The work of Donald Epstein and Network Spinal Analysis continues to be a focus of many researchers in the healthcare field.

Network Spinal Analysis: A System of Health Care Delivery Within the Subluxation-Based Chiropractic Model
Journal for Vertebral Subluxation Research, Volume 1, Number 1, 1996, p.51-59
Donald Epstein, D.C.

Abstract:
The theoretical basis and clinical application of Network Spinal Analysis (NSA) is described. NSA delivers health care within the subluxation-based chiropractic model and seeks to contribute to the distinction of the various techniques and methods within the profession by describing and discussing its major characteristics. In this regard, clinical observations relative to the application of the Network Protocol have been described in relation to the monitoring of patient and practitioner outcomes. Relevant research from a separate Network Care retrospective study, which impacts on its characterization, profiles the patient population as predominantly female. Other data indicates that Network Care is widely and consistently practiced. Additionally, patients report significant, positive changes in health-related quality of life measures linked to certain clinical components of Network Care.

A Retrospective Assessment of Network Care Using a Survey of Self-Rated Health, Wellness and Quality of Life
Journal for Vertebral Subluxation Research, Volume 1, Number 4 , 1997, p.15-31
Robert H. I. Blanks, Ph.D, Tonya L. Schuster, Ph.D, Marnie Dobson, B.A.

Abstract:
The present study represents a retrospective characterization of Network Care, a health care discipline within the subluxation-based chiropractic model. Data were obtained from 156 Network offices (49% practitioner participation rate) in the United States, Canada, Australia, and Puerto Rico. Sociodemographic characterization of 2818 respondents, representing a 67-71% response rate, revealed a population predominately white, female, well-educated, professional, or white collar workers. A second objective of the study included the development and initial validation of a new health survey instrument. The instrument was specifically designed to assess wellness through patients' self-rating different health domains and overall quality of life at two "time" points: "presently" and retrospectively, recalling their status before initiating care ("before Network"). Statistical evaluation employing Chronbach's alpha and theta coefficients derived from principle components factor analyses, indicated a high level of internal reliability in regard to the survey instrument, as well as stable reliability of the retrospective recall method of self-rated perceptions of change as a function of duration of care. Results indicated that patients reported significant, positive perceived change (p < 0.000) in all four domains of health, as well as overall quality of life. Effect sizes for these difference scores were all large (>0.9). Wellness was assessed by summing the scores for the four health domains into a combined wellness scale, and comparing this combined scale "presently" and "before Network." The difference, or "wellness coefficient" spanning a range of -1 to +1, with zero representing no change, showed positive, progressive increases over the duration of care intervals ranging from 1-3 months to over three years. The evidence of improved health in the four domains (physical state, mental/emotional state, stress evaluation, life enjoyment), overall quality of life from a standardized index, and the "wellness coefficient," suggests that Network Care is associated with significant benefits. These benefits are evident from as early as 1-3 months under care, and appear to show continuing clinical improvements in the duration of care intervals studied, with no indication of a maximum clinical benefit. These findings are being further evaluated through longitudinal studies of current populations under care in combination with investigation of the neurophysiological mechanisms underlying its effects.

Functional Magnetic Resonance Imaging: About the Cover (cover picture)
Journal of Vertebral Subluxation Research
Volume 2, Number 2, 1998

Abstract:
Functional Magnetic resonance Imaging (fMRI), which measures the relative presence of oxy-hemoglobin, has gained attention as a non-invasive medium through which high resolution images of the brain and other tissue may be acquired.

About the Cover: Functional Magnetic resonance Imaging (fMRI), which measures the relative presence of oxy-hemoglobin, has gained attention as a non-invasive medium through which high resolution images of the brain and other tissue may be acquired. This technology may provide a useful assessment of cortical changes following chiropractic intervention. Images of the patient depicted on the cover, on the left, reflect cortical activity (lighted areas in the parietal cortex, frontal cortex areas 9, 10; visual association areas 19, 37, and 39) associated with the learning process of a "novel" muscular maneuver of the foot. Images on the right reflect cortical activity following a Network Spinal Analysis (form of chiropractic) adjustment session, taken approximately 20 minutes after the first set of images, involving the same activity. The decrease in "lighted" areas before and after the adjustment session suggests that less cortical "planning" or "activity" is associated with the "novel" foot maneuver. Thus, the ability of fMRI to visualize changes in cortical activity may play a significant role in elucidating the consequences of vertebral subluxation correction on neurological function.

