Clinical Biomechanics: Basic Factors of Biodynamics and Joint Stability

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

The following is Chapter 3 from RC’s best-selling book:
Clinical Biomechanics: Musculoskeletal Actions and Reactions

The following materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 3:   Basic Factors of Biodynamics and Joint Stability

The techniques used for analyzing static positions of the body are only approximate inasmuch as forces accompanying movement incorporate such dynamic factors as acceleration, momentum, friction, the changing positions of rotational axes, and the resistance and support offered by tissues other than muscles. This chapter discusses the basic concepts and terms of biodynamics, biomechanical stress, and the biomechanical aspects of articular cartilage pertinent to the clinical setting.

Structural Motion

The study of dynamics is concerned with loads and the motions of bodies (kinematics) and the action of forces in producing or changing their motion (kinetics). Kinematics lets us describe the characteristics of motion position, acceleration, and velocity such as in gait or scoliotic displacements. Here we are concerned with the position of the center of mass of the body and its segments, the segmental range of motion, and the velocity and direction of their movements. In kinetics, we become concerned with the forces that cause or restrict motion such as muscle contraction, gravity, and friction. A complete biomechanical analysis of human motion or motion of a part would include both kinematic and kinetic data.

Motion can be defined as an object’s relative change of place or position in space within a time frame and with respect to some other object in space. Thus, motion may be determined and illustrated by knowing and showing its position before and after an interval of time. While linear motion is readily demonstrated in the body as a whole as it moves in a straight line, most joint motions are combinations of translatory and angular movements that are more often than not diagonal rather than parallel to the cardinal planes. In addition to muscle force, joint motion is governed by factors of movement freedom, axes of movement, and range of motion.

Degrees of Freedom

JOINT AXES

As previously discussed, the body is composed of numerous uniaxial, biaxial, and multiaxial joints. Joints with one axis have one degree of freedom to move in one plane such as pivot and hinge joints, joints with two axes have two degrees of freedom to move in two different planes, and joints with three axes have three degrees of freedom to move in all three planes, eg, the ball-and-socket joints. Thus, that motion in which an object may translate to and fro along a straight course or rotate one way or another about a particular axis equals one degree of freedom.

In Chapter 1, joint classification was given under the major divisions of synarthrodial, amphiarthrodial, and diarthrodial joints. This is the classic anatomic classification. However, from a purely biomechanical viewpoint, joint motion can be reduced to just two types: (1) ovoid, which permits motion in one plane, X; and (2) sellar, which permits motion in two planes, Y and Z (Fig. 3.1).

You may review the complete Chapter (including sketches and Tables)
at the
ACAPress website

Pingbacks, Tweets, and Referrals, Oh My!

We are asking that our readers please use the actual address (URL) of our posts (for example, http://www.chiro.org/wordpress/?p=3413 ) when you make a Tweert or mention of one of our articles in any form of social media.

Search engines do not count shortened URLs as real traffic to our site, because their software does not track them to the final destinations. All you do is raise the Stats for Tiny or Bit.

So, if you are interested in supporting our website, and increasing our standing with the search engines, please use the full URL address to our materials. Thank you!

"I Want Normal Kids"

This week, the news has been full of the tragic story of a Texas mother who murdered her children because she suspected them to be autistic.  According to the LA Times,

An Irving, Texas, mother accused of strangling her two children with an antenna wire told a 911 operator that she killed them because they were not "normal."

"Both are autistic," she said. "I don't want my kids to be like that. I want normal kids."

From the little information available, it seems clear that this particular mother was not able to fully understand the magnitude of her actions.  In fact, it seems likely that there were many issues behind this tragic action that had nothing whatever to do with autism.

What makes this story hit home, though, besides the terrible nature of the crime itself, is the searing statement "I want normal kids."

Of course we all, really, want "normal" kids.  That is, we want kids who can talk, laugh, play, learn, run, make friends, excel, discover and grow.  When we have kids who are diagnosed as "other than normal," our days and nights are dedicated to helping those kids find paths to enjoying life as normally as possible.  Sometimes, the struggle to achieve normalcy is overwhelming - even to parents who understand the disorder, feel empowered to help their child, and have the support they need to take action.

