you need to have the good rest. You need to give all that. And let’s say that’s all given, if you’d got those three key ingredients, then I’m pretty confident, and I think the literature supports it, that anything is possible.
Damian: I love that. Carlo, I just want to hang on that point for a second, because, where we can take people through this podcast and take them on a little journey in the application of what it is that we’re talking about. Often, as a naturopath and as a chiropractor, I might have recommended to people, and I still do recommend that they go for a 30-minute walk on at least a daily basis. And if they can go and do extra stuff, then that’s fantastic.
But the benefit of that is profound. I also recommend that people do stretching. Stretch your chest muscles out and open your thoracic cage up, and get on a posture pole. Do all those sorts of things to kind of help activate various parts of the nervous system that help to promote repair and restoration, and so on, and so forth. These are all good neurological hygiene things to do.
But when you say that I need to “change it up,” that I need to encourage people to do something slightly different, for the practitioners that are listening to this, what might be a change? What might you think of? Would you say, maybe “Aim to go faster?” Or, would you say, “Take a different terrain,” or would you say, “Maybe do it barefoot?” What sort of things might you suggest in that space?
Carlo: There’s an important concept in neuroplasticity, and one that I use within my research. It’s called context specificity. Context specificity means we do better at what we train most. So if I’m sitting at a desk all day and all I do is do exercises that sit down in a chair, or move my eyes and move my fingers, and so on, that’s not going to translate necessarily to me being a better tennis player.
So, for me to be a better tennis player, I need to add context of holding a racket, standing, translating or transferring from side to side, following something that’s fast, like a tennis ball. As therapists, we should be including these in our patients’ care as well. So that context specificity is really important. Specificity matters. Doing something general is going to give you general improvements. Doing something specific will give you specific changes.
So, whatever that context is… and I’ve had ice hockey players at a semiprofessional level that have come in with concussion, and we’ve done sort of the standard protocols in our office and got them feeling better, their memory, their symptoms have really abated. But they come back to me and say, “You know what? I feel good until I hit the ice and then I feel those symptoms return.” Because it’s the moving, it’s the context of other people movement, it’s the translating on the ice. It’s whatever it might be. So, some number of years ago, I sort of took the idea and said, “Well, let’s try to add therapy in the context of the environment in which you experience these symptoms.” So I started to go to people’s place of work or their sporting arena.
So this guy here, we actually had to do rehab exercises. Him firstly standing with his skates on, holding a stick. And then we got to a point of proficiency there. And then I had to actually go with him to the ice. And we were doing therapy and exercises that were specific to him moving on the ice. Now, I’m not an ice skater, so that was interesting. But nowadays, we use virtual reality in our office that can augment some of these more challenging environments and place someone in the context of what they’re experiencing.
To give you another example, we have many persistent dizziness patients that have issues driving, or have issues in a shopping centre, or in a lift. So, now, we’ve got virtual reality systems that can place people in these environments, and we can challenge or minimise the complexity of the environment, at a 10% increment to where they can handle.
And we basically help the brain adapt, neuroplasticity, so they can be better at integrating that sensory input. So the brain goes, “Oh, okay. You know what? That’s not so much of an issue for me. I feel okay with it.” And their symptoms reduce and they go about their life. So that’s a really important point, that context specificity, and it’s one that I would encourage practitioners of all sorts to give thought to and ask patients, “Where do you experience your issues? Where do you experience your symptoms?” And try to replicate that, if not in the office, outside of the office. Because in my opinion, if we can’t do that, then, really, we haven’t really translated those results as a home run.
Damian: That’s so cool. That’s so cool. And I’m thinking, in my practice, and I know that all those people out there doing nutrition are thinking, “Oh, my gosh, now I’ve got to go to the pub with my patients and teach them how to read a menu. How am I going to get them to choose steak and veggies versus the pasta carbonara?” Kind of thing.
So, there’s a context specificity piece you just spoke to, which I absolutely love and it makes so much sense, Carlo. That’s gold. And essentially what you’re talking about here is neuro-rehabilitation. And so, following on from post-concussion syndrome, for example, or people who are suffering with long-term vertigo, or people having migraine for decades of their life, and children in neurodevelopment, you’re trying to find ways in which you put them into the environment to give them that opportunity to rehab in that space. Is that what we’re talking about?
