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Bhogal Instrumentation Lecture

Bhogal Instrumentation Lecture - Instrumentation...

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Unformatted text preview: Instrumentation Instrumentation Instrumentation Instrumentation ► Purpose of Instrumentation Objectify Objectify Neurologic Function Target Target area of for further assessment ►Break Analysis VS. Pattern Analysis?? WHEN WHEN to and when NOT to adjust Satisfy Satisfy the “Asymmetry” of the “PART” system of insurance coding Staying Staying true to chiropracTIC Bolster Bolster the reproducibility of chiropractic care by having a set protocol Instrumentation Instrumentation ► Limitations of Instrumentation Examiner Examiner reliability initially low Improved Improved with technology and expertise Clinical Clinical presentations of the epidermis ►Burn / Sunburn ►Blemish / Acne ►Infection ►Fever ►Others……… Physiological Physiological variability ►Dermatomes / Neuropathies Instrumentation Instrumentation ► What are you assessing? Vasomotor Vasomotor function as a reflection of aberrant neuromodulaton TyTron CTyTron C-3000 is an infrared paraspinal thermal imaging system which is gathering information in in the first 5mm of the epidermis Gathering Gathering information in the dermal microvasculature Autonomic Autonomic Nervous System (ANS) ►Sympathetic Nervous System (SNS) Functions Functions without an antagonist Smooth Smooth muscle regulation Tunica Tunica Media of the vessel Instrumentation Instrumentation ► Thermoregulation Core Core control and ambient control ► AMBIENT CONTROL Dermatome specific Begins with cutaneous sensory input from the skin Warmth receptors are unmyelinated Cold receptors are myelinated - saltatory Neurologic Neurologic Pathway ► This signal enters the cord as an AFFERENT SENSORY INPUT and synapses in the DORSAL HORN at the Tract of Lissauer ► This tract “sorts” between pain and temperature ► Next synapse is from gray matter to white matter to become the LATERAL SPINOTHALAMIC TRACT Neurologic Neurologic Pathway ► This LST ascends into the brain carrying the cutaneous message and terminates at the VENTRAL POSTEROLATERAL NUCLEUS of the THALAMUS. ► The thalamus functions as a sorting relay. ► Thalamus synapses to: BRODMANN BRODMANN AREA 3,1,2 ►Primary Somatosensory Cortex Insular Insular Cortex (Insula / “Isle of Reil”) ►Anterior portion regulates VISCEROVISCEROAUTONOMIC FUNCTION Thalamic Thalamic Cerebellar Relay Thalamic Thalamic Cerebellar Relay Neurologic Neurologic Pathway ► Insula forwards message to HYPOTHALAMUS Adenohypophysis Adenohypophysis (ANTERIOR HYPOTHALAMIC NUCLEUS) Regulation Regulation of autonomic function ► AHN becomes a DESCENDING AUTONOMIC TRACT TRACT which passes through the BRAINSTEM ► This DAT travels to the original site of dermatomal thermoregulation PREGANGLIONIC PREGANGLIONIC SYMPATHETIC FIBER ► PSF will synapse with the SYMPATHETIC PARAVERTEBRAL GANGLIONIC CHAIN Neurologic Neurologic Pathway ► PSF will synapse with the SYMPATHETIC PARAVERTEBRAL GANGLIONIC CHAIN ► Three synapse outcomes of the PSF: 1. 1. Ascend to ganglion at a higher cord level 2. 2. Descend to ganglion at a lower cord level 3. 3. Stay at the same ganglionic level ►Most likely outcome for dermatomal thermoregulation ► PSF will neurotransmit AcH and stimulate a nicotinic POSTGANGLIONIC FIBER which will transmit Epinephrine. Neurologic Neurologic Pathway ► POSTGANGLIONIC FIBER which will release Epinephrine. ► This will terminate at the TUNICA MEDIA and constrict the vasculature. ► This is an “unopposed” regulation. No antagonist. Neurologic Neurologic Pathway Neurologic Neurologic Pathway ► Sympathetic Nervous System T1 T1 – L3 What What about the CERVICAL SPINE? ► Sympathetic chain extends extends upward ► A reflection of “core activity below” Supports Supports PATTERN ANALYSIS!!! ► Also consider that the DAT passes through BRAINSTEM! CORRELATIONS BETWEEN PARASPINAL TEMPERATURE VARIATION AND HEALTH STATUS: FROM MANUAL THERAPEUTIC ART TO OBJECTIVE MEASUREMENT Douglas G. Richards, Ph.D., David L. McMillin, M.A., Eric A. Mein, M.D., and Carl D. Nelson, D.C. The purpose of this study was to explore correlations between an objective measurement related to manual medicine - paraspinal temperature variation - and health quality of life. The use of manual diagnostic and therapeutic techniques for systemic illness has often been seen as more of a healing art than a science. However, paraspinal temperature variation has claims for relevance going back to the early days of osteopathy and chiropractic. This exploratory study compared paraspinal temperature measurements using the Tytron C-3000 with questionnaire measurements using the SF-36 short form health survey, a well-validated measure of health status. Data from 79 people participating in health assessments were used. The correlations of the SF-36 with measurements of temperature differential on either side of the spine, and temperature variations along the spine were statistically significant. This study demonstrates that temperature imbalances in the spine are correlated with lower health quality of life, offering objective support for historical claims in the art of manual medicine. Note: This study was presented at the annual meeting of the American Academy of Osteopathy in Norfolk, Virginia on March 23, 2002. Anesth Analg. 