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Microsoft word - job analysis 2014 write-up-ac_01112014-with toc-final.docx

American Chiropractic
Neurology Board

Lucinda Harman. Ph.D.
JOB ANALYSIS
Technical report of the three year job analysis of the chiropractic or functional neurologist derived from an international cadre of professionals. Table of Contents
Analysis Survey 2010-2013 . 2 Demographics . 2 Overall Survey Design . 3 Definitions Common to all Categorical Surveys . 4 Decision Rules. 6 Examination Blueprints . 6 Performance Exam Blueprint . 6 Job Analysis Subject Matter Experts . 9 Items on Categorical Surveys and their Decision Weights . 10 Survey 1: Demographics and Pre-screening History . 10 Appendix C . 122 Expanded Performance Exam Blueprint . 122 Appendix D: References . 128 Analysis Survey 2010-2013

The Job Analysis undertaken by the American Chiropractic Neurology Board, Inc. was
initiated in 2010, starting with the development of the Job Analysis subject matter expert
survey (SME) design group. (Please see Appendix A for the description of this panel.)
The group designed the surveys from January through June of 2010. The pilot occurred
from July through December of 2010 and was edited and revised based on feedback from
the pilot exam. The final surveys were loaded into Survey Monkey in 24 segments
covering various areas specific to skills and knowledge related to practicing as
Chiropractic Neurologists.
The job analysis from 2002 served as the platform for the general topic categories. As an
incentive for completion of the entire set of surveys, the ACNB approved 10 Continuing
Education credits to each certificant completing the entire set of surveys. Many of the
doctors stated that the review of their practice and of the knowledge required was an
excellent look into the entire field as well as their own practice.
Demographics

The total number of surveys received was 256; however, 29 were completed by students
and that data was deleted as not relevant to the job analysis leaving 227 completed
surveys to consider. The number of current, qualified certificants ranged from 402 to 475
over the years of the survey collection (2011 through 2013).
Demographics by Gender
Percent of Total Respondents

Demographics by Board Association
Percent of Total Respondents
Diplomates of DACNB Diplomates of DABNC Diplomates of DACAN Other Specialty Certification
The number of years of experience as a Diplomate ranged from at least 23 years
(category of before 1990) to less than 1 year for those completing the survey during the
year they certified.
Demographics by Country
Percent of Total Respondents
United States of America Demographics by Country (cont'd)
Percent of Total Respondents
Republic of Korea Diplomates completing surveys resided in 43 of the 50 states in the United States. This geographic presence is representative of the total registry of the ACNB. Overall Survey Design

The Job Analysis Survey consisted of twenty-two categorical sections; the first covering
the technical skills of collecting history and performing examination and the second
covering the cognitive areas needed for diagnosis and treatment. Inclusive in the
diagnosis are tests necessary for diagnostic confirmation. Inclusive in treatment are
various modalities, considerations and rehabilitation. Patient management or co-
management with another discipline was included in the cognitive areas. One categorical
section of the survey consisted of "red flag" considerations or those clinical issues where
a patient is in immediate danger of death. The following is a list of the twenty-two
sections of the survey.
The Categorical Surveys 1-6 combine to delineate the Blueprint for the Performance
Examination.
Survey 1: Prescreening History
Survey 2: History, Physical Examination Components of Vital Signs and Cranial Nerves
Survey 3: Physical Examination Component Sensory System
Survey 4: Physical Examination Component Motor System
Survey 5: Physical Examination Component Reflexes
Survey 6: Physical Examination Components Cerebellum, Balance, Vestibular System
The Categorical Surveys 7-24 determine cognitive knowledge necessary for the safe
practice of chiropractic neurology and in combination determine the blueprint for the
Written Examination.
Survey 7: "Red Flag" Issues
Survey 8: Neuron Theory (microscopic neurological principles necessary for safe
practice)
Survey 9: Receptors Survey 10: Peripheral Nerve Survey 11: Spinal Cord Survey 12: Brainstem Survey 13: Cranial Nerves Survey 14: Head and Face Pain Survey 15: Cerebellum Survey 16: Basil Ganglia Survey 17: Reflexogenic Systems Survey 18: Autonomic Nervous System Survey 19: Limbic System Survey 20: Lobes of the Brain Survey 21: Brain and Its Environment Survey 22: Neuroendocrine and Neurometabolic Survey 23: Pain Survey 24: Special Studies Definitions Common to all Categorical Surveys

Each categorical survey addresses the topics from three perspectives: frequency of use of
the information, importance of the information to safe practice and management of
patients with related conditions. The surveys used Lykert Scale measurements and
definitions as follows:
Frequency: refers to the time that the credentialed professional spends performing duties
that require proficiency in each of the domains and tasks. For domains, frequency is
calculated from the various tasks. For tasks, the frequency scale is as follows with the
responder noting the different meanings for the types of tasks indicated:
0 = Never (on no patients)
1 = Rarely (once per year) (On very few patients)
2 = Sometimes (once per month) (On select patients when indicated)
3 = Often (once per week) (On all new patients)
4 = Repeatedly (every day) (On all patients, new and returning)
5 = Specialty Practice (Not applicable as the specialty does not include this area)
The calculation to determine the relative weight of the frequency for each survey item is
as follows:
Weight = ((0*n0)+(1*n1)+(2*n2)+(3*n3)+(4*n4))/(N-n5)
Where N is the total number of respondents, n0, n1, n2, n3, n4, and n5 represent the number
of respondents choosing the respective Lykert scale values.
Importance: refers to the value of the knowledge or skill that the credentialed
professional determines for each item in each of the domains and tasks. For domains,
importance is calculated from the various tasks. The question asked for importance is,
"How essential is the domain to the competent performance of the credentialing
professional?" For tasks, the importance scale is as follows (with the responder noting the different meanings for the types of tasks indicated): 0 = Of No Importance 1 = Of Little Importance 2 = Moderately Important 3 = Very Important 4 = Extremely Important The calculation to determine the relative weight of importance for each survey item is as follows: Weight = ((0*n0)+(1*n1)+(2*n2)+(3*n3)+(4*n4))/(N) Where N is the total number of respondents, n0, n1, n2, n3, and n4 represent the number of respondents choosing the respective Lykert scale values. An additional data point is acquired in the first seven categorical surveys. That information is the identification of who performs the task. Those choices are as follows: Chiropractic Neurologist Treatment Assistant Receptionist No One (if No One is chosen, then Importance and Frequency are both rated "0") The calculations for this identification are in percentages. For surveys 7 through 24 the additional category of Management is applied. The definition provided to the respondents is, "Management refers to how you will treat the patient in the diagnostic areas related to this subject field." The Lykert type identifiers for management of patients with specific conditions are as follows: 0 = Refer to Allopath without follow-up by Chiropractic Neurologist 1 = Refer to Allopath with Chiropractic Neurologist Rehabilitation 2 = Co-manage with Allopath with Allopath primary and Chiropractic Neurologist secondary 3 = Co-manage with Allopath with Chiropractic Neurologist primary and Allopath secondary 4 = Independent management by Chiropractic Neurologist The weight for the management of the patient is calculated as indicated below: Weightm = ((0*n0)+(1*n1)+(2*n2)+(3*n3)+(4*n4))/(N) Where N is the total number of respondents, n0, n1, n2, n3, and n4 represent the number of respondents choosing the respective Lykert scale values. Decision Rules

The SME team determined that items would be included in the blueprint under the
conditions listed below.
In the items where the "Who Performs" identification is determined, at least 70% of the
time it must be a Chiropractic Neurologist.
For frequency, importance and management the calculated weight must be 2.5 or higher
for all except survey 7. That survey indicates conditions where referral to an Emergency
Department is mandated so the calculation is below 2.5 for inclusion.
Once the individual items (cognitive or task) are classified as belonging in the blueprint,
the overall weight of each Domain is calculated by determining the sum of the weight of
each item in that domain divided by the number of items in that domain.
The actual number of items in each survey meeting the decision rule is then totaled and a
percentage is calculated based on the total number of items in the set of surveys (1-6 or 7-
24). This percentage is applied to the total number of items for the practical exam
(Surveys 1-6) and total number of items for the written exam (Surveys 7-24).
The two sets of calculations, as indicated by the weight of the items and the number of
items meeting criteria, are compared. The final blueprint is calculated from these two sets
of summary data. See Appendix B for Categorical Survey Items and Weights, Appendix
C for the Calculation Tables.
Examination Blueprints Performance Exam Blueprint

New patient information is collected at almost all chiropractic neurologists' offices
but the doctors do not perform this task. The practical exam will address those tasks
that the chiropractic neurologist must perform for safe practice of the job.
Performance Exam Blueprint
Percent of the Exam
Review& Clarification of pre-screen history Physical Exam: Sensory Physical Exam: Motor Physical Exam: Muscle Stretch Reflexes Performance Exam Blueprint (cont'd)
Percent of the Exam
Physical Exam: Cerebellum/Vestibular Written Exam Blueprint

