E 110 Vestibular Research and Dizziness Rehab PhD cand Dr. Carlo Rinaudo, DC

e 110 a doctors perspective carlo rinaudo dc vestibular research phd
Dr. Carlo Rinaudo, DC Phd (cand)talks to Dr. Justin Trosclair DC on A Doctor's Perspective Podcast

Vestibular, ocular, autonomic and dizziness issues, exam findings and rehab with Carlo Rinaudo DC PhD (cand). Managing spinal and MSK conditions with chiropractic and how vestibular rehab affects the nervous system, plus we talk about neuroConnect.

I didn’t know this but in Australia the term Dr is reserved for medical doctors and all others, even Phd’s have to clarify behind their name what type of doctor you are. Also, you can’t just say chiropractic can help headaches and low back pain without having research cited on your website to back up your claims. If you don’t the regulatory board is quick to fine you and require changes.  We discuss some more of those type of nuisances today.

He started out being fascinated by AK and soon realized that most techniques get results and it’s because of neurology.

Is it necessary, clinically, to become a diplomate in neurology (2 year program)? How much of this advanced neurology can actually be used in practice and how much can be used to build referrals from neurologists?

Functional Neurology or Chiropractic Neurology are terms that in Australia will get your license revoked ‘in minutes’ and drag you through the coals.

Some chiropractic techniques are starting to incorporate neurology theories as to how they work but is it cherry picked research?

Why would the chiropractic profession benefit from having the research conducted to be scrutinized by other non chiropractic Phd experts?

Dr. Rinaudo is in the faculty of biomechanical engineering at a university that doesn’t have to do with chiropractic.

The brain and neuro is a window into seeing how the rest of the body is functioning.

The vestibular and ocular system starts when we are so young and connects the autonomic nervous system, balance, cognitive and body awareness system which influences how our spine functions.

PhD clinical trial on a new vestibular rehabilitation technique:  Gait, balance, proprioception, eye movement exercises. He is not advocating to abandon the adjustment nor is he saying all things can be remedied by the adjustment.

Dr. Carlo runs though a mock patient exam with proper questions for vestibular, ocular, vertigo or dizziness symptoms and offers a few pointers for treatment and exercises. Especially this is relevant for whiplash injuries because the three little ear bones, otolith or otoconia, and the crystals can be injured causing dizziness and vertigo.

Dysfunction of the neck changes the signaling and coding to the brain stem. It can alter our eye movement, higher cortical function, balance and more.  

It’s not a cookbook approach in his 4 module NeuroConnect program. Each case will present unique dysfunction and you will tailor a multitude of options for their individual needs. Many of the exercises will function on balance, eye function, proprioception training, inner ear and cerebellum.

He goes through a synopsis of the 4 modules near the mid-end of the episode and I think it will get you excited to visit the website to learn more. For instance: why is that some patients seem to plateau, maybe we hit their metabolic capacity of their autonomic nervous system to heal until you get to a more root cause. How to explain all this neuro stuff so a patient can understand it.

Family: If you go to seminars, take your family.

Books: John Demartini

  – role chiropractors play in dizziness and poor balance conditions

  – the benefit of chiropractic on the brain?

  – a brain based approach to managing spinal and MSK conditions

  – are spinal dysfunctions the result of a local or brain-based problem

Carlo Rinaudo of Sydney, Australia has a neurology diplomate via the Carrick Instutite back in 05-06 and is now a  PhD (cand) in Vestibular Rehabilitation (neuroscience) at UNSW and Neuroscience Research Australia (NeuRA) in collaboration with John's Hopkins Medical University (USA),  has Brainhub website and podcast and  neuroConnect for training other doctors. His main study looks at the adaptation of the vestibular-ocular reflex in patients with vestibular hypo function and the improvements in balance, dizziness, gait and quality of life.

 Dr Carlo Rinaudo, Chiropractor/ Neuro-Rehabilitation Chiropractor – Speaker – Researcher BMedSci(Hons) MChiro ICSSD DACNB PhD(cand)  

email: carlo@brainhub.com.au

website: www.brainhubacademia.com.au

NeuroConnect 4-part series starting in Hong Kong March 2019: https://www.brainhubacademia.com.au/event_landing/neuroconnect-hong-kong/

Show notes can be found at www.adoctorsperspective.net/110 here you can also find links to things mentioned and the full transcript.

Full Transcript of the Interview (probably has some grammatical errors). Just Click to expand

Justin Trosclair 0:06
Episode 110 distributor research and business rehab. I'm your host, Dr. Justin trust where today we're talking to Carlos Fernando respect to 2017 and 2018 podcast Awards Nominated host as we get behind the curtain look at all types of doctors and guests specialties. Let's hear a doctor's perspective.

Back a great guest today he's from Australia, and he was chiropractor for almost 20 years, I guess he's still is. But he's a fascinating story on how he got super excited about distributor vertigo, autonomic nervous system, Peppa neurology. And so he actually decided to go and get his PhD. And he's almost finished, but not quite. And one of the things they're doing is the rehab portion of how to help with vertigo and PvP those types things. He also is a lecturer and he's created his own own programs about a 60 hour for module called neural Connect. And he'll discuss that at the end of the episode. But we're going to go through questions you should be asking your patients especially that like, you're just in the neck, their headaches are getting better, their next still hurts or like they just got this weird posture, you know, questions to ask maybe something more than just the next out. And then of go through, like, oh, here's some of the exam things that you could do. And here's something that you can do about rehab. So he'll give a little bit away. But just really a fascinating story. It's to me, it's always nice to hear what's going on in chiropractic, from a neurology standpoint with the adjustment and been able to broaden your scope and learn something new that you might have interested in. And you might realize you don't have enough skills to be super effective. And now there's an option. So again, you know, roll the chiropractor plays and dizziness and poor balance issues which the aging population that could be super important. Managing Spinal Muscular conditions, brainstorming style, neurology style, and our sponsors functions even are sort of local or brain based problems to begin with. Before we get into the interview, I'm probably remember had a no no acupuncture knee giveaway on top of the normal for that's going are probably is going to be going if you check now it'll be vertigo. So just kind of plug a little bit of the needle acupuncture stuff, obviously it will not take the place of what he's teaching. But if you want a free download, see what points views are some vertigo relief, doctor's perspective, net slash vertigo. All right. All the show notes can be found at a doctor's perspective, net slash 110. Let's go hashtag behind the curtain.

