New Hampshire Chiropractic Continuing Education

• Identify the layers of integument that you are piercing while doing acupuncture
• Compare and contrast the physiological consequences of superficial, medium and deep needling
• Differentiate which depth of needling is appropriate for the desired effect
• Describe the neurological pathways involved with acupuncture needling
• Explain the significance of needle retention time

Hour 1:

• Review and expand on, from a Western perspective, the neurophysiological basis of acupuncture
• Outline the pain pathway from the periphery to the central nervous system
• Review excitation/contraction coupling and muscle contraction theory
• Discuss the functions and distribution of alpha and gamma motor neurons

Hour 2:

• Explain and emphasize the functions of interneurons in the spinal cord
• Discuss muscle spindles and golgi tendon organs anatomy
• Explain the role of muscle spindles and golgi tendon organs in acupuncture
• Contrast slow versus fast stretch
• Introduce the concept of the “central integrated state” as it relates to acupuncture and acupuncture therapy
• Emphasize the relevance of cerebellar function to acupuncture as it relates to cerebellar output and modulation

• Acquaint the clinician with the physiological effects of acupuncture and needling
• Provide supportive literature for the physiological effects of acupuncture and needling
• Present the concept of central desensitization as it relates to acupuncture and needling
• Discuss how needling affects pain modulation, range of motion, muscle activation and the chemical environment surrounding trigger points

• Review the 2 major afferent pain pathways
• Discuss the local, segmental and cortical responses to pain and a painful stimulus
• Describe the major, descending inhibitory pathways for pain including the enkephalinergic, serotonergic and noradrenergic pathways
• Describe the cholinergic inhibitory pathway for pain
• Explain how acupuncture affect these pain pathways

• Discuss the layers of the skin as related to a practitioner’s perception during acupuncture
• Review the neurological pathways involved with acupuncture
• Summarize the local, segmental and cortical effects of acupuncture
• Contrast the physiological effects of depth of insertion and retention time of acupuncture

• Outline the basics of clean needle technique, including defining “clean field” and offering recommendations as it related to acupuncture
• Discuss the most common methods of sterilization
• Contrast sterilization vs disposable needles
• Present the most common complications of acupuncture
• Discuss contraindications to acupuncture
• Present the most common infectious agents as risk factors for acupuncture

• Develop diagnostic tools and complementary treatment approaches to common foot disorders
•  Outline a complete approach to treatment from assessment to acupuncture to patient advice
•  Discover major points and regions used most to achieve better treatment outcomes
•  Apply palpation and needling concepts to regions affecting/affected by foot disorders
•  Devise treatment plans specific to patient’s foot complaint

• Develop diagnostic tools and complementary treatment approaches to lateral ankle issues, inversion injuries and sinus tarsi syndrome
• Discover the association between lateral ankle injuries and sinus tarsi syndrome
• Outline a complete approach to treatment from assessment to acupuncture to patient advice
• Gain a better understanding of the distribution, pathology and function of the six leg muscle channels
• Devise a treatment plan specific to patient’s lateral ankle injury and sinus tarsi syndrome

• Develop diagnostic tools and complementary treatment approaches to Morton’s metatarsalgia, capsulitis and forefoot pain
• Outline a complete approach to treatment from assessment to acupuncture to patient advice
• Discover major foot points and regions used most to achieve better treatment outcomes
• Apply palpation and “grid” needling concepts to regions affecting/affected by Morton’s metatarsalgia, capsulitis and forefoot pain
• Devise treatment plans specific to patient’s forefoot complaint

• Develop diagnostic tools and complementary treatment approaches to Metatarsophalangeal joint pain, Turf toe and first Metatarsophalangeal (MTP) joint issues
• Outline a complete approach to treatment from assessment to acupuncture to patient advice
• Discover major foot points and regions used most to achieve better treatment outcomes
• Apply palpation and traction needling concepts to regions affecting the first metatarsophalangeal joint
• Devise treatment plans specific to patient’s first metatarsophalangeal joint complaint

• Develop diagnostic tools and complementary treatment approaches to heel pain, plantar fasciitis and plantar fascia disorders
• Outline a complete approach to treatment from assessment to acupuncture to patient advice
• Discover major points and regions used most to treat plantar fascia disorders
• Apply palpation and needling concepts to regions affecting/affected by heel pain, plantar fasciitis and plantar fasciopathy
• Devise treatment plans specific to the patient’s plantar fascia complaint

• Develop diagnostic tools and complementary treatment approaches to tarsal tunnel syndrome
• Outline a complete approach to treatment from assessment to acupuncture to patient advice
• Discover major points and regions used most to treat issues related to the tarsal tunnel of the foot
• Apply palpation and needling concepts to regions affecting/affected by tarsal tunnel syndrome
• Devise treatment plans specific to the patient’s medial foot/tarsal tunnel complaint

