David Herrin, DC

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.

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 sequelae in relationship to the spinal cord and spinal nerve roots.

MRI interpretation of bone, intradural, extradural, cord and neural sleeve lesions. Tuberculosis, drop lesions, metastasis, 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 sequelae.

MRI slices, views, T1, T2, STIR axial, stacking, FFE, FSE and sagittal images. Clinical indication for the utilization of MRI and pathologies of disc in both trauma and non-trauma sequellae, including bulge, herniation, protrusion, extrusion and sequestration.

MRI slices, views, T1, T2, STIR axial, stacking, FFE, FSE and sagittal images in the interpretation of lumbar degeneration. With the co-morbidities and complications of stenosis, pseudo-protrusions, cantilevered vertebrate, Schmorl's nodes and herniations. Central canal and cauda equina compromise interpretation with management.

MRI slices, views, T1, T2, STIR axial, stacking, FFE, FSE and sagittal images in the interpretation of lumbar herniations. With the co-morbidities and complications of stenosis, pseudo-protrusions, cantilevered vertebrae, Schmorl's nodes and herniations. Morphology of lumbar disc pathologies of central and lateral herniations, protrusions, extrusions, sequestration, focal and broad based herniations are defined and illustrated. Central canal and cauda equina compromise interpretation with management.

MRI slices, views, T1, T2, STIR axial, stacking, FFE, FSE and sagittal images in the interpretation of cervical degeneration. With the co-morbidities and complications of stenosis, pseudo-protrusions, cantilevered vertebrae, Schmorl's nodes and herniations. Spinal cord and canal compromise interpretation with management.

MRI slices, views, T1, T2, STIR Axial, FFE, FSE and sagittal images in the interpretation of lumbar herniations. With the co-morbidities and complications of stenosis, pseudo-protrusions, cantilevered vertebrae, Schmorl's nodes and herniations. morphology of lumbar disc pathologies of central and lateral herniations, protrusions, extrusions, sequestration, focal and broad based herniations are defined and illustrated. Spinal cord and canal compromise interpretation with management.

MRI slices, views, T1, T2, STIR Axial, FFE, FSE and sagittal images in the interpretation of degenerative spondylolesthesis, spinal canal stenosis, Modic type 3 changes, central herniations, extrusions, compressions, nerve root compressions, advanced spurring and thecal sac involvement from an orthopedic, emergency room, chiropractic, neurological, neurosurgical, physical medicine perspective.

An in-depth understanding of the protocols in triaging and reporting the clinical findings of the trauma patient. Maintaining ethical relationships with the medical-legal community.

An extensive understanding of the injured with clinically coordinating the history, physical findings and when to integrate neurodiagnostics. An understanding on how to utilize emergency room records in creating an accurate diagnosis and the significance of “risk factors” in spinal injury.

An extensive understanding of the physics involved in the transference of energy from the bullet car to the target car. This includes G's of force, newtons, gravity, energy, skid marks, crumple zones, spring factors, event data recorder and the graphing of the movement of the vehicle before, during and after the crash. Determining the clinical correlation of forces and bodily injury.

MRI interpretation, physiology, history and clinical indications, bone scan interpretation, physiology and clinical indications, x-ray clinical indications for the trauma patient.

Electromyography (EMG), Nerve Conduction Velocity (NCV), Somato Sensory Evoked Potential (SSEP), Visual Evoked Potential (VEP), Brain Stem Auditory Evoked Potential (BAER) and Visual-Electronystagmography (V-ENG) interpretation, protocols and clinical indications for the trauma patient.

Understanding the necessity for accurate documentation and diagnosis utilizing the ICD-9 and the CPT to accurately describe the injury through diagnosis. Understanding and utilizing state regulations on reimbursement issues pertaining to healthcare.

The Cartesian Coordinate System from the history to the application in the human body. Explanation of the x, y and z axes in both translation and rotations (thetas) and how they are applicable to human biomechanics.

Spinal biomechanical engineering of the cervical and upper thoracic spine. This includes the normal and pathobiomechanical movement of both the anterior and posterior motor units and normal function and relationship of the intrinsic musculature to those motor units. Nomenclature in reporting normal and pathobiomechanical findings of the spine.