Live from China in Sydney, Australia. Today we've got a PhD candidate in vestibular rehabilitation at the neuroscience of research in Australia. He owns his own site called brain her to podcast as well. He's fallen in love with David or ocular reflects in patients and dizziness with chiropractic. Yes, that's right. He's a chiropractor as well. And he's taking the carrot Institute is deployment of that. So please welcome to the show called Ronaldo. A just a good doctor Carlo Ronaldo.

Unknown 3:12
In Australia a little less formal. So Carlo works works? Well. There's no lab coats in our office. No doctors really casual.

Unknown 3:22
Just you don't have your Well, yeah, it's

Unknown 3:26
you can get in trouble unless you qualify the term doctor in Australia. So unless you're a medical doctor, even even a PhD is generally going to qualify themselves. Post name to say that the array A doctor of chiropractic or paper or a Doctor of Philosophy, so in Australia, where we tend to use just our names, although some we do have the ability to but but it is with a little bit of danger at times.

Justin Trosclair 3:56
So like if you were to introduce yourself at a party, which would be a hot meal, how arrogant.

Unknown 4:03
You have

Justin Trosclair 4:03
data Carlo chiropractor like that, otherwise, you have potentially get in trouble.

Unknown 4:08
Exactly you would anytime you in on your social media, in person or a letter, you would need to qualify the term doctor by writing thereafter Doctor of Chiropractic or or equivalent because a regulation board will look upon that. Not very fondly, because it could be misleading to the public. That would be their turn. Sometimes people just don't, don't bother at all.

Justin Trosclair 4:35
I think one of the two states that I'm a chiropractor in officially, it was the same way you had to put in advertising, you had to put DC of some sort in the back. But that's neither here nor there. I was just giving you a hard time a little bit. That's fun. So good. Okay, so you're a chiropractor for quite a while and give us a little backstory about yourself. How'd you end up switching gears, you know, once you're in practice on this little back to school is kind of crazy and want a family and everything. And then how do you pick vestibular stuff?

Unknown 5:03
Well, I've been in practice, they are going on to 19 years. Actually, before I got into chiropractic, I did a medical research degree, really got into research and are really enjoyed it. But I looked around my peers. And I realized it didn't quite offer the lifestyle that I was looking for. You know, I'm not afraid of doing work. But at the same time, I want to be rewarded for it. I didn't quite see that in the research profession. So I got into medicine, actually, I wouldn't say I was accepted into medicine. And before I started, I had headaches, Judah, my studies, posture and all the sorts of things. And I A friend of mine was working as a CA in a chiropractic office and he said look, why don't you go check out this guy. And this guy had been around for a while very experienced. And I said sure. And I you know, I was a bit you know, to be out there to be wishy washy, give me the hard, good chiropractor, the medical staff. But anyway, I went and I gotta say I was blown away, he did ik work and I was like all fancy stuff at the time. I knew nothing about it, tell you what, it worked beautifully. And I started looking at bit more intuitive started seeing other professionals not perfect not as their patient but started to see what they what they do, what sort of life they lead, did some observation work and I made a speech I changed into Chiropractic

Unknown 6:31
and are still working as a research assistant during the day and I was doing the doing the catch up chiropractic degree at at night, which is the first three years condensed because I had already done a medical science degree. And then And then the final two years were full time master's degree in Australia we have it as a master's degree, got into it and loved it and and really haven't looked back since. And really it was three or four years as being a our practice when I realized I had a lot more question. I love the the neuro. I'm not wasn't very much a a program or systems person. I had questions. Why did this happen? Why do we see this? And so I got into AK because some ways that was my beginnings. And that also raised a lot of questions as well. And from that, I thought, well, how is it that this part is connected to this was that we can do this test and we will hit turn this way or the eyes turn that way we see a certain response. And, and the reality is, is the commonality between that technique and many other techniques is neurology. It was you know, how is everything strung together? How is it that we respond to the environment. And really, it was at that point that I got into neurology. And it took my first course starting in 2004 2004

Unknown 7:52
completed it within the to you to program and then it's been a life changing event from then on. I've since I've taken the course a number of times, and I'll do my own version of it at a at a different level that I was taught to back then. So I haven't I haven't looked back and I've thoroughly enjoyed the ride since

Justin Trosclair 8:13
Would you say that the learn more about the neurology will help the clinical practitioner really excel at what they're doing more, is it really that necessary to go that deep?

