New York Naturopathic Physician Continuing Education

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

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

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

Hour 1:

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

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

Hour 3:

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

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

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

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

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

Hour 1

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

 Hour 2

• Produce a specific conservative treatment plan
• Measure the patient’s response to care.
• Neurological differential diagnosis via pain patterns
• Choosing the most appropriate type of manual therapy
• Provide Appropriate Documentation

• Compare the difference between angular and linear motion.
• List the limiting factors necessary for stability in respect to linear motion.
• List and describe the function of the limiting structures of the atlantooccipital joint and the atlantoaxial joint.
• Describe the path of the vertebral artery from the subclavian artery to the basilar artery
• List the three types of Atlantooccipital fractures.
• Describe five diseases that may compromise the stability of the cervical region and how.
• List and elaborate on the immune specific diseases that can affect the atlantoaxial joint.
• Summarize the normal growth of the cervical spine and craniovertebral region in children.
• Outline the details of IFOMPT Framework for Red Flags.
• Demonstrate three stability tests of the cervical region and interpret the results.
• Demonstrate a neurological scan to clear spinal cord and neurological dysfunction in the cervical spine.
• Apply a vigorous mandatory scan for all patients to rule out serious pathology of the cervical spine and the neurological system and be able to interpret the results.

• Recognize the importance of knowing and diagnosing a tremor.
• Define what is a tremor List some of the general symptoms of a tremor.
• Discuss the triggers that may exacerbate a tremor.
• Name the main categories of a tremor.
• Recall the subclasses of action tremor List the most common diseases and syndromes demonstrating each type of tremor.
• Differentiate the symptoms of Essential tremors (ET) and debate the current gold standard treatment plan of action.

• Recognize the signs and symptoms of a knee disorder.
• List differential diagnosis of knee disorders.
• Outline the different elements of a knee exam.
• Identify “red flags” during the evaluation of knee complaints.
• Summarize additional knee tests that can be performed and the reasons why to use them.

• Identify the 4 muscles that are associated with the Rotator Cuff.  
• Recall the major epidemiological variables associated with Rotator Cuff Tears.
• Differentiate the 2 major etiological factors associated with Rotator Cuff Tears.
• Recognize the symptoms and signs associated with Rotator Cuff Tears.
• Determine conservative treatment approaches in the acute and/or sub-acute phase of Rotator Cuff Tears.
• Select appropriate ancillary studies that may be necessitated upon failed conservative treatment of presented upper extremity conditions.

• Recognize and apply the diagnostic criteria for hypermobility spectrum disorders (HSD) including hypermobile Ehlers-Danlos Syndrome (hEDS).
• Outline the importance of blood pressure screening and review evidence-based recommendations for clinical practice.
• Appraise the evidence regarding nonpharmacological approaches used in the management of restless legs syndrome (RLS).
• Summarize a contemporary clinical framework for identifying red flags for four serious spinal pathologies that may present in chiropractic practice.
• Describe our contemporary understanding of the appropriate diagnosis and management of cervical spondylotic myelopathy (CSM).

• Investigate the effect of patient expectations on short-term, subjective improvement in recurrent or persistent low back pain patients.
• Determine whether the ritual of the history and physical examination results in meaningful change in pain and function for low back pain patients before any treatment is provided.
• Assess the potential negative effect of routine MRI reports on the perception of the patient and treatment outcomes and explore a method for improvement.
• Explore the level of association between kinesiophobia and pain, disability, and quality of life as well as its role as a prognostic factor in people with chronic musculoskeletal pain.
• Quantify the role of contextual effects in the nonpharmacologic treatment of knee osteoarthritis.

• Outline the congruence of the manual interventions used in clinical practice with the scientific evidence regarding the biomechanical aspects of degenerative disc disease (DDD) leading to pain.
• Compare the efficacy and cost-effectiveness of a stratified care model versus usual care for patients with sciatica.
• Assess the value of intervertebral disc degeneration detected in early adulthood as a predictor for progression of degenerative changes as well as low back pain symptoms and disability in middle age.
• Define deep gluteal syndrome and the deep gluteal space, as well as propose a general diagnostic pathway for this condition.
• Breakdown the utilization of conservative treatments used in lumbar disc herniation patients successfully treated nonoperatively versus unsuccessfully treated nonoperatively.

