RESUMO
Background: There has been rapid growth of chiropractors pursuing career opportunities in both public and private hospitals and other integrated care settings. Chiropractors that prosper in integrated care settings deliver patient-centered care, focus on the institutional mission, understand and adhere to organizational rules, and are proficient in navigating complex systems. The Council on Chiropractic Education Accreditation Standards do not outline specific meta-competencies for integrated care clinical training. Objective: The purpose of this study was to develop preliminary integrated health care competencies for DC programs to guide the advancement of clinical chiropractic education. Methods: A systematic literature search was performed. Articles were screened for eligibility and extracted in duplicate. Domains and seed statements were generated from this literature, piloted at a conference workshop, and evaluated via a modified Delphi consensus process. Of 42 invited, 36 chiropractors participated as panelists. Public comment period yielded 20 comments, none resulting in substantive changes to the competencies. Results: Of 1718 citations, 23 articles met eligibility criteria. After 2 modified Delphi rounds, consensus was reached on all competency statements. A total of 78 competency statements were agreed upon, which encompassed 4 domains and 11 subdomains. The 4 domains were: 1) Collaboration, (2) Clinical Excellence, (3) Communication, and (4) Systems Administration. Conclusion: We identified 78 preliminary competencies appropriate for preparing DC students and early career chiropractors for clinical practice in integrated healthcare settings. Educational programs may consider these competencies for curricular design and reform to strengthen DC program graduates for integrated practice, advanced training, and employment.
RESUMO
OBJECTIVE: The purpose of this case report is to describe the conservative management of 2 cases of acquired torticollis in children under 3 years of age. CLINICAL FEATURES: Both patients awoke with painful, stiff, twisted necks the day after play in a bouncy house. Range of motion was limited, and hypertonic muscles were palpated. Their neurologic and physical evaluation was consistent with a diagnosis of acquired torticollis of musculoskeletal origin. INTERVENTION AND OUTCOMES: Both children were treated with chiropractic care that consisted of light myofascial release, use of an Activator instrument, and home stretching. Patients improved in pain and range of motion immediately posttreatment and returned to normal ranges in 1 or 2 visits. CONCLUSION: Chiropractic care provided relief for these 2 young patients with acquired torticollis.
RESUMO
BACKGROUND: In two previous studies we established the mean location of the upright inferior angle of the scapula (IAS) to be near the spinous process of T8. The current study investigates the common belief that the prone IAS lines up with the T6 SP. METHODS: The location of the IAS in relation to the spine of 20 mostly asymptomatic subjects was assessed on a Hi-Lo table in 7 different postures, 2 upright and 5 prone. RESULTS: THE SCAPULA MOVED CEPHALAD IN TWO OF THE TEST POSITIONS: prone, arms at side and prone, chicken-wing. It moved caudad in the other 4 test positions, including prone, using armrest (18.4 mm). CONCLUSIONS: With the prone patient's arms on the arm pieces, the most likely patient posture, the average caudad IAS movement is about one vertebral level, notwithstanding the common belief that the IAS is one level cephalad to the upright level.
RESUMO
OBJECTIVE: The purpose of this study was to determine which spinal segment most closely corresponds to the level of the inferior angle of the scapula (IAS) using measurements taken on A-P full-spine radiographs. METHODS: Fifty sequentially selected radiographs were analyzed independently by two examiners. A straight edge was used to ascertain which spinal levels corresponded with the right and left IASs. For analysis, each spinal level was subdivided into three regions: upper vertebral body, lower vertebral body, and intervertebral space. RESULTS: he mean spinal level corresponding to the left IAS was midway between the T8-9 interspace and the upper T9 body (range, lower T7 to upper T10). The mean spinal level corresponding to the right IAS was slightly lower, but still within the upper T9 body (range, lower T7 to lower T10). These levels correspond to the T8 spinous process. CONCLUSIONS: There is a considerable amount of variability in where the IASs are located, but most commonly, they correspond to the level of the upper body of T9.