May 2008

A strategy for clinical assessment

by Dr. Christopher Kent

In 1935, BJ Palmer began to experiment with the development of the electroencephaloneuromentimpograph, to measure "the quantity flow of mental impulse nerve force between Innate above and function below, between brain and body…" [1] Today, various technologies are available to assess neurospinal function. These include evaluation of autonomic function through skin temperature analysis and heart rate variability; somatic muscle function using surface electromyography, sensory function using algometry, and biomechanics using spinography and inclinometry. [2]

Paraspinal muscle activity can be reliably assessed using paraspinal surface electromyography. [3,4,5] Paraspinal skin temperature measurements, using infrared sensors, is a reliable indicator of vasomotor activity, and may also relate to general health status. [6,7,8] Autonomic balance can be evaluated using heart rate variability, which is decreased in various clinical conditions, and is responsive to chiropractic care. [9-18] Spinal ranges of motion may be evaluated, and compared to normative data to evaluate spinal biomechanics. [19-22] Pressure algometry is used to evaluate pressure pain sensitivity. [23-26]

Aspects of biomechanical and neurophysiological function can be quantitated. Reliable and valid indicators of pressure point sensitivity, ranges of motion, paraspinal muscle muscle function, and autonomic function may be expressed as a neurospinal functional index (NSFi). By mathematically integrating these five technologies, a neurospinal functional index (NSFi) can be derived, which is expressed as a number from 1 to 100. This number may be used to follow the progress of patients undergoing chiropractic care.

My vision is that one day, as people come to understand the importance of vertebral subluxation, the spine and nervous system in human health, the NSFi will be as commonly referenced as our blood pressure readings and cholesterol counts are today.

References

1. Palmer BJ: "History in the Making." Palmer School of Chiropractic. Davenport, IA. 1957. P. 43.

2. Eriksen K: Chapter 10. "Outcome assessments and documentation." In: Eriksen K, Rochester RP (eds): "Orthospinology Procedures." Lippincott Williams & Wilkins. Philadelphia. 2007.

3. McCoy M, Blanks R, Campbell I, Stone P, Fedorchuk C, George I, Jastremski N, Butaric L: "Inter-examiner and Intra-examiner reliability of static paraspinal surface electromyography." Presentation. 2006 International Research and Philosophy Conference. Sherman College of Straight Chiropractic. Spartanburg, SC. November 3-5, 2006.

4. Faulkner HC: "Test-retest reliability of sEMG paraspinal scans: A comparative study." Institute of Medicine, Health and Social Care. University of Portsmouth. M.Sc. dissertation. August 2006.

5. Kelly S, Boone WR: "The clinical application of surface electromyography as an objective measure of change in the chiropractic assessment of patient progress: a pilot study." Journal of Vertebral Subluxation Research 1998;2(4):1-7.

6. Richards DG, McMillin DL, Mein EA, Nelson CD: "Correlations between paraspinal temperature variations and health status: from manual therapeutic art to objective measurement." Meridian Institute. Presented at the American Academy of Osteopathy. Norfolk, VA. March 23, 2002.

7. Hart J: "5 Minute Thermal Pattern Analysis and Health Perception." J Vertebral Subluxation Res. May 3, 2007: 1-6.

8. Owens EF, Hart JF, Donofrio JJ, Haralambous J, Mierzejewski E: "Paraspinal Skin Temperature Patterns: An Interexaminer and Intraexaminer Reliability Study." Journal of Manipulative and Physiological Therapeutics. March 2004 (Vol. 27, Issue 3, Pages 155-159)

9. Sinnreich R, Kark JD, Friedlander Y, et al: "Five minute recordings of heart rate variability for population studies: repeatability and age-sex characteristics." Heart 1998;80:156-162.

10. Sabdercrock GR: "Heart rate variability measures: a fresh look at reliability." Clin Sci (Lond) April 23, 2007. (Epub ahead of print).

