Clinical Chiropractic最新文献

Paratonia and gegenhalten – the involuntary resistance to passive movement – are terms used in the field of neurology to describe a form of hypertonia often associated with dementia. It is however also found to be present in children suffering from developmental delay where it may be accompanied by signs of dyspraxia and learning disabilities. Its presence may cause an elderly patient to appear to be being deliberately difficult and the child to be misbehaving.

Objective

To bring an awareness of how common paratonia/gegenhalten are in a general patient population.

Method

An overview of the literature retrieved from searches of computerised databases, the world-wide web and authoritative texts.

Discussion

As paratonia in children and gegenhalten in the elderly population occur at significantly high rates, as has been found with many of the primitive reflexes, it is suggested that their retention and reappearance may be associated with the postnatal development of the brain and its demise associated with ageing.

Conclusion

With such a high percentage of both the juvenile and elderly population manifesting signs of resisted movement it is considered essential that practitioners dealing with either of these groups have a good working knowledge of this common neurological sign.

Background

To describe the chiropractic management of a patient with Scheuermann's kyphosis.

Case presentation

An 18-year-old male sought care for thoracic spine pain of over 6 weeks’ duration. Thoracic flexion and lumbar spine flexion/extension were decreased. Digital postural analysis showed postural kyphosis, anterior head carriage, shoulder protraction and posterior translation of the thorax relative to the pelvis. Radiographs demonstrated multiple spinal levels with endplate irregularities, suggestive of Schmorl's nodes primarily involving the thoracic spine with associated reduced anterior vertebral body heights. Thoracic kyphosis measured 90° from T1 to T11, with a left thoracic list and right rotation with right lateral lumbar curvature.

Conclusions

An 18-year-old man with Scheuermann's kyphosis was successfully managed using a combination of chiropractic adjustments and postural exercises. This suggests a role for chiropractic care for Scheuermann's kyphosis. Further research is necessary to examine this in more detail.

Introduction

Estimates place some 300 million people worldwide suffer from asthma with 180,000 deaths attributed to the disease. The financial burden from Asthma in Western countries ranges from $300 to $1,300 per patient per year. In the United States, asthma medication costs between $1 billion and $6.2 billion per annum. With an increasing prevalence of 50% every decade, there is no question that the burden of asthma is tremendous. The prevalence of complementary and alternative medicine (CAM) use amongst adult asthmatics ranges from 4% to 79% whilst, in children, it ranges from 33% to 89%. Of the various practitioner-based CAM therapies, chiropractic stands as the most popular for both children and adults. As with other chiropractors, the authors aspire to the principles of evidence-based practice in the care of asthma sufferers. Recent systematic reviews of the literature places into question the effectiveness of chiropractic. To assuage the discord between our clinical experience and those of our patients with the dissonant literature, we performed a systematic review of the literature on the chiropractic care of patients with asthma.

Methods

Our systematic review utilized the following databases for the years indicated: MANTIS [1965–2010]; Pubmed [1966–2010]; ICL [1984–2010]; EMBASE [1974–2010], AMED [1967–2010], CINAHL [1964–2010], Index to Chiropractic Literature [1984–2010], Alt-Health Watch [1965–2010] and PsychINFO [1965–2010]. Inclusion criteria for manuscript review were manuscripts of primary investigation/report published in peer-reviewed journals in the English language involving the care of asthmatic patients.

Results

The studies found span of research designs from non-experimental to true experimental studies consisting of 3 randomized controlled clinical trials (RCTs), 10 case reports, 3 case series, 7 cohort studies, 3 survey studies, 5 commentaries8 and 6 systematic reviews. The lower level design studies provide some measure of evidence on the effectiveness of chiropractic care for patients with asthma while a critical appraisal of 3 RCTs revealed questionable validity of the sham SMTs involved and hence the conclusions and interpretations derived from them. The RCTs on chiropractic and asthma are arguably comparison trials rather than controlled clinical trials per se.

Conclusion

Chiropractic may offer an alternative care approach for asthmatic patients. Future investigations of this conservative care approach for patients with asthma should pave the way for higher-level design studies such as randomized controlled clinical trials.