Case Reports

The Journal considers Case Reports to be the building blocks of evidence-informed practice. We accept they are 'n of 1' and find that rather than placing them low on the evidential hierarchy, it is this very characteristic that makes them compelling. A case report brings together the 'patient' and the 'practitioner' in a record of clinical decision making with outcomes. 
It is the myriad of clinical observations documented and published by chiropractors as case reports that point to the knowledge-gaps that formal inquiry should be addressing as structured research.
Each paper published by the Journal offers the reader the ability to turn a clinical problem into an opportunity to improve Well-Being. Our attitude is to welcome your reports of practice so we can share them with chiropractors globally.    

Points to consider when writing to the CARE Guidelines for Case Reports

Abstract: Case Reports have high evidential value. The greatest evidence is where reports are written in accord with these CARE Guidelines. This paper sets out the guidelines to follow.

Indexing Terms: Case reports, CARE Guidelines, chiropractic, evidence

Cite: Doyle M. Points to consider when writing to the CARE Guidelines for Case Reports. Asia-Pac Chiropr J. 2021;1.3:Online only. URL www.apcj.net/doyle-care-checklist-for-case-reports/

SOT Chiropractic Care of a 6yo boy diagnosed with Asperger’s Syndrome and related conditions: A case report.

Abstract: Introduction: The field of chiropractic may play a part in the treatment of autism spectrum disorders [4] and sacro occipital technique (SOT) and cranial techniques have been found to be of promise for improving symptoms and function. 

Case History: A six-year-old male patient was brought to this office for SOT and cranial chiropractic care at this office. Initial complaints included: Asperger’s Syndrome (3-year duration) that resulted in uncontrollable “rocking, jumping and flapping” of his hands, asthma triggered by exertion, and severe seasonal allergies.

Methods – Treatment/Intervention: Specific SOT (Sacro Occipital Technique) spinal and cranial evaluation revealed subluxation patterns and a treatment program was implemented to address these patterns using SOT protocols and procedures. 

Results: The patient and family reported that the Asperger’s Syndrome symptoms “settled down within the first week of care,” he was seen once a week for 5-months, reduced to a wellness treatment schedule which for him was 1-2 times per month. At 8-year follow-up, his condition has remained stable.

Conclusion: With the risk benefit ratios associated with the reduced risk of chiropractic care with increased risk of the typical medications used for this condition, a trial of chiropractic care for children or adults with this condition may yield important information.

Indexing Terms: Asperger’s Syndrome, chiropractic, SOT.

Cite: Rosen M, Blum C. SOT Chiropractic Care of a 6yo boy diagnosed with Asperger’s Syndrome and related conditions [Case Report]. Asia-Pac Chiropr J. 2021;1.3:Online only. URL www.apcj.net/rosen-and-blum-aspergers-syndrome/



Reports

Colic and infant birth trauma [Case Report]

Abstract: Infants are often presented by their desperate parents to chiropractic clinics with a range of health problems, that in the case of the very young these attendances often appear to arise after a difficult birth. In many cases, these patients are referred by their midwife or infant health care nurse, who while dedicated health delivery professionals, understand the limitations of what they have to offer and have seen many positive results when such infants receive appropriate chiropractic care, particularly when conventional medical protocols do not appear to be effective or offer acceptable symptomatic relief. This collaborative trend is positive, and while the nursing profession often appears to encompass this approach, it is still strongly resisted by medical practitioners. (1) A paediatric condition that does appear to benefit from chiropractic care is colic. (2) This case study presents both a potential birth injury being linked to colic and the efficacy of chiropractic care for this individual. 

Indexing Terms: Colic, birth trauma, 5th Thoracic, resuscitation, chest compression, subluxation, infant adjusting, chiropractic, Gonstead.

Cite: Rossborough I, Hart C. Colic and infant birth trauma [Case Report]. Asia-Pac Chiropr J. 2021;1.3:Online only. URL www.apcj.net/rossborough-and-hart-infantile-colic/  


9 year old canine with lumbar disc syndrome: Bella improves under chiropractic care.

Abstract: Human care protocols were applied to a small dog with lumbar disc syndrome following an MVA which injured her head and neck. The dog has recovered well with basic chiropractic principles of adjusting to remove nerve interference. 

Indexing Terms: Animal, chiropractic, upper cervical.

