Midterm Study Guide (X-ray + tytron/Philosophy)

Lateral/Longitudinal X-ray: Occipital Condyle Line (OCL) → Reference Points

Anterior and posterior aspects of the occipital condyle as they meet the floor of the skull

Drawn first on lateral x-ray!

Lateral/Longitudinal X-ray: Occipital Condyle Line (OCL) → Utilization and misalignment

1.) gives position of the skull/head

2.) used to construct listing line (LL)

3.) will help obtain AS or AI atlas

Lateral/Longitudinal X-ray: Atlas Plane Line (APL) → Reference points

base of anterior tubercle and middle of the posterior arch

Drawn second on lateral x-ray!

Lateral/Longitudinal X-ray: Atlas Plane Line (APL) → Utilization and misalignment

1.) gives position of atlas

2.) compared to LL (angle measured)

3.) will help obtain AS or AI atlas

Lateral/Longitudinal X-ray: Listing Line (LL) → Reference points

Parallel down from OCL until the posterior reference point of APL is intersected

Drawn last on lateral X-ray!

Lateral/Longitudinal X-ray: Listing Line (LL) → Utilization and Misalignment

will be used to generate angle measurement for AS or AI atlas

Nasium / Horizontal X-ray: Ocular Orbit Line (OOL) → Reference Points

like (analogous) points visualized through the orbits

two sets are identified for confirmation

Drawn first on nasium view!

Nasium/ Horizontal X-ray: Ocular Orbit Line (OOL) → utilization and misalignment

gives pitch/tilt of the skull/head

will be used to construct SBL and VML

Drawn second on Nasium view!

Nasium/ Horizontal X-ray: Superior Basic Line (SBL) → reference points

medial inferior condyle tips

parallel down from OOL until the first condyle tip is intersected

Drawn third on nasium view!

Nasium/Horizontal X-ray: Superior Basic Line (SBL) → Utilization and Misalignment

allows us to quantify condyle asymmetry

will be used to apply the 70% of rule

Nasium/Horizontal X-ray: Inferior Basic Line (IBL) → Reference Points

lateral inferior tips of C1 lateral masses

Drawn fourth on Nasium View!

Nasium/Horizontal X-ray: Inferior Basic Line (IBL) → Utilization and Misalignment

1.) provides a reference line for C1

2.) C1 laterality will be measured with it

3.) will be used to apply the 70% rule

Nasium/Horizontal X-ray: Vertical Median Line (VML) → reference points

drawn 90 degrees to OOL intersecting the center of the spinal canal (+ sign drawn)

Center is obtained by bisecting the width of the foramen magnum with a compass (+ sign)

Drawn LAST on Nasium

Nasium/Horizontal X-ray: Vertical Median Line (VML) → Utilization and Misalignment

1.) represents bio-geometric center of the canal/foramen magnum

2.) provides center point from which to measure C1 laterality (R or L)

Base Posterior/Vertical X-ray: Atlas Plane Line (APL) → Reference Points

center of the Transverse foramina on C1

drawn first on base posterior X-ray!

Greater than 90 degrees = Posterior

Less than 90 degrees = Anterior

= 90 degrees → No rotation

Base Posterior/Vertical X-ray: Atlas Plane Line (APL) → Utilization and Misalignment

gives rotational position of C1

will be used to determine degrees of rotation

Base Posterior/Vertical X-ray: Perpendicular Skull Line (PSL) → Reference Points

Drawn from the nasal septum intersecting the center of basilar process

(+ sign) and meets APL

Base Posterior/Vertical X-ray: Perpendicular Skull Line (PSL) → Utilization and Misalignement

Takes into account the rotation of the head when determining C1 rotation (A or P)

APOM/Vertico-Horizontal X-ray: Ocular Orbit Line (OOL) → Reference Points

Like (analogous) points visualized through the orbits, two sets are identified for confirmation

Drawn first on APOM!

APOM/Vertico-Horizontal X-ray: Ocular Orbit Line (OOL) → Utilization and Misalignment

gives pitch/tilt of the skull/head

will be used to construct VML

APOM/Vertico-Horizontal X-ray: Superior Basic Line (SBL) → Reference Points

Jugular processes

if they cannot be seen, alternate points are used along the base of the skull

Drawn second on APOM!

APOM/Vertico-Horizontal X-ray: Superior Basic Line (SBL) → Utilization and Misalignment

Provides reference line for the Assumed Atlas Listing

APOM/Vertico-Horizontal X-ray: Inferior Basic Line (IBL) → Reference points

lateral inferior tips of C1 lateral masses

Drawn third on APOM!

