Rick Junnila, DC FPSC, DAAPM

Current and Future Trends in Documentation, Evidence-Based demonstrative documentation for creating successful patient-centered collaborative care. Using "reputation building" through effective documentation to develop relationships with MD PCPs, MD Specialists, ERs, and Urgent Care Centers. Using demonstrative evidence will eradicate the Non-Specific Back Pain "Dogma,” allowing chiropractic utilization to increase based on the evidence.

MRI SpineAncillary Tumor Detection and Advanced Imaging Stroke Detection, Spinal imaging techniques to assess spinal structures and detect abnormalities. The sequences also identify ancillary findings such as renal, ovarian, extradural, and intradural tumors. Careful evaluation of spinal MRIs can reveal critical pathologies beyond musculoskeletal issues. Analyzing the morphology of the abdominal aorta to determine potential stroke risks.

Analyzing Spinal Pathobiomechanics, Identifying and diagnosing spinal segmental lesions in the facet, joint capsules involving ligamentous mechanoreceptors, and spinal proprioceptors. The central segmental motor control mechanism with upper motor neuron involvement with disparate efferent effects and demonstrative diagnostic tools to differentially diagnose the primary lesion. The statistical outcome of treating biomechanical spinal lesions.

Identifying and diagnosing spinal segmental lesions in the facet, joint capsule involving ligamentous mechanoreceptors, and spinal proprioceptors. The central segmental motor control mechanism with upper motor neuron involvement with disparate efferent effects and demonstrative diagnostic tools to differentially diagnose the primary lesion. The statistical outcome of treating biomechanical spinal lesions.

Advanced Credential Reporting, creating a professional bio and CV, essential for establishing credibility in the medical-legal field. Incorporating outcome statistics from cases helps demonstrate your work's real-world impact, especially in the medical legal arena. Getting published in the National Institutes of Health (NIH) using research, peer review, and adherence to scientific standards and enhances your reputation by validating your work within the healthcare community and increasing your authority in the healthcare community field.

Age-Dating Herniated Disc via MRI and X-Ray, Utilizing the evidence in the literature to age-dating spinal herniated discs and trauma. Including interpreting X-rays, MRIs in T1, T2, STIR and Fat Saturation sequences, and other imaging alongside understanding the evidence of joint pathology. Being able to collaborate with physicians or as a medical-legal expert. Accurate age-dating helps establish a prognosis for patient recovery. The process must be grounded in evidence-based rationale to ensure reliability. Mastering this skill enhances both clinical decision-making and legal credibility.

Clinical Grand Rounds in Primary Spine Care, Clinical Grand Rounds for a case involve assessing disc, ligament, and spinal pathology. The process includes establishing a diagnosis, determining the prognosis, and developing a treatment plan. Special attention is given to conditions such as cord edema, myelomalacia, myelopathy, and tethered cords. Utilizing follow-up examinations as a step in crucial in refining the diagnosis and treatment approach. Adjustments to the treatment plan are made as new clinical findings emerge. This ensures that patient care remains dynamic and responsive to evolving spinal conditions.

Understanding future trends in chiropractic and clinical record-keeping is essential for maintaining professional excellence and delivering a high-quality patient care. As healthcare evolves with new technologies and reimbursement models, clinical documentation must adapt to remain effective and compliant. This module provides a structured, step-by-step guide to creating accurate clinical notes, covering their purpose, context, key elements, practical tips, and relevant legal considerations. Mastery of these skills supports both regulatory compliance and the highest standards of patient care.

Provided instruction in the interpretation of MRI sequences, including sagittal, axial, T1, T2, STIR, and proton density. Trained students to accurately identify vertebrae, spinal cord, discs, nerve roots, thecal sac, posterior longitudinal ligament, epidural veins, and fat saturation pulses. Emphasized recognition of common pathologies such as bulges, herniations, protrusions, extrusions, myelomalacia, cord edema, and Schmorl’s nodes. Developed students’ practical skills in applying MRI findings to clinical decision-making.

This module covers the foundational principles of biomechanical lesions, starting with ligamentous pathology and extending to overall biomechanical dysfunction. Students will learn how ligament damage impacts spinal stability and joint function. The course explores the compensatory changes that develop into chronic biomechanical pathology. Emphasis is placed on the clinical relevance of these lesions for accurate diagnosis, effective treatment, and thorough documentation.

This module examines the neurological impact of connective tissue injuries and biomechanical pathology. It highlights how structural damage can create effector organ dysfunction, leading to abnormal neurological signaling. The course traces the progression from localized tissue pathology to widespread central sensitization. Focus is placed on understanding the mechanisms that connect tissue injury to long-term neurological consequences.

This module develops the essential skill of “Evidence-Based” age-dating for herniated discs and spinal trauma. Students will learn to combine imaging interpretation from X-ray, MRI, and other modalities with clinical insights into joint pathology. Emphasis is placed on applying this expertise in collaborative medical and medical-legal contexts. The course also underscores the importance of evidence-based reasoning in establishing accurate patient prognoses.

This module covers the diagnosis and management of ligament pathology in acute and chronic patients. It reviews the evidence-based physiology of ligament morphology, trauma mechanisms, and resulting compensatory spinal changes. A master-level analysis addresses ligament anatomy, vascularization, neurological innervation, and tissue repair, emphasizing clinical relevance. The course also explores how ligament pathology drives patho-neuro-biomechanical lesions and informs the mechanisms of chiropractic spinal adjustments.

This module focuses on the screening and diagnosis of brain injuries, from concussion and mild traumatic brain injury (mTBI) to severe TBI and stroke. It emphasizes recognizing key clinical signs to support timely and accurate assessment. Participants learn essential triage protocols to ensure patients receive appropriate care. The course also introduces evidence-based strategies for distinguishing between conditions and minimizing the risk of delayed or missed diagnoses.

This course module provides an evidence-based framework for spinal diagnosis, focusing on accurate identification of specific pathologies rather than generalized labels like “non-specific back pain.” Clinicians are trained to integrate clinical assessment and imaging findings to establish definitive diagnoses. The module emphasizes collaborative management with medical specialists to improve patient outcomes. Participants learn to apply evidence-based reasoning to guide treatment decisions and strengthen interdisciplinary care.

This course module outlines the documentation requirements essential for supporting long-term chiropractic care and fostering collaborative relationships. It provides an evidence-based framework for spinal diagnosis, emphasizing precise identification of specific pathologies over broad labels such as “non-specific back pain.” Clinicians are trained to synthesize clinical assessments with imaging findings to establish accurate and definitive diagnoses. The module highlights strategies for collaborative management with medical specialists to optimize patient outcomes. Participants learn to apply evidence-based reasoning to guide treatment decisions while enhancing interdisciplinary communication and care coordination.

MSK Extremities, Identifying arthritis, advanced cartilage pathology, rotator cuff tears, labral tears, tendon injuries and degeneration, meniscal tears, ligamentous injuries, common fractures, sports related injury patterns, and plantar fasciitis in both upper and lower extremities.

MSK Extremities – Clinical Research, Contemporary literature based evidence with rheumatoid, osteo, spondylar, gouty, and psoriatic arthritides, advanced cartilage pathology, rotator cuff tears, labral tears, tendon injuries and degeneration, meniscal tears, ligamentous injuries, common fractures, sports related injury patterns, and plantar fasciitis in both upper and lower extremities.

2-year program on spinal trauma, spinal management, advanced imaging, electrodiagnostics, accident engineering, spinal biomechanical engineering, triaging the injured, stroke diagnosis, demonstrative documentation, connective tissue pathology, ligament pathology diagnosis and management, and spinal treatment evidence-based outcome studies. The program requires collaboration in advanced imaging for spinal and MSK radiology and being published in case studies.

Trends in Triage and Diagnosing Spinal Pathology, Diagnosing and demonstrative reporting of the spinal cord, nerve root, thecal sac, disc recurrent meningeal nerve, myelomalacia, myelopathy, fracture, chemical radiculitis, and connective tissue pathologies, and osseous compression of nociceptors. Collaborative care with medical specialists on spinal pathology and medical-legal reporting requirements.

MRI Spine Interpretation, Identifying and diagnosing spinal disc pathologies: bulged, herniated, protruded, extruded-comminuted, extruded-sequestered. MRI sequence protocols: T1, T1 fat saturation, T2, T2 fat saturation, STIR, proton density, fast spin echo, echo gradient, coronal, sagittal and axial. Triage of disc pathologies and collaborative care.

Spinal Biomechanical Pathology, Identifying and diagnosing spinal segmental lesions in the facet, joint capsule involving ligamentous mechanoreceptors, and spinal proprioceptors. The central segmental motor control mechanism with upper motor neuron involvement with disparate efferent effects and demonstrative diagnostic tools to differentially diagnose the primary lesion. The statistical outcome of treating biomechanical spinal lesions.

Differentially Diagnosing Arthridities on X-ray and MRI, Identifying and diagnosing Osteoarthritis in hand, wrist, elbow, shoulder, foot, ankle, knees, hips on X-ray. Identifying and diagnosis erosive arthritis and Rheumatoid Arthritis on X-ray, MRI imaging, and ultrasound MRI in the hand, elbow, knee, and spine, Psoriatic and Lupus/Jaccoud Arthritis in the hand. Crystallin Arthropathy of the hand, Gout in the feet and spine, and Calcium Pyrophosphate Dihydrate Deposition Disease (CPPD) of the hand. Diagnosing of ankylosing spondylitis of the spine was also identified.

Incidental Tumors and Pathology Visualized on MRI Spine Images, Identifying and diagnosing Schwannoma’s, Adenoma’s, Fibroid Leiomyomas and Uterine Sarcoma’s, Renel Cell Tumors, Renal Cysts, and Aortic Aneurysms. The physics of T1, T1 fat saturation, T2, T2 fat saturation, STIR, proton density, fast spin echo, echo gradient, coronal, sagittal, and axial. CT Hounsfield units and diagnosing tumors.

Documentation, Diagnosis and Reporting on Medical-Legal Trauma Cases, Determining and documenting the history of proximate cause, how to demonstratively document pain, weakness, and numbness using evidence-based protocols. The demonstrative documentation of MRI spine pathology and being able to differentially diagnose previous vs current pathology in prognosing permanencies. The clinical correlation of causality, demonstrative bodily injury, and persistent functional losses using emotional intelligence.

