Hawaii Chiropractic Continuing Education

Musculoskeletal

• Explain the causes behind Musculoskeletal Injuries
• Compare the minimum/maximum times during the Acute, Repair, and Remodeling Phase of Recovery
• Summarize protocols for acute inflammation
• Demonstrate a Kinetic Chain Assessment
• Explain why indirect cause of injury can be as disabling due to tissue overuse and overload
• Contrast and compare male vs female most common extremity injuries
• Contrast the differences between high school, collegiate, and professional athletic injuries
• Summarize how gold-standard management drives lower injury rates and duration
  

Nutrition

• Develop components of a typical healthy meal plan for athletes
• Differentiate between healthy and unhealthy food choices in each category of FAT, CHO, PRO
• Identify problem foods specific to the individual athlete
• Explain CHO loading and examples of high glycemic index foods
• Describe meal plan for post-exercise "window of recovery"
• Describe benefits and sources of branched chain amino acids for athletic recovery
• Explain purpose of omega 3 fatty acids during recovery phase of athletic activity
• Define components of female athlete triad
• List vitamins and minerals required to rebuild bone health in female athlete triad
• Name ergogenic nutrients acceptable to the World Anti-Doping Agency

Dehydration

• Explain difference between dehydration and hyponatremia
• Recognize early or acute signs and symptoms of dehydration and hyponatremia
• Discuss benefits of each method of determining hydration status
• Demonstrate treatment intervention for heat cramps
• Compare energy drink to sports drink

Concussion

• Define and recognize brain concussion, second impact syndrome, and chronic traumatic encephalopathy.
• Describe frequency of sports concussion and common duration of signs and symptoms.
• Describe all possible results of head trauma, including second impact syndrome, intracranial hematoma, skull fracture, brain contusion, cervical injury (both mild and dangerous)
• Differentiate and rule out dangerous results from head trauma.
• Demonstrate proper exam procedures following head trauma on field.
• Demonstrate proper exam procedures to clear the cervical spine on field.
• Perform the SCAT 3 exam and describe how it is to be used both on field and in the office.
• Describe how and why one performs serial exams after head trauma on field.
• Describe return to play protocols for concussed athletes.
• Describe prevention procedures for sports concussion.

• Describe the biomechanics of rotation of a thoracic ring at the levels T1-T7.
• Describe the biomechanics of the Cervical spine, Thoracic spine, ribs, clavicle and manubrium with elevation of the right or left shoulder.
• Describe the biomechanics of flexion and extension at the Costotransverse joint at T9.
• Describe the differences in motion of the mobile segments between T3 -T7 with side flexion occurring first in the Thoracic spine.

• This contains all courses with the educational objectives listed from Breathing Essentials 201 through Breathing Essentials 207

• Describe the physiology of breathing and how altered pH can affect the body.
• Describe two functions of the diaphragm.
• Identify limited chest expansion and Bradcliff angles and ski jumps
• Identify limited lateral costal breathing and how to facilitate normal lateral costal breathing

• Describe how altered breathing patterns can alter pH and how this can affect the body.
• Describe the autonomic nervous system and function.
• Name three physiological consequences of respiratory alkalosis.
• Describe suboptimal breathing patterns and their effect on the cervical spine and chronic pain.

• Name and describe the different types of sleep apnea.
• Describe the three levels of Apnea-hypopnea index AHI.
• List five symptoms of sleep apnea.
• List two treatments for sleep apnea.

• Describe the physiological response of aerobic exercise on the respiratory system.
• Describe the effect of running on the viscera and the diaphragm.
• Describe the response to inspiratory muscle fatigue on the body.
• List one device than may increase endurance of the respiratory muscles.

• Describe the anatomical structure of the diaphragm including innervation and blood supply.
• List four causes that may damage the innervation to the diaphragm and effect normal function.
• Describe the factors involved in Intensive Care Unit Acquired Weakness.
• Be able to describe the pros and cons of early mobilization in the ICU.

