Written by David O'Bryon, ACC Executive Director
Friday, 27 June 2008 14:09
David O’Bryon , J.D., LL.D (Hon), F.I.C.C., is founder and president of O’Bryon & Company. With more than thirty years of association and government experience, he has served organizations as an executive, consultant, and volunteer. His responsibilities have included policy formulation and implementation for associations; design and management of membership recruitment efforts; development and implementation of government relations strategies and public affairs programs; volunteer and staff recruitment; designing, writing and editing communications/publications; and administrative management of budgeting and financial oversight. He registered as a lobbyist before the U.S. Congress in 1980 and has been involved in virtually all the major federal legislative initiatives for the chiropractic profession since that time. He has served as Executive Director of the Association of Chiropractic Colleges (ACC) since 1996.
Mr. O’Bryon is a Certified Association Executive (CAE). The Federation of Chiropractic Licensing Boards honored him last year with its Presidential Leadership Award.
In an interview with The American Chiropractor (TAC), Mr. David O’Bryon tells us about the ACC and it’s part in helping achieve progress for the chiropractic profession.
TAC: Dr. O’Bryon, give us some background on the Association of Chiropractic Colleges.
O’Bryon: The ACC was formed in 1988 and was the successor of the organization known as the Association of Chiropractic College Presidents. As the organizing document stated, "The specific purpose of the corporation is to provide an opportunity to have a cooperative base whereby chiropractic colleges may participate together in pursuit of the most effective practices and concepts for the academic, clinical and continuing education of students and practitioners of chiropractic, including the funding of educational offerings, research efforts and general operational concerns." The board is comprised of the chief executive officer of the institution or a designee. Individually, the chiropractic colleges are working to strengthen their institutions. ACC’s current president, Dr. Carl Cleveland III of Cleveland Chiropractic Colleges–Kansas City and Los Angeles, has witnessed the changes and noted that chiropractic educational institutions have grown and strengthened and that is reflected in the major capital improvements of our campuses. The most recent example is Cleveland Chiropractic College–KC, which has just completed a move to a new campus. We have seen a number of new technology state of the art buildings added to our campuses.
TAC: Tell us about your position and your responsibilities.
O’Bryon: From 1988 to 1996 the ACC was administered by the president of the association and his/her institution. In 1996, the ACC leaders hired me as its first Executive Director. The position’s responsibilities include oversight of the association’s everyday activities and budget along with its programs and outreach as the association’s chief staff officer. I have represented the profession in Washington, D.C., since 1980. Previously, I worked for the United States Congress.
TAC: What are ACC’s goals for the chiropractic profession?
O’Bryon: The ACC’s goals are to further chiropractic education, advance research and enhance the profession.
TAC: How do the ACC’s actions affect or impact the already practicing DC’s?
O’Bryon: The ACC schools want to help their graduates succeed and want to help create job opportunities. The ACC has been directly involved in advancing chiropractic as a service in the United States Armed Forces and in the United States Department of Veterans Affairs. A further example is the ACC’s CVA DVD that seeks to inform, update and educate the field on important research and public safety issues.
TAC: What are the most pressing issues facing chiropractic education currently?
O’Bryon: The health care delivery system is changing and the educational community must be training the next generation of practitioners for that new environment. We are currently evaluating educational outcomes and that will impact our future curriculums.
TAC: What are the latest projects the ACC has been involved in?
O’Bryon: The ACC is just completing an Informed Consent document that outlines the elements that should be included in such a document. We are also working to develop an educational template containing the elements for training chiropractic office workers and assistants. The ACC is sponsoring an educational conference with the World Federation of Chiropractic (WFC) in Beijing in November at the World Health Organization (WHO) meeting.
TAC: The ACC/RAC (Research Agenda Conference) meeting was held this past March 13-15, 2008, in Washington, DC. What is the purpose of this conference?
O’Bryon: Each year the ACC sponsors an educational conference designed to improve and enhance the various institutional departments as well as advance the educational system itself. The abstracts of the peer reviewed papers and posters that are presented are then published in the Journal on Chiropractic Education. The educational conference was joined with the Research Agenda Conference a number of years ago and the ACC/RAC conference has become the premier educational event in the profession. Speakers come from around the world to discuss the most recent advances in research.
TAC: Can you tell us ACC’s recent plans to increase/develop the chiropractic relationships with other health care providers?
O’Bryon: One of the most exciting developments is the participation of chiropractic programs and their students with the Department of Veterans Affairs. ACC was a prime supporter of the Congressional law that authorized the service. At the time the chiropractic program in the VA was initiated, the then VA Secretary said all colleges should develop a working relationship with his agency. I think that integrative health care is the future and we are working to train the next generation of chiropractors to be prepared for professional interaction. I currently am serving in my second year as president of the Federation of Schools of the Allied Health Professions, a Washington, D.C. based federation comprised of over a dozen of the associations of all the major health disciplines, The Federation of Associations of Schools of the Health Professions (FASHP). The organization is working together to advance health care education and cooperation. Also the ACC worked with the World Health Organization (WHO) to develop WHO’s guidelines on international growth of chiropractic education.
TAC: Any highlights regarding the research promoted by the ACC that has taken place in the last two years?
O’Bryon: We continue to work on a number of fronts. The colleges are working to strengthen their resources and have been successful with obtaining competitive federal grants. One example is the recent study about chiropractic reducing blood pressure; it bears further study as the profession offers great promise in a number of areas.
TAC: What is the biggest problem or challenge you see in the chiropractic profession today?