Unknown 8:25
Not well, that's that's a great point, the person that I am, and the questions that I had, I wanted to go deep, and it is a very deep rabbit hole. And the truth be told is that it doesn't appeal to everyone. And it's soon doesn't appear a lot of chiropractors. And I think it puts people off learning neurology, and it need not to so you know, having taught the program in similar programs, you know, the first question I get is do I really need to know all of this. And the reality is at the end of the program, it's like, well, you might take only 10% of that information and use it effectively in practice, a lot of it is it's stored, but it doesn't get using, you know, over a period of time you just lose it. So I'm a big advocate of having a theater program was something that is appealing to far more people is more broader is certainly more clinical applicable. And then, you know, at a small percentage of those people that do that will go, oh my god, this is the answer to everything I want to know, I'm now going to go down that rabbit hole, but at the same time, and that's fine. And it will do that. And that's what that's what happened happened to myself. But it doesn't appeal to a lot of people. And unfortunately, many people will look at the new row nerds got all you know, they they are at that level, the two leaders, I don't want to know about them. And it's too difficult. But there's a lot of baby steps that they could take that that will thoroughly enjoy the neuro, they'll thoroughly enjoy the results that they get with their patients without having to invest, you know, 20 $30,000

Unknown 9:58
in a program, travel every second week, every month in spent so many hours studying. I mean, that appealed to me, but certain doesn't do a lot of people. So I think there's a is a condensed program version that is certainly appealing, and I think is something that should also pretty much a big part of the undergraduate curriculum to a level that I don't think he's taught at the moment, I think we're taught a very basic neurology in a pathology model. And I used to teach it at university. But it's frustrating because it's typically not what we see as practitioners, particularly our practice. in office, we don't see the DOD lesions in the heart pathology. Typically, they've already come to us from a neurologist, or I've been doing urologist with a diagnosis of these conditions. And then it's the shade of gray that we see in our office that what can I do to make these patients function better, we know the spinal wouldn't has huge bearing. But it really is. It's not, it's not enough. And we need to open up our Skype to how to assist and manage these patients. And where I think as primary care practitioners, we should be able to have a bigger toolbox to be able to help more and more people. And that's what I'm passionate about, at the moment been interested in the neurology, you

Justin Trosclair 11:09
you get out of school, you go through school, like you said, you kind of like I feel confident in this based on like what I actually will need in a vise catch something that's like would seem right, we send them off to the neurologist, and I've had some people like yourself who have taken the class and that I do it is tough. It's tough. It's hard. And then my thought was, you know, as chiropractors, we get these deployments, but to the outside professions, they're like, I don't care. I don't know what that means. It's not a residency, it's not a fellowship to them. It's just like, so what are you, you know, extra stuff? What do you still can't do anything, surgeries or anything with it. So part of me was always like, if I ever take a class, I'd want to like, look at the course of everything. What can I take this practical that I can put into practice? Because getting all this knowledge isn't going to give me a leg up? And then the other profession? I don't think except in chiropractic land. So I don't know if that's true or not? Or if you found that What do you think?

Unknown 12:03
Yeah, I do get that unfortunate with my studies that I'm around different professions, a lot of neurologists, into surgeons, and I tend their seminars, and I tend and I often presented these seminars, but I'll tell you, I'll tell you what, having the near anatomy and physiology, understanding and the depth of knowledge that we've obtained it, it's great to be rubbing shoulders into talking to these medical practitioners, and they looking at you go, how is it that you know about this? And about that? So it's cool, yeah, does it translate to me, to the average chiropractor to be a better practitioner in their office, you know, it's, it's questionable. I mean, it's cool, and I'll confidence

Justin Trosclair 12:45
will be their confidence is there

Unknown 12:48
at the same time, we need to be, I think we also need to be cautious, because, you know, walstad depth of knowledge is there, you know, we don't have the scope to diagnose and to manage a lot of these conditions were at least in Australia, so we, you know, in Australia, the word Functional Neurology or chiropractic neurology, or neurological, chiropractic, neurological consultant, these are terms that are regulatory body will literally pull you over the coals and, and find and find you, and you may lose your license within minutes. So we're very restricted here in Australia. And you know, Willie, that's a good thing or a bad thing. I think this scope of practice that we need to be concerned with. So advertising, anything I say, on my website, in my clinic website, in if I say that I can help someone with condition I BOC on need to have a list of references on data. So this is the reason why I think I can help people. And really, yeah, it's it, we have to justify it because someone the public, remember the regulatory body is is there not to protect us as practitioners, it there too, protect the patients from unscrupulous practitioners who claimed things when they shouldn't. So that's a primary goal. And they'll go through our websites and highlight things the same. You cannot say this, because you've not found evidence to do so. So it's it's difficult, which, again, is somewhat I'm not against it, because it keeps things and checks and balance.

Justin Trosclair 14:24
Well, there's a lot of cookies out there that I'm pretty sure America was first and then Australia got chiropractic second. So they probably saw the kookiness that was going on there. Like Yeah, we're not going to have that if we're going to have you guys come here. Not going to work.

Unknown 14:37
Yeah, I think I think there's a lot of test cases that out regulation boards is, you see what's happening in the States. We don't want anything like

Unknown 14:48
this.

Unknown 14:50
You know, and it look again, it has its advantages, disadvantages, and I think all in all, I think it's for the best, it is a little bit stifling our environment. But

Justin Trosclair 14:59
what things like herniated disc disposal, is there anything audience we will get into the neuroscience stuff, but when you're are there certain conditions that there's like, Look, you're approved, you don't need to research, the backup headaches, low back pain, this bulges, there anything that's just really assumed.

Unknown 15:16
And check out some carpet and websites, and all those things must be thick. Well, you know, the ones that aren't getting letters from the regular regulation board saying that this is not approved,

Justin Trosclair 15:27
strike one or you're done after one strike,

Unknown 15:30
strokes, you have to update and it can be it can be quite stressful for a lot of people. So it's no your rules. It is what it is exactly you got to play do need to play by the rules here in Australia.

