Changes in Cerebral Blood Flow With Spinal Manipulative Therapy vs. Voluntary Motion

NCT01205490 | Unknown

• 1 other identifier: 102026
• Study Type: interventional
• Target: 10
• Locations: 1 country
• Sites: 1

Brief Summary

The investigators are performing a study to determine whether changes in blood flow occur in the neck and back of the brain following a series of head positions and a manipulation of the upper neck. Each participant will be asked to undergo a series of MRI's to evaluate whether there are any changes in blood flow resulting from any of the head positions or manipulation. The study will be conducted over a period of 1 day and each participant can anticipate the testing to take approximately 120 minutes.

Conditions

Vertebral Artery Dissection; Cerebrovascular Accident; Cerebrovascular Stroke

Outcome Measures

Primary Outcomes (1)

• change in advanced magnetic resonance imaging

  A change in vertebral, posterior cerebellar and collateral arterial blood flow associated with various head positions and an upper cervical manipulation will be measured using blood oxygen level dependent (BOLD). A BOLD MRI generates a signal by tracking changes in the local oxyhemoglobin to deoxyhemoglobin ratio. Signal changes are due to a combination of altered microvascular perfusion, blood volume, and fluctuations in cellular metabolism. It will also provide more sensitivity in determining the impact of changes in blood flow during the various head positions.

  immediately after head positions.

Interventions

head positions and spinal manipulation OTHER

Each subject will then undergo a baseline MRI in a head neutral position (0 degrees rotation). They will then be placed in head rotation (45 degrees) to the non-dominant and undergo a MRI. Maximum rotation to the side with MRI will follow. Finally, each subject will receive an upper cervical rotary manipulation to the non-dominant side with MRI immediately after. A total of 4 test conditions will be evaluated (rest, 45 degree, maximal, post-manipulation). The manipulation will be performed by an experience practitioner on a bed just outside the MRI room in supine position. A controlled impulse load will be applied and the head/neck returned to neutral position. Prior to each maneuver, the subject will be queried on their comfort, condition and willingness to continue

Eligibility Criteria

• Age: 18 Years - 35 Years
• Sex: male
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may not qualify if:

• Enrolled and matriculated as a student in the Canadian Memorial Chiropractic College.
• Healthy asymptomatic male patients who would otherwise receive cervical manipulation on a regular basis as a part of their normal learning experience and will have had a cervical manipulation in the last 3 months.
• Sufficient English language ability to complete study questionnaires (see appendix).
• No history of disabling neck, arm or headache pain within the last 6 months.
• No current or prior history of neurological symptoms including, facial or extremity weakness, abnormal sensation to the face, body or extremities, uncontrolled movements, abnormal gait, dizziness, unexplained nausea/vomiting, difficulty with speaking or swallowing.
• Subjects will have had no prior history of head trauma or prior history of surgery to the neck region.
• No history of claustrophobia, metallic implants or tattoos to ensure compatibility with MRI requirements.

Sponsors & Collaborators

• Canadian Memorial Chiropractic College: lead
• Canadian Medical Protective Association: collaborator
• NCMIC: collaborator

Study Sites (1)

St. Joseph Healthcare, Research Imaging Institute

Hamilton, Ontario, L8N 4A6, Canada

Location

Related Publications (12)

• Boyle E, Cote P, Grier AR, Cassidy JD. Examining vertebrobasilar artery stroke in two Canadian provinces. J Manipulative Physiol Ther. 2009 Feb;32(2 Suppl):S194-200. doi: 10.1016/j.jmpt.2008.11.019.

  PMID: 19251064 BACKGROUND

• Cassidy JD, Boyle E, Cote P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. J Manipulative Physiol Ther. 2009 Feb;32(2 Suppl):S201-8. doi: 10.1016/j.jmpt.2008.11.020.

  PMID: 19251066 BACKGROUND

• Rubinstein SM, Peerdeman SM, van Tulder MW, Riphagen I, Haldeman S. A systematic review of the risk factors for cervical artery dissection. Stroke. 2005 Jul;36(7):1575-80. doi: 10.1161/01.STR.0000169919.73219.30. Epub 2005 Jun 2.

  PMID: 15933263 BACKGROUND

• Zaina C, Grant R, Johnson C, Dansie B, Taylor J, Spyropolous P. The effect of cervical rotation on blood flow in the contralateral vertebral artery. Man Ther. 2003 May;8(2):103-9. doi: 10.1016/s1356-689x(02)00155-8.

