Introduction

‍Functional Neuroscience is an approach within healthcare that promotes the use of various methods to stimulate physical receptors within the body in order to produce positive neuroplastic change in the nervous system. We within this field attempt to promote one or all four types of functional neuroplasticity. There are at least four major forms of functional neuroplasticity that can be studied in humans: homologous area adaptation, cross-modal reassignment, map expansion, and compensatory masquerade. Homologous area adaptation is the assumption of a particular cognitive process by a homologous region in the opposite hemisphere. Cross-modal reassignment occurs when structures previously devoted to processing a particular kind of sensory input now accepts input from a new sensory method. Map expansion is the enlargement of a functional brain region on the basis of performance. Compensatory masquerade is a novel allocation of a particular cognitive process to perform a task. By focusing on these four forms of functional neuroplasticity, several fundamental questions about how functional cooperation between brain regions is achieved can be addressed (1). What we have noted in the clinical setting for the past several years is that there are many complex cases that require an integrated and more complete approach to care. The trademarked and patented NeuroSolution Methods were born out of this need and are defined to include protocols and modalities that were designed to achieve more sustainable and more rapid results for this more complex demographic of patients. Dr. Brandon Crawford and Dr. Kyle Daigle are the pioneers behind the NeuroSolution Methods. Dr. Crawford’s team located at the NeuroSolution Center of Austin (Formerly the Austin Center for Developing Minds) was the treating facility for this case study.

Functional Medicine is an approach within healthcare that utilizes a more specific and functional approach to healing rather than relying solely on drugs and surgery alone. The functional medicine practitioner will often times first employ nutritional, supplemental, and other lifestyle changes to influence one’s condition. They still may use medication or surgery; often times in combination with various other lifestyle changes or after a round of conservative care. More recently we have seen the rise of the field of Restorative Medicine; some refer to this as Regenerative Medicine. This field is most notably known for the use of stem cells, peptides, platelet rich plasma (PRP), and other similar procedures.

The specific Restorative Medicine modality used for this case study was that of photobiomodulated platelet rich plasma (PRP). This procedure has been pioneered by Dr. Todd Ovokaitys PhD. Dr. Marcella Madera, MD is a neurosurgeon that has continued to develop this procedure. Dr. Madera was the doctor that administered this procedure in this case study. Human very small embryonic-like (hVSEL) stem cells are pluripotent stem cells found in peripheral blood and most tissues, and represent a unique and readily available source of stem cell for regenerative medicine procedures. Other authors have also confirmed the presence of hVSEL stem cells in peripheral blood and that these cells may be envisioned as “cellular paramedics” that are involved in immune surveillance or tissue and organ rejuvenation. It is generally agreed that hVSEL stem cells are a population of epiblast-derived cells created during embryonic gastrulation which further highlights their important role in normal physiology as well as their role in rejuvenation and longevity. The possible role of hVSEL stem cells in disease modulation is under intense study, including research on cardiovascular disease, neurogenesis, Crohn’s disease and even reproductive biology. Given this background, it is clear that hVSEL stem cells play an important role in both normal physiology and disease. An enhanced understanding of how we may improve the biological potential of these cells by using modulated laser light will lay the ground- work for future exciting collaborations between healthcare scientists and quantum physicists to develop a unified understanding of cell biology at the finite level (2) (3).

Photobiomodulation defines the use of various forms of light therapy to evoke a biochemical change within a living organism. Photobiomodulation is the term that has been accepted by the North American Association of Photobiomodulation Therapy (NAALT) that defines the use of non-ionizing light therapy in the form of lasers, LED's, and / or broadband light sources in the visible (400-700 nm) and near infrared (700-1100 nm) electromagnetic spectrum. It is a process that involves exciting endogenous chromophores that create photophysical and photochemical events within biological systems. Essentially the term can be broken down as: Photo = light; Bio = life; Modulation = to alter, change or adjust; therefore, the term literally means to change life with light. Chromophores are receptors for light that are scattered all over the outside and inside our body. Each chromophore responds differently depending on the wavelength of the light.