Spinal biomechanical engineering of the lumbar spine. This includes the normal and pathobiomechanical movement of both the anterior and posterior motor units and normal function and relationship of the intrinsic musculature to those motor units. Nomenclature in reporting normal and pathobiomechanical findings of the spine.

Utilizing whiplash associated disorders in various vectors of impact and whiplash mechanisms in determining pathobiomechanics. Clinically correlate annular tears, disc herniations, fractures, ligament pathology and spinal segmental instability as sequelae to pathobiomechanics from trauma. The utilization of digital motion x-ray in diagnosing normal versus abnormal facet motion along with case studies to understand the clinical application.

Integrating spinal biomechanics and pathobiomechanics through digitized analysis. The comparison of organized versus disorganized compensation with regional and global compensation. Correlation of the vestibular, ocular and proprioceptive neurological integration in the righting reflex as evidenced in imaging. Digital and numerical algorithm in analyzing a spine.

Digitizing and analyzing the cervical spine in neutral, flexion and extension views to diagnose pathobiomechanics. This includes alteration of motion segment integrity (AOMSI) in both angular and translational movement. Ligament instability/failure/pathology are identified all using numerical values and models. Review of case studies to analyze pathobiomechanics using a computerized/numerical algorithm.

Digitalizing and analyzing the lumbar spine images to diagnose pathobiomechanics. This includes anterior and posterior vertebral body elements in rotational analysis with neutral, left and right lateral bending in conjunction with gate analysis. Ligament instability/failure/pathology is identified all using numerical values and models. Review of case studies for analysis of pathobiomechanics using a computerized/numerical algorithm along with corrective guidelines.

Digitalizing and analyzing the full spine images to diagnose pathobiomechanics as sequelae to trauma in relation to ligamentous failure and disc and vertebral pathology as sequalae. This includes anterior and posterior vertebral body elements in rotational analysis with neutral, left and right lateral bending in conjunction with gate analysis. Ligament instability/failure/pathology is identified all using numerical values and models. Review of case studies for analysis of pathobiomechanics using a computerized/numerical algorithm along with corrective guidelines.

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 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.

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 gray matter, thalamus and cortices involvement.

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.

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.

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

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.

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

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 homeostasis until tetanus ensues creating osseous changes under the effect of Wolff's Law.

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.

Normal anatomy of axial and sagittal views utilizing T1, T2, gradient and STIR sequences of imaging. Degeneration and annular fissures of discs in both trauma and non-trauma patients and the biochemical properties of joints in age dating pathology. Disc bulges from degenerative and sequala to osseous issues, herniation pathology and protrusion, extrusion, migrated and sequestered variations. Clinical scenarios as sequela to disc and pre-existing pathologies.

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.

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 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.

Understanding the necessity for accurate documentation, diagnosis and clinical correlation to the injury when reporting injuries in the medical-legal community. Documenting the kinesiopathology, myopathology, neuropathology, and pathophysiology in both a functional and structural paradigm.

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.

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.

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.

Integration of 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.

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.

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.

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. Concussion protocols in traumatic brain injury short of demonstrable bleeding on advanced imaging.

Concussion etiology and cognitive sequela where gross bleeding has not been identified on advanced imaging. The significance of electroencephalogram testing in determining brain function and pathology (if present). Understanding of waveforms in electroencephalogram testing in both normal and abnormal scenarios.

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. Electroencephalograms and event-related potentials which measure the brain response that is a direct result of specific sensory or motor events. EEG is a stereotype electrophysiological response to a stimulus and provides a noninvasive means of evaluating brain function. Multiple case studies are discussed with ensuing triage protocols pending the results.

The anatomy and physiology of the brain and how blood perfusion affects brain function. A detailed analysis of the blood supply to the brain and the physiology of ischemia.

Various types of stroke identifying ischemia, hypoperfusion, infarct and penumbra zones and emboli. Cardiac etiologies and clinical features as precursors to stroke with associated paradoxical emboli and thrombotic etiologies. Historical and co-morbidities that have etiology in stroke inclusive of diabetes, coagulopathy, acquired and hereditary deficiencies.

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.

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.

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

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.

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.

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.

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.

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.

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.

