THE CERVICAL SPINE: WHAT GUIDES CURRENT 'BEST PRACTICE' IN OSTEOPATHY?

Size: px
Start display at page:

Download "THE CERVICAL SPINE: WHAT GUIDES CURRENT 'BEST PRACTICE' IN OSTEOPATHY?"

Transcription

1 THE CERVICAL SPINE: WHAT GUIDES CURRENT 'BEST PRACTICE' IN OSTEOPATHY? LOS 20th May 2008 Laurence Butler BA(hons); DO(hons); MSc/D.Ost

2 My thanks go to: Barry Jacobs (slides on cervical rotation) Steve Vogel (examples up to date references) Janet Suckley (general moral support) David Tatton (liaison with LOS) Martin Pendry (IT support and smiles)

3 OVERVIEW Vascular structures e.g. vertebrobasilar tree Neural structures e.g. spinal cord

4 OVERVIEW Vascular structures e.g. vertebrobasilar tree Neural structures e.g. spinal cord

5 OVERVIEW In summary, we have found the burden of evidence to support (a weak to moderately strong) cause-and-effect relationship between cervical manipulation with vertebral arterial dissection and subsequent stroke. Miley, Wellik et al (2008) The Neurologist 14 (1): 66-73

6

7

8

9

10

11

12 Arterial structure

13 Ernst E (2007) J R Soc Med 100: Adverse effects of spinal manipulation: a systematic review Finds majority of cases associated with chiropractic Osteopathy comes out relatively well (Force-related? related? Tissue warm up?)

14 Osteopathic philosophy guides us Vascular symptoms and signs are caused by altered vessel/blood function governed by altered vessel/blood structure

15 NECK VESSELS Are pain sensitive Can be intimally traumatised (especially in young) Vulnerability is hard to predict at present Supply vital structures Supply important structures Supply structures that can cause signs and symptoms

16

17 NECK VESSELS Dittrich R, Rohsbach D et al (2007) Cerebrovascular Diseases 23: They found no association between any single risk factor (in isolation) and cervical artery dissection. Cervical manipulation and infections were more common In people with vascular damage, but failed to reach significance. Mild mechanical stress, including cervical manipulation, plays a role as possible trigger factor in the pathogenesis of cervical artery dissection.

18 There is, as yet, NO credible research base for the use of pre-manipulation positioning tests in relation to neck vessels

19 SO,, the history comes to the fore Consider factors that lead to a suspicion of neck injured vessels. Such as recent and previous trauma, connective tissue disorders, generalised vascular degeneration, previous poor response to treatment

20 The Society for Orthopaedic Medicine Moving Musculoskeletal Medicine Forward Risk factors associated with cervical vascular dysfunction/trauma etc drop attacks, black outs, loss of consciousness nausea, vomiting and general unwell feelings dizziness or vertigo, particularly if associated with head positioning disturbances of vision (e.g. decreased, blurred, diplopia) unsteadiness in the gait (ataxia) and general feelings of weakness tingling or numbness (especially, dysaethesia i.e. tingling around the lips, hemianaesthesia or any alteration in facial sensation) difficulty in speaking (dysarthria) or swallowing hearing disturbances (e.g. tinnitus, deafness) headache past history of trauma cardiac disease, vascular disease, altered blood pressure, previous cerebrovascular accident or transient ischaemic attacks blood clotting disorders/anticoagulant therapy oral contraceptives long term oral steroids a history of smoking immediately post partum (Kleynhans & Terrett, 1985; Grant, 1988; Hutchinson, 1989; Chapman-Smith, 1994; Kunnasmaa & Thiel, 1994; Rivett, 1994; Carey, 1995; Rivett,1995; Grant,1994; Kuether et al, 1997; Rivett, 1997; Kesson & Atkins, 1998; Di Fabio, 1999).

21 Is there Vascular (Arterial)( Damage in this Neck? There follows a potential mnemonic of important clinical features NB how useful is it? -Your feedback is welcome-

22 V A D N Vessel pain Vertigo V / VII CNS Ataxia (clumsy) Anhydrosis Drop attacks Diplopia Dysarthria Numbness (face/body) Nausea Vision change Aphasia Dysphagia Nystagmus Vomiting

23 V A D N Vessel pain Vertigo V / VII CNS Ataxia (clumsy) Anhydrosis Drop attacks Diplopia Dysarthria Numbness (face/body) Nausea Vision change Aphasia Dysphagia Nystagmus Vomiting

24 V A D N Vessel pain Vertigo V / VII CNS Ataxia (clumsy) Anhydrosis Drop attacks Diplopia Dysarthria Numbness (face/body) Nausea Vision change Aphasia Dysphagia Nystagmus Vomiting

25 V A D N Vessel pain Vertigo V / VII CNS Ataxia (clumsy) Anhydrosis Drop attacks Diplopia Dysarthria Numbness (face/body) Nausea Vision change Aphasia Dysphagia Nystagmus Vomiting

26 V A D N Vessel pain Vertigo V / VII CNS Ataxia (clumsy) Anhydrosis Drop attacks Diplopia Dysarthria Numbness (face/body) Nausea Vision change Aphasia Dysphagia Nystagmus Vomiting

27 Reciprocal holism

28 PERIPHERAL CIRCULATION Are there any indicators of aterial vessel susceptibility elsewhere too?

29 OVERVIEW Vascular structures e.g. vertebrobasilar tree Neural structures e.g. spinal cord

30 OVERVIEW Vascular structures e.g. vertebrobasilar tree Neural structures e.g. spinal cord

31 Antero-listhesis at C4-C5 with C5-C6 block vertebra

32 Is there Spinal Cord Damage in this Neck?

33 MRI: cervical cord compression

34 Osteopathic philosophy guides us Neurological symptoms + signs are caused by altered spinal cord function governed by altered spinal cord structure

35

36 Is this cord intact? What is a good way to decide whether a patient has damage to the spinal cord? Examine the functions of its sub- structures UMN (cortico( cortico- and reticulo-spinal tracts) Spinothalamic tract Dorsal Columns Is it susceptible to provocation?