Kim Stagliano of Age of Autism has written a moving piece about the struggles she's gone through to help her girls.  Even for an editor at a major autism blog who has a book coming out and all kinds of support networks within the autism community, it's not easy.

For those of us with kids on the autism spectrum, the reality is that we may never be able to achieve that "normal" life we long for.  Sometimes, that feels okay.  Other times it doesn't.  Sometimes we may need time away, and other times we may feel overwhelmed.

It's okay to step away.  It's okay to feel overwhelmed.  It's more than okay to ask for help.  It's also important to remember that occasional frustrated, sad or angry feelings - combined with responsible, thoughtful action - are natural and appropropriate.  While stories about murder may terrify us, they do not reflect who we are as individuals or as a community.

"I Want Normal Kids" originally appeared on About.com Autism on Thursday, July 29th, 2010 at 15:14:45.

Permalink | Comment | Email this

Clinical Biomechanics of the Cervical Spine

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

The following is Chapter 7 from RC’s best-selling book:
Clinical Biomechanics: Musculoskeletal Actions and Reactions

The following materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 7:   CLINICAL BIOMECHANICS OF THE CERVICAL SPINE

This chapter considers those factors that are of biomechanical and related clinical interest imperative to the satisfactory evaluation of common or not infrequent cervical syndromes. The discussion assumes that the physician is skilled in taking a thorough clinical history and performing the basic physical, orthopedic, neurologic, and roentgenographic examination procedures. The kinesiology and kinematics of the neck, the effects and mechanisms of cervical trauma, and a number of clinical problems are discussed that are pertinent to the diagnosis and management of musculoskeletal cervical disorders.

Background

The viscera of the neck serve as a channel for vital vessels and nerves, the trachea, esophagus, spinal cord, and as a site for lymph and endocrine glands. The cervical spine provides musculoskeletal stability and support for the cranium, and a flexible and protective column for movement, balance adaptation, and housing of the spinal cord and vertebral artery. When the head is in balance, a line drawn through the nasal spine and the superior border of the external auditory meatus will be perpendicular to the ground.

Cervical subluxations may be reflected in total body habitus, and insults can manifest themselves throughout the motor, sensory, and autonomic nervous systems. Many peripheral nerve symptoms in the shoulder, arm, and hand will find their origin in the cervical spine. Nowhere in the spine is the relationship between the osseous structures and the surrounding neurologic and vascular beds as intimate or subject to disturbance as it is in the cervical region.

Many of the skeletal landmarks readily observed in the thin individual are frequently obscured in the obese (Fig. 7.1). Except for the manatee and some sloths, all mammals have seven cervical vertebrae.

Kinesiology of the Neck

The cervical spine is a miracle in design and structure as it moves in various planes. It must support the head, and it must move the eyes and the ears for various sensory orientations.

Mechanically, the head teeters on the atlanto-occipital joints, shaped like cupped palms tipped slightly medially. Because the line of gravity falls anterior to these articulations, a force must be constantly provided in the upright posture by the posterior neck muscles to hold the head erect. Added to this gravitational stress is the action of the anterior muscles of the neck, essentially the masticatory, suprahyoid, and infrahyoid groups, which as a chain join the anterior cranium to the shoulder girdle.

Flexion, extension, rotation, lateral flexion, and circumduction are the basic movements of the cervical region. Movements of the head on the neck are generally confined to the occiput-atlas-axis complex and can be described separately from movements of the neck on the trunk. The prime movers and accessories involved in neck motion are listed in Table 7.1.

Table 7.1. Neck Motion

You may review the complete Chapter (including sketches and Tables)
at the
ACAPress website

Chiropractor helps PGA players work through their aches and pains

Source Observer-Dispatch
by FRAN PERRITANO

Tom LaFountain hails from a very athletic family, so it would be natural that his career is somehow connected to sports. LaFountain is a chiropractic orthopedist who practices in Utica, but he also has been a member of the PGA sports medicine team since 1997. He has worked with some famous golfers including Phil Mickelson, Tiger Woods, Jim Furyk, Vijay Singh, Davis Love, Jack Nicklaus and Arnold Palmer.