O’Bryon: The ACC is starting a new centralized application service for the chiropractic schools. We are entering a new ground with a common purpose that will help prospective students find their way to chiropractic. We want to create a process that starts by helping students enter chiropractic education to successfully launching them on to their career path, be that as clinicians, academicians or researchers. The health care delivery system is a changing one and giving today’s student the necessary skills and training to evolve and thrive in an integrative system that is directed at patient care is the challenge.
TAC: Where do you see the future of chiropractic headed?
O’Bryon: I think we are at the tipping point for chiropractic to surge forward. We need to embrace the demographic and cultural changes that are upon us. The profession needs to reach out and be inclusive. Also the baby boom generation wants to remain strong and active without drugs, so chiropractic’s conservative care should be quite popular. Professional and Olympic athletes have discovered chiropractic and that is a testament to our care. The U.S. Department of Labor’s Occupational Outlook reports a strong need for chiropractors with a growth of 14 percent for chiropractic.
TAC: Any final words for our readers?
O’Bryon: Keep recommending those outstanding students to chiropractic institutions!
You may contact David O’Bryon at
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Written by Dennis Woggon, DC, B.Sc.
Monday, 28 April 2008 14:12
Dennis Woggon grew up in Onalaska, Wisconsin—a small town just outside of La Crosse—and attended Wisconsin State University in La Crosse. Dr. Fred Barge, a pioneer in chiropractic and scoliosis, was his field doctor. Dr. Woggon graduated cum laude from Palmer College of Chiropractic in 1974 and has a Bachelor of Science degree in biology. He is the founder and director of the St. Cloud Chiropractic Clinic in St. Cloud, Minnesota, where he has practiced full-time since 1974. He was certified in Videofluorscopy at Palmer College in 1992 and taught Spinal Biomechanics with his mentor, Dr. Burl Pettibon, for twenty-eight years. Dr. Woggon has written many articles and books on chiropractic and lectured nationally and internationally.
In an interview with The American Chiropractor (TAC), Dr. Woggon discusses the chiropractic approach to scoliosis care and changing people’s lives, one spine at a time.
TAC: Tell us about the services and products you offer chiropractors and how or why they are offered.
Woggon: In 2000, I established the CLEAR Institute, which stands for Chiropractic Leadership, Educational Advancement & Research. The Institute was set up to advance the profession of chiropractic and then evolved into scoliosis care. In 2004, CLEAR Institute began teaching scoliosis seminars to the chiropractic profession.
TAC: What motivated you to start working with scoliosis patients?
Woggon: My practice has always been outcome assessment based on pre and post X-ray and spinal biomechanics. Initially in practice, I saw improvement in scoliosis cases, but not consistent results. In 1990, my good friend, Dr. Gary Lawrence, brought his daughter to my Clinic for treatment of a severe scoliosis. With the assistance of Dr. Lawrence, we began to study scoliosis. We looked at the great results that we have seen in our profession and incorporated many ideas from many mentors. These included Drs. Fred Barge, Bob Mawhiney, Burl Pettibon, Don Harrison (CBP), Clarence Gonstead, Nucca, Grostic, Orthospinology, Leander Eckard, Vern Pierce, Roger Turner (Cranial Adjusting), Clayton Stitzel, with Gerry Cook of Pneumex Rehab, and many more. We really wanted to focus on what worked and what would help the scoliosis patient without getting hung up on egos.
TAC: By your assessment, how are the schools doing at providing students with the minimum basic competence to service scoliosis care?
Woggon: When I attended Palmer College in the early 70’s, I was taught that chiropractic care could not help correct scoliosis, but was beneficial in the control of the symptoms of scoliosis. I was also taught not to adjust the patient for symptoms. Fortunately, this is now changing as we understand more about scoliosis and its cause. Doctors of Chiropractic are the specialists in the neuro-muscular skeletal system. Scoliosis is a dis-ease of the neuro-muscular skeletal system. We should be the spinal experts.
Students at various chiropractic colleges, including Parker, Palmer Florida, and Logan, have expressed an interest in learning more about scoliosis treatment as part of their established curriculum, and I hope that this interest continues to grow. Scoliosis has been documented since the time of Hippocrates, and chiropractic has the potential to take the lead in the field of scoliosis rehabilitation. We really are breaking new ground, and I think today’s chiropractic student understands that demonstrating consistent, positive results with scoliosis will validate the science of what we do in the eyes of the general public, as well as our colleagues in the healthcare industry and that the benefits of promoting chiropractic care for scoliosis will extend far beyond what we do today, and impact our entire profession. It’s a very exciting time to be a chiropractor!
TAC: What is the medical approach to scoliosis treatment and how are the attitudes toward you from MD’s that recommend the medical treatment?
Woggon: The medical approach to scoliosis is to observe it from 10 to 25 degrees, brace it from 25 to 40 degrees, and then do surgery. Research has shown that bracing is ineffective and surgery is disabling. There has to be a better, more conservative approach. The MD’s who care about scoliosis patients have shown a positive interest in what we do and we receive many referrals from them. The cost of scoliosis surgery is currently about $160,000 and, frequently, the finances dictate the treatment recommendations.
TAC: What are your success rates?
