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Find out why Life University
is receiving accolades from the Council on Chiropractic Education’s Commission
on Accreditation
By Jennifer LeClaire
It’s been three years since Life University’s College of Chiropractic
lost its accreditation. Now, the same group that criticized the school is singing
its praises.
When the Council on Chiropractic Education’s Commission (CCE) on Accreditation
stripped Life University of its accreditation, it cited a lack of research as
a major concern. But instead of hanging its head or making excuses, university
administration took the criticisms to heart and made measured steps toward re-accreditation.
It’s a comeback story that takes Life to the next level with cutting-edge
research projects that get to the root causes of patient problems. Life’s
faculty is on the way to important breakthroughs and the CCE is lauding the
school for its forward-thinking initiatives, including the establishment of
its Office of Sponsored Research and Scholarly Activities (OSRSA).
OSRSA Director Dr. Matthew McCoy says implementing a stronger research focus
at the university required a cultural change. For example, professors now receive
promotions and rank changes based on their participation in research activities.
Life also made changes in curriculum and student testing.
The sweeping changes are already bearing fruit and McCoy says this is just the
beginning of a long-term program that gives research an important place in the
university’s core. To that end, Life recently held a research, scholarship
and service activities colloquium to encourage, communicate and showcase the
faculty and its research breakthroughs.
“Research at Life has undergone a major transformation over the past two
years,” McCoy says. “We went from a highly centralized research
department where only a few individuals were responsible for conducting research
to a decentralized model where all faculty are encouraged and expected to engage
in research and scholarship. This colloquium marks the beginning of the next
phase in this process as we set the agenda for research and scholarship at the
institution.”
Indeed, Life is undergoing a transition that some say could revolutionize the
profession with education-based research. It all begins with six featured research
projects, which range from ulnar tunnel syndrome and scoliosis studies to technique
and range of motion research and quality assurance programs. Let’s take
a look at six projects from Life faculty and students.
First Place Faculty Winner:
Ulnar Tunnel Syndrome Discovery
Brent S. Russell, D.C., an assistant professor at Life University’s College
of Chiropractic, was awarded first place for his research into how chiropractic
can effectively relieve ulnar tunnel syndrome. The research involved a suspected
case of ulnar tunnel syndrome treated with chiropractic extremity adjustment
methods.
Russell labeled the case as a “suspected” ulnar tunnel syndrome
because making a definitive diagnosis of a nerve compression syndrome would
require abnormalities found in Nerve Conduction Velocity (NCV). It is important
to note that without abnormal NCV findings, this case remains a diagnostic impression
of UTS, rather than a true diagnosis. Electromyography, or somatosensory, could
also be appropriate in such a case.
According to Russell, there is no established explanation as to why a manipulative
thrust to the hand would affect compression of the ulnar nerve, whatever the
cause. Many previous discussions about the mechanism of adjustment has focused
on spinal joints.
The professor theorized two possibilities in the case. First, it may be that
swelling of an articular capsule adjacent to the tunnel was the source of compression
of the nerve, and this was reduced by the adjustments. Alternatively, he considered
that perhaps the adjustments stretched the transverse carpal ligament (which
forms the “roof” of the ulnar tunnel) enough to reduce pressure
within the tunnel, and relieve the nerve compression (as demonstrated by Sucher,
1993, for carpal tunnel syndrome).
Russell determined that since electrodiagnostic examination adds additional
cost and complexity to management of a given patient, most practitioners would
find it reasonable in similar cases to proceed with a trial of care without
the additional studies. The case Russell studied was non-traumatic, of low complexity,
and resolved quickly. The cost of care was borne solely by the patient and the
total fee was $168.
Second Place Faculty Winner:
Technique Study on Spinal Ranges of Motion
In second place, Life University instructor Jerry I. Hochman, D.C., studied
the effect of the Sacro Occipital Technique blocking Category II on spinal ranges
of motion.
