SlideShare a Scribd company logo
1 of 115
Download to read offline
How to confidently communicate
the science of chiropractic
Introductory Workshop
Dr Heidi Haavik
DG Melbourne 22nd February 2014
PhD, PG Dip, BSc (chiro), Bsc (physiology)
Director of Research, New Zealand College of Chiropractic
Adjunct Professor, Master of Health Sciences Program, University of Ontario Institute of Technology
World Federation of Chiropractic Research Council member
My background
 1999 University of Auckland, BSc, Physiology
 1999 Chiropractic degree from NZCC
 2000 Private chiropractic practice
 2003 University of Auckland, PG Dip (Science)
 2006 Director of Research, NZCC
 2007 Editorial board Journal of Chiropractic Education
 2008 PhD University of Auckland
 2009 Editorial board member of JMPT
 2011 World Federation of Chiropractic Research Council
 2011 Associate Graduate Faculty Member, UOIT
 2014 Adjunct Professor, Master of Health Sciences
Program, University of Ontario Institute of
Technology, Ontario, Canada.
My background
 15 national and international research awards
 ½ million dollars in national and international research grants
 Developed, course-coordinated and lectured in Neuroscience,
Research Methodology, Visceral Physiology, Professional
Development, etc.
 Co supervised 5 MSc students and 1 PhD student
 Authored 23 peer reviewed research manuscripts
 51 peer reviewed abstracts presented
 40 invited or keynote presentations in NZ, Australia, Europe and
USA
 Chiropractic, Research & Neuroscience business for 14 years
Heidi’s Vision
 A world of people expressing optimal
potential
Heidi’s mission
 Run a ridiculously successful and
Vitalistic International Centre for
Chiropractic Research
Heidi’s why
 To allow more people access to
chiropractic care through he
power of cutting edge top quality
research about mechanisms
Heidi’s role
1. Facilitate research
2. Mentor researchers
3. Inform / teach
4. Raise funds
Purpose of Today
That you can confidently talk
about the science of chiropractic
AIM: Confident Communication!
 Knowing what you can and cannot say
about the science of chiropractic
10
Outline for the day
 Where are you at now?
– Where do you want to get to?
– How I can best help you
 The Brain 101
 The big picture - chiropractic
 Science 101
 How to talk about specific
studies
heidi.haavik@nzchiro.co.nz
heidihaavik.com
• Written for the public
• Describes in easy to
understand language
what happens when we
adjust a VS
heidi.haavik@nzchiro.co.nz
Where are you at now?
In pairs (one being the chiro, the other
the patient) each take turns explaining:
 What a subluxation is
 How chiropractic care works
How did that go?
Where you
confident?
Do you know if your
‘story’ has scientific
backing?
The big
picture
In a nutshell
What is a subluxation?
How does chiropractic
care work?
A subluxation is.....
“a central segmental
motor control problem”
Which means that the central nervous system is not
controlling the movement pattern of the spinal
segment as it should, which alters the stretching of
the paraspinal muscles which changes the input to the
brain which impacts how it processes other
information
So that it can accurately perceive
what is going on and respond
appropriately
which in turn improves the
communication between your brain,
the body and the environment
Chiropractic is a healing art that
improves the health and function of
the spine
Wisdom vs Knowledge
When talking about the chiro-
relevant scientific studies:
1. This is what they did
2. This is what they found
3. This is what that possible means to
you
4. BUT..... (mention limitations with
study for you patient)
My potential role
 Help you communicate about the key neuroscience concepts
vital to understand how chiro care likely works
 Help you to understand and communicate about the
chiropractic relevant neuroscience research
 To patients, the public, and to other health care providers
 Help you to understand and communicate about the
chiropractic relevant neuroscience research specific to
particular groups
 Sports, paediatric, asymptomatic,
What I can help you with
Various topics:
 Research and science
 Difference between different research methods
 Evidence based practice
 Sensorimotor integration
 Mulitimodal integration
 Neural plasticity
 Inner body schema – inner brain reality
 How the brain works
Various topics
 Functional role of paraspinal muscles
 Segmental movement research and biomechanics
 Sensory chiro research
 SMI chiro research
 Motor control chiro research
 Functional outcomes chiro research
 Clinical chiro research
 Props to use to explain each topic
Props are helpful!!
• Simple tests you can do in your office
• Poster for the Office to help explain mechanisms
• Office brochures explaining mechanisms
• A book for the patient (fully referenced)
Office Poster
Patient pamphlet
The Brain & CNS 101
34
The Matrix
Principles of Neural Science by Eric R. Kandel,
James H. Schwartz, and Thomas M. Jessell.
Elsevier, 2000, 4th Ed, Ch 33, p. 654
 “IN THE PRECEDING PART of this book we
considered how the brain constructs internal
representations of the world by integrating
information from the different sensory
systems.
 These sensory representations are the
framework in which the motor systems plan,
coordinate, and execute the motor
programs responsible for purposeful
movement.”
This is SENSORI-MOTOR-INTEGRATION
This is MULTI-MODAL-INTEGRATION
In pairs, take turns explaining to each
other the following concepts:
 Multimodal integration and the
inner brain reality
 Sensorimotor integration and its
importance for accurate purposeful
movements
How did that go?
Where you
confident?
Did any questions
arise?
The inner brain reality
is it always accurate?
Phantom limb pain
Moseley GL, Olthof N, Venema A, Don S, Wijers M, Gallace A, Spence C. 2008.
Psychologically induced cooling of a specific body part caused by the illusory ownership of an
artificial counterpart Proc Nat Acad Sci USA; 105(35):13169-73. Copyright (2008) National
Academy of Sciences, U.S.A.
Central filtering of info
Sensory information in the central nervous
system is processed in stages, in the
sequential relay nuclei of the spinal cord, brain
stem, thalamus, and cerebral cortex. Each of
these processing stations brings together
sensory inputs from adjacent receptors and—
using networks of inhibitory neurons—
transforms the information to emphasize the
strongest signals.
Kandel, Schwartz, and Jessell, 2000, p.428
“We are continuously exposed to stimulation across
our senses; some of which is relevant to the task at
hand but most of which is not. The ability to isolate
and process appropriate sensory stimulation whilst
inhibiting irrelevant stimulation is essential in order to
achieve our goals in a timely and efficient manner.
However as we age it is thought that the inhibition of
irrelevant information becomes more difficult such
that available sensory information is processed more
extensively.”
(Setti et al 2011, Experimental Brain Research, 209;p.379)
Brain fills in the gaps and/or alters your
reality based on past expectations,
surrounding information and intentions.
““Ceoinsdr the anmzaig pweor of the
hmuan biran. It dseno’t metatr in waht
oredr the lrttees in a wrod are, the
olny tihng taht is iproamtnt is the frsit
and lsat ltetres are in the rghit pclae.
The rset can be a tatol mses and you
can sitll raed it wuhotit a plboerm.
Azanimg huh?”
Morning Tea
 9.35 – 10.20
Video clip – TEDxAdelaide - Lorimer Moseley -
Why Things Hurt:
http://www.youtube.com/watch?v=gwd-wLdIHjs
Pain and Plasticity
“We can mess with that”
48
Blind spot testing
Neural plasticity
Neural Plasticity
“Many important behaviors are learned. Indeed, we
are who we are largely because of what we learn and
what we remember. We learn the motor skills that
allow us to master our environment, and we learn
languages that enable us to communicate what we
have learned, thereby transmitting cultures that can
be maintained over generations. But not all learning is
beneficial. Learning also produces dysfunctional
behaviors, and these behaviors can, in the extreme,
constitute psychological disorders.”
Kandel, Schwartz, and Jessell, 2000, p.1228
Maladaptive vs Adaptive Plasticity
Maladaptive vs Adaptive Plasticity
Symptoms don’t just appear out of thin air
Neuroscience concepts covered:
 CSN, PNS, neurons, synapses, networks
 Internal representations
– Internal body schema
– Inner Matrix
 Problems with false internal body schema
– Phantom limb pain, tinnitus, and on smaller
scale
 Central filtering
 Brain filling in the gaps (blind spot)
 Neural plasticity (good and bad)
 Sensorimotor integration and movement control
The connection
between the
neuroscience and
chiropractic!
Paraspinal Muscles act as CNS sensors
Spinal muscle afferents are important
for the brain sensory integration of other
afferent input
Uthaikhup et al 2006. The influence of neck pain on sensorimotor function
in the elderly Archives of Gerontology and Geriatrics; 55 p.667
Spinal
adjustments
Appropriate
joint movement
Appropriate spinal
information sent to
brain and CNS
Appropriate
processing and
integration
by brain and CSN
Better control
of the spine
and body
The specific research hypothesis
Spinal
adjustments
Abnormal
Somatosensory
Filtering & processing
Altered function
(pain and disability)
Altered
sensorimotor
integration
Altered
motor control
Altered
afferent
input
Subluxation
Appropriate
Joint
movement
Normal
afferent
input
Appropriate
Somatosensory
Filtering & processing
Appropriate
sensorimotor
integration
Accurate
motor control
Good function
What evidence is there for this model?
Abnormal
Somatosensory
Processing
Altered function
(pain and disability)
Altered
sensorimotor
integration
Altered
motor control
Altered
afferent
input
Subluxation
Marshall & Murphy, 2006
Murphy et al, 2009; 2010
Haavik & Murphy 2012b
What evidence is there for this model?
Spinal
manipulation
Abnormal
Somatosensory
Processing
Altered function
(pain and disability)
Altered
sensorimotor
integration
Altered
motor control
Altered
afferent
input
Joint
dysfunction
Appropriate
Joint
movement
Appropriate
afferent
input
Appropriate
Somatosensory
Processing Appropriate
sensorimotor
integration
Accurate
motor control
Good function
Marshall & Murphy, 2006
Murphy et al, 2009; 2010
Haavik & Murphy 2012b
67
Amplitude
Time
Signal
Background 
noise
Amplitude
Time
Aberrant spinal movement
 Can mean that the brain may not be fully aware of what is
going on in your spine, which appears to influence how it
controls the rest of the body
– Growing body of research supports this!
 May impact the accuracy of our Matrix
– Theory, but with some evidence that suggests this
 Spinal function impacts integration of sensory information
 Growing body of research supports this!
 This could lead to accidents, the develop pain and
dysfunction, syndromes, conditions, etc.
So that it can accurately perceive
what is going on and respond
