Concussions and Hidden Anterior Neck Pathology with Dr. John McClaren | E65

What if one of the missing pieces in concussion recovery isn't in the brain—but in the neck?

In this episode of Life After Impact, Dr. Ayla Wolf welcomes back functional neurologist Dr. John McClaren for a fascinating conversation about the hidden relationship between dysautonomia, neck dysfunction, and persistent post-concussion symptoms. Together, they explore why so many people experience dizziness when bending over, standing up, or looking overhead—and why these seemingly simple movements may reveal much deeper dysfunction within the autonomic nervous system.

Dr. McClaren shares emerging clinical observations suggesting that deep neck flexor dysfunction, restricted mobility of the anterior neck, and impaired sensory integration may play a much larger role in concussion recovery than previously recognized. The discussion also explores how breathing mechanics, vagus nerve function, glymphatic drainage, visual processing, smell, and auditory localization all interact to influence brain function and autonomic regulation.

Together, they discuss:

• Why dysautonomia has become increasingly common after concussion
• The surprising role of the deep neck flexor muscles in headaches and autonomic dysfunction
• How manual therapy may improve brain function beyond simply reducing neck pain
• The connection between breathing mechanics, airway function, and nervous system regulation
• The glymphatic system and why the neck may be critical for clearing metabolic waste from the brain
• Why visual overload, bright lights, and busy environments overwhelm the injured brain
• New approaches to visual rehabilitation using color perception and peripheral vision
• Smell retraining, auditory localization, and sensory mapping as tools for neurorehabilitation
• Why effective concussion rehabilitation requires treating the brain as an interconnected sensory network

One of the most powerful takeaways from this conversation is that concussion recovery isn't about fixing one isolated symptom. It's about helping the brain rebuild efficient communication across multiple sensory systems so that everyday activities once again become automatic instead of exhausting.

Whether you're recovering from a concussion, living with dysautonomia, or simply interested in the latest developments in functional neurology, this episode offers practical insights and exciting new ideas that may change the way you think about brain rehabilitation.

If this resonates, subscribe for more concussion recovery tools, share this with someone stuck in symptoms, and leave a review so more people can find it. What’s the most reliable trigger for your dizziness or symptom flare ups?

Dr. McClaren can be found at: Advanced Chiropractic & Neurology in Omaha Nebraska

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Transcript

The Neck And Brain Drainage

Dr. John McClaren 0:00

Where does the gymphatic system feed through from the brain on its way down to the subclavian vein? The neck. The neck. The front of the neck is special. You've got lymph nodes in the back of the neck, but a ton of this stuff in the front of the neck.

Dr. Ayla Wolf 0:16

Welcome to Life After Impact, the Concussion Recovery Podcast. I'm Dr. Ayla Wolf, and I will be hosting today's episode where we help you navigate the often confusing, frustrating, and overwhelming journey of concussion and brain injury recovery. This podcast is your go-to resource for actionable information. Whether you're dealing with a recent concussion, struggling with post-concussion syndrome, or just feeling stuck in your healing process, know that you are not alone. This podcast can be your guide and partner in recovery, helping you build a better life after impact. Dr. John McLaren, welcome back to

Why Dysautonomia Shows Up Everywhere

Dr. Ayla Wolf 0:55

Life After Impact.

Dr. John McClaren 0:56

It is always a pleasure to be here. Thank you so much.

Dr. Ayla Wolf 1:00

Yes. Well, always a pleasure to talk to you and pick your brain. So uh we were just talking uh off-air, and you made the comment that it seems like these days everybody coming into your office uh seems to have dysautonomia. So let's start there.

Dr. John McClaren 1:15

Absolutely. That's the thing. We we we look at parcelating our diagnostics into subtypes, right? You go, I've got a vestibular concussion, or I've got a concussion that is oculomotor, or I've got a concussion that is mood-based or liptic or brain fog or things like that. And one of the linkages in all of these is that they've got fuel delivery issues, which is what the autonomic system is one of the things it's ultimately responsible for. Everybody's got some kind of orthostatic issue where, you know, I get, you know, I bend over to pick up a basket of clothes and I get dizzy when I stand up, or I can't change the water in the fountain or something like that without getting dizzy, or I can't look up and grab, you know, the top shelf thing without getting dizzy. These people have this stuff, and it's after they've had some kind of a traumatic brain injury, or you know, some of these long COVID types things and and Lyme and all those things we see. Uh it's out there because people just seem like they're so much more inflamed in general these days. So they're more predisposed to maybe having it.

Dr. Ayla Wolf 2:25

The thing of I bend forward and then I stand back up and I get dizzy, I hear that all the time. So much and or, you know, I'm putting my clothes from the washing machine into the dryer and just making that movement makes makes me dizzy. I hear that a lot too. Yeah. And so so you're really seeing kind of this increase in dysautonomia that you think is maybe in part due to just general levels of inflammation being higher in our population.

