Australia Chiropractic Continuing Education

• Outline the limitations of a recent trial on preventive treatments including spinal manipulation for neck pain and how they contribute to our interpretation of the results of the study
• Interpret results of an important trial on spinal manipulation and exercise for neck pain
• Discuss recent evidence comparing spinal manipulation to mobilization for recent onset neck pain
• Use recent evidence to justify manipulating various spinal regions for patients with neck pain
• Critique the potential for chest and neck mobilizations to affect spirometric performance (breathing)

• Contrast Clinical Guideline-based care with usual medical care for acute low back pain
• Recognize the potential benefit of adding exercise prescription to spinal manipulation for low back pain
• Compare the effectiveness of spinal manipulation to McKenzie Method interventions for persistent low back pain
• Outline factors that may help predict improvement in patients seeking chiropractic care for low back pain
• Explain the benefits of evidence-based care for low back pain

• Compare the efficacy of standard medical care (SMC) alone versus chiropractic spinal manipulation + SMC for acute low back pain patients
• Discuss the value of a combined (pragmatic) chiropractic approach for treating low back pain
• Analyze the state of the research literature directly comparing spinal manipulation, exercise and acupuncture as treatments for low back pain
• Update your understanding of joint cavitation during side posture lumbar manipulation
• Critique the only study (to date) on maintenance care for low back pain including spinal manipulation

• Develop evidence-based chiropractic treatment recommendations for nonspecific (mechanical) neck pain in adults
• Discuss the clinical criteria justifying spinal manipulative therapy for neck pain
• Assess the relative effectiveness of spinal manipulative therapy and rehabilitative exercise for neck pain in seniors
• Describe the working mechanism of manual therapy in participants with chronic tension-type headache
• Examine the cerebrovascular hemodynamic response of cervical spine positions using MRI on the vertebral artery

• Critique the state of the evidence for manual therapy interventions in the treatment of cervical radiculopathy
• Compare two common interventions – spinal manipulation and nerve root injection – for patients with MRI-confirmed lumbar disc herniation
• Critique the state of the evidence for spinal manipulation (specifically) in the treatment of cervical radiculopathy
• Interpret the results of a cohort study of MRI-confirmed symptomatic cervical disc herniation patients treated with cervical manipulation
• Compare isolated cervical SMT versus a combination of cervical, cervico-thoracic and thoracic SMT in patients with chronic mechanical neck pain

• Describe the science behind chiropractic care
• Translate the intent of manipulative therapy to patients and other healthcare providers
• Describe the potential results of not having recommended chiropractic care
• Outline the different theories of the subluxation complex
• Justify the care you recommend based on electrodiagnostic, imaging, and laboratory studies

• Compare chiropractic maintenance care to symptom-guided care for patients with persistent or recurrent low back pain
• Investigate whether adding chiropractic care to usual medical care improves outcomes for military personnel suffering from low back pain
• Evaluate the research on the effectiveness of mobilization and manipulation for chronic non-specific low back pain
• Determine the effects of spinal manipulation on biochemical markers in humans
• Appraise the associations between chiropractic and primary care physician care in relation to acute lumbar disc herniation with early surgery

• Define and classify adverse events associated with manipulation and mobilization
• Review symptoms patients perceive as adverse
• Describe the incidence of severe adverse events among chiropractic recipients
• Outline adverse events in the pregnant and postpartum periods

• Describe the vertebral architectural distortion that predicts spinal imbalances. 
• Explain the factors involved in the etiology related to the primary components of the proprioceptor-cerebellar network. 
• Cite the law that establishes a classic chiropractic patient via radiograph. 
• Compare the classic manual osseous adjustment to Sensor-Based-Technique in regards to risk and effectiveness for reversing the cause of most chronic subluxations: An aberrant proprioceptor-cerebellar network feedback loop, (usually initiated by injury,) sustained through time by wedged vertebral bodies via Wolff's law, involving neuromuscular fixation engrams compensating for unlevel vertebral architecture. 
• Palpate the tendinous insertions of the paraspinal musculature in the areas of the spinous process tips and identify those areas that show tension, and demonstrate proper cross-friction massage at those points.

