Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder (PTSD)

PTSD can develop after experiencing or witnessing a life-threatening event such as combat, a natural disaster, a car accident, or sexual assault. PTSD, from a diagnostic standpoint, is typically considered a psychological disorder under anxiety, but new research is challenging this. Understanding how the brain structurally and functionally plays a role in the development and symptoms of PTSD offers much more promise for treatment.

Signs and Symptoms

PTSD patients often suffer from symptoms including anxiety, depression, and concentration difficulty. Symptoms of PTSD are the result of chemical changes in the brain caused by an increase in autonomic drive. Other symptoms commonly reported by PTSD patients include abnormal laughing and crying, aggression, impulsivity, irritability, fatigue, anger, anxiety, loneliness, nausea, persistent headache, depression, and post-traumatic seizure, and suicide.

What Is PTSD?

PTSD is classically viewed as a disorder in which a person has difficulty recovering after experiencing or witnessing a terrifying event. Within the worldview and paradigm of clinical neurology, PTSD is an adaptive response to traumatic events which creates a heightened sensitivity of brain regions involved in producing the natural stress response. This is a great example of negative neuroplasticity, where the brain just got too efficient at detecting stress to the point where, even in harmless situations, a threat or danger is perceived.

Any psychological disorder at its core really a neurochemical issue, which is why most traditional treatments are aimed at neurotransmitter levels. We know from research that PTSD is not purely a neurochemical issue, but results in structural alterations as well. This would create a basis for it being considered a primary neurological disorder with psychological characteristics.

Unfortunately, the majority of individuals diagnosed with PTSD are sent to psychiatrists to be treated for anxiety, depression, and other emotional signs. This works for a few, but unfortunately, the majority have pervasive symptoms. Understanding how the brain structurally and functionally plays a role in the development and symptoms of PTSD offers much more promise for treatment.

Revive's Treatment Options for Post-Traumatic Stress Disorder (PTSD)

1Level 1: Standard Revive Treatment Suite

Level 1 Post-Traumatic Stress Disorder (PTSD) Treatment Package: Revive’s Standard Treatment Suite

Diagnostics

– Videonystagmography (VNG) testing for eyes

– Vestibular testing

– Full history exam

– Metabolic assessment

– Neurological exam

– Psychiatric exam

Neurological Rehabilitation Treatments

– Repetitive Transcranial Magnetic Stimulation (rTMS)

– Eye Therapy

– Electrical Stimulation (ReBuilder, SSEP)

– Functional Movement Therapy

– Vestibular Therapy (GyroStim)

– Cold Laser Therapy (Low Level Laser Therapy – LLLT)

– Sensory Motor Integration (SMI)

– Meditation / Breathing Coaching

– Hyperbaric Oxygen Therapy (HBOT)

Post-Care

– Specialized Supplement Package

– At-Home Exercise Videos

– Dietary Recommendations

– Follow-Up Phone Calls, Video Call, Coaching

2Level 2: Standard Revive Treatment Suite + Infusions

Level 2 Post-Traumatic Stress Disorder (PTSD) Treatment Package: Standard Suite + Infusions

Standard Revive Treatment Suite (see Level 1)
Intravenous Infusions
– NAD+
– Nutrient Therapy (Fast Vitamin)

3Section

Level 3 Post-Traumatic Stress Disorder (PTSD) Treatment Package: Standard Suite + Infusions + Regenerative Cell Therapy

Standard Revive Treatment Suite (see Level 1)
PTSD Infusion Package (see Level 2)
Regenerative Cell Therapy

Our Approach to Diagnostics and Testing

Revive utilizes research-based diagnostics to evaluate function in specific areas of the brain. Looking at eye movements, motor function, sensory function, cranial nerves, cognitive function, balance, and gait. This information allows us to better understand what areas are affected so we can develop a treatment plan that targets those regions and networks to make them stronger and more efficient. These tests include eye movements, motor function analysis, physical exam, cognitive ability and balance.

The VGN or testing of eye movement gives us a representation of the function of eye muscles, cranial nerves, brainstem nuclei, cerebellum and cortical regions. By measuring things like gaze stabilization, smooth pursuits, saccades, and optogenetics it helps us to differentiate the areas of weakness.
Motor function analysis enables us to see the strength, tone, and coordination of the movement of muscle groups so we can better understand the regions and networks of involvement. Networks that are utilized in a movement are the coordination of movement involve the frontal lobes, parietal lobes, and the cerebellum.
In our office, the physical examination is focused on not only finding definitive signs of functional deficits but also catching the subtle changes which give us greater insight into the physiology and function (these findings are often considered irrelevant or ‘within normal limits’ in most conventional clinical settings).
Cognitive testing is utilized as a baseline marker to measure and monitor patient outcomes. These quantifiable tests validate results in many different avenues. Our testing encompasses depression screening, anxiety screening, verbal memory, psychomotor speed, processing speed, simple attention, and motor speed.
Balance test or vestibular testing gives us an insight into the function of networks that are needed for standing, walking, even riding in a car. We look at the three main factors of balance (Vestibular, proprioception, and vision) both together and individually to isolate the areas of involvement.

Our Approach to Care

At Revive we specialize in providing treatment to the neurological regions affected by PTSD. Your treatment can include balance, gait, and eye training; as well as hand-eye coordination, repetitive transcranial magnetic stimulation (rTMS), hyperbaric oxygen, diet, and supplements.

We offer a unique process that is built to maximize time and results. To reach your personal healthcare goals, it is imperative that your physicians and care providers precisely know your individual story and desires. Your individual goals are the focal point of the comprehensive treatment plan which is based off your exam, diagnostics, and lab results.

