The limitations of single journal reading.
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Chiropractic↗
Biomedical subjects
S Haldeman
Publications and source records attributed to S Haldeman.
North American Spine Society: failure of the pathology model to predict back pain.
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Aging↗
Back impairment and disability determination. Another attempt at objective, reliable rating.
Present disability evaluation schedules for the low back are not scientifically based and produce very great interexaminer differences. The authors have developed a new impairment schedule based on a comprehensive review of the medical literature and the collected opinions of a large number of back specialists. Tests of the new schedule show a marked decrease in interexaminer differences compared to the prior California disability rating schedule. The impairment schedule can be readily adapted to any legal system of disability rating and can be modified easily to reflect new medical knowledge. The result should be a disability rating which is more objective, more scientifically valid, and more consistent, reducing litigation, with fairness to both the low-back impaired worker and the employer.
Disability Evaluation↗
Computed tomography, electrodiagnostic and clinical findings in chronic workers' compensation patients with back and leg pain.
One hundred patients with complaints of low-back pain and leg pain, consistent with a diagnosis of sciatica, were evaluated. All patients had complaints for longer than 6 months and had recently undergone electrodiagnostic testing and computed tomography (CT). Correlation was made between symptoms, straight leg raising, clinical neurological deficits, electrodiagnostic and CT findings. The radiation of pain above or below the knee and pain on straight leg raising did not show a high correlation with each other or with neurological deficits or CT findings. Electrodiagnostic studies often defined a radiculopathy in patients with equivocal clinical signs. CT findings did not predict the nature of symptoms or clinical and electrodiagnostic findings. Electrodiagnostic abnormalities showed the greatest ability to predict CT abnormalities. It is concluded that in chronic sciatica patients, no single diagnostic parameter is conclusive and a combination of clinical and laboratory findings is necessary to reach a diagnosis. In addition, many assumptions, valid in patients with acute pain cannot be extrapolated to patients with chronic sciatica.
Back Pain↗
A prospective study of 2,000 patients attending a chiropractic college teaching clinic.
A prospective study was undertaken to characterize 2,000 patients attending a chiropractic teaching clinic and the effectiveness of the care they received. Fifty-two percent of the patients were between 21 and 34 years old; 41% categorized their occupation as professional and 14% as skilled blue collar; 79% presented with musculoskeletal complaints; 44% had low back pain; 41% had complaints less than 1 month; 83% had no work time loss. Eighty-one percent of musculoskeletal diagnoses were reported as strain, with less than 1% intervertebral disc syndrome. The primary treatment approach was manipulation in 90% of cases. As a group, both patients and interns had similar expectations about the likelihood of improvement following treatment and similar assessments of the degree of improvement actually attained. Eighty-two percent of patients improved during their course of treatment. An average 4.4 patient visits were encountered per episode of care, with an average total charge of $66.00.
Adolescent↗
The neurovisceral and electrodiagnostic evaluation of patients with thoracic spinal cord injury.
We studied nine patients with complete thoracic spinal cord injury in order to investigate distal electrophysiologic and end organ function. Studies included motor and sensory nerve conduction velocities, spinal and cortical somatosensory evoked responses, bulbocavernosus reflex responses, cystometry and colonic compliance, motor and myoelectrical activity. These studies confirmed an intact peripheral nervous system, as well as normal nerve root, cauda equina, conus medullaris and distal spinal cord function. Cystometry demonstrated decreased bladder capacity and inability to suppress detrusor contractions. Colonic compliance was greatly reduced, compared to control subjects. While basal colonic motor and myoelectrical activity was normal, these spinal cord injury patients failed to demonstrate the postprandial increase in colonic motor and myoelectric activity seen in normal subjects. These tests allow the clinician to define and document the extent of neuronal injury distal to a transverse myelopathy and to evaluate visceral end organ function.
Adult↗
Spinal manipulative therapy in sports medicine.