Spinal Disc Morphology, and Chronicity of Disc Pathology, Spinal disc morphology of lamellar tracts and fiber orientation, the non-uniformity of discal zones with the chemical content of each. How Proteoglycans and Aggrecans are integral in disc hydration and age-dating pathology. Understanding the vascularization of the osseous endplate, cartilaginous end-plate, and disc from birth through puberty is essential to accurately diagnosing disc pathology. Being able to relate disc herniations to end-plate fractures with central herniation and clinically correlating it to chronic back pain.

Spinal Biomechanics in Clinical Practice, The utilization of X-Ray digitization to diagnose spinal biomechanical pathology and analyzing trends in healthcare when triaging mechanical spine pain. The role of credentials in interprofessional collaboration.

MRI Spine Sequence Acquisition and Interpretation, The understanding and utilization of T1, T2, STIR, Proton Density, FSE, GRE imagine sequencing for conclusive diagnosing of fracture, tumor, infection, and disc pathology. Identifying herniation, protrusion, bulge, extrusion-migrated, and extrusion-fragments on MRI images.

Interprofessional Collaboration on Mechanical Back Pain in Clinical Practice, Triaging neurologically compromised cases in conjunction with positive MRI images, and collaboratively managing cases with neurosurgeons in clinical practice. Post-operative management of spinal cases through full recovery.

Spinal Biomechanical Engineering Analytic, The analytics of spinal biomechanical engineering utilizing X-Ray digitizing for Alteration of Motion Segment Integrity and biomechanical pathology. Determining laxity of ligaments in connective tissue pathology and the long-term negative sequels of the pathology.

Demonstrative Reporting of MRI Spinal Disc Pathology, The diagnosis, and reporting of spinal disc bulges, herniations, protrusions, extrusions, and fragments. Reporting varices, Modic 1, 2, and 3, posterior longitudinal, interspinous, and intertransverse ligament. Reporting the ligamentum Flavum and epidural fat as a space-occupying lesion.

Spinal Biomechanics in Clinical Practice, The utilization of X-Ray digitization to diagnose spinal biomechanical pathology and analyzing trends in healthcare when triaging mechanical spine pain. The role of credentials in interprofessional collaboration.

Evidence-based studies in Modic Changes, Disc and Referred Pain, MRI and Cervical Musculature, Kinetic MRI Images, Neurological Innervation, MRI and Injury Mechanisms, Discogenic Pain, Annular Tears and Fissures, Asymptomatic Herniations.

Identify and oral examination of 60 MRI sequences (over 2500 images) of disc bulges, circumferential, radial, and transverse fissures, varices, and herniations inclusive of the following types: protrusion, extrusions (sequestered and migrated/comminuted extrusions). MRI sequencing for accurate interpretation with contemporary nomenclature and reporting.

Advanced MRI and X-Ray Documentation in Clinical Practice, Interpreting and utilizing X-ray and MRI findings in creating demonstrative documentation. Advanced identification of spinal disc lesions, herniations, bulges, protrusion, extrusion, and fragmentations through computer graphics. Identification and demonstrative documentation of vertebral motor unit pathology and reporting demonstratively using computer graphics.

Advanced MRI Interpretation in Clinical Practice, Utilization of thin slice acquisitions with T2 Fat suppressed, STIR, proton density, T1 and T2 sequencing for advanced identification of spinal disc lesions, herniations, bulges, protrusion, extrusion, and fragmentations. Better visualization of intradural and extradural lesions, neoplasms, and infections.

Ethics in Clinical Practice, Ethical, collaborative relationships with medical PCPs and specialists using advanced documentation and accurate reporting of imaging and advanced imaging. Creating a collegial relationship when conflicts arise in concluding accurate diagnosis to allow consensus and the evidence to determine final diagnosis.

Spinal CAT Scan Interpretation, Understanding the utilization of CAT Scan slicing and the reformatting when using bone and soft tissue windows. Correlating MRI to CAT Scan when either creates an unclear conclusion to render a complete image of the morphology of the indeterminate pathology. Understanding the physics of CAT Scan and the radiation levels with different types of CAT Scan technology.

Connective Tissue/Strain Sprain Pathology, Understanding the morphology and physiology of connective tissue at the cellular and extra-cellular levels in building a foundation to understanding the function and interaction of ligaments, tendons, muscles, and bones, Identifying connective tissue pathology and the repair process with a foundation of r permanent aberrant sequella.

Advanced Spinal Biomechanical Engineering, Understanding the concepts of normal vs. pathological movement of vertebral motor units in accurately concluding diagnosis on biomechanical pathology when considering excessive motion. An evidence-based approach to determining translation, angular deviation and rotations beyond pathobiomechanical limitations in the spine.

; Trends in Spinal Care, An evidence-based approach to concluding accurate diagnosis, prognosis, and treatment plan, Eradicating the non-specific back pain dogma utilizing X-ray digitizing based on literature standards, Creating treatment plans with identifying the primary spinal lesions using evidence-based tools.

Documentation in Clinical Practice, Understanding and including all historical elements; current history, past history, family history, and social history when documenting a 99201, 99202, 99203, 99204, and 99205. The application of time as the prime element as per Medicode in coding examinations and re-examination with face to face, review of records and the time necessary to document in an electronic health record.

Interpretation sequencing of STIR, T1, T2, Axial and Sagittal acquisitions. Landmarks, physics, and literature-based definitions of disc and osseous pathology, Visualizing, diagnosing, and documenting cervical and lumbar anatomy vs. pathology.

Visualizing, diagnosing, and documenting lumbar spine sequencing, disc herniations, neural canals, cauda equina, conus medullaris, nerve sleeves, canal stenosis grading, and vertebral width vs. height in determining segmental remodeling. Diagnosing thecal sac abutment, central canal root compression and ligamentum flava involvement.

Case study visualizing, diagnosing, and documenting cervical spine sequencing, disc herniations, neural canals, cauda equina, conus medullaris, and vertebral width vs. height in determining segmental remodeling. Identifying the Pons, Occipital junction, and spinal cord to identify Chiari 1 malformations.

Visualizing, diagnosing, and documenting lumbar spine sequencing, disc extrusion type herniations, neural canals, cauda equina, conus medullaris, spondylolisthesis, degenerative spondylolisthesis, disc degeneration, neural canal and central root compressions, central canal stenosis. Varices vs. herniations, and multiple level disc pathology with biomechanical failures.

Visualizing, diagnosing, and documenting cervical spine sequencing, disc extrusion type herniations, neural canals, disc degeneration, thecal sac compression, central canal stenosis, cord displacement, reversal of cervical curve, Chiari 1 malformation. Identifying spinal biomechanical failure in MRI sequencing, with visualizing ligamentous pathology as cause for failure. Differentially diagnosing recent vs. older trauma based upon edematous signal in T1, T2, and STIR images.

Visualizing, diagnosing, and documenting cervical spine sequencing, multiple disc extrusion type herniations, vertebral remodeling, intradural tumor displacing the spinal cord visualized in T1, T2, and STIR sequences, neural canal stenosis, disc degeneration, thecal sac compression, central canal stenosis, cord displacement, reversal of cervical curve, Chiari 1 malformation, and identifying of inferior brain structures.

Visualizing, diagnosing, and documenting 1) improper sequence acquisitions invalidating interpretation 2) incomplete study invalidating interpretation 3) visualizing, diagnosing, and documenting lumbar spine sequencing, multiple disc extrusion type herniations, vertebral remodeling, multiple thecal sac compressions, neural canal stenosis, disc osteophyte/ridging complex, central canal stenosis, spondylolisthesis. Identifying the spleen, liver, kidneys, inferior vena cava, and psoas musculature on imaging.

Visualizing, diagnosing, and documenting cervical spine sequencing, cervical spondylosis, pathological spinal biomechanics, reversal of lordotic curve, and vertebral width vs. height in determining segmental remodeling, central herniation, thecal sac compression of the cord, identifying tongue, epiglottis, hyoid cartilage, pharynx, thyroid. Reviewing fat saturation sequences for osseous metastatic tumors and advanced degeneration.

Visualizing, diagnosing, and documenting lumbar spine sequencing, degenerative disc disease, nerve root sleeve abutment, far lateral herniations vs. bulges, normal vs. dissected inferior vena cava aneurism, epidural fat as a space occupying lesion, facet arthropathy and edema, hypertrophy of ligamentum flava, and pseudo disc at the S1-S2 level.

Visualizing, diagnosing, and documenting cervical spine sequencing utilizing T1 weighted images for pathology, inclusive of advanced degeneration and tumor detection. STIR in a fat saturated image for ligamentous pathology inclusive of the posterior longitudinal, ligamentous flava and interspinal ligaments. Normal clivus and odontoid for cerebellar tonsil location. Cerebral spinal fluid (CSF) flow and the utilization of the spinal cord’s central canal for CSF transport.

Trends in Spinal Healthcare, Analyzing spinal healthcare trends in both utilization and necessity and understanding the marketplace and how a level of clinical excellence is reflected in a doctors' documentation and credentials. Treatment pathways in triaging spinal pathobiomechanics,

MRI Spine Interpretation, An evidence-based understanding of time-related etiology of disc pathology considering the American Society of Neuroradiology's designation of protrusion, extrusion, and sequestration of spinal discs, Considering the signal intensity of discs in age-dating pathology and acquisition protocols for advanced spinal imaging.

Spinal Biomechanics; A Literature Perspective, An evidenced-based model for spinal biomechanical engineering and pathobiomechanics considering the pathophysiological limits in translations, angular deviation, and rotational planes. Utilizing the Cartesian system in plotting vertebral points to demonstratively conclude an accurate diagnosis, prognosis and biomechanical treatment plan with the consideration of long-term care in the non-specific mechanical spine pain patient when necessary.

Case Management of Mechanical Spine Pathology, Clinical Grand Rounds of herniated, protruded, extruded, sequestered, and bulging discs. Differentially diagnosing vascular vs. mechanical spinal lesions and the necessity for urgent vascular, neurological intervention, Collaborating in a team environment utilizing a neuroradiologist, electrophysiologist, and neurosurgeon with the chiropractor as the primary spine care provider.

MRI Spine Interpretation Basics: Overview of MRI Spine Language, interpreting MRI spine images, Extremities MRI & X-Ray Interpretation: Interpret all extremities in the body, MRI Clinical Grand Rounds: Multiple cases on spine and review protocols, Case Management, Spinal MRI and Documentation: Multiple cases on spine and review protocols, Primary Spine Care #12: Correlating imaging, spinal biomechanics and triage, Spinal Disc and Ligament Neurology and Pathology: Connective tissue physiology and pathology and Spinal Trauma Pathology: Managing the spinal trauma case.

