Evaluating the baseline auscultation abilities of second-year chiropractic students using simulated patients and high-fidelity manikin simulators: A pilot study.

OBJECTIVE: To assess the ability of 2nd-year students to identify normal and abnormal findings during cardiac and lung auscultation using high-fidelity manikin simulators and standardized patients. A secondary objective was to assess students' perceived competence and confidence in their abilities. METHODS: This was a descriptive pilot study of randomly selected 2nd-year students at 1 chiropractic training program. Participants were asked to perform cardiac and lung auscultation on high-fidelity manikins (2 stations) and standardized human patients (2 stations) with normal and abnormal auscultation sounds. Participants described the auscultated sound as "abnormal" or "normal" and were also asked to score their confidence in describing the sound and competence in performing auscultation on a 100-mm visual analog scale. Descriptive statistics were calculated for all study variables. RESULTS: Thirty-two students (23 women and 9 men) were included. For lung auscultation, 15.6% were incorrect on the human subject and 6.2% were incorrect on the manikin. For cardiac auscultation, 62.5% were incorrect on the human subject and 40.6% were incorrect on the manikin. Confidence mean scores ranged from 34.8 to 60. Competence mean scores ranged from 34.8 to 50. CONCLUSION: Results identified that 2nd-year students from 1 institution were correct in identifying an abnormal sound during lung auscultation but reported low levels of perceived competence or confidence in their responses. They performed poorly on cardiac auscultation and reported low perceived confidence and competence in their abilities to perform cardiac auscultation and identify sounds.

Locus of control in patients with Huntington disease: a cross-sectional study.

BACKGROUND: Health locus of control (LOC) represents an individual's beliefs regarding one's ability to influence health outcomes. In patients with chronic and neurodegenerative diseases, greater internal LOC has been associated with lower levels of disability. OBJECTIVE: To examine LOC in patients with Huntington disease (HD). METHODS: A cross-sectional study of individuals affected by HD, stratified by disease status, was conducted. Participants completed a demographic questionnaire, the Internal Control Index (ICI), and the Hospital Anxiety and Depression Scales. RESULTS: Thirty-four subjects completed the study. All groups demonstrated greater internal LOC (measured by ICI scores), and significant differences between groups were observed. Secondary analysis demonstrated relationships between depressive symptoms and anxiety symptoms, and ICI score and time from clinical diagnosis of HD. CONCLUSION: As patients with chronic pain and neurodegenerative diseases such as HD are likely to present for chiropractic care, identifying factors such as anxiety, depression and LOC may affect patients' response to care.

CONTEXTE: Le locus de contrôle de la santé (LCS) représente les croyances d'une personne sur sa capacité d'influer sur son état de santé. Chez les patients atteints de maladies chroniques et neurodégénératives, un locus de contrôle plus interne est associé à des degrés d'invalidité moindres. OBJECTIF: Observer le LCS chez des patients atteints de la maladie de Huntington. MÉTHODES: On a mené une étude transversale auprès de personnes atteintes de la maladie de Huntington, regroupées en fonction du stade de la maladie. Les participants ont rempli un questionnaire démographique, le questionnaire Internal Control Index (ICI) et le questionnaire HADS (Hospital Anxiety and Depression Scale). RÉSULTATS: Trente-quatre sujets ont participé à l'étude jusqu'à la fin. Dans tous les groupes, on a observé un locus de contrôle plus interne (mesuré par les scores ICI), et des différences significatives entre les groupes. Une étude secondaire a montré l'existence de liens entre les symptômes de la dépression et les symptômes de l'anxiété, de même qu'entre le score ICI et le temps écoulé à partir du diagnostic clinique de la maladie de Huntington. CONCLUSION: Les patients souffrant de douleurs chroniques et de maladies neurodégénératives, comme la maladie de Huntington, sont susceptibles de chercher de l'aide auprès des chiropraticiens. Certains facteurs comme l'anxiété, la dépression et le LCS peuvent influer sur la réponse des patients aux soins.

Calcium pyrophosphate deposition disease in the ankle joint: a case report.