appropriately
which in turn helps clear up the
communication between your brain,
the body and the environment
Chiropractic care improves the
health and function of the spine
A subluxation is.....
“a central segmental
motor control problem”
Which means that the central nervous system is not
controlling the movement patter of the spinal segment
as it should, which alters the stretching of the
paraspinal muscles which changes the input to the
brain which impacts how it processes other
information
7 essential components
1. Neuroplasticity - Good or Bad
2. Inner brain reality / body schema
3. Subconscious processing
4. Brain fill in the gaps & filters info
5. Paraspinal muscles are SENSORS
6. What happens when a segment is not moving properly
7. What happens when we adjust these
Self Test!
See if you can
remember the
key essential
components to
explain the
effects of an
adjustment !
7 essential components
1. Neuroplasticity - Good or Bad
2. Inner brain reality / body schema
3. Subconscious processing
4. Brain fill in the gaps & filters info
5. Paraspinal muscles are SENSORS
6. What happens when a segment is not moving properly
7. What happens when we adjust these
Take 10 minutes to plan your 10 min talk about
the mechanisms of chiropractic care for a
patient’s Report of Findings. Include the
following components and use SIMPLE examples
1. Neuroplasticity - Good or Bad
2. Inner brain reality / body schema
3. Subconscious processing
4. Brain fill in the gaps & filters afferent info
5. Paraspinal muscles are SENSORS
6. What happens when a segment does not move
properly
7. What happens when we adjust these segments
Include in your the plan the use of Office Poster & Pamphlet!
Name: __________
Components:
Tick if 
discussed
Tick if simple 
example included:
Note what may have 
been missed:
Specific Notes:
Neuroplasticity – Can be 
good and bad
Inner brain reality /  body 
schema
Subconscious processing
Brain fill in the gaps & 
filters afferent info
Paraspinal muscles are 
SENSORS
What happens if spinal 
segments don’t move 
properly
What happens when we 
adjust these segments
Use of Poster
Use of Pamphlet
In groups of 3 Practice
the talk!
 One be the Chiro
 One the patient
 One take notes and provide feedback
 Rotate so everyone gets to try being
the chiropractor.
 Debrief after each round about what
worked well and what did not
Lunch
 12.30-1.45
Recap of Morning Session
Questions?
Review and you will
remember 70% more!
How did practical go?
Where you confident?
What were you less confident
about?
What did you not remember ?
Biggest gaps in
understanding/knowledge?
Neuroscience concepts covered:
 CSN, PNS, neurons, synapses, networks
 Internal representations
– Internal body schema
– Inner Matrix
 Problems with false internal body schema
– Phantom limb pain, tinnitus, and on smaller
scale
 Central filtering
 Brain filling in the gaps (blind spot)
 Neural plasticity (good and bad)
 Sensorimotor integration and movement control
Link between neuro to chiro concepts
covered:
 Functional role of paraspinal muscles
 The muscle spindle
 Where spindle info goes
 How spindle info impacts brain function
 Descending brain control of ...... everything
 The research model
 Effects of VS (too much or too little movement)
– Signal to noise ratio
– Working in the dark
Science & Research 101
Evidence Informed Practice
Improved
patient
outcomes!
Patients own values and expectation
Overall Working
Model
Narrow down to
testable question
Test with
scientific method
Interpret your
results
Clinical
research
Basic
Science
Research
The floor-plan research
methodology analogy
Basic Science
Qualitative researchClinical Trials
RCTs
Case reports
Copyright ©Dr Heidi Haavik 2014
Systematic Reviews
Editorials, Expert Opinion
Randomised Controlled Trials
Cohort Studies
Case-control Studies
Case Series, Case Reports
The hierarchy
of evidence
Turn to your neighbour and explain the
difference between basic science and
clinical science and answer the following:
1. How can you tell the difference between basic science and
clinical science? What evidence do each provide?
2. Can you think of some difficulties scientist have when doing
research into the subluxations and effects of adjusting them?
3. What is the key difficulty when trying to do clinical science with
a chiropractic intervention?
4. What is the benefit to you with good chiropractic basic science?
5. What is the benefit to you with positive chiropractic clinical
science?
2. Issues for scientists wishing to explore the
subluxation and the effects of the adjustment
 An intervention is supposed to be properly defined
and repeatable
– What is a subluxation?
– How do you find one?
– Can you find them reliably?
– What is the spinal manipulation / adjustment
intervention?
– Can it be repeated in a reliable manner?
3. What is the key difficulty when trying to do
clinical science with a chiropractic
intervention?
 Clinical research is about the effects of an
intervention on a particular condition
 So what (conditions) does chiropractic
treat?
Simple balance testing in the Office
Copyright ©Dr Heidi Haavik 2014 Copyright ©Dr Heidi Haavik 2014
Scrambled sentence & Blind spot
testing
Blind spot test
and instructions
in your booklet
Square Illusion
In groups of 3 practice these tests on
each other (patient, chiro, assessor)
 Square A and Square B illusion
 Blind spot testing
 Scrambled sentence
 Rhomberg’s testing
 Assessor: how are they communicating this, do
they seem confident, can they answer questions,
are they using their new knowledge?
How did that go?
Share with another
pair how it went
What was easy?
What was hard?
Where you
confident?
Afternoon Tea
 3.00 – 3.45
Lets get stuck into some studies
Clinical research
 Read and be able to discuss the RCTs and reviews
that demonstrate spinal manipulation is as good as
anything else out there for
– Back pain (E.g. UK BEAM study 2004 BMJ; LBP Brontfort et
al 2008; AM-LBP - Bishop et al 2010)
– Neck pain (Haldeman S, Carroll L et al. (2008) The Bone and
Joint Decade 2000-2010 Task Force on Neck Pain and Its
Associated Disorders; Executive Summary, Spine 33(4S):S5-S7)
– Headaches (See review in The chiropractic report Sept 2010)
Clinical research
 And that chiro patient satisfaction is MUCH better
than other care (See review in The chiropractic report Jan
2007)
 And we are more cost effective (See review in The
chiropractic report Nov 2009)
 And we are safe (Cassidy JD, Boyle, E, Cote et al. 2008 Risk of
Vertebrobasilar Stroke and Chiropractic Care: Results of a
Population-Based Case-Control and Case-Crossover Study, SPINE
33(4S): S176-183)
 There is even evidence for maintenance care for
low back pain (Senna MK, Machaly SA. 2011. Does Maintained
Spinal Manipulation Therapy for Chronic Non-Specific Low-Back Pain
Result in Better Long Term Outcome? SPINE)
In groups of 3 practice telling your
patient about the clinical research
there is about chiropractic
 See if you can turn the subject’s
attention from the clinical research to
the basic science research in simple
language
Feedforward Activation
(Marshall & Murphy. J Manipulative Physiol Ther 2006;29:196-202)
(Govorko,MScThesis,2007,p.106)
(Marshall & Murphy. J Manipulative Physiol Ther 2006;29:196-202)
Pre Adjustments
Post Adjustments
17/90 impaired FFA
13/17 retested
6 month later
38% improvement
in FFA times after
SI adjustments
Example 1
 This is what they did and this is what they found:
– They tested 90 healthy young male cricket players in their ability to feed-forward
activate their abdominal muscles - 19/90 could not
– Six months later 13/17 still could not
– One adjustment session – 40% improvement
 This is what this means to you
– You may not be able to feed forward activate your core abdominal muscles
– These are important low back support mechanism for you
– If you cannot you are basically causing mini low back whiplash each time you lift
your arm
– No symptoms in those guys, so you may not have felt it either – so can be why
your low back pain started.... You said you did not know why
– We know being unable to activate core muscles leads to LBP
 Caution/Limitations.......... ‘BUT...’
– You are a woman, the study was only on men
– We dont know how long the effects last, was only one pre/post
Practice this
 In groups of three (chiro, patient, assessor) practice telling a
patient about this study. Remember:
– What did they do
– What did they find
– What does this mean to your patient
– But....limitations of study
 Swap around so everyone has a go at being chiro
 Assessors: please provide feedback to chiropractor!
 Patient:
– create a story for the chiro (e.g. I’m a 48 female with LBP)
– And ask questions like – why did I get low back pain, I
had no injury, it just happened, why would chiropractic
work for me?
How did that go?
Share with another
pair how it went
What was easy?
What was hard?
Where you
confident?
(Award winning poster at 2009 WFC; Award winning paper at ACC RAC 2010)
Haavik & Murphy, 2011,
JMPT; 34:88-97
Copyright ©Dr Heidi Haavik 2014
Example 2
 This is what they did and this is what they found:
– Twenty-five SCNP participants and 18 control participants were tested for their elbow
JPS before to see if SCNP participants JSP was worse than controls – and they were!
– The SCNP group then were retested after either SM or control intervention. SM
improved elbow JPS!!
 This is what this means to you
– If your brain is not fully aware of where your elbow is, it could be why you keep
knocking it in doorframes
– This study suggests that spinal function impacts how accurately your brain can
interpret propriocpetive information from your arms
 Caution/Limitations.......... ‘BUT...’
– You are a older than the individuals in this particular study, although there is an study
done in 65 + year olds done with anckle JPS and they improved significantly over a
four week period
– We dont know how long the effects last, was only one pre/post
– The anckle study showed effects of 12 weeks chiro care, but no follow up done
Practice this
 In groups of three (chiro, patient, assessor) practice telling a
patient about this study. Remember:
– What did they do
– What did they find
– What does this mean to your patient
– But....limitations of study
 Swap around so everyone has a go at being chiro
 Assessors: please provide feedback to chiropractor!
 Patient:
– create a story for the chiro (e.g. I’m a 48 female with LBP)
– And as questions like – why did I get low back pain, i had
no injury, it just happened, why would chiropractic work
for me?
How did that go?
Share with another
pair how it went
What was easy?
What was hard?
Where you
confident?
Feedback Please
Resources & further info:
 Intermediate model here next year
 My book www.heidihaavik.com
 CJA and JEK review articles – email me!!
 CAA online learning modules
 NZCA/CCR online learning modules
 Seminar series like this to be run in NZ
 And Australia?

