Nebraska Chiropractic Assistant Education and Continuing Education

• Describe the biomechanical fundamentals of grip, posture and swing
• Identify golf injuries and golfers’ problems
• Develop protocols of rehab, strength training and adjusting for golfers

• This contains all courses with the educational objectives listed from Sports Medicine 109 through Sports Medicine 113

• Investigate the anatomical structures strained during the Ober and Modified Ober tests for iliotibial band concerns
• Evaluate the utility of screening tests for predicting injury risk in athletes
• Describe the biomechanics associated with the extensor carpi ulnaris and recognize the variety of pathologies that can affect this structure
• Summarize recommendations for the assessment, diagnosis and management of Femoroacetabular Impingement (FAI)
• Assess whether expert and novice Functional Movement Screen raters can report the same scores

• Determine appropriate exercise recommendations
• Design a proper fitness program for patients
• Identify proper exercises for the osteoporotic patient
• Review exercise guidelines with patients and encourage compliance

Hour 1

• Review basic concepts of exercise physiology
• Understand the fitness training model
• Identify various communication strategies
• Determine appropriate behavior change techniques

Hour 2

• Identify the components of the client investigation stage
• Review the various tests to determine functional ability of a client
• Discuss the tests necessary to determine a clients physiological sport abilities
• Analyze proper movement patterns through testing

Hour 3

• Design an appropriate resistance exercise program
• Understand the components of an appropriate cardiovascular program
• Determine various ways to progress in training
• Review basic concepts of sport nutrition

• Summarize the current body of literature surrounding the anatomy and biomechanics of the iliotibial band (ITB), to better understand the etiology, clinical examination and treatment of ITB syndrome 
• Explore and integrate connections between tissue structures, function, environmental and personal factors for the management of patients with lateral epicondylosis 
• Outline our contemporary understanding of possible musculoskeletal causes of inguinal-related groin pain in athletes
• Determine whether the Ottawa Ankle Rules accurately rule out ankle fractures in adults 
• Compare non-operative treatment, open surgical repair, and minimally invasive surgery for acute Achilles tendon ruptures

• Illustrate the pathogenesis of CADs ­dissection mechanisms
• Identify putative causes and triggers of CAD
• Estimate the purported incidence of cerebrovascular syndromes following cervical manipulation
• Distinguish between the neurological syndromes
• Identify stroke risk factors in general
• Assess the value of pre-manipulation testing: to screen or not to screen?
• Outline the warning signs/symptoms of CAD
• Indicate what to include in the patient history and examination
• Describe what to do if you suspect CAD
• Point out how to communicate risk to patients as well as implementing strategies to prevent CAD
• Assess the current literature on the relationship between stroke and manipulation
• Describe the anatomy of the blood supply to the brain
• Summarize the clinical biomechanics of vertebral arteries
• Outline the epidemiology and classification of cervicocerebral (vertebral and internal carotid) arterial dissections (CAD) or strokes
• Recognize the diseases affecting cervicocerebral arteries

• This contains all courses with the educational objectives listed from Stroke and Manipulation 101 through Stroke and Manipulation 104

• Compare the associations of chiropractic care and stroke with primary care physician (PCP) care and stroke in the Medicare population
• Quantify risk of stroke after chiropractic spinal manipulation, as compared to evaluation by a primary care physician, for Medicare beneficiaries aged 66 to 99 years with neck pain
• Determine the hemodynamics in the Circle of Willis with Internal Carotid Artery Stenosis under cervical rotatory manipulation: a finite element analysis
• Review compensation claims for chiropractic in Denmark and Norway 2004-2012
• Examine the risk of traumatic injury associated with chiropractic SMT in the Medicare population

• Compare the risk of injury (via Medicare data) between two cohorts of patients treated by chiropractic spinal manipulation versus treatment by a primary care physician
• Investigate the association between chiropractic manipulative treatment and vertebrobasilar artery stroke
• Assess the level and quality of evidence regarding the potential association between cervical manipulation and cervical artery dissection/stroke
• Evaluate the diagnostic accuracy of premanipulative vertebrobasilar tests in terms of sensitivity, specificity, predictive values and likelihood ratios in adults
• Observe vertebral artery blood-flow after cervical manipulation and various head positions