Analyzing evidenced-based spinal healthcare trends in both utilization and necessity and understanding the marketplace. The use of evidenced-based demonstrative documentation in reporting treatment pathways in triaging spinal pathobiomechanics.

Clinical case review of MRI’s including sagittal, axial, T1, T2, STIR, and proton density sequences. Identified will be the vertebrate, spinal cord, discs, nerve roots, thecal sac, posterior longitudinal ligament, epidural veins, and fat saturation pulses. Pathology will include bulges, herniations, protrusions, extrusions, myelomalacia, cord edema, and Schmorl’s nodes. Learn how to collaborate effectively with radiologists, neuroradiologists, and neurosurgeons on the clinical findings.

Analysing evidence-based outcomes in triaging non-anatomical lesions. The analysis of neuro-biomechanical pathological lesions defines primary spinal lesions and removes the dogma of non-specific back pain. Managing collaborative relationships with medical primary providers and specialists in clinical practice.

Effectively creating demonstrative medical-legal documentation and meeting the needs of the courts, and making your "4-Corner" (narrative) report to build your reputation as an evidence-based provider. The step-by-step minutiae of building a report, accomplishing report writing timely and effectively by understanding the regulatory and administrative rules. Learn how to educate the lawyer on bodily injury through evidence-based demonstrative reporting.

Master-Class in ligaments; anatomy, physiology, vascularization, neurological innervation, tissue repair and how they all relate to clinical practice. Ligament pathology correlating to the mechanisms of patho-neuro-biomechanical lesions (vertebral subluxation complex). Also, how ligaments play a critical role in the chiropractic spinal adjustment and in defining the chiropractic spinal adjustment mechanisms.

Diagnosing, triaging, and documenting headaches, migraines, and vascular incidents (stroke) in the primary provider's office. Imaging protocols based upon history and clinical presentation will be presented, along with analyzing imaging findings in determining the etiology. There will be an extensive question and answer session following the instructional presentation.

Age dating herniated discs and trauma is a critical skill for an expert in spine. It combines the clinical skills of interpreting X-ray, MRI, and other imaging modalities with a clinician's understanding of joint pathology. This level of expertise is critical when collaborated with other physicians or working in the medical-legal environment as an expert. Age dating pathology is also central to creating a prognosis on your patient's recovery and must be evidence-based in rationale.

Case reviews utilizing E/M, MRI, and x-ray mensuration report to conclude an accurate diagnosis, prognosis, and treatment plan. Common diagnosis requiring interprofessional collaboration with a discussion of diagnostic dilemmas and proper communication methods.

A clinical discussion of collaborating with neurosurgeons on spinal cord and spinal nerve root co-morbidities. Triaging cases with herniated, protruded, extruded, fragments discs and differentially diagnosing tethered cord, syringomyelia, traumatic Schmorl’s Nodes, Myelomalcia, spinal cord edema, vacuum disc and other intra, and extra-dural lesions.

This qualification includes graduate chiropractic education in healthy and traumatically altered spinal morphology inclusive of osseous, connective tissue and neurological structure, function and pathology. This certifies you are qualified in assessing predictive models in spinal biomechanics and devising engineering paradigms for treatment plans to maximize spinal homeostasis in an evidenced based conclusion. In addition, this qualification acknowledges your expertise in triaging the injured and coordinating collaborative care from the trauma through conclusion of rehabilitation,

Recognized by Cleveland University-Kansas City, Chiropractic and Health Sciences with courses recognized by the ACCGME in conjunction with the State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences. Qualification language approved by the American Chiropractic College of Radiology (ACCR) and the American Chiropractic Board of Radiology (ACBR)

Normal Morphology and Tissue Damage, Connective tissue morphology, embryology and wound repair as sequalae to trauma. Full components of strain-sprain models and permanency implications with wound repair and osseous aberration with aberrant structural integrity.

Spinal Biomechanics and Disc Pathology, Disc pathology as sequella to trauma; herniation, extrusion, protrusion, sequestration and how the spinal unit as one system creates homeostasis to balance the pathology.

Neurological Innervation, The peripheral and central innervation of the disc and spinal ligaments of the dorsal root ganglion, spinal thalamic tracts, periaqueductal gray areas innervating the Thalamus and multiple regions of the brain. The efferent neurological distribution to disparate areas of the spine to create homeostatis until tetanus ensues creating osseous changes under the effect of Wolff's Law.

Clinical record-keeping, why write clinical notes, the importance of context, what to include in a clinical note, tips for better clinical documentation, basic legal considerations, open clinical notes, how to keep documentation efficient.

Utilizing pain patterns, the high signal in the annulus, high signal outside the annulus, Modic changes, disc height, vacuum disc, sclerosis, Phirrman rating, facet edema, and previous MRIs to determine the chronicity of pathology., Master-Class in ligaments; anatomy, physiology, vascularization, neurological innervation, tissue repair, and how they all relate to clinical practice. Ligament pathology correlating to the mechanisms of patho-neuro-biomechanical lesions (vertebral subluxation complex). Also, how ligaments play a critical role in the chiropractic spinal adjustment and in defining the chiropractic spinal adjustment mechanisms.

Case reviews concluding and accurate diagnosis, prognosis, and treatment plan utilizing evidence-based instrumentation and algorithms. Using demonstrative reporting of case findings to collaborate with co-treating physicians.

A documentation discussion on meeting the requirements of the courts, carriers, and licensure boards in complete and accurate reporting. Ensuring the diagnosis, prognosis, and treatment plan are demonstratively documented.

Evaluation and Interpretation of ERP, qEEG, and Audiometry Data, neurophysiology of ERP/qEEG biomarkers, identifying the ERP/qEEG features from test data, evaluating and interpreting of patient reports, summarizing study findings from clinical data with over-reading by qualified Cognision experts.

Using the COGNISION® software to order the COGNISION® test; applying the electrode harness and earphones properly, administering a COGNISION® test under standard clinical conditions, monitoring the ongoing test, Uploading the data upon test completion, Reviewing the data quality with Cognision electrophysiology experts and proper care and maintenance of the testing apparatus. Evaluation and Interpretation of ERP, qEEG, and Audiometry Data; Neurophysiology of ERP/qEEG biomarkers, Identifying the ERP/qEEG features from test data, Evaluating and interpreting of patient reports, Summarizing study findings from clinical data with over-reading by qualified Cognision experts.

An overview of the evaluation and management process inclusive of utilizing electronic medical records to conclude evidenced-based conclusions with the utilization of macros. The importance of adhering to an academic standard and considering co-morbidities.

Concluding a chief complaint, history and what needs to be considered in a physical examination. This covers in dept the required elements for chief complain, history of present illness, review of systems, and past, family, and/or social history. This module also covers the following components of a physical examination: observation, palpation, percussion, and auscultation.

Coding and Spinal Examination: Detailing 99202-99205 and 99212-99215 inclusive of required elements for compliant billing. It reviews the elements for an extensive review of systems, cervical and lumbar anatomy and basic testing. The course also covers the basics of vertebra-basilar circulation orthopedic assessment.

Neurological Evaluation: Reviewing complete motor and sensory evaluation inclusive of reflex arcs with an explanation of Wexler Scales in both the upper and lower extremities. The course breaks down testing for upper and lower motor neuron lesions along with upper and lower extremity motor and sensory testing examinations.

Documenting Visit Encounters: Forensically detailing the S.O.A.P. note process for visit encounters and discussing the necessity for clinically correlating symptoms, clinical findings and diagnosis with the area(s) treated. It also details how to modify treatment plans, diagnosis, document collaborative care and introduce test findings between evaluations.

Case Management and Treatment Orders: This module discusses how to document a clinically determined treatment plan inclusive of both manual and adjunctive therapies. It discusses how to document both short-term and long-term goals as well as referring out for collaborative care and/or diagnostic testing. It also includes how to prognose your patient and determine when MMI (Maximum Medical Improvement) has been attained.

Traumatic Brain Injury and Concussion Overview: This section is an in-depth overview of traumatic brain injury in concussion. It discusses that all brain injuries are traumatic and dispels the myth of a “mild traumatic brain injury.” Also, this covers triage protocols and the potential sequela of patients with traumatic brain injuries.

Head Trauma and Traumatic Brain Injury Part 1: This section discusses gross traumatic brain injuries from trauma and significant bleeding with both epidural and subdural hematomas. There are numerous case studies reviewed inclusive of neurosurgical intervention and postsurgical outcomes.

Head Trauma and Traumatic Brain Injury Part 2: This section continues with multiple case studies of gross traumatic brain injuries from trauma requiring neurosurgical intervention and also discusses recovery sequela based upon the significance of brain trauma. This module also concludes with concussion protocols in traumatic brain injury short of demonstrable bleeding on advanced imaging.

Concussion And Electroencephalogram Testing: This this section covers concussion etiology and cognitive sequela where gross bleeding has not been identified on advanced imaging. It discusses the significance of electroencephalogram testing in determining brain function and pathology (if present). This module also covers the understanding of waveforms in electroencephalogram testing in both normal and abnormal scenarios.

Concussion And Electroencephalogram Testing Pathological Results: This module covers amplitude, conduction and conduction delays as sequela to traumatic brain injury to diagnose concussion and traumatic brain injury in the absence of gross bleeding and advanced imaging. This section covers electroencephalograms and event-related potentials which measures the brain response that is a direct result of specific sensory or motor events. It is a stereotype electrophysiological response to a stimulus and provides a noninvasive means of evaluating brain function. In this module multiple case studies are discussed with ensuing triage protocols pending the results.

Trends in Spinal Healthcare, Analyzing spinal healthcare trends in both utilization and necessity and understanding the marketplace and how a clinical excellence level is reflected in a doctors' documentation and credentials. Treatment pathways in triaging spinal pathobiomechanics.

MRI Spine Interpretation Advanced Diagnosis, An evidence-based understanding of time-related etiology of disc pathology considering the American Society of Neuroradiology's designation of protrusion, extrusion, and sequestration of spinal discs, T1, T2, STIR and Proton-Density weighted evaluation to diagnose spine form MRI accurately.

Spinal Biomechanical Engineering Analytics and Case Management, Utilizing spinal mensurating algorithms to conclude a pathobiomechanical vs. normal spine in the absence of anatomical pathology. Clinically correlating a history and physical examination findings to x-ray biomechanical results in creating an accurate diagnosis, prognosis, and treatment plan.

MSK Extremity Radiological Interpretation, Utilizing both MRI and x-ray to diagnose 1) Arthritis - Inflammatory and Degenerative, 2) Advanced cartilage assessment, 3) Rotator Cuff Tears, 4) Labral tears (shoulder and hip), 5) Tendon injuries and degeneration, 6) Meniscal tears, 7) Ligamentous injuries, 8) Common fractures, 9) Sports-related injury patterns, 10) Plantar fasciitis.

