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Debt Attack
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Written by Stanley Greenfield, RHU   
Tuesday, 14 November 2006 16:53

Are you afraid that some day you will be walking down the street and, out of nowhere, some debt will attack you?  Do you live with that fear? I think that most chiropractors do fear debt. Their mantra is to be “debt free” at all cost.  Now don’t take this the wrong way.  I am not advocating that you should get in debt and stay in debt.  I just believe that there is “life after debt” as well as “life with debt.”  

Debt, as I have stated in the past, is not necessarily a “four-letter word.”  Not all debt is bad.  You must first understand what debt is and how to work with it to do one important thing: accomplish what YOU want to accomplish, not what someone else feels EVERYONE should accomplish.  Got that?  Good!  Let’s continue.
Debt comes in all shapes and sizes.  You probably have some of the following debt:

1. Student loans
2. Mortgage on a home
3. Credit card debt
4. Just plain debt

I have chosen these four, but I am sure that you have others as well as some that I have never heard of.  It really doesn’t matter.  Let me show you how you can deal with these four now.

Student Loans.  Now there is a big one!  Most students leave Chiropractic College today with a six-figure loan.  How can a person manage this?  It’s not easy. You must first remember that paying off a loan like this is like trying to eat an elephant.  You cannot try to choke it down in one bite.  You must do it bite by bite.  The same is true with any debt.  Student loans are quite unique.  They allow you as long as thirty years to pay it off.  They now even let you deduct some of the interest you pay as a tax deduction, so that lowers the interest rate that you are paying, after taxes.

I always suggest that people consider consolidating their loans as soon as they graduate, which locks in the interest rate and also changes the loan to simple interest instead of compound interest.  I also suggest that you take the longest payout possible.  This gives you a lower payment and you can always accelerate payments later to pay this loan off early.  Some may suggest that you will end up paying a lot of interest and they are correct, if you kept this for the entire life of the loan.  That is not what I suggest.  Your major concern should be about cash flow at this time.  Once your “positive” cash flow improves, you can accelerate your payments and pay off the debt earlier. 

Mortgages.  “The cheapest money you will ever buy.”  Never forget that statement.  Think about that for a moment.  You get a mortgage for $150,000 at six-percent interest.  You are in a thirty-percent tax bracket.  That means that the loan only costs you a “net” of just 4.2%.  Can you borrow money anywhere for that amount?  If that is the case, then why pay off your mortgage early?  If you do pay it off and then need to get to YOUR money, how do you do it?  You must BORROW it, at whatever the CURRENT rate is.  That number could and will go up in the future.  My advice is to take a thirty-year mortgage and, if you want to, make some extra payments and cut the length of the mortgage to suit you. 

Credit cards.  This is the one item that could ultimately destroy mankind!  Those little pieces of plastic can do a lot of harm, but they can be useful if you know how to play the game.  Do you have any in your wallet?  If so, what interest rate are you paying?  If you are paying over twelve percent, then you need to do some work. 

When was the last time you called your credit card company and ask them to lower your rate?  If you haven’t done that then you need to do it now.  Believe me when I say that they will not call you in this lifetime and offer to lower the rate because you are such a good customer!  You can get a fixed rate of below ten percent, if you call and ask for it.  Believe it or not, but credit cards are probably the best source of money at the best interest rate and terms at the present time.  By the way, if you use a credit card for purchases for your practice, the interest you pay on that card is deductible since it is for business purposes.  So, if you have a card at ten percent interest, the cost is really only seven percent if you are at a thirty-percent tax bracket.

Just plain debt.  The four letter kind!  I’ve lumped all of the other debt under this category.  It could be a line of credit, auto loan, equipment loan, or whatever.  It’s just plain old debt.  If the debt was incurred to purchase something for your practice, then the interest on that loan is tax deductible.  This makes the “net” cost for this money more reasonable.  It is important to keep personal debt separate from business debt for that reason.  It is important to keep good records, too. 

