Kentucky Chiropractic Continuing Education

• 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.

• 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.

• Develop the skills for medical documentation record keeping for proper patient care and adherence to insurance protocols
• Summarize informed consent, Evidenced-based care, Medicare guidelines and NCQA guidelines
• Identify common treatment procedures and modalities used in a chiropractic practice And recognize contraindications to them
• designate specific items to consider when interpreting and/or taking plain film X-rays
• Summarize the value of laboratory and diagnostic testing.
• Recognize the importance of patient communication skills in order to assist in the diagnosis and treatment of patients
• Modify procedures and forms to prevent the possibility of a legal malpractice action against the doctor

Hour 1

• Utilize improved patient communication skills with Medicare Patients 
• Apply appropriate risk management procedures to enhance patient communication
• Identify the four elements of legal malpractice and recognize the key components to avoid a malpractice action  
• Utilize key components of good documentation and record keeping
• Integrate the legal requirements of informed consent in your informed consent process 

Hour 2

• Summarize why doctors are held to higher standards
• Discuss the Do’s and Don’ts of record keeping
• Use the 21 NCQA guidelines for appropriate medical record keeping and integrate the 3 key components of Evidence Based Practice (EBP)

Hour 3

• Assess Medicare’s mandatory Electronic Health Records (EHR) requirement        
• Discuss key items related to the Office of Inspector General (OIG) reports regarding Medicare and chiropractic services
• Summarize Executive Order issued by the White House titled reducing improper payments and eliminating waste in the Federal Programs

Hour 4

• Determine what triggers an audit and key items to consider if audited
• Utilize a step by step approach to meet all Federal Medicare Documentation guidelines 
• Summarize Medicare’s guidelines for necessity of chiropractic care and its covered services
• Prepare treatment plans per Medicare’s regulation requirements
• Recognize Medicare’s policy requirements pertaining to x-ray/diagnostic reimbursement
• Determine if ordering vs. referred services meet Medicare’s policy when performed by a chiropractic physician

Hour 1

• Demonstrate the key elements pertaining to Medicare’s documentation requirements for initial and subsequent patient encounters  
• Describe the three categories of chiropractic care covered through Medicare and the one category exempt from Medicare coverage
• Apply Medicare’s x-ray requirements for documenting a subluxation
• Utilize Medicare Advance Beneficiary Notification (ABN) form and its guidelines 
• Use Medicare’s PARTS system to document a subluxation
• Summarize the transformation of Medicare’s PARTS system utilizing the AIR S & M method               
• Include proper Medicare documentation for daily progress notes (SOAP), in order to meet insurance guidelines and meet medical necessity 

Hour 2

• Integrate a 4 step approach to meet E/M (Evaluation/Management) coding requirements to meet Medicare’s guidelines

Hour 3

• Review Medicare Access and CHIP Reauthorization Act of 2015 (MARCA) aka Medicare Quality Payment Program (QPP) and the Merit Based Incentive Payment Program (MIPS)                                                                    

Hour 4

• Apply the critical components of Chiropractic Manipulative Treatment (CMT) coding and Medicare’s requirements for documentation
• Use diagnostic codes ICD-10 (primary subluxation M-codes biomechanical lesions and secondary medical codes) to meet Medicare’s diagnosis requirements
• Recognize Current Procedure Terminology (CPT) codes and how it relates to the Medicare system
• Utilize Medicare modifiers   
• Identify some of the key items with regards to completing the Center for Medicare and Medicaid Services (CMS) 1500 claim form   
• Summarize Medicare’s mandatory claims submission policy                                   
• Explain the five levels of Medicare appeals process
• Distinguish between Medicare participating vs. non-participating provider requirements

Hour 1

• Define standard of care.
• Examine the requirements of Chiropractic documentation.
• Evaluate Chiropractic care and the functional relationship.
• Review state specific examples of documentation requirements.
• Discuss what is mean by episode of care.

 Hour 2

• Establish the baseline of care.
• Identify the inadequacies of intake forms.
• Comply with the requirements of the initial encounter report.
• Review the consultation documentation in various case scenarios.
• Apply appropriate medical decision-making processes and documentation.

 Hour 3

• Examine the Documentation Requirements of a SOAP Note.
• Utilize PART in documentation.
• Utilize outcome assessment tests in documenting medical necessity of care.
• Identify Assessment and its relationship to medical necessity.
• Solidify elements of the treatment plan to support medical necessity.
• Apprise utilization management and review analysis of documentation.

• Recognize the common pitfalls that can put your clinic at risk
• Review the difference between a mandatory ABN and a voluntary ABN
• Identify the appropriate time to initiate a mandatory ABN
• Implement customized and compliant ABNs for your clinic by following the rules

• Demonstrate understanding of the key elements of revised E/M services
• Determine the elements that count as Time-Activities and how to calculate appropriately
• Establish protocol to determine Medical Decision Making element of E/M encounter
• Apply the new algorithm to appropriately code for E/M services under the 2021 model
• Discover how to still demonstrate Medical Necessity with the revised E/M codes
• Determine why history and examination are still needed

• 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 for those Doctors not using an EHR

• 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

• 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

• 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

• 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

• 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

• 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'

• Demonstrate the components of recognizing Medical Necessary Care vs. Clinically Appropriate
• Identify CMT coding trends and indicators as they relate to medical necessity
• Properly manage treatment effectiveness for exacerbations and reoccurrences
• Determine Proper Diagnosis and Assessment for Federal Patients
• Acknowledge and audit CMT coding ratios to evaluate the potential risk

• Apply the changes in the 2022 ICD-10 code set to the clinical diagnosis process
• Compare examination findings, couple with history, to select the most appropriate written diagnosis
• Document within the clinical record your thought process of selecting diagnostic codes
• Classify diagnoses in order of severity and hierarchy to match projected treatment plan

• Properly document “doctor thinking” daily in routine patient visit documentation
• Recognize the role of the PART documentation process in Routine Office Visit notes
• Identify and execute the key components of written assessment in daily documentation
• Recognize aspects of documentation and coding of Route Office Visits (ROV) whether active treatment, preventative maintenance, or wellness care.
• Distinguish the unique components of Subjective, Objective, Assessment and Plan

Hour One: Documentation and Compliance Overview, Rules and Regulations

• Recognize and avoid or correct behavior that is contrary to the rule of “no opt-out for chiropractors”
• Apply compliance rules set forth by governmental agencies that apply to providers of service to Federally insured patients
• Demonstrate day-to-day application of guidance on Federal Program and state requirements for coding, billing, and finances
• Differentiate between active and maintenance care, according to the official Medicare definitions and other third-party guidelines
• Interpret the four types of risk the Office of Inspector General (HHS) expects providers to focus on with Policy and Procedure, per the OIG Guidance for Small Practices
• Recognize the limitations of experimental, investigational, and unproven technologies

 Hour Two: Documentation of Initial Visits-New Patients, New Episodes, and New Conditions

• Identify and apply concepts that differentiate types of initial visits, from new patients to updated episodes
• Produce documentation of initial visits that comply with board requirements for chiropractors
• Summarize documentation requirements as they apply to the new initial Evaluation and Management guidelines set forth January 1, 2021
• Establish medical necessity for your care and know with surety that initial visit documentation is complete
• Rank complicating factors and contraindications according to priority and include with initial assessment
• Populate a required treatment plan for care, whether for short- or longer-term care

 Hour Three: Documentation and Case Management for Routine Visits, Preventive Maintenance, and Wellness Care

• Differentiate between requirements for medically necessary services vs. maintenance which is self-pay
• Apply primary subluxation vs secondary compensation logic to mitigate risk for the full-spine adjustment
• Reproduce the key elements of routine chiropractic visits in documentation as set forth by third-party, State and Federal guidelines
• Interpret functional data to determine stages and levels of care
• Demonstrate the ability to implement therapeutic withdrawal and to document its results
• Recognize maximum therapeutic benefit (MTB) and properly document discharge from active treatment

 Hour Four: The Risks Associated Billing and Financial Compliance Regulations

• Give examples of billing and financial compliance that cross the line of False Claims Act and Anti-Kickback Statute violations
• Apply billing and financial compliance regulations to the day-to-day operations of the practice, including payment and prepayment plans
• Execute random auditing of charges and collections to meet OIG compliance guidelines
• Recognize and apply the rules of offering financial hardship discounts
• Produce advertising that falls within the guidelines of board and federal rules