Demonstrative Medical-Legal Documentation, The narrative report. How to effectively create medical-legal documentation and what the courts look for. Making your "4-Corner" (narrative) report demonstrable and build a reputation as an evidence-based provider. The step-by-step minutiae of building a report.

Managing Non-Anatomical Spine Pain, Treatment modalities centered upon "best-outcomes" in an evidence-based model considering chiropractic vs. physical therapy and chiropractic vs. medicine. Considerations of disability, pain reduction, functional improvement, drugs utilized, and side-effects are all considered.

Qualified

Diagnosing and documenting: Ependymoma, Astrocytoma, Hemangioblastoma, Lipoma, Meningioma, Neurofibroma, Schwannoma, Myxopapillary Ependymoma.

Analyzing neuro-biomechanical pathological lesions defines primary spinal lesions and removes the dogma of non-specific back pain. Creating evidence-based demonstrative documentation in the creation of treatment plans.

Demonstrative Documentation Requirements, Analyzing the requirements in anatomical diagnostic imagery to communicate spinal pathology. Integrating technology, clinical findings, and advanced graphic tools to communicate a diagnostic conclusion.

Clinical case review of MRI including intra and extra-dural findings inclusive of the disc and vascular anatomical lesions. Deferentially diagnosing central cord lesions, and spinal cord vascular lesions in both acute trauma and degenerative presentations.

Huma Haidler, MD., Recognition and Screening of Concussion Injuries, Treatment Considerations, mTBI (mild) vs TBI (moderate/severe)

Huma Haidler, MD., Recognition and Screening of Concussion Injuries, Treatment Considerations, mTBI (mild) vs TBI (moderate/severe)

History, symptomology, psychological and endocrinological aspects of traumatic brain injuries.

Concluding an E&M report in cases involving medical primary care providers of medical specialists that have complicated case histories, significant risk factors, and inconclusive findings. Triage and management of complicated cases requiring the clinical evaluation, advanced imaging and electrodiagnostics.

Contemporary acquisition protocols including slice thicknesses and sequences inclusive of the ordering process. Interpretation of axial, sagittal and coronal views in T1, T2 and stir views inclusive of the disc, spinal cord, extra-dural and intra-dural pathology.

Having referral relationships with emergency rooms, neurosurgeons, orthopedic surgeons, pain management specialists, neurologists, neuroradiologist and medical primary care providers based upon clinical dilemmas that processed after a thorough history, examination and imaging if clinically indicated to conclude diagnostic dilemmas. Utilizing evidence-based protocols and acquisition of images and treatment pathways, collaborating with medical specialists and primaries to conclude and accurate treatment plan.

Constructing and concluding an E&M (99202-99205) report that accurately reflects the history, clinical findings and management of trauma cases that concurrently meets the needs of both the carriers in the courts and ethical relationship that concurrently matches the standards of both contemporary academia requirements and a contemporary literature-based standard.

Morphology of healthy and traumatized connective tissue and the permanency implication of adhesions, spinal disc morphology in the healthy and pathological patient as sequella to trauma in relationship to bulges, herniations, protrusions, extrusions and sequestrations. Aberrant spinal biomechanics and negative sequella to trauma.

The ability of your electronic health records to convey tissue pathology while documenting case studies, field experiments, randomized trials and systematic literature reviews, Introducing evidence based macros in documentation to support the literature and necessity of care.

Analyzing segmental pathology, adjusting vs. mobilization with cervicogenic headaches, Opioid alternatives and case management of mechanical spine pain based upon outcome studies.

Literature reviews of mechanoreceptor, proprioceptor and nociceptor stimulation of later horn gray matter with periaqueductal stimulation affecting the thalamus and cortical regions with efferent distribution in disparate regions of the body in both pain and systemic stimulation.

Identifying normal anatomy on both MRI and x-ray, inclusive of osseous, connective tissue, and neurological structures. Identifying fractures in the adult and pediatric cases. Deferentially diagnosing various arthritic etiologies of osseous derangement.

Identifying fractures in the adult and pediatric cases. Differentially diagnosing various arthritic changes vs. benign and metastatic Tumors.

Identifying normal anatomy on both MRI and x-ray, inclusive of osseous, connective tissue, and neurological structures, identifying fractures in the adult and pediatric cases. Deferentially diagnosing various arthritic etiologies of osseous derangement. Deferentially diagnosing various arthritic changes vs. benign and metastatic Tumors.

Identifying normal anatomy on both MRI and x-ray, inclusive of osseous, connective tissue, and neurological structures, identifying fractures in the adult and pediatric cases. Differentially diagnosing various arthritic etiologies of osseous derangement. Differentially diagnosing various arthritic changes vs. benign and metastatic Tumors.

Identifying normal anatomy on both MRI and x-ray, inclusive of osseous, connective tissue, and neurological structures, identifying fractures in the adult and pediatric cases. Differentially diagnosing various arthritic etiologies of osseous derangement. Deferentially diagnosing various arthritic changes vs. benign and metastatic Tumors.

Identifying normal anatomy on both MRI and x-ray, inclusive of osseous, connective tissue, and neurological structures. Identifying fractures in the adult and pediatric cases. Differentially diagnosing various arthritic etiologies of osseous derangement.

Identifying fractures in the adult and pediatric cases. Differentially diagnosing various arthritic changes vs. benign and metastatic Tumors.

Identifying normal anatomy on both MRI and x-ray, inclusive of osseous, connective tissue, and neurological structures. Identifying fractures in the adult and pediatric cases. Differentially diagnosing various arthritic etiologies of osseous derangement.

Identifying fractures in the adult and pediatric cases. Differentially diagnosing various arthritic changes vs. benign and metastatic Tumors.

Identifying normal anatomy on both MRI and x-ray, inclusive of osseous, connective tissue, and neurological structures, identifying fractures in the adult and pediatric cases. Differentially diagnosing various arthritic etiologies of osseous derangement. Differentially diagnosing various arthritic changes vs. benign and metastatic Tumors.

Identifying normal anatomy on both MRI and x-ray, inclusive of osseous, connective tissue, and neurological structures, identifying fractures in the adult and pediatric cases. Differentially diagnosing various arthritic etiologies of osseous derangement. Differentially diagnosing various arthritic changes vs. benign and metastatic Tumors.

Electrodiagnostics: Electromyogram/Nerve Conduction Velocity (EMG/NCV), Diagnosis & Interpretation: Anatomy and Physiology of Electrodiagnostics: An in-depth review of basic neuro-anatomy and physiology dermatomes and myotomes to both the upper and lower extremities and the neurophysiology of axons and dendrites along with the myelin and function of saltatory for conduction. The sodium and potassium pump’s function in action potentials.

Electromyogram/Nerve Conduction Velocity (EMG/NCV), Diagnosis & Interpretation: Nerve Conduction Velocity (NCV) Part 1: Nerve conduction velocity testing, the equipment required and the specifics of motor and sensory testing. This section covers the motor and sensory NCV procedures and interpretation including latency, amplitude (CMAP) physiology and interpretation including the understanding of the various nuances of the wave forms.

Electromyogram/Nerve Conduction Velocity (EMG/NCV), Diagnosis & Interpretation: Nerve Conduction Velocity (NCV) Part 2: Compound motor action potentials (CMAP) and sensory nerve action potentials (SNAP) testing and interpretation including the analysis and diagnosis of the wave forms. It also covers compressive neuropathies of the median, ulnar and posterior tibial nerves; known as carpal tunnel, cubital tunnel and tarsal tunnel syndromes. This section offers interpretation algorithms to help understand the neurodiagnostic conclusions

A Quick Solution Based on Your Documentation & Clinical Excellence, Utilizing your documentation to accurately reflect the Evaluation and Management code billed. Inclusive of a complete current, past history, previous care, and a full review of systems. The management of post-traumatic cases in a collaborative environment in a literature-based standard.

Case Management, Spinal MRI and Documentation Documenting Herniated Discs, Age-Dating Disc Pathology, and Connective Tissue Pathology as Sequella to Trauma, Herniated Discs and Connective Tissue Pathology, differentially diagnosing herniated discs vs. normal and bulging discs and protruded, extruded and fragmented discs. Normal vs. Pathological connective tissues and age-dating herniated discs.

Case Management, Spinal MRI and Documentation, Case Management of Traumatic Spinal Injuries, Understanding flexion-extension cervical injures and diagnosing connective tissue pathology. Determining impairments and the literature-based standard for permanent injuries.

Case Management, Spinal MRI and Documentation, Managing Herniated and Bulging Discs, Serious Injury in Non-Herniated Cases from Trauma, Spinal disc morphology, and innervation. Herniated, bulged, protruded, and sequestered disc characteristics and management. Literature-based documentation requirements for no-dis spinal injuries.

Case Management, Spinal MRI and Documentation, Herniated Discs and Permanent Brain Malfunction & Biomechanical Failure, A case-study of a post-traumatic herniated disc and related brain malfunction supported by contemporary literature, MRI acquisition, and necessity protocols.

Case Management, Spinal MRI and Documentation, Demonstrative Documentation of Disc Herniationand MRI Physics, Understanding the documentation requirements to demonstratively show spinal disc lesions in reporting pathology. Understanding the physics of a nucleus resonating in T1 and T2 weighted imagery.

Case Management, Spinal MRI and Documentation, Post-Traumatic Herniated Discs, Related Migraines-Headaches & Strain/Sprain Permanences, Relationship of headaches, and migraines to cervical spine disc herniation, clinical rationale for ordering MRI’s and the relationship of ligamentous pathology to spinal trauma.

Case Management, Spinal MRI and Documentation, Documentation of Low-Speed Crashes in Determining Etiology of Serious Bodily Injuries, Documentation requirements during the evaluation, and management encounter to understand the etiology of spinal injuries. Having a complete understanding the forces involved to conclude a differential diagnosis, while concurrent ruling malingerers, if applicable.

Electromyogram/Nerve Conduction Velocity (EMG/NCV), Diagnosis & Interpretation: Needle Electromyogram (EMG) Studies: The EMG process, inclusive of how the test is performed and the steps required in planning and electromyographic study. This covers the spontaneous activity of a motor unit action potential, positive sharp waves and fibrillations. The insertional activity (both normal and abnormal), recruitment activity in a broad polyphasic presentation and satellite potentials. This covers the diagnosing of patterns of motor unit abnormalities including neuropathic demyelinated neuropathies along with acute myopathic neuropathies. This section also covers the ruling out of false positive and false negative results.