More Related Content

What's hot

Biofeedback and other Psychophysiological Techniques for Headache - Neuro Exp...
Biofeedback and other Psychophysiological Techniques for Headache - Neuro Exp...Biofeedback and other Psychophysiological Techniques for Headache - Neuro Exp...
Biofeedback and other Psychophysiological Techniques for Headache - Neuro Exp...
Norton Healthcare
 
Acupuncture Presentation
Acupuncture PresentationAcupuncture Presentation
Acupuncture Presentation
Irina Bubnova
 
Neuroplasticity
NeuroplasticityNeuroplasticity
Neuroplasticity
LMRF
 
Pain Management by Acupuncture
Pain Management by AcupuncturePain Management by Acupuncture
Pain Management by Acupuncture
yusiye
 

What's hot (17)

Biofeedback and headaches
Biofeedback and headachesBiofeedback and headaches
Biofeedback and headaches
 
Powerpoint acupuncture works
Powerpoint acupuncture worksPowerpoint acupuncture works
Powerpoint acupuncture works
 
Advances in Neurological Rehabilitation
Advances in Neurological RehabilitationAdvances in Neurological Rehabilitation
Advances in Neurological Rehabilitation
 
Biofeedback and other Psychophysiological Techniques for Headache - Neuro Exp...
Biofeedback and other Psychophysiological Techniques for Headache - Neuro Exp...Biofeedback and other Psychophysiological Techniques for Headache - Neuro Exp...
Biofeedback and other Psychophysiological Techniques for Headache - Neuro Exp...
 