Dr. John McClaren 2:53

I feel like it. It it's interesting in the last, well, let's see, six years. You know, for some reason, there's a lot more of that out there. And and the world is just what it is. You see so much more mold sensitivity. I I think in in all of our practices who do functional neurology, we're seeing everybody's got a mold issue now. Or if people had Lyme, it seems like it's worse. These kind of things, or the dietary things are maybe a little more sensitive than they used to be. So it's like, gosh, I have to be really more deliberate on my diet than I used to be to be okay. The guts inflamed, whatever it is. Yeah.

Dr. Ayla Wolf 3:33

Yeah. And I think that it I think it's frustrating for people because from my perspective, I feel like it is harder and harder to live in this world and live in the environment that we live in and maintain health. You have to be aware of everything from, oh, it are my dish pods co coating my dishes in microplastics, you know, so much. There's so much. Like, am I breathing in chemicals? Am I, you know, how much glyphosate am I eating in my diet? Um, it just it's like we have to be aware of what are we drinking, what are we eating, what do

Living Inflamed In A Modern World

Dr. Ayla Wolf 4:13

we have in our household, where do we live, what kind of air pollution are we breathing in? Uh and it just like I agree. I think we are all walking around more inflamed, but I also think it's because of our environment, which I is what makes me a little frustrated, because then it's like, well, how do we, how do we fix the world if it's the actual environment that's making us more inflamed?

Dr. John McClaren 4:36

Absolutely. And is there incentive in society to do that and and all these kind of things? But that's the problem too, is now a lot of us know this stuff too. It it's so much more information out there. You you hear on almost every show now, oh, you've got four or five bottle caps worth of plastic in your brain and all this stuff. And now I'm hyper-vigilant about it, which is always great for your stress state too. So now I'm stressed out about not being healthy. And and and of course, you want to go out to eat, not so easy. And and seed oils are something a lot of people are really concerned about too. And you know, so then what do you do? It's like it, it's it's very difficult to navigate the world, absolutely. And that's where we talked a little bit about, you know, people use artificial intelligence to kind of try and guide their decisions. And the problem with that is who's writing the language for the searches and how much does it learn you, and how much does it kind of feed what you're already doing, and those kind of things. And that's where you need people who have the clinical background, the training. I I I'm character trained. I will say that again until I'm on my grave. It'll go on my gravestone, probably. Hashtag character trained. The the character trained people are the best, in my opinion, at the world in the world at helping people ferret out this information.

Dr. Ayla Wolf 6:02

Well, I think that we are trained to constantly be reading the research and to be paying attention to the research because when it comes to the brain and neuroscience, that whole field is advancing so quickly that what you learned two years ago is already outdated. And I'm getting ready to teach a Parkinson's class in two months. And I had to, I was going through my slides from a Parkinson's course. I I presented at ISCN, uh the International Symposium of Clinical Neuroscience in 2017, and I presented a Parkinson's case. And so I had, so I had my slides from 2017. I had

Parkinson’s Trends And Toxic Exposure

Dr. Ayla Wolf 6:40

to double the numbers on my slides because I had to, I pulled all the epidemiological reports, right? And I'm looking at the numbers, and the amount of Parkinson's has basically doubled since 2017, since I had my PowerPoint slides from then. Wow. And I gotta tell you, it was really just this sad moment of like having to update my slides. It was a it was sad. I got unfortunate, isn't it?

Dr. John McClaren 7:06

You just you hear that and you go, and and and I would imagine one of the other things you saw in that was the age range really widening, younger and younger people getting it. It it's it is, it's unfortunate. And then you go, Well, what has changed? Is it the human brain or is it the world that the human brain is surrounded in?

Dr. Ayla Wolf 7:26

Right. And so, I mean, not to get too off topic and talk about Parkinson's, but uh, you know, the FDA finally did ban trichloral ethylene. And I and it was because of all of the soldiers at Camp Lejeune and all the data that came out of that that said uh everybody got exposed to this chemical in the drinking water there for a certain time frame until they discovered it. And on and basically those people, like 70% of them, went on to get Parkinson's.

Dr. John McClaren 7:56

It's just terrible.

Dr. Ayla Wolf 7:58

It's terrible. And the data was just you you couldn't refute it. It was so clear. And so finally they said, okay, clearly we need to ban this, but we it's also gonna take us about five years to like regulate that ban. And so, you know, it's gonna take a while. But it just goes to show you that I think glyphostate is also the perfect example of this, where um, you know, they just passed a law that said the that the people who manufacture chemicals containing glyphosate are now immune from any prosecution, almost saying, okay, we know that this it's gonna come out that this causes lymphoma and cancers. And so we're just gonna give you all a blanket immunity so no one sues you, so that to fast forward in 10 years when it's so glaringly obvious, there's nothing anybody can do about it, you know? And so it's again, we're living in this world, just feels crazy town.

Dr. John McClaren 8:56

But can we phase it out? That's the thing, too. It's like, okay, give immunity if you have to, but phase the stuff out. And the problem is then you go, okay, the the stuff is in the water for a reason. Maybe it's a sanitation thing or whatever it is. So you go, okay, I don't want listeria in my drinking water either, because that's really terrible for people, or you know, the flesh-eating Ebola or those kind of things that could come. I don't want that stuff either, but there's gotta be a way. I just read uh, you know, I I got back on social media, so everything on Instagram's real, right? Some 18-year-old somewhere came up with a filter that takes 95% of microplastics out of your drinking water. And we can do this very well. And if you can do that, you can probably filter a lot of this other stuff out. And and the filter is supposedly totally safe and on toxic and and all this stuff. So you go, maybe we need to talk to some of these young people who really do want to make a difference.