Justin Trosclair 15:43
Yeah, that's fair. Okay. So this is interesting, when I was in school, AK was considered, you definitely get laughed out of our school, they're like, Look, if you're gonna go AK you what you probably shouldn't came to the school. And then once I think, like the activator protocol, I'm a big fan of his to Justin. And one of the drawbacks of that is, you know, doing a leg check or one leg look shorter touch here, and when they go short, one day goes even. And you'll have some people like, that's the craziest thing. It doesn't work. But then if you talk to people who then activate it for a long time to like, well, it's pretty consistent. And we don't know how it's working. But we didn't know how corporate worked, you know, 50 years ago, really either. So does the neurology show that this stuff is kind of accurate with eight K, and

Unknown 16:30
I think it's emerging, I think now, I'm not technique specific. And I sort of pulled away from these groups. I'm not in the inner sanctum as much as I once was. But I know, they're some of these protocols are starting to introduce the neurology behind. So T, the neurology behind AK, the neurology behind various techniques, because I guess, again, they feel that it's a common language and common framework that can give some substance as to what they do. I know that introducing caught up the neurology component into some of these coursework. I don't know to what level the maybe cherry picking things to suit what they're doing. And that's fine, too. And to an extent, I don't think there's many studies that have shown the reasons why these techniques work. So you know, I think if if we have someone from the outside of our profession looking in, and I would look at the quality of evidence with these techniques, I think it might be a little hard to swallow for some people. And I guess, you might, I think carpeting is very insular, I think we have our, we have our, you know, people at the food of each these technique, food chains. And in some ways, they don't get asked a lot of questions about why or what they do. And show me the evidence. I think it's, well, this is what we've been doing for so many years. And this is it. And you know, what, if you have if, if you you want to build credibility, particularly outside of our profession, that's not the right way to do it. And the way I look at it is if I had my supervisor, who, my PhD supervisor, who, by the way is a biomedical engineer, is not a chiropractor. If I if I placed on his desk, I said, Would you mind reading this and show me how valid and how well does this stack up? To me, that would be a great test, because you pick it apart as an engineer would? And he'd say, well, that's how does that water there infer this? How do I make this leap from one point to another? And to me, that's what our profession needs is the someone from outside going, let's, let's see how robust this study is. Let's not Pat each other on the back at conferences, and our own modality conference and say, Hey, we're doing fantastic. But the truth is, is that the research world will look upon that and go, Well, no, that's not the case. So which is impacted the reason why I've taken a PhD project and in a school in a university that has absolutely nothing to do with chiropractic. I mean, the Faculty of Engineering, within the Department of Biomedical Engineering in a university that has nothing to do with chiropractic, the very least critical medical and engineering University, probably one of the top two or three universities in Australia, and I want to have my research stacked up against the best in the world. And if a contract is names attached to it, my hope is that people look at this and go, Oh, well, that's the contract is doing a pretty good work. And he's he's doing all that is taking all the right boxes. And then my goal is that we can then feed that back into chiropractic with a low level of credibility that is typically not seen, amongst our research into the research is generally limited, the best of times was I'm very happy to say that, you know, changing but from an external point of view, I want to add a level of credibility that I University, sorry, out proficient, desperately need. So that's one of my goals.

Justin Trosclair 20:01
So your PhD is going to be in vestibular stuff. So balance, dizziness gate. That's to me that has a wide implications for old people potentially falling for people who have like many years are benign positional something for vertigo.

What we see in the office, so are you looking at? I'm curious how you got into that of all the things that you could have gotten into, you know, and then when you're doing your research, is it to show that carpet, they can get better? Are you trying to discover something new about the disease, or just try to map it out or show what's going on there? Well,

Unknown 20:37
I got into this part of the neuro world opens up the brain as a window of how the rest of the body is working. So we can start looking at I movements, we can start looking at certain areas of the brain working and how they're connected to each other. And now how that influences movement, spinal control, and what we see as practitioners all day. vestibular system is one system that I was fascinated about, because evolutionary, it's, it starts very young, it develops very young, it's involved with how kids develop it, it has strong connections with our autonomic nervous system, strong connection with our balance system, with a cognitive system, we are body awareness system, and all these again, have directly influence on how our spine functions. So I was really intrigued by the vestibular system. And over the years, I learned, I took some courses, I read up more about it, I just started having a better outcomes in my patients with these conditions. So so I had an affinity for it, I developed an interest. And then I got in contact with this, my, my, my net PhD supervisor about five years ago, spend some time in his lab. And he was curious to know what the chiropractor doing in my office. And then we started talking and I said, Listen, I, you know what, I'm, I'm due for a change in my life. You happen to have a chiropractor as part of you as a student as a PhD student, and he said, why not? And it got it got started. And that perspective and, and really it and my PhD is all about were trialing we're doing a clinical trial on a new vestibular rehabilitation technique. So, so vestibular rehabilitation is a broad term term that's given to exercises to help people overcome dizziness and improve their balance very broadly. And these exercises are the gate exercises are the balance exercises that most most cars cars would use some stage in their practice or be familiar with, like an athlete or like a proprioception, ball or proprioception. So it's more than that, you know, standing on a jury disc, or using a ball or doing tendon exercises or, you know, doing things that involve standing and balancing whether it be sitting on a ball or standing on a desk. So most common eyes closed when they go exactly so they the purpose of it by exercise, then there's ocular motor exercise, so how our eyes move, so we might give what people would dizziness conditions will typically have a normal life. So we might give exercises that help retrain these I'm movement. And then now this gets into more in the specialized field. So most carriers won't do this. And most cars wouldn't do a vestibular specific therapy and then involves, you know, positioning the head, or turning the head rapidly from side to side, whilst a big site on a point, some car is no the employees maneuver. And, you know, they may know some of those types of conditions. But it typically limit most cars wouldn't know beyond that point. So my study is not chorus specific, its research specific, its basic science specific, but it has it can be extrapolated, and it can have interpretations within the car world very, very well. And met, my goal is that my goal is to translate that information and to penetrate that research field. So Kairos can be better position to say, I am now more competent, I can competent to manage patients better to see more patients within this field. And to open up the scope of practice that Kairos typically don't get involved with, I deal with a lot of spirit medical specialists that wouldn't not 99.9% of the time, consider a chiropractor as a referral source for the patient that present with the these type of condition. It's generally a PT, an audiologist, but certainly a car unless a car is built up that relationship with a practitioner, we're just not trained in that field. So one of my goals in studying this vestibular rehab is to have the skills and I guess the competency to then train other Karros to say, Hey, listen, this is perfectly within our

