Sublux Midterm Flashcards
__ refers to the measurement of the human individual. Used as an early tool of anthropology
Anthropometry
What educates the patient about postural distortions/imbalances, indicates areas of biomechanical stress, insightful to chronic VSC areas, explains visually the muscular causes of pain, is an outcome measure for patient and other interested parties, and helps indicate/pinpoint pathologies?
the Postural Analysis
When visualizing posture, it is important to use a frame of reference (such as a gridline) for __ and __?
reliability, reproducibility
T/F: When visualizing posture, you should have a different examiner take measurements for the pre/posttest validity?
False. The same examiner should take the measurements pre/post test, then be confirmed by a 2nd examiner if so applicable.
When visualizing posture, the findings should be documented from whose perspective?
The Patient’s perspective
T/F: Patient stance during a postural analysis should be normal, neutral, and reproducible?
True. Also, best if the patient is gowned so that symmetry/asymmetry can be visualized accurately.
This word was originally a nautical term utilized to describe a ship’s overall appearance or tendency to favor the starboard or portside?
List
Which term means that posturally, a patient’s overall tendency will be to favor their right or left. From anterior view, what are the 2 reference points?
List; 2 reference points anteriorly are sternum & baseline
Which term means to be in or to move into a sloping position? Posturally, this describes a patient’s “regional” tendency to break from an established vertical baseline.
Lean. Regional=Lean *Ant view should be recorded as right, left, neutral.
When assessing Lean, what are the 3 regional areas we utilize from anterior view?
*upper 1/3: glabella-sternum *middle 1/3: sternum-pubic symphysis *lower 1/3: pubic symphysis-baseline
When assessing head tilt (ant. view), what are the 3 reference points?
glabella-nose-chin
When assessing thoracic tilt from anterior view, what is our reference point?
acromioclavicular joints. *Left thoracic tilt would be a shoulder lowered on the left side. Think of a marble rolling downhill, and that is the direction of the tilt.
When assessing postural analysis from lateral view, what are the global list reference points?
AC joints-baseline
How should we record the List on lateral view?
Anterior, Posterior, or Neutral
On lateral lean, what are the 2 regions of reference points?
AC-trochanter, Trochanter-baseline
On head carriage looking from the lateral view, what are our reference points?
EAM-AC joint *Classify as anterior or posterior head carriage
Which clinical condition would give a “rounded back appearance” which utilizes Cobb Angles for the radiological mensuration?
thoracic kyphosis *hyperkyphosis (extremely rounded back like quasimodo-hunchback of notre dame) or hypokyphosis (not enough thoracic anterior curve)
When assessing thoracic rotation from lateral view, what are the 2 reference points?
chest-back prominence
Which clinical condition is the visualization of a “swayback”, an overly posterior curvature of the spine?
lumbar lordosis
In posterior view, what are the 2 reference points for the overall List?
VP-baseline
When looking at our patient from posterior view, we notice that we can see more of the left cheek and/or jaw. What would this be classified as?
Left head rotation *Use facial prominence (jaw or cheek)
For head translation (post. view), what are the 2 reference points?
EOP-VP
___ scoliosis is due to vertebral malformation or fused ribs during development?
Congenital
__ scoliosis is caused by poor muscle tone, or paralysis due to diseases such as cerebral palsy (CP), muscular dystrophy, spina bifida, or polio?
Neuromuscular
__ scoliosis is of unknown cause?
Idiopathic
What is the most common type of scoliosis in adolescents?
Idiopathic scoliosis *more common in tall women
T/F: Scoliotic curves generally correct themselves during growth spurts?
False. Curves generally worsen during growth spurts.
Using this instrument (___) ,if either measure is 5 degrees or more, then consider referral to a scoliosis center.
scoliometer
Scoliometer readings of 5 degrees or more have high likelihood of Cobb angles greater than __ degrees on xray?
10 degrees
T/F: An increased Cobb Angle =worse scoliosis?