2009 Mar;108(3):1034-6. The efficacy of skin temperature for block assessment after infraclavicular brachial plexus block. Minville V, Gendre A, Hirsch J, Silva S, Bourdet B, Barbero C, Fourcade O, Samii K, Bouaziz H. Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, Rangueil HospitalOrthopedic section, University Paul Sabatier, Toulouse, France. BACKGROUND: In this prospective observational study, we evaluated whether a simple infrared thermometer can reliably predict block effectiveness after infraclavicular brachial plexus blockade. METHODS: Thirty consecutive patients undergoing upper limb surgery under infraclavicular block were enrolled. From the end of the local anesthetic injection, skin temperature was measured in all four major nerve distribution areas. A successful block was defined as the absence of sensation to cold. Skin temperature measurements were performed using a noncontact temperature probe. RESULTS: 30 patients were anesthetized. Twenty-five patients had a successful block. Four patients required supplementation for block failure. General anesthesia was performed in one patient. There was a statistically significant increase in cutaneous temperature after nerve block compared to the same skin area before the procedure. CONCLUSION: Skin temperature assessment with an infrared thermometer is a reliable, simple and early indicator of a successful nerve block. J Bone Joint Surg Br. 2007 Jul;89(7):933-9. Thermometric diagnosis of peripheral nerve injuries. Assessment of the diagnostic accuracy of a new practical technique. Ya'ish FM, Cooper JP, Craigen MA. Trauma & Orthopaedic Department, University Hospital Birmingham, UK. The diagnosis of nerve injury using thermotropic liquid crystal temperature strips was compared blindly and prospectively against operative findings in 36 patients requiring surgical exploration for unilateral upper limb lacerations with suspected nerve injury. Thus, for detection of a nerve injury, comparison was made against the unaffected nerve distribution in the same hand. Receiver operating characteristic curve analysis showed that an absolute temperature difference > or = 1.0 degrees C was diagnostic of a nerve injury (area under the curve = 0.985, sensitivity = 100%, specificity = 93.8%). Thermotropic liquid crystal strip assessment is a new, reliable and objective method for the diagnosis of traumatic peripheral nerve injuries. If implemented in the acute setting, it could improve the reliability of clinical assessment and reduce the number of negative surgical explorations. Paraspinal skin temperature patterns: an interexaminer and intraexaminer reliability study. JMPT 2004 Owens EF Jr, Hart JF, Donofrio JJ, Haralambous J, Mierzejewski E. Palmer Center for Chiropractic Research, 741 Brady Street, Davenport, IA 52803, USA. BACKGROUND: Paraspinal thermography is used by chiropractors as an aid in assessing the presence of vertebral subluxation. Few reliability studies have been carried out, with mixed results. Digital infrared scanning equipment is now available with location tracking that may enhance reproducibility. Digitized scans enable a computer-aided interpretation of thermographic patterns. OBJECTIVE: To assess the ability of examiners to reproduce thermal patterns. STUDY DESIGN: Repeated measures with 2 examiners assessing the same patient on 2 occasions. Thirty asymptomatic students served as subjects. RESULTS: Skin temperatures ranged from 35.4 degrees C to 30.0 degrees C over all scans. The average temperatures changed little from the first to the last scans, indicating that subjects' overall skin temperatures were stable during the scanning procedure. CONCLUSION: Intraexaminer and interexaminer reliability of paraspinal thermal scans using the TyTron C-3000 were found to be very high, with ICC values between 0.91 and 0.98. Changes seen in thermal scans when properly done are most likely due to actual physiological changes rather than equipment error. Relative Relative Skin Temp TyTron C-3000 Copyright Strazewski Spine BarSpine Bar-Graph Screen NCM NCM Screen Pattern Pattern ►Three (minimally) readings taken in a 24 hour period. ►Clues us in on the body’s ability to modulate modulate surface temperature relative to to ambient temperature. ►A reflection of the homeostatic status of the autonominc nervous system. Three Three Types of Readings ► Pattern/Subluxation ►Adaptation ►Stress Pattern Adaptation Stress Causes Causes of Stress Readings ► Chemical Drugs Drugs ►Prescription / Recreational Dietary Dietary “drugs” ►Emotional ►Physical ...
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