CJA Vol.34 Issue 3Editorial: What's Worth Writing Is Worth Writing Well - p81 Coughing to Release the Dura in Category III
Patients Experiencing Sciatica: Report of 3 Cases - p82 A Comparison of Patient Entrance skin Exposure for
Videofluoroscopic and Functional Plain X-Ray Techniques Used in Cervical
Spine Kinematics - p87 The Somatovisceral Reflex: How Important for the
"Type O" Condition? - p97 International Equivalency for First-Professional
Programs of Chiropractic Education - p103 A Perverse and Discriminatory Policy: The De-Listing of
Chiropractic Care in Ontario, Canada - p113 Letters to the Editors - p120 Corrigendum - p120 ABSTRACTS Coughing to Release the Dura in Category III Patients Experiencing Sciatica: Report of 3 Cases GRAEME J. PIERA, PATRICK J. DWYER, CHARLES L. BLUM Objective: To discuss the outcome of a case series comprising 3 chiropractic patients presenting with severe low back pain accompanied by signs and symptoms characteristic of nerve root involvement. Clinical Features: All patients presented with low back pain radiating into one or both legs. Setting: a private chiropractic practice in Victoria, Australia. Methods: Retrospective evaluation of 3 patients who consulted a private chiropractic practice and were treated with Sacro-Occipital technique (SOT) Category III protocol and a novel coughing procedure. Intervention and Outcome: Standard SOT protocol was used, in particular a Category III work-up with a coughing technique that achieved resolution of low back pain. Conclusion: Some patients presenting with signs and symptoms of nerve root irritation due to intervertebral disc involvement might be effectively treated using SOT and coughing as a possible mechanism to decrease intrathecal impingement. INDEX TERMS: (MeSH): CHIROPRACTIC; INTERVERTEBRAL DISC; SCIATICA; VALSALVA'S MANOEUVER. (Other): SACRO-OCCIPITAL TECHNIQUE. PETER W. BULL and ROBERT A. DAVIDSON Functional radiography has long been used to observe the kinematic behaviour of the vertebral segments of the cervical spine, especially under the influence of spinal injury and other mechanical problems. Potentially high patient entrance skin exposures have been suggested by some authors as one reason for not utilising videofluoroscopy in cervical spine kinematics despite mathematical estimates that dose rates, when compared with plain film radiography, should be lower. This study compared actual skin entry exposure measurements for a 5-second videofluoroscopic scan with 3 plain film x-ray exposures of the lateral cervical spine. Measurements were made using LiF-100 thermoluminescent dosimetry on an anthropomorphic model. The thermoluminescent dosimeter chips directly exposed to the primary beams at C1, C4 and C7 recorded approximately twice the skin exposure during plain radiography (mean: 4551.03 mGy) than when compared with the 5-second videofluoroscopy (mean: 2242.24 mGy). These results indicated, therefore, that the patient skin entrance radiation dose is significantly less during a 5-second videofluoroscopic scan of the cervical spine than that experienced during the 3 plain x-ray neutral lateral, flexion and extension views. This study has demonstrated that concerns over possible high radiation doses associated with functional videofluoroscopic screening for determining cervical spine kinematics are unfounded. The development of the use of videofluoroscopy for cervical spine kinematics should not be limited due to concerns that the procedures produce high patient skin entrance exposure. INDEX TERMS: (MeSH): RADIOGRAPHY; FLUOROSCOPY; RADIATION DOSAGE. Chiropr J Aust 2004; 34: 87-92.. The Somatovisceral Reflex: How Important for the "Type O" Condition? HENRY POLLARD Objective: To review the neurophysiology of somatovisceral reflexes and discuss the factors that influence the reflexes in the context of management of systemic or organic disease (as distinct from musculoskeletal injury). Data Sources: MEDLINE search using key words: chiropractic, osteopathy, neurophysiology, review, spinal reflex, supraspinal reflex, manipulation. Data Selection: The search resulted in more than 200 papers that fit the key words. Papers were selected on the basis that they contained relevant information on somatovisceral, viscerosomatic or supraspinal reflexes or treatment approaches relevant to the management of visceral disorders by spinal manipulative therapy. Data Extraction: Ninety-four selected papers contained information that related to somatovisceral and viscerosomatic reflexes or on supraspinal influences on these reflexes. Data Synthesis: A review of the proposed mechanisms of the effect of spinal manipulative therapy on visceral neurophysiology was conducted. The reflexes affect the resting status of the somatic structures via mechanical and neurological (somato-somatic reflex) mechanisms that can cause a change to the afferent arm of the somato-visceral reflex. Such changes can occur by the direct action of a somatovisceral effect at the segmental level, but the effect is minimised by the action of the supraspinal pathways in the integration of the reflexes. It is hypothesised that SMT may affect the supraspinal inhibitory and excitatory pathways to the preganglionic neurones, although this has not been demonstrated. There is scanty evidence of SMT affecting visceral disease through manipulation of the spine. Conclusions: Spinal manipulative therapy can affect the resting status of somatic structures via mechanical and neurological (somato-somatic reflex) mechanisms, and this change can cause a change to the afferent arm of the somato-visceral reflex. It is likely that supraspinal influences play a major role in this effect, however the exact nature of this effect has not been demonstrated with respect to manipulation of the spine. Much research is required to establish a causative relationship between the treatment of somatic structures of the spine and normalisation of pathological visceral tissues via somatovisceral or supraspinal reflexes. INDEX TERMS: (MeSH):CHIROPRACTIC; OSTEOPATHY; NEUROPHYSIOLOGY; REVIEW ARTICLE. (Other): SPINAL REFLEX; SUPRASPINAL REFLEX. International Equivalency for First-Professional Programs of Chiropractic Education PHILLIP EBRALL and KAZUYOSHI TAKEYACHI The status of external professional accreditation of chiropractic programs has been diminished by artificial trade barriers and other locally-imposed restrictions to the reciprocal recognition of graduates. The authors explore the construct of an international standard for chiropractic programs and to advance the concept of international equivalency in chiropractic education propose a new model with four elements, one of which remains the established process of professional accreditation. It is appreciated that the accreditation standards of the CCE (United States) represent the minimum standard an institution and program must attain and that minimum standards represent the lowest common denominator; in turn this may be why regulatory bodies in various jurisdictions have introduced mechanisms that now replace reciprocity. An underlying concept within this paper is that the expertise to determine, establish and comply with a true international standard of chiropractic education may now be seen as lying more within those universities around the world which are responsibly delivering a very high standard of chiropractic education driven by three elements in addition to professional accreditation. These elements are identified and described in this paper. The authors argue that the external professional accreditation process should be re-evaluated with a view to reinstating it at a level that will establish true international equivalency and facilitate reciprocity between countries and jurisdictions without the need for third-party assessments. INDEX TERMS: (MeSH): ACCREDITATION; CHIROPRACTIC; HEALTH EDUCATION; LICENSURE. (Other): INTERNATIONAL EQUIVALENCY. Chiropr J Aust 2004; 34: 103-112. |
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