TRUE
When visualizing scoliosis, what are our 2 reference points?
spinous processes, scapular inferior angles (& prominency)
When assessing pelvic tilt, what are the 2 reference points?
iliac crests-PSIS’s
If our patient has a Right pelvic tilt, which hip is lower?
the Right hip. Again, think the marble rolling downhill
When assessing pelvic rotation, what is our reference?
gluteal prominence
What is the most consistent way of performing a prone leg check?
the Hydraulic HyLo table
When assessing the prone leg check, which part of the shoe should we use?
either the “seam” of the shoe, or “like points” on both shoes
When doing the prone leg check, we are checking for asymmetry in which 3 structures?
- inversion/eversion 2. foot flare 3. plantar flexion/dorsiflection
Steps in the prone leg check:
- use consistent hand placement 2. apply slight headward pressure to remove “slack” in the shoe 3. flatten the foot so as to neutralize any inversion/eversion 4. do NOT torsion the tibia/femur 5. Visualize the deficient side while maintaining slight headward pressure 6. Record findings… example: 1/4” R/L
When in practice, what is the most important factor to base our procedures on?
**Patient preferences**
Research alone does not equal __?
evidence
When a new patient comes through the door, this is the order of assessment ideal to proceed in:
- history/symptomatology 2. visualization (posture/leg check) 3. instrumentation 4. static/motion palpation 5. spinographic analysis
Which portion of the initial assessment (and ongoing assessments) provides us with a patient’s concerns and guides our care plan? Here, we should shift the paradigm so we are not just alleviating pain, but the patient shares other concerns such as visceral functions and wellness/prevention habits. Hint: Dr. Bhogal spends a majority of his time as a clinician in this facet?
Patient History/symptomatology
Which portion of the assessment allows us to see biomechanical awareness and overall function based on their posture/mannerisms?
Visualization
What is the most cost effective method to objectifying neurological function?
instrumentation
Which portion of the assessment makes our work much easier and can be reproducible from one doctor to another?
Instrumentation
What portion of the assessment shows soft tissue changes relative to the VSC? It includes myopathology of muscle hyper/hypotonicity, tissue prominency and palpatory tenderness.
Static palpation
Which portion of the assessment shows kinematic changes relative to the VSC? It includes the kinesiopathology of the global ROM as well as intersegmental fixation.
Motion palpation
Which portion of the assessment utilizes spinal radiography/x-ray analysis to correlate motion palpation findings, postural distortions, and allows more specific adjusting by the DC?
spinography
A conservative and conscientious form of health care that concerns itself (primarily) w/the functional integrity of the nervous system is __?
Chiropractic (Bhogal’s definition)
Homeostasis should be replaced by the word __?
homeodynamics *dynamic=movement, health. homeostasis implies staying the same. not what we want to illustrate to our patients.
An aberration (deviation from the norm) in biomechanical spinal anatomy, such that the functional integrity of the nervous system is compromised (compromised capacity to adapt to a stimulus) is a __?
subluxation (Bhogal’s definition)
A __ __ is what the patient perceives; a pathophysiology.
subluxation syndrome
What is the love of wisdom?
Philosophy
Chiropractic wisdom tells us what?
The body is intelligent, self-regulating (innate intelligence), created by a universal intelligence, has a love/hate relationship with educated intelligence, and how well we utilize Educated facilitates the expression of Innate
Who authored the 33 principles?
Ralph W. Stephenson.
What are the 4 T’s associated w/Chiropractic?
Thoughts, trauma, toxins, threshold (an individual’s ability to adapt to life situations)
What are the 5 components of the Vertebral Subluxation Complex (VSC)?
- Kinesiopathology 2. Myopathology 3. Neuropathology 4. Histopathology 5. Pathophysiology
Which part of the VSC is atypical position or motion?
Kinesiopathology
Which part of the VSC is muscular dysfunction resulting in hypo/hypertonicity?
Myopathology
Which part of the VSC is a dysfunction or disease of the nervous system?
Neuropathology
What is the most important tool in determining neuropathologies?
Instrumentation
Which part of the VSC is a disease or dysfunction at a cytological level?
Histopathology Inflammation
What part of the VSC includes functional changes associated w/disease or injury?
Pathophysiology Patient education crucial at this step
What is the system devised by the Centers for Medicare and Medicaid Services (CMS) to validate the necessity of chiropractic care through either x-ray or physical examination?
the P.A.R.T system
What does the P.A.R.T. system stand for?