• Defend a contemporary view of the implications of the biology of pain and injury for sensorimotor function
• Outline neuroplastic structural and functional changes as they relate to non-specific (mechanical) low back pain and sensorimotor function
• Appraise the current state of the literature regarding the changes in motor control in those with low back pain
• Assess whether low back pain patients display signs of muscular guarding or splinting
• Summarize existing observational evidence regarding the association between primary or chronic headache and persistent low back pain

Hour 1 

• Document the patients history to include an accurate list of all herbal/dietary supplements and other medicinals they are taking and refer to their MD if there are any concerns that it will affect Chiropractic Care being considered
• Explain the concept of the use of simultaneous interventions to treat a single condition as it is relative to the patient history.

 Hour 2

• Discuss potential side effects of herbal/dietary supplement as components of history taking & physical exam procedures.
• Refer to Medical Doctor if you feel any signs or symptoms are related to any side effects of anything the patient is taking
• Give examples of how herbal/dietary supplement use may impact the history taking, physical exam procedures, and treatment plan.

Hour 3

• Describe pertinent patient medical history and physical examination procedures included in a comprehensive evaluation for conditions that may have been previously treated with surgical interventions
• Connect patient medical history and physical examination with evidence-based intervention/treatment plan of care to achieve best patient outcomes

Hour 4

• Identify evidence-based rehabilitation principles for patients whose history may include prior surgical intervention.
• Explain specific rehabilitation programs for each case based on documented evaluation findings

Hour 1

• Describe behavioral model for insomnia
• Explain why sleep quality is important
• Discuss sleep interventions as prevention for chronic musculoskeletal pain
• Discuss sleep interventions for chronic musculoskeletal pain

 Hour 2

• Ask the correct questions to assess sleep and sleep behaviors
• Identify factors to maladaptive sleep habits
• Discuss sleep efficiency and tracking progress
• Explain why rest in bed is not optimal
• Refer patients to appropriate healthcare providers for sleep dysfunction

• Increase awareness and recognition of statin intolerance in musculoskeletal patients.
• Learn the risk factors associated with Statin Associated Muscle Symptoms (SAMS).
• Identify the signs and symptoms of myositis/myopathy.
• Discuss the physiological process involved with SAMS and tests to confirm.

• Investigate the diagnostic accuracy of information from the patient history associated with hip-related pain 
• Characterize the association between manual therapy dosing and treatment outcomes for patients with hip osteoarthritis
• Summarize the literature regarding the diagnosis and non-operative treatment of femoroacetabular impingement (FAI) syndrome 
• Determine whether the addition of hip treatment and rehabilitation improves outcomes in patients with low back pain
• Quantify the prevalence of hip girdle weakness and tenderness in people with chronic non-specific low back pain

• List the major divisions and subcomponents of the neurological examination. 
• List, contrast and compare the neurological signs associated with “release phenomenon” and “deficit phenomena”.
• Contrast and compare the effects of neurological lesions on the neurological examination of the central nervous system versus the peripheral nervous system.
• Recite the implications of neurological examination findings on disorders involving various components of the central and peripheral nervous system.
• Draw the anatomy of the lower motor neuron in its relation to the spinal cord, nerve root, spinal nerve, and the neuro-myal junction.
• Describe the physical positioning of the patient during aspects of the neurological examination.
• List the subjects to question when in taking a good patient history.
• Describe and perform aspects of the neurological examination of the Cranial Nerves of the patient.
• Draw the neurologic pathways associated with the eye light reflexes.  Include reference to cells of the retina, the optic nerve, the optic chiasm, the optic tract, the Pretectal nucleus, and the Edinger Westphal nucleus.
• Describe and perform aspects of the neurological examination of the Motor Systems of the patient.
• Describe and perform aspects of the neurological examination of the Sensory Systems of the patient.
• Recite findings related to neurological “drift” performed during the neurological examination.
• Describe and perform aspects of the neurological examination of the Reflex Systems of the patient.
• Illustrate components of the muscle stretch reflex including the role of the Alpha motor neuron, Gama motor neuron, and large sensory fibers in relation to the muscle fibers and spinal cord.
• Discuss the common shorthand used for grading muscle stretch reflex responses and discuss the results of the neurological examination associated with each grade.
• Perform and discuss three versions of the extensor plantar response (extensor toe sign, Babinski sign).
• Describe and perform aspects of the neurological examination of movement of the patient.