Acupuncture presentation
Acupuncture presentationAcupuncture presentation
Acupuncture presentation
 
Shambavi
ShambaviShambavi
Shambavi
 
Biological basis of tcm & acupuncture
Biological basis of  tcm  & acupunctureBiological basis of  tcm  & acupuncture
Biological basis of tcm & acupuncture
 
InnerEngineering
InnerEngineeringInnerEngineering
InnerEngineering
 
Acupuncture Presentation
Acupuncture PresentationAcupuncture Presentation
Acupuncture Presentation
 
FICCDAT June 2011 Abstract
FICCDAT June 2011 AbstractFICCDAT June 2011 Abstract
FICCDAT June 2011 Abstract
 
The SharpBrains Guide to Brain Fitness (book presentation)
The SharpBrains Guide to Brain Fitness (book presentation)The SharpBrains Guide to Brain Fitness (book presentation)
The SharpBrains Guide to Brain Fitness (book presentation)
 
Evidence based acupuncture
Evidence based acupunctureEvidence based acupuncture
Evidence based acupuncture
 
Isha inner-engineering-medical research-summary
Isha  inner-engineering-medical research-summaryIsha  inner-engineering-medical research-summary
Isha inner-engineering-medical research-summary
 
Neuroplasticity
NeuroplasticityNeuroplasticity
Neuroplasticity
 
Acupuncture & pain relief
Acupuncture & pain reliefAcupuncture & pain relief
Acupuncture & pain relief
 
Pain Management by Acupuncture
Pain Management by AcupuncturePain Management by Acupuncture
Pain Management by Acupuncture
 
Acupuncture
AcupunctureAcupuncture
Acupuncture
 

Viewers also liked

Celebrity Chiropractic Chiro Ed
Celebrity Chiropractic Chiro EdCelebrity Chiropractic Chiro Ed
Celebrity Chiropractic Chiro Ed
Matthew Gilbert
 
Diagnosa penyakit
Diagnosa penyakitDiagnosa penyakit
Diagnosa penyakit
arieww
 

Viewers also liked (13)

Chiropractic Presentation
Chiropractic PresentationChiropractic Presentation
Chiropractic Presentation
 
50 analogies explaining chiropractic to patients
50 analogies explaining chiropractic to patients50 analogies explaining chiropractic to patients
50 analogies explaining chiropractic to patients
 
10 Benefits of Chiropractic Care for the Elderly
10 Benefits of Chiropractic Care for the Elderly10 Benefits of Chiropractic Care for the Elderly
10 Benefits of Chiropractic Care for the Elderly
 
Chiropractic And Pregnancy
Chiropractic And PregnancyChiropractic And Pregnancy
Chiropractic And Pregnancy
 
Chiropractic biophysics
Chiropractic biophysicsChiropractic biophysics
Chiropractic biophysics
 
Understanding Chiropractic
Understanding ChiropracticUnderstanding Chiropractic
Understanding Chiropractic
 
Chiropractor Bankstown: how can chiropractic help me?
Chiropractor Bankstown: how can chiropractic help me?Chiropractor Bankstown: how can chiropractic help me?
Chiropractor Bankstown: how can chiropractic help me?
 
Heart of gold chiropractic
Heart of gold chiropracticHeart of gold chiropractic
Heart of gold chiropractic
 
Celebrity Chiropractic Chiro Ed
Celebrity Chiropractic Chiro EdCelebrity Chiropractic Chiro Ed
Celebrity Chiropractic Chiro Ed
 
Spinal Dynamics - What is Chiropractic
Spinal Dynamics - What is ChiropracticSpinal Dynamics - What is Chiropractic
Spinal Dynamics - What is Chiropractic
 
Chiropractic Efficacy For The Treament Of Headache
Chiropractic Efficacy For The Treament Of HeadacheChiropractic Efficacy For The Treament Of Headache
Chiropractic Efficacy For The Treament Of Headache
 
Diagnosa penyakit
Diagnosa penyakitDiagnosa penyakit
Diagnosa penyakit
 
Herbalogi
HerbalogiHerbalogi
Herbalogi
 

Similar to Dr Heidi Haavik Melbourne Presentation

What is going on in psychiatry when nothing seems to happen
What is going on in psychiatry when nothing seems to happenWhat is going on in psychiatry when nothing seems to happen
What is going on in psychiatry when nothing seems to happen
Adonis Sfera, MD
 
Premotor Cortex Argumentative Analysis
Premotor Cortex Argumentative AnalysisPremotor Cortex Argumentative Analysis
Premotor Cortex Argumentative Analysis
Amanda Hengel
 
The Psychology Of Childhood Social And Emotional Development
The Psychology Of Childhood Social And Emotional DevelopmentThe Psychology Of Childhood Social And Emotional Development
The Psychology Of Childhood Social And Emotional Development
Kristen Stacey
 
NeuroAnatomy Resource List for Manual Therapists, Kimberly Burnham, PhD Nerve...
NeuroAnatomy Resource List for Manual Therapists, Kimberly Burnham, PhD Nerve...NeuroAnatomy Resource List for Manual Therapists, Kimberly Burnham, PhD Nerve...
NeuroAnatomy Resource List for Manual Therapists, Kimberly Burnham, PhD Nerve...
Kimberly Burnham, PhD
 

Similar to Dr Heidi Haavik Melbourne Presentation (20)

Kent talk pickersgill
Kent talk pickersgillKent talk pickersgill
Kent talk pickersgill
 
Use Your Mind to Change Your Brain: Tools for Cultivating Happiness, Love an...
Use Your Mind to Change Your Brain:  Tools for Cultivating Happiness, Love an...Use Your Mind to Change Your Brain:  Tools for Cultivating Happiness, Love an...
Use Your Mind to Change Your Brain: Tools for Cultivating Happiness, Love an...
 
Tononi koch-08
Tononi koch-08Tononi koch-08
Tononi koch-08
 
Mindfulness in Clinical Practice - Rick Hanson, PhD
Mindfulness in Clinical Practice - Rick Hanson, PhDMindfulness in Clinical Practice - Rick Hanson, PhD
Mindfulness in Clinical Practice - Rick Hanson, PhD
 
What is going on in psychiatry when nothing seems to happen
What is going on in psychiatry when nothing seems to happenWhat is going on in psychiatry when nothing seems to happen
What is going on in psychiatry when nothing seems to happen
 
Premotor Cortex Argumentative Analysis
Premotor Cortex Argumentative AnalysisPremotor Cortex Argumentative Analysis
Premotor Cortex Argumentative Analysis
 
Brain Bee Facts
Brain Bee FactsBrain Bee Facts
Brain Bee Facts
 
Self -Directed Neuroplasticity: Using the New Brain Research to Deepen Clinic...
Self -Directed Neuroplasticity: Using the New Brain Research to Deepen Clinic...Self -Directed Neuroplasticity: Using the New Brain Research to Deepen Clinic...
Self -Directed Neuroplasticity: Using the New Brain Research to Deepen Clinic...
 