  PMID: 12890438 BACKGROUND

• Cagnie B, Jacobs F, Barbaix E, Vinck E, Dierckx R, Cambier D. Changes in cerebellar blood flow after manipulation of the cervical spine using Technetium 99m-ethyl cysteinate dimer. J Manipulative Physiol Ther. 2005 Feb;28(2):103-7. doi: 10.1016/j.jmpt.2005.01.005.

  PMID: 15800509 BACKGROUND

• Mitchell JA. Changes in vertebral artery blood flow following normal rotation of the cervical spine. J Manipulative Physiol Ther. 2003 Jul-Aug;26(6):347-51. doi: 10.1016/S0161-4754(03)00074-5.

  PMID: 12902962 BACKGROUND

• Johnson C, Grant R, Dansie B, Taylor J, Spyropolous P. Measurement of blood flow in the vertebral artery using colour duplex Doppler ultrasound: establishment of the reliability of selected parameters. Man Ther. 2000 Feb;5(1):21-9. doi: 10.1054/math.1999.0227.

  PMID: 10688956 BACKGROUND

• Sakaguchi M, Kitagawa K, Hougaku H, Hashimoto H, Nagai Y, Yamagami H, Ohtsuki T, Oku N, Hashikawa K, Matsushita K, Matsumoto M, Hori M. Mechanical compression of the extracranial vertebral artery during neck rotation. Neurology. 2003 Sep 23;61(6):845-7. doi: 10.1212/01.wnl.0000078081.12097.ae.

  PMID: 14504337 BACKGROUND

• Haynes MJ. Doppler studies comparing the effects of cervical rotation and lateral flexion on vertebral artery blood flow. J Manipulative Physiol Ther. 1996 Jul-Aug;19(6):378-84.

  PMID: 8864968 BACKGROUND

• Licht PB, Christensen HW, Hojgaard P, Hoilund-Carlsen PF. Triplex ultrasound of vertebral artery flow during cervical rotation. J Manipulative Physiol Ther. 1998 Jan;21(1):27-31.

  PMID: 9467098 BACKGROUND

• Licht PB, Christensen HW, Svendensen P, Hoilund-Carlsen PF. Vertebral artery flow and cervical manipulation: an experimental study. J Manipulative Physiol Ther. 1999 Sep;22(7):431-5. doi: 10.1016/s0161-4754(99)70030-8.

  PMID: 10519558 BACKGROUND

• Bendick PJ, Jackson VP. Evaluation of the vertebral arteries with duplex sonography. J Vasc Surg. 1986 Mar;3(3):523-30. doi: 10.1067/mva.1986.avs0030523.

  PMID: 3512861 BACKGROUND

MeSH Terms

Conditions

Vertebral Artery Dissection; Stroke

Interventions

Manipulation, Spinal

Condition Hierarchy (Ancestors)

Cerebrovascular Trauma; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Trauma, Nervous System; Dissection, Blood Vessel; Aneurysm; Vascular Diseases; Cardiovascular Diseases; Wounds and Injuries

Intervention Hierarchy (Ancestors)

Musculoskeletal Manipulations; Physical Therapy Modalities; Therapeutics; Rehabilitation

Study Officials

• Greg Wells, PhD

  University of Toronto

  PRINCIPAL INVESTIGATOR

• Jairus Quesnele, BSc, DC

  Canadian Memorial Chiropractic College

  PRINCIPAL INVESTIGATOR

• John J Triano, DC, PhD

  Canadian Memorial Chiropractic College

  STUDY CHAIR

• Michael Noseworthy, PhD

  McMaster University

  STUDY DIRECTOR

Central Study Contacts

Jairus J Quesnele, BSc, DC

CONTACT

647 261 2760; jquesnele@gmail.com

Greg Wells, PhD

CONTACT

416-710-4618; greg.wells@utoronto.ca

Study Design

• Study Type: interventional
• Phase: not applicable
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: BASIC SCIENCE
• Sponsor Type: OTHER

Study Record Dates

• First Submitted: September 17, 2010
• First Posted: September 20, 2010
• Study Start: July 1, 2011
• Primary Completion: August 1, 2012
• Study Completion: August 1, 2012
• Last Updated: June 28, 2011

Record last verified: 2011-06

Locations

CA (1)