Cite: Ierano J. 9 year old canine with lumbar disc syndrome: Bella improves under chiropractic care. Asia-Pacific Chiropr J. 2021;1.3. URL www.apcj.net/ierano--bella-the-dog-improves-with-chiropractic/

Cranial optokinetic reflex and cervical dystonia

Abstract: A 45-year-old female presented with acute cervical dystonic myotonic spasms and pain of two-day duration, unresponsive to acupuncture and physical therapeutic interventions. Initially her optokinetic reflex system was stimulated to increase dopamine activity related to specific left mesencephalic ocular stimulation. This required an optokinetic strip motion from the subject’s right upper visual field diagonally directed toward their left lower visual field. Directing the optokinetic strip on the diagonal was selected by the extraocular muscles innervation pathways. The selection of diagonal right upper to left lower optokinetic activation was specifically chosen to increase the activation and collateral stimulation of the ascending left mesencephalic reticular system and dopaminergic generating centers. This action was intended to regulate and modulate control through the left cerebral cortical-striatal pathways and through the descending medial longitudinal fasciculus to regain inhibitory balance to the output of her right cervical ventral horn cells. Completion of the intervention was determined when her symptoms were reduced by approximately 75%. Home exercises consisted of a download application of optokinetic strips into her iPhone with instructions to direct the optokinetic stimulus diagonally down and away from the side of cervical tension

Indexing Terms: Cervical Dystonia, cranial, optokinetic reflex, optokinetic strip motion

Cite: Pick M. Cranial optokinetic reflex and cervical dystonia [Case Report]. Asia-Pac Chiropr J. 2021;1.3:Online only. URL www.apcj.net/pick-cervical-dystonia-optokinetic-reflex/


Conservative chiropractic management of 13-month old patient with facial palsy: A case report

Abstract: In the general population facial palsy is a complex condition, which currently lacks a consensus on its optimal management in the healthcare arena. A 13-month-old female child presented to this clinic with facial palsy. Prior to being seen at this office she was being told by other physicians that the condition would resolve on its own; however, the parents were concerned because the condition was ongoing for nine months and appeared stable.

Methods/Intervention: At each office visit the child was assessed and her thoracic and cervical spine was adjusted with very gentle pressures. Treatment to the cranial and craniofacial bones focused on temporal bone balancing/decompression with cranial tension patterns released using Howat’s Cranio Fascial technique. 

Results: At the first follow-up visit the parent reported a big change from the initial visit with both of the child’s eyes appearing more open. By the sixth visit (3 weeks) the parents no longer noticed a large crease on her mouth when feeding her with a bottle, as well as the child being more calm and relaxed through the day and at night. 

Conclusion: While facial palsy in infants is usually self-limiting and recovery is generally expected, in this case it had sustained itself for nine months without any change. Both the physical changes in her appearance as well as clinical changes occurring in close association with the treatments rendered suggest a possible temporal relationship. 

Indexing Terms: Congenital facial palsy, chiropractic, sacro-occipital technique.

Cite: Tovar A, Blum C. Conservative chiropractic management of 13-month old patient with facial palsy [Case Report]. Asia-Pac Chiropr J. 2021;1.3:Online only. URL www.apcj.net//tovar-and-blum-facial-palsy/

Chiropractic care of a 9-week old female with Erb’s palsy: A case report

Abstract: Objective: This is a single case study involving a 9-week old female with a right Erb’s palsy injury following birth trauma. 

Clinical features: A 9-week old female presented with no movement in her right arm, rather it hung limply by her side. Chiropractic examination revealed a S1 subluxation. 

Intervention and Outcomes: Chiropractic care was administered which was associated with restoration of movement to her right shoulder and elbow with strength and motor skills continually becoming greater with time and further treatment. Passive range of motion exercises along with taping of the brachioradialis muscle were also used in the early stages of care. 

Conclusion: This case provides some supporting evidence that chiropractic care can have a positive effect on resolving Erb’s palsy from birth trauma. 

Indexing Terms: Erb’s palsy, subluxation, birth trauma, dural tension, Gonstead chiropractic.

Cite: Forsyth K. Chiropractic care of a 9-week old female with Erb’s palsy [Case Report]. Asia-Pac Chiropr J. 2021;1.3:Online only. URL www.apcj.net/forsyth-erbs-palsy/

12y female with Coeliac Disease and associated physiological disturbances. A pre-case report

Abstract: 8yo female not managing her Coeliac Disease, with constipation and nightmares. Chiropractic adjustments in the Gonstead Methods appropriately modified for her age, somatotype, and disposition, were typically given at segments L2 as PR-m, T9 as PR-T, T6 as PR-T and C3 as PL-La. Counselling supported by conventional chiropractic care produce good outcomes.  

Indexing Terms: Coeliac Disease; constipation, sleep issues, behavioural problems, gluten, subluxation.