Let’s master the digital toolkit to harness lifelong neuroplasticity
Let’s master the digital toolkit to harness lifelong neuroplasticityLet’s master the digital toolkit to harness lifelong neuroplasticity
Let’s master the digital toolkit to harness lifelong neuroplasticity
 
The Psychology Of Childhood Social And Emotional Development
The Psychology Of Childhood Social And Emotional DevelopmentThe Psychology Of Childhood Social And Emotional Development
The Psychology Of Childhood Social And Emotional Development
 
Mindfulness Workshop at Australian Counselling Association Conference 2016
Mindfulness Workshop at Australian Counselling Association Conference 2016Mindfulness Workshop at Australian Counselling Association Conference 2016
Mindfulness Workshop at Australian Counselling Association Conference 2016
 
Neuromarketing
NeuromarketingNeuromarketing
Neuromarketing
 
The Efficacy of Post Traumatic Stress Disorder Research for Former High Deman...
The Efficacy of Post Traumatic Stress Disorder Research for Former High Deman...The Efficacy of Post Traumatic Stress Disorder Research for Former High Deman...
The Efficacy of Post Traumatic Stress Disorder Research for Former High Deman...
 
CME on SLEEP, CONSCIOUSNESS & MEDITATION: NEUROPHYSIOLOGICAL CORRELATES
CME on SLEEP, CONSCIOUSNESS & MEDITATION: NEUROPHYSIOLOGICAL CORRELATESCME on SLEEP, CONSCIOUSNESS & MEDITATION: NEUROPHYSIOLOGICAL CORRELATES
CME on SLEEP, CONSCIOUSNESS & MEDITATION: NEUROPHYSIOLOGICAL CORRELATES
 
Buddha's Brain: The Practical Neuroscience of Happiness, Love and Wisdom - Ri...
Buddha's Brain: The Practical Neuroscience of Happiness, Love and Wisdom - Ri...Buddha's Brain: The Practical Neuroscience of Happiness, Love and Wisdom - Ri...
Buddha's Brain: The Practical Neuroscience of Happiness, Love and Wisdom - Ri...
 
Decolonization, Indigenization, spirituality conference 021721.pptx
Decolonization, Indigenization, spirituality conference 021721.pptxDecolonization, Indigenization, spirituality conference 021721.pptx
Decolonization, Indigenization, spirituality conference 021721.pptx
 
Buddha's Brain: The Practical Neuroscience of Happiness, Love and Wisdom
Buddha's Brain: The Practical Neuroscience of Happiness, Love and WisdomBuddha's Brain: The Practical Neuroscience of Happiness, Love and Wisdom
Buddha's Brain: The Practical Neuroscience of Happiness, Love and Wisdom
 
Cognitive Behavioral Therapy ( Cbt ) Essay
Cognitive Behavioral Therapy ( Cbt ) EssayCognitive Behavioral Therapy ( Cbt ) Essay
Cognitive Behavioral Therapy ( Cbt ) Essay
 
NeuroAnatomy Resource List for Manual Therapists, Kimberly Burnham, PhD Nerve...
NeuroAnatomy Resource List for Manual Therapists, Kimberly Burnham, PhD Nerve...NeuroAnatomy Resource List for Manual Therapists, Kimberly Burnham, PhD Nerve...
NeuroAnatomy Resource List for Manual Therapists, Kimberly Burnham, PhD Nerve...
 
Use Your Mind to Change Your Brain: Tools for Cultivating Happiness, Love and...
Use Your Mind to Change Your Brain: Tools for Cultivating Happiness, Love and...Use Your Mind to Change Your Brain: Tools for Cultivating Happiness, Love and...
Use Your Mind to Change Your Brain: Tools for Cultivating Happiness, Love and...
 

Recently uploaded

VIII.1 Nursing Interventions to Promote Healthy Psychological responses, SELF...
VIII.1 Nursing Interventions to Promote Healthy Psychological responses, SELF...VIII.1 Nursing Interventions to Promote Healthy Psychological responses, SELF...
VIII.1 Nursing Interventions to Promote Healthy Psychological responses, SELF...
JRRolfNeuqelet
 
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancementsCAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
Naveen Gokul Dr
 
Cytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose Academics
Cytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose AcademicsCytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose Academics
Cytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose Academics
MedicoseAcademics
 
Sonia Journal club presentation (2).pptx
Sonia Journal club presentation (2).pptxSonia Journal club presentation (2).pptx
Sonia Journal club presentation (2).pptx
palsonia139
 

Recently uploaded (20)

ESC HF 2024 Spotlights Day-2.pptx heart failure
ESC HF 2024 Spotlights Day-2.pptx heart failureESC HF 2024 Spotlights Day-2.pptx heart failure
ESC HF 2024 Spotlights Day-2.pptx heart failure
 
TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...
TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...
TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...
 
VIII.1 Nursing Interventions to Promote Healthy Psychological responses, SELF...
VIII.1 Nursing Interventions to Promote Healthy Psychological responses, SELF...VIII.1 Nursing Interventions to Promote Healthy Psychological responses, SELF...
VIII.1 Nursing Interventions to Promote Healthy Psychological responses, SELF...
 
The Orbit & its contents by Dr. Rabia I. Gandapore.pptx
The Orbit & its contents by Dr. Rabia I. Gandapore.pptxThe Orbit & its contents by Dr. Rabia I. Gandapore.pptx
The Orbit & its contents by Dr. Rabia I. Gandapore.pptx
 
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancementsCAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
 
ROSE CASE SPINAL SBRT BY DR KANHU CHARAN PATRO
ROSE  CASE SPINAL SBRT BY DR KANHU CHARAN PATROROSE  CASE SPINAL SBRT BY DR KANHU CHARAN PATRO
ROSE CASE SPINAL SBRT BY DR KANHU CHARAN PATRO
 
Post-Cycle Therapy (PCT) in bodybuilding docx.pdf
Post-Cycle Therapy (PCT) in bodybuilding  docx.pdfPost-Cycle Therapy (PCT) in bodybuilding  docx.pdf
Post-Cycle Therapy (PCT) in bodybuilding docx.pdf
 
Dermatome and myotome test & pathology.pdf
Dermatome and myotome test & pathology.pdfDermatome and myotome test & pathology.pdf
Dermatome and myotome test & pathology.pdf
 
Tips and tricks to pass the cardiovascular station for PACES exam
Tips and tricks to pass the cardiovascular station for PACES examTips and tricks to pass the cardiovascular station for PACES exam
Tips and tricks to pass the cardiovascular station for PACES exam
 
Cytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose Academics
Cytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose AcademicsCytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose Academics
Cytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose Academics
 
Treatment Choices for Slip Disc at Gokuldas Hospital
Treatment Choices for Slip Disc at Gokuldas HospitalTreatment Choices for Slip Disc at Gokuldas Hospital
Treatment Choices for Slip Disc at Gokuldas Hospital
 
