Functional Neurology: A New Approach To Brain Health

Key Takeaways:

• Functional neurology focuses on brain function rather than structural damage and provides solutions where traditional neurology falls short.
• Eye movements, balance testing, and cognitive assessments are essential in diagnosing neurological dysfunction.
• Neuroplasticity is at the core of functional neurology, allowing the brain to rewire and heal.
• A true functional neurology approach integrates rehabilitation, functional medicine, and lifestyle interventions.
• Not all functional neurology providers are equal—expertise, training, and diagnostic tools matter.

If you’ve been struggling with chronic fatigue, brain fog, dizziness, post-concussion symptoms, or other neurological issues, this episode is a must-listen to understand why functional neurology may be the missing piece in your recovery.

To check out the blog: https://peakbrainandbody.com/functional-neurology-tampa/

Transcript

Functional neurology, a new approach to brain health. Functional neurology is likely a new term that you have not heard before. In the growing world of functional health, functional medicine, when you look at social media is about a hundred times more popular than functional neurology. Despite that, functional neurology actually holds the keys and answers to many of the things individuals seek medical care for. From dizziness to brain fog to memory to concentration to chronic fatigue and other neurological-based symptoms, functional neurology offers a new approach that you should know about. We are going to discuss what is functional neurology? How does it differ from traditional neurology? What should you be looking for in a functional neurology evaluation and treatment? Who can functional neurology actually help? And lastly, what has the evolution of functional neurology been and what are the highest levels of functional neurology out there? First, who can functional neurology help? These are all the different types of patients that I have come into my office. Long COVID, dysautonomia or postural orthostatic tachycardia syndrome, stroke, neurodegenerative conditions such as Parkinson's, early dementia or early Alzheimer's, concussion, chronic migraines or headaches, vertigo, dizziness, and neurodevelopmental disorders. Now, there are more things that could be on this list, but that is eight to get us started. Now, first, it's really important to understand that not all functional neurology is functional neurology. What do I mean by that? Well, in the functional medicine world, you have medical neurologists who will say they do functional neurology. What they mean by that is instead of medications being their primary focus, they're focused more on in-depth labs and creating a personalized solution for you based upon nutrition and lifestyle changes. Whereas on the other side, functional neurology is going to do testing, but it's also focused very strongly on a rehabilitative model. Whereas general neurology or medical neurologists that do what they consider functional neurology, there's an absence of rehabilitation that is present. So it's really important to understand that If a medical neurologist says they do functional neurology, and then you have someone who usually is a chiropractor who does functional neurology, there may be some overlap in what they're talking about from a nutritional and a lab standpoint. But as far as the rehabilitation side, the medical neurology side, isn't going to have any of that. And it's important to understand that when we look at general neurology, general neurology is based upon in-depth labs, maybe spinal taps. And then MRIs and other imaging modalities to see pathology. And then only when certain amounts of pathology are seen, do they really treat it? Now, there are some things where they don't see a ton of pathology, such as migraines and other headaches that they are treating with medication, but Other things such as multiple sclerosis and many other things in that arena, they really are looking for the pathology to be present to provide any type of treatment. And treatment usually is reserved to medications, surgery, if it's something that would respond to it. And there also is a lot of referrals to rehabilitative providers, such as physical therapists, speech, and occupational therapy. Now, the downside of some of these referrals, so let's say you've had a stroke and you're seeing traditional neurology. They're going to do your MRI. Here's a part of your brain that's been injured. General neurologist, can you help me recover? Well, that's actually not my arena. And so they will then refer you to a physical therapist. The problem is most of these providers don't actually have training in neurology. And so they're trying to use a physical therapy lens to rehab a brain. which sometimes it goes okay for individuals, but many times it does not go okay. And these are the individuals who are routinely coming to my office with more of these mild strokes and then lots of brain injuries who've done physical therapy and using a physical therapy lens, not a neurological lens, doesn't give them the answers they are looking for. And it's important that we realize that functional neurology is not an actual degree. functional neurology is a training that individuals can receive but beyond that it really is a mindset of how we are evaluating and then treating neurological based symptoms and conditions which we'll talk more about that in a little bit it's important to understand that with functional neurology It really is about the brain and saying, how is the brain functioning? So for example, if we look at muscles, if you understand how muscles attach, you understand what movements have to be done to activate those muscles. Now you don't have to have tears in those muscles to impact how well they function. Well, the same thing is true in neurology, right? You don't have to have a stroke to impact your ability to be balanced, to walk, to perform coordinative tasks, to perform eye movements. And that's why a lot of individuals leave general neurology pretty frustrated because the neurologist says your MRI looks great. You know, I