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, 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 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

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, and a 99212-99213-99214-99215

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

Identified the vertebrae, 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

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

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

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.

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.

Understanding flexion-extension cervical injures and diagnosing connective tissue pathology. Determining impairments and the literature-based standard for permanent injuries.

Spinal disc morphology, and innervation. Herniated, bulged, protruded, and sequestered disc characteristics and management. Literature-based documentation requirements for no-dis spinal injuries.

A case-study of a post-traumatic herniated disc and related brain malfunction supported by contemporary literature, MRI acquisition, and necessity protocols.

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.

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.

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.

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 conduction. The sodium and potassium pump’s function in action potentials.

Nerve conduction velocity testing, the equipment required and the specifics of motor and sensory testing. This section covers the motor and sensory NVC procedures and interpretation including latency, amplitude (CMAP) physiology and interpretation including the understanding of the various nuances of the wave forms.

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.

The EMG process, inclusive of how the test is performed and the steps required in planning an 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.

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 how to conclude accurate treatment plans based upon electro-neurodiagnostic findings when clinically indicated.

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 depth, the required elements for chief complaint, 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.

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 vertebrobasilar circulation orthopedic assessment.

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.

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.

Discusses how to document a clinically determined treatment plan inclusive of both manual and adjunctive therapies. How to document both short-term and long-term goals as well as referring out for collaborative care and/or diagnostic testing. How to prognose your patient and determine when MMI (Maximum Medical Improvement) has been attained.

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.

Report writing in a medical-legal case inclusive of causality, bodily injury, persistent functional loss and restrictive sequela from trauma. Demonstratively documenting bodily injury utilizing models, graphs and patient image of x-ray and advanced imaging.

Demonstratively reporting spinal biomechanical failure and spinal compensation. How in a medical-legal environment to ethically report pre-existing injuries vs causally related current injuries and what is permissible in a legal proceeding.

Causality, bodily injury and persistent functional losses documented and reported in a medical-legal environment as your direct opinion. Avoiding hearsay issues to ensure ethical relationships.

Preparing demonstrative documentation in a medical-legal case ensuring that you are familiar with all other treating doctor’s reports. Correlating your initial and evaluation and management (E&M) report and your follow-up E&M reports with the narrative upon maximum medical improvement documenting continuum of care.

How to prepare your documentation for courtroom testimony and ensuring your qualifications are documented properly on an admissible, professional curriculum vitae. How to include indexed peer-reviewed literature in medical-legal documentation.

Preparing patient history in a medical-legal case based upon your initial intake forms and understanding the work, social, academic, household and social activities of your patient. Understanding and explaining your doctoral and post-doctoral credentials in the courtroom.

Preparing demonstrative documentation in a medical-legal case to report the bodily injuries of your patients, inclusive of loss of function and permanent tissue pathology.

Preparing documentation in a medical-legal case ensuring that you can communicate permanent vs. temporary functional losses and permanent vs. temporary tissue pathology. How to maintain and explain ethical relationships in medical-legal cases.

How to report bodily injury and functional losses as supported by your credentials in a medical-legal case. Clinically correlating causality and permanent tissue pathology as sequela to trauma.

How to report records of collaborative treating doctors and communicating your scope of practice in the management of your case. How to ethically report your role as a doctor in medical-legal cases.

The member doctor has undergone rigorous training related to spine and trauma and is now formally qualified to either diagnose or manage all spine cases. The graduate has completed an extensive program in triaging the injured, MRI spine interpretation, spinal orthopedics, early detection for stroke, spinal biomechanical engineering and accident reconstruction for motor vehicle accidents. Additionally, professional relationships and collaboration with a vast array of medical surgeons and physicians as part of the team that manages spine cases, ensures excellence in patient care of the injured patient.

Credentialed in hospital protocols, emergency room protocols, acute and chronic patient triage inclusive of MRI spine interpretation, spinal biomechanical engineering, head trauma, concussion, mild traumatic and traumatic brain injuries.

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.

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.

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.

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.

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.

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.

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.

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 understanding 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, Academy of Chiropractic.

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.

The credentials and knowledge based from an academia perspective when cooperatively treating in a collaborative environment inclusive of understanding pathology and mechanical spine issues.

