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- Objective: To investigate the effect of chiropractic treatment as measured on electroencephalography.
- Method: A literature search on CINAHL, MANTIS, PubMed, and Cochrane databases yielded 15 results that were used in this study. The study excluded literature that failed to meet the inclusion criteria.
- Results: The systematic review reveals that an electroencephalogram is an important tool in measuring the effects of chiropractic as the methodology shows.
- Conclusion: The majority of reviewed studies support the applicability of EEG in chiropractic measurements. The recommendations should be assessed further to strengthen the findings of this study.
The EEG has gained dominance within chiropractic care over the recent decades. [1, 2, 3] Evidence indicates that alterations take place during chiropractic spinal adjustments, affecting several bodily functions. Further evidence suggests that chiropractic adjustments pass on brain signals, which affect the body, brain, and nervous systems. Teplan emphasizes that the brain emits different brainwaves concurrently, allowing the EEG to capture the readings each time. 
According to the author, placing the EEG on scalps to capture the waves with varying characteristics can provide information on a patient’s level of alertness, autonomic stimulation, and responses to stimuli. This application is valuable to chiropractic research, making it the foundation for this study. The EEG can, therefore, be used to investigate the relative electrical activity in various brain regions. The EEG is also applicable to observing alertness, reading cognitive engagement and locating damage resulting from injuries or tumours. 
Most notably, EEGs are known to investigate symptoms of various diseases, to test the drug effect on different diseases, and to test the efficacy of chiropractic care. In studying epilepsy, it locates seizure regions, assisting in locating the epileptic focus during treatment.  This review focuses on studies investigating the effect of chiropractic treatment as measured on the EEG and their validity as supported in the available literature. The review also seeks to understand the neurophysiological effects of chiropractic spinal manipulation using EEG measures.
Application of the EEG
The electroencephalogram (EEG) is a tool that monitors brain rhythms and imbalances by monitoring brain waves.  The brain structure generates the electrical activity that the EEG tool reads and later communicates. Using an EEG allows chiropractics to measure electrical impulses, which communicate information within the brain, in hertz. Rather than print EEG oscilloscope tracings on paper, chiropractics digitize the generated data on computers, display them on screens, and save them for later use. 
Digitization makes waveform recreation possible for later display and statistical analysis. Indeed, the ability to store EEGs and quantitatively analyze data facilitates cross-comparison of an individual’s EEG against a database of persons without any neurological disorder. This analysis reveals patterns in background activities that routine EEG inspection cannot show. A study by Barwell et al. measures brains trauma using an electroencephalogram to investigate the depth of the damage.  The authors choose to use an electroencephalogram given its success in obtaining significant and meaningful results. 
The electroencephalogram facilitates the measuring of waveforms that cortical grey matter generates. Most data on quantitative EEG signals explain the impact of various spinal manipulation systems.
We performed an extensive review of literatures investigating the effect of chiropractic treatment as measured on the EEG. In the search, there were studies from the CINAHL, MANTIS, PubMed, and Cochrane databases. The standard measure of each study depended on PICA (patient, intervention, comparator, and outcome) as the exclusion strategy. PICA allowed the researchers to focus solely on peer-reviewed articles published between 2000 and 2014 that addressed the research question. The main keywords used in our search included chiropractic, care, adjustment, manipulation, effects, EEG, and measure.
This analysis includes two systematic reviews, two case studies, two case-control studies, and one review paper that met the criteria and left out inaccessible full texts. A critical analysis of each study for validity assisted in finding accurate results that were linked to chiropractic treatment and EEG measurement. Relevant hand-searched journals were also included in the analysis. Key details of each study were recorded to assess the value of EEG in measuring the impact of chiropractic treatment.
Only complete systematic reviews, case studies, case-control studies, and review papers were included in the literature review. Those that were left out failed to pass the validity assessment using the PICA. Studies with unclear eligibility or with insufficient data were also left out, enabling judgment on eligibility and usage of proper data for analysis. The two reviewers resolved discrepancies arising through discussions and confirmed the validity of the chosen studies. Relevant texts were also assessed for biases and manipulations that could have rendered the studies irrelevant. The PRISMA flow diagram below summarizes the search strategy and results of the study.
Our search strategy located 841 articles from the CINAHL, MANTIS, PubMed, and Cochrane databases. These articles were assessed according to the search strategy, and 227 met the inclusion criteria based on title and abstract. These articles were retrieved for full-text review, and only seven met the inclusion criteria. This review analyzes two systematic reviews, two case studies, two case-control studies, and one review paper on the impact of chiropractic care as measured by an EEG.