P-pain/tenderness A-asymmetry/misalignment R-range of motion abnormality T-tissue/tone changes
Which portion of the PART system uses observation & documentation, palpation or percussion, a visual analog scale (pain 1-10), audio confirmation, and a pain questionnaire to inquire about the patient?
P-pain/tenderness
Which portion of the PART system allows us to observe patient posture or analyze gait, describe the misaligned vertebrae, and using x-rays, CAT scans or MRI’s to identify misalignments?
A-asymmetry/misalignment
Which portion of the PART system shows increased/decreased flexibility via observation, motion palpation, x-rays, or goniometers or inclinometers for specific measurements?
R-range of motion abnormality
Which portion of the PART system has visible changes like spasm, inflammation, swelling, rigidity, palpable edema, documented instrument findings, and **documented leg length, scoliosis contracture, and strength/length of muscles that relate?
T-tissue tone changes tests for length/strength
Which part(s) of the VSC correlates to asymmetry/misalignment and ROM abnormality of the PART system?
Kinesiopathology
Which part(s) of the VSC correlates with pain/tenderness, asymmetry/misalignment, and tissue/tone changes of the PART system?
Myopathology, Neuropathology, Histopathology
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. It facilitates the analysis of soft or bony tissue structures within the body. What is being described?
Static palpation
Static palpation is insightful to what parts of the VSC?
Kinesiopathology (position/motion), myopathology (tonicity), histopathology (cytological/inflammation/edema)
Static palpation is insightful to what parts of the PART system?
P-pain/tenderness A-asymmetry/misalignment T-tissue/tone changes
T/F: Static palpation is best utilized before instrumentation?
False. Static palpation is best utilized AFTER instrumentation. An instrumentation “break” will guide our area of static assessment
In terms of turgidity, give examples of places where you would find normal turgidity, hyperturgidity, and hypoturgidity?
.normal turgidity: middle of palm -hyperturgidity: thenar pad; feels spongier than it should -hypoturgidity: back of hand; feels elastic, flaccid, loose; think of elderly skin w/loss of fluid; “tenting”
In static palpation, we utilize both active light tough and deep tough, always going from least invasive to most invasive. What are the 3 areas for active light touch?
Active light tough: sudoriferous changes, turgidity changes, surface tonicity
In static palpation, we utilize both active light tough and deep tough, always going from least invasive to most invasive. What are the 3 areas for deep touch?
Deep touch: tissue prominency, palpatory tenderness, deep tonicity changes.
In active light touch, __ glands are located all over the integument and secrete a blood plasma metabolite called __ for thermal regulation. These glands help us determine which portion of active light touch?
eccrine; sweat .Sudoriferous changes
Innervation to eccrine glands is through the __ by cholinergic & adrenergic fibers
SNS
T/F: When checking for sudoriferous changes, we should NOT deform the skin as we only are checking for heat/moisture on the surface?
True.
Sudoriferous changes are associated w/which part of the VSC?
neuropathology
Oily, greasy, slippery, sweaty, clammy, or tacky texture can indicate __?
an acute VSC
Dry, scaly, flaky, or rough skin texture can indicate __?
a chronic VSC
Intrinsic pressure or resistance offered by a cell or tissue is called __?
Turgidity
An accumulation of interstitial fluid (ISF) under the skin usually results to altered homeostasis, injury, or inflammation is called __?
edema aka “palpable sponginess”
Changes in muscle tone perceived as contracture, spasm, tightness, fullness, or being rope-like describe this term.
Tonicity
Turgidity is correlated w/which part of the VSC?
Histopathology (inflammation)
Surface tonicity is associated w/which part of the VSC? Which part of the PART system?
Myopathology; T-tissue/tone changes
What is the most invasive step of static palpation where we elicit minor pain in the patient?
Deep touch
Generally a palpable prominence in the paravertebral gutter due to an osseous misalignment and facet prominence is describing what?
Tissue prominency
Tissue prominency aka?
bony prominency
What type of pain would we find in tissue prominency?
sclerotogenous pain
Which part of the VSC is tissue prominency correlated with?