Dr. Ayla Wolf 9:53

So so maybe there is hope that the uh the young generations are gonna just be the inventors of making the world a safer place.

Dr. John McClaren 10:01

Yeah, yeah. Maybe they'll take care of us, right?

Dr. Ayla Wolf 10:06

We can only hope.

Dr. John McClaren 10:07

Stewards of the next generation, absolutely.

Dr. Ayla Wolf 10:10

Yeah. Oh my gosh. Okay. Well, so uh switching back to this idea that we've got people with dysautonomia, dysautonomia is becoming more common. You've discovered some patterns in your patients with dysautonomia involving what we would call maybe some deep flexor pathology. Explain what you mean by that. What are you finding in your exams? And what are you, how are you treating that in order to actually help these people function better?

Dr. John McClaren 10:38

It's really interesting. You you go back through the John McLaren clinical origin story a little bit here. When I was in chiropractic college, I had a professor who taught one of our rehab classes. Jeff Rockwell is his

Deep Neck Flexors As A Missing Link

Dr. John McClaren 10:50

name. He's an absolutely fabulous uh he was a massage therapist before he was a doctor of chiropractic. And he's one of those people who looks for different tools in his toolbox, so to speak. He's he's a he's an explorer, he's a striver, one of those, one of those instructors that motivates you in a good manner, right? And he taught a lot of different things as opposed to just here's the cookbook, rehab, past your boards. He's like, I'm gonna give you stuff that you can use in your practice. And Dr. Rockwell is one of my formative figures, along with Dr. Carrick. The the hands-on body work that I do, a lot of that came from things I learned from him and have integrated with the functional neurology patterns and aspects and things like that. So, fast forward, there, I think, deep neck flexor hands-on work for Dr. Rockwell way back when in the 90s. To date myself, the late 90s, right? So Dr. Rockwell teaches this deep neck flexor work and talks about it with motor vehicle accidents and post-trauma injuries because we look at a lot of times at the musculature, the back of the neck, the SCMs, the spalines, people that dry needle do that stuff, doctors at chiropractic do that stuff, snags and all those kind of things that we've been taught through a variety of these TDI courses address that two-thirds or three-quarters of the neck musculature. You learn the cervical plexus in your professional training, and then you kind of get away from it, right? It's like, well, I I checked the boards and off I go. Maybe I'm working with some SEM or some scalene and these muscles on the these big muscles that you can see that do get injured and and traumatic brain injury and things like that as well. And one of the things we learned, so again, the long story, right? We did the not the first TBI fellowship program through the Kerrick Institute. There was the sixth uh series one that was kind of the step-up TBI program. I it was the certification or something that they did at the end of that. Uh one of the papers or a couple of the papers that they looked at in that centered on what's called the deep neck flexor endurance test. This is something that's rather commonly done. Like athletic trainers use it to assess their athletes, especially if you've had a traumatic brain injury, concussion, post-concussion, and you've still got headaches. So they'll come in. And with the deep neck flexor endurance test, you lay the patient supine, which is on their back, you pick your head up maybe a half inch off the table. Try to do a little bit of a chin tuck. So it's like give yourself a double chin as you pick your head up to really uh accentuate those muscles. I'm not gonna give myself a double chin on air. Already there. The beard's on its way back, right? So you do this, and females should be able to hold their head for 30 seconds that way. Males for 50 seconds. We were presented the data at that time, and then there wasn't really anything we were given in that program specifically to address if we saw pathology. Fast forward a little bit. And and here's how it is: I've been in practice for 24 years now. You have a lot of tools in your chest that you get away from, that you get back to, you start to see trends. And I had these post-traumatic headache patients that had dysautonomia. I had one in particular that had come in, and it was this paper was in the back of my head for some reason. And I'm looking at this guy, he's a trumpet player, high school kid, traumatic brain injury, dysautonomia. And one of the activities that was still bothering him, I'm like, well, really close to clearing it. Eye movements are really, really pristine at this point. His postural controls are beautiful. He's got a little bit of a high resting heart rate still. That's the only real autonomic finding I've got. I'm using my reflex pupil app, which I use on my iPhone or my iPad. His pupillary data is really nice, all told. There's a little bit of fine-tuning that needs to be done still, but he's still got post-traumatic headaches when he plays his trumpet. Or when he does squats, which again is this orthostatic load that we talked about at the beginning. So I said, okay, what's happening here? Why do we tilt our head when we play the trumpet? He doesn't have a rotational skew or anything that I can find with my ophthalmoscopic examination. These are all things that we do. We we look at breakdowns and eye movements and things like that. And I'm thinking to myself, what do I have to do to play the trumpet or to vocalize to sing? I have to use my cricothyroid, my cricohyoid, my longest coli, and my longest capitus to fight the back pressure of the trumpet off. Or if I'm a if I'm a singer, those are singing muscles. I'm very fascinated with the neurology and muscular control with singing as well. So I've kind of, this is one of my geeky deep dives that I'm doing is learning how people ting and vocalize. So I said, okay, we've gotta we've got to use this anterior next musculature to fight the back pressure of a trumpet off. Let's do the deep neck flexor endurance test, which is one of the biomarkers I have looked at with this patient. Like five seconds, he completely breaks down and gets the headache.

unknown 15:52

Wow.

