Functional neurology is an approach to care that looks at how well the different parts of your nervous system are working, and how well they work together. Rather than only asking whether part of the brain or nervous system is damaged, it looks at how each system is functioning, such as your eye movements, balance, coordination and sensory processing. Care uses targeted therapies that don’t involve drugs or surgery, with the goal of supporting the systems that are struggling.

Functional neurology care is designed to work alongside your physicians, neurologists and other providers, never in place of them. It isn’t a substitute for emergency or medical care, and it doesn’t replace medication or surgery when those are needed. Please don’t change or stop any medication without talking with your prescriber.

What Training Do Functional Neurology Providers Have?

Functional neurology training is postdoctoral education in the evaluation and management of neurological conditions. Providers take it after they have already earned a doctoral degree and a license in their own field, and it usually takes several years to complete. Courses are taught at locations throughout the country, including chiropractic colleges, medical schools and university campuses.

Several educational institutions offer this training. The largest and longest-running is the Carrick Institute, which has trained providers in North America, Europe, Asia and Australia for more than 40 years.

Most providers who complete functional neurology training are chiropractors, but other licensed health care providers, including medical doctors, osteopathic physicians and naturopathic physicians, have also completed it. Functional neurology training is not a separate license. Each provider continues to practice within the scope of their own license, and in Oregon, chiropractic physicians practice within the scope of Oregon chiropractic law.

What Does Board Certification Mean?

After completing their training, providers may sit for board certification exams. Two main organizations provide certification in this field: the American Chiropractic Neurology Board (ACNB) and the American College of Functional Neurology (ACFN).

To become a Diplomate of the American Chiropractic Neurology Board (DACNB), a doctor must complete postdoctoral training in functional neurology and pass the ACNB’s written and performance exams. The ACNB’s board certification program is accredited by the National Commission for Certifying Agencies (NCCA), the same independent body that accredits many respected professional certification programs for multiple professions. The ACFN offers fellowship credentials (FACFN) for doctors who complete additional training and examination.

Dr. Glen Zielinski is a Diplomate of the American Chiropractic Neurology Board (DACNB) and a Fellow of the American College of Functional Neurology (FACFN).

Absolutely not. Our care is not intended to be an alternative to care from a medical neurologist or any other physician. Our services are designed to complement medical care, never to replace it.

We work closely with many medical providers, including neurologists, neurosurgeons, physiatrists, internists and primary care providers. In many cases, we require you to be under the care of a medical provider before we can accept your case. If we find something during your exam that needs medical attention, we will refer you to the right provider.

Please don’t change or stop any medication without talking with your prescriber. If you have a medical emergency, such as sudden weakness, numbness, trouble speaking, vision loss or a sudden severe headache, call 911.

No. We cannot cure neurological diseases or change the long-term course of a degenerative condition.

We treat people, not their diseases. Our care is not designed to fix incurable conditions. Instead, it is designed to support function in the parts of the nervous system that are still working, with the goal of helping you have the best possible quality of life.

When someone develops a neurodegenerative condition such as Parkinson’s disease, Alzheimer’s disease or multiple sclerosis, some nerve cells are lost and some pathways in the nervous system are permanently damaged. Nothing we do can change that. But even with these conditions, many parts of the nervous system are still working, and we look for ways to help those working parts function as well as they can.

We aim to precisely stimulate and exercise the pathways that are still healthy, with the goal of helping them work more efficiently, building their endurance and supporting your ability to function in daily life. Every person’s nervous system is different, so results vary from person to person. Your medical providers remain in charge of managing your condition, and our care works alongside theirs.

Our process starts with a detailed history. To understand your case, we need to learn about the factors and events in your past that brought you to where you are now. We follow this with a thorough neurological examination. Our exam is similar to a medical neurological exam, but it has a different focus.

A medical neurological exam is designed mainly to find disease and significant damage to the nervous system, such as from tumors, strokes, nerve injuries and other conditions where nerve cells have been lost. This is essential, and it’s an important part of your medical care. In that type of exam, if a reflex responds reasonably well, it is generally considered normal.

