Midterm Flashcards
(117 cards)
1
Q
According to the ACA, what is the most common therapeutic procedure performed by chiropractors?
A
Spinal manipulation, AKA the chiro adjustment
2
Q
Cleveland Comprehensive Methods teaches techniques that come from which different chiropractic techniques?
A
Recoil, diversified and Gonstead
3
Q
- What percent of chiropractors use diversified style adjusting?
A
96.2%
4
Q
- Know the five methods to increase force production. (Example – True/False – Lengthening the moment arm on the doctor is a plausible mechanism for increasing force production.)
A
a. Shorten moment arms on doc
b. Lengthen moment arms on patient
c. Use momentum of doctor and patient
d. Use impact
e. Minimize energy leaks through doctor’s joints
5
Q
- If there is too long of a moment arm on the doctor, what is the most likely mechanism for a resultant decrease in force?
A
Energy leak
6
Q
- Forces applied that deviate from __________ do not contributed significantly to vertebral movement.
A
Perpendicular
7
Q
- When more than __________ percent of the total force of a side posture adjustment is produced through the hand, cavitation is not likely to occur.
A
20%
8
Q
- Development of organized patterns of muscular activities guided by signals from the environment is known as a:
A
Psychomotor skill
9
Q
- What are the four stages of competence?
A
a. Unconsciously unskilled
b. Consciously unskilled
c. Consciously skilled
d. Unconsciously skilled
10
Q
What is the highest risk component of a chiro adjustment
A
Adjustive thrust
11
Q
The decrease in preload force immediately before the thrust is known as the:
A
Downward incisural point (DIP)
12
Q
- According to the study by Descarreaux and Dugas, a significant increase in peak force and rate of force production occurred over what time period?
A
Over the first two years
13
Q
- According to the study by Descarreaux and Dugas, at what point did peak force variability significantly decrease?
A
In the first year
14
Q
- According to the study by Descarreaux and Dugas, over what time period did global coordination index continue to improve?
A
Linearly throughout both stages of learning
15
Q
- According to the study by Triano, Gissler, Forgie, & Milwid, what differences existed between male and female chiropractic students in HVLA force development?
A
No differences were found based on sex
16
Q
- According to the study by Triano, Gissler, Forgie, & Milwid, at greater levels of experience the total force amplitude __________ while the rate of force application __________.
A
Decreases
Increases
17
Q
- According to the study by Ndetan, Rupert, Bae, & Singh, what is the overall risk of injury to chiropractic students either from being adjusted or adjusting?
A
31.5%
18
Q
- According to the study by Bisiacchi, what type of adjustment were chiropractic students most confident performing?
A
Prone thoracic adjustments
19
Q
- When used in the treatment of vertebral subluxation complex (VSC), the adjustive thrust or mobilization is typically delivered in the direction of the:
A
Reduced joint motion
20
Q
- In order to compare effectiveness of different adjusting techniques, further classification of techniques by __________ should be explored.
A
Objective characteristics
21
Q
HVLA is an acronym for what?
A
High velocity, low amplitude
22
Q
What are possible effects of improper pt positioning prior to SMT
A
a. Patient may be apprehensive and unlikely to relax
b. Doc left a a mechanical disadvantage and/or in a position of increased risk of injury
c. Failure to develop joint preadjustive tension, adjustive localization and efficiency
23
Q
- According to the study by Holm & Rose, of the 40.1% of chiropractors who report being injured while working, what percent of those were injured while performing SMT?
A
66.7%
24
Q
For pelvic, lumbar and thoracic adjusting, the table should be level with:
A
The middle or sup aspect of knee
25
When performing manual SMT, the docs center of gravity should be located:
Behind the line of drive
26
What are the characteristics of a correctly performed toggle stance?
a. Feet almost parallel and angled at 90 degrees to the table
b. Feet shoulder width apart
c. Slight bend in knees
d. Neck in a neutral alignment with the torso
e. Pelvis rotated forward
f. Lumbar lordosis maintained
27
What are the characteristics of a correctly performed fencer’s stance?
a. Feet parallel to table
b. Leg closes to table towards foot of table
c. Knees bent
d. Back heel off the floor
28
In a short-lever chiro adjustment, the segmental contact is located where?