ANAPHYLAXIS BY DR.SOHAN BISWAS,MBBS,DNB(INTERNAL MEDICINE) RESIDENT.pptx
ANAPHYLAXIS BY DR.SOHAN BISWAS,MBBS,DNB(INTERNAL MEDICINE) RESIDENT.pptxANAPHYLAXIS BY DR.SOHAN BISWAS,MBBS,DNB(INTERNAL MEDICINE) RESIDENT.pptx
ANAPHYLAXIS BY DR.SOHAN BISWAS,MBBS,DNB(INTERNAL MEDICINE) RESIDENT.pptx
 
Bangalore whatsapp Number Just VIP Brookefield 100% Genuine at your Door Step
Bangalore whatsapp Number Just VIP Brookefield 100% Genuine at your Door StepBangalore whatsapp Number Just VIP Brookefield 100% Genuine at your Door Step
Bangalore whatsapp Number Just VIP Brookefield 100% Genuine at your Door Step
 
DR. Neha Mehta Best Psychologist.in India
DR. Neha Mehta Best Psychologist.in IndiaDR. Neha Mehta Best Psychologist.in India
DR. Neha Mehta Best Psychologist.in India
 
Capillary Blood Collection Tubes: The Complete Guidebook
Capillary Blood Collection Tubes: The Complete GuidebookCapillary Blood Collection Tubes: The Complete Guidebook
Capillary Blood Collection Tubes: The Complete Guidebook
 
Mgr university bsc nursing adult health previous question paper with answers
Mgr university  bsc nursing adult health previous question paper with answersMgr university  bsc nursing adult health previous question paper with answers
Mgr university bsc nursing adult health previous question paper with answers
 
Gross Anatomy and Histology of Tongue by Dr. Rabia Inam Gandapore.pptx
Gross Anatomy and Histology of Tongue by Dr. Rabia Inam Gandapore.pptxGross Anatomy and Histology of Tongue by Dr. Rabia Inam Gandapore.pptx
Gross Anatomy and Histology of Tongue by Dr. Rabia Inam Gandapore.pptx
 
Gait deviations in Transtibial prosthesis users
Gait deviations in Transtibial prosthesis usersGait deviations in Transtibial prosthesis users
Gait deviations in Transtibial prosthesis users
 
Video capsule endoscopy (VCE ) in children
Video capsule endoscopy (VCE ) in childrenVideo capsule endoscopy (VCE ) in children
Video capsule endoscopy (VCE ) in children
 
Sonia Journal club presentation (2).pptx
Sonia Journal club presentation (2).pptxSonia Journal club presentation (2).pptx
Sonia Journal club presentation (2).pptx
 

