CHIR12006

Week 1 Study Guide Questions

Please read these documents to help answer these questions:

APA Clinical Guidelines ©APA 2006 for Assessing Vertebrobasilar Insufficiency

in the Management of Cervical Spine Disorders

A risk–benefit assessment strategy to exclude cervical artery dissection in

spinal manual therapy: a comprehensive review

Q1. In the assessment for the presence of symptoms and signs associated
with VBAI occurs in four stages in the management of a patient with an
upper quadrant disorder. What ae the 4 stages?
1. History (subjective examination)
2. Physical (objective examination)
3. During treatment of cervical spine
4. Following treatment

Q2. What are the specific symptoms that a patient may present with first if
experiencing a cervical artery dissection (CAD). As a clinician what type of
history may be regarded as suspicious?
Sudden onset:
- unilateral headache which may resemble a migraine or cluster headache
- Neck pain
When examining a patient, a suspicious history would include:
- Trauma to the cervical region
- Pain and stiffness in the neck with great restriction in movement
- Recent acute respiratory infection
- Hyperhomocysteinaemia
- Vitamin deficiency
- Low body mass index and cholesterol
- Smoking
- Family history such as arterial anomalies, connective tissue disorders
Q3. What other conditions may co-exist with VBAI?
- vestibular disease
 - ear disease
- cardiovascular disease
- migraine
- epilepsy
- stroke
- head injury

Q4. Name the practices that may minimise the risk of VBI when performing a
cervical manipulation.
If cervical manipulation is indicated, the risks associated with this procedure
may be minimised by avoiding the following practices:
- Non-specific multi segmental procedures.
- Procedures involving upper cervical spine rotation, end-range cervical
spine rotation or extension, or neck traction.
- Use of excessive thrusting force or range of movement.
- Multiple manipulations of the same or different cervical joints in any one
treatment session.
It is recommended that cervical mobilisation is used at least 24 hours before
this to determine how the patient reacts.

Q5. How do you define informed consent, and what does it indicate to the
practitioner?
Informed consent is defined as 'the voluntary and revocable agreement of a
competent individual to participate in a therapeutic or research procedure,
based on an adequate understanding of its nature, purpose, and implications’.
This can be verbal or written.

Q7. When is informed consent considered valid?

When it is given by the patient voluntarily.

Q8. Before gaining informed consent from a patient what pertinent

information is necessary to be provided to the patient?
- The procedure/treatment that will be taking place
- Any adverse effects the treatment may cause
- Alternatives to the proposed procedure
- Opportunity to ask questions
- Opportunity for the patient to change their mind and also time to reflect
the procedure
Q9. If dizziness is present with a patient’s presentation what other symptoms
associated with VBAI should be investigated?
- Visual disturbances
- Dysarthria
- Dysphagia
- Drop attacks
- Nausea and vomiting
- Light-headedness and fainting
- Disorientation or anxiety
- Hearing disturbances
- Facial or oral paraesthesia or anaesthesia
- Pallor, tremors and sweating
- Other neurological symptoms

Q10. Where should you record informed consent details?

Information and obtaining of consent must be recorded in a standardised
manner in the patient’s clinical notes at each treatment or cervical
manipulation or any procedure involving end-range rotation.

Q11. Why is it advisable to incorporate the use of mannequins into

chiropractic education? Describe the advantage of this approach.
With the use of mannequins throughout chiropractic education, it provides
students a better understanding of the real-life issues they may face during
practice – eg weight of the head. Not only this, but students are also able to
practice freely without thinking they may hurt someone. The advantage of this
is that students are able to feel an approximate end range of motion

Q12. What are the 5 “Ds” and 3 “NS” (Triano J, Kawchuk, G 2006)
Five D’s
- Dysarthria
- Dysphagia
- Drop attacks
- Dizziness, vertigo, giddiness
- Diplopia or other visual disturbances
3 N’s
- Nausea, vomiting
- Numbness on one side of face or body
- Nystagmus
1A
- Ataxia of gait, walking difficulties, incoordination of extremities
Q13. How does the World Health Organisation (WHO) regard manual
mobilization and or spinal manipulative treatment conducted by
chiropractors.
The World Health Organization regards manual mobilization and/or spinal
manipulative treatment conducted by chiropractors to be a safe and effective
treatment with few, mild, transient AEs, such as local soft tissue tenderness
and tiredness on the treatment day. A few case studies have reported serious
AEs following cervical spinal manipulative therapy (SMT), but whether there is
a causal relationship between cervical SMT and CAD has not been determined
because of the methodological design, low level of evidence and low
prevalence

Q14 What does the literature say about chiropractors contributing to CAD.
Provide 3 peer reviewed articles to support your answer.

Q15. With the use of a diagram please explain the systematic approach to
exclude a serious and potential life-threatening disorder such as a CAD within
primary care and especially the manual therapy clinical settings.