At or near the level of the dysfunctional joint
29
29. What types of adjustments are most likely to lead to suspicion of inappropriate contact from an uninformed patient’s point of view?
Supine thoracic adjustments and side posture lumbar or pelvic adjustments
30
30. Superficial tissues are commonly tractioned in the direction of ___ _______ prior to the thrust.
The adjustive thrust
31
The HVLA force associated w/ SMT is designed to induce joint distraction and cavitation without:
Exceeding the limits of anatomic joint motion
32
32. When performing a recoil style thrust, the vector is determined by orientation of the Dr.’s __________ in relation to the contact point on the patient.
Episternal notch
33
33. A doctor takes a moment to assess the degree of established joint tension and tissue resistance before thrusting. What is the best term to describe this type of thrust?
Pause thrust
34
34. Patients are allowed to present directly to a chiropractor’s office if they feel it would benefit them, without the need for a referral. What type of health care provider does this describe?
Portal of entry provider
35
35. What are the five components of the Faye model of VSC?
a. Neuropathophysiology- facilitation, degeneration, decreased axoplasmic flow
b. Kinesiopathology- hypomobility, hypermobility, loss of joint play
c. Myopathology- smaspm, Antonia
d. Histopathology- inflammation
e. Biochemical changes- hormonal and chemical effects
36
36. According to Faye, what aspect of the 5 component model of VSC does SMT directly affect?
Kinesiopathology
37
An abbreviated description for describing abnormal joint position or movement
Spinal listing
38
All stating listings are described with the relationship of the _____ vertebra compared w the ______ vertebra
Superior
Inferior
39
a. At T5, a left rotation restriction (LRR) is detected with palpatory tenderness. The adjustment for this finding would be the same as an adjustment for the static National Diversified listing of
RP
40
b. At T9, a right rotation restriction (RRR) is detected with palpatory tenderness. The adjustment for this finding would be the same as an adjustment for the static Palmer Gonstead listing of
PR
41
c. At L1, a left rotation restriction and left lateral flexion restriction is detected with palpatory tenderness. The adjustment for this finding would be the same as an adjustment for the static National Diversified listing of
RPI
42
d. At L3, a right rotation restriction and left lateral flexion restriction is detected with palpatory tenderness. The adjustment for this finding would be the same as an adjustment for the static Palmer Gonstead listing of
PRI-M
43
40. The reproducibility or consistency of measurement or diagnosis between more than one examiners is known as
Reliability
44
41. The degree to which a test actually evaluates what is intended is known as
Validity
45
42. The ability of a diagnostic procedure to reflect improvement or worsening in the condition or function it is measuring is known as
Responsiveness
46
43. The value a procedure has in directing effective patient care is known as
Utility
47
44. Examination of any complaint begins with
Superficial observation
48
45. Postural assessment has demonstrated __________reliability & validity as a screening procedure for distinguishing back pain subjects from normal ones.
Satisfactory
49
46. What method of measuring gross range of motion has demonstrated consistent reproducibility within & between examiners?
Inclinometery measurement- becoming a minimal standard
50
47. Interexaminer reliability for segmental ROM palpation & end feel (EP) is generally
Poor
51
48. Intraexaminer reliability for EP motion palpation is
Slightly better than segmental ROM palpation
52
Inter & intraexaminer reliability for joint pain provocation tests is
Fair to good
53
50. Inter & intraexaminer reliability for palpation of bony or soft tissue pain is
Good
54
51. Inter & intraexaminer reliability for palpation for soft tissue textural changes is
Poor
55
52. Inter & intraexaminer reliability for leg length evaluation is __________ for the prone, extended knee position and __________ in the prone flexed knee position.
Good
Poor
56
53. Lumbar mamillary processes are not directly palpable. They are located by a sense of __________ palpated through the overlying muscle layer.
Deep resistance
57
54. Normal anatomical variance, congenital or developmental malformation, and compensation without dysfunction are all complicating factors to using the presence of __________ as the sole indicator for VSC.