• Explore contemporary healthcare issues from the perspective of Robert Lustig, MA and John Abramson, MD.
• Integrate the relevance of these issues to the chiropractic profession.
• Evaluate at the concept of evidence-based “medicine,” especially the “randomized controlled trial,” and describe how it applies to the chiropractic profession.
• Discriminate recent examples of “randomized controlled trials,” especially as related to pain syndromes and opioid drugs.Discusss the importance of the 2021 Nobel Prize for the chiropractic profession and mechanical-based care.
• Detail the physiology of the Piezo1 mechanical receptor.
• Introduce the concepts of mechanical function and mechanical neurology.
• Integrate the importance of the cerebellum to mechanical integrity and mechanical based care.
• Explain a randomized clinical trial that supports mechanical-based chiropractic care for visceral physiology.
• Distinguish the basic physiology of the neurotransmitter norepinephrine.
• State the basic physiology of the neurotransmitter dopamine.
• Outline the basic physiology of the neurotransmitter serotonin.
• Integrate the balance of the neurotransmitters dopamine and serotonin.
• Recite the relationship between the neurotransmitters dopamine, epinephrine and norepinephrine.
• Explore the concept of Heart Rate Variability (HRV).
• Integrate upper cervical chiropractic care, spinal chiropractic care, and HRV.

• Explain how beneficial commensal microbes support gastrointestinal health
• Describe the major components of the intestinal barrier
• Summarize the microbial composition of a typical stool sample
• Explain the role of comprehensive stool testing in assessing gastrointestinal health

• Recognize the three most common types of microbial dysbiosis
• Describe common factors that can reduce beneficial microbes and disrupt the intestinal barrier
• Assess pathogens and opportunistic microbes identified with comprehensive stool testing
• Discuss how the selection of microbial testing methodology may affect the identification of pathogens and opportunists
• Outline therapeutic approaches that address common dysbiosis types identified via comprehensive stool testing

• This course contains all courses with the educational objectives listed from Functional Medicine and Nutrition Virtual Classroom 201 through 210

• Describe the current epidemiologic trends in autoimmune incidence, morbidity and mortality.
• Associate the linkage between autoimmune disease prevalence and factors including the GI microbiota composition, food immune reactions, stealth infections, molecular mimicry, lack of early diverse antigen exposure, and other elements.
• Examine the available clinical laboratory testing related to autoimmune disease risk assessment, diagnosis, and clinical management, including qPCR molecular-based evaluation of the GI microbiota.
• Explain the difference between quantitative molecular testing (qPCR) versus next-generation sequencing of the GI microbiota in the support of clinical decision making.
• Appraise the available evidence-based integrative and complementary therapeutic interventions for autoimmune disorders.

• Describe the current common routes and mechanisms of toxic exposure for individuals living in the industrialized world.
• Associate the linkage between chronic diseases, including mitochondrial dysfunction, obesity, diabetes, Alzheimer’s disease, Parkinson’s disease, cancer and others with increased levels of exposure to various environmental and food toxins.
• Examine the available clinical laboratory testing related to toxic load and related disease risk assessment, diagnosis, and clinical management using various lifestyle and nutritional approaches.
• Explain the difference between the various methods to assess toxic burden and detoxification at the level of the individual in the support of clinical decision making.
• Appraise the available evidence-based integrative and complementary therapeutic interventions for lowering toxic load and improving detoxification function.

Hour 1

• Describe the general diagnostic criteria of Metabolic Syndrome and CVD.
• Demonstrate an understanding of the enhanced diagnostic criteria and the importance of investigating these potential earlier markers.
• Demystify the “Cholesterol and HDL hypothesis” and explain the compensation mechanisms of the body for this.
• Recognize the biometric and physical signs of the progressive nature of CVD, CHD and MetS.
• Investigate Lifestyle Modification Programs as the major intervention strategy for the reversal and stagnation of these comorbidities. 

• Describe the general dietary interventions of Metabolic Syndrome and CVD.
• Demonstrate an understanding of sodium/salt as it relates to CVD/HTN.
• Demystify the confusion of major supplements and foods as it relates to CVD/HTN. 
• Recognize the associations between insomnia and CVD, CHD and MetS.
• Investigate various peer reviewed studies and the outcomes of nutritional interventions.  

• Provide an understanding of the clinical applications of biochemical/metabolic evaluations to determine a patient’s hormonal status
• Explain the differences between various assessments of hormonal status
• Evaluate hormonal imbalances and disorders
• Evaluate nutrient needs in metabolic disorders Plan and monitor nutrient interventions to correct abnormalities found by the tests

• Describe the origin of mitochondria from an evolutionary perspective.
• Understand the critical role that the thyroid plays in metabolism and how this relates to healthy mitochondrial function.
• Explain how to test for mitochondrial function/dysfunction.
• Show how living in a thermos neutral modern society contributes to obesity.
• Recognize how antibiotics can damage mitochondria and how that can play a role in obesity.
• Give examples of toxins/drugs that can adversely affect mitochondria.