• Summarize our current understanding of biomechanical and biochemical processes that contribute to the development of discogenic back pain 
• Assess the possible association between receiving chiropractic spinal manipulation and the risk of subsequent cauda equina syndrome (CES) in adults with low back pain 
• Determine the impact of receiving chiropractic spinal manipulation on the odds of being prescribed Benzodiazepines for radicular low back pain 
• Establish if receiving chiropractic spinal manipulation following a radicular low back pain diagnosis influences the likelihood of subsequently receiving a gabapentin prescription 
• Examine the association between receipt of spinal manipulation and tramadol prescription among adults with a new diagnosis of radicular low back pain

History and Background

• Recognize the historical emergence of spinal manipulation (SMT) throughout numerous time periods and among different professions
• Outline the development of the chiropractic profession from the late 1800s to modern day
• Briefly review existing and historical models of spinal manipulative therapy (SMT)

What’s that sound?

• Distinguish cavitation from tribonucleation and explore the relevance of the popping sound with SMT.

 Mechanisms

• Integrate the concept of mechanotransduction into your understanding and appraisal of SMT mechanisms
• Outline different ways methods to provide mechanical stimulation during chiropractic treatment
• Explain what the evidence tells us about joint motion, gapping and location of popping sounds with SMT
• Explore contemporary areas of scientific inquiry into the neurophysiologic mechanism(s) of action for high-velocity spinal manipulation
• Describe how SMT may influence pain modulation
• Critique the evidence relating to the influence of SMT on blood biomarkers and immunity
• Discuss the potential brain and sensorimotor functional impacts of SMT
• Appreciate the relevance of spinal stiffness and the potential impact of SMT on spinal biomechanics
• Summarize existing evidence relating to the SMT and muscle function.

Clinical Considerations

• Describe clinical factors that could influence how SMT exerts its effect(s).
• Discuss existing evidence on the dose-response relationship between SMT and clinical outcomes.
• Recognize the importance of contextual factors, patient expectations and comfort in driving positive clinical outcomes.
• Briefly summarize existing research on studies evaluating SMT for non-spinal conditions.

Course Conclusion

• Propose an integrated, conceptual model of how SMT may exert its effects for our patients.
• Recognize that chiropractic care helps patients via many aspects of the clinical encounter.

• Summarize the following types of medical errors:
  1. medication errors
  2. handoff errors
  3. diagnostic errors
  4. healthcare acquired infections
  5. device associated infections
• List factors that increase the risk of the above medical errors
• Describe strategies to prevent the above medical errors

• Recommend taking Medical Errors 202a and 202b prior to taking this course
• Summarize surgical errors and identify factors that increase the risk of surgical error as well as strategies to prevent them
• Discuss proper reporting of medical errors
• Enumerate the elements that comprise root cause analysis
• Describe strategies patients, providers, systems can use to reduce the risk of medical errors and improve patient health and safety
• Describe what to do when things go wrong

• List and define the components of the SINSS classification used for an upper quarter evaluation
• Recall two neurophysiological effects of upper quarter joint mobilizations
• Cite two indications for performing grade 1-2 joint mobilizations to the upper quarter
• Identify two conditions that would warrant performing grad 3-4 joint mobilizations to the upper quarter
• Enumerate 5 contraindications for performing joint mobilizations to the upper quarter State two specific diagnostic or impairment-based indications for performing a cervical distraction mobilization.
• Summarize the purpose for performing a posterior mobilization to the glenohumeral joint
• Paraphrase the clinical prediction rule used to determine the effectiveness of cervico-thoracic mobilizations for patient’s presenting with subacromial impingement.