Woggon: The success rate depends on patient compliance. There is no cure for scoliosis. Our goal is to allow the patient to function normally and live a good life without bracing and surgery. In the peer reviewed study in BioMed Central Results, after four to six weeks of treatment, the treatment group averaged a 17 degree reduction in their Cobb angle measurements. None of the patients’ Cobb angles increased. A total of three subjects were dismissed from the study for noncompliance relating to home care instructions, leaving nineteen subjects to be evaluated post-intervention. Conclusions: The combined use of spinal manipulation and postural therapy appeared to significantly reduce the severity of the Cobb angle in all nineteen subjects.
TAC: Is there anything you would like to add or comment on regarding hanging X-rays?
Woggon: Logan college and Robert Mawhiney, DC, did some great work with hanging traction starting in the late 1940’s. They had some positive results, but the theory was never developed until we began incorporating traction and de-rotation.
TAC: Is there any study planned for the future that will assess effectiveness?
Woggon: In the fall of 2007, we established a CLEAR Scoliosis Center on the campus of Parker College of Chiropractic. The STAR Clinic (Scoliosis Treatment and Research) is directed by Dr. Glenn Robinson and my son, Josh Woggon. This Clinic is independent of the College, but will be working together with the College for specific, unbiased research regarding scoliosis and chiropractic. This is the first time that a Chiropractic College has had a Scoliosis Clinic on campus, and it is already attracting international patients. My son Josh was so motivated by what he saw in our Clinic with scoliosis patients that he began working with CLEAR Institute in 2003, and joined the student body of Parker College of Chiropractic in 2006.
TAC: What is the biggest problem or challenge you see in the chiropractic profession today?
Woggon: The biggest challenge is to overcome apathy and ignorance. We are told we can’t do something, so we don’t even try. We need to get away from being glorified therapists who only treat back pain and focus on what chiropractic can do for spinal rehabilitation and wellness care. We need to become the spinal experts of health care. We need to be able to do scoliosis screenings on all our patients and start the necessary treatment when we first discover a scoliosis during the medical observation phase.
TAC: What kind of change is it for an office to go from traditional chiropractic, to one that specifically addresses scoliosis?
Woggon: The scoliosis spine does not follow what we would consider normal spinal biomechanics. For example, the rotation of the spinous into the concavity contradicts normal motion. The thoracic scoliosis spine exhibits a hypokyphosis, which means that P-A thoracic or adjusting the "high side of the rainbow" is contraindicated. We have noticed that when the spine loses its normal lateral curves, it adapts by developing A-P curves. In order to correct the scoliosis, the normal curves must be re-established first. In order to correct the scoliosis, the normal curves must be established. The upper cervical subluxation component has neurological ramifications with the spinocerebeller tracts of the spinal cord.
In order to change this, we utilize Mix, Fix, Set protocols. First, the spine needs to be prepared for the specific adjustment with warm-up procedures; this is the Mix step. The Fix part is specific upper cervical and spinal unit adjustments. The Set protocols involve specific spinal isometric exercises and scoliosis stretching exercises. The postural muscles and nervous system must be rehabilitated with proprioceptive neuromuscular reeducation. The average office visit for a scoliosis patient takes about two hours. The majority of the rehab is preformed by our spinal technicians with equipment we have developed. The most important change in the office is that the doctor has to think. There are scoliosis patterns, but no two scoliosis patients are the same. It isn’t easy; it is very humbling, but it is extremely rewarding. The tears in the patients’ and parents’ eyes when they find out they don’t have to be braced or have surgery is the ultimate reward.
TAC: What type of maintenance program do patients have to be placed on to maintain results?
Woggon: The scoliosis patient is a lifetime patient. They will be monitored at least twice a year and will be doing exercises for their entire life. Spinal hygiene is like dental hygiene; it is an ongoing daily process. This commitment isn’t unique to scoliosis patients, either—in my opinion, everybody should be doing exercises to maintain their spinal health. You can get a false set of teeth, but not a false spine.
TAC: How long does it take a doctor to learn how to treat scoliosis through your approach?
Woggon: CLEAR Institute offers a three-part scoliosis seminar series with the last weekend being a workshop, hands-on approach. We are currently working with on-line classes which will be ready this summer. We also offer advanced workshops at various clinics throughout the United States. These are under the direction of approximately twenty doctors who are on the Board of Advisors for CLEAR Institute. We are constantly implementing new ideas in regard to scoliosis care; these are also available on our website. Our goal is to continually provide assistance and encouragement to the doctor who decides to work with these patients. We have about three hundred doctors who have taken the seminar with clinics throughout the world, and an online support system to ensure their skills continue to develop after the seminar is finished.
TAC: Where do you see the future of chiropractic headed?
Woggon: I see chiropractic changing the world in regard to the screening and treatment of the scoliosis patient. I see the scoliosis patient being referred by the school nurse to a Doctor of Chiropractic, instead of an Orthopedic Surgeon, for conservative care for scoliosis. In the near future, society will look back and question why we would ever do spinal fusion surgery on a scoliosis patient. We will change people’s lives, one spine at a time.
TAC: Any final words for our readers?
Woggon: Albert Schweitzer said, "At that point in life where your talent meets the needs of the world, that is where God wants you to be."
You may contact Dr. Woggon at http://www.clear-institute.com/.
Written by Allan Dyer, B.S., M.D., Ph. D.
Wednesday, 19 March 2008 09:59
Dr. Allan Dyer has a Bachelor of Science degree in Pharmacy and is a doctor of Internal Medicine. He was also awarded a Ph.D. for his graduate studies and pioneer work in Transthoracic Cardiac Defibrillation.
