ECU 2010 Allan Terrett MAppSc(Chiro), FACCS

	Dr. Allan Terrett is an Associate Professor in the School of Health Sciences at RMIT University (Australia) and teaches clinical neurology and clinical orthopaedics. His early research on vertebrobasilar stroke following spinal manipulation therapy was a major stimulus to research on this important topic. Dr. Terrett has been involved in over 300 medico legal malpractice cases as an expert witness in neurology and orthopaedic related claims of professional negligence.
Thursday, 13 May
Lecture Session 1A 09.00-10.30	Chiropractic is a Neurological Science (in the past, the present and the future) The earliest reference I can find, written by D.D.Palmer regarding chiropractic and the nervous system is 1899 (The Chiropractic, 1899, number 26). Over the last 110 years, neurology has been important as an explanation for the effects following chiropractic treatment with various neurological theories developed by chiropractors being: Nerve compression / irritation Spinal cord compression / irritation Somatovisceral (autonomic) reflexes Viscerosomatic reflexes Sympathetic nerve irritation Joint fixation - intrinsic (intraarticular meniscoid locking) and extrinsic, (capsulo-ligamentous sprain being the pain generator) Vertebrobasilar (brainstem) ischaemia Neurodystrophic hypothesis Central sensitisation / neuroplasticity Double Crush hypothesis Cerebral hibernation hypothesis The neurosciences have also been a major area of research for our scientists and is likely to continue to be, as there is no other organ system in the body which appears to be emerging as an explanation for our treatment. But neurology has another very important role in chiropractic, and that is in the minimisation of patient injury following our treatment. While chiropractic is a very safe method of health care, we have to accept that serious injury can occur. Other than sprains, strains, muscle soreness and fractures; the most serious injuries associated with our treatment are neurological, such as nerve compression syndromes, spinal cord compression syndromes, and brainstem ischaemic syndromes. The chiropractic profession has been a leader in the manual therapies professions in researching this difficult topic. With new research information that is becoming available, it is our obligation, not only to educate our students, but to educate practitioners who graduated 20 or 30 years ago, to take all steps to minimise patient injury.
Workshop 1 Session 3A/4A 14.30-18.00	Neurological Injury Following Chiropractic SMT Reports of neurological complications following spinal manipulation therapy (SMT) fall into six major categories: Cervical disc syndromes causing nerve root injury, Lumbar disc syndromes causing nerve root injury, Cervical disc syndromes causing spinal cord compression (myelopathy), Lumbar disc syndromes causing cauda equina syndrome, Cervico-cerebral (vertebral and carotid) artery dissections causing stroke syndromes, and Miscellaneous and often unexplainable post-manipulation events. After being involved as an expert witness in over 300 professional negligence (malpractice) cases, it is obvious that in many cases the injury could not have been foreseen, and therefore could not have been prevented. In many cases the patient already had an evolving pathology, and the outcome would have most likely been the same, whether the patient had or had not attended the practitioner. But many of the cases are not just bad luck, - they were just bad practice. In many chiropractic colleges the topic of injuries following chiropractic treatment is discussed a bit in neurology classes, a bit in technique classes and a bit in orthopaedic classes. At RMIT University we have developed a specific unit in the 5th year of our chiropractic program which deals with SMT associated injury. If a practitioner realises while taking the history, during the physical examination, or during or after treatment that: a nerve root compression syndrome is possible (1, 2 and 4 above), then the appropriate examination consists of myotome, dermatome, reflex and nerve tension tests. a brainstem syndrome is possible (5 above), then the appropriate examination consists of a screening cranial nerve examination. a spinal cord compression syndrome (3 above) is possible, then the appropriate examination consists of going to the lower limb and examining long tracts (especially the cortico-spinal tract), and many of the miscellaneous cases could not have been foreseen, but some may have been avoided by careful attention to the history and then performing an appropriate examination. In each case, these examinations in an uncomplicated case should be able to be completed within 3 minutes.
Saturday, 15 May
Workshop 6 Session 3C/4C 14.30-18.00	Case Presentations & Discussion: Presentations and Audience Participation in Diagnosis and Clinical Decision Making Panel Member