Technology


Light Therapy: Making the Right Choice
Technology
Written by Gerry Graham III. D.C., and Joan Murnane, D.V.M., M.S., Ph.D.   
Wednesday, 26 October 2005 21:24

Choosing the right laser for your light therapy can be extremely confusing, because the literature available on light therapy is not only confusing but contradictory.  Laser light has unique physical properties that no other light source or LED has. There is a big difference between a colorful brochure and the clinical efficacy of the unit being sold.  To date, laser instruments have been sold which do not even contain a laser. To help you make the right choice, this article defines the common terms used in light therapy and presents the biological basis of the unique clinical efficacy of Low Level LASER Therapy.

The word LASER is an acronym for Light Amplification by Stimulated Emission of Radiation.  Scientists recognize lasers by two parameters.  Laser light is coherent (single wavelength) and collimated (focused).  Coherent light means waves of the light quanta or photons are synchronous and move in the phase with each other.  By collimating or focusing a specific wavelength of light, energy can broadcast great distances and remain a focused dot of energy.  Advertised light therapy units, such as the LED, CO2, infrared or near-infrared lasers, are, in general, not collimated.  Removing the collimator from a laser will cause the light array to look just like an LED or any other colored light, but the biological and clinical effects are not the same. Laser light is the only source of coherent and collimated light.  This underlies the biological basis of light therapy.

While there is no legal definition for “Low-Level Laser Therapy (LLLT), most scientists and clinicians agree that Low-Level means that the power output is low enough not to raise the temperature of the tissue being irradiated by more than 1 degree.  The FDA classifies lasers with this power output as Class IIIa lasers.  Any potential danger from a Class IIIa laser results from direct irradiation of the eyes. Thermal damage is not possible. Class IIIa lasers allow LASERS to be used as therapeutic tools to, “… relieve pain and suffering and above all else, DO NO HARM….”

Low-level light therapy works by stimulating a cell’s innate metabolism.  Again, the effects are biochemical, not thermal and, therefore, cannot damage living cells.  The therapeutic effects of LLLT result from biomodulation of a tissue. Low-Level Laser Therapy is safe for both operator and patient.  LLLT lasers are therapeutic, because they allow living tissue to maintain or return to homeostasis without damaging tissue.

Four distinct biological effects occur when using LLLT, i.e., when photon energy is transferred to a biological chromophore.  These include:

1. Growth factor production occurs within cells and tissue in response to increased ATP and protein synthesis.

2. Pain relief results from suppression of the nociceptor response mediated by increased serotonin and endorphin release.

3. Immune-modulation and mitigation of the inflammatory response occur because the mononuclear phagocytic cells, mast cells, and leukocytes are stabilized, preventing the release of harmful inflammatory mediators. In addition, vasodilatation and increased microcirculation allows a rapid return to homeostasis and promotes first intention healing.

4. Direct trigger point stimulation allows direct release of endorphins and other endogenous pain mediators, such as serotonin, VIP, substance P, prostaglandins, etc.

Propagation of light though tissue is regulated by reflection, penetration, or absorption and transfer of energy of light quanta to the cell.  This is laser dependent.

Reflected energy becomes scatter radiation and is dangerous to both operator and patient.  This is a natural protection mechanism. The body could never control its internal environment, temperature, and, therefore, cellular metabolism, if all exposed photon energy was transferred to the tissue. The majority of energy from uncollimated and noncoherent light sources is reflected off the skin surface.  Most infrared light sources are uncollimated or noncoherent, or both, and depend on scatter or reflection to reduce the thermal damage due to irradiation.  Therefore, very little photon energy is transferred to the tissue.

As advertised, photon energy from high-power infrared lasers penetrates deep into the tissue.  Again, this is a physical and thermal phenomenon, not a therapeutic phenomenon.  Energy is dissipated as heat.  Thermal activation overrides the cells homeostatic metabolic state.  The cell may be turned on or off, but not in a functional manner. This can cause damage deep in tissues, out of sight of the clinician.  Furthermore, energy transfer to a biological chromophore does not occur.

