Sharon Docherty

Safety of chiropractic manipulation of the cervical spine: a prospective national survey

Study Design. Prospective national survey. Objective. To estimate the risk of serious and relatively minor adverse events following chiropractic manipulation of the cervical spine by a sample of U.K. chiropractors. Summary of Background Data. The risk of a serious adverse event following chiropractic manipulation of the cervical spine is largely unknown. Estimates range from 1 in 200,000 to 1 in several million cervical spine manipulations. Methods. We studied treatment outcomes obtained from 19,722 patients. Manipulation was defined as the application of a high-velocity/low-amplitude or mechanically assisted thrust to the cervical spine. Serious adverse events, defined as “referred to hospital A&E and/or severe onset/worsening of symptoms immediately after treatment and/or resulted in persistent or significant disability/incapacity,” and minor adverse events reported by patients as a worsening of presenting symptoms or onset of new symptoms, were recorded immediately, and up to 7 days, after treatment. Results. Data were obtained from 28,807 treatment consultations and 50,276 cervical spine manipulations. There were no reports of serious adverse events. This translates to an estimated risk of a serious adverse event of, at worse ≈1 per 10,000 treatment consultations immediately after cervical spine manipulation, ≈2 per 10,000 treatment consultations up to 7 days after treatment and ≈6 per 100,000 cervical spine manipulations. Minor side effects with a possible neurologic involvement were more common. The highest risk immediately after treatment was fainting/dizziness/light-headedness in, at worse ≈16 per 1000 treatment consultations. Up to 7 days after treatment, these risks were headache in, at worse ≈4 per 100, numbness/tingling in upper limbs in, at worse ≈15 per 1000 and fainting/dizziness/light-headedness in, at worse ≈13 per 1000 treatment consultations. Conclusion. Although minor side effects following cervical spine manipulation were relatively common, the risk of a serious adverse event, immediately or up to 7 days after treatment, was low to very low.

Prevalence of low back pain (LBP) in rotary wing aviation pilots.

INTRODUCTION The high prevalence of low back pain (LBP) in helicopter pilots has been well documented, although the reason behind it remains unclear. To date, little research exists comparing the Royal Air Force (RAF) to civilian pilots. METHODS A questionnaire inquiring into participant demographics, flying experience, and back pain was distributed to RAF pilots based at units around the United Kingdom and civilian pilots working for groups such as Air Ambulance and Her Majestys Coastguards. RESULTS RAF pilots were significantly younger than civilian pilots (mean age 38.9 +/- 8.8 yr and 47.1 +/- 9.2 yr, respectively) and had been flying for a mode length of 6-10 yr compared with +26 yr in civilian pilots. Of civilian pilots, 40% had previously served as a pilot in the military. Neither RAF (83%) nor civilian (81%) pilots were significantly more likely to suffer from LBP and the nature of the pain experienced was similar. There were 33% of RAF and 55% of civilian pilots who used a back support. DISCUSSION The high prevalence of back pain reported by civilian and RAF pilots may be due to several factors. To investigate this further would require responses from a greater number of civilian pilots, particularly those who do not have previous military experience. In the meantime, further use of lumbar support may go some of the way to alleviating the problem.

Changes in Rod and Frame Test Scores Recorded in Schoolchildren during Development – A Longitudinal Study

The Rod and Frame Test has been used to assess the degree to which subjects rely on the visual frame of reference to perceive vertical (visual field dependence- independence perceptual style). Early investigations found children exhibited a wide range of alignment errors, which reduced as they matured. These studies used a mechanical Rod and Frame system, and presented only mean values of grouped data. The current study also considered changes in individual performance. Changes in rod alignment accuracy in 419 school children were measured using a computer-based Rod and Frame test. Each child was tested at school Grade 2 and retested in Grades 4 and 6. The results confirmed that children displayed a wide range of alignment errors, which decreased with age but did not reach the expected adult values. Although most children showed a decrease in frame dependency over the 4 years of the study, almost 20% had increased alignment errors suggesting that they were becoming more frame-dependent. Plots of individual variation (SD) against mean error allowed the sample to be divided into 4 groups; the majority with small errors and SDs; a group with small SDs, but alignments clustering around the frame angle of 18°; a group showing large errors in the opposite direction to the frame tilt; and a small number with large SDs whose alignment appeared to be random. The errors in the last 3 groups could largely be explained by alignment of the rod to different aspects of the frame. At corresponding ages females exhibited larger alignment errors than males although this did not reach statistical significance. This study confirms that children rely more heavily on the visual frame of reference for processing spatial orientation cues. Most become less frame-dependent as they mature, but there are considerable individual differences.