The written exam blueprint addresses both the Cognitive Domains necessary for the
Chiropractic Neurologist to practice and the task sets necessary to the job. These
task sets we have identified as Work Activities for the purpose of the Blueprint. The
Cognitive Domains and the Work Activities are directly related to each other. An
additional two percent of the exam is devoted to ethical issues. (The survey did not
address the Ethics issue as those items are taken from the actual issues that arise
each year. )
Percent of Written Exam
Receptor Systems Peripheral Nerves Head and Face Pain Reflexogenic Systems Autonomic Nervous System Lobes of the Brain Brain and Its Environment Neuro-Endrocrine System Work Activities
Percent of Written Exam
Processes/Metabolic Rate/Pathways Treatment and Rehabilitation (includes anatomy & physiology pertinent to Treatment & Rehabilitation) Special Topic
Percent of Written Exam
Appendix A
Job Analysis Subject Matter Experts
Robert Humphreys, DC, DACNB-board of directors' representative and faculty at Chiropractic University Heidi Grant, DC, DACNB-representative from the UK Randy Beck, DC, DACNB-representative from Australia and faculty in Australia programs Charles Nelson, DC, DABCN-representative from France and English as a Second Language (herein designated by ESL) representative Merry Hanson, DC, DACNB-representative from the northwestern United States Youn Min Woo, DC, DACNB-representative from Asian areas and ESL Heith Root, DC, DACNB-representative from southern United States Kurt Kuhn, DC, DACNB-representative from northern United States Candace Duty, DC, DACAN-representative of DACAN Karen Feeney, DC, DACNB-representative of eastern United States Facilitated by Lucinda Harman, Ph.D.-Executive Director Assisted by Kari Hodge, B.Ed., M.Ed.- doctoral student at Baylor University in Educational Psychology majoring in measurement under the direction of Grant Morgan, Ph.D.-faculty at Baylor University in Department of Educational Psychology Appendix B
Items on Categorical Surveys and their Decision Weights
Survey 1: Demographics and Pre-screening History
Name (for CE credit) Age Range: five-year increments from 20 through 71+ (Range: 20-25 through 71+ with the Mode and Mean at 40-45) Gender: Female 20.78% Year Receiving Certification as a Chiropractic Neurologist (used to determine years of practice): Range before 1990-2012 Type of Certification: DABCN (15.67%), DACAN (3.69%), DACNB (78.80%), or Specialty (1.8%) Years as a Chiropractor <1 to 46 years Years as a Chiropractic Neurologist <1 to 24 years Location of Practice (See Demographic Write-up in Body of Analysis) Login ID-individual Pre-screening section
1. Do you prescreen your patients? (Answers) Yes 71.11% No 28.89% 2. If more than one person participates in this, who are they and how frequently and how important is this in your practice? (Answers) Chiropractic Neurologist-33.33%, New Patients Only and Moderately and Extremely Important = 72.27% 3. If you prescreen, what is the method (select all that apply)? (Answers) telephone (82.14%), Internet (32.14%), email (31.43%), walk-in (51.43%) 4. Does your office have more than one chiropractic neurologist? How many? (Answers) 1 = 86.51%, 2 = 12.56%, 3 = .93%, 4 = 0%, 5 = 0% 5. Does your office have non-neurological chiropractors? How many? (Answers) 0 = 61.40%, 1 = 24.65%, 2 = 6.51%, 3 = 5.58%, 4 or more = 1.58% 6. Is the prescreen information used to assign the physician to the patient? (Answers) Yes = 28.44% No = 71.67% 7. What determines the classification of a patient as a neurology patient? Check all that apply. (Answers) Physician referral = 46.05%, specific symptom list = 84.65%, other (list) 3.23% (usually examination) 8. Is the prescreen used to determine the amount of time scheduled for the patient's first visit? (Answers) Yes = 44.85% or No = 55.35% 9. Approximately, what percentage of your new patients present as neurological patients? (Answers) Full range of answers. 10. Do you have new patient paperwork that the patient completes prior to seeing the physician? (Who initiates it, how frequently and how important) (Answers) Receptionist was most frequent answer at 70.75%. On new patients, every day and extremely important. 11. If more than one person initiates it, who else? How frequently and how important? 12. Does your new patient paperwork include (information, frequency, and importance): a. personal information = patients answer independently b. consent for insurance = patients answer independently c. emergency contact = patients answer independently d. medical history = patient interacting with chiropractic neurologist 71.5% e. informed consent for treatment = patient interacting with chiropractic neurologist 66.6% f. complaint and current symptoms = patient interacting with chiropractic neurologist 75.2% g. systems review = chiropractic neurologist 51.87% h. questions about neuraxis = chiropractic neurologist 58.41% Survey 2: Patient Exam-Vital Signs & Cranial Nerves

1. Respondent ID 2. After reviewing the patient pre-examination paperwork, which of the following best describes what you do? Percent Yes
A problem focused history only looking at the patient's presenting problem A problem focused history that you modify based on patient's response A comprehensive history: pain, family, social, travel, past medical & ROS on all new patients 3. Which one of the following best describes your physical examination? Percent Yes
A focused physical examination based on the complaint and history A primarily focused physical examination intensifying around abnormal findings A standard comprehensive physical examination for every new patient (sensory, motor, reflexes, cranial nerves, cerebellum/balance, cognitive function, and autonomic evaluation) 4. Approximately, how many new patient exams do you perform a week? Range from 1 to 25 with mean of 10. 5. Do you review and discuss a new patient's history as part of the exam? Who Does It?
Importance
ChiroNeuro
Do you review and discuss a new patient's history as a part of the exam? Initial Exam Section of Survey 2

1. Do you take vital signs? Who Does It?
Frequency
Importance
ChiroNeuro
Do you take the patient's 2. What vital signs do you check? All that apply. Percent Yes
Pulse: Bilateral Blood Pressure: One side Blood Pressure: Bilaterally Blood Pressure: Sitting Blood Pressure: Lying Blood Pressure: Standing Pulse Oxygen level Peripheral Perfusion Index: One side Peripheral Perfusion Index: Bilaterally 3. Does your new patient exam include Cranial Nerve 1: Olfaction? Frequency
Importance
Olfaction: Test? Each side perceives? Each side identifies scent? 4. Does your new patient exam include Cranial Nerve 2? Importance
Frequency Weight
Vision: Snellen (Distance Near Visual Acuity? 5. Does your new patient exam include Cranial Nerve 3? Importance
Frequency Weight
Measure pupil diameter? Direct pupillary light Consensual pupillary light Corneal light reflection? Response to near vision? Repeated convergence? 6. Does your new patient exam include Cranial Nerve 3,4 and 6: H-Pattern? Importance
Frequency Weight
7. Does your new patient exam include CN5: Trigeminal? Importance
Frequency Weight
Deviation of jaw? prominence/clicks on opening & closing? Sensation on V1, V2 & V3 Sensation on V1, V2 & V3 8. Does your new patient exam include CN5 & CN7? Importance
Frequency Weight
Corneal Reflex one time? Corneal Reflex to summation comparing side to side? 9. Does your new patient exam include CNII: Facial Muscles of Expression? Importance
Frequency Weight
Smile-volitional Smile-spontaneous 10. Does your new patient exam include CN8: Hearing & Vestibular? Importance
Frequency Weight
Infants only (startle/loud Infants only Moro 11. Does your new patient exam include CN9: Glossopharyngeal? Importance
Frequency Weight
Observe palatal atrophy? 12. Does your new patient exam include CN9 and CN10: Gag? Importance
Frequency Weight
Gag on each side? Gag on each side to In no gag, perceive touch? Observe palatal fatigue on intonation of AHH? 13. Does your new patient exam include CN11? Importance
Frequency Weight
Strength testing of upper SCM strength testing? 14. Does your new patient exam include CN12: Hypoglossal? Importance
Frequency Weight
Observe resting tongue for deviation in mouth? Deviation on protrusion of Equal volitional movement of tongue left & right? Strength of tongue push inside of cheek side to side? Survey 3: Physical Exam Sensory System

The purpose of this survey is to determine the Sensory System practices of a Chiropractic
Neurologist for the Physical Examination.
1. Testing for Light Touch Who Does It?
Frequency
Importance
ChiroNeuro
Evaluate touch over dermatomes in upper extremities Evaluate comparison of touch perception equalities side to side in upper extremities Evaluate touch over dermatomes in lower extremities Evaluate comparison of touch perception equality side to side in lower extremities 2. Testing for Vibration Who Does It?
Frequency Importance
ChiroNeuro
Evaluate vibration perception over dermatomes in upper extremities Evaluate cessation of vibration perception accuracy in upper extremities Evaluate comparison of perception of vibration side to side in upper extremities Evaluate vibration perception over dermatomes in lower extremities Evaluate cessation of vibration perception accuracy in lower extremities Evaluate comparison of perception of vibration side to side in lower extremities 3. Testing for Sharp Touch Who Does It?
Frequency
Importance
ChiroNeuro
Evaluate sharp over dermatomes in upper extremities Evaluate comparison of sharp perception equalities side to side in upper extremities Evaluate sharp over dermatomes in lower extremities Evaluate comparison of sharp perception equality side to side in lower extremities 4. Testing for Temperature Who Does It?
Frequency
Importance
ChiroNeuro
Evaluate hot over dermatomes in upper extremities Evaluate comparison of hot perception equalities side to side in upper extremities Evaluate hot over dermatomes in lower extremities Evaluate comparison of hot perception equality side to side in lower extremities Evaluate cold over dermatomes in upper extremities Evaluate comparison of cold perception equalities side to side in upper extremities Evaluate cold over dermatomes in lower extremities Evaluate comparison of cold perception equality side to side in lower extremities Survey 4: Physical Exam: Motor Systems

The purpose of this survey is to determine the Motor System practices of a Chiropractic
Neurologist for the Physical Examination.
1. Muscle Strength Testing Who Does It?
Frequency
Importance
ChiroNeuro
Do you observe for asymmetry of bulk side to side? Do you observe for soft pyramidal paresis in the upper extremity? Do you observe for soft pyramidal paresis in the lower extremity? Do you evaluate active range of motion in the upper extremity? Do you evaluate active range of motion in the lower extremity? Do you observe active range of motion in the cervical spine? Do you measure range of motion in the cervical spine? Do you evaluate for hypotonia (increased passive range of motion)? Do you evaluate for hypertonia on passive range of motion? Do you do a postural Do you do a gait During the gait assessment, do you instruct the patient to turn around and come back toward you? 2. Do grade the strength when you perform manual muscle tests? Percent Yes
Finger extensors Finger Abductors Finger Adductors Extensor Hallicis Longus Ankle dorsiflexors Ankle plantar flexors Survey 5: Physical Examination: Reflexes

The purpose of this survey is to determine the Reflex testing practices of the Chiropractic
Neurologist.
1. Muscle Stretch Reflexes: Do you test the following muscle stretch reflexes? Who Does It?
Frequency
Importance
ChiroNeuro
Medial hamstring 2. Do you reinforce (Jendrasik) any reflex that was not elicited? Who Does It?
Frequency
Importance
ChiroNeuro
Jendrasik on upper Jendrasik on lower 3. Pathological Reflexes Who Does It?
Frequency
Importance
ChiroNeuro
Do you evaluate for Hoffman's reflex? Do you evaluate for Tromner's reflex Do you evaluate for a Plantar response (Babinski)? 4. If the Plantar response elicited is extensor (non-infant), do you evaluate for: Percent Yes
5. Pathological reflexes continued: Who Does It?
Frequency
Importance
ChiroNeuro
Do you evaluate for percussion myotonia on the thenar eminence? Do you evaluate for wrist Do you evaluate for ankle Survey 6: Physical Exam: Cerebellum, Balance, Vestibular, Basal Ganglia, Limbic
System and Cognition