OBJECTIVE: To detail the presentation of calcium pyrophosphate deposition disease (CPPD) in the ankle joint. The aim of this case report is to inform health-care practitioners about the presentation of this condition in an uncommon location and discuss the diagnosis, potential treatment, and management strategies for a patient with CPPD. CLINICAL FEATURES: A 36-year-old male patient presented to a chiropractic clinic with an acute, painful, and swollen ankle, which was later diagnosed by plain film radiograph as CPPD. A rheumatology follow-up was recommended and at-home treatment was prescribed to treat acute symptoms and monitor progress. OUTCOME: No chiropractic treatment was provided and the patient has been referred to a rheumatologist for further assessment. The diagnosis of CPPD was confirmed and he was advised to take an anti-inflammatory if symptoms recurred and booked for further follow-up in six months. SUMMARY: Although the presentation is less common, CPPD can present in the ankle joint and mimic other inflammatory disorders. Conservative treatment can be applied to treat acute symptoms and referral to a rheumatologist is suggested to monitor progress of this condition.

OBJECTIF: Expliquer en détail la présentation de la chondrocalcinose articulaire (CCA) dans l'articulation de cheville. Cet exposé de cas a pour but d'informer les professionnels de la santé à propos de la présentation de ce trouble dans un endroit inhabituel et de discuter du diagnostic, du traitement potentiel et des stratégies de prise en charge pour un patient atteint de CCA. CARACTÉRISTIQUES CLINIQUES: Un patient de 36 ans se présente à une clinique de chiropratique avec une cheville enflée avec douleur aiguë, trouble qu'on a plus tard diagnostiqué au moyen d'un cliché sans préparation comme étant une CCA. On a recommandé un suivi en rhumatologie et prescrit un traitement à domicile pour traiter les symptômes aigus et surveiller la progression. RÉSULTAT: On n'a pas fourni de traitement chiropratique et le patient a été envoyé à un rhumatologue pour une évaluation plus poussée. Le diagnostic de CCA a été confirmé; on lui a conseillé de prendre un anti-inflammatoire si les symptômes réapparaissaient et on a planifié un suivi six mois plus tard. RÉSUMÉ: Bien que la présentation soit moins commune, la CCA peut se présenter dans l'articulation de cheville et imiter d'autres affections inflammatoires. Un traitement conservateur peut permettre de soigner les symptômes aigus et on recommande d'envoyer le patient voir un rhumatologue pour surveiller la progression du trouble.

Learning spinal manipulation: A best-evidence synthesis of teaching methods.

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of different reported methods used to teach spinal manipulative therapy to chiropractic students. METHODS: For this best-evidence literature synthesis, 5 electronic databases were searched from 1900 to 2015. Eligible studies were critically appraised using the criteria of the Scottish Intercollegiate Guidelines Network. Scientifically admissible studies were synthesized following best-evidence synthesis principles. RESULTS: Twenty articles were critically appraised, including 9 randomized clinical trials, 9 cohort studies, and 2 systematic reviews/meta-analyses. Eleven articles were accepted as scientifically admissible. The type of teaching method aids included a Thrust in Motion cervical manikin, instrumented cardiopulmonary reanimation manikin, padded contact with a load cell, instrumented treatment table with force sensor/transducer, and Dynadjust instrument. CONCLUSIONS: Several different methods exist in the literature for teaching spinal manipulative therapy techniques; however, future research in this developing area of chiropractic education is proposed. It is suggested that various teaching methods be included in the regular curricula of chiropractic colleges to aid in developing manipulation skills, efficiency, and knowledge of performance.

The examination of soft tissue compliance in the thoracic region for the development of a spinal manipulation training mannequin.

