Many chiropractors manage their cases based upon symptomatic responses, while teaching patients that their goal is correcting subluxations. This contradiction is confusing to the patient. To many patients, "nerve interference" is an abstract phenomenon that is difficult to comprehend. Both doctor and patient seek technical excellence based upon objective, physiological evidence. Modern instrumentation is available to help realize these goals. Pain frequently brings the patient into the office of the chiropractor. The doctor is then faced with the formidable task of educating the patient concerning ver- tebral subluxation and nerve interference. Proper use of this instrumentation helps in this task by providing tangible evidence of nerve dysfunction. We often tell new patients, "Your nervous system has three important functions. The first is sensory. You came here because of the sensation of pain. The second function of the nerve system is motor function. This runs your muscles. It allows you to walk, talk, and express yourself as a human being. The third function is called autonomic. This is the part that controls your organs and glands, and we want to make sure this is working right, too. We're going to make some measurements today, and then check periodically to see how you're doing." This tells the patient that you are a whole body doctor, not just a "pain trcatcr," and that there is more to their problem, the subluxation, than may initially have been suspected. Furthermore, the patient knows that you will be basing his or her care on objective measurements, which can be seen and understood. Surface Electromyography (sEMG) Traditional chiropractic analysis includes examination of the paravertebral tissues for "taut and tender" muscle fibers. D. D. Palmer expressed the relationship between "tone" and the dynamics of health and disease: "Life is an expression of tone. Tone is the normal degree of nerve tension. Tone is expressed in function by normal elasticity, strength, and excitability.... The cause of disease is any variation in tone."1 Evaluation of paraspinal muscle dysfunction is generally accepted as a method for assessment of the vertebral subluxation complex.2-' Reliability Decades of research by independent investigators show that surface electrode electromyography exhibits very good to excellent test-retest reliability. Reliability is expressed as a coefficient where 0.00 represents chance agreement, and 1.00 represents perfect reliability. Spcctor4 conducted a study at New York Chiropractic College that yielded correlation coefficients ranging from 0.73 and 0.97. A study, examining surface EMG reliability5, was conducted at the NZCA School of Chiropractic in New Zealand. The study involved chiropractic care . provided by 19 chiropractic interns in a teaching clinic. The equipment used was an Insight Subluxation Station™. The investigators further observed, "Under the conditions of this study, it is concluded that sEMG is an objective measure of change, which can be used as an assessment of patient progress." Construct Validity The clinical utility of a procedure may be evaluated by determining the ability of the test to perform up to the standards predicted by a theoretical model or construct.6. In the case of surface EMG, the assumption is made that significant changes will not be observed in controls. Shambaugh7 conducted a controlled study where surface electrodes were used to record paraspinal EMG activity pre-and post-chiropractic adjustment. Shambaugh concluded, "Results of this study show that significant changes in muscle electrical activity occur as a consequence of adjusting." In the osteo-pathic literature, Ellestad, et a/.,* conducted a controlled study, which found that paraspinal EMG activity decreased in patients following osteopathic manipulation. Such changes were not observed in controls in either study. Therefore, these stud- ies support the construct validity of paraspinal SEMG as an outcome assessment for chiropractic adjustment. Skin Temperature Analysis Hippocrates stated, "Should one part of the body be hotter or colder than the rest, then disease is present in that part.9 Since then, significant advances have been made in our understanding of the relationship between the dynamics of health and alterations in temperature. Today, there is strong support in the scientific literature for the use of skin temperature measurement to assess sympathetic nerve function. Ucmatsu, et al.,10 measured the temperature differences obtained by measuring 40 matched re- gions of the body surface in 90 healthy subjects. They concluded, "These values can be used as a standard in assessment of sympathetic nerve function, and the degree of asymmetry is a quantifiable indicator of dysfunction." Skin temperature instrumentation is a valuable tool for the subluxation-based chiropractor. Because the autonomic system controls organs and glands as well as blood vessels, assessment of autonomic function is important to the chiropractor concerned with the whole-body implications of the vertebral subluxation. An instrumentation examination is often an excellent place to open a dialog with the patient concerning the whole person consequences of the subluxation. Conclusion Collection and analysis of paraspinal skin temperature data has been simplified and rendered more accurate with the availability of computer-based instrumentation. Infrared sensors permit rapid and accurate skin temperature measurement. Once the readings are taken, the computer can supply NCM- or DTG-type graphics. Furthermore, the readings of the patient can be compared to the database published in the Journal ofNeuro-surgery, and the number of standard deviations from these values displayed. Instrumentation provides the chiropractor with a rapid, cost-effective, objective look at nervous system function. It provides both the doctor and the patient with hard data upon which to base chiropractic management. This liberates the clinician from the symptom-chasing merry-go-round that encumbers many chiropractic practices. To many chiropractors and patients, nerve interference is an elusive concept. With today's technology, manifestations of nerve interference can be measured objectively and communicated effectively. Christopher Kent, D.C., is a J 973 graduate of Palmer College of Chiropractic. The author of numerous professional publications. Dr. Kent has been recognized nationally as "chiropractor of the year" and "chiropractic researcher of the year. " He is co-founder of the Chiropractic Leadership Alliance, Inc. For further information, contact Chiropractic Leadership Alliance, Inc., 255 W. Spring Valley Avenue, Maywood, NJ 07607 or phone 800-285-2001. References 1. Palmer D: The Chiropractor's Adjusior, Portland. OR. Portland Pub lishing House. 