Cite: Stephenson R. 12y female with Coeliac Disease and associated physiological disturbances ( A pre-case report]. Asia-Pac Chiropr J. 2021;1.3:Online only. URL www.apcj.net/stephenson--coeliac-disease-and-gonstead-methods/

Two sisters with plagiocephaly: one treated with a cranial band and the other with sacro occipital technique cranial care; A comparative case report

Abstract: Plagiocephaly (non-synostotic) in otherwise normal children is a relatively frequent occurrence (3-61% with mean at 47%) with a common therapeutic option utilising the cranial helmet (band). This study seeks to evaluate two-sisters with plagiocephaly (2-years-apart) and compare outcomes of one that received helmet care and the other only SOT cranial care (SCC).

Clinical Features: Both sisters were treated at this chiropractic clinic with the older sister first seen at age 4-years-old having used a cranial helmet for her plagiocephaly. The younger sister with a similar-type plagiocephaly was seen from age 3-6 months for SCC instead of a helmet intervention.

Intervention/Outcome: The older-sister (helmet) initially seen at age four was found to still have some cranial asymmetry, though not profound, however she had significant scoliosis and cervical spine imbalance which has persisted over approximately 3-years of care. The younger-sister (SCC) has good cranial symmetry, no scoliosis, cervical imbalance, or leg length functional inequality for the past 3-years.

Conclusion: Greater research is needed to help determine if there are instances when SCC may offer an alternative to cranial helmets and if helmets while aesthetically improving cranial appearance might have secondary adverse affects not occurring with SCC. 

Indexing Terms: Facial palsy, chiropractic, sacro-occipital technique, comparative cases.

Cite: Nichols K, Blum C. Two sisters with plagiocephaly treated with one treated with a cranial band and the other with sacro occipital technique (SOT) cranial care [Comparative Case Report]. Asia-Pac Chiropr J. 2021;1.3:Online only. URL www.apcj.net/nichols-and-blum-sisters-with-plagiocephaly/

Plagiocephaly: The Oblique Skull; A method of chiropractic correction, with a case report.

Abstract: Introduction: Plagiocephaly is general term used to describe cranial asymmetry.  Pathologenically, plagiocephaly is classified as synostotic (SP), caused by abnormal sutural development or deformational (DP) (non-synostotic or positional), caused by external forces acting on the cranium. Commonly accepted treatments for DP include alternate sleeping postures, carefully monitoring the child when placed in a prone position, as well as in resistant cases use of cranial orthoses or helmets. Chiropractic -Sacro Occipital Technique  (SOT) cranial care might offer a conservative option that is a bridge between alternate sleeping and use of a helmet.  

Case Report - Assessment:  This case report presents a four and a half month old male child presenting at a chiropractor’s office.  The child’s working diagnosis was: (1) Occipital condyle compression, (2) Plagiocephaly; and (3) KISS syndrome type 1.  Specific SOT cranial treatment was used to correct the child’s presenting plagiocephaly.  This patient received 12 treatments over a period of 3 months and showed a significant improvement in head shape. 

Discussion: DP has some concomitant syndromes that might be coincidental or related in a primary or secondary manner, which include scoliosis, KISS, and torticollis. From a biological plausibility standpoint it would seem that allowing the brain to grow in a symmetrical fashion, balanced stress on vascular membranes, and maintaining normal anchoring of muscular attachments would be beneficial. Recent research has indeed found a relationship between DP and neurodevelopmental delays and that posterior DP may even affect visual field development.

Conclusion: The purpose of this paper was to offer an alternative view of how DF might be treated in a chiropractor’s office and at what stage intervention might prove effective.  Since parents often are not willing to “just wait and see” and are leaning towards some degree of intervention, chiropractic cranial care appears to be a viable intermediate therapy and may facilitate a reduced need for helmet therapy.

Indexing Terms: Paediatric care, chiropractic, sacro-occipital technique, cranial technique, plagiocephaly correction.

Cite: Williams S, Blum CL, Billings S. Plagiocephaly: The Oblique Skull; A method of chiropractic correction, with a case report. Asia-Pac Chiropr J. 2021;1.3:Online only. URL www.apcj.net/williams-plagiocephaly--a-method-of-correction/




Improvement in plagiocephaly, cervical range of movement, primitive reflexes, and subjective parental feedback in an infant co-managed with chiropractic care and helmet therapy: A case report and review of the literature.

Abstract: 

Objective: To chronicle the improvement in plagiocephaly measurements, cervical range of movement, primitive reflexes, and subjective parental feedback in an infant co-managed with age appropriate chiropractic care for assessment and correction of vertebral and cranial subluxation and helmet therapy. This case report was prepared following the CARE guidelines as presented in 2017. 