Electromyogram/Nerve Conduction Velocity (EMG/NCV), Diagnosis & Interpretation: Overview of EMG and NCV Procedures, Results, Diagnoses and Documentation. The clinical incorporation of electrodiagnostic studies as part of a care plan where neuropathology is suspected. It also covers how to use electrodiagnostics in a collaborative environment between the chiropractor as the primary spine care provider and the surgeon, when clinically indicated. This section covers sample cases and health conclude and accurate treatment plans based upon electro-neurodiagnostic findings when clinically indicated.

MRI results are often a fork-in-the-road not only in clinical decision making but also in the direction of litigation in med-legal cases. It is a simple, yet fundamental observation that many human musculoskeletal conditions are impacted by gravity, and that many patients experience signs and symptoms in weight bearing positions even when they do not in the recumbent one. Thus, recumbent imaging alone may not demonstrate the full degree of pathology, due to muscle and ligament relaxation and in the case of the spine, disc retraction. Conventional magnetic resonance imaging systems are limited to acquiring scans with patients in the recumbent position (r-MRI). The Positional Weight-Bearing MRI (pwb-MRI) system allows upright, angled (slanted) and recumbent imaging, replicating partial or full weight bearing conditions. It also allows kinetic maneuvers of the patient’s whole body or any body part. Our service enables imaging of the relevant body part in any position of normal everyday stress, across the limits of normal range of motion. Even more importantly, imaging is performed in the specific position of the patient’s clinical symptomatology. Several published scientific studies and reviews have validated that radiologically occult but clinically relevant weight bearing and/or motion dependent disease can be better demonstrated on pwb-MRI compared to conventional MRI. These studies have imaged the spine in a close-to-physiological state, either by using external axial loading or better still, by imaging with flexion-extension, in the erect position using pwb-MRI. The literature indicates that Positional Weight-Bearing MRI provides a more sensitive evaluation of spinal pathology. This in turn may provide the referring physician with a more relevant diagnosis, especially in cases where the pain is worse in a sitting or standing position.

A practical review of MRI and x-ray evaluation of the spine and appropriate referral for advanced imaging. Emphasis will be placed on x-ray positioning, interpretation of signs and search pattern, appropriate referral, case management implications and advanced imaging. MRI of the cervical and lumbar spine with review of x-ray positioning and evaluation of radiographs. Discussion will include radiographic signs, clinical impact, and the need for additional studies and advanced imaging- particularly MRI of the spine. Discussion will include radiographic signs, clinical impact, and the need for additional studies or advanced imaging such as MRI. Case studies will include x-rays followed by MRI with discussion of advanced imaging terminology and clinical application.

An evaluation of the spine, specific to trauma and spinal instability. Emphasis will be placed on x-ray positioning, interpretation of signs and search pattern, appropriate referral, case management implications and advanced imaging. Review of x-ray positioning, evaluation and interpretation of the spine, emphasis on trauma and spinal instability. Discussion will include radiographic signs, clinical impact and a need for additional studies or advanced imaging. Review of spine evaluation and interpretation with emphasis on trauma and spinal instability. Discussion will include radiographic signs, clinical impact and a need for additional studies or advanced imaging.

CPT Coding Guidelines for Initial and Established Patients with particular attention paid to Patient History, Review of Systems, Social and Family History, Physical Examination, and Medical Decision making. Specific differences in coding levels and required elements for a 99202-99203-99204-99205.

Pathways to improve coordination of care, and interprofessional communication with collaborating physicians. Maintaining ethical relationships in the medical-legal community through documentation and communication of demonstrable diagnosis, prognosis and treatment plans.

History of clinical biomechanics with an emphasis on the diagnosis and management of spine pain of mechanical/functional origin. Evidence-based symptomatic vs. asymptomatic parameters using peer-reviewed medical index literature. Computerized mensuration analysis of spinal biomechanical pathology. Comparison of demonstrable spinal biomechanical failure on imaging to clinical evaluation and physical examination.

Case reviews utilizing E/M, MRI, and x-ray mensuration report to conclude an accurate diagnosis, prognosis, and treatment plan. Common diagnosis requiring interprofessional collaboration with a discussion of diagnostic dilemmas and proper communication methods.

Impairment Rating, The understanding and utilization of the protocols and parameters of the AMA Guide to the Evaluation of Permanent Impairment 6th Edition. Spine, neurological sequelae, migraine, sexual dysfunction, sleep and arousal disorders, station and gait disorders and consciousness are detailed for impairment rating. Herniated discs, radiculopathy, fracture, dislocation and functional loss are also detailed in relation to impairment ratings.

Chiropractic as the First Option for Spine, A Literature-Based Standard, Utilizing clinical findings in conjunction with advanced imaging and electrodiagnostic findings in managing collaborative relationships with medical specialists. Applying a literature standard to care to ensure conservative care as the first option.

Chiropractic as the First Option for Spine, A Literature-Based Standard, Managing spinal related cases based upon MRI findings of herniations, bulges, protrusion, extrusions (comminuted and fragmented) utilizing thin-sliced acquisition protocols. When to consider ordering T1, T2, Short Tau Inversion Radiant, proton density and Dixon sequencing for spinal related pathology,

Chiropractic as the First Option for Spine, A Literature-Based Standard, Creating literature-based documentation inclusive of history and a clinical examination that encompasses causality, diagnosis, prognosis and treatment plans. Ensuring the whole person impairment ratings are consistent with contemporary literature, PACE Approved for the Federation of Chiropractic Licensing Boards, Cleveland University Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island NY 2020

Chiropractic as the First Option for Spine, A Literature-Based Standard, Spinal biomechanical engineering models related to pathobiomechanics and literature-based standards in creating an accurate diagnosis, prognosis, and treatment plan. Determining impairment ratings based upon alteration of motion segment integrity utilizing motion-imaging, and creating demonstrable evidence for continued treatment plans, PACE Approved for the Federation of Chiropractic Licensing Boards, Cleveland University Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island NY 2020

The understanding and utilization of the protocols and parameters of the AMA Guide to the Evaluation of Permanent Impairment 6th Edition. Spine, neurological sequelae, migraine, sexual dysfunction, sleep and arousal disorders, station and gait disorders and consciousness are detailed for impairment rating. Herniated discs, radiculopathy, fracture, dislocation and functional loss are also detailed in relation to impairment ratings.

Medical-Legal-Insurance Documentation, Accurate and compliant documentation of history and clinical findings inclusive of functional losses, loss of activities of daily living, duties under duress and permanent loss of enjoyment of life. Prognosing static vs. stable care, gaps in care both in the onset and in the middle of passive care with a focus on detailed diagnosing. The integration of chiropractic academia, the court system and the insurance reimburser’s requirements for complete documentation.

Evolution of The Personal Injury Case. How Insurance Companies Analyze Personal Injury Medical Claims. Importance of Chiropractors in Personal Injury. 7 Things you must know before handling Personal injury Cases. Assignment of benefits and the new case law. Uninsured and Underinsured Motorist Claims.

Overview of the most common imaging modalities used in musculoskeletal injuries – XRay, CT, MRI. Basic MRI physics – How does an MRI work without any radiation. Relevance of using proper nomenclature in radiology reports for personal injury cases. How MRIs may be “False Negative”, how that affects both medical and legal case management in personal injury cases and how to utilize proper techniques to minimize that problem.

Overview of the most common imaging modalities used in musculoskeletal injuries – XRay, CT, MRI. Basic MRI physics – How does an MRI work without any radiation. Relevance of using proper nomenclature in radiology reports for personal injury cases. How MRIs may be “False Negative”, how that affects both medical and legal case management in personal injury cases and how to utilize proper techniques to minimize that problem.

General classes of neck and back injuries. Which examinations and procedures are helpful/required? Review of current best practices for neck and back pain treatment and evaluation. Home care measures. Multi-modal care. Which therapies have evidence they work, and which don’t. Trials of care & therapeutic withdrawal. Co-management/referral issues.

Obtaining and documenting the history. How to document clinically meaningful changes & when to reassess. What IME’s look for in your notes. Bullet proofing your care with practice guidelines and research. How to get your care denied and not paid. Documenting consent. Red flags & yellow flags to consider- documenting factors that delay recovery. Documenting functional improvement. Daily treatment notes: the good, the bad and the ugly.

Epidemiology of neck and back pain- how long will it last? Maximum medical improvement: when, and what next. Prognosis and your crystal ball. Avoiding “maintenance” and “supportive care” terms. What are reasonable treatment parameters for chronic conditions.

Understanding report writing and the types of medical reports required for court inclusive of diagnosis, prognosis and treatment plans with requirements of reporting causality and permanency.

Organizing your documentation and understanindg all collaborative documentation and how it fits into your diagnosis, prognosis and treatment plan, Understanding the nuances of the functional losses of your patients related to their bodily injuries

Utilizing demonstrative documentation in direct examination and communicating the results of your care concurrently with the written documentation and reporting an accurate diagnosis for all images,

The evaluation, interpretation and reporting of collaborative medical specialists results and concluding an accurate diagnosis inclusive of all findings and reviewing all images to ensure an accurate diagnosis,

Determining and documenting disabilities and impairments inclusive of loss of enjoyment of life and duties under duress and the evaluation and validation of pain and suffering,

Reporting your documentation factually and staying within the 4 corners of your medical report and scope of practice inclusive of understanding how your credentials allow you to report your documentation.

The level of organization required in a medical-legal case that accurately reflects the bodily injuries of your patients and the time constraints in rendering an accurate report.

Reviewing the facts of the case inclusive of your documentation, the defense medical examiner, medical specialists and the attorney to ensure accurate and consistent reporting.

Creating demonstrative evidence, visuals of your patient's bodily injuries inclusive of x-rays, MRI's, CAT Scans and electrodiagnostic findings, the spinal biomechanics of herniated disc with ipsilateral findings and contralateral symptomatology.

Deferentially diagnosing mild traumatic brain injury vs. traumatic brain injury and the clinical and imaging protocols required to conclude an accurate diagnosis for head trauma.

Trends in hospital and emergent care in the healthcare delivery system inclusive of policies, hospital staffing and current care paths for mechanical spine issues.

Report writing for legal cases, the 4 corners of a narrative and documenting damages with understanding defense medical documentation and consistent reporting of bodily injuries.

Primary Spine Care 5, The biological, neurological and mechanical mechanisms and pathways from the thrust to the lateral horn and brain connection and how the brain processes the chiropractic spinal adjustment based upon the literature. Care paths of chiropractic and physical therapy from an outcome basis.