• Develop diagnostic tools and complementary treatment approaches to Achilles tendinopathy and related Achiiles tendon issues
• Outline a complete approach to treatment from assessment to acupuncture to patient advice
• Discover major points and regions used most to treat Achilles tendon issues
• Apply palpation and needling concepts to regions affecting/affected by Achilles tendinopathy
• Devise treatment plans specific to the patient’s Achilles tendon issue

• This contains all courses with the educational objectives listed from Acupuncture 400 through Acupuncture 461

• Explain Universal Precautions
• Prepare a Clean Field for administering acupuncture
• Secure, handle and dispose of Biohazard material, normally encountered in an acupuncture practice
• Recognize, avoid, and handle acupuncture side effects
• Explain the cautions and contraindications of acupuncture treatment

• Identify the various sizes of acupuncture needles
• Describe needle techniques to tonify and sedate acupuncture points
• Demonstrate the common needle insertion angles
• Compare and contrast the size of acupuncture needles with other common needles
• Infer safe and appropriate needle depths for many common acupuncture points

• Identify the various grades of moxa
• Describe various methods for applying indirect moxa
• Demonstrate safe procedures for administering indirect moxa
• Compare and contrast direct and indirect moxibustion
• Determine appropriate methods for administering moxibustion in specific clinical

• Identify conditions which are amenable to treatment with electro-acupuncture
• Distinguish between invasive and non-invasive electro-acupuncture devices and administrative practices.
• Demonstrate safe procedures for administering electro-acupuncture
• Compare and contrast milliamp stimulation with microamp stimulation
• Determine appropriate frequency and intensity settings for administering electro-acupuncture, based on clinical findings

• Identify conditions which are amenable to treatment with cupping and gua sha
• Identify various types of cups and gua sha instruments
• Demonstrate safe procedures for administering gua sha
• Describe post-treatment recommendations and procedures for gua sha & cupping
• Demonstrate safe procedures for administering cupping with both fire silicone cups

• Identify conditions which are amenable to treatment with Laser and TDP Lamp.
• Identify various types and wavelengths of lasers employed in acupuncture
• Demonstrate safe procedures for administering laser acupuncture
• Describe the physical mechanisms associated with photobiology
• Demonstrate safe procedures for administering TDP Lamp

• Define HIV
• Outline HIV epidemiology and symptoms
• Discuss the effects of HIV on health and wellness
• Review current facts about the HIV and AIDS epidemic both in the U.S. and worldwide

• Discuss strategies for preventing HIV in the health care workplace
• Outline universal precautions and additional precautions to prevent transmission of HIV by blood
• Apply what to do when there has been a possible exposure to HIV infection

• Define and discuss confidentiality laws covering the medical records of HIV/AIDS patients
• Define and discuss behavioral interventions for HIV/AIDS patients
• Outline the screening of HIV-infected persons for HIV transmission risk

Hour 1

• Indicate the immune system’s complexity as it fits into the body’s function
• Give examples of various Interleukins involved in the immunity
• List neurotransmitters, and vasoactive dilators
• Contrast TH1 and TH2 immune cells and apply a working knowledge of their clinical phenotype.

Hour 2

• Discuss signs and symptoms of anaphylaxis and current therapy.
• List the major immune cells responsible for allergic reactions
• Name the major receptor responsible for IgE sensitization, and what cells it is primarily found on.
• Summarize the meaning of WAO.
• List signs and symptoms of a typical allergic response after re-exposure to a sensitized allergen
• List different methods of allergy testing and critique their strengths and weaknesses.
• Give an example of a complicating factor that might skew an IgE(total) test result
• Apply the terms sensitivity and specificity in lab tests
• Categorize who is at risk of allergic sensitization.

Hour 3

• List 1-2 examples of research supporting IgE sensitization prevention.
• List 1-2 examples of factors which may increase risk of IgE sensitization.
• Explain the effect of smoking on IgE
• Have working knowledge of the effect of SO2 on health, and its primary source.
• Describe how and why it Ragweed is fast becoming worse of a problem throughout the US and worldwide.
• Indicate a potential sequela of Rhinoconjunctivitis and why it is meaningful to treat
• Identify and name a treatment backed by clinical evidence for Ragweed allergy and its meaning for natural therapy to be used by non-prescribing practitioners
• Describe a potential problem with medical Sublingual allergy therapy, and then defend it.
• Outline the major allergens in Ragweed.
• Give an example of co-sensitivity
• Define Pan allergen and give an example

Hour 1

• List the cells where histamine is predominantly found.
• Describe the role of the Mast Cell.
• Explain histamine’s function and recall what causes its release.
• List the Histamine receptor types and where each are each found.
• Summarize or give examples of symptoms in over activation of histamine receptors.
• Many of our patients are on OTC Antihistamine medications.  List their effects, positive and negative.

