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Chiropractic Methods II: Skills Analysis 2 - #33120


X-ray Marking

 

 
Jeffrey Rich, DC, DACBR
2.0
45.0
1.0
2.0

The development and integration of skills necessary to detect various manifestations of spinal subluxations and/or dysfunction, including static and motion palpation (active, passive, end-feel); radiographic marking and mensuration; and postural examination.

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  8. Competence in one's Discipline
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Course Objectives
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COGNITIVE SKILLS:

  1. Integrate static and motion palpation, postural analysis, and radiographic mensuration findings in the analysis of a spinal motion segment
  2. Interpret normal and abnormal range of motion findings in the "R" of the acronym P.A.R.T.S. in the analysis of motion segments within the spine, pelvis, and ribs. This includes an understanding of the reliability, validity, and clinical utility of various motion palpation procedures.
  3. Interpret normal and abnormal spinal relationships demonstrated on static x-rays. This includes an understanding of the reliability, validity, and clinical utility of various x-ray marking procedures.
  4. Interpret Vertebral Basilar Insufficiency (VBI) testing. This includes an understanding of the reliability, validity, and clinical significance of VBI testing.
  5. Understand the purpose of pro vocational"orthopedic" test of the cervical and lumbar spine.
  6. Understand the basic neurologic evaluation (sensory, motor, reflex) of the cervical and lumbar spine.
  7. Understand, interpret, and correlate the language of chiropractic assessment. 

PSYCHOMOTOR SKILLS:

  1. Perform the basic chiropractic spinal assessment utilizing the PARTS approach.
  2. Perform Motion palpation of the spine, pelvis, and ribs including active, passive, and the accessory motions of end feel and joint play.
  3. Demonstrate various markings and measurements on static A-P and Lateral x-rays.
  4. Reinforce and further develop the competencies of Methods 1:
    a) Perform static palpatory skills including static alignment, palpatory tenderness, temperature, tone, and texture
    b) Postural analysis
  5. Perform common provocative "orthopedic" tests of the cervical and lumbar spine. 
  6. Perform the basic neurologic evaluations (sensory, motor, reflex) of the cervical and lumbar spine.

AFFECTIVE SKILLS:

  1. Proper gowning of patients to respect and maintain their comfort zones in the performance of static palpation, motion palpation, and postural analysis.
  2. Appropriate touch of patients to respect and maintain their comfort zones in the performance of static palpation, motion palpation, and postural analysis. This includes the ability to communicate with the patient what examination procedure is about to be performed, why it is necessary to perform it, and how it will be performed.
  3. Respect for the patient's pain tolerance level when performing any provocative testing procedure including static and motion palpation and orthopedic/neurologic testing.
Materials
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A. Required Text(s):
  1. Class notes required (available in the bookstore)
  2. Evans, Illustrated Orthopedic Physical Assessment, 2nd Edition
  3. Chiropractic Technique, 2nd edition; Bergmann and Peterson

B. Recommended Text(s):

Chiropractic Technique; Bergmann, Peterson, and Lawrence

Reference texts

  1. Physical Exam of the Spine and Extremities; Hoppenfeld
  2. Essentials of Skeletal Radiology; Yochum and Rowe
  3. Textbook of Clinical Chiropractic; Plaugher

Reference materials
  1. Evaluation of Cervical Spinal Mechanics; Conley
  2. Radiographic, Biomechanical and Clinical factors in Lumbar spine Flexion; JMPT; Grice.
  3. Motion palpation tapes of the Spine; Faye

C. Required Materials for Lab:
  1. Gowns and shorts to be worn in class
  2. Skin marking pencil
  3. X-ray marking pencil and ruler, protractor
  4. Copies of x-rays
Assignments
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  1. Weekly P.A.R.T.S. assessment
  2. Postural Evaluation/s
  3. Reading assignments
  4. Paper on chiropractic office visit 
Attendance
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  1. Students are required to attend all lectures and labs. A grade of "F" will be given if more than two labs are missed.
  2. Students with health related conditions which contraindicate participation in any class activity, must notify the instructor during the first week of class or immediately following the onset of the condition. Students who believe they have incurred an injury or exacerbated a preexisting condition while in class, should report to the instructor immediately.
Grading Criteria
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  1. Examinations
    1. Announced lecture quizzes = 22%
    2. Written midterm and Written final = 61%
    3. Practical (midterm and final) - pass/retake/fail
    4. Paper = 17%
  2. Make up examinations are given with an excused absence. The usual fee will be charged, as outlined in the Student Handbook; or as advised by the instructor if there are extenuating circumstances being allowed.