Spinal manipulation or manual therapy is becoming an increasingly popular method of treating athletes with spinal problems. The primary theoretic basis for the claimed beneficial results of manipulation is the restoration of motion with subsequent effect on ligamentous adhesions, muscle spasm, disk nutrition, and central nervous system endorphin systems. The concept of joint barriers has been developed to differentiate among exercise therapy, mobilization, and manipulation. Research trials suggest that spinal manipulation is beneficial in relieving or reducing the duration of acute low back pain and acute neck pain but has much less effect on chronic low back pain and neck pain. There is evidence that manipulation increases certain parameters of motion of the spine but this evidence is not yet conclusive. There are a wide variety of manipulative procedures that are utilized to manipulate the spine to increase range of motion, and the selection of the procedures is based on manual diagnostic skills. Manipulation, however, is not a benign procedure and has been implicated in the aggravation of disk herniation or bony fractures as well as the precipitation of vertebrobasilar artery occlusion.
Back Pain↗
A critical study of the student interns' practice activities in a chiropractic college teaching clinic.
The diagnoses and treatment provided for 2000 patients attending a chiropractic college teaching clinic are described. The relationship between presenting complaint and the diagnostic and treatment procedures used is examined. Inconsistencies were noted with regard to interns' practice activities. Certain therapeutic modalities were clearly underutilized. Interns rarely sought advice or help in diagnosis or treatment, and they were generally unable to successfully predict the number of treatments that would be required. Support is given that links these findings to the fact that patients are not truly representative of patients seen by chiropractors in the field; they are relatively young, with mild complaints. The study concludes that students' clinical training and experience may not reach the level at which they will be tested by patient problems in active practice after graduation. Three alternatives to the current clinical teaching model are presented.
Adult↗
Adult onset of tethered spinal cord syndrome due to fibrous diastematomyelia: case report.
Adult onset of the symptoms of tethered spinal cord is a rare entity that is occasionally associated with diastematomyelia. Only one case of fibrous diastematomyelia in an adult has been reported. The fibrous nature of this disease may present a diagnostic difficulty. A 32-year-old man with the adult onset of impairment of sacral functions with lumbar fibrous diastematomyelia is reported. Surgical release of the spinal cord was followed by improvement of the patient's function.
Adult↗
The conus demyelination syndrome in multiple sclerosis.
Bowel, bladder and sexual dysfunction are common in multiple sclerosis and are generally attributed to the widespread nature of the involvement of the neuroaxis by the demyelinating plaques. Recently we encountered a specific subset of patients within this group who had characteristic clinical complaints of hesitancy, straining and incomplete voiding, perineal hypesthesia on examination, areflexia by cystometry and colonometry and electrophysiological parameters suggesting involvement of the conus medullaris. This heretofore postulated but undocumented mechanism of neurovisceral dysfunction in multiple sclerosis is detailed and discussed in 2 patients in this report.
Adult↗
Colonic dysfunction in patients with thoracic spinal cord injury.
Severe constipation is a debilitating concomitant of complete traumatic thoracic spinal cord injury. In order to investigate the pathophysiology of this symptom, we studied colonic compliance, as well as motor and myoelectrical activity, in the fasting and postprandial states and after neostigmine stimulation in 9 patients with clinically and electrophysiologically documented complete thoracic spinal cord injury. Electrophysiologic studies, including nerve conduction velocities, cortical and spinal somatosensory-evoked responses, and bulbocavernosus reflex responses, as well as urinary bladder cystometry, documented normal peripheral somatosensory function, integrity of the distal spinal cord, conus medullaris and cauda equina, and interruption of the somatosensory and descending spinal pathways proximal to the cauda equina. These 9 patients with spinal cord injury demonstrated a decrease in colonic compliance compared with a control group (p less than 0.01). They failed to demonstrate the postprandial increase in colonic motor and myoelectrical activity observed in a control group (p less than 0.01), but did respond to neostigmine with an increase in both motor and myoelectrical activity (p less than 0.02), suggesting an intact myogenic component. In these patients, decreased colonic compliance and absent postprandial colonic motor and myoelectrical activity may be mediated by ablation of outflow from higher centers to the lower spinal cord and may be correlates of visceral neuropathy and severe constipation.
