Quick Case! Functional Use of the Capnotrainer
Thanks to Mountain River Physical Therapy for sending me a patient all the way from Asheville, NC! Well, actually, he lives in Buffalo NY part time and NC, part time, but you get the idea.
The great staff at Mountain River essentially opened up the pickle jar that others could not in terms of getting rid of most of the gentleman's neck pain after MVA. He presented as DP with moderate loss in all planes but mostly complained of stiffness and being reliant on medication to alleviate his discomfort with motion. He was reportedly 80% improved and sought my assistance in getting closer to 100%.
After 2 visits, he has stopped taking medication, and his discomfort during the motion is improved, with most discomfort being at the end range. He has no improvement in ROM in all planes, but is more worried about the perceptions of pain and stiffness. Between visit 1 and 2, I only changed his HEP from isolated cervical rotations to just cervical retractions repeatedly throughout the day. This is what got him over the 80% hurdle.
For the 3rd visit, I decided it was time for some ETCO2 baselines with the Capnotrainer. The patient stated repeatedly that every time he woke in the morning he felt perfect. Baseline ETCO2 in sitting was 27 mmHg (35-45 mmHg is WNL). I had him practice for about 20 minutes and being mindful of his breathing rate and how long he paused at the end of inhale and exhale. To make a long story short, in lying supine, visualizing waking up in the morning, he was able to get his average ETCO2 38 mmHg. Upon rising and sitting again, ETCO2 dropped.
Visualization is important and one of the focuses of Capnolearning - it helps when the head of Better Physiology is a PhD in Psychology. While sitting upright, I had the patient visualize lying supine, with his eyes closed, he reported feeling pain free. Then I had him continue this visualization with eyes closed while he rotated his head back and forth. Not only did he continue to keep ETCO2 levels to between 35-37 mmHg, but he was able to rotate completely pain free and devoid of perceptions of stiffness.
I am sure our shared patient will get over his hurdle now that his nervous system has been shown he can move without threat. I'll be following up with him in two weeks.
Keeping it Eclectic...