Hour 1:

• Identify the requirements to become a National Registry Certified Medical Examiner
• Report Completed CDL Exams to the National Registry
• Obtain a CLIA Certificate of Waiver
• Specify Commercial Driving Licenses, vehicles, commerce, standards and medical guidance requirements and definitions

Hour 2:

• Summarize the Medical Examiner Role and Responsibilities
• Assist Drivers in filling out the driver portions of the Medical Exam Report Form
• Complete and review the Medical Exam Report Form
• Issue a Medical Examiner’s Certificate

Hour 3:

• Review medication use by drivers
• Assess driver general health and wellness factors and medical condition health risk
• Perform the physical examination of a driver of commercial vehicles
• Evaluate Vision disorders related to driving a commercial vehicle

Hour 1:

• Identify the requirements to become a National Registry Certified Medical Examiner
• Report Completed CDL Exams to the National Registry
• Obtain a CLIA Certificate of Waiver
• Specify Commercial Driving Licenses, vehicles, commerce, standards and medical guidance requirements and definitions

Hour 2:

• Summarize the Medical Examiner Role and Responsibilities
• Assist Drivers in filling out the driver portions of the Medical Exam Report Form
• Complete and review the Medical Exam Report Form
• Issue a Medical Examiner’s Certificate

Hour 3:

• Review medication use by drivers
• Assess driver general health and wellness factors and medical condition health risk
• Perform the physical examination of a driver of commercial vehicles
• Evaluate Vision disorders related to driving a commercial vehicle

Hour 4:

• Calculate ANSI, ISO, and Whisper hearing testing values
• Perform external and otoscopic evaluation related to driving requirements
• Appraise driver ear disorders that affect safe driving
• Evaluate drivers with hypertension for driving a commercial vehicle

Hour 5

• Perform the cardiovascular examination for drivers
• Assess cardiovascular disease in drivers of commercial vehicles
• Determine acceptable cardiovascular safe driving risk for drivers
• Assign medical certificate duration for drivers with cardiovascular disease

Hour 6:

• Evaluate drivers with Cardiac Arrhythmias, pacemakers, implanted defibrillators
• Recall driving requirements for arrhythmias, syncope, transplants
• Distinguish cardiovascular medication effects that are a risk to safe driving
• Determine driving status and duration for safe driving

Hour 7:

• Apply Respiratory guidance for drivers with respiratory disease
• Conduct the respiratory and sleep apnea exam and evaluation
• Determine which drives must be tested and treated for OSA
• Assess Obstructive Sleep Apnea safety risk in drivers

Hour 8:

• Assess the drivers neurological history
• Determine neurological driving safety risk according to FMCSA guidance
• Explain severity’s affect on driving status from cerebrovascular, head trauma and spinal cord injuries on driving status
• Assess driver eligibility for a Federal Seizure disorder exemption.

Hour 9:

• Appraise diabetes in drivers of commercial vehicles
• Determine driving status and duration according to FMCSA guidance for drivers with diabetes
• Evaluate risk to safe driving for drivers with other endocrine disorders and other diseases without specific FMCSA guidelines in drivers
• Recall classifications of hypoglycemic medications and their impact on safe driving

Hour 10:

• Differentiate between psychological disorders affecting drivers
• Identify medical treatment and therapy for psychological disorders
• Recall disqualifying psychological disorders for drivers of commercial vehicles
• Appraise medications for psychological disorders for safe driving risk

Hour 11:

• Discuss the FMCSA musculoskeletal standard and guidelines
• Determine those drivers eligible for a Special Performance Examination
• Apply the FMCSA Drug and Alcohol testing to drivers and motor carriers
• Asses drivers to refer for substance abuse professional evaluation

Hour 12:

• Review FMCSA provided practice scenarios
• Derive FMCSA evaluation procedure as provided in practice scenarios
• Apply FMCSA evaluation concepts to drivers as contained in FMCSA practice scenarios
• Prepare for the FMCSA Certification Test

• Identify the requirements to become a National Registry Certified Medical Examiner
• Report Completed CDL Exams to the National Registry
• Obtain a CLIA Certificate of Waiver
• Specify Commercial Driving Licenses, vehicles, commerce, standards and medical guidance requirements and definitions

• Summarize the Medical Examiner Role and Responsibilities
• Assist Drivers in filling out the driver portions of the Medical Exam Report Form
• Complete and review the Medical Exam Report Form
• Issue a Medical Examiner’s Certificate

• Review medication use by drivers
• Assess driver general health and wellness factors and medical condition health risk
• Perform the physical examination of a driver of commercial vehicles
• Evaluate Vision disorders related to driving a commercial vehicle

Hour 1:

• Calculate ANSI, ISO, and Whisper hearing testing values
• Perform external and otoscopic evaluation related to driving requirements
• Appraise driver ear disorders that affect safe driving
• Evaluate drivers with hypertension for driving a commercial vehicle

Hour 2:

• Perform the cardiovascular examination for drivers
• Assess cardiovascular disease in drivers of commercial vehicles
• Determine acceptable cardiovascular safe driving risk for drivers
• Assign medical certificate duration for drivers with cardiovascular disease

Hour 3:

• Evaluate drivers with Cardiac Arrhythmias, pacemakers, implanted defibrillators
• Recall driving requirements for arrhythmias, syncope, transplants
• Distinguish cardiovascular medication effects that are a risk to safe driving
• Determine driving status and duration for safe driving

• Calculate ANSI, ISO, and Whisper hearing testing values
• Perform external and otoscopic evaluation related to driving requirements
• Appraise driver ear disorders that affect safe driving
• Evaluate drivers with hypertension for driving a commercial vehicle

• Perform the cardiovascular examination for drivers
• Assess cardiovascular disease in drivers of commercial vehicles
• Determine acceptable cardiovascular safe driving risk for drivers
• Assign medical certificate duration for drivers with cardiovascular disease

• Evaluate drivers with Cardiac Arrhythmias, pacemakers, implanted defibrillators
• Recall driving requirements for arrhythmias, syncope, transplants
• Distinguish cardiovascular medication effects that are a risk to safe driving
• Determine driving status and duration for safe driving

Hour 1:

• Apply Respiratory guidance for drivers with respiratory disease
• Conduct the respiratory and sleep apnea exam and evaluation
• Determine which drives must be tested and treated for OSA
• Assess Obstructive Sleep Apnea safety risk in drivers

Hour 2:

• Assess the drivers neurological history
• Determine neurological driving safety risk according to FMCSA guidance
• Explain severity’s affect on driving status from cerebrovascular, head trauma and spinal cord injuries on driving status
• Assess driver eligibility for a Federal Seizure disorder exemption.

Hour 3:

• Appraise diabetes in drivers of commercial vehicles
• Determine driving status and duration according to FMCSA guidance for drivers with diabetes
• Evaluate risk to safe driving for drivers with other endocrine disorders and other diseases without specific FMCSA guidelines in drivers
• Recall classifications of hypoglycemic medications and their impact on safe driving

• Apply Respiratory guidance for drivers with respiratory disease
• Conduct the respiratory and sleep apnea exam and evaluation
• Determine which drives must be tested and treated for OSA
• Assess Obstructive Sleep Apnea safety risk in drivers

• Assess the drivers neurological history
• Determine neurological driving safety risk according to FMCSA guidance
• Explain severity’s affect on driving status from cerebrovascular, head trauma and spinal cord injuries on driving status
• Assess driver eligibility for a Federal Seizure disorder exemption.

• Appraise diabetes in drivers of commercial vehicles
• Determine driving status and duration according to FMCSA guidance for drivers with diabetes
• Evaluate risk to safe driving for drivers with other endocrine disorders and other diseases without specific FMCSA guidelines in drivers
• Recall classifications of hypoglycemic medications and their impact on safe driving

Hour 1:

• Differentiate between psychological disorders affecting drivers
• Identify medical treatment and therapy for psychological disorders
• Recall disqualifying psychological disorders for drivers of commercial vehicles
• Appraise medications for psychological disorders for safe driving risk

Hour 2:

• Discuss the FMCSA musculoskeletal standard and guidelines
• Determine those drivers eligible for a Special Performance Examination
• Apply the FMCSA Drug and Alcohol testing to drivers and motor carriers
• Asses drivers to refer for substance abuse professional evaluation

Hour 3:

• Review FMCSA provided practice scenarios
• Derive FMCSA evaluation procedure as provided in practice scenarios
• Apply FMCSA evaluation concepts to drivers as contained in FMCSA practice scenarios
• Prepare for the FMCSA Certification Test

• Differentiate between psychological disorders affecting drivers
• Identify medical treatment and therapy for psychological disorders
• Recall disqualifying psychological disorders for drivers of commercial vehicles
• Appraise medications for psychological disorders for safe driving risk

• Discuss the FMCSA musculoskeletal standard and guidelines
• Determine those drivers eligible for a Special Performance Examination
• Apply the FMCSA Drug and Alcohol testing to drivers and motor carriers
• Asses drivers to refer for substance abuse professional evaluation

• Review FMCSA provided practice scenarios
• Derive FMCSA evaluation procedure as provided in practice scenarios
• Apply FMCSA evaluation concepts to drivers as contained in FMCSA practice scenarios
• Prepare for the FMCSA Certification Test

• Explain the phases of human walking gait
• Discuss the biomechanical events associated with stance phase of gait
• Discuss the biomechanical events associated with swing phase of gait
• Explain biomechanically what is happening during each phase of gait in the foot, ankle, knee and hip
• Discuss the 3 rockers of the foot and how they apply to the gait cycle
• Understand the calcaneocuboid locking mechanism and defend it's importance in the stance phase of gait
• Summarize the ranges of motion of the foot, ankle, knee and hip and their importance in normal gait
• Explain how stance phase abnormalities would impact the gait cycle
• Demonstrate competency in obtaining a reproducible Pedograph print
• Interpret rearfoot, midfoot and forefoot mechanics as seen on a pedograph print
• Identify and interpret problem areas in a pedograph print
• Identify stance phase abnormalities on a Pedograph print
• Extrapolate pathomechanics which would occur rostrally in the kinetic chain during pathomechanics occurring in the gait cycle
• Evaluate the impact of gait abnormalities on human locomotion

• Describe how the motor and sensory homunculus relate to the foot and are integral to training and rehabilitation
• Discuss the 3 rockers of the foot
• Give examples of problems that result from a loss of the 3 rockers of the foot
• Explain the concept of pelvis neutrality and its effect on training
• Describe and examine the tripod of the foot
• Breakdown most movement into 2 basic rules or tenets
• Give examples of the problems which can arise if the 2 basic rules or tenets of movement are not followed
• Discuss the clinical consequences of loss of the medial and lateral tripods of the foot