PURPOSE: To determine if the soft tissue compliance of the thoracic paraspinal musculature differs based on gender and body type to help create a foam human analogue mannequin to assist in the training of spinal manipulative therapy. METHODS: 54 volunteers were grouped based on their gender and body types. In the prone position, thoracic paraspinal soft tissue compliance was measured at T1, T3 T6, T9 and T12 vertebrae levels bilaterally using a tissue compliance meter. RESULTS: There was no significant difference in tissue compliance when comparing the genders except at T1 (p=0.026). When comparing body types, significantly higher tissue compliance was found between endomorphs and the other groups. No significant difference was found between ectomorphs and mesomorphs. The compliance for the participants in this study ranged from 0.122 mm/N to 0.420 mm/N. CONCLUSION: There are significant differences in thoracic spine soft tissue compliance in healthy asymptomatic patients between genders in the upper thoracic spine, and between different body types throughout the thoracic spine. It may be beneficial to create multiple versions of practice mannequins to simulate variations amongst different patients.

OBJECTIF: Déterminer si la compliance des tissus mous de la masse musculaire thoracique paradorsale diffère selon le sexe et le type corporel afin de créer un mannequin en mousse de forme humaine pour aider à la formation en traitement par manipulation dorsale. MÉTHODOLOGIE: On a regroupé 54 volontaires en fonction de leur sexe et de leur type corporel. En position allongée, on a mesuré la compliance des tissus mous thoraciques paradorsaux au niveau des vertèbres T1, T3, T6, T9 et T12 bilatéralement à l'aide d'un dispositif de mesure de compliance. RÉSULTATS: Il n'y a pas de grande différence sur le plan de la compliance des tissus lorsqu'on compare les sexes, sauf à la vertèbre T1 (p = 0,026). En comparant les types corporels, une compliance des tissus bien plus élevée a été remarquée chez les endomorphes par rapport aux autres groupes. Il n'y a pas de différence importante entre les ectomorphes et les endomorphes. La compliance pour les participants à cette étude allait de 0,122 mm/N à 0,420 mm/N. CONCLUSION: Il existe de grandes différences entre la compliance des tissus mous thoraciques dorsaux chez les patients en santé asymptomatiques entre les sexes dans la colonne thoracique supérieure et entre les différents types corporels dans toute la colonne thoracique. Il peut être bénéfique de créer plusieurs versions de mannequins de pratique pour simuler les variations chez les différents patients.

Observed improvements in an intern's ability to initiate critical emergency skills in different cardiac arrest scenarios using high-fidelity simulation.

Objective : The objective of this study was to report observed changes in an intern's ability to initiate critical emergency skills in different cardiac arrest scenarios with high-fidelity simulation over a 10-month period. Methods : One intern's performance was retrospectively analyzed using video recordings of 4 simulations at different stages in the training program. The key outcome was the duration of time expired for 4 critical skills, including activating the emergency response system, initiating cardiopulmonary resuscitation (CPR), using an automated external defibrillator (AED), and passively administrating oxygen. Results : The intern became more efficient in each subsequent simulation for activating the emergency response system and initiating CPR. The time to use the AED stayed relatively constant. The administration of oxygen was inconsistent. Conclusion : An improvement in the speed of applying emergency critical skills was observed with this intern. These improvements in skill may improve patient outcomes and survival rates. We propose further educational research with high-fidelity simulation in the area of assessing emergency skills.

Guyon Canal Syndrome: lack of management in a case of unresolved handlebar palsy.

OBJECTIVE: To present the clinical diagnostic features including management of Guyon canal syndrome in a case with unresolved sensory deficits in a young female cyclist. CLINICAL PRESENTATION: After 14 days of cycling across Canada, a 23-year old female experienced sensory loss, followed by atrophy and a "claw" hand appearance of her left hand. INTERVENTION AND OUTCOME: Treatment included cervical chiropractic manipulation, soft tissue therapy and the use of cycling gloves. Seven years after the initial injury a lack of sensation in the ulnar nerve distribution of her left hand has persisted. DISCUSSION: This case demonstrates that a lack of proper management can lead to permanent sensory loss and is worth highlighting. Various therapists evaluated the patient's symptoms and provided minimal care. No diagnosis was given, nor were appropriate measures taken for her to understand the risks of continuing to ride. SUMMARY: Although treatment for Guyon Canal Syndrome can be as easy as cessation from cycling until symptoms subside, other treatment options could be utilized to help manage ulnar nerve compression injuries in cyclists.

