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SMT > SMT-1 Manual, pgs 56-66 > Flashcards

SMT-1 Manual, pgs 56-66 Flashcards

1
Q

What did Fernandez-de-las-Penas 2005 measure?

A

The validity of the lateral shift test, confirming that the distance between subjacent transverse processes of the dysfunctional joint would be reduced.

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2
Q

What was the difference in mm between subjacent transverse processes in the Fernandez-de-las-Penas 2005?

A

3.44 mm less at hypomobile side

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3
Q

How did Smedmark et al 2000 test PPIVMs?

A

2 PTs assess C2-3 lateral flexion, 1st rib depression, C7-T1 flex/ext, and C1-C2 rotation for 61 patients = 244 tests.

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4
Q

What was the percent of agreement in Smedmark et al 2000 study?

A

77%

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5
Q

What was inter-rater reliability of the Smedmark et al 2000 study?

A

70-87% (Fair to moderate).

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6
Q

What is the Kappa Co-Efficient of Smedmark et al 2000 study?

A

.28 and .43

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7
Q

Did Jull et al 1994 find that pain was needed to identify a dysfunctional joint?

A

No-pain is not needed

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8
Q

How will an symptomatic joint present

A

Abnormal displacement, abnormal tissue resistance, and pain.

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9
Q

How did Jull et al 1994 examine and label joints?

A

PAIVM and PPIVM C0-C1 to C6-C7 manual rated 0-6 (Gonnella et all 1982)

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10
Q

The percent agreement of normal joint as painless in Jull et al 1994?

A

98%

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11
Q

What did Jull et al 1997 find with pain?

A

Pain provocation and joint dysfunction was used.

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12
Q

How was the inter-examiner agreement with Jull et al 1997?

A

Excellent to complete.

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13
Q

What area was examined in Jull et al 1997?

A

C0-C1, C1-C2, C2-C3

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14
Q

What was the most common dysfunctional segment in Jull et al 1997?

A

C1-C2

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15
Q

What was the second most common dysfunctional segment in Jull et al 1997?

A

C2-C3 > C0-C1

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16
Q

According to Ernst 2010, how man Chiropractic SMTs have resulted in death?

A

26

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17
Q

According to Dvorak & Orelli, what was the estimated rate of overall, “slight neurological complications”?

A

1 in 40,000

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18
Q

Estimated rate of “important complication”?

A

1 in 400,000

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19
Q

According to Lee et al 1995, what % of neurologists reported at least one case of stroke?

A

21%

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20
Q

What was the reported estimate of CVAs from Danish Chiro’s?

A

1 per 1.3 million Cx treatments / 1 in 362 tx

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21
Q

In cadavers, Symons et al 2002 found what % of strain from cervical ROM testing of vertebral artery?

A

1.2-12.5% greater than at rest

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22
Q

During cervical HVLAT, what % of strain is found on vertebral artery?

A

6.2% greater than at rest

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23
Q

When did mechanical failure of vertebral artery occur?

A

139-162% greater than at rest

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24
Q

According to Rothwell et al 2001, what was the relationship of age, chiro, and VBA stroke?

A

For those aged <45 years, cases were 5 x more likely than controls to have visited a chiro within 1 week of VBA stroke

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25
Q

Did Smith et al 2003 find a significant association between neck HVLAT and ischemic stroke or TIA.

A

NO

26
Q

What did sub group show in the Smith et al 2003 study?

A

The 25 cases with VBA dissection were 6x more likely to have consulted a chiro within 30 days before their stroke compared to the control.

27
Q

Did Dittrich et al 2007 find an association between CAD and HVLAT to Cervical spine.

A

No

28
Q

Murphy 2010 found what two explanations related to screening for CAD?

A
  1. No way to predict or screen for @ risk post manip/stroke.

2. Pts sought chirocare but still stroked out independent of cervical manipulation, meaning VA was already in progress.

29
Q

What did Murphy 2010 conclude regarding the relationship between chiros, PCPs, and CADs.

A

No strong claim that there is causal relationship between cervical HVLAT and VADs, a VAD is already in progress, but seek chiro or PCP care for neck pain and HA. The dissection takes its natural course independent of cervical HVLAT.

30
Q

Does Murphy 2010 feel it is the PTs job to screen for an “at risk” patient.

A

No it is for PTs to determine a differential diagnosis and refer because current evidence indicates that VADs is no a complication to cervical HVLAT.