• Discuss the normal walking gait cycle
• Apply the biomechanics of the pelvis and lower kinetic chain during walking to clinical practice
• Predict and discuss problems and clinical strategies that can arise from altered lower extremity biomechanics
• Apply visual analysis skills
• Evaluate case studies in gait analysis
• Clinically apply solutions for gait abnormalities

• Discuss the salient points of conducting a visual gait analysis
• Review the gait cycle and associated kinetics and kinematics
• Discuss step length, stride length and how they are affected in a case of a person with posterior compartment weakness
• Review the biomechanics associated with heel rise
• Propose rehabilitation strategies for specific cases that were reviewed

• Discuss the pitfall of video assessment of gait cases
• Review the gait cycle with respect to stance phase abnormalities in a gait case
• Differentiate between step length and stride length
• Review heel rise and the windlass mechanism
• Discuss the function of the long flexors of the toes in gait
• Evaluate pelvic posturing as it relate to a gait case
• Discuss the gait pathomechanics that result from a herniated disc

• Briefly describe the history of the pedograph
• Compare pedographs with other technologies available for foot imprinting
• Explain how to obtain a reproducible pedograph
• Discuss pedograph interpretation and what it means clinically

• Define the crossover gait
• Visually identify the crossover gait
• Explain the biomechanical elements of the crossover gait
• Analyze the cross over gait
• Give examples of the cross over gait
• Integrate your knowledge of the cross over gait to formulate an appropriate treatment plan
• Outline some common exercises for cross over gait remediation

• Examine how arm swing correlates and integrates with the gait cycle
• Visually identify arm swing
• Explain the biomechanical elements of arm swing
• Analyze arm swing
• Give examples of normal and abnormal arm swing
• Integrate your knowledge of arm swing to formulate an appropriate treatment plan

• Review static postural foot assessment as it relates to a case study
• Describe muscular compensations that may occur as the result leg length differences
• Compare muscular action vectors and their changes with aberrant foot mechanics
• Discuss the concept of flexor dominance and how it relates to the long flexors of the toes

• Review the anatomical and functional causes of  leg length discrepancies
• Review the kinematics and kinetics of leg length discrepancies during the gait cycle.
• View and discuss several new case studies looking at anatomical leg length discrepancies and the impact of compensations to accommodate the fixed changes. 
• Discuss examination procedures to facilitate understanding of the pathomechanics resulting from a leg length discrepancy. 
• Propose intrinsic and extrinsic remedies for the gait abnormalities seen.

• Provide an overview of orthotic therapy
• Review orthotic casting processes and contrast differences and potential pitfalls in them
• Discuss common problems arising from orthotic prescription (blisters, pain during use, pressure spots, etc)
• Propose mechanisms for why problems occur biomechanically
• Present remedies for common problems that arise

• Discuss retraining CNS sensory and motor patterns
• Present several key concepts in visual gait analysis
• Introduce lesser known anatomical points of interest in the sacroiliac joint
• Discuss some rehabilitation strategies for the sacroiliac joint

• Discuss the ideal kinetics and kinematics of the walking gait cycle
• Present the normal lower extremity parameters/ontogeny surrounding the requisites for gait
• Explore the impact of lower extremity torsions on foot progression angle
• Highlight the differences between tibial and femoral leg length discrepancies
• View video examples of different aspects of gait

• Review the mechanics of the bridge exercise
• Discuss the current indexed literature surrounding the bridge exercise
• Describe potential pitfalls in performing and prescribing the bridge exercise
• Point out the differences of maintaining a "neutral spine" versus an increased or decreased lumbar lordosis
• Identify potential ways to correct faulty mechanics and optimize performance of the bridge exercise

The bridge exercise has been a staple amongst conditions seeking to rehabilitate everything from lower back pain to gait abnormalities. Traditionally, this is predominantly a gluteus maximus exercise however we often find that it is dominated by the hamstrings. This presentation goes through the recent research surrounding this exercise as well as ways to optimize its efficacy and clinical utility.

• describe a new, novel test to diagnose gluteus medius tears
• explain the various functions of the gluteus maximus and medius
• explore the effects of a resistance band around the knees on the gluteus maximus, quadricep and valgus angles on the knees during a back barbell squat
• contrast gluteus medius resistance and rehabilitation exercises with respect to maximal recruitment
• discuss electromyographic activity in the gluteus medius, gluteus maximus, biceps femoris, vastus lateralis, vastus medialis and rectus femoris during the Monopodal Squat, Forward Lunge and Lateral Step-Up exercises.

• Review ideal walking gait biomechanics
• Discuss the current indexed literature surrounding sandals and open back footwear relative to musculoskeletal symptoms
• Describe pathomechanics associated with wearing flip flops and open back footwear
• Contrast the ideal gait cycle with the gait cycle while wearing flip flops, sandals and open back footwear
• Identify potential ways to correct faulty mechanics associated with wearing open back footwear

Ever wonder if “flip flops” are bad for you? How about open back shoes? With the prevalence of sandal and open back footwear use, we thought it appropriate to talk about the biomechanics and potential pitfalls of this type of footwear. In this preservation we examine the biomechanics, pathomechanics literature and potential sequelae of sandals and open back shoes.

• Describe the biomechanics of rotation of a thoracic ring at the levels T1-T7.
• Describe the biomechanics of the Cervical spine, Thoracic spine, ribs, clavicle and manubrium with elevation of the right or left shoulder.
• Describe the biomechanics of flexion and extension at the Costotransverse joint at T9.
• Describe the differences in motion of the mobile segments between T3 -T7 with side flexion occurring first in the Thoracic spine.

• This contains all courses with the educational objectives listed from Breathing Essentials 201 through 204

• This contains all courses with the educational objectives listed from Breathing Essentials 201 through Breathing Essentials 207

• Describe the physiology of breathing and how altered pH can affect the body.
• Describe two functions of the diaphragm.
• Identify limited chest expansion and Bradcliff angles and ski jumps
• Identify limited lateral costal breathing and how to facilitate normal lateral costal breathing

• Describe how altered breathing patterns can alter pH and how this can affect the body.
• Describe the autonomic nervous system and function.
• Name three physiological consequences of respiratory alkalosis.
• Describe suboptimal breathing patterns and their effect on the cervical spine and chronic pain.

• Name and describe the different types of sleep apnea.
• Describe the three levels of Apnea-hypopnea index AHI.
• List five symptoms of sleep apnea.
• List two treatments for sleep apnea.

• Describe the physiological response of aerobic exercise on the respiratory system.
• Describe the effect of running on the viscera and the diaphragm.
• Describe the response to inspiratory muscle fatigue on the body.
• List one device than may increase endurance of the respiratory muscles.

• Describe the anatomical structure of the diaphragm including innervation and blood supply.
• List four causes that may damage the innervation to the diaphragm and effect normal function.
• Describe the factors involved in Intensive Care Unit Acquired Weakness.
• Be able to describe the pros and cons of early mobilization in the ICU.

Hour 1

• Describing common conditions affecting the middle aged adult, including the following: osteoarthritis, rheumatoid arthritis, disc herniations, Type 2 diabetes mellitus, and abdominal aortic aneurysms
• Observing diagnostic imaging related to each of the above conditions and determining the best imaging modality to use for the various conditions
• Determining appropriate prevention and ancillary treatments for the discussed conditions

Hour 2

• Analyzing obesity through assessment and intervention
• Discussing breast cancer diagnostic imaging and disease management
• Diagnosing and treating congestive heart failure
• Evaluating diagnosis and treatment options for the osteoporosis patient

Hour 3:

• Review the pathophysiology of spondylolisthesis
• Evaluate the two classifications of spondylolisthesis
• Classify transitional segments
• Determine necessity and efficacy of imaging of spondylolisthesis and transitional segments

Hour 4

• Differential diagnosis osteopenia and its relevance towards Chiropractic practice
• Identify imaging features of osteopenia
• Recognize ominous features of osteopenia
• Select appropriate chiropractic treatments for the osteoporotic patient

Hour 5

• In plain film radiographs, identify the orthopedic hardware used to treat femur, humerus, tibia, and radius fractures.
• Discuss special situations for fracture repair, such as osteoporosis, metastasis, pediatrics, and obesity.
• Review various fracture risk assessment tools that can be used in clinical practice.
• Evaluate when various hardware such as screws, nails, and plates are utilized.

Hour 6

• Identifying vertebral characteristic features on plain film for the following diagnoses: Adolescent Idiopathic Scoliosis, Neurofibromatosis-1, Multiple myeloma, Paget's disease of bone, and vertebral compression fractures.
• Determining what advanced imaging might be warranted for each of the vertebral conditions.
• Describing general features of each condition such as incidence, clinical presentation and treatment options.

Hour 7

• Determine the incidence and the characteristics of different spine pathology.
• Demonstrate, with plain film radiographs and magnetic resonance imaging, characteristics of central nervous system tumors and metastasis, syringomyelia, disc herniation, and trauma.
• Identify clinical features and treatment for various spine pathologies.

Hour 8

• Understand the general features of the inflammatory arthritides
• Discuss the clinical presentation, radiographic features, and chiropractic treatments for Rheumatoid Arthritis
• Discuss the clinical presentation, radiographic features, and chiropractic treatments for Ankylosing Spondylitis
• Compare the two most common inflammatory arthritides – Rheumatoid Arthritis and Ankylosing Spondylitis – to the other diseases in this category
• Compare the inflammatory arthritides to the most common arthritide – osteoarthritis

Hour 9

• Differentiate Rheumatoid Arthritis from Ankylosing Spondylitis, the two most common inflammatory arthritides.
• Differentiate Rheumatoid Arthritis from Erosive Osteoarthritis, both hand arthritides.
• Differentiate Degenerative from Inflammatory arthritis.
• Differentiate Osteoarthritis from Gout, the most common arthritide and the most common metabolic arthritide respectively.

Hour 10

• Learn a systematic approach to feature identification of arthritis
• Identify radiographic features of arthritis
• Develop a differential diagnosis of arthritis
• Apply knowledge to classify unknown cases

• Comprehend basic diagnostic ultrasound terminologies and definitions. 
• Outline general diagnostic ultrasound equipment and image formation. 
• Identify the normal sonographic appearance of muscle, tendon, ligament, bone, nerve and cartilage. 
• Identify sonographic artifacts. 
• Utilize diagnostic ultrasound in the assessments and diagnosis of common musculoskeletal conditions. 