Clinical features: A five-month-old female infant was presented to clinic by her mother “seeking shared care” for her daughters plagiocephaly. Previous care included four chiropractic visits over the previous month, and recent attendance at a specialist paediatric physiotherapist. Clinical assessments using the caliper system demonstrated a 20 mm difference in diagonal cranial vault measurement. Decreased left lateral flexion and left rotation of the cervical spine, cranial restrictions, vertebral subluxations, and altered primitive reflexes were found. 

Intervention and Outcomes: Age appropriate chiropractic care was delivered on 35 visits between 5 months and 17 months of age. Home care including tummy time and infant exercise ball posterior chain activation was recommended. Helmet therapy began at 6 months and finished at 10.5 months. Growth charts were within considered developmentally appropriate percentiles. Prior to helmet therapy beginning, cervical range of motion and aberrant primitive reflexes improved. Cranial Vault Asymmetry (CVA) and Cranial Vault Asymmetry Index (CVAI) improved over the 12 months from a CVA of 20mm and CVAI of 14.3% to a CVA of 9mm and CVAI of 5.8%. 

Conclusion: This case report chronicles reduction of plagiocephaly rating from severe to mild, improvements in primitive reflexes and in cervical range of motion, and subjective parent reported infant quality of life in an infant co-managed with age appropriate chiropractic care and helmet therapy. Further prospective studies are required to ascertain the clinical significance of helmet therapy with chiropractic care, helmet therapy versus chiropractic care, and different technical approaches (cranial/cervical/pelvic or combinations of each) for the delivery of the adjustment.

Indexing Terms: plagiocephaly; chiropractic; helmet therapy, case report.

Cite: Doyle M. Improvement in plagiocephaly, cervical range of movement, primitive reflexes, and subjective parental feedback in an infant co-managed with chiropractic care and helmet therapy: a case report and review of the literature. Asia-Pac Chiropr J. 2020;1.2:online only. URL https://apcj.rocketsparkau.com/plagiocephaly-reduction--doyle/

Increasing the cervical lordosis in paediatrics: A Chiropractic Biophysics case series

Abstract: This case series describes the increase in cervical lordosis and resolution of symptoms in two pediatric males, aged 5 and 6-years of age. Both patients presented with neck symptoms and cervical hypolordosis. Both patients were treated using Chiropractic Biophysics technique including full-spine spinal manipulative therapy, mirror image drop-table adjustments with daily home cervical extension traction on the pediatric cervical Denneroll orthotic. Both received 18 treatments over 6.5- and 7.5-weeks, respectively. Both patients attained relief of symptoms and had a significant increase in cervical lordosis.

Indexing Terms: pediatrics; cervical lordosis; cervical spine.

Cite: Norton TC, Oakley PA, Harrison DE. Increasing the cervical lordosis in paediatrics: A Chiropractic Biophysics case series. Asia-Pac Chiropr J. 2020;1.2:online only. URL https://apcj.rocketsparkau.com/paediatric-cervical- lordosis-and-cbp-outcomes/

Female adolescent soft-baller with upper-cervical subluxation.

Abstract: It is a fine line for a chiropractor to decide whether a particular case is appropriate for a trial of chiropractic care or specialist referral.

Indexing Terms: adolescent; upper cervical technique; subluxation.

Cite: Ierano J. Female adolescent soft-baller with upper-cervical subluxation. Asia-Pac Chiropr J. 2020;1.2:online only. URL https://apcj.rocketsparkau.com/upper-cx-subluxation--ierano/

Anterior thoracic adjusting and the relationship to cervical flexion: A retrospective case series of twenty-four patients.

Abstract: Twenty-three of 24 patients show improvement in cervical forward flexion following ‘anterior thoracic adjustment’. Only one patient showed no improvement in CFF at the post-adjustment check; he was the only patient with a scoliotic spine.

Indexing Terms: subluxation; thoracic spine; anterior thoracic technique; chiropractic.

Cite: Getzoff H. Anterior Thoracic adjusting and the relationship to cervical flexion: A retrospective case series of twenty-four patients. Asia-Pac Chiropr J. 2020;1.2:online only. URL https://apcj.rocketsparkau.com/anterior-thoracic-adjustment--getzoff/

78y female with symptoms of Ménière's Disease, and subluxation.

Abstract:  Head pain in a 78y female anxious patient related to weather and low-pressure systems. Cranials? Or manual adjustment of her upper cervical complex?

Indexing Terms: Ménière's Disease; subluxation, upper cervical, Gonstead Methods.

