Midterm Flashcards
Definition of Chiropractic
A conservative and conscientious form of health care that primarily concerns itself with the functional integrity of the nervous system
What is chiropractic built upon?
the constructs of Vitalism, holism, conservativem, naturalism and rationalism
How do we adapt to stressors?
Innate Intelligence
What happens when there is an interference of the nervous system?
it can disrupt homeostatic balance which can affect the expression of health
What is a subluxation?
An abberation in biochemical spinal anatomy, such that the functional integrity of the nervous system is compromised its capacity to adapt to stimulus
What causes disease?
states in which we fail to adapt to stimuli
What are the four Ts that can cause a subluxation?
thoughts traumas, toxins, exceeding threshold
What does the love of wisdom tell us?
the body is intelligent, it’s self regulating because of innate intelligence, innate intelligence comes from universal intelligence and innate intelligence has a love-hate relationship with educated intelligence
What is an internal cause?
a subluxation that causes the patient presentation
What is an external cause?
it causes the state of dis-ease
What is principle 17?
every cause has and effect and every effect has a cause
Principle number 18
we should live life to its potential. The goal is not to see patients every day, but , but to get them to a point of wellness.
Principle 20
every living thing has innate intelligence
Should there be changes going on with a patient?
Yes, there will be little changes throughout the day, which is normal when you are dealing with a healthy patient
principle 21
the mission of innate intelligence is active organization (homeostasis)
principle 24
Limitations of adaptation. We can only adapt so much before we see pathologies.
principle 30
the cause of dis-ease is the failure to adapt (transmission of innate)
principle 31
adjusting can be a cause or effect
What are the 5 parts of the subluxation complex?
kinesiopathology, myopathology, neuropathology, histopathology, pathophysiology
kinesiopathology
atypical motion/position (inflammation is a cellular change)
how do you find a kinesiopathology?
history, static/motion palpation, range of motion, posture, imaging
How do you determine kinesiopathology?
a list
myopathology
dysfunction in muscle (tonicity/weakness/asymmetry)
How do you determine myopathology?
history, palpation, motor exam, posture, specialized studies (EMG)
Neuropathology
compression/stretch, axoplasmic flow of the nervous system
How do you determine neuropathology?
history, instrumentation, deep tendon reflex, sensory/motor exam, specialized studies (imaging, NCV)
pathophysiology
functional changes associated with disease (measles, cancer, etc.), dis-ease (subluxation complex) or injury
What is the PART system?
a clinical documentation of the subluxation utilizes the PART acronym if you are utilizing a physical examination
What does the P stand for in the PART system?
pain and tenderness
How do you determine pain and tenderness?
observe the pain the patient exhibits during the examination, percussion, palpation, provocation (let me know if it hurts), visual analog type scale, audio confirmation, pain questionaire
What does the A stand for in the PART system?
asymmetry or misalignment
How do you determine asymmetry or misalignment in a patient?
observing patient posture and gait, static and dynamic palpation, diagnostic imaging
What does the R stand for in the PART system?
range of motion abnormality
How do you determine range of motion abnormalities?
observing and increase or decrease in range of motion, motion palpation, stress diagnostic imaging
What does the T stand for in the PART system?
tissue tone changes
How do you determine tissue tone changes?
observation, palpation, instrumentation use, tests for length and strength (leg checks)
What are the visual observations of tissue tone changes?
signs of spasm, inflammation, swelling, rigidity
What can you find when palpating for tissue tone changes?
changes in tissue, hypertonicity, hypotonicity, spasm, inflammation, tautness, rigidity, flaccidity
When stress diagnostic imaging, what can you use?
X ray using flexion/extension views)
How do you use a visual analog scale?
have patient write down how much pain they are in on a scale of 1-10
What do you do when checking leg length and strength?
document leg length, scoliosis contracture, strength of muscles
What is the relationship between the vertebral subluxation complex and PART system?
Kinesiopathology- asymmetry or misalignment, ROM abnormality
myopathology- pain and tenderness, asymmetry or misalignment, tissue tone changes
neuropathology- pain and tenderness, asymmetry or misalignment, tissue tone changes
histopathology- pain and tenderness, asymmetry or misalignment, tissue tone changes
static palpation
a method of using one’s hands to feel and assess several parameters that govern the mobility and health of tissues located near or on the body’s surface.