Carlo: It’s exactly it. And there’s a fine line. It’s not an all or nothing. The brain will basically say, “Okay, that’s too much of a difference from where I am to what you are providing,” and it will either ignore it, or symptoms will be provoked.
So, as the practitioner, it is very important, and you may remember from the course some years ago, Damian, that it’s titrating. It’s providing an incremental increase in what they can handle, and again, I use that 5% to 10% increment, and it’s what they can just tolerate. And the brain learns to go, “Oh, you know what, that’s not such a threat. I don’t feel threatened by that.” Particularly when we look at people that have got anxiety or depression or hyper vigilance type of conditions, which many people do, particularly if it’s a chronic neurological condition.
So last thing you want to do is evoke an emotional response. Last thing you want to do is get someone in that sympathetic dominance state. So providing a very tailored, incremental, progressive, graded therapy is one that, in my opinion, a practitioner should always be aiming to do. And particularly the sticky patients, particularly those that are a bit more sensitive, particularly those that have had, not the great experiences with others or even with your previous care, they’re telling you, “Hey, don’t go too hard. Just use a more blunt instrument rather than a big hammer at the moment, and just be cautious in the way you provide that care.” And home exercises, and obviously, nutritional support, emotional support should all be titrated at that amount.
Damian: Yeah. I’m loving that. I’m loving that sort of gradual approach. And I think there’s a tendency for a lot of practitioners to try and vomit over their patients all of the knowledge that they’ve got and all of things that have got to happen. And so, in a report of findings or in a preparation of a schedule of care, whether it be through nutrition, naturopathy, general practice, chiropractic, physiotherapy, whatever it is, often with the excitement and enthusiasm of a practitioner, we’ll tell our patients way too much information, and go way beyond that 10%, I don’t know, what do you call that? Probably a 10% kind of capacity or shift capacity, or even like… Yeah, that titrating approach is very clever. I really love that.
Carlo, often we hear about chiropractors and other musculoskeletal practitioners affecting the body, affecting the way in which the body perceives pain or the way in which the body can perform, whether it’s with reflexes or whatever else. And to me, this is a brain interaction, but could it be more specific than the brain? Could we be talking about a specific component of just brain function, and where would we go with that? Is this more of a vestibular thing?
Carlo: Yeah. Great question. I think if there’s anything that I know, it’s the brain is not linear. It’s certainly not a one, two, three sort of step scenario, you do one thing, you get this response. There’s too many variables, there’s too many networks at play, there’s too many connections. There’s too many experiences that someone’s had that will alter what we do and what they experience. So, definitely, linear, it’s just not simple. And unfortunately, a lot of traditional care is aimed at that, and it’s just very limiting.
In terms of the areas of the brain or parts of the brain that are involved in this, there are many. Unfortunately, again, there’s never a simple answer. But more recently, there’s a sort of a school of thought that looks at body maps. Maps in our brain that give us an awareness of our surrounding.
And I often teach that almost every issue, at least musculoskeletal-based that we see in practice, with the exception of traumatic injuries like being hit by a car for instance, but let’s put that aside. Most injuries that we see are repetitive strain or load-based injuries, those sorts of things. I am confident that all, if not many of these injuries are due to an alteration between the facts and our reality. So, what we think is happening to what is actually happening, there’s a disconnect. And that disconnect can be in the shape of many things from visual, from vestibular, to proprioceptive. We look at footie players all the time that sprain their hamstring, and we think, “What’s going on there? All he did was kick a ball. He’s probably done that 1,000 times.”
Well, it’s probably because of altered joint mechanics, or altered biofeedback from those proprioceptors. There has been some disconnect with the action of what he’s attempting to do to what actually he did, and there’s a load on the muscle, and the muscle tore. So, we see this.
So, these maps in our body, there’s many of them. The one that most people are familiar with is what we call somatotopic maps. And again, it goes back to that proprioception. Somatotopic maps are these funny looking maps that we have in our brain, in particular our parietal lobe, that have a localisation of our body parts. So if we look at these somatotopic maps, there is an overrepresentation of our hands and our feet in our brain because of the dexterity that we have, because of the precision that we need to have with our hands and our lips. These areas are blown up in our brain. So meaning it’s like a whole…
Damian: Is this homunculus thing we’re talking about?