The purpose of this survey is to determine the importance and frequency of use of the
techniques relative to the: Cerebellum/Balance/Vestibular/Limbic & Cognitive Systems
in the practice of a Chiropractic Neurologist.
1. Cerebellum/Balance/Vestibular System: Do you test the following? Who Does It?
Frequency
Importance
ChiroNeuro
Rhomberg eyes open & closed; with head positioning Tandem Stance Right leg forward & then left leg forward One leg standing eyes open Finger to Nose eyes closed Finger to Finger eyes open Finger to Finger moving Alternating hand movement; extended and elbow flexed Thumb to each finger Hypermetric saccade VOR Vestibular Ocular Response Testing with & without fixation Canal related eye weakness-hypo or hypertropia OPK, head position Rebound and check Positional testing (Dix- 2. Special Tests: Do you perform any of the following? Who Does It?
Frequency
Importance
ChiroNeuro
CAPS testing (other machine testing) Cerebellar antibodies 3. Basal Ganglia: Do you perform the following? Who Does It?
Frequency
Importance
ChiroNeuro
Finger coordinating movement (piano playing) Observation of movement Eyes closed-observe for eye blepharospasm Observation of initiation of spontaneous saccades Pupillary light response Gait/shuffling steps/turning 4. Limbic System: Do you test the following? Who Does It?
Frequency
Importance
ChiroNeuro
Social testing-answer questions reasonably Normal questioning without outbursts Emotional responses to sensory input (light, smell, pinwheel) Affect-inappropriate for 5. Cognitive: Do you perform the following? Who Does It?
Frequency
Importance
ChiroNeuro
History responses Memory of sequencing Recall and interpretation of Mathematical Calculations Right & left brain Conversational assessment of hyperactivity General questions regarding attention and hyperactivity General questions Spatial orientation testing (Necker squares, mazes, spinning ballerina) Long term versus short term versus immediate recall memory (not immediate but what did you have for breakfast) Semantic versus episodic versus procedural memory (metabolic rate when doing testing) Blind Spot Mapping Pre-motor testing versus Supplementary motor testing (internal versus external cuing) 6. Do you perform the following Special Tests? Who Does It?
Frequency
Importance
ChiroNeuro
Mental Status Exams Vascular testing Neuropsychological testing Blind Spot Mapping by 7. General Special Testing Laboratory studies: Do you perform the following? Who Does It?
Frequency
Importance
ChiroNeuro
Survey 7: Red Flag Issues
This survey deals only with the issue of critical types of presentations where, if the doctor misdiagnoses the patient, death or permanent disability is likely. These types of cases require immediate intervention or emergency transport. They occur infrequently, but every practitioner must recognize them to practice safely. The purpose of this survey is to identify and describe Red Flag Issues that may present to the Chiropractic Neurologist. 1. Red Flag Issues: Who Makes
Referral
Referral?
Frequency
Importance
ChiroNeuro
Meningitis: neck rigidity, severe headache and high fever Increased intracranial pressure: eye exam ophthalmoscope-bulging optic disc with severe headache on same side Blood pressure: diastolic 110+ or systolic 180+; headache Blood pressure adult: diastolic 50- or systolic 80- with presenting symptoms Heart Rate/Rhythm: presentation: SOB, diaphoresis, chest pain, left arm pain, thoracic back pain; Rate above 140+ at rest with no medication indicator Cauda Equina Syndrome- disc patients: saddle pain, inability to urinate, urinate or defecate without knowing it Syndrome: fever, head/face pain, infection in nasal triangle Subarachnoid hemorrhage (subdural, epidural): "worst headache I've ever had" Blood sugar non-fasting: Blood sugar non-fasting: above 300 mg/deciliter with no history of diabetes and with diaphoresis, lowered level of alertness Sepsis: Blood sugar above 120 fasting in non-diabetic patient: look for sepsis and ship; fever or abnormally low for individual (>97 <100); HR >100 bpm; Resp rate > 20 cpm Emergent Stroke: lethargy, lower level of consciousness Respiration: below 7 and above 20 OR in a known patient plus or minus 5 either direction at rest with altered breath sounds Visual field defects: Pie in sky/ floor; hemifield loss; Quadrantanopia; loss of central vision; peripheral visual loss (tunnel vision) Temperature: hypothermia below 96 core/95 oral; hyperthermia above 103 core/102 oral; history of vomiting Projectile vomiting or unremitting vomiting Survey Sections on Cognitive Information and Management Decisions Surveys 8 through 22 Survey 8: Theory of the Neuron
Understanding neuron theory is the microscopic basis for everything that the Chiropractic Neurologist does in treating patients. It is important for increased activation and more life or decreased activation and cell death or too sudden activation in a weakened cell resulting in cell death. The purpose of this survey is to determine the frequency and importance of the cognitive information and the patient management decisions used. 1. Please indicate how important knowledge of the each of the following principles of functional anatomy is to the practice of chiropractic neurology and how frequently you use each in your practice. Frequency
Importance
D. Endoplasmic Reticulum G. Micro Tubules K. Golgi apparatus 2. Please indicate how important knowledge of the following disease processes/diagnoses is to the practice of chiropractic neurology and how frequently you use this knowledge in your practice and how you manage patients with these issues. Management
Frequency
Importance
A. Disorder of the cell will be because of the following: 1. Energy failure 2. Swelling of the cell 3. Membrane rupture 4. Inflammation cytoplasmic disintegration 6. Programmed cell B. Apoptotic Pathway #1 C. Apoptotic Pathway #2 D. All of the disorders that the body goes through are a result of the failure of the cell proliferation. We are either proliferating the cells or destroying them. 3. Please indicate how important the following rehabilitation principles/treatment modalities are and how frequently you use these in your practice. Frequency
Importance
A. Rehabilitation or treatment 1. Increase activation 2. Inhibit activation 3. Promote cell proliferation by increasing fuel delivery but not exceeding the metabolic rate of the area being stimulated. B. Specific adjustments will increase C. Specific Adjustments will increase D. Nutrition to increase activation. 4. Please indicate how important the following diagnostic issues are to the chiropractic neurologist and how frequently you use them in your practice. Frequency
Importance
D. Hair analysis Survey 9: Cognitive Area: Receptors

The purpose of this survey is to determine the frequency and importance of the cognitive
information and the treatment modalities used in the area of Receptors.
1. Sensory Receptors Frequency
Importance
A. Retinal receptors-rods and cones B. Olfactory receptors- chemoreceptors-not integrated through thalamus-memory linked-direct link to limbic C. Gustatory receptors-taste- chemoreceptors-integrated through thalamus-sweet, salty, bitter, sour D. Auditory-cochlea- mechanoreceptor-hertz and decibel-speech perception (512)-low tone (128)-mid level (256)-localization-phase-reflex (orienting)-dampening reflex (CN 5&7) E. Vestibular-semicircular canals, utricle, saccule-hair cells are the receptors-dynamic and static division-connected with eyes and eye movements-8th CN-cerebellum connection (vestibular nuclei) F. Cutaneous receptors - free and G. Proprioceptors - joint mechanoreceptors, muscle spindles, Golgi tendon organs H. Visceral - mechano (stretch/baro) and chemoreceptors 2. Disease Process Issues: Retina Management
Frequency
Importance
Age related macular Diabetic retinopathy Retinal detachment 3. Disease Process Issues: Olfactory Management
Frequency
Importance
Nasal obstruction Toxic damage (inhalants) Trauma, age related 4. Disease Process Issues: Gustatory Management
Frequency
Importance
Upper respiratory/oral Nutritional deficiencies Olfactory related disorder Age related degeneration 5. Disease Process Issues: Cochlear Management
Frequency
Importance
Age related degeneration 6. Disease Process Issues: Vestibular Management
Frequency
Importance
7. Disease Process Issues: Cutaneous Management
Frequency
Importance
8. Disease Process Issues: Proprioceptors Management
Frequency
Importance
9. Disease Process Issues: Visceral Management
Frequency
Importance
Primary disease of organs 10. Rehabilitation Principles Frequency
Importance
1. Environmental receptors transduce external stimulus into an electrochemical event that may change the CNS 2. To achieve great probability of CNS change: fast adapting receptors need to be stimulated with varying amplitudes or patterns 3. To achieve great probability of CNS change: slowly adapting receptors will maintain a change in firing rate with a new, but constant stimulus 4. Receptors that fire frequently (slowly adapting or associated with a frequently changing system) and are very responsive to change (high sensitivity) often have the greatest CNS input; these are mostly proprioceptors and vestibular receptors 11. Rehabilitation Applications Frequency
Importance
Visual stimulus and filtering Auditory training with tones, clicks Olfactory and gustatory stimulus Vestibular training (yaw, pitch and Therapeutic caloric Canalith repositioning Crude and accurate touch stimulation Chiropractic adjusting technique Range of motion therapeutics (resistance training, stretch, muscle work) 12. Diagnostic issues in which the chiropractic neurologist is skilled Frequency
Importance
Visual stimulus and filtering Auditory training with tones, clicks Olfactory and gustatory stimulus Vestibular training (yaw, pitch and Therapeutic caloric Canalith repositioning Crude and accurate touch stimulation Chiropractic adjusting technique Range of motion therapeutics (resistance training, stretch, muscle work) Survey 10: Cognitive Area: Peripheral Nerves
The purpose of this survey is to determine the frequency and importance of the cognitive information and treatment modalities used by the chiropractic neurologist. These additional demographic questions will assist in the data analysis. 1. I have completed a 120-150 hour Electro-diagnostics Class Response Percent
2. I have X-ray facilities in my office: Response Percent
3. Please indicate how important the following functional Neuroanatomy is in your practice and how frequently you use this information? Frequency
Importance
A. Gross anatomy and relationship of a root to the vertebral column b. Sensory roots c. both Motor and Sensory Roots B. Gross anatomy of the Brachial a. upper, middle and lower trunk b. lateral, medial and posterior D. Peripheral Nerves a. lateral antibrachial cutaneous b. medial antibrachial cutaneous d. palmar median f. palmar ulnar g. dorsal ulnar h. superficial radial k. superficial peroneal l. medial and lateral plantar n. lateral femoral p. cluneal nerves E. Motor Peripheral Nerves f. anterior interosseous i. superior gluteal j. inferior gluteal l. superficial peroneal m. deep peroneal o. medial and lateral plantar 4. Please indicate how important knowledge of these disorders is and how frequently you see each of them in your practice and how you manage patients with them. Frequency
Importance
Management
Responsibility Weight
A. motor root lesion B. sensory root lesion C. motor & sensory root D. compressive root b. inflammatory lesion (Sclerotogenous pain referral) a. biomechanical, i.e., b. motor vehicle c. vertebral fracture compression fracture F. brachial plexus lesions a. Erbs Palsy (upper brachial plexus lesion) b. lateral traction injury c. Klumpke Palsy (lower brachial plexus lesion) G. lumbosacral plexus a. lumbar plexus lesion b. sacral plexus lesion a. radial nerve 1. crutch palsy 2. Saturday Night 3. supinator syndrome b. median nerve 1. pronator syndrome 2. carpal tunnel 1. retro cubital tunnel 2. cubital tunnel 3. Canal of Guyon (Pisiform-Hamate) syndrome 4. ulnar nerve lesion d. anterior Interosseous e. sciatic palsy f. tibial Nerve 1. Baker's cyst 2. tarsal tunnel g. peroneal nerve 1. lesion at fibular 2. anterior tarsal I. Systemic peripheral a. diabetic neuropathy b. Charcot-Marie- c. lead neuropathy e. pernicious anemia f. Friedreich's ataxia g. alcoholic neuropathy h. rheumatoid arthritis 5. Please indicate how important these Diagnostic Procedures are with respect to peripheral nerve lesions and how frequently you use them in your practice, and who performs them (management). Frequency
Importance
Management
Responsibility Weight
3. Lumbosacral MRI a. brachial plexus b. shoulder soft tissue 5. Upper extremity Nerve conduction velocity testing without needle EMG 6. Upper extremity Nerve Conduction velocity testing with needle EMG 7. Lower extremity Nerve conduction velocity testing without needle EMG 8. Lower extremity Nerve Conduction velocity testing with needle EMG 9. Laboratory testing a. heavy metals c. Complete Blood d. Comprehensive Metabolic Profile f. Genetic testing g. Hair analysis h. Neuro- transmitter 10. Cardiac testing c. Echo Cardiogram d. Cardiac Stress test a. cervical spine b. thoracic spine c. lumbosacral spine d. shoulder series e. elbow series f. wrist series m. ankle series 6. Please indicate how important these Referrals are with respect to peripheral nerve lesions and how frequently you use them in your practice. Frequency
Importance
A. Refer only until a definitive cause 1. Orthopedic Surgeon 2. Neurosurgeon 3. Cardiologist 4. Endocrinologist 5. Primary Care Physician (if not 6. Rheumatologist B. Refer and Co-treat with other 1. Physical Therapist 2. Occupational therapist 3. Primary Care Physician (if not C. Treat without Co-Management D. Refer based upon outcome of initial trial therapy 7. Please indicate how important these treatment modalities are with respect to peripheral nerve issues and how frequently you use them in your practice. Frequency
Importance
A. spinal manipulation B. extremity manipulation C. Nutritional support (vitamins, D. muscle tone modulation 1. Electrical muscle stimulation 2. myofacial release 6. fast stretch 7. slow stretch E. Thermotherapy (hot or cold) F. central integrated state (to increase or decrease) 8. Please indicate how important the rehabilitation principles are with respect to peripheral nerve issues and how frequently you use them in your practice. Frequency
Importance
Physical Rehab in office Physical Rehab at home Cortical stimulation Survey 11: Content Area: Spinal Cord
The purpose of this survey is to identify the importance and the frequency of chiropractic neurologists' use of knowledge with respect to the Spinal Cord. 1. Functional Neuroanatomy Frequency
Importance
A. Gross anatomy and relationship with vertebral column B. Main Nuclear groups: Dorsal Horn C. Main Nuclear groups: D. Main Nuclear groups: Ventral E. Main Nuclear groups: (Rexed F. White matter pathways: Sensory G. White matter pathways: Motor H. Spinal nerves and their roots I. Functional relationships: Segmental J. Functional relationships: Homologous columns Management
Frequency
Importance Responsibility
A. Spinal Cord Injury: Lateral lesion B. Spinal Cord Injury: Anterior lesion C. Spinal Cord Injury: Posterior D. Spinal Cord Injury: Complete E. Compressive mechanisms G. Ventral horn cell disease H. Multiple sclerosis I. Dorsal column disease J. Vascular disease K. Cauda Equina Syndrome 3. Rehabilitation Principles Frequency
Importance
1. Central vs Peripheral nerve lesions and limitations to regeneration 2. Segmental relationships 3. Peripheral signaling into cord 4. Suprasegmental signaling into cord 5. Decompression and vascular 6. Metabolic capacity 7. Central integrated state and potential for plastic change 8. To achieve great probability of CNS change: fast adapting receptors need to be stimulated with varying amplitudes or patterns 9. To achieve great probability of CNS change: slowly adapting receptors will maintain a change in firing rate with a new, but constant stimulus 10. Receptors that fire frequently (slowly adapting or associated with a frequently changing system) and are very responsive to change (high sensitivity) often have the greatest CNS input; these are mostly proprioceptors and vestibular receptors 4. Rehabilitation Applications Frequency
Importance
3. Vestibular reflexes 4. Bladder control 5. Gait retraining 6. Brain based therapies 7. Crude touch, pain, temperature and accurate touch modalities 8. Chiropractic adjusting technique 9. Range of motion theraputics (resistance training, stretch, muscle work) 10. Mental imagery 5. Diagnostic Issues Frequency
Importance
A. History taking differentiating spinal cord lesions from lesions elsewhere B. Complete neurological examination with emphasis on: Muscle spindle reflexes C. Complete neurological examination with emphasis on: Strength D. Complete neurological examination with emphasis on: Primitive reflexes E. Complete neurological examination with emphasis on: Assessment of tone F. Complete neurological examination with emphasis on: Tactile sensation testing G. Localization of spinal cord lesions at different levels H. Differentiating between a single lesion, multiple lesions and systemic lesions Survey 12: Cognitive Area: Brainstem
The purpose of this survey is to identify the importance and frequency of chiropractic neurologists' use of knowledge with respect to the brainstem. 1. Functional Neuroanatomy Frequency
Importance
A. Gross anatomy and relationship with cranial structures B. Neocortical and Paleocortical C. Relationships with deep cerebral nuclei and cerebellum D. Medulla Pathways E. Medulla Cranial nerves and their F. Medulla Other nuclei and reticular G. Medulla Vasculature H. Pons Pathways I. Pons Cranial nerves and their J. Pons Other nuclei and reticular K. Pons Vasculature L. Mesencephelon Pathways M. Mesencephelon Cranial nerves and their nuclei N. Mesencephelon Other nuclei and reticular formation O. Mesencephelon Vasculature Management
Frequency
Importance
A. White matter disease B. Ventricular lesions C. Medulla ventral D. Medulla Lateral E. Medulla Craniocervical F. Medulla Integrative J. Pons Paramedian K. Pons Integrative L. Mesencephelon M. Mesencephelon Tectal N. Mesencephelon 3. Rehabilitation Principles Frequency
Importance
1. Central vs Peripheral nerve lesions and limitations to regeneration 2. Segmental relationships 3. Peripheral signaling into brainstem 4. Suprasegmental signaling into 5. Metabolic capacity 6. Central integrated state and potential for plastic change 7. To achieve great probability of CNS change: fast adapting receptors need to be stimulated with varying amplitudes or patterns 8. To achieve great probability of CNS change: slowly adapting receptors will maintain a change in firing rate with a new, but constant stimulus 9. Receptors that fire frequently (slowly adapting or associated with a frequently changing system) and are very responsive to change (high sensitivity) often have the greatest CNS input; these are mostly proprioceptors and vestibular receptors 4. Rehabilitation Applications Frequency
Importance
1. Cranial nerve activation 3. Segmental spindle and GTO 4. Vestibular reflexes 5. Autonomic controls 6. Gait retraining 7. Brain based therapies 8. Crude touch, pain, temperature and accurate touch modalities 9. Chiropractic adjusting technique 10. Range of motion therapeutics (resistance training, stretch, muscle work) 11. Mental imagery 12. Desensitization 13. Sleep patterning 14. Breathing exercises 5. Diagnostic Issues Frequency
Importance
A. History taking differentiating brainstem lesions from lesions elsewhere B. Complete neurological examination with emphasis on: Cranial nerve testing C. Complete neurological examination with emphasis on: Vitals D. Complete neurological examination with emphasis on: Muscle spindle reflexes E. Complete neurological examination with emphasis on: Strength F. Complete neurological examination with emphasis on: Primitive reflexes G. Complete neurological examination with emphasis on: Assessment of tone H. Complete neurological examination with emphasis on: Tactile sensation testing I. Localization of brainstem lesions at different levels J. Differentiating between a single lesion, multiple lesions and systemic lesions Survey 13: Cognitive Area: Cranial Nerves