Dr Heidi Haavik Melbourne Presentation

  • 1. How to confidently communicate the science of chiropractic Introductory Workshop Dr Heidi Haavik DG Melbourne 22nd February 2014 PhD, PG Dip, BSc (chiro), Bsc (physiology) Director of Research, New Zealand College of Chiropractic Adjunct Professor, Master of Health Sciences Program, University of Ontario Institute of Technology World Federation of Chiropractic Research Council member
  • 2. My background  1999 University of Auckland, BSc, Physiology  1999 Chiropractic degree from NZCC  2000 Private chiropractic practice  2003 University of Auckland, PG Dip (Science)  2006 Director of Research, NZCC  2007 Editorial board Journal of Chiropractic Education  2008 PhD University of Auckland  2009 Editorial board member of JMPT  2011 World Federation of Chiropractic Research Council  2011 Associate Graduate Faculty Member, UOIT  2014 Adjunct Professor, Master of Health Sciences Program, University of Ontario Institute of Technology, Ontario, Canada.
  • 3. My background  15 national and international research awards  ½ million dollars in national and international research grants  Developed, course-coordinated and lectured in Neuroscience, Research Methodology, Visceral Physiology, Professional Development, etc.  Co supervised 5 MSc students and 1 PhD student  Authored 23 peer reviewed research manuscripts  51 peer reviewed abstracts presented  40 invited or keynote presentations in NZ, Australia, Europe and USA  Chiropractic, Research & Neuroscience business for 14 years
  • 4. Heidi’s Vision  A world of people expressing optimal potential
  • 5. Heidi’s mission  Run a ridiculously successful and Vitalistic International Centre for Chiropractic Research
  • 6. Heidi’s why  To allow more people access to chiropractic care through he power of cutting edge top quality research about mechanisms
  • 7. Heidi’s role 1. Facilitate research 2. Mentor researchers 3. Inform / teach 4. Raise funds
  • 8. Purpose of Today That you can confidently talk about the science of chiropractic
  • 9. AIM: Confident Communication!  Knowing what you can and cannot say about the science of chiropractic
  • 10. 10
  • 11.
  • 12. Outline for the day  Where are you at now? – Where do you want to get to? – How I can best help you  The Brain 101  The big picture - chiropractic  Science 101  How to talk about specific studies
  • 14. heidihaavik.com • Written for the public • Describes in easy to understand language what happens when we adjust a VS
  • 16. Where are you at now?
  • 17. In pairs (one being the chiro, the other the patient) each take turns explaining:  What a subluxation is  How chiropractic care works
  • 18. How did that go? Where you confident? Do you know if your ‘story’ has scientific backing?
  • 19. The big picture In a nutshell What is a subluxation? How does chiropractic care work?
  • 20. A subluxation is..... “a central segmental motor control problem” Which means that the central nervous system is not controlling the movement pattern of the spinal segment as it should, which alters the stretching of the paraspinal muscles which changes the input to the brain which impacts how it processes other information
  • 21. So that it can accurately perceive what is going on and respond appropriately which in turn improves the communication between your brain, the body and the environment Chiropractic is a healing art that improves the health and function of the spine
  • 22.
  • 24. When talking about the chiro- relevant scientific studies: 1. This is what they did 2. This is what they found 3. This is what that possible means to you 4. BUT..... (mention limitations with study for you patient)
  • 25. My potential role  Help you communicate about the key neuroscience concepts vital to understand how chiro care likely works  Help you to understand and communicate about the chiropractic relevant neuroscience research  To patients, the public, and to other health care providers  Help you to understand and communicate about the chiropractic relevant neuroscience research specific to particular groups  Sports, paediatric, asymptomatic,
  • 26. What I can help you with Various topics:  Research and science  Difference between different research methods  Evidence based practice  Sensorimotor integration  Mulitimodal integration  Neural plasticity  Inner body schema – inner brain reality  How the brain works
  • 27. Various topics  Functional role of paraspinal muscles  Segmental movement research and biomechanics  Sensory chiro research  SMI chiro research  Motor control chiro research  Functional outcomes chiro research  Clinical chiro research  Props to use to explain each topic
  • 28. Props are helpful!! • Simple tests you can do in your office • Poster for the Office to help explain mechanisms • Office brochures explaining mechanisms • A book for the patient (fully referenced)
  • 31.
  • 32. The Brain & CNS 101
  • 33.
  • 34. 34
  • 36. Principles of Neural Science by Eric R. Kandel, James H. Schwartz, and Thomas M. Jessell. Elsevier, 2000, 4th Ed, Ch 33, p. 654  “IN THE PRECEDING PART of this book we considered how the brain constructs internal representations of the world by integrating information from the different sensory systems.  These sensory representations are the framework in which the motor systems plan, coordinate, and execute the motor programs responsible for purposeful movement.” This is SENSORI-MOTOR-INTEGRATION This is MULTI-MODAL-INTEGRATION
  • 37. In pairs, take turns explaining to each other the following concepts:  Multimodal integration and the inner brain reality  Sensorimotor integration and its importance for accurate purposeful movements
  • 38. How did that go? Where you confident? Did any questions arise?
  • 39. The inner brain reality is it always accurate?
  • 41. Moseley GL, Olthof N, Venema A, Don S, Wijers M, Gallace A, Spence C. 2008. Psychologically induced cooling of a specific body part caused by the illusory ownership of an artificial counterpart Proc Nat Acad Sci USA; 105(35):13169-73. Copyright (2008) National Academy of Sciences, U.S.A.
  • 42. Central filtering of info Sensory information in the central nervous system is processed in stages, in the sequential relay nuclei of the spinal cord, brain stem, thalamus, and cerebral cortex. Each of these processing stations brings together sensory inputs from adjacent receptors and— using networks of inhibitory neurons— transforms the information to emphasize the strongest signals. Kandel, Schwartz, and Jessell, 2000, p.428
  • 43. “We are continuously exposed to stimulation across our senses; some of which is relevant to the task at hand but most of which is not. The ability to isolate and process appropriate sensory stimulation whilst inhibiting irrelevant stimulation is essential in order to achieve our goals in a timely and efficient manner. However as we age it is thought that the inhibition of irrelevant information becomes more difficult such that available sensory information is processed more extensively.” (Setti et al 2011, Experimental Brain Research, 209;p.379)
  • 44. Brain fills in the gaps and/or alters your reality based on past expectations, surrounding information and intentions. ““Ceoinsdr the anmzaig pweor of the hmuan biran. It dseno’t metatr in waht oredr the lrttees in a wrod are, the olny tihng taht is iproamtnt is the frsit and lsat ltetres are in the rghit pclae. The rset can be a tatol mses and you can sitll raed it wuhotit a plboerm. Azanimg huh?”
  • 45. Morning Tea  9.35 – 10.20
  • 46. Video clip – TEDxAdelaide - Lorimer Moseley - Why Things Hurt: http://www.youtube.com/watch?v=gwd-wLdIHjs Pain and Plasticity
  • 47. “We can mess with that”
  • 48. 48
  • 51. Neural Plasticity “Many important behaviors are learned. Indeed, we are who we are largely because of what we learn and what we remember. We learn the motor skills that allow us to master our environment, and we learn languages that enable us to communicate what we have learned, thereby transmitting cultures that can be maintained over generations. But not all learning is beneficial. Learning also produces dysfunctional behaviors, and these behaviors can, in the extreme, constitute psychological disorders.” Kandel, Schwartz, and Jessell, 2000, p.1228
  • 54.
  • 55. Symptoms don’t just appear out of thin air
  • 56.
  • 57. Neuroscience concepts covered:  CSN, PNS, neurons, synapses, networks  Internal representations – Internal body schema – Inner Matrix  Problems with false internal body schema – Phantom limb pain, tinnitus, and on smaller scale  Central filtering  Brain filling in the gaps (blind spot)  Neural plasticity (good and bad)  Sensorimotor integration and movement control
  • 59. Paraspinal Muscles act as CNS sensors
  • 60.
  • 61. Spinal muscle afferents are important for the brain sensory integration of other afferent input Uthaikhup et al 2006. The influence of neck pain on sensorimotor function in the elderly Archives of Gerontology and Geriatrics; 55 p.667
  • 62. Spinal adjustments Appropriate joint movement Appropriate spinal information sent to brain and CNS Appropriate processing and integration by brain and CSN Better control of the spine and body
  • 63. The specific research hypothesis Spinal adjustments Abnormal Somatosensory Filtering & processing Altered function (pain and disability) Altered sensorimotor integration Altered motor control Altered afferent input Subluxation Appropriate Joint movement Normal afferent input Appropriate Somatosensory Filtering & processing Appropriate sensorimotor integration Accurate motor control Good function
  • 64. What evidence is there for this model? Abnormal Somatosensory Processing Altered function (pain and disability) Altered sensorimotor integration Altered motor control Altered afferent input Subluxation Marshall & Murphy, 2006 Murphy et al, 2009; 2010 Haavik & Murphy 2012b
  • 65. What evidence is there for this model? Spinal manipulation Abnormal Somatosensory Processing Altered function (pain and disability) Altered sensorimotor integration Altered motor control Altered afferent input Joint dysfunction Appropriate Joint movement Appropriate afferent input Appropriate Somatosensory Processing Appropriate sensorimotor integration Accurate motor control Good function Marshall & Murphy, 2006 Murphy et al, 2009; 2010 Haavik & Murphy 2012b
  • 66.
  • 67. 67
  • 70. Aberrant spinal movement  Can mean that the brain may not be fully aware of what is going on in your spine, which appears to influence how it controls the rest of the body – Growing body of research supports this!  May impact the accuracy of our Matrix – Theory, but with some evidence that suggests this  Spinal function impacts integration of sensory information  Growing body of research supports this!  This could lead to accidents, the develop pain and dysfunction, syndromes, conditions, etc.