We look for the same kinds of problems in our exam, and if we find signs that need medical attention, we refer you to the right provider. We also look at a different question: not just whether a reflex works, but how well it works, how quickly it tires and what happens when it starts to fail.

For example, a standard neurological exam may tap the tendon below the kneecap with a reflex hammer, see that the knee moves, grade the reflex and move on. We do the same thing, but we also look at how long the response takes, how strong it is and how quickly it fatigues with repeated testing.

We combine these findings with computerized testing of your eye movements, inner ear reflexes and balance. Together, this helps us build a picture of how well your nervous system is working, how it responds under stress and what happens when it tires. We use that picture to design your personal NeuroRescue Program.

After a brain injury, the pathways that connect the eyes, the inner ear and the muscles and joints are often affected, either one at a time or together. Our exam is designed to measure how well each of these systems is working and how well they work together.

We use computerized testing to measure and document how your visual, vestibular (inner ear) and proprioceptive (body position) systems are working. This includes videonystagmography and saccadometry to measure eye movements, the video head impulse test to measure inner ear reflexes, and CAPS computerized posturography to assess your balance under different conditions.

Combined with our neurological exam, this testing helps us see which systems are working well, which are struggling and, most importantly, which aren’t working well with the others. We use that information to design a rehabilitation program for your specific brain and your specific challenges, with the goal of supporting your recovery.

Our care works alongside your physicians and other providers, never in place of them. If you have a new head injury, or symptoms that are getting worse, such as a severe or worsening headache, repeated vomiting, confusion, unusual drowsiness, slurred speech, weakness, numbness or a seizure, call 911 or get emergency care right away.

We use several different technologies, along with a thorough neurological exam.

Computerized Platform Posturography

We put you through a series of balance tests on different surfaces, with your eyes open and closed and with your head in different positions. This shows us how well you can keep yourself steady against gravity. It also shows how your brain uses different types of sensory information to know where your body is in space, and how it combines that information. This helps us see how well each of your sensory systems is working and how well the information they provide matches up.

Videonystagmography

Videonystagmography (VNG) assesses your important visual reflexes. You wear a set of infrared goggles that precisely track your eye position as you follow a series of targets on a screen. This gives us information about how a number of important brain regions and circuits are working, and how well they work together in different situations. Many of these regions are important not only for vision, but also for thinking, attention and emotional processing. When they are struggling, people may notice problems with vision as well as with some of these other functions.

Video Head Impulse Testing

The video head impulse test (vHIT) measures how well the structures in your inner ear are working. You wear goggles that contain an infrared camera and a motion sensor, and we gently move your head in several directions to see how your eyes respond. This lets us measure your vestibulo-ocular reflexes, which are important to recovery and can be easy to miss without specialized testing.

These reflexes tell your brain how your head is moving and how fast. They also help your brain build its automatic sense of where you are in space. If they send inaccurate information, the brain may not know exactly where it is when your head moves. This can cause it to activate the wrong stabilizing muscles at the wrong time, which may contribute to ongoing muscle and joint problems.

Additional Testing

Depending on your needs, we may also use saccadometry to measure fast eye movements, NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and your perception of vertical in a virtual reality environment.

We combine your testing results with your exam findings to create a rehabilitation program designed specifically for your brain.

Therapy often starts with different types of gentle stimulation, which may include electrical stimulation, laser and light therapy, sounds and visual inputs, and touch and body position (proprioceptive) therapies. Chiropractic adjustments may also be part of your care when they are appropriate and safe for you. We use these to stimulate the parts of your nervous system that are struggling, with the goal of building endurance in systems that tire easily. We then use exercises that activate those areas through precise tasks done in a specific order.

We start with basic brain reflexes and functions and build up to more complex tasks as you’re ready. We design exercises that bring together the different areas that are struggling, with the goal of helping them work together again. Then we create exercises that simulate the real-world situations where you struggle most, so you can practice and build function in the settings that matter to you.