The purpose of this survey is to determine the frequency and importance of the cognitive
information and the treatment modalities used.
1. Please rate the following functional Neuroanatomy according to its importance to your practice and the frequency you use it in your practice. Frequency
Importance
1. Olfactory-tract-bulb-olfactory 2. Optic nerve chiasm-tract-lateral 3. Oculomotor nerve-midbrain a. Edinger-Westphal nucleus 4. Trochlear nerve-midbrain 5. Trigeminal nerve-pons/midbrain 6. Abducens nerve-pons 7. Facial-nerve-pons a. Superior salvatory n. 8. Vestibular cochlear-pons sva (special visceral afferent) 9. Glossopharyngeal –medulla a. Inferior salvatory n. 10. Vagus nerve-medulla a. Nucleus tractus solitarius 11. Spinal accessory-medulla/cord 12. Hypoglossal-nerve-medulla 2. Please rate the following function/physiology according to its importance to your practice and the frequency you use it in your practice. Frequency
Importance
1. GSA (general somatic afferent)- -touch, pain, temperature, proprioception-V,VII,IX,X 2. SSA (special somatic afferent)-- hearing, balance-VIII 3. GVA (general visceral afferent)--mechanical, chemosensory-V,VII,IX,X 4. SVA (special visceral afferent)- -taste, olfaction-I,VII,IX,X 1. GSE (general somatic efferent)- -skeletal muscle control-III,VI,IX,XII 2. GVE (general visceral efferent)- -autonomic control-III,VII,IX,X 3. SVE (special visceral efferent)-- brachiometric control-V,VII,IX,X,XI 3. Please rate the following Disorders according to the importance of being able to diagnose them and how frequently you see them in your practice and how they are managed. Management
Frequency
Importance
1. Tumors-locations a. TIA—transient c. AVM—arteriovenous 5. Congenital anomalies 6. Plasticity/deafferentation 7. Hemisphericity 8. Macular degeneration, RAPD—relative afferent papillary defect 9. Nerve palsies—CN III, 4. Please rate the following rehabilitation principles as to their importance in your practice and the frequency that you use them in your practice. Frequency
Importance
A. Restore/maintain-fuel B. Surgical referral – removal/eliminate/repair frank pathology C. Monitor metabolic capacity D. Improve plasticity 1. Active activation 2. Active inhibition E. Create symmetry/balance in functionality from right and left 5. Please rate the following rehabilitation applications/treatment modalities as to the importance in your practice and how frequently you use them. Frequency
Importance
1.Olfaction identification- peppermint/lavender 2. Olfaction localization 1. hemifield stimulation 2. Color stimulation 3. Optokinetic stimulation 4. Accommodation exercises 5. Localization 6. Blocking techniques 4. VOR—Vestibular Ocular reflex 5. OPK—optokinetic 6. Memorized targets D. Edinger-Westphal 1. Light stimulation- 2. Accommodation-near/far 1. Therapeutic exercises -chewing 2. Myofascial release 3. Manipulation 4. Sensory stimulation-V-I,V-II,V- 1. Muscle activation 2. Cortical based facial expression 3. Limbic based facial expression G. Superior Sallivatory Nucleus- 1. Corneal stimulation 2. Gag stimulation 3. Caloric stimulation 4. Odor stimulation 1. Tone recognition 2. Sound localization 6. Blocking techniques 1. Angular acceleration 2. Linear acceleration 3. Visualization J. Glossopharyngeal- 1. Taste stimulation K. ISN (inferior salivatory nucleus) - 1. Taste stimulation 2. Visualization of taste 1. Carotid compression 2. Angular acceleration 3. Corneal stimulation M. Spinal accessory- 1. Myofascial release 2. Therapeutic exercises 3. Manipulation 4. Slow/fast stretch 1. Therapeutic exercises Diagnostic issues Eg. Distinguishing Horners' syndrome from cranial nerve disorder Simple versus pathological anisocoria Survey 14: Cognitive Area: Head and Face Pain
The purpose of this survey is to determine the frequency and importance of the cognitive information and treatment modalities used for patients with head and face pain. 1. Please rate the following functional Neuroanatomy in terms of importance and frequency of use in your practice. Frequency
Importance
A. Cranial bones, sutures, foramina B. Potential sites of neural C. Pain sensitive structures of the D. Upper cervical spinal cord E. Location of cranial nerves and F. Neocortical and Paleocortical G. Relationships with deep cerebral nuclei and cerebellum 2. Please indicate the importance of knowledge about the following disorders and how frequently you see them in your practice and how those patients are managed. Frequency
Importance
Management
Responsibility Weight
B. Cluster headache C. Cervicogenic headache D. Tension type headache E. Temporal neuritis F. Subarachnoid hemorrhage G. Trigeminal neuralgia H. Atypical facial pain I. Temporo-mandibular joint 3. Please indicate how important the following rehabilitation principles are in terms of treating your patients and how frequently you use these principles. Frequency
Importance
1. Central vs Peripheral nerve lesions and limitations to regeneration 2. Cranial nerve sensory and motor 3. Peripheral signaling into brainstem 4. Suprasegmental signaling into 5. Metabolic capacity 6. Central integrated state and potential for plastic change 7. To achieve great probability of a. fast adapting receptors need to be stimulated with varying amplitudes or patterns b. slowly adapting receptors will maintain a change in firing rate with a new, but constant stimulus 8. Receptors that fire frequently (slowly adapting or associated with a frequently changing system) and are very responsive to change (high sensitivity) often have the greatest CNS input; these are mostly proprioceptors and vestibular receptors 4. Please indicate how important the following rehabilitation applications are to your practice and how frequently you use them in your practice. Frequency
Importance
1. Sympathetic inhibition 2. Mechanisms of nerve 3. Oxygenation (decreased CO2) 4. Vestibular reflexes 5. Autonomic controls 6. Gait retraining 7. Brain based therapies 8. Crude touch, pain, temperature and accurate touch modalities 9. Chiropractic adjusting technique 10. Range of motion therapeutics (resistance training, stretch, muscle work) 11. Mental imagery 12. Desensitization 13. Sleep patterning 14. Breathing exercises 5. Please indicate how important the following diagnostic issues are and how frequently you use them in your practice. The chiropractic neurologist is skilled in: Frequency
Importance
A. History taking differentiating primary head pain lesions with secondary or sinister ones B. Complete neurological examination with emphasis on: a. Cranial nerve testing b. Autonomic assessment c. Muscle spindle reflexes e. Primitive reflexes f. Assessment of tone g. Tactile sensation testing C. Use of diagnostic imaging D. Differentiating between a single lesion, multiple lesions and systemic lesions Survey 15: Cognitive Area: Cerebellum
The purpose of this survey is to determine the frequency and importance of the cognitive information and the treatment modalities used with respect to the cerebellum. 1. Please indicate how important knowledge of the following functional Neuroanatomy is to the practice of chiropractic neurology and how frequently you us this information in your practice. Frequency
Importance
A. Deep cerebellar nuclei 2. Interpossitus (Emboliform, B. Cortex Layers 1. Granular layer-granule, golgi 2. Purkinje layer-purkinje cells 3. Molecular layer-stellate & basket cells, parallel fibers 1. Afferent Pathway 1) (destination: deep cerebellar nuclei & granular cells; originate from: a) DSCT/VSCT (descending spinocerebellar tract, vestibulospinal tract) b) pontine reticular formation b. Climbing fibers 1) Destination: deep cerebellar nuclei & purkinje cells 2) Originate from: inferior olive 3) Parallel fibers activated by climbing fibers in molecular layer: 1) Superior-brachium 2) Red nucleus-parvocellular 3) Middle-brachium pontis 4) Red nucleus-magnocellular 5) Ventral lateral ventral anterior 6) Inferior-restiform body e. Efferent Pathway D. Functional Anatomy: 1. Cerebrocerebellum-lateral 2. Spinocerebellum-intermediate 3. Vestibulocerebellum-midline E. Developmental functional anatomy 1. Neocerebellum 2. Paleocerebellum 3. Archeocerebellum 2. Please indicate how important knowledge of the following functional physiology is to the practice of chiropractic neurology and how frequently you use this information in your practice. Frequency
Importance
1. Data of motoric activity that actually took place as measured by the various receptors that is sent back to CNS by afferent proprioceptive system via DSCT and SCT. 2. Sensory input into cerebellum 1. Data that is fed forward to the cortex by the dentate prior to and during execution of commands. 2. Input into cortex C. Efferent copy (Defined: Brain relays copy of motoric commands to contralateral cerebellum via ipsi pontine reticular formation to be analyzed by contra cerebellum (comparing command versus actual expression that is taking place so that modulation can be implemented.)) F. Surround Inhibition-priming of basket and stellate active inhibition of purkinje system to allow ease of summation of deep cerebellar nuclei related to an expected summation as a consequence of carried out patterns of movement. 3. Please indicate how important knowledge of the following disease processes/diagnoses are to the practice of chiropractic neurology and how frequently you use this knowledge in your practice and how you manage patients with these issues. Management
Frequency
Importance
D. Genetic diseases F. Pathway disease- J. Location-tremor-symptoms 4. Please indicate how important the following rehabilitation principles are and how frequently you use these principles in your practice. Frequency
Importance
2. Intermediate C. Metabolic indicators E. Manifestation 1. Disdiadochokinesia 6. Bradykinesia 7. Limbic relationships 8. Vestibular interactions a. Canal relationships/Angular b. Otolithic relationships/Linear 5. Please indicate how important the following rehabilitation applications/treatment modalities are and how frequently you use these principles in your practice. Frequency
Importance
B. Finger-to-nose 3. One leg standing D. Finger to finger 2. Contralateral 3. Target shifting 4. Computerized target shifting E. Rapid coordinated finger movements-Piano playing F. Temperature gradient and modulated calorics G. Novel and known faces H. Alternating movements I. Active passive/movement J. Visualization K. Vestibular integration 1. Linear/angular acceleration 2. Ocular activation b. Pursuit/cicade targeting L. Extremity temperature M. Electrical modulation: N. Visualization activity 6. Please indicate how important the following diagnostic techniques/issues are to the chiropractic neurologist and how frequently you use them in your practice. Frequency
Importance
A. Neurological exam 1. Extremity execution of coordinated movements 2. Core execution of coordinated movements B. Differentiating tremors C. Oculomotor abnormalities 1. Hypometria/hypermetria 2. Saccades pursuits 3. Canal related movements D. Frank pathology 2. Genetic disease 3. Degenerative disease 7. Please indicate how important the following treatment issues are to the chiropractic neurologist and how frequently you use them in your practice. Frequency
Importance
A. Supplementation B. Fuel delivery C. Metabolic stability E. Medical referral Survey 16: Cognitive Area: Basal Ganglia
The purpose of this survey is to determine the frequency and importance of the cognitive information and the treatment modalities used with respect to the basal ganglia. 1. Please indicate how important knowledge of the following functional anatomy/physiology is to the practice of chiropractic neurology and how frequently you use this in your practice. Frequency
Importance
A. Striatum/Neostriatum, used a. Caudate: concerned with emotion and head and face b. Putamen: concerned with c. Globus Pallidus: main inhibitory system and developmentally linked to Substantia Nigra i. Globus Pallidus Externa (GPe) ii. Globus Pallidus Interna (GPi) B. Substantia Nigra a. a. Substantia Nigra Pars b. b. Substantia Nigra Pars Reticulata (SNr) C. Subthalamic Nucleus (STN) D. Direct Pathway: multiple brain areas, primary premotor frontal areas, fire to a. Excite Neostriatum, which fires to inhibit GPi, which inhibits thalamic nuclei that b. Excite frontal motor areas: excitation of inhibition of inhibition results allows for c. Thalamic excitation of frontal E. Indirect Pathway: multiple brain areas excite neostriatum which fires to inhibit a. GPe's inhibition of STN's excitation of GPi: excitation of inhibition of inhibition of b. Excitation of inhibition ultimately results in inhibition of motoric output. F. Functional output is not always direct or indirect, i.e., indirect pathway may a. Inhibit motoric output that is antagonistic to excitation of an action that will b. Contradict a movement that will result in instability. G. Substantia Nigra (Mesencephalon) a. Reticulata: functions similarly b. Compacta: neurotransmitter dopamine to the neostriatum D1 receptors in Direct Pathway are excitatory D2 receptors in Indirect Pathway are inhibitory H. Limbic Component a. Nucleus accumbens (NA) b. Ventral pallidum c. Ventral tegmental area (VTA): VTA efferents provide dopamine to NA in d. Reward learning. 2. Please indicate how important knowledge of the following disease processes/diagnoses is to the practice of chiropractic neurology and how frequently you use this knowledge in your practice and how you manage patients with these issues. Management
Frequency
Importance
A. Movement Disorders Disease: loss of SNc dopamine to neostriatum disease: damage to neostriatum c. Ballismus: STN syndrome: lack of inhibition of pathways resulting in motor tics and at least one phonic tic. Compulsive disease: dopaminergic hyperfunction in the prefrontal cortex and serotonergic hypofunction in the basal ganglia. f. Dystonia: increased and sustained output of motoric centers; begins focally and spreads unilaterally and then bilaterally. g. Wilson's Disease: hepatolenticular degeneration (copper metabolism) 3. Please indicate how important the following rehabilitation principles/treatment modalities are and how frequently you use these principles in your practice. Frequency
Importance
A. CIS assessment of component B. Activation of appropriate nuclei: a. Frontal mechanisms to activate b. Mesencephalic activation to activate frontal lobe c. Mesencephalic inhibition to limit active pathway and frontal lobe d. Cerebellum activation or inhibition depending upon state of contralateral mesencephalon e. Cerebellum mossy fiber or climbing fiber activation for increased surround inhibition or for purkinje inhibition C. Measurement of metabolic iii. Respiratory rate, quality & iv. Skin color, v. Capillary filling, vi. Skin temperature. b. Measurement of component tissue cis, with example of mesencelphalon: i. Pupillary response, 1) Ipsilateral medius rectus 2) Inferior rectus 3) Inferior oblique 4) Ipsilateral superior rectus 5) Contralateral superior rectus iii. Contralateral limb flexors, ocular convergence, bilateral activation of sympathetic pathway. 4. Please indicate how important the following diagnostic issues are to the chiropractic neurologist and how frequently you use them in your practice. The chiropractic neurologist is skilled in: Frequency
Importance
A. History taking differentiating central/basal ganglionic lesions from peripheral lesions. a. History of areas of function i. Motoric function ii. Frontal related function: 1) right and left executive 2) Trouble with saccade 4) Posture of pyramidal paresis iii. Cerebellum related function: 2) Coordination 3) Dizziness (spin,etc) 4) Eye control problems 5) Repetitive sprain/strains iv. Mesencephalon: 1) Trouble with light 2. Heart rate (may be perceived as panic attacks) 3) Visual problems 4) Sleep problems 5) Decreased energy 7) Activated by inflammatory immune cytokine receptors. v. Emotion and control or physical output secondary to emotion (caudate/limbic). B. Complete neurological examination with emphasis on: a. Frontal output: ii. Vertical optokinetics iii. Monotone and melodic iv. Analytic capability v. Understanding humor. c. Mesencephalon i. Perception right vs. left vision iii. Touch modalities. e. Autonomic Nervous System f. Heart, Lungs, Abdomen i. Pyramidal paresis ii. Flexor tone iii. Hemiparesis Survey 17: Cognitive Area: Reflexogenic Systems