Asymmetry
58
55. Joint play is evaluated with the joint in a __________ position.
Neutral
59
56. End play is evaluated as a joint nears its
Elastic limits
60
57. The extra motion that is possible in a joint after cavitation is known as the
Paraphysiologic space
61
58. Restriction of a joint in AROM is usually a result of
Myofascial shortening
62
59. Restriction of a joint at the end range of passive motion is usually a result of shortening in the
Joint capsule and peri articular surfaces
63
60. Capsular end play, such as in the facet joints of the spine, should feel:
like an increasing sense of resistance as it is approached, followed by a second firmer resistance as its limits are approached.
64
61. Marked or persistent pain upon __________ may indicate fracture or non-mechanical pathology.
Percussion
65
62. Currently in the literature, there is __________ justification for the routine use of radiographic spinal displacement analysis in clinical practice.
NO
66
63. Algometry has demonstrated __________ reliability & responsiveness, and __________ be used as a measureable outcome.
Good
Can
67
64. A problem identified before a procedure is performed that makes that procedure inadvisable is known as a
Contraindication
68
65. A problem that occurs after the application of a procedure is known as a
Complication
69
66. Any form of manual therapy is contraindicated when it may
produce an injury, worsen an associated disorder, or delay appropriate curative or life-saving treatment
70
67. A condition that implies that caution should be used in applying SMT and that modification may need to be made to technique, force, area, etc. is known as a
Relative contraindication
71
Potential complication, method of detection, and management modifications of.....
Atherosclerosis of major blood vessels
Complication: blood vessel rupture; dislodged thrombi
Detection: palpation; auscultation; x-rays; visualization; Doppler US
Modification: Soft tissue & mobilizing techniques with light or distractive adjustments; referral to vascular surgeon
72
Potential complication, method of detection, and management modifications of.....
Vertebrobasilar insufficiency
Complication: Wallenberg syndrome (brain stem stroke)
Detection: US; angiography; MRA
Modifications: no cervical thrusting techs to anticoagulant therapy
73
Potential complication, method of detection, and management modifications of.....
Aneurysm
Complication: rupture; hemorrhage
Detection: irregular pulse; abd palpation; auscultations, X-ray examination
Mods: referral to vascular surgeon
74
Potential complication, method of detection, and management modifications of.....
Tumors
Comp: metastasis to spine; path fracture; disease progression
Detection: palpation; X-ray examination; laboratory findings; MRI; CT
Modifications: Referral
75
Potential complication, method of detection, and management modifications of.....
Fractures
Comp: increased instability; delayed healing
Detection: radiograph; CT
Modification: referral
76
Potential complication, method of detection, and management modifications of.....
Severe sprains
Comp: Increased instability
Detection: stress X-ray examination; motion palpation
Mods: if severe, referral. If not, rehab and manipulation of area
77
Potential complication, method of detection, and management modifications of.....
Osteoarthritis (late stage)
Comp: neurological compromise; increased pain
Detection: radiograph
Mods: mobilization; gentle manipulation, distractive adjustments
78
Conditions that require a referral
a. Conditions not responding to rendered treatment
b. Condition is worsening with treatment
c. Serious and/or progressive infectious condition
d. Medical emergency (MI, cerebrovascular accident, severe laceration, pneumothorax, etc)
e. Increasing neurological deficits (cauda equine syndrome)
79
Serious injuries from SMT are:
Very uncommon
80
The majority of spinal manipulation complications arise from
Misdiagnosis or improper tech
81
73. A reaction to SMT that appears within 12 hours, does not affect work, and resolves within 48 hours would be considered a(n)
Adequate reaction
82
74. A reaction to SMT that appears within 12 hours, does affect work, and does not resolve within 48 hours would be considered a(n)
Exceeding reaction
83
75. A reaction to SMT that appears within 2 days, causes tissue damage, but allows the patient to return to preoccurance status would be considered a(n)
Reversible complication
84
76. A reaction to SMT that appears within 2 days, causes permanent tissue damage and impairment would be considered a(n)
Irreversible complication
85
77. Risks of some serious complications to SMT are extremely low. Does this possible rare risk need to be discussed with the patient as part of the informed consent process?
Duh
86
78. The rate of mild (acceptable) reactions to SMT in the thoracic spine is __________ compared to the other regions of the spine.