• Describe how common mitochondrial genetic problems are in the general population.
• Explain how mitochondria are needed to produce glutathione and why glutathione is needed for healthy mitochondria.
• Discover how oxidative stress can be both good and bad for the body.
• Discuss how mitochondrial dysfunction plays a key role in a variety of diseases ranging from Parkinson’s, Cancer, NASH, Alzheimer’s, Autism and Diabetes.
• Discover key ways to optimize mitochondrial function in patients.

• Describe the associations of micronutrient deficiencies as it relates mental health disorders.
• Demonstrate an understanding of major prescriptive medications and their negative influence on mental health disorders. 
• Explain the overlap of certain pathophysiological conditions and mental health disorders.
• Recognize the current lack of proper diagnosis of mental health disorder.

• Describe the associations of micronutrient and nutritional deficiencies as it relates mental health disorders.
• Demonstrate an understanding of the major biochemical pathways, their enzymes and nutritional elements as it relates to psychological issues.
• Explain the importance of fatty acids in mental health disorders.
• Recognize the current lack of proper nutritional interventions as it pertains to TBI, mTBI and PCS.

• Provide an understanding of the clinical applications of biochemical/metabolic evaluations to determine a patient’s status of nutrients, toxicants and cell regulators, and functional gastrointestinal status.
• Explain the differences between various assessments of element status
• Evaluate specific nutrient deficiency states
• Determine weaknesses in digestive, assimilative and intestinal microbiological status
• Plan and monitor nutrient interventions to correct abnormalities found by the tests

• Define and explain the difference between "calories in, calories out" versus the “carbohydrate-insulin model of obesity”. Discuss the causes of increased intestinal permeability in competitive athletes and identify strategies to combat the condition. Identify the energy intake athletes require by calculating their total energy expenditure.
• Recall the quality and function of macronutrients and their role in physical performance.
• Describe common micronutrient deficiencies seen in competitive athletes and identify strategies to prevent such occurrences.

• Summarize the physiological energy and macronutrient requirements of the sprint/power athlete and game-playing athlete. Identify supplement strategies to support the sprint/power athlete and game-playing athlete.
• Summarize the physiological energy and macronutrient requirements of the endurance athlete.
• Identify supplement strategies to support the endurance athlete.
• Outline an effective whole food diet to support competitive athletes.

• Describe the secondary metabolites in whole foods.
• Understand the role of phytochemicals.
• Demonstrate an understanding of how they interact with our cells.
• Explain how to preserve them during cooking.

• Recognize the challenges caused by ultra-processed foods
• Identify the compounds in the Brassicaceae family
• Explain the health benefits of sulforaphane
• Explain the importance of preserving secondary metabolites
• Recognize the benefits of the fungal kingdom

Hour 1

• Describe the characteristics and mechanisms of actions of essential oils.
• Explain several key controversies in aromatherapy and the implications.
• Generalize the safety and quality issues surrounding the clinical use of essential oils.
• Compare the various modes of applications of essential oils.
• Summarize the pharmacology and biotransformation of essential oils and its constituents.
• Recognize the potential interactions of essential oils with medications and nutraceuticals.

Hour 2 

• Generalize the various considerations for prescribing essential oils.
• Calculate equivalent dosages of essential oils using several different units of measurement.
• Apply the guidelines for appropriate prescribing the internal use of essential oils.
• Determine the proper application and dosage for various essential oils used for digestive health.
• Specify the usage and dose determination for essential oils for mental health.

• Analyze the concept of central pain processing and the consequences of dysfunction of descending inhibition.
• Associate FM with trauma and abuse, depression, anxiety, sleep disorder and pain processing disorders with emphasis on limbic system dysfunction, aberrant stress physiology, and ultimate failure of descending anti-nociception. 
• Assess the difference between regionalized somatic pain and true central allodynia
• Describe the accurate differential diagnosis of patients presenting with suspicion of FMS
• Identify common subsets of clinical disorders that may lead to an erroneous diagnosis of FMS (i.e., “pseudo” FMS)

• Describe and Identify the functional medicine approach to common pediatric problems
• Develop a comprehensive functional medicine assessment and treatment of common pediatric problems such as constipation, headaches and migraines, upper respiratory infections and otitis media, food sensitivities, allergies, asthma and atopy
• Examine the salient features of history, physical examination and laboratory testing to best implement functional medicine interventions to common pediatric problems
• Utilize a functional medicine approach to assess what each child may need to get or get rid of to treat each of these common pediatric problems 
• Summarize the literature supporting the use of functional medicine in pediatrics
• Recognize the four pillars of a functional medical approach to chronic pediatric illness – gastroenterologic, immunologic, metabolic and neurologic
• Classify and explain the importance of the genetic and genomic susceptibilities/predisposition and environmental triggers of chronic pediatric illnesses
• Utilize a functional medicine approach to assessing and treating chronic pediatric disease such as ADHD, Autism, Autoimmune Encephalitis, Anxiety, Allergy and Atopy
• Interpret the literature citations and develop protocols based on emerging evidence supporting a functional medicine approach to these chronic pediatric problems
• Appraise the assessment and management of the importance of the microbiome in immune tolerance, allergy and autoimmunity.