During his career as a senior administrator and Deputy Minister of Health, he instituted the hospital services quality assessment, generic drug substitution program, prescription drug benefit, emergency air ambulance and paramedic programs for the government of Ontario.
On retirement from government service, he pursued research leading to the development of spinal decompression technology
He coined the term Vertebral Axial Decompression and registered the first medical device to administer this procedure with the Food and Drug Administration. He has been awarded three US patents on the equipment and the procedure for non-surgical spinal decompression .
In an interview with The American Chiropractor (TAC), Dr. Dyer….
TAC: Could you tell our readers about the VAX-D table. How did the idea evolve?
Dyer: The recognition that chiropractic manipulation does help relieve low back pain coupled with the fact that research had shown discogenic lesions to be the main pain generator led to investigation to develop technology that could be programmed to modulate intervertebral discs beyond that possible with manual methods.
Many years ago, a pioneer in the back pain field named Cyriax hypothesized that, if we could find a method to distract the spine that would not elicit trunk muscles’ contraction, we should be able to produce negative intradiscal pressure, which, if strong enough, could suck a herniated disc back in.
We started the search with standard traction devices like the Tru-Trac device, but found that linear traction (whether applied statically or intermittently) did not bypass trunk muscle contraction.
We discovered that tension applied to the spinal column using a logarithmic time force curve bypassed the muscle guarding reflex, and lowered the disc pressure to negative levels.
Recently, we have made significant advances in motion control technology that incorporates physiological biofeedback to control and perfect the decompression procedure.
TAC: There are a certain amount of doctors out there that would say there is no difference between decompression and traction. How would you respond to this assertion?
Dyer: Because there are commonalities with traction superficially, some people equate the procedures. The same superficial attitude would state that a CT scan is nothing more than an X-ray. The difference in both cases is the inclusion of computer technology that significantly impacts the outcome of the procedure.
Traction has been in use for many years as an unsupervised physical therapy modality. Traction has not been shown to lower intradiscal pressures, and has had a dismal track record with chronic low back pain. Anderson and Nachemson placed pressure transducers in four subjects in the lumbar spine during traction procedures. They found that the intradiscal pressures went up dramatically in both cases. They concluded that at no time was negative intradiscal pressure observed and, therefore, the disc could not be sucked back in as proposed by Cyriax. They suggested that, in order to produce a relative reduction in disc pressure, traction must be administered in such a way as to allow trunk muscle relaxation. Traction can be expected to increase intradiscal pressure and can, therefore, aggravate a protruded, herniated or extruded disc. It is, therefore, contra-indicated for patients with herniated discs.
Technological advances, along with our research, led to the development of VAX-D Treatment. The computer control of the equipment allows controllable, effective axial distraction to be applied to the lumbar vertebral column without eliciting trunk muscle contraction. We found that distractive forces must be applied and released in a progressive logarithmic fashion.
TAC: Can you please explain what is meant when you say that it is a logarithmic pull pattern?
Dyer: VAX-D incorporates computer programmed technology that applies the tension according to a logarithmic curve. Essentially, as tension is increased, the time function is progressively slowed. This is a critical difference between VAX-D and traction and is the reason VAX-D was issued a US patent #6,039,7376. This patent describes the complex computer program and illustrates the logarithmic time/tension curve.
Traction applies tension on a linear time rate; e.g., if you plot the strength of tension (lbs.) vs. time (secs.), the plot is a straight line. The biological response to traction causes reflex muscle guarding. This is a homeostatic protective response that prevents traction from decompressing discs. When the procedure is governed by a logarithmic time rate, reflex guarding is averted, and the disc pressure can be decreased to negative levels.
TAC: What would you say is the percentage of tables sold to chiropractors versus those sold to other professions?
Dyer: About 65 percent of our devices are utilized by MD’s and DO’s. The remainder are used by chiropractors and PT’s.
TAC: What kind of research has been done on the VAX-D and/or decompression in general?
Dyer: It should be noted that VAX-D is the only device proven to achieve spinal decompression through direct recording of negative pressures in intervertebral discs in living subjects. No other device has been shown to lower the disc pressure. In addition, independent clinical research has demonstrated neurodecompression following VAX-D. No other product has ever published comparable research studies. Therefore, practitioners using any other devices cannot legally substantiate spinal decompression claims.
VAX-D also has a number of clinical studies that have demonstrated significant efficacy. That fact that these clinical studies have shown consistent levels of success also provides practitioners with research evidence of efficacy.
In a recent internet search (January 2008) using PubMed, Medline, and Embase, we could not find any clinical research on any of the other so called decompression tables published in "peer reviewed" medical journals. Yet they all claim success rates in excess of 85 percent.
TAC: What is the biggest difference between the way the way MD’s approach the use of the decompression, versus how a DC initially approaches it? Is it any different to that of a DO?
Dyer: MD’ and DO’s are able to utilize the complete VAX-D protocol in the treatment of back and neck pain. Many patients have a large inflammatory component to their spinal disorder. The VAX-D protocol includes the use of certain prescription pharmaceutical agents in conjunction with the mechanical therapy. In addition, particular diagnosis, such as Internal Disc Disruption, require the concomitant use of Matrix Metalloproteinase Inhibitors (MMPI’s) along with an oral steroid such as methylprednisolone.
DC’s and PT’s are unable to prescribe so they are not able to take advantage of all of the treatment adjuncts unless associated with a multi disciplinary practice.
Also, many DC’s (and some DO’s) add spinal manipulation to the procedure. We caution all practioners not to add any adjunct that has the potential to increase the intradiscal pressure.
