June '96


TOPICS IN CLINICAL CHIROPRACTIC

Abstracts from June 1996

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Introduction

Future Editions

Table of Contents / Abstracts

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Introduction

Each quarter, Chiropractic OnLine Today will present the Table of Contents and current Abstracts from Aspen Publications' Topics in Clinical Chiropractic.

The following list comprises TICC's Editorial advisory board:

Editor

Robert D. Mootz, DC, DABCO, FICC

Associate Editors:

Linda J. Bowers, DC, DABCO, DABCI, DACBN, DACAN

Daniel T. Hansen, DC, DABCO, FICC

Kevin A. McCarthy, DC, DABCO

Howard Vernon, DC, FCCS

Continuing Education Editor:

Dorrie M. Talmage, DC, DABCO

Editorial Board

Alan H. Adams, DC

Alan Breen, DC

Bernard A. Coyle, PhD

Phillip S. Ebrall, BAppSC (Chiropractic)

Gary Greenstein, DC

Warren I. Hammer, DC, MS, DABCO

Karl C. Kranz, DC

Marion McGregor, Bsc, DC, FCCS (c)

Donna M. Mannello, DC

Paul J. Osterbauer, DC, MPH

Lindsay J. Rowe, MAppSc, MD, DACBR (USA), FCCR (CAN), FACCR (AUST), FICC

Olga Rutherford, BA, Msc, PhD

Tilden H. Sokoloff, DPM, MS, DC

Thomas A. Souza, DC, CCSP

Richard D. Stonebrink, BS, DC, ND, FACO, FICC

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Future Editions

Care of the Lumbar Spine

Functional capacity evaluation
Spinal stabilization
Back pain pathoanatomy

Wellness

Exercise
Maintenance chiropractic
Smoking cessation
Self examinations
Health risk appraisal

Advances in Imaging and Special Studies

Appropriate applications of radiology
Coordinating radiographic and neurophysiologic findings
Decision making in the use of advanced imaging


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Table of Contents / Abstracts for June 1996

In this issue: The importance of Geriatric Care in Chiropractic Practice

  • Page iv:
  • Letters to the Editor

  • Page v:
  • Clinical Pearls

  • Page vi
  • Back to Basics: Normal Aging

  • Page 1: Thomas Souza, DC, DACBSP, and Shahihaz Soliman, MD
  • Clinical Assessment of Geriatric Patients: Unique Challenges

  • Page 10: Linda J. Bowers, DC
  • The Geriatric Patient: Diagnostic Imaging of Common Musculoskeletal Disorders

  • Page 23: John A.M. Taylor, DC, DACBR, and Lisa E. Hoffman, DC
  • Chiropratic Patients in a Comprehensive Home-Based Geriatric Assessment, Follow-up and Health Promotion Program

  • Page 46: Ian D. Coulter, PhD, Eric L. Hurwitz, DC, PhD,
    Harriet U. Aronow, PhD, Donald M. Cassara, PhD, and
    John C. Beck, MD
  • Manipulative Care and Older Persons

  • Page 56: Thomas F. Bergmann, DC, FICC, and Link Larson, DC
  • Management Consideration in the Geriatric Patient

  • Page 66: Kevin A. McCarthy, DC, DABCO
  • Appendixes: Algorithms, Forms and Other Clinical Aids Related to the Articles in this Issue

  • Page 76
  • Continuing Education Credit

  • Page 82

  • Back To Basics:

    Normal Aging

  • Thomas Souza, DC, DACBSP:
    Professor; Department Chair of Diagnosis; Palmer College of Chiropratic-West
  • Sahihaz Soliman, MD:
    Assistant Professor; Department of Diagnosis; Palmer College of Chiropractic-West; San Jose, California
  • Purpose:

    An overview of physiologic and clinical issues associated with normal aging is presented. Specifically, a discussion of theories of morphology of aging of the neuromusculoskeletal, cardiovascular, urinary, pulmonary, and gastrointestinal systems is offered.

    Methodology:

    A qualitative review of relevant clinical literature attenuated by the authors’ experience and expertise is provided.

    Summary:

    The older patient may present with a host of problems, some related to end-state diseases such as diabetes and some the result of poor lifestyle choices and habits. There are some natural or normal decreases in function that must be noted to better place the patient presentation in proper context. These decreases are discussed with a focus on the pathophysiology and clinical manifestations that set the geriatric patient apart from the younger patient. Most changes can be adapted to and supplemented by intellectual, neural, and attitude changes. Key words: aging; chiropractic; geriatric; hypertension; osteoporosis


    CLINICAL ASSESSMENT OF GERIATRIC PATIENTS: UNIQUE CHALLENGES

  • Linda J. Bowers, DC
    Professor and Chiar; Diagnosis Department; Northwestern College of Chiropractic; Bloomington, Minnesota

  • Purpose:

    The geriatric population presents some unique considerations relative to clinical assessment procedures, particularly in the areas of interviewing and physical examination. This article dicusses these areas as well as mental status, functional assessment, and nutritional assessment issues and concerns. Diagnostic testing in older patients is also reviewed as it presents additional challenges in ordering and interpreting results.

    Methodology:

    A qualitative review of relevant literature was undertaken.

    Summary:

    The clinical assessment of geriatric patients presents unique challenges and opportunities for the primary care physician. The comprehensive geriatric assessment improve the quality of geriatric care. Key words: activities of daily living; geriatric assessment; laboratory, diagnosis; medical history taking; mental status schedule; nutrition assessment; physical examination.