Kinesiopathology
In deep touch of static palpation, which procedure uses firmly applied pressure in an I-S and P-A direction on the spinous processes that our instrumentation readings have found? After this, bilateral L-M pressure is applied to the same spinous process
Palpatory tenderness
Besides spinous processes, what is the other most common area used for palpatory tenderness and tissue prominency?
Transverse processes
Which part of the VSC is palpatory tenderness correlated with?
Kinesiopathology
Which type of pain is pertaining to ligaments, tendons, discs, periosteal, or zygapophyseal structures?
sclerotogenous pain
What type of pain is deep, nondescript pain that is unlocalized?
sclerotogenous pain
Which part of deep touch is utilized when the thumb tip or thumb pad firmly “strums” the paraspinal muscles in all regions of the spine? If pain is elicited on this, or if hypertonicity is noted, it is a reliable indicator of a component part of the VSC.
Deep tonicity changes
Myotogenous pain is correlated with which deep touch procedure?
Deep tonicity changes
What pain is arising in muscle bellies, musculotendinous junctions, and tendon insertions?
myotogenous pain
Which pain is more localized, more superficial, and feels like a “ropelike” muscle?
myotogenous pain
Deep tonicity changes are associated with which part of the VSC?
myopathology
Kinesiopathology is correlated with which parts of deep touch?
tissue prominency, palpatory tenderness
Neuropathology is associated w/which active light touch?
sudoriferous changes
Histopathology is associated w/which active light touch?
turgidity changes
Myopathology is associated w/which active light and deep touches?
surface tonicity, deep tonicity changes
Instrumentation is associated w/which portion of the VSC?
neuropathology
Instrumentation satisfies which portion of the PART system?
T-tissue/tone changes
The purpose of __ is to objectify neurological functions and target areas for further assessment?
instrumentation
Limitations of instrumentation include: examiner reliability is initially __, clinical presentation of the __, and __ variability?
low (improves w/technology, practice); epidermis; physiologic variability (like dermatomes/neuropathies)
During instrumentation, what are some different clinical presentations of the epidermis?
burn/sunburn, blemish/acne, infection, fever, perspiration
Perspiration for instrumentation can be bad because it leads to __?
IR (infrared) scatter- hard to pick up accurate readings on sweaty/clammy skin
Instrumentation is assessing __ function as a reflection of aberrant (out of the norm) neuromodulation.
vasomotor
This instrument is an infrared paraspinal thermal imaging system which is gathering information in the first 5mm of the epidermis?
TyTron C-3000
Which portion of the ANS functions without an antagonist, regulates smooth muscle, and affects the tunica media of a vessel?
sympathetic nervous system
Why was the tomato blushing?
Because he saw the salad dressing ahahahahahaa :)
What are the 2 types of thermoregulation for instrumentation?
Core control (takes over when ambient control cannot keep up) and ambient control
Which form of control in thermoregulation is dermatome specific, is the first line of defense when temperature changes, and begins w/sensory input from the skin?
ambient control
In ambient control, which receptors (warm/cold) are myelinated, and which ones are unmyelinated?
Warmth receptors are unmyelinated. Cold receptors are myelinated for saltatory conduction (which is why we tend to feel cold faster than we feel warm).
In the neurologic pathway, the afferent sensory input enters the cord and synapses in the __ horn at the __ of __?
Dorsal. Tract of Lissauer
Which tract in the neurologic pathway sorts between pain and temperature?
Tract of Lissauer
After the Tract of Lissauer, the next synapse is from gray matter to white matter to become the __ __ Tract?
Lateral Spinothalamic Tract
The Lateral Spinothalamic Tract ascends to the brain carrying the cutaneous message and terminates at the __ __ Nucleus of the __?
Ventral Posterolateral Nucleus; thalamus
Which structure in the brain functions as a sorting relay center?
Thalamus
The thalamus synapses to which Brodmann areas?
Brodmann 3, 1, 2. Primary Somatosensory Cortex
If the thalamus doesn’t synapse at the primary somatosensory cortex (BA 3, 1, 2), what other cortex does it synapse at?
