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MS II > Cervical Manual Therapy > Flashcards

Cervical Manual Therapy Flashcards

1
Q

What percentage of cervical artery dissection cases are of the internal carotid artery?

A

54 %

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2
Q

What percentage of cervical artery dissection cases are of the vertebral artery?

A

46 %

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3
Q

What percentage of cervical artery dissections are classified as spontaneous?

A

61 %

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4
Q

What percentage of cervical artery dissections were associated with trauma/ trivial trauma?

A

30 %

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5
Q

What percentage of cervical artery dissections were associated with cervical spine manipulation?

A

9 %

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6
Q

How often does a stroke occur following cervical spine manipulation?

A
  • Varies from study to study

1: 10,000 –> 1:5.85 Million

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7
Q

Is it more dangerous to drive in your car or to recieve a c-spine manipulation?

A

Driving in car

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8
Q

How likely is riding an airline to be fatal?

A

1:8 million

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9
Q

How likely is the development of a GI bleed while receiving NSAIDS?

A

4:1,000

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10
Q

Is a cervical manipulation or an NSAID more likely to be fatal?

A

NSAIDS 4 times more risky than the most severe c-spine manip statistics

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11
Q

Is there more evidence for C-spine manipulation or other therex type techniques for neck pain?

A

C-spine manips

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12
Q

Are mobilizations, traction, PROM, and strengthening risk free?

A
  • No.
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13
Q

At which vertebra and above is the vertebral artery most at risk for dissection?

A

C2

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14
Q

What combination of motions is thought to be the most stressful to the vertebral artery?

A
  • Contralateral rotation with extension
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15
Q

What is the mechanism of stroke following a cervical manipulation?

A
  • Stretch/ pinch separates inner and outer lining of the artery leading to an internal bleed
  • Thrombus forms –> Dislodges or flakes off to become an embolus
  • Travels to small diameter arteries
  • Causes ischemia/ infarct
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16
Q

Is stroke following dissection of the vertebral artery immediately apparent?

A
  • Not always; it can take time
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17
Q

Why is the incidence of manipulation induced stroke difficult to obtain?

A
  • Under-reported in literature
  • Delay between manipulation and stroke clouds the correlation and causation
  • Dissection may have been in process leading to the practitioner to perform the manipulation
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18
Q

How is the Vertebral Basilar Artery Insufficiency test performed?

A
  • Place patient into end-range rotation with some possible distraction and/or extension.
  • Hold for 10 seconds
19
Q

Is the Vertebral basilar Artery Insufficiency test valid and reliable?

A
  • Not sensitive or specific
20
Q

What are the 10 signs of VBI (5 Ds, 3 Ns, 1 H, and 1 A)?

A
  • Dizziness
  • Drop Attacks
  • Diplopia
  • Dysarthria
  • Dysphagia
  • Ataxia
  • Nausea
  • Numbness
  • Nystagmus
  • Headache
  • Hearing Disturbances
21
Q

What is dysarthria?

A
  • Slurred speech
22
Q

What is dysphagia?

A
  • Trouble swallowing
23
Q

Where is numbness typically felt in patients with VBI?

A
  • Around mouth, or one side of the face or body
24
Q

What may occur instead of a headache if the VBI is sudden or severe?

A
  • Neck pain
25
Q

What is an example of the type of hearing disturbance that will be heard in a patient with VBI?

A

Tinnitus

26
Q

What may be the ONLY sign in spontaneous cervical artery dissection?

A
  • Pain
27
Q

What artery do VBI screens not assess that is just as commonly dissected as the vertebral?

A
  • The internal carotid
28
Q

How strong is the evidence supporting the construct validity of the screening tests to predict the occurrence of VBI?

A
  • No evidence
29
Q

What are 5 signs in the patient’s history that are risk factors for VBI?

A
  • Hypertension (>180/100)
  • Migraine
  • Smoking
  • Trauma
  • Ateriosclerosis
30
Q

Should premanipulation tests be performed if there is a storng likelihood of VBI?

A
  • No; refer the patient out
31
Q

Check slide 19

A

Check slide 19

32
Q

What is the professional theory of chiropractors?

A
  • The “Law of the Nerve”
33
Q

What is the professional theory of Physical Therapists?

A
  • Aligned with medicine
34
Q

How does WHO is treated with PT differ from who is treated with Chiropractors?

A

PTs ONLY those who fall within the classification system (backed by evidence)

35
Q

How does WHAT is treated with PT differ from what is treated with Chiropractors?

A

PTs: Spinal segment hypomobility, and ROM deficits
Chiros: Spinal subluxation

36
Q

How does WHEN treatment is provided differ between PTs and Chriopractors?

A

PTs use a spectrum of mobilizations, and use the gentlest mobilization that obtains results within a spectrum of other treatments

Chiros: Manip manip manip

37
Q

How is VBI traction performed?

A
  • Pt supine
  • End range extension for 10 seconds
  • End range rotation for 10 seconds
38
Q

Describe an OA distraction manipulation.

A
  • Cup Pt’s chin, cradle their head with dominant forearm
  • Support head below nuchal line with non-dominant hand
  • Introduce flexion around an axis through the mastoids
  • Introduce side bend to the contralateral side, and rotation to the same side
  • Engage the movement barrier, and provide a HVLA in a cranial direction with both hands
39
Q

Describe OA self-mobilization.

A
  • Guide the upper C spine into flexion with two fingers on the chin with retraction
  • Avoid excess lower C-spine motion
  • Rotation to about 30 degrees on one side targets the mobilization on one specific joint
40
Q

Describe a sub-occipital distraction.

A
  • Side bend head on neck to isolate motion to one OA joint
  • Press fingers on the occiput until the soft tissue relaxes
  • Place dominant hand the on occiput
  • Place non-dominant hand on C2 at the laminae
  • Stabilize C2 and provide a slight inferior force
  • Perform an axial distraction
  • Reassess sidebending
41
Q

Describe AA self-mobilization.

A
  • Flex neck with a chin tuck
  • Guide self into an movement barrier of axial rotation
  • Perform gentle mobilizations at barrier
  • Introduce self muscle energy technique
42
Q

Describe an upslope manipulation.

A
  • Contact posterolateral aspect of C4
  • Grasp chin/ occiput and neck
  • Move c-spine segment into the movement barrier of rotation, and add a small amount of side bend
  • Thrust to the opposite eye with a combined rotation of the neck
43
Q

Describe a downslope manipulation.

A
  • Contract posterolateral aspect of C4
  • Grasp chin or occiput and neck
  • Side bend segment to movement barrier
  • Add a small amount of rotation to the opposite side
  • Make final adjustments
  • Thrust toward opposite shoulder combined with a sidebend

MS II (20 decks)

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