When was the last time you reviewed all your debt?  I am not suggesting that you do this so you can beat on yourself!  You might be able to consolidate some debt or refinance some debt and possibly lower your payments and the interest rate you are paying.  It never hurts to check.  I have seen some amazing savings from just such a review.  You might want to consider doing this one night when there is nothing worthwhile on television.  Make sure you have all the information you need to do a complete review before you start.

After all of this, do you now feel a little better about debt?  You should!  Maybe a few deep breaths are in order and close your eyes and repeat after me: “Debt is not out to attack me.  I can control debt.  I do not have to let debt control me.” 

Believe it or not, debt can be your friend.

Stanley B. Greenfield has been engaged in the fields of Financial Management and Insurance since 1962.  He is a Registered Financial Consultant, and was awarded the designation of RHU, Registered Professional Disability and Health Insurance Underwriter, in 1979, as one of its Charter Members. 

Mr. Greenfield has authored thousands of articles concerning tax, financial, and practice management, and has spoken throughout the world on these subjects to both business and professional associations. He is a regular contributor to numerous other professional journals.

Mr. Greenfield also serves as a member of the Board of Directors of the Florida Chiropractic Foundation for Education and Research. You may reach him at This e-mail address is being protected from spambots. You need JavaScript enabled to view it , call 800-585-1555 or 904-513-2229 or visit his website, www.stanleygreenfield.com.

 
Overview of Functional Neurology
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Written by Randy Beck, B.Sc., D.C., Ph.D.   
Tuesday, 14 November 2006 16:50

Neurology and the neurological examination are traditionally taught using a disease-orientated model.  While this approach may help to detect the presence of many neurological disorders, it may be less sensitive for investigating and estimating the physiological integrity of the nervous system associated with the majority of neurological symptoms.

The clinical interventions utilized in functional neurology have been derived from the integration and application of many of the theoretical concepts of a vast array of basic and biomedical sciences, including embryology, psychology, neuropsychology, neurology, neuroanatomy, cellular biochemistry, neurophysiology and genetics. Functional neurology may, therefore, be viewed as a concept that emphasizes the neuron and the nervous system as being the modulator of human expression and experience.  The unique and complex response of each individual’s nervous system to changes in their environment may provide insight into the neuronal health and output at multiple levels of the neuraxis.  

The original concepts of this approach to treatment were developed by my friend and mentor Professor Frederick Carrick, of the Carrick Institute for Professional Studies in Florida. Prof. Carrick’s original ideas have evolved as he has gained a deeper understanding of how the neuraxis functions and on the knowledge gained from clinical experience into their present form, which is taught by the Carrick Institute.

Investigations involving functional neurological applications have been published in myriads of journals that span the disciplines listed above and make it extremely difficult to establish an overview of the vast array of material that comprise the state of functional neurology today in a single article such as this one.
It has become quite clear that functional neurology has numerous diverse and widespread applications in the restoration and maintenance of health in the human population.

It may seem quite amazing that the interventions, ranging from simple to complex, utilized in the application of functional neurology are engineered to address three basic fundamental activities present and necessary in all neurons.

These activities include:

1. Adequate gaseous exchange, namely oxygen and carbon dioxide exchange. This includes blood flow and anoxic and ischemic conditions that may arise from inadequate blood supply;
2. Adequate nutritional supply including glucose, and a variety of necessary cofactors and essential compounds;
3. Adequate and appropriate stimulation in the form of neurological communication, including both inhibition and activation of neurons via synaptic activation.

Synaptic activation of a neuron results in the stimulation and production of immediate early genes and second messengers within the neuron that stimulate DNA transcription of appropriate genes and the eventual production of necessary cellular components such as proteins and neurotransmitters.

The investigation and determination of how well neurons are performing these three basic activities and how to alter these activities, if inappropriate or inadequate, comprise the fantastic clinical journey that is functional neurology.

