- Surface Electromyography in Network Spinal Analysis (pdf download)
Read the latest articles on this research which involves human subjects, has been approved the the University Part Institutional Board (IBR) of the University of Southern California.
- Network Spinal Analysis: A Research Perspective
- ANC Research Accepted for presentation at the International Conference "Physics and Control"
- Statement of Efficacy
- ResearchThe Retrospective Study
- Theoretical Basis & Clinical Application (Evidence Based Document)
- News from the Association of Network Care Research Director
- A Retrospective Assessment of Network Care Using a Survey of Self-Related Health, Wellness and Quality of Life
- References and Additional Resources
NSA is a unique system for advancing spinal and neural integrity; developing
new strategies of self-organization, and living life from the "inside out".
By Donald Epstein, D.C.
Published in The Chiropractic Journal September, 2000
I am proud to report that studies of NSA patients' self reported changes span the largest range of health and wellness domains for a non-medical approach. Even more exciting is that this study performed through the University of California, Irvine College of Medicine indicates improvements in all areas surveyed. Strikingly, 76% of the 2,818 patient self-reported retrospective assessments show statistically significant improvement in their Physical, Emotional, Stress, and Life Enjoyment categories of health and wellness as well as their overall quality of life. Even in patients in care for more than 3 years, there appeared to be no ceiling to improvement.
Network Care is associated with significant improvement in self-rated perceptions of "wellness." Patients who have been under care the longest time reported the greatest improvement in wellness. This retrospective study reflects a large epidemiological group and could be a benchmark for future studies assessing health and wellness related outcomes among patients with a more holistic view of health.
The completed longitudinal study followed a population in care over a one year period. The data collected further validated the questionnaire used to measure wellness and quality of life, and gave us great insight into the strong changes patients achieve in Network Care.
It was found that patients continue in care long after symptoms reduce or disappear. They make healthier choices in their life and enjoyed life more. The study of people receiving Network Spinal Analysis demonstrated that people found reasons other than physical symptoms to continue in care. This was revealed by their improved wellness and quality of life indicators.
Network care is delivered to enhance improvement in the patent's passive, active, neural, and emotional subsystems, advancing their spinal and neural integrity. Outcome assessment revealed predictable and reproducible development of new strategies of self-organization as one progressed through a series of Levels of Care.
Each Level of Care appears to be accompanied by an increase in self- awareness and self-responsibility by the patient for his spine, and nervous system, in relationship to his healing and life.
Rather than attempting to fix or control any problem, including nerve tension, pressure, stress, pain, fixation or subluxation, or to return a patient to a previous state, an NSA practitioner will seek to promote new properties within the nervous system and spinal tissues. These properties are believed to assist in advancing spinal and neural integrity, wellness, quality of life and self organization, allowing the expression of a greater degree of wellness.
Research demonstrates that even if a patient changes diet, exercise, meditates, and performs other health promoting practices, the wellness index questionnaire does not predict greater wellness, unless there is also a greater level of life enjoyment. This is paradigm shifting information. In my opinion, this supports the concept that an internal state of well being helps empower the educated choices we make, and that doing "the right things"does not necessarily produce wellness and health. Increased wellness helps our lifestyle choices to work for us.
The improvement in each of the domains of wellness almost doubled when NSA care was applied, as compared to when only constructive health/lifestyle changes were implemented.
You may have seen, experienced, or heard about the two types of natural body waves, one respiratory and one somatopsychic, that develop uniquely in Network Spinal Analysis care. These waves are believed to dissipate tension and re organize the functioning of the spine and nervous system. The awareness of the waves in patients is the most significant predictor of enhanced wellness on all levels measured.
The "somatopsychic wave"is a consistent, repeatable physiological phenomenon which can be studied as a nonlinear mathematical model. This is of interest to other disciplines studying the dynamics of human function. At the University of Southern California, the NSA population is being studied to assess certain mathematical aspects of biological self-organization. Moreover, in a group of people expressing the ""somatopsychic wave", it has been observed that movements of the larger spinal muscles exhibit synchrony, or "entrain" within the population.