When light quanta are absorbed, energy is transferred to water, some organic molecule, or to one or more chromophores within tissue, thereby producing a cellular response which changes the cell’s homeostatic set point.

Within the cell, the signal is transduced and amplified by a photon acceptor (chromophore).  When a chromophore first absorbs light, electronically excited states are stimulated, and primary molecular processes are initiated which lead to measurable biological effects.  These photobiological effects are mediated through a secondary biochemical reaction, photosignal transduction cascade, or intracellular signaling which amplifies the biological response.

The ionizing effects of LLLT allow photon acceptors to accept an electron. This turns on the oxidation-reduction cycle of the stimulated chromophores, such as Cytochrome oxidase, hemoglobin, melanin, and serotonin.  Changing the re-dox state of the chromophore changes the biological activity of that chromophore; e.g., hemoglobin changes its oxygen carrying capacity. This is in contrast to the destructive ionizing effects of X-rays, which remove or disrupt electrons from an atom or molecule and damage tissue.

When photon energy breaks a chemical bond, changes occur in the allosteric proteins in cell membranes (cell, mitochondrial, nuclear) and monovalent and divalent fluxes activate cell metabolism and intracellular enzymes directly.  Direct activation of cell membranes alters ion fluxes, particularly calcium, across that membrane.  Changes in intracellular calcium alter the concentrations of cyclic nucleotides, causing an increase in DNA, RNA, and protein synthesis, which stimulate mitosis and cellular proliferation.

When all of the above occur correctly, the photon activates a chromophore and that single enzyme molecule rapidly catalyzes thousands of other chemicals similar to the well known, calcium regulated, 2nd messenger cAMP cascade. This biological amplification process explains how low-power laser therapy can produce such profound systemic, cellular, and clinical effects.

One of the most confusing aspects of light therapy is dozens of published reports, which fail to find any effect from LLLT.  As with any treatment, clinical efficacy depends on diagnosis, dosage, treatment technique and individual reaction.  Similarly, each stage of the biomodulation cascade depends on additional laser specific factors, including the light source, wavelength, irradiation dose, power density, and tissue specific factors.  Alterations in any of these parameters can minimize or cancel the effects of light therapy. Here are some basic examples:
 
Light sources: A cell’s response to light differs markedly in vivo and in vitro.  The coherent properties of laser light are not important in cell suspensions or tissue culture monolayers.  In vitro, coherent or noncoherent light (both lasers and LED’s) with the same wavelength, intensity, and dose can stimulate the same biological response.  However, in vivo, in living tissue, only photons of coherent light are able to pass through optical windows in cell membranes to become accepted by photon acceptors (chromophores).

Coherent light is only created by a LASER light source, not from LED or SLD light sources.  Even coherent light, if left uncollimated, will, for the most part, reflect off the skin as dangerous scatter radiation. Coherent, collimated, laser light has, by far, the greatest therapeutic potential.  Because laser light triggers the cells own homeostatic mechanism, only low intensities and doses are required for dramatic biological responses.

Wavelengths: Every chromophore has an absorption coefficient for peak activation, which is wavelength specific. However, each chromophore has a wide range of wavelengths in which it will accept or donate electrons. Within living tissue, peak activation of a chromophore can occur within a broad range of wavelengths (e.g., oxygenated hemoglobin has absorption peaks at 420 and 577 nm; reduced hemoglobin at 560nm).  Wavelengths longer than 1200 nm (infrared) and shorter than 200 nm (ultraviolet) are absorbed by inter- and intracellular water.

Wavelengths of 620-720 nm are typi-cally better able to penetrate optical windows in cellular membranes because their photons are not easily absorbed by living tissue which, on average, are composed of 70-80% water. Chromophores found in eukaryotic (mammalian) tissue have peak activation spectra between 600 nm to 720 nm.   Since laser light acts as a trigger for normal cellular metabolism, it is not necessary to utilize a wavelength that strikes the peak activation of each chromophore.  It is only necessary for the wavelength to fall within the spectra of the chromophore.  The wavelength of 635 nm is contained within the spectra of the chromophores found in mammalian tissue and, therefore, has the potential to biomodulate all eukaryotic tissue.

