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)
Revive Neurological Suite
- – Videonystagmography (VNG)
- – Vestibular Testing
- – Medical History Assessment
- – Metabolic assessment
- – Neurological Exam
- – Psychiatric / Neurocognitive Assessment
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)
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) 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.
- Enhancing memory performance with rTMS in healthy subjects and individuals with Mild Cognitive Impairment: the role of the right dorsolateral prefrontal cortex
- Non-invasive Brain Stimulation in the Treatment of Post-stroke and Neurodegenerative Aphasia: Parallels, Differences, and Lessons Learned
- The treatment of fatigue by non-invasive brain stimulation.Role of the Human Medial Frontal Cortex in Task Switching: A Combined fMRI and TMS Study
- Transient Storage of a Tactile Memory Trace in Primary Somatosensory Cortex
- Effects of Low Frequency Repetitive Transcranial Magnetic Stimulation (rTMS) on Gamma Frequency Oscillations and Event-Related Potentials During Processing of Illusory Figures in Autism
- Low-Frequency Repetitive Transcranial Magnetic Stimulation (rTMS) Affects Event-Related Potential Measures of Novelty Processing in Autism
- Transcranial magnetic stimulation provides means to assess cortical plasticity and excitability in humans with fragile X syndrome and autism spectrum disorder
- Adults with cerebral palsy: a workshop to define the challenges of treating and preventing secondary musculoskeletal and neuromuscular complications in this rapidly growing population
- rTMS: Updates in the Treatment of Spasticity Associated With Cerebral Palsy
- Interhemispheric Balance in Parkinson’s Disease: A Transcranial Magnetic Stimulation Study
- Cognitive Training and Noninvasive Brain Stimulation for Cognition in Parkinson’s Disease: A Meta-analysis
- Effectiveness of high-frequency repetitive transcranial magnetic stimulation in patients with depression and Parkinson’s disease: a meta-analysis of randomized, controlled clinical trials
- Using non-invasive transcranial stimulation to improve motor and cognitive function in Parkinson’s disease: a systematic review and meta-analysis.
- Follow up study: The influence of rTMS with high and low frequency stimulation on motor and executive function in Parkinson’s disease.
- Repetitive transcranial magnetic stimulation combined with cognitive training for the treatment of Alzheimer’s disease
- Treatment of Alzheimer’s Disease with Repetitive Transcranial Magnetic Stimulation Combined with Cognitive Training: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study.
- Repetitive Transcranial Magnetic Stimulation as an Alternative Therapy for Cognitive Impairment in Alzheimer’s Disease: A Meta-Analysis
- Effects of noninvasive brain stimulation on cognitive function in healthy aging and Alzheimer’s disease: a systematic review and meta-analysis
- Modulation of a brain-behavior relationship in verbal working memory by rTMS
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.
- Hyperbaric oxygen therapy for brain injury, cerebral palsy, and stroke.
- Hyperbaric oxygen – its mechanisms and efficacy
- Hyperbaric oxygen therapy may improve symptoms in autistic children
- Randomized trial of hyperbaric oxygen therapy for children with autism
- Study the effect of hyperbaric oxygen therapy in Egyptian autistic children: A clinical trial
- Neuroprotective effect of combined therapy with hyperbaric oxygen and madopar on 6-hydroxydopamine-induced Parkinson’s disease in rats
- Hyperbaric Oxygen Pretreatment Improves Cognition and Reduces Hippocampal Damage Via p38 Mitogen-Activated Protein Kinase in a Rat Model
- Hyperbaric Oxygen and Ginkgo Biloba Extract Ameliorate Cognitive and Memory Impairment via Nuclear Factor Kappa-B Pathway in Rat Model of Alzheimer’s Disease.
- Hyperbaric oxygen therapy for multiple sclerosis.
- Regional gray matter atrophy and neuropsychologcal problems in relapsing-remitting multiple sclerosis.
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.
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.
- Clinical Use of Neuromuscular Electrical Stimulation for Children With Cerebral Palsy, Part 1: Lower Extremity
- THE USE OF THERAPEUTIC ELECTRICAL STIMULATION IN THE TREATMENT OF HEMIPLEGIC CEREBRAL PALSY
- Effect of Neuromuscular Electrical Stimulation during Gait in Children with Cerebral Palsy
- Action mechanisms of transcranial direct current stimulation in Alzheimer’s disease and memory loss.
- Temporal cortex direct current stimulation enhances performance on a visual recognition memory task in Alzheimer disease.
- Non-invasive neuromodulation to improve gait in chronic multiple sclerosis: a randomized double blind controlled pilot trial
- Transcutaneous Vagal Nerve Stimulation (tVNS): a new neuromodulation tool in healthy humans?
- Working memory improvement with non-invasive brain stimulation of the dorsolateral prefrontal cortex: a systematic review and meta-analysis
- Effects of functional electrical stimulation on gait in people with multiple sclerosis – A systematic review.
- Management of the symptoms of multiple sclerosis using functional electrical stimulation and exercise.
- Effects of functional electrical stimulation on gait in people with multiple sclerosis – A systematic review.
- A Multimodal, Nonpharmacologic Intervention Improves Mood and Cognitive Function in People with Multiple Sclerosis.
- The effects of vagus nerve stimulation therapy in patients with intractable seizures and either Landau–Kleffner syndrome or autism
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.
- Functional brain imaging of peripheral and central vestibular disorders
- Studies of caloric vestibular stimulation: implications for the cognitive neurosciences, the clinical neurosciences, andneurophilosophy
- Effects of vestibular and cerebellar deficits on gaze and torso stability during ambulation
- Vestibular stimulation influence on motor development in infants
- Effects of vestibular stimulation on motor development and stereotyped behavior of developmentally delayed children
- Effects of Vestibular Stimulation on Motor Development of Cerebral-palsied Children
- The influence of rotational exercises on freezing in Parkinson’s disease
- Gaze and viewing angle influence visual stabilization of upright posture.
- Vestibular stimulation influence on motor development in infants
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.
- Transcranial infrared laser stimulation produces beneficial cognitive and emotional effects in humans
- Treating cognitive impairment with transcranial low-level laser therapy
- Cognitive enhancement by transcranial laser stimulation and acute aerobic exercise
- Role of Low-Level Laser Therapy in Neurorehabilitation
Functional Movement exercises and whole body vibration have shown tremendous results in increasing strength and self-awareness, while activating the cerebellum and areas of the parietal lobes.