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Category: Scientific Studies
Date 10-mar-2003
Title Heart rate changes in response to mild mechanical irritation of high cervical cord region in infants
Author Koch L.E.; Koch H.; Graumann-Brunt S.; Stolle D.; Ramirez J.-M.; Saternus K.-S.
Main Condition/ Disease  SIDS
Source Forensic Science International 128 (2002) 168-176
Abstract As Quoted: Alterations in the heart rate were monitored before, during and after the application of a unilateral mechanical impulse to the high cervical spine cord region which was administered strictly in connection with the so called manual therapy (diagnosis=KISS). The investigation is based on a survey of 695 infants between the ages of 1 and 12 months. A notable change in heart rate was evident in 47.2% of all examined infants (n=695). in 40.1% of these infants the change in heart rate was characterized by heart rate decrease of 15-83% compared to control conditions. Infants in their first 3 months of life responded more often with severe bradycardia (50-85% decrease), older infants (7-12 months) more often with a mild bradycardia (15-49.9% decrease). This comparison revealed a significantly increased occurrence of severe bradycardia in the younger age group compared to the group of children > 3 months (significance 0.0017). In the 12.1% (n=84) of the infants, the bradycardia was accompanied by an apnea. We discuss the hypothesis that mechanical irritation of the high cervical cord region serves as a trigger that may be involved in sudden infant death (SID).
Summary The paper starts with an introduction, which states “One of the major risks [SIDS] is the prone position of the sleeping baby” and “There is increasing evidence that SID-victims exhibit a pronounced bradycardia before dying. This bradycardia is followed by apnea and the generation of gasping.” This “gasping … is normally associated with an increased heart rate and arousal.” Further “As a consequence, these children seem to die because gasping does not lead to successful recovery.”
For the layperson, bradycardia is a heart rate that is too slow and is defined as a sinus rhythm with a resting heart rate of 60 beats/minute or less. The term ‘prone’ refers to the position of lying on the stomach. In this paper Koch et al investigate “whether a mechanical irritation of the atlanto-occipital region can cause bradycardia.” It seems reasonable to conclude that this ‘irritation’ could be quite possible with the baby lying in a prone position and with the head turned to one side. It is postulated, “this position will cause a mechanical irritation of important autonomic nerves” e.g. the vagal (or vagus) and the phrenic nerve (which innervates the diaphragm) and such irritation may also cause occlusion or obstruction of the vertebral arteries.
The authors noted during chiropractic treatment of 6000 infants diagnosed with “kinematic imbalance due to suboccipital strain” (KISS) that there was “pronounced sensitivity of the atlanto-occipital region.” That is, at the joint of the skull and first cervical vertebra – atlas.
The study involved only infants diagnosed with “orthopedic abnormalities” including “asymmetries … of body posture and motion.” As you would realize from reading my comments on my site, postural and motor problems in children and adults I suggest are the result of subluxations of the upper cervical spine. Typically the study infants might exhibit scoliosis and wry-neck (torticollis).
Importantly the quantitative (statistical) analysis included infants diagnosed with KISS, 365 males and 330 females. “All infants showed some kind of deficit in neuromuscular steering as well as asymmetry” like c-scoliosis and wry-neck. X-ray of these infants in the upper cervical region indicated a “slight predominance for the left sided asymmetry”, however no patients exhibited anomalies of the spinal column of cord.
The authors go on to describe a “therapeutic impulse used to treat KISS” which consists “of a short, gentle thrust administered onto the suboccipital region” using “a portion of the second digit” (finger), said thrust having a force in the range of 30N to 70N, typically in the order of 50N.
This impulse was applied to each infant and the “impulse-induced changes in heart rate, blood pressure, frequency of breathing, oxygen saturation and the peripheral temperature were measured”. Some measurements being inconsistent or unreliable were not evaluated, however, the study focused on heart rate.
Interestingly, Koch et al describe a “flush” immediately following the thrust, which they say is due to increased blood flow, resulting in “facial reddening, which then spread further down to other body parts.” See my comments on my site where I discuss the ‘warm feeling’ patients have when they experience a well delivered upper cervical adjustment. I have theorized that this is either “arterial release” or “immediate positive adjustments made by the nervous system”. They go on to state “Apnea (respiratory arrest) usually occurred with a delay of several seconds” following the “irritation” of the suboccipital region. Breathing was restored immediately by “blowing air into the baby’s face”.
Heart rate measurement was taken in all 695 infants and it was compared before, during and after the application of the impulse. The impulse resulted in 40.1% of cases to a decrease in heart rate, with more significant change in heart rate occurring in the younger age group (1 month or less). “Most bradycardia led to fast recovery” and was associated with brief “tachycardia” – increased heart rate. It is suggested this “constitutes a normal and physiological response”.
The question is asked “How safe is chiropractic treatment for young infants?” Koch et al say, “In many cases, chiropractic treatment seems to be most successful therapy” in disorders in which there is retardation of development, motor and sensory disturbances. “Further we can report more than 20,000 children treated without serious complications.”
They conclude that “the chiropractic impulse that triggers a bradycardia and apnea suggests that comparable mechanical stimuli associated with the prone position may result in similar adverse response”, and their “findings are consistent with the possibility that a minor mechanical irritation of the cervical region may trigger the first step in the events that lead to SID. It’s clear that, the resulting bradycardia will not lead to death in healthy awake children and our data indicate that these children recover very quickly from a bradycardia.”
I think this provides compelling evidence as to how profound and important upper cervical chiropractic adjustments are in the treatment of disease, and suggest again that well directed funding toward research into upper cervical chiropractic will prove that this decades old therapy has its place in patient treatment plans.
Keywords SIDS; sudden infant death syndrome; bradycardia; apnea; vertebral artery;

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