Technology and Technique: New Partners in Patient Care

II' you're still wondering what role tech­nology should play in chiropractic practice today, consider this: from B.J. to Gonstead, doctors have been looking for more objective data for guiding and evalu­ating what they do. Whether you rely on instruments or X-rays, you've already identified that you need more information. And, if you're looking for methods that can improve patient care and clinical de­cisions, regardless of technique, the tools of choice for many doctors are thermog-raphy and surface electromyography (sEMG). Most DCs agree that traditional exam procedures often produce equivocal find­ings, resulting in the need for additional objective measures to expand the clinical picture of the patient. And, since the suc­cessful application of any technique is highly dependent on what doctors know about their patients prior to starting care, many are looking to technology for that additional information. Three of the most common decisions DCs make every day are determining what areas to adjust, what techniques and adjunctive methods to use, and the fre­quency of care. Decision-making be­comes even more complex with minimally symptomatic and wellness patients. And knowing whether to continue or withdraw care can be just as challenging. Larry Miggins. DC. has practiced in Seattle, WA, for more than 15 years and has been using sEMG for nearly half that time. As DC, practice coach, and instruc­tor in sEMG, he has performed and inter­preted over 6,000 scans. According to Dr. Miggins, "Doctors share the common dilemma ol'liovv to apply their techniques. And, while sEMG can't tell you exactly how to treat your patients, it can give you a definite advantage in making those de­cisions. It does this by providing addi­tional objective data for correlation with other clinical findings, thereby giving the doctor more confidence in determining a course of care." SEMG Benefits for the Doctor SEMG is a valuable tool for helping doctors identify areas of dysfunction, for differentiating muscular responses, and for tracking change over time. No matter what technique you use, you can apply it more effectively when you have the most amount of information possible about your patient. SEMG can also help deter­mine the symmetry of muscle activity, muscle recruitment patterns, areas of po­tential compensation, muscle injury and recovery, malingering, and response to care. And sEMG also offers the benefits of quantifiable data for clinical use, and clear, concise graphics to help patients understand their condition and their care. "Once you have the information you need, you can apply your technique with greater confidence and with the knowl­edge that you have a baseline of measur­able information for evaluating the patient's progress," says Dr. Miggins. "I also use thermography and sEMG for confirming suspected areas of dysfunc­tion. When both are abnormal in a par­ticular region, I consider that to be two more signs of subluxation in that area." When evaluating adjustment frequency, he uses the graphics as a guide, watch- ing for changes in abnormal readings. A steadily improving scan warrants less fre­quent care; but if readings spike again, it can be an indicator to increase treatment frequency. SE1MG Benefits for the Patient SEMG also provides detailed compara­tive information for tracking patient progress and response to care. This is especially valuable when making clinical decisions for asymptomatic or wellness patients. By performing intake and peri­odic scans, changes in muscle activity associated with dysfunctional areas can be continuously monitored. As patients improve, scan results become more bal­anced and readings decrease. Scan data and graphics also help patients under­stand retracing, and the phases they will experience as they change long-stand­ing patterns. "I find it helpful to explain to patients with chronic conditions that they will most likely feel a little worse before they feel better," says Dr. Miggins. "By performing periodic scans, I can show patients how this process is unfolding and, also, let them know when they are turning the corner." While it goes without saying that doc­tors favor particular techniques, sEMG can guide them in selecting one method over another, and in formulating their ex­pectations. "In my experience," says Dr. Miggins, "patients who are being treated with a structural technique, such as Gonstead or Diversified, will show faster improvement in their sEMG readings, while their thermal patterns take longer* to stabilize. I've found the opposite to be true for patients being treated wtih low-force methods. This can guide doctors in measuring patient progress and deciding when to change techniques.1" Static sEMG testing can be considered an "electronic form of palpation" that illustrates muscle balance around the spine. And sEMG can also help with decisions about the use of ad-junctive modalities. Palpable muscle density caused by spasm will show abnormal activity on dynamic sEMG, while well de­veloped muscles will generate normal dynamic patterns. A patient's response to the addition of modalities can be mea­sured by performing scans before and after the changes in care. Always consider this information in the broader context of the patient's overall presentation, and any other factors af­fecting patient progress. For patients considering spinal surgery or other medical op­tions, sEMG can help confirm progress under chiropractic care, or show that conservative methods are not yielding the de­sired results. For Dr. Miggins, one series of scans had an unexpected outcome. "A female patient of mine was progress­ing normally in every way, except for her thermography read­ings in the T2 to T4 region. I was uncomfortable with this finding and I referred her to her MD, who determined she had breast cancer. While these methods cannot diagnose specific conditions, they gave me enough information to be suspicious and look elsewhere for answers." To ensure you have the most data possible, all patients should receive both thermography and static sEMG testing on intake, and periodically, thereafter. Dynamic testing is also useful when considering rehab, evaluating its results, determining the patient's readiness for higher activity levels, and when justify­ing the need for continuing care. "I've found dynamic testing to be very helpful in making rehab decisions," says Dr. Miggins. "If a patient shows a decrease in co-contraction and fascicula-tion patterns, rehab is appropriate. But. if contraction, guard­ing, or muscle irritation increase with ROM testing, it may be too soon to begin this phase of care." The benefits of these findings and related objective data are substantial for the med-legal practitioner. Regardless of the techniques you choose, technology is a new practice partner that can make a world of difference for you and your patients. If you're looking for the ultimate confi­dence builder for what you do everyday, this new association just may be your answer. David Marcarian, MA, is founder and president of Preci­sion Biometrics, supplier of the Myo Vision sEMG and Thermoglide systems. He lectures for Palmer College of Chi­ropractic, and his course is endorsed by all U.S. chiropractic associations that mandate sEMG training. He has personally instructed more than 6,000 chiropractors on proper sEMG use. He can he reached at 800-969-6961, or visit his company's web site at wxw.myovision.com.