CJA Vol.37 Issue 3Commentary: Chiropractic Plus: Wellness Care the Australian Way -
p81 Failure to Use Vertebral Subluxation Complex as a
Diagnostic Term: A Flaw of Reductionistic Diagnosis with Resultant
Compromise of Student and Patient Outcomes in Chiropractic Teaching
Clinics - p84 Cervical Spine Degeneration: Radiographic Analysis
Demonstrating the Kirkaldy-Willis Model: A Case Report - p92 General Health Status as Measured by the SF-36 of
Patients with Spinal Disorders: A Chiropractic Perspective -
p100 Transient Modulation of Intracortical Inhibition
Following Spinal Manipulation - p106 Chiropractic Management of Cluster-Tic Syndrome: A
Case Report - p117 Letters - p122 History Corner - p123 ABSTRACTS ADRIAN REPKA, PHILLIP EBRALL and BARRY DRAPER Objective: To determine and report the extent to which the term vertebral subluxation complex is applied as a working diagnosis by contemporary chiropractic students in a clinical education environment and the extent to which student interns diagnose and manage patients’ health beyond simple mechanical joint dysfunction. Methods: All 39 final year students in the RMIT chiropractic program self-selected then reviewed and summarised the health records of any 10 patients they had seen as a new patient within the University Chiropractic Teaching Clinics during the previous 6 months. The resulting 400 reports were then reviewed by the authors and the diagnostic categories identified and collapsed into themes. Results: There were 355 patients with a spinal complaint for whom a working diagnosis of vertebral subluxation complex could have been appropriate, however this diagnostic term was used in only 13 cases. The more common diagnostic term was biomechanical joint dysfunction. In the vast majority of cases students diagnosed and managed patients attending the clinic with regard to mechanical joint pain and dysfunction only, and in the majority of cases did not address any health issues in patients beyond this clinical descriptor. Discussion: Despite being provided with an extensive variety of diagnostic and management tools that enable them to assess and manage patients’ health issues beyond the reductionist diagnosis of mechanical joint pain, the greater majority of students within the RMIT teaching clinics do not appear to function beyond a limited, mechanical paradigm. It is argued that diagnostic reductionism to mechanical descriptors is counter-productive to the holistic attribute of chiropractic practice. One possible explanation for this disconnection may be the manner in which students are assessed in the clinical environment. Conclusion: This apparent disconnection between the foundation clinical decision making skills taught in the classroom and the application of those skills in the clinical education environment is a cause of concern to chiropractic educators and deserves further investigation. INDEX TERMS: (MeSH): WELLNESS; CHIROPRACTIC; AUSTRALIA. (INDEX TO CHIROPRACTIC LITERATURE): WELLNESS; EDUCATION, CHIROPRACTIC; EDUCATION, CHIROPRACTIC/AUSTRALIA; SUBLUXATION; SUBLUXATION, DIAGNOSIS; VERTEBRAL SUBLUXATION COMPLEX. Chiropr J Aust 2007; 37:84-91. MATTHEW T. SMITH, PETER W. BULL and BRENT D. GORDON Objective: To review the existing literature regarding the nature of cervical spine degeneration, with specific emphasis on the Kirkaldy-Willis model. This information is presented and used to analyse the radiographic features of a case study demonstrating a classic representation of this model occurring over a 9-year period in the cervical spine of a patient. Case: A 42-year-old woman presents with a history of chronic neck pain. Her symptoms include reduced range of motion and pins and needles extending down the right arm and into the thumb. Radiological, CT and MRI findings indicate degenerative joint disease, intervertebral disc protrusion at C5/6, and C6/7 right lateral recess stenosis. Conclusion: This case presents a classic demonstration of the Kirkaldy-Willis model, and how degenerative joint disease affects the cervical spine in a patient, occurring over a 9-year period. By better understanding the pathophysiology of joint degeneration, and how degenerative changes in a 5-joint complex progress through 3 identifiable stages, practitioners can recognise early changes, which are visible on routine chiropractic x-rays, and predict the likely outcome of their patient’s structural and functional state. This will enable practitioners to provide a better standard of care with emphasis on early preventative medicine. INDEX TERMS: (MeSH): CHIROPRACTIC; CERVICAL VERTEBRAE; OSTEOARTHRITIS; INTERVERTEBRAL DISC. (Other): DEGENERATION; KIRKALDY-WILLIS; DEGENERATIVE JOINT DISEASE. Chiropr J Aust 2007; 37:92-99. MAX J. WALSH Objectives: The aim of this paper is to examine published data on the impact of spinal conditions upon self-reported health status as measured by the Short Form-36 (SF-36) survey, and how comorbidities associated with wellness further impact on this measure. Methods: Data was drawn from published peer-reviewed literature 1995 to 2006 located from searches of PubMed, CINAHL, and ICL electronic databases, Australian Bureau of Statistics 1995 Health survey, and original data from a case series study. Results: SF-36 data analysed