• Discuss the catecholamine pathway will be presented in an organized fashion with emphasis on real world applications. 
• Review clinical case studies. 
• Assess different genetic mutations within the catecholamine pathway . 
• Individualize treatment plans in practice. 
• Demonstrate a basic road map of the catecholamine pathway. 
• Use genetic parsing software and the tools attained form this course to highlight and modulate genes/SNPs of interest. 
• Derive natural therapeutic agents to modulate epigenetic expression. 
• Utilize basic nutrigenomic assessment and treatment knowledge in the catecholamine pathway.

• Define and explain the different terms that identify exercise intensity and their relationship to maximal oxygen uptake (VO2 max).
• Discuss the history of exercise physiology and how technology influenced research and ultimately, exercise guidelines.
• Differentiate the physiological responses to sprint interval training and to low-to-moderate intensity continuous training.
• Reconstruct a lay explanation to patients and/or clients of why sprint interval training is an extremely effective strategy for improving overall health and fitness.
• Summarize key research studies that support sprint interval training.

Hour 2

• Recognize additional research that supports sprint interval training.
• Identify key physiological benefits of sprint interval training.
• Recall important case study benefits.
• Outline effective overall strategies for implementing sprint interval training.
• Distinguish appropriate sprint interval exercises for differing populations.

Hour 1:

• Summarize the differences between genomics, genetics, and epigenetics
• Illustrate how genomics can affect risk and outcomes in auto-immune and inflammatory conditions
• Interpret relative function of genes based on presence of relevant SNPs
• Identify genes and SNPS involved in autoimmune disease and chronic inflammation
• Assess Dietary, Lifestyle and Herb/Nutrient recommendations based on genomics

 Hour 2:

• Apply nutritional genomics in autoimmune and inflammatory diseases
• Outline basic disease pathogenesis in autoimmune and inflammatory diseases
• Explain which genes and SNPs are relevant depending on the clinical scenario
• Assess other contributors to chronic inflammation and autoimmune disease

• Discuss ethical standards of insurance reporting and coding
• Illustrate how documentation can affect state board complaints
• Discuss why insurance companies file complaints against chiropractors
• Discuss why patients file board complaints against chiropractors
• Define the Problem Oriented Medical Record (POMR)
• Illustrate taking a thorough history using the OPQRST method
• Discuss the components of the ortho/neuro exam

Hours 1 - 3

• Discuss ethical standards of insurance reporting and coding
• Illustrate how documentation can affect state board complaints
• Discuss why insurance companies file complaints against chiropractors
• Discuss why patients file board complaints against chiropractors
• Define the Problem Oriented Medical Record (POMR)
• Illustrate taking a thorough history using the OPQRST method
• Discuss the components of the ortho/neuro exam

• Discuss the misrepresentation of certain orthopedic tests
• Illustrate sensitivity and specificity of orthopedic tests
• Define the 2021 changes to Evaluation and Management codes
• Discuss the differences between using time vs. medical decision making for E/M
• Distinguish between subjective and objective outcome assessments Illustrate methods of proving medical necessity
• Illustrate the CMS requirements of chiropractic documentation
• Illustrate condition-specific functional outcome questionnaires
• Define the A of P.A.R.T. from Centers for Medicare/Medicaid Services
• Define the R of P.A.R.T. from Centers for Medicare/Medicaid Services
• Illustrate the different methods of evaluating spinal range of motion
• Define the T of P.A.R.T. from Centers for Medicare/Medicaid Services
• Describe the timing of the first re-assessment
• Demonstrate proper coding for range of motion measurements
• Describe the P.A.R.T. format of documentation
• Define the P of P.A.R.T. from Centers for Medicare/Medicaid Services
• Describe the concept of outcome assessments in clinical practice

• Illustrate different outcome assessments for the T of P.A.R.T
• Demonstrate the POMR and P.A.R.T. formats for the initial patient encounter
• Integrate the POMR and P.A.R.T. formats for subsequent patient encounters
• Discuss proper diagnosing in notes and on a claim form
• Define the short, moderate and long-term diagnoses for Medicare
• Define proper Assessments
• Illustrate how to determine an assessment for each condition
• Illustrate complicating factors that can be documented for each condition