Exam 1 Flashcards
1
Q
Clarence selmer gonstead life
A
1898-1978
2
Q
Gonstead’s family is from
A
Norway
3
Q
Original family name was
A
Halvorson
4
Q
Parents gonstead
A
Carl and sarah - farmers - had 6 children
5
Q
Clarence graduated 8th grade at
A
19 - went to school periodically while working on teh family farm
6
Q
Gonstead moved away from home and attended engineering school.
A
More than likely an automotive mechanic education since he worked for a company that manufactured automobiles at the time
7
Q
While in trade school gonstead got sick
A
Acute rheumatoid arthritis
8
Q
Aunts doctor that came in to take care of gonstead
A
DR. JAcob B. Olson - chiropractor
9
Q
After trade school young gonstead took a jow wokring as an automotive engineer. The job allowed him to save money to pay for chiro school. He also borrowed
A
$500 against family estate for school tuition
10
Q
Clarence gonstead graduated
A
From palmer college in 1923 in a class of 800.
11
Q
How long was chiro schoool
A
1.5 years with no prereqs
12
Q
Palmer offered a curriculum
A
4 terms of four months.
Each term cost $150 ($7600)
13
Q
Special lectures in chiro school
A
Psychology Obstetrics Surgical emergencies First aid to the injured Care of teeth and mouth
14
Q
The prevailing theory at the time
A
BJ palmer’s idea that the subluxation was the result of a vertebral bone on nerve causing nerve pressure
15
Q
What technique did chiros learn in the 20s
A
Full spine, lot on knee chest but modified, adjusting the full spine with a focus on upper cervical
16
Q
After graduation gonstead
A
Worked briefly for Dr. Olson
Merton gonstead his younger brother joint the practice in 1929.
17
Q
Collaberation with merton resulted in
A
The gonstead disc concept.
18
Q
Gonstead concept
A
Vertebral disc with primary culprit of nerve pressure.
Would later become recognized as a model for understanding discogenic back pain
Vertebrae shifts on disc which then causes nerve pressure - abnormal motion can affect the nerve
19
Q
Gonstead bought his practice
A
In mount horeb from Dr. BJ jones
20
Q
Married
A
Elvira
Feb 14, 1924
21
Q
First x-ray machine
A
Feb 1925
First DC in wisconsin to have x-rays
22
Q
Obtained degree as a naturopath
A
1943-1949
23
Q
Merton gonstead
A
Younger brother
Joint practice in 1929 and stayed until 1934
Collaboration resulted in gonstead disc concept
24
Q
Palmer school of chiro lost their leader BJ
A
1961
25
Under new leadership, palmer faculty
Decided to reqrite technique curriculum
Gonstead method bevcame cornerstone of school’s technique department
Today gonstead is represented on chiro national borad
26
What book was written for palmer college’s new curriculm
Gonstead chiropractic science and art - roger hertz one chapter at a time and published that way as well
27
Gonstead was the first chiro in wisconsin to have an office that was
Separate from his home
Stayed in the clinic until 1939
28
Had central air and carport/garage - something most people didn’t even have at their house
Attached garage - second practice on main street
29
Feeder system
Changing room attached to adjsuting room. Light lets doctor know when patient is ready to be seen
30
Dr. Gonstead built clinic
1964 at the age of 65
19,000 sq ft
Karakhal inn hotel
31
Gonstead was the largest ___ in mt. Horeb
Employer and taxpayer
32
Advertising
Gonstead never spent the cost of a stamp on advertising
33
Gonstead saw
150-200 people per day with no appointments
34
Gonstead worked
18-20 hours per day, 6.5 days per week
35
Associates
2, worked same hours - after 1962
36
More than ___% of patients came from more than 100 miles away. No hotels so towns peopel could rent out rooms.
80%
37
Gonstead reluctantly taught his first seminar
1946 after practicing for 23 years
38
Seminars were formally organized in
1954 with help of Dr. Ted and Phyllis Markham and Lee Vogel
39
Gonstead searched to correct
The cause of disease
40
Gonstead had a medical lab
In his office adn employed a med-tech so he could measure changes
41
Gonstead consulted with electronic development lab (EDL) to produce
Better nervoscope (descent of neurocalometer)
42
Gonstead refined
Knee-chest table
43
Zenith 210 Hylo table to add
Break away thoracic section
44
X-ray line marking system developed by
Dr. Lee Vogel.