Question: You’ve been involved as a chiropractor on the PGA Tour since 1997. How did that come about?

Answer: I had worked for seven years for the U.S. Speedskating Team and had done the Winter Olympic Games in Albertville, France, in 1992 and Lillihammar, Norway, in 1994. I became friends with a physical therapist who worked on the U.S. Luge team. He left to work with the PGA Tour after the 1992 Olympics. In 1997, he called me and said that they needed someone to work on the PGA Tour that had a specialty in spinal problems, and that he thought that I would be a good fit. I did a trial tournament at the Riviera Country Club in Los Angeles, signed on and have been there since.

Q: What do you work on with the players?

A: When a player presents with an injury, I am responsible for assessing his condition as it relates to normal functioning and how it will affect his performance. I then set up a comprehensive treatment regime (soft tissue procedures, spinal manipulation), implement it and guide him through exercise rehabilitation to stabilize the condition.

Q: You’ve had a lot of positive reactions from the likes of Tiger Woods, Phil Mickelson, Jack Nicklaus and Arnold Palmer. What runs through your head when these pros compliment the work you do?

A: Their compliments are my barometer for letting me know the effectiveness and efficiency of the treatments I am performing on them. They all have had exposure to very capable healthcare specialists throughout the world and it lets me know that I am on track with adapting to their different demands and utilizing appropriate techniques.

Q: At what point in your life did you decide to work with athletes?

A: Having grown up with sports a significant part of my life, I enjoyed the challenges and what they demanded of an athlete. The dedication and sacrifice required of an individual to excel in their respective sport was right in line with my upbringing. Even though I did not have an opportunity to carry my sports career further, I wanted to be plugged into helping someone get the most of their physical talents. The same feeling carries through with the patients in my office.

Q: You come from a very athletic family? Was there a lot of friendly competition growing up?

A: At the time I did not think of it as competitive, it was just a way of life. Whether it was arm wrestling with my dad or trying to throw a better knuckle-curve than my uncle, fun challenges were always there.

Q: How did your upbringing in the Mohawk Valley prepare you for your career?

A: I could not have chosen a better place to grow up than in the Mohawk Valley. The educational opportunities and the families that became friends through sports provided a fertile ground for self growth. When I set up my practice, there was never a doubt it would be in the Mohawk Valley. Having traveled to many great places, it is the best kept secret.

Q: Is your chosen profession something you’ve always wanted to do?

A: Throughout college, I wanted to be a corporate attorney. I majored in economics until my junior year when I got injured playing football. After being told I would need surgery and that my future in sports was questionable, my father brought me to his chiropractor for another opinion. I was treated a couple of times per week for three weeks and resumed playing the remainder of the season with no problems. The result and the type of treatment used intrigued me. I went on to take more science courses to enter chiropractic school.

Q: Is there one athlete that stands out among the rest who really worked hard with you and had great results after working with you?

A: Jim Furyk. In 2005, when I began working with Jim – it was three days of 36 holes per day at the Presidents Cup in Washington, D.C. Jim had some back and neck issues that required me to treat him regularly on the course during competition for three days under orders of our captain, Jack Nicklaus. Jim was experiencing a myriad of injuries that compromised his play and threatened his career. Just as bad, it was starting to get to him mentally. Through many ongoing assessments, soft tissue and manipulative treatments, and guidance with exercise therapy in season and off at his home in Florida, Jim committed to getting better. It was great to work with him because he would do exactly as you wanted and more. His patience, thoroughness and need to know what was going on every step of the way made for a great working relationship. It led to him winning twice this year at 40 years of age and being ranked fifth in the world.

Q: Complete this sentence: “If my life had taken a different path, I probably would have …”
A: Gone onto marine biology. Jacques Cousteau was popular when I was growing up and sparked my interest in marine biology. His explorations of the ocean with an emphasis on preservation was something that I was very interested in. Had I lived nearer an ocean I probably would have moved more in that direction.