There are chromophores that control our circadian rhythm and chromophores that produce more ATP within our cells; there are many different types that have various biological effects. Photomedicine goes back over 3000 years ago around 1400 BC in India where they would employ the use of sunlight to treat various ailments. Beginning in the 1700's doctors began to use forms of light therapy to treat infections such as tuberculosis and others, ulcers, cancers and other internal maladies. It was also noted how much the light therapy accelerated wound healing. This really marked the birth of photobiomodulation and it's use in modern medicine. Albert Einstein was a leading pioneer in the field of photobiomodulation. He was actually awarded a Nobel Prize in Physics for defining the law of the photoelectric effect. The photoelectric effect occurs when photons collide with eletrons at the atomic level; this causes the electrons to either jump into a higher orbit or causes them to be emited or ejected from their orbit. This process allows for more energy to be emitted and absorbed by the surrounding matter; thus raising the voltage of the tissue which speeds up healing. Photons are the smallest meaurable unit of light; they are defined as massless packets of energy or quanta. The energy of the photon depends on its wavelength and is measured in electron volts (eV). For example a red photon has about 2 eV of energy where a blue photon has about 3 eV of energy.

Summary of Patient Presentation

Gender: Assigned Male at Birth
Date of Birth: October 31, 1985
Date of Exam: October 24, 2022
Onset of Symptoms: Insidious over past 20 years. Previous, failed L5/S1 discectomy noted 20 years ago. Symptoms exacerbated suddenly October 2, 2022 after a 3 mile run.

Patient presents in intense pain that he rates a 9/10. Pain travels down the left leg predominantly in the S1 dermatome. Pain will at times refer into the left testicle.

Patient can ambulate slowly. Patient reports that the pain has affected multiple activities of daily living including sleep, work, intimacy, sitting, and walking.

Previous to this onset of pain patient was rather active and healthy with no major health concerns or limitations. He would typically run 5-15 miles per week. Diet is mostly organic whole foods. Patient lives a rather healthy life, but does admit to a high amount of stress that is mostly work related. Dehydration is admittedly a chronic problem coupled with excessive caffeine/coffee consumption.

Current treatment involves NSAID use of Advil at 900 mg - 1200 mg per day. Previously tried manual therapies via an Arrosti clinic. No consistent chiropractic care was performed but he did have “a few” adjustments over the past few weeks.

Sensory

Hypoesthesia noted in left S1 dermatome at the lateral aspect of his foot and sole of his foot.

Motor

Lower extremity strength is assessed to be 3/4 on the left in the S1 myotome (gastrocnemius / soleus). All else WNL.

MSR

Reduced S1 reflex on the left graded 1-. All else WNL graded as a 2.

Blood Flow / Pulses

Lower extremity pulses present and equal to palpation bilaterally. Left extremity noted to have a cooler temperature at the foot 95.5 degrees vs 97.0 degrees.

Orthopedic Tests

• ‍+ Straight Leg Raise Left and Right leg
• ‍+ Valsalva

Facial Tone

• Reduced tone right

Pupils

• Right pupil larger and less reactive to light (history of Horner’s Syndrome)

Core Tone

• Prone Plank: Cannot perform due to pain
• Supine Plank: Cannot Perform due to pain

Primitive Reflex Evaluation (graded 0-4 with 4 being most positive)

• Rooting: 0
• Palmer: 0
• Babinski: 1 bilaterally
• Tonic labyrinthine: 0
• Asymmetric Tonic Neck Reflex: 1 bilateral
• Symmetric Tonic Neck Reflex: 0
• Moro: 1
• Fear Paralysis: 0
• Spinal Galant: Muscles guarding
• Spinal Perez: Muscles guarding

Postural Reactions

• Head righting: Present

Cerebellar Tests

• Rhomberg: Mild sway right
• Fukuda: Mild right turn
• Finger to Nose: WNL
• Heel to Shin: Difficult to perform with left leg due to pain

Cortical Soft Pyramidal Signs

‍Left, as noted by increased flexor tone down left side of body, reduced blood flow as assessed with temperature disparity left vs right foot, personality, and social characteristics.