don't know why you are dealing with what you're dealing with. Now, there are times where the MRI is positive and they say, well, that's just kind of the way it is. So that leaves a lot of people frustrated. And that's where functional neurology has really bridged the gap is to say, let's look at your function and then let's rehab it. Over the past few years, neuroplasticity has become all the rage. Everyone's talking about it. On podcasts, you've got people who have no medical training at all who keep talking about it, who are life coaches and everything like that. Everyone wants to talk about it. Well, before the medical community even acknowledged that neuroplasticity truly existed, those who did functional neurology were already embracing it and were years ahead of their time. They were so far ahead of their time that they were called crazy. They were attacked in the early days of the internet for being crazy. quacks because well, neuroplasticity didn't exist according to them, even though it was interesting that it was in some of the medical neurology textbooks. But when you would talk to a medical neurologist or other individuals in that arena, they would tell you it was a construct that really wasn't a thing. Well, needless to say, those individuals, they learned about the brain, they did rehab and they saw improvements. And so those were the early days of of functional neurology and we will talk about in a little bit how those early days have progressed because early on it was very much about let's evaluate the brain and then let's rehab the brain and it was zoned in in that main arena and it didn't deviate from that a lot up front So what exactly is neuroplasticity? This term everyone is talking about. Neuroplasticity is the brain's ability to change based upon stimulation. That's it. So the ability to change, to learn, or to adapt based upon stimulation. Now, neuroplasticity can be positive. It can also be negative. So for example, Let's say every time something happens, you get slapped. Well, you're going to be like, I'm not doing that anymore, right? So some people say, oh, that's positive because you're not doing it anymore, right? But if you have a fear and you shouldn't really have a fear, now that's actually a negative response. So neuroplasticity can be negative. It's not always that your brain adapts in the way you want it to. They can maladapt, and that's where you get people who can't go to grocery stores. They can't leave their houses or anything anymore because of the neuroplastic changes. Whereas on the other side, you can have positive neuroplasticity. So you take someone post-stroke who now is getting their life back or with a concussion or long COVID or many other things. What are factors that impact neuroplasticity? There's a laundry list, sleep, stress, foods, hormones, chemicals, infections, mold, blood sugar, chemo, radiation, and really the list can go on and on. It is important to know that in the early days of functional neurology, most of the individuals were not very keen on all of these components. They were trying to rehab the brain in isolation. Now, that's not saying everyone that's been doing this for twenty years, thirty years fell in that boat because that is not true. I was privileged to have learned from individuals who did not think that one dimensional. Now, a lot of those people that were one dimensional, they have evolved, which we'll talk about that. Quick reminder, my name is Dr. Spencer Zimmerman. I've been doing functional neurology for over a decade. I'm licensed as both a nurse practitioner and doctor of chiropractic, and I've got a unique blend of training and experience that I'm bringing to you and talking about these topics. So neuroplasticity is really what functional neurology is all about. Reminder, what can functional neurology help? lots of different symptoms and conditions. So these are mostly conditions, but there would be symptoms in here, chronic fatigue, brain fog, headaches, word finding, concentration, mood changes, chronic pain states, and other things like that. First, what is a functional neurology evaluation? This is what everyone's wondering about. So when you go to a general neurologist, it's usually a brief evaluation. They may check some reflexes. They may check right? Motor strength, but it's very heavy on imaging and blood work. And if that's normal, it's usually, well, we don't really have a lot for you. Whereas on the functional neurology side, it really is about evaluating how the brain's functioning. Our eyes are known as the windows into the health of the brain. So one of the things you would find at many functional neurology clinics is technology known as video oculography or video nystagmography. Not all clinics have this, but The more advanced clinics, the more successful clinics that can afford it, they definitely do. And with this information, we're able to map out how different parts of the brain are functioning. One of the questions we get all the time is, are the eyes really that important? I'm going to spare you all of the research that looks at eye movements. But for example, one of the tests that people perform is called saccadometry. And one of those tasks is called anti-saccades. And when you look at this research paper on anti-saccades, they actually looked at what happens to anti-saccades. So there's what's called a latency. So from the time a task should begin to actually begins from the individual, what does it look like? And there's research you'll see from Parkinson's to dementia to gaming to ADHD and other things like that. So Eye movements are a really big thing. So I'll get people say, well, I've been told I have ADHD and now eyes aren't perfect for ADHD. But I will say, yes, you definitely have it based upon your eye movement patterns. Because with ADHD, they're what we call blazing fast and reckless. A target moves and they do nothing. not move appropriately okay um so with an anti-saccade you should move opposite of the target with adhd they'll move to the target a lot more than they should and they're super fast so short latency horrible amount of going in the wrong direction now on the other side we have