What is the purpose of static palpation?
to facilitate the analysis of soft or bony tissue structures within the body
What are the parameters of static palpation?
osseous landmarks, topographic anatomy, sudoriferous changes, muscle tonicity/turgidity (edema), tissue prominency, palpatory tenderness
Which part of the PART does static palpation satisfy?
pain and tenderness, asymmetry/misalignment, tissue/tone changes
when is static palpation best used? why?
after instrumentation, a “break” will direct the areas of static assessment.
What are the levels of static palpation?
sudoriferous, turgidity, tonicity, tissue prominency, palpatory tenderness, deep tonicity changes
sudoriferous changes
oily, greasy, slippery, sweaty, clammy, tacky for acute subluxations. dry, scaly, flaky, rough for chronic subluxations.
what does the skin do?
it has eccrine glands that secrete a blood plasma metabolite for thermal regulation
How is the skin innervated?
through the SNS by cholinergic and adrenergic fibers
turgidity changes
intrinsic pressure or resistance offered by a cell or tissue. Sometimes you can feel edema
edema
accumulation of interstitial fluid under the skin usually resultant to altered homeostasis, injury, or inflammation.
what is increased turgidity like?
spongy, puffy, throbbing, hot
what is decreased turgidity like?
dehydration, which can be seen in alcoholics, flaccid, loose, baggy (old people)
tonicity
changes in muscle tone perceived as contracture, spasm, tightness, fullness or being rope like
what is increased muscle tonicity like?
tight, sore, rigid
what is decreased muscle tonicity like?
flabby, atrophied
What must you remember when moving on to deep touch
you must be aware of verbal and non-verbal cues from the patient since this is the most invasive step of static palpation
tissue prominency
generally a palpable prominency in the paravertebral gutter or spinous process.
What is a tissue prominency due to?
osseous misalignment and facet prominence (Z-joint, spinous, lamina)
palaptory tenderness
pressure is firmly applied in an I-S and P-A direction on the spinous processes brought into question by instrumentation findings. Then bilateral L-M pressure is applied to the same spinous process. Pressure can also be applied to any additional structures identified in tissue prominency.
What are examples of additional structures that can be palpated for tenderness that we found in tissue prominency?
zygapophyseal joints, transverse processes, costal articulations, mammillary processes, spinous processes
What does it mean when there is pain during palpatory tenderness procedure?
It means there is sclerotogenous pain that can be arising from articular or periosteal tissues.
sclerotogenous definition
pertaining to ligament, tendon insertion on bone, disc, periosteal or zygopophyseal structures
deep tonicity changes
utilize the thumb tip or pad to firmly strum the paraspinal muscles in all regions of the spine.
what is the primary consideration in deep tonicity changes?
tonicity change
what is the secondary consideration in deep tonicity changes?
pain
What do the primary and secondary indications of deep tonicity changes indicate?
a subluxation
myotogenous pain
pain arising from muscle bellies and musculotendinous junctions.
What must you be aware of during deep tonicity changes?
the patient’s presenting history for potential pain
remember we need to be aware of the different people who have a famous definition of chiropractic.
Homewood, Stephenson, Palmer college, Strang, Mercy confrence, Haldemen, WCA, ACA council on technique, Gatterman, ACC
What are the steps we follow as chiropractors?
history/symptomatology
visualization-posture/leg check
instrumentation
static and motion palpation
spinography (intrinsic cause)
vertebral subluxation complex
adjust with appropriate technique
lifestyle education (extrinsic cause)
What is the purpose of instrumentation?
to objectify neurologic function, target an area for further assessment
who uses break analysis typically?
full spine practitioner
who uses pattern analysis typically?
uppercervical and progressive exam practitioners
What are the limitations of instrumentation?
the examiner reliability is low initially
the clinical presentations of the epidermis can affect the instrument
physiological variability
What are some examples of clinical presentations of the epidermis?
burn, sunburn, blemish, acne, infection, fever, perspiration
What are you assessing for when using an instrument?
vasomotor function (the shrinking and expanding blood vessels)
Where does the information come from when using an instrument? What information do you gather?
the first 5 mm of the epidermis
dermal microvasculature and autonomic nervous system
What does the ANS do?
functions without an antagonist, smooth muscle regulation, tunica media of the vessel
What must you do first before using an instrument?
allow the body to acclimate to the temperature of the room
What should you expect when using an instrument?
you should expect different dermatomes to have different temeratures, but they should be flowing
When trying to maintain homeostasis, what specifically occurs when altering the dermatomes?
