TOPICS IN CLINICAL CHIROPRACTIC
Abstracts from June 1996
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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:
Robert D. Mootz, DC, DABCO, FICC
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
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),
Olga Rutherford, BA, Msc, PhD
Tilden H. Sokoloff, DPM, MS, DC
Thomas A. Souza, DC, CCSP
Richard D. Stonebrink, BS, DC, ND, FACO, FICC
Care of the Lumbar Spine
Functional capacity evaluation
Back pain pathoanatomy
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
In this issue: The importance of Geriatric Care in Chiropractic Practice
Letters to the Editor
Appendixes: Algorithms, Forms and Other Clinical Aids
Related to the Articles in this Issue
Continuing Education Credit
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.
A qualitative review of relevant clinical literature attenuated by the authors experience and expertise is provided.
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
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.
A qualitative review of relevant literature was undertaken.
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.
Diagnostic imaging illustrations and discussions are presented to review the imaging findings clinical presentations of various musculoskeletal conditions that occur commonly in older patients.
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.
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.
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.
A detailed examination of a database collected during a randomized clinical trial testing the effectiveness of a comprehensive geriatric assessment program was performed.
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.
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.
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.
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.
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 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.
A qualitative review of selected representative and relevant literature, incorporating clinical experience, is offered.
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.
Topics in Clinical Chiropractic is published quarterly, for $58,
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