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ECU 2010 Donald R. Murphy DC, DACAN
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Dr. Murphy holds a Diplomate from the American Chiropractic Academy of Neurology and has been in clinical practice for over 20 years. He is Clinical Director of the Rhode Island Spine Center in Providence, RI, USA and Clinical Assistant Professor at the Alpert Medical School of Brown University as well as Adjunct Associate Professor in the Department of Research at New York Chiropractic College. He lectures throughout the world on various topics related to back pain, neck pain and headaches. Dr. Murphy has published dozens of articles in numerous peer-reviewed scientific journals and his textbook, Conservative Management of Cervical Spine Syndromes is widely utilized by chiropractic schools and field practitioners throughout the world. |
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Lecture
Session 1B
08.30-10.30 |
Cervical Manipulation and Stroke: Where are we now?The relationship between cervical manipulative therapy (CMT) and vertebral artery dissection and stroke (VADS) has been a source of great controversy for a many years. A great deal has been written about this topic, from emotionally charged commentaries to high quality science. The evolution of our knowledge about the relationship between CMT and VADS has evolved considerably, from a few case reports to surveys to biomechanical studies and, finally, to large case control studies.
The purpose of this presentation is to follow the evolution of the literature regarding this relationship to where we are today and to help the practicing chiropractor and policy makers understand the various issues related to CMT and VADS. In addition, to make recommendations as to what the responsibility is of the practicing chiropractic with regard to CMT and VADS.
The current understanding, based on the evidence to date, suggests that while there is a clear, though rare, temporal relationship between CMT and VADS, no plausible causal connection can be made. It appears that, as the most common initial symptom of vertebral artery dissection is neck pain and headache, there are instances in which a patient who has these symptoms, without obvious manifestation of stroke, consults a chiropractor for the neck pain and headache, and subsequent to this experiences a full stroke, independent of anything that the chiropractor does or does not do. This current understanding has changed the responsibility of the practitioner from one of “screening” to one of diagnosis and public health education. |
Workshop 1
Session 3B/4B
14.30-18.00 |
An Evidence Based Model for Diagnosis and Management of Cervical Spine SyndromesThe purpose of this course is to present an integrated approach to the diagnosis and management of patients with cervical spine syndromes. The approach is based on the three essential questions of diagnosis:
1. Are the patient’s symptoms reflective of a visceral disorder or a serious or potentially life-threatening illness?
2. From where is the patient’s pain arising?
a. Segmental joint signs
b. Centralization signs
c. Neurodynamic signs
d. Myofascial signs
3. What has gone wrong with this person as a whole that would cause the pain experience to develop and persist?
a. Instability
b. Oculomotor Dysfunction
c. Central pain hypersensitivity
d. Fear, catastrophizing, passive coping, poor self-efficacy, depression
Evidence-based methods of seeking the answers to these questions are used. The answers to these three questions allow for the formulation of a multifactorial diagnosis upon which treatment can be based. Evidence-based treatment approaches are then used to address the important diagnostic entities that are detected on history and examination. These are provided in an integrated cognitive-behavioral context. The recommended treatment approaches are:
1. In response to Question #1:
a) Special tests
b) Referral
2. In response to Question #2
a) Segmental joint signs: Manipulation
b) Centralization signs: End range loading maneuvers
c) Neurodynamic signs: Neural mobilization
d) Myofascial signs: Myofascial therapy
3. In response to Question #3
a) Instability: Stabilization training
b) Oculomotor dysfunction: Retraining of eye-head-neck coordination
c) Central pain hypersensitivity: Education and graded exposure
d) Fear, catastrophizing, passive coping, poor self-efficacy, depression: Education, graded exposure, counseling
This allows an algorithmic approach to diagnosis and treatment
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Workshop 6
Session 3C/4C
14.30-18.00 |
Case Presentations & Discussion: Presentations and Audience Participation in Diagnosis and Clinical Decision Making
Panel Member
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