• Review normal anatomy of the shoulder 
• Discuss the ultrasound examination scanning techniques of the shoulder 
• Recognize normal sonographic anatomy of the shoulder 
• List the complete standard sonographic protocol of the shoulder 
• Distinguish abnormal sonographic findings and pathologies of the shoulder 

• Review normal anatomy of the ankle
• Discuss the ultrasound examination scanning techniques of the ankle
• Recognize normal sonographic anatomy of the ankle
• List the complete standard sonographic protocol of the ankle
• Distinguish abnormal sonographic findings and pathologies of the ankle

• Review normal anatomy of the knee
• Discuss the ultrasound examination scanning techniques of the knee
• Recognize normal sonographic anatomy of the knee
• List the complete standard sonographic protocol of the knee
• Distinguish abnormal sonographic findings and pathologies of the knee

• Develop the skills for medical documentation record-keeping for proper patient care and adherence to insurance value based parameters
• Recognize the importance, and benefits of thorough chart documentation from the standpoint of the patient, the provider, the profession and third-party payors
• Show how outcome assessment documentation benefits the patient, the provider, the profession, and third-party payors
• Demonstrate physical examination procedures that are the basis for diagnosis formulation and value based data
• Examine skills necessary to incorporate an outcomes-based, evidenced-influenced approach to patient-centered health care in bodily injuries

• Develop the skills for medical documentation record-keeping for proper patient care
• Recognize the importance and benefits of documentation methodology from the standpoint of risk management
• Identify selected documentation problems and errors
• Summarize recommendations for improving patient care documentation

• Define the Problem Oriented Medical Record (POMR).
• Demonstrate taking a complete patient history.
• Define the Evaluation and Management examination for the musculoskeletal system.
• Define Outcome Assessment.
• Illustrate the P.A.R.T. format of documentation.
• Define proper assessment for SOAP notes.
• Discuss proper documentation of treatment performed on each visit.
• Discuss proper documentation of treatment plans.

• Comprehend the reasons for transitioning from ICD9 to ICD10
• Determine the critical differences with the new ICD10 codes
• Utilize the proper alpha and numeric aspects of commonly used ICD10 codes for  Chiropractic
• Observe the practicality of combining clinical documentation and the proper use of ICD10 codes.

• Discuss the history of ICD-10-CM codes
• Discuss the Official ICD-10-CM Guidelines for Coding and Reporting
• Identify and discuss the tools needed to navigate the ICD-10 codes
• Discuss the General Equivalence Mappings (GEM’s) and their significance and how they relate to ICD-10-CM Tabular List of Diseases and Injuries
• Identify and discuss how to select the appropriate ICD-10 code to its highest specificity
• Examples to be discussed

• Recognize the key components regarding good documentation and record keeping
• Identify the legal requirements of informed consent and the key elements of the informed consent process
• Discuss why doctors are held to higher standards
• Describe the 21 NCQA guidelines for record keeping
• Document progress notes (SOAP) to meet insurance guidelines and medical necessity
• Apply the PARTS system and its transformation utilizing a new method AIR S & M
• Utilize CMT coding appropriately
• Utilize E/M (Evaluation/Management) coding appropriately to meet insurance guidelines and medical necessity
• Identify the 3 categories and 2 subcategories of E/M codes
• Identify the 5 levels of E/M services for new and established patients
• Identify the 7 components (descriptors) used to determine the level of E/M service
• Select the appropriate level of E/M services utilizing 7 simple steps

• Differentiate between active and maintenance care in clinical documentation
• Execute the use of advance notice in third party patients correctly and accurately
• Identify and implement strategies to clarify the difference between active and maintenance care in documentation
• Recognize and adopt best practices in proper notification about maintenance care vs. active treatment

• Properly document findings and recommendations around muscle therapies
• Master the documentation necessary in daily visits to verify medical necessity
• Identify and implement strategies the most important findings and rationale necessary to add muscle therapies to the treatment plan
• Recognize how to differentiate between various manual therapies to meet the requirements of third-party payers' medical review policy

• Differentiate between supervised modalities, constant attendance modalities, and therapeutic procedures
• Properly document the time and service for any physical medicine modality and procedure
• Clearly define the rationale for these services within the patient's medical record

• Recognize the varying specific requirements for documenting unique adjusting techniques in regards to compliant records and risk management
• Properly document patient encounters for medical necessity
• Discuss the Medical Review Policy insurers use in reviewing medical documentation
• Review case studies and examples to identify documentation errors during self-auditing

• Cite the difference between Therapeutic Exercise and Therapeutic Activities
• Properly document all aspects required when utilizing timed therapy services
• Assimilate payer policy details to ensure proper code utilization
• Discuss common errors when documenting and billing therapy services

• Apply best practices for using abbreviations, addressing legibility, authentication of signatures, and managing the day-to-day flow of your patient records 
• Clearly delineate the beginning and end of episodes of patient care, proper recording of these episodes, and boundary discussions with patients 
• Locate and utilize the definitions of medically necessary care, and apply it as a differentiator from clinically appropriate care
• Assess documentation across the life cycle of the patient’s chart from history to discharge and on through maintenance and wellness care based on live examples demonstrated
• Identify the deficiencies that may be present in your documentation through the eyes of an auditor

• Utilize documentation requirements for the most commonly used CPT codes in the profession
• Apply coding techniques and algorithms to ensure the proper code is selected to meet E/M documentation guidelines
• Recognize the codes that carry the highest degree of risk and confirm that documentation meets the code requirements
• Identify the mandatory elements of medical review policy for selected chiropractic codes

• Compose Complete and Accurate Treatment Plans
• Formulate multiple Standard Treatment Protocols for better compliance and efficiency
• Differentiate patient care plans per Patient condition severity
• Propose recommendations based on exam findings, not third party coverage

• Discuss Medicare’s guidelines for documenting quality measures 
• Discuss Medicare’s Merit-Based Incentive Program (MIPS)
• Identify and determine the eligibility requirements for MIPS
• Identify and discuss the 4 categories under MIPS (Quality, Cost, Promoting Interoperability (PI) and Clinical Practice Improvement Activities (CPIA)
• Recognize how Medicare calculates MIPS to determine payment adjustments

• Know how to document exactly what’s required for initial visit treatment plans including physical medicine procedures
• Apply sample language to include in each daily visit note that will meet documentation guidelines for these modalities and procedures, including properly recording time for timed services
• Command the mechanics of how to authenticate documentation for services provided by auxiliary team members
• Tie the patient’s diagnosis to the treatment plan for tissue-specific, physical medicine solutions
• Tell a complete and coherent account of the patient’s daily visit journey, outlining the crucial language necessary to justify medical necessity for all services rendered

• Recognize and document the difference between active and maintenance care
• Use a decision-making matrix to determine the reportability of active treatment, and to be able to help the patient understand the distinction
• Apply the Medicare standard of recordkeeping to intake requirements to establish a baseline for episodes of care
• Determine whether routine visits qualify as active treatment when presented with new and updated complaints

• Describe the need for prognosis
• Summarize what a prognosis is
• Demonstrate the use of prognostic tools
• Appraise your individual patient’s outlook for recovery.
• Measure the progress
• Make evidence based clinical decisions
• Substantiate your opinion for expert testimony.
• Illustrate the evidence for care.
• Prescribe evidence based care plans.
• Properly document and code complicated cases
• Improve the patient report of findings and discharge procedures

Hour 1 - 5

• Describe the need for prognosis
• Summarize what a prognosis is
• Demonstrate the use of prognostic tools
• Appraise your individual patient’s outlook for recovery.
• Measure the progress
• Make evidence based clinical decisions
• Substantiate your opinion for expert testimony.
• Illustrate the evidence for care.
• Prescribe evidence based care plans.
• Increase your reimbursement for complicated cases.
• Improve the patient report of findings and discharge

Hour 6

• Interpret in documentation, the difference between active, medically necessary care vs. clinically appropriate but possibly maintenance adjustments
• Able to distinguish compensatory vs. primary subluxations and document them properly
• Specify proper documentation techniques as a full spine adjuster
• Demonstrate the ability to classify documentation for each chiropractic technique employed

• Interpret in documentation, the difference between active, medically necessary care vs. clinically appropriate but possibly maintenance adjustments
• Able to distinguish compensatory vs. primary subluxations and document them properly
• Specify proper documentation techniques as a full spine adjuster
• Demonstrate the ability to classify documentation for each chiropractic technique employed

• Perform functional testing to identify patients who will benefit from active care rehab
• Correlate functional testing findings with a protocol-driven care plan customized to the patient’s diagnosis
• Recognize and document preferred outcomes that result from properly executed active care techniques
• Follow clinical algorithms to best understand the beginning, middle and end points of active care rehab
• Properly document the clinical rationale for active care rehab by linking it to the diagnosis and treatment plan of initial visit documentation

• Discover all the elements necessary for appropriate documentation of an episode of care, from the initial visit through the discharge from active treatment
• Have clearer delineation of the beginning and end of episodes of patient care
• Decide when an active episode of care should turn into maintenance care, and document the decision making appropriately
• Identify the required components of documentation as they are outlined in state board documentation requirements, Medicare documentation requirements and other entities’ regulations

• Define and recognize common procedures that may be deemed unproven, investigational or experimental
• Determine how individual state boards and payers view these various treatments
• Recognize guidance or rulings from state boards that dictate the need for informed consent
• Properly document the procedures in the medical record
• Apply correct coding to describe the procedure provided
• Personalize a sample Consent to Treat for the procedure provided

• Awareness of the value of orderly documentation to you and others
• Ability to duplicate key documentation components that auditors and reviewers expect
• Steps necessary to address how poor documentation can turn a simple record review into a full audit
• Ability to identify commonly missed links connecting documentation to treatment

• Recognize and apply E/M documentation requirements for history and consultation
• Properly execute the four sub-components of history to be documented for new and established patient documentation
• Properly execute the appropriate documentation for chiropractic examination components necessary to meet E/M documentation requirements
• Reproduce quality documentation components within history and examination for new and established patients
• Distinguish necessary elements of E/M documentation guidelines necessary for various levels of coding

• This contains all courses with the educational objectives listed from Documentation 180 through Documentation 181

