SMT-1 Manual, pgs 56-66 Flashcards
What did Fernandez-de-las-Penas 2005 measure?
The validity of the lateral shift test, confirming that the distance between subjacent transverse processes of the dysfunctional joint would be reduced.
What was the difference in mm between subjacent transverse processes in the Fernandez-de-las-Penas 2005?
3.44 mm less at hypomobile side
How did Smedmark et al 2000 test PPIVMs?
2 PTs assess C2-3 lateral flexion, 1st rib depression, C7-T1 flex/ext, and C1-C2 rotation for 61 patients = 244 tests.
What was the percent of agreement in Smedmark et al 2000 study?
77%
What was inter-rater reliability of the Smedmark et al 2000 study?
70-87% (Fair to moderate).
What is the Kappa Co-Efficient of Smedmark et al 2000 study?
.28 and .43
Did Jull et al 1994 find that pain was needed to identify a dysfunctional joint?
No-pain is not needed
How will an symptomatic joint present
Abnormal displacement, abnormal tissue resistance, and pain.
How did Jull et al 1994 examine and label joints?
PAIVM and PPIVM C0-C1 to C6-C7 manual rated 0-6 (Gonnella et all 1982)
The percent agreement of normal joint as painless in Jull et al 1994?
98%
What did Jull et al 1997 find with pain?
Pain provocation and joint dysfunction was used.
How was the inter-examiner agreement with Jull et al 1997?
Excellent to complete.
What area was examined in Jull et al 1997?
C0-C1, C1-C2, C2-C3
What was the most common dysfunctional segment in Jull et al 1997?
C1-C2
What was the second most common dysfunctional segment in Jull et al 1997?
C2-C3 > C0-C1
According to Ernst 2010, how man Chiropractic SMTs have resulted in death?
26
According to Dvorak & Orelli, what was the estimated rate of overall, “slight neurological complications”?
1 in 40,000
Estimated rate of “important complication”?
1 in 400,000
According to Lee et al 1995, what % of neurologists reported at least one case of stroke?
21%
What was the reported estimate of CVAs from Danish Chiro’s?
1 per 1.3 million Cx treatments / 1 in 362 tx
In cadavers, Symons et al 2002 found what % of strain from cervical ROM testing of vertebral artery?
1.2-12.5% greater than at rest
During cervical HVLAT, what % of strain is found on vertebral artery?
6.2% greater than at rest
When did mechanical failure of vertebral artery occur?
139-162% greater than at rest
According to Rothwell et al 2001, what was the relationship of age, chiro, and VBA stroke?
For those aged <45 years, cases were 5 x more likely than controls to have visited a chiro within 1 week of VBA stroke
Did Smith et al 2003 find a significant association between neck HVLAT and ischemic stroke or TIA.
NO
What did sub group show in the Smith et al 2003 study?
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.
Did Dittrich et al 2007 find an association between CAD and HVLAT to Cervical spine.
No
Murphy 2010 found what two explanations related to screening for CAD?
- 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.
What did Murphy 2010 conclude regarding the relationship between chiros, PCPs, and CADs.
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.
Does Murphy 2010 feel it is the PTs job to screen for an “at risk” patient.
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.
- What did Cassidy et al 2008 find regarding the association between chiropractic care, primary care practitioners, and stroke?
There is a strong association between primary care visits and stroke in those >45yo compared to chiro visits.
- What did Cassidy et al 2008 find regarding those patients <45 years old with sxs (HA and neck pain)?
They are 3x more likely to see a chiro or PCP before their stroke compared to controls.
- Is the VBI test validated according to Kerry &Taylor 2006?
No. There is little evidence that a neg test predicts the absence of an arterial pathology or identifies those at risk.
- According to Kerry & Taylor is the VBI test sensitive or specific?
It is neither Sn or Sp.
- What were the results of Carlesso et al 2010 systematic review of adverse events after cervical manipulation or mobilization?
Thiel et al 2007 reported no major or catastrophic outcomes in 50,276 Cx HVLATs. Average 16.3% of minor events across all studies.
- What did the 16.4% minor events consist of according to Thiel et al 2007?
An increase in neck pain and headaches.
- Why did Carlesso et all 2010 systematic review say no definitive conclusions can be made by the existing research?
- small number of studies
- weak association
- moderate study quality
- ascertainment bias
- What is the gold standard for measuring blood flow?
MRA - Magnetic Resonance Angiography
- According to Kerry et al 2008 what is a better term than VBI?
Cervical Artery Dysfunction
- How do Kerry & Taylor 2006 screen for CAD in patients presenting with neck pain and headache sxs?
- 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
What should the PT recognize as a clue related to carotid artery dissection (CAD)?
A Headache that is like no other that the patient has had before.
Does Kerry et al 2008 feel there is an increase risk of upper cervical HVLAT?
No studies have focused on that question
Why is the upper cervical so taboo?
because of the course of the vertebral artery between C2 and occiput
Where are most plaques found in the vertebral artery?
At the bifurcation of the internal and external vessels found in the mid to lower cervical spine.
According to Kerry et at 2008, is HVLAT as risky as joint mobilizations?
No, a gentler, repeated movement could cause potential dissection
Have Mckenzie or other non-thrust manual therapies been subject to the same degree of study?
No
According to Kerry & Taylor 2010 what signs and symptoms should a PT be aware of during a potential CAD screening?
CN Palsies and Horner’s syndrome (ICA pathology)
What nerve is most commonly affected in ICA pathology?
Hypoglossal (12)- Tongue out
What are 3 other nerves that could be affected besides the most common (hypoglossal)?
Glosspharyngeal, Vagus, Accessory
What % of ICA dissection patients is Horner’s syndrome present in?
82%
Signs & Symptoms of Horner’s syndrome:
Head, Neck or Facial pain Drooping eyelid (ptosis) Sunken eye (enophthalmia) Constricted pupil (miosis)Facial dryness (anhidrosis) Retina & Cerebral Ischemia signs
What is Horner’s syndrome an interruption of?
Sympathetic nerve fibers supplying the eye
Where does the superior cervical ganglion lie
In the posterior wall of the carotid artyery
What does the ICA supply in terms of the eye?
Supplies the retina via the opthalmic artery
What can an emboli from an ICA cause?
Retinal ischemic dysfunction
What are the signs and symptoms of retinal ischemic dysfunction?
Painless episodic loss of vision
blackout
localize/patchy blurring of vision
Amaurosis Fugax - loss of vision to one eye
What should the PT be aware of in terms of Headache?
A headache like never before
According to Thomas et al 2011 are general cardiovascular risk factors enough to determine risk of CADS?
No, a neurological/neurovascular is better gauge
1 complaint of symptoms in Thomas et al 2011 for VBA
HA, Neck pain, diziness
What % of dissections had a history of minor mechanical neck trauma 3 weeks prior?
64%