Cite: Stephenson R. 78y female with symptoms of Ménière's Disease, and subluxation. Asia-Pac Chiropr J. 2020;1.2:online only. URL https://apcj.rocketsparkau.com/upper-cx-78yo-female--stephenson/

Sitting disc technique and the relationship to the straight leg raise: A retrospective case series of thirty patients.

Abstract: The SLR appeared to be a helpful method to monitor the functional improvement of the lumbar spine after successful Sitting Disc Technique  adjustments. The SLR also appeared to parallel symptomatic changes that accompanied lumbar spine improvement following the SDT applications.

Indexing Terms: subluxation; lumbar spine; sitting disc technique; Lasègue; chiropractic.

Cite: Getzoff H. Sitting disc technique and the relationship to the straight leg raise: A retrospective case series of thirty patients. Asia-Pac Chiropr J. 2020;1.2:online only. URL https://apcj.rocketsparkau.com/sitting-disc-and-slr--getzoff/ 

Lumbosacral transitional vertebra as a potential contributing factor to scoliosis: a report of two cases

Abstract: Lumbosacral transitional vertebrae (LSTVs) are the most common congenital anomaly of the lumbosacral spine that presents either as L5 sacralisation or S1 lumbarisation. Although most of the LSTVs are of minor clinical importance, these anomalies may contribute to disruptions in biomechanics and alterations in spinal and paraspinal structures. Here, we present two cases of adolescent idiopathic scoliosis to illustrate some overlooked effects of a unilateral LSTV on spinal deformity. Cure correction was not attained in both cases. While a unilateral LSTV was on a different side of their lumbosacral spine, it is incidentally noticed that the direction of the curve was convex on the contralateral side of the LSTV. Most likely, unilateral LSTVs on certain occasions could cause the growing spine to curve and rotate. The aim of this report is to demonstrate an overlooked association between minor anomalies and the growing spines, which may be important to tailor an appropriate treatment plan.

Indexing Terms: Adolescent idiopathic scoliosis; congenital anomaly; lumbosacral transitional vertebra, Chiropractic adjustment, Vertebral adjustment

Cite: Chu ECP, Huang KHK, Shum JSF. Lumbosacral transitional vertebra as a potential contributing factor to scoliosis: a report of two cases. Asia-Pac Chiropr J. 2020;1:007 DOI https://doi.org/10.46323/2021007


Cervicogenic headaches and neck pain attributed to a suboccipital vertebral subluxation complex: A single case report of articuloautonomic pathophysiology involving multiple health professions.

Abstract: This paper seeks to discuss the clinical and inter-professional issues in the recognition of an aetiology and treatment of a patient with chronic neck pain, and headaches. This was ultimately attributed to a vertebral-autonomic dysfunction of an upper cervical segment of the spine - a vertebral subluxation complex (VSC). The patient’s discomfort may have been prolonged due to this unrecognised clinical presentation of a classic biomechanical neuromusculoskeletal lesion. Limitations in the recognition of the neurological and orthopaedic signs and symptom patterns associated with vertebral mechanical dysfunction are likely to have led to a delay in appropriate care. 

Indexing Terms: Cervicogenic headache, Chiropractic adjustment, Inter-professional collaboration, Inter-Professional Relationships, Neck Pain, Segmental Spinal Pain, Spinal Manipulation, Suboccipital subluxation, Vertebral adjustment, Vertebral Subluxation Complex

Cite: Holdway KB, Rome P. Cervicogenic headaches and neck pain attributed to a suboccipital vertebral subluxation complex: A single case report of articuloautonomic pathophysiology involving multiple health professions. Asia-Pac Chiropr J. 2020;1:008 DOI https://doi.org/10.46323/2021008


A 9 year old with Headache and Clumsiness: A question of ‘what next?’

Abstract: This ongoing case discusses a 9yo female patient known since birth to the chiropractor who presented differently to usual. The parent’s report provided valuable data that was not clinically evident. The recommendations to collimate a plain-film radiograph of the cervical spine to exclude the skull were over-ridden and a higher clinical yield provided information that led to the child being treated and then referred for further investigation. The specific learning outcome of this report relates to the value of practitioner experience and patient (including parental) input as powerful elements in evidence-based practice.

Indexing Terms: Upper Cervical, headache, copper beaten skull, chiropractic adjustment, vertebral subluxation complex.

Cite: Ierano J. A 9 year old with Headache and Clumsiness: A question of ‘what next?’ [Case Report] Asia-Pac Chiropr J. 2020;1:021 DOI https://doi.org/10.46323/2021021


Resources

From J Contemp Chiropr. 2018:1(1):45-58.

Ensuring credibility, from Jap J Int Med, with permission

From Chiropr J Aust. 2020;47(1):29-43.

 

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