Guaranteed grades are as follows:

A = 90 - 100%
B = 80 - 89%
C = 75 - 79%
D = 70 - 74%
F = less than 70%
Course Competencies
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-

COGNITIVE DOMAIN


Students will understand the definition of the following terms and be able to use them appropriately:

  1. All terms discussed in Methods 1.
  2. Nutation/Counternutation
  3. Cavitation
  4. Joint play, Active and Passive movement, End feel, Paraphysiological space, Anatomic limit, Elastic Barrier
  5. Coupled motion
  6. Diplopia, Dysphagia, Dysarthria, Drop attacks, Dizziness Nystagmus

    Students will have an understanding of the following topics and/or concepts:

    1. Motion assessment of the spine and pelvis
    2. Grice and Cassidy classifications for segmental lateral flexion
    3. Cobb's Scoliosis classification
    4. Vertebrobasilar (V.B.I) screening
    5. Use of plain film radiography in Chiropractic


      Students will be able to interpret the following x-ray marking procedures:

      1. cervical x-rays views
        1. APOM
          1. Measurement for Rotation of the Occiput
          2. Lateral Mass Measurement for Rotation (Atlas)
          3. Lateral ADI (Atlanto-Dens Interval)
          4. Measurement for Rotation (Axis)
        2. Lateral cervical (LCN)
          1. Normal Curve Markings
          2. George's Line
          3. Disk Angle Line
          4. Cervical Gravity Line
          5. Atlantodental Interval (Atlanto-Odontoid Interval) AOI
          6. Prevertebral Soft Tissue Space
          7. A-P Sagittal Diameter of the Spinal Canal
          8. Posterior Cervical Line (Spinolaminar Line)
        3. A-P cervical (APLC)
          1. Body Lines
          2. Rotation
      2. thoracic x-ray views
        1. A-P thoracic (APT)
          1. Body Lines
          2. Rotation
          3. Scoliosis--Cobb method (A-P full spine)
        2. Lateral thoracic (LT)
          1. Normal Curve Marking
          2. Disk Angle Lines T3-T12
          3. Body Lines
          4. George's Line
      3. lumbar x-ray views
        1. A-P lumbo pelvic (APLP)
          1. Disk Lines
          2. Lumbar Rotation
          3. Femur Head Line
          4. Internal/External Rotation of the Ilium
          5. Flexion/Extension of the Ilium
          6. Sacral Plane Line
          7. Sacral S2 Line
        2. Lateral lumbar (LLS)
          1. Sacral Base Angle (Fergusson's Angle; Lumbosacral Angle)
          2. Fergusson's Line (Gravity Line)
          3. George's Line (L1-L5)
          4. Disk Line L1-L4
          5. Lumbosacral Disk Angle
          6. Lumbar Curve Marking
          7. Ullmann's Line (Right angle test line)
          8. Meyerding's Spondylolisthesis Grading


Conditions:

Few mentioned by illustration



PSYCHOMOTOR DOMAIN


Students will refine their static spinal palpatory and postural examination skills acquired in Methods 1.

Students will be able to perform and assess motion, regionally and segmental, in the spine, pelvis and ribs through the following procedures:

  1. active ROM assessment
  2. passive ROM assessment
  3. joint play
  4. end feel

Students will be able to assess spinal, pelvic, and thoracic motion segments according to the following components of the 'P.A.R.T.S' acronym for the manifestations of a subluxation:

  1. Pain: through the use of
    1. palpatory tenderness
    2. tenderness during motion assessment
      1. active motion palpation
      2. passive motion palpation
      3. end feel
      4. joint play
  2. Asymmetry: through the use of
    1. postural analysis
    2. static osseous alignment
    3. x-ray mensuration
    4. observation

  3. Range of motion: through the use of
    1. active range of motion
    2. passive range of motion
    3. regional and segmental motion palpation
      1. active
      2. passive
      3. end feel
      4. joint play
  4. Tone, Texture, Temperature
    1. through static palpation
    2. through use of the nervoscope