Preliminary studies demonstrate that the organization of the surface EMG signal (recorded on patients possessing the strategy of the Somatopsychic wave) develops greater levels of complexity as the subjects progressed through subsequent Levels of Care.
An exciting next step in research will be to characterize the mathematics of this wave in relation to each Level of Care. This would permit a correlation between each of the Levels of Care and such aspects of patient progress as enhanced self-organization
I am actively supporting further clinical investigation. I believe it is essential to conduct ongoing research to further understand NSA's mode of action. This will advance our knowledge and improve the quality of service we can provide to the public.
I have clinically dedicated myself to furthering the knowledge of the biological links which will help us express a greater range of our humanity. I believe this will help us make healthier choices for ourselves, be to be a more compassionate, vital, creative, self aware, and responsible human culture. I believe that by optimizing the individual's biology, NSA will facilitate positive transformation on a global scale, changing the world a spine at a time.
Ralph Boone, Ph.D., D.C., has served on the consensus panels of all three Standards of Care Documents which have been developed within the chiropractic profession. He has experience with the academics, and the accreditation process, having been president of a national professional accrediting agency, site visitor for a regional accrediting agency, and faculty member at both chiropractic colleges and universities.
He has served as president of an American chiropractic college, and is currently Executive Officer for Academics/Research for the New Zealand School of Chiropractic. He is the current editor of the peer-reviewed Journal of Vertebral Subluxation Research, and author or co/author of numerous publications
Dr. Boone has been on several research teams at various academic institutions. Recently, as the Research/Education Director for the World Chiropractic Alliance (WCA), he was the representative of the WCA, which holds Non Governmental Organization holding recognition with the U.N. Department of Information (NGO/DPI), at the Seoul International Conference of NGOs where he presented a discussion session on "The Role of Chiropractic Care in Global Health."
Dr. Boone also serves as Vice President of the Council on Chiropractic Practice, and is involved with international education of chiropractic and other allied healing arts.
From the Desk of W.R. Boone, Ph.D.,DC
Dr. Donald Epstein
Network Spinal Analysis
October 27th, 1999
Dear Dr. Epstein:
Please feel free to use this letter pertaining to the efficacy and scientific scrutiny which surrounds Network Spinal Analysis (NSA). I offer the following comments based on my experience relative to non-chiropractic basic science research and education, chiropractic research, and chiropractic education.
I have been involved with the evolution of study relative to NSA for approximately five years. That time has permitted the accumulation of sufficient data to develop a sophisticated analysis of previous anecdotal reports concerning NSA care. To date, the system of care delivery associated with NSA has been studied from the perspective of its formal documentation, description, retrospective analysis, and longitudinal clinical outcomes. Moreover, its relationship to academic disciplines other than chiropractic has also occurred (notably nonlinear systems mathematical analysis, and regression modeling relative to the social sciences). A publication history detailing the findings to date can be supplied. Three other manuscripts relative to the social sciences, and the longitudinal study are currently in preparation for publication submission. All articles published have been subjected to the peer-review process to ensure scientific quality and proper evaluation of the findings. As well, a current model of NSA based on these published findings is available.
Currently, the body of scientific information that has accumulated supports earlier reports regarding the efficacy of NSA as well as its positive health and wellness benefits to those receiving NSA care. Thus, in my opinion, it is appropriate to state that NSA has been thoroughly studied in terms of efficacy and benefits to its recipients. Some aspects of the unique "somatopsychic wave" associated with NSA escapes current neurological and physiological explanations relative to mechanism of action. However, this factor alone has been a principle attraction for those representing non-chiropractic disciplines to explore NSA relative to their respective areas of study.
Dr. Epstein is committed to a long-term research program, as should be expected for any technique or methodology, findings to date reveal that a significant number of individuals, spanning a wide spectrum of locations and life situations, respond essentially the same to the NSA care delivered. These findings are epidemiological in scope crossing both geographical and cultural boundaries. I know of no other chiropractic technique to which this level of scientific inquiry has been undertaken. Furthermore, because of the high level of consistency found across the populations studied, only the most rigorous statistical methods of analysis have been used to assess the data.
