CHI304 Chiropractic 11: Upper body
Admission
Admission to this course requires successful completion of CHI 301, CHI 302, CHI 303, CHIS 333, and either completion of all other identified Year 1 and Year 2 courses of the Bachelor of Chiropractic or recognition of prior learning for equivalent courses.
The dress requirements for these classes are comfortable clothing and footwear appropriate for the climate. Female students will wear a sports bra and briefs in class and these may be worn under clothing. Males are mandated to wear underpants in addition to clothing. All students are asked to wear the approved university scrubs for Chiropractic students and to ensure cleanliness. Students will carry a water bottle and remain properly hydrated.
All units in this course require attendance and participation-in-person for all 48 hours. The passing grade is 80%. Repeated absence may result in a failing grade.
Course overview
The Learner will be able to explain and defend detailed clinical meanings attached to the assessment of the upper body, especially the torso and back, by integrating elements that are bony, muscular, connective tissue, trigger points, neurological, vascular, and neurolymphatic points to facilitate critical clinical assessment.
The Learner will apply a contemporary understanding of trigger points and neurolymphatic points about this region as supportive of subluxation being the primary treatable clinical focus of disorders. They will knowingly value Chiropractic as a global profession and particularly as an emerging health system in their nation. They will understand and value the role of subluxation in 21st Century Chiropractic in the global health community. They will build on knowledge gained-to-date to develop higher level knowledge and clinical skills in a range of contexts for professional practice and as a pathway for Continuous Professional Learning.
This course has immediate clinical application and Learners will act in a professional manner in a context expressing the combined traits of beneficence, non-maleficence, autonomy, justice, and professionalism as essential to Chiropractic health care, health promotion, and public health practices, and will demonstrate the responsibility to provide ethical, professional care and to uphold good conduct in all practices.
Complexity of learning outcomes
The complexity of learning outcomes is Level 8 Bachelor Honours where learners will integrate and interpret advanced knowledge and skills for employment as a Chiropractic Assistant and/or further learning to become a registered Chiropractor. They will have advanced, integrated theoretical and technical knowledge in the clinical nature of clinical findings from palpation including subluxation and their potential for correction by hand within the context of the discipline of Chiropractic practice about the back to select and apply methods and technologies to:
analyse critically, evaluate and transform information to complete a comprehensive range of activities of clinical assessment of the back
analyse, generate and transmit solutions to complex clinical problems involving the back
transmit knowledge, skills and ideas to others
refine communication skills to present a clear, coherent and independent exposition of knowledge and ideas, and
applied clinical reasoning for basic interpretation of clinical evidence of subluxation with patient-centred recommendations for care and management by a Chiropractor.
Specific knowledge and skills
The student will will apply knowledge and skills to demonstrate autonomy, well-developed judgement, knowledge adaptability and responsibility as a practitioner or learner and will demonstrate the integration of knowledge and skills with initiative and judgement in planning, problem solving and decision making in professional Chiropractic practice and/or scholarship; be able to to adapt knowledge and skills in diverse contexts with responsibility and accountability for own learning and professional practice and in collaboration with others within broad parameters.
CEXP-22: To demonstrate cognitive-driven tactile abilities to conduct functional assessment of the upper body within the chiropractic context. (Here ‘cognitive’ is used as an adjective to include the of exercise critical thinking and judgement and their integration into a clinical picture to guide patient-centred care).
CEXP-34: To demonstrate cognitive skills to review, analyse, consolidate and synthesise knowledge to identify and provide solutions to complex problems with intellectual independence for clinical presentations involving the back.
HPRO-9: To correctly use the basic language of Chiropractic clinical assessment to skilfully observe then explain findings as within normal limits or not as seen in a patient including possible underlying structural causes and neurological implications.
HINF-1: To knowingly utilise communication skills to present a clear and coherent exposition of knowledge and ideas to a variety of audiences.