• Recognize and apply E/M documentation requirements for medical decision making, to include levels of risk, problem points, and data points.
• Calculate the appropriate levels of medical decision making based on complexity tables
• Properly execute the appropriate documentation medical decision-making components necessary to meet E/M documentation requirements
• Reproduce quality documentation elements necessary in new and established patient documentation
• Compute, using appropriate algorithms, the levels of E/M coding based on documentation

• Differentiate and document for the difference between medical necessity and clinical appropriateness
• Execute a complete and compliant treatment plan that includes all required elements
• Properly record the elements necessary to justify the full-spine adjustment
• Command the mechanics of properly documenting clinical rationale for ordered diagnostics and treatment
• Ensure the inclusion of diagnostic assessment and doctor’s rationale in routine daily visit notes

• Evaluate the necessary elements to properly document established patient re-evaluations of all types
• Deliver appropriate evaluation and management services to justify continued care, assess progress, and discharge from this active care when the time is right
• Report the necessary components of documenting the transitional diagnosis and treatment plan after a periodic re-evaluation
• Complete the fundamentals of documenting the assessment of change since the last evaluation as it applies to federal regulations in Medicare

• Recognize the mandatory enrollment guidelines for chiropractors and apply the rules to daily practice
• Distinguish between active and maintenance care and employ proper procedure to administrate both types of care
• Complete and document required elements of documentation of active treatment
• Prepare patients to best differentiate care that Medicare considers medically necessary from care that the patient is expected to pay for
• Apply the Medicare standard of financial transactions with patients in order to stay within the Federal collection guidelines

• Discover how proper documentation impacts the revenue cycle and profitability of your office
• Distinguish between Medically Necessary and Clinically Appropriate Care
• Demonstrate how your office compliance program either leaves you vulnerable or reduces your risk
• Develop understanding of compliant fee systems
• Evaluate federal guidelines regarding discounting and/or hardship

• Discern Part B from Part C and know the rules for each
• Discuss mandatory enrollment necessary for Chiropractic specialty
• Master the definition of medical necessity vs. clinical appropriateness and who pays in either case
• Recognize the differences between acute, chronic, and maintenance car
• Locate and understand the Medicare Local Coverage Determination (LCD) for your state including all the rules and guidelines
• Identify CMT coding and how it is differentiated from maintenance in Medicare

• Understand the difference between clinically appropriate and medically necessary care
• Identify the clinical indications of when to initiate therapeutic withdrawal
• Execute the components of a final discharge evaluation with proper documentation and recommendations
• Learn how to transition a client from an active phase of care to maintenance as a part of your treatment plan

• Cite the difference between Therapeutic Exercise and Therapeutic Activities
• Properly document all aspects required when utilizing timed therapy services
• Assimilate payer policy details to ensure proper code utilization
• Discuss common errors when documenting and billing exercise therapy services

• Demonstrate why each and every digit of the DX tells the payer something important Distinguish the nuances of specialized DX coding rules for carriers such as Medicare.
• Discover the importance of DX pointing, and which CPT codes are an absolute MUST to point to DX
• Illustrate how to diagnose with a higher level of specificity and through proper hierarchy Identify the role of the diagnosis in the documentation process'

• Differentiate between assault and battery
• Outline various kinds of legal problems that may result from sexual impropriety claims
• Identify and describe distinctions between innocent flirtatious behavior and sexual misconduct
• Evaluate possible defenses to sexual misconduct Disciplinary complaints
• Discuss the applicability of the transference phenomenon to Doctors of Chiropractic

• Recognize the legal and ethical implications of billing, collections, fees, bartering, and financial gain
• Navigate the tricky waters of appropriate interaction with vendors/suppliers.
• Understand the fiduciary relationship that governs patient-doctor interactions.
• Grade your role as the chiropractor in all professional inter-relationships, including staff, patients, peers.
• Use self-assessment techniques to stay compliant in all areas of ethics and boundaries.

• Discuss ethical standards of insurance reporting and coding
• Define the Problem Oriented Medical Record (POMR)
• Describe the P.A.R.T. format of documentation
• Define the P of P.A.R.T. from Centers for Medicare/Medicaid Services
• Define the A of P.A.R.T. from Centers for Medicare/Medicaid Services
• Demonstrate the POMR and the P and A of P.A.R.T. formats for the initial patient encounter
• Describe the concept of outcome assessments in clinical practice
• Distinguish between subjective and objective outcome assessments Illustrate methods of proving medical necessity
• Develop a strategy to justify treatment

Hour 1 - 3

• Discuss ethical standards of insurance reporting and coding
• Define the Problem Oriented Medical Record (POMR)
• Describe the P.A.R.T. format of documentation
• Define the P of P.A.R.T. from Centers for Medicare/Medicaid Services
• Define the A of P.A.R.T. from Centers for Medicare/Medicaid Services
• Demonstrate the POMR and the P and A of P.A.R.T. formats for the initial patient encounter
• Describe the concept of outcome assessments in clinical practice
• Distinguish between subjective and objective outcome assessments Illustrate methods of proving medical necessity
• Develop a strategy to justify treatment

Hour 4 - 6

• Define the R of P.A.R.T. from Centers for Medicare/Medicaid Services
• Illustrate the different methods of evaluating spinal range of motion
• Define the T of P.A.R.T. from Centers for Medicare/Medicaid Services
• Describe the timing of the first re-exam
• Demonstrate proper coding for range of motion measurements
• Illustrate different outcome assessments for the T of P.A.R.T
• Demonstrate the POMR and P.A.R.T. formats for the initial patient encounter
• Integrate the POMR and P.A.R.T. formats for subsequent patient encounters
• Define proper Assessments
• Illustrate the two types of Plan
• Demonstrate proper documentation for timed codes
• Define the short, moderate and long-term diagnoses for Medicare

Hour 7 - 9

• Illustrate the legal definition of medical necessity
• Describe the red flags of a record review
• Demonstrate the determination of causation for a motor vehicle collision
• Discuss the different mechanisms of injury for motor vehicle collisions
• Demonstrate the key value drivers of Colossus
• Discuss the difference between impairment and disability
• Illustrate the determination of the end of justifiable treatment
• Define the main components of an impairment evaluation
• Illustrate Duties Under Duress and Loss of Enjoyment

Hours 10 - 12

• Illustrate the important diagnoses for personal injury cases
• Define the 5 Colossus prognoses
• Demonstrate the 5 grades of injury severity for the Croft Guidelines for the Treatment of CAD Injuries
• Illustrate the Croft Treatment Guidelines
• Discuss the complicating factors for the Croft Guidelines
• Define the critical points for documentation of personal injury cases
• Discuss the concepts that personal injury attorneys look for in our documentation

• Define the R of P.A.R.T. from Centers for Medicare/Medicaid Services
• Illustrate the different methods of evaluating spinal range of motion
• Define the T of P.A.R.T. from Centers for Medicare/Medicaid Services
• Describe the timing of the first re-exam
• Demonstrate proper coding for range of motion measurements
• Illustrate different outcome assessments for the T of P.A.R.T
• Demonstrate the POMR and P.A.R.T. formats for the initial patient encounter
• Integrate the POMR and P.A.R.T. formats for subsequent patient encounters
• Define proper Assessments
• Illustrate the two types of Plan
• Demonstrate proper documentation for timed codes
• Define the short, moderate and long-term diagnoses for Medicare

• Illustrate the important diagnoses for personal injury cases
• Define the 5 Colossus prognoses
• Demonstrate the 5 grades of injury severity for the Croft Guidelines for the Treatment of CAD Injuries
• Illustrate the Croft Treatment Guidelines
• Discuss the complicating factors for the Croft Guidelines
• Define the critical points for documentation of personal injury cases
• Discuss the concepts that personal injury attorneys look for in our documentation

• Integrate infection, evolution, immunity, inflammation, fibrosis, blood flow, mitochondria, ATP, oxidative stress, and DNA.
• Integrate mechanical integrity in gravity, weight, load, levers, posture, mechanoreception, mechanotransduction, mechanobiology, tensegrity, neurology, blood flow, and DNA.
• Justify high vegetable, low lectin, low glycemic dietary habits, and their influence on physiology.
• Summarize problems with refined carbohydrates, monosodium glutamate, aspartame, and chemical toxins.
• Support high intensity interval training, weight lifting, brain derived neurotrophic factor, human growth hormone, and interleukin-10.
• Explain the biphasic nature of laser photon therapy, wavelength, frequency, speed of light, fluence, penetration, secondary and primary physiological influences.
• Develop the relationship between mitochondria, free radicals, ATP, cytochrome c oxidase enzyme, and laser photon therapy
• Justify why all people need between 5-8 different supplements and explain why.
• Diagram a protocol for influencing immunology and the brain through the intestinal tract; integrating the vagus nerve and the nucleus tractus solitarius.
• Integrate a protocol for brain function that discusses trauma, degenerative, and vascular compromise.
• Demonstrate a protocol for chronic low back pain that integrates the intervertebral disc, posture, mechanics, exercise, and laser therapy.
• Support a protocol for acute whiplash that includes applying controlled motion and anti-inflammation strategies.
• Apply a protocol for remodeling scar tissue and the fibrosis of repair.