1910. 2. Janse J, Houser RH, Wells BF: Chiropractic Principles ana" Teclwic. National College of Chiropractic. Chicago. IL. 1947 (reprinted 1978). Schafer RC: Basic Chiropractic Procedural Manual. American Chi ropractic Association. Arlington. VA. 1984.1 Spector B: Surface clectromyography as a model for the development of standardized procedures and reliability testing. JMPT I979;2(4):214. Kelly S. Boone WR: "The clinical application of surface eleclromy- ography as an objective measure of change in the chiropractic assess ment of patient progress: a pilot study" Journal of Vertebral Subluxa tion Research 1998;2(4): 1 75. Patrick DL. Deyo RA: "Generic and disease-specific measures in as sessing health status and quality of life" Med Care 1989; 27(3 Suppl):S217. Shambaugh P: "Changes in electrical activity in muscles resulting from chiropractic adjustment: a pilot study" JMPT 1987: No. 10(6):300. Ellestad S, Nagle R. Boesler D. Kilmore M: "Electromyographic and skin resistance responses to osteopathic manipulative treatment for low-back pain" JAOA 1988; 88(8):99I. 9. Adams F (translator): "The Genuine Works of Hippocrates" Baltimore, MD. Williams and Wilkins. 1939. lO.Ucmatsu S. Edwin D. Jankcl WR, el al: "Quantification of thermal asymmetry" ./ .VViira.v/i/.t; 19SX;69:552. Patient Case Study Patient Name: Debbi (See charts on opposite page). Purpose of Initial Visit: Medical Doctor stated she had 6 months to live. History: The patient awoke with a congested feeling in .December 1994. She reported to her family MD, who diag-Inosed her with indigestion. Symptoms became more severe and constant over the following days and she was referred to a specialist who arrived at a diagnosis of asthma. She was placed on various inhalers and sent home. Over the next three months, her condition worsened and she was admitted to the ER on three occasions. Medical Treatment: The patient was treated with a variety of steroids and inhalers over the course of the past several years. Her condition continued to worsen. At the time ot consultation in this office, she was taking daily doses ol Albuterol, Flovent, Serevent, Prilosec, Paxil, Valium, Maxide, Prcdnisone and Hycatus. Chiropractic Findings: At first glance, it was obvious the patient was very ill. Her skin was a gray/blue color and her eyes were surrounded by dark black circles. She was unable to carry on a conversation due to an irretractable cough ■ihe had had for over five years. Palpation of the cervic; and upper thoracic spine revealed severe myospasm and decreased motion indicating subluxation. An exam was performed, utilizing sEMG and Thermal testing. Results (see opposite page) demonstrated severe effects of vertebral subluxation. Subsequent scans were performed after every 12 adjustments. Outcome: The patient noted immediate change in her quality of life. Breathing eased and her use of inhalers/ncbulizci > decreased. On March 26, she was re-scanned and demonstrated great progress. She reported her cough of five years was completely gone, that she was able to sleep through the night for the first time in over five years, and that she was off all medications. Despite her feeling "completely well", her scans, although greatly improved, still demonstrated moderate and severe findings. The patient chose to continue with the care plan until objective data showed she was ready for lifetime wellness care. Final Note: Debbi had been told by her MD's that she had six months to live. On her intake form, she had written, as her expectation of care with us, to: "breathe and enjoy life again". She had been referred to this office by her daughter, who knew we had the technology to truly discover what was causing her mother's loss of health. Today, Debbi reports a level of wellness she never dreamed possible. She continues with weekly wellness care and, as her most recent scans reveal, is doing very well. Patient: Debbi Reason for coming to office: Told by medical doctor that she had 6 months to live. InfraredThermal Scans The autonomic nervous system regulates the organs and glands of the body. A person may have disturbances in the autonomic nervous system and experience no pain at all. By measuring skin temperature, we can monitor autonomic function. With Debbi, you can see the skin temperature balance improved as she continued with care. The color bars indicate the number of levels and severity of abnormality. The improvement in the scans measures the positive changes in her nervous system with chiropractic care. Surface EMG Scans When muscles contract, they give off an electrical signal. The more they contract, the higher the signal. Surface EMG measures that signal. Muscle control is regulated by motor nervous system. As you can see, through time, with chiropractic care, Debbi's surface EMG scans improved, as did her health. Notice how the signals are progressively lower with better balance. By monitoring the nervous system, we can better understand how a patient is responding to chiropractic care. Editor's Note: TAC wants to share your thought on this important topic; so be sure to fill out our Fax Back Survey on page 5 of this issue or online at: www.amchiroDractor.com