Dr. Ayla Wolf 15:52

So you're supposed to be able to hold it for 50 seconds and he was able to hold it for five before and then suddenly became symptomatic.

Dr. John McClaren 15:59

Yeah, symptomatic. And and you get this like ratchety ataxia too. Like, you know, how long are you gonna make me do this kind of thing? Yeah. Yeah, you know, he gives me a look like, is this bad? And it's like, yeah, that's pretty bad. Wow. And and I'm going through my my thought process, and I thought, let's just go ahead and check the integrity of these muscles out. You get in there, you can kind of move the trachea around a little bit. And in people who've got this, you might feel some crepitus or things like that. So your biomarker again is a deep neck flexor endurance test, and some of these autonomic things. So I get in, do some of the work with this guy, clears everything out. I can play trumpet, I don't tilt my head anymore. This, that. Cool. So then naturally, what do we do? This is how we develop things in practice. Start looking at it more and more, and it's there all the time. You know, this is this is a nice revelation in the last year that I've had.

Dr. Ayla Wolf 16:53

And so was your therapy with him mostly manual work on the neck muscles?

Dr. John McClaren 16:58

With to clear that out for him, yeah, that's what I did. But we had done a lot of vestibular activation, a lot of oculomotor strategies, a lot of the things that you'll see in functional neurology clinics that had got him mostly really good.

unknown 17:13

Right.

Dr. Ayla Wolf 17:14

You'd cleared up all those other sensory errors, and this was the thing that was left that was still driving the dysotenomia.

Dr. John McClaren 17:20

Yeah. And and you go, well, what is the mechanism behind that, right? Well, there's a lot of mechanisms. That that musculature is supplied by that cervical plexus that I talked about, which doesn't have necessarily a direct feedback into the autonomic system, because that it it does have some aspects of vagal activation and things like that. And it was interesting to work that and see his resting heart rate come down too, which is really, really cool. That's one of those biomarkers we look at where when the autonomics aren't calibrated, right, you'll see a higher resting heart rate or a lower resting heart rate than somebody should have, depending on their phenotype. Which when I say phenotype is how the patient presents with what they have. So it it worked really well for this patient. And again, it's something I started to look at with a lot of other patients. And, you know, some of the things that it's added to my outcomes have been really two thumbs up. So yeah, in that case, it was a lot of manual work. You could come back in and add some different neck strengthening strategies. You could make that deep neck flexor endurance test an exercise for them.

Dr. Ayla Wolf 18:21

Right. Because that is a very common exercise you see for, you know, strengthening the neck is is simply doing the double chin, bringing your head up off the table, holding it. Yeah.

Dr. John McClaren 18:32

They give those therapy all the time, yeah.

Dr. Ayla Wolf 18:34

Mm-hmm. Mm-hmm. Well, and now you're seeing kind of way more benefits from not just strengthening the neck, but also from an autonomic perspective.

Dr. John McClaren 18:45

Tons of it. And and it makes sense where you look at the way the the nervous systems wired through the cervical and upper thoracic spine. That's where your sympathetic activation happens. We talked about in our prior discussions, there were a lot of these dysautonomia phenotypes where they didn't have proper sympathetic nervous system activation. And those are actually some of our most unstable dysautonomias out there.

Dr. Ayla Wolf 19:07

Yeah. Okay. So let's let's talk about the airway because I also think that this is something that is huge. And I've been watching a lot of these videos on nasal release technique where they, you know, insert like the balloon into the nostrils. Yeah. So let's talk about that. I mean, if you've been studying singing, I I imagine you've been studying kind of the role of just proper airway opening. And I mean, I had a patient with uh two concussions and um she had a like a double tongue tie and airway obstruction that her dentist caught. And so suddenly it was like we had cleaned up so many things. And the one thing that was really kind of keeping her having a lot of chronic headaches and jaw issues was just more of like almost orthopedic uh or orthodontic type problems with her jaw alignment, structural stuff, and this tongue tie and issues with her airway not being perfectly uh intact and open.

Dr. John McClaren 20:12

Well, it it's interesting when you look at that, you consider tracheal mobility and again that cervical plexus that supplies a lot of those muscles that close and open the glottis when we do breathing versus eating and those kind of things. Again, that gets damaged. What you're getting in there doing manually is you're not necessarily and and some people will say this like you're not really on the cricothyroid or you're not really on the cricohyoid because they are so small and they're so deep. Again, I'm on the fossil connections in there. I'm tracing the nerve pattern. So you're doing nerve tracing

Airway Mechanics And Autonomic Chemistry

Dr. John McClaren 20:43

techniques and things like that. Nerves, remember, just like muscles and just like blood vessels, like to be able to move. And when they don't move and they don't glide, they get inflamed, they get irritated, and they do all sorts of misbehaving, so to speak. So what I can't do is maybe have proper mobilization of my tracheal apparatus. Now, maybe my airway isn't as efficiently functioning. And again, if I've got it perception that my airway isn't open, what am I gonna do? Maybe even in a subconscious level. I'm gonna change my respiration rate. When I change my respiration rate, what do I do? I affect my blood chemistry. So I change blood calcium, blood pH. My neurons become hyper excitable or hypo excitable depending on the person. So less or more excitable. I've got an autonomic nervous system issue where I already can't fuel my brain very well. Now I take a brain that's not getting fueled, I make it really, really sensitive, off I go.