  5. Special Tests: through the use of
    1. VBI tests, leg length inequality, subluxation station

Students will be able to perform the following VBI tests, etc.:

  1. cervical x-rays views
    1. APOM
      1. Measurement for Rotation of the Occiput
      2. Lateral Mass Measurement for Rotation (Atlas)
      3. Lateral ADI (Atlanto-Dens Interval)
      4. Measurement for Rotation (Axis)
    2. Lateral cervical (LCN)
      1. Normal Curve Markings
      2. George's Line
      3. Disk Angle Line
      4. Cervical Gravity Line
      5. Atlantodental Interval (Atlanto-Odontoid Interval) AOI
      6. Prevertebral Soft Tissue Space
      7. A-P Sagittal Diameter of the Spinal Canal
      8. Posterior Cervical Line (Spinolaminar Line)
    3. A-P cervical (APLC)
      1. Body Lines
      2. Rotation

  2. thoracic x-ray views
    1. A-P thoracic (APT)
      1. Body Lines
      2. Rotation
      3. Scoliosis--Cobb method (A-P full spine)
    2. Lateral thoracic (LT)
      1. Normal Curve Marking
      2. Disk Angle Lines T3-T12
      3. Body Lines
      4. George's Line

  3. lumbar x-ray views
    1. A-P lumbo pelvic (APLP)
      1. Disk Lines
      2. Lumbar Rotation
      3. Femur Head Line
      4. Internal/External Rotation of the Ilium
      5. Flexion/Extension of the Coxal Bone
      6. Sacral Plane Line
      7. Sacral S2 Line
    2. Lateral lumbar (LLS)
      1. Sacral Base Angle (Fergusson's Angle; Lumbosacral Angle)
      2. Fergusson's Line (Gravity Line)
      3. George's Line (L1-L5)
      4. Disk Line L1-L4
      5. Lumbosacral Disk Angle
      6. Lumbar Curve Marking
      7. Ullmann's Line (Right angle test line)
      8. Meyerding's Spondylolisthesis Grading


AFFECTIVE DOMAIN


  1. Proper gowning of patients to respect and maintain their comfort zones in the performance of static palpation, motion palpation, and postural analysis.
  2. Appropriate touch of patients to respect and maintain their comfort zones in the performance of static palpation, motion palpation, and postural analysis. This includes the ability to communicate with the patient what examination procedure is about to be performed, why it is necessary to perform it, and how it will be performed.
  3. Respect for the patient's pain tolerance level when performing any provocative testing procedure including static and motion palpation.
Weekly Calendar of Learning Objectives
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Week Dates Topics/Learning objectives
Week 1 5/3/06 Lec: Introduction
Week 2 5/10/06 Lec: PARTS assessment
Week 3 5/17/06

Lec: Pelvic assessment/Paper
Week 4 5/24/06

Lec: X-ray marking lumbar and pelvis
Week 5 5/31/06

Lec: Lumber assessment

Week 6 6/7/06 Lec: Review
Week 7 6/14/06

Lec: MIDTERM WRITTEN 
Week 8 6/21/06 Lec: Thoracic assessment
Week 9 6/28/06 Lec: Lower cervical assessment
Week 10 7/5/06 Lec: Upper cervical assessment
Week 11 7/12/06 Lec: New research on VBI
Week 12 7/19/06 Lec: Research and Case Studies
Week 13 7/26/06 Lec: Review for Lab practical/Written final
Week 14 7/31-8/4/06
 FINAL EXAMS AS SCHEDULED
Week 15 8/7-10/06
 FINAL EXAMS AS SCHEDULED
Please Note
This schedule of lecture and lab topics and quizzes and exams may be changed during the course of the trimester as circumstances require. Whenever possible, such changes will be announced in class before the date and time in question. You are responsible for anything that transpires during lectures and labs, even when you are unable to attend. In the event that you miss a class session, make sure you check with a classmate about any announcements or schedule changes which may have been made. Makeup exams are allowed only according to the policies described in the current student handbook, which is available in the Student Affairs office.
Maintained by Northwestern College of Chiropractic
Last updated: 25 April, 2006
 

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