• Label the main driver is for “Medical Necessity”, how and why you must communicate this to 3^rd party payers
• List the foundation of coding and be able to apply pertinent ICD10 coding guidelines
• Discover how correct coding may dictate our strength to 3^rd parties and have national implications for our profession.
• Discuss critical questions of the benefits and risks of our Chiropractic diagnosis codes in the insurance industry.
• Identify red flags, complicating factors, and have awareness of Risk management when documenting and coding.
• Identify how insurance companies rank the importance of various diagnoses and its effect on claims’ coverage and processing

• Explore contemporary healthcare issues from the perspective of Robert Lustig, MA and John Abramson, MD.
• Integrate the relevance of these issues to the chiropractic profession.
• Evaluate at the concept of evidence-based “medicine,” especially the “randomized controlled trial,” and describe how it applies to the chiropractic profession.
• Discriminate recent examples of “randomized controlled trials,” especially as related to pain syndromes and opioid drugs.Discusss the importance of the 2021 Nobel Prize for the chiropractic profession and mechanical-based care.
• Detail the physiology of the Piezo1 mechanical receptor.
• Introduce the concepts of mechanical function and mechanical neurology.
• Integrate the importance of the cerebellum to mechanical integrity and mechanical based care.
• Explain a randomized clinical trial that supports mechanical-based chiropractic care for visceral physiology.
• Distinguish the basic physiology of the neurotransmitter norepinephrine.
• State the basic physiology of the neurotransmitter dopamine.
• Outline the basic physiology of the neurotransmitter serotonin.
• Integrate the balance of the neurotransmitters dopamine and serotonin.
• Recite the relationship between the neurotransmitters dopamine, epinephrine and norepinephrine.
• Explore the concept of Heart Rate Variability (HRV).
• Integrate upper cervical chiropractic care, spinal chiropractic care, and HRV.

• Explain how beneficial commensal microbes support gastrointestinal health
• Describe the major components of the intestinal barrier
• Summarize the microbial composition of a typical stool sample
• Explain the role of comprehensive stool testing in assessing gastrointestinal health

• Recognize the three most common types of microbial dysbiosis
• Describe common factors that can reduce beneficial microbes and disrupt the intestinal barrier
• Assess pathogens and opportunistic microbes identified with comprehensive stool testing
• Discuss how the selection of microbial testing methodology may affect the identification of pathogens and opportunists
• Outline therapeutic approaches that address common dysbiosis types identified via comprehensive stool testing

• Describe the current epidemiologic trends in autoimmune incidence, morbidity and mortality.
• Associate the linkage between autoimmune disease prevalence and factors including the GI microbiota composition, food immune reactions, stealth infections, molecular mimicry, lack of early diverse antigen exposure, and other elements.
• Examine the available clinical laboratory testing related to autoimmune disease risk assessment, diagnosis, and clinical management, including qPCR molecular-based evaluation of the GI microbiota.
• Explain the difference between quantitative molecular testing (qPCR) versus next-generation sequencing of the GI microbiota in the support of clinical decision making.
• Appraise the available evidence-based integrative and complementary therapeutic interventions for autoimmune disorders.

• Describe the current common routes and mechanisms of toxic exposure for individuals living in the industrialized world.
• Associate the linkage between chronic diseases, including mitochondrial dysfunction, obesity, diabetes, Alzheimer’s disease, Parkinson’s disease, cancer and others with increased levels of exposure to various environmental and food toxins.
• Examine the available clinical laboratory testing related to toxic load and related disease risk assessment, diagnosis, and clinical management using various lifestyle and nutritional approaches.
• Explain the difference between the various methods to assess toxic burden and detoxification at the level of the individual in the support of clinical decision making.
• Appraise the available evidence-based integrative and complementary therapeutic interventions for lowering toxic load and improving detoxification function.

Hour 1

• Describe the general diagnostic criteria of Metabolic Syndrome and CVD.
• Demonstrate an understanding of the enhanced diagnostic criteria and the importance of investigating these potential earlier markers.
• Demystify the “Cholesterol and HDL hypothesis” and explain the compensation mechanisms of the body for this.
• Recognize the biometric and physical signs of the progressive nature of CVD, CHD and MetS.
• Investigate Lifestyle Modification Programs as the major intervention strategy for the reversal and stagnation of these comorbidities. 

• Describe the general dietary interventions of Metabolic Syndrome and CVD.
• Demonstrate an understanding of sodium/salt as it relates to CVD/HTN.
• Demystify the confusion of major supplements and foods as it relates to CVD/HTN. 
• Recognize the associations between insomnia and CVD, CHD and MetS.
• Investigate various peer reviewed studies and the outcomes of nutritional interventions.  

• Provide an understanding of the clinical applications of biochemical/metabolic evaluations to determine a patient’s hormonal status
• Explain the differences between various assessments of hormonal status
• Evaluate hormonal imbalances and disorders
• Evaluate nutrient needs in metabolic disorders Plan and monitor nutrient interventions to correct abnormalities found by the tests

• Describe the origin of mitochondria from an evolutionary perspective.
• Understand the critical role that the thyroid plays in metabolism and how this relates to healthy mitochondrial function.
• Explain how to test for mitochondrial function/dysfunction.
• Show how living in a thermos neutral modern society contributes to obesity.
• Recognize how antibiotics can damage mitochondria and how that can play a role in obesity.
• Give examples of toxins/drugs that can adversely affect mitochondria.

• Describe how common mitochondrial genetic problems are in the general population.
• Explain how mitochondria are needed to produce glutathione and why glutathione is needed for healthy mitochondria.
• Discover how oxidative stress can be both good and bad for the body.
• Discuss how mitochondrial dysfunction plays a key role in a variety of diseases ranging from Parkinson’s, Cancer, NASH, Alzheimer’s, Autism and Diabetes.
• Discover key ways to optimize mitochondrial function in patients.

• Describe the associations of micronutrient deficiencies as it relates mental health disorders.
• Demonstrate an understanding of major prescriptive medications and their negative influence on mental health disorders. 
• Explain the overlap of certain pathophysiological conditions and mental health disorders.
• Recognize the current lack of proper diagnosis of mental health disorder.

• Describe the associations of micronutrient and nutritional deficiencies as it relates mental health disorders.
• Demonstrate an understanding of the major biochemical pathways, their enzymes and nutritional elements as it relates to psychological issues.
• Explain the importance of fatty acids in mental health disorders.
• Recognize the current lack of proper nutritional interventions as it pertains to TBI, mTBI and PCS.

• Provide an understanding of the clinical applications of biochemical/metabolic evaluations to determine a patient’s status of nutrients, toxicants and cell regulators, and functional gastrointestinal status.
• Explain the differences between various assessments of element status
• Evaluate specific nutrient deficiency states
• Determine weaknesses in digestive, assimilative and intestinal microbiological status
• Plan and monitor nutrient interventions to correct abnormalities found by the tests

• Define and explain the difference between "calories in, calories out" versus the “carbohydrate-insulin model of obesity”. Discuss the causes of increased intestinal permeability in competitive athletes and identify strategies to combat the condition. Identify the energy intake athletes require by calculating their total energy expenditure.
• Recall the quality and function of macronutrients and their role in physical performance.
• Describe common micronutrient deficiencies seen in competitive athletes and identify strategies to prevent such occurrences.

• Summarize the physiological energy and macronutrient requirements of the sprint/power athlete and game-playing athlete. Identify supplement strategies to support the sprint/power athlete and game-playing athlete.
• Summarize the physiological energy and macronutrient requirements of the endurance athlete.
• Identify supplement strategies to support the endurance athlete.
• Outline an effective whole food diet to support competitive athletes.

• Describe the secondary metabolites in whole foods.
• Understand the role of phytochemicals.
• Demonstrate an understanding of how they interact with our cells.
• Explain how to preserve them during cooking.