• Outline methods used and estimations as to the incidence of cervical spinal manipulative therapy and subsequent vertebrobasilar ischemia.
• Review and describe cerebrovascular anatomy and hemodynamics.
• Discuss proposed patho-physiological mechanisms believed responsible for subsequent vertebrobasilar ischemia.
• Review and discuss past and present scientific literature to explore the evolution of what we think we know about the process of cervical spinal manipulative therapy and subsequent vertebrobasilar ischemia.
• Identify radiographic signs of a vertebral artery dissection.
• List and discuss the uses, pros and cons of current examination tools as they apply to vertebral artery dissection.
• Explore issues and examination procedures related to patient assessment as well as vertebrobasilar ischemia recognition and proper diagnosis.
• Define and contrast currently suggested procedures and develop a vertebrobasilar ischemia plan of action.
• Explore various perspectives and reveal bias in both public media and biomedical journals.
• Identify and define new theoretical concepts and prophylactic therapies.
• Give multiple examples of anti-chiropractic bias in the biomedical literature
• List and describe the most common red flags for a patient “at risk” for suffering Vertebrobasilar Ischemia following cervical manipulation.
• Recite list of scientific studies relating to laboratory testing of plasma Homocystine levels and its relationship to Vertebrobasilar Ischemia from vertebral artery dissection.
• List examples of bias against chiropractic cited in both the popular media as well as in biomedical journals.
• Critically review landmark articles regarding the issue of cervical manipulation and vertebrobasilar distribution ischemia.
• List studies suggesting that a high plasma homocystine level may be associated with vertebrobasilar dissection.
• Cite studies suggesting that increasing folic acid intake can reduce plasma Homocystine levels.
• Identify laboratory tests that may be useful in helping calculate an individual’s risk of suffering vertebrobasilar stroke following cervical manipulation.

• Cite the strength of evidence about whether chiropractic neck manipulation causes cervical artery dissection (CAD) based on a systematic review, meta-analysis, and evaluation of the body of evidence as a whole
• Summarize our current state of knowledge on cervical artery dissection and how it impacts the practice of cervical spinal manipulation
• Outline the state of knowledge regarding bedside diagnosis and management of an acute vestibular syndrome, with the suspicion for stroke 
• Describe the demographics, past health care utilization, and comorbidities of vertebrobasilar artery stroke patients in Ontario, Canada who consulted a chiropractor within one year prior to their stroke
• Analyze the nature of internal carotid artery biomechanics and associated risk of injury during cervical spinal manipulation

• Outline methods used and estimations as to the incidence of vertebrobasilar ischemia.
• Review and describe cerebrovascular anatomy and hemodynamics
• Discuss proposed patho-physiological mechanisms believed responsible for subsequent vertebrobasilar ischemia.
• Review and discuss past and present scientific literature to explore the evolution of what we think we know about the process of cervical spinal manipulative therapy and potential vertebrobasilar ischemia.
• Identify radiographic signs of a vertebral artery dissection.
• List and discuss the uses, pros and cons of current examination tools as they apply to vertebral artery dissection.
• Explore issues and examination procedures related to patient assessment as well as vertebrobasilar ischemia recognition
• Define and contrast currently suggested procedures
• List and describe the most common red flags for a patient “at risk” for suffering Vertebrobasilar Ischemia
• Recite list of scientific studies relating to laboratory testing of plasma Homocystine levels and its relationship to Vertebrobasilar Ischemia from vertebral artery dissection.
• List examples of bias against chiropractic cited in both the popular media as well as in biomedical journals.
• Critically review landmark articles regarding the issue of cervical manipulation and vertebrobasilar distribution ischemia.
• List studies suggesting that a high plasma homocystine level may be associated with vertebrobasilar dissection.
• Cite studies suggesting that increasing folic acid intake can reduce plasma Homocystine levels.
• Identify laboratory tests that may be useful in helping calculate an individual’s risk of suffering vertebrobasilar stroke