    THE GERIATRIC PATIENT: DIAGNOSTIC IMAGING OF COMMON MUSCULOSKELETAL DISORDERS

  • John A.M. Taylor, DC, DACBR
    Associate Professor; Department of Radiology

  • Lisa E. Hoffman, DC
    Resident in Radiology; Western States Chiropractic College; Portland, Oregon
  • Purpose:

    Diagnostic imaging illustrations and discussions are presented to review the imaging findings clinical presentations of various musculoskeletal conditions that occur commonly in older patients.

    Methodology:

    The cases presented were collected from several chiropractic clinics and private offices during the course of radiologic consultations. They are representative of common clinical presentations seen in these settings.

    Summary:

    Musculoskeletal complaints are common in the older population. Diagnostic imaging is useful in the evaluation of several of these conditions. A discussion of relevant clinical issues is provided for several of the more widespread disorders affecting geriatric patients. Imaging techniques discussed include conventional radiography, computed tomography, scintigraphy (bone scan), and magnetic resonance imaging. The specrum of abnormalities include arthritic, metabolic, neoplastic, taumatic, hematologic, and vascular disorders. Key words: aging; articulation, diagnostic imaging; geriatric; musculoskeletal abnormalities; radiography.


    CHIROPRACTIC PATIENTS IN A COMPREHENSIVE HOME-BASED GERIATRIC ASSESSMENT, FOLLOW-UP AND HEALTH PROMOTION PROGRAM

  • Ian D. Coulter, PhD
    RAND; Santa Monica, California; Los Angeles College of Chiropractic; Whittier, California; School of Dentistry; University of California, Los Angeles, California

  • Eric L. Hurwitz, DC, PhD
    Assistant Researcher; Department of Epidemiology; School of Ublic Health; University of California, Los Angeles; Los Angeles, California

  • Harriet U. Aronow, PhD
    Multicampus Program in Geriatric Medicine and Gerontology; University of California, Los Angeles Los Anges, California; Senior Health Peer Counselling; Santa Monica, Californnia

  • Eric L. Hurwitz, DC, PhD
    Donald M. Cassata, PhD; Director; Department of Hospital Education; Porter Memorial Hospital Valparaiso, Indiana

  • John C. Beck, MD
    Multicampus Program in Geriatric Medicine and Gerontology University of California, Los Angeles; Los Angeles, California
  • Purpose:

    The purpose of this study was to access characteristics of older patients who seek chiropractic care. In addition, a qualitative literature review was done to identify what has been published regarding chirorpactic care and geriatrics.

    Methodology:

    A detailed examination of a database collected during a randomized clinical trial testing the effectiveness of a comprehensive geriatric assessment program was performed.

    Results:

    Within a total sample size of 414, a subpopulation of 28 (5.65%) reported receiving chiropractic care. This figure is similar to published reports of distribution of chiropractic patients in the general popoulation. Chiropractic users were less likely to have been hospitalized, less likely to have used a nursing home, more likely to report a better health status, more likely to exercise vigorously, and more likely to be mobile in the community. In addtion, they were less likely to use prescription drugs.

    Conclusions:

    Results suggest a need to develop chiropractic models that address the special preventive and rehabilitative needs of the older patients. Key words: chiropractic; geriatrics; home care; older persons; wellness interventions.


    MANIPULATIVE CARE AND OLDER PERSONS

  • Thomas F. Bergmann, DC, FICC
    Professor; Methods Department; Faculty Clinician; Center for Clinical Studies; Northwestern College of Chiropractic; Bloomington, Minnesota
  • Link Larson, DC
    Assistant Professor; Diagnosis Department; Northwestern College of Chiropractic; Bloomington, Minnesota; Private Practice; St. Paul, Minnesota
  • Purpose:

    This article discusses the use of manipulative procedures for dysfunctional joint conditions affecting older patients. The effective and efficient conservative management of the geriatic patient requires some significant differences from management techniques used in younger populations.

    Method:

    A qualitative review of selected relevant literature was undertaken to determine manual treatment options for older patients. In addition, data were sought on the role of manual therapy in maintaining function in the older population.

    Conclusions:

    Manual treatment of musculoskeletal conditions in older patients can be undertaken with several precautions and modifications to usual manipulative procedures. They include adequate screening (eg. Radiograph, appropriate laboratory studies, etc.), attention to patient positioning, and minimization of the applied force. There is enough anecdotal evidence to justifiy further study to evaluate the effectiveness of manual therapy and specifically chiropractic adjunctive procedures for improving functional performances in older individuals. Key words: aged; geriatric; manipulation-chiropractic; manipualtion-orthopaedic.


    MANAGEMENT CONSIDERATIONS IN THE GERIATRIC PATIENT

  • Kevin A. McCArthy, DC, DABCO
    Dean of the College; Palmer College of Chiropractic-West San Jose California
  • Purpose:

    Management of geriatric patients often requires the clinician to consider issues not normally addressed in the general patient population. A number of these issues are identified, and methods to collect and assess information in each area are outlined. Ongoing management strategies for reducing potential injury, illness and frailty and developing habits that promote wellness are outlined.

    Methods:

    A qualitative review of selected representative and relevant literature, incorporating clinical experience, is offered.

    Summary:

    Unique considerations that may require emphasis in managing the older patient include living arrangements and family relationships, along with health and functional disabilities. Key clinical issues can involve multiple pathologies, atypical presentations, drug-related symptoms, and atypical responses to care. The importance of activation and exercies in maintaining cardiovascular functions, pulmonary function, musculoskeletal performance, and conditioning needs to be emphasized in the older population. Wellness interventions, including nutrition and exercise, play key roles. Key words: activities of daily living, aging, chiropractic, geriatric.


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    Topics in Clinical Chiropractic is published quarterly, for $58, by Aspen Publishers.

    Aspen may be contacted directly at: 800-638-8437


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