WEEK NINE WORKBOOK QUESTIONS

General Questions
1. Describe the anatomy of the vertebral artery.
Of subclavian artery, enters C6 foramen and continues to form the basilar artery.
2. What are the signs and symptoms of vertebral artery insufficiency?
- Headache
- Neck pain
- Shortness of breath
- Facial sensation (tingling)
- Visual disturbances
- Poor balance
- Speech disturbances
- Paraesthesia within the body
- Weakness of muscles (arm and less)
- Cognitive issues/ mental inequity
3. What should be included in your history taking to determine if there is a compromise of
the vertebral artery
- Symptoms mentioned above
4. What is the incidence of vertebral artery stroke from chiropractic manipulation?
- Low (1 out of 3 million)
5. It is possible that the true incidence of vertebral artery stroke is over-reported or under-
reported? Explain your answer.
Underreported
6. What does CPirls stand for and how is it used? Do you this is a useful recording tool?
A strong tool used by Chiro Australia (chiropractic patient incident reporting & learning
system) to record incidence that have occurred during practice.
7. People who suffer vertebral artery insufficiency are young healthy adults between the
ages of 3-45 years, more females than males having an uneventful medical history: True or
False?
True
8. What are the risk factors of VBAI?
- Mechanical trauma
- Infection
- Cardiovascular issues (high blood pressure, cholesterol, smoking, diabetes, over >55 years)
9. What is the standard recommendation for cervical spine adjustments/manipulation for
rotation? Why is this standard in place?
- No more than 30 degrees
10. What are the different types of vertebral artery injury?
- Dissection and blood trauma
11. Describe the tests for the vertebral artery? Are they valid?
Hortons (prontation), underbergs, declines (mainges), provocation
(nystagmus and possible dizziness). Tests are not reliable.
12. What is your recommended physical examination procedure to confirm vertebral artery
testing?
WEEK NINE WORKBOOK QUESTIONS

Good case history (trauma, CV, infection, risk factors)

CVS exam (blood pressure, bruits)
13. Describe the reason for ‘informed consent’ with VBAI.
1 in 3 million chance this will happen, must be given as it’s a legal situation.
14. What is the mechanism for injury for ‘Whiplash’?
Hyperextension/hyperflexion injury
Torsion/distraction injury
Acceleration/deceleration injury
15. What structures/tissues are injured in a hyperextension whiplash injury?
Depending on the degree and severity of the structure. Due to sudden translation force to
trunk C5/C6 level, overstretched anterior spinal structures/compression of posterior
structures.
16. What structures/tissues are injured in a hyperflexion whiplash injury?
Usually less severe, overstretch of posterior structures (paraspinal/facet capsule) with
compression anterior to spine
17. What are the different degrees of injury for a whiplash patient?
1st Degree – Myofascial strain (uncomplicated)
• Pain develops the next day (12-48 hours)
• Strain of the SCM and Scalenes
• Heals rapidly, should be symptom free within 6 months
nd
2 Degree: moderate – severe injury
• Pain develops 12 hours after the accident
• Pain increases within the next 12-48 hours
• Damage to the scalenes, longus colli and SCM
• Retropharyngeal and oesophageal haematoma
• Some disability. Usually normal after 6-24 months.
rd
3 Degree: Pain immediate or within 2 hours
• Muscular and ligamentous tearing
• The pain increases in 24-48.
• Anterior longitudinal tearing separation of the vertebra.
• Damage to the sympathetics causing blurred vision, tinnitis, nystagmus, deafness
• 3-12% continue to have problems after 2-3 years.
th
4 Degree: Fracture, dislocation
• May be permanently disabling
• Concussion, palpable swelling, deformity
• Spinal cord compression

18. What are the different phases with treatment?

Phase 1: Objective – Pain reduction. Treatment of inflammation and muscle spasm
Operational end-point: No pain at rest
• Acute: ice 24 hours (joints and muscle spasm). A collar may be used in the
initial phases of the acute stage. The more severe the degree of injury the
longer it is worn
• Decrease manual activity
• STW: trigger points and stretching
• Electrical therapy
• Manipulation of related areas
• Patient education – stressing their abilities
• Ergonomic advice: sleeping posture, back support
• Nutritional advice for healing and stress
• Exercises: Passive for ROM
WEEK NINE WORKBOOK QUESTIONS

Phase 2: Objective – recovery of movement function

Operational end-point: the capacity to perform unstressed basic daily activities
• Electrical therapy
• Ergonomic advice
• Mobilisation of the specific and traumatised segments: ice
• Nutritional advice for healing and stress
• Manipulation of related areas
• Exercises: active for stretching passive for ROM
Phase 3: Objective: restore the normal movement patterns along with conditioning of normal
strength and function.
• Operational end point: the capacity to perform normal activities under some constraints
and conditions
• Manipulation to traumatised areas using a lateral break, toggle, Gonstead
(technique using minimal rotation)
• Begin walking. This improves CSF flow and increases endorphins and
serotonin causing a decrease in the pain and patient depression
• Psychological counselling
• Ergonomic advice
• Exercises: Isometric strengthening for the injured areas
Phase 4: the return of the patient to and full active lifestyle and help in the prevention of future
episodes
Operational end-point: the recovery of the full, normal, and uncontrollable activities, and release
from active care.
– Manipulation as indicated
– STW: trigger points, massage etc
– Walking for C.V.F
– Lifestyle management
– Exercises: isotonic or isometric for strengthening
RECOVERY
Phase 1: 4 to 21 days
Phase 2: 22 to 45 days
Phase 3: 46 to 180 days
Phase 4: > 6 months recovery prognosis.

19. According to the ‘code of conduct’ (link found in week 5), what are the 14 factors that
reflect ‘good practice’
- recognising and working within the limits of the chiropractor’s competence and scope and
area of practice, which may change over time
- maintaining adequate knowledge and skills to provide safe and effective care, including
providing treatment/care and advice and where relevant, arranging investigations and
liaising with, or referring to, other health professionals
- practising patient-centred care, including encouraging patients to take interest in, and
responsibility for, the management of their health and supporting them in this
- maintaining adequate records
- considering the balance of benefit and harm in all clinical management decisions
- communicating effectively with patients
- providing treatment/care options based on the best available information and practising
in an evidence-based context and not being influenced by financial gain or incentives
- ensuring that services offered are provided with the best possible skill, care and
competence
- taking steps to alleviate the symptoms and distress of patients
WEEK NINE WORKBOOK QUESTIONS

- supporting the right of the patient to seek a second opinion

- consulting with and taking advice from colleagues when appropriate
- making responsible and effective use of the resources available to chiropractors (see
Section 6.2 Wise use of healthcare resources)
Refer to the PDF on the ‘Code of Conduct’ from the Chiropractic Board of Australia and answer the
following questions. Refer to ‘working with patients’ section 8
True or False
1. Good practice involves understanding and applying the key principles of risk minimisation
and management in practice. TRUE
2. It is not important for ALL chiropractors to report adverse events. FALSE
3. The National Law requires that chiropractors (and all of the regulated health professions)
keep their knowledge and skills up to date through CPD to ensure that chiropractors can
continue to work within their competence and scope of practice. TRUE