Irradiation Dose: The product of power density (mW) and exposure time defines the irradiation dose and is measured in Jules of energy per square centimeter (J/cm2).  This is an extremely important parameter for laser treatment and biomodulation.  Scientists have shown the therapeutic efficacy of LLLT is enhanced by repetitive low doses within a specific time, in contrast to the same total dose in a single treatment. In addition, the biomodulation effects of LLLT are cumulative.  Repeated doses, within relatively short intervals, produce greater biological responses than single frequency lasers. Doses which are too low produce no effect.  Doses which are too high produce no effect or dampen biological activity.  Each biological tissue has an optimal dose, which is laser dependent.

Power density from 2 to 5 mW is adequate to activate mammalian chromophores. Power higher than 5 mW may exceed the activation levels of some chromophores. The greatest biomodulation is created with repeated doses of pulsed collimated laser light at or around 5 mW of power.

Chromophore response is dependent upon the functional metabolic state and composition of the tissue at the time of irradiation. LLLT produces separate responses in separate tissue based on the active chromophore within that tissue, e.g. bronchial tissue (mast cells), skin (melanin).  Healthy, injured, and malignant tissues absorb light, or transfer energy differently, because they contain different chromophores, and are in different metabolic states.  This explains the wide array of therapeutic effects of the LLLT in damaged tissue and the lack of response in healthy tissue.

The most dramatic examples include the different effects of LLLT irradiation on healthy tissue, inflamed tissue, and malignant tissue. Healthy tissue does not contain a high concentration of biologically active chromophores (e.g., biogenic amine, histamine, serotonin, VIP, substance P), while inflamed tissue does. LLLT can mitigate the inflammatory response by stabilizing mononuclear phagocytic cells, stimulating leukocyte chemotaxsis, and preventing mast cell degranulation.  This prevents the release of histamine, and other biogenic amines, which cause the cellular infiltration responsible for the four cardinal signs of inflammation: redness, heat, pain, and swelling.  LLLT dampens the inflammatory cascade, mitigates inflammation, and allows first intention healing.  Similarly, malignant tissue is defined by its high mitotic index, which supports the rapid, uncontrolled growth of cancer.  Mitotic cells appear insensitive to LLLT irradiation while injured and dormant cells can be stimulated to divide.

While LLLT may have no effect on a healthy, normal cell, it has profound biological and therapeutic effects on inactive, sick or injured cells.  The power of LLLT lies in the fact that injured cells respond to irradiation, turning on or off, allowing the cell to return to, or maintain, cellular homeostasis.  In short, LLLT allows the cell to heal itself.
 
In conclusion, for safe and effective light therapy, the ideal therapy device should be a low powered (between 2 and 5 mW), laser (capable of producing collimated and coherent light), which produces wavelength between 600 than 720 nm, and is capable of rapidly delivering pulsed frequencies to tissue.

R. Gerry Graham, DC, is a licensed chiropractor, graduate of Logan College of Chiropractic and practices in Aurora, Colorado. Dr. Graham is President of LED Healing Light LLC.

Joan M. Murnane holds a PhD from Emory University School of Medicine, a DVM from the College of Veterinary Medicine, University of Georgia and a Masters in Pharmacology and Physiology from Washington State University College of Veterinary Medicine, Pullman, Washington.

For additional information or dates for upcoming seminars, please email This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 
Revolutionizing Access to Continuing Education and More!
Technology
Written by Peter Fernandez, DC   
Wednesday, 22 June 2005 16:46

Dr. Peter Fernandez, a 1961 Logan College graduate, is past president of the Florida Chiropractic Association, and past chairman of the Chiropractic Knights of the Roundtable, an organization of the world’s most successful chiropractors.  His practice, with 5 staff chiropractors and 12 satellite offices, was, at one time, one of the country’s largest all referral, high income chiropractic clinics.

Dr. Fernandez has been a practice consultant for the last 24 years and, in this capacity, has consulted with approximately 5,000 DC's, as well as in the opening of over 3,000 new practices.