In the quest to answer the aforementioned questions, the functional neurologist may enlist the help of a variety of complex and sophisticated testing equipment, including neuropsychological testing instruments, objective muscle strength testing instruments, somtosensory evoked potentials, visual evoked potentials, qEEG, visual kinetic tracking, nystagmography or visuomotor testing, computerized balance platforms, MRI and PET scans, or tests as simple as looking at pupil reactions to light, bilateral blood pressure or temperature differentials of the forehead or peripheral limbs.

It is essential that the practitioner perform a complete and thorough physical examination in which different areas of the neuraxis are tested and challenged at the appropriate level. The practitioner must also strive to understand the meaning of the results obtained from a neurological and functional perspective. The level of response obtained during the physical examination is often used to assess the level of activity in a certain area of the neuraxis and to later gauge the effectiveness of treatment.

It is not until we start to examine the three fundamental activities of the neuron in detail that we begin to realize their importance to the neuron and, hence, nervous system function in both health and pathological states. Mild alterations from optimum in any of these activities may result in dysfunction of whole systems in the neuraxis, such as the altered movement states in Parkinson’s and Huntington’s diseases due to imbalances of stimulatory or inhibitory thalamic activation respectively.

A variety of conditions or states may also arise when afferent stimulation or inhibition is aberrantly distributed asymmetrically to the cortex, resulting in functional hemispheric imbalance which may result or contribute to a variety of learning disabilities, attention deficit disorders, affective and emotional disorders, and central autonomic dysfunctional conditions, including the complex regional pain syndromes and dysautonomia.

It is also becoming apparent in recent years that the functional state of the neuraxis and the functional immune state of an individual are closely interconnected, and states of hemispheric imbalances can result in immune system dysfunction such as systemic inflammatory or autoimmune reactive states.

Correcting functional neurological imbalance requires an extensive knowledge of neuroanatomy and neurophysiology in an attempt to understand the central integrative state of the neuraxis. An understanding of the central integrative state of different areas of the neuraxis is obtained by a variety of testing procedures and observations of gateways to the neuraxis, such as the activity of cranial nerves, reflex activity of muscles, and tonic activation levels or responses to stimuli of the autonomic nervous system.

Intact afferent pathways are identified which, when stimulated or inhibited, will result in the appropriate stimulation reaching a target area in the neuraxis. Stimulation of these pathways is then utilized in restoring the functional state of the area.

Consideration of the current metabolic state of the target area must be considered and monitored as the intervention is instituted and as it progresses so that no damage occurs as a result of over stimulation, which may result in free radical formation and ultimately neuronal necrosis.

External forms of afferent stimulus may be utilized to stimulate the neuraxis including all of the sensory modalities, i.e., visual, auditory, taste, pain, etc., manipulation, vestibular stimulation, and reflex (spinocerebellar) stimulation.

Internal forms of stimulus include mental function and memory exercises.

Chiropractors are well placed to understand and apply the concepts of functional neurology due to their undergraduate and postgraduate education and their clinical experience in the application of afferent stimuli such as manipulation.

Although the shear volume of material that needs to be assimilated in order to begin clinically applying functional neurology may seem daunting to the student or practitioner at first glance, the journey is filled with discovery and excitement as the workings of the neuraxis unfold. The clinical results are often dramatic and immediate which, above all, has inspired many a practitioner to embark on this lifelong adventure of enlightenment and learning.

Randy Beck, B.Sc., D.C., Ph.D., is a graduate of Canadian Memorial Chiropractic College. He has completed postgraduate studies in Psychology, Immunology and Neurology. He is presently involved in a number of international research projects and is co-authoring a textbook on Functional Neurology. He was formerly the Dean of Chiropractic and Basic sciences and Director of Research at the New Zealand College of Chiropractic. Presently, he practices Chiropractic Functional Neurology at the Papakura Neurology Center and The Maungakiekie Clinic located in Auckland, New Zealand.

