Scott Cuthbert, DC, Anthony Rosner, PhD, LLD[Hon]
Chiropractor, Chiropractic Health Center, PC, Pueblo, CO.
OBJECTIVE: The purpose of this case report is to describe the chiropractic care of a 10-year-old boy who presented with developmental delay syndromes, asthma, and chronic neck and head pain and to present an overview of his muscular imbalances during manual muscle testing evaluation that guided the interventions offered to this child.
CLINICAL FEATURES: The child was a poor reader, suffered eye strain while reading, had poor memory for classroom material, and was unable to move easily from one line of text to another during reading. He was using 4 medications for the asthma but was still symptomatic during exercise.
INTERVENTION AND OUTCOME: Chiropractic care, using applied kinesiology, guided evaluation, and treatment. Following spinal and cranial treatment, the patient showed improvement in his reading ability, head and neck pain, and respiratory distress. His ability to read improved (in 3 weeks, after 5 treatments), performing at his own grade level. He has remained symptom free for 2 years.
CONCLUSION: The care provided to this patient seemed to help resolve his chronic musculoskeletal dysfunction and pain and improve his academic performance.
From the Full-Text Article:
Developmental delay syndromes (DDSs) encompass the conditions known as dyspraxia, dyslexia, learning disabilities, and attention-deficit/hyperactivity disorder. Over the past decade, there has been a dramatic increase in the number of DDS-related visits to health care providers. The percentage of children with severe behavioral and language problems is increasing.  A study by the US Department of Education stated that more than 50% of minority and nonminority children are not reading at their grade level.  With the increase of Ritalin (Novartis, East Hanover, NJ) use by 700% since 1990,  it may occur to parents of children suffering from DDS to consider chiropractic and other means of treatment.
A recent case series suggests that a link may exist between motor impairments and DDSs in children. The muscle inhibitions found in 157 children with DDS were diagnosed using a manual muscle test protocol (MMT) developed in applied kinesiology (AK). Common psychometric tests used in the fields of educational psychology and special education were used pre- and post-treatment, revealing measurable improvements in cognitive function for 157 children with DDS between 6 and 13 years of age after the application of chiropractic treatments specified by AK. 
A growing body of research evidence has found that poor muscle tone is related to postural disorders, sensory-motor and coordination disorders, and kinesthesia in children with DDS. [5-7] It has been shown that motor dyscoordination, especially affecting the postural and ocular muscles, is the most common comorbid condition associated with this spectrum of disorders.  Because motor dysfunction, and specifically muscular inhibition, has been found as a common comorbidity associated with DDS, a reliable clinical tool for the diagnosis of this muscular inhibition is desirable. Poor motor performance is most practically assessed, with good reliability and validity in the clinic using MMT. [9-14]
Applied kinesiology evaluates muscle function using MMT, a diagnostic test that has shown good reliability and validity for patients with muscle strength impairments. The use of MMT procedures is for 2 purposes in AK: to aid in the diagnoses of structural, chemical, and/or mental aspects of disease and to determine the effectiveness of treatments. In so doing, AK has been presumed to guide the therapeutic application itself. [15, 16]
In AK, muscular dysfunction is thought to reflect neural function. First, Kendall et al  in the 1950s, then Goodheart  in the 1960s, followed by many others, have expanded the construct validity and the clinical usefulness of the MMT [9-19] because of the recognition that muscular imbalance is a key characteristic of spinal and articular dysfunction. Applied kinesiology is a diagnostic and therapeutic chiropractic technique that has gained peer-reviewed published support within the chiropractic, dental, biofeedback, acupuncture, veterinary, and other health care literature. [20-27] The theories underlying the AK manual muscle testing procedures as this relates to the treatment of children have been reported. [4, 28-31] A recent narrative literature review by Pauli  presents the AK concepts and the clinical research articles regarding the treatment of children with DDS.
The purpose of this case report is to describe the chiropractic management of a child with DDS (slow learning, reading disability, distractibility), complicated by neck pain, headaches, and asthma.
In this case, the muscular impairments associated with the pain appeared to be an accurate measurement of the distress the patient was under. Treatment for these factors eliminated the patient’s pain and restored his postural and muscular balance. In AK, the assessment became treatment in that muscular inhibitions found with the MMT were given specific physical challenges that improved the patient’s muscular strength; these challenges guided the manipulative treatment applied and normalized tissue tensions on follow-up MMT.
Insalivation refers to the fact that the taste buds on the tongue can detect extremely small concentrations of substances within a fraction of a second of stimulation.  Oral nutrient evaluations are used in AK because they are clinically useful in the assessment process. Exposure to taste elicits a variety of neurologic, muscular, digestive, endocrine, cardiovascular, thermogenic, and renal responses.  The relationships between muscle function and specific nutritional deficiencies have been presented by Travell and Simons,  and biological plausibility of muscle and nutrient interactions is based on these rationales.
The nerve pathways causing change in muscle function as observed by MMT are still unclear; however, there is considerable evidence in the literature of extensive efferent function throughout the body from stimulation of the gustatory and olfactory receptors with actual insalivation  rather than merely the contact of a substance with the hand or belly as often taught and erroneously labeled AK to practitioners. 
Insalivation of choline (a component of the neurotransmitter acetylcholine) corrected this finding. The use of choline for exercise-induced asthma (EIA) has good evidence for efficacy. [43, 44] This patient suffered from EIA; and EIA is defined as a bronchial constriction and a decrease in airflow that is triggered by exercise with symptoms of chest tightness, coughing, wheezing, and difficulty breathing.  A number of recent published reports have demonstrated the effectiveness of the AK system of analysis for acupuncture system dysfunctions. [46-48]
The previous treatments did not deal directly with the craniosacral system, nor did they appear to evaluate adequately the sensory input into the nervous system from the musculoskeletal and viscerosomatic system (adrenal glands and lungs). Applied kinesiology theory suggests that to resolve biomechanical, biochemical, psychosocial, and sensory problems, many areas of the body must be examined and corrected to achieve long-lasting symptomatic relief. This global view of integrated biomechanics and neurophysiology is one that may distinguish chiropractic practice from that of many of the other manipulative therapy professions.
Limitations to this study were that standardized asthma outcome scores, including peak expiratory flow rates,  daily ß-2 inhaler use, depression anxiety stress scales,  and cortisol levels, were not recorded in this particular patient. Other objective measures such as reading test scores and headache pain diaries were not included. As in any case study, the natural resolution of symptoms in the patient cannot be ruled out. It is possible that the patient’s symptoms resolved on their own at the same time that the treatment was being rendered.
After 3 years of neck pain and headaches and 4 years of asthma, reading difficulty, and learning disability, this patient’s symptoms resolved. The patient has remained free of symptoms in these areas of difficulty for 2 years since his initial treatments.