Properties of discs, ligaments, muscle and bone, as well as the normal motion of the cervical spine. Soft tissues have viscoelastic material properties which is key to understanding injury mechanisms. He will also touch on the concepts of coupled, intersegmental, and paradoxic motion.

Widely adopted cervical acceleration/deceleration (CAD) (or whiplash-associated disorder or WAD) grading system which he developed more than a decade ago. This grading system, which has now been validated in numerous studies, provides the basis for effective intervention and for prognostication.

The tremendous scope of the current public health problem and the factors contributing to it. He reviews the substantial international literature, including the latest crash data of real world crashes obtained from on-board black boxes. He develops from this analysis—as well as his own published research—a risk estimate for adults and for children, incidence rates, and the prevalence of chronic pain in the U.S. attributable to motor vehicle trauma. With all the confusion and misinformation that exist regarding low speed crashes, amounts of property damage, and relative risk, Dr. Croft is careful to clarify these issues in great detail. For example, and perhaps counter-intuitively, within a specific range of low speed crashes, it is shown that the risk for occupant injury is actually greater when property damage is minimal.

Nomenclature and progresses to a discussion of velocity change (delta V), barrier velocity, and the ways in which velocity, time, and acceleration interact to affect the risk for occupant injury. Dr. Croft then takes attendees on an exploration of our current knowledge based on mathematical models, animal experiments (including the porcine experiments from whence the neck injury criterion (NIC) was proposed), cadaver experiments (where many recent discoveries have been made), dummy experiments (including those of the newest rear impact dummies or RID, which have been tested at the Spine Research Institute of San Diego by Dr. Croft and others), and, finally, the numerous human subject volunteer crash tests. Dr. Croft discusses his several years of crash testing as well as all of the other serious research in that area. As always, his presentation is replete with video footage and illustration to assist in understanding. Also in this section, Dr. Croft will discuss crash vectors other than rear, the important vehicle and subject parameters which modify risk, the dubious practice of estimating injury risk from property damage, the New Car Assessment Program and its unintended effects in low speed crashes, head restraints, seat backs, air bags, and other safety systems and how they modify injury risk and severity. Also discussed will be the general sequence of kinematic events in CAD injury and their relative timing, the head injury criterion (HIC), the neck injury criterion (NIC), and other important injury assessment reference values (IARV).

Soft and hard tissue injuries resulting from whiplash, including data obtained from experimental animal research and surgical and autopsy findings. Fractures (stable and unstable), dislocations, and the broad range of soft tissue lesions, or WAD, will be discussed in the context of mechanism of injury and vector-based occupant kinematics. Dr. Croft has catalogued an immense database of this literature. He will offer an explanation for most of the common components of CAD/WAD including headache, various types of neck and back pain, shoulder and upper extremity pain, lower extremity pain, neurological syndromes, dizziness/lightheadedness, vertigo, visual disturbances, cognitive, and endocrinological disorders, and will additionally explore the common phenomenon of delayed onset of symptomatology.

Common syndromes associated with whiplash include cognitive disorders, usually resulting from mild traumatic brain injury (MTBI), postconcussion syndrome (PCS), thoracic outlet syndrome (TOS), TM joint disorder, carpal tunnel syndrome (CTS), posttraumatic headache, myofascitis, and numerous other less common conditions. Also discussed will be the clinical and diagnostic components of each, again making constant reference to current world literature. Common symptoms of whiplash will be explained and, for those conditions that remain poorly understood, Dr. Croft will discuss the relevant literature and develop and/or describe the best and most current hypotheses. Dr. Croft goes into extensive detail on the subject of MTBI, ranging from the history of our knowledge base to current predictive models, and outlines the range of common symptoms resulting from this all too common, but poorly understood, condition. Headaches are discussed in the context of current classification systems, including that of the International Headache Society. Long-term consequences of MTBI in children and adults is also discussed.

The two most common forms of posttraumatic muscle disorder: myofascitis and fibromyalgia, going into detail about their respective diagnostic methods and criteria, such as those of the American College of Rheumatology. He will also provide a historical account of this controversial area, beginning with Virchow in 1852, and ending with the latest research findings.

Neurogenic pain, i.e., the pain that is conducted from peripheral nociceptor to dorsal root ganglion, to spinal cord, and eventually to the somatosensory cortex via the lateral spinothalamic tracts and thalamus, is the type studied and understood by most practitioners. However, few practitioners possess a deep understanding of discogenic, vertebrogenic, and scleragenic pain mechanisms, all of which are critically important in the diagnosis, management, and medicolegal explanation of most CAD cases. Dr. Croft explores the various pain mechanisms associated with CAD injury and its sequelae. He also looks at the epidemiology of chronic pain, sleep disturbance, and depression as an alternate explanation for some CAD symptoms.

For many, this is perhaps the most poorly understood area of this science, despite the magnitude of the current literature that is available. It is also one of the most hotly contested subjects from a forensic standpoint. Yet, in spite of the commonly voiced misconceptions about recovery from CAD, the preponderance of the evidence is clear and unambiguous. Dr. Croft reviews the substantial outcome literature and statistics in detail, and presents not only a thorough meta-analysis of it, but also develops a comprehensive risk analysis methodology found nowhere else. He explores the known risk factors for acute injury, as well as the risk factors for poor outcome—information that provides the physician and the patient with a meaningful guide to management and a scientific basis for clinical expectation. Moreover, Dr. Croft will emphasize the unique qualifications and role of the physician in this comprehensive risk analysis, which typically overshadows simple crash reconstruction or biomechanical analysis in its scope and construct validity. The section concludes with a review of the current literature on litigation neurosis concerning CAD and MTBI.

Newton's laws of motion, vehicle dynamics, conservation of linear momentum methods, restitution and energy methods, barrier equivalent methods, computer methods, and the practical application of those laws to the understanding vehicle dynamics and occupant kinematics. Dr. Croft will also discuss the application of data retrieved from event data recorders (ERD)—the vehicle’s on-board black box—and his own research from years of crash testing. He will also go beyond classical reconstruction and correlate these reconstructions with occupant kinematics and known risk factors: a dimension in which classically-trained accident reconstructionists, biomechanists, and engineers are not trained. With a good comprehension of the principles taught in this section, along with the risk factor analysis material and other information presented in Module 1, physicians will have the necessary intellectual tools to assess the relative validity and credibility of most reconstructions and biomechanical analyses pertaining to LOSRIC. A final section critically examines the uncertainty of LOSRIC reconstruction and presents both mathematical (log-differential) and practical ways of assessing the reliability and validity of these reconstructions based on the data from which they were constructed.

The historical data necessary to provide not only optimal medical/chiropractic care, but also to ensure that a comprehensive record of pertinent facts is available for forensic purposes when needed. Attendees will learn to use a standardized history form developed by Dr. Croft. From this, concise and comprehensive case reports can be produced, as will be developed in great detail in Module 3. Moreover, in cases in which permanent residuals result, it is important to make a determination concerning apportionment of any pre-existing disability that may have been present. Dr. Croft will present a standardized, scaled lexicon for severity and frequency of symptoms for general use and for use in apportionment questions. This method is formula-based and is highly dependent on accurate historical data.

The important general and special examination procedures and methods, including neurological (sensory, deep tendon and superficial reflexes, motor, visual, and coordination), orthopaedic, and cognitive examination methods. Dr. Croft will discuss the use of the SCL-90-R and all of its dimensions, the postconcussion syndrome examination, and vestibular tests. He’ll also discuss musculoskeletal exam procedures, special tests, such as those for the TM joint, CTS, and TOS; tests to rule out malingering (including the AMA’s methods of assessing repetitive ranges of motion vs. the coefficient of variation methods), and the most scientific way of estimating probable normal ranges of motion using published regression equations.

Guideline-based radiographic procedures in terms of what views to obtain and when. He will also discuss the sensitivity and specificity of radiography in terms of its limitations in the diagnosis of both fractures and soft tissue injury, comparing emergency department films (e.g., cross-table laterals) with clinic-based films (e.g., standing 7-view studies). He’ll contrast cost containment issues with physician accountability and responsibility. He’ll additionally review the various established methods of stability assessment of motion films, using mensuration schemes as well as templating protocols, and he’ll point out their relative validity. Some are as recent as 2003. He’ll discuss the cervical curve and the SRISD’s ongoing research in that area.

CT technology remains the test of choice in the acute situation for conditions such as serious brain trauma. It is also still an important imaging study for fracture and other conditions. These are discussed in this section.

Motion MRI and MRI neurography, as well the limitations of this technology in CAD trauma. It is now emerging that special techniques, such as proton density-weighted MRI, are required to visualize the various ligamentous components of the cervical spine and that certain cervical ligaments are better viewed using T2-weighted fast spin echo sequences, while others are better appreciated using T1-weighted sequences. Despite this, however, recent cadaver research highlights the shortcomings of even high resolution MRI in the detection of some cervical soft tissue lesions. Dr. Croft will discuss the most recent and relevant studies. He will also contrast the sensitivity of CT, MRI, and SPECT for brain injury.

Advanced diagnostic imaging modalities which are available to clinicians today, including intravenous contrast-enhanced MRI and CT, arthrography, discography, videofluoroscopy (VF), radionuclide bone scan, single photon emission computed tomography (SPECT), positron emission tomography (PET), and color-coded duplex sonography (CCDS). The relative strengths, weaknesses, and clinical indications of each will be described. An algorithm for choosing specific tests will be developed. In this section, Dr. Croft will also review the natural history of disc disease and the prevalence of herniation among the asymptomatic population in both cervical and lumbar spines—another area rife with misinformation.

Foundational discussion of relevant neuropathophysiology which segues into an easily understood synthesis of the currently available electrodiagnostic tests which are potentially useful in CAD trauma. These include various forms of electroencephalography (EEG), brain stem auditory evoked response (BAER), visual evoked potentials (VEP), electronystagmography (ENG), brain electrical activity mapping (BEAM), electromyography (EMG and sEMG), nerve conduction velocity (NCV), and somatosensory evoked potentials (SSEP). Discussions will always include the modality’s relative strengths and weaknesses and clinical indications/contraindications. As always, tables are provided for convenient reference.

Summary and simplification of the myriad of imaging, electrodiagnostic, and other tests that are currently available on a condition-by-condition basis. For example, for MTBI, imaging studies include CT and MRI, SPECT can be used to evaluate perfusion, PET can be used to evaluate the brain’s metabolism, and potentially useful electrodiagnostic tests include QEEG, BEAM, VEP, ENG, BAER. Other available tests include chemosensory evaluation, audiologic evaluation, polysomnography, and posturography. All are available in most areas of the country.