• Recognize the challenges caused by ultra-processed foods
• Identify the compounds in the Brassicaceae family
• Explain the health benefits of sulforaphane
• Explain the importance of preserving secondary metabolites
• Recognize the benefits of the fungal kingdom

Hour 1

• Describe the characteristics and mechanisms of actions of essential oils.
• Explain several key controversies in aromatherapy and the implications.
• Generalize the safety and quality issues surrounding the clinical use of essential oils.
• Compare the various modes of applications of essential oils.
• Summarize the pharmacology and biotransformation of essential oils and its constituents.
• Recognize the potential interactions of essential oils with medications and nutraceuticals.

Hour 2 

• Generalize the various considerations for prescribing essential oils.
• Calculate equivalent dosages of essential oils using several different units of measurement.
• Apply the guidelines for appropriate prescribing the internal use of essential oils.
• Determine the proper application and dosage for various essential oils used for digestive health.
• Specify the usage and dose determination for essential oils for mental health.

• Analyze the concept of central pain processing and the consequences of dysfunction of descending inhibition.
• Associate FM with trauma and abuse, depression, anxiety, sleep disorder and pain processing disorders with emphasis on limbic system dysfunction, aberrant stress physiology, and ultimate failure of descending anti-nociception. 
• Assess the difference between regionalized somatic pain and true central allodynia
• Describe the accurate differential diagnosis of patients presenting with suspicion of FMS
• Identify common subsets of clinical disorders that may lead to an erroneous diagnosis of FMS (i.e., “pseudo” FMS)

• Describe and Identify the functional medicine approach to common pediatric problems
• Develop a comprehensive functional medicine assessment and treatment of common pediatric problems such as constipation, headaches and migraines, upper respiratory infections and otitis media, food sensitivities, allergies, asthma and atopy
• Examine the salient features of history, physical examination and laboratory testing to best implement functional medicine interventions to common pediatric problems
• Utilize a functional medicine approach to assess what each child may need to get or get rid of to treat each of these common pediatric problems 
• Summarize the literature supporting the use of functional medicine in pediatrics
• Recognize the four pillars of a functional medical approach to chronic pediatric illness – gastroenterologic, immunologic, metabolic and neurologic
• Classify and explain the importance of the genetic and genomic susceptibilities/predisposition and environmental triggers of chronic pediatric illnesses
• Utilize a functional medicine approach to assessing and treating chronic pediatric disease such as ADHD, Autism, Autoimmune Encephalitis, Anxiety, Allergy and Atopy
• Interpret the literature citations and develop protocols based on emerging evidence supporting a functional medicine approach to these chronic pediatric problems
• Appraise the assessment and management of the importance of the microbiome in immune tolerance, allergy and autoimmunity.

• Discuss the catecholamine pathway will be presented in an organized fashion with emphasis on real world applications. 
• Review clinical case studies. 
• Assess different genetic mutations within the catecholamine pathway . 
• Individualize treatment plans in practice. 
• Demonstrate a basic road map of the catecholamine pathway. 
• Use genetic parsing software and the tools attained form this course to highlight and modulate genes/SNPs of interest. 
• Derive natural therapeutic agents to modulate epigenetic expression. 
• Utilize basic nutrigenomic assessment and treatment knowledge in the catecholamine pathway.

• Define and explain the different terms that identify exercise intensity and their relationship to maximal oxygen uptake (VO2 max).
• Discuss the history of exercise physiology and how technology influenced research and ultimately, exercise guidelines.
• Differentiate the physiological responses to sprint interval training and to low-to-moderate intensity continuous training.
• Reconstruct a lay explanation to patients and/or clients of why sprint interval training is an extremely effective strategy for improving overall health and fitness.
• Summarize key research studies that support sprint interval training.

Hour 2

• Recognize additional research that supports sprint interval training.
• Identify key physiological benefits of sprint interval training.
• Recall important case study benefits.
• Outline effective overall strategies for implementing sprint interval training.
• Distinguish appropriate sprint interval exercises for differing populations.

Hour 1:

• Summarize the differences between genomics, genetics, and epigenetics
• Illustrate how genomics can affect risk and outcomes in auto-immune and inflammatory conditions
• Interpret relative function of genes based on presence of relevant SNPs
• Identify genes and SNPS involved in autoimmune disease and chronic inflammation
• Assess Dietary, Lifestyle and Herb/Nutrient recommendations based on genomics

 Hour 2:

• Apply nutritional genomics in autoimmune and inflammatory diseases
• Outline basic disease pathogenesis in autoimmune and inflammatory diseases
• Explain which genes and SNPs are relevant depending on the clinical scenario
• Assess other contributors to chronic inflammation and autoimmune disease

• Summarize the effect of exercise on wound healing in older adults
• Discuss the relationship between trunk muscle composition and functional capacity
• Assess the effects of high-intensity strength training on balance
• Describe a study that examines the reliability and validity of a new steadiness measure
• Assess the effect of an endurance exercise program on depression, anxiety and quality of life

• Summarize the concept of mitochondrial degeneration
• Discuss the free-radical mitochondrial theory of aging and the susceptibility of the brain to oxidative stress
• Assess the relationship between mitochondrial decay and age-related neurodegenerative diseases, such as Alzheimer's disease (AD) and Parkinson's disease (PD)
• Illustrate the array of mitochondrial nutrients and the various vitamins that may improve mitochondrial function

• Breakdown the biomechanical processes of spinal degeneration
• Explain the biochemical processes that occur in the geriatric population in 
• Differentiate between various diagnosis of structural and chemical conditions seen in geriatric patients
• Analyze the radiological findings and how they influence clinical decisions
• Explain Syndrome X and how it affects physiology
• Differentiate trauma and its late effects on the body

Hour 1

• Describe psychoneuroimmunology and its application to clinical diagnosis of geriatric patients
• Apply psychoneuroimmunology to activities of daily living

Hour 2

• Differentiate clinical approaches to managing psychoneuroimmunology
• Measure clinical treatment outcomes

Hour 3

• Relate what factors contribute to this field in the elderly patient
• Incorporate hormonal balancing with nutrition in clinical treatment plans for Chiropractic Patients

• Implement nutrients that promote spinal and joint function to obtain positive clinical outcomes
• Explain Ph., alkalinity and acidity as it impacts the physiology of the body in regards to healing
• Categorize toxins in the environment that create clinical presentations of  geriatric patients clinical care
• Utilize vitamins herbals and supplements to augment patients’ care
• Factor nutritional aspects of protein, fats and carbs into clinical treatment plans to improve healing
• Create treatment goals and nutritional plans

• Assess various treatment modalities
• Implement treatment protocols as found in the latest research
• Progress patients to incorporate wellness into their lifestyle
• Perform postural evaluations and discuss clinical significance to the patient
• Appropriately factor radiographic findings into diagnosis and clinical decision making of the geriatric patient
• Examine physical findings and set specific and measurable patient treatment goals

• Review evidence-based recommendations regarding best practices for chiropractic care of older adults
• Outline the relationship between individual sagittal posture and risk falling in an elderly back pain population
• Explore the cost impact of utilizing chiropractic in older patients with chronic low back pain and multiple comorbidities
• Examine the effectiveness of nonpharmacological therapies for dizziness in older people
• Assess the impact of chiropractic care on measures of sensorimotor function associated with the risk of falls in older adults

• Summarize the United Nations (UN) Decade of Healthy Aging and its initiatives
• Describe challenges specific to conducting clinical research on older patients
• Examine epidemiological trends and opportunities related to an aging population
• Define agism and elderspeak
• Explore relevant concepts of, and goals for, healthy aging
• Outline relevant clinical considerations for aging patients in a chiropractic practice
• Specify red flags in older patients that would warrant clinical referral
• Assess general function in elderly patients using simple clinical tests
• Examine our unique clinical opportunities (and challenges) relating to providing chiropractic care for older patients
• Recognize the clinical impact of multi-site pain in elderly patients
• Cite existing data on chiropractic care patterns for older patients
• Summarize and critique the existing body of research on chiropractic care for spinal conditions in older patients
• Explore the relationship between hip and spine function in elderly patients
• Integrate existing literature pertaining to the patient experience and understand what matters to them
• Summarize best practices for providing chiropractic care for older patients
• Discuss the rational use of imaging in chiropractic practice
• Define osteoarthritis and review the societal impact of this condition
• Identify risk factors for the development of osteoarthritis
• Outline our current state of knowledge on the pathophysiology and diagnosis of osteoarthritis
• Appraise the state of the evidence regarding general treatment recommendations for osteoarthritis
• Explore the scientific literature regarding various treatment modalities for osteoarthritis
• Recognize the value of exercise for managing osteoarthritis
• Critique the literature regarding common medical interventions for osteoarthritis
• Define lumbar spinal stenosis and review the societal impact of this condition
• Classify pathognomonic signs and symptoms of lumbar spinal stenosis
• Differentiate lumbar spinal stenosis from other clinical conditions
• Breakdown the evolving evidence relating to the management of lumbar spinal stenosis
• Discover the important role chiropractic can play in the treatment of lumbar spinal stenosis
• Outline our current state of knowledge on the pathophysiology and diagnosis of degenerative cervical (spondylotic) myelopathy
• Recognize the importance of identifying this pathology in aging patients to facilitate appropriate care

