Ralph Latyschow, DC DAAMLP

Correlating history and a thorough clinical evaluation in determining the necessity for x-ray and MRI evaluations in the trauma and non-trauma patient. Considering whole spine patho-biomechanics in formulating treatment plans and long-term supportive care. Documentation requirements in transitioning from telemedicine to in-office care.

Understanding the algorithmic interpretation of spinal biomechanical pathology in a 3-D model and creating treatment plans, impairment ratings and teaching models based upon the vertebral motor unit angles. Determining sagittal and axial alignments in creating a normative baseline for treatment goals and outcomes

Utilizing x-ray, MRI and other modalities of advanced imaging in conjunction with spinal biomechanical failure and clinical evaluation to collaboratively create treatment protocols for patients in both the operative and non-operative cases. Determining the boundaries of scope of care for both the chiropractor and neurosurgeon based upon a definitive diagnosis of the mechanical vs. an anatomical lesion

Creating ethical relationships based upon accurate documentation reflective of the casually related condition of the injured. Ensuring accepted credentials of the doctor based upon Voir Dire standards reflected in an admissible curriculum vitae. How to present demonstrative documentation in the courts reflective of the patient’s pathology.

Ensuring the correct codes are utilized in an evaluation and management encounter. The correct elements are utilized to support the level of E&M coded along with a self-audit program to ensure ethical billing occurs. Guidelines for history of present illness, primary complaint, review of systems, family, social and past histories are discussed and how to document the same

Migration of spinal care for mechanical spine issues from hospitals and medical specialists to trauma qualified chiropractors based upon published outcomes. Utilizing imaging studies in spinal biomechanics, pain models and clinical outcomes to determine a conclusive diagnosis, prognosis and treatment plan for triaging in a collaborative environment

Understanding the normal of spinal biomechanics and the neurotransmitters required for homeostasis. The interconnected role of Pacinian Corpuscles, Ruffini Corpuscles, Golgi Organ Receptors, Nociceptors, Proprioreceptors and Mechancoreceptors in maintaining sagittal and axial alignment in the presence of mechanical pathology

The literature, academic and clinical standards to age-date herniated discs. The clinical correlation the pain patters with advanced imaging findings of bone edema, spurs based upon the Piezoelectric effect of remodeling, high signal on T2 weighted images, Vacuum Discs and disc heights in determining the time frames of the etiology of the spinal disc pathology

Documenting electrodiagnostics, concussion and disc pathology as reflective of clinical findings when collaborating with medical specialists in private practice and hospital settings or in the medical-legal arena. Ensuring complete documentation in the evaluation and management process for both initial and re-evaluation processes

The latest research on the six ways to age-date disc herniations and bulges from trauma inclusive of disc pathology nomenclature. MRI ordering protocols, inclusive of Dixon format and fat-suppressed images. The neurology and pathology of connective tissue and the sequellae of trauma at the biomechanical level to bio-neural-mechanical failure. Contemporary evidenced based building blocks for triaging and in a collaborative environment

integrating automated mensuration into creating treatment plans and determining maximum medical improvement. A literature-based study of normal vs. abnormal motor unit function. Determining ligamentous laxity, alteration of motion segment integrity and pathological stress units and whole person impairments based upon the literature and academic standards. Cleveland University, Kansas City, Chiropractic and Health Sciences, Academy of Chiropractic Post-Doctoral Division, Long Island, NY

The literature-based definitions of both the mechanisms of the chiropractic adjustments and how it affects the central nervous system in pain pathways and systemic issues that is the arbiter for normal vs. abnormal function. The physiological mechanisms of how the chiropractic spinal adjustment affects the peripheral and central nervous systems. Subluxation degeneration/Wolff’s Law will be detailed from a literature perspective combined with the mechanism of subluxation (bio-neural-mechanical lesion). A literature perspective why long-term chiropractic care is clinically indicated as usual and customary to effectuate demonstrable biomechanical changes in the spine. An evidence-based perspective of why physical therapy is a poor choice for spine as a first referral option for any provider inclusive of the literature. Cleveland University, Kansas City, Chiropractic and Health Sciences, Academy of Chiropractic Post-Doctoral Division, Long Island, NY

An academic basis for documentation that is usual and customary across professions in collaborative care. Maintaining ethical medical-legal relationships based upon Voir Dire and Duabert standards with ensuring an inclusive report. Ensuring primary care status based upon academic standards. Cleveland University, Kansas City, Chiropractic and Health Sciences, Academy of Chiropractic Post-Doctoral Division, Long Island, NY

Triage, care and collaboration for herniated, bulged, protruded, extruded and fragmented spinal discs. Compliant documentation of evaluation and management of new and established patients inclusive of chief complaint, history of present illness, review of systems, past-family-social histories with case management protocols and the required elements. Clinically coordinating treatment with subjective complaints, clinical findings and diagnosis for each encounter. PACE Approved for the Federation of Chiropractic Licensing Boards, academy of Chiropractic Post-Doctoral Division, Long Island, NY

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. Texas Chiropractic College, ACCME Joint Providership with the State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, Buffalo, NY

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. Texas Chiropractic College, ACCME Joint Providership with the State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, Buffalo, NY

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. Texas Chiropractic College, ACCME Joint Providership with the State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, Buffalo, NY