37 Likely cord-related related symptoms Lhermitte s/barber s/barber s chair Loss of fine motor control Heaviness in limbs Loss of temperature/pain sensitivity Problems after dark!

38 Treatment implications

39 0 o 60 o

40

41 0 o 60 o

42 0 o 60 o

43 Vascular arterial damage - or not?

44 Which elements of a thrust are most damaging? NB PhD material!

45 CONCLUSIONS

46 A few of the points discussed: Provocative tests are just that - potentially dangerous They have no proven utility - they do not predict who will go wrong This makes sense - only a thrust can mimic a thrust If thrusts have some danger associated with them, why is osteopathy s s record relatively good? British osteopaths appear to contribute to vascular accidents on a relatively small scale and at a relatively low level of morbidity/mortality Patients affected by injury - esp vascular - appear mainly relatively young (often below 45 years of age) Is this an artefact of statistical sampling, stats, self-referral? OR is it because of their intrinsic nature (e.g. connective tissue)? OR is it because they tend to suffer more trauma? OR is it because of practitioner complacency in the face of an apparently a youngish and healthy-ish patient? THEN is too little warm up ttt followed by a single-leverage leverage thrust (usu. rotational) with excessive angular momentum?

47

Spinal Manipulation and Stroke: A Lawyer s Primer on reviewing the liability case

Spinal Manipulation and Stroke: A Lawyer s Primer on reviewing the liability case Spinal Manipulation and Stroke: A Lawyer s Primer on reviewing the liability case I. A brief historic background According to reported statistics, cerebrovascular accidents (CVAs) are not the most common

More information

10/5/2017. Cervical Manual Evaluation and Mobilizations. Upper Cervical Stability Testing Alar Ligament

10/5/2017. Cervical Manual Evaluation and Mobilizations. Upper Cervical Stability Testing Alar Ligament Cervical Manual Evaluation and Mobilizations Upper Cervical Stability Testing Alar Ligament Upper Cervical Stability Testing Transverse Ligament 1 Upper Cervical Stability Testing Transverse Plane Positive

More information

UPDATE OF CODE OF PRACTICE FOR CERVICAL SPINE MANAGEMENT (2016)

UPDATE OF CODE OF PRACTICE FOR CERVICAL SPINE MANAGEMENT (2016) UPDATE OF CODE OF PRACTICE FOR CERVICAL SPINE MANAGEMENT (2016) Background Early in 2000, the New Zealand Manipulative Physiotherapists Association (NZMPA) developed a New Zealand Cervical Spine Pre-screening

More information

Neuroanatomy of a Stroke. Joni Clark, MD Professor of Neurology Barrow Neurologic Institute

Neuroanatomy of a Stroke. Joni Clark, MD Professor of Neurology Barrow Neurologic Institute Neuroanatomy of a Stroke Joni Clark, MD Professor of Neurology Barrow Neurologic Institute No disclosures Stroke case presentations Review signs and symptoms Review pertinent exam findings Identify the

More information

What Do You Think of My Posterior?

What Do You Think of My Posterior? What Do You Think of My Posterior? Posterior Stroke and Stroke Mimics Peter Panagos, MD, FACEP, FAHA Associate Professor Emergency Medicine and Neurology Washington University School of Medicine Disclosures

More information

Pre-Hospital Stroke Care: Bringing It To The Street. by Bob Atkins, NREMT-Paramedic AEMD EMS Director Bedford Regional Medical Center

Pre-Hospital Stroke Care: Bringing It To The Street. by Bob Atkins, NREMT-Paramedic AEMD EMS Director Bedford Regional Medical Center Pre-Hospital Stroke Care: Bringing It To The Street by Bob Atkins, NREMT-Paramedic AEMD EMS Director Bedford Regional Medical Center Overview/Objectives Explain the reasons or rational behind the importance

More information

Nicolas Bianchi M.D. May 15th, 2012

Nicolas Bianchi M.D. May 15th, 2012 Nicolas Bianchi M.D. May 15th, 2012 New concepts in TIA Differential Diagnosis Stroke Syndromes To learn the new definitions and concepts on TIA as a condition of high risk for stroke. To recognize the

More information

CLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION

CLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 04/26/2014 Radiology Quiz of the Week # 108 Page 1 CLINICAL PRESENTATION AND RADIOLOGY

More information

The Katie May Discussion. Life University Gerard W. Clum, D.C. Director, The Octagon

The Katie May Discussion. Life University Gerard W. Clum, D.C. Director, The Octagon The Katie May Discussion Life University Gerard W. Clum, D.C. Director, The Octagon First and foremost.. The Life University community and the chiropractic profession at large extend deepest sympathies

More information

What could be reffered to as dizziness by the patient?