 
Groans about Loans
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Written by Stanley Greenfield, RHU   
Tuesday, 14 November 2006 15:54

I hear a lot of groans about loans. Have you ever groaned about your loans? Have you ever heard anyone else groan about his or her loans? Better yet, have you done anything other than groan about your loans??? Maybe it is time to do more than groan about loans. I know that it is time to stop this phrase about loans and groans! Most feel that is all they can do about their loans. They feel helpless. They shouldn’t feel that way. There are a lot of things that can be done to stop that groaning.

If you have some loans, and who doesn’t, start by making a list of those loans in detail. What was the original amount of the loan? What was the loan for? What was the date of the loan? Who was the money borrowed from? In other words, who was the lender? What was the original interest rate? What are the payments and when are they due? What is the length of the loan? What is the current balance of the loan? If the interest rate has changed, what is the current rate? Are you current with the payments? Keep in mind that many so-called leases are really loans, so you need to list the information on them, too.

All of this information is available and you should be able to find most of it in the original papers you received when to got the loan. You say, you don’t have those papers? Call your lender and request copies from them. From now on, make sure you set up a file for all future loans and keep complete records of those loans. Very important!

You might want to use a notebook to keep all of the paperwork you receive on a loan. This makes a neat way to keep track of your loans and what is happening with them. It is also a way to make sure that you have all the information on a loan.

The rest of the basic information you need can be found on the annual statements that you receive from the lenders. They usually send them after the first of the year, so you will have the information you need for tax purposes. If the loan was for business purposes, the interest is most likely tax deductible. That includes loans for equipment, too.

While we are on the subject of deductibility of interest on loans, the interest on home mortgages is tax deductible, also. That goes for your residence and also for a second home. It is a good idea to have a file for each of these, as well. That’s another place where the notebook can come in handy.

Once you have all the information on your loans, it is time to review and see if something can be done to improve your situation with these loans. What am I referring to? Now that you know what the current interest rates are, you might see that it is possible to re-finance the loan and reduce the interest rate and possibly lower the payment as well. If cash flow is an issue, then, by reviewing this information, you may see that you can lengthen the loan and reduce the required payment. Don’t be too concerned about paying a loan off as fast as possible. Make sure that the payments fit within your budget and cash flow concerns. The loan will get paid off eventually. The key is to make sure you can live with the payments and avoid any additional stress.

I think I should spend a little time to say that a loan is not necessarily a bad thing. A loan can allow you to obtain something that you need long before you could afford it. I would also state that a loan is debt and I know that most reading this consider debt a bad thing. Debt is a "four-letter word," but not all debt is bad, as long as you are in control of your debt. You must never forget that money is worth what you can borrow it for. If you can borrow money at a rate lower than the current cost of money, that is not a bad idea. It allows you to operate on OPM (other people’s money). Never get yourself into a situation where you are debt-free and also asset-free and cash-poor. You always need to have a cash reserve to cover emergencies that may arise.

Stanley B. Greenfield has been engaged in the fields of Financial Management and Insurance since 1962. He is a Registered Financial Consultant, and was awarded the designation of RHU, Registered Professional Disability and Health Insurance Underwriter, in 1979, as one of its Charter Members.

Mr. Greenfield also serves as a member of the Board of Directors of the Florida Chiropractic Foundation for Education and Research. You may reach him at This e-mail address is being protected from spambots. You need JavaScript enabled to view it , call 800-585-1555 or 904-513-2229 or visit his website, www.stanleygreenfield.com.

 

 
Fundamental Concepts in Functional Neurology
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Written by Randy Beck, B.Sc., D.C., Ph.D.   
Tuesday, 14 November 2006 15:42

In this model, spinal motor neurons integrate synaptic activity and, when a threshold is reached, they fire an action potential. The firing of this action potential is followed by a period of hyperpolarization or refraction to further stimulus in the neuron. This early "integrate and fire" model was then extrapolated to other areas of the nervous system, including the cortex and central nervous system, which strongly influenced the development of theories relating to neuron and nervous system function.