Unknown 24:59
third, upscale, competent and to manage more of the patients. So we can be more relevant. In in healthcare within this cohort of patients, which typically at the state at this stage, we don't do very well.

Justin Trosclair 25:11
So what we want is for you to do really good job getting these systems taking care of finalizing your PhD. So then you can potentially create some kind of program so that as chiropractors, whoever I'm assuming that point can take a course of some sort and say, Hey, when you leave here, one weekend, two weekends, whatever it is, you can say this is this is probably what you've learned in school, it works for some people, but now we know here other bags Did you can use more tools to help these kind of patients, you can probably niche down in this now potentially a little bit more. And then you can learn like the complimentary fields.

This is he would go through this is how this is when you would use an audiologist versus an optometrist versus Hey, you need to go to a neurologist and all work together.

Unknown 25:54
Exactly. And I'm very pleased when I teach these programs to chiropractors is that let's not lose is what we know. There's not lose our history. I'm still a very big advocate of spinal adjustments. I still use spinal adjustments when appropriate, I'm probably be more selective when I use it in my patients. But still do. And I see phenomenal results that neuroscience and neurology hasn't provided at times, where, you know, at the same time, I know when there's limitations, I know when to dive into my toolbox into use other therapies that have given the results that have not been able to see with standard corporate the case. So I'm not about site this, put down your adjustments, and do what I do, I think collectively that will add to it. And that you'll find times when one works better than the other you find time when they were both work really well together. And again, when when we look at when we're in an era where carpet has an issue, and we collectively should be looking at not only getting patients better, but also doing a professional a better justice, then I think it's important that we up skill in what translating that into into better patient outcomes, but at the same time not losing your identity. And I think that's important. People say well, the neuro guys just go off on all these tangents and they forget about what we do as chiropractors, I definitely don't say that are different than advocate that. But at the same time, when someone comes in with a head tilt, and you you know, you adjust their neck, and you think that's the answer. But they keep coming in with, you know, maybe it's because they're distributed system is not balanced, and namely the analytic organs, which of these little organs in the interview, which help position our head relative to gravity, if they're imbalance, one's not working well, relative to the other, we can either hit tilt, the patient will have a hit and present you with sore neck with a hit till now unless you can identify that that patient actually has a vestibular imbalance, not simply a nick subway station or Joe dysfunction, however you want to describe it, then, you know, we're doing ourselves that patient and our profession a big disservice, we can identify where the primary problem is. And I think as chiropractors we've always tried to position ourselves as looking for where the source of the problem is. And and typically we look at the spine. And whilst that's true for a lot of conditions, it's not true for many hours. And I think it's important that we brought in that look and look at other areas that could potentially contribute to why our patients present the way they do. diagnostically. I guess

Justin Trosclair 28:29
other scores, I guess, go with the stuff we see in the office, he said the head tilt, maybe they have this thing was the talk about being dizzy, say do the, you know a couple different maneuvers. And you get the new stagnant you're like, Okay, that's a pretty clear case for maybe let's try that, please. But do you happen to have either one or two diagnosis nuggets for us to check out like this probably is screaming more vestibular. And then do you have one or two therapies that we could possibly implement on Monday morning, of just a compliment what we're doing so maybe maybe like a take home exercise that you do employees, you know, they're not going to be fixed yet. And they're like, Can I do anything else at home? You like, yes, you should try X, Y, and Z show amazing results.

Unknown 29:08
I think the the best example to give would be someone comes in with chronic neck problem, you know, they've had it for years, that may have had multiple years they've been in your office, you've done your network, and was the joint mobility may improve. They still complaining of a variety of symptoms. And it's important to listen to the patient. So the first thing I would say to the practitioner is ask questions is unless you ask questions, if the patient, you know, if you ask a patient walks in the door, and they're complaining of the same symptoms and and you just get him to lay down on the table, you've missed an opportunity,

Justin Trosclair 29:45
not just tapping the Atlas.