In an interview with The American Chiropractor, Dr. Fernandez describes his latest project, bringing chiropractic continuing education into the internet age on a very unique level.

TAC: With your history of more than 24 years as a practice management consultant, describe the major changes you’ve seen in chiropractic technology over the years and how  this technology has helped the chiropractic profession?

Fernandez: First of all, the development and usage of mechanical instruments for the correction of spinal subluxations is revolutionizing our profession.  There was a time when only brute strength could make spinal corrections but, now, even the most petite doctor can render care to any size individual.

Computer technology has increased our ability to diagnose and document spinal aberrations, i.e., range-of-motion analysis and muscle testing can now be done by pushing a button.  And, since insurance companies believe computers first and doctors second, these instruments are a real plus for validating chiropractic care.

Outsourcing of services, such as insurance billing, accounting services, etc., is made much easier by the electronic broadcasting of data between doctors’ offices and these service providers.  This technology frees up the doctor to do what he/she does best—treat patients.

Computerized patient education aids, such as the Neuropatholator, make it much easier to explain chiropractic to our patients; thus, when used regularly, they will increase a doctor’s practice.

There is no question that “Knowledge is Power.”  The more knowledge a doctor acquires on how to fix patients’ health problems, the quicker his/her patients recover and the more referrals the doctor will receive. Today, doctors all over the world can research any health problem by clicking a button and logging onto the Internet. 

TAC: With this issue of TAC’s focus on Technology, tell us how your latest venture, MBAChiropractic.com, is revolutionizing the way chiropractors access continuing education, license renewal and consulting services.

Fernandez: The strategy of any good pathfinder is to first understand the changing external elements that are affecting his or her industry and then develop a plan to prosper within those changes. Tom Cavanaugh, D.C., M.B.A., and I have researched and understand the changing external environment that affects chiropractic and have assembled the technology to deal with these changes.

Our new technology is a futuristic advance, which helps chiropractors grow their practices in spite of our changing health care environment. Actually, we may be the first company in any profession to bring continuing education, license renewal, and practice building seminars to doctors by video streaming classes over the Internet. As easy and convenient as it is for doctors to view these classes, the process in making it happen was not. Being a brand new concept, it required massive research and development efforts on our part.

Our research was conclusive in that most doctors felt they were in a “Catch 22” situation.  They want to attend seminars, but are concerned about expenses, time out of the office and loss of patients from being gone on Fridays or Saturdays.  But, if they didn’t attend seminars, they wouldn’t get the knowledge or expertise needed to build and maintain a successful practice.  Their concerns became our primary focus.  How could we help doctors get continuing educational, license renewal and practice-building seminars without having to close their practices or incur a lot of expense?  We also determined that the greatest expense in attending seminars was not the seminar registration fees, but the associated travel, lodging and food expenses.  (See Seminar Expense Chart.) Our answer to these legitimate needs and concerns ($250,000 later) was to merge advanced technology with our professional practice building seminars; in other words, put our seminars online. From that, www.MBAChiropractic.com was born!

Now doctors can put the majority of what it used to cost them to attend seminars back in their own pockets. They can also have their chiropractic assistants trained online—no more travel, lodging and food expenses.  And, as the reader knows, attending seminars is not only costly financially, it can also put a strain on personal relationships and family matters.  By taking our practice-building and post-graduate education classes on line, the doctor’s family will be happier, because the doctor doesn’t have to leave home!  That alone is revolutionary!

We found that, not only is there a huge savings when attending seminar classes online, there is also a valuable comfort factor, as well. Think of the tremendous convenience for doctors by having expert classes video taped live at actual seminars available to them online—anywhere, anytime.

An admitted “seminar junkie,” I know that seminars typically mean wading through about 80 percent of what you’re not interested in to get to the 20 percent that you truly need or want to hear.  In offering video seminars “by the class”, we have solved that problem.  Now, doctors essentially customize their own practice building, post graduate and license renewal seminars by selecting only those classes that interest them …and, they get to stay home and save money, too.