Hour 2

• Quote what OAS stands for.
• Define OAS and describe what happens to those with this problem.
• Recognize at what age(s) OAS occurs.
• Memorize, recognize and describe 1-5 OAS examples.
• Educate your patient on how to deal with OAS.
• Describe NFkB as a system
• Describe NFkB’s role in canonical and non-canonical pathways
• Explain what IκBα is and its potential role in downregulating inflammation

Hour 3

• Discuss how specific herbs, nutrients, and Vitamin E work to manage histamine at both a macro and microscopic level.
• Be able to describe allergic inflammation
• Discover how NSAIDs are being noted to reduce CNS diseases with inflammation and may help manage allergic disorder(s). 
• Identify what particular NSAID is naturally occurring and available to us and your patients to help them manage their allergic inflammation.  Calculate its clinical dose and avoid its lethal dose.
• List various SPMs (Specialized Proresolving Mediators)
• Describe how SPMs can control IgE production and play a potential role in the treatment of Alzheimer’s Disease.
• Relate histamine’s role in IBS (Irritable Bowel), name and synthesize the type of 2 known GI receptors involved.

• Identify the trigger points for the selected muscles of the neck
• Label the primary and secondary referral patterns for the trigger points of the neck
• Summarize the differential diagnoses associated with each trigger point of the neck
• Indicate the proximal and distal attachments of the selected muscles of the neck
• Describe the action of the selected muscles of the neck

• Identify the trigger points for the selected muscles of mastication
• Label the primary and secondary referral patterns for the trigger points of the muscles of mastication
• Summarize the differential diagnoses associated with each trigger point of the muscles of mastication
• Indicate the proximal and distal attachments of the selected muscles of mastication
• Describe the action of the selected muscles of mastication

• Identify the trigger points for the selected muscles connecting the shoulder to the torso
• Label the primary and secondary referral patterns for the identified trigger points
• Summarize the differential diagnoses associated with each trigger point
• Indicate the proximal and distal attachments of the selected muscles connecting the shoulder to the torso
• Describe the action of the selected muscles connecting the shoulder to the torso
• Recognize when muscles are acting agonistically and antagonistically

• Identify the trigger points for the selected muscles of the shoulder and arm
• Label the primary and secondary referral patterns for the identified trigger points
• Summarize the differential diagnoses associated with each trigger point in the shoulder and arm
• Indicate the proximal and distal attachments of the selected muscles of the shoulder and arm
• Describe the action of the selected muscles of the shoulder and arm
• Recognize when muscles are acting agonistically and antagonistically

• Identify the trigger points for the selected muscles of the Forearm and hand
• Label the primary and secondary referral patterns for the identified trigger points
• Summarize the differential diagnoses associated with each trigger point in the forearm and hand
• Indicate the proximal and distal attachments of the selected muscles of the forearm and hand
• Describe the action of the selected muscles of the forearm and hand
• Recognize when muscles are acting agonistically and antagonistically

• Identify the trigger points for the selected muscles of the abdominal wall and back
• Label the primary and secondary referral patterns for the identified trigger points
• Summarize the differential diagnoses associated with each trigger point in the trunk
• Indicate the proximal and distal attachments of the selected muscles of the abdominal wall and back
• Describe the action of the selected muscles of the trunk
• Recognize when muscles are acting agonistically and antagonistically

• Identify the trigger points for selected muscles in the posterior and medial compartment of the hip and thigh
• Label the primary and secondary referral patterns for the identified trigger points
• Summarize the differential diagnoses associated with each trigger point in the hip and thigh
• Indicate the proximal and distal attachments of the selected muscles in the posterior and medial compartment of the hip and thigh
• Describe the action of the selected muscles in the posterior and medial compartment of the hip and thigh
• Recognize when muscles are acting agonistically and antagonistically

• Identify the trigger points for the selected muscles of the leg
• Label the primary and secondary referral patterns for the identified trigger points
• Summarize the differential diagnoses associated with each trigger point in the leg
• Indicate the proximal and distal attachments of the selected muscles of the leg
• Describe the action of the selected muscles of the leg
• Recognize when muscles are acting agonistically and antagonistically

• Identify the trigger points for the selected muscles of the foot
• Label the primary and secondary referral patterns for the identified trigger points
• Summarize the differential diagnoses associated with each trigger point in the foot
• Indicate the proximal and distal attachments of the selected muscles of the foot
• Describe the action of the selected muscles of the foot
• Recognize when muscles are acting agonistically and antagonistically

Musculoskeletal

• Explain the causes behind Musculoskeletal Injuries
• Compare the minimum/maximum times during the Acute, Repair, and Remodeling Phase of Recovery
• Summarize protocols for acute inflammation
• Demonstrate a Kinetic Chain Assessment
• Explain why indirect cause of injury can be as disabling due to tissue overuse and overload
• Contrast and compare male vs female most common extremity injuries
• Contrast the differences between high school, collegiate, and professional athletic injuries
• Summarize how gold-standard management drives lower injury rates and duration
  