W. Ralph Boone, Ph.D., DC
The Epstein model of Spinal and Neural Integrity on top of which Network Spinal Analysis developed continues to be the focus of various disciplines in the academic community.
The Retrospective study of almost 3,000 patients in Network offices in the USA, Australia, Canada and Puerto Rico demonstrated "within the boundaries of this study design, these findings provide substantial evidence that Network Care should be included among those practices with established health benefits." Through this study a new instrument which allows for the much desired patient self reported assessment of health was designed and gain initial validity.
This questionnaire evaluated wellness through the patient's own experience of changes in the following categories: Improved Physical State, Improved Mental/Emotional State, Improved Response to Stress, Improved Life Enjoyment, and Improved Overall Quality of life. Not only did Seventy-six percent of the patients studied report improved combined wellness changes in all categories assessed, but the longer the individuals were in care, the greater the level of improvement. After over 3 years of care, no limit or ceiling was found to the benefits. This is remarkable.
Findings from the retrospective study showed that all measured characteristics of care exerted a pronounced impact on perceived improvements in wellness. Individuals who had experienced significant "life stress (change in job, etc..)" and trauma were more likely to report perceived improvements in wellness than those with less stress or trauma.
Statistical analysis using multivariate regression has allowed the development of a "model" to analyze the influence of a number of factors on a given outcome. The influence of the variables on the outcome portion of the overall model is referred to as the R2. If only the variables considered account for all of the variance around a predicted outcome the R2 would be equal to 100%. Relative to the retrospective study, a number of factors were tested to find out the extent to which they influenced the outcome variable "wellness." When a patient reports a perceived change in their health a number of factors could be contributing to that change. A regression model tests what influence personality factors, social status factors, and other social conditions may have on a person's perceived wellness. Through this process, it is possible to construct an overall model which shows what impact the actual care had on respondent's perceived wellness independent of other demographic characteristics such as age, gender, income, lifestyle, and amount of stress due to change in life activities.
Following this logic, the retrospective study showed that sociodemographic factors such as age, gender, education, and income contributed very little to explaining the large change in "wellness" experienced by respondents under Network Care. However, the indicators of potentially "stressful" life circumstances such as change in marital status, job, residence, etc., or experiences of past trauma collectively explained 16% of the variance in improved "wellness." This is interpreted to mean that patients reporting a significant change in life circumstances and past traumatic experiences report a greater perceived improvement in wellness. This further suggests that those who "needed" stress buffering the most (holding all other variables constant) had the highest perceived benefit from Network Care. Interestingly, when duration of care, awareness of the wave, awareness of change in breathing , and whether or not respondent's expectations were met, were added to this regression model, explained variance rose from 16% to 24%, a 50% increase. This suggests that even when holding other variables such as external social factors and interpersonal factors constant, Network Care had an additional effect on the respondent's perceived improvement in health and wellness.
To understand the effect of lifestyle behaviors on present wellness, another regression model was constructed. This model showed that higher present wellness was predicted, (explaining 3% of the variance) by being younger, having a job, and being married. Moreover, when other variables such as having no ailments, reporting a higher emotional state score, and higher perceived prior wellness, the explained variability rose to 36%. When adding Network Care Characteristics; such as, time under care, awareness of the wave, awareness of breathing, and expectations met, the explained variance rose to 38%.
Patients were also asked about health promoting changes in lifestyle practices such as exercise, relaxation, meditation, yoga, diet, vitamins, vegetarianism; and health risking lifestyles such as smoking, beef and caffeine consumption. However, when change in lifestyle was included in a regression model predicting a perceived improvement in wellness (before care minus present wellness), it accounted for only 5% of the variance. Future analysis will likely explain the dynamic between lifestyle habits, the use of NSA, and perceived wellness. That is, does using NSA lead to a change in lifestyles, and if so, do these lifestyle changes, rather than NSA, account for the improvement reported by patients?
The Retrospective questionnaire is being utilized at the New Zealand Chiropractic Association School of Chiropractic, in Auckland. The Epstein model of spinal and neural integrity is part of the curricula at the school, as well as Network Spinal Analysis being taught as an elective at the school and practiced in their clinical program.
