The evaluation data also may serve as a means for deciding which form of manual therapy is best suited for the particular patient. Identifying the various attributes of subluxation may help clarify why one patient responds quickly to treatment while another responds slowly or not at all. The identification of other findings will serve as a modifier or qualifier to the subluxation. The balance of the examination portion can be considered to focus on identification of pathophysiologic problems that may be associated with the subluxation. The traditional chiropractic portion of physical examination identifies the subluxation. The fundamental malady treated by doctors of chiropractic is the joint dysfunction commonly referred to as subluxation, vertebral subluxation complex (VSC), or vertebral subluxation syndrome (VSS). There remains, however, a great deal of controversy among chiropractors, as well as other practitioners of manual therapy, as to the most valid, objective, and efficient means of detecting joint dysfunction. As the most specialized and significant therapy used by the doctor of chiropractic involves the adjustment of the articulations of the human body, the articular examination becomes the focal point of the patient's evaluation. The chiropractic articular spinal examination is unparalleled in the healing arts. While the chiropractic examination considers all aspects, it especially emphasizes the assessment of the spinal column and the nervous system. This information allows a clinician to develop and implement indicated treatment procedures and determine their effectiveness. It also aids the clinician in clarifying the nature and extent of the lesion and to establish a basis on which to judge progress. The role of the evaluative process is to differentiate a particular pathologic process from other possible causes of the presenting signs and symptoms. A comprehensive examination is a critical step in the management of patients with musculoskeletal problems. It is therefore necessary to identify the nature and extent of the patient's problem before initiating treatment. Most patients seeking the services of health care professionals, including doctors of chiropractic, present with problems or complaints. This article suggests the need for, and possible form of, a standardized assessment procedure for use by chiropractic clinicians. The role of this assessment process in the chiropractic office is to determine whether the patient should receive chiropractic care only, chiropractic care in concert with other forms of health care, or a referral to another health care professional for some other form of stand-alone management such as acute, crisis care. Having gathered and interpreted this information, it must be processed in order to arrive at a sound clinical conclusion. Therefore, the clinical information that any primary contact provider would want, including a case history, physical examination, clinical laboratory findings, radiographic findings, and any other tests necessary to check for suspected health problems, is needed. Before employing any therapy, a clinician must first determine if there is a need for treatment. As such, they must maintain broad and thorough assessment/diagnostic skills. Key words: Articular range of motion, chiropractic, Medicare, palpation, physical examination, subluxationÄoctors of chiropractic are portals of entry to the health care system for many patients seeking health care services. Useful scientific data also are limited to only a few approaches, and there is a need for a more systematic assessment approach profession wide. Summary: Variation in assessment techniques exists for identification of spinal and other articular joint dysfunction. Method: A qualitative review of clinical and scientific literature related to assessment methodologies for subluxation was performed. Literature on assessment approaches is reviewed and a discussion is presented. Purpose: An approach to systematically perform clinical work-up for chiropractic subluxation is proposed. Send all comments or additions to: Topics in Clinical Chiropractic 2000 7 (3): 1–10 ~ FULL TEXT
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