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Chiropractic Methods 3: cervical & thoracic manual therapies - #33230


 

 

Thomas Bergmann, DC
952-888-4777 Ext. 279
Clinical Sciences Faculty Offices, 2nd Floor
3.25
75
1.5
3.5

Introduction to applied adjustive procedures using high velocity, low amplitude thrusts in the cervical and thoracic regions. Emphasis is on understanding the normal mechanics and the pathomechanics of the cervical and thoracic spinal regions and to safely apply techniques derived from various technique systems (e.g., Gonstead, Diversified, Faye - Motion Palpation, Thompson) to dysfunctional joints. Methods are practiced under direct supervision after PARTS evaluation has identified segments for which adjustments are indicated.
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Course Objectives
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  1. Use and demonstrate understanding of the distinguishing features for the classification of manual therapies;
  2. Understand normal joint structure and function in the cervical and thoracic regions;
  3. Appraise the role of radiology in joint assessment;
  4. Understand the role of provocative orthopedic and neurological tests in determining the nature and extent of the lesion;
  5. Appreciate the nature of pain;
  6. Begin to combine clinical findings to determine a tentative or working diagnosis through case presentation;
  7. Understand contraindications to and complications from spinal manipulative therapy;
  8. Appreciate that the effect of thrust techniques is on joints rather than bones.
  9. Identify the subluxation complex by recognizing specific characteristics using a systematic multidimensional method of evaluation (PARTS);
  10. Review x-ray markings for the cervical and thoracic regions;
  11. Apply orthopedic and neurological tests to provoke or identify tissues and/or structures involved with spinal joint dysfunction.
  12. Assess joint structure and function using PARTS evaluation;
  13. Decide which technique approach to use based on mechanical findings, patient tolerance and doctor ability;
  14. Demonstrate techniques to restore the six degrees of freedom at each spinal level from occiput to T12, discussing patient positioning, doctor position, contact, indifferent hand, and line of drive;
  15. Re-establish optimal joint structure and function using psychomotor skills of chiropractic adjusting.
Materials
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A. Required Text(s):
  1. Peterson, Bergmann. Chiropractic Technique, 2nd edition, Mosby 2002.
  2. Evans R. Illustrated Essentials in Orthopedic Physical Assessment, 2nd edition, Mosby, 2001.

B. Recommended Text(s):
  1. Plaugher. Textbook of Clinical Chiropractic
  2. Kirk, Lawrence, Valvo. States Manual of Spinal, Pelvic and Extravertebral Technics, 2nd ed.
  3. Shafer, Faye Motion Palpation and Chiropractic Technique
  4. Grove, Chiropractic Technique
  5. Eder, Tischer Chiropractic Therapy

C. Required Materials for Lab:
  1. Lecture/Lab Notes - available in the bookstore
  2. Lab Video - available in the bookstore or from AV
  3. Practical competencies - handed out in class
  4. Recommended texts - additional sources (see B above)
Assignments
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  1. Read weekly assignments in required textbook.
  2. Read class notes.
  3. Review psychomotor skills and procedures taught in previous Methods classes at NWHSU (specifically static palpation for Methods 1, and motion palpation and x-ray analysis from Methods 2).
  4. Proper attire is expected in the laboratory sessions - department policy will be followed. Please review the outline prior to class to ensure reasonable access to the scheduled body region.
  5. Bring colored practical competency sheets to the indicated lab session each week--failure to do so will result in not being able to do the weekly competency evaluation.
  6. Daily practice of adjustive exercises.
  7. Participation in practical laboratory sessions is essential. If you have a physical reason not to participate, you must request accommodation for the disability from the Student Affairs office. For pre-existing conditions this request is to be completed prior to the beginning of the semester. For new conditions, participation will be waived for one (1) week while a request is being made.
Attendance
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Attendance is required.
Grading Criteria
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  1. Weekly Competency Evaluations: (120 points) 12, each worth 10 points; procedures from the previous week will be performed and assessed for proper patient positioning, doctor position, contacts and thrust vector.
  2. Final Practical: (120 points) 6 stations (upper cervical, lower cervical, thoracic, rib, orthopedic/neurologic, and x-ray).
  3. Portfolio: (75 points) contains written assignments as well as a videotape cassette
  4. Adjusting Competency: (Extra credit)  must correctly identify the characteristics of subluxation (PARTS) and restore joint function through indicated thrust techniques on 3 classmates during the lab class or open lab sessions.
  5. Examination Competency: (Pass/Fail)   Must complete 5 examinations on clasmates during lab class or open lab sessions.
  6. Written Midterm and Final: (100 points each -200 total), true/false, multiple choice and short answer.