Table 1.1 shows details of the studies reporting the effect of chiropractic treatment as measured on EEG. Previous studies, which show that chiropractic care improves the well-being of patients call for rigorous scrutiny of underlying evidence related to this particular study.
This research tries to establish whether EEG is feasible in measuring chiropractic care by examining if evidence comes to a central finding. With burgeoning research focusing on chiropractic and EEG measurements as standalone subjects, this analysis shifts focus on the effects of chiropractic as measured on EEG.  To promote the significance of chiropractic care in improving patient’s well-being, this review will shed light on the possible effects of chiropractic care.
Table 1.1 – Studies reporting the effect of chiropractic treatment as measured on EEG.
|Authors||Type of Study||Intervention||Outcome|
|Lystad and Pollard (2009)||Review Paper||The authors use measurement tools in evaluating changes in neural activities after chiropractic spinal manipulation.||The findings reveal that, although little neurophysiological evidence exists to support the modulation capabilities, chiropractic spinal manipulation modulates sensorimotor integration.|
|Sabeti, Katebi and Boostani (2009)||Case-control study||The authors describe the impact of chiropractic on active brain regions. They use EEG signals to discriminate schizophrenic and control participants.||EEG scans are useful in helping to diagnose schizophrenic patients. The results show that adjustments do not affect brain activity negatively, given that participants with balanced and active brain scans prior to the chiropractic care were not affected much in later scans.|
|Surmeli (n.d.)||Case-control study||The author investigates the impact of chiropractic care on brain functions and the nervous system.||The encephalogram measures alterations in spinal adjustments, as well as distinct changes in the brain’s processing, approaches. The EEG measurements show that manipulating the spine changes sensorimotor integration.|
|Duff (2009)||Case Report||The author measures EEG patterns of twelve volunteers with recurring neck pains prior to and after passive head movements.||The results of the EEG measurements show that spinal manipulations alter the neural processing and motor control of muscles located in upper limbs.|
|Allred (2010)||Systematic Review||The author investigates the neurology behind epilepsy and the efficacy of electroencephalogram biofeedback on neurons within the brain.||The study findings reveal that the EEG depicts abnormal readings during epileptic events and can be used to improve behavioural problems. Upon completing the treatments, the participants showed improved EEG readings and reduced abnormalities.|
|Barwell et al. (2009)||Case Study||The researchers look into the direct effect of chiropractic adjustments on nerve systems before and after adjustments.||The study findings show that chiropractic activity alters levels in nervous systems. The scans also revealed increased activities are accompanying the alpha activity. The EEG scans provided evidence that chiropractic adjustments affect the body, especially nervous systems.|
|Baldwin et al. (2001)||Systematic Review||The authors study the significance of the electroencephalogram test in diagnosing various conditions by measuring brainwave patterns.||The EEG gives a neurologist the best approach of analyzing chiropractic and advises on treatment following diagnosis. EEGs may also show abnormal discharges in particular diseases, such as epilepsy.|
Barwell et al. carried out a study to investigate the direct effect of chiropractic adjustments on the nervous system.  Researchers obtained data on brain wave frequencies using a quantitative EEG measurement device.  The authors collected the data before and after the adjustments and used brain wave activity as the exclusion criterion for determining the effects of chiropractic adjustments.
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Later, the authors investigated the impact of adjustments on these three listed areas and the quantity of activity shown in the regions.  The data covered 100 subjects within three years and concluded that the study findings represented the study’s effects. The study intended to investigate the effect of chiropractic adjustments on the central nervous system to disapprove this effect. However, the results showed that chiropractic altered activity levels in nervous systems.
The EEG scans proved that chiropractic adjustment places subjects in a conscious meditative state.  The conscious meditative state indicated a predominant Alpha brainwave pattern. Evidence also supporting the Alpha pattern included greater relaxation and health. With this being the intent of the adjustments trials, these were indeed the expected results. The scans also revealed increased activities are accompanying the Alpha waves. The EEG scans provided evidence that chiropractic adjustments affect the body, especially nervous systems.
Research by Surmeli also shows that chiropractic care influences the functions of the brain as well as the nervous system.  In the study, the author found that the encephalogram could measure alterations in the EEG during spinal adjustments.  For instance, the EEG measured distinct changes in the brain’s processing approaches. Chiropractic adjustments relay brain signals that affect the spine’s movements through the nerve systems, a useful aspect of chiropractic care. 