APOM/Vertico-horizontal X-ray: Inferior Basic Line (IBL) → Utilization and Misalignment

Provides reference line for C1

C1 laterality will be measured with it

Used to find the Assumed Atlas Listing

APOM/Vertico-Horizontal X-ray: Vertical Median Line (VML) → Reference Points

Drawn 90 degrees to OOL intersecting the center of the spinal canal (+ sign)

The center is obtained by bisecting the width of the foramen magnum with a compass (+ sign)

Drawn Last on APOM

APOM/Vertico-Horizontal X-ray: Vertical Median Line (VML) → Utilization and Misalignment

1.) represents the bio-geometric center of the canal/foramen magnum

2.) provides reference points for the C2 listing as well as the Assumed Atlas Listing

Axis Listing

1.) Place a dot in the center of the base of the odontoid process

2.) place a dot at the junction of lamina/tip of spinous of C2

3.) compare C2 spinous to the dens and then compare the dens to the VML

SPINOUS TO DENS AND DENS TO THE LINE

Assumed Atlas listing

1.) side of larger measurement is actual atlas laterality

2.) assumed atlas rotation is derived from looking at the SBL and IBL on the side of measured atlas laterality

3.) Converging lines = Anterior

4.) Diverging lines = posterior

5.) parallel lines = NO assumed atlas rotation

Lateral/Longitudinal: primary and secondary purpose

Primary purpose: to get 2nd letter of atlas listing

Secondary Purpose: Evaluate C1/C2 relationship, check cervical anomalies, and evaluate cervical spine

Nasium/Horizontal: primary and secondary purpose

Primary purpose: to get 3rd letter of atlas listing

Secondary purpose: determine condyle malformation

Base Posterior/Vertical: primary and secondary purpose

Primary purpose: to determine atlas rotation

Secondary Purpose: Inspect the integrity of the odontoid and ring of atlas

APOM/Vertico-Horizontal Primary and Secondary purpose

Primary: to determine axis listing

Secondary: to determine the assumed atlas listing (double check)

Constant

when atlas and axis rotate in the SAME DIRECTION

Variable

When atlas and axis rotate in OPPOSITE DIRECTIONS

Non-applicable

When atlas and/or axis shows NO ROTATION

Axis Simple listings

1.) spinous Right-Body pivot (SpRtBP)

2.) spinous left-body pivot (SpLtBP)

3.) Entire segment Right (ESR)

4.) entire segment left (ESL)

-ESL and ESR

Compound atlas listings

1.) spinous right-body pivot, entire segment right

2.) Spinous left-body pivot, entire segment left

3.) spinous right body pivot, entire segment left

4.) spinous left body pivot, entire segment right

Constant/same direction

can consider adjusting either atlas or axis depending on segmetn with the greater misalignment

Variable/opposite direction

should only consider adjusting atlas

One or both segments show no rotation (N/A)

treat as you would a constant and adjust the segment with the largest misalignment

Toggle

Knee-like joint that transmits pressures at right angles. it has 2 arms that are hinged together at an angle

A force applied at the hinge, causing the angle to straighten, produces a much greater force at the end of the arms

Recoil

Vibratory or oscillatory motion of a system due to the innate elasticity of that system in response to the application of a force until new equilibrium is realized

BJ said the 4 elements of a true subluxation

1.) occlusion of an opening

2.) vertebra out of alignment

3.) pressure on nerve tissue

4.) interference with the flow of mental impulses

Misalignment

1.) less than a subluxation, could be vertebra out of alignment

2.) may show up on x-ray

3.) may have taunt and tender nerve fibers

4.) may have contracted muscles

5.) may be found on dead as well as live bodies

Subluxation

1.) more than a misalignment

2.) does occlude foramen

3.) does produce pressure (irritation)

4.) does offer interference

5.) does create resistance

6.) only exists in live bodies

BJ said if Chiropractic works, it should work 100% of the time if

Right adjustment

right place

right time

right manner

3 Divisions of intelligence:

Universal: source

Innate: semi-source

Educated: non-source

X-ray

Diagnostic: fx, tumors, anomalies

Analytical: determine listings, not subluxations (placement)

Instrumentation

used to determine when to and when not to adust

never (by itself) where

Leg check

used to determine factor as to when and when not to adjust

Palpation

used to determine factor as to when to and when not to adust

static: structure and recognition, muscular evaluation

Motion: comparative study

Symptomatology

used to determine when to and when not to adjust

least important of the 5 on a routine visit

adjust subluxation not symptoms

Accommodation

need of the doctor to alter body position in order to allow the minimal and equal elbow bend