Integrating Spinal Biomechanical Engineering and MRI Spine Interpretation into a primary spine care model, inclusive of necessity and acquisition protocols. A comprehensive review the latest evidence in documenting mechanical issues.

Understanding hospital and medical specialist's care paths for mechanical spine pathology and integrating the doctor of chiropractic in the hospital and allopathic treatment protocols.

Central nervous system connection and the thalamus, hypothalamus connection in both ascending and descending central pathways with neuro-endocrine implications that have the mechanisms to be a component of Schizophrenia, Dementia and Alzheimer's with a linear relationship to the chiropractic spinal adjustment and chronic pain.

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

Herniated, bulged, protruded and extruded discs, etiology and morphology. Age-dating disc pathology inclusive of Modic changes, piezoelectric effect, Wolff’s Law and radicular clinical presentation

Utilization in spinal models considering the opioid abuse and various spinal models in contemporary health care. Care paths for mechanical spine pain and the evidence for conservative chiropractic care

Mechanoreceptor, proprioceptor, nociceptor innervation and control of the spinal system with central nervous system action and interaction. The integration of the pain processing network and the HPA Axis (hypothalamus, adrenal and pituitary) with the chiropractic spinal adjustment

Maintaining ethical Interprofessional relationships based upon an evidenced based practice inclusive of triage, diagnostics and reporting. Creating thorough documentation that reflects your complete findings encompassing descriptive ICD-10 codes and concludes the presence or absence of pathology.

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,

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,

MRI Spine The spine-brain connection in managing chronic pain patients. Understanding how chronic pain negatively effects brain morphology and potential pathology as sequela. 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,

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,

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.

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.

Clinically correlating the history, clinical findings, imaging findings and diagnosed bodily injuries to conclude and accurate diagnosis, prognosis, and treatment plan.

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.

Cervical whiplash case presentation and treatment, including spinal manipulation, dry needling, exercise programs, patient education, injection therapy and medication pain management, surgical interventions, prehabilitation and post-op care, and other multimodal care in managing whiplash and ligament injury

Cervical radiculopathy case presentation and treatment with discussion of cervical disc arthroplasty and ACDF, cervical traction, manual therapy and exercise, differentiating cervical spine and shoulder pathology, and nonoperative management of cervical radiculopathy in an interdisciplinary approach.

Low back pain case presentation and treatment with discussion of rehab management, facet capsular ligament and spinal stability, lumbar disc pathology, fusion, disc replacement, new procedures including basivertebral nerve ablation, and evidence-based clinical guidelines for low back pain in an interdisciplinary approach.

Case presentation and management for failed back syndrome, misnomer discussed, influence of sagittal balance, cluneal nerve entrapment, reoperation, optimizing management outcomes utilizing various providers over the course of pre and post operation. Future, continued care needs discussed.

Case study of spinal stenosis reviewed and management discussed, consultation, history, and examination considerations from perspective of multiple practitioners, chiropractic and physical therapy methods of care, pain management options, surgical stabilization of degenerative spinal stenosis.

Case review of severe spinal cord injury with integrated team approach to notification, transport, emergency imaging and care, surgical intervention, post-operative inpatient care, outpatient care, in-home care, patient education and goal-setting for future outcome, discussion of fear-avoidance behaviors and motivators, and long term care.

Participate in an educational activity that increased provider education, collaboration and accessibility by breaking down medical hierarchy and creates and environment where all medical disciplines are on the same level to examine spine cases from every angle. Utilize data-driven strategies in the treatment of spine disorders from a viewpoint of an interdisciplinary team.

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.

Differentially diagnosing disc vs. posterior longitudinal ligaments vs. Thecal Sac vs. spinal cord vs. Ligamenta Flava pathology and insult. Identifying the borders of lesions and discerning between anatomic structures pathologically affected demonstrably.

Discussion regarding causes of inflammation affecting joints, with integrative health management through combining Chiropractic Care, Functional Medicine, Rehabilitation, Pilates, Core Yoga Therapy, and Biological Resonance.

How structure and function are optimized through a poly-therapeutic intervention program that develop superior clinical outcomes, key concepts ranging from Chiropractic care, laser therapy, ATP, mitochondrial function, diet, exercise, brain health, low back pain and state-of-the-art technologies that are tailor-made for expert chiropractic care to enable managing common clinical syndromes validated through extensive scientific research and proven techniques.