The research intended to measure changes in the inhibitory and facilitatory interactions within the brain following chiropractic session. This session included cervical spine manipulation pulse using transcranial magnetic stimulation protocols. The study measured EEG patterns of 12 volunteers with recurring neck pains prior to and after passive head movements. The results were also measured after spinal manipulation. 
The results of the EEG measurements showed that spinal manipulations alter the neural processing and motor control of muscles located in upper limbs. The EEG measurements proved that manipulating the spine changed sensorimotor integration, mechanisms that effectively relieve pain and restore functional abilities. The study lays the groundwork for evidence documenting the advantages of chiropractic adjustments in altering the nervous system.
The need to understand the neurophysiological impacts of chiropractic care on the spine has created increased interest on the subject.  Understanding functional imaging of the brain using electroencephalography adds depth to chiropractic research. Haavik-Taylor and Murphy recommend using the electroencephalogram when investigating the impacts of chiropractic manipulation.  As chiropractic patients receive care and report improved musculoskeletal complaints associated with brain functions, such as autistic spectrum disorder, there are increasing calls to measure these effects. An analysis by Lystad and Pollard reported that only a few studies used measurement tools in evaluating changes to neural activities after chiropractic spinal manipulation. 
Allred investigated the efficacy of electroencephalogram on neurons within the brain using a systematic review on the neurology behind epilepsy.  The electroencephalogram test helped in diagnosing conditions by measuring brainwave patterns.  As Beta waves occur at a frequency of 13 to 30 cycles per second, the EEG gives a neurologist the best approach of analyzing chiropractic and advises on treatment following diagnosis. Moore supports this sentiment, stating that an irregular EEG could flag previously diagnosed conditions while a normal EEG did not rule out the presence of a disease. 
Sometimes, an epileptic can only display irregular brain spikes during seizures. As chiropractic becomes widely accepted in improving central nervous system functions, EEGs will have increased significantly in demonstrating how adjustments can create brain wave alterations, thereby restarting nervous systems. The findings of this study explain why chiropractic care can effectively help patients with various symptoms to fight diseases.
This study shows that the encephalogram is the best tool for measuring the primary frequencies of the brain. These primary frequencies include the Beta, Alpha, Theta, and Delta.  Research emphasizes that Alpha waves are a reflection of the brain’s meditative state. Next, Beta waves correspond to a state of full activity. Conversely, Theta waves correspond to relaxed states, such as sleep. Last, Delta waves correspond to a state of full repair activity that mostly occurs when the brain is immersed in sleep. In a three-year study to measure chiropractic adjustments using an EEG, Sabeti, Katebi, and Boostani examined the balance of the right and left hemispheres of the brain. 
The EEG measured the total brain activity during the Alpha, Beta, Theta, and Delta states. These different states helped in displaying differential responses to treatment and the impact of adjustment effects on active regions. The findings show that correlating the symptoms with EEG changes creates an increased understanding of negative symptoms and brain states. This is evidence that EEG scans are valuable in studying the impact of chiropractic care on brain functions. 
This review highlights the need to understand the neurophysiological effects of chiropractic spinal manipulation using EEG measures. Using the EEG to analyze the brain’s response to spinal manipulation will aid in developing chiropractic. Therefore, this review carries significant implications for patients and chiropractors. This paper intended to synthesize existing knowledge on the effects of chiropractic as measured by an EEG.
The included studies show that EEGs are effective in measuring the effects of chiropractic care, and further research is required to determine the generalization of these findings. The current literature on chiropractic care offers evidence that supports the effectiveness of EEG in measuring chiropractic. The methodological quality of this literature allows us to reach conclusions on the effectiveness of EEGs in measuring chiropractic care but requires further studies to validate the findings.
It is important that chiropractics determine the mode of measurement approach to use in imaging. From this study, the EEG is a suitable neuroelectrical technique that best explains the effects of chiropractic care, which suit the specific research questions. EEG is also a powerful neuroimaging tool for use in chiropractic care. The findings of this study encourage the chiropractic research community to use the EEG in research.
Using measurement tools, such as the EEG, gives chiropractors knowledge on how best spine manipulation can stimulate the neuroplastic change alongside medical recovery. This review affirms that chiropractic adjustments do not negatively affect the brain. This review supports the view that chiropractic care does not negatively affect participants with balanced and active brains.