What could be reffered to as dizziness by the patient? What could be reffered to as dizziness by the patient? Rotational vertigo Sense of instability Ataxia of gait Disturbance of vision Loss of contact with surroundings Nausea Loss of memory Loss of confidence

More information

Identification of Painful Tissue Orthopaedic Examination DX 612. James J. Lehman, DC, MBA, DABCO University of Bridgeport College of Chiropractic

Identification of Painful Tissue Orthopaedic Examination DX 612. James J. Lehman, DC, MBA, DABCO University of Bridgeport College of Chiropractic Identification of Painful Tissue Orthopaedic Examination DX 612 James J. Lehman, DC, MBA, DABCO University of Bridgeport College of Chiropractic Generalized Pain Description Joint pain may be constant

More information

Vertigo. Tunde Magyar MD, PhD

Vertigo. Tunde Magyar MD, PhD Vertigo Tunde Magyar MD, PhD What could be reffered to as dizziness by the patient? Rotational vertigo Sense of instability Ataxia of gait Disturbance of vision Loss of contact with surroundings Nausea

More information

STUDY GUIDE Component C

STUDY GUIDE Component C STUDY GUIDE Component C The Component C exam is the third of three exams required to be awarded the Canadian Chiropractic Examining Board Certificate. Collectively, these three exams are designed to evaluate

More information

Dr. Hussein Elsangak. Precautions / Contraindications in Chiropractic Management

Dr. Hussein Elsangak. Precautions / Contraindications in Chiropractic Management Dr. Hussein Elsangak Precautions / Contraindications in Chiropractic Management " Instability syndromes " Fractures " Infection of the spine " Malignancy " Abdominal aortic aneurysm " Progressive neurological

More information

Vertebral & internal carotid arteries and biomechanics

Vertebral & internal carotid arteries and biomechanics LECTURE 17- VERTEBRAL BASILAR INSUFFIENCY (VBI) Definition and aetiology o Temporary signs and symptoms arising from insufficiency of blood supply to the posterior brain. o Due to compromise of the vertebral

More information

Key Clinical Concepts

Key Clinical Concepts Cerebrovascular Review and General Vascular Syndromes, Including Those That Impact Dizziness Key Clinical Concepts Basic Review of Cerebrovascular Circulation Circulation to the brain is divided into anterior

More information

Cervical Spine Exercise and Manual Therapy for the Autonomous Practitioner

Cervical Spine Exercise and Manual Therapy for the Autonomous Practitioner Cervical Spine Exercise and Manual Therapy for the Autonomous Practitioner Eric Chaconas PT, PhD, DPT, FAAOMPT Assistant Professor and Assistant Program Director Doctor of Physical Therapy Program Eric

More information

Stroke School for Internists Part 1

Stroke School for Internists Part 1 Stroke School for Internists Part 1 November 4, 2017 Dr. Albert Jin Dr. Gurpreet Jaswal Disclosures I receive a stipend for my role as Medical Director of the Stroke Network of SEO I have no commercial

More information

P1: OTA/XYZ P2: ABC c01 BLBK231-Ginsberg December 23, :43 Printer Name: Yet to Come. Part 1. The Neurological Approach COPYRIGHTED MATERIAL

P1: OTA/XYZ P2: ABC c01 BLBK231-Ginsberg December 23, :43 Printer Name: Yet to Come. Part 1. The Neurological Approach COPYRIGHTED MATERIAL Part 1 The Neurological Approach COPYRIGHTED MATERIAL 1 2 Chapter 1 Neurological history-taking The diagnosis and management of diseases of the nervous system have been revolutionized in recent years by

More information

Vascular Disorders. Nervous System Disorders (Part B-1) Module 8 -Chapter 14. Cerebrovascular disease S/S 1/9/2013

Vascular Disorders. Nervous System Disorders (Part B-1) Module 8 -Chapter 14. Cerebrovascular disease S/S 1/9/2013 Nervous System Disorders (Part B-1) Module 8 -Chapter 14 Overview ACUTE NEUROLOGIC DISORDERS Vascular Disorders Infections/Inflammation/Toxins Metabolic, Endocrinologic, Nutritional, Toxic Neoplastic Traumatic

More information

Management of TIA. Dr Ali Ali Consultant Stroke and Geriatrics Royal Hallamshire Hospital

Management of TIA. Dr Ali Ali Consultant Stroke and Geriatrics Royal Hallamshire Hospital Management of TIA Dr Ali Ali Consultant Stroke and Geriatrics Royal Hallamshire Hospital Objectives Definition TIA and stroke TIA: Diagnosis & mimics Risk assessment Referral and emergency management Secondary

More information

Clinical Rounds. Chiropractic, Stroke & Dissection. Key Points. Inside this issue: Volume 1, Issue 1. Clinical Rounds.

Clinical Rounds. Chiropractic, Stroke & Dissection. Key Points. Inside this issue: Volume 1, Issue 1. Clinical Rounds. Volume 1, Issue 1 January 2011 Chiropractic, Stroke & Dissection Key Points Recordkeeping Chronic Headaches & Stroke Risk Communication Unusual findings after an adjustment Symptoms prior to an adjustment

More information

Clinical Guidelines for Spinal Manipulation in Naturopathic Practice

Clinical Guidelines for Spinal Manipulation in Naturopathic Practice QUALITY ASSURANCE REPORT ON NATUROPATHIC MANIPULATION Clinical Guidelines for Spinal Manipulation in Naturopathic Practice Executive Summary April 19, 2005 Clinical guidelines are designed to assist clinicians

More information

Brain and Central Nervous System Cancers

Brain and Central Nervous System Cancers Brain and Central Nervous System Cancers NICE guidance link: https://www.nice.org.uk/guidance/ta121 Clinical presentation of brain tumours History and Examination Consider immediate referral Management

More information

The NIHSS score is 4 (considering 2 pts for the ataxia involving upper and lower limbs.