Guaranteed grades are as follows:

A = 92 - 100% of Total Possible Points (440)
B = 83 - 91 % of Total Possible Points
C = 74 - 82% of Total Possible Points
D = 65 - 73% of Total Possible Points
F =

Failure accrue at least 65% of the Total Possible Points

Grading: The assignment of and changes to course grades are the sole responsibility of the instructor of record. A grade may be changed only if there was an error in calculation. If you believe there has been an error in the calculation of a grade, contact me for an explanation of the grade within the first week of classes the following term. If a grade is determined to be in error, a grade change report will be issued to the Department of Student Records. The changed grade can be checked on eNorthwestern as soon as it is made available.

Grade Appeals: The instructor is responsible for evaluation of student performance and for determining a student's course grade. The student is responsible for fulfilling the academic requirements for the course, as established by the instructor in the course syllabus. A student may appeal a grade only through an informal resolution process. The student should first talk with the instructor.

Course Competencies
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COGNITIVE DOMAIN


Students will understand and be able to apply the following concepts for manual thrust techniques:
  1. Patient positioning
  2. Doctor positioning
  3. Contact points on the hand
  4. Segmental contact points on the patient
  5. Vectors of force, line of drive
  6. Tissue slack, articular slack
  7. Prestress - assisted, resisted, neutral


Conditions:
Musculoskeletal Conditions

Students will be able to make case management decisions regarding common musculoskeletal conditions based on their understanding of the following information regarding each condition:

A. Definition F. Natural history/Clinical course
B. Epidemiology G. Management
C. Etiology ---1. Chiropractic
D. Pathophysiology ---2. Physiological Therapeutics
E. Manifestations ---3. Nutrition and/or supplementation
---1. Symptoms ---4. Exercise
---2. History findings ---5. Lifestyle Management
---3. Exam findings ---6. Medical
---4. Chiropractic findings ---7. Other
---5. Lab findings H. Management Guidelines (where available
---6. Diagnostic imaging findings  
---7. Findings from special tests  

Conditions:

None specifically described in laboratory setting


PSYCHOMOTOR DOMAIN


Students will be able to conduct an appropriate joint function assessment using the following procedures and/or criteria (PARTS assessment):

A. Pain Location, character and description of reported pain correlated to pain produced by percussive palpation;
B. Asymmetry Interpretation of postural distortion, static palpation findings for joint position, and interpretation of static radiographic findings of joint position;
C. Range of Motion Evaluation of gait, interpretation of changes in global or regional active ranges of joint motion (inclinometers, goniometers), evaluation of passive joint motion and overpressure for accessory joint movement (joint play, end feel), use of stress x-ray for segmental active motion changes (hyper- or hypomobility);
D. Tone, texture, temperature Palpatory evaluation of the soft tissues for changes in tone (hyper- hypotonicity, spasm) and texture (ropiness, cords, bands, nodules), evaluation of the skin for temperature changes using the dorsum of the hand and/or a temperature detecting instrument;
E. Special tests Use of any other evaluation procedures that may relate characteristics of joint dysfunction (leg length inequality, correlation with visceral findings)

Students will be able to perform and interpret the following orthopedic procedures:

a. Bakody Sign k. Allen Maneuver
b. Brachial Plexus Tension Sign l. Costoclavicular Maneuver
c. Distraction Test m. Roos' Test
d. Foraminal Compression Test n. Wright's Test
e. Shoulder Depression test o. Chest Expansion Test
g. Spurling's Test p. Schepelmann's Sign
h. Valsalva Maneuver q. Rib Springing Test
i. Vertebrobasilar Provocation Tests r. Rib Compression Test
j. Adson's Test  

Students will be able to perform and interpret the following neurological procedures:

  1. Upper limb motor evaluation for strength, volume, and tone
  2. Upper limb muscle stretch reflexes
  3. Upper limb sensory evaluation for pin, light touch, vibration
  4. Students will be able to select and properly employ the following adjustive techniques:
    a. supine cervical techniques
    b. seated cervical techniques
    c. prone cervical techniques
    d. prone and supine thoracic/rib techniques
    e. basic soft tissue techniques (effleurage, pétrissage, roulemont, tapotement, friction)

    Students will have performed at least three (3) specific adjustments to different individuals under the direct supervision of a faculty member and after evaluating for subluxation using the multidimensional index (PARTS).