HINF-5: Be capable to identify and describe what is meant by health and well-being and to knowledgeably determine and apply the assessment skills of subluxation within this field as characteristic of Chiropractic clinical practice.
Application and Responsibility
The outcomes of this course include that on completion Learners will demonstrate the application of knowledge and skills with initiative and judgement in professional practice and/or scholarship, to adapt knowledge and skills in diverse contexts, and with responsibility and accountability for own learning and practice and in collaboration with others within broad parameters.
They will be able to to plan and execute care plans for individual patients for non-spinal care of a patient and also for implementation within a plan of spinal care for a registered Chiropractor. This knowledge and skill will feed into research and scholarship with some independence.
Learners will demonstrate functioning levels of personal competence involving knowing how to conduct oneself in a specific situation, and ethical competence involving the possession of certain personal and professional values.
In particular they will understand, own, and practice patient confidentiality at first with their class-mates and then advance that into the doctor-patient interaction and clinical practice.
Course outcome
The outcome of this course is that the Learner will have capability to contextualise subluxation as it may affect the functionating of the patient within the discipline of Chiropractic in specific, concise terms and be able to situate themselves as a learner within this capability. They will exhibit sociocultural responsibilities specific to Chiropractic and demonstrate matters of ethics and integrity appropriate for its practitioners.
Attendance
Learners are required to personally attend and participate in all 8 hours of this course each day, total 48 hours over one 6-day week. Any missed hour or class must be ‘made-up’ and the Learner remains responsible for all learning outcomes of this course.
Required learning object
Complete Anatomy. Elsevier. Student price available at https://www.us.elsevierhealth.com/complete-anatomy
Assessment guidelines
Each 8-hour day of this course provides the knowledge and skills required to be assimilated into the developing sociocultural and profession-specific knowledge based of chiropractic. The assessment period is the afternoon of day 6 of the course.
This is a pass/not pass course. You will be graded as ‘you are at a beginners level and must be re-assessed following remedial learning’ OR ‘you are demonstrating acceptable attainment across all stated Learning Outcomes of this course’. A numerical grade is not awarded.
Students must not share images of classmates taken in class, nor share their class-work on-line or on social media. Failure to comply may result in dismissal from the program. You must respect the privacy of your class-mates.
Students must at all times be prepared to adequately defend their clinical decision-making with evidence including citations from the indexed literature in particular from the assigned reading.
Delivery schedule: Day 1 ~ Hours 1 through 8
7.15 Prepare your device with the sklips and test the AV system in-room.
7.30 Welcome class, lead prayer, take attendance roll.
Latecomers are marked absent and must justify why they should be marked ‘present’. Reject arrivals after 8.15
7.40 Introduction to CHI 304
Advise Learners that Muscle knowledge now includes, muscle name, form, fibres, attachments, actions, testing, innervation, vascular and lymphatic, trigger points, neurolymphatic points, clinical signs of weakness. Review to ensure all are on he same page.
8.00 Take learners through each of the Learning Outcomes addressed by this course. Lead discussion and answer questions. Select Learners to explain and lead a small group discussion then finish with each group presenting their interpretation of any one Learning Outcome. Be sure to cover all 5.
CEXP-22: To demonstrative cognitive-driven tactile abilities to conduct functional assessment of the upper body within the chiropractic context. (Here ‘cognitive’ is used as an adjective to include the of exercise critical thinking and judgement and their integration into a clinical picture to guide patient-centred care).
CEXP-34: To demonstrate cognitive skills to review, analyse, consolidate and synthesise knowledge to identify and provide solutions to complex problems with intellectual independence for clinical presentations involving the back.
HPRO-9: To correctly use the basic language of chiropractic clinical assessment to skilfully observe then explain findings as within normal limits or not as seen in a patient including possible underlying structural causes and neurological implications.
HINF-1: To knowingly utilise communication skills to present a clear and coherent exposition of knowledge and ideas to a variety of audiences.