The NIHSS score is 4 (considering 2 pts for the ataxia involving upper and lower limbs. Neuroscience case 5 1. Speech comprehension, ability to speak, and word use were normal in Mr. Washburn, indicating that aphasia (cortical language problem) was not involved. However, he did have a problem

More information

NEUROLOGY CLERKSHIP CORE CURRICULUM GUIDELINES

NEUROLOGY CLERKSHIP CORE CURRICULUM GUIDELINES NEUROLOGY CLERKSHIP CORE CURRICULUM GUIDELINES Endorsed by the following organizations - October 2000: American Academy of Neurology Association of University Professors of Neurology American Neurological

More information

EMU 2017 DIZZINESS AND VERTIGO Walter Himmel MD

EMU 2017 DIZZINESS AND VERTIGO Walter Himmel MD EMU 2017 DIZZINESS AND VERTIGO Walter Himmel MD There is only one essential challenge in the world of dizziness and vertigo: Don t miss a posterior circulation stroke (vertebral/basilar artery) or TIA.

More information

Patient Name: Date of Birth: Patient Name: DOB: Patient Guardian/Representative: How old are you. Handed: Right Left Ambidextrous Male

Patient Name: Date of Birth: Patient Name: DOB: Patient Guardian/Representative: How old are you. Handed: Right Left Ambidextrous Male Patient Name: Welcome to Cerebrum Health Centers. Carefully complete all of the following health history questionnaires. The accuracy of your answers will help us better diagnose and treat your condition.

More information

Spinal Cord: Clinical Applications. Dr. Stuart Inglis

Spinal Cord: Clinical Applications. Dr. Stuart Inglis Spinal Cord: Clinical Applications Dr. Stuart Inglis Tabes dorsalis, also known as syphilitic myelopathy, is a slow degeneration (specifically, demyelination) of the nerves in the dorsal funiculus of the

More information

Patient Name: Date of Birth:

Patient Name: Date of Birth: Patient Name: Date of Birth: Marital Status: Single Married Divorced Widowed Height: Referring Doctor: Weight: Primary Care Dr.: Preferred Pharmacy:(name/address) ALLERGIES: Do you have any drug allergies?

More information

Faculty of Clinical Forensic Medicine Committee 1/2018

Faculty of Clinical Forensic Medicine Committee 1/2018 Guideline Subject: Clinical Forensic Assessment and Management of Non-Fatal Strangulation Approval Date: January 2018 Review Date: January 2021 Review By: Number: Faculty of Clinical Forensic Medicine

More information

NMH happens when there is an abnormal reflex interaction between the heart and the brain, although both are structurally normal.

NMH happens when there is an abnormal reflex interaction between the heart and the brain, although both are structurally normal. Neurally mediated hypotension: is also known as: the fainting reflex, neurocardiogenic syncope, vasodepressor syncope, the vaso-vagal reflex, and autonomic dysfunction. (Hypotension= low blood pressure,

More information

DISORDERS OF THE NERVOUS SYSTEM

DISORDERS OF THE NERVOUS SYSTEM DISORDERS OF THE NERVOUS SYSTEM Bell Work What s your reaction time? Go to this website and check it out: https://www.justpark.com/creative/reaction-timetest/ Read the following brief article and summarize

More information

Pre-manipulative testing: where do we go from here?

Pre-manipulative testing: where do we go from here? Invited Clinical Commentary Pre-manipulative testing: where do we go from here? Darren A. Rivett, BAppSc(Phty), MAppSc(ManipPhty), PhD 1 Lucy Thomas, DipPhty, GradDipAppSc(ManipPhty) 1 Philip Bolton, PhD

More information

Initial Assessment Date. Therapist... PHYSIOTHERAPY ASSESSMENT FORM. Patient Details. Name. Address. Post Code.. Telephone Home.

Initial Assessment Date. Therapist... PHYSIOTHERAPY ASSESSMENT FORM. Patient Details. Name. Address. Post Code.. Telephone Home. Initial Assessment Date Therapist... PHYSIOTHERAPY ASSESSMENT FORM Patient Details Name. Address. Post Code.. Telephone Home Telephone Work Mobile E-Mail Date of Birth.. GP / Consultant. GP s Address...

More information

ANASTAMOSIS FOR BRAIN STEM ISCHEMIA/Khodadad et al.

ANASTAMOSIS FOR BRAIN STEM ISCHEMIA/Khodadad et al. ANASTAMOSIS FOR BRAIN STEM ISCHEMIA/Khodadad et al. visualization of the posterior inferior cerebellar artery. The patient, now 11 months post-operative, has shown further neurological improvement since

More information

Suspected neurological conditions: clinical questions

Suspected neurological conditions: clinical questions Suspected neurological clinical questions For questions on signs and symptoms, the committee wanted to consider any studies that determine whether a certain sign or symptom accompanying a main presenting

More information

SURNAME: FIRST NAME: Address: Who Is your GP and where do they practice? Friend: Please Name

SURNAME: FIRST NAME:  Address: Who Is your GP and where do they practice? Friend: Please Name PATIENT INTAKE FORM OFFICE USE ONLY: Intake Date: Practitioner: Dr. S. Venaille Dr. C. Lees Dr. J. Mokrzycki Informed consent: / Limited Flags: Notes: TITLE: SURNAME: FIRST NAME: BIRTHDATE: AGE: SEX: M

More information

Stroke: clinical presentations, symptoms and signs

Stroke: clinical presentations, symptoms and signs Stroke: clinical presentations, symptoms and signs Professor Peter Sandercock University of Edinburgh EAN teaching course Burkina Faso 8 th November 2017 Clinical diagnosis is important to Ensure stroke