Lumbar Spine MRI was completed on 10/25/2022, relevant findings

• L5/S1: 8 mm left paracentral disc extrusion that causes severe compression of the left S1 nerve root and mild central canal stenosis.
• L5/S1: “Large blooming artifact” noted as post surgical scar tissue from previous L5/ S1 discectomy 20 years prior.
• L4/L5: 4.2 mm central disc protrusion causing mild central canal stenosis.
• L3/L4: posterior annular fissure with a 1-2 mm annular bulge with mild impression on the anterior thecal sac.
• Disc degeneration noted at L3/4, L4/5, L5/S1

Initial assessment and therapy began at the NeuroSolution Center of Austin

• Sensory stimulus to include vibration and heat on the right leg, arm and right side of the spine
• Proprietary Vagal System Stimulus via pulsed radio frequency delivered via the Stimpod through Bilateral Cymba Concha in the ear targeting the auricular branch of the vagus nerve
• Pulsed Radio Frequency Stimulus via the Stimpod to the Left L5 and S1 myotomes
• Neurosage Therapy: Performed 1 round of Brick Breaker game for left hemisphere stimulation while standing with the right leg only on the vibe plate set at 30 hz while the left leg was on a Bosu ball.
• Photobiomodulation performed via co-activation as defined in the Crawford Theories for Co-activation. Therapy was performed with 4 NeuroSolution therapy lasers and included the following: Pro IR 2800 mW of 808 nm wavelength, Pro Red 2000 mW of 637 nm wavelength, Z model 1000 mW of 637 nm wavelength and 1400 mW of 808 nm wavelength, and Revi (violet) 500 mW of 405 nm wavelength. Areas of laser therapy included: Carotid arteries, vertebral arteries, abdominal aorta, Lumbar spine, left glute, left hamstring, left calf, left foot. Right Cerebellum with co-activation techniques, Left cortex with co-activation techniques.

Assessment was then performed by Dr. Madera in her private practice at Austin Integrative Spine. It was determined that surgery was needed and scheduled for November 11, 2022. In the meantime she recommended performing a round of photobiomodulated PRP. An initial round of photobiomodulated PRP was performed on October 27, 2022. By Monday October 31, 2022 an average pain level of 4-5 was reported; best scores of 1-2 / 10 that would go up to an 8-9 at times. This was a great improvement in such a short period of time; previous scores was an average of 7/10 that would often times rise to a 9/10.

Surgery was performed on November 11, 2022 and included:

• L5/S1 discectomy
• Autologous mesenchymal stem cell administration to L3/4, L4/5 and L5/S1 discs, facets and major muscles / ligaments.

Post surgery pain levels reduced however the following was then present:

• S1 parathesia - intense pins and needles noted in the foot in the S1 dermatome distribution
• S1 radicular pain - more focused at the left calf
• S1 motor neuropathy - MMS now rated a 1/4 in the left calf

Achieved Results

Therapy at the Neurosolution Center of Austin resumed on November 15, 2022 and included more of what was previously described with heavier focus on the pulsed radio frequency of the L5 and S1 myotome, cymba concha stimulus and photobiomodulation. This care continued for 3 hours per week over the next 4 weeks.

An additional round of photbiomodulated PRP was administered on November 18, 2022 with Dr. Madera’s team.

As of today December 27, 2022 the following results have been achieved:

• Pain levels are consistently at a 0/10, at times there will be mild pain in the left calf with certain movements.
• S1 parathesia resolved.
• S1 motor neuropathy resolved - MMS now rates a 4/4 in the left calf.
• There’s no longer any affected daily activities.
• Patient has resumed a near normal lifestyle, just to be care not to lift too much or over exert himself at work.

Follow up exam performed at the NeuroSolution Center of Austin on December 16, 2022 included the following changes in previously positive results:

Sensory

WNL bilaterally in lower extremities

Motor

4/4 bilaterally in lower extremities

Blood Flow / Pulses

Lower extremity pulses present and equal to palpation bilaterally. Both feet measure a 97.3 degrees F temperature.

Orthopedic Tests

• - Straight Leg Raise Left and Right leg
• Valsalva

Core Tone

• Prone Plank: Can hold for 60+ seconds
• Supine Plank: Can hold for 90+ seconds

Primitive Reflex Evaluation (graded 0-4 with 4 being most positive)

• Babinski: 0
• Asymmetric Tonic Neck Reflex: 0
• Moro: 1
• Spinal Galant: 0
• Spinal Perez: 0

Cerebellar Tests

• Rhomberg: WNL
• Fukuda: WNL
• Heel to Shin: WNL

Cortical Soft Pyramidal Signs

Still noted increased left flexor tone.