- signal enters cord as afferent sensory input in the dorsal horn
- signal synapses from grey to white matter to become lateral spinothalamic tract
- thalamus relays signals to broadmann areas 3, 1, 2 and the insular cortex
- insula takes signal to hypothalamus (anterior hypothalamic nucleus specifically)
- anterior hypothalamic nucleus becomes descending autonomic tract that passes through brain stem
- descending autonomic tract goes to original site via preganglionic sympathetic fiber
- preganglionic sympathetic fiber synapses with sympathetic paravertebral ganglionic chain
- preganglionic sympathetic fiber transmits ACH to stimulate postganglionic fiber which transmits epinephrine
- postganglionic fiber releases epinephrine, terminates in tunica media and will constrict vasculature (unopposed, no antagonists)
When the preganglionic sympathetic fiber synapses with the sympathetic paravertebral fiber ganglionic chain, what are the 3 outcomes?
ascend to ganglion at higher cord level
descend to ganglion at lower cord level
stay at same ganglionic level (most likely when regulating temperature with dermatomes)
What did the study demonstrate (correlations between paraspinal temperature variation and health status)?
demonstrated that temperature imbalances in the spine are correlated with lower health quality of life, which offers objective support for historical claims in the art of manual medicine
What does the nervoscope assist in?
objectifying neurological dysfunction and can cost anywhere between $600 and 900
What is a nervoscope used for primarily?
segmental “break” analysis, but it can also be used for pattern analysis if connected to an analagraph
Describe a nervoscopce.
a relative skin temperature instrument that has skin contact probes, it can be used across all demographics
Name the parts of a nervoscope
thermocouples, tension knob, bowl of the instrument, probes or barrels, analagraph connector, sensitivity switch, 3 minute “on” button
Heat swing
observed as a gradual sweeping deflection of the needle reflecting the gentle thermal shifts present on the skin’s surface as a part of normal physiologic function. Generally multisegmental
Break
observed as a rapid reproducible deflection of the needle reflecting an atypical and unexpected thermal shift present over a neurological fiels as a part of dysfunctional physiology
Describe what the patient placement when using a nervoscope.
- patient gowned or shirt removed, ideally has 10 minutes to acclimate
- jewelry, glasses and garments must be removed/unfastened/unbuckled from the full spine path
- patient is seated with proper posture with spinal curves intact and feet flat on the ground with hands up or down
- for cervicals, patient needs to be all the way to the back of the stool
- for everything else, the patient needs to be a hand width from the back of the chair
Doctor’s stance- cervicals
- scissored stance (45 degrees) or less to patient with contact arm in line with the patient’s spine
- contact elbow is in close to the doctor’s body
- stabilization hand will support the forehead or sweep hair
- singe hand grip of instrument
describe cervical spine glide
- probes parallel or slightly inward
- glide commences at T1 and terminates one half inch above the occiput
- pressure is even, slight dimpling of the skin so there is an air seal (no leaks)
- instrument pitch is always in accordance with disc plane line/surface of skin
- glide speed is 3 seconds per segment, smooth and continuous (18-21 seconds)
- follow lateral curvatures keeping spinous processes centered between probes
- confirmed breaks are marked 1/4 inch below mid thermocouple outside of the glide path
Describe the throacolumbar spine glide
- probes are parallel or wide open if patient has a larger frame
- glide commences at C7 and will terminate at S2
- pressure must be even and slight dimpling of the skin, which creates an air seal
- instrument pitch is always in accordance with the disc plane line or the surface of the skin
- glide speed is approximately 2 seconds per segment and is smooth and continuous (33-38 glide time
- fllow lateral curavures keeping spinous processes centered between the probes
- confirmed breaks are marked 1/2 inch above mid thermocouple well outside of glide path
What are the segmental field general break locations?
C1 suboccipital
C2-T3 interspinous space below
T4 at its own spinous level
T5-T9 interspinous space above
T10-T12 at its own spinous level
L1-L5 lower 25% of involved segment
How do you document when you find a break?
segmental level involved, direction, amplitude
T4/R/3
What is a tytron?
paraspinal thermal imaging system
primarily used for pattern analysis, but can sometimes be used for breaks
Who is the tytron popular with?
upper cervical techniques as a periodic evaluation tool
What are some advantages of the tytron?
highly reproducible
requires little training
minimally invasive
great education tool
charts progress well
well researched
benefits those looking at patterns
regarded well by insurance companies
What are some disadvantages of the tytron?
not very portable from room to room
less effective for break analysis
costs $3000-9000
doesn’t work well in the cold,
moisture can cause IR scatter
technical upkeep
What kind of -pathology can affect your findings?
histopathology
Which letter of the PART system is the tytron insightful about?