Methods of developing working, differential, and final diagnoses. This will include assembling sensible and accurate diagnoses encompassing stage, causation, condition, and complications. This is an indispensable skill which many practitioners have yet to completely master. Emphasized here are the skills required to provide clear, concise, unambiguous, and accurate communication of your objective assessment of the patient’s condition(s). Dr. Croft cautions, for example, against the use of poorly defined terminology, and against commonly misused diagnoses.

Honest and straightforward communication with patients, avoiding the unrealistic or overly sanguine expectations commonly espoused by some authorities, while also avoiding pessimism or negativism at the other end of the spectrum. This section includes a risk-based discussion of informed consent pertaining to spinal manipulation along with a brief presentation of Dr. Croft’s published research on arterial injuries attributed to spinal manipulation.

CAD treatment guidelines he developed in 1992, and how to use them. These guidelines have been widely adopted in the U.S. and Canada. Grading the severity and staging the injury are important components discussed here, as well as how to deal with common complicating factors. Dr. Croft will tie in a recap of known risk factors from Module 1 here because they figure into the grading system and the topic of maximal medical improvement (MMI).

An overview written by Dennis Steigerwald, DC, one of the leading chiropractic TMD experts in the multidisciplinary management of the TM joint.

; Primary Spine Care 5, MRI Spine The spine-brain connection in managing chronic pain patients. Understanding how chronic pain negatively effects brain morphology and potential pathology as sequala. The role of chiropractic in preventing the loss of gray matter and the most recent evidence as outlined in indexed peer reviewed literature over the last 10 years verifying chiropractic’s role.

Primary Spine Care 5, MRI Spine Interpretation of the spine. How to triage a trauma and non-trauma with advanced imaging and document the necessity. We will also cover the basics of MRI Spine Interpretation inclusive of all types of herniations, bulges.

Primary Spine Care 5, A literature based model for collaborating with hospitals, medical primary care providers and specialists. Reviewing the documentation requirements to communicate the diagnosis, prognosis and treatment plans with medical entities and having the evidence as a basis for those recommendations

Spinal Trauma Pathology, Triage and Connective Tissue Injuries and Wound Repair, Triaging the injured and differentially diagnosing both the primary and secondary complaints. Connective tissue injuries and wound repair morphology focusing on the aberrant tissue replacement and permanency prognosis potential.

Spinal Trauma Pathology, Ligament Anatomy and Injury Research and Spinal Kinematics, Spinal ligamentous anatomy and research focusing on wound repair, future negative sequelae of abnormal tissue replacement and the resultant aberrant kinematics and spinal biomechanics of the spine.

Clinical Grand Rounds, how to integrate orthopedic testing in the clinical setting utilizing both simple and complex patient scenarios. It includes potential stroke, or vertebrobasilar insufficient patients and understanding the nuances in a clinical evaluation with orthopedic testing as a critical part of the evaluation and screening process. How to integrate orthopedic testing in the clinical setting utilizing both simple and complex patient scenarios. It includes potential stroke, or vertebrobasilar insufficient patients and understanding the nuances in a clinical evaluation with orthopedic testing as a critical part of the evaluation and screening process.

: Lumbar Spine, Integration of lumbar orthopedic testing in the clinical setting to develop a differential diagnosis. Utilizing radiographic and advanced imaging inclusive of MRI and CAT scan findings to verify tissue pathology suspected by orthopedic testing conclusions and developing a treatment plan as sequelae.

Cervical Spine, Integration of cervical orthopedic testing in the clinical setting to develop a differential diagnosis. Utilizing radiographic and advanced imaging inclusive of MRI and CAT scan findings to verify tissue pathology suspected by orthopedic testing conclusions and developing a treatment plan as sequelae.

Orthopedic Testing: Cervical Spine, Integration of cervical orthopedic testing in the clinical setting to develop a differential diagnosis. Utilizing radiographic and advanced imaging inclusive of MRI and CAT scan findings to verify tissue pathology suspected by orthopedic testing conclusions and developing a treatment plan as sequelae.

Principles, Clinical Application and Triage, Integration of orthopedic testing in the clinical setting to develop a differential diagnosis. Utilizing radiographic and advanced imaging inclusive of MRI and CAT scan findings to verify tissue pathology suspected by orthopedic testing conclusions and developing a treatment plan as sequelae.

Clinical Evaluation and Protocols for Identifying Stroke Risk, The neurological history and examination for identifying stroke risks with a focus on supra and infratentorial regions, upper and lower motor lesions, cranial nerve signs, spinal cord pathology, motor and sensory pathology and gait abnormalities. Examining genetic and family histories along with dissection risk factors. Stroke orthopedic testing and clinical guidelines pertaining to triage for the primary care provider.

Stroke Principles of Treatment an Overview for the Primary Care Provider, Stroke type and treatments performed by vascular specialists. The goals of treatment with the physiology of the infarct and penumbra zones and the role of immediate triage in the primary care setting. Detailing the complications of stroke and future care in the chiropractic, primary care or manual medicine clinical setting.

Stroke Anatomy and Physiology: Stroke Types and Blood Flow, Various types of stroke identifying ischemia, hypoperfusion, infarct and penumbra zones and emboli. Cardiac etiologies and clinical features as precursor to stroke with associated paradoxical emboli and thrombotic etiologies. Historical and co-morbidities that have etiology instroke inclusive of diabetes, coagulopathy, acquired and hereditary deficiencies.

Stroke Anatomy and Physiology: Brain Vascular Anatomy, The anatomy and physiology of the brain and how blood perfusion effects brain function. A detailed analysis of the blood supply to the brain and the physiology of ischemia.

Spinal Trauma Pathology, Spinal Biomechanics, Central Nervous System and Spinal Disc Nomenclature, The application of spinal biomechanical engineering models in trauma and the negative sequelae it has on the central nervous system inclusive of the lateral horn, periaqueductal grey matter, thalamus and cortices involvement.

Spinal Trauma Pathology, Biomechanics of Traumatic Disc Bulge and Age Dating Herniated Disc Pathology, The biomechanics of traumatic disc bulges as sequelae from trauma and the comorbidity of ligamentous pathology. Age-dating spinal disc pathology in accordance with Wolff’s Law.

Spinal Trauma Pathology, Clinical Grand Rounds, The review of case histories of mechanical spine pathology and biomechanical failures inclusive of case histories, clinical findings and x-ray and advanced imaging studies. Assessing comorbidities in the triage and prognosis of the injured.

Spinal Trauma Pathology, Research Perspectives, The review of current literature standards in spinal trauma pathology and documentation review of biomechanical failure, ligamentous failure and age-dating disc pathology.

Delta V issues correlated to injury and mortality, side impact crashes and severity of injuries, event data recorder reports correlated to injury, frontal impact kinematics, crash injury metrics with many variables and inquiries related to head restraints.

The mathematical calculations necessary utilizing time, distance, speed, coefficients of friction and acceleration in reconstructing an accident. The application of the critical documentation acquired from an accident site.

Delta V issues correlated to injury and mortality, side impact crashes and severity of injuries, event data recorder reports correlated to injury, frontal impact kinematics, crash injury metrics with many variables and inquiries related to head restraints

The mathematical calculations necessary utilizing time, distance, speed, coefficients of friction and acceleration in reconstructing an accident. The application of the critical documentation acquired from an accident site

Factors that cause negative acceleration to zero and the subsequent forces created for the vehicle that get translated to the occupant. Understanding critical documentation of hospitals, ambulance reports, doctors and the legal profession in reconstructing an accident.

The forces in physics that prevail in accidents to cause bodily injury. Quantifying the force coefficients of vehicle mass and force vectors that can be translated to the occupant and subsequently cause serious injury.

Deferentially diagnosing mild traumatic brain injury vs. traumatic brain injury and the clinical and imaging protocols required to conclude an accurate diagnosis for head trauma.

Neurophysiological central and peripheral nervous systems mechanisms of pain with integrated higher cortical functions of the thalamus, cingulate, amygdala, pre-frontal, motor and sensory cortexes. Trauma and chronic pain care effecting mechanoreceptors, nociceptors and proprioceptors through adjustive therapy based upon evidenced based care and current literature verification

Triage of patients based upon MRI findings of disc herniation, disc bulge, protrusion, extrusion or sequestrations and spinal cord or nerve root negative sequella, clinical findings of neuro-compressive pathologies and neurodiagnostic findings of EMG-NCV, SSEP, VEP, BAER, VEP and V-ENG findings.

Magnetic fields, T1 and T2 relaxations, nuclear spins, phase encoding, spin echo, T1 and T2 contrast, magnetic properties of metals and the historical perspective of the creation of NMR and MRI.

Spinal anatomy of all MRI views utilizing T1, T2, 3D Gradient, stacking and STIR sequences of imaging. Advanced protocols of MRI examination with multiple sequences to create concurrent diagnostic findings

MRI interpretation of spinal disc pathologies as a result of trauma and degenerative factors and resultant neurological compromise. Spinal Cord and Spinal canal pathologies and space occupying lesion interpretation.

Normal anatomy of axial and sagittal views utilizing T1, T2, 3D Gradient and STIR sequences of imaging. Standardized and desired protocols in views and sequencing of MRI examination to create an accurate diagnosis in MRI.

MRI interpretation of bulged, herniated, protruded, extruded sequestered and fragmented disc pathologies in etiology and neurological sequellae in relationship to the spinal cord and spinal nerve roots.

MRI interpretation of bone, intradural, extradural, cord and neural sleeve lesions. Tuberculosis, drop lesions, metasasis, ependymoma, schwanoma and numerous other spinal related tumors and lesions.

MRI interpretation sequencing of the cervical, thoracic and lumbar spine inclusive of T1, T2, STIR and 3D gradient studies to ensure the accurate diagnosis of the region visualized.

The clinical application of the results of space occupying lesions. Disc and tumor pathologies and the clinical indications of manual and adjustive therapies in the patient with spinal nerve root and spinal cord insult as sequellae.

Spinal Disc and Spinal Canal Disorders, MRI interpretation of herniated, protruded, extruded, bulged and sequestered discs & spinal stenosis as sequelae of ligamentous hypertrophy, congenital malformation, spinal cord pathology.

MRI interpretation of herniated, protruded, extruded, bulged and sequestered discs and their relationship to the spinal cord and spinal nerve roots and the clinical correlation to spinal adjustments, manual spinal therapy and joint mobilization.