• Assess the association between cervical spinal manipulation and cervical artery dissection among adults in the United States using insurance claims data 
• Evaluate the relationship between cervical spinal manipulation and cervical artery dissection among Medicare beneficiaries aged 65–99 
• Describe the effects of cervical spine manipulation on the vertebral artery concerning length changes and associated tensile forces 
• Quantify the effects cervical spinal manipulation on angular displacements of the head relative to the sternum as well as associated vertebral artery length changes 
• Compare the total vertebral artery elongations during cervical spinal manipulation and range of motion procedures

• Summarize the concept of a subluxation as recognized by other Doctors of Chiropractic.
• List and discuss the various definitions of the term subluxation.
• Outline the basic premise of the effects of aging, subluxation and the adjustment.
• List and discuss terms used by other health professions for a similar clinical syndrome.
• Define pain, nociception and antalgia.
• Draw the basic nociceptive pathway to consciousness.
• Describe and differentiate antalgic scoliosis.
• List and discuss the various definitions of spinal adjustment, manipulation, and mobilization.
• List the deep paraspinal muscles responsible for subluxation maintenance.
• Compare and contrast paraspinal muscle response to the acute abdomen.
• List and discuss therapies used by other health professions for similar clinical syndromes.
• Describe and summarize the Maintland manipulation classifications.
• Itemize scientific evidence regarding physiologic studies regarding subluxations.
• Explain how and why documentation of a subluxation is so important for Medicare patients in chiropractic practice.
• Define requirements for chiropractic services to be covered by Medicare.
• List and discuss how a subluxation may be properly documented in the medical record for Medicare patients.

• Describe the profile of suicide in the US, noting psychosocial and cultural factors that effect risk
• Identify 3 common precipitating events for suicide attempts
• Describe risk factors for suicide including co-existing psychiatric disorders
• Name the most frequent co-existing psychiatric disorders
• Use the sad person scale to assess suicide risk
• Give examples of primary, secondary, and tertiary interventions
• Describe basic level interventions that take place in the hospital or community
• Identify key elements of suicide precautions and environmental safety factors in the hospital
• Describe the problem on non-suicidal self-injury
• Explain the range of self-protective behavioral responses
• Discuss 3 myths about suicidal behaviors
• Identify 2 cultural or social factors that relate to suicide
• Examine 4 categories of motivation for attempting suicide
• Explain how suicide affects family members and friends
• Describe 3 theories that attempt to explain the causes of suicide
• Discuss the occurrence of suicide throughout each life cycle
• Outline the process for assessing the suicidal potential of a client
• Choose 3 therapeutic goals and interventions for clients with suicidal behaviors

• Understand and differentiate thermal and nonthermal effects of ultrasound
• Understand the effect of ultrasound on tissue repair
• Identify potential hazards to the use of ultrasound
• Identify parameters to the safe use of ultrasound during clinical application
• Identify current trends in the use of ultrasound
• Identify methods for maximizing therapeutic effects of ultrasound and phonophoresis

Hour 1

• Identify the societal cost of migraine in the US
• Describe the global burden of disease studies related to migraine
• Summarize the genetic components of migraine to help understand the various phenotypes
• Define migraine based on the ICHD-3 criteria
• Outline the 4 main phases of migraine

Hour 2

• Summarize the impact of brainstem nuclei in migraine
• Identify how autonomic dysfunction impacts migraine and vice versa
• Explain how autonomic changes leads to blood flow abnormalities in the facial blood flow of migraine patients
• Distinguish the 3 main theories of migraine from the new ‘brain-state’ theory of migraine

Hour 3

• Be able to identify common dietary stressors for migraine and how to eliminate them
• Discuss vitamin, herbal, and other supplemental remedies for migraine
• Explain how an increased allostatic load increase the probability of migraine
• Identify migraine patients that would benefit from hormonal testing