Changes in Digital Skin Temperature, Surface Electromyography, and Electrodermal Activity in Subjects Receiving Network Spinal Analysis Care
Journal for Vertebral Subluxation Research Volume 2, Number 2, June, 1998, p.87-95
Eric B. Miller, Ph.D. , Peter D. Redmond, D.C.

Abstract:
A preliminary study was conducted to evaluate changes in digital skin temperature (DST), surface electromyography (sEMG), and electrodermal activity (EDA) in a group of twenty subjects receiving Network Spinal Analysis (NSA) care. Data, simultaneously derived from all three parameters, were considered to be indirect correlates of sympathetic nervous system activity. Subjects, including a group of five controls, were assessed for a period of 17 minutes. The continuous assessment period included a baseline interval of 4.5 minutes, followed by a 12.5 minute period which was divided into five 2.5 minute intervals. Care was administered to the NSA recipient group immediately after the baseline period, whereas controls received no intervention following baseline. Results revealed no significant differences in DST either within or between the two groups. Surface EMG readings were relatively constant over the five intervals following baseline in the NSA group, while controls showed significant (p < 0.05) increases in sEMG at the second through fifth intervals relative to the first interval following baseline activity. Electrodermal activity was significantly decreased (p < 0.01) in the NSA group in the second through fifth intervals compared to baseline. Moreover, decreases varied between intervals, but exhibited a leveling from the third through fifth interval. Control subjects, alternatively, exhibited an increase in EDA in all intervals following baseline. The extent of increase resulted in EDA activity significantly greater than the NSA group at the third through fifth intervals. It was concluded that the increase in EMG activity in the control groups may have reflected an increasing level of anxiety due to the duration of the recording period. Since the NSA group expressed constancy in sEMG activity during the same period, coupled to significant decreases in EDA, a "sympathetic quieting effect" was postulated to occur in subjects receiving NSA care. This conclusion is consistent with hypothesized neurological pathways linked to responses observed during NSA care, as well as other reports of self-reported improvements in mental/emotional state and stress reduction in patients receiving Network Chiropractic Care.

Chaotic Modeling in Network Spinal Analysis: Nonlinear Canonical Correlation with Alternating Conditional Expectation (ACE): A Preliminary Report
Journal of Vertebral Subluxation Research, Vol. 2, No. 4, 1998, p.188-195
Stephan Bohacek, Edmund Jonckheere , Ph.D.

Abstract:
This paper presents a preliminary non-linear mathematical analysis of surface electromyographic (sEMG) signals from a subject receiving Network Spinal Analysis (NSA).The unfiltered sEMG data was collected over a bandwidth of 10-500 Hz and stored on a PC compatible computer. Electrodes were placed at the level of C1/C2,T6, L5, and S2 and voltage signals were recorded during the periods in which the patient was experiencing the "somatopsychic" wave, characteristic of NSA care. The intent of the preliminary study was to initiate mathematical characterization of the wave phenomenon relative to its "chaotic," and/or nonlinear nature. In the present study the linear and nonlinear Canonical Correlation Analyses (CCA) have been used. The latter, nonlinear CCA, is coupled to specific implementation referred to as Alternating Conditional Expectation (ACE). Preliminary findings obtained by comparing canonical correlation coefficients (CCC's) indicate that the ACE nonlinear functions of the sEMG waveform data lead to a smaller expected prediction error than if linear functions are used. In particular, the preliminary observations of larger nonlinear CCC's compared to linear CCC's indicate that there is some nonlinearity in the data representing the "somatopsychic" waveform. Further analysis of linear and nonlinear predictors indicates that 4th order nonlinear predictors perform 20% better than linear predictors, and 10th order nonlinear predictors perform 30% better than linear predictors.This suggests that the waveform possesses a nonlinear "attractor" with a dimension between 4 and 10. Continued refinement of the ACE algorithm to allow for detection of more nonlinear distortions is expected to further clarify the extent to which the sEMG signal associated with the "somatopsychic" waveform of NSA is differentiated as nonlinear as opposed to random.