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. Texas Chiropractic College, ACCME Joint Providership with the State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, Buffalo, NY

the opioid epidemic and spinal manipulation for pain management. Functional neuroanatomy and neurochemistry of pain perception, including descending modulation of pain in the central nervous system. Review of specific research outlining spinal manipulations influence on the central nervous system in the spine pain patient. Clinical assessment and inter-professional communications relating to the diagnosis and management of the mechanical spine pain patient. Academy of Chiropractic, Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Cherry Hill, New Jersey

Detailed review of spinal instability, mechanical spine trauma and global spinal biomechanical balance. The influence of spinal sagittal curvature, pelvic incidence, sacral slope and pelvic tilt on conservative and surgical care outcomes. Clinical correlation with radiographic and advanced imaging findings specific to the spine pain patient. Academy of Chiropractic, Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Cherry Hill, New Jersey

Focus on the safety of chiropractic management of the spine pain patient and review of research related to specific phases of care, acute intervention, corrective care and health maintenance care were reviewed. Documentation and workflows related to an inter-professional team approach focusing on compliance and delivery in the modern practice environment. Academy of Chiropractic, Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Cherry Hill, New Jersey

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

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 comormidities in the triage and prognosis of the injured.

The biomechanics of traumatic disc bulges as sequelae from trauma and the comorbibity of ligamentous pathology. Age-dating spinal disc pathology in accordance with Wolff's law.

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, thalmus and cortices involvement.

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

Triaging the injured and deferentially diagnosing both the primary and secondary complaints. Connective tissue injuries and permanency prognosis potential.

The utilization of GFAP and UCH-I-1 in determining traumatic brain injury, mild traumatic brain injury and mild-moderate traumatic brain injury as a triage tool to manage head trauma

Central neural pathways of pain and higher cortical responses to pain and the effect of high amplitude low velocity forces on mechanoreceptors and proprioceptors. The effects of neuropetides on the hypothalmus, pituitary and adrenal axis when treating patients

The effects of trauma on spinal vertebral segments and the short and long term sequellae to morthology, identyfying and diagnosing bone edema, spurring, types of Modic and Pfeiffer changes

Identifying spinal lesions inclusive of cord nd root lesion through examiantion and advanced imaging in creating an accurate diagnosis, prognosis and treatment plan to effectively triage in collaboration and coordination with medical specialists and emergency department physicians. Deferentially diagnosing and triaging disc degenerative bulges, traumatic disc bulges, protrusion herniations, extrusion herniations and fragmented herniations along with managing traumatically induced pain as a sequellae to degenrative disc traumal

Creating patient centered approaches to healthcare to improve outcomes in treatment models while concurrently reducing risk

Defining roles in a collaborative environment based upon skills, knowledge and abilities of each provider while engaging patients in the process

The most effective management and recovery treatment strategy from concussion injuries and working with multidisciplinary team and the multiple evidence based modalities available to effectively address them

Magnetic fields, T1, 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, extrdueral, 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 a sequelae.

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.

Interpretation and protocols for the use of an MRI in the spine.

The effects and dynamics of a whiplash injury on the brain, spinal structures, and surrounding soft tissues in a acceleration – deceleration traumatic occurrence,

Diagnosis, Differential diagnosis of spinal trauma, the use of radiographs and other advanced imaging,

Documentation and report writing for insurance carriers and court testimony

The causality, effects, and treatment of repetitious use disorders affecting the upper and lower extremities,

The effects of trauma on the vertebral spinal column and its prognosis,

The evaluation of the spine and extremities and the functional losses in their personal, social and work environment through an impairment rating system

Differential diagnosis and treatment of lower back conditions, including MRI and CT studies

Differential diagnosis, treatment and management of patients with headaches

Differential diagnosis of various disorders of the spine

Differential diagnosis of spinal conditions that require medical intervention

Diagnosis and treatment of patients presenting with injuries to the cervical spine

Mechanism of action of cold laser therapy, laser protocols, and the application of use with cervical, lumbar, shoulder, hip, wrist and knee conditons, American Institute of Medical Laser Applications, New York College of Chiropractic, Monroe, NJ 2012

MRI interpretation of bulged, herniated, protruded, extruded and sequestered disc pathologies in etiology and neurological sequella in relationship to the spinal cord and spinal nerve roots. Utilization of MRI sequencing to maximize visulaization of pathology in the trauma and non-trauma patient, Academy of Chiropractic Post-Doctoral Division, New Jersey Office of Attorney General, Division of Consumers Affairs, State Board of Chiropractic, Woodbridge, NJ, 2013.

MRI interpretation of herniated, protruded, extruded, bulged, sequestered discs and spinal stenosis as sequalae of ligamentous hypertrophy, congenital malformation, spinal cord pathology. Clinical necessity and contraindications. Carpal Tunnel Syndrome and Cumulative Trauma Disorders Headaches, Chiropractic Evaluation and Management Whiplash and Brain Traumatology Low Back Pain; Diagnosis and Treatment

Review of current issues with regard to PIP/AICRA regulations as it regards to coding, fee schedule, decision point review, ability to order, read and interpret MRI findings.

Review of current issues with regard to new scope laws, including the ability to provide dietary/nutritional counselling, prescribe/dispense nutritional supplements, utilize modalities/therapies without adjusting, treat extremities, and order additional diagnostic test/studies.

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.

MRI interpretation of herniated, protruded, extruded, bulged and sequestered discs & spinal stenosis as sequelae of ligamentous hypertrophy, congenital malformation, spinal cord pathology. Clinical necessity and contraindications.

Clinically coordinating spinal pathology with neurological and functional sequelae including station & gait, migraines, sexual dysfunction, sleep & arousal disorders, paroxysmal disorders, radiculopathic disorders and central nervous system disorders.