History and Orthopedic testing of Cervicobrachial Syndrome, Rotator Cuff Syndrome, Upper Extremity Nerve Entrapment and Fractures; Documentation and Care Types, Brainstem and Brain Trauma-related symptoms, Mild Traumatic Brain Injury (MTBI) symptomatology, evaluating spinal conditions.

Epidemiology and Identification of Foot, Ankle, Knee, Hip, Shoulder, Elbow and Wrist Injuries, Biomechanics and postural distortions with corresponding case studies, Lumbar spinal adaptation, TMJ Syndrome and Cervicalgia Pathophysiology of Chronic Headaches.

Discuss inflammation from the perspective of evolutionary biology, investigate prominent causes of systemic inflammation, integrate inflammation and the pathoanatomy of the chiropractic subluxation, glycosylation: learn what it is and what it does to the aging process, including disc degeneration, neurochemistry of catecholamines, fatty acids, excitotoxins and neurodegenerative diseases, Quantify the opioid crisis and the effectiveness of chiropractic as an alternative.

Proper history and management of the Post-Concussive Pediatric case, referral and co-management, follow-up care, return to school and athletics.

Identifying the Primary Health care issues in America Today, overview of health care delivery, discussion on adequate production of ATP, mitochondrial function in health and disease, free radicals, laser photon therapy, brain function in trauma, degeneration, vascular disease, scar tissue and fibrosis of repair.

Recognize the key components regarding good documentation and record keeping, Identify the legal requirements of informed consent, Document progress notes (SOAP) to meet insurance guidelines and medical necessity, apply the PARTS, Utilize CMT coding appropriately, Utilize E/M (Evaluation/Management) coding appropriately to meet insurance guidelines and medical necessity.

Describe the contribution of hip vs. spinal motion, distinguish poor motor patterns of hip and low back movements and what to do about it. Delineate the neural adaptations to exercise and apply towards rehabilitation

Define proprioception and discuss proprioception from a rehabilitative perspective. Examine spinal proprioception and sensorimotor training.

Identify and describe the major factors influencing muscular strength, assess the chiropractic influences on strength. Identify and discuss the strength training principles and components of a training session.

Review sensory-motor control and rehabilitation, discuss aerobic exercise for LBP patients, muscle training of the hip, abdominal and paraspinal muscles. Identify how aerobic exercise improves motor performance in the elderly, distinguish the effects of different training styles on the cross-sectional area of paraspinal muscles.

Summarize the functional anatomy of core strength training, discuss the principles of core strength. Develop an assessment of spinal stabilization and distinguish specific evaluation tests for spinal stability.

Summarize the effect of training on the fatigue of multifidi muscles, which muscles are involved in stabilization exercises. Assess the relation between low back pain and clinical instability, describe a study implementing manipulation and stabilization exercises for chronic LBP.

Summarize the effect of whiplash on neck muscle strength, the effects of manipulation vs. mobilization on head and neck pain in whiplash patients. Describe a study predicting the response of neck pain patients to neck strengthening exercise.

Identify the anatomy of upper motor neuron tract systems and discuss the functionality of upper motor neuron tract systems, the effects of a spinal cord injury, anatomy and functionality of regions of the brain, complications post injury of brain and spinal cord injury, treatment options for rehabilitation of spinal cord and head injured patients.

Summarize the central role of muscle protein in whole-body metabolism and muscle mass, outline the role of skeletal muscle metabolism in health and disease (such as diabetes, obesity, osteoporosis). Describe the role of hormones for influencing muscle metabolism and health, the catabolic and anabolic mediators of muscle metabolism, specify ways to maximize muscle mass and metabolism to promote wellness.

Explain the anatomical constituents of the core musculature, consider implications of weak or inadequate core muscles, emphasize the importance of the gluteal muscle group in rehabilitation. Illustrate common compensation patterns when individuals have weak core musculature with clinical examples, explain the concept of neural adaptation, and review reciprocal inhibition and physiological overflow and their clinical application.