Applied Physiotherapy: Rehabilitation Methodology

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

The following is Chapter 13 from RC’s best-selling book:
Applied Physiotherapy in Chiropractic

The following materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 13:   Rehabilitation Methodology

The topics of this chapter have been adapted from Volume 1, Chiropractic Rehabilitation, by K. D. Christensen, DC, © 1990, and used here with permission.

INTRODUCTION

Strengthening exercises for the muscular system play an essential role in the chiropractic management of various neuromusculoskeletal disorders. Knowledge of various training methods and exercise techniques are thus among the most important requirements for effective treatment. [1] Properly conducted individual exercise programs help prevent many injuries and serve to shorten the recovery period necessary to restore the patient back to health. [2] Exercise programs can be designed to increase strength, aid weight loss, increase cardiorespiratory efficiency, or simply improve overall musculoskeletal performance.

All exercise programs should have specific goals in mind. The cornerstone of exercise is Davis’ Law, or the (SAID) principle that states that the body makes specific adaptation to imposed demands. [3] The more specific the exercise, the more specific the adaptation. Exercise, therefore, should be as specific as possible to the individual’s goals and needs.

The patient who participates in a well-devised, scientifically based, properly instructed exercise program should benefit in at least four areas: [4]

1. Enhanced musculoskeletal performance
2. Decreased risk of injury
3. Decreased severity should an injury occur
4. Accelerated rehabilitation and return to activity after injury.

Reid and Schiffbauer indicated that hypertrophy of muscle through exercise protects against bodily injury. [5] To avoid injury, Gallagher states patients should supplement recovery activities with exercises to increase the size and the strength of the muscles, which will then protect joints from injury. [6] Thorndike reports that exercise to strengthen joints can reduce the incidence of injuries. [7] Adams reports that habitual exercise can cause a significant increase in the strength of ligaments surrounding a joint and therefore prevent injuries. [8] Kraus reveals that while exercise is an important factor in the prevention of injury, it is also important in the prevention of reinjury. [9]

TYPES OF EXERCISE

You may review the complete Chapter (including sketches and Tables)
at the
ACAPress website

VIDEO: What Parents Need to Know

Child neurologist, Dr. Martin Kutsher, answers the question, "What would you most like parents to know about ADHD?" and discusses the importance of keeping it positive, keeping it calm, and keeping it organized. Additionally, medication issues for ADHD are addressed.

WATCH VIDEO

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Learn more or join the conversation!

NEWSLETTER | FORUM | BIO | FACEBOOK | TWITTER

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

VIDEO: What Parents Need to Know originally appeared on About.com ADD / ADHD on Tuesday, July 27th, 2010 at 12:23:32.

Permalink | Comment | Email this

Parenting a Child with ADHD

"A child being diagnosed with attention deficit hyperactivity disorder is very much different than his getting diagnosed with strep throat, a broken arm or diabetes. Although they are all medical conditions, with ADHD, many parents either openly or in the back of their minds wonder if their child's ADHD is because of some failure on their part. I thought it would be easier being a Pediatrician who cares for and sees so many success stories among his patients with ADHD, but it wasn't." -- Dr. John Sardo

To read more about what one parent went through in getting his child diagnosed and treated for ADHD click on Coping with a New Diagnosis

Parenting a Child with ADHD originally appeared on About.com ADD / ADHD on Tuesday, July 27th, 2010 at 12:16:22.

Permalink | Comment | Email this

ADHD Coaching For The High School and College Student

The high school and college years can be a particularly challenging time for a young person, especially for one with ADHD. These students are making the transition into adulthood and independence and responsibilities and expectations are increasing. Luckily, there are a growing number of support systems and programs that can be put in place to help students with ADHD. One of these is an ADHD coach.

Read more about ADHD Coaching

Photo © Microsoft

ADHD Coaching For The High School and College Student originally appeared on About.com ADD / ADHD on Tuesday, July 27th, 2010 at 12:15:07.