Carlo: The homunculus. Exactly. That’s a more exact term for that. Correct.
So most people are aware of these somatosensory maps. There’s motor maps as well, which do the opposite, which gives us the control of these body parts based on these regions in our brain. But what most people don’t know is there’s also retinotopic maps. And as the name suggests, they are maps that relate to our vision. So I can close my eyes and I know where things are in space. I can move my eyes precisely in certain directions because my brain has a map of my visual world.
There’s tonotopic maps, or sound-related maps. I can close my eyes and someone can click a finger and I can turn my head or I can identify where that sound is coming from because my brain has an auditory map of where sounds are coming from. And there are other maps.
And there’s also vestibular maps. So I can spin to the left or spin to the right, or I could move forwards or backwards. Again, with my eyes closed, I’m not getting any other sensory feedback, but my brain is recognising that, “Oh, I’m moving forwards” or “I’m moving back,”or “I’m spinning to the right.” When we’re in a lift and we can detect our body moving up and down. We’re in a lift and we don’t see the outside, but our brain is understanding and recognising where our body is.
So going back to your point, these maps are incredibly important. And for many of us, there’s a mismatch of these maps where what we think we are experiencing to what is actually occurring, there’s incongruency, or there’s a sensory mismatch, as they often refer to it.
And many spinal, many peripheral joint problems, many anxiety-based problems navigating, I mean, I could list so many things that one would experience that often are the result of these altered body maps. And as practitioners, our job is really to, as I describe it to patients, we are there to help identify those maps and to help calibrate it, because that’s really what we do. And our spinal adjustments or our nutritional support or our exercise, or our vestibular therapies, or our eye movement exercises, are all aimed at a recalibrating these sensory maps, and typically in combination with each other.
Which is why therapy, in my opinion, should always be very multimodal because you’re hitting all the highlights of the areas that typically we find challenging with people. So, yeah. But you asked me a question and I’m never going to answer it as clean as probably what you expect.
Damian: I’m voting Carlo one for the next PM. That’s a great answer. But that’s just so great, mate. And, again, it’s this contextual piece around helping your patients move through care, not race through care, I think is really great. And it’s very important for people to be mindful of the staging and the stepping out of a person’s care when they come into your care. Help them through it. Offer them guidance and support over a longer period of time, as opposed to trying to just get the job done very, very quickly, because it’s a process.
And there’s a few things actually that you said there that rang true for me, particularly around mapping. I’m sure there’s an olfactory map, like sometimes you’ll smell things and that brings up a memory. So often maybe what you’re talking about, which we might have categorised loosely as memories at some point in our life, maybe this is that mapping thing, or is that something that’s similar to that? Would I be right in thinking that?
Carlo: Certainly, memory, and olfaction or smell are very, very primitive in our developments as humans and embryologically. I don’t know if there’s a localisation map as such, but certainly memory are incredible. I mean, all of us will have had some experience where we walk past a shop and we smell something like a bakery shop, and we immediately cast our mind back to our grandparents, our grandmother making this particular cake at age five. And the emotion that that brings back.
Damian: So that’s different.
Carlo: Again that’s a double-edged sword. There are times when we smell things, and it may remind us of burnt rubber of when we were involved in a car accident and we’ve got a very strong visceral response to that. So, again, it goes both ways. But olfaction and memory are hard-wired together.
Damian: Carlo, I want to switch into a subject that you are very passionate about, and you are an expert in this space. And I’d love for us to delve into the vestibular system and really understand a lot of our patients will be suffering with migraine, a lot of our patients will be suffering with vertigo, Meniere’s disease, for example. And I’d love to really understand more about the vestibular system.
And so, I’ll just start with a question, is the vestibular system dizziness only? I know it maybe sounds very simple, but is it only dizziness that the vestibular system deals with?
Carlo: To answer your question, no. And even dizziness, we’ll almost need to unpack the word dizziness because, again, what people describe as dizziness may not be necessarily how we like to define it.