Early in the 1970’s, studies started to emerge that revealed the existence of neurons that operated under much more complex intrinsic firing properties. The functional output of these neurons and neuron systems could not be explained by the existing model of the "integrate and fire" hypothesis.

Since the discoveries of these complex firing patterns, many other forms of neural interaction and modulation have also been discovered. We now know that, in addition to complex firing patterns, neurons also interact via a variety of forms of chemical synaptic transmission, electrical coupling through gap junctions, interactions through electric and magnetic fields, and can be modulated by neurohormones and neuromodulators, such as dopamine and serotonin.

With this fundamental change in our understanding of neuron function came new understanding of the functional interconnectivity of neuron systems, new methods of investigation and new functional approaches to treatment of nervous system dysfunction.

Through the course of this series on Functional Neurology, I will attempt to explore and explain the fundamental concepts and theories that comprise this exciting clinical approach to diagnosis and treatment. Please understand from the beginning that Functional Neurology is not a technique. Virtually all existing chiropractic techniques can be utilized in the application of the concepts of the functional neurological approach to the patient.

In the next few segments of this series on Functional Neurology, I will introduce some of the fundamental concepts and definitions that will be referred to frequently in subsequent segments, so we are "speaking the same language."

This series will be successful if it awakens a desire in you to discover the challenge that defines the human nervous system.

The first concept that we will consider is that of the central integrative state of a single neuron and then, via extrapolation, the central integrative state of a collection of neurons forming a system or circuit.

Central Integrative State of a Neuron (CIS)

The central integrative state of a neuron (CIS) is the total integrated input received by the neuron at any given moment and the probability arising from that state of integration that the neuron will produce an action potential based on the degree of polarization and the firing requirements of the neuron to produce an action potential at one or more of its axons.

The physical state of polarization existing in the cell, at any given moment, is determined by the temporal and spatial summation of all the excitatory and inhibitory stimuli it has processed at that moment. The complexity of this process can be put into perspective when you consider that a single motor neuron may have up to 10,000 individual synapses, and certain neurons in the cerebellum 100,000 different synapses firing at any given moment.

The firing requirements of the neuron are usually genetically determined, but environmentally established, and can demand the occurrence of complex arrays of stimulatory patterns before a neuron will discharge an action potential. Some examples of different stimulus patterns that exist in neurons are "and/or" gated neurons. "And" pattern neurons only fire an action potential if two or more specific conditions are met. "Or" pattern neurons only fire an action potential when one or the other specific conditions are present. These types of neurons have been demonstrated in the association motor cortex in man.

The neuron may be in a state of relative depolarization, which implies the membrane potential of the cell has shifted toward the firing threshold of the neuron. This generally implies that the neuron has become more positive on the inside relative to the outside and the potential difference across the membrane has become smaller. Alternatively, the neuron may be in a state of relative hyperpolorization, which implies the membrane potential of the cell has moved away from the firing threshold. This implies that the inside of the cell has become more negative in relation to the outside environment and the potential difference across the membrane has become greater.

The membrane potential is established and maintained across the membrane of the neuron by the flux of ions, usually sodium (Na) and potassium (K). The movement of these ions across the membrane of the neuron is determined by changes in the permeability or ease at which each ion can move through selective channels in the membrane.

The firing threshold of the neuron is the membrane potential that triggers the activation of voltage gated channels, which are usually concentrated in the area of the neuron known as the axon hillock or activation zone that allow the influx of Na into the cell, resulting in the generation of an action potential in one or more of the neuron’s axons.