Perception of subjective visual vertical and horizontal in patients with chronic neck pain: A cross-sectional observational study

Previous studies have shown that chronic neck pain (CNP) patients have a larger spread of perceptual errors for subjective visual vertical (SVV) than those exhibited by asymptomatic controls. The current study investigated whether this was also the case for perception of subjective visual horizontal (SVH) and whether there was a correlation between the two measurements. Fifty patients with CNP were compared with a group of 50 age- and gender-matched controls. All subjects were required to complete a test to measure SVH as well as SVV using the computerised rod and frame (CRAF) test. These tests were conducted under various frame conditions. No difference was found between the errors of the CNP and control groups in the absence of a surrounding frame. When a tilted frame was added to the CRAF test, the range of errors observed in the CNP group increased for both SVV and SVH. In particular, significantly more CNP patients fell outside the reference range of errors and a subgroup of patients, characterised by higher neck pain disability indices, was identified who demonstrated higher than expected errors for both SVV and SVH. However no conclusion could be drawn with regards to the direction of error asymmetry and laterality of pain as those patients with unilateral pain exhibited errors both towards and away from the affected area.

Augmented asymmetrical visual field dependence in asymptomatic diabetics: Evidence of subclinical asymmetrical bilateral vestibular dysfunction

BACKGROUND Diabetes negatively affects the vestibular system in many ways, with vestibular dysfunction (VD), a co-morbidity with a high prevalence in diabetics. PROCEDURES The ability to perceive subjective visual vertical (SVV), as a sign of vestibular dysfunction, and visual field dependence was measured using a computerized rod and frame test (CRAF). Alignment errors recorded from 47 asymptomatic Type II diabetics (no vertigo or falls, without peripheral neuropathy or retinopathy) were compared to 29 healthy age matched (46-69years) controls. FINDINGS Visual field dependence was significantly larger and more asymmetrical in the diabetics than controls. In the absence of any visual references, or when a vertical reference frame was provided, SVV perception was accurate in both groups, with no significant difference between the controls and diabetics. During tilted frame presentations, the proportion of subjects with either SVV deviations, or an asymmetry index, larger than an upper limit derived from the control data was significantly greater in diabetics than controls. CONCLUSION These results suggest that the decreased ability to resolve visuo-vestibular conflict in asymptomatic diabetic patients (free of retinopathy and peripheral neuropathy) compared to controls may be related to diabetic complications affecting vestibular structures and thus causing a decompensation of subclinical vestibular asymmetries.

Subjective visual vertical perception and sense of smell in Parkinson disease

This article describes an open cross-sectional observational study involving 47 participants with Parkinson disease (PD) and 47 (age- and sex-matched) nondisabled controls without PD. The aim was to determine the profiles of subjective visual vertical (SVV) perception and sense of smell perception in both groups. There was a statistically significant difference (p < 0.001) between patients and controls on their smell test performance. Controls were more likely to correctly identify odors, with a median score of 10 out of 12 compared with 6.5 out of 12 for patients with PD. The median SVV error for the PD group when the frame was untilted was 0.75 degrees compared with 0.50 degrees for controls. This difference was statistically significant (p = 0.02). When the frame was tilted, the median SVV error for the PD group was 2.31 degrees compared with 2.00 degrees for controls (not statistically significant), with both groups showing similar distribution pattern of errors. There was no statistical correlation between number of correctly identified odors and an individuals SVV error. However, a statistically significant negative correlation (r = -0.45, p = 0.01) was found between Mini-Mental State Examination score and mean time taken to complete each rod and frame test in patients with PD, suggesting that SVV errors might be more correlated with cognitive function than with loss of sense of smell.

The “Rod and Fran Test”: Relationship Priming Influences Cognitive-Perceptual Performance

We theorized that interpersonal relationships can provide structures for experience. In particular, we tested whether primes of same-sex versus mixed-sex relationships could foster cognitive-perceptual processing styles known to be associated with independence versus interdependence respectively. Seventy-two participants visualized either a same-sex or other-sex relationship partner and then performed two measures of cognitive-perceptual style. On a computerized Rod and Frame Test, individuals were more field-dependent after visualizing a mixed-sex versus same-sex relationship partner. On a measure involving perceptions of group behavior, participants demonstrated more holistic/contextually based perception after being primed with a female versus male relationship partner. These findings support the hypothesis that activated cognitive structures representing interpersonal relationships can shape individuals’ cognitive-perceptual performance.