More information

CERVICAL SPINE MANIPULATION: A RAPID LITERATURE REVIEW

CERVICAL SPINE MANIPULATION: A RAPID LITERATURE REVIEW CERVICAL SPINE MANIPULATION: A RAPID LITERATURE REVIEW JANUARY 2017 Please note that this Rapid Literature Review is a summary of information from other sources, not a representation of the policy position

More information

CONSULTATION ADMITTANCE FORM

CONSULTATION ADMITTANCE FORM CONSULTATION ADMITTANCE FORM Last Name: First Name: Address: City Postal Code: Home Phone: Work Phone: Age: Birth date (dd/mm/yr): Sex: M / F Height Weight Occupation: Alberta Health Care #: PLEASE CHECK

More information

Journal of Orthopaedic & Sports Physical Therapy. January 2012; Volume 42; Number 1; pp. 5-18

Journal of Orthopaedic & Sports Physical Therapy. January 2012; Volume 42; Number 1; pp. 5-18 1 Upper Cervical and Upper Thoracic Thrust Manipulation Versus Nonthrust Mobilization in Patients With Mechanical Neck Pain: A Multicenter Randomized Clinical Trial Journal of Orthopaedic & Sports Physical

More information

Inside Your Patient s Brain Michelle Peterson, APRN, CNP Centracare Stroke and Vascular Neurology

Inside Your Patient s Brain Michelle Peterson, APRN, CNP Centracare Stroke and Vascular Neurology Inside Your Patient s Brain Michelle Peterson, APRN, CNP Centracare Stroke and Vascular Neurology Activity Everyone stand up, raise your right hand, tell your neighbors your name 1 What part of the brain

More information

/ / / / / / Hospital Abstraction: Stroke/TIA. Participant ID: Hospital Code: Multi-Ethnic Study of Atherosclerosis

/ / / / / / Hospital Abstraction: Stroke/TIA. Participant ID: Hospital Code: Multi-Ethnic Study of Atherosclerosis Multi-Ethnic Study of Atherosclerosis Participant ID: Hospital Code: Hospital Abstraction: Stroke/TIA History and Hospital Record 1. Was the participant hospitalized as an immediate consequence of this

More information

MUSCULOSKELETAL AND NEUROLOGICAL DISORDERS

MUSCULOSKELETAL AND NEUROLOGICAL DISORDERS MUSCULOSKELETAL AND NEUROLOGICAL DISORDERS There are a wide variety of Neurologic and Musculoskeletal disorders which can impact driving safety. Impairment may be the result of altered muscular, skeletal,

More information

High Yield Neurological Examination

High Yield Neurological Examination High Yield Neurological Examination Vanja Douglas, MD Sara & Evan Williams Foundation Endowed Neurohospitalist Chair Director, Neurohospitalist Division Associate Professor of Clinical Neurology UCSF Department

More information

Patient Name: Date of Birth: Preferred Pharmacy: (name/location/phone #)

Patient Name: Date of Birth: Preferred Pharmacy: (name/location/phone #) Patient Name: Date of Birth: Referring Doctor: Primary Care Dr: Preferred Pharmacy: (name/location/phone #) CURRENT MEDICATIONS: Please list all Medication Dose Frequency 1 2 3 4 5 6 7 8 9 10 11 12 13

More information

Clinical Examination. of the. Cervicothoracic Region. Neck Disability Index. Serious Pathological Conditions. Medical Screening Questionnaire

Clinical Examination. of the. Cervicothoracic Region. Neck Disability Index. Serious Pathological Conditions. Medical Screening Questionnaire Clinical Examination Clinical Examination of the Cervicothoracic Region Screening for associated serious pathological conditions Neck disability index Physical Exam Serious Pathological Conditions Cervical

More information

387

387 http://images.tutorvista.com/content/control5coordination/human5brain.jpeg!! 387! 388! http://my.fresnounified.org/personal/lygonza/gonzalez/neuron/neuron5synapse%20communication.png!! http://www.urbanchildinstitute.org/sites/all/files/databooks/2011/ch15fg25communication5between5neurons.jpg!!

More information

Do you suffer from Headaches? - November/Dec 2011

Do you suffer from Headaches? - November/Dec 2011 Do you suffer from Headaches? - November/Dec 2011 Inside this month's issue Headaches Acute single headaches Recurring Headaches: Migraine What causes Migraine? Treatments for migraine & prevention Headaches

More information

Assessing the Stroke Patient. Arlene Boudreaux, MSN, RN, CCRN, CNRN

Assessing the Stroke Patient. Arlene Boudreaux, MSN, RN, CCRN, CNRN Assessing the Stroke Patient Arlene Boudreaux, MSN, RN, CCRN, CNRN Cincinnati Pre-Hospital Stroke Scale May be done by EMS o One of many o F facial droop on one side o A arm drift (hold a pizza box, close

More information

Vague Neurological Conditions

Vague Neurological Conditions Vague Neurological Conditions Dr. John Lefebre, MD, FRCPC Chief Regional Medical Director Europe, India, South Africa, Middle East and Turkey Canada 2014 2 3 4 Agenda Dr. John Lefebre, M.D., FRCPC 1. TIA

More information

Spinal injury. Structure of the spine

Spinal injury. Structure of the spine Spinal injury Structure of the spine Some understanding of the structure of the spine (spinal column) and the spinal cord is important as it helps your Neurosurgeon explain about the part of the spine

More information

Chiropractic , The Patient Education Institute, Inc. amf10101 Last reviewed: 01/17/2018 1