T (tissue/tone changes)
What is the patient placement when using the tytron?
- patient gowned or shirt removed, ideally has 10 minutes to acclimate
- jewelry, glasses and garments must be removed/unfastened/unbuckled from the full spine path
- patient is seated with proper posture with spinal curves intact and feet flat on the ground with hands up or down
- for cervicals, patient needs to be all the way to the back of the stool
- for everything else, the patient needs to be a hand width from the back of the chair
Describe what needs to happen before you start your scan with the tytron.
scanner barrels never touch the skin, only the rollers
maintain proper disc plane line
Describe the scanning process with the tytron
scan starts at S2 and terminates at the base of the occiput
smooth and continuous speed of 1 segment per segment
doctor has an ergonomic squat so the scan can be as smooth as possible
hair sweep needs to be on the fly (need to think about it in the scapular area)
every scan is accompanied by a mastoid fossa reading, which provides more specific information about the upper cervical complex
Describe how to do a fossa reading
press F on the keyboard
right barrel on right fossa
right barrel on left fossa
.5 degrees celcius is clinically significant (tells us that there is a neuropathology coming)
Define pattern analysis
a system of analysis that takes into consideration that thermal shifts on the surface of the skin occur as a part of normal physiology
What if thermal shifts are not present when doing a pattern analysis?
it can be correlated with autonomic dysfunction and compromised ability to adapt
What is the “gold standard”
take 3 thermal readings over a 24 hour period as evenly as possible
What does the gold standard allow the doctor to do?
allows them the opportunity to see how the body can or cannot adapt over time
once a pattern is established, every scan after that is compared to the original pattern to see if an adjustment is needed
When can the pattern change?
trauma, illness, medication change, etc.
When are pattern analysis scans used?
during a re-evaluation/progress scan, upper cervical chiropractors use it as well (cervicals only)
What are some reasons for a stress scan?
emotional, physical stress/pain, drugs, caffeine
What are the 3 general scan types for a doctor to consider?
pattern, adaptive, stress
What is a pattern scan?
when the scans look roughly the same all the time. this can be bad because it means they aren’t adapting anymore, which could mean a subluxated state
What is an adaptive scan?
Scans that look different each time. This is good because it means that the body is adapting to different stressors normally
Sandra Jones has been coming to your office every week for a couple months now because of a sprained ankle and you don’t see it necessary for her to come in every week anymore because she is doing so well. She’s afraid because she doesn’t want to mess it up again. What principle could you explain to her that may help her?
principle 18- we should live life to its potential. Being afraid that you’re going to sprain your ankle isn’t going to allow you to live life to your potential.
Missy comes in with a fever and she feels horrible and wonders if it will ever go away. Which principle can you use to explain to her she will get better?
principle 21 the mission of intelligence is active organization (homeostasis). The fever is to get rid of any other bacteria may be in your body so it can finally go back to homeostasis.
Mark is one of your patients you haven’t been seeing for very long. Though some questions to complete your background, you find out he has been smoking since he was 20. What principle can you use to explain to him that smoking can eventually kill him?
Principle 24 limitations of adaptations. If he smokes for too long, then the cells will no longer be able to cope with the stress and can eventually metastasize into a tumor, or even cancer.
Little Susie is sad because her puppy, Spot, got hurt when he was playing with a porcupine. Which principle could you use to let her know that the puppy will get better?
principle 20 every living thing has innate intelligence. This means that Spot can heal and play after his owie just like Susie can play after she lets her owie heal.
James is sad because his mother had a heart attack and died. He doesn’t understand why this had to happen to her. Which principle can you use to help explain this to him?
Principle 17 every cause has an effect and vice versa. This happened because the cause was her genetic predisposition to heart conditions and the effect was her having a heart attack.
You have a new patient come in and she has heard a little bit about adaptation and wants to know more about it. Which principle can you use to help explain this to her.
Principle 30 the cause of dis-ease is the failure to adapt. If you have a lot of upper back pain, it is because one of the vertebrae is out of line and the body could no longer adapt to that problem
Kyle comes in regularly to get adjusted for his lower back pain while his wife, Regina comes in because it makes her feel better. They want to know why they can both come in and be helped. Which principle can you use to explain why this works?
principle 31 adjusting can be a cause or effect. Regina’s adjustment is the cause, and the effect is her feeling better. Kyle’s low back pain is the cause for him to come to the office and the effect was to get adjusted.