Dr. Ayla Wolf 21:49

Right. Yeah. And going back to this whole thing of I bend forward and then I come back up and I'm dizzy, it's like, well, when we bend forward, what do we do? Well, we're looking, you know, we're We're looking down too, and so we're like closing all of this off.

Dr. John McClaren 22:04

Tons of activation in those muscles, absolutely. And again, if you're neurologically misbehaving, so to speak, you're gonna get some aberrancy in that autonomic backflow and forward flow as well. Yeah. That's one of the factors that's very significant with us. The other thing you mentioned too, and and I love how, you know, we we we think we're like off topic, but we're really not, is you talked about, you know, glyphosphates and all these kind of things and microplastics, and those things, again, when we're talking about people already being a little bit inflamed, they impede what? Gymphatic and lymphatic flow. Where does the glymphatic system feed through from the brain on its way down to the subclavian vein? The neck, the neck, the front of the neck, especially. You've got lymph nodes in the back of the neck, but a ton of this stuff in the front of the neck. So again, if I've got a if I've got a kink in the hose because I'm so fossally adhered here and I've got so much mechanical restriction, and there aren't a lot of people that are doing this kind of work. There's a few out there. Um and I think it's really, really important, and I think it's something like we've talked about writing a class for it or something like that to bring in people to do some hands-on, because you know it's it's nice to be the only guy in town that does this. But you know, two hands and and me aren't enough for everybody, and and and I'm sure there are people that are better at it than I am. But it's it's very important. So again, now what I'm doing is I'm getting the gutters of the brain, so to speak, where you're getting that garbage removal system more efficient, less post-traumatic headache, less brain fog.

Dr. Ayla Wolf 23:47

Yeah, incredible.

Dr. John McClaren 23:49

Less inflammation, which it feeds that autonomic apparatus. If your brain's inflamed because you can't clear that stuff, that dysautonomia runs rough shot.

Dr. Ayla Wolf 23:57

Right. Cause I know a lot of the more recent studies on the lymphatic system say that all of that metabolic waste actually drains along the vagus nerve. Like it like it's actually kind of following that exact same pathway.

Dr. John McClaren 24:13

Yep, 100%. Which again, when when you come in and you do your neuromodulation, and and that's another thing you can do to follow up if you want to do, okay, what am I gonna do? I'm gonna manually clear this. They they offered the neuromodulation course back in November where Herb's point, which lives right in that apparatus, is one way to activate the vagus nerve. The baroreceptors activate the vagus nerve, 100%. So you can increase the efficiency of a lot of these responses by mechanically clearing that out.

Dr. Ayla Wolf 24:40

Mm-hmm. Right. And I think that speaks volumes to the ability to not only be able to perform kind of a complete functional neurological exam, but also have more of that orthopedic background, manual therapy background, understanding all of it. You know, I was just talking to Dr. Kaiser, and he was kind of saying the same thing, like of that whole journey of, you know, you start out studying all this manual therapy and orthopedic structure, and then you learn the nervous system, and then you kind of go down that rabbit hole, and then you come full full circle and realize it's all connected. And it all doesn't matter. Yeah, it it just everything plays off of each other, and and you need you need both.

Dr. John McClaren 25:26

You really do, and and that's the great thing where you get a lot of these patients that come in and it's like, boy, I've been to three or four medical neurologists, and and nothing against them, not to disparage anybody, but the frustration I hear from a lot of these dysautonomia patients is all they wanted to give me was medications. And I'm like, I get that. That's one of the major tools in their chest. But the medications aren't super specific on how they act on that autonomic system. So you kind of get some side effects or some different profiles that can cause other problems or maybe not regulate the system properly. So when you get in and you can do some of these other things, it it supplements the medicine, if not replaces it really well.

Dr. Ayla Wolf 26:09

Yeah, yeah, absolutely. And then um, you also mentioned that you're doing more like visual field therapy too lately. Talk about that.

Dr. John McClaren 26:18

Well, and it's really interesting when you when you consider all of these things. What I got into a long time ago in this long COVID course that I wrote for the Kerrick Institute was looking at different ways to treat people who had fragile nervous systems because long COVID is a dysautonomia, along with a lot of other things. And as I got into the training and and restoring smell was was kind of a focus initially because a lot of people had olfaction issues. And again, as I got into my lab studies in the clinic, what I saw was a lot of the people who had anosmia or hyposmia or some olfactory changes, parosmias, olfactory hallucinations. I smell things that aren't there, like cigarette smoke and things like that, had a lot of contrast sensitivity too. There was a lot of convergence in the medial temporal cortex that processes that and the olfactory cortex, which lives somewhat in the temporal lobe as well. It's really interesting.