Adult↗
Cortical evoked potentials on stimulation of pudendal nerve in women.
Somatosensory evoked potentials were recorded in five normal women on percutaneous stimulation of the pudendal nerve. A consistent response was obtained over the scalp 2 cm behind the Cz electroencephalographic recording site. The latency of onset of this response had a mean value of 33 msec, and the mean latency of the first positive peak was 39.6 msec. This test has potential clinical value in the evaluation of patients with bowel, bladder, or sexual dysfunction when a neurologic causation is suspected.
Adult↗
Acute flaccid neonatal paraplegia: a case report.
A 3-day-old neonate became acutely and irreversibly paraplegic below L1/L2 after umbilical artery catheterization. The paraplegia was attributed to infarction of the spinal cord because of thrombosis of the artery of Adamkievicz or injection of drugs through the catheter into the spinal cord circulation. Catheterization of a more peripheral artery or placement of the umbilical catheter tip at a lower level in the aorta may prevent similar complications.
Catheterization↗
Almeda Haldeman, Canada's first chiropractor: pioneering the prairie provinces, 1907-1917.
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Chiropractic↗
Spinal manipulative therapy. A status report.
Spinal manipulative therapy is one of the most commonly used treatments for patients with low back pain. It is both a manual diagnostic and a treatment method. Manual diagnosis includes the palpation of vertebral position, vertebral motion, joint play, end feel, soft tissue texture changes, and muscle contracture. Manipulative treatment can be divided into seven categories: long-lever, nonspecific manipulation; specific, short-lever high-velocity spinal adjustments; active or functional manipulation; mobilization; manual traction; soft tissue massage; and point pressure manipulation. Clinical experience with manipulation for low back pain is extensive, and controlled observations show that it is possible to produce immediate relief of pain in some cases. The effectiveness of manipulation is greatest in patients who have acute pain and no leg pain or neurologic deficits. Long-term effects of manipulation have not been demonstrated. Manipulation appears to increase spinal range of motion and straight leg raising but is not known to reduce intervertebral disc herniations. Complications following manipulation, although rare, can be catastrophic.
Back Pain↗
Pudendal evoked responses.
The dorsal nerve of the penis or clitoris, a branch of the pudendal nerve, was stimulated while averaged evoked responses over the spinal cord, sensory cortex, and bulbocavernosus muscle were recorded in a series of normal subjects. The morphologic features, peak latencies, and peripheral and central conduction times were compared with spinal and cortical evoked responses from the posterior tibial nerve. These tests are of potential clinical importance in the evaluation of sacral nerve root or plexus injuries and bowel, bladder, or sexual dysfunction.
Adult↗
Colonometry, cystometry, and evoked potentials in multiple sclerosis.
The conditions of three patients with advanced-stage multiple sclerosis and symptoms related to bowel and bladder function were evaluated using colonometry, cystometry, and somatosensory evoked responses from the posterior tibial nerve. The colonometrograms and cystometrograms showed notable hyperreflexia and reduced filling capacity when compared with neurologically intact patients. The neurological lesions were localized to above the conus medullaris by recording normal somatosensory responses at L-1 and abnormal responses over the scalp. This combination of tests are important in the documentation of bowel and bladder dysfunction, the localization of the neurological lesion causing the symptoms, and the determination of treatment of bowel and bladder symptoms in patients with multiple sclerosis.
Brain↗
Urodynamics: continuous monitoring.
Continuous ambulatory monitoring of intravesical and intraurethral pressures was done in 26 patients using a portable tape recorder, a specially designed urethral catheter and pressure sensitive catheter tip transducers. With this technique we overcame some of the difficulties encountered with previously described recording systems for monitoring intravesical and intraurethral pressures on a continuous basis. Pressure changes in the urethra and bladder were recorded in response to various resting and stressful situations, with the patient in a natural environment and with freedom of activities of daily living. A correlation was established between the symptoms and the results of continuous monitoring, at the same time unmasking the discrepancies between the results of cystometry and the urinary complaints of the patient.
Aged↗