• List and define the components of the SINSS classification used for a lower quarter evaluation
• Recall two neurophysiological effects of joint mobilizations as applied to the lower quarter
• Cite two indications for performing grade 1-2 joint mobilizations for the lower quarter
• Identify two conditions that would warrant performing grad 3-4 joint mobilizations for the lower quarter
• Enumerate 5 contraindications for performing joint mobilizations as applied to the lower quarter
• State two specific diagnostic or impairment-based indications for performing a lateral to caudal hip joint mobilization.
• Explain the purpose for performing a posterior to anterior proximal tibiofibular glide
• Provide two common indications for performing a medial patella mobilization technique

• Define the basic principles of MRI imaging as it relates to the musculoskeletal system.
• Summarize current criteria utilized to identify Lumbar pathology and the appropriate lexicon utilized in neuroradiology to assist the Doctor of Chiropractic in interpreting studies ordered.
• Identify normal anatomy of the lumbar spine on MRI images.
• Differentiate gross pathology associated with the most common MRI presentations associated with general Chiropractic practice.
• Assess the necessity of MRI imaging for lumbar pathology, with an understanding of the pathophysiology of the degenerative process associated with lumbar spine aging

• Demonstrate skills to properly perform a patient interview
• Properly record a chief complaint
• Perform a neurological examination of the head and neck
• Perform a mental status examination

• This course contains all content from Neurological Exam 101 through 107. Please see educational objectives for those courses

• Cite anatomy and function of the cranial nerves
• Examine the twelve cranial nerves during a clinical examination
• Discuss disorders of cranial nerves

• Perform and chart a neurological examination of the voluntary motor system and the somatic sensory system
• Apply results of the examination findings in the differential diagnosis of patients
• Describe the three neuron pathway involved with sensorineural innervation
• Discuss multimodal sensations

• Perform an appropriate examination of the reflexes, including deep tendon, superficial, visceral and pathological reflexes
• Describe the anatomy associated with reflexes
• Properly grade and record reflexes
• Interpret the Results of Reflex Testing

• Perform an examination of the systems involved with Movement and Coordination
• Discuss cerebellar anatomy
• Differentially Diagnose by applying clinical signs of cerebellar dysfunction
• Recognize cerebellar syndromes by their anatomical areas
• Apply specific principles of examination to improve the Chiropractic Spinal Examination
• Describe specific procedures of the spinal examination

• Perform a clinical assessment of pain and function
• Explain the psychophysiological profile of pain patients
• Discuss the treatment of pain

• Maintain proper records of neurological examination in the SOAP format
• Write narrative reports reflecting the neurological examination
• Apply an outline of fundamental procedures in performing a complete chiropractic neurological examination

• Identify the neurological aspects of manipulation
• Review the basics of cellular physiology as it relates to manipulation
• Discuss action potentials and synapses
• Evolve an understanding of receptors
• Describe nociception and effects of manipulation

• Further elucidate the neurological aspects of manipulation
• Discuss nociceptive input to the spinal cord
• Review mechanoreceptors and their fibers
• Identify the relationship of mechanoreceptors with endorphin/enkephalin
• Analyze the history of referred pain patterns

• Describe axonal degeneration in inflammatory neuropathy
• Construct criteria for diagnosis of multiple sclerosis
• Discuss the use of antioxidant therapy in neurologic disease
• Review the sensory innervation of the SI joint
• Identify mechanoreceptor control of shoulder musculature

• Evaluate the basics of nerve conduction
• Comment on recording action potentials
• Review NCV/EMG recording issues
• Identify the diagnostic usefulness of H-reflex and F-response
• Construct differential diagnosis with Nerve Conduction

• Define the use of Co-Enzyme Q as preventive treatment for migraines
• Discuss the modular headache theory
• Describe the neurovascular aspects of cluster headaches
• Identify the nutritional etiology of headache and ataxia
• Review the relationship of migraines and menstruation

• Describe the effect of chiropractic on motor control
• Discuss theories of how movements are chosen
• Discuss how movements are sequenced, and skills are learned
• Develop a motor control examination for your practice
• Distinguish components of the motor assessment