Adjustment

delivery of a specific dynamic thrust to a motor unit so as to remove the subluxation complex

Analyzing tytron readings new patient

1.) establish a pattern

2.) look at all 3 lines

3.) delta T for the initial comparison is felt to be he most important of the 3 lines

4.) Compare pattern to subsequent visits on possible treatment days

Full pattern

all 3 lines are the same as the established pattern → ADJUST

Deta T same, both DTS same

Full Adaptation

All 3 lines are the different from established patterns → DO NOT ADJUST

Partial pattern

When majority of the lines are the same as the established pattern or the delta is the only one matching → evaluate 2 degree findings

Tytron: secondary findings

Fossa, leg check, palpation (Static and motion), symptomatology

Mastoid Fossa Screen

1.) >0.5 degrees C is SIGNIFICANT

2.) 1st right barrel right ear, 2nd right barrel left ear

3.) lift earlobe, barrel is 90 degrees to fossa

4.) hold trigger for 3 seconds each

Line graph screen

1.) left column: Actual Temperature

2.) Middle column: differential

3.) Right column: Actual temperature

AO Founders

Roy W. Sweat (founder of atlas orthogonal chiropractic; early 1970’s)

Evolution of Cranio/Atlas/Cervical spine adjustments

1.) BJ palmer adjusted by hand with 44lbs of force straight side to side (Side posture)

2.) John F. Grostic Adjusted by hand with 12lbs side posture utilizing X-ray guided vectors

3.) Roy W. Sweat adjusted by instrument with 5-6lbs side posture utilizing X-ray guided vectors

AO uses

stylus → 1.8lb solenoid which is released by a magnet, solenoid strikes aluminum stylus and imparts 5lbs of force in the form of vibration

the vibration moves the 2 ounce atlas back into a more level position

AO Adjustment

Profile, history, exam

palpation of posterior cervical muscles

palpate region of the atlas-axis

check uneven leg length

imaging analysis

AO was developed from

Hole In One technique

Origin of NUCCA

1.) atlas moves laterally like on a circle, measure in degrees (A.A Wernsing)

2.) Realized need for repeatable accurate adjustments (John F. Grostic)

3.) Collaborated with Grostic, continued to advance the work and NUCCA (Ralph R. Gregory)

Dr. Aleck A. Wernsing

1.) basis of orthogonal techniques → atlas moves laterally like on the rim of a circle. Began listing misalignment factors in degrees

John F. Grostic

1.) ill with hodgkin’s lymphoma at 22 years old → miraculous recovery with BJ palmer (enrolled in palmer then practiced MI 1933)

2.) X-ray tube hit his head in 1935 and he had a sudden and severe relapse of Hodgkin’s and was given only weeks to live

3.) no other chiros around could help him, returned to BJ and back to health in days

4.) began a deep exploration in to Upper cervical recognizing the need for accurate, repeatable adjustments

5.) credited with: pre and post x-rays, modified HIO adjusting table, mastoid support head piece, precise vectors for adjustments

Dr. Ralph Gregory

1.) collaborated with John F. Grostic to develop a more biomechanically accurate system to adjust the ASC

2.) 1964 Dr. Grostic death, Dr. Gregory did not want to continue teaching seminars but focused on advancing the basic work

3.) 1966 persuaded to resume seminars and NUCCA organization was formed

Dr. Ralph Gregory was credited with

1.) precisely aligned X-ray equipment for distortion free x-ray

2.) precise and reproducible patient placement

3.) analyzing instruments developed, triceps pull adjustment

4.) Anatometer by Dr. Gregory and peter Benesch

NUCCA is not just a technique, it is a

predictable, repeatable system to restore the atlas and entire spine to normal alignment thus allowing the body to resolve the concurrent neurological impairment

What makes NUCCA Unique? (1)

1.) Anatometer: literally measure the presence of absence of the ASC

2.) NUCCA is the only upper cervical technique that has an instrument designed specifically for measuring the postural distortion resulting from the ASC

3.) without a complete adjustment to restore the atlas and cervical spine to normal, the rest of the spine will remain at least in partially distorted posture with the concurrent neurological impairment. Adjustments won’t hold. Subluxations will recur in the same areas of the spine over and over

What make NUCCA Unique? (2)

only technique that uses post x-rays to measure the amount of reduction of the misalignment and immediately use that additional information to refine the adjustment to get a greater correction (when needed)