The purpose of this survey is to determine the frequency and importance of the cognitive
information and the treatment modalities used to assist patients with reflexogenic
symptoms.
1. Please indicate how important knowledge of the following functional anatomy/physiology is to the practice of chiropractic neurology and how frequently you use this in your practice. Frequency
Importance
muscle spindle (1a)-ventral horn cell Disynaptic reflex-muscle spindle(1A)-1A interneuron-antogonist ventral horn cell Multisynaptic reflex-suprasegmental control, modulation, of ventral horn cell Pyramidal system-corticospinal, Extrapyramidal system-basal ganglia, nigrostriatal, cerebellum, vestibular Reticular formation Superior collicular Inferior collicular 2. Vasculature-obstruction/tone 3. Deafferentation 4. Genetic disease 6. Hemisphericity Survey 18: Cognitive Area: Autonomic Nervous System
The purpose of this survey is to determine the frequency and importance of the cognitive information and the treatment modalities used related to the autonomic nervous system. 1. Please rate the following functional Neuroanatomy according to its importance to your practice and the frequency you use it in your practice. Frequency
Importance
A. Most rostral portion the hypothalamus with sympathetic and parasympathetic divisions a. Sympathetic: fight or flight 1) increases hr, dilates pupils (10% control of size) 2) Sweat stimulated, blood diverted from GI tract to skeletal muscles 3) Sphincters of alimentary tract b. Parasympathetic: viewing, constricts pupils (90% 1) Adapts the eyes for close up control of size), 2) slows heart rate 3) promotes secretion of salivary and intestinal juices 4) accelerates intestinal c. Sympathetic and parasympathetic combined in sexual intercourse. B. Sympathetic & Parasympathetic a. Controlling fibers in hypothalamus and brainstem send central fibers to synapse upon the preganglionic fibers in the bs and spinal cord (IML). b. From IML, preganglionic neurons project out of CNS to synapse upon neurons in autonomic ganglia. c. Unmyelinatec postganglionic fibers emerge and form terminal networks in target tissues. C. Sympathetic post ganglionic fibers a. Nearest ganglion to accompany spinal nerves and supply sweat and vessels. b. Ascend to synapse in superior, middle, or stellate ganglion (fusion of inferior and first thoracic ganglia) and post ganglionic fibers supply head, neck, upper limbs and heart. c. Descend to synapse in lumbar or sacral ganglia and post ganglionic fibers enter lumbosacral plexus for blood vessels and skin of lower limbs. D. Parasympathetic post ganglionic a. Cranial PS System: pregang fibers emerge in four cranial nerves to synapse on: 1) In CN III to ciliary gang: post gang fibers to sphinctor of pupil and ciliary 2) Muscle (accommodation 3) In CN VII to pterygopalatine i) lacrimal and nasal glands; ii) In CN VII to submandibular gang to submandibular and sublingual glands. 3) In CN IX to otic gang: parotid i) to heart, lungs, lower esophagus, stomach, pancreas, gall bladder, small intestine ii) Ascending and transverse E. Neurotransmission a. Sympathetic preganglionic: b. Parasympathetic pregang: ACh c. Symp postgang: norepinephrine (except sweat = Ach) d. PS postgang: ACh 2. Please rate the following disorders according to the importance of being able to diagnose them and how frequently you see them in your practice and how you manage patients with these issues. Management
Frequency
Importance
A. Sympathetic Escape (decreased pontine control) 1. End organ effect: i.e., tachycardia on right and arythmia on left 2. 2End organ effect: i.e., intestinal hypofunction C. Complex Regional Pain aggravation of immune response (asthma) E. Horner's syndrome 3. Please rate the following rehabilitation principles as to their importance in your practice and the frequency that you use them with your patients. Frequency
Importance
A. Pontine inhibition of B. Frontal activation of pontine C. Limbic activation of D. Adrenal activation of E. Measurement of metabolic rate: 1. Pulse oxymetry 3. Pupilary response 4. Respiratory rate 5. Erector pilar 6. Muscle activation 4. How important are the following diagnostic issues to your practice and how frequently do you use each in your practice? Frequency
Importance
A. History taking including lifestyle factors B. Complete neurological examination with emphasis on: a. Pupilary resonse b. Corneal reflex (pontine cis) f. Capillary filling g. Limbic changes to above (such as emotional testimony) i. Adrenal function (lab testing or ability to sleep through night) j. ALL cranial nerves Survey 19: Cognitive Area: Limbic Area