Although some research has shown a relationship between spinal manipulation
and changes in spinal ranges of motion, in almost all cases these manipulations
were performed in the same regions as those measured. There is little evidence
that manipulation in one area can affect spinal range of motion in any other
region. In fact, in a search of the literature, no evidence was found relating
pelvic manipulation to changes in spinal range of motion.
Hochman’s objective was to describe changes in lumbar and cervical range
of motion measurements after supine pelvic blocking as used in Sacro Occipital
Technique. Supine blocking, referred to as Category II blocking, is commonly
used to enhance sacro iliac stabilization and reduce pelvic distortions.
In this prospective case series, five subjects were recruited and selected for
Sacro Occipital Technique of sacro iliac distortion and instability. Each subject
had their cervical and lumbar ranges of motion measured both pre- and post-Category
II blocking. Blocking procedures were used to change pelvic mechanics. Pre-
and post-measurements were taken by a blinded assessor using a Zebris (Zebris
GmbH Tuebingen, Germany) ultrasonic motion detector.
Hochman obtained a comparison of pre and post data on the five subjects for
changes in cervical and lumbar ranges of motion in all planes. He found significant
changes in the lumbar spine only. Increased ranges of lumbar motion (21 percent
to 57 percent) occurred in all planes except extension.
Hochman concluded that supine pelvic blocking as used in Sacro Occipital Technique
had an effect on lumbar ranges of motion in these five cases. This may indicate
that functional change in the pelvis results in changes in lumbar motion, especially
lumbar flexion.
Third Place Faculty Winner:
Impacts of Quality Assurance Program
The third place faculty winner is Life University Professor Marc P. Schneider,
D.C., with his retrospective analysis of patient files following implementation
of a quality assurance program in a chiropractic teaching clinic.
Health care education and delivery are difficult to qualify due to differences
in opinion and clinical judgment. Schneider noted that each practitioner tends
to make decisions based on personal education, experience and biases. Schneider
launched his research with the consideration that, in quality assurance, one
must find some “common ground” from which to form judgments.
Schneider determined that the setting of a minimum standard is developed through
the acceptance of commonly accepted works, whether evidentiary or anecdotal.
His method of retrospective analysis of patient files includes the focus of
a peer review process to identify when a significant variation from the norm
has occurred. He determined that no judgment should take place, simply a reporting
of the variation to those who are ultimately responsible. He concluded that
the responsible parties are then tasked with taking whatever action they deem
appropriate.
Student First Place Winner:
A Mechanism for Idiopathic Scoliosis
Life University College of Chiropractic student Kevin Miller’s research
involved an aberrant force transfer and the righting reflex as a mechanism for
Idiopathic Scoliosis. Miller presents a case study of a 14-year-old with scoliosis.
Miller began with the understanding that Gracovetsky describes the function
of the spine as an “engine” that drives gait, and the spine derives
its “fuel” from potential energy stored as the legs lift the center
of mass in the gravitational field. The impulse created at heel strike is shaped
and directed by the feet, knees and pelvis.
Miller holds that an asymmetry of force transfer may cause joints to exceed
their physiologic limits, resulting in ligamentous creep and/or plastic deformity
of osseous structures. To avoid this result, the body may attempt to create
symmetry of force transfer by altering structural asymmetry, such as increasing
Q-angle in the long leg, carrying the hips and shoulders out of parallel in
the coronal plane or a number of other possibilities.
Miller submits that any adaptation is mediated by mechanoreceptors, thus controlled
by the spinal chord and cerebellum. Further, if the CNS “chooses”
to force the hips and shoulders to remain parallel in the coronal plane, the
only option to maintain normal gait with the head erect is through spinal curvature.
Miller presented photos of a 14-year-old scoliosis patient who had experienced
progressive curvature totaling 29 degrees in the year prior to the photos. An
attempt to correct structural asymmetry, and by proxy, correct asymmetry of
force transfer was accomplished through High Velocity, Low Amplitude manipulation
and subsequent fabrication of volume reducing orthoses.