High-normal blood glucose levels may be associated with decreased spatial perception in young healthy adults

The negative effects of high normal glucose on cognitive function were previously reported in euglycemic individuals of middle age and the elderly population. This study aimed at examining the effect of baseline blood glucose levels on spatial ability, specifically verticality perception on the computerized rod and frame test (CRFT) in young healthy adults. 63 healthy male medical students (age range from 18–23 years), of whom 30 were non-fasting outside the month of Ramadan and 33 fasting during Ramadan of the year 2016, were recruited in order to create varying degrees of glycemia during which verticality perception was carried out. Baseline blood glucose reading was obtained prior to commencing the CRFT test. Blood glucose levels at the time of testing decreased as the duration between the last meal and testing increased. A blood glucose range of 62–117 mg/dl was achieved among participants for this study. Linear regression analysis showed that blood glucose level at testing correlated positively with all alignment spatial error parameters, indicating a probable reduction of spatial perception ability with higher blood glucose levels. These results are consistent with other cognitive studies in older healthy humans and emphasize the critical impact of early glucose dys-homeostasis on cognitive function. They also indicate that elevated blood glucose may affect cognitive functioning outside of the usual complications of diabetes.

Menstrual phase influences gender differences in visual dependence: A study with a computerised Rod and Frame Test

Previous mechanical Rod and Frame Test (RFT) studies suggested gender and menstrual cycle effects on visual vertical perception with evidence from other studies on spatial tests showing large gender effects in their original form and a decreased gender difference effect on the computerised versions. We investigated whether gender and menstrual cycle effects on visual dependence can be maintained on a computerised version of the RFT (CRFT) in 30 males, 30 females in the follicular phase and 22 females in the midluteal phase. No difference was found between the errors of the male and female groups in the presence of an untilted frame (0°, Frame0°). With a tilted frame (Frame±18°) presentation, males and females in the follicular phase had significantly smaller errors than females in the midluteal phase. These results confirm findings of a male advantage on the RFT and also indicate that menstrual cycle phase does affect gender differences in visual dependence on the CRFT; thus, caution with RFT results is recommended when female subjects are involved.

A pilot study to compare passive lumbar spine re-positioning error in those with chronic low back pain with healthy volunteers

Abstract Study design Cross-sectional laboratory study. Objective To compare the difference in passive re-positioning accuracy in the frontal plane, as a measure of lumbar kinaesthesis, between participants with chronic non-specific low back pain (CNSLBP) and healthy volunteers. Background Evidence suggests that spinal kinaesthesis impacting on spinal stability might be compromised in those with CNSLBP. It is suggested that in those with CNSLBP, there may be changes in ligamentous patho-physiology which lead to altered kinaesthetic perception. Methods Fourteen female participants, representing two groups, took part in the study. Participants in group one (n = 7) were those with CNSLBP (mean age 47.1 ± 15.41) and participants in group two (n = 7) were healthy volunteers (mean age 45.6 ± 10.63). There were no significant differences between the groups with regards to age, education, height, weight, hip, and waist circumference and all were right handed. Passive lumbar re-positioning accuracy was measured in the frontal plane using a motorized plinth with the Zebris® ultrasound-based motion analyser and the target positions were 10° left and right lumbar side flexion and neutral. Results The mean reporting error for the neutral position for participants with CNSLBP vs. healthy volunteers was <2.4° and <2.2° on both occasions (P > 0.05), respectively. The mean reporting error in left-side flexion for participants with CNSLBP vs. healthy volunteers was <1.5° and <2.0° on both occasions (P < 0.01; P < 0.05). The mean reporting error in right-side flexion for participants with CNSLBP vs. healthy volunteers was <2.1° and <1.1° on both occasions (P > 0.05). Conclusion There was a statistically significant difference in passive re-positioning accuracy to the left side only between participants with CNSLBP and healthy volunteers. This may represent an important finding in relation to structures that provide sensory information and the integration of that information in those with CNSLBP.