TAC: Are there any threats to the use of this technology as a form of improving low back pain in the future?
Dyer: There are several unrelated answers to this question. One threat has been the use of fraudulent and illegal marketing techniques. Some practitioners have already been subject to fines for making false claims.
The other threat to the availability of the treatment is improper denial of claims for the service by insurance providers and third party payers. The treatment is often denied on the basis that the treatment is "investigational and experimental" in nature. In fact, the treatment does not have an investigational regulatory status with the US Food and Drug Administration, whose mandate is to make such determinations. Investigation devices must be utilized under an Investigational Device Exemption.
Several landmark class action lawsuits against a number of managed care companies have concluded that they have engaged in a conspiracy to improperly deny and delay claims, in whole or in part, and/or reduce payment to physicians based upon improper use of definitions of Experimental and Investigational status of treatments.
We believe that "evidence based medicine" should be a determining factor in whether a drug or device should be recognized and reimbursed by the health insurance industry.
VAX-D is the only device with a long history of studies published in peer reviewed journals, including a recent study, in February 2008, that showed short- and long-term outcomes after VAX-D treatment in a large sample of patients with activity-limiting low back pain that had failed at least two previous, non-surgical treatments. The study showed that patients had significantly improved pain and disability scores at end of treatment, at 30 days and at 180 days post-discharge.
TAC: Can you tell our readers about the cervical component? What kind of conditions have demonstrated improvement?
Dyer: Anatomical differences and enhanced proprioceptor reflex sensitivity, compared to the lumbar spine, dictate the use of higher precision and special adaptations to successfully treat discogenic lesions in the cervical spine.
Research found that the application of tension needed to be strictly controlled in the horizontal plane and the vertical plane in order to avoid triggering muscle guarding and spasm in the cervical spine. The cervical collar component is also critical for distracting the head and neck, because it allows the required mobility of a circumferential lift system, while providing the necessary support and immobilization for patients in the post treatment period when the muscle guarding reflexes have been reduced. Without the protection of the collar, head and neck movements will trigger muscle spasm, increased intradiscal pressure and neck pain.
We have many of the new Genesis Cervical systems in the field now, and they all report success with herniated and degenerative disc disease cases. We will need to do properly designed clinical studies in order to determine the overall success rates with different conditions.
TAC: How do post surgical patients respond to decompression?
Dyer: Post surgical patients respond positively to VAX-D treatment, although the reported success rate in the literature is lower. An outcome study on 778 patients wrote: "Thirty-one patients had previous lumbar disc surgery. Eighty-four percent of this group’s pain scores, 71 percent of their mobility scores and 61 percent of their activity scores improved by one unit or more with therapy, and 65 percent of their pain scores were reduced to 0 or 1. Vertebral axial decompression was well tolerated."
TAC: While there are many different types of decompression tables available with varying degrees of research to support it, what’s your advice to our readers who may be using any type of "decompression" table in their practice?
Dyer: Look to purchase equipment that has clinical support published in peer reviewed medical journals. Don’t base the purchase on marketing hype. Look for at least Level II evidence of efficacy.
TAC: Is there an issue that doctors using decompression along with cash prepayment plans should be aware of? (Ie, Is the patient paying for something that they’re not getting??) Can you explain this concern?
Dyer: Yes, there is an issue when a practitioner is charging a patient for decompression, using a traction device. In addition, a patient should be treated with equipment that has clinical support for its efficacy.
TAC: When it comes to decompression, there are many concerns and/or rumors about the government or insurance companies giving doctors problems when utilizing this new technology. Who are these people/organizations? And why do you think they are giving doctors such a hard time?
Dyer: The Department of Justice has an obligation to protect the public against false advertising. The DOJ and some insurance companies have initiated investigations into fraudulent claims made by decompression device manufacturers, and then repeated by practitioners in promoting the service. Patients cannot be induced to take a treatment based upon fraudulent claims.
The spinal decompression industry is full of misinformation, unsubstantiated claims and marketing hype. Many manufacturers have been quoting research done on VAX -D as though it applies to their device. That is illegal. It is disconcerting that the industry has grown so large, when a search of the medical literature reveals there are no studies published in peer-reviewed medical journals on devices other than VAX-D.
Many device manufacturers claim that their equipment will lower the intradiscal pressure. To this day, VAX-D is the ONLY device shown in clinical research to decompress the disc to negative levels (Ramos & Martin, Journal of Neurosurgery).
TAC: Any final words for our readers?
Dyer: We at VAX-D have always been more interested in the outcome for the patient, rather than the marketability of the equipment. One of our mottos is, "Real Science, Real Studies, Real Results".
I would advise purchasers to make their decisions on clinical evidence rather than on marketing hype, and to make sure that they can substantiate any claims that they make regarding the treatment and its success rates.
Written by Frederick Carrick, D.C.
Friday, 29 February 2008 15:16
Frederick Robert Carrick, D.C., Ph.D., is the Distinguished Post Graduate Professor of Clinical Neurology at Logan University and is Parker College of Chiropractic’s Professor Emeritus of Neurology. He serves as the President of the American Chiropractic Association’s Council on Neurology and is the President of the American Board of Chiropractic Specialties of the American Chiropractic Association. Professor Carrick is a 1979 graduate of the Canadian Memorial Chiropractic College and received a Doctor of Philosophy degree specialty in Brain Based Learning from Walden University’s Faculty of Education. He is the recipient of a multitude of professional, governmental and societal awards and the subject of the Emmy Award Winning Public Broadcasting Service series, Waking up the Brain. Dr. Carrick was recently honored with a Life Time Achievement Award in Contemporary Scientific Paradigms from Life University. He holds board certification in a variety of disciplines central to the neurosciences and has enjoyed an international reputation as a clinician and educator for twenty-eight years.