Unknown 29:49
So I'd asked him, you know, so I think the one of the best examples to to talk to contract is about as it relates to how to look at the Brian and how to use brain based therapies to help manage the neck is at will manage the spine is the whiplash, whiplash patient. So you know, we've got many patients in our office that have had car accidents, sporting injuries, falls, blast injuries, fights, whatever it might be that they've enjoyed their neck. And if you ask a patient are the what are the symptoms do you have? Or if you lead them inside you? Do you get any blurred vision? give any troubles reading? Do you get into lightheadedness or disorientation? What's your balance? Like any brain fog, poor sleeping memory issues, you have any body awareness based problems? You may think Well, what's this got to do with the neck. And any one of us that have been in practice for you know, more than a week will know that someone comes in with chronic neck issues will typically have a lot of these symptoms. So so the first thing I'd say to people is ask your patients, do you have any of these related symptoms? More often than not, they'll say, yeah, I've troubles reading or bounces off, or I'm bumping into things or get lightheaded, I get a little bit of anxiety or, or fee when I when I move around. For the practitioner, you should be thinking, Okay, it's now just not the neck. But now we're looking at part of the cerebellum, we're looking at part of your vestibular system, we're looking at ocular motor function, we're looking at higher cortical function. So how is it that the neck is related to these areas, and we know through particular, we pick two parts of the brain stem that have a lot of connections to these different areas is very, very strong. When we have a purpose receptive deficit, George dysfunction, the neck, it will cause a change in signaling, or brain coding to this, let's call it a black box within our brain stem. And this change in our black box will then have strong influences on our I movements on a distributed function on our balance function on a higher cortical function on our autonomic function. So if we have a problem with their Nick will more than likely you're going to see co-morbidities or concurrent symptoms or signs in these other areas. So it's important we ask these questions. So once we've established that, you know, it seems like you've got some of these other issues going on. But the thing we need to do is, how do we examine these people. And again, it's not just put the patient down on the table, examine the Nick and that's it, we now need to look at and evaluate these areas will so we may do a balanced test, we may get a match or a phone block, and ask the patient to to stay in on a map on a match or phone block and see what the balances I we may get into walk along the corridor and see how stable they are, we may simply place your finger in front of the patient and just ask them to follow our finger from side to side, we may check their blood pressure and heart right, we might get him to do some Sarah Bella tests, which you may remember from your undergraduate training, we may do some vestibular test and we might do the whole pipe because with whiplash injuries, there is a force that gets displaced or the head and and also the in the E that may dislodge some of these little out of cognac or crystals in the E and contribute to be people they open on purchase more positional vertigo. So these are all the tools that you now have to go, Oh, let me evaluate this so I can better understand what you're presenting with. So we may do out of balance test it test our autonomic tests we may do as Sarah abilities, we may do our our BP BP test. And once we've evaluated all these things, we can then say okay, you're coming in with neck pain, but your eye movements are great your balances and good. Your body awareness isn't good. You got BP movie because the whiplash dislodged as little over Konya and now you've got the free floating form, and you've got dizziness, when you turn over in bed, you better I have that as well. So once we've got that we can say, All right, I'm now going to put together I a therapeutic plane and exercise plan, I really have plan in conjunction with your spinal adjustments to add to that. So we might do our dicks whole pike maneuver, we may do our I movement therapies, we might give people a bunch of perceptive balance exercises, we might give them some targeting exercises that will help the cerebellum, we might give them some breathing or exercises or mindfulness exercises to help with the autonomic stresses that they're experiencing. So what I try to teach you my program is there's no cookbook approach, there's no step one, two and three, we try to teach a principles based way of looking at the body. So once you understand how one area of the body is connected to another, it then opens up your understanding to Well, maybe I should look at this, maybe I should look at this. He's Howard assess it. Based upon those assessment results, I'm now going to convert that into a therapeutic plant into a management plan. And now, this is what your your home exercises or in office therapy plane is going to start looking like. And it gets funky, it gets weighed in our office, you know, we have people doing all sorts of things that are very specific to their history, examination results and what their goals are. And once you can tell us something specific to the patient, patient results are just through the roof. And we see some great results based upon the specificity of what we see. So it's hard to say, here's your one or two things that you would do, I would try to get the practitioner to look at ask the questions first, based upon those questions, at what examiner before eyes bounce in a autonomic cerebellum, and so on. And then what you find in those examination findings should be turned around and become a therapeutic or rehab exercise that you can do as an adjunct to your car. Oh, very, very nicely. So I think you know, in a long about, in a long way, just enough. I've opened up Pandora's box. Because, you know, there's, there's certainly a one size fits all. But really what I try to do is get people to think about first principles and users first principles to be a better practitioner.

Justin Trosclair 36:25
And I think that's important. I think that's what some patients, not patients, that's probably what some of the practitioners are going to Want is All right, a plus b, I thought that's all I wanted, I just want to know what to do with it, now that I see it. But in reality one, that's not the way it's going to work because every patient is going to be different. But if you have a set of I don't know how many different exercises, let's just say there's 10, you could be able to pick like yeah, the four is what you would use for you know, they can figure out for this type of condition, you use these three for this one, but then that's pretty much what you're trying to figure out right now for your PhD is these are working, these aren't and you're going to have control group and variation a variation being just kind of seeing who's actually getting the best results with these different techniques and you're just not there yet. Right. Okay, now you've got a seminar coming up in Hong Kong, which is interesting, in my opinion, but um, the brain hub academy.com dot A you give us a little bit about what you're teaching. Do you ever make it stateside Europe? Is it just Australia, Europe, Asia, I think so within

Unknown 37:30
it, Brian hub academia is I guess my, one of my past where it's, it's very much along the lines and I'll be talking to you about it's it's getting contractors and practitioners interested and not scared about neurology, and a really want to make it translatable or clickable to their to their practice. And I hear this over and over that, that they just want to condense program that they can use without, you know, spinning many years or many thousands of dollars. And that's what that's what it's designed to do. So I've been teaching in Australia for number of years, I mean, Europe, a fair bit. And I mean, as your as a bit, I haven't been to the site yet. And I've got a number of practitioners and colleagues are calling the app hoping to get me out there. And I hope to do that very soon. But neuro Connect is really my new baby. I am it's a it's a full part 16 hour course that is aimed at really bringing the contractor up to speed with managing a lot of the conditions that we see but with evidence with clear understanding of how things were a model losing any of the identity. So So yeah, that's that's kicking off in Hong Kong as of March next year. Wow.