• Review common conditions and how low-level laser affects treatment outcome
• Describe the Opioid Epidemic
• Discuss Low Level Laser Therapy FDA Clearances
• Analyze FDA Study details and research validation
• Perform myotome Testing - Neck and Shoulder 
• Utilize 635 nm red correction
• Perform Myotome Testing - Neck and Shoulder
• Utilitze 405 nm FDA Clearance correction
• Utilize 405 nm identifying hidden weaknesses
• Demonstrate Soft tissue/percussion - Neck and Shoulder
• Explain laser physics at a cellular level
• Perform myotome Testing - Low Back 
• Utilize 635 nm red correction
• Demonstrate Soft tissue/percussion - Lower back
• Discuss Low Level Laser Therapy FDA Clearance Plantar Fasciitis
• Utilize rehabilitation - Slant Board / Calf Master
• Identify normal vs abnormal length and strengthen the low physical capacity related to foot/knee symptoms of the patient
• Recite PubMed studies in regard to the health benefits of scoring and improving structure and soft tissue
• Examine how your physical capacity score predicts Activities of Daily Living and health outcomes
• Discuss a neuro-mechanical treatment approach
• Provide nutritional support for your patients

• Contrast benefits of non‐thermal versus thermal lasers     
• Discuss the history and method of action of non‐thermal lasers         
• Distinguish the unique benefits of non‐thermal violet lasers     
• Demonstrate the easy of using non-thermal lasers           
• Utilize basic applied clinical nutrition information to support the foundation  for healing in patients   
• Explain the 4 keystones of health     
• Identify digestive dysfunction and create a plan for correction     
• Assess acid reflux and hypochlorhydria
• Review the importance of gallbladder function in liver detoxification   
• Outline the basics of leaky gut   
• Explore the cascade of poor health   
• Integrate clinical tips and suggestions        
• Recognize the opportunity of when to use non‐thermal laser therapy and  which conditions respond best to it     
• Review non‐thermal laser techniques for resolving immune, pain, brain and  organ system presentations   
• Discuss multiple non‐thermal laser therapy applications          
• Determine whether to treat empirically or test    
• Interpret basic laboratory values using functional levels   
• Selecting from the specialty lab test options for objective feedback and to  target treatment plans     
• Integrate non‐thermal laser therapy with acupuncture treatments for  exponential patient outcomes   
• Perform non‐thermal laser treatments for FDA cleared conditions and  successful therapies for conditions not yet formally studied    
• Demonstrate using non‐thermal laser for immune system strengthening and  faster infection resolution      
• Apply non‐thermal laser techniques to balance energy or emotional centers  of patients to enhance acupuncture treatments

• Summarize optimal treatment parameters of low level lasers
• Outline at least 3 major physiological effects that low level lasers have on the human body
• Describe the 4 major pathophysiological changes in degeneration
• Identify lab markers that can be used to assess the integrity of tight junction barriers
• Give examples of nutrition and other factors that may damage barrier systems
• Recognize how low level laser can directly and indirectly the body
• Integrating basic neurology and low level laser applications to support normal adaptive physiology for common disorders
• Discuss how low level laser can be used to affect physiological and biological effects in the body
• Describe pain from peripheral and central mechanisms. 
• Specify how to use low level lasers for chronic pain management for low back pain
• Summarize base low level laser protocols

• This includes all content in Laser 206 and 207. Please see educational objectives for those courses

• Identify the principles of photobiomodulation
• Discuss the ability of the body to repair itself
• Explain the scope of non-thermal low-level laser
• Summarize the action the laser has at a chemical level
• Explain Medawar’s Hypothesis and Kirkwood’s addition to it
• How Non-Thermal Low-Level Laser Therapy helps maintain a healthy life
• Classify different ways of using Non-Thermal Low-Level Laser Therapy
• Outline the research about Non-Thermal Low-Level Laser Therapy
• Summarize the areas that Non-Thermal Low-Level Laser Therapy is used in
• Discuss the differences between 405, 532, and 635nm Non-Thermal Low-Level Laser Therapy
• Give Examples of the immunological benefits of treatment
• Relate the of 405, 635 nm combo in tissue healing
• Explain the differences between Non-Thermal Low-Level Laser Therapy, Hot Laser and LED
• State the uses and effects of hot laser
• Indicate the benefits of LED
• Assess the science behind Non-Thermal Low-Level Laser Therapy
• Apply Non-Thermal Low-Level Laser Therapy

• Identify the common threads of most health challenges that patients are currently presenting with in our offices.
• Examine the facets and protocols that are most effective for mitochondrial dysfunction, systemic inflammation, and chronic pain syndromes.
• Apply practical applications of Low Level Laser Therapy or photobiomodulation for the improvement of mitochondrial dysfunction, reducing systemic inflammatory cascades, and improving overall quality of life.
• Integrate the most researched skill sets and protocols to achieve powerful results.
• Test inflammatory markers to determine proper treatment protocols and efficacy.
• Compare the level of weakness for brachial and lumbar plexus before and after treatments.
• Measure the degree of neuroinflammation and its impact on cerebellar function with the sway test.
• Assess cognitive decline accurately with Montreal cognitive assessment form and specific lab
• Application of Low Level Laser Therapy to chronic pain syndromes of the plantar fascia.
• Solve the issue of chronic pain with FDA approved Low Level Laser Therapy
• Predict the recovery time for specific conditions for treatment plan accuracy.
• Utilize and blend these proven methods to take your confidence and clinical outcomes to a higher level.

• Recognize areas of risk and liability within Personal Injury cases
• Identify common med-legal concerns
• Recognize various important components associated with the Personal Injury history
• Improve the accuracy and thoroughness of the initial Personal Injury history
• Examine and document common Personal Injury traumatic injuries 
• Create a plan to minimize patient risk and improve provider outcomes
• Recognize the versatility and benefits of low level laser therapy for musculoskeletal injuries  
• Develop clinical protocols for low lever laser application and documentation for musculoskeletal injuries  
• Recognize conditions, injuries and symptoms requiring advanced imaging 
• Apply diagnostics and humanize trauma cases
• Discover the importance and relevance of Personal Injury case management 
• Identify opportunities for improved clinical decision making and case management

• Summarize the differences between the effects of 635 nm laser and 405 nm laser
• Illustrate effective protocols with the laser and exercises to support each condition
• Discuss case studies to demonstrate potential therapeutic outcomes
• Summarize the results of the level 1, double blind study that showed the effectiveness of class 2 635 nm for chronic pain and inflammation
• Discuss how inflammation can lead to many chronic musculoskeletal conditions that affect people in the United States
• Use lab testing to identify inflammation
• Illustrate treatment applications and contraindications
• Identify the conditions that respond to laser therapy for support, the research that supports them, and to identify which conditions are either not supported with laser therapy or are contraindicated
• Aggregate which class of lasers can be used for support and which are contraindicated
• Generate a treatment plan with lasers for different musculoskeletal conditions
• Categorize the negative impacts of scar tissue on range of motion, pain, and function
• Classify which conditions are contraindications and which types of lasers are contraindicated 
• Summarize the changes that occur in scar tissue and when movement of tissue or a joint triggers pain for a prolonged period
• Apply low level laser to musculoskeletal injuries that respond well to low level laser
• Summarize the studies that have been published on PubMed for these conditions being supported with lasers
• Set up methods and treatment protocols for several conditions
• Summarize the studies that showed improvement from laser therapy in performance metrics like muscle strength, endurance, and recovery
• Comprehend the studies that show a 25 to 35% faster recovery for several sports injuries and auto accident injuries when laser therapy is applied
• Use laser therapy with athletes in the office both for injuries and for performance enhancement by rehabilitating their balance and coordination with lasers

Hour 1

• Breakdown the implications of inflammation on epigenetics and relate inflammation to genetic damage and musculoskeletal disease.
• Develop a plan for clinical anti-inflammatory protocols

Hour 2

• Interpret blood chemistry markers related to inflammation, and translate into laymen’s terms for patient understanding.
• Devise office strategies for obtaining blood chemistry markers, delivering the report of findings to the patient
• Discuss the physiological mechanisms of the gut-brain axis, distinguish the molecular players in gut-brain axis syndromes, and identify behavioral modifications and nutritional therapies
• Demonstrate knowledge of calcium ions as an egregious free radicals

Hour 3

• Identify blood chemistry markers
• Differentiate between different classes of lasers, Class I, II, IIIA, IIIB, and IV lasers, and outline the therapeutic effects of each

Hour 4

• Explain the difference between nIR and fIR saunas, and identify key physiological mechanisms
• Discuss Low Level Laser Therapy wavelengths as they pertain to various upregulation of metabolic functions, and integrate into the health of the body.
• Differentiate between Class 1, Class 2, Class 3R, Class 3B, and Class 4 lasers, and determine proper clinical application of each laser
• Develop plans to calculate Joules of output for various lasers using physics, and demonstrate fundamental understanding of laser frequency output to address various clinical cases.

Hour 5

• Discuss Clinical Cases and outcomes citing specific patient histories and medical studies from the National Institute of Health and PubMed.com; integrate these ideas and extrapolate health plans into current clinical situations.
• Discuss how low level laser therapy affects the body
• Discuss supplementation and integrate effective neuroprotective supplementation protocols in a clinical setting based on the work of the world’s best universities’ studies

Hour 6

• Outline the basic types of intermittent fasting, relate to patient goals as determined in nutritional consultations, and design intermittent fasting protocols for clinical settings.
• Summarize the concepts of ketosis, brain energy utilization, and neuroprotection; relate to medium-chain triglyceride consumption.

• Review evidenced based research on Posture and use for proper adjusting technique
• Discuss occupational issues Chiropractors face pertaining to providing manipulative care
• Make changes regarding postural issues during provision of manipulative therapy to avoid injury
• Outline common positioning errors during manipulative therapy and develop more appropriate postural performance

• Discuss aspects of motor skills and forces associated with providing manipulative therapy
• Develop a program of flexibility exercises and proprioceptive exercises to help the practicing Chiropractor avoid injury while providing manipulative therapy
• Develop Chiropractic Arch Hand Skills
• Develop the supine thenar contact

• Determine the effect of spinal manipulation on cervicobrachialgia (neck/arm pain)
• Assess the effects of upper cervical spine manipulation on muscular and non-muscular structures of the motion segment
• Determine the effect of spinal manipulation on angina pectoris
• Review theories of the physiological effects of spinal manipulation
• Assess the effects of spinal manipulation on H-Reflex amplitude in healthy and symptomatic subjects

• This contains all courses with the educational objectives listed from Manipulation 103 through Manipulation 114

• Determine the effect of chiropractic on movement time
• Assess the effects of spinal manipulation and ultrasound on chronic low back pain
• Describe heart rate variability as a measurement tool
• Assess the effects of chiropractic on heart rate variability

• Determine the effect of thoracic spine manipulation on autonomic output to the heart
• Review criteria for the diagnosis of cervicogenic headaches
• Describe a clinical assessment for cervicogenic headaches
• Assess the effects of chiropractic and spinal manipulation on cervicogenic headaches

• Describe spinal manipulation use by time, place, and person, identify predictors of the use of spinal manipulation
• Review cost-effectiveness of SMT compared to other treatment options for people with spinal pain of any duration
• Describe the current literature on patient-centered outcomes following a specific type of commonly used SM, high-velocity low-amplitude (HVLA), in patients with LBP
• Review the putative mechanical features of the subluxation and three theories that form the foundation for much of chiropractic practice

• Provide an overview of research on the effects of spinal manipulation on sensory processing, motor output, functional performance and sensorimotor integration
• Examine performance based outcome measures used in an attempt to objectively measure the ramifications of spinal manipulation
• Update knowledge regarding several physical characteristics of an applied SMT, and review what is known about the signaling characteristics of sensory neurons innervating the vertebral column in response to spinal manipulation
• Review the physiological evidence that spinal manipulation can impact visceral function