In an interview with The American Chiropractor (TAC), Dr. Carrick expresses some of the innovations that he has pioneered through his work.
TAC: Dr. Carrick, please tell our readers about some of the services and research that the Carrick Institute has been doing?
Carrick: The F. R. Carrick Institute for Clinical Ergonomics, Rehabilitation, and Applied Neuroscience (C.E.R.A.N.) of Leeds Metropolitan University consists of a faculty of world class scientists and clinical researchers in Biomedical Engineering and Rehabilitation, Experimental Psychology and Adult and Developmental Neuropsychology, Ergonomics and Human Factors, Cognitive Neuroscience, Linguistics, Developmental Neuroscience and research in Physical Therapy and Occupational Therapy. The participants have produced numerous patents and developments as well as translational research in fundamental biomedical technologies, including applications of high temperature superconductivity, imaging science, brain pacemakers, apnea monitoring, laparoscopy, pain management systems, neural nets, treatments for decubitus ulcer, drug delivery systems, non-invasive anesthesia, acoustic body parts identification, acoustic correlation transform, miniaturized MRI, and neurochemical modulation by weak magnetic fields. The Institute is affiliated with Winthrop-University Hospital in Mineola, New York. A doctoral program in Rehabilitation Sciences and in Clinical Rehabilitation Neuropsychology is offered by the F. R. Carrick Institute through the Faculty of Health of Leeds Metropolitan University.
The Carrick Institute for Graduate Studies conducts Graduate School Programs in Neurology in five languages and maintains thirty extension facilities throughout the world. Our program qualifies individuals for a professional Master of Neuroscience degree as well as fulfilling the requirements for the Board Certification Examination in Neurology by the American Chiropractic Neurology Board (ACNB). The ACNB was the first certification agency in chiropractic to achieve full accreditation through the National Commission for Certification Agencies (NCCA) of the National Organization for Competency Assurance (NOCA).
Our research investigations have resulted in many publications in the indexed scientific literature by our faculty and learners. We also have participated in numerous international congresses specific to neurology and rehabilitation. This year, I have been a co-author on two major publications involving Posturographic Changes and Motor Learning.1,2
We are publishing in the mainstream medical journals due to the impact factor of our investigations that represent our approach to brain function without drugs or surgery. Our acceptance and participation in major scientific congresses with platform presentations of our research have assisted us in our responsibility of sharing and service to others.
TAC: We understand that the Carrick Institute is also involved in humanitarian efforts. Could you tell us a bit more about them?
Carrick: Yes, the F. R. Carrick Clinics at the Meru District Hospital have been established to assist in serving the health care needs of the citizenry of Meru, Kenya. These people live in extreme poverty and suffer from devastating illnesses and diseases. Medicines are expensive and scarce in this area and the applications of neurological applications by chiropractors can assist in the diagnosis and treatment of many disorders without drugs or surgery. Chiropractic neurologists volunteer their time and pay their own expenses to work in our clinics. Their talents and dedication enable us to help people who truly are in need.
As well as our volunteer staffing, the Carrick Institute has coordinated the shipment of $500,000 worth of medicines and supplies to be distributed at our clinics this year. Microscopes, mosquito nets and other supplies are shipped directly to the F. R. Carrick Clinics at the Meru District Hospital. Our chiropractic neurologists work in concert with other health care providers. While the treatment of disorders of humankind without drugs or surgery is an option in developed countries, it is often a necessity in areas of the world where medicines are not available. Our interdisciplinary approach to health care and the dedication to service, above self, of our learners have allowed us to learn more about diseases not typically seen in our country and promotes the development of applications in a patient based paradigm of care.
TAC: How is the use of concepts in Functional Neurology different from what your average chiropractor is doing on a day in day out basis?
Carrick: Functional Neurology promotes an ability to understand the nervous system at a specialist level that compliments the role of the chiropractor and other health professionals specific to the nervous system of humankind. When we refer to function, we embrace not only the pathology in a system but those areas that are intact. A Functional Neurologist is trained to serve as a specialist consultant in the field of neurology. His/her examinations need to be more detailed than the general practitioner, and the treatment parameters are often different with a greater emphasis on multi-modal environmental stimulations including light, sound, temperature and rehabilitation. We find that many general practitioner chiropractors elect to train in neurology to enhance their skills and service to their community without a desire to become Board Certified.
Certainly, we attract chiropractors from very diverse backgrounds such that a neurological approach to patient care can be utilized to measure the consequence of a therapy. A functional neurological approach to patient care can allow the practitioner to know if his/her applications are in the best interest of a patient or if there is a need to do something different. By attending to a therapeutic approach addressing maximizing human neurological potential, we tend to embrace a different concept from those practitioners who have a pathology based practice.
TAC: Is this approach only taught to chiropractors?
