CJA Vol.38 Issue 2
Editorial: Toward Cultural Authority - p41
Mary Ann Chance and Rolf E. Peters
Development of the 2006-2009 CAA Strategic Plan - p42
Dennis M. Richards
Traumatic Determinism: Tumours Misdiagnosed as
Sporting Injuries: A Report of Two Cases - p45
Lisa Rimmelzwaan and Peter Bull
Critical Reflection in Work-Integrated Learning -
Phillip Ebrall, Adrian Repka and Barry Draper
Designing Core Clinical Bioethics Training for
Master’s Level Students in an American Chiropractic College -
Dana J. Lawrence
Chiropractic Care of a 3-Year-Old Male with Sleep
Disordered Breathing Syndrome - p69
Joel Alcantara, Julie Desilets and Rosemary E. Oman
General Health Status of a Sample of Chiropractic
Patients with Uncomplicated Biomechanical Neck or Low Back Pain -
Max J. Walsh, John Reece and Frank Donnoli
Traumatic Determinism: Tumours Misdiagnosed
as Sporting Injuries. A Report of Two Cases
LISA RIMMELZWAAN and PETER BULL
Objective: To report two cases of patients presenting to chiropractic
clinics with previously diagnosed activity-related conditions, in whom
bone tumours were found on plain film radiography.
Clinical Features: Case 1 presents a soccer player with a one-year
history of left groin pain that had been non-responsive to treatment by
a physiotherapist for suspected groin sprain. The physical examination
findings reproduced pain over the left superior pubic ramus, but were
otherwise unremarkable for the hip. Plain film radiographs demonstrated
an expanded sclerotic lesion of the superior pubic ramus. The patient in
Case 2 had a previous history of prostate and lung cancer. The
55-year-old presented with right elbow pain that had been previous
diagnosed by his oncologist as “tennis elbow.” Physical examination of
the elbow was unremarkable; cervical spine examination revealed
restrictions and pain, predominantly within the early range of motion
and upon right Kemps manoeuvre. Radiology demonstrated metastatic
destruction of the C7 spinous process.
Intervention and Outcome: Both cases were immediately referred to their
general practitioner and then for advanced imaging. The diagnosis of the
soccer player in Case 1 was fibrous dysplasia rather than a malignant
lesion. The patient in Case 2 had surgical removal of bone metastasis,
although outcomes were not known upon completion of this paper.
Conclusions: Musculoskeletal tumours may mimic activity-related
conditions from both local and referred sites. It is therefore important
that a clinician consider imaging or referral to rule out a
musculoskeletal tumour. This is particularly emphasised in the case
where a suspected.
INDEX TERMS: TUMOUR; SPORTS-RELATED CONDITION; MISDIAGNOSIS;
Chiropr J Aust 2008; 38:45-8.
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Critical Reflection in Work-Integrated
PHILLIP EBRALL, ADRIAN REPKA and BARRY DRAPER
To report the outcomes of an approach to clinical learning that
requires chiropractic students to critically reflect on directed
activity that drives an engagement with work-integrated learning (WIL).
Methods: A preview of learning objectives in RMIT University’s Bachelor
of Applied Science, the degree that constitutes the first 3 years of the
5-year chiropractic program, led to implementation of a learning task
that engaged students as a subject within a new patient assessment
conducted by senior students in the University’s chiropractic teaching
clinics, and then as an observer of a real-world chiropractic
practitioner. A series of prompts were constructed to drive each task.
The prompts reflected contemporary educational philosophy that required
connection with the learning objectives of the course and utilised
action verbs to drive a deeper learning engagement in the realm of the
cognitive and qualitative dimensions.
Results: A total of 105 completed Learning Journals were submitted by a
class of 107 students. The reported comments represent the work of 22
individual students, a sample of 23.1% of the total class.
Discussion: The themes that emerged included reinforcement of a
student’s career choice and their approach to learning, reinforcement of
classroom-based practical skills, and a connection between classroom
learning and the workplace. The submitted work has power to inform
teachers of current workplace practices and provide insight into the WIL
practices in the teaching clinics. The authors see the outcomes as being
supportive of the value of critical reflection to contribute strongly to
a deepening of the student’s clinical learning.
Conclusion: The authors are of the view that a thoughtful combination of
structure and prompts will allow the development of an appropriate tool
to engage students in the process of critical self-reflection in their
INDEX TERMS: MeSH: CHIROPRACTIC; EDUCATION, HEALTH; CHIROPRACTIC
EDUCATION; CHIROPRACTIC TRENDS. ICL: EDUCATION, CHIROPRACTIC; EDUCATION,
Chiropr J Aust 2008; 38:49-56.