• Distinguish the relationship between lumbar spinal manipulation, cavitation and zygapophyseal joint gapping
• Clarify the role of spinal manipulative therapy in the care of acute LBP based on current evidence
• Explain the state of the literature on utilizing spinal manipulation for radiculopathy
• Compare spinal manipulation to microdiskectomy as treatments for sciatica based on a recent trial
• Critique the proposed importance of spinal manipulation in altering the contractile thickness of the Transversus Abdominis

• Outline the limitations of a recent trial on preventive treatments including spinal manipulation for neck pain and how they contribute to our interpretation of the results of the study
• Interpret results of an important trial on spinal manipulation and exercise for neck pain
• Discuss recent evidence comparing spinal manipulation to mobilization for recent onset neck pain
• Use recent evidence to justify manipulating various spinal regions for patients with neck pain
• Critique the potential for chest and neck mobilizations to affect spirometric performance (breathing)

• Contrast Clinical Guideline-based care with usual medical care for acute low back pain
• Recognize the potential benefit of adding exercise prescription to spinal manipulation for low back pain
• Compare the effectiveness of spinal manipulation to McKenzie Method interventions for persistent low back pain
• Outline factors that may help predict improvement in patients seeking chiropractic care for low back pain
• Explain the benefits of evidence-based care for low back pain

• Compare the efficacy of standard medical care (SMC) alone versus chiropractic spinal manipulation + SMC for acute low back pain patients
• Discuss the value of a combined (pragmatic) chiropractic approach for treating low back pain
• Analyze the state of the research literature directly comparing spinal manipulation, exercise and acupuncture as treatments for low back pain
• Update your understanding of joint cavitation during side posture lumbar manipulation
• Critique the only study (to date) on maintenance care for low back pain including spinal manipulation

• Develop evidence-based chiropractic treatment recommendations for nonspecific (mechanical) neck pain in adults
• Discuss the clinical criteria justifying spinal manipulative therapy for neck pain
• Assess the relative effectiveness of spinal manipulative therapy and rehabilitative exercise for neck pain in seniors
• Describe the working mechanism of manual therapy in participants with chronic tension-type headache
• Examine the cerebrovascular hemodynamic response of cervical spine positions using MRI on the vertebral artery

• Critique the state of the evidence for manual therapy interventions in the treatment of cervical radiculopathy
• Compare two common interventions – spinal manipulation and nerve root injection – for patients with MRI-confirmed lumbar disc herniation
• Critique the state of the evidence for spinal manipulation (specifically) in the treatment of cervical radiculopathy
• Interpret the results of a cohort study of MRI-confirmed symptomatic cervical disc herniation patients treated with cervical manipulation
• Compare isolated cervical SMT versus a combination of cervical, cervico-thoracic and thoracic SMT in patients with chronic mechanical neck pain

• Examine the effects of thoracic manipulation and non-thrust mobilization on pain sensitivity and intensity in patients with chronic mechanical neck pain
• Summarize the state of the literature on the utility of spinal manipulation for managing hypertension
• Critique a recent study on the importance of cavitation in the autonomic nervous system (ANS) effects of thoracic spinal manipulation
• Evaluate the scientific literature on the validity and reliability of the common methods used by chiropractors to inform the choice regarding where spinal manipulation is to be applied once it is deemed an appropriate treatment
• Explore biomechanical and neurophysiologic mechanisms of thoracic manipulation that might result in clinical benefit for patients with rotator cuff tendinopathy

• Describe the science behind chiropractic care
• Translate the intent of manipulative therapy to patients and other healthcare providers
• Describe the potential results of not having recommended chiropractic care
• Outline the different theories of the subluxation complex
• Justify the care you recommend based on electrodiagnostic, imaging, and laboratory studies

• Compare the cost effectiveness of spinal manipulative therapy (SMT) to other treatment options for people with acute, subacute and chronic spinal pain
• Evaluate the relative effectiveness of high-dose, supervised exercise with and without spinal manipulation and low-dose home exercise for chronic neck pain
• Investigate whether spinal manipulative therapy (SMT) can reduce pain at the level of the treated spinal segment, in the broader region of the treatment and/or systemically
• Outline a clinical prediction rule designed to identify patients with neck pain likely to benefit from spinal manipulative therapy
• Examine the relative effectiveness of segment-specific and non-specific spinal joint mobilization on pain and range of motion
• Determine which side of the upper cervical spine cavitates during a rotatory C1-2 HVLA thrust manipulation

• Describe axonal degeneration in inflammatory neuropathy
• Construct criteria for diagnosis of multiple sclerosis
• Discuss the use of antioxidant therapy in neurologic disease
• Review the sensory innervation of the SI joint
• Identify mechanoreceptor control of shoulder musculature

• Evaluate the basics of nerve conduction
• Comment on recording action potentials
• Review NCV/EMG recording issues
• Identify the diagnostic usefulness of H-reflex and F-response
• Construct differential diagnosis with Nerve Conduction

• Describe the application of the multifidi muscle to Chiropractic
• Discuss proprioception in individuals with and without back pain
• Identify the pathophysiological mechanisms underlying muscular tension and pain
• Determine how knee range of motion affects proprioception
• Develop the relationship of decreased cutaneous tactile sensation with the pathogenesis of peripheral entrapment syndromes

• Define the use of Co-Enzyme Q as preventive treatment for migraines
• Discuss the modular headache theory
• Describe the neurovascular aspects of cluster headaches
• Identify the nutritional etiology of headache and ataxia
• Review the relationship of migraines and menstruation

• Describe the effect of chiropractic on motor control
• Discuss theories of how movements are chosen
• Discuss how movements are sequenced, and skills are learned
• Develop a motor control examination for your practice
• Distinguish components of the motor assessment

• Describe an approach to the assessment and diagnosis of functional symptoms in neurology
• Outline an approach to the management of functional symptoms in neurology
• Discuss concepts in neuropathic pain

• Analyze current literature regarding spinal adjustments, and break down concepts, physiology and theories behind chiropractic treatment
• Appraise new and existing ideas related to mechanisms involved whereby chiropractic spinal adjustments might effect the vascular and nervous system
• Describe the anatomy and physiology of relevant components of human nervous system as it relates to chiropractic adjustments, neural plasticity, articular neurology, and mechanisms of pain
• Explore current understanding of pain physiology and theories behind neuropathic pain, allodynia and proposed treatment using chiropractic adjustments

• Summarize the anatomy and hemodynamics of the upper cervical spine and brain
• Discuss the nature of the pathophysiological changes common in arterial dissection
• Outline the various forms and limitations of the bedside examination and laboratory tests and diagnostic imaging
• Develop criteria for necessity of evaluation procedures (physical, orthopedic, neurologic)
• Justify the development and significance of recognition and management of vascular accidents
• Integrate current considerations regarding risk factors and therapeutic intervention

• Outline the categorizations for the specialty of radiology and its related subspecialties
• Summarize typical chiropractic x-ray suite set-up
• Classify concepts and physics of ionizing radiation
• Compare and contrast typical analog x-ray suites with Computed Radiography (CR)
• Compare and contrast typical analog x-ray suites with Digital radiology (DR) detection systems

• Discuss common conditions that are associated with neuropathy
• Identify presenting signs and symptoms in patients that would lead to examination for neuropathy
• Differentiate different conditions that can present with signs and symptoms similar to neuropathy
• Measure and interpret blood chemistries to demine the possible cause of neuropathy in a patient
• Prepare a comprehensive diagnostic and management strategy for patients with neuropathy
• Comprehend and be able to assess relative to neuropathy, drug-nutrient interactions in patients
• Breakdown possible contributions of poly-pharmacy to the development and or maintenance of the neuropathic condition in their patients
• Appraise risk factors for complications such as neuropathy and diabetic ulcers in patients with elevated blood sugar
• Order and interpret neuropathy screening tests for patients with symptoms of neuropathy
• Devise a strategy to reduce risk factors of neuropathy and translate this strategy into a treatment plan for the patient
• Choose and apply biomarker lab tests to manage patients with neuropathy
• Provide basic interpretation of  nerve conduction and EMG findings for patients
• Discuss the use of medications in neuropathy and explain their  mechanisms  of action
• Advise patients on possible side effects of neuropathy medications
• Use Tinel's Sign as a diagnostic procedure and translate these findings into optimal location for therapy in neuropathy patients

• Discuss the history of GVS and the historic use of GVS as diagnostic procedure.
• Identify the effects of GVS on the nervous system and use this information to construct an effective clinical protocol for his/her patient
• Apply GVS as an adjunct procedure to assist in balance rehabilitation.
• Understand and apply GVS as part of a comprehensive strategy for the treatment of neuropathic pain syndromes.
• Create a treatment protocol in terms of electrode placement, intensity, duration and precautions for the use of GVS in clinical practice.

• Recognize Traumatic Brain Injury (TBI) in your chiropractic patients
• Summarize the prevalence in your patient population
• Identify the type of patient that presents with TBI
• Explain why a chiropractor needs to differential diagnose TBI patients
• Compile correlations of TBI inciting factors with your patient presentations
• Demonstrate the pathology that occurs with TBI
• Classify the grades of TBI and discriminate what can be treated conservatively
• Identify the incidence of injuries that commonly cause TBI
• Evaluate the probability of TBI in your patient
• Describe the many different types of evaluations, in the field, in the office and upon referral
• Implement in-office Screening Tools and apply diagnostic criteria
• Identify the risk of post-concussive syndrome
• Detect patients with “Brain Cognitive Reserve”
• Identify Second Impact Syndrome
• Assess the value of MRI
• Identify Chronic Traumatic Encephalopathy
• Integrate the current concepts of conservative treatment
• Design Cognitive Rehab
• Provide appropriate patient advice, treatment or referral options

Hour 1 - 5

• Recognize Traumatic Brain Injury (TBI) in your chiropractic patients
• Summarize the prevalence in your patient population
• Identify the type of patient that presents with TBI
• Explain why a chiropractor needs to differential diagnose TBI patients
• Compile correlations of TBI inciting factors with your patient presentations
• Demonstrate the pathology that occurs with TBI
• Classify the grades of TBI and discriminate what can be treated conservatively
• Identify the incidence of injuries that commonly cause TBI
• Evaluate the probability of TBI in your patient
• Describe the many different types of evaluations, in the field, in the office and upon referral
• Implement in-office Screening Tools and apply diagnostic criteria
• Identify the risk of post-concussive syndrome
• Detect patients with “Brain Cognitive Reserve”
• Identify Second Impact Syndrome
• Assess the value of MRI
• Identify Chronic Traumatic Encephalopathy
• Integrate the current concepts of conservative treatment
• Design Cognitive Rehab
• Provide appropriate patient advice, treatment or referral options

Hour 6

• Define the trophic model
• Describe the pathology of trophic model to your patients
• Apply the trophic model of subluxation into clinical practice
• Detect signs & symptoms that correlate with the trophic model
• Extrapolate the model to patient care, especially maintenance manipulative therapy.