Justin Trosclair 38:52
So what what type of things will kill we learn their

Unknown 38:55
module one is all about laying the foundation of what we going to do it really talks about I mentioned before about the the neck and and the neurology behind neck dysfunction when bad neck, and it has so many deleterious effects on other parts of the body. But how do we explain that, you know, we've used a bit of an outdated model for number of years now. And I think carpet is need to move from that bone on nerve that that analogy of you know, pressure on a hose, and it's causing problems in the brain. I think it's that doesn't stack up, the research is now showing that there's a lot more to it. And it fits what we do very nicely. But I think we just need to be up skilled, and we need to be versed in how we describe that. So module one is all about talking about how can we use proper terminology? How, what is the neuroscience behind spinal dysfunction and succession? What effect does it have on the brain? What is it that we can do to the brain that can have an effect on the spine.

Unknown 40:01
So we look at it from different points of view, but we want to get people to understand the connection with the spine and the brain, the autonomic nervous system is a beautiful, as we've seen people that we've adjusted in the past, and they've been unwell, they've had headaches, doing nauseous, they've been lightheaded, four hours or days after the adjustment. And we often think well, that's just the the adjustment taking effect. And you know, we've put it down to where your body is not used to it, and we need time to adjust. And so the reality is, is that what probably happened is that we've exceeded that patient specific metabolic capacity, the brain stimulated the brain at a point where autonomic Lee they've not been able to withstand that type of input. And that tells us something, it tells us that there be more sensitive, it tells us that we need to be more cautious in our approach. It tells us that if they're sensitive to this, that may be more sensitive to light, and noise and motion in daily life. So again, we teach our practitioners how to look at the autonomic nervous system, how is that important for us as chiropractors and once we have that information, in Module Two, we talk about the examination, we show how to perform an examination, how to perform a detailed neuro exam, how to interpret the results, how to do a quick screen if you want to do something in a in a nursing home how to do a falls risk assessment. So we do both the condensed and the more detailed version. We want to show practitioners how to do a report of findings. That's neuro based how to do a review examination again, that's neuro based and based upon their initial presentation, how to perform a history, what questions to ask. So module two is all about, I've got this knowledge, how do I be a better clinician in terms of assessing? And

Justin Trosclair 41:49
that's really important words to what

Unknown 41:51
what how do we describe these two patients? Are we just are we talking about bone on nerve? Are we talking about sensory motor mismatch? And we can talking about, you know, the beautiful neurology that happens and patients get this, but we just got to be updated, and such as patients, but it's your colleagues, and also our drive what we do to a doctor, that they're not going to roll their eyes and go, Oh, here we go again. I want I want the contract, you decide. We were describing ABC and D and the doctor to go. Yeah, you know what that makes sense. I understand that. I understand what you're doing. That's awesome. And, you know, obviously, we need that and we need to be a referral source. We want our game to be up a notch or two. And that's really the crux of what I'm trying to do. It was nice to just not some sales pitchy weird. This is how you communicate for sales. You're

Justin Trosclair 42:43
like, no, this is what we're going to do. We're going to learn all about this neurology, and then we're going to use it in layman's terms so that they understand what's going on. Because that was what that was kind of what I was alluding to earlier is you got all this information and even try to talk to some patient. And they're like, yeah, you lost me a neuro practically. So just do what you need to do. Yeah, it's too much information. So that's great that you're trying to

Unknown 43:04
Yeah, I'll definitely have a lot of clinical pearls over a dining years of practice what I've learned, and what I've seen doesn't work, you know, that we learn from our mistakes as well. And I'll be happy to share those. Module Three is all about the spine, how it controlled balance and posture. So, you know, the crux of what Kairos do, and why patients present to their office is all about the spine. So we look at scoliosis, you know, I want to show Karros, what is another way that we can look at assessing and managing patients with scoliosis. And most of us look at, you know, spinal adjustments or may be taping, maybe bracing, maybe mirror box and mirror adjust adjustments. But what we don't realize is, those spinal muscles are controlled by descending influences of the brain, particularly the vestibular system. So we're going to explore how is it that we can assess and manage people with spinal conditions, like poor posture, like scoliosis, like recurrent back problems with more of a brain based approach, and it's, it's cool it is it opens people's eyes. Again, I'm not here to take away from what we currently use. But I want to add to that, and for those 20 or 30% of people that don't get better with what we do, this could be the answer tour. And module four is all about integrative approaches to pain conditions. You know, as chiropractors, we see a lot of people with back pain and headaches, chronic pain, you know, chronic regional pain syndromes, things that that specific spinal adjustments don't often help. When it comes to chronic pain, we need to be familiar with that problem is not local, its brain based. And all the research now is talking about this cortical reorganization how the brain reorganize itself over time, based upon a chronic injury. And unless we address how the brain interacts, perceives and functions, then we're not going to help our patients with chronic pain by doing spinal related work only. So we look at the bias, psycho social model, we look at nutrition, we look at cool and funky ways to get the brain to work better, like mirror box therapy, like Left, Right integration exercises, like whole by a whole bunch of different I exercises and, and body awareness exercises that help the brain recalibrate itself to understand what the body is doing. And it doesn't happen by doing our typical spinal work. So we're going to dive into that. So I mean, more I talk about it, the more I think she's gonna like to cover in 60 hours in 65. Tricky is it and what I pride myself on is distilling that information. So the average chiropractor when I say average the car practice doing musculoskeletal work, spinal adjustments, and doing great work, what they do, what is it that they're looking for? What is it that I can

Unknown 46:04
that more do I see the result, and I upscale, and I get themselves to a new level and get out proficiency new level. So that's my task with neuro Connect, which starts in Hong Kong next year. So I'm looking forward to it because it's, and the truth is that, you know, hopefully, I'll take this program, and, you know, the market for Australia thereafter to Europe, and hopefully in the States. And I think it's something that our profession needs.