Reduction of Psoriasis in a Patient under Network Spinal Analysis Care: A Case Report
Journal of Vertebral Subluxation Research, Vol. 2, No. 4, 1999, p.196-200
Madeline Behrendt, D.C.

Abstract:
This case report describes the progress of a 52 year old male with chronic psoriasis, first diagnosed in April of 1992. After the condition exacerbated over a five year period, he was placed on 12.5 mg/week methotrexate, and oral immunosuppressant medication in October of 1997.After commencing the medication, the condition reduced from 6% body coverage, with flares of 15-20%, to a body coverage of 5%. Following a cessation of the oral medication in February, 1998, the condition recurred at the previous uncontrolled level within one month. The patient was again placed on 12.5 mg/week methotrexate, and subsequently the condition reduced to 5% body coverage. The patient's dose was reduced to 10 mg/week, and later to 7.5 mg/week, with the psoriasis remaining at 5% coverage. On 5/18/98, the patient commenced regular NSA care. He reported a reduction in the psoriasis condition on 6/3/98, and was taken off the oral medication on 6/25/98. The reduction continued, and the patient was advised by his medical physician on 7/01/98 to continue the cessation of oral medication. As of 9/30/98 the psoriasis had decreased to 0.5% to 1.0% of coverage, and prior plans to initiate ultraviolet-A therapy were canceled. As of 11/98, a five month period since cessation of methotrexate, the patient has remained under regular NSA care, with no recurrence of psoriasis body coverage greater than 1%, the only medication being a topical ointment. This is contrasted to the recurrence after one month, following the patient's first cessation of methotrexate, and prior to NSA care. The possible role of NSA care in the reduction of the patient's psoriasis, and other health benefits is discussed.

An Impairment Rating Analysis Of Asthmatic Children Under Chiropractic Care
Journal of Vertebral Subluxation Research, Volume 1 Number 4, 1997 p. 41-48
Robert L. Graham, D.C., Richard A. Pistolese, B.S.

Abstract:

A self-reported asthma-related impairment study was conducted on 81 children under chiropractic care. The intent of this study was to quantify self-reported changes in impairment experienced by the pediatric asthmatic subjects, before and after a two month period under chiropractic care. Practitioners, representing a general range of six different approaches to vertebral subluxation correction, administered a specifically designed asthma impairment questionnaire at the appropriate intervals. Subjects were categorized into two groups; 1-10 years and 11-17 years. Parents/guardians completed questionnaires for the younger group, while the older subjects self-reported their perceptions of impairment. Significantly lower impairment rating scores (improvement) were reported for 90.1% of subjects 60 days after chiropractic care when compared to the pre-chiropractic scores (p < 0.05) with an effect size of 0.96. As well, there were no significant differences across the age groups based on parent/guardian versus self rated scores. Girls reported higher (less improvement) before and after care compared to boys, although significant decreases in impairment ratings were reported for each gender. This suggested a greater clinical effect for boys which was supported by effect sizes ranging from 1.2 for boys compared to 0.75 for girls. Additionally, 25 of 81 subjects (30.9%) chose to voluntarily decrease their dosage of medication by an average of 66.5% while under chiropractic care. Moreover, information collected from patients revealed that among 24 patients reporting asthma "attacks" in the 30 day period prior to the study, the number of "attacks" decreased significantly by an average of 44.9% (p <.05). Based on the data obtained in this study, it was concluded that chiropractic care, for correction of vertebral subluxation, is a safe nonpharmacologic health care approach which may also be associated with significant decreases in asthma related impairment as well as a decreased incidence of asthmatic "attacks." The findings suggest that chiropractic care should be further investigated relative to providing the most efficacious care management regimen for pediatric asthmatics.