Cartesian Coordinate System, Cervical Pathobiomechanics, Lumbar Pathobiomechanics, Spinal Biomechanics in Trauma, Organizational Analysis, Cervical Digital Analysis, Lumbar Digital Analysis, Full Spine Digital Analysis

Spinal Disc Microanatomy, The understanding of the human spinal discal elements; annulus, nucleus pulposis, cartilaginous end plates inclusive of the neurology, visualization, differentiation from the neonate to adults. The understanding of the etiology of Modic changes on MRI and how spinal biomechanics are altered.

Electromyogram/Nerve Conduction Velocity (EMG/NCV), Diagnosis & Interpretation: Needle Electromyogram (EMG) Studies: The EMG process, inclusive of how the test is performed and the steps required in planning and electromyographic study. This covers the spontaneous activity of a motor unit action potential, positive sharp waves and fibrillations. The insertional activity (both normal and abnormal), recruitment activity in a broad polyphasic presentation and satellite potentials. This covers the diagnosing of patterns of motor unit abnormalities including neuropathic demyelinated neuropathies along with acute myopathic neuropathies. This section also covers the ruling out of false positive and false negative results.

Electromyogram/Nerve Conduction Velocity (EMG/NCV), Diagnosis & Interpretation: Overview of EMG and NCV Procedures, Results, Diagnoses and Documentation. The clinical incorporation of electrodiagnostic studies as part of a care plan where neuropathology is suspected. It also covers how to use electrodiagnostics in a collaborative environment between the chiropractor as the primary spine care provider and the surgeon, when clinically indicated. This section covers sample cases and health conclude and accurate treatment plans based upon electro-neurodiagnostic findings when clinically indicated.

A Quick Solution Based on Your Documentation & Clinical Excellence, A case study of managing a patient where the MRI was inaccurate based upon literature standards and the collaboratively working through a system in triaging an extruded disc patient from psychological support to appropriate surgical care.

Chiropractic as the First Option for Spine, A Literature-Based Standard, Utilizing clinical findings in conjunction with advanced imaging and electrodiagnostic findings in managing collaborative relationships with medical specialists. Applying a literature standard to care to ensure conservative care as the first option. PACE Approved for the Federation of Chiropractic Licensing Boards, Cleveland University Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island NY 2020

Characteristics of Laser, Laser Physics, Safety, Mechanisms of Therapy. Dose, Time and Power. Treatment Procedures, Wound Healing, Tendonopathies, Myofascial Pain, Muscular Injury, Osteoarthritis, Sports Injury and Fatigue, Tinnitis, TMJ and Other Indications

Review of Medical Staff and Committees, Admitting Procedures and Criteria, Discharge Procedures, Medical-Surgical Records, Surgical Dictation, Differential Diagnosis, Out Patient Work-Up, X-Ray, EMG, Lab Studies, and Surgical Protocols.

MUA Certification: Review of Anesthesiologist Procedures, Indications, Contraindications, Admitting, Techniques for the Cervical, Thoracic and Lumbar Spines, Extremities, Fibrotic Tissue Stretching Techniques, Patient Safety, Discharge, Charting and Review of Literature.

Intestinal and Systemic Detoxification, Gastrointestinal Nutrition, Liver Metabolism, Immune Function, Cardiovascular, Glucose Tolerance, Pulmonary Function, Urological Nutrients, Musculoskeletal Nutrition, Urinalysis, Fasting, Hair Analysis, Fecal Analysis, Modified Elimination Diets, etc.

Medical History, Injury Mechanics, Employment History, Activities of Daily Living, Occupational Requirements, Reasonable and Necessary Treatment, Clinical Assessment, Review of Records, Causation, Apportionment, Disability Rating, etc.

Physical Therapy Methods and Concepts: Passive Motion, Active Exercise, Strengthening Exercise, Dynamic Neuromuscular Stabilization, Soft Tissue Mobilization, Dry Needling for Muscular Fibrosis.

Neurophysiological Foundation fo Physical Therapy Approaches: Neuroplasticity, Evolutionary Plasticity, Repair Placidity, Neuroplastic and Sensorimotor Programs, Training and Exercises, etc.

Entrapment Syndromes: Etiology, Manifestation, Pathogenesis, Treatment and Diagnosis. Entrapment of; Upper Thoracic Aperature, Scalenus, Costoclavicular, Hyper-Abduction, Supra Clavicular, Median Nerve, Ulnar Nerve, Radial Nerve, Femoral Nerve, Sciatic Nerve, Peronial Nerve, Tibial Nerve, ect. Treatment and Rehabilitation.

Deficits in Cerebellar Function: Vestibular System Disturbances, Unilateral Vestibular Lesion, Benign Proxismal Positional Vertigo, Bilateral Vestibular Deficit, Deficits due to Cervical Spine, Central Balance Deficits, Vertebral Artery Syndrome, Psychogenic Vertigo. Extrapyramidal Deficits; Hypokenetic and Hyperkenetic Deficits, Bradykinesia, Akinesia, Rigidity, Tremor and Postural Deficits.

Influence of Function on Morphological Tissue Restructuring: Functional Changes in Soft Tissue, Motion Restrictions, Hypermobility, Change in Afferentation from Receptors, Motor Learning from Central Regulation, Overloading causing Tendonitis, Enthesopathy, Paratenonitis, Paritendinitis and Tenosynovitis. Post-Surgical Rehabilitation. Treatment Rehabilitation and Strategies.

Degenerative Joint Diseases: Primary OA, Secondary OA, Coxarthrosis, Gonarthrosis, Surgical Procedures, Rehabilitation following Arthroplasty. Traumatology of the Movement System; Contusion, Tendon Injury, Muscle Injury, Bone Injury Joint Injury, Treatment Options, Rehabilitation.

Shoulder - Knee - Paraspinal Soft Tissue Findings: Shoulder Disorders, Shoulder Dislocations, Shoulder Fractures, Knee Disorders, Knee Dislocations, Knee Fractures, Abdominal Aortic Aneurism Calcification in; Arteries, Prostate, Lymph Nodes, Gallstones, Urinary Calculi, Teratomas, Heart and Chest Studies, Pneumothorax, etc.

Fractures of the Upper and Lower Extremities: Pott's Fracture, Jones, Calcaneal Fractures, Tibila Plateau, Patella, Toddler's, Fender Fractures. Radial Head Fractures, Supracondylar, Olecranon, Manteggia' s, Collie's, Bennett's, Smith's, Scaphoid, Gamekeeper's Thumb, etc.

Principals of Magnetic Resonance Imaging: Tendons and Muscles: Degeneration, Tenosynovitis, Tears, Subluxation/Dislocation, Indirect and Indirect Muscle Injury, Muscle Trauma. TMJ, Shoulder, Elbow, Wrist, Hand, Hip, Knee, Foot and Spine: Normal Anatomy, Tendon, Ligament, Nerve and Bone Injury both Traumatic and Non-Traumatic

Chest Imaging: MRIiography, Scintigraphy, Bronchography, Fluoroscopy. Radiographic Signs of Chest Disease: Rosette Pattern, Silhouette Sign, Atelecatasis, Interstitial Disease, Calcifications, Alterations in Lung Volume, HRTC patterns of Airway Disease, Lung Disease, Congenital Malformations, etc.

Functional and Neurologic Symptomology: Postural Stability, Stabilization, Reactibility, Disturbances. Gait Cycle, Typology of Gait Dysfunctions Neurological, Examination of Postural Stabilization and Postural Reactibility. Trigger Points, Muscular Disturbances, Myotatic Reflexes, Involentary movements, Tremor, Spasm, Clonus, Fibrillar Twitches. Chorelic and Athenoid Hyperkensesis.

Neurologic Syndromology: Myasthenia Gravis, Lambert-Eaton Myasthenic Syndrome. Peripheral Nerve Deficits. Spinal Cord: Transverse (sudden/gradule) Cord Lesions, Pseudoparetic, Spastic, Mixed Cord Lesions. Conus Medularis, Cauda Equina, Posterior Cord. Cerebellar Syndrome, Flaccidity, Hypermetria, Diadochokinesia, Extrapyramidal, Thalamic and Brain Stem Syndromes. Meningeal Irritation, Intracranial Hypotension and Ventricularr Syndromes, etc.

Kinesiology and Clinical Examination of the Joint System: Kinesiology of the Spine, Thorax, Pelvis, Shoulder Girdle, Elbow Joint, Wrist, Hand, Hip, Knee, Lower leg and Foot.

Lumbar Spine: Low Back Syndromes and their Related X-Ray Scanning Lines and Angles, Spondylolesthesis, Spondylolysis, Retrolesthesis, Block Vertabrae, Coronal and Sagittal Tropism, Lumbar Stenosis, Spina Bifida, Lumbosacral Transitional Vertebrae, Knife Clasp Deformity, Hemi and Butterfly Vertebrae, etc.

Pelvic - Sacroilliac _ Hip Roentgenology: Hip Fractures, Stenton's Line, Protrusio Acetabuli, Osteitis Condensans Ilii, Osteitis Pubis, Sacroilliac Alterations, Congenital Structural Faults, Aknalosing Spondylitis, Infections, Congenital Hip Displasia, Slipped Femoral Capital Ephysis, Osteochondrosis, etc.

Cervical Spine: Whiplash Syndromes and their Related X-Ray Scanning Lines and Angles, Whiplash Syndromes, Joints of Luschka, Posterior Joint Arthrosis, Basilar Impression, Klippel-Feil Syndrome, Cervical Ribs, Twelve Indirect Signs of Cervical Spine Trauma, Cervical Fractures, etc.

Primary Characteristics and Sites: Benign vs. Malignant, Infection vs. Malignant, Osteoperosis, Paget's, Target Areas of Bone Disorders

Bone Tumors - Benign and Malignant: Bone Tumor Characteristics - Contrast between Benign and Malignant, Neoplasms, Metastatic Carcinoma, and Sarcoma.

Arthritis and Osteochondrosis: Osteoarthritis, Infective Arthritis, Inflammatory Arthritis and Gout. Non-Articular Rheumatism. Legg-Calve-Perthes', Scheuermann's disease, Traumatic Epiphysitis, Osgood Schlatter's, Sever's Disease, Kohler's, Kienbock's Disease, etc.

The Vertebral Motor Unit: Degeneration of Motion Segments, Effects of Subluxation, Vertebral Body Fractures, Congenital/Developmental/Pathological Vertebral Body Alterations, Schmoral's Nodes, Persistent Notochord, Bone-Within-A-Bone, Ivory Vertebrae, Ruptured Disc, Disc Bulge, Herniation, Circumferential Tears, etc.