Dr. Ayla Wolf 27:16

So I And so define for the audience contrast sensitivity.

Dr. John McClaren 27:20

So I've had a traumatic brain injury. I walk into Costco, those bright lights kill me. I'm light sensitive. I have to wear sunglasses everywhere because the light bugs my head so much.

Dr. Ayla Wolf 27:33

The thing I hear is when people are driving and the sun is like beaming through like a row of pine trees. And so all of a sudden it's like light dark, light dark, light dark. Like, you know, it's like just that flicker of sunlight through the trees, and

Visual Contrast Sensitivity And Field Rehab

Dr. Ayla Wolf 27:46

people are like, I can't, I can't do that.

Dr. John McClaren 27:47

Yeah, it overwhelms their system for sure. Or, or they maybe even have some sound sensitivity. This is where it's really starting to spread for me. I had a I had a scholar uh at the board review that I taught in March ask about sound localization with some of this stuff. And I said, I don't know. You know, it's really interesting. There was a ton of topic maps course, and I hadn't taken it yet. Do they have disorders in sound localization? Was the the question as well because the auditory cortex also lives in the temporal lobe. And I said, I don't know. And I came back into my practice, and sure enough, you know, it was a great question. I love the scholars for the Kerrick Institute because they ask questions I might not have thought to ask myself. And I said, Yeah, sure enough, they can't localize sound super well either, because that's a network hub for all of those things that temporal lobe is. So what I've done is I've looked at these people who have this contrast sensitivity. I use focus bolder as a program to test eye movements. I love it because you can test different backgrounds with a fast eye movement or a pursuit eye movement or any of these kind of things that we want to look at clinically. And you'll see plain screen people do pretty well. You change it to like a bright red background or a light bright blue background or a bright yellow background, and they just completely fall apart. They'll look at you and go, you know, these really photosensitive, light-sensitive people, they'll be like, Are you gonna make me look at that screen? Yeah. Sorry. They get like limbic about it, you know, which means they're like really emotional. They know it's gonna make them feel really bad.

Dr. Ayla Wolf 29:17

Yeah. Oh, at work, basically my entire wardrobe is like black shirts because you know, the few times you wear a striped shirt to work, people are like, I I can't follow your thumb. You're wearing a striped shirt and the background, like it can't, I can't do it, you know?

Dr. John McClaren 29:32

And then you go, you go, crap, does that mean I did a bad job with you? You know, it's like, darn, my wardrobe choices impact my outcomes. Right. Yeah. But you hear that all the time. People will say, I do really well when I'm in an office where there's plain white walls, but when I go to Costco or Sam's Club or whatever store it is, like I completely fall apart. And it's it's the amount of visual information that comes in. It's the bright lights, the overhead, you know, the the like fluorescent troughers, a lot of people will tell you. And and you'll see people come in, like maybe they've been to a vision therapist and they get the red lenses or or things like that because they've got that. And and I'm like, that's okay, you know, that's a that's a nice way to let this just recalibrate and calm down. But eventually, ideally, what we want to do as functional neurologists is get them to function in the world as good or maybe better than they did before their injury, hopefully, when they present with you. And again, in my master's program, I looked at a lot of training on visual fields, and and what a lot of people do is they'll use electronics to do like a hemi field stimulation. So you're getting a bright check screen that's off your sometimes that's too much for a lot of people that had this stuff, especially when the autonomous system is involved. So again, back into the research, look at it. What did we do before we had this stuff? And let me uh let me grab something here that's really cool. And I give Dr. Aunt Nucci credit for this as well. Is the assessment is do it's digital field. So you stand in front of the patient or behind the patient, you know, let me know when you see this thing in your peripheral vision. Let me know. Dr. Ant Nucci in functional neurology management management of compassion takes it up a notch and he says, Okay, well, the retina processes all light using three primary colors red, green, and blue. Those are your primary retinal receptors. So what we do is we take like an autocard, we bring it in, let me know when you see the color. What he'd seen and in the research is people with traumatic brain injury maybe process red differently than green, then blue. So then what do you do with red eating later? So the the thing I thought again, talking analog with some of these people, is we will use that as a therapy. This is called border training. You can train the border that lines off, you bring it in. So that's a nice analog application that is very palatable.

Dr. Ayla Wolf 32:03

Okay, so you're using different colored cards, red, green, blue, and you're basically just and yellow, and you're kind of trying to expand someone's peripheral vision for individual colors.

Dr. John McClaren 32:15

Perhaps. Yes. And and the thing that's interesting with some people that have dysautonomia, what they'll see it'll be black or it'll be gray, and then they see the color. Or maybe if I've got an issue, it's a red card, but they see it as green, and then they see it as red.

Dr. Ayla Wolf 32:32

Uh, interesting.

Dr. John McClaren 32:34

So there's a breakdown in that visual processing network.