Beyond the neurological system, there are many factors that can impact the presentation of PTSD: the immune system, diet, sleep, and stress (to list a few). By integrating knowledge of the brain and influence of these factors, we are able to be very specific with targeted therapies which create lasting neurological changes. Your treatment plan is designed specifically for you and is not a protocol.

This plan is executed over 5-10 days. Patients see measurable improvement during their time in our office and continue to make gains once they leave. To help ensure success on your journey of healing, we create and define a plan for you when you go home. This plan may include sourcing local specialist for a safe and effective continuum of care. Our goal is to see each patient continue to build upon the initial results they achieved in our office.

Research On our Treatments

Repetitive Transcranial Magnetic Stimulation (rTMS)

Repetitive Transcranial Magnetic Stimulation (rTMS) sends a magnetic waveform through the skull that depolarizes the brain cells. rTMS can be directed at specific regions of the cortex to cause activation of the neurons in the area.

Hyperbaric Oxygen Therapy (HBOT)

Hyperbaric oxygen therapy (HBOT) is the medical use of oxygen in a pressurized environment, at a level higher than 1 atmosphere absolute (ATA). Increased pressure allows for oxygen to dissolve and saturate the blood plasma (independent of hemoglobin/red blood cells), which yields a broad variety of positive physiological, biochemical and cellular effects. This noninvasive therapy is the most trusted way to increase oxygen levels to all organs of the body. The typical treatment lasts for 60-90 minutes, during which the patient lies down and breathes normally. HBOT has been demonstrated in several clinical studies to enhance the body’s innate ability to repair and regenerate. It is used as an adjunct therapy to complement and enhance the healing process in both chronic and acute conditions.

Hyperbaric Oxygen Therapy (HBOT) has been shown to increase oxygen saturation to tissues and increase the amount of stem cell production and circulation. This allows for the greatest potential for healing in the brain.

Electrical Stimulation (SSEP, ReBuilder)

We utilize Electrical Stimulation (E-stim) in many different waveforms to increase strength, increase self-awareness, decrease spasticity, and active brainstem neurons.

Somatosensory Evoked Potential (SSEP)

SSEP utilizes a non-invasive electrical current that, when applied directly to certain nerves in the face and body, can stimulate and upregulate areas of the brain affected by traumatic brain injury, stroke, neuropathy, or neurodegenerative disease. Based on each patient’s extensive diagnostic testing, Revive‘s doctors create a treatment plan that targets the exact nerves that will activate the lobes and systems in the brain affected by the patient’s condition. Some cranial nerves that are often stimulated by SSEP are the hypoglossal nerve (Cranial Nerve XII) and the trigeminal nerve (Cranial Nerve V) for neurological conditions. For many of our stroke and TBI patients learning to walk again, we utilize our gait protocol. Our gait protocol stimulates the saphenous nerve and tibial nerve in various places in the leg(s) affected by the stroke, priming the neural pathways with electrical stimulation in order to increase communication to and from the brain, optimizing our patients’ ability to re-develop these damaged neural pathways.

AL-TENS is a form of hyperstimulation described by Sjölund and colleagues in the 1970s. It can be used if patients do not respond to conventional TENS (5). IASP defines the characteristics of AL-TENS as “Low-frequency (2–4Hz), higher intensity (to tolerance threshold), longer pulse width (100–400μs)” (4). Low-frequency trains or bursts (2–4Hz) of high-frequency pulses (100–200pps) are often used in clinical practice. The intention of AL-TENS is to stimulate small diameter, high threshold peripheral afferents (A-delta) in order to activate extrasegmental descending pain inhibitory pathways. Non-painful muscle twitches occur during stimulation causing activity in small diameter muscle afferents (Fig 2b). Electrodes are positioned over myotomes, trigger points, and acupuncture points. The term AL-TENS is used loosely in literature making the synthesis of research findings difficult.

ReBuilder

In effect, the ReBuilder acts like a pacemaker works for your heart’s electrical signals. If the pacemaker does not send exactly the right signal, then the four chambers of the heart may not pump in the right order and if the signal is too fast or too slow, the heart stops. So, too, the ReBuilder’s precisely controlled waveform coaxes your nerves to transmit their signals in the proper order. Although designated as a TENS relative to the FDA’s regulations, the ReBuilder’s signals are vastly more controlled and precise.

The ReBuilder is typically used on patients as a neurological intervention to help with cortical remapping. If the brain is unsure of where the feet are in space after a stroke or other biomechanical event, the ReBuilder can help strengthen those signaling pathways. Additionally, vagal stimulation or gait protocols may be used for similar reasons.

Vestibular/Rotational Therapy (GyroStim)

Vestibular/Rotational Therapy is a very powerful tool in the world of neurological rehabilitation. When we look at brain development we see that movement drive brain growth and one of the most important areas for sensing movement is the vestibular system. When we utilize rotational therapy to active the vestibular system we see an increase in activating in several cortical regions. Our multi-axis rotational device (GyroStim) utilizes the otolithic and vestibular system to stimulate and strengthen projections throughout the brain. By utilizing a controlled directional spin in our multi-axis rotational device, we can activate specific regions of the brain in order to affect a variety of different disorders.

At lower levels of motion intensity, the multi-axis rotational device is used by those recovering from physical and cognitive dysfunction as a result of a concussion, traumatic brain injury, PTSD, autism, aging, and other conditions. At higher levels of intensity, GyroStim is used by active individuals, athletes, and others with fast-paced, demanding, high-stress lifestyles to maintain and enhance peak performance.

Cold Laser Therapy (Low Level Laser Therapy - LLLT)

Cold Laser Therapy, also known as Low Level Laser Therapy (LLLT), has shown increases in mitochondria production in cells, helping to decrease inflammation and increase healthy cellular activity. When the cold laser is utilized as a transcranial (through the skull) therapy we see an increase in brain activation to the targeted areas.