The purpose of this survey is to determine the frequency and importance of the cognitive
information and the treatment modalities used related to the limbic system.
1. Please indicate how important knowledge of the following functional anatomy is to the practice of chiropractic neurology and how frequently you use this in your practice with respect to the limbic system. Frequency
Importance
1. Ventral tegmentum 2. Reticular formation 3. Locus coeruleus 4. Lateral dorsal tegmental 5. Pedunculopontine nuclues B. Deep brain structures 3. Nucleus accumbens 4. Parahippocampus 6. Perirhinal cortex 8. Entorhinal cortex 9. Cingulate gyrus 10. Septal nuclei 2. Please indicate how important knowledge of the following disease processes/diagnoses are to the practice of chiropractic neurology and how frequently you use this knowledge in your practice and how you manage these issues with your patients with limbic symptoms. Management
Frequency
Importance Responsibility
C. Hyper sexuality D. Hypo-sexuality E. Spirituality hyper/hypo F. Hallucinations 3. Gustatory primarily, however can be of any sense modality dysregulation/autonomia I. Emotional manifestations or lack 1. Right hemisphere - sadness, 2. Left hemisphere - euphoria, anger, excessive surprise, unwarranted bliss N. Microvascular disease O. Atrophy (in limbic area or cortex affecting inhibition of limbic output) R. Neurodegenerative disorders S. Developmental disorders 3. Please indicate how important the following rehabilitation principles/treatment modalities are to your practice and how frequently you use these principles in your practice. Frequency
Importance
B. metabolic indicators C. sensory stimulation a. Quadrant specific stimulation b. Light frequencies-colors 3) Still/movement a. Localization 1) Hemisphere specific 2) Emotion specific a. Pleasant versus non-pleasant b. Olfactory localization c. Olfactory identification b. Localization d. Pain/pleasure D. Connotation of a paragraph for right hemisphere. (interpretive meaning) E. Enteroception concentration (focus on body part or system) for right hemisphere. F. Vocalization of text for left G. Spatial awareness for right H. Mathematical calculations for left G. Spatial awareness and manipulation right hemisphere 4. Please indicate how important the following diagnostic issues are to the chiropractic neurologist and how frequently you use them in your practice. Frequency
Importance
A. Neurological exam 1. Evaluation of emotional expression and manifestation a. Responses to humor b. Responses to pain c. Responses to suffering d. Responses to joy e. Responses out of context f. Responses to sadness 2. Sexual preferences 3. Relationship tactics c. Argumintaitive e. Optimistic/pessimistic f. Complimentary g. Length of relationships b. Bowel regularity c. Bladder regularity d. Blood pressure g. Extremity temperatures h. Emotional effects of B. Spiritual beliefs 1. Percentage of time dedicated to religious activities 2. Hallucinations c. Somatosensory 6. Introversion/extroversion 5. Please indicate how important these diagnostic testing modalities are to the chiropractic neurologist and how frequently you use them in your practice with patients with limbic symptoms. Frequency
Importance
D. Referral-specific Survey 20: Cognitive Area: Lobes of the Brain

The purpose of this survey is to determine the frequency and importance of the cognitive
information and the treatment modalities used related to the lobes of the brain.
1. Please indicate how important the following functional Neuroanatomy is to the practice of chiropractic neurology and how frequently you use this knowledge in your practice: Frequency
Importance
A. Gross anatomy and relationship with cranial structures B. Main anatomic areas for each i. Gyri- precentral, superior, paracentral, cingulate, middle, inferior i. postcentral, superior, inferiGyror (angular, supramarginal), paracentral, precuneus, cingulate i. Cuneus, lingual, lateral i. Superior, middle, inferior, lingual, parahippocampal f. Additional landmarks- saggital sulcus, central sulcus, sylvian fissure, parieto-occipital sulcus, calcarine fissure, temporal-occipital notch, uncus of the temporal lobe, frontal/temporal/occipital pole C. Generalized functional designations for neocortex a. Paleo-neocortex b. Neo-neocortex D. Functional areas of the frontal a. Motor, premotor, prefrontal E. Six layers of human cerebral F. Localization of primary sensory and motor functions G. Relationships with deep nuclei, brainstem, spinal cord and cerebellum 2. Please indicate how important knowledge about the following disorders is to the practice of chiropractic neurology and how frequently you use this in your practice: Management
Frequency
Importance
A. Functional categories e. Sensorimotor integration & Movement Excecution f. Interhemispheric B. Anatomic categories C. Terminology of c. Perseveration f. Hallucinations 3. Please indicate how important the following rehabilitation principles are in treating issues involving the lobes of the brain and how frequently you use them in your practice. Frequency
Importance
1. Functional vs Pathological lesions 2. Left-right relationships 3. Ascending and descending 4. Metabolic capacity 5. Central integrated state and potential for plastic change 6. Central changes associated with correction of joint biomechanics 7. Frequency, intensity and durations factors in promoting central plasticity 4. Please indicate how important the following rehabilitation applications are in treating issues involving the lobes of the brain and how frequently you use them in your practice. Frequency
Importance
1. Right-left hemisphere relationships with joint mechanoreceptor activity 2. Local brain functions as 3. Visual stimulation i. Hemifield glasses 4. Auditory stimulation i. Novel faces or other stimuli ii. Nature pictures, sounds, etc. iii. Poetry via audio ii. Strong beat iii. Prose via audio 5. Olfactory stimulation 6. Gustatory stimulation 7. Tactile stimulation d. Eyes closed identification 8. Cognitive activation ii. Spatial tasks iii. Novel faces i. Word problems/games ii. Sequencing activities iii. Planning activities 9. Vestibular activity 10. Categorizing, sequencing 11. Decision making 12. Spatial relationships 14. Accurate touch 5. Please indicate how important the following diagnostic issues are for the practice of chiropractic neurology with respect to the lobes of the brain and how frequently you use them in your practice. Frequency
Importance
A. History taking differentiating hemispheric lesions from lesions elsewhere B. Complete neurological examination with emphasis on: a. Hemispheric localization b. Cognitive functions c. Primary and secondary sensory and motor functions d. Related "lower/reflexive" C. Localization of lesions go specific or grouped by gyri D. Differentiating between a single lesion, multiple lesions and systemic lesions E. Use of Broadman's taxonomy. Survey 21: Cognitive Area: Brain and Its Environment
The purpose of this survey is to determine the frequency and importance of the cognitive information and the treatment modalities used relative to the brain and its environment. 1. Please indicate how important knowledge of the following functional anatomy is to the practice of chiropractic neurology and how frequently you use this in your practice. Frequency
Importance
1. Develops embryologically from neuroectodermal tube (adult ventricles) 2. Medial surfaces of the diencephalon form the walls of the 3rd ventricle 3. 3rd ventricle: a. Opens into lateral ventricles thru interventricular foramen of Monro b. Continuous posteriorly with cerebral aqueduct of Sylvius c. Continuous with the 4th ventricle (pons and medulla) 4. 4th ventricle: a. Continuous with central canal of the caudal medulla and spinal cord 3. Parietooccipital D. Insula: overlies site where telencephalon and diencephalon fused during embryological development 1. Epidural space 3. Arachnoid Mater 5. Subdural space 7. Blood brain barrier. B. Dural venous sinuses: 1. Superior sagittal sinus transverse sinuses 2. Several smaller sinuses a. Inferior sagittal sinus b. Occipital sinus c. Inferior sinus d. Superior petrosal sinuses. C. Dural vasculature and 1. Maxillary artery 2. Middle meningeal artery 3. Ophthalmic artery 4. Occipital artery 5. Vertebral arteries 6. Primary sensory innervation 7. Sensory innervation of the posterior fossa of the dura D. Cerebrospinal Fluid: Formed by filtration of blood through the fenestrations of the choroidal capillaries that circulates through the ventricles of the brain. E. Blood Supply of Brain: 1. Arterial Internal carotid system: a. Internal carotid artery pathway 2. Posterior communicating artery 3. Anterior choroidal artery 4. Anterior Cerebral Artery b. Supply frontal & parietal lobe c. Occlusion-restricted contralateral motor and somatosensory deficits 5. Middle Cerebral Artery b. Many branches c. Supplies deep brain structures d. Lenticulostriate arteries. 1) Ganglionic or penetrating branches collect anterior to the base of the brain and are called the anterior and posterior perforated substances. 2) Frequently involved in 3) Small damage to these arteries can equal disproportionate damage 6. Vertebral Basilar system: 1) Posterior spinal artery 2) Anterior spinal artery 3) Posterior inferior cerebellar 7. Basilar Artery 1) Anterior Inferior Cerebellar a) Supplies inferior surface cerebellum (flocculus) b) Supplies parts of pons c) Supplies Internal Auditory Artery-occulsion can give rise to vertigo and ipsilateral deafness 2) Superior Cerebellar Artery a) Supplies superior surface of cerebellum b) Supplies caudal brain c) Supplies rostral pons 3) Unnamed Branches a) Supply Pontine b) Supply remainder of 8. Posterior Cerebral Artery b. Supplies the medial and inferior surfaces of the occipital and temporal lobes. c. Gives rise to the Posterior Chorodial Arteries 1) Supply the choroid plexus of the third ventricle 2) Supply body of the lateral 3) Occlusion of a posterior cerebral artery at its origin leads to visual field losses. 9. Circle of Willis: b. Result of occlusion 1) Venous Drainage 2) Superficial groups 1) Initial drainage 2) Drainage into straight 1) Drains some deep 2) Empties into the straight 2. Please indicate how important knowledge of the following disease processes/diagnoses is to the practice of chiropractic neurology and how frequently you use this knowledge in your practice and how you manage these issues with your patients. Management
Frequency
Importance
2. Transient ischemic a. Hard lesion (clot) b. Physiological lesion 4. Arteriovenous 7. Leakage of CSF 8. Increased intracranial 9. Cavernous sinus syndrome/thrombosis 3. Please indicate how important the following diagnostic issues are to the chiropractic neurologist and how frequently you use them in your practice. Frequency
Importance
1. Special Studies for Diagnosis a. CT angiography; b. MRI/MRA of brain c. Lumbar puncture 2. Complete neurological examination by clinician. 3. Emergent vascular accident-get 4. Discriminate between occlusive transient ischemia and physiologic ischemia 4. Please indicate how important the following rehabilitation principles/treatment modalities are and how frequently you use these principles in your practice. Frequency
Importance
1. Post emergent rehabilitation a. Examine after stabilization b. Treat with functional neurology c. Patient education to recognize additional similar incidents or risks Survey 22: Cognitive Area: Neuroendocrine System