Two chiropractic colleges in the USA have showed an interest in utilize this revolutionary patient self reported wellness assessment tool.
A Longitudinal Study was performed, also at the Medical College of the University of California- Irvine, which tracked patients over time in care, with some patients still in care after one year. The questionnaire developed for the Retrospective study, was repeatedly completed. This study, soon to be submitted for publication appears to support the conclusion of the Retrospective study, further validating the questionnaire and the effectiveness of care. Interesting unique factors associated with care will be highlighted in this study.
A study by Miller and Redmond (1998), evaluated changes in digital skin temperature, sEMG, and electrodermal activity in subjects receiving NSA. The NSA group demonstrated a significant decline in electrodermal activity and constancy of sEMG activity compared to controls, thus prompting the authors to proposed that a "sympathetic quieting effect" was in effect during the clinical application NSA. These authors also suggested that these findings were consistent with the self-reported improvements in mental/emotional state and stress reduction in patients receiving Network Care in the retrospective study.
A recent study by Behrendth reported a significant reduction in psoriasis in a male patient who had been under medical care for about eight years. While under concurrent NSA care, although at times undergoing personal stress which a known exacerbating factor in psoriasis, the patient maintained a decrease in body coverage to approximately 1.0% in the absence of methotrexate, a common immunosuppressant medication given to control psoriasis. Prior to NSA, he mistakenly withdrew from the medication, only to experience "flares" of up to 15% body coverage. The patient also reported other quality of life improvements. The author proposes that concurrent NSA care may have been helpful to this patient, possibly by positively affecting psychoneuroimmunological pathways.
Dynamical Nonlinear Model
The actual neurophysiological processes which take place in patients under NSA care are under investigation. Two wave forms have been described to date. Specific changes have been reported by patients when expressing predominantly the "respiratory wave," while other benefits are reported during periods when patients are experiencing both the "respiratory wave," and the "somatopsychic wave." The time periods under care when these waves are most likely to be experienced has been described and identified relative to the Levels of Care, or clinical application of NSA.
It is visually apparent that a unique set of muscular contraction patterns are associated with the "somatopsychic wave," Thus, this neurophysiological phenomenon initiated through the clinical application of NSA was chosen for investigation Observation of the "somatopsychic wave" reveals that the muscular contraction patterns are unique to each individual, but the overall group of patterns exhibit characteristic movements that seem common to a wide range of individuals expressing the wave. It also has been observed that when a large group of people are expressing the "somatopsychic wave" that some of the movements of the larger muscle groups exhibit synchrony within the population. Moreover, while certain muscle contraction patterns are characteristic of the process, it is not predictable as to when a given pattern will be expressed by a patient, or if the pattern will be expressed at all. Additionally, the individual patient can consciously arrest the "somatopsychic wave" but not reproduce it consciously. This combination of characteristics led to the development of a research hypothesis that the neuromuscular process was not only nonlinear, but dynamical (chaotic) as well.
Current investigation has provided preliminary information in support of this hypothesis.
That is, when surface electromyographic (sEMG) data was analyzed by nonlinear mathematical algorithms, a nonlinear attractor estimated to be of an order between 4 and 10 was predicted. Future study in this area will focus on confirming the suspected "chaotic" non-linearity of the "somatopsychic wave," and depicting its respective attractor. If predictions hold true, the next step will be to differentiate the wave relative to Levels of Care to see if attractors specific to each Level of Care can be discerned. This would permit confirmation of patient progress as to their respective status relative to the Network Protocol. Patients have been sampled at different Levels of Care. Preliminary mathematics is promising in regards to a potential relationship between progression in NSA Levels of Care and organization state of the signal and therefore the nervous system.
Milestone: The "somatopsychic wave" represents a consistent, readily repeatable physiological model for nonlinear mathematical modeling. This characteristic should be of interest to a wide range of disciplines interested in the dynamics of human function.
A Functional MRI (brain scan without X-rays) in a pilot study of only one person suggested a extremely significant increase in brain efficiency via change in blood flow to the cerebral cortex (the thinking brain). This study was sufficient to have a grant awarded to a medical college for further study of the potential enhanced brain function in Network Care. It is hoped that this study will be expanded upon and will be performed at various international institutions.