Our online video seminar classes also solved two other problems.  Every weekend there are dozens of seminars available on a smorgasbord of subjects.  Most doctors want to attend a number of these great seminars, but just can’t fit all of them into their schedules. At www.MBAchiropractic.com doctors can take all the classes they want (we currently offer over 145 classes on a wide range of subjects) and never have to leave home.  

TAC: Sounds great. What do you think the long-term implications are for chiropractic and chiropractors for utilizing this type of technology?

Fernandez: What we have accomplished is truly innovative and revolutionary.  Our site will become the “vehicle” in which practice management consultants, license renewal firms, vendors and post-graduate educators will deliver their courses and seminars.  Viewing seminars and classes online is the future of chiropractic education.  Just as our profession evolved from manual, intensive labor to computer technology in their offices, so it will evolve from going to seminars to having seminars come to them via their home or office computer.

This new advance will not only make it easier for doctors to enhance their knowledge of the philosophy, art and science of chiropractic as well as their management and practice-building skills, but it will also save them 70-80 percent of the associated travel costs.  As doctors increase their personal skills and knowledge, their practices will grow and so will the chiropractic awareness within their communities.

Our www.MBAchiropractic.com site also gives beginning doctors the business skills they will need to run and market their new practices.  This site gives them affordable access to the “hows” of the best practice consultants, and allows them to start learning these vital principles months before they actually graduate from chiropractic college.  The quicker a doctor can “come out of the shoot” with this knowledge, the less money he or she will lose through “trial and error.”

TAC: Anything else about MBAchiropractic.com you want to add?

Fernandez: Our site includes the talents and expert knowledge of accomplished instructors who teach classes on technique, nutrition, rehab, X-ray, wellness, sports, personal injury, workers’ compensation injury and a number of other subjects. Doctors throughout the United States, Canada, Europe, Australia, England, New Zealand, Japan and any other country will now be able to tap into this enormous library of talent for pennies.  (Doctors from these countries are already experiencing the benefits of using www.MBAchiropractic.com).

I would like to make another important point.  Many vendors have developed great products that can help chiropractors in their practice.  However, it is very difficult for doctors to sort through and find those new products that best serve their patients.  And, before www.MBAchiropractic.com, it was pretty much impossible for doctors to learn about those great products developed outside of their own country.  While some vendors exhibit their products at seminars, they can only talk to one doctor at a time; and the amount of time a doctor can spend at one booth is also limited.  Therefore, we are making our site available to companies wanting to demonstrate their products in video format so that doctors all over the world can become more intimately acquainted with them and be able to make better choices.

Many products also require instructions on how to use them.  Vendors are using our site to teach doctors how to effectively use their products.  This service saves vendors millions of dollars, which results in lower prices for our doctors.

Just imagine these scenarios.  Beginning doctors want to know the “A through Z's” on how to open a practice.  Now they can sit on the couch, put their one-year-old in their arms, eat a hot dog and learn how to open their practices…all at the same time!

An established doctor has an important deposition tomorrow, but his/her consulting firm doesn’t teach that particular subject for four months.  All the doctor has to do is “click” on our deposition video before going to bed that night and he/she is prepared in the morning.  Doctors are always hiring CA's, but few understand the intricacies of finding, hiring and training them.

In growing a practice, most doctors will also need to eventually find, hire and train an associate.  Colleges want and need to expand their post-graduate education programs to all chiropractors worldwide.  All of this has been made possible through www.MBAchiropractic.com. The possibilities are unlimited!

Dr. Fernandez can be reached by email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it ; or, for more information, visit www.DrFernandez.com, or www.MBAChiropractic.com.

 
Chiropractic Office Technology
Technology
Written by Mark Mandell, DC   
Wednesday, 22 June 2005 16:42

Imagine a paperless office.  Handheld computer terminals contain all your patients’ records for instant access and quick-touch information entry.  Conferring with other doctors or obtaining treatment guidelines all can be had at your fingertips.  Patient check out and billing can be done electronically.  Appointments can be made online and products can be purchased by patients through your website.