• Define the trophic model
• Describe the pathology of trophic model to your patients
• Apply the trophic model of subluxation into clinical practice
• Detect signs & symptoms that correlate with the trophic model
• Extrapolate the model to patient care, especially maintenance manipulative therapy.

Hour 1

• Identify and recite all components of the neurological examination 
• Outline basic peripheral and central nervous system pathways that are clinically relevant to the bedside (ambulatory) neurological examination.
• Perform an examination of the cranial nerve and somatic motor system, including aspects of strength, tone and volume.

Hour 2

• Perform an examination of the cranial nerve and somatic sensory system, including sensory testing of deep and superficial CNS pathways.
• Perform an examination of the reflex system, including testing of deep, superficial, visceral and pathological reflexes.

Hour 3

• Perform an examination of the movement, balance and coordination systems, including tests of cerebellar function.
• Demonstrate an examination flow and performing tests taking the patient from sitting to standing, to the supine and prone positions.
• Summarize implications of neurological findings for lesions in various parts of the central nervous system.
• Summarize implications of neurological findings for lesions in various parts of the peripheral nervous system.

Hour 1

• Explain how the balance system depends on symmetrical input
• Describe the relationship between the deep tendon monosynaptic reflexes and posture control
• Explain the importance of the tonic neck reflexes to posture and functional assessment

Hour 2

• Describe the flexion and extension synergistic patterns
• Explain the function of the flexor withdrawal reflex in relation to central pattern generators
• Outline the role of the Galant reflex in postural control

Hour 3

• Explain the relationship between the flexor withdrawal reflex and the crossed extensor reflex.
• Describe the anticipated response in testing the upper Galant reflex
• Outline the normal display of the tonic lumbar reflex

Hour 4

• Explain the etiology of cortical release signs
• Describe the determinant of posture
• Outline the test for normal stance and gait and analyze the results

• Describe the types of muscle fibers and how they respond to deaffrentation
• Outline the anatomy of the cerebellum
• Explain the function of the various areas of the cerebellum

Hour 2

• Outline the afferent cerebellar pathways
• Describe the efferent cerebellar pathways and their interconnections
• Summarize the blood supply to the cerebellum and brain stem

Hour 3

• Describe the relationship between cerebellar output and autonomic function
• List the signs of pathological cerebellar expression
• Explain the concept of surround inhibition

Hour 4

• Recognize how variations in functional muscle testing procedure will yield different clinical information
• Explain the difference is the influence of uniarticulate muscles versus multiarticulate muscle on stability and affrentation
• Describe the normal responses of the primitive reflexes

Hour 5

• Explain the role of the pyramidal and extrapyramidal systems
• Select appropriate procedures to test for pyramidal distribution of weakness
• Describe exercises to address pyramidal distribution of weakness
• Recognize the foundational concept of receptor input
• Explain the role of the primitive reflexes as a diagnostic tool
• Summarize how functional manual muscle testing can reveal the presence of deaffrentation

• Review the clinical presentation of Diabetes
• Examine the role of nutrition and diet in Diabetes
• Design an appropriate supplement protocol for the diabetic patient
• Develop nutritional guidelines for hypoglycemia

• This contains all courses with the educational objectives listed from Nutrition 148 through 154

• Identify sources and functions of carbohydrates, proteins, fats, alcohol, vitamins, minerals, and water in the human body.
• Demonstrate the importance of a balanced diet and use tools that can be utilized to evaluate the nutritional adequacy of a diet (RDA, Dietary Guidelines, MyPlate, etc.).
• Identify the relationship between diet and chronic diseases/illnesses (cardiovascular disease, diabetes, obesity, cancer, hypertension, osteoporosis, etc.) and what modifications can be made in the diet to reduce the risk for these diseases/illnesses.
• Recall current nutritional recommendations for healthy eating habits (American Heart Association, American Cancer Society, etc.).
• Utilize nutrition terminology and related terminology appropriately.
• Demonstrate lifelong healthful eating habits by differentiating between beneficial and non-beneficial dietary practices.
• Develop nutritional scripts for 10 of the most common adult pathologies that can be potentially palliative or reverses through dietary changes.

• Understand the relationship between BPH and nutrition/supplements
• Develop a nutrition treatment program for UTI's
• Design a nutrition therapy program for kidney stones and gallstones
• Explore the relationship between diet and hyperestrogenism and its related diseases such as PMS and FBD
• Outline a nutrition treatment program for menopause

• Analyze the relationship between tendonitis/bursitis and nutrition
• Identify the nutritional treatment of muscle cramps/leg cramps and soreness
• Discuss nutrition treatment for Muscular dystrophy
• Determine an appropriate nutrition treatment for Fibromyalgia

• Identify the etiology and pathology of arthritis.
• Outline a diet that is helpful in the treatment of arthritis.
• Apply specific supplements to an arthritic condition.

• Review the risk factors and mechanisms of heart disease.
• Identify the parts of a proper diet to prevent heart disease.
• Evaluate various supplements that are beneficial in prevention and treatment of heart disease.

• Recall various foods with high amounts of Flavonoids and briefly relate their impact health
• Indicate the basic chemical structural similarities and differences of Flavonoids
• Relate potential benefits of combining Flavonoids, and ways of improving their bioavailability and efficacy
• Explain why some Flavonoids may be effective according to their chemical structure, specifically in a study for neuroprotection
• Discuss Flavonoid use and neuromuscular treatment considerations
• Integrate knowledge of Flavonoids and biochemical pathways to prescribe individualized nutrition treatments to your patients and appreciate the potential for overprescribing too many competing herbs
• Examine and demonstrate how and why Green Tea extract may play an inclusive role in health

• Quantify the prevalence rates of patients using opioids and herbal products
• Demonstrate the significance to the chiropractor of interactions between different herbs and common prescription drugs
• Discuss the at risk populations for interactions including the pregnant, and elderly populations
• Record and list the most common interactions of common food and herbal products
• Record and list the effects of the common interactions of common heart medication and herbal products
• Demonstrate evidence that supports the use of health care providers assessing patients for these interactions.
• Discuss the role of the chiropractor in the role of identifying these interactions.
• Illustrate several books, and smart phone based electronic applications to make the process of identification easier for a chiropractor and patient.
• Evaluate common case scenarios

Hour 1: Evolutionary Biology Influence on Clinical Physiology

• Discuss infection, evolution, immunity, inflammation, and fibrosis.
• Compare short-term survival v. long-term chronicity.

 Hour 2: Summarize Inflammation in both Pain and Disease

• Utilize Laboratory diagnosis of inflammation.
• Provide Nutritional management for inflammation.

Hour 3: Justification of Sleep Hygiene

• Explain the role for sleep and sleep’s influence on immunity, cognition, psychiatric conditions, hunger, fertility, blood sugar control, vascular health, and more.
• Summarize the influence of sleep on brain neurochemistry.

Hour 4: Define the Recently Discovered Glymphatic System

• Discuss the glymphatic system and how to optimize its influence on health.
• Emphasize the importance of the glymphatic system in relation to neurodegenerative diseases.

Hour 5: Point out the Role of Vitamins for Chronic Disease Prevention

• Emphasize the importance of B vitamins to lower homocysteine.
• Point out the relationship between elevated homocysteine and vascular injury risks.
• Justify why people need between 5-8 different supplements and explain why.

Hour 6: Analyze the Science of a Healthy Diet

• Justify high vegetable, low lectin, low glycemic dietary habits, and their influence on physiology.
• Summarize problems with refined carbohydrates, monosodium glutamate, aspartame, and chemical toxins.
• Explain the drivers and consequences of a leaky gut.
• Demonstrate glycation and its consequences.
• Explore the benefits of Intermittent Fasting

Hour 7: Appraise Chiropractic Clinical Practice and Pain Management

• Integrate the Gate Theory of Pain and the Chiropractic Adjustment
• Quantify the Opioids Epidemic and the Positive Influence of Chiropractic
• Diagram the importance of the omega-6 / omega-3 ratio
• Caution Against the Ingestion of Excitotoxins

Hour 8: Detail the Benefits of Exercise

• Emphasize the Benefits of High Intensity Interval Training.
• Introduce the Harmful Effects of Fructose on Energy Production

• Explain the complex multidimensional and individual specific nature of pain
• Present the theories and science for understanding pain
• Define the terminology for describing pain and associated conditions
• Describe the impact of pain on society
• Explain how cultural, institutional, societal and regulatory influences affect assessment and management of pain  
• Use valid and reliable tools for measuring pain and associated symptoms to assess and reassess outcomes as appropriate for the clinical context and population.
• Describe patient, provider, and system factors that can facilitate or interfere with effective pain assessment and management
• Assess patient preferences and values to determine pain-related goals and priorities
• Demonstrate empathetic and compassionate communication during pain assessment

• Explain the complex multidimensional and individual specific nature of pain
• Present the theories and science for understanding pain
• Define the terminology for describing pain and associated conditions
• Describe the impact of pain on society
• Explain how cultural, institutional, societal and regulatory influences affect assessment and management of pain  
• Use valid and reliable tools for measuring pain and associated symptoms to assess and reassess outcomes as appropriate for the clinical context and population.
• Describe patient, provider, and system factors that can facilitate or interfere with effective pain assessment and management
• Assess patient preferences and values to determine pain-related goals and priorities
• Demonstrate empathetic and compassionate communication during pain assessment
• Demonstrate the inclusion of patient and others, in the education and shared decision-making process for pain care
• Identify treatment options that can be assessed in a comprehensive pain management plan
• Explain how health promotion and self-management strategies are important to the management of pain
• Develop a pain treatment plan based on benefits and risks of available treatments
• Monitor the effects of pain management approaches to adjust the plan of care as needed
• Differentiate physical dependence, substance use disorder, misuse, tolerance, addiction, and nonadherence
• Develop a treatment plan that accounts for the differences between acute pain, acute-on-chronic pain, chronic/persistent pain, and pain at end of life
• Describe the unique pain assessment and management needs of special populations
• Explain how to assess and manage pain across settings and transitions of care
• Describe the role, scope of practice, and contribution of the different professions within a pain management care team
• Implement an individualized pain management plan that integrates the perspectives of patients, their social support systems, and health care providers in the context of available resources
• Describe the role of the clinician as an advocate in assisting patients to meet treatment goals

