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.    

Reports

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: 

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


Cranial optokinetic reflex and cervical dystonia

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. 2020;1:021 DOI https://doi.org/10.46323/2021031

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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