Insular Cortex “Isle of Reil”
The insular cortex’s anterior portion regulates __-__ function.
viscero-autonomic
What is another name for the anterior hypothalamic nucleus?
Adenohypophysis
The insula forwards sensory message to the __, which is the region for regulation of autonomic function?
Hypothalamus
The __ __ Nucleus becomes a descending autonomic tract which passes through the brainstem, then travels back to the original site of dermatomal thermoregulation with its’ preganglionic sympathetic fiber?
Anterior Hypothalamic (adenohypophysis)
The preganglionic sympathetic fiber will synapse with the __ __ ganglionic chain?
sympathetic paravertebral
What are the 3 synapse outcomes of the preganglionic sympathetic fiber?
- ascend to ganglion at a higher cord level 2. descend to ganglion at a lower cord level 3. Stay at the same ganglionic level
In terms of outcomes for the preganglionic sympathetic fiber, what is the MOST likely outcome for dermatomal thermoregulation?
It will stay at the same ganglionic level
The preganglionic sympathetic fiber will secrete which NT?
Acetylcholine (ACH)
ACH will (stimulate/inhibit) a nicotinic postganglionic fiber which will transmit __?
stimulate; epinephrine
Epinephrine secreted from the postganglionic fiber has what effect on other tissues?
excitatory; up-regulatory; epinephrine has no antagonist to counteract it, and it will cause constriction of the sympathetic nervous system, decreasing temp. while increasing force/pressure
Epinephrine will terminate at which portion of the muscle and have what effect on the vasculature?
Tunica media; constricts vasculature
What is a good way to describe heat swings as opposed to breaks?
Heat swings are normal and healthy; gentle, thermal shifts
The sympathetic nervous system is found at which spinal cord levels?
T1-L2/L3
How does the cervical spine receive sympathetic innervation if sympathetics are only found between T1-L2/L3?
The sympathetic chain extends upwards, reflecting the “core activity below”, which supports pattern analysis (systemic).
Is break analysis considered segmental or systemic?
segmental
Is pattern analysis considered segmental or systemic?
systemic
Pattern analysis (systemic overview) is usually used in which instances?
For upper cervical techniques and progressive exams re-evaluating a patient’s status
Which instrument is used primarily for segmental “break” analysis, costs approximately $600-$800, and assists in objectifying neurologic dysfunction?
Nervoscope
The nervoscope can be used for pattern analysis if connected to a recording unit called a(n) __?
analagraph
For our purposes, what is the sensitivity switch set to on the nervoscope?
medium
What will be observed as a gradual sweeping deflection of the nervoscope needle reflecting the gentle thermal shifts present on the skin’s surface as a part of normal physiologic function?
Heat swing
T/F: a heat swing is generally multisegmental/multidermatomal?
TRUE
What will be observed as a rapid reproducible deflection of the nervoscope needle reflecting an atypical and unexpected thermal shift present over a neurological field (dermatome) as a part of dysfunctional physiology?
Break
T/F: Ideal acclimation occurs for 20 minutes for a patient before using the nervoscope on them?
False. Ideal acclimation is 10 mins
When doing a cervical glide, the patient should be seated where? What about a thoraco-lumbar assessment?
cervical: patient even w/back of the stool .thoraco-lumbar: patient slightly forward, about a hand-width from the back of the bench
T/F: The head should be flexed when running a cervical glide w/the nervoscope?
False. The chin should be tucked, the head should not be flexed.
Upon a cervical glide w/the nervoscope, the doctor’s stance should be?
scissored stance @ 45 degrees or less with contact arm in line w/patient’s spine, contact elbow close to the doctor’s body, stabilization hand doing a hair sweep or supporting the head, a single hand grip on the instrument, and the lateral leg touching the lateral posterior side of the bench
When doing a cervical glide, the probes are __ or slightly __ if patient is petite/pediatric?
parallel; slightly inwards
Cervical glide commences at __ and will terminate __ up onto the occiput into the hairline.
T1; 1/2”
Cervical glide speed is __ seconds/segment for a total glide time of __-__ seconds?
3; 18-21 seconds total
Confirmed cervical breaks are marked __ (above/below) mid thermocouple well outside of the glide path.