But, no, the vestibular system, because of its broad and extensive connection to almost every part of the brain, many of these parts of the brain aren’t necessarily related to what we would term as dizziness. So there’s obviously a strong component to it, and if someone presents with dizziness, vestibular system is one that we need to unpack further. But, no, they’re not necessarily interchangeable as such.
Damian: It’s great, because it makes the vestibular system massive. Like, it’s not just this tiny little area that’s kind of in the ear area. It becomes big.
Carlo: It’s a great question, and one that I’m so happy you asked because it’s one that I teach almost, one of my first few slides when I teach is just to get people’s attention to know, “Hey, the vestibular system is not just about dizziness or not just about tiny rocks in the ears.” At 25 weeks gestation, so in utero, bub is developing in mum, at 25 weeks gestation, the vestibular system, the organs that help us understand how we’re navigating in the world are fully developed. I’ll repeat that.
Carlo: At 25 weeks gestation, the vestibular system is 1 centimetre cubed in size and it is adult size.
Carlo: Now, it’s not fully functional, but it is anatomically developed and there is no part of the brain, particularly at birth, that is adult size or even close to it at 25 weeks.
So, to me, when I tell people that, and one of the reasons we have that is one of the most primitive actions that a foetus has just after that age is the capacity to rotate and move. And that happens because of the vestibular system starting to become active, starting to orientate itself in mum’s womb and know where up is, where down is, and how move away from threats. So it is a very primitive action.
Now, think of it. If it’s developed at full adult size at 25 weeks gestation, unlike anything else that’s happened, even the other part of the brain are not developed at maturity at that age, it must tell us of how important the vestibular system is in terms of our neurodevelopment as a bub. And it can’t be by accident. It’s not by accident.
Damian: No. No.
Carlo: So if it’s there at that age, then it really serves an important role. And we see that during the first few months and years of age, everything’s about orientation, it’s about knowing where am I? Lifting their head up, turning their head, looking with the eyes, developing spinal muscles. These are all primitive reflexes. These are all vestibular driven responses. Attachment, social engagement. These are all, again, really important, and it’s driven in a lot of part by the vestibular system. So the vestibular system is not just what happens in the inner ear. It’s broad connections to many other parts.
Damian: That’s so cool. 25 weeks. It just blows my mind. It blows my mind. And it blows my mind for such a number of reasons, particularly in and around… actually, you said something which I love, and that is, that it’s not by accident. And I don’t think there’s much that happens that grows in the body by accident. Even an appendix, I don’t think is an accident. I think that’s really important. A lot of people just whip these things out and go, “Oh, you don’t need it anyway,” but you do.
Anyway, I digress, but I’m thinking about the vestibular system. Obviously, it’s involved in that very early, and it’s developing and feeling presence and position sense in utero, in a gravity-less environment, more or less, in a tight environment inside the mother’s womb. There’s movement, but it’s very limited. But there’s so much happening.
What happens, because this sounds so important in the development of a child, the development of a human being, what happens after birth? What happens to this vestibular system after birth? What if someone’s just lying on their back all day, every day when they’re born?
Carlo: Yeah. Unfortunately, like every other part of the body, it responds to our environment and it will grow and it will learn, it will navigate, it will make mistakes and learn from it. So, that only occurs with experience, and when placed in, again, graded, progressive, novel environments. And laying on your back or in a Bumbo or strapped into something and too worried about something’s going to occur, will make a difference to a baby’s development.
And for any of your practitioners that see kids or have seen kids, if we go through their history, parents come in with their Blue Books and we look at their development at certain ages and we see, “Oh, wow, Johnny doesn’t like tummy time,” or “Johnny didn’t roll over,” or “Johnny couldn’t sit independently,” or “Johnny couldn’t crawl.” These are all milestones and landmarks that we use to say, how developed is the brain? And invariably, you’ll see that the vestibular system is intricately involved in that development, or lack of, based on movements. So this is why trampolines and climbing and rumbling and rolling over and…
Carlo: Well, being a kid.