31
Q
  1. What did Cassidy et al 2008 find regarding the association between chiropractic care, primary care practitioners, and stroke?
A

There is a strong association between primary care visits and stroke in those >45yo compared to chiro visits.

32
Q
  1. What did Cassidy et al 2008 find regarding those patients <45 years old with sxs (HA and neck pain)?
A

They are 3x more likely to see a chiro or PCP before their stroke compared to controls.

33
Q
  1. Is the VBI test validated according to Kerry &Taylor 2006?
A

No. There is little evidence that a neg test predicts the absence of an arterial pathology or identifies those at risk.

34
Q
  1. According to Kerry & Taylor is the VBI test sensitive or specific?
A

It is neither Sn or Sp.

35
Q
  1. What were the results of Carlesso et al 2010 systematic review of adverse events after cervical manipulation or mobilization?
A

Thiel et al 2007 reported no major or catastrophic outcomes in 50,276 Cx HVLATs. Average 16.3% of minor events across all studies.

36
Q
  1. What did the 16.4% minor events consist of according to Thiel et al 2007?
A

An increase in neck pain and headaches.

37
Q
  1. Why did Carlesso et all 2010 systematic review say no definitive conclusions can be made by the existing research?
A
  • small number of studies
  • weak association
  • moderate study quality
  • ascertainment bias
38
Q
  1. What is the gold standard for measuring blood flow?
A

MRA - Magnetic Resonance Angiography

39
Q
  1. According to Kerry et al 2008 what is a better term than VBI?
A

Cervical Artery Dysfunction

40
Q
  1. How do Kerry & Taylor 2006 screen for CAD in patients presenting with neck pain and headache sxs?
A
  • Cranial Nerve and eye exam
  • Blood Pressure
  • Signs of ICA or VA dissection
  • Past medical history related to atherosclerosis
  • hand held Doppler
  • Functional CAD positional tests: ROT for VA, EXT for ICA
41
Q

What should the PT recognize as a clue related to carotid artery dissection (CAD)?

A

A Headache that is like no other that the patient has had before.

42
Q

Does Kerry et al 2008 feel there is an increase risk of upper cervical HVLAT?

A

No studies have focused on that question

43
Q

Why is the upper cervical so taboo?

A

because of the course of the vertebral artery between C2 and occiput

44
Q

Where are most plaques found in the vertebral artery?

A

At the bifurcation of the internal and external vessels found in the mid to lower cervical spine.

45
Q

According to Kerry et at 2008, is HVLAT as risky as joint mobilizations?

A

No, a gentler, repeated movement could cause potential dissection

46
Q

Have Mckenzie or other non-thrust manual therapies been subject to the same degree of study?

A

No

47
Q

According to Kerry & Taylor 2010 what signs and symptoms should a PT be aware of during a potential CAD screening?

A

CN Palsies and Horner’s syndrome (ICA pathology)

48
Q

What nerve is most commonly affected in ICA pathology?

A

Hypoglossal (12)- Tongue out

49
Q

What are 3 other nerves that could be affected besides the most common (hypoglossal)?

A

Glosspharyngeal, Vagus, Accessory

50
Q

What % of ICA dissection patients is Horner’s syndrome present in?

A

82%

51
Q

Signs & Symptoms of Horner’s syndrome:

A 
Head, Neck or Facial pain
Drooping eyelid (ptosis)
Sunken eye (enophthalmia)
Constricted pupil (miosis)Facial dryness (anhidrosis)
Retina &amp; Cerebral Ischemia signs
52
Q

What is Horner’s syndrome an interruption of?

A

Sympathetic nerve fibers supplying the eye

53
Q

Where does the superior cervical ganglion lie

A

In the posterior wall of the carotid artyery

54
Q

What does the ICA supply in terms of the eye?

A

Supplies the retina via the opthalmic artery

55
Q

What can an emboli from an ICA cause?

A

Retinal ischemic dysfunction

56
Q

What are the signs and symptoms of retinal ischemic dysfunction?

A

Painless episodic loss of vision
blackout
localize/patchy blurring of vision
Amaurosis Fugax - loss of vision to one eye

57
Q

What should the PT be aware of in terms of Headache?

A

A headache like never before

58
Q

According to Thomas et al 2011 are general cardiovascular risk factors enough to determine risk of CADS?

A

No, a neurological/neurovascular is better gauge

59
Q

1 complaint of symptoms in Thomas et al 2011 for VBA

A

HA, Neck pain, diziness

60
Q

What % of dissections had a history of minor mechanical neck trauma 3 weeks prior?

A

64%

SMT (11 decks)

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