Justin Trosclair 46:30
Well, selfishly, I hope you record Hong Kong, and then you can just sell it to us online. For for those who, who are like, Oh my gosh, is going to be 2021 out here I've got

Unknown 46:42
I do often record my my seminars, because I am a strong believer that it's, um, you know, I want to spread this, you know, I don't necessarily want to be all mine. And it's not my information, I must say this up front that, you know, the research is not mine at the moment whilst I'm going to be adding to it lot of its out the I just pull it in, I distill it. And I use my my almost 20 years of experience, and I try to think what is it that I'd like to know, topics, these slides together? He's like, oh, man, this is awesome. I love I wish I knew this. I wish it was it was told to me in this way over the years. So, you know, I I'm pretty sure will be recorded. I'm not sure if it's going to record in Hong Kong, but it'll be more than likely recorded at a later stage. So um, so stay tuned for that.

Justin Trosclair 47:26
Awesome, awesome. Well, hey, before we let you go, I always like to ask you sound like a super busy guy. Obviously, at this point, you you have a spouse, how are you able to have this work life balance, keeping your family happy, you got any secrets for us?

Unknown 47:41
I poor secrets, I'll tell you what I do, whether it's a sacred or not, it works. And it's been working for the last three years I've been. So I study full time. So I'm a full time PhD student, but also in practice 15 hours a week. And I travel probably for sorry, after China Nicholas six days about European much of it European and Asian again. So I'm, I travel a lot. I have a family of two young kids are at school, a professional wife who works, I just what I try to do is, whenever I travel, my family comes with me. So during school holidays, I both teach and spend time with my family and my kids and family. love traveling. So I try to integrate as much as I do with them. They're invested in my success, I do it for my family, I do it for my professional adult for myself. And I think once you've got a clean, my what I do it in my profession is very much tied with my values as a person with my family. So it seems to blend well. I think if it was disjointed, if my family wanted something different, or I couldn't do what I I wasn't able to provide for them with what I do, then it wouldn't last so I just tied together and it works really well with us. I'm blessed that I've got a are supporting wife, kids that love what I do and obviously love traveling. And they know that what daddy does enables him to travel and the chief and they come along with you know, they love that, you know, when we travel together. So you know it's working. It's working really well.

Justin Trosclair 49:18
That's working mom and the kids are going explore the city we were at a time we know you weren't there

Unknown 49:22
that would you is kind of we had dinner, Greg photos throughout the when I present and they're you know they're in shops, or they're on amusement parks, or they're here or there on the beach. So I get that and you know what? I don't I don't begrudge that at the moment. I love that they doing that. And, and I'll look at a look at the audience. I'm when I'm on stage, I sort of reflect at times and I think, Wow, I'm you know, last year I was in Japan, you know, talking to 40 or 50 contractors in Japan. And I just pinched myself before I got on stage thinking. This is ridiculous. You know, I? It's great. And it all started because I watched the show a food show and not talking about ramen noodles. I love Japanese food. And it was. And I said to myself, I want to get the best ramen noodles in Japan, how is it that I can do that got in contact with a couple of colleagues in Japan. And I said, Let's, let's put a seminar on. And you know, and about nine months later I was getting it all started with me watching a show about ramen noodles. And I thought, you know, this is this is pretty cool.

Justin Trosclair 50:24
So when we find out where you're going to be at we know this guy has an ulterior motive

Unknown 50:28
is there it's generally food, or its family, what food is catching up with colleagues, I do have a lot of colleagues around the world and I love catching up with him. Food colleagues, and where does my family want to go on the next vacation? So if I said to me, Dad, I want to get a Disneyland. You know, I you know, probably I'll be putting on a conference in in LA shortly thereafter.

Justin Trosclair 50:54
You may want to go to the one in for

a long day. It is a longer trip from Australia. He had any books or podcasts that you think we should, we should check out before

Unknown 51:06
I start. I start sending me go and listening to me. I'm sure you and many of your listeners would would know you know all about gratitude. It's all about values. And you know, it wasn't Dr. Dee Martini john Dee Martini. Okay. Yeah. You know, connecting and just being congruent with your values. To me what is such an important thing and, and because of that, I just feel that things that just flowing for me so I would get on to a lot of do martinis work. JOHN Dee Martini is work. It can get quite deep, or it can be quite superficial. But it works. It works really well for me. So that'd be something that I'd be encouraging new grads or people who are stuck in a rut to to explore.

Justin Trosclair 51:50
Very good. That's a Carla Rinaldo, chiropractor, almost PhD. Thank you so much for being on the show. And for those who don't realize we record early, I want to wish you a belated Merry Christmas.

Unknown 52:04
Fantastic. Thank you, Justin, I appreciate your time. And I certainly hope your listeners got a lot out of it today. And as we bring in 2009 soon I hope to have a prosperous year and and, and everything goes well.

Justin Trosclair 52:16
Oh, where do people find you it? What's website?

Unknown 52:19
Yep, brain hub. academia so be our API in Haiti up I see a d e m i a brain hub academia.com.ai you can check out where some of our upcoming seminars they'll be updated very shortly. And I'm more than happy to take any emails or any questions that people have through Carlo at brain hub.com dot Are you

Justin Trosclair 52:51
okay? You guys don't forget the AU Yes.

Unknown 52:55
Right.

Justin Trosclair 52:59
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We just went hashtag behind the curtain. I hope you will listen and integrate with some of these guests have said by all means please share across your social media. write a review and you go to the show notes page. You can find all the references for today's guest. You've been listening to Dr. Justin trust Claire giving you a doctor's perspective.

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