Discuss conventional sit-ups and their pitfalls, provide a logical rationale for core training, explain and demonstrate a logical progression of exercises for core training, emphasizing skill, then endurance and strength.

Recognize common mistakes with conventional sit ups and how to correct them, narrate the ideal sit up, recognize the importance of the brain and cortex in core training, how inhalation and exhalation affect muscular activity, and how to utilize this in training. Examine the importance of the thoracolumbar fascia.

Demonstrate the proper patient positioning for the lunge and squat exercises, common problems with the lunge and squat exercises, cues for proper patient positioning. Introduce, explain and demonstrate proper and improper performance of additional, advanced gluteal activation exercises including the Texas walk, ball squats, drops, roman chair and 1 legged dead lifts.

The neuroendocrine-immune interactions and communication pertaining to exercise, sprint training with endurance training regarding performance adaptations and cardiac output. The benefits and underlying mechanisms of agonist-antagonist paired set training for improving strength and power.

Contemporary rehabilitation strategies for anterior cruciate ligament patients, the importance of proximal stability and rehabilitation in patients with patellofemoral pain syndrome. Relationship between quadriceps strength, proprioception and knee osteoarthritis, potential value of gait retraining for improving lower limb biomechanics in runners with patellofemoral pain.

a proposed model for the logical sequence of active rehabilitation, core muscle activity during physical fitness exercises, an introduction to dynamic neuromuscular (core) stabilization and athletic performance.

The effects of external pelvic compression on the passive, active and neuromotor control systems of the lumbopelvic region and thigh, the importance of core stability assessment and rehabilitation in lumbosacral radiculopathy cases. Differences in torso motion and muscle activity between elliptical trainer use and treadmill walking.

Evidence-based and practical methods to reduce unwanted thoughts, facilitate wellbeing, and improve sleep in patients and health professionals working in medical, dental and psychological settings.

Precise filing of Medicare claims, avoiding costly errors, ICD 10 coding, proper documentation standards, establish and utilized a compliance plan.

Requisite and comprehensive biomechanics knowledge for experts, whiplash and brain injuries on the rise, minimal property damage and risk, In-depth analysis of brain and cervical spine trauma mechanisms, soft tissue injuries and analysis, and clinical syndromes and conditions resulting from whiplash.

In depth training on all aspects of management of trauma, a comprehensive primer on crash reconstruction, historical documentation in personal injury and forensic medicine applications, comprehensive physical examination of whiplash and traumatic brain injury, special laboratory methods, radiographic examination methods and special diagnostic imaging modalities, and rendering a diagnosis.

Satisfactorily completed a comprehensive training program in whiplash and brain injury traumatology, emphasizing the biomechanics of injury mechanisms, occupant kinematics, automobile crash reconstruction methods, our most current knowledge of soft tissue, endocrinolgical, bony, and nervous system disorders, advanced imaging techniques, and comprehensive case management of whiplash and related disorders.

The fundamentals of expository, scientific writing you were never taught, the essential craft of narrative report preparation, incorporating outcomes assessment and disability instruments into your reports, application of AMA guidelines in personal injury, modern guidelines and best practices, and critical rebuttal methods and strategies.

Medical photography; when and how to use it and incorporate it, taking the pain out of depositions, arbitrations, and testifying in court, preparing for the classic cross-examination strategies, using evidence effectively with models, charts, diagrams, photos, movies, and more, and Daubert and Frye rules.

How to correctly document patient notes and code correctly for services rendered while maintaining compliance.

Discussion of proper documentation, submission of claims, and office systems regarding injured patient cases.

Investigating the effects of brain trauma, function, mechanism of injury, and current literature. Integrating chiropractic care and laser photon therapy in terms of mechanical integrity in gravity, weight, load, levers, posture, mechanoreception, mechanotransduction, mechanobiology, tensegrity, neurology, blood flow, and DNA.

X Ray analysis of common spinal conditions, evidence-based mechanism of the chiropractic adjustment and neurological pathways, the biochemistry of inflammation, sports medicine and athletic injury management, treatment of the extremities.

Evaluating the mechanics of whiplash, training doctors in management of personal injury cases with documentation and treatment, demonstrating the scientific validation of chiropractic care and its relationship to structure and function mediated through the nervous system.