Stroke and Manipulation - Chiropractic Doctor

Stroke and Manipulation 105
Clinical Aspects of Cervical Artery Strokes

1.0

  • Cite the strength of evidence about whether chiropractic neck manipulation causes cervical artery dissection (CAD) based on a systematic review, meta-analysis, and evaluation of the body of evidence as a whole
  • Summarize our current state of knowledge on cervical artery dissection and how it impacts the practice of cervical spinal manipulation
  • Outline the state of knowledge regarding bedside diagnosis and management of an acute vestibular syndrome, with the suspicion for stroke 
  • Describe the demographics, past health care utilization, and comorbidities of vertebrobasilar artery stroke patients in Ontario, Canada who consulted a chiropractor within one year prior to their stroke
  • Analyze the nature of internal carotid artery biomechanics and associated risk of injury during cervical spinal manipulation

Shawn Thistle, DC

Downloadable Course in PDF
Journal Article Review
Text

$20.00 USD

Stroke and Manipulation 104

Cervical Spinal Manipulative Therapy (CSMT) and Vertebrobasilar Ischemia (VBI)


8.0

  • Outline methods used and estimations as to the incidence of cervical spinal manipulative therapy and subsequent vertebrobasilar ischemia.
  • Review and describe cerebrovascular anatomy and hemodynamics.
  • Discuss proposed patho-physiological mechanisms believed responsible for subsequent vertebrobasilar ischemia.
  • Review and discuss past and present scientific literature to explore the evolution of what we think we know about the process of cervical spinal manipulative therapy and subsequent vertebrobasilar ischemia.
  • Identify radiographic signs of a vertebral artery dissection.
  • List and discuss the uses, pros and cons of current examination tools as they apply to vertebral artery dissection.
  • Explore issues and examination procedures related to patient assessment as well as vertebrobasilar ischemia recognition and proper diagnosis.
  • Define and contrast currently suggested procedures and develop a vertebrobasilar ischemia plan of action.
  • Explore various perspectives and reveal bias in both public media and biomedical journals.
  • Identify and define new theoretical concepts and prophylactic therapies.
  • Give multiple examples of anti-chiropractic bias in the biomedical literature
  • List and describe the most common red flags for a patient “at risk” for suffering Vertebrobasilar Ischemia following cervical manipulation.
  • Recite list of scientific studies relating to laboratory testing of plasma Homocystine levels and its relationship to Vertebrobasilar Ischemia from vertebral artery dissection.
  • List examples of bias against chiropractic cited in both the popular media as well as in biomedical journals.
  • Critically review landmark articles regarding the issue of cervical manipulation and vertebrobasilar distribution ischemia.
  • List studies suggesting that a high plasma homocystine level may be associated with vertebrobasilar dissection.
  • Cite studies suggesting that increasing folic acid intake can reduce plasma Homocystine levels.
  • Identify laboratory tests that may be useful in helping calculate an individual’s risk of suffering vertebrobasilar stroke following cervical manipulation.

Joseph Ferezy, DC, DACAN, FIACN

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AudioVisual Course

$160.00 USD

Stroke and Manipulation 103
Risk, Association, Screening and Blood Flow

1.0

  • Compare the risk of injury (via Medicare data) between two cohorts of patients treated by chiropractic spinal manipulation versus treatment by a primary care physician
  • Investigate the association between chiropractic manipulative treatment and vertebrobasilar artery stroke
  • Assess the level and quality of evidence regarding the potential association between cervical manipulation and cervical artery dissection/stroke
  • Evaluate the diagnostic accuracy of premanipulative vertebrobasilar tests in terms of sensitivity, specificity, predictive values and likelihood ratios in adults
  • Observe vertebral artery blood-flow after cervical manipulation and various head positions

Shawn Thistle, DC

Downloadable Course in PDF
Journal Article Review
Text

$20.00 USD

Stroke and Manipulation 102

SMT in the Medicare Population - Risks, Facts, and Figures


1.0

  • Compare the associations of chiropractic care and stroke with primary care physician (PCP) care and stroke in the Medicare population
  • Quantify risk of stroke after chiropractic spinal manipulation, as compared to evaluation by a primary care physician, for Medicare beneficiaries aged 66 to 99 years with neck pain
  • Determine the hemodynamics in the Circle of Willis with Internal Carotid Artery Stenosis under cervical rotatory manipulation: a finite element analysis
  • Review compensation claims for chiropractic in Denmark and Norway 2004-2012
  • Examine the risk of traumatic injury associated with chiropractic SMT in the Medicare population

Dean Smith, DC, PhD

Adobe PDF Download
AudioVisual Course

$20.00 USD

Stroke and Manipulation 101

Stroke and Spinal Manipulation: Anatomy, Epidemiology, Pathogenesis of Dissections and Triggers, Neurological Syndromes, Clinical Management


2.0

  • Illustrate the pathogenesis of CADs ­dissection mechanisms
  • Identify putative causes and triggers of CAD
  • Estimate the purported incidence of cerebrovascular syndromes following cervical manipulation
  • Distinguish between the neurological syndromes
  • Identify stroke risk factors in general
  • Assess the value of pre-manipulation testing: to screen or not to screen?
  • Outline the warning signs/symptoms of CAD
  • Indicate what to include in the patient history and examination
  • Describe what to do if you suspect CAD
  • Point out how to communicate risk to patients as well as implementing strategies to prevent CAD
  • Assess the current literature on the relationship between stroke and manipulation
  • Describe the anatomy of the blood supply to the brain
  • Summarize the clinical biomechanics of vertebral arteries
  • Outline the epidemiology and classification of cervicocerebral (vertebral and internal carotid) arterial dissections (CAD) or strokes
  • Recognize the diseases affecting cervicocerebral arteries

Dean Smith, DC, PhD

Adobe PDF Download
AudioVisual Course

$45.00 USD