Hour 4

• Discover how to tailor neuromodulation techniques to each migraine patient
• Identify current literature evaluating the benefits of low level laser
• Discuss probable mechanisms of action for low level laser
• Summarize migraine pathophysiology and explain a comprehensive approach to reducing and eliminating migraine days

• List the components of the vital signs
• Cite normal and abnormal pulse rates
• Define Tachycardia, Bradycardia and Arrhythmia
• Recognize factors that can influence heart rate and rhythm
• Identify common locations for palpating the pulse
• Describe the process for determining the pulse
• Outline the chambers of the heart
• Define systole and diastole
• Explain systolic and diastolic pressure
• Describe the procedure for obtaining the blood pressure
• Define hypertension and hypotension
• Recognize the blood pressure categories as define by the American Heart Association
• List causes and risk factors for hypertension and hypotension
• Recognize the ranges for normal body temperature by location
• Describe the procedure for obtaining body temperature, orally, in the ear and over the forehead
• Summarize the accuracy of the body temperature obtained at different locations
• Define fever, hyperthermia and hypothermia
• List causes and risk factors for fever, hyperthermia and hypothermia
• Define respiration rate
• Cite the normal range of respiration rate at different ages
• Define tachypnea and bradypnea
• List causes and risk factors for tachypnea and bradypnea

• Determine the epidemiology, etiology and background on obesity
• Assess the theories of obesity development and pathophysiology
• Outline the risks and morbidities related to obesity

• Outline the management of obesity
• Summarize the assessment of obesity for the busy clinician
• Synthesize the literature on the dietary management of obesity
• Discuss the role of exercise and physical fitness in the management of obesity and overweight

• Outline the principles of body composition assessment
• Review the anthropometic measures of body composition
• Discuss the circumference measurements of body composition
• Assess the laboratory and field assessments of body composition

• Outline the definition and components of health and wellness
• Review the dimensions of wellness
• Discuss various models of health and the need for wellness lifestyles
• Outline the publication and goals of Healthy People

• Identify the differences between the holistic and allopathic models for health and wellness
• Show how the Web of Well-Being can be used to assess and educate clients about the various factors impacting their wellness.
• Describe the conclusions of research into the benefits of meditation for human health.
• Explain the basic principles and practice of a simple mindfulness meditation technique.

• Emphasize the unique anatomy of the cervical spine as related to spinal trauma.
• Point put the importance of the uncinate process joints as related do disc herniation, the nerve root, the vertebral artery, and the spinal cord.
• Explain how cervical spine injury may manifest clinically as low back and leg pain.
• Explain the role for sleep and sleep’s influence on the ability to safely operate a motor vehicle.
• Summarize the influence of sleep on brain neurochemistry.
• Explain the influence of awareness on an impending collision and the muscles ability to protect joints.
• Explain how being “caught by surprise” by a collision is related to a poor prognosis for full recovery.
• Summarize the history of whiplash injuries, including mechanical mechanisms, biological mechanisms, pathology, diagnostics and management.
• Define the issues that the early whiplash literature got wrong.
• Emphasize the issues that early whiplash literature got correct.
• Summarize recent advances in the understanding of whiplash injuries, emphasizing anatomy, diagnostics, pain production and pain suppression.
• Integrate whiplash trauma, chronic pain, and chiropractic care.
• Point out the mathematics of how a low speed vehicle to vehicle collision can result in passenger injury.
• Explain why vehicle damage should not be used as a proxy for passenger injury.
• Integrate the concepts of awareness, rotation, and pre-accident spondylosis in injury magnitude and prognosis.
• Define the three phases of soft tissue healing and point out the time sequence for each phase.
• Justify the clinical interventions that have a positive therapeutic influence on each phase of soft tissue injury healing.
• Emphasize the concept of motion in the healing of injured soft tissues, especially spinal adjusting (specific manipulation) motion.
• Quantify acute injury and ultimate recovery(prognosis) by using measurement outcomes.
• Summarize the biology and published data on treatment frequency and duration for whiplash spinal trauma.
• Point out published studies relating to recovery and prognosis.
• Reference the incidence of acceleration of spondylosis in long-term studies following a whiplash injury.