• Discuss the use of electrotherapy to control pain
• Establish parameters for wobble board rehabilitation of the ankle
• Describe how SI manipulation affects anterior knee pain
• Discuss the use of post-fracture manipulation
• Construct therapeutic exercises for patients with lumbar spinal stenosis

• Describe ideal pad placement for interferential therapy
• Discuss increasing muscle strength in the elderly
• Construct screening procedures and treatment for the TMJ
• Relate the evaluation and treatment of whiplash
• Review rehabilitation of ankle injuries

• Explain that the key to increased utilization of ultrasound lies in chiropractic providers knowledge and training
• Recognize the ultrasound procedure, its benefits, effects, proper application, and potential outcomes
• Point out precautions and contraindications affiliated with ultrasound
• Internalize a level of knowledge and comprehension of diathermal principles
• Develop skill sets when rendering ultrasound (continuous or pulsed) therapy

• Discuss the unique properties of lasers and their clinical applications
• Identify indications and contraindications to cold laser therapy
• List parameters and protocols of cold laser therapy
• Evaluate the current body of low level laser therapy clinical research
• Explain the advantages and disadvantages of using cold laser therapy

Hour 1

• Discuss the history of elastic taping.
• Define the anatomy of fascial layers in the human body, and how the mechanotransduction concept relates to the use of elastic taping.
• Recognize the most common indications and contraindications for the use of elastic tape within the manual therapist’s practice.
• Describe the application process of elastic taping .

Hour 2

• Discuss the evidence providing support of the use of elastic taping
• Outline various conservative management options for taping musculoskeletal problems
• Construct a treatment plan for a typical patient with acute traumatic swelling
• Apply specific taping techniques for certain biomechanical dysfunctions

Hour 3

• Describe and demonstrate the application of elastic taping procedures for carpal tunnel syndrome
• Describe and demonstrate the application of elastic taping procedures for biomechanical low back pain
• Describe and demonstrate the application of elastic taping procedures for shoulder stabilization
• Describe and demonstrate the application of elastic taping procedures for knee osteoarthritis

• Examine the relationship between hip flexibility and patellofemoral pain
• Summarize the evidence pertaining to the efficacy of manual and physical therapies for the management of Patellofemoral Pain Syndrome
• Outline the possibility of a continuum existing between patellofemoral pain and patellofemoral osteoarthritis
• Discuss the evidence regarding prevalence, diagnosis and management of patellar tendinopathy
• Review the most common clinical tests used to determine balance in those with knee OA a clinical setting

• Outline the innovation of the therapy
• Summarize the Physics behind the modality
• Describe the interaction of LLLT with live tissue
• Detect the contraindications & precautions
• Assess the different LLLT devices.
• Comprehend the different types of LLLT available
• Optimize the LLLT parameters for improved outcomes
• Apply LLLT in a manner that optimizes your treatment
• Explain the physiological effects to your patients
• Examine the current clinical evidence

• Appraise the combination of pain neuroscience education and exercise or motor control training to alter ‘pain memories’ associated with chronic pain
• Assess the relationship between vibration training and muscle strength and bone mineral density in older adults
• Measure the effects of whole-body vibration (WBV) training on balance and strength in elderly patients suffering from diabetic neuropathy who are at high risk of falls
• Examine the effectiveness of unimodal and multimodal physical therapies for base of thumb osteoarthritis
• Explore the evidence on the effects of manual therapy for the treatment of plantar heel pain