Developed pelvis listing particularly IN and EX analysis and lisitngs. Also pull move for EX listing
45
Chiro x-ray machine,
Split screen x-ray film cassettes
46
Adjusting cervic cal spine in chair position with
Posteriority as teh focus of correction
47
In his 55 years of practice gonstead categorized
Visceral conditions were into 2 systems, sympathetic and parasympathetic
48
Sympathetic response
C6-L5
49
Parasympathetic response
C0-C5, sacral segments, ilium
50
Adjustments were made
One segment per visit
51
Gonstead found he got the best results with
Just one bone being corrected at a time.
52
While there is a case management guideline guideline that tells you areas of teh spine where he got the best results on a certian condition, it is always important to remember
That no segment is ever adjusted unless all the criteria exists there
53
Guideline does not mimic
The meric chart
54
Results were considered
Diagnostic
55
High systolic BP
Adjust sympathetic first.
| T1-T3 for heart contractility or T10-12 for kidneys
56
High diastolic BP
Adjust upper cervical spine for the tension in the vascular system
57
High systolic and diastolic BP
Adjust sympathetci first, correct it, wait one week then adjust parasympathetic
58
Find it where you find it
Accept it where you find it
59
A diabetic patient comes for care, you find subluxations at C2, T9 and the right SI joint.
What if anything would a gonstead doctor adjust on the first visit
T9
60
Tension headache
Correct cervical curve
Suboccipital headaches may be from hypermobility in the upper cervical spine caused by fixation lower C6-T3
61
Headaches upon waking
Chemistry problem C6-T3 (thyroid hormone)
T12-L3 (adrenal dysfunction)
Alcohol intake the night before
Strained sleeping positions
62
Cluster headaches
Trigeminal nerve dysfunction - atlas/occiput/axis
63
Digestive headaches
Occur 1 hour after eating = upper cervical
1-2 hours after eating = T4-L3
64
Classic/common migraine
Sympathetic C6-T3, T12-L3
| Dietary considerations
65
TMJ headaches
Correct cervical curve
Atlas subluxation
TMD
66
Dr. Gonstead’s commitment to chiropractic
```
3 million adjustments
1.5 million different patients
55 years
6.5 days per week
18 hours per day
One patient at a time
```
67
Learn from others mistakes
You can’t live long enough to make them all yourself
68
On gravestone
Find the subluxation correct it, leave it alone
69
What year did gonstead graudate from palmer
1923
70
How lond did gonstead attend school
1.5 years
71
What physical condition inspired him to become a chiropractor
Rheumatoid arhtritis - juvenile
72
How many days per week did he see patients
6.5 days/week
73
How many hours per day did he work
18 hours
74
What was his first theory called
Gonstead disc concept
75
What chiro table do we use today that he altered
Knee-chest table
76
What town and state was gonsteads clinic located
Mt. Horeb wisconsin
77
How many years did he practice
55 years
78
What is written on his headstone
Find the subluxation, correct it, leave it alone
79
What levels of the spine were measured to have a symptathetic response
C6-L5
80
The patient is positioned with R side up spinous L4 contacted and CCW torque
PLS pull
81
Pt positioned on knee chest. Listing is T2 PL-T. What adjustment, SCP and torque
Single hand, right TP, no torque
82
C5 PL-L LOC
PA-IS-RL
83
BP sacrum line of correction
Disc adjustment
| PA-SI
84
P-L or P-R LOC
PA
85
L5 PLS-M what is LOC and torque
PA-IS-RL, CCW
86
Gonstead analysis
```
History
Visualization
Instrumentation
Static palpation
Motion palpation
X-rays
```
87
History
Very important part of learning about your patient
MOI
May have to use your CSI - chiropractic spinal investigator skills
88
Visualization
```
Posture
Antalgia
Symmetry
Color
Movement
```
89
Instrumentation
Where to adjust, when to adjust, when not to adjust
Heat differential
Procedure - looking for a break in the scoping, rates, direction and levels
Cord pressure
Mistakes of scoping pg 166
90
Multiple glides are required to confirm
A break
91
Rescope area of break
3 times
92
See if the break fades away
False break
93
If the break becomes sharper and distinct
True break
94
Static palpation
```
Soft tissue palpation
Hyperemia or red response
Tenderness
Musculature
Trophic changes - edema
Lateral flexion
```
95
Motion palpation
Abnormal end-feel, abnormal quality of resistance to motion adn reproduction of pain
Three planes for motion - sagittal, frontal, horizontal
Visualization of motion
96
X-rays
Acceptability for chiro care
Biomechanical irregularities
Chiro analysis and evaluation
97
Acceptability for chiro care
Ruling out conditions that are contraindications for chiropractic care - pathologies, fractures, etc
Conditions that need referrals
98
Biomechanical irregularities
Congenital variations
Degenerative changes
Pathologies
99
Chiro analysis and evaluation
Determine the appropriate adjusting table
Generate listings and how you are going to adjust your patient - segment, segmental contact point, LOC