Carlo: I’m confident, and I’m sure you would agree with this. I’m confident that many of the kids that we see in practice are living in an environment that is somewhat different than what you and I, and probably the older people have experienced, in that we learnt the hard way. We climbed up trees, we had playgrounds where you fell, you got hurt, and you got up and you did more. It wasn’t all padded. It wasn’t all cordoned off because it was dangerous. And I feel that I think a lot of…and a lot of that is vestibular-based. The spinning and the climbing and the moving the head and focusing as I move my body, as I ride a bike, as I…these are all very vestibular-centric activities.
So we spend a lot of time, unfortunately, with care and just reprogramming some of the things that are being missed just in normal development. And, don’t get me wrong, there are many kids that obviously that’s not the reason. There are other genetic or acquired conditions that that’s not the case. But for a good many people, I think that we’ve missed a lot of those early steps. And a lot of it is vestibular and movement-based.
Damian: It’s so important just to consider that and the movement. And I know that as a dad, I used to just wrestle with my son, Jackson, and I’d roll and tumble, and do it very safely. But of course, roll and tumble and throw him around and all those little things that I used to have done to me when I little boy, and just passing that on through the generations. I do see a lot of people who try to wrap their children up in cotton wool, don’t pass them around to other people, don’t let them crawl near tables just in case they bump their head. But these are all such important little steps and stages for children to develop their brains.
But at the other end of it, at the other end of the nervous system in terms of age and years, we see lots of things happening these days. There’s motor neuron disease, we’ve got Alzheimer’s, dementia, we’ve got all these neurodegenerative diseases that are going on. Is there much that we can do to prevent that? Is there much that we can do to treat that and manage that in our practices? What can we be doing to help people as their brains are ageing? What can we be doing to assist them in maintaining the health of the spine and the nervous system?
Carlo: Great question. And I think one that, again, requires a very broad answer in that there’s lifestyle, there’s nutrition, there’s proper sleep, there’s purpose in life. There’s the relationships we have with ourselves and others, there’s a lot of emotional… So putting all those aside for the moment, and not for a moment am I saying that they’re not important, but they certainly are. But I guess where my focus is, is probably more on the rehab aspect.
Again, going back to the vestibular system and its connections, we know, and there’s a lot of good evidence to say that there’s strong connections between the vestibular system and our frontal lobe, which is our cognitive, our executive function part. It’s our attention and focus. It’s our decision-making. So, there’s strong connections there. And when we’re seeing whether it’s an associative or a correlative or a causative type of relationship, the jury’s still out on that. But there’s certainly a connection between the vestibular system and high cognitive function.
So there’s been some good papers that have looked at vestibular therapy. So movement-based therapies, therapies that involve balance and coordination and left, right integration. Crossbody exercises, eye movement exercises, spatial awareness exercises, that has had a profound effect, a significant effect on people with dementia, Alzheimer’s, frontal lobe atrophy, obviously, stroke and those sorts of conditions as well.
So, there’s good supporting evidence to say that those therapies, again, the more targeted, more context-specific the better, can make a big difference. I mean, things like the Nintendo Wii Board was, I think, a recommendation now in a lot of nursing homes to help people combat Alzheimer’s. Because, again, there’s an engagement part. There’s a, “Oh, I want to do better. I want to move to the next level.” So there’s a dopamine reward system that goes with it which comes from the brain stem, and that frontal lobe just is bathed in those receptors.
There’s the engagement with other people. You can compete against your colleague. There’s spatial navigation. You’re navigating a figure on the board through a tunnel or through a maze. There’s eye movements. There’s sound integration in that as well. So there’s so many things that tie in a lot of these more complex conditions. And I’m not necessarily saying that it’s reversible or a cure to these conditions, but certainly, we approach it with our patients in terms of improving outcome measures. And that outcome measure may be balance, it may be self-rated questionnaires about stress and about confidence of life. It might be about walking up and down stairs and the strength that we have. There’s many outcome measures that we can use, and these therapies help that.
Again, not necessarily reversing the condition itself, but certainly making the quality of life. We can improve that. And many family members of people with these conditions are very appreciative that we’ve been able to restore some memory. They’ve been able to understand or identify family members, or have become a bit more independent. And independence to people later in life is a real concern for them. And now we can certainly help them with that.
Damian: Yeah. Oh, gosh, this is such a big meaty topic, and I think we could probably keep on talking for hours and hours about how we can train the brain and rehabilitate the neurological system, particularly with reference to the vestibular system. And I’ve learned how important the vestibular system is.