• Discuss ethical standards of insurance reporting and coding
• Illustrate how documentation can affect state board complaints
• Discuss why insurance companies file complaints against chiropractors
• Discuss why patients file board complaints against chiropractors
• Define the Problem Oriented Medical Record (POMR)
• Illustrate taking a thorough history using the OPQRST method
• Discuss the components of the ortho/neuro exam

• Discuss the misrepresentation of certain orthopedic tests
• Illustrate sensitivity and specificity of orthopedic tests
• Define the 2021 changes to Evaluation and Management codes
• Discuss the differences between using time vs. medical decision making for E/M
• Distinguish between subjective and objective outcome assessments Illustrate methods of proving medical necessity
• Illustrate the CMS requirements of chiropractic documentation
• Illustrate condition-specific functional outcome questionnaires
• Define the A of P.A.R.T. from Centers for Medicare/Medicaid Services
• 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-assessment
• Demonstrate proper coding for range of motion measurements
• Describe the P.A.R.T. format of documentation
• Define the P of P.A.R.T. from Centers for Medicare/Medicaid Services
• Describe the concept of outcome assessments in clinical practice

• 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
• Discuss proper diagnosing in notes and on a claim form
• Define the short, moderate and long-term diagnoses for Medicare
• Define proper Assessments
• Illustrate how to determine an assessment for each condition
• Illustrate complicating factors that can be documented for each condition

• Illustrate the two types of Plan
• Discuss common therapeutic modalities
• Demonstrate proper documentation for time-based codes
• Illustrate how to document measurable treatment goals
• 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
• Discuss some of 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
• 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

• Prepare to manage and document protocols, for litigation protection, in a crisis, such as Covid.
• Discover how to avoid a HIPAA investigation and becoming a ‘HIPAA statistic’, often by surprise.
• Operate an office with protocols to avoid ransom ware and other Cyber-attacks.
• Complete a HIPAA program to be prepared for document production, demanded by the government, when a complaint (or even a simple inquiry) is made by a patient, peer, or ex-employee.

• Prepare for the required OIG compliance program, required for all who treat one of more Medicare patients per year.
• Aid in understanding and preparing required written documented policies under the HIPAA law.
• Identify what thieves do with stolen patient information.
• Discover what is included in a comprehensive table of contents for a HIPAA compliance program.
• Describe the type and number of complaints against doctors and their often surprise origins
• Use of required accounting logs

• Classifying what you say and when, when notified of an investigation or audit, to avoid saying the wrong thing and complicating your case.
• Examine what every office must do, regarding the ONC law, to deliver patient records electronically if so requested, even if you don’t have computers.
• Show a step-by-step approach to responding to the government in the event of a breach, investigation, or audit.
• Solve the puzzle as to avoiding audits and compliance investigations.

• Explain tele-health pros and cons.
• Categorize the risks that lead to being turned in for violations, often not knowing you were doing anything wrong.
• Point out the most common HIPAA scams that involve impersonating a federal official.
• Examine the parts of the HIPAA law that enforcers are enforcing and those parts they are not enforcing.

• Discover how to conduct the required ISAR (information system activity review) that leads to maximum fines if not completed.
• Aid you and/or your staff in conducting the required risk analysis that leads to maximum fines, if not completed.
• Prepare an electronic device maintenance schedule to protect yourself relative to data breaches.
• Examine how to reduce your exposure to HIPAA fines.

• Discover illegal fee structures and the legal options that do exist.
• Prepare the four requirements relative to the notice of patient privacy policy.
• Generate a legally required BAA process for every individual or company with whom you share or provide access to your patient data.
• Discuss the requirements for data recover and emergency mode operations under HIPAA.

• Prepare a protocol for creating required policies under HIPAA.
• Assess the risks of seeing Medicare patients with inadequate use of the ABN form.
• Operate proper procedures to appropriately use the ABN form in a Medicare practice.
• Summarize the Ohio workers’ compensation requirements that elevate chiropractic and put restrictions upon spinal surgeons.

• Generate proper staff training to meet HIPAA requirements.
• Examine the pitfalls around a physical plant audit and what you must do to avoid them.
• Completing a required disciplinary policy that will pass an investigation.
• Classify the little-known training requirements above and beyond the ‘annual HIPAA training’.

• 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

• 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.

• Build the ultimate back: from chronic back pain to high performance
• Evaluate exercise’s effect on hormones and human performance
• Create a flowchart explaining laser therapy and its application during the correlated stages of healing
• Review the newest laser research and its clinical applicability
• Apply neurodynamic tests and advanced corrective laser protocols
• Evaluate techniques for non-invasive fat reduction
• Elucidate the science of different types of fasting
• Utilize advanced clinical breakthroughs in the treatment of musculoskeletal injuries
• Implement strategies to initiate the positive impact of gut health on the musculoskeletal system
• View hands-on reproducible, implementable protocols 
• Incorporate laser effectively into your practice
• Assess intestinal and blood-brain barrier dysfunction
• Integrate leading-edge protocols for SIBO
• Identify modern lifestyle and environmental triggers that affect the gut brain axis

Hour 1

• Discuss the etiology, pathophysiology, and symptoms of trauma and post-auto whiplash.
• Translate how low-level laser impacts inflammation and trauma.
• Explain modern neuron theory and how low-level laser can optimize cellular communication within the PNS/CNS.
• Conceptualize how to change the brain and body by using low-level laser and sensory inputs to modify central circuitry.

Hour 2

• Discuss the interplay between the sympathetic and parasympathetic systems.
• Explain how changes in autonomic function affect the brain and body following trauma.
• Share relevant research about the gut/brain connection.
• Give an overview of the neuroinflammatory cascade of trauma and how low-level laser impacts inflammatory processes.

Hour 3

• Discuss the anatomy/physiology of the cerebellum and it’s integration with the cervical spine.
• Outline how changes in cerebellar function and the cervical spine affect the brain and body following trauma
• Explain how low-level laser therapy can optimize structural, neurological, and metabolic parameters following trauma.
• Create a greater understanding for providers to know how to utilize their skillset to treat complex cases.

Hour 4

• Discuss the anatomy and physiology of the visual and vestibular systems.
• Identify how changes in the visual and vestibular system affect the brain and body following trauma.
• Share mechanisms and treatment applications for utilizing low-level laser therapy.
• Create awareness around the modern utilization of structural, neurological, and metabolic treatment paradigms for complex cases.

Hour 1:

• Integrate the following concepts as it pertains to laser therapy:  wavelength, frequency, speed of light, fluence, penetration, secondary and primary physiological influences
• Contrast the differences between thermal and non-thermal laser therapy

Hour 2:

• Conceptualize the relationship between mitochondria, free radicals, ATP, cytochrome coxidase enzyme, and laser photon therapy
• Explain the biphasic nature of laser therapy

Hour 3:

• Introduce evidence as to the integrative physiology between chiropractic care for musculoskeletal pain syndromes and improved systemic health.
• Develop a neuroanatomical and neurophysiological model for the influence of spinal mechanical function with visceral neurology.

Hour 4:

• Correlate upper cervical spine symmetry and the function of the nucleus tractus solitarius of the vagus nerve.
• Explore the mechanical, vascular and cerebrospinal fluid dynamics as related to spinal anatomy.