Nutrition

• Develop components of a typical healthy meal plan for athletes
• Differentiate between healthy and unhealthy food choices in each category of FAT, CHO, PRO
• Identify problem foods specific to the individual athlete
• Explain CHO loading and examples of high glycemic index foods
• Describe meal plan for post-exercise "window of recovery"
• Describe benefits and sources of branched chain amino acids for athletic recovery
• Explain purpose of omega 3 fatty acids during recovery phase of athletic activity
• Define components of female athlete triad
• List vitamins and minerals required to rebuild bone health in female athlete triad
• Name ergogenic nutrients acceptable to the World Anti-Doping Agency

Dehydration

• Explain difference between dehydration and hyponatremia
• Recognize early or acute signs and symptoms of dehydration and hyponatremia
• Discuss benefits of each method of determining hydration status
• Demonstrate treatment intervention for heat cramps
• Compare energy drink to sports drink

Concussion

• Define and recognize brain concussion, second impact syndrome, and chronic traumatic encephalopathy.
• Describe frequency of sports concussion and common duration of signs and symptoms.
• Describe all possible results of head trauma, including second impact syndrome, intracranial hematoma, skull fracture, brain contusion, cervical injury (both mild and dangerous)
• Differentiate and rule out dangerous results from head trauma.
• Demonstrate proper exam procedures following head trauma on field.
• Demonstrate proper exam procedures to clear the cervical spine on field.
• Perform the SCAT 3 exam and describe how it is to be used both on field and in the office.
• Describe how and why one performs serial exams after head trauma on field.
• Describe return to play protocols for concussed athletes.
• Describe prevention procedures for sports concussion.

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

• This contains all courses with the educational objectives listed from Biomechanics 201 through Biomechanics 216

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

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

• Describe and identify how the parts of a running shoe affect running biomechanics
• Compare and contrast different shoe constructions to the biomechanical needs of an individual
• Determine the appropriate last shape for different foot types
• Discuss the biomechanical consequences of improper vs. proper selection of last types
• Predict which features in a shoe are necessary to correct faulty gait patterns

• Explore barefoot running from a position of biomechanical efficiency
• Contrast the differences in shod vs unshod running
• Predict problems that can arise from shod and barefoot running
• Apply visual analysis skills to barefoot running technique
• Describe how to introduce barefoot running to your patient population

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

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

• Review the pertinent anatomy of the knee
• Review the kinematics and kinetics of knee function during the gait cycle
• View and discuss case studies involving knee function
• Predict pathomechanics that will arise from the gait abnormalities presented
• Propose remedies for the gait abnormalities seen

• Review the pertinent anatomy of the hip
• Review the kinematics and kinetics of hip function during the gait cycle
• View and discuss case studies involving hip function and common clinical scenarios
• Predict pathomechanics that will arise from the gait abnormalities presented
• Propose remedies for the gait abnormalities seen

• Review the walking gait cycle
• Review the running gait cycle
• Identify the key differences between walking and running gait
• Review the kinematics and kinetic differences between walking and running gait
• View case studies involving different walking and running gait styles
• Predict pathomechanics that may arise from gait abnormalities presented

• Review anatomical vs functional short leg
• Review the kinematics and kinetics of the short leg during the gait cycle
• View and discuss case studies looking at functional and anatomical short legs
• Predict pathomechanics that will arise from a short leg
• Propose remedies for the gait abnormalities seen

• This contains all courses with the educational objectives listed from Biomechanics 211 through Biomechanics 222

• Review fore foot to rearfoot relationships
• Review the different rear foot types
• Review the kinematics and kinetics of rear foot function during the gait cycle
• View and discuss case studies involving different rear foot types
• Predict pathomechanics that will arise from gait abnormalities presented
• Propose remedies for the gait abnormalities seen

• Breakdown the gait cycle into its component parts
• Recognize some less common gait abnormalities seen in gait analysis
• Assess actions of the lower kinetic chain during gait
• Predict pathomechanics that will arise from gait abnormalities presented

• Review how to determine foot type
• Describe and identify the five common foot types
• Explain how foot type effects gait biomechanics
• Compare and contrast different clinical examples of each foot type
• Discuss some treatments that can be utilized when a client presents with a particular foot type

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

• Review the pertinent anatomy of the foot
• Review the kinematics and kinetics of foot function during the gait cycle
• View and discuss case studies involving foot function and common pathomechanics
• Predict pathomechanics that will arise from the gait abnormalities presented
• Propose remedies for the gait abnormalities seen

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

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

• Define minimal vs. neutral vs. guidance vs. motion control shoes
• Contrast minimal vs. neutral vs. guidance vs. motion control shoes
• Discuss current shoe trends
• Discuss ramp delta and its implications in shoes and shoe fit

• Review the injuries associated with an improperly fitting bike frame and how to properly size a frame to a person
• Discuss how cleat position can lead to biomechanical problems and injuries related to power loss.
• Demonstrate how to properly place cleats on shoes to avoid injury and increase power transfer
• Discuss injuries that stem from inappropriate seat height, saddle for and aft position and handlebar reach and explain how to determine appropriate seat height, fore and aft saddle position and handlebar reach.