OBJECTIF: Présenter les caractéristiques de diagnostic clinique, dont le traitement du syndrome du canal de Guyon dans un cas de déficits sensoriels non traités chez une jeune cycliste. TABLEAU CLINIQUE: Après 14 jours de vélo à travers le Canada, une femme de 23 ans a souffert une perte sensorielle, suivie par une atrophie et l'aspect d'une « main en griffe ¼ à sa main gauche. INTERVENTION ET RÉSULTATS: Le traitement comportait la manipulation chiropratique cervicale, le traitement des tissus mous et le port de gants de vélo. Sept ans après la blessure initiale, un manque de sensation dans la distribution du nerf cubital de la main gauche a persisté. DISCUSSION: Ce cas démontre que le manque de traitement approprié peut entraîner la perte sensorielle permanente et mérite qu'on s'y attarde. Différents thérapeutes ont évalué les symptômes de la patiente et lui ont fourni des soins minimaux. Aucun diagnostic n'a été fait, ni des mesures appropriées n'étaient prises pour lui faire comprendre les risques de continuer à faire du vélo. RÉSUMÉ: Bien que le traitement du syndrome du canal de Guyon soit aussi simple que l'arrêt de la pratique du vélo jusqu'à la disparition des symptômes, d'autres options thérapeutiques pourraient être utilisées pour aider à traiter les lésions de compression du nerf cubital chez les cyclistes.

A survey of Canadian Alpine ski racing coaches regarding spinal protective devices for their athletes.

INTRODUCTION: Spinal protective devices are a recent addition to the protective equipment worn by competitive and recreational alpine skiers and snowboarders. Their rate of use is not documented at the time of publication. The objective of this study was to examine the current attitudes and recommendations of Canadian alpine ski racing coaches towards spinal protective devices. METHODS: A convenience sample of alpine ski racing coaches across Canada were contacted in each provincial sport governing body in the ski racing community. A ten question online survey was attached to the initial email. Descriptive statistical analysis was utilized. RESULTS: A total of 29 Canadian alpine ski racing coaches completed the study survey. All participants were familiar with spinal protective devices and 51.7% of respondents reported that they do not actively enforce spinal protective device use with their ski racing athletes. 80% of respondents reported that their Canadian ski racing club did not have guidelines or policies regarding spinal protective device use. 86.2% of respondents were unaware if their provincial sport organization had a policy regarding their use. DISCUSSION: The majority of coaches reporting training athletes aged 10-15, which may help to explain why only half of those surveyed enforce the use of spinal protective devices. This group of athletes may not participate in speed events as frequently as older athletes, where the use of spinal protective devices is more common. CONCLUSION: The majority of Canadian Alpine ski coaches report a belief that spinal protective device use is important, however, far fewer enforce their use, or work in an environment with a policy requiring it. Further research is required to determine the differences in beliefs and practice.