pro saccades as well that can be performed and people say well is this appropriate for my age Now, when we look here at the left, we see pro and this shows you psychotic latencies throughout the lifespan of this research study from the age of ten to even ninety. And you'll see starts at two hundred. And then it basically doesn't hit a psychotic latency of two hundred again until people are in their sixties. And it stays that way for the rest of their life. And there's even at its fastest, even down about one seventy five. So really, we're looking for people to be. between about one fifty and two hundred, maybe two twenty five on the high end. Now we do see some anomalies. It would be really good to see in the research what other things those individuals have been diagnosed with or their history. But on the flip side, we also have anti saccades, which is the anti saccades are slow when you're younger and then they speed up and hit a peak speed at about the age of twenty. And then they're still pretty good all the way up to about seventy. And then after seventy, we do start seeing a breakdown comparatively. So this is where it's like, look, you know, this is really good information. So we can say what is normal, what is appropriate versus what is not. Now over here where we see the red and green, this is for individuals that performed it in my office. This is a before and after, and you see it scattered from two hundred to six hundred. The higher the latency, the slower they are doing the task, the more unhealthy a brain. Now after treatment, one fifty to three hundred. So it clustered in quite a bit. So when that happens, these individuals are doing a lot better. And there's actually an analysis that will tell us how fast they were going. So this individual is probably averaging about two twenty five to ten when they finish care compared to at the start of care. We're going to be a little over three hundred. So saccades is frontal lobes, but there's more to it than just that. Next, balance testing is another big component of a functional neurological evaluation. Pretty much everyone should have a computerized balance platform at this point in time. You can get some that are a few thousand dollars to really expensive, but there's really no reason why someone shouldn't have a computerized technology and this shows what happens to someone balance before and after treatment with eyes open eyes closed on a firm surface compared to eyes open eyes closed on a balance pad and we see tremendous improvement and people often say well my balance you know it's not that bad I'm not running into walls I'm not tripping so why should we even look at this to begin with which is a great question who should care about balance? Who should care about their vestibular function? Is it a big thing? When we look at this next research, it looks at what happens when you have vestibular loss, vestibular impairment. Well, you can get impairment in your ability for one. So you've got postural instability. So that's the balance we looked at, but you could also get gaze instability. So gaze is your ability to hold your eyes steady. And also you can have things with tracking targets. So you can get problems with eye movements based on vestibular dysfunction. Yeah, but once again, I don't see the point. Well, we see vestibular loss points down and we see that you can actually get mood disorders from vestibular impairment, anxiety, depression, and panic disorders. On the other side, you can also get cognitive impairment. when you have vestibular dysfunction and there's a lot of research that looks at vestibular dysfunction balance and likelihood of ending up with dementia and cognitive impairment because when you're little as you grow and develop your balance gets better and better because your brain is developing on the other end of life if you end up heading to dementia then your balance can be impaired due to vestibular system issues. And ultimately that can correlate and is linked to a lot of cognitive based issues. And then the last thing you may see in functional neurology clinics, and this isn't everything, this is quantitative electroencephalogram. So QEEG. This is definitely not in all the clinics, but it is in some, and this is our way to look at the makeup of the brainwaves and how different networks are functioning and operating in a way that we can't see with balance and eyes. But neither of these tests replaces the other. So you shouldn't do a QEEG only and ignore eye movements, and balance testing. So this is a pretty good example of what to be looking for in a functional neurological exam. Now there are things beyond this, such as cranial nerves, walking, dual tasking, coordination, and other things in that arena. And so a functional neurology evaluation tends to be pretty complex and in-depth. And it's really, really rare that someone goes to a really good provider who does functional neurology. And they're like, oh yeah, I've had this done before. It's usually, why has no one else done this? Well, because it takes a lot of time. It takes a lot of training. And you have to know what to do with the data. Even if someone had the ability to perform a functional neurology evaluation, If you don't know how to turn into a treatment plan, now it's a waste of time. So what does functional neurology treatment look like? Functional neurology treatment is based on identifying the dysfunction and the impaired networks within the brain. For example, many individuals with issues that we've talked about before will seek care and they will receive vision therapy or oculomotor-based therapy. because the eyes are a big window into the health of the brain. So this is an example of virgins-based exercises. So your ability of your eyes to move closer or align whenever a target comes closer to you versus separate when a target goes further away. It's important to note that vision therapy means a wide variety of things depending on who you talk to, just like vestibular therapy does as well. Next, we have hand-eye coordination and cognitive tasking. So we look at reaction time. What's your accuracy like? Can you multitask? We'll blend and balance and all