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

• Discuss the gait cycle and gait cycle biomechanics
• Discuss Tetrasomy 18 and Chronic Inflammatory Demyelinating Polyneuropathy etiologies
• Discuss Tetrasomy 18 and Chronic Inflammatory Demyelinating Polyneuropathy gait abnormalities
• Propose rehabilitation strategies for abnormalities commonly seen in many neurological disorders

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

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

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

• Discuss retraining CNS sensory and motor patterns
• Present several key concepts in visual gait analysis
• Introduce lesser known anatomical points of interest in the sacroiliac joint
• Discuss some rehabilitation strategies for the sacroiliac joint
• Discuss the ideal kinetics and kinematics of the walking gait cycle
• Present the normal lower extremity parameters/ontogeny surrounding the requisites for gait
• Explore the impact of lower extremity torsions on foot progression angle
• Highlight the differences between tibial and femoral leg length discrepancies
• View video examples of different aspects of gait
• Review the mechanics of the bridge exercise
• Discuss the current indexed literature surrounding the bridge exercise
• Describe potential pitfalls in performing and prescribing the bridge exercise
• Point out the differences of maintaining a "neutral spine" versus an increased or decreased lumbar lordosis
• Identify potential ways to correct faulty mechanics and optimize performance of the bridge exercise
• describe a new, novel test to diagnose gluteus medius tears
• explain the various functions of the gluteus maximus and medius
• explore the effects of a resistance band around the knees on the gluteus maximus, quadricep and valgus angles on the knees during a back barbell squat
• contrast gluteus medius resistance and rehabilitation exercises with respect to maximal recruitment
• discuss electromyographic activity in the gluteus medius, gluteus maximus, biceps femoris, vastus lateralis, vastus medialis and rectus femoris during the Monopodal Squat, Forward Lunge and Lateral Step-Up exercises

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

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

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

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

• Review ideal walking gait biomechanics
• Discuss the indexed literature surrounding movement patterns, gait remodeling and therapeutic uses of a split treadmill
• Rehab gait movement patterns
• Develop a deeper understanding of arm swing, leg swing, and interlimb timing and coordination.

• Identify ideal walking gait biomechanics
• Discuss the indexed literature surrounding movement patterns, gait impairments and compensations.
• Analyze arm swing, leg swing, and interlimb timing and coordination.
• Interpret local foot biomechanics and compensations.

• Review the gait cycle and gait cycle biomechanics
• View and discuss case studies of gait pathologies
• Assess actions of the lower kinetic chain during gait
• Predict pathomechanics that will arise from gait abnormalities presented
• Propose remedies and rehabilitation strategies for the gait abnormalities seen

Hour 1

• Identify some common gait abnormalities seen in gait analysis and develop mental strategies in evaluating the 3 cardinal planes of motion and potential failures in the loading of these planes.
• Categorize the Fast and Slow phases of an imbalance asymmetrical gait and define rehabilitation strategies to remedy the gait pathology.
• Develop a conceptual overview of how step length and stride length change in a limping gait.
• Breakdown portions of the gait cycle into its component parts, including compensation patterns
• Conceptualize the gait changes oriented around a hallux (great toe) amputation and learn to predict gait compensations off of a fixed anatomic anomaly.
• Describe arm swing and how it plays out in gait, particularly asymmetrical, and develop some treatment concepts in addressing this asymmetry.

Hour 2

• Discuss the critical function of the deep neck flexors and transverse abdominus, and how they related to gait, especially the running athlete.
• Identify the 3 compartments of the thoracolumbar fascia and translate them into gait concepts and treatment concepts.
• Develop treatment concepts in addressing this asymmetry and define in-phase and out-of-phase arm and leg swing assimilation
• Discuss on a surface level the concepts of speed in gait, and how to adjust the speed of one's gait to break down gait components that might lead to better treatment directions.
• Describe central pattern generators and relate to arm swing on a neurologic level.
• Recognize some common gait abnormalities seen in gait analysis such as arm swing, step length, the cross over gait, and develop mental strategies in evaluating the 3 cardinal planes of motion and potential failures in the loading of these planes when it comes to these gait parameters.