indicates that patients with spinal disorders have significant reductions in self-reported health status as measured by the SF-36 survey, particularly for physical domains The health status of these patients is similar or worse than for many other disease conditions such as cancer and AIDS. The presence of comorbidities, such as smoking, obesity, active compensation and other disease conditions, further decrease the health status of these patients. Studies on chiropractic spinal patients demonstrate similar results and suggest that chiropractic manipulation is effective in increasing their perceived health status. Conclusions: Spinal conditions cause a significant lowering of health status, which is exacerbated by the presence of comorbidities. When treating patients with spinal conditions, health practitioners, including chiropractors, need to be aware of the impact of spinal condition upon quality of life, and management of these patients should take this into account. There is a significant negative effect of factors often associated with wellness management, such as smoking, obesity, hypertension and nutrition. This indicates a strong need for practitioners to assess and manage these factors in order to achieve optimal health for their patients. INDEX TERMS: (MeSH): MANIPULATION, CHIROPRACTIC; QUALITY OF LIFE; OUTCOME AND PROCESS ASSESSMENT; SPINAL DISEASES; HEALTH PROMOTION. (Other): SHORT FORM-36. Chiropr J Aust 2007; 37:100-105. Transient Modulation of Intracortical Inhibition Following Spinal Manipulation HEIDI HAAVIK-TAYLOR and BERNADETTE MURPHY Objective: To study the immediate sensorimotor neurophysiological effects of cervical spine manipulation using transcranial magnetic stimulation (TMS). Design: Experimental design. Setting: This study was carried out at the Human Neurophysiology Laboratory at the University of Auckland in Auckland, New Zealand. Participants: Thirteen (13) subjects with a history of recurring neck stiffness and/or neck pain, but no acute symptoms at the time of the study were invited to participate in the study. Intervention: Three (3) interventions were carried out in a randomised order: a control with no intervention, a passive head movement control condition, and a session of spinal manipulation of dysfunctional cervical joints. Main Outcome Measures: Motor evoked potentials (MEP) and cortical silent periods (CSP) in the abductor pollicis brevis (APB) muscle of the dominant hand following transcranial magnetic stimulation (TMS) over the motor cortex. Results: The major finding of this study was that the TMS-induced CSP measured in APB was significantly decreased for the first 20 minutes following spinal manipulation. No such changes were observed following either control condition, i.e. following no intervention or following passive head movement. Conclusion: Spinal manipulation of dysfunctional cervical joints can lead to transient central neural plastic changes, as demonstrated by shortening of the TMS-induced CSP. This study suggests that cervical spine manipulation may alter sensorimotor integration. These findings may help to elucidate the mechanisms responsible for the effective relief of pain and restoration of functional ability documented following spinal manipulation treatment. INDEX TERMS: (MeSH): MANIPULATION, CERVICAL; PSYCHOMOTGOR PERFORMANCE; TRANSCRANIAL MAGNETIC STIMULATION. (Other): HUMAN; BRAIN PLASTICITY; CORTICAL SILENT PERIOD. Chiropr J Aust 2007; 37:106-116. Chiropractic Management of Cluster-Tic Syndrome: A Case Report MICHAEL SWAIN, HENRY POLLARD and ROD BONELLO Objective: To report a case of cluster-tic syndrome (CTS), a rare chronic head pain syndrome recognised by the International Headache Society (IHS). This report describes utilisation of chiropractic in a multi-modal management plan for CTS. The case illustrates a cervical association with head pain, a feature that has not previously been reported. The confluence of nociceptive afferents through the trigenminocervical nucleus and trigeminovascular system has been hypothesised to be responsible for the change. Clinical Features: This case involves a 61-year-old Caucasian male who has suffered typical cluster headaches for more than 30 years. He recently developed a tic-like pain that overlapped his typical cluster headaches. Cervical spine flexion relieved the headaches and the tic-like pains. Intervention and Outcome: The condition was managed with a multi-modal approach that integrated a traditional pharmacological approach and chiropractic, which included cervical and thoracic spinal manipulation therapy (SMT). This approach provided great relief when the pharmacological approach alone did not. Conclusions: This paper describes a new form of management for alleviation of cluster-tic syndrome. Further case studies are required to outline the utility of this approach. Future research should investigate the role of the cervical spine in head pain syndromes. Use of allied health professions may provide new opportunities in the management of chronic pain syndromes. INDEX TERMS: (MeSH): CHIROPRACTIC; HEADACHE; CLUSTER HEADACHE; TIC DISORDERS; MANIPULATION, SPINAL; MANIPULATION, CERVICAL Chiropr J Aust 2007; 37:117-122. |
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