A study of immunologic function associated with NSA care is currently being developed in conjunction with a Professor of immunology at the University of Auckland.
Candace Pert, Ph.D., former chief of brain biochemistry at the Nation Institutes of Mental Health and currently Professor of Research at the department of Physiology and Biophysics, Georgetown University Medical Center is currently involved in developing a further research agenda studying monocyte selectivity for neuropeptide associated with various phases or states of spinal cord tension patterns proposed by Dr. Epstein. Dr. Pert and Dr. Epstein are entering into a cooperation for a theoretical paper bridging the Pert model of neuropeptide (chemicals of emotion) and membrane research with the Epstein model of spinal and neural integrity and model of the Emotional subsystem. It is being proposed that the alteration of membrane tension at the spinal level may be associated with a predisposition to certain neuropeptide binding at the cell membrane. It is further proposed that the Somatopsychic wave seen in Network Care is associated with a change in this peptide-membrane relationship as tension is liberated from the nervous system and tissues regain flexibility and compliance.
NSA, through specific clinical methodology elicits an innate response, which through its apparent chaotic character can be surmised to involve inherent neurophysiological processes which are also chaotic in nature. This response appears to link the active, passive, neurological, and emotional subsystems, into a deterministic complex affecting spinal/neural integrity. The results of this process are reflected at the human perception level as improvements over a wide range of physical, mental, and emotional factors; all of which are believe to be components of health. These responses and expressions of improvement have been quantified as a wellness coefficient and measured through a non-medical health questionnaire format which has demonstrated a high level of internal and external validity.
"A Retrospective Assessment of Network Care Using a Survey of Self-Related Health, Wellness and Quality of Life."
A Study of Network Patients' Self-reported Outcomes Conducted within the Department of Anatomy & Neurobiology, College of Medicine, and Department of Sociology. University of California, Irvine, California 92697-1275.
How does one evaluate health?
There are two distinct models, Biomedical model and Holistic or Wellness model. The Biomedical model considers the symptoms of a person and their laboratory test results to assess their condition or disease. The Holistic wellness model considers the person, their extent of function, their perceptions, and their overall quality of life.
Have health professionals studied their patients to demonstrate the changes across both models of health?
Some studies have been done in various professions. Members of the Association for Network Chiropractic have participated in a study conducted by researchers within the study conducted by researchers within the University of California, Irvine, College of Medicine. One objective of this study was to develop a patient reported questionnaire to evaluate health and well being through a wide range of Biomedical and Wellness indicators incorporating both models. This survey bridges the Biomedical and Wellness assessments. The study evaluated a population of over 2800 patients in the U.S. and abroad under Network Care. It represents the largest study to date assessing the health and wellness benefits of a specific form of chiropractic care. Seventy-six percent (76%) of the patients reported improved combined wellness changes in all categories assessed.
What is Network Care?
Network Care utilizes Network Spinal Analysis (NSA). NSA is a system of assessing and contributing to spinal and neural integrity, as well as health and wellness. Practitioners employ gentle force applications to the spine to assist the body to eliminate mechanical tension in the neurological system. The body naturally develops strategies for dissipation of stored tension/energy, thus enhancing self-regulation of tension and spinal interference.
What trends were seen in patients receiving this form of care?
An increasing percentage of patients reported progressively greater improvements in the areas assessed, as a function of duration of care. That is, in the population studied, there was no "ceiling" to the results over time, for the health and wellness categories investigated. The benefits reported among patient respondents were evident from those under care as recent as 1-3 months, to those under care for as long as 3 plus years. These results have led the investigators to conclude that "within the boundaries of this study designs, these findings provide substantial evidence that Network Care should be included among those practices with established health benefits.
What Categories relating to health and wellness have been investigated, and with what results?
The following categories, with examples from each section, all showed statistical and clinically significant benefits.
