Sublux Midterm

VSC

model of spinal dysfunction

*takes us away from bone on nerve paradigm

VSC - how does it benefit us

gives us a model to surround our exam around

Parts of VSC

kinesiopathology

neuropathology

myopathology

histopathology

pathoanatomy

pathophysiology

pathobiochemistry

Kinesiopathology (AR)

postition/motion

*lack of motion causes degenerative changes

How is kinesiopathology oberserved (2)

static palpation and posture

What is the cornerstone of chiropractic theory

neuropathology

Neuropathology (PAT)

reflexes/altered sensation/pain

*more than just compressing nerve roots (also pain, sensory, motor, visceral)

*expands our scope of practice

Neuropathology expands our

scope of practice

How is neuropathology oberserved (2)

instrumentation (thermoregulation of capillaries)

deep tendon reflexes (nerves)

Myopathology (PAT)

tone/weakness/atrophy

*muscles maintain osseous relationships and move bones

*Disuse atrophy

How is myopathology oberserved (2)

static palpation and posture

Hisopathology (PAT)

edema/inflammation

*Dis-ease at tissue level

*inflammation response (redness, swelling, heat, pain)

Pathoanatomy

nature of disease (causes, processes, development, consequences)

Pathophysiology

disruption of normal physiology

Pathobiochemistry

disruption of normal biochemistry

PART system developed when and who

Jan 2000 by CMS

PART system - ____ of the 4 components are needed, 1 MUST be _____________

2; Asymmetry or ROM

PART - P

pain/tenderness

*pain elicited during the course of examination, described in terms of location, quality and intensity

PART - A

asymmetry/misalignment

*may be described at a regional and/or segmental level

PART - R

ROM abnormality

*hypermobility

PART - T

tissue tone changes

*describe changes in tone of soft tissue

*spasms, inflammation, hyper and hypotonicity, heat-measuring instruments, leg length discrepancy

Postural analysis is a systematic way to describe/document a patient's

structural presentation

*documents findings from PATIENTS PERSEPECTIVE

Listing is _____ tilt/lean is ______

global; regional

Static palpation is performed least invasive to most invasive

skin

edema

muscle tonicity (superficial)

muscle tonicity (deep)

tissue prominence (bone)

palpable tenderness

Skin (Histopathology - T)

color, blemishes, swelling, sebaceous changes, relative temperature differential

*warm - acute

*cold - chronic

Edema (Histopathology - T)

abnormal accumulation of fluid in tissues

Muscle tonicity - superficial (Myopathology - T)

comparative of relative muscle tone just below the surface of the skin

*increased tone = spasm

*decreased tone = atrophy

Muscle tonicity - deep (Myopathology - T)

deep strumming motion of paraspinal musculature

Pain noted in these areas (muscle tonicity - deep) will be _______ in nature

myogenous

*originating in muscle

*relating to origin of muscle cells or fibers

Tissue prominence - bone (Kinesiopathology - A)

paraspinal palpation for increased tissue density from possible osseous misalignment

*posterior body rotation is always opposite of spinous rotation

*palpate bilateral lamina, TVP, or mammillary processes

Palpable tenderness (Neuropathology - P)

compare adjacent structures for frame of reference (SP, TVP, Z-joints)

*rate pain 1-10

Pain noted in any of these areas (palpable tenderness) will be ______ in nature

sclerotogenous

*pain pertaining to ligaments, tendons, discs, periosteum

Instrumentation (T) tells us _____ to adjust

WHEN

Instrumentation dates

1924 - Neurocalometer

1930 - BJ palmer (pattern system)

1950 - Gonstead (break system)

Warm receptors are ________ and cold receptors are _______ (saltatory)

unmyelinated; myelinated

Nervoscope (T) is ideal for _____ analysis

break

Heat swing

needle deflection over MULTIPLE segmental levels

*normal physiology

Break

needle deflection over SINGLE segmental level

*ideal 2 increments or more

*REPEATABLE

Cervical glide (nervoscope)

patient sits at back of stool

Dr knee touching OUTSIDE of stool

single hand grip (forearm perpendicular to spine)

Start at T1 - End 1/2" on occiput

3 seconds per segment (18-21sec)

Where do you mark breaks on a cervical glide

1/4" BELOW mid thermocouple

Throacolumbar glide (nervoscope)

patient sits hand width forward

Dr knee touching INSIDE of stool

dual hand grip

Start C7 - End S2

2 seconds per segment (35-38sec)

Where do you mark breaks on a thoracolumbar glide

1/4" ABOVE mid thermocouple

Break location guidelines - Occiput/C1

suboccipital/upper cervical (between the 2 segments)

Break location guidelines - C2-T3

interspinous space below

Break location guidelines - T4

at own spinous level

Break location guidelines - T5-T9

interspinous space above

Break location guidelines - T10-T12

at own spinous level

Break location guidelines - L1-L5

lower 25% of spinous of involved segment

Documentation of a break includes (3)

segmental level

direction of break (1st deflection)

amplitude (increments)

Tytron (T) is ideal for _____ analysis

pattern

Tytron reads what two parts of VSC model

neuropathology (thermoregulation)

histopathology (inflammation)

What does the Tytron do that nervoscope can't do? Limitations?

aids in patient education

limitation = perspiration/sweat causes IR scatter

Tytron procedure

patient seated at back of stool

1 second per segment

Start rollers over S3 (barrels over S2) to C1

Middle line graph most important (differential)

Tytron Mastoid Fossa procedure

>0.5 C is significant

Right barrel - R ear

Right barrel - L ear

hold trigger for 3 seconds each side

Adaptive

normal changes in thermoregulation that fluctuate with the patient's presentation and environment

*Tend to be smooth gradual line presentations

*Do NOT follow a pattern

*Are NOT reproducible

Stress

abnormal changes in thermoregulation

*tend to be sharp in irregular line presentations

*Do NOT follow a pattern

*Are NOT reproducible

Pattern

abnormal fixation of thermoregulation

*Can be smooth or sharp in line presentation

****REPRODUCIBLE