The carbon graphite, acrylic matrix pair orthoses were fabricated from an AMFIT
contact digitizer scan, with one-half total correction of Leg Length Discrepancy
accomplished with 60 durometer Ethyl Vinyl Acetate. In addition, a stretching
program was implemented and a Spinal Orthosis, which had been part of therapy
prior to entrance into case study, continue with original prescription, worn
six to eight hours, five to six nights per week, while sleeping.
Second Place Student Winner:
Successful Management of Chronic Low Back Pain
Dr. John Hoeffner and Dr. Joseph Haezebrouck studied the impact of flexion distraction
and spinal pelvic stabilizers on the successful management of chronic lower
back pain.
A 41-year-old man presented with moderate to severe constant back pain with
onset in 1992. Until five years ago the patient was involved in athletic activities,
including basketball and track. Today, his activities were now restricted to
walking. Previous treatment with Vertical Axis Decompression brought no relief.
The patient had five leg surgeries including a total left hip replacement. Magnetic
Resonance Imaging had also confirmed a diagnosis of a lumbar herniated disc.
The duo used prone and supine adjustments in the cervical spine. In the lumbar
spine, Flexion Distraction technique was used on a Hill Air-Flex table. The
patient also received a massage from an electric massager and interferential
electrical stimulation in the sweep mode. The settings for the interferential
stimulation were at a frequency of 80–150 Hz cycles.
From Feb. 6, 2004 to May 5, 2004, the patient had 16 office visits. After the
eighth visit, the patient was fitted for Spinal Pelvic Stabilizers for daily
use to provide comfort, support, balance, shock absorption for the lower extremities
and improved posture. With the synergistic combination of adjustments and use
of orthotics, the patient demonstrated an excellent recovery within three months.
Third Place Student Winner:
Coupled Cervical Range of Motion Pattern
Life University College of Chiropractic student Chukwuemeka “Emeka”
Chidebelu-Eze, along with Stephanie Roy, D.C., Brent Russell, D.C., Mike Desaulniers,
D.C., Ron Kirk, D.C., and Bruce Fox, D.C., D.A.C.B.R. made determinations on
coupled cervical range of motion patterns following spinal adjustments.
It is a basic premise of the chiropractic profession that subluxation and misalignment
of the spine may affect spinal range of motion. Chiropractors are taught to
examine range of motion as a usual and customary portion of patient examination.
While traditional and common examination techniques using visual observation,
goniometers, and inclinometers are inexpensive and convenient, their precision
and reliability are limited.
A number of chiropractic adjustment techniques are at least partially based
upon concepts that range of motion may be restricted intersegmentally by the
presence of subluxation and/or misalignment, and that the range of motion will
be improved following an adjustment.
While this has been tested through manual examination, studies using more sophisticated
methods are lacking. Furthermore, the mensuration methods commonly used are
only able to determine restricted or excessive range of motion in a single plane
(e.g., sagittal, coronal or transverse plane). The other planes are ignored.
It is known that most directions of cervical range of motion are “coupled”;
for instance, lateral flexion involves a certain degree of rotation, and vice
versa.
The investigators hold that it is possible that patients may adopt abnormal
patterns of movement in response to restrictions. So even though flexion and
extension are, under normal conditions, relatively “pure” motions,
in the presence of subluxation it is possible that these motions might include
a certain degree of compensatory rotation or lateral flexion that cannot be
detected by simple examination methods.
The investigators hold that the ability to analyze true cervical range of motion
requires examination equipment that is able to detect these motions. The main
purpose of this study was to investigate the effect of a chiropractic adjustment
on the three dimensional range of motion of the cervical spine. The investigators
determined to find out also if an adjustment performed anywhere other than the
cervical spine will illustrate a change in the range of motion of the cervical
spine.
“The next step now is to get this research published,” McCoy says.
“Another goal is to develop a research program with some good funding
behind it. We are looking at avenues of private funding that will allow us to
go beyond the typical government-funded subjects like neck pain, back pain and
headaches. We’ve made great strides and we look forward to taking it to
the next level. To go from the CCE being concerned about research to giving
us a commendation is outstanding. We are very pleased.”
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