Permalink | Comment | Email this

Socialization, Homeschool and the Child with Autism

This fall, we begin our fourth year of homeschooling our now-fourteen-year-old son with high functioning autism.  Homeschooling has been a good choice for us, at least as a temporary measure (we are debating the pros and cons of high school!), but one of the tougher aspects has been combating the prevalent myth that homeschooling means zero socialization.

Every time we explain that we homeschool, we hear from at least one concerned parent or teacher -

"But how can he learn to socialize if he's all alone?"

"Public school is such a great place to learn to make friends!"

"Don't you worry that he won't develop social skills?

In fact, however, Tom's public school experience was far more isolating than homeschool.  Here's why.

In public school, Tom was in an "autism only" class with nine boys, none of whom could act as role models and all of whom lived in other school districts (he was in a county-based program, not a local district program).  In homeschool, Tom can take homeschool-oriented classes or get involved with a wide range of activities with local, typical peers.

In public school, Tom's therapies were often scheduled to conflict with social and/or important but non-academic experiences such as music, art, gym and recess.  In homeschool, we can schedule around inclusive, non-academic experiences.  Even better, we can carefully select the inclusive, non-academic experiences so that our son can meet kids with similar talents and passions and learn to work in a group (through band, homeschool gym and collaborative projects).

In public school, the educational emphasis was on building "typical" learning and social skills so that our son could learn through verbal presentations and express himself through speaking and writing.  In homeschool, while we work on those skills, we can also allow and encourage our son to learn and express himself through observation of the natural world, through drawing, music, construction and more.  What this means is that Tom can show off his achievements in a setting where he gains genuine respect (on the stage, at a "geography fair," etc.).

At public school, kids like our son are often strangers to the typical students, popping in and out of specific classes "as they are able."  Worse, they are often the targets of bullying.  Recess and gym, when at least some typical kids are able to socialize freely, are the most difficult times of all for our kids.  When things aren't working well, it can take months to make a change.  In homeschool, we can pick and choose the settings where Tom interacts with typical peers - so that he has a reasonable shot at connecting in a positive way.  If things aren't working well, we can make a change on a dime.

In public school, kids learn to interact with kids their own age - and with authority figures.  The expectations change constantly, as peers age and demands increase.  In homeschool, our son learns to interact with community members of all ages.  As a result, he gains skills  -- at the library, the grocery store, the local theater, the local conservatory, the birding club, the museums -- which will last him a lifetime.

There's a lot more to be said about the pros of homeschooling - and the reasons why homeschooling can actually improve social skills.  As I've mentioned, we may make a change at some point in the future... or we may not.  In some public settings, and for some kids, public school really is an ideal choice.  But for any readers who are considering homeschool for their child with autism - and for those concerned that homeschool = isolation - it's important to set the record straight!

Join the conversation at the Autism at About Dot Com Facebook Page!

Socialization, Homeschool and the Child with Autism originally appeared on About.com Autism on Monday, July 26th, 2010 at 08:16:54.

Permalink | Comment | Email this

Instrument Adjusting: Chiropractic Research

SOURCE: Chiropractic Economics

An overview of the study of instrument adjusting

By Arlan W. Fuhr, DC

Nearly 40 years ago, Drs. Scott Haldeman and Jay Triano, along with a small collection of college presidents, attended the National Institute for Neurological and Communicative Disorders and Stroke (NINCDS) Conference, and, at that time, there were no clinical trials on chiropractic or manipulation.

Those esteemed visionaries lamented how unscientific the chiropractic profession appeared to the greater scientific community, and dedicated themselves to improving the availability of research to provide evidence of chiropractic’s efficacy.

Much progress has been made since that fateful conference in 1974. Today, a commitment to research endures, as doctors have recognized how necessary research is to the ongoing acceptance of chiropractic into traditional medicine.

Despite limited resources, doctors and academics have joined together to publish a surprisingly useful and credible collection of high-quality scientific papers. In fact, any doctor who attended last year’s World Federation of Chiropractic (WFC) biennial congress would agree that some of the research presentations rivaled the finest of any scientific or research conference.

The evolution of technique research

Jim Cox, DC, DACBR, is considered one of the earliest to focus on research as a way to support flexion distraction technique, and those interested in pioneering research on instrument adjusting viewed Dr. Cox as a mentor.