• Present the etiology of blister and callus formation
• Review the gait cycle and the biomechanical events relevant to callus formation
• Review pronation and supination motions of the foot and how they relate to low and high gear push off
• Review the 3 rockers and how they can relate to callus formation
• Discuss the more common callus patterns in feet
• Describe the foot pathomechanics that lead to callus formation

• Discuss the concept of Gender as it relates to society, language and culture
• Identify Gender roles in Western Society
• Recognize innate gender traits in males and females
• Summarize socially imposed gender traits

• This includes all courses with the educational objectives listed from Boundary Training 101 through Boundary Training 112

• Identify aspects of male and female psychological development
• Relate basic concepts of Gender and Power
• List female and male leadership factors
• Discuss gender and the Doctor/Patient relationship
• Identify the ways which gender affects the Doctor/Patient relationship

• Describe what accounts for the differences, in practice style and patient care, between males and females healthcare providers
• Define differing sexualities in western culture
• Review sexuality as it relates to the Doctor/Patient relationship
• Identify misconceptions in personal definitions of male, female, power and sexuality
• Recognize when Power is misused and becomes a threat

• Define Touch as it relates to perception, gender and culture
• Discuss the giving up of power as it relates to patients and touch
• Recognize the perception, intention, and uses of touch
• Perform an analysis of individual conceptions of gender and sexuality

• Perform an exercise to identify personal concepts of touch
• Create practical applications for healthcare practitioners with regard to gender, touch, and sexuality
• Define sexual misconduct
• Recognize the difference between sexual misconduct and sexual harassment
• Critique different models of misconduct

• Describe how misconduct occurs
• Distinguish between different types of offenders
• Give examples of case studies in sexual misconduct
• Identify common fears and misconceptions of sexual misconduct
• Specify important concepts of treated a patient who has a history of abuse

• Define professional boundaries and relate the issue of consent
• Describe the three types of power, the three patterns of power, and how power is used
• Discuss the differences between adherence vs. compliance and transference vs. countertransference
• Identify anatomical risk levels for touch

• Develop safe touch guidelines
• Create a set of office based interventions and patient based interventions in the development of safe practice strategies
• Define educational interventions for safe practice strategies
• Define the basics of the supervision for a safe practice strategy

• Develop and outline for safe practice analysis
• Perform a risk factor analysis
• Execute a healthcare provider questionnaire
• Create a staff evaluation to implement at the office

• Develop and implement a buddy/supervisor evaluation of the healthcare provider and staff
• Develop and implement a patient evaluation of the healthcare provider and staff
• Create a system of analysis for the buddy/supervisor, healthcare provider, staff and patient evaluations

• Develop a plan for change based on the risk factor analysis (RFA) and practice evaluation questionnaires
• Identify areas of improvement for touch, consent, communication and respect
• Address concerns raised by staff and patients
• Discuss ways to defuse attraction

• Develop guidelines of dealing with a patient who is attracted to you
• Develop guidelines of dealing with feeling an attraction
• Discuss the six factors for a safe practice
• Describe the new partnership between healthcare providers and patients

• Identify the purpose of professional boundaries
• Differentiate between boundary violations and boundary crossings
• Identify the various factors related to dual relationships
• Identify issues related to bartering, gifts and boundaries

• Recognize the challenges of social networking and boundaries
• Evaluate issues specific to boundaries
• Clarify guidelines for maintaining professional boundaries
• Reflect on the maintenance of professional boundaries

• 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.

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

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

• Discuss the place cannabis products have in healthcare.
• Recall the historic relevance cannabidiol (CBD) has in patient care.
• Analyze which manual therapeutic modalities best compliment CBD usage and apply it to their practice.
• Discuss federal and state laws that apply to CBD use within their practice.
• Assess and differentiate between different CBD products to find that best suits their personal/ professional use.

• Outline the most commonly encountered neurological complaints of pregnancy that a D.C. might encounter in practice
• Differentiate between similar complaints to establish best course of care
• Modify normal practices, techniques and methods to accommodate for the biomechanical changes of the pregnancy patient
• Integrate other palliative therapies to relieve these complaints
• Analyze and adjust according to the complaint and concomitant exam findings

• This contains all courses with the educational objectives listed from Chiropractic and Pregnancy 201 through Chiropractic and Pregnancy 207

• Outline eight commonly encountered complaints of pregnancy that a DC might encounter in practice
• Differentiate between similar complaints to establish best course of care
• Understand the various causes of each complaint and how to address these causes
• Integrate other palliative therapies to relieve these complaints
• Analyze and adjust according to the complaint and concomitant exam findings

• Outline the most common herbal and homeopathic remedies that may be useful to a DC who cares for pregnant patients
• Differentiate between helpful remedies and those contraindicated for use during pregnancy
• How and when to successfully integrate these palliative therapies to relieve common complaints of pregnancy
• Recognize the basics of homeopathy, why and how it works, how to administer remedies and proper use and storage of remedies
• Generalize the use and need for these remedies to accommodate the special needs and concerns of the pregnancy patient

• Outline necessary dietary requirements for the mother to be
• Differentiate between safe and unsafe exercises that can be recommended to the expectant mother
• Give examples of safe exercise practices to the pregnant patient
• Identify the normal and customary weight gain during a healthy pregnancy
• Offer dietary recommendations and healthy food choices to the pregnant patient