Improved Mental/Emotional State
- Positive feelings about self
- Moodiness, less angry outbursts
- Less depression, more interest in life
- Improved ability to think and concentrate
- Less anxiety and concern about vague fears
- Improved ability to stay on task
- Less distress about pain
Improved Response to Stress (less stress related to:)
- Significant relationship
- Daily problems
- General well being
Improved Life Enjoyment
- Openness to guidance by "inner voice feelings"
- Experience of relaxation and well being
- Positive feelings about self
- Interest in maintaining a healthy lifestyle
- Feeling open when relating to others
- Confidence when dealing with adversity
- Compassion for, acceptance of others
- Incidence of feelings of joy or happiness
Improved Overall Quality of Life relative to:
- Personal life
- Extent one adapts to change
- Handling of problems in life
- Actual life accomplishments
- Life as a whole
- Overall contentment with life
- Significant other
- Life being what one wants it to be
- Romantic life
- Actual work done
- Physical appearance
In addition to these categories, there was also a significant increase in health promoting practices and a decrease in health detracting practices.
A demographic analysis of the retrospective study (conducted between Nov. 1994 and April 1995) demonstrates that NETWORK CARE targets highly motivated individuals interested in alternative and complementary care, vitalistic or holistic care.
- 95% of respondents reported their expectations had been met; and
- 99% wished to continue Network Care.
A longitudinal study has been completed to assess practitioners' findings and patients' self-reported health and wellness changes over time. Other research is in progress to better understand the mechanisms underlying the apparent effectiveness of his approach. Researchers in a variety of scientific disciplines are currently involved in studying the benefits and mechanisms of NSA. It is hoped that the interdisciplinary relationships established between the communities representing the chiropractic, medical, basic sciences, and social sciences will assist the public in receiving and understanding the benefits of NSA and other evidence based methods of health and wellness care.
Papers are in preparation which highlight the "stress busting" nature of Network Spinal Analysis,and the positive benefits for senior citizens.
- Epstein DM. Theoretical Basis and Clinical Application of Network Spinal Analysis (NSA). Longmont, Colorado Innate Intelligence Inc. Nov. 1995.
- Epstein DM. Network Spinal Analysis: A system of health care delivery within the subluxation-based chiropractic model.. Journal of Vertebral Subluxation Research. August 1996 1(1) p51-59.
- Blanks, RH., Schuster, TL., Dobson, M A Retrospective Assessment of Network Care Using a Survey of Self-Related Health, Wellness, and Quality of Life. Journal of Vertebral Subluxation Research.. 1997: 1(4) p15-31.
- Robert H. Blanks, Ph.D.
Tanya L. Schuster, Ph. D.
W. Ralph Boone, Ph.D., DC
- Literature produced by:
- The Association for Network Chiropractic
444 North Maine Street
Longmont, Colorado 80501
(303) 678-8101 fax (303) 678-8089
- A Retrospective Assessment of Network Care Using a Survey of Self-Related Health, Wellness, and Quality of Life: A Study of Network Patients Self-Reported Outcomes conducted within the Department of Anatomy & Neurobiology, College of Medicine, and Department of Sociology, University of California, Irvine, CA.
Available at http://www.associationfornetworkcare.com/pdf/ancresearchbrochure.pdf
- Blanks, R.H., Schuster, T. L., Dobson, M. A., Retrospective Assessment of Network Care Using a Survey of Self-Related Health, Wellness and Quality of Life, Journal of Vertebral Subluxation Research, 1997, Vol. 1, No. 4, p.15-31.
- Epstein, Donald. Network Spinal Analysis'99: A Research Perspective. The Chiropractic Journal, September, 2000.
Epstein, D. M., Theoretical Basis and Clinical Application of Network Spinal Analysis (NSA), Longmont, Colorado, Innate Intelligence, Inc., November 1995.
- Epstein, D. M., \Network Spinal Analysis: A system of health care delivery within the subluxation-based chiropractic model, Journal of Vertebral Subluxation Research, August 1996, Vol. 1, No. 1, p. 51-59.
- Home Page for Donald Epstein, D.C.
- Home Page for Wise World Seminars. http://www.wiseworldseminars.com
- Home Page for the Association for Network Care. http://www.associationfornetworkcare.com