• Demonstrate the inclusion of patient and others, in the education and shared decision-making process for pain care
• Identify treatment options that can be assessed in a comprehensive pain management plan
• Explain how health promotion and self-management strategies are important to the management of pain
• Develop a pain treatment plan based on benefits and risks of available treatments
• Monitor the effects of pain management approaches to adjust the plan of care as needed
• Differentiate physical dependence, substance use disorder, misuse, tolerance, addiction, and nonadherence
• Develop a treatment plan that accounts for the differences between acute pain, acute-on-chronic pain, chronic/persistent pain, and pain at end of life
• Describe the unique pain assessment and management needs of special populations
• Explain how to assess and manage pain across settings and transitions of care
• Describe the role, scope of practice, and contribution of the different professions within a pain management care team
• Implement an individualized pain management plan that integrates the perspectives of patients, their social support systems, and health care providers in the context of available resources
• Describe the role of the clinician as an advocate in assisting patients to meet treatment goals

• Develop a rational clinical approach to evaluating and diagnosing disorders affecting the temporomandibular joint
• Outline conservative treatment options for temporomandibular joint conditions
• Appraise and critique the rationale and supporting evidence for utilizing manual therapy in the management of cervicogenic and tension-type headaches
• Explain the relationship between temporomandibular joint pain and the trigeminal and limbic systems
• Summarize the current evidence surrounding alternative therapies used in the treatment of primary headache syndromes of childhood

• Define the differences between visual fields and pathways.
• Recognize the three most common eye conditions and diseases affecting the cranial nerves seen within the chiropractic practice.
• Diagnose common eye diseases and conditions from a funduscopic examination.
• Propose management and co-management options for specific common eye conditions.

• Explain jurisdictional authority over school enrollment and pre-participation physical examinations
• List the common items required on a school enrollment and pre-participation physical examinations
• Outline the key components of the health history
• Identify normal values for vision and hearing acuity
• Calculate BMI and determine age appropriate percentile ranking
• Classify physical maturity using the Tanner Scale
• Assess immunization records for statutory compliance
• Indicate the difference in the level of detail required in the pre-participation exam versus the school enrollment physical
• Recognize the classifications of sports based on exertion required and level of contact
• Describe the process of clearing an athlete to resume training and competition
• Recognize the risk factors to sudden cardiac death syndrome
• Determine the association between risk factors and specific sports

• Recognize the elements and significance of the jugular venous pulse
• Know the physiology and sound of S1 and S2
• Know the physiology and sound of S3 and S4
• Identify systole and diastole by palpation and listening
• Describe heart murmurs
•  Hear and understand the mechanism of two common systolic murmurs

• Outline tests of high diagnostic utility for spinal disorders
• Examine the association between work-related neck injury and future neck pain
• Breakdown the proposed relationship between neck muscle strength, cervical range of motion and neck pain
• Summarize recent Clinical Practice Guidelines on the chiropractic treatment of adults with neck pain

• Differentially diagnose prostate pathologies in individuals who present to your office with musculoskeletal pain,
• Differentiate various types of common prostate pathologies
• Expand understanding of prostate pathophysiology, including hormonal and biochemical implications
• Identify prostate pathology risk factors
• Identify the common pre-disposing factors for prostate pathologies that can ultimately mimic musculoskeletal complaints
• Interpret conventional prostate diagnostic procedures and identify protocols to evaluate and monitor prostate health and/or pathology
• Hone diagnostic skills by reviewing and analyzing patient case studies, inclusive of history, exam findings, lab test results for patients presenting with musculoskeletal complaints that may have underlying prostate pathologies

• Recognize the signs and symptoms of a wrist and hand disorder
• Be able to list appropriate exam procedures for a differential diagnosis of wrist and hand disorders
• Outline the different elements of a wrist and hand exam
• Discuss the importance of “red flags” in the exam and evaluation of wrist and hand complaints
• Be able to summarize additional wrist and hand tests that can be performed and under what conditions to use them

• Outline the current state of the literature on the etiology, diagnosis and management of frozen shoulder
• Clarify the influence of the spine on shoulder range of motion in middle-aged and elderly patients
• Assess the utility of three clinical tests evaluating subscapularis muscle function
• Utilize and integrate a simple clinical test to assist in distinguishing neck from shoulder pain
• Summarize the recent Clinical Practice Guideline (APTA) regarding the treatment of adhesive capsulitis

• Quantify the levels of intensity for manual techniques using the Tolerance, Incremental, Light or Energy Method categories when considering the patient’s medications to determine the proper treatment application. 
• Differentiate the three types of precautions/contraindications (Permanent, Ongoing and Temporary) when categorizing the patient’s current and past medications to assist the clinician in diagnosis and treatment planning.
• Contrast the permanent nature of corticosteroids, depending upon dosage and delivery method, and how this alters the clinician’s differential diagnosis options and future treatment plans.
• Compare and contrast the short and long-term effects of non-steroidal anti-inflammatories, aspirin and acetaminophen, including specific discussion about the alteration of the patient’s musculoskeletal symptomatology during examination.
• Discuss the alteration in the clinician’s palpation when the patient is under the influence of muscle relaxants, their half-life, and the necessary changes in treatment while influenced.
• Interpret the symptomatology of the presenting patient with musculoskeletal symptoms when under the influence of bisphosphonates (and similar), as medications used to treat osteoporosis and osteopenia have significant side effects including hypocalcemia and severe musculoskeletal pain.
• Determine the necessary pharmaceutical precautions when considering the side effects of medications used to control cholesterol (including statins and PCSK9 inhibitors), specifically those those that may mimic musculoskeletal symptoms during patient examination.
• Recognize the potential side effects of the 7 most common cardiovascular medication classes that are important to consider in the differential diagnosis of the patient presenting symptoms.
• Explain the pharmacodynamics of various types of blood pressure medications and detail which require limiting or avoiding the prone position to avoid complications with the clinician’s therapy.
• Detail the procedure of BoNT injections for musculoskeletal conditions, and clarify the side effects and precautions that are significant to the clinician when determining diagnosis and treatment protocols.

• Recognize the signs and symptoms of a mid-back disorder
• Be able to list differential diagnosis of mid-back disorders
• Outline the different elements of a mid-back exam
• Understand the importance of “red flags” in the exam and evaluation of mid-back complainants
• Be able to summarize additional mid-back tests that can be performed and the reasons why to use them

• List five statistical references that relate to evidence based practice.
• List four Red flags that are pertinent in the evaluation component of treatment.
• Identify the five categories that pertain to possible spinal pain and referred pain.
• Describe two metabolic diseases that can affect the spine.

• This contains all courses with the educational objectives listed from Physical Diagnosis 166 through Physical Diagnosis 169

• Recognize and list four red flags for the cervical and shoulder girdle.
• Identify three medical conditions that may refer to the cervical spine but are non-musculoskeletal in origin and require a physician's intervention.
• Name and describe two CPR for the Cervical Spine.
• List two dural tests that are done for the nervous system in the Cervical region.

• Identify and describe two musculoskeletal issues of the thoracic region.
• List one dural test that is used to evaluate the thoracic region which will assist in determining normal neuromeningeal pathway mobility.
• List two CPR of the spine in the thoracic region that have good reliability and are effective in use.
• List and describe two vascular diagnoses which may relate to Thoracic Spine referred pain

• Identify two serious pathologies that appear to be related to the lumbar spine but are not.
• Describe three categories of pelvic fractures than may occur.
• Describe the objective differences between vascular claudication and neurogenic claudication.
• List the five screening tests for the pelvis and SI joint.

Hour 1:

• Knowledge of human gait analysis and its application to clinical scenarios.
• Explain the common gait terminology, such as stride length, step width, and cadence.
• Identify the stance and swing cycles of gait.
• Summarize the gait cycle and how it relates to normal human ambulation.
• Explain how movements at the pelvis, lower extremity, hip, knee, ankle, and subtalar joints interact during stance to conserve energy, and to protect one from injuries that might otherwise result from the repetitive stresses that occur during gait.

• Describe how patients with over-pronation and over-supination present in a clinical setting.
• Comprehend the functional biomechanics of the lunge, and squat and its relationships to faulty movement patterns.
• Compare Janda’s lower extremity functional screens.
• Demonstrate that clinical gait analysis alters treatment decisions to improve functional outcomes.

Hour 3:

• Illustrate the LEFS (lower extremity functional scale), and report its clinical value.
• Demonstrate evidence-based exercises to help improve over-pronation in patients.
• Apply the scientific foundations of modifications for custom orthotics with clinical case scenarios.
• Illustrate, through the use of case scenarios the typical examination findings and documentation of gait analysis in the “O” (objective) section of notes.

• Identify musculoskeletal anatomy pertinent to the abdominal exam.
• Identify the location of intra-abdominal contents relative to the abdominal wall and what is normally palpable.
• Recognize examination techniques used for inspection, auscultation, percussion and palpation of the abdomen.
• Name advanced techniques used to evaluate the acute abdomen.

• Describe thyroid anatomy and physiology. 
• Outline the pathophysiology of hypothyroidism, including possible causes and associated conditions.
• Identify signs and symptoms of hypothyroidism and hyperthyroidism.
• Demonstrate the typical thyroid exam performed in the chiropractor’s office.
• Review the usual and customary conservative and non-conservation management for common thyroid conditions.
• Discuss the role of the chiropractic spinal manipulation in care for patients with thyroid conditions.

• Identify vascular anatomy pertinent to the cardiovascular exam
• Interpret cardiovascular physiology as it relates to physical examination.
• Discuss characteristics of, and techniques used to evaluate, the pulse and blood pressure.
• Name advanced techniques used to evaluate peripheral artery disorders and conditions.

• This contains all courses with the educational objectives listed in Physical Diagnosis 173 thru 175

Hour 1

• Define Nonspecific Low Back/Neck Pain            
• Outline the subcategories of Nonspecific Spinal Pain
• Provide an overview of different techniques
• Analyze the anatomical source of the injury
• Examine Differentiate the functional or anatomical diagnosis

 Hour 2