Hour 5:

• Show the history and modern-day evidence for the influence of exposure to non-ionizing electromagnetic field waveforms.
• Detail the two most plausible mechanisms of exposure non-ionizing electromagnetic field waveforms on human biology.

Hour 6:

• Explore the various relationships from a functional neurological perspective.
• Contrast the relationship between various neurochemicals

Hour 7:

• Justify why many people need between 5-8 different supplements and explain why.
• Connect the link between dietary lectins, leak gut, systemic inflammation and autoimmune conditions.

Hour 8:

• Explain some of the physiological complications to COVID-19.
• Review studies that explain the biological plausibility related to COVID-19.

Hour 1

• Discuss the physiology associated with laser therapy
• Describe the electron transport chain
• Examine common cervical and plexus pathologies through orthopedic and soft tissue testing
• Treat the scapular area using non-thermal lasers
• Outline a description of electron volts

Hour 2

• Summarize important factors regarding wavelengths relative to using laser therapy
• Describe mitochondiral function
• Recognize damage to mitochondria and appreciate its role in disease
• Examine patients with potential upper extremity nerve entrapments using orthopedic testing, soft tissue testing 

Hour 3

• Discuss neuron receptors
• Explain pain to patients
• Identify soft tissue structures
• Summarize the function of progenitor cells

Hour 4

• Perform an evaluation of the shoulder
• Perform an evaluation of the elbow
• Perform an evaluation of the wrist and the hand
• Perform an evaluation of the lower extremities

• Integrate concepts in laser photon therapy: wavelength, frequency, speed of light, fluence, penetration, secondary and primary physiological influences
• Contrast the differences between thermal and non-thermal laser therapy
• Develop the relationship between mitochondria, free radicals, ATP, cytochrome c oxidase enzyme, and laser photon therapy
• Discuss the physiology of applying laser therapy to both the anatomical part of injury/complaint and to the nerve roots that innervate that anatomical part
• Explain the biphasic nature of laser photon therapy as related to evolutionary biology and current clinical applications

• Ssummarize the volume of research that led to the USSR implementing laser by 1974 as standard care
• Discuss the differences between LEDs and different classes of lasers
• Identify which wavelength was preferred by the Soviets, and also has 18 of the 21 FDA clearances
• Analyze case studies to identify that the effect is not a placebo
• Prevent cyber attacks on your data
• Create protocols to prevent willful neglect fines
• Develop guidelines for patient rights to access their own information
• Perform a self audit on your practice
• Identify the most common HIPAA fines issued to doctors and create procedures to prevent them
• Realize who gets investigated and how to lower your risk
• Identify the documentation you will have to provide if investigated
• Recognize what to do if you are investigated
• Discuss the the results of the level 1, double blind study that showed a 635 nm class 2 laser was more effective than opioids for chronic low back pain of a minimum duration of 8 years
• Integrate laser therapy into an existing practice for better patient outcomes
• Contrast the difference in clearances and uses for a class 4 laser vs a class 2 laser for chronic condition for better implementation into treatment protocols
• Analyze video’s and pictures in regard to treatment applications and contraindications

Hour 1:   

• Improve specific elements of the four PI office visits.
• Outline the documentation steps of a causation statement.

Hour 2:  

• Identify med-legal considerations associated with PI documentation.
• Develop an outline to create a PI final discharge report.

Hour 3: 

• Recognize and evaluate several commonly missed traumatic injuries.  
• Create a to plan improve the capture of acute objective findings.

Hour 4:  

• Recognize LLLT versatility and benefits with PI-related conditions.   
• Develop clinical protocols for LLLT application in PI cases.

 Hour 5:  

• Identify and avoid inherent risks within PI case management.       
• Create an algorithm for case management clinical decisions.

Hour 6:  

• Discover the importance and relevance of PI co-management.
• Assess cases for co-management decisions and opportunities.

• Explore the societal burden of headaches
• Rank the prevalence of common headache types
• Give examples of common lifestyle contributors to headache syndromes
• Recognize the difference between primary and secondary headaches
• Review clinical characteristics of common headache types
• Differentiate cervicogenic headache from occipital neuralgia
• Contrast trigeminal neuralgia and idiopathic facial pain
• Summarize relevant clinical history questions for headache patients
• Recognize red flags specific to headache patients
• Define ‘dizziness’, ‘vertigo’ and other related terms
• Review common differential diagnoses and assessment strategies for the dizzy or vertiginous patient
• Utilize a TiTrATE approach to differentially diagnose and/or classify dizzy patients
• Breakdown our contemporary understanding of cervicogenic dizziness
• Summarize current diagnostic criteria for cervicogenic dizziness
• Outline various physical examination procedures for evaluating cervical sensorimotor function
• Define and outline the defining features of sports-related concussion
• Outline the ‘neuro-metabolic cascade’ in concussion injuries
• Summarize known risk factors for concussion
• Contrast on-field versus in-clinic evaluation of concussion
• Explore various clinical tools for evaluating concussion (ex. SCAT5, CRT, VOMS)
• Identify and categorize common concussion symptoms
• Recognize risk factors for prolonged recovery from concussion
• Explore short- and long-term consequences of concussion
• Summarize contemporary concussion management considerations for chiropractors
• Appraise the reasons for concern relating to neck manipulation and stroke
• Classify cervical artery strokes
• Explore the epidemiology of cervical artery strokes
• Summarize best-evidence relating to the association between spinal manipulation and cervical artery stroke
• Outline relevant challenges and other factors relating to researching the relationship between neck manipulation and cervical artery stroke
• Define protopathic bias and how it relates to stroke and neck manipulation
• Critique potential mechanisms of injury relating to cervical manipulation and the cervical arteries
• Integrate best practices into your clinical approach for ruling our emergent stroke in neck pain and headache patients
• Review the HINTS examination as a mechanism to differentially diagnose acute vestibular syndrome
• Review the evidence on the appropriateness and efficacy of manual therapy for treating headaches
• Explore the literature pertaining to the complex interplay between cervical spine function and dizziness, persistent post-concussion symptoms, neck pain and headache
• Critique the literature pertaining to the management of cervicogenic dizziness
• Summarize existing evidence regarding the chiropractic management of concussion

• Explain the biomechanics of the elbow, wrist and hand.
• Administer thorough examination of the elbow, wrist and hand.
• Differentially diagnose the pathological conditions of the elbow, wrist and hand.
• Perform soft tissue treatments for the elbow, wrist and hand.
• Apply functional relationships of the elbow, wrist and hand to associated regions for thorough evaluation and treatment.

• Explain the biomechanics of the thoracic spine and ribs 
• Describe the examination of the thoracic spine and ribs 
• Describe the pathological conditions of the thoracic spine and ribs 
• Demonstrate soft tissue treatments for pathological conditions of the thoracic spine and ribs 
• Define functional relationships of the thoracic spine and ribs with associated regions

• Investigate the association between brain age and chronic low back pain duration and pain severity 
• Compare Medicare expenditures over time in older adults with chronic low back pain who initially receive opioid analgesic therapy versus spinal manipulation 
• Recognize the impact of spinal manipulation on escalation of care and risk of adverse drug events among older Medicare patients with chronic low back pain 
• Summarize existing clinical practice guidelines on fall prevention and management for older adults 
• Outline the neuroinflammatory contribution to the development of tissue damage and joint-related pain in osteoarthritis and rheumatoid arthritis

• Discuss relevant anatomy associated with specific injuries to climbers
• Summarize common climbing movements and grip types
• Apply knowledge of relevant anatomy, movement, and grip types in discussing etiology of climbing injuries
• Differentiate common presentations of injuries in rock climbers
• Determine which presentations and etiologies require further interventions such as imaging, surgical consult etc..
• Briefly describe active management strategies and treatment plans for rock climbing injuries

• Summarize the recent NASS clinical guideline on the diagnosis and treatment of low back pain 
• Assess the literature to determine which mode(s) of exercise is/are best for treating chronic low back pain 
• Discuss the comparative effectiveness of currently available treatments for acute and subacute mechanical non-specific low back pain 
• Explore how clinicians can optimally facilitate self-management in patients with back pain 
• Evaluate the effectiveness of Foot Levelers shoe orthotics with and without chiropractic treatment for chronic low back pain as compared with no treatment