AFFECTIVE DOMAIN


Students will demonstrate integrity, sensitivity, respect, courtesy, compassion and professionalism at all times, both in lectures and labs, and will be able to apply the examination and treatment techniques learned in this course to any patient while demonstrating those same qualities.
Weekly Calendar of Learning Objectives
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Week Dates Topics/Learning objectives
Week 1 -- Lec: Introduction: Syllabus, Joint Assessment.
Readings: Review chapters 2 and 3
Lab: Adjustive exercises, spinal evaluation (PARTS review)
Lab: PARTS Evaluation of C0-C1; Altanto-Occipital adjustments
Week 2 -- Lecture: Biomechanics of the upper cervical spine
Readings: Pages 184-189
Lab: X-ray markings of cervical and thoracic regions - bring x-rays to class
Lab: Orthopedic tests for the cervical spine
Week 3 --

Lec:  Complications and contraindications
Readings:  Pages 106-122 
Lab: Neurological tests for the cervical spine - bring percussion hammer to class
Lab: Competency Evaluation 1: Altanto-Occipital adjustments continued
Week 4 --

Lecture:  Complications/Contraindications: Biomechanics of lower cervical spine 
Readings: Pages 106-122; 190-195
Lab: PARTS evaluation of C1-C2, Atlanto-Zxial adjustmentsT
Lab: Competency Evaluation 2

Week 5 --

Lecture: Memorial Day - NO CLASS
Readings: None
Lecture: Biomechanics of the lower cervical spine - continued
 Lab: PARTS evaluation of C2-C7; Lower cervical adjustive techniques.
Lab: Competency Evaluation 3 - bring x-rays to class
Week 6 -- Lecture: Biomechanics of the lower cervical spine
Readings: Pages 190-195; Notes
Lab: Lower cervical adjustive techniques - continued.
Lab: Competency Evaluation 4 - Videotaping of cervical adjustment - bring tape
Week 7 --

Written Midterm
Readings: None - STUDY! 463-469
Lab:  Soft tissue techniques - MUST wear gowns and have the ability to have a bare back.
Lab: Competency Evaluation 5: - bring x-ays to class.  Review.
Week 8 -- Lecture:  Manipulative mechanics
Readings: Pages 139-166
Lab: Cervico-Thoracic adjustments
Lab: Competency Evaluation 6: Cervico-Thoracic adjustments.
Week 9 --

Lecture: Biomechanics of the thoracic spine
Readings: Pages 228-233
Lab: PARTS assessment of the thoracic spine; Prone Thoracic adjustments.
Lab: Competency Evaluation 7 - brink x-rays to class
Week 10 -- Lecture: Supine ("Anterior") thoracics
Readings: Pages 246-255, 268-274, Notes
Lab: 4th of July, No Class
Lab: Competency Evaluation 8 & 9 - Supine thoracic adjustments.
Week 11 -- Lecture: Biomechanics of the ribs
Readings: Pages 233-235
Lab:  PART assessment of the ribs; Rib adjustments.
Lab: Competency Evaluation 10 - adjusting mannequin; technique review.
Week 12 -- Lecture: T-L junction
Readings: Pages 235-236
Lab: Videotaping of Thoracic adjustment - bring tape; Spinal assessment; technique review - bring x-rays to class
Lab: Competency Evaluation 11 - Spinal assessment; technique review - bring x-rays to class
Week 13 -- Lecture: Case studies: 20/20 video segment on chiropraactic
Readings: Notes
Review - HOT SEAT
Lab: Competency Evaluation 12 - Spinal assessment; technique review - bring x-rays to class
Week 14 --
 FINALS WRITTEN - EXAM DATES TBA (true/false, multiple choice, and short answer - total 100 points)
PRACTICAL: 6 stations (upper cervical, lower cervical, thoracic, rib. ortho/neuro, and x-ray - total 120 points) 50 minute time allotments, a sign-up schedule will be posted.
Week 15 --
 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: 27 April, 2006
 

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