And I want to, very quickly just before we finish, we did touch on the nutrition. I mean, I was always under the impression that the brain needed very specific things. It needs oxygen, stimulation, and sugar. That’s kind of what I learnt in uni, that’s what I kind of took away. But is there anything specific that you might be using in practice that you might be thinking about, that people would require for a healthy vestibular system or a healthy nervous system, Carlo?
Carlo: Yeah, look, I think obviously, aside from the macronutrients and the micronutrients aspect, we know gut health to be extraordinarily important. A lot of the neurotransmitters are produced within the gut. There’s a strong brain-gut connection, as we know, via the vagus nerve. So, ensuring that the gut is healthy is something that we should all be achieving. So that’s, again, a given that that’s occurring.
Inflammation, auto-immunity tend to be big things that we see in practice. So, we certainly want to make sure that they’re run through the appropriate channels and people to assess that. And for most people, it’s definitely more than just your standard blood test that most people would be getting from their GP. Although it’s a good place to start, it’s generally not enough to identify these things.
So, autoimmunity inflammatory. And then from that, nutrition can be obviously more accurately prescribed, and whether it be anti-inflammatories or brain-based, turmeric is a great one, resveratrol is a great supplement that we often suggest. Things like huperzine, medicinal mushrooms, are great ways to shift people out of that fight and flight state into a more of that parasympathetic dominant state.
The other things that I often look at with patients is blood sugar handling issues and iron-related issues. So you mentioned fuel and oxygen and glucose and things. Sure. But we need to make sure that what carries that to the brain is not impaired. So we often look and dig deeper on those aspects, particularly if their history is indicating some blood sugar healing issues or some oxygen-carrying capacity issues.
So, I think I often, before I start getting into the specifics of nutrition, I want to rule out things like autoimmunity, particularly, again, the history can guide you on that, any inflammatory conditions. If there’s a history of concussions, inflammatory issues are a real problem. So you want to look at that blood sugar, blood oxygen-carrying capacities, metabolic components that relate to thyroid also make a difference.
So, again, it’s never a simple answer on that that I could give you, but essential fatty acids, keeping in mind the composition of all the neurons. We are very big on phosphatidylserine, phosphatidylcholine as being precursors and requirements. We’re big proponents of a ketogenic diet, particularly for those that have had a concussion. It can certainly help calm down glial immune responses in the brain post-concussion.
So, it depends on the person. It depends on what we suggest, but typically moderate carbohydrate, high, good quality protein, a high-fat diet. Again, good quality fats. Things that we recommend, some nootropic type of supplements like your medicinal mushrooms, your huperzine, green tea extract could be good as well. A ketogenic-based diet and ensuring that we’ve got all the adequate components that ensure the brain is getting the fuel and supply that it requires.
Damian: My gosh. You can see, and I think everyone who’s listened to this, that’s amazing, Carlo. You can see how important it is to be co-managing in these sorts of spaces. It’s very important for us to be working with multi practitioners and different skill sets. It’s not just up to the chiro. It’s not just up to the GP. It’s not just up to the naturopath. We’ve all got to be working together in this space. And you can imagine if you’re a patient and you need all of these levels of intervention, how important it is to have professionals that are keen to work together. It’s so important. And, Carlo, you’ve driven that home beautifully today, and your knowledge is unbelievable, unparalleled.
So, Carlo, thank you so much for joining me today. I’ve thoroughly enjoyed interviewing you and chatting with you, and I know that our listeners will have got so much from you. Thank you, mate.
Carlo: Thank you, Damian. Yeah, it’s always a pleasure. And we can always continue on, but thank you and the audience for the opportunity to have the chat.
Damian: Thanks, Carlo. Now, to get more information, head to brainhub.com.au.
Thanks, everybody, for listening today. Don’t forget that you can find all of the show notes, transcripts, and other resources on the FX Medicine website. I’m Dr Damian Kristof. Thanks for joining us.
Released April 7th, 2022.
Original Source: https://www.fxmedicine.com.au/podcast/vestibular-system-more-just-rocks-your-head-dr-damian-kristof-and-dr-carlo-rinaudo