• Explain current best practices for the diagnosis and management of Achilles tendinopathy 
• Synthesize the evidence from randomized controlled trials to determine the clinical effectiveness of shockwave therapy, either as a monotherapy or part of a multimodal package of care for chronic mid- and insertional-Achilles tendinopathy 
• Appraise an international, multi-disciplinary consensus statement on return to sport decisions after lateral ankle injuries 
• Outline best practices in the management of plantar heel pain based on the latest evidence 
• Establish the effectiveness of the Nordic Hamstring Exercise for preventing hamstring injuries in athletes

• Explain the biomechanics of the lumbopelvic spine
• Describe the examination of the lumbopelvic spine
• Explain the mechanism of scoliosis
• Describe the pathological conditions of the lumbopelvic spine
• Demonstrate soft tissue treatments for pathological conditions of the lumbopelvic spine  

• Explain the biomechanics of the TMJ
• Describe the examination of the TMJ
• Describe the pathological conditions of the TMJ
• Demonstrate soft tissue treatments for pathological conditions of the TMJ
• Define functional relationships of the TMJ with associated regions

• Explain injury and healing of soft tissues
• Perform somatic technique and strain/counterstrain
• Utilize friction massage and post isometric relaxation
• Perform active release and myofascial release
• Apply trigger point ultrasound, exercise, stretching and manipulation

Hour 1:

• Describe the tensegrity model as it relates to biomechanics from a cellular to organism level.
• Define fascia, including anatomical lines and physical properties.
• Describe the Dural Fascial Kinetic Chain and its relationship to Adverse Mechanical Tension (AMT) on the spine and CNS.
• Describe the clinical relevance of biotensegrity, and how to apply these updated architectural and biomechanical principles to the delivery of chiropractic adjustments.

Hour 2:

• Explain the impact of chronic stress
• Recognize common signs and symptoms of sympatheticotonia during initial patient presentation.
• Outline the diagnostic process for sympatheticotonia, including both testing and interpretation.
• Summarize clinical considerations for the patient with sympatheticotonia.

Hour 3:

• Recognize and describe the common signs and symptoms of imbalance during initial patient presentation.
• Outline and demonstrate testing procedures for imbalance.
• Describe clinical interpretation of test results for imbalance.
• Make referral for imbalance when appropriate.

Hour 4:

• Describe statistical incidence and association with head and neck trauma
• Be able to recognize in clinical practice the common signs and symptoms of head and neck trauma
• Outline the diagnostic process for head and neck trauma, including both testing and interpretation.
• Summarize clinical considerations for the patient with head and neck trauma

Hour 1:

• Describe layered components of restrictions including updated osseous, muscular, and fascial relational anatomy.
• Describe how to palpate muscle tension versus fascial adhesion versus fascial tension lines.
• Differentiate between osseous restriction, muscular tension, and fascial restriction as they relate to spinal motion restriction.
• Use palpatory findings to select technique application for adjustments that last longer by addressing mechanical root cause and encourage parasympathetic dominance at rest.

Hour 2:

• Describe the difference between static misalignments and dynamic spinal restrictions (joints incapable of full range of motion).
• Differentiate with palpation both static and dynamic spinal restrictions.
• Describe neurological information gathered from palpation, including dysesthesia, hyperesthesia, reactive erythema, temperature differentials, and other signs.
• Palpate the patient with chronic pain, trauma history, and/or sympatheticotonia without triggering sympathetic bracing.

Hour 3:

• Describe the Oxford Grading Scale for manual muscle testing.
• Describe interpretation of manual muscle testing findings, including differentials for clinical significance of findings other than normal.
• Demonstrate manual muscle testing of major postural muscles.
• Apply manual muscle testing as pre- and post-clinical intervention measures during adjustment visits and to track change during review examination.

Hour 4:

• Describe the relevance of clinical history as it relates to chronic stress and trauma.
• List specific questions to assess for sympatheticotonia.
• List specific questions to assess for indications of head and neck trauma
• Determine appropriate individualized examination procedures based on history answers.

Hour 1:

• List the relevant indications to assess using cross-crawl patterning.
• Describe testing procedures to determine specific cross-crawl pattern issues
• Describe testing procedures to assess for signs of sympatheticotonia.
• Describe testing procedures to assess for signs of imbalance.

Hour 2:

• Perform seated functional range of motion testing with segmental and curve analysis.
• Perform standing functional range of motion testing with segmental and curve analysis.
• Describe fascial considerations to modify common orthopedic tests (including straight leg raise, supine apparent arm length inequality, bilateral prone knee flexion, and soto hall).
• List the orthopedic exam procedures specifically relevant to Fascial Kinetic Chain tension.

Hour 3:

• Describe clinical considerations in terms of safety of providing care (knowing when to adjust and when NOT to adjust).
• Define what is “primary” (including considerations of “cause” as well as “least stressful point of access” to determine what to adjust or otherwise apply therapeutic input).
• Recognize patterns of and describe gestalt clinical interpretation for sympatheticotonia.
• Recognize patterns of and describe gestalt clinical interpretation for adverse mechanical tension in the Fascial Kinetic Chain
• Describe patterns of peripheral nerve interference found through synthesis of clinical history and exam procedures.

Hour 4:

• Summarize the concept of an initial Therapeutic Trial of care, including reasoning behind it and how to complete this extension of initial assessment in order to customize patient care.
• Describe considerations for technique selection (including where to start, how intensely to adjust, and how to adjust).
• Explain reasoning behind initial frequency of care, and how/when/why to modify this frequency.
• Describe the considerations for projecting response to care and prognosis.
• Summarize guidelines for patient home care recommendations, including considerations for movement and rest, ergonomics, nutrition, and referrals when appropriate.

• Identify the neurological aspects of manipulation
• Review the basics of cellular physiology as it relates to manipulation
• Discuss action potentials and synapses
• Evolve an understanding of receptors
• Describe nociception and effects of manipulation

• Further elucidate the neurological aspects of manipulation
• Discuss nociceptive input to the spinal cord
• Review mechanoreceptors and their fibers
• Identify the relationship of mechanoreceptors with endorphin/enkephalin
• Analyze the history of referred pain patterns

• 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

• 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

• Explore current understanding of pain concepts, physiology and theories behind neuropathic pain
• Discuss in detail the relevant neurological anatomy and functional neurology
• Describe the anatomy and physiology of relevant components of human nervous system as it relates to pain receptors and neural integration
• Describe the anatomy and physiology of relevant components of human nervous system as it relates to neural plasticity, articular neurology, and mechanisms of pain

• Explore current understanding of pain concepts, physiology and theories behind neuropathic pain and allodynia
• Discuss the importance of the neurological implications of a nerve injury
• Describe mechanisms of neural plasticity
• Describe the anatomy and physiology of relevant components of human nervous system as it relates to neural plasticity, articular neurology, and mechanisms of pain

• 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

• 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

• This contains all courses with the educational objectives listed from Neurology 115 through Neurology 116

• Contrast historical versus neuroanatomical theories of acupuncture
• Describe the 4 basic mechanisms of acupuncture analgesia.
• Identify and utilize the local, segmental and central effects of acupuncture for neuropathy pain control
• Combine nutraceutical substances that may enhance the effectiveness of acupuncture
• Prepare a comprehensive acupuncture point prescription for maximum analgesic effects in patients suffering from neuropathy 
• Contrast real versus placebo acupuncture and discuss the pitfalls in placebo controlled trials
• Utilized knowledge of the effects of acupuncture on GABA, Glutamate & 5HTP to maximize acupuncture analgesia in neuropathy patients
• Utilize basic pharmacognosy to support and enhance the neurotransmitter effects of acupuncture
• Apply sensory stimulation techniques to promote Neurotrophic factors in nerve repair and regeneration
• Apply the basic science of acupuncture as a bridge to non-invasive neuromodulation in neuropathy patients

• Relate the effects of voltage gated sodium and calcium channels to the development of neuropathy
• Draw the pathways specific of TRPs, NaV 1.8 and CaV 3.2 ion channels in the nervous system
• Understand the application of selective NaV 1.8 and CaV 3.2 channel blockers in patients with neuropathy
• Discuss basic science research that links ion channels with the signs and symptoms of neuropathy
• Utilize the neurobiology of the Rubber Hand phenomena to treat patients with peripheral neuropathy.
• Discuss various ion channels and their roles in neuron hyper-excitability related to neuropathy
• Utilize natural substances that modulate ions channels related to neuropathy
• Differentiate the roles of Protein Kinase C and Aldose Reductase  in neuropathy
• Identify potential signaling pathways that are targets of neuromodulation through natural substances
• Prepare a comprehensive natural-substance management strategy for patients with neuropathy

• This contains all courses with the educational objectives listed from Neurology 117 through Neurology 121

• Discuss how insulin signaling abnormalities can directly and indirectly contribute to neuropathy
• Utilize natural substances that modulate insulin signaling pathways
• Differentiate the roles of Endocannabinoid receptors in pain processing versus recreation “High”
• Create a strategy to modulation Endocannabinoids receptors with legal natural substances for pain relief
• Understand the role of Nerve Growth Factors (NGF) in the development of symptoms of neuropathy and also the role of NGF promoting natural substances which may stimulate repair and regeneration.