11. Zhang J, Dean D: "Effect of short‑term chiropractic care on pain and heart rate variability in a multisite clinical Study." International Research and Philosophy Symposium: Abstracts. Sherman College of Straight Chiropractic. Spartanburg, SC. October 9‑10, 2004

12. Kautzner J, Camm AJ: "Clinical relevance of heart rate variability." Clin Cardiol 1997;20(2):162.

13. O'Brien IA, O'Hare P, Corrall RJ: "Heart rate variability in healthy subjects: effect of age and the derivation of normal ranges for tests of autonomic function." Br Heart J 1986;55(4):348.

14. Toyry J, Mantysaari M, Hartikainen J, Lansimies E: "Day‑to‑day variability of cardiac autonomic regulation parameters in normal subjects." Clin Physiol 1995;15(1):39.

15. Sato N, Miyake S, Akatsu J, Kumashiro M: "Power spectral analysis of heart rate variability in healthy young women during the normal menstrual cycle." Psychosom Med 1995;57(4):331.

16. Gallagher D, Terenzi T, de Meersman R: "Heart rate variability in smokers, sedentary, and aerobically fit individuals." Clin Auton Res 1992;2(6):383.

17. Dixon EM, Kamath MV, McCartney N, Fallen EL: "Neural regulation of heart rate variability in endurance athletes and sedentary controls." Cardiovasc Res 1992;26(7):713.

18. Kristal‑Boneh E, Raifel M, Froom P, Ribak J: "Heart rate variability in health and disease." Scand J Work Environ Health 1995;21(2):85.

19. Guides to the Evaluation of Permanent Impairment. American Medical Association. Chicago, IL. Fifth Edition.

20. Miller KJ: "Range-of-Motion Testing: A Fresh Look." Journal of the American Chiropractic Association. Oct. 2003.

21. Dvorak J, Antinnes JA, Panjabi M, Loustalot D: "Age and gender related normal motion of the cervical spine." Spine 17:10S 393-398, 1992.

22. McGregor AH, McCarthy ID, Hughes, SP: "Motion characteristics of the lumbar spine in the normal population." Spine 20:22 2421-2428, 1995

23. Antonaci F, Sand T, Lucas GA: "Pressure algometry in healthy subjects: Inter examiner variability." Scandinavian Journal of Rehabilitation Medicine. 1998 Vol. 30 Pgs. 3-8.

24. Nussbaum EL, Downes L: "Reliability of Clinical Pressure-Pain Algometric Measurements Obtained on Consecutive Days." Physical Therapy. 1998 Vol. 78 Pgs. 160-9.

25. Farasy A, Meeusen R: "Pain Threshold Research: Pressure pain thresholds in healthy subjects: influence of physical activity, history of lower back pain factors and the use of endermology as a placebo-like treatment." Journal of Bodywork and Movement Therapies. . 2003 Jan Vol. 7(1) Pgs. 53-61.

26. Prushansky I, Dvir Z, Dernn-Assa K: "Reproducibility Indices Applied to Cervical Pressure Pain Threshold Measurements in Healthy Subjects." The Clinical Journal of Pain. 2004 Sep-Oct Vol. 20(5) Pgs. 341-7.

(Dr. Christopher Kent, president of the Council on Chiropractic Practice, is a 1973 graduate of Palmer College of Chiropractic. The WCA's "Chiropractic Researcher of the Year" in 1994, and recipient of that honor from the ICA in 1991, he was also named ICA "Chiropractor of the Year" in 1998. He is director of research and a co‑founder of Chiropractic Leadership Alliance. An attorney as well as a chiropractor, Dr. Kent is a member of the California bar. With Dr. Patrick Gentempo, Jr., Dr. Kent produces a monthly audio series, "On Purpose," covering current events in science, politics and philosophy of vital interest to the practicing chiropractor. For subscription information call 800-892-6463.)