February 2009

An evaluation to be proud of

by Dr. Scott Little

One of the greatest challenges I've had as a chiropractor has been to perform a truly relevant chiropractic evaluation.

Don't be offended by this question, but does your chiropractic examination adequately demonstrate the need for care to everyone interested in the case?

In other words, do you get any significant information from your exam to influence your recommendations or help you to communicate the need for your care? Do you get any information from your exam that shows you, the patient, a third party payer, or a referring physician that the patient's nervous system isn't responding to stress appropriately and that chiropractic care is necessary?

Ortho/Neuro tests

In chiropractic college we learn dozens of orthopedic and neurologic tests, all named for their developers. None demonstrates presence or absence of subluxation. We do these tests to appease boards, insurance companies, and to sound medical, but do they affect our care. I never do orthopedic tests on my mother before I adjust her.

X-ray

We've taken X-rays since 1910. X-rays are great for ruling out pathology and as an educational tool, but I wonder how many times I've shown a patient how their vertebra was rotated and in reality the spinous process was just bent.

B.J. Palmer and Dr. William Blair both found that spinal asymmetry was the norm-- not the exception. Yet chiropractic has invested a lot in the idea that we can demonstrate subluxations on X-ray. Now that X-ray has gone digital, we've REALLY invested a lot.

Here's another question: if we're using an X-ray to demonstrate that a patient needs our care, wouldn't it be appropriate to perform follow-up films to show that we've made a change. Some of us do. I never did.

SEMG/Thermal Scans

I practice a tonal technique, so my main focus is on the nervous system and the amount of tension on the nerves. In 1996 the office I worked in purchased one of the first chiropractic instruments that measured paraspinal SEMG and bilateral thermal spot checks. I thought I'd died and gone to heaven! Finally an instrument that allowed me to assess a patient's nervous system with non-invasive equipment that showed where the nervous system was out of balance.

I built my practice with this equipment but over time used it less and less. I found it to be a great patient education tool but I questioned just what it was really telling me. There were questions of reproducibility and accuracy. What would I say to patients if their scans looked worse, but they felt better; or if their scans looked better but their symptoms hadn't resolved?

In reality, a patient's neuromuscular system should always be adapting, so what was a static paraspinal SEMG really telling me? I felt I was asking the equipment to give me more information than it was designed to provide. Eventually I stopped using it, but didn't have anything to replace it.

NeuroInfiniti and the stress response evaluation

Then I read an article by DeDe Van Riper about new technology being introduced to the chiropractic profession. I was acquainted with Ms. Riper and her husband David through the purchase of my other equipment and office software, and I knew that if they were involved in something, it was worth looking at.

I learned that they were working with Richard Barwell, DC, who was promoting the use of an instrument called the NeuroInfiniti for the chiropractic profession. I was instantly interested and introduced the NeuroInfiniti to my practice.

Basically, this new equipment allows the chiropractor to hook a patient up with a variety of sensors to monitor several physiologic indicators of neurologic function. The test involves EEG to measure brainwave activity, EMG to measure muscle function, EKG and respiration to measure heart rate and heart rate variability, hand temperature, and skin conductance (sweat response).

What makes this evaluation so dynamic is that once patients are hooked up, they are put through a series of events designed to alternate between stress and relaxation. The idea is to see if their nervous systems rise to the occasion during stress (as it should,) and perhaps more importantly, how long it takes to recover and come back to normal when relaxed.

For chiropractors, there are many benefits in using equipment that is already accepted by the medical and research communities to see how stress affects a patient's nervous system.

Is their nervous system in balance, or is it under aroused, over aroused, or exhausted? Is your patient going to respond quickly to your care, or will a much more significant care plan be needed?

Wouldn't you like to have some hardcore neurologic data in front of you when creating and presenting your recommendations? This stress response evaluation has revolutionized my care, my communication, and my practice, and I believe it will revolutionize chiropractic.

I've always known I was a great chiropractor and that chiropractic had far-reaching effects on the nervous system but until now I didn't have evidence that truly showed the patient, and other healthcare professionals, that neurologically based chiropractic was much more than a treatment for musculoskeletal pain.

Finally, we have found a way to prove our effectiveness using equipment and physiologic vital signs that the medical and scientific communities can understand and appreciate.

(Dr. Scott Little is a private practitioner based in Indiana. He can be reached at 812-333-2501 and welcomes calls from doctors wishing to learn more about neurologically based chiropractic and the NeuroInfiniti. Or, call DeDe Van Riper at 877-233-0022.)