The purpose of this survey is to determine the frequency and importance of the cognitive
information and the treatment modalities used related to the Neuroendocrine system.
1. Please indicate how important the following functional Neuroanatomy is to the practice of chiropractic neurology and how frequently you use this knowledge in your practice. Frequency
Importance
A. Neuroendocrine cells a. Endocrine system b. Nervous system c. Hypothalamic/pituitary portal a. Supraoptic and paraventricular C. Pituitary Gland a. Anterior pituitary (adenohypophysis) i. Rathke' pouch ii. Blood supply (a) Superior hypophysial (b) Internal carotid arteries b. Posterior pituitary (neurohypophysis) i. Pituitary stalk D. Other structures information and relationships between the hypothalamus and pituitary: i. Infundibulum ii. Median eminence iii. Tuber cinerium iv. Sella turcica v. Blood brain barrier vi. Mammillary bodies 2. Please indicate how important knowledge about the following disorders is to the practice of chiropractic neurology and how frequently you use this in your practice and how you manage these disorders. Management
Importance
A. Hyperprolactinemia a. Associated conditions iii. iGalactorrhea b. Disease states i. Pituitary tumors a) Prolactinomas b) Adenomas secreting GH and prolactin c) Adenomas secreting ACTH and prolactin (Cushing's disease) d) Nonfunctioning chromophobe adenomas compressing pituitary stalk ii. Hypothalamus b) Craniopharyngiomas c) Cranial irradiation iii. Other diseases b) Chronic renal failure d) Chest wall trauma B. Hypoprolactinemia a. Panhypopituitarism C. Growth Hormone D. Pituitary Dwarfism a. Gonadotropin: i. Ectopic secretion b) Precocious puberty ii. Pituitary adenomas a) FSH secreting b) LH secreting ii. Hyperthyroidism a) Pituitary disease b) Hypothalamic v. Pituitary or TSH induced hyperthyroidism b) Resistance to thyroid c. Adrenocorticotropic a) Cushing's syndrome b) Nelson's Syndrome ii. Causes of excess a) Pituitary ACTH b) Ectopic ACTH c) Adrenal tumors corticosteroid administration iii. ACTH Deficiency: a) After prolonged glucocorticoid administration E. Deficiency of Vasopressin (Diabetes Insipidus) a. Causes affecting pituitary or hypothalamus: i. Neoplastic lesions ii. Infiltrative lesions iv. Isotopic ablative v. Severe head injuries F. Syndrome of Inappropriate AVP Secretion (SIADH): i. Lung carcinoma ii. Nontumorous lung c) Other pulmonary G. Thyroid Disorders 1. Sick euthyroid 2. Simple nontoxic goiter a. Iodine deficiency b. Hypothyroidism a) In children - c. Thyrotoxicosis a) Abnormal thyroid b) Grave's disease d. Hyperthyroidism e. Diffuse goiter f. Opthalmopathy a) Trophoblastic tumor b) Intrinsic thyroid 3. Hyperfunctioning 4. Toxic multinodular goiter 5. Disorders of hormone 7. Ectopic thyroid tissue a. Functioning follicular 8. Complications of 9. Thyrocardiac disease 10. Thyrotoxic crisis 11. Thyroiditis 12. Thyroid tumors H. Diseases of the Adrenal a. Hyperfunction of the i. Excess cortisol a) Cushing's syndrome i) adrenal hiperplasia ii. Aldosteronism a) Hyper secretion of i). adrenal adenoma ii) adrenal carcinoma i) renin angiotensin iii. Syndromes of adrenal i) Oligomenorrhea iii) Virilization iv) Causes in women adrenal hyperplasia b. Hypofunction of the i. Addison's disease adrenocortical insufficiency 2. surgical removal 3. destruction from adrenocortical insufficiency 1. Hypopituitarism 3. steroid from c. Acute adrenocortical b) surgical stress destruction of both adrenal glands i) anticoagulant ii) sometimes during I. Pheochromocytoma a. Chromaffin tumors i. Catecholamines ii. Adrenal medulla i. Autosomal dominant ii. Neurofibromatosis iii. Tumors are bilateral c. Extraadrenal i. abdomen ganglia b) superior mesenteric c) inferior mesenteric d. Associated diseases i. medullary carcinoma of thyroid in MEN ii. Type II and III neurofibromatosis J. Diabetes Mellitus a. Type I (IDDM) b. Type II (NIDDM) c. Secondary diabetes i. Pancreatic disease iii. drug or chemical iv. insulin receptor v. genetic syndromes d. Complications of DM i. Diabetic ketoacidosis ii. Hyperosmolar coma iii. Late Complications c) Diabetic foot ulcers e) Mononeuropathy g) Variety of skin K. Abnormalities of Testicular Function a. Hypothalamic/Pituitary i. Panhypopituitarism ii. Hypogonadotropic i. Klinefelters Syndrome or XX male ii. Acquired defects a) viral infection c) radiation drugs d) systemic diseases c. Sperm transport L. Abnormalities of the b. Menstrual Cycle c. Menopause i. M.Disorders Affecting Multiple Endocrine Organs a. Multiple Endocrine Neoplasia, Type I (Werner syndrome) b. Multiple Endocrine Neoplasia, Type II (Sipple syndrome) c. Multiple Endocrine Neoplasia, Type III 3. Please indicate how important the following rehabilitation applications/treatment modalities are to the practice of chiropractic neurology and how frequently you use them in your practice. Frequency
Importance
A. Rehab Application a) Serum Prolactin levels b) Glucose tolerance tests c) Serum T3, T4 and FT4I d) Calcium levels e) Potassium levels f) Vitamin D levels g) Basal and random GH levels h) Hormone levels j) Dehydration test k) Dexamethasone suppression test m) Cortisol Response i) Plasma cortisol ii) Urinary cotisol o) Urinary glucose and ketones 2. Radiographically a) CT/MRI scanning of hypothalamus/pituitary area of brain b) Conventional skull x-rays c) CT scan of abdomen vii) Sleep cycle b) Physical and Neurological exam i) Cranial Nerves iii) Visual field iv) Cardinal gaze v) Pupillary responses vi) Skin and hair texture and vii) Core temperature B. Rehab Principle 1. Patient education 2. Refer out for medical management a) Drug therapy i) Bromocriptine ii) Anti-thyroid agents c) Radiation therapy d) Hormone replacement Survey 23: Cognitive Area: Pain