Applications in chiropractic research
According to Coutin-Churchman, increasing evidence of neural changes using spinal manipulation will increase the number of patient referrals to chiropractors. [11, 12] The neuroimaging modalities are the best tools for obtaining data on alterations in brain activity. Integrating several aspects of sensorimotor of musculoskeletal conditions will receive wider interest, especially with the availability of measurement tools, such as the EEG. The EEG shows changes in sensorimotor integration following a cervical spinal manipulation. Using electrical nerve simulations of EEG to detect nerve stimulation and changes in chiropractic will receive increased relevance in future spinal care.
The implication of this study
This study carries several implications that are of value to the chiropractic profession. This research provides details on the significance of EEG in measuring chiropractic care. The functional EEG will elaborate on patient condition. Davis supports this sentiment, arguing that EEG will elaborate on studies investigating spinal manipulation on sensorimotor integration.  The EEG could gain more relevance in explaining neurodevelopmental disorders, such as autism and epilepsy. Further research should also explore the effects of chiropractic adjustments on the central nervous system. Studies in controlled environments are most recommended.
Another aspect with significant relevance is examining how the nervous system processes pain. This especially relates to the modulation of pain processing among patients suffering from chronic pain. Duff states that the EEG will gain relevance in providing objective neurophysiological evidence on effective chiropractic spinal manipulation. [14, 15] This is achievable by measuring changes in identifying the functions of the brain. The EEG will be an important tool in measuring the best treatment methods for many patients responding to spinal manipulation. This will aid in identifying the best treatment combinations with therapeutic effects.
- Wyatt, L. Handbook of Clinical Chiropractic Care. Massachusetts, United States: Jones & Bartlett Learning; 2004.
- Teplan, M. Fundamentals of EEG Measurement. Measurement Science Review, 2002; 2(2): 1-10.
- Barwell, R., Long A., Byers, A., & Schisler, C. A four Case Study: The effect of the Chiropractic adjustment on the brain wave pattern as measured by QEEG. Summarizing an additional 100 (approximately) cases over a three year period. The Chiropractic Journal, 2009. Web.
- Surmeli, T., Ertem, A., Elarp E., & Kos I. Schizophrenia and the Efficacy of QEEG and Neurofeedback Treatment: A Clinical Case Series; n.d. Web.
- Haavik-Taylor H, & Murphy B. Cervical spine manipulation alters sensorimotor integration: A somatosensory evoked potential study. Clinical Neurophysiology, 2007; 118(2): 391-402.
- Lystad, R., & Pollard, H. Functional neuroimaging: A brief overview and feasibility for use in chiropractic research. Journal of Canadian Chiropractic Association, 2009; 53(1): 59–72.
- Allred, R. Chiropractic care and other alternative treatments for ADHD: A literature review; 2010. Web.
- Moore N. A review of EEG biofeedback treatment of aexery disorders. Clinical Electroencephalography, 2000; 31: 1-6.
- Saxena, V. & Nadkarni, V. Nonpharmacological treatment of epilepsy. Annals of Indian Academy of Neurology, 2011; 14(3): 148–152.
- Sabeti, M., Katebi, S., & Boostani, R. Entropy and complexity measures for EEG signal classification of schizophrenic and control participants. Artificial Intelligence Medicine, 2009; 47(3): 263-274.
- Baldwin, M., Cote, P., Frank, J., & Johnson W. Cost-effectiveness studies of medical, and chiropractic care for occupational low back pain: A critical review of the literature. The Spine Journal, 2001; 1: 138-147.
- Coutin-Churchman P., Anez Y., Uzcategui M., Alvarez L., Vergara F., Mendez L., Fleitas R. Quantitative spectral analysis of EEG in psychiatry revisited: drawing signs out of numbers in a clinical setting. Clinical Neurophysiology, 2003; 114(12): 2294-306.
- Davis, T., Gannan, C., Kamer, S., McCoy, K., Slayton, R. & Montgomery, P. The effects of chiropractic manipulative therapy on heart rate variability and heart rate in patients with history of low back pain; 2005. Web.
- Duff, J. The Usefulness of Quantitative EEG (QEEG) and Neurotherapy in the Assessment and Treatment of Post-Concussion Syndrome. Clinical EEG and Neuroscience, 2009; 35(4): 198-205.
- Egner T. & Sterman M. Neurofeedback treatment of epilepsy: from basic rationale to practical application. Expert Review of Neurotherapeutics, 2006; 6(2): 247-257.