It’s not hard to imagine all this technology, because it all exists for the doctor’s office, but the adoption of this technology by chiropractors to support patient care is slow.  According to the Center for Studying Health System Change (HSC), a non-partisan policy research organization, larger physician practices tend to be more rapid adopters of office technology but, with group practices still rarely found in chiropractic, many chiropractic offices have few, if any, of these technological features.

HSC’s 2001 Community Tracking Study Physician Survey of 12,400 physicians examined the forms of information technology (IT) used in practice to support five distinct clinical functions: obtaining treatment guidelines, exchanging clinical data with other physicians, accessing notes on individual patients, generating treatment reminders for the physician’s use, and writing prescriptions.  The results of the survey showed that the vast majority of the physician practices lacked significant IT support for patient care.  Nearly one in four physicians surveyed was in practice with no computer or other form of IT support for any of the five clinical functions.  Another quarter of the doctors only had IT available for one function.  Only 27 percent of the doctors were in offices with IT support for three or more of the functions.  Interestingly, of those physicians who had IT support, only 37 percent used technology to access patient records.

“Computerized patient records can be one of the most important ways to use technology to improve patient care,” according to Craig Oberfeld, CEO of QuickNotes, Inc., a leading chiropractic documentation software company.  “It took a big push from Medicare toward requiring electronic billing to get chiropractors to switch from paper to digital claims submission; but, now that they are familiar with handling digital patient billing records, it is only natural that they are considering the move to digital treatment records. Chiropractors are realizing the benefits of using technology to manage more of their patients’ care.  Hand-held documentation systems can be faster than hand-written notes, and the generated typed notes are more easily deciphered by claims adjusters for faster payment.”

Today’s handheld computers and touch-screens have enormous memory capacity and can hold vast amounts of patient records.  Running from treatment room to treatment room, a doctor can carry the handheld unit, access patient records and record subjective, objective, assessment, and plan (SOAP) notes and reminders, by touching a screen or using handwriting recognition technology.  Some systems even offer voice recognition for instant dictation and note generation, although there are some talking-speed and enunciation limitations.

Chiropractors may hesitate to purchase technology because of the cost, but they would be failing to recognize the long-term cost savings.  Using an electronic patient documentation system can reduce the need for a staff member whose responsibility is typing up patient notes, dictation, or photocopying records to mail to insurance companies.  Special report-generating programs can also transcribe SOAP and exam notes into legal care reports.  Entering notes electronically can take the doctor less time than it takes to write them by hand or even to dictate, so the total money saved in one year can be as much as $40,000!

“Websites are the number one online marketing tool for chiropractors, but a website should be the beginning, not the end, of an online marketing program,” explains Asaf Ben-Haim, CEO of iMatrix, Inc., a chiropractic website development company.  “A standard website, by itself, is only a digital brochure and not much of a new patient generator.  However, by leveraging the search engine technologies and offering services like appointment scheduling and an online product store, chiropractors can make their websites more interactive, and attract both new and current patients.”

Online marketing is much more cost effective than mailings or print versions.  Electronic patient newsletters, patient reminders and birthday cards can be emailed to patients at no cost, instead of paying 37 cents for a stamp.  Online promotions are a fraction of the cost of similar print promotions to reach the same audience.  For an office with a limited marketing budget, online marketing makes much more economic sense than local print advertising.

Mark Mandell, DC, MBA is the Director of Business Development at Foot Levelers and was the Medical Staff Chairman of the 1994 World Cup Opening Ceremonies.  Dr. Mandell is a popular educator on the business of chiropractic and how to grow the profession.  He can be reached at 800-553-4860.

 
Building the Perfect Chiropractic Website
Technology
Written by Yamia Benheim   
Wednesday, 22 June 2005 16:31

computer1A website is no longer a luxury, but a necessity, for chiropractors striving for the best practice possible. No chiropractic practice, large or small, should ignore the many benefits that come from having its own, professional website. So, what should practices consider when launching them online or considering an overhaul?

There are two types of websites to choose from: custom and prefabricated. Custom interactive websites will prove to be far more effective, look more professional, and have longer-lasting value than the cheaper prefabricated versions.  Every practice is different, so a design company should take the time to understand what the practice has to offer and convey that in their site.