We pace your program carefully, so it challenges your nervous system without overwhelming it. The therapies we recommend are always chosen based on your testing and exam findings, and we adjust your program as you go.

We take great care to exercise your fragile pathways at a level that doesn’t push them into fatigue.

Our goal is to keep your program at a level your nervous system can handle, because pushing a struggling system until it fails can set it back. If you feel worse during or after a therapy, we take that as a sign that something needs to change, such as the type of therapy, its intensity or how long it lasts. Our testing helps us choose the right starting point, and we adjust your program as we go.

Some people feel tired after a session, especially early in their program, and symptoms can change from day to day. Please tell us how you feel during and after each session, so we can adjust your program. If you have new or worsening symptoms that concern you, contact us or your medical provider, and call 911 for any emergency.

We also review your health history and any relevant lab work, because other parts of your health, such as blood sugar, sleep, hormones and inflammation, can affect how your brain is working. When we find problems that are better managed by other providers, we coordinate with your primary care provider or refer you to the right provider, so those issues can be addressed alongside your neurological care.

No. Our therapies are designed to be comfortable, and most people find treatment painless.

Some exercises are meant to gently challenge your nervous system, so you may briefly feel a little dizzy, tired or off balance during a session. Some people also notice mild, short-lived soreness after manual therapies or adjustments. If anything feels uncomfortable, tell us right away, and we will adjust your program.

After a traumatic brain injury, many common symptoms, such as headache, dizziness and brain fog, can be linked to the brain having trouble figuring out where it is in space.

To adapt to the world, your brain needs to make sense of your surroundings and know where you are within them. That depends on three kinds of accurate information: visual information from your eyes to locate the world around you, vestibular information from your inner ear to tell you where your head is in relation to gravity and how it is moving, and proprioceptive information from your muscles and joints to tell your brain where your body parts are and what they are doing. These systems need to send the right information to the brain and work together so you can make sense of your surroundings and function well in them.

The pathways that carry this information are often affected to some degree in a brain injury. They come from many areas of the brain and send long, thin fibers to the brainstem, where the information is combined. Because these fibers are long and delicate, they can be strained by the twisting and shearing forces of an injury. Just as important, these pathways can lose some of their ability to work together. When that happens, the information from different senses may not match in certain situations, which can make it harder for the brain to adapt. This is one reason symptoms may show up in busy, moving or visually complex environments.

Call 911 or get emergency care right away after a head injury if you have a severe or worsening headache, repeated vomiting, confusion, unusual drowsiness or trouble waking up, slurred speech, weakness or numbness, a seizure, or one pupil larger than the other.

Many types of therapy are used to help people recover from brain injuries, and each can play a valuable role.

Physical therapy and chiropractic care can help with structural problems that cause pain. Vestibular therapy can help with balance problems and dizziness. Vision therapy can help with problems such as double vision and trouble focusing the eyes. Your physicians may also recommend medications, cognitive or speech therapy, counseling or other care.

Sometimes, though, symptoms continue because the visual, vestibular and body position systems aren’t working well together, even when each one has been addressed on its own. For example, ongoing neck pain may be linked to the brain tensing the neck muscles to make up for an eye movement reflex that isn’t working well. In that case, the pain may keep coming back until the reflex is addressed too. Similarly, a visual reflex may be affected because an inner ear pathway that helps move the eyes isn’t working well, and dizziness may continue when the eyes and inner ear aren’t working well together.

That’s why we created the NeuroRescue Program. Our approach draws on neurology, vestibular rehabilitation, vision rehabilitation and physical medicine, with a focus on how these systems work together. We evaluate how well your visual, vestibular, proprioceptive and cognitive systems are working, both on their own and together.

Using our computerized testing and neurological exam, we design a program for your specific brain and condition, with the goal of helping these systems work together more smoothly. Our care works alongside your physicians, therapists and other providers, never in place of them.