  • 71. So that it can accurately perceive what is going on and respond appropriately which in turn helps clear up the communication between your brain, the body and the environment Chiropractic care improves the health and function of the spine
  • 72. A subluxation is..... “a central segmental motor control problem” Which means that the central nervous system is not controlling the movement patter of the spinal segment as it should, which alters the stretching of the paraspinal muscles which changes the input to the brain which impacts how it processes other information
  • 73. 7 essential components 1. Neuroplasticity - Good or Bad 2. Inner brain reality / body schema 3. Subconscious processing 4. Brain fill in the gaps & filters info 5. Paraspinal muscles are SENSORS 6. What happens when a segment is not moving properly 7. What happens when we adjust these
  • 74. Self Test! See if you can remember the key essential components to explain the effects of an adjustment !
  • 75. 7 essential components 1. Neuroplasticity - Good or Bad 2. Inner brain reality / body schema 3. Subconscious processing 4. Brain fill in the gaps & filters info 5. Paraspinal muscles are SENSORS 6. What happens when a segment is not moving properly 7. What happens when we adjust these
  • 76. Take 10 minutes to plan your 10 min talk about the mechanisms of chiropractic care for a patient’s Report of Findings. Include the following components and use SIMPLE examples 1. Neuroplasticity - Good or Bad 2. Inner brain reality / body schema 3. Subconscious processing 4. Brain fill in the gaps & filters afferent info 5. Paraspinal muscles are SENSORS 6. What happens when a segment does not move properly 7. What happens when we adjust these segments Include in your the plan the use of Office Poster & Pamphlet!
  • 78. In groups of 3 Practice the talk!  One be the Chiro  One the patient  One take notes and provide feedback  Rotate so everyone gets to try being the chiropractor.  Debrief after each round about what worked well and what did not
  • 80. Recap of Morning Session Questions?
  • 81. Review and you will remember 70% more!
  • 82. How did practical go? Where you confident? What were you less confident about? What did you not remember ? Biggest gaps in understanding/knowledge?
  • 83. Neuroscience concepts covered:  CSN, PNS, neurons, synapses, networks  Internal representations – Internal body schema – Inner Matrix  Problems with false internal body schema – Phantom limb pain, tinnitus, and on smaller scale  Central filtering  Brain filling in the gaps (blind spot)  Neural plasticity (good and bad)  Sensorimotor integration and movement control
  • 84. Link between neuro to chiro concepts covered:  Functional role of paraspinal muscles  The muscle spindle  Where spindle info goes  How spindle info impacts brain function  Descending brain control of ...... everything  The research model  Effects of VS (too much or too little movement) – Signal to noise ratio – Working in the dark
  • 87. Overall Working Model Narrow down to testable question Test with scientific method Interpret your results
  • 90. Basic Science Qualitative researchClinical Trials RCTs Case reports Copyright ©Dr Heidi Haavik 2014
  • 91. Systematic Reviews Editorials, Expert Opinion Randomised Controlled Trials Cohort Studies Case-control Studies Case Series, Case Reports The hierarchy of evidence
  • 92. Turn to your neighbour and explain the difference between basic science and clinical science and answer the following: 1. How can you tell the difference between basic science and clinical science? What evidence do each provide? 2. Can you think of some difficulties scientist have when doing research into the subluxations and effects of adjusting them? 3. What is the key difficulty when trying to do clinical science with a chiropractic intervention? 4. What is the benefit to you with good chiropractic basic science? 5. What is the benefit to you with positive chiropractic clinical science?
  • 93. 2. Issues for scientists wishing to explore the subluxation and the effects of the adjustment  An intervention is supposed to be properly defined and repeatable – What is a subluxation? – How do you find one? – Can you find them reliably? – What is the spinal manipulation / adjustment intervention? – Can it be repeated in a reliable manner?
  • 94. 3. What is the key difficulty when trying to do clinical science with a chiropractic intervention?  Clinical research is about the effects of an intervention on a particular condition  So what (conditions) does chiropractic treat?
  • 95. Simple balance testing in the Office Copyright ©Dr Heidi Haavik 2014 Copyright ©Dr Heidi Haavik 2014
  • 96. Scrambled sentence & Blind spot testing Blind spot test and instructions in your booklet
  • 98. In groups of 3 practice these tests on each other (patient, chiro, assessor)  Square A and Square B illusion  Blind spot testing  Scrambled sentence  Rhomberg’s testing  Assessor: how are they communicating this, do they seem confident, can they answer questions, are they using their new knowledge?
  • 99. How did that go? Share with another pair how it went What was easy? What was hard? Where you confident?
  • 101. Lets get stuck into some studies
  • 102. Clinical research  Read and be able to discuss the RCTs and reviews that demonstrate spinal manipulation is as good as anything else out there for – Back pain (E.g. UK BEAM study 2004 BMJ; LBP Brontfort et al 2008; AM-LBP - Bishop et al 2010) – Neck pain (Haldeman S, Carroll L et al. (2008) The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders; Executive Summary, Spine 33(4S):S5-S7) – Headaches (See review in The chiropractic report Sept 2010)
  • 103. Clinical research  And that chiro patient satisfaction is MUCH better than other care (See review in The chiropractic report Jan 2007)  And we are more cost effective (See review in The chiropractic report Nov 2009)  And we are safe (Cassidy JD, Boyle, E, Cote et al. 2008 Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study, SPINE 33(4S): S176-183)  There is even evidence for maintenance care for low back pain (Senna MK, Machaly SA. 2011. Does Maintained Spinal Manipulation Therapy for Chronic Non-Specific Low-Back Pain Result in Better Long Term Outcome? SPINE)
  • 104. In groups of 3 practice telling your patient about the clinical research there is about chiropractic  See if you can turn the subject’s attention from the clinical research to the basic science research in simple language
  • 105. Feedforward Activation (Marshall & Murphy. J Manipulative Physiol Ther 2006;29:196-202) (Govorko,MScThesis,2007,p.106)
  • 106. (Marshall & Murphy. J Manipulative Physiol Ther 2006;29:196-202) Pre Adjustments Post Adjustments 17/90 impaired FFA 13/17 retested 6 month later 38% improvement in FFA times after SI adjustments
  • 107. Example 1  This is what they did and this is what they found: – They tested 90 healthy young male cricket players in their ability to feed-forward activate their abdominal muscles - 19/90 could not – Six months later 13/17 still could not – One adjustment session – 40% improvement  This is what this means to you – You may not be able to feed forward activate your core abdominal muscles – These are important low back support mechanism for you – If you cannot you are basically causing mini low back whiplash each time you lift your arm – No symptoms in those guys, so you may not have felt it either – so can be why your low back pain started.... You said you did not know why – We know being unable to activate core muscles leads to LBP  Caution/Limitations.......... ‘BUT...’ – You are a woman, the study was only on men – We dont know how long the effects last, was only one pre/post
  • 108. Practice this  In groups of three (chiro, patient, assessor) practice telling a patient about this study. Remember: – What did they do – What did they find – What does this mean to your patient – But....limitations of study  Swap around so everyone has a go at being chiro  Assessors: please provide feedback to chiropractor!  Patient: – create a story for the chiro (e.g. I’m a 48 female with LBP) – And ask questions like – why did I get low back pain, I had no injury, it just happened, why would chiropractic work for me?
  • 109. How did that go? Share with another pair how it went What was easy? What was hard? Where you confident?
  • 110. (Award winning poster at 2009 WFC; Award winning paper at ACC RAC 2010) Haavik & Murphy, 2011, JMPT; 34:88-97 Copyright ©Dr Heidi Haavik 2014
  • 111. Example 2  This is what they did and this is what they found: – Twenty-five SCNP participants and 18 control participants were tested for their elbow JPS before to see if SCNP participants JSP was worse than controls – and they were! – The SCNP group then were retested after either SM or control intervention. SM improved elbow JPS!!  This is what this means to you – If your brain is not fully aware of where your elbow is, it could be why you keep knocking it in doorframes – This study suggests that spinal function impacts how accurately your brain can interpret propriocpetive information from your arms  Caution/Limitations.......... ‘BUT...’ – You are a older than the individuals in this particular study, although there is an study done in 65 + year olds done with anckle JPS and they improved significantly over a four week period – We dont know how long the effects last, was only one pre/post – The anckle study showed effects of 12 weeks chiro care, but no follow up done
  • 112. Practice this  In groups of three (chiro, patient, assessor) practice telling a patient about this study. Remember: – What did they do – What did they find – What does this mean to your patient – But....limitations of study  Swap around so everyone has a go at being chiro  Assessors: please provide feedback to chiropractor!  Patient: – create a story for the chiro (e.g. I’m a 48 female with LBP) – And as questions like – why did I get low back pain, i had no injury, it just happened, why would chiropractic work for me?
  • 113. How did that go? Share with another pair how it went What was easy? What was hard? Where you confident?
  • 115. Resources & further info:  Intermediate model here next year  My book www.heidihaavik.com  CJA and JEK review articles – email me!!  CAA online learning modules  NZCA/CCR online learning modules  Seminar series like this to be run in NZ  And Australia?