Dr. Ayla Wolf 32:36

Right. Yeah. One of the uh optometrists that I send a lot of my patients to, he has a really cool, you know, fancy way of assessing peripheral visual field with red, green, and blue. And so he spits out those maps that kind of shows you the patient's peripheral vision with the different colors. And so I've also heard that people with mold sensitivity seem to lose their peripheral vision more specifically with the color green. Have you have you seen that?

Dr. John McClaren 33:07

I've seen a lot of that, but I've seen it vary. I haven't always seen it just with green with my mold phenotypes, but it may be because they have other things going on. Interesting with that.

Dr. Ayla Wolf 33:16

Yeah. Yeah.

Dr. John McClaren 33:18

A lot of your people who have sleep wakeful disruptions, like, hey, I have a hard time getting to sleep. Blue is a lot of times what they will process improperly because blue light sets the circadian rhythm. Interesting. Yeah. Yeah. Yeah. It's really interesting. So what I I found too that was really nice is once you kind of find the color they break down on, I brought yellow in because I found people struggle with that a lot and maybe not with the others. Granted, it's not a primary color, but it's it's in the Uno deck already, and I have it.

Dr. Ayla Wolf 33:51

Okay. And so essentially you're looking at people's peripheral vision for different colors, and then also, in a sense, kind of re-remapping their peripheral visual field for different colors. And then we can layer in, you mentioned auditory localization, a person's ability to know where sound is coming from. Um, so I used to try to snap, and I found that I'm not a very good snapper. And so one of my patients had brought like their kid had some toy, and it's like a little like clacker thing. So one of my pay, yeah, so one of my patients just like gifted my clinic uh this clacker.

Dr. John McClaren 34:32

And you know, now I can do it all the time.

Dr. Ayla Wolf 34:34

Exactly. So now I have this child's toy that I use to test for auditory localization. But it it just I I guess what I'm trying to say is that it seems like when it comes, when it comes to dysautonomia, when it comes to brain injuries, a big part of the therapy is helping the brain utilize all of its different maps, whether we're talking about a visual map, whether we're talking about an auditory map, whether we're talking about uh a joint position map of how is my body positioned, and making sure that just all of these different maps are actually giving the brain accurate information because the second we introduce some kind of sensory error, whether it's auditory or visual or proprioceptive, then all of a sudden we have an autonomic response to that. Yeah.

unknown 35:24

Absolutely.

Dr. Ayla Wolf 35:25

And so you're finding that by kind of cleaning up some of these visual maps with different colors and expanding someone's peripheral vision, that suddenly their autonomic system is functioning better.

Dr. John McClaren 35:36

Yes, absolutely. And that's the thing when you're looking at concussion and traumatic brain injury. You have a disruption in a lot of the networks that these maps regulate and are responsible with interacting in. And what'll happen is now I have to use other parts of my brain to do that that can do it, that aren't so good at it, that demand more fuel. And so if we compare those networks, we'll get them to function more efficiently, we free up resources.

Dr. Ayla Wolf 36:02

Yeah, yeah. So it's all about just making the system more efficient to free up more energy so the brain can put that energy towards other things.

Dr. John McClaren 36:11

Absolutely. Absolutely. Then I can then I can remember to get up to my alarm and remember what what underwear I'm supposed to wear for Thursday, so to speak, or whatever it is.

Dr. Ayla Wolf 36:22

Yeah, it's kind of like, you know, when they they do these brain scans, and so when someone's learning a new song on the piano, it takes more brain energy. But once they've memorized that song, then their brain, then they can play that song even better than they used to, but it actually takes less brain power. And it's almost like in the case of someone with dysautonomia or concussion, they never get to that place where they can do the basic thing and their brain doesn't have to think about it. It's like they're always stuck in that beginner mode of the brain needing to utilize way more energy than it should to do all of these tasks throughout the day. And that's why they're so tired by, you know, noon.

Dr. John McClaren 37:00

100%. The automatic stuff, the stuff that should be automatic doesn't become automatic and they struggle. And that's what we do when we do brain rehab is we help the automatic stuff become automatic again in a lot of ways.

Dr. Ayla Wolf 37:13

Yeah. That's a good way to put it.

Dr. John McClaren 37:15

Yeah.

Dr. Ayla Wolf 37:17

All right. What else you got?

Dr. John McClaren 37:18

What else do I have? Well, and and you can layer, like you said, I like talking about layering things in where we can use visual mapping, we can use auditory mapping. I've layered in olfaction a lot as well. Again, this is something where I'm I'm postulating offering a course on olfactory rehabilitation and traumatic brain injury and dysautonomia because it's it's a really fascinating, and again, as long as they're not allergic to like an essential oil or things you use, it's something that's very nice on a brain that is suffering from fuel delivery issues. To smell things is a lot easier than doing a fast eye movement or an anti psychotic or some of these things. And you can kind of prime the brain doing some of these relatively basic functions that don't take a lot of cognitive load. You get that brain to kind of go, oh, okay, I can handle a little stimulation. Now I can get some tupillary dilation and constriction like I'm supposed to. Now I can layer some of those other therapies in where you might have taken two or three or four sessions to be able to do that stuff before it.

Dr. Ayla Wolf 38:18

Mm-hmm. Yeah. And so are there certain smells that seem to be uh, I don't know, more gentle on the system or other like have you had people had kind of a paradoxical reaction or the opposite response you were looking for?