He set the standard with regard to proving the effectiveness of instrument adjusting; his case series that studied more than 500 patients suffering from sciatica and reported positive results with flexion distraction established a benchmark for the breadth and scope of technique research.

The first recognized research on instrument adjusting commenced in 1986, when the National Institutes of Health (NIH) awarded a $50,000 grant to study the safety of the Activator adjusting instrument.

Funding for similar studies required an affiliation with a major university, so the study was moved to Arizona State University where Dr. Jack Winters was seeking projects within the newly-formed Biomechanics department on that campus.

Becoming involved with a recognized research institution opened more doors to chiropractic research, as the principals managing these studies, including myself, could attend major scientific conferences and get an overview of where the research needed to lead.

Much was learned from that first NIH grant, and while the research process was overwhelming at times, it also led to better knowledge about how to secure funding for future studies.

For example: Prior to submitting a grant proposal, a pilot program with a peer-reviewed published paper was required by the NIH. The grant-making body needed to see some progress and have an understanding of the purpose of a given study before funding would be offered.

As previously mentioned, being associated with a major university was also an asset, as the NIH recognized the research capabilities of such institutions which lent credibility to the process.

More than two decades have passed since that first grant, and to date, the NIH has provided nearly half of a million dollars in funding to study instrument adjusting. Research begets research, and ongoing clinical trials help grow the possibility for future trials.

The relationship between research, adjusting, and patient care

How does this research affect you and the profession? There was a time when doctors simply looked to their peers to determine how best to approach patient care; they evaluated the strongest, most successful clinics, and assumed the techniques used at those clinics were best.

But in today’s world, where all fields require evidence to make decisions and establish truths, simple clinical observation no longer suffices as adequate proof. Published data from third-party researchers and respected academics is what students and doctors seek as they determine the best way to treat patients.

And that same data is sought by other healthcare professionals looking to find ways to relieve their patients when traditional medicine fails. As doctors, you must trust findings, not feelings, and research gives you the power to do so.

One of the most controversial topics in the chiropractic profession centers on what technique works best for a given condition. The two most significant studies on this topic have been led by Dr. Woods, who studied the neck, and Dr. Gemmell, who studied the low back.

The neck study compared an instrument adjustment to a diversified rotary break technique, which was published in Journal of Manipulative and Physiological Therapeutics (JMPT), Volume 24 Number 4 May 2001. Woods’ conclusion was that both techniques have beneficial effects with reducing pain and disability and improving cervical range of motion.

The other study was a randomized controlled clinical trial by Dr. Hugh Gemmell which compared an instrument adjustment to a Meric adjustment on patients with acute low back pain. His conclusion was that there was no advantage of one procedure over the other for the reduction of pain. This was published in JMPT Volume 18, Number 7, Sept. 1995. The findings in these two studies are very important to chiropractic on the whole; they aid us in understanding our patients’ needs and help us make confident decisions regarding our approach.

Case studies also provide substantial information to doctors and students. Recent graduates of chiropractic colleges do not have a broad scope of clinical experience to relate to their college curriculum. Because that clinical experience takes years to acquire, both students and new graduates can benefit greatly from case studies conducted by more experienced practitioners, especially for complex or unusual cases.

Earlier this year, a paper was published on bedwetting and bowel incontinence in The Journal of Chiropractic Medicine (2010 Issue 9, pages 28–31). The study, titled “Chiropractic management of a 5-year-old boy with urinary and bowel incontinence” by Keith R. Kamrath, concluded that after five instrument adjustments and a follow up, the patient’s problem resolved for six months.

When the problem recurred, a second course of treatment was administered and the problem resolved. A case such as this helps other clinicians proffer the most-effective treatments to their own patients.

Integrating chiropractic into the healthcare landscape

Beyond helping practitioners determine the best treatments for their patients, research also advances the acceptance of chiropractic among allopathic physicians and other healthcare professionals.

Demonstrating proof of concept to skeptical providers was the catalyst for this growth, and today instrument adjusting is embraced throughout the facility as an effective treatment for patients with musculoskeletal issues.