INTRODUCTION: Les dispositifs de protection de la colonne vertébrale sont un ajout récent à l'équipement de protection porté par les skieurs alpins et planchistes amateurs tout comme professionnels. Leur fréquence d'utilisation n'est pas connue à la date de cette publication. Cette étude vise à examiner les attitudes et les recommandations actuelles des entraîneurs canadiens de ski alpin de compétition concernant le port de dispositifs de protection de la colonne vertébrale. MÉTHODOLOGIE: Un échantillon de commodité d'entraîneurs de ski alpin de compétition de partout au Canada a été contacté dans chaque organisme provincial directeur du sport de ski de compétition. Le courriel initial a été suivi par un questionnaire en ligne comportant dix questions. On a eu recours à une analyse statistique descriptive. RÉSULTATS: Un total de 29 entraîneurs canadiens de ski alpin de compétition ont rempli le questionnaire de l'étude. Tous les participants étaient familiers avec les dispositifs de protection de la colonne vertébrale et 51,7 % des répondants ont déclaré qu'ils n'imposent pas activement le port de dispositifs de protection de la colonne vertébrale à leurs skieurs de compétition. 80 % des répondants ont indiqué que leur club canadien de ski de compétition n'avait pas de directives ou de politiques relatives au port de dispositifs de protection de la colonne vertébrale. 86,2 % des répondants ne savaient pas si leur organisme provincial de sport avait une politique concernant leur utilisation. DISCUSSION: La majorité des entraîneurs ont déclaré entraîner des athlètes âgés de 10 à 15 ans, ce qui peut aider à expliquer le faible pourcentage de ceux qui imposaient le port de dispositifs de protection de la colonne vertébrale. Ce groupe d'athlètes ne participe pas nécessairement à des épreuves de vitesse aussi souvent que les athlètes plus âgés, chez qui le port de dispositifs de protection de la colonne vertébrale est plus fréquent. CONCLUSION: La majorité des entraîneurs canadiens de ski alpin se disent convaincus que le port de dispositifs de protection de la colonne vertébrale est important, mais beaucoup moins font respecter leur port, ou font partie d'un milieu qui a une politique obligeant le port. D'autres recherches sont nécessaires pour déterminer les différences dans les convictions et les pratiques.

Addressing the risk factors and prevention of Sudden Cardiac Death in young athletes: a case report.

BACKGROUND: Mandatory prescreening for the identification of risk factors and prevention of sudden cardiac death (SCD) is a widely debated topic within academic literature. In addition, the effective emergency management of sudden cardiac arrest (SCA) has reported lower survival outcomes (9% with bystander CPR, 24% with AED application) although improvements, such as strategic placements of AED units and Hands-Only (compression only) CPR, are being made. PURPOSE: This case will outline the importance of establishing a true SCD incidence rate and the increased need for trained personal with proper equipment available to deliver immediate emergency cardiac management. CONCLUSION: Given the lack of overall expert consensus and the low survival outcomes associated with SCD, a true incidence rate will need to be determined prior to developing a widely accepted policy. Since pre-screening all young athletes does not appear to prevent all SCD's, having properly trained personnel and easily accessible equipment at sporting venues, especially in remote locations, appears to be key.

CONTEXTE: le dépistage obligatoire pour l'identification des facteurs de risque et la prévention de la mort subite par arrêt cardiaque est un sujet largement débattu dans la documentation spécialisée. En outre, la gestion efficace des urgences d'un arrêt cardiaque soudain s'est traduite par des taux de survie plus faibles (9 % avec les RCP de spectateurs, 24 % à l'aide de DEA) bien que des améliorations, comme les placements stratégiques des unités DEA et des RCP manuelles (pression uniquement), soient effectuées. OBJECTIF: ce cas va souligner l'importance d'établir un taux d'incidence réel des morts subites par arrêt cardiaque et le besoin accru de personnel qualifié doté d'équipement adéquat accessible pour assurer une gestion d'urgence immédiate des arrêts cardiaques. CONCLUSION: compte tenu de l'absence de consensus global d'experts et les faibles taux de survie associés aux morts subites par arrêt cardiaque, il faut définir un taux d'incidence réel avant d'élaborer une politique largement acceptée. Étant donné que le dépistage préliminaire de tous les jeunes athlètes ne semble pas empêcher toutes les morts subites par arrêt cardiaque, il semble qu'avoir un personnel bien formé et du matériel facilement accessible sur les sites sportifs, en particulier dans les régions éloignées, est essentiel.

Management approaches to acute muscular strain and hematoma in National level soccer players: a report of two cases.

OBJECTIVE: To detail the presentation of two elite female soccer players with right thigh pain that occurred during training. This article will outline the investigation, diagnosis and management of their cases. CLINICAL FEATURES: The patients presented with anterior thigh pain following injuries incurred during training camp. Both were diagnosed with acute muscular strain and associated muscular hematomas. The plans of management included rest and removal from sport, cryotherapy, and interferential current. Treatment progressed to soft tissue therapy and rehabilitative exercises. The patient in the first case received additional treatment from another practitioner that involved aggressive soft tissue therapy and a strengthening program in the initial stages of recovery. OUTCOME MEASURES: For both athletes, outcome measures included return to play and re-injury. SUMMARY: Two female elite soccer players presented with acute muscle strain and hematoma. These case reports attempt to highlight the differences in treatment options in female soccer players.