• Utilize natural substances as neurotransmitter based treatments for neuropathy.
• Identify GABA modulating substances and their effects on GABA metabolism and GABA receptors
• Utilize natural substances that modulate Glutamate metabolism and receptors
• Differentiate the roles of GABA, Glutamate and Glycine receptors in pain processing
• Create a strategy to modulation neurotransmitter receptors using natural substances for pain relief

• Compared and contrast usual transcutaneous nerve stimulation techniques (TENs) with techniques of non-invasive neuromodulation using High Voltage Pulsed Galvanic stimulation
• Identify the anatomical location of electrode placement for central and peripheral non-invasive neuromodulation techniques
• Differentiate various forms of peripheral versus central non-invasive neuromodulation techniques
• Discuss the theory of application and be able to apply techniques of non-invasive neuromodulation in practice.
• Create a strategy for neuromodulation of the patient suffering from neuropathy
• Identify appropriate choices of non-invasive neuromodulation techniques for a patient suffering from neuropathy.
• Breakdown risk versus benefits of neuromodulation and be able to discuss them with the patient suffering from neuropathy
• Appraise a neuropathy patient and construct a comprehensive neuropathy treatment plan which includes non-invasive neuromodulation techniques
• Breakdown and discuss the investigational nature of non-invasive neuromodulation techniques and understand the importance of obtaining written informed consent before proceeding with non-invasive neuromodulation in neuropathy patients
• Comprehend the basic electronics of non-invasive neuromodulation techniques.

• Discuss stimulation parameters for using High Voltage Galvanic stimulation for neuromodulation
• Identify optimal ranges for pulse-width, milli-AMPs, phase and other parameters of electrical stimulation
• Differentiate and choose optimal types of electrical stimulation (TENS vs. HVG) for clinician applications
• Draw out the neuro-anatomical pathways of vagal nerve stimulation and use this information to guide appropriate use of vagal nerve stimulation in clinical practice
• Discuss the investigational nature of tVNS, potential risk-benefits, with patients and construct a treatment plan using tVNS with a properly informed and consenting patient.

• Understand the differences and similarities between TENs, low voltage and high voltage galvanic and be able to use this knowledge to select the most appropriate type to stimulation for use in ts-DC applications
• Apply precautions, other safety considerations and informed consent when administering high voltage galvanic stimulation for non-invasive spinal cord stimulation.
• Craft evidence-based treatment strategies using ts-DC stimulation for pain control and modulation of both ascending sensory and descending motor pathways based on recently published literature on central nervous systems effects of direct current stimulation.
• Be able to select optimal electrode placement for ts-DC based on clinical presentation of the patient
• Understand the basic technique for non-invasive Stellate Ganglion transcutaneous stimulation and its possible application for sympathetic maintained pain.

• 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.

• Communicate the risks, potential benefits and the investigational nature of tDC with a potential patient for the purpose of securing a written informed consent prior to treatment
• Understand the similarities and differences between low voltage direct current and high voltage pulsed galvanic and how to apply knowledge of their polarity specific effects in clinical neuromodulation
• Identify brain targets for neuromodulation and construct a therapeutic electrode montage, treatment protocol in terms of intensity, duration, frequency and dose of tDC 
• Explain the theory of tDC as it relates to pain modulation based on contemporaneous scientific literature
• Apply tDC  as an adjunct procedure to assist in intractable pain relief

• Compared and contrast galvanic vestibular stimulation and Tone Burst Vestibular Stimulation in the treatment of the balance impaired patient.
• Apply the polarity specific effects of the anode and cathode on the vestibular system for amelioration of common balance impairments.
• Identify the anatomical location of electrode placement for Galvanic Vestibular Stimulation.
• Create a treatment strategy using Tone Bursts based on physiological pairing of semicircular canals.
• Apply Specific Tone Protocols based on Saccule versus Utricle dysfunction in balance impaired patients.

• 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

• 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.

• Identify the domains of and concepts within motor control
• Outline some research on chiropractic's influence on motor control
• Discuss principles of motor control and rehabilitation applied to practice

• Describe the importance of the primitive reflexes
• Explain the role of fundamental patterns
• Summarize the generation of cortical release signs

• Diagram the muscle – brain interactions and the hypothalamus – hormonal feedback loop
• Define deaffrentation
• Explain spinal dyscoupling and its effect on the neuraxis

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

• Relate the effects of chemotherapy to the development of neuropathy.
• Draw the pathways specific to Lamina I versus Lamina V sensory pathways.
• Discuss basic science research that links Na, Ca and TRPA1 ion channels with hyper-excitability of sensory neurons.
• Apply Lo-TENs over acupuncture points known to down regulate TRPA1 and PKC for the treatment of neuropathy.
• Utilize natural substances that modulate ions channels related to neuropathy.

• Obtain the most appropriate diagnostic tests  for their patients suspected of suffering from small fiber neuropathy
• Implement the use of serum biomarkers for the management of small fiber neuropathy
• Utilize hair analysis for heavy metals, in cases of chemotherapy induced peripheral neuropathy
• Implement a nutritional detox strategy for the elimination of heavy metals in patients suffering from peripheral neuropathy
• Institute a nutritional strategy to elevate NAD+  or to down regulate NAMPT to protect axons from degeneration in cases of peripheral neuropathy.

• Discuss how small fiber nerve dysfunction may contribute  to painful conditions commonly seen in chiropractic practice.
• Apply the Thermal Grill to evoke Conditioned Pain Modulation and Offset Analgesia to relieve neuropathy pain.
• Utilize techniques to treat deafferentation pain.

• Draw the components of the Central Autonomic Network
• Relate the effects of brain lateralization and asymmetry to sympathetic-parasympathetic balance and tone.
• Apply the technique of High Voltage Galvanic stimulation to create a non-invasive Stellate Ganglion Block.
• Apply Lo-TENs to transcutaneously perform Vagal Nerve Stimulation.

• Formulate a viable alternative treatment for chemotherapy induced neuropathy.
• Offer guidance to patients on how they may prevent or reduce the severity of chemotherapy induced neuropathy.
• Utilize various forms of nervous system  stimulation as a substitute for  acupuncture.
• Apply techniques for determining where nerves are attempting to heal and formulate a treatment strategy designed to accelerate nerve repair.
• Choose the most beneficial type of stimulation and the optimal locations where stimulation should reduce  symptoms and promote nerve repair in chemotherapy induced neuropathy.

• Define physiological lesion & functional lesion
• Differentiate an anatomical pathology from physiological pathology
• Recognize the debate on it’s validity
• Apply the defined lesions to current known brain pathologies
• Illustrate the physiological lesion in known cord pathologies
• Demonstrate how the lesions can be measured
• Examine the applications to manipulative therapy
• Investigate clinical application
• Evaluate the validity of the theory to chiropractic applications.