Aid in generating a prognosis and determining frequency of care
100
Lateral disc lesion
Patient will lean away form the side of pain
101
Medial disc lesion
Patient will lean toward side of pain
102
Subrhizal disc lesion
At the nerve, toward the nerve, aroudn or directly at a nerve root
Patient will lean forward or not at all
103
Central disc lesion
Patient will have bilateral pain or switching pain and antalgias
104
Important to determine what kind of disc lesion a patient has because it will determine
How long it may take for symptoms to resolve
105
Lateral disc healing
2 weeks
106
Medial disc healing
4 weeks
107
Subrhizal disc healing
4-6 weeks
108
Central disc healing
6 weeks
109
History
What happened
Has it ever happened before
OPQRST
110
Ortho/neuro physical exam acute low back
Valsalvas/dejerines
SLR + at 45 degeres
Neurological package - mildly + in 50% of disc pts
Pain pattern correlation
111
Chiro exam acute low back
```
Scope
Static palpation
Motion palpation
Percussion/vibration
X-ray
```
112
Scope
Sympathetic reaction to pain may be inconclusive
113
Static palpation
A lot of fluid and muscle fuarded/spasms
114
Motion palpation
Difficult to perform but is still done
115
Percussion/vibration
Positive on spinous of involved segment - start tapping spinous
116
X-ray
APOM, full spine 14x36, lateral full spine
117
You may perform a standing lumbar regional series ONLY IF
Patient is leaned over too much with an antalgic position to get a proper full sine view
118
Chiro management low back
Pt placed on hi-lo table which can be distorted to their antalgia
Ice over affected disc for analgesic effect
Pump the disc (passive motion) by contacting spinous of affected segment - repeat until patient can tolerate it well
Raise pt off hi-lo table
Side posture pull adjustment contacting spinous below the affected disc
119
Patient home care instructions
Pt can be seen 2x/day (6 hours apart) - everday until symptoms are noticeably improved and antalgia is redcuced or gone
Instructed to ice 20 minutes/hour
Instructed to walk at least 5 min/hour
Mild stretching of the lower back
No sitting
120
Follow up care low back
With improvement = adjust 1x/day afternoon or evening
When symptosm subside = re x-ray and continue subluxation correction
121
What is the mechanism of fixation in gonstead system
Cross fiber adhesions in annular fibers
122
A break is seen on instrumentation. A break is
A deviation and return of the needle to the starting point within one segment level
123
The proper way to scope for a break is
Glide instrument from T1 up and C7 down
124
Which motion is greatest in the lumbar spine
Flexion and extension
125
In a standing patient (or sitting up straight) what is the coupled motion of right lateral flexion in the lumbar spine
Right spinous rotation
126
Which of the following are the components of analysis in the gonstead system
```
Visualization
Instrumentation
Static palapation
Motion palpation
X-ray
```
127
What is a pit of edema
Interstitial fluid built up around the facet joint
128
What ortho tests are important for evaluating a patient with acute low back pain
SLR
Valsalva
Dejerine’s triad
129
Your patient presents with left antalgia and pain readiating down left leg. What kind of disc herniation is this likely
Medial
130
Why might it be important to know what type of disc bulge your patient has
Tells you the length of time it will take to get better
131
The patient has pain that extends from the low back to the big toe. What neurologic package is this?
L4?
132
What is preferred x-ray used in gonstead to evaluate a patient with acute lower back
A-P and lateral full spine standing
133
What does a D1 disc look like
Level disc with possible increase disc space
134
What should you do to patient before pump teh individual disc
Put ice on the lower back for 20 minutes
135
What adjustment is used in Gonstead for a patient with acute low back
Side posture
136
After the adjustment, the patient is instructed to
Walk for at least 5 minutes
137
How often is a patient seen when they are very acute and antalgic
Twice a day, morning and afternoon
138
What home instructions should the patient follow
All of the above - ice 2- minutes every 1-2 hours; walk at least 5 minutes per hour; don’t sit
139
Your ability to detect an instrumentation break with scoping in the acute lower back patient will
Be diminished because of the edema and increased heat in the area but you will use the scope and look for the break
140
What is the order of care for the acute lower back patient on first visit
Ice, pump the disc, adjust the segment below
141
Describe the type of x-ray that a gonstead chiro takes for acute lower back patient
A-p full spine, lateral full spine
142
D1
Swollen disc
143
D2
Slightly decreased at posterior
144
D3
Disc that is even more narrow at posterior
145
D4
Level disc with decreased disc space at about 1/3
146
D5
Decreased disc space at about 2/3
147
D6
Almost completely flat