Effective websites take into account common practice management tasks, and integrate them with online tools that not only create a marketing presence but, also, empower the practice in its daily operations.  Specific tools include keeping in touch with patients through e-mail newsletters, greeting cards and special promotions.

A few companies that specialize in chiropractic websites compile newsletters that they prepare and deliver automatically on behalf of a doctor to his or her patient database. Such newsletters, which can be updated on a regular basis on the website and automatically e-mailed to patients, are extremely helpful in keeping in touch with patients that do not come in as often. Additionally, patients who subscribe may forward them to others, which could serve as a form of referrals.

Another useful feature is the ability to easily send out pre-scheduled e-mail cards for birthdays, appointments, various holidays, etc. Such e-cards, with fun, professional designs, provide another great opportunity to keep in touch with patients and improve patient relations, while minimizing the cost of traditional cards and postage, not to mention saving time.

Practices should also consider providing potential patients with an incentive to visit the office by having printable promotions or coupons on their websites, where allowable by law. After all, the hardest part is getting the patient to come in for the first time.

Websites can also give patients the ability to schedule appointments, access patient forms and even verify insurance. This way, rather than request patients to come in fifteen to twenty minutes early, practices can post their forms online and request that patients go online to print and complete them before coming in. 

The opportunities for patient education online are almost limitless; a doctor can provide informational resources on preventative care and exercises, explanatory diagrams and illustrations, and descriptions of the unique services of their practice.  A website can also assist the practice in selling different products and supplements to anyone, anywhere and any time—not just to the existing patient base of the practice. Doctors should not limit their opportunities—current studies show the public is looking for health information, by the millions. Having an online presence now is crucial, not only in reaching new patients but also retaining existing ones.  By not being online, a doctor misses out on 100 percent of the Internet-derived business he or she could see.

The key to bringing in new patients who are searching online for health providers and information lies in search engine placement. Who would want a website if no one can find it? In selecting your website company, be sure that the commissioned company can create a search engine and marketing campaign aimed at excellent placement with search engines and directories, and use both innovative and standard Search Engine Optimization techniques.  More traffic means more patients, a better bottom line and a dramatic return on   investment. Through a website, they can get their questions answered in a non-threatening, non-confrontational way. A website can even help a practice maximize the benefits of spreading the message of chiropractic.  This new technology is not only limitless, but also much more affordable than all previous means of publicity utilized by doctors in the past.  A practice armed with these new tools will be much more efficient, effective and professional in gaining new patients and servicing them 24/7.

Whether you have a current web site that isn’t high enough quality, or if you have no website to speak of, the next decision is who should you turn to for the creation of your professional website? In terms of working with a freelancer versus an established company, as a general rule, it is usually best to work with a company that will provide the necessary customer service and support.  Even if your “nephew Jimmy” or the “nice kid down the street” can build you a professional  website to begin with—and that’s a big “if”—will they be around when you need to update your website?
 
It helps to find a company who can identify with the practice and even specializes in chiropractic websites.  A company or freelancer that does not specialize in chiropractic fields will require a significant amount of time from the doctor in developing the content and educational materials for the website.  While several design companies specialize in chiropractic websites, not all are alike in the quality of their designs and services. There is probably no need to dump $10,000 into a doctor of chiropractic website, but an investment of over $1,000 should be expected. A chiropractor can no longer maintain the mindset that “the computer is just for my kids.”  A practice without a professional website will be an immediate turnoff for more and more potential patients each and every day.

Yamia Benhaim is the founder of ChiroMatrix.com, a design firm specializing in custom website design and Internet marketing for the chiropractic community. She can be contacted at 800-398-3933 or through the website www.chiromatrix.com.

 
Clinical Certainty in the 21st Century
Technology
Written by Christopher Kent, DC   
Sunday, 22 May 2005 15:23

Practicing chiropractors are faced with the challenge of determining when to adjust.  Trying to apply examination procedures, such as medical orthopedic tests, which do not indicate the presence or correction of vertebral subluxations, has frustrated many doctors.