Hour 1 

• Point out the probable mechanisms for direct injury to the lower back during motor vehicle collisions.
• Distinguish between radiculopathy, neuropathy, and sclerogenic referral of extremity pain.

Hour 2 

• Define the parameters for cervical and lumber spine central canal stenosis.
• Utilize both the Torg/Pavlov and the ratio radiographic methods for assessing cervical spine central canal stenosis.
• Explain the critical relationship between central canal stenosis and hyperextension spinal injuries.
• Demonstrate a practical method for the clinical assessment of cervical spine central canal stenosis.

Hour 3

• Identify differences seen between a blow brain injury and an inertial brain injury.
• Define the pathoanatomic and patho-biochemistry of injury.
• Explore the relationship between cervical spine injury and TBI

Hour 4

• Discuss the concept of how the systemic inflammatory profile affects local injury.
• List 8 systemic inflammatory factors that should be considered and co-managed on whiplash-injured patients.

Hour 5 

• Discuss the anatomy of the thoracic outlet.
• Demonstrate a management protocol for thoracic outlet syndrome.
• Define cervical angina.
• Demonstrate the single most important test to distinguish cervical angina

Hour 6

• Draw the anatomical basis for cervicogenic headache.
• Integrate cervicogenic headache and the temporomandibular joint (TMJ).
• Define inertial injury and the TMJ articulation.
• Demonstrate a practical assessment and management of TMJ injury.

Hour 7

• Distinguish between a percipient witness and an expert witness.
• Explain what a subpoena is and what it means to the treating chiropractor.
• Explain what a deposition is for the treating chiropractor. Summarize the basic rules of a treating expert deposition.
• Summarize the mechanics of a personal injury trial from the perspective of the treating chiropractor.

Hour 8 

• Demonstrate a typical soft tissue direct examination.
• Show the two most common drawings to support chiropractic care for soft tissue injuries.

• Recite exercise guidelines and recommendations by the ACSPPSE, HHS and ACOG
• Outline and describe 6 benefits of exercise during pregnancy
• Describe 4 maternal physiologic changes that occur during pregnancy
• Describe 3 physiologic changes associated with exercise during pregnancy
• List 5 relative and 5 absolute contraindications to exercise during pregnancy
• Describe 2 fetal outcomes associated with maternal exercise during pregnancy

• Review anatomy and physiology of the female patient
• Perform Physical Examination procedures unique to the female patient
• Identify conditions unique to the female patient that require referral to a Medical Doctor
• Discuss the presentation, evaluation, and management of conditions affecting women’s health within the scope of Chiropractic practice
• Discuss risk factors, screening and prevention recommendations with female patients
• Review nutritional supplementations that can augment conditions affecting women’s health within the scope of Chiropractic practice

Hour 1

• Illustrate the patterns behind disordered eating in female athletes.
• Distinguish differences in the hormonal cycle, and menstrual disturbances in different kinds of female athletes.
• Contrast the differences of evaluation and management of female athletes.
• Compare and contrast the chemically and structural differences between male and female athletes.

.Hour 2:

• List common female athletic injuries.
• Explain how to evaluate knee and lower leg injuries.
• Apply knowledge of muscle strength and hormonal differences to provide suitable training recommendations for a strength athlete.
• Explain nutritional deficiencies in female athletes.

 Hour 3:

• List the detriments in health and/or sports performance from lack of proper nutrition.
• Provide recommendations for appropriate nutritional guidelines for female athletes.
• Consider body composition, increase muscle mass, and improve overall sports performance of female athletes.

Hour 1

• Identify the radiographic features which aid in lesion recognition, to distinguish between benign or aggressive skeletal neoplasia.
• Expand overall radiographic interpretation skills with respect to diagnosis of benign skeletal neoplasia.
• Assess a variety of benign skeletal neoplasia for clinical significance, by reviewing which ones are merely incidental findings.
• Recognizing those benign conditions which possess malignant potential, by gaining familiarity with the clinical and radiographic changes that suggest malignant degeneration.
• Apply improved patient management when patients present with these conditions.