• Identify the most common birth trauma(s) to a newborn
• Assess the biomechanics of the pregnant pelvis
• Recognize how certain maternal pelvic misalignments can lead to increased incidence of various birth traumas
• Modify adjustive techniques and methods to better care for the pregnant patient
• Reduce the prevalence of certain birth traumas due to distortions and misalignments in the maternal pelvis

• Identify the most common medical tests and procedures performed on pregnant and laboring women
• Recognize the risks of these tests and procedures
• Assess the benefits of these tests and procedures
• Effectively explain these risks and benefits to the pregnant patient
• Assist in the preparation of a well thought out and defined birth plan for the pregnant patient

• Outline commonly encountered misalignment and/or subluxation patterns that present with a breech presentation
• Outline commonly encountered misalignment and/or subluxation patterns that present with various common complaints of pregnancy
• Identify the various causes of a breech presentation and how to address these causes
• Integrate or eliminate other palliative therapies to aid in the reversal of a breech presentation and common complaints of pregnancy
• Analyze and adjust according to the patient history and concomitant exam findings

• Outline commonly encountered misalignment and/or subluxation patterns that present with a breech presentation
• Outline commonly encountered misalignment and/or subluxation patterns that present with various common complaints of pregnancy
• Outline commonly encountered misalignment and/or subluxation patterns that present with a twin breech presentation
• Integrate or eliminate other palliative therapies to aid in the reversal of a breech presentation and common complaints of pregnancy
• Analyze and adjust according to the patient history and concomitant exam findings

• This contains all courses with the educational objectives listed from Chiropractic and Pregnancy 208 through Chiropractic and Pregnancy 212

• Outline commonly encountered misalignment and/or subluxation patterns that present with a breech presentation
• Identify the correlation between a misaligned pubic bone and an occiput posterior presentation
• Draw a parallel between a superior pubic bone misalignment and round ligament pain
• Develop a pregnancy care plan based on exam findings and presenting complaints

• Outline commonly encountered postpartum complaints that a chiropractor might encounter in practice
• Understand the various chiropractic causes of each complaint and how to address these causes.
• Integrate other palliative therapies to relieve these complaints if applicable
• Analyze and adjust according to the complaint and concomitant exam findings
• Modify adjustive techniques and methods to better care for the postpartum patient

• Discuss the role of chiropractic manipulation and the evidence surrounding reduced back pain in pregnant women.
• Discuss the role of chiropractic manipulation and the evidence surrounding musculoskeletal conditions related to pregnancy
• Describe the somatovisceral reflex
• Review options for conservative pain management for musculoskeletal conditions related to pregnancy
• Interpret evidence-based data for safety of spinal manipulation of pregnant women.
• Describe presentation of musculoskeletal conditions seen in postpartum patients
• Perform evaluation of musculoskeletal conditions seen in postpartum patients
• Discuss treatment options for musculoskeletal conditions seen in postpartum patients
• Formulate a nutritional plan for women

• Evaluate the evidence for chiropractic care for pregnancy-related low back pain and pelvic girdle pain
• Assess the effectiveness of treatments within the chiropractic scope of practice for low back pain, pelvic girdle pain, or combination pain during the postpartum period
• Summarize best-practice recommendations for chiropractic care of pregnant and postpartum patients

• Summarize the three stages of pregnancy.
• Recognize common pregnancy abbreviations.
• List the benefits of exercise during pregnancy.
• Explain how the hormones, relaxin and hCG, can impact physical activity.
• Design a subjective and history taking examination for a pregnant patient.
• Complete a physical examination on a pregnant patient including common complaints such as pelvic girdle pain and low back pain.
• Assess patient positions to ensure comfort and safety during physical assessments and/or rehabilitation.
• Recognize when to refer a pregnant patient to another specialty for evaluation and treatment.
• Identify pelvic health dysfunction and determine appropriate referral.

• Evaluation of post-partum patients
• Common complaints and assessment – LBP/SI, pelvic floor dysfunction, DRA
• Impact of birth type/healing time frame
• Biomechanics of lifting and carrying baby
• Sleep, activity, and nutritional considerations

• Utilize the Official Disability Guidelines for Low Back Pain.
• Apply the Official Disability Guidelines for the chiropractic treatment of low back pain.
• Use the CCGPP Guidelines for the treatment of low back pain.
• Integrate Outcome Assessments for clinical justification of chiropractic treatment low back pain.

• Utilize the Official Disability Guidelines for Neck Pain.
• Apply the Official Disability Guidelines for the chiropractic treatment of neck and upper back pain.
• Use the CCGPP Guidelines for the treatment of neck and upper back pain.
• Integrate Outcome Assessments for clinical justification of chiropractic treatment for neck and upper back pain.