Upper extremity deep vein thrombosis presenting to a chiropractic clinic: a description of 2 cases.

OBJECTIVE: The purpose of this case series is to describe the presentation of 2 patients who presented to a chiropractic teaching clinic with Paget-Schroetter syndrome (PSS) and to discuss the potential role for conservative therapy in the management of symptoms. CLINICAL FEATURES: Two patients presented with a vascular and muscular findings suggesting activity-related upper extremity deep vein thrombosis. One patient presented with recent onset of symptoms (pain in the neck with a "pinched nerve sensation" in the left upper trapezius); and the other presented with chronic, low-grade neck pain of 1 year's duration. INTERVENTION AND OUTCOME: The initial treatment approach for the patient with acute symptoms included soft tissue therapy. During the second appointment, he was immediately referred for medical evaluation and management because of worsening symptoms. He was diagnosed with thrombus in the left brachial vein, started immediately on a thrombolytic agent, and referred to a thrombosis clinic. Treatment for the second patient with chronic symptoms included soft tissue therapy, spinal manipulative therapy, and active care. Two months after 3 treatments, she reported improved symptoms. She remains under supportive care and has reported continued relief of her symptoms. CONCLUSION: Although a rare condition, PSS has the potential to result in significant morbidity and potentially fatal complications; thus, it is critical that practitioners recognize the signs and symptoms to facilitate appropriate and timely referrals. Clinicians should be aware of the presentation and proposed pathogenesis of PSS, and consider this diagnosis in patients with unilateral upper limb and/or neck pain.

A survey of wellness management strategies used by Canadian doctors of chiropractic.

OBJECTIVE: The purpose of this study was to investigate if Canadian doctors of chiropractic consider using wellness strategies after functional recovery in acute and chronic conditions. This study also attempted to determine if there is a difference in the use of wellness management strategies between broad and narrow scope practitioners. METHODS: Forty-one practicing, licensed chiropractors were recruited to complete an interview survey regarding 2 mock clinical case presentations. Interviews were recorded, and influential words or word pairings were identified. Investigators formulated criteria to divide practitioners into broad scope (mixers) and narrow scope (straights). Data were analyzed using Crawdad Analysis Software (version 1.2). RESULTS: All subjects indicated that they would provide information regarding public health and wellness strategies to a patient after functional resolution of the presenting chronic or acute complaints. The responses of broad scope (mixer) chiropractors appeared to be focused on the patient specifically, whereas narrow scope (straight) responses appeared to be more varied when analyzed for noun and noun-pair influence. CONCLUSION: This study of practicing, licensed Canadian chiropractors suggests that wellness strategies may be commonly considered in practice. All subjects in this study reported a number of strategies to educate patients regarding wellness after functional recovery of a complaint.

Neuromusculoskeletal disorders following SARS: a case series.

OBJECTIVE: To detail the presentation of three health care workers diagnosed with sudden acute respiratory syndrome (SARS) who later presented to a CMCC teaching clinic with neuromusculoskeletal sequelae and underwent conservative treatments. This case series aims to inform practitioners of the potential pathogenesis of these neuromuscular complaints and describes their treatment in a chiropractic practice. CLINICAL FEATURES: Three patients presented with a variety of neurological, muscular and joint findings. Conservative treatment was aimed at decreasing hypertonic muscles, increasing joint mobility, and improving ability to perform activities of daily living. INTERVENTION AND OUTCOME: The conservative treatment approach utilized in these cases involved spinal manipulative therapy, soft tissue therapy, modalities, and rehabilitation. Outcome measures included subjective pain ratings, disability indices, and return to work. CONCLUSION: Three patients previously diagnosed with SARS presented with neuromusculoskeletal complaints and subjectively experienced intermittent relief of pain and improvement in disability status after conservative treatments.