sorts of things because healthy brains have three things in common. They are fast, they're accurate, and they are cognitively flexible. Those are all the things that we challenge when we do things like this. Now, there are many other things that are incorporated in a functional neurology-based treatment program, depending on the clinic. And there's a whole other level beyond neurological rehabilitation on its own, which we are going to discuss in a few minutes. First, though, I want to go into protocoled care versus mechanism-based care. Many individuals want to know exactly what a provider is going to do for them before they ever get an evaluation. as most functional neurology clinics are self-pay. And people want to understand, well, what are you going to do for me? I've got dizziness. I've got headaches. What are you doing? And we completely understand why you want to know. The question is, are you wanting a protocol that we give to every single person with headaches, which would be the medical model? Patient walks in, you've got a headache. Have you taken your Tylenol or ibuprofen? Yes, I have. It's not working. Great. Have you done an Excedrin migraine? Yes, I have. It's not working. Great. Let's do Imitrex. And that is the protocol-based care that we see in traditional medicine. And unfortunately, traditional medicine has so much power that people have basically accepted a protocol-based care, and that's what they are looking for. but it's also why they are not getting better because protocols for symptoms or conditions completely ignores what is actually happening underneath to drive those symptoms or conditions to begin with. We're going to use an example of something that many in the functional neurology space see all the time, specifically because many of them do chiropractic still and do chiropractic adjustments. People come in, they've got neck pain and they've got headaches. And let's also add in symptoms such as chronic fatigue, brain fog, and word finding issues. non-functional neurology approach if you just see a chiropractor and say oh well you've got neck pain your neck pain is why you've got your headaches and when you add those two together the pain and the discomfort in your neck is going to prevent you from sleeping well the problems with sleep is now going to contribute to brain fog and fatigue and now that's why you can't concentrate and you have problems with memory while that could be true is that the assumption that we want to make The answer is probably not. Now, most of the people that I see, they've already done chiropractic three, four times. They've done physical therapy and they're not getting better. And it's because it's based upon really close to protocols for those symptoms and having single factors. Whereas functional neurology for this same issue, when we focus on purely a brain connectivity neuroplasticity standpoint is going to say, well, You have neck pain and headaches. What is driving that? Is it your neck? Yes or no. What about your visual system? So when we perform your eye movements, what most people are unaware of is if your brain cannot control your eye movements appropriately, you actually have reflexes that go down from your visual system into your upper cervical spine and it locks up the muscles at the base of your skull and it can often progress to down in between your shoulder blades. And many of these individuals have that same pattern of issues and they will do chiropractic, they'll work on their posture and they're not getting better. On the other side, you also have vestibulospinal reflexes. So if your balance is off and your vestibular system is off, that also can create issues for people. So imagine you've got neck pain and headaches, and someone is trying to treat you purely through a neck issue from that standpoint, and they're ignoring the fact that you have dysfunction within your vestibular system and your visual systems. Ultimately, you don't get better. It's also why most functional neurology providers are not just going to evaluate just your visual system or your vestibular system. They're going to evaluate both because if we only evaluate one thing, we now have to hope that is everything. Are there people who get better when you adjust their neck and all those symptoms go away? Yes, but the likelihood of success goes down because you do not have enough metrics to really say that is going to be the best approach for those individuals. So that is what a functional neurology approach is going to look like and why the in-depth evaluation, which if it reveals dysfunction within the vestibular system and the visual system, how so many individuals are able to get better even when the other things they've tried haven't worked, even though they've done PT and chiropractic and acupuncture and every other thing. There's been an evolution in functional neurology since its inception. And as I said up front, it would be wrong to say that there weren't some people who are already years ahead of their game who are blending functional medicine with functional neurology. Because functional neurology at its core, it is much more than just neurological rehab. It's about understanding what supports or hurts the brain. When we look at the brain, we have neurons. These are the functional cells. We should say, what makes my neuron healthy and what makes my neuron unhealthy? And we listed a lot of those things that impact neuroplasticity. Those are the same things that are going to ultimately impact the health of the neurons. But it's not just about the neurons. Those are not the only cells present in the nervous system. You also have immune cells, specifically the microglial cells. We are going to discuss the microglial cells more in a second, but it's important to understand that rehab in the office is good, but physical exercise is a must. The benefits of physical exercise, as we see here in this picture, just on the brain alone is neuroplasticity, neurogenesis, so the generation of new brain cells, and angiogenesis, the generation of new blood vessels. Beyond that, there are benefits in the liver, in the muscles, in the heart, and other things like that. So physical