Vestibular therapy is a well-established, research-supported treatment for dizziness and balance problems, and many people benefit from it. Our program shares many of the same goals but has a different emphasis.

Vestibular therapy typically uses several strategies. Adaptation exercises help the inner ear reflexes respond more accurately. Substitution exercises help the brain rely on other senses, such as vision and body position, to make up for what the inner ear isn’t doing well. Habituation exercises gently and repeatedly expose you to movements or settings that bring on symptoms, so the brain gradually becomes less sensitive to them [3]. Habituation can be very helpful, but because it is designed to bring on some symptoms, it can feel uncomfortable for some people.

Our emphasis is on finding the specific reflexes that aren’t working well, and the ones that aren’t working well together, and training them directly whenever possible. Our goal is to support better function in those reflexes, not only to build ways to work around them.

For example, the inner ear reflex that responds when you turn your head back and to the right may not work well together with the reflex that responds when you tilt your right ear toward your right shoulder. Someone with this pattern might see their general balance improve but still feel dizzy, off balance or nauseated when looking over their right shoulder. If these reflexes also don’t work well with the visual system, symptoms may be worse in visually busy settings, such as checking your blind spot while driving or walking through a grocery store. Our testing is designed to find patterns like these, so your program can target them.

We pace your program to challenge your nervous system without pushing it into fatigue or a flare of symptoms. When building coping strategies is needed, habituation and other compensation-based exercises can still be part of your care. Results vary from person to person, and our care can work alongside a vestibular therapist and your other providers.

Brain injury survivors often seek vision therapy for problems with visual focus, double vision, light sensitivity, and headaches or fatigue while reading. Vision therapy is often very helpful.

After a brain injury, many visual symptoms aren’t caused by problems with the eyes themselves. Instead, they come from changes in the brain pathways that control the eyes. Some of the most common problems after a brain injury involve moving the eyes quickly, smoothly, accurately and together. Even more basic is the ability to hold the eyes steady on a target, which is often affected too.

When an eye muscle doesn’t activate properly during a movement, the cause could be the muscle itself, the nerve that drives it or, more often, one or more of the many reflexes that activate that nerve. These reflexes can involve different parts of the inner ear, several areas of the brainstem, the frontal and parietal lobes, and other parts of the brain. Problems in different areas can look similar but may respond best to different types of rehabilitation.

Our neurological exam and computerized testing are designed to help identify which parts of the system need attention, both before and during eye movement exercises. We use that information to choose and pace your therapies.

Our care isn’t a replacement for vision care. When vision therapy is needed, we refer to and work with experienced vision therapy providers so our care and theirs can work together. We also recommend a complete eye exam with an optometrist or ophthalmologist after a brain injury. If you have sudden vision loss, new double vision or other sudden vision changes, get emergency care or call 911.

Physical therapy is commonly used to address the physical injuries that can come with a traumatic brain injury. It can be very helpful for reducing pain, headaches and muscle spasms and for helping injured tissues heal.

After a brain injury, though, some of the physical problems found on exam may be partly a result of the brain injury itself. When that’s the case, care that addresses both the physical and the neurological sides of the problem can be helpful.

Here’s an example. If the brain pathways that move the eyes to the left aren’t working well, the eyes may tend to drift to the right. These pathways involve the frontal lobe, the cerebellum, the brainstem, the inner ear and other areas, alone or in combination. To keep you looking straight ahead, the brain may use a reflex that turns your head slightly to the left by tightening the muscles at the base of your skull. Over time, those muscles can become tight and painful and may contribute to headaches. The brain isn’t trying to cause headaches. It’s trying to make sure you can see where the world is and stay steady.

In a case like this, treating the tight muscles can ease the neck pain and headaches, but the tension may return if the eye movement reflex driving it isn’t addressed too.

Our approach is to look for the brain pathways that may be behind these patterns and include targeted rehabilitation for them, along with hands-on and structural care when appropriate. Our goal is to address the neurological and physical sides of the problem together. Our care can work alongside your physical therapist and other providers, and results vary from person to person.