HINF-5: Be capable to identify and describe what is meant by health and well-being and to knowledgeably determine and apply the assessment skills of subluxation within this field as characteristic of chiropractic clinical practice.
9.00 Lead a round of Genie flicks then Introduce and play sklip 304-01 https://www.youtube.com/watch?v=LD8x9mMBkb4&t=26s as spine review and memory jogger
9.30 Lead discussion and answer questions. Call on several students by name and ask them to explain to the class an aspect you choose
9.45 Review macro Cx spine (X-ray, posture, gait, ROM, dermatomes, myotomes, clinical signs & symptoms). You need a selection of cervical X-rays and maps for dermatomes and myotomes to display on monitors.
Identify landmarks on X-rays, explaining what they mean and how to identify visually and by palpation.
Sklip 304-02 https://www.youtube.com/shorts/qYfHZmAIgAc. Pause to be a still image. Speak to it and be particular with ADI, RPI, RTI; explain normal & clinical relevance & importance
Note sagittal curvatures (normal, increased, decreased, mixed) and their relevance. refer to work by Harrison on this. Quantify curvatures (normal, hyper, hypo lordosis)
Identify head tilt and rotation on postural exam. Have Learners speak to reasons and possible involved musculature Explore their reasoning
10.30 Lead Learners to understand and become capable with the following:
The skull and neck:
Sternocleidomastoid (Walther p. 432). Explain why its correct name is ‘Sternocleido-occipito-mastoid’ (SCOM), be particular with each of the 4 heads, describe the different nerve supply to each head and what this means clinically. Demonstrate muscle testing. Give cautions for palpation and trigger point work, identify and demonstrate the treatment of trigger-points. Rehearse. sklip 304-3: 3 way to stretch SCM (1 min.) Discuss and apply.
Neck flexors (Walther pp. 436, 7) and Neck extensors (Walther pp. 440-441). These are generic, demonstrate muscle testing, generic tripper point care.
sklip 304-4: Blood supply to the brain (13:05). Discuss wth clinical implications.
12:00 Review macro Cx spine (X-ray, posture, gait, ROM, dermatomes, myotomes, clinical signs & symptoms). You need a selection of cervical X-rays and maps for dermatomes and myotomes to display on monitors.
Perform seated ROM and include rotation in flexion in extension and explain how extension locks the upper Cx complex to emphasise restrictions in the lower Cx spine, and flexion opens the lower Cx spine to reduce its influence on rotation, placing an emphasis on Upper Cx fixation. Be pedantic with Dr supporting Patient and have observer document and then discuss observations.
Identify dermatomes and myotomes. Have Dr draw with skin pencil on Pt and Observer to check, then ensure each of the 3 plays the role of Doctor. Relate key myotomes to key sensory areas and muscular actions of the face & scalp. Test relevant dermatomes with soft touch, sharp touch, hot/cold
1.30 Lunch break
Students may remain in the room and rehearse, but no food is allowed.
3.30 Interactive tutorial
Cover cervical compression (central and lateral) and distraction
Be alert to local and radiating pain, and cognitive & sensory changes
Integrate clinical signs and symptoms of Upper Cx complaints
Play Sklip 304-05 https://www.youtube.com/watch?v=Ph-o472fCyg (8 mins) then speak to the Cranial Nerves. Engage learners with exploring each other & models.
Integrate anatomy, radiography, neurology, clinical findings, Gonstead listings. Do not muddle the mind with other listings at this point. Focus on static and movement palpation. Note: We do not teach ‘Motion Palpation’ as the named technique.
~4.30 Student self-study time. Remain in the class to respond as requested.
Seed the student time with a Case Report.
Use: http://www.apcj.net/papers-issue-6-1/#CuthbertScalenusAnticus. Students are required to do self-discovery on the scalene muscles.
Use: http://www.apcj.net/papers-issue-6-2/#TymmsPlantarFasciitis to show how the presenting complaint may differ to the cause, in this case plantar fasciitis.