exercise is a must. Whether you've got POTS, long COVID, concussions, there is always some degree of physical exercise you can do. My preference for a lot of people is stationary bike, three minutes, five times a day. If you're a really bad case, some people can run. Some people do elliptical. That is okay. Goal is to do something to drive blood flow, to drive oxygen, to help promote neuroplasticity because any thing that you can layer and stack together is going to be better than care provided in isolation. Now, when we look at this, it looks at a variety of different physical exercises and once again, its role in brain health, working memory, protecting the brain, spatial memory, cognition, cognitive flexibility, reaction time, concentration, And it does it through increasing cerebral blood flow. Brain volume actually increases with exercise. You can get remodeling of different structures of your brain and ultimately the brain waves become healthier. So physical exercise is a must. And that's why if I take someone who wants me to help them with dementia or Parkinson's, they have to exercise because the treatment in the office is not sufficient to help those individuals if they ignore this crucial component. And this is super big because not everyone that does functional neurology is really going to harp on what you need to do at home. As we move forward in this arena, functional neurology has evolved into understanding the immune system, specifically neuroimmunology. What happens with these cells, specifically these microglia? So these microglia, they get signaled to become pro-inflammatory or anti-inflammatory. This can happen for a wide variety of reasons, from a brain injury to mold to a stroke to infections, long COVID, and many other things like that. can drive inflammatory responses, even sleep deprivation, blood sugar issues. All of those can do it. Needless to say, when the microglial cells get activated, nothing good happens, especially when it's sustained. It ultimately leads to, as we see, more neuroinflammation. You impact energy production. You also can lead to the death of neurons at an accelerated rate. and it leaves people in a sticky spot. This is one of the big reasons why many people who've had COVID are still struggling. It's due to the microglial dysfunction, which promotes abnormal neuroplasticity. If you have long COVID and you've done everything you've been told and you're still not getting better, It's often because your brain is being completely ignored. You have a lot of the neurological symptoms from chronic fatigue to brain fog, to memory, to word finding, to dizziness, to headaches. And even in the natural health space, they are not evaluating your brain. They are trying to do everything through labs, through the gut, through hormones to make up for the brain. While some individuals will get better with that approach, which is great, others will not. And it's because it is not well-rounded enough for what those individuals need. On the other end of the spectrum, not everyone in functional neurology takes a complete approach to health either. As we look here, when you have a traumatic brain injury or we just say dysbiosis in general which is an imbalance of your gut microbiome what do you get neuroinflammation mitochondrial issues you get microglial activation you can get breach of your intestinal wall ultimately this can impact the brain so those doing functional neurology at the highest level it's not about rehabbing the brain It's about rehabbing the brain and making sure that anything that would negatively impact the brain is also being addressed. So that may involve doing Treatment for the digestive tract and the gut for the immune system or hormones and other things like that. And this is really the evolution of where a lot of healthcare is going. You do not see a lot of providers doing this. Learning the nervous system alone can seem overwhelming. I know when I was in my training, it felt like I was Rocky Balboa in any of those fights where he got the crap kicked out of him. But when you layer on immunology on top of it, it's just a whole nother game trying to blend both arenas but for the hardest of cases you really do have to do them both you cannot pick one or the other they need to both be done and often at the same time and overlapping when we look at brain injuries as many people's concussions do seek out functional neurologist. Once again, we see with either repetitive mild traumatic brain injuries or a single moderate or severe, you get inflammation. You can get damage to the tissue. And as a result, this causes the production of once again, inflammation, and it's going to accelerate the aging of the brain and increases the likelihood of neurodegenerative conditions. I wanna recap on everything. Functional neurology is a concept of how we evaluate and treat the brain. Many individuals seek out functional neurology because the traditional neurology approach is not working. Despite the results that many functional neurology providers have, most people are unaware it exists and they will try multiple chiropractors, physical therapists, and functional medicine providers before ever finding their way to a functional neurology provider. Even though people are using the words like vestibular rehab, vision therapy, these are not to be used universally or judged as such. So if someone says we do vestibular therapy, understand that the level and the skill of those doing it and their understanding is going to vary drastically. As a result, don't give up because you see one functional provider who claims to do something or you saw a physical therapist who said they did vestibular therapy because they're not all created equal functional neurology has evolved from its early days of being primarily focused on rehab to really being focused on what drives the ability of the brain to be healthy and that's where bringing in functional medicine with functional neurology is the highest outcomes for those individuals if you have other topics that you would like me to cover comment on these videos or in the podcast and I will gladly do so if I get enough requests for variety of topics