Dr. John McClaren 38:33

Very, very rarely have I seen people struggle with olfaction again, unless they were allergic to some kind of a component of the oil. If you're looking at olfactory research, you're gonna see eucalyptus, lemon, cloves, and rose. Those are the four scents they're looking at with any identification, all the all the COVID research, all the Parkinson's

Olfactory Training For Fragile Nervous Systems

Dr. John McClaren 38:52

research, those are the four basic oils that they'll use, or the four basic scents. You get into the upset testing and things like that, they expand on that. You know, between 16 and 40. The human nose can smell a trillion different scents when it works well. Wow, a trillion. Yeah, you would have thought that, right? Everybody says, oh, we don't smell anything. We smell tons of stuff when it works. So it's really cool when you look at that. So you can kind of do the same thing, like I said, with the colors that are close together. You can do the same thing with scents, where it's like, can I distinguish between lemon and orange or things like that? You can activate different parts of the brain with that. So you can kind of really bias your olfactory training based upon maybe what hemisphere you'd like to bias in your activation or stay away from in your activation with having them do different things.

Dr. Ayla Wolf 39:42

Yeah, yeah. I remember uh, you know, when I first started out and I was interning with Dr. Kemp, every single new TBI patient would come in and he would grab his vanilla and he'd grab, you know, like a lavender. And I remember being surprised at how many people he would like give some kind of floral scent to. And they to them it smelled bad. It didn't smell like flowers. And it just kind of struck me of, oh wow, you know, you're I I'm I know he's got lavender under this person's nose, and they're saying it does not smell like floral scent at all. And uh really stood out to me just how common this like um response was to not being able not only s identify smells appropriately, but like you were talking about with COVID, people were having those phantom cigarette smells. I had patients with that too. And um, you know, just how fascinating the brain is when it starts mixing up things and misinterpreting smells and scents and yeah.

Dr. John McClaren 40:40

Well, yeah. And you know they haven't had an injury necessarily at the curbiform plate where they can't smell that it would make a good thing smell bad. It's interesting. And and I've got a I've got a new uh kind of connection I've made in my clinic where I've got a a mental health therapist who sees a lot of patients with functional neurological disorder. The olfaction is something that feeds really well into some of the brain hubs that that's worked into. So we've started to work in, you know, nice pleasant sense or pleasant perceived sense with functional neurology, uh neurological disorder patients. It's been pretty good so far. It's really interesting. The impact you have you just with some essential oils. Again, more analog applications where you're not having to necessarily subscribe to a service to get a therapy or something like that. So some people are looking for that that are clinicians and patients as well, I think.

Dr. Ayla Wolf 41:32

Yeah, yeah. Well, and it just um points out just how three-dimensional uh rehab really needs to be. You know, it's not just uh let's go sit on the computer and do lumacity for two hours a day.

Dr. John McClaren 41:45

It's like a drag, right? What a drag. You go, man. It's it's like I want to, I want to go out and play pickleball or something.

Dr. Ayla Wolf 41:54

Mm-hmm. Right. Yep. Yep. We gotta, we gotta have movement, we gotta have smells, we gotta have color distinctions, we've gotta have all the things, eye movements intact.

Dr. John McClaren 42:03

Yeah, all that stuff, exactly.

Dr. Ayla Wolf 42:05

Anterior neck muscles relaxed.

Dr. John McClaren 42:06

You need those bad boys, yeah. You'd want those relaxed but ready to go.

Dr. Ayla Wolf 42:10

Mm-hmm. Man, crazy.

Dr. John McClaren 42:12

Yeah. So those are things I've been working on and and some developmental, maybe academia that that's to come. And and again, uh, we're getting the word out there on this for patients as well. Absolutely. And and this is, I really appreciate you having me on and talking to me about this. It's just something I'm I've become really fascinated with, and it's it's very clinically relevant.

Dr. Ayla Wolf 42:35

Yeah, yeah. Well, I will look forward to your course when you put all that together and uh start uh sharing all that information with everybody else.

Dr. John McClaren 42:42

It'll be fun for sure.

Dr. Ayla Wolf 42:44

Awesome. Well, why don't you tell people where they can find you?

Dr. John McClaren 42:48

I am located in practice in suburban Omaha, Nebraska at Advanced Chiropractic and Neurology. My website is www.omahawspinecare.com. We just revamped our website. It's really exciting. We've got some new things coming forward, working with a lot of any kind of patients out there. I am also uh assistant faculty at the Carrick Institute. So I do offer courses for uh practitioners as well through the Carrick Institute. I'm also out there with Cedric with Nerd Solutions. Great. Just try to stay busy.

Dr. Ayla Wolf 43:23

Yes, I'm sure you are. Love it. Well, I will add all that uh into the show notes. And once again, thanks. I know you're taking time out of your clinic day to come on the show. And so thanks for taking the time and being here today.

Dr. John McClaren 43:39

Always a pleasure. I appreciate you having me.

Dr. Ayla Wolf 43:45

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Where To Find Dr. McLaren

Dr. Ayla Wolf 44:21

link to our full medical disclaimer is available in the notes.