Chiropractic , The Patient Education Institute, Inc.   amf10101 Last reviewed: 01/17/2018 1 Chiropractic Introduction Chiropractic is health care that focuses on disorders of the musculoskeletal system and the nervous system, and the way these disorders affect general health. Chiropractic uses

More information

BRAIN STEM CASE HISTORIES CASE HISTORY VII

BRAIN STEM CASE HISTORIES CASE HISTORY VII 463 Brain stem Case history BRAIN STEM CASE HISTORIES CASE HISTORY VII A 60 year old man with hypertension wakes one morning with trouble walking. He is feeling dizzy and is sick to his stomach. His wife

More information

Table 1: Baseline characteristics of 108 isolated vertigo patients Clinical or laboratory variable n (%) Female 67 (62%)

Table 1: Baseline characteristics of 108 isolated vertigo patients Clinical or laboratory variable n (%) Female 67 (62%) 4. Results The 108 patients who fulfilled the inclusion and exclusion criteria were analyzed. Baseline demographic and epidemiological characteristics of the patients are given in Table 1. Table 1: Baseline

More information

Australian Canoeing Limited Concussion Guidelines

Australian Canoeing Limited Concussion Guidelines Australian Canoeing Limited Concussion Guidelines Date 5 th January 2016 Australian Canoeing PO Box 6805 Silverwater, NSW 2128 T: (02) 9763 0670 W: canoe.org.au CONTENTS 1. Overview... 1 2. Introduction...

More information

How to Think like a Neurologist Review of Exam Process and Assessment Findings

How to Think like a Neurologist Review of Exam Process and Assessment Findings Lehigh Valley Health Network LVHN Scholarly Works Neurology Update for the Non-Neurologist 2013 Neurology Update for the Non-Neurologist Feb 20th, 5:10 PM - 5:40 PM How to Think like a Neurologist Review

More information

YOUR INFORMED CONSENT PACKET

YOUR INFORMED CONSENT PACKET YOUR INFORMED CONSENT PACKET National Chiropractic Council 800-622-6869 www.chiropracticcouncil.com Implementing Informed Consent Process 800-622-6869 www.chiropracticcouncil.com The best, most conscientious

More information

Cervical Spine Adjusting and the Vertebral Artery

Cervical Spine Adjusting and the Vertebral Artery www.fisiokinesiterapia.biz Cervical Spine Adjusting and the Vertebral Artery Contemporary perspectives on patient safety and protection, clinical reality and patient management Why? Currently the single

More information

Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study

Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study 1 Spine Volume 33(4S), February 15, 2008 pp S176-S183 Cassidy, J David DC, PhD;

More information

ACTIVE EDGE CHIROPRACTIC

ACTIVE EDGE CHIROPRACTIC ACTIVE EDGE CHIROPRACTIC HEALTH HISTORY QUESTIONNAIRE PERSONAL INFORMATION Name: Female Male Alberta Health Care# Address: City: Province: Postal Code: Telephone: Home: Work: Cell: Email: Occupation: Birth

More information

STROKE INTRODUCTION OBJECTIVES. When the student has finished this module, he/she will be able to:

STROKE INTRODUCTION OBJECTIVES. When the student has finished this module, he/she will be able to: STROKE INTRODUCTION Stroke is the medical term for a specific type of neurological event that causes damage to the brain. There are two types of stroke, but both types of stroke cause the same type of

More information

Daniel J. Blizzard, MD, MS

Daniel J. Blizzard, MD, MS Daniel J. Blizzard, MD, MS None Common degenerative (usually) condition caused by compression on the spinal cord that is characterized by clumsiness and difficulty with fine motor tasks in the hands and

More information

THE LUMBAR SPINE (BACK)

THE LUMBAR SPINE (BACK) THE LUMBAR SPINE (BACK) At a glance Chronic back pain, especially in the area of the lumbar spine (lower back), is a widespread condition. It can be assumed that 75 % of all people have it sometimes or

More information

TALKING POINTS Chiropractic Cervical Manipulation and Informed Consent

TALKING POINTS Chiropractic Cervical Manipulation and Informed Consent TALKING POINTS Chiropractic Cervical Manipulation and Informed Consent One superior court judge has said that the risk of stroke due to a chiropractic cervical adjustment is so remote that informing the

More information

CERVICAL SPINE EVALUATION MARK FIGUEROA PHYSICAL THERAPIST

CERVICAL SPINE EVALUATION MARK FIGUEROA PHYSICAL THERAPIST CERVICAL SPINE EVALUATION MARK FIGUEROA PHYSICAL THERAPIST OVERVIEW OF CLINICAL REASONING Stage of disorder Pathoanatomical diagnosis Signs and symptoms Consideration of the evidence gathered Common sense

More information

CHIROPRACTIC NEW PATIENT FORM REASON FOR VISIT

CHIROPRACTIC NEW PATIENT FORM REASON FOR VISIT FULL NAME: DATE OF BIRTH (DD/MM/YYYY): STREET ADDRESS: PROVINCE: HOME PHONE: (CHECK WHICH PREFERRED) WORK PHONE: EMAIL ADDRESS: NEW LEGISLATION REQUIRES THAT WE OBTAIN CONSENT PRIOR TO SENDING EMAILS TO

More information

ETA STAFF - concussion

ETA STAFF - concussion These guidelines are designed to be used by Referees, Coaching staff and Managers This guideline has been adapted from the Rugby Football Union (RFU) guidance, World rugby guidance and the Zurich Consensus

More information

Objectives. Stroke Facts 2/27/2015. EMS in Stroke Care: A Critical Partnership

Objectives. Stroke Facts 2/27/2015. EMS in Stroke Care: A Critical Partnership EMS in Stroke Care: A Critical Partnership Spokane County EMS Objectives Identify the types and time limitations for acute ischemic stroke treatment options Identify the importance of early identification