• List common symptoms and physical examination findings that are seen with concussions and mild traumatic brain injuries.
• Recognize red flags and referrals needed in patients diagnosed with concussion.
• Implement tools like the CDC’s Acute Concussion Evaluation into the patient interview.
• Utilizef advanced imaging and diagnostic testing used for the diagnosis of concussion and pathologies that resemble concussion.
• Identify specific findings from the patient interview and examination that led to the diagnosis of other co-occurring pathologies

• Recall classifications of neurodevelopmental disorders.
• Itemize the four-step approach to management of ADHD.
• Administer sensorimotor integration techniques – Interactive Metronome.
• Assess balance and posture and implement rehabilitation.
• Observe eye movement abnormalities and implement therapeutic protocols.

• Identify the correlation of resistance exercise and lipoprotein Patterns
• Discuss the effect of boswelia on arthritis
• Review the effect of green tea on weight loss
• Establish the relationship of exercise and water replacement
• Identify the relationship of red wine and the cardiovascular system

• Distinguish how orange juice can improve blood lipid profiles
• Discuss dietary aspects for the vegetarian athlete
• Identify the relationship between bromelain and acute inflammation
• Develop the anti-septic activity of tea tree oil
• Describe Probiotics

• Review aspects of antioxidants and free radicals
• Discuss how silymarin can improve an alcohol-damaged liver
• Describe the connection/mechanism between atherosclerosis and vitamin E
• Identify research evidence between whole grains and disease
• Delineate the relationship of magnesium and hypertension

• Identify risk factors of cardiovascular disease
• Construct a list of appropriate food and food groups associated with cardiovascular disease prevention
• Evaluate various supplements that are beneficial in prevention and treatment of cardiovascular disease
• Differentiate various diets in regard to cardiovascular disease

• Discuss various diet and lifestyle factors involving hypertension
• Recognize the relationship between various minerals and hypertension
• Distinguish the nutritional aspects of various related cardiovascular conditions
• Identify the relationship between various herbs and peripheral vascular diseases

• Discuss the basics of herbal medicine
• Identify the conditions treated with herbs
• List the effects, indications and dosages for T Bilberry and Black Cohosh

• Identify the conditions treated with specific herbs
• List the effects, indications and dosages for Boswellia, Burdock Root, Bromelain, Calendula, Cascara sagrada, Cayenne, CBD (cannabis), Chamomile, Echinacea

• Discuss the mechanism and effects of Feverfew, Garlic, Ginger, Ginkgo Biloba, Ginseng, Goldenseal, Gugulipid, Gymnena Sylvestre, Horse Chestnut, Lemon Balm, Licorice, Milk Thistle, Nettle, Passionflower, Psyllium, Pygeum, Senna, Shiitake, St. Johns Wort, Saw Palmetto, Tea Tree Oil, Tumeric, Valerian Root, and White Willow

• Identify changes in vitamin needs and status that occurs with aging and in the elderly
• List changes in mineral needs and status that occurs with aging and in the elderly
• Demonstrate an understanding of protein, fiber and water needs of the elderly
• Identify important antioxidants in the elderly and the interactions that exist between them
• Create a list of nutritional deficiencies and how they can lead to disease and illness in the elderly

• Demonstrate an understanding of the role of calcium and other minerals in osteoporosis
• Design a treatment protocol for the osteoporotic patient
• Create nutritional guidelines for the pregnant female
• Identify changes in vitamin and mineral requirements in pregnancy
• Review the nutritional changes that occur with lactation

• Understand proper growth rates and weight gain in early childhood
• Identify specific minerals involved in childhood nutrition
• Explain the stages of obesity development in childhood
• Review the importance and problems associated with childhood obesity
• Evaluate the role of fiber in childhood

• Identify the link between obesity and disease
• Understand body composition and assessment methods
• Design a practical weight loss diet program
• Perform obesity related calculations quick and easily in the office
• Recognize the role of exercise and other lifestyle factors that can influence obesity.

• Identify the challenges inherent in the diagnosis and management of patients with complex and chronic multi-factorial problems
• Associate a multitude of common symptomatic complaints with foundational metabolic disorders such as elevated total toxic load and "leaky gut"
• Apply a systematic approach to functional laboratory diagnostics and associate the findings with the need for specific therapeutic strategies using nutrients, botanical medicines, and nutraceutical compounds
• Demonstrate an ability to institute life-style modifications, such as dietary changes, stress management techniques, and exercise in the management of patients with complex chronic illness
• Measure your ability to assess, diagnose, and treat patients with fatigue-related disorders, vague gastrointestinal complaints, cognitive dysfunction, thyroid-adrenal problems, food intolerance, and more

• Identify the challenges inherent in the diagnosis and management of patients with complex and chronic multi-factorial problems
• Associate findings such systemic skin problems with foundational metabolic disorders
• Apply a systematic approach to functional laboratory diagnostics and associate the findings with the need for specific therapeutic strategies
• Discuss the modification of your approach to case management based on outcome-assessment
• Assess, diagnose, and treat patients with serious food allergy and sensitivity, dermatologic disorders, immune dysfunction, and persistent serious hypertension

• Identify the sources of toxic exposure in modern industrial society, the prevalence of exposure, and the health ramifications of elevated total toxic body burden
• Associate a multitude of common symptomatic complaints (ie: fatigue, cognitive dysfunction, skin problems, global pain, etc.) with foundational metabolic disorders related to issues such as elevated total toxic load and "leaky gut"
• Discover the specific biochemical methodology utilized by human metabolism to render toxins harmless and excrete them from the body
• Explain the inherent complications within the normal detoxification process related to the formation of toxic intermediates and the increase in oxidative stress
• Explore the effect of elevated oxidative stress on mitochondrial function and cellular energy production

• Identify various pathologies associated with increased toxicity and total oxidative stress
• Outline specific strategies of patient assessment to determine toxic load and individual hepatic detoxification capacity
• Discriminate between the various pathways of hepatic detoxification biochemistry and objectively assess each pathway
• Explain the use of specific nutrients, nutraceutical compounds, botanical medicines, and foods to lower oxidative stress
• Explore the benefits and complications of adjunctive therapies in the management of patients with elevated toxic load and poor detoxification capacity

• Identify common drug and nutrient interactions
• Identify herbal interactions
• Identify nutrient and nutrient interactions
• Recognize different toxicity levels for various nutrients
• To formulate treatment recommendations based a patient's medication intake.

• Identify some of the functions of Co Q10
• Use Co Q10 for as appropriate as a supplement
• List the issues of performance changes with Co Q10
• Discuss the reasons for, and application of, Co Q10 for patients with Parkinson Disease and migraines

• Identify how free radicals are formed and what parts of the body are affected.
• Determine the relationship between antioxidants and cardiovascular disease and cancer
• Discuss the role that vitamins, amino acids and herbs have in pain control.
• Examine inflammation and the pro-inflammatory state.
• Construct an anti-inflammatory diet
• Determine which vitamins, minerals and herbs are useful as natural anti-inflammatories.
• Identify the role of Proteolytic enzymes and inflammation and review sources of fatty acids.

• Frame the problem and basic epidemiology of chronic G.I. disorders
• Present evidence of linkage between chronic G.I. disorders with other common medical conditions
• Discuss the current hypothesis of associations between intestinal hyperpermeability and systemic illnesses
• Review cutting edge assessment tools and tests for G.I. disorders
• Outline and suggest rational and efficacious cutting-edge non-drug treatment interventions for functional G.I. disorders.

• Understand how muscle contraction occurs
• Review practical muscle physiology
• Determine how the body responds to exercise
• Discuss the role of hormones in regards to muscle
• Identify the components of proper assessment for physical fitness
• Review the main components of a weight training exercise program
• Identify various exercise training methods
• Discuss the practical aspects of body composition
• Review basic nutrition and how it relates to sport and exercise
• Determine the energy needs and energy balance of the athlete

• Discuss the causes and genetics of Alzheimer's Disease
• Review the diagnosis of Alzheimer's Disease, including symptoms, incidence, course, and risk factors
• Understand conventional lab tests for Alzheimer's Disease
• Review the conventional treatment options for Alzheimer's disease, including drug therapies
• Understand new drug research and innovative drug strategies for Alzheimer's disease
• Utilize nutritional strategies for Alzheimer's disease, including vitamin, mineral and herbal therapies
• Discuss and define drug-vitamin-herb interactions for nutritional supplements recommended for Alzheimer's disease