Continuing to challenge ourselves and the profession to build on the body of research that has been amassed in the past four decades is crucial. Research leads to acceptance and better patient care, making it the lynchpin for complete integration into the healthcare landscape.

Arlan W. Fuhr, DC, is the co-founder and CEO of Activator Methods International. A practitioner and researcher for more than 40 years, Fuhr is widely acknowledged for bringing instrument adjusting to the chiropractic profession.

You may enjoy reviewing our
Instrument Adjusting Research Page

Demand Chiropractic in the New National Health Care Plan

The government is currently deciding the “minimum” benefits that will be provided in the new National Health Care Plan. Chiropractic services are in danger of being left out.

When Congress passed national healthcare legislation in March, they gave the Secretary of Health and Human Services (HHS) the authority to determine the categories of services which must be included in future health plans. The initial categories being considered do not include “neuromusculoskeletal care”, which is the core of what is treated by chiropractors. Unless neuromusculoskeletal care is added as an essential benefit category, chiropractic care will be left out of the plan.

The purpose of the Chiropractic Essential Benefit Campaign is to bring pressure on the HHS to make sure your patients have access to care. If the federal government decides that chiropractic services do not have to be covered, states around the country are almost certain to adopt this standard for workers compensation, and personal injury.

Your profession, your income, and the health of your patients is at risk. Be proactive to save chiropractic

Please visit www.chirobenefit.org to make your stand!

TMA v TBCE–TRIAL UPDATE.

Source Texas Chiropractic Association

This situation was reported on in a previous article.

August 16th Trial Date POSTPONED

On Wednesday, July 7, 2010, two matters were heard in the TMA v. TBCE lawsuit…

In the first matter, the TMA and the TMB questioned the TCA’s “standing” to be a party in the suit – they claimed Doctors of Chiropractic have no legal interest in the position taken by the Texas Medical Board under its act about what constitutes the unauthorized practice of medicine. TCA responded with legal argument and testimony on all the reasons why Doctors of Chiropractic would be significantly affected by the outcome in this lawsuit, including being threatened with criminal action, civil action, TBCE discipline, and potentially being shut down if diagnosis is ruled to be exclusive to medical doctors. TCA presented testimony on all of the ways in which the profession and the public would be harmed by the position being taken by the TMA and TMB. The TMA and TMB backed off from any claim that TCA cannot defend the TBCE scope of practice rule. The Judge has yet to rule on the TCA’s standing to challenge the Texas Medical Board’s statute.

The second motion was the TMA’s and TMB’s motion to strike TCA’s request for a jury trial. After extensive argument, the Judge directed the parties to submit questions of law regarding diagnosis to him in a process of cross-briefing that will not be complete for a month. The Judge indicated that, once all the legal questions are resolved, if a disputed question of fact remains, he would not deprive TCA of a jury trial. He did not expressly rule on the motion to strike.

TBCE and TCA attorneys, including appellate attorney former Texas Supreme Court Justice Tom Phillips, felt that the proceeding was productive and not unfavorable.

Podcast Interview About ADHD

The Children's Anxiety Institute is a new website that provides information and support to parents and loved ones of children with anxiety disorders and phobias. Anxiety can often overlap with ADHD and because of this Rich Presta, the founder and director of the Institute, wanted to include information about ADHD to parents who visit the Children's Anxiety Institute site. He asked to interview me about some of the basics of ADHD.

Below are a few of the questions addressed in the interview.

*What is ADHD?

*Since kids can't always find the words for what they're feeling, what does ADHD look like?

*How is a diagnosis made?

*Are there different types of ADHD?

*How do you tell the difference between an energetic child and ADHD?

*Are there lifestyle factors or other changes a parent can make to help?

*What effect can ADHD have on the rest of the family?

If you go to the following link Articles & Resources and scroll down to the bottom of the resources page, you can hear a podcast of the interview. The podcast is approximately 25 minutes in length.