More information

Stroke Advice. What is a Stroke. What is a Stroke 1

Stroke Advice. What is a Stroke.   What is a Stroke   1 Stroke Advice 2 What is a Stroke www.nichs.org.uk What is a Stroke www.nichs.org.uk 1 What is a Stroke? Every two hours someone in Northern Ireland has a stroke, that s about 4,000 strokes a year. A stroke

More information

CERVICAL SPINE TIPS A

CERVICAL SPINE TIPS A CERVICAL SPINE TIPS A Musculoskeletal Approach to managing Neck Pain An ALGORITHM, as a management guide Rick Bernau & Ian Wallbridge June 2010 THE PROCESS An interactive approach to the management of

More information

Past Surgical History

Past Surgical History Name: DOB: Check All That Apply Past Medical History o Anemia o Aneurysm o Asthma o Bipolar o Bleeding Disorder o Blood Clot o Brain Tumor o Bronchitis o Cancer o Crohn s Disease/Ulcerative Colitis o Depression

More information

Identifying Cerebrovascular Disorders. Wengui Yu, MD, PhD Department of Neurology, University of California, Irvine

Identifying Cerebrovascular Disorders. Wengui Yu, MD, PhD Department of Neurology, University of California, Irvine Identifying Cerebrovascular Disorders Wengui Yu, MD, PhD Department of Neurology, University of California, Irvine Objectives Review different types of cerebrovascular disorders. Briefly discuss etiology,

More information

Patient Information. Client/Responsible Party Signature: Date: Legal Representation (If applicable): Name: Signature:

Patient Information. Client/Responsible Party Signature: Date: Legal Representation (If applicable): Name: Signature: Patient Information First Name: Middle Name: Last Name: Address: Apt/Unit: City: State: Zip: Date of Birth: / / Gender: Last 4 of Social Security #: Home Phone #: Cell #: E-Mail: Emergency Contact: Phone#:

More information

TIAs and posterior circulation problems

TIAs and posterior circulation problems TIAs and posterior circulation problems A/Professor Helen Dewey Head, Stroke Service Austin Health Austin Health How many strokes and TIAs are out there? depends on the definition! ~60,000 strokes in

More information

Vertebral Artery Pseudoaneurysm

Vertebral Artery Pseudoaneurysm Vertebral Artery Pseudoaneurysm T. W. Khanzada,K. R. Makhdoomi ( Department of Vascular Surgery, Liaquat National Postgraduate Medical Centre, Karachi. ) Vertebral artery (VA) pseudoaneurysms are exceedingly

More information

WHAT IS A STROKE? What causes a stroke? What disabilities can result from a stroke?

WHAT IS A STROKE? What causes a stroke? What disabilities can result from a stroke? Know Stroke Stroke is the third leading cause of death in the United States and a leading cause of serious, long-term disability in adults. About 600,000 new strokes are reported in the U.S. each year.

More information

Brisbin Family Chiropractic

Brisbin Family Chiropractic Information reviewed with patient: Dr. Initials Today s Date Brisbin Family Chiropractic Name: Sex: Male Female Address: City: Postal Code: Home Ph# Work# Ext# Cell# Preferred number (circle one) Home

More information

LA CLINICA E LA DIAGNOSI DELLA VERTIGINE VASCOLARE

LA CLINICA E LA DIAGNOSI DELLA VERTIGINE VASCOLARE LA CLINICA E LA DIAGNOSI DELLA VERTIGINE VASCOLARE M. Mandalà Azienda Ospedaliera Universitaria Senese WHY ARE WE SCARED? NEED TO BETTER UNDERSTAND PATHOPHYSIOLOGY WHAT IS KNOWN WHAT IS EFFECTIVE and SIMPLE

More information

National Hospital for Neurology and Neurosurgery. Migraine Associated Dizziness. Department of Neuro-otology

National Hospital for Neurology and Neurosurgery. Migraine Associated Dizziness. Department of Neuro-otology National Hospital for Neurology and Neurosurgery Migraine Associated Dizziness Department of Neuro-otology If you would like this document in another language or format or if you require the services of

More information

Central nervous system

Central nervous system Central nervous system By Dr. Mohsen Dashti Clinical Medicine & Pathology 316 7 th Lecture Lecture outline Review of structure & function. Symptoms, signs & tests. Specific diseases. Review of structure

More information

STROKE UPDATE ANTHEA PARRY MAY 2010

STROKE UPDATE ANTHEA PARRY MAY 2010 STROKE UPDATE ANTHEA PARRY MAY 2010 Delivery of stroke care Clinical presentations Management Health Care for London plan 8 HASU (hyperacute) units 20 stroke units TIA services Hyperacute stroke units

More information

Various Stroke and Symptoms and Causes

Various Stroke and Symptoms and Causes Various Stroke and Symptoms and Causes ShinJung Park Daegu Dongho high School, Korea G12 [Abstract] Stroke is one of the most common leading causes of death. In America, it is the 5 th leading cause of

More information

Using the Neuro Exam to Diagnose Mimics

Using the Neuro Exam to Diagnose Mimics Using the Neuro Exam to Diagnose Mimics Jennifer Simpson, MD Neurohospitalist Vascular Neurologist None 2 Review the differential diagnosis for stroke Identify patients physical examination findings that

More information

Vertebrobasilar Artery Insufficiency (VBI) and Cervical Artery Dissection (CAD)