1/4” below
T/F: When starting the cervical glide, the bowl should be superior to the barrels?
TRUE
In the T/L spine glide, probes are __ or __ __ if patient has a larger frame?
parallel; wide open
T/L glide commences at __ and will terminate at __?
C7; S2
T/L glide speed is __ seconds/segment, smooth and continuous for a total glide time of __-__ seconds?
2; 35-38
Confirmed T/L breaks are marked __ (above/below) mid thermocouple well outside of the glide path?
1/2” above
When recording positive instrumentation findings, be sure to document which 3 things?
Segmental level involved, direction of the break, and amplitude (increments of deflection) ex: T4/R/3
Between occiput-C1, the general break location is marked where?
between the 2 segments
Between C2-T3, the general break location is marked where?
the interspinous space below. ex: C3 (break) C4: The break most likely belongs to C3
At which segmental fields is the general break location at its own spinous level?
T4; T10-T12
Between T5-T9, the general break location is marked where?
the interspinous space above. ex: T6 (break) T7: The break most likely belongs to T7 (we found the break in the space above the segment that is actually subluxated, so T7 is our culprit)
The Tytron C-3000 is primarily used for pattern analysis or break analysis?
Pattern analysis (systemic); popular w/upper cervical techniques
The Tytron C-3000 is a paraspinal thermal imaging system using infrared technology for what?
relative skin temperature (multiple sites) and direct skin temperature (one segment)
T/F: Tytron C-3000, and instrumentation in general, is regarded well by 3rd-party payers?
TRUE
What are 3 disadvantages of the Tytron C-3000?
Doesn’t work well in cold, can cause IR scatter, and cost is $3,000-$5,000
The Tytron C-3000 is insightful about which components of the VSC and PART systems?
Neuropathology, histopathology; T-tissue/tone changes
T/F: When using a Tytron C-3000, the scanner barrels are placed directly on the skin?
False. Scanner barrels never touch the skin, only the rollers do.
When using the Tytron C-3000, the scan commences at __ and terminates __?
S2; at the base of the occiput (bony ridge)
What is the glide speed when using a Tytron C-3000?
1 sec/segment
T/F: When using a Tytron C-3000, the hair sweep has to be done on the fly.
TRUE
When using the Tytron C-3000, every scan that is run is accompanied by a __ __ reading, which provides more specific info. about the upper cervical complex?
mastoid fossa
When doing the fossa reading w/Tytron C-3000, which barrel goes in both the right fossa and the left fossa? You commence by pressing which key on the keyboard? How many degrees celsius is clinically significant?
Right barrel: “F” key; .5 degrees C
Which system of analysis takes into consideration that thermal shifts on the surface of the skin occur as a part of normal physiology?
Pattern analysis
If it’s found that the patient has a diminished dynamic adaptability, it can be correlated with __ dysfunction and a compromised ability to adapt.
autonomic
The “gold standard” when using the Tytron C-3000 is to take _ scans over a _ hour period with the scans spaced apart as evenly as possible.
3; 24 ex: should be down at Hour 0, 12, and 24
T/F: Once a pattern has been established for a patient using the Tytron C-3000, each subsequent scan on each visit is compared to that pattern to determine if an adjustment is appropriate?
TRUE
What are the 3 scan outcomes of the Tytron C-3000?
Pattern, Adaptive, Stress
In which scan outcome of the Tytron C-3000 is the patient subluxated and should be given an adjustment?
Pattern scan=no adaptation
In which scan outcome of the Tytron C-3000 is the patient probably not subluxated and probably doesn’t need an adjustment?
The adaptive scan because their body is reacting the way it should
Which scan outcome of the Tytron C-3000 is strange and atypical, possibly resulting from emotional stress, physical stress, drugs (prescription & recreational) and caffeine?
the Stress scan
A perfect adaptive scan w/the Tytron C-3000 would resemble which structure that sooooo makes us despise Faruqui?
a double helix
Name the instrument used mainly for the segmental approach.
Nervoscope
Name the instrument mainly used for pattern analysis (systemic approach).
Tytron C-3000
Why is Pete gay?
No one knows.