Central Integrative State of a Functional Unit of Neurons

The concept of the CIS described above, in relation to a single neuron, can be loosely extrapolated to a functional group of neurons. Thus, the central integrative state of a functional unit or group of neurons can be defined as the total integrated input received by the group of neurons at any given moment and the probability that the group of neurons will produce action potential output based on the state of polarization and the firing requirements of the group.

The concept of the central integrative state can be used to estimate the status of a variety of variables concerning the neuron or neuron system, such as:

• the probability that any given stimulus to a neuron or neuron system will result in the activation of the neuron, or neuron system;

• the state of prooncogene activation and protein production in the system;

• the rate and duration that the system will respond to an appropriate stimulus.

Next Segment, we will introduce the concepts of trans-neural degeneration, diaschisis and neural plasticity.

 
Case Management: The Chiropractic Mystery
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Written by Dwight C. Whynot, D.C.   
Saturday, 11 November 2006 16:17

I hear this all of the time. This is because most chiropractic offices’ sense of case management revolves around the statistic known as RETENTION. The more the doctors can increase their retention statistics, the more income they will gather. Well, that is fine and good but, if my mother, sister, or grandmother were to see a chiropractor and they recommended a sixty-visit plan on the second day during their report of findings and told them to pre-pay for care, I would tell them to run for the hills, because this is what some management consultant told them to say and tells the same story to every new patient that walks in the door.

There is absolutely no way of knowing for certain that any particular patient needs that many visits from the first visit—on the other hand, maybe they need more than sixty visits?

Do you see what I am getting at here? We, in the chiropractic profession, have let practice management gurus all over the country run the case management strategies for our practices, because we have no idea how to use case management effectively when we graduate from school.

Now I want to let you know that there are a handful of practice management people which teach proper case management strategies that will get you paid better and faster--strategies such as those I will outline in this article. My advice: Keep looking till you find those people.

Another reason that I know that we are poor case managers is because the insurance industry only wants to pay for twelve to fifteen visits or six weeks’ worth of care. This is because most offices provide no clinically objective evidence to support the need for care beyond that. This is why documents like the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) have been created. The insurance industry wants to have a set of guidelines to use to deal out care in an appropriate manner. The only problem with the CCGPP guidelines is that it is wrought with bias, gives a substandard level of care to patients and provides no direction to practitioners on appropriate levels of frequency and duration of care based on the patient’s health history and present condition. The MERCY document was created for this purpose for low back pain but was refuted by a good portion of the profession. The Council on Chiropractic Practice guidelines have also been developed and they are the only chiropractic guidelines registered on the National Guidelines Clearinghouse (NGC). It is the position of the Guideline Panel that individual differences in each patient and the unique circumstances of each clinical encounter preclude the formulation of "cookbook" recommendations for frequency and duration of care. (Chapter 7, pg. 84) The CCP Guideline states that a chiropractor must adjust a subluxation until all indicators of subluxation are gone. (Chapter 7, pg. 84) These are the only guidelines that are available for the chiropractic profession at present that can be used for the entire spine and are actually fair for all concerned: the doctor, the insurance company and, most importantly, the patient.

The words maximum medical improvement are foreign words to us. In fact, these words create anxiety in most chiropractic offices, because these words are synonymous with, "The insurance company doesn’t want to pay me." Maximum medical improvement is defined as when a patient has improved to the point where their physical functioning is normal or when the patient has plateaued in their improvement over several reexaminations.

The definition of maximum medical improvement includes words such as functioning, not pain. The insurance industry is not interested in treating the patient for pain; it is a given that you are going to get the patient out of pain. The insurance industry is more interested in getting the patient back to normal function or as close to it as possible, given the patient’s present health condition. The definition of medical necessity creates just as much anxiety only because the definition is dependant on the insurance company itself. But there is a common denominator in nearly all definitions and that is FUNCTION.

 

Medicare Policy on Medical Necessity

A treatment plan that seeks to prevent disease, promote health and prolong and enhance the quality of life, or a therapy that is performed to maintain prevent deterioration of a chronic condition is not a Medicare benefit. Once the maximum therapeutic benefit has been achieved for a given condition, ongoing maintenance therapy is not considered to be medically necessary under the Medicare program.

