Mrs. Johnson has been referred for chiropractic treatment. This sequence of initial evaluation, referral for consultation and repeated assessment of treatment efficacy is a typical clinical care pathway.
Clinical Care Pathway
Image
Reference
Adapted From: A hospital-based standardized spine care pathway: report of a multidisciplinary, evidence-based process. J Manipulative Physiol Ther. 2011 Feb;34(2):98-106
Initial Visit with the Chiropractor
Gait and Range of Motion
Physical Examination: Some Important Concepts
- Assess balance status
- Gait (wide based/ataxic/shuffling)
- Observation of spine
- (curvature/antalgia)
- Range of motion
- Spinal
- Extremity
Image
Neurologic Examination in the Older Adult
- Special considerations:
- Myotomes
- Myotome- muscles innervated by a single nerve root
- Reflexes
- Dynamic Testing
- Sensory evaluation
- Dermatome- sensory region of skin innervated by a nerve root
- Pinprick
- Vibration
- Proprioception
- Myotomes
Orthopedic Exam
- Standing, seated, supine, prone
- Always perform what is most comfortable for the patient and gains the most information
- Named tests often do not provide the entire picture
- Anatomy
- Stretch, Compress, Distract, Translate the spine.
- Assessment of the spine in each of these directions assists in determining treatment plan.
- Directional preference
- Provides information for both treatment and home exercise
Treatment
- Fall prevention
- Nutritional Recommendations
- Osteoporosis: Calcium/Magnesium/Vit D
- Confirm with pharm D and primary care provider
- Encourage activity and exercise
- Activity is often better than specific exercises
- Referral to Physical Therapy for continuation of exercise program