The concept of nerve interference is often challenging to patients.  Their confusion is compounded when the chiropractor claims to be subluxation based, but bases care on the presence or absence of symptoms.

The ideal clinical examination procedure:

• Will provide objective measurements.
• Is completely non-invasive.
• Provides a reliable and valid assessment of the functional status of the nervous system.
• Provides a means of re-examination to track progress.
• Is time and cost effective.
• Uses protocols supported by peer-reviewed publications.
• Is applicable to persons of all ages, including infants, toddlers, children, adolescents and adults.
• Facilitates patient education by providing easy-to-understand, tangible evidence.
• Is suitable for spinal screening.
     
Advances in technology, such as electromyography (EMG) and thermal scanners that are designed especially for chiropractors, have resulted in instrumentation that empowers the chiropractor with objective evidence of nervous system function.  Enabling the chiropractor to evaluate aspects of functional integrity, which are related to the analysis of vertebral subluxation, is essential.  For instance:

1. Static surface EMG (sEMG) measures the electrical activity in the muscles surrounding the spine.  This test enables the chiropractor to objectively evaluate the innate response of the paraspinal muscles to gravity.  Tonic muscle activity is assessed with static sEMG.

2. Dynamic surface EMG allows the chiropractor to graph up to four channels of sEMG activity as the patient goes through ranges of motion.  The result is an objective assessment of voluntary motion.

3. Paraspinal Infrared Temperature analysis evaluates the integrity of the autonomic nervous system, which controls organs, glands, and blood vessels.  It allows the chiropractor to relate vertebral subluxation to autonomic function.  A rolling thermal scanner allows the doctor to examine infants, children, and adult patients in a single pass.

4. Computerized inclinometry measures ranges of spinal motion.  These measurements relate to the biomechanical component of vertebral subluxations.

5. Pressure algometry evaluates sensory function by measuring the pressure/pain thresholds of tender regions along the spine.

Having the ability to display dramatic color graphics in a format that is easy to apply clinically and to communicate effectively and objectively to patients, is the goal of every chiropractor.  Seeking technical certainty through advanced methods and technologies should be the path for each of us.  Improve your patient communication and commit to the vision of lifetime, subluxation-based wellness care and raise your practice to a higher level.

Bibliography

1. Saur PM, Ensink FB, Frese K, et al: Lumbar range of motion: reliability and validity of the inclinometer technique in the clinical measurement of trunk flexzibility.  Spine 1996;21(11):1332.
2. Whatmore GB, Kohi DR: Dysponesis: A neurophysiologic factor in functional disorders.  Behav Sci 1968;13(2):102.
3. Kent C: Surface electromyography in the assessment of changes in paraspinal muscle activity associated with vertebral subluxation: a review.  Journal of Vertebral Subluxation Research 1997;1(3):15.
4. Uematsu S, Edwin DH, Jankel ER, et al: Quantification of thermal asymmetry.  J Neurosurg 1988;69:552.
5. Kent C, Gentempo P: Instrumentation and imaging in chiropractic: a centennial retrospective.  Today’s Chiropractic 1995;24(1):32.
6. Kelly S, Boone WR: The clinical application of surface electromyography as an abjective measure of patient progress: a pilot study.  Journal of Vertebral Subluxation Research 1998;2(4):175.800-892-6463 or 201-368-9600.
7. Kent C: Instrumentation and imaging.  In: Masarsky C, Todres-Masarsky M: Somatovisceral Aspects of Chiropractic—An Evidence-based Approach.  New  York.  Churchill-Livingstone.  2001.

Christopher Kent, DC, is a 1973 graduate of Palmer College of Chiropractic.  The author of numerous professional publications, Dr. Kent has been recognized nationally as “chiropractor of the year” and “chiropractic researcher of the year.”  He is co-founder of the Chiropractic Leadership Alliance, Inc.  For further information, contact Chiropractic Leadership Alliance, Inc., 1 International Blvd., Mahwah, NJ  07495 or phone 800-892-6463 or 201-368-9600.

 
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