Vertebrobasilar Artery Insufficiency (VBI) and Cervical Artery Dissection (CAD) WSCC Clinics Protocol Adopted: 10/98 Revised: 9/01, 7/07,4/08 To be reviewed: 7/10 Vertebrobasilar Artery Insufficiency (VBI) and Cervical Artery Dissection (CAD) This protocol has been updated adopting

More information

Fractures of the Thoracic and Lumbar Spine

Fractures of the Thoracic and Lumbar Spine A spinal fracture is a serious injury. Nader M. Hebela, MD Fellow of the American Academy of Orthopaedic Surgeons http://orthodoc.aaos.org/hebela Cleveland Clinic Abu Dhabi Cleveland Clinic Abu Dhabi Neurological

More information

Cascadia Chiropractic Centre

Cascadia Chiropractic Centre Name: Cascadia Chiropractic Centre New Patient Information & Clinical Record Date: Date of Birth: Your age: Care Card #: Address: City/Prov: Postal Code: Phone: Cell: Work Phone: E-mail Address: Marital

More information

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.

MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question. EPC Ch 24 Quiz w-key Name MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question. 1) Which of the following best explains the presentation and prognosis of

More information

Carotid Artery Dissection Causing an Isolated Hypoglossal. Nerve Palsy

Carotid Artery Dissection Causing an Isolated Hypoglossal. Nerve Palsy Archives of Clinical and Medical Case Reports doi: 10.26502/acmcr.96550035 Volume 2, Issue 5 Case Report Carotid Artery Dissection Causing an Isolated Hypoglossal Muzzammil Ali*, Yatin Sardana Nerve Palsy

More information

Neurology on the MAU. Geraint Fuller

Neurology on the MAU. Geraint Fuller Neurology on the MAU Geraint Fuller Conflicts of Interest Clinical neurologist No drug company links Past President of Association of British Neurologists Co-Editor of Practical Neurology Receive Royalties

More information

Vertebrobasilar Insufficiency

Vertebrobasilar Insufficiency Equilibrium Res Vol. (3) Vertebrobasilar Insufficiency Toshiaki Yamanaka Department of Otolaryngology-Head and Neck Surgery, Nara Medical University School of Medicine Vertebrobasilar insufficiency (VBI)

More information

Acoustic neuroma s/p removal BPPV (Crystals)- 50% of people over 65 y/ o with dizziness will have this as main reason for dizziness

Acoustic neuroma s/p removal BPPV (Crystals)- 50% of people over 65 y/ o with dizziness will have this as main reason for dizziness Dizziness and the Heart Mended Hearts Inservice Karen Hansen, PT, DPT, Cert Vestibular Rehab, CEAS Tennessee Therapy & Balance Center, LLC July 21, 2016 Balance We maintain balance with input from our

More information

FILED: NEW YORK COUNTY CLERK 04/12/ :57 PM INDEX NO /2011 NYSCEF DOC. NO RECEIVED NYSCEF: 04/12/2018

FILED: NEW YORK COUNTY CLERK 04/12/ :57 PM INDEX NO /2011 NYSCEF DOC. NO RECEIVED NYSCEF: 04/12/2018 ' NYNeurological.- 't Associates, P.C. e 3He e a David Dc vld Snyder, M.D. Emilio Oribe, M.D., F.A.C.P Tonya FOtiml, M.D. Yvonne Zoharckis, M,b. www.nynapc.com July 3, 2017 Sabatini 4 Associates 237 West

More information

what is the permanent impact of loss of the vestibular sense? for balance, vision and spatial orientation)

what is the permanent impact of loss of the vestibular sense? for balance, vision and spatial orientation) what is the permanent impact of loss of the vestibular sense? for balance, vision and spatial orientation) loss of speed - poor dynamic vision (daily life) - fear to fall and falls loss of automatisation

More information

Spasm of the extracranial internal carotid artery resulting from blunt trauma demonstrated by angiography

Spasm of the extracranial internal carotid artery resulting from blunt trauma demonstrated by angiography Spasm of the extracranial internal carotid artery resulting from blunt trauma demonstrated by angiography Case report ELISHA S. GURDJIAN, M.D., BLAISE AUDET, M.D., RENATO W. SIBAYAN, M.D., AND LLYWELLYN

More information

Therapeutic Exercise And Manual Therapy For Persons With Lumbar Spinal Stenosis

Therapeutic Exercise And Manual Therapy For Persons With Lumbar Spinal Stenosis Therapeutic Exercise And Manual Therapy For Persons With Lumbar Spinal Stenosis The program consisted of manual therapy twice per week (eg, soft tissue and neural The components of the Boot Camp Program

More information

Chapter 32. Hearing, Speech, and Vision Problems. Copyright 2019 by Elsevier, Inc. All rights reserved.

Chapter 32. Hearing, Speech, and Vision Problems. Copyright 2019 by Elsevier, Inc. All rights reserved. Chapter 32 Hearing, Speech, and Vision Problems Copyright 2019 by Elsevier, Inc. All rights reserved. Lesson 32.1 Define the key terms and key abbreviations in this chapter. Describe the common ear, speech,

More information

HISTORY PAPERWORK FOR APPOINTMENTS WITH DAVID A. PROPST, D.O.

HISTORY PAPERWORK FOR APPOINTMENTS WITH DAVID A. PROPST, D.O. HISTORY PAPERWORK FOR APPOINTMENTS WITH DAVID A. PROPST, D.O. Name: Age: Room Number: Sex: MALE or FEMALE Dominant Hand: RIGHT or LEFT Height Weight Blood pressure HISTORY 1. Did your first symptoms begin

More information