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Designing Core Clinical Bioethics Training
for Master's Level Students in an American Chiropractic
DANA J. LAWRENCE
Objective: To develop a core curriculum for teaching biomedical
ethics to master’s level students in a clinical research training
program at a chiropractic institution and research centre and to provide
a background and overview about bioethics curricula.
Method: Qualitative research using interviews with semi-structured
questions. Four leaders with experience in ethics teaching or
administration were interviewed. Each was asked to consider a set of
topics for bioethics, add to, alter or delete topics, and then to
provide one key learning objective for each final topic. Answers were
coded thematically, with responses used to develop a curriculum for a
course in clinical bioethics.
Results: Responses from participants provided guidance for the
development of a course in clinical bioethics that relies upon the use
of case scenarios and combined teaching and learning methodologies. It
includes weekly “driving Scenarios” around which classroom discussion
takes place. It also provides a list of learning objectives.
Conclusion: A curriculum in clinical bioethics for master’s students was
developed from information provided by interviewees. Early assessment
indicates that students are successfully incorporating information from
the bioethics class into research projects developed later in their
course of study.
INDEX TERMS: MeSH: BIOETHICS; CURRICULUM; EDUCATION, MEDICAL;
(Other): QUALITATIVE RESEARCH.
Chiropr J Aust 2008; 38:57-68.
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Chiropractic Care of a 3-Year-Old Male with
Sleep Disordered Breathing Syndrome
JOEL ALCANTARA, JULIE DESILETS, ROSEMARY E. OMAN
Objective: To describe the chiropractic care of a patient with a
chief complaint of “sleeping problems.”
Clinical Features: A 3-yr-old boy with “sleeping problems” characterised
as loud snoring, episodes of “breath-holding” and disturbed continuous
sleep by awakening several times per night is cared for with
chiropractic. His health history revealed recurrent sinusitis, one
episode of bronchitis, episodes of otitis media and bronchitis. The
child experienced no obvious injuries, according to his parents.
Previous medical care seemed ineffective, a motivation for chiropractic
Intervention andOutcome: The patient received chiropractic care based on
the correction of the vertebral subluxation complex (VSC).
Contact-specific, high-velocity, low-amplitude (HVLA) type thrusts were
applied to sites of vertebral subluxations along with craniosacral
therapy. Following 5 visits, the patient’s sleep was significantly
Conclusion: This case study may demonstrate a link between sleep
disorders and its amelioration through chiropractic care. We advocate
for more research in this field.
INDEX TERMS: (MeSH) CHIROPRACTIC; SLEEP APNEA SYNDDROME. (Other):
SLEEP DISORDERED BREATHING SYNDROMET.
Chiropr J Aust 2008; 38:69-74.
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General Health Status of a Sample of
Chiropractic Patients with Uncomplicated Biomechanical Neck or Low Back
MAX J. WALSH, JOHN REECE and FRANK DONNOLI
Objective: This study evaluates the general health status (as
measured by the RAND-36 survey) of a sample of chiropractic patients
with uncomplicated low back pain or neck pain and the impact that
chiropractic treatment has on their health status.
Design: Prospective case series.
Setting: RMIT University chiropractic teaching clinics. Patients:
Sixty-nine (69) patients of the RMIT chiropractic clinic diagnosed with
either uncomplicated biomechanical neck pain (n=34) or low back pain
Intervention: Manual or instrument HVLA spinal adjustments plus soft
tissue therapy as indicated.
Main Outcome Measure: RAND-36 version 1.0 of the Medical Outcomes Trust
short form 36 (SF-36) health questionnaire. Assessment was done
pre-treatment and following an average of 7 treatments. Results: A case
series of 69 patients with uncomplicated low back pain or neck pain
found the patients to have a lower health status as measured by the
RAND-36 v1 than comparable population norms prior to treatment. All
scores in the RAND-36 improved following standard chiropractic
treatment. A similar pattern was found for low back patients and neck
pain patients separately. There were no significant differences between
males or females or age groups. There were some significant treatment
differential effects between acute compared with chronic cases.
Conclusion: For the study sample, the presence of uncomplicated low back
pain or neck pain was associated with a lowering of general health
status as measured by the RAND-36 questionnaire, compared with the
normal population. Chiropractic treatment for these patients would
appear to lead to an increase in general health status for both low back
and neck pain patients, however as there were no controls, the results
cannot be directly related to the treatment regime. A randomised
clinical trial is recommended to clarify the results.
INDEX TERMS: (MeSH): CHIEROPRACTIC; HEALTH STATUS; (Other):
Chiropr J Aust 2008; 38:75-80.
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