Higher
87
79. What are possible contributors to complications of SMT in the thoracic spine?
a. Sprains to costovertebral and costotransverse articulation
b. Strains of the IC muscles
c. Rib fractures
d. TVP fractures (rare)
e. Hematomyelia (rare)
88
80. What are some known red-flags for cauda equine syndrome?
a. Bilateral radiculopathirs with distal paralysis of lower limbs
b. Sensory loss in the sacral distribution
c. Sphincter paralysis
89
81. Axial rotation in the lumbar spine must exceed __________ to cause microscopic failure to annular fibers.
3 degrees
90
82. The orientation of the lumbar facets limits axial rotation to less than
3 degrees?
91
83. The lumbar disc is generally more vulnerable to what motions?
a. Flexion injuries (compression)
b. Axial loading (compression
c. Axial rotation
92
84. The body of literature reveals a __________ incidence of reported manipulation-induced disc herniation
Low
93
85. According to NCMIC, __________ account for the greatest percentage of malpractice claims filed against chiropractors.
Disc problems
94
Treatment of _____ is the main reason chiropractors are consulted
NMS
95
Patients rate chiro care as superior to medical care for the tx of:
Back pain
96
88. Currently more evidence supporting manipulation as therapy for __________ than any other treatment.
Low back pain
97
89. At present time, what internal organ diseases have SMT been shown as curative for in the research literature?
a. There are no appropriately controlled studies that establish the spinal manipulation or any other somatic therapy representing a valid curative strategy for the tx of any internal organ disease
98
90. Single-level joint cavitation is __________ in side posture pelvic, lumbar, and supine cervical adjustments.
Uncommon
99
91. Where do side posture pelvic adjustments commonly generate cavitation?
In the lumbosacral spine
100
92. What types of adjustments are more likely to produce cavitation localized to the level of contact when compared to side posture and pelvic adjustments?
Prone thoracic
101
93. The targeted joint is more likely to cavitate when __________ cavitation(s) are produced.
Multiple
102
94. The formation of vapor and gas bubbles within fluid through the local reduction of pressure is known as
Cavitation
103
Cavitation is associated with what post adjustment phenomena?
a. Transitory increase in passive ROM
b. Temp increased joint space (Though put in doubt with recent research)
c. Approx 20-min refractory period
d. Increased joint separation (Put in doubt with recent research)
104
96. A tearing sound associated with manual therapy could represent
Cross-linkages in traumatized soft tissues
105
97. A snapping sound associated with manual therapy could represent
tendon over bony protuberances
106
98. A clunking sound associated with manual therapy could represent
movement of impinged bony outgrowths
107
99. A crackling sound associated with manual therapy could represent
crepitus from degenerative changes
108
The theory that restrictions are due to the development of adhesions between the articular surfaces of the facet joints is known as
Inarticular adhesions
109
101. The theory that restrictions are due to the product of some derangement within the synovial joint (inside the joint capsule) is known as
Interarticular block
110
102. The theory that restrictions are due to internal derangement of the disc is known as
Interdiscal block
111
103. The theory that restrictions are due to the development of adhesions & contractures from fibrotic repair of tissue damage is known as
Periarticular fibrosis and adhesions
112
104. The theory that SMT alters central processing of noxious stimuli leading to reduced pain is known as
Analgesic hypothesis
113
105. One theory of the effects of SMT is that a self-perpetuating cycle, known as the __________, may be interrupted by HVLA adjustments
Myofascial cycle
114
106. The theory that VSC induces persistent nociceptive activity and altered proprioceptive input, potentially triggering a segmental cord response leading to pathologic somatosomatic or somatovisceral dysfunction is known as
Reflex dysfunction
115
107. The theory that SMT improves circulation by restoring joint function and removing a source of sympathetic irritation is known as
Circulatory hypothesis
116
108. How is the term subluxation defined according to the neuroplasticity model?
A central segmental motor control problem
117
109. What are the steps in the subluxation cycle according to the neuroplasticity model?
a. Subluxation
b. Altered afferent input
c. Abnormal somatosensory processing
d. Altered sensorimotor integration
e. Altered motor control
f. Altered function (pain and disability)
g. Subluxation