 

Bluecross/Blueshield Policy on Medical Necessity

 

Manipulation is a covered service when performed with the expectation of restoring the patient’s level of function which has been lost or reduced by injury or illness. Manipulation should be provided in accordance with an ongoing, written treatment plan.The Council on Chiropractic Practice guidelines state that, "The appropriateness of chiropractic care should be determined by objective indicators of vertebral subluxation" (Chapter 7, Pg 84) and further states that, "Since the duration of care for correction of a vertebral subluxation is patient specific, frequency of visits should be based upon the reduction and eventual resolution of indicators of the subluxation." (Chapter 7, pg. 83)

Therefore, based on the fact that we need to provide objective evidence that the patient has a loss of function and that we need to provide more evidence that we are improving that function to the extent the patient is now functioning normal or has plateaued over several reexaminations, I propose a case management strategy such as the one illustrated in Table 1. (See Pg. 48)

Table 1
Initial Visit-                 Questionnaire(s), Examination, X-rays, Therapeutic Modalities (3)

Second Visit-                     cROM Testing, CMT, Therapeutic Modalities

Third Visit-                         cMT, CMT, Therapeutic Modalities

Fourth Visit-                      PPT testing, CMT, Therapeutic Modalities (3)

Fifth Visit-                          CMT, Therapeutic Modalities

Sixth Visit-                         CMT, Therapeutic Modalities

Seventh Visit-                   CMT, Therapeutic Modalities

Eighth Visit-                      CMT, Therapeutic Modalities

Ninth Visit-                        CMT, Therapeutic Modalities

Tenth Visit-                       CMT, Therapeutic Modalities                          

Eleventh Visit-                  CMT, Therapeutic Modalities

Twelfth Visit-                    Re-Exam, Questionnaire(s), CMT, Rehabilitation

Thirteenth Visit-               cROM Testing, CMT, Rehabilitation

Fourteenth Visit-              cMT, CMT, Rehabilitation

Fifteenth Visit-                  PPT testing, CMT, Rehabilitation

Sixteenth Visit- Rehabilitation, CMT

 

As you can see, there are several diagnostic tests at the beginning of care that need to be performed: X-rays, computerized ROM testing (cROM), computerized muscle testing (cMT), pain pressure threshold testing (PPT) and questionnaires. These cROM, cMT, PPT testing, questionnaires, and X-rays are all diagnostic tests that take the patient’s subjective symptoms and place them in an objective format so that you, the doctor, can re-test the patient using the same tests and objectively determine whether or not the patient has improved, not improved, or regressed.

 

Table 2 is a list of subjective signs and/or symptoms and the list of diagnostic tests that the doctor of chiropractic would use to evaluate those signs and/or symptoms: (See table 2)

Table 2
Pain
Questionnaires (Oswestry, Neck Pain, Roland Morris, VAS, Headaches Disability Index), Pain Pressure Threshold Testing)

Numb/Tingling/Burning Pain                      NCV testing, EMG testing, DSEP Testing

Disc Lesions                                                MRI

Fractures                                                    CT, Radiographs

Loss of Range of Motion                                cROM testing

Loss of Strength                                          cMT Testing

LMSI                                                          Radiographs

 

 

Dr. Dwight C. Whynot is in fulltime practice in Johnson City, Tennessee. Dr. Whynot gives license-renewal lectures on Evidence-Based Chiropractic Practices which are promoted by the International Chiropractors Association and sponsored by Myologic and Spinal-logic Diagnostics. For questions regarding evidence-based practice procedures, email questions to This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

For 12-hours CCE license renewal lecture dates and places call the ICA at 1-800-423-4690. For more information on Myologic or Spinal-logic, go to www.myologic.com or www.spinallogic.com.

 
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