• Utilize self-auditing methods to identify high risk areas of patient finance in the office
• Develop systems for accountability and transparency in patient accounting
• Apply appropriate fee schedule measures to ensure validity in account posting
• Address federal and state guidelines for discounting to ensure compliance

• Apply the process for setting your fees legally and compliantly and according to Federal regulation
• Know the policies of ALL your carriers to be compliant
• Properly administer desired discounts without running afoul of the Federal and State regulations
• Implement legal hardship discounts, if desired, using the Federal guidelines to appropriately verify hardship

• Distinguish between the five most important federal fraud and abuse laws that apply to physicians
• Identify red flags in your practice that increase vulnerability
• Comprehend what has been discovered in previous OIG workplans and how to apply the findings to your practice
• Determine what entities require a formal compliance program for your office
• Develop an action list to start today for implement a Compliance Program for your clinic

• Identify regulatory authorities that impact compliance
• Review federal, state and payer’s compliance related requirements and regulations
• Recognize types of self-audits that can keep your compliance program healthy
• Update important annual requirements related to carrier contractual agreements
• Execute appropriate EOB, coding, documentation, and billing audits for year end

Hour 1

• Discuss the Inflammatory Cascade
• Identify the mechanics of concussion that results in inflammation
• Describe the neuro-chemical cascade of concussion

Hour 2

• Perform physical exam protocols in inflammation as it relates to concussion
• Perform Neurological exam protocols in inflammation as it relates to concussion
• Perform Chiropractic exam protocols including incorporating AK exam
• Apply Chiropractic exam protocols in inflammation
• Utilize advanced examination protocols in inflammation

Hour 3

• Perform structural treatment protocols to treat inflammation related to concussion
• Utilize phytonutrient protocols to treat inflammation related to concussion
• Use specific therapeutic protocols to resolve inflammation with literature citations

• This contains all courses with the educational objectives listed from Concussion 201 through 202

Hour 1

• Discuss the Selye Stress Response
• Discuss the mechanics of concussion that results in the inflammatory response
• Describe the cortisol cascade response associated with concussion

Hour 2

• Perform physical exam protocols in the stress response
• Perform Neurological exam protocols in the cortisol cascade
• Apply Chiropractic exam protocols in the cortisol cascade
• Utilize advanced examination protocols in evaluating the stress response

Hour 3

• Perform chiropractic treatment protocols to treat the stress response
• Utilize nutritional protocols to treat inflammation related to the stress response and concussion
• Use evidenced based therapeutic protocols to address the cortisol cascade associated with concussion with literature citations

Hour 1

• Recognize signs and symptoms of concussion and make appropriate referral.
• Realize the pathophysiology of symptoms related to concussions. 
• Identify red flags and potential dangers of manipulation.
• Realize concussion diagnostic testing efficacy.

 Hour 2

• Define binaural beats history and development.
• Explore binaural beat frequencies.
• Describe binaural beats impact
• Distinguish binaural beats for sleep, vertigo, pain and  memory.
• Integrate binaural beats protocols

 Hour 3

• Combine binaural beat frequencies to enhance therapy results.
• Monitor results of binaural beat therapy.
• Review current research studies on binaural beats.
• Discuss future utilization and research of binaural beats.

• Identify the need for cultural competence in health care and in medical literature.
• Examine and Research the historical perspectives
• Examine your world view or cultural beliefs about diversity and explain how you can develop an attitude of cultural competence.
• Analyze the five aspects of ethnicity used to describe cultural differences in the health care environment. 

• Review and explain the racial and ethnic disparities in health care.
• Explain the role of health care providers and organizations as mechanisms to reduce racial and ethnic disparities in health care. 
• Explain how language and communication of the health care provider can be a barrier to establishing relationships.
• Identify tools that can foster empathy for differing cultures.

• Explain the need for improving cultural awareness in the workplace to build cultural competency.
• Identify five practices that can be implemented to increase cultural awareness in the workplace.
• List the benefits of building an organization's cultural competence
• Explain how to deliver culturally competent care.

• Demonstrate The ability to communicate clearly and concisely with current and future patients 
• Describe ways to establish and maintain relationships and facilitate constructive interactions with individuals and diverse groups.
• List strategies to align personal and organizational conduct with ethical and professional standards that include a responsibility to the patient and health care community. 
• Demonstrate an understanding of the healthcare system and the environment in which healthcare managers and providers function.

• 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

Hour 1 - 5

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

Hour 6

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

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

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

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

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

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

• 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.
• Distinguish between active and maintenance care.
• Employ proper procedure to administrate both active and maintenance types of care.
• Complete and document required elements of documentation of active treatment.
• Apply the Medicare standard of financial transactions with patients in order to stay within the Federal collection guideline.

• 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'

• Identify the expected standards of a compliant and complete patient record
• Audit documentation to ensure the most important details are present
• Demonstrate how to conduct a complete baseline audit of record documentation

• 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