Read more:
What is ADHD - The Basics
Misconceptions About ADHD - Separating Fact from Fiction
Understanding Anxiety in Children
Helping Your Child Overcome Anxiety

Podcast Interview About ADHD originally appeared on About.com ADD / ADHD on Tuesday, July 20th, 2010 at 16:46:17.

Permalink | Comment | Email this

Medical Pushback on Provider Nondiscrimination Law

SOURCE: Health Insights Today

By Daniel Redwood, DC

Among the important changes in the recently passed health reform law is Section 2706, which makes it illegal for insurance companies to discriminate against providers acting within the scope of their state licenses. Predictably, medical physicians who have benefited from many decades of discrimination now seek to turn back the clock and reinstate the pro-discrimination policies that have served them so well for so long.

Meeting in Chicago in mid-June (as reported in the “Contain and Eliminate” post below) , the House of Delegates of the American Medical Association (AMA) passed a resolution sponsored by the American Academy of Ophthalmology and the American Society of Anesthesiologists. This new AMA policy directs the organization to use its considerable firepower to overturn the provider nondiscrimination clause, citing its “troubling language” that upsets the “dynamic balance” under which insurers were free to discriminate against a long list of non-MD providers, including optometrists, chiropractors, podiatrists, nurse anesthetists, nurse midwives, psychologists, clinical social workers, acupuncturists, and other groups of licensed health practitioners.

If you have been wondering whether the nondiscrimination language in the health reform law packs real power, wonder no more. Just look at the seriousness with which the AMA is approaching it.

Toward a Level Playing Field

While the AMA and its specialty groups frame their pro-discrimination campaign in terms of protecting public health, saving taxpayer and patient dollars, helping the public avoid “massive confusion,” and supporting the highest possible standards of health care quality, the underlying motivation is transparently self-serving. Why, for example, are the ophthalmologists and anesthesiologists leading the charge? As noted by John Weeks on The Integrator Blog, ophthalmologists fear that a level playing field will weaken their competitive position vis-à-vis optometrists, while anesthesiologists have similar concerns about nurse anesthetists.

Let’s pause for a fact-check.

The Patient Protection and Affordable Care Act of 2010 in no way expands the scope of practice for optometrists, nurse anesthetists, chiropractors, or any other non-MD profession. Optometrists will not be performing eye surgeries; nurse anesthetists will not suddenly be permitted to determine the dosage of prescription medications. Chiropractors and acupuncturists will not be prescribing pain medications or performing back, neck or brain surgeries. Nor will clinical social workers be prescribing antidepressants.

But for those diagnostic and therapeutic procedures permitted these practitioners by state licensure laws, insurers will no longer be allowed to discriminate in favor of medical doctors simply because they are medical doctors. For example, the law specifically allows insurers to reimburse practitioners at higher rates when higher quality and performance have been demonstrated.

Check our Cost-Effectiveness of Chiropractic Page for more information about why this passage makes medicine nervous.

If this law is properly enforced, simply having the letters “M.D.” after one’s name will no longer qualify as a demonstration of high quality care.

This is the heart of the matter. This is the level playing field that the medical profession (along with pharmaceutical and device manufacturers) urgently wishes to avoid.

Comparative effectiveness research, along with rigorous evaluation of quality healthcare delivery, can make a major long-term difference. Both are significantly expanded by the health reform law. Chiropractors should welcome, not fear, fairly applied evaluations of quality and effectiveness.

An Opening for Chiropractic

Chiropractors have historically been among the groups discriminated against by private insurance companies and federal health plans. In the past (and in some cases, the present), this has often taken the form of spinal manipulation being covered only when performed by a medical or osteopathic physician.

More frequently in recent years, annual caps have been applied to chiropractic care but not to the same services when delivered by practitioners such as medical doctors and physical therapists. Today, perhaps the most insidious form of discrimination is tiered reimbursement, in which spinal manipulation delivered by chiropractors is reimbursed at rates significantly lower than the same service performed by other practitioners, who in many cases are far less qualified to deliver it.

This also applies in varying degrees to other services provided by chiropractors. Such unjust discrimination must end, and the nondiscrimination policy that is now the law of the land has the potential to end it.