Carrick: Our institute trains a variety of health professionals in functional neurology. Our programs are based upon neurophysiological principles that are true to all disciplines. In some locations, our participants are mostly medical doctors, whereas in others they might be mostly chiropractors and, oftentimes, a blend. Our training is not discipline specific but more specific to the diagnosis and treatment of neurological conditions without drugs or surgery. These types of treatments are being actively embraced by the global community subsequent to the needs of our public and growing concerns over the utilization of pharmaceuticals. Our methods of examination are standard in neurology and our learners are also trained to identify those conditions that are not best treated in these manners. Ours is a realistic program of education that prepares our clinicians to recommend the best mode of treatment in a paradigm that is patient based. The acceptance of our work by peer reviewed scientific committees for presentation at specialty congresses demonstrates an increased receptiveness of a functional neurological approach in health care.
TAC: Can you tell us about chiropractors and medical doctors studying together with the Carrick Institute?
Carrick: Our Institute provides instruction in a variety of areas central to the function of the human nervous system. The breadth and depth of material is central to all professions, whereas the applications that we provide are those that do not use drugs or surgery. There is a great demand from the public for the types of applications we provide.
While we do not teach medical doctors to adjust joints, we surely teach them the need for referral to a qualified chiropractor for certain conditions and vice versa. We attract learners from all disciplines because of the expertise of our faculty in sharing material which applies to all health care providers. We have very talented instructors and our programs have become very popular. For example, our program in Functional Brain Anatomy serves the needs of all disciplines and our program in this knowledge area is attended by both medical doctors and chiropractors. Our chiropractic learners’ level of knowledge is most impressive and they are on par with learners from other disciplines. In fact, it is most impressive when you observe a chiropractic neurologist on research rounds in the brain lab; they make us very proud.
TAC: What is it that motivates your activities with the Carrick Institute?
Carrick: We are motivated primarily by our service to humankind. We are an educational institution and our programs exist only due to the demands and needs of our learners to serve others. We are the largest provider of graduate school education in neurology to chiropractors and serve the clinical educational needs of a present learner enrollment of approximately 4,000 individuals. We have a responsibility to them and their patients to facilitate their learning of a difficult knowledge area. We have learned how to teach and how to inspire a mastery of a specialty through our attention to the breadth and depth of the subject material and by our direction to an application based outcome.
TAC: What are some of the obstacles you have had to overcome to arrive where you are?
Carrick: Our greatest obstacles have been our ability to serve the demand for our programs. We continue to have a greater demand than we can serve. We pride ourselves in attracting faculty who are skilled clinicians and talented educators. We only accept faculty that have the ability to teach and are considered top in their field. As a consequence, we find our programs very popular but we are limited in the number of programs we can maintain. We are able to maintain thirty programs throughout the world but, unfortunately, cannot serve the demands of all communities for our educational programs. We do not offer faculty appointments to individuals who are not best suited to clinical instruction and leadership. We have maintained a superior sharing and education but continue to face the obstacle of saying no to groups of doctors who desire our program in their area.
TAC: How are the attitudes toward this approach from other professionals you work with?
Carrick: We train our learners to be skilled professionals who speak the same language as others specific to the nervous system. Consequentially, we attract a diverse population of professionals as learners and our graduates are able to participate in a team approach to health care. Our candidates do well in multi-disciplinary scenarios. For example, at a recent symposium in Amsterdam on coma and vegetative states, our chiropractic learners sat side by side with medical neurologists and neurosurgeons who are also our learners. The level of understanding and fluency in mutual disciplines promoted a superior sharing which has benefited our global patient population. I am very proud of all of them; they work together and understand the skills and abilities of each other and, more so, they become more than colleagues, they become a global family of neuromates. So, I would suggest that the attitudes of those exposed to our programs and to our graduates is wonderful. Chiropractors refer to our chiropractic neurologists as do other practitioners and our specialists also refer to the general chiropractor and to their medical counterparts. Our graduates are well trained and contemporary in their knowledge base.
TAC: Can you tell us about Board Certification in neurology for chiropractors?
Carrick: Board Certification in neurology for chiropractors is through the American Chiropractic Neurology Board (ACNB). This autonomous agency is recognized by the American Chiropractic Association as the sole authority for credentialing in neurology for the chiropractic profession. The ACNB is fully accredited by the National Commission for Certification Agencies (NCCA) of the National Organization for Competency Assurance (NOCA). Chiropractors who have completed our program of study are eligible to take the written and practical portions of the examination. The standards of Board Certification have been elevated to the level of NOCA/NCCA and are designed to protect the public and assure all stake holders of the quality of the certification process.
TAC: What kind of conditions would have the best likely outcome when being treated with some of the concepts you teach?
Carrick: Customarily conditions involving human posture and gait including disorders of movement, such as dystonia, seem to have superior outcomes with the drugless approaches we utilize. Falls are the greatest cause of accidental death in almost all age groups and our approaches to fall prevention appear to be superior to any other modality. Learning and behavioral disorders show promise as do a variety of pain syndromes. A Functional Neurological approach to neurological syndromes may have a varied outcome, such that the individuality of the patient has a great deal to do with the consequence of treatment. Two individuals with the same syndrome might not have the same results; however, a neurological approach will enable the practitioner to know if the patient is not progressing or is getting worse so that a change can be directed.
TAC: How is it that you would interpret the vertebral subluxation complex, based upon your research?
Carrick: My research is brain based and not specific to a vertebral subluxation complex. I can tell you, however, that angulation of joints is a consequence of brain activity. An individual who has suffered a stroke with an angulation of his arm and leg has that posturing because of his brain situation. Quite simply, the joint angulation did not result in the brain pathology of the infarct; it represents a state of the nervous system that already exists. It is a window or marker of a pathological process. I would suggest that angulation of joints in the spine is similar and might act as an observable marker that something is wrong in the nervous system. Applications that are specific to brain function can change the angulation of joints due to their effects on soft tissue tensions, just as they might change what is referred to as a vertebral subluxation complex. I measure extensor tone and activity in spinal, trunk and appendicular muscles and observe changes with environmental stimuli of a variety of modalities, including chiropractic adjustments. It would appear, from a brain based perspective, that the subluxation reflects a functional view of the nervous system and exists as a result of the soft tissue tensions produced by segmental and super segmental neurological integration similar to other joint angulations. It does not appear to be the cause of syndromes but the consequence.
TAC: Is there any diagnostic or therapeutic equipment that you would recommend to the average chiropractor?
Carrick: Absolutely. The CAPS force plate by Vestibular Technologies provides data that allows the clinician to predict the probability of a fall. It is a computerized force plate that measures human stability and sway and gives a statistical report that does not have to be interpreted by the doctor.
Falls are the greatest cause of accidental death and most fallers have no signs or symptoms before a fall. In fact up to 70 percent of the population is at risk of falling and might be helped by those individuals who can identify their pathology. We recommend that the chiropractor not charge for the test, even though there are CPT codes for the procedure. Our rationale is simple. This testing is necessary and is a public service. If the test is free, then people will get the testing and pathology will be identified. If people have to pay for a test, the probability increases that they will not have it done. With 70 percent of the population having pathology of stability, we find that people who are in need of care will customarily choose the provider who gave them the test. The treatment of pathology of human stance and stability is by a drugless non surgical approach and is in the armamenterium of the chiropractor.
Both the doctor and patient have an outcome measurement in the post tests which will indicate an improvement or worsening or even no change, so that they both can understand the direction and consequence of their care. Since neither I nor any of our faculty or the Institute accepts any royalties or commissions for recommending a modality, we feel comfortable in talking about it. We also have several registered studies utilizing the technology.
TAC: Are you personally teaching the seminars currently?
Carrick: I rarely teach anymore, spending the majority of my time involved with brain research, although I do present papers at a variety of scientific meetings throughout the year. I will be the instructor for our Alpine Neurology Symposium in Zermatt, Switzerland, this coming April. We couple neurology with a ski week and our symposium is specific to human posture and movement disorders. We have participants from around the world who have registered to participate and it is difficult to say no to such meetings.
TAC: What is the biggest opportunity you see in the chiropractic profession today?
Carrick: Chiropractors are uniquely positioned to serve a greater percentage of the population due to advances in clinical procedures and outcome measures. Our society is embracing a more intimate relationship with our environment and demands for a drugless approach to health care are exploding. Our patients are better educated than ever before and demand a superior knowledge base from their health care providers. Those doctors who increase their knowledge base and skill levels will enjoy an opportunity that will facilitate the service of their practice. The neurological consequences of chiropractic care demand a superior knowledge of clinical neurophysiological applications. Chiropractors might consider higher education as the biggest opportunity they have if that education is specific to their job. I can think of no opportunity superior to the chiropractor than an increase in their clinical knowledge of the nervous system and the applications that they might use to evoke change. . Managed care has affected both patient and provider satisfaction and many providers are forced to obtain the skills which allow them to escape the boundaries of such management. A large majority of our learners are able to establish a reasonable fee for service and establish practices that allow them to escape the bonds of third party relationships. The demand for a Functional Neurological approach to health care exceeds the number of our specialists and promotes an opportunity for those doctors who desire to raise their knowledge levels and abilities to a higher level.
TAC: Where do you see the future of chiropractic headed?
Carrick: The role of all health care providers is changing. Chiropractors utilize a patient based paradigm that demands a higher level of training for the health care professional. Chiropractors are being directed to additional training beyond the DC degree because of the public interest. We have seen an explosion in the number of chiropractors who enroll in our Graduate School Programs in Clinical Neurology and we understand our role and responsibility in our training. We train chiropractors that have many years of experience in practice and they become better doctors. We train debutante practitioners and they are able to enter practice at a superior level. The future is very bright for those chiropractors that continue their education and obtain a superior level of mastery of their profession. The chiropractic profession is based upon a neurological approach and I see that we have little choice but to embrace it; our future is bright.
TAC: Any final words for our readers?
Carrick: We have trained chiropractors who are skilled in a variety of techniques and philosophies. Ours is not a program of technique but a process by which the doctor might be able to do his/her job in a superior fashion, regardless of their techniques. We have trained the majority of the technique gurus in chiropractic and, at the end of day, we find that we have been able to promote a mélange of so many talented people. Chiropractors who speak the same language and can communicate within and beyond our profession have skills which are better and their role as part of a global health care team is ensured. I have been blessed to have been associated with so many talented people in my life and I am very proud to have played a part in their training; they have taught me much.
You may contact Dr. Carrick at Carrick Institute for Graduate Studies, 203-8941 Lake Drive, Cape Canaveral, Florida 32920. Phone 1-321-868-6464; Fax 1-321-868-6468; or visit www.carrickinstitute.org.
1. Carrick FR, Oggero E, Pagnacco G, Brock JB, Arikan T. Posturographic testing and motor learning predictability in gymnasts. Disabil Rehabil. 2007 Dec 30;29(24):1881-9. Epub 2007 Feb 9. PMID: 17852265
2. Carrick FR, Oggero E, Pagnacco G. Posturographic changes associated with music listening. J Altern Complement Med. 2007 Jun;13(5):519-26. PMID: 17604555 [PubMed - indexed for MEDLINE]
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