The purpose of this survey is to determine the frequency and importance of the cognitive
information and the treatment modalities used related to pain.
1. Please indicate how important knowledge of the following functional anatomy is to the practice of chiropractic neurology and how frequently you use this in your practice. Frequency
Importance
A. Spinothalamic pathway, a lateral pain pathway: three neuron pathway 1. Trunk and Limbs: 2nd order neuron in posterior gray horn and crosses to ascend via spinothalamic pathway to ventral posteral lateral nucleus of thalamus and then to primary somatic sensory cortex (location, severity) and lateral sulcus (visual attention to stimulus source). 2. Head and Neck: 2nd order neuron in the spinal nucleus of the trigeminal nerve and travels via trigeminal thalamic projection to contralateral ventral posterior medial travels via trigeminal thalamic projection to contralateral ventral posterior medial travels via trigeminal thalamic projection to contralateral ventral posterior medial nucleus and then to primary somatic sensory cortex and lateral sulcus. B. Spinoreticular/trigeminoreticular 1. Polysynaptic via spinoreticular and trigeminoreticular tracks to a) the contralateral medial dorsal thalamic nucleus and then on to the interior cingulate cortex (concerned with effective/emotional component of pain) b) reticular formation of medulla and pons. Many fibers do not cross the midline. C. Spinomesencephalic: via anterolateral quadrant of spinal cord projects neurons from laminae I and V to mesencephalic reticular formation and periaqueductal gray and then via spinoparabrachial tract to the parabrachial nuclei that then project to the amygdala that is involved with the affective/emotional component of the pain experience. D. Cervicothalamic tract: nociceptive neurons in laminae III and IV mostly cross the midline and ascend in the medial lemniscus of the brain stem to lateral cervical nucleus in the midbrain and then to the ventroposterior lateral and posteromedial nuclei of the thalamus. Some axons from laminae III and IV project through the dorsal columns of the spinal cord and terminate in the gracile and cuneate nuclei of the medulla. E. Spinohypothalamic tract: nurons in laminae I, V, and VIII project directly to the supraspinal autonomic control centers and activates neuroendocrine and cardiovascular responses associated with pain. 1. c fibers (unmyelinated, .5 – 2 m/s); dull, achey pain; polymodal nociceptors (mechanical deformation, intense heat/cold, and irritant chemicals. 2. delta fibers (myelinated, 25 m/s); sharp pain; severe mechanical deformation of the skin. G. 1st order pain neurons activate H. Mesencephalic pain inhibition 1. Peri-aquaductal gray matter (PAG) sends excitatory projections to the Nucleus Raphe Magnus that sends bilateral caudal projections (serotonergic) via Lissauer's tract to terminate in the substantia gelatinosa at all levels of the spinal cord to excite enkephalinergic internuncials (GABA-ergic) that are inhibitory to the second order pain neuron. 2. Locus ceruleus neurons (noradrenergic) descend to inhibit the second order pain neuron. I. Segmental pain inhibition: A fibers (mechanoreceptors) activate inhibitory internuncials that in turn inhibit excitatory internuncials and second order neuron of the pain pathway. 2. Please indicate how important knowledge of the following disease processes/diagnoses is to the practice of chiropractic neurology and how frequently you use this knowledge in your practice and how you manage these issues with your patients. Frequency
Importance
A. Complex regional pain syndrome B. Neurogenic inflammation: local C fiber release of one or more peptide substances, notably substance P, which binds with receptors on the walls of arterioles, leading to arteriolar dilatation, and also binds with receptors on the surface of mast cells, stimulating them to release histamine which increases capillary permeability and leads to local accumulation of tissue fluid, the wheal response. C. Chronic pain associated with decreased brainstem function. D. Chronic pain associated with decreased internuncial function. E. Hypoxic nociceptive F. Neuropathic pain: secondary to direct injury to nerve I. Post-surgical acute pain J. Cancer related pain K. Arthritic pain 3. Please indicate how important the following rehabilitation principles are and how frequently you use these principles in your practice. Frequency
Importance
1. Segmental relationship to pain 2. Mesencephalic relationship to pain 3. Suprasegmental signaling into cord 4. Hypoxic relief 5. Metabolic capacity 6. Central integrated state and potential for plastic change 7. To achieve great probability of a. fast adapting receptors need to be stimulated with varying amplitudes or patterns b. slowly adapting receptors will maintain a change in firing rate with a new, but constant stimulus 8. Receptors that fire frequently (slowly adapting or associated with a frequently changing system) and are very responsive to change (high sensitivity) often have the greatest CNS input; these are mostly proprioceptors and vestibular receptors. Proprioceptors inhibit pain segmentally and vestibular receptors activate pontine inhibition of IML. 9. Cortical stimulation left and/or 4. Please indicate how important the following treatment modalities are and how frequently you use them in your practice. Frequency
Importance
1. Ice/cold packs 3. Alternating heat and cold B. Interferential E. Cortical stimulation 1. Right brain modalities 2. Left brain modalities J. Oxygen therapy (gain referral if necessary in your state/province) K. Referral for allopathic intervention 5. Please indicate how important the following diagnostic issues are to the chiropractic neurologist and how frequently you use them in your practice: Frequency
Importance
A. History taking differentiating: 1. Nociceptive receptor activation 2. Decreased suprasegmental pain 4. Central lesions 5. Organic pain 6. Situational issues potentiating pain c. Financial difficulty d. Loss of any sort (empty nest, loss of status, move to new local, etc.) e. Drug &/or alcohol abuse f. Chronic prescription drug use B. Complete neurological examination with emphasis on: 1. Autonomic Nervous System 2. Complete brainstem function i. Mesencephalic 3. Limbic system contributions 4. Cortical centers of pain appreciation regarding: ii. severity of receptor Survey 24: Cognitive Area: Special Studies

The purpose of this survey is to determine the frequency and importance of the cognitive
information and the treatment modalities used.
1. How important is your knowledge about the following special studies in diagnosing and treating your patients and how frequently do you order them? How do you manage the special studies (perform yourself, refer, etc.) Management
Frequency Importance Responsibility
1. How important is your knowledge about the following special studies in diagnosing and treating your patients and how frequently do you order them? How do you manage the special studies (perform yourself, refer, etc.) a. Imaging studies: i. Arteriograms/Angiography 1) WADA (speech center) ii. Barium Studies 4) Other Barium studies iii. Bone density scan v. Diagnostic Ultrasound vi. Doppler Vascular Studies xi. Nuclear Medicine Bone xii. Plain Film Radiology xiv. Regional cerebral blood xv. Sinu-rhinoscopy xvii. Thermography xviii. Retrograde pyelogram xix. Cystoscopy b. Electrodiagnostic Studies: i. Evoked Potentials 1) Brainstem Auditory Evoked Potentials 2) Visual Evoked Potentials 3) Somatosensory Evoked ii. Electrocardiogram 1) Exercise stress test 2) Chemical stress test iii. Electroencephalography iv. Electronystagmography v. Needle Electromyography vi. Nerve Conduction vii. Quantitative Electroencephalography c. Other diagnostic Studies i. Advanced Quantitative Gustatory testing ii. Advanced Quantitative Olfactory testing iii. Auscultatory 1) Subclavian bruit 2) Carotid bruit 3) Temporal bruit 4) Intracranial (Orbital) iv. Audiometric Examination v. Typanography vi. Bronchoscopy vii. Balance Testing viii. Bimanual pelvic exam ix. Caloric Testing xi. Diagnostic educational xii. Dichotic listening xiii. Dynamic walking orthotic scanning xvi. Gustatory Zinc testing xvii. Just Noticeable Difference Testing 4) Distance apart to see 2 5) Pitch, decibel 6) Touch and distance apart xviii. Mammogram xix. Neuro-psychologic xx. Behavioral testing xxi. TOVA testing xxiii. Posturography xxiv. Quantitative Strength xxv. Skin temperature xxvi. Spirometry xxvii. Video nystagmography xxviii. Visual studies 3) Retinal photography 5) Visual field, perimetry d. Laboratory Studies: i. Basic Metabolic Profile 8) Stomach, other GI 12) Amniocentesis iv. CBC with diff v. Culture & sensitivity vi. Cytokine levels vii. DNA testing viii. Food allergy/sensitivity ix. Genetic testing x. Hair analysis xi. Heavy metal testing xii. Hemoglobin A1C xiv. Testing for Illegal drugs xv. Kidney panel xvi. Liver panel xvii. Lumbar Puncture 3) Elecrophoresil 5) Opening pressure xviii. Lyme testing xix. Ova & Parasite xx. Pharmicokinetics testing- monitor therapeutic blood levels, detecting early toxicity xxi. Postprandial blood xxii. Salivary cortisol xxiii. Serum Folate xxiv. Serum Vit B12 xxv. Serum 25 hydroxy - xxvi. Sputum culture xxvii. Stool analysis fat xxviii. Thyroid Function 3) Calculated Free T3 6) Thyroid Antibodies xxix. UA with microscopic, xxxi. 24 hr Urinary halide with Iodine loading Appendix C
Expanded Performance Exam Blueprint

Performance Exam Blueprint
Percent of the Exam
Review& Clarification of pre-screen history Physical Exam: Sensory Physical Exam: Motor Physical Exam: Muscle Stretch Reflexes Physical Exam: Cerebellum/Vestibular Items to be Included in Performance Exam
Vital Signs Meeting Decision Rule
Pulse: Bilateral Respirations Blood Pressure: Bilaterally Pulse Oxygen level Cranial Nerve Tests Meeting Decision Rule
Cranial Nerve I
Olfaction: Test? Each side perceives? Each side identifies scent? Cranial Nerve II
Visual Field Fundoscopic Cranial Nerve III
Oculomotor: Measure pupil diameter Direct pupillary light reflex Consensual pupillary light reflex Corneal light reflection Response to near vision Repeated convergence Cover/Uncover Cranial Nerves III. IV & VI
Cranial Nerve V: Trigeminal
Deviation of jaw? Palpate TMJ for prominence/clicks on opening & closing? Sensation on V1, V2 & V3 touch? Sensation on V1, V2 & V3 sharp? Cranial Nerves V & VII
Corneal Reflex one time?
Cranial Nerve VII: Facial Muscles of Expression
Frown
Eye Closure
Smile-volitional
Smile-spontaneous
Purse lips
Puff cheeks
Cranial Nerve VIII: Hearing & Vestibular
Weber Rinne Infants only (startle/loud noise) Infants only Moro Cranial Nerve IX: Glossopharyngeal
Observe palatal atrophy Cranial Nerves IX & X: Gag
Gag on each side? Swallow? Observe palatal fatigue on intonation of AHH? Cranial Nerve XI
Strength testing of upper trapezius? SCM strength testing? Cranial Nerve XII: Hypoglossal
Observe resting tongue for deviation in mouth? Deviation on protrusion of tongue? Equal volitional movement of tongue left & right? Strength of tongue push inside of cheek side to side? Sensory Testing
Light Touch
Evaluate touch over dermatomes in upper extremities Evaluate comparison of touch perception equalities side to side in upper extremities Evaluate touch over dermatomes in lower extremities Evaluate comparison of touch perception equality side to side in lower extremities Vibration
Evaluate vibration perception over dermatomes in upper extremities Evaluate cessation of vibration perception accuracy in upper extremities Evaluate comparison of perception of vibration side to side in upper extremities Evaluate vibration perception over dermatomes in lower extremities Evaluate cessation of vibration perception accuracy in lower extremities Evaluate comparison of perception of vibration side to side in lower extremities Sharp Touch
Evaluate sharp over dermatomes in upper extremities Evaluate comparison of sharp perception equalities side to side in upper extremities Evaluate sharp over dermatomes in lower extremities Evaluate comparison of sharp perception equality side to side in lower extremities Motor Testing
Strength Muscle Testing Muscle Testing for Strength
Do you observe for asymmetry of bulk side to side Do you observe for soft pyramidal paresis in the upper extremity Do you observe for soft pyramidal paresis in the lower extremity Do you evaluate active range of motion in the upper extremity Do you evaluate active range of motion in the lower extremity Do you observe active range of motion in the cervical spine Do you measure range of motion in the cervical spine Do you evaluate for hypotonia (increased passive range of motion) Do you evaluate for hypertonia on passive range of motion Do you do a postural assessment Do you do a gait assessment During the gait assessment, do you instruct the patient to turn around and come back toward you Do You Grade the Strength When You Perform Manual Muscle Tests
Deltoid Biceps Brachioradialis Triceps Wrist extensors Wrist flexors Finger extensors Finger flexors Finger Abductors Finger Adductors Extensor Hallucis Longus Ankle invertors Ankle evertors Ankle dorsiflexors Ankle plantarflexors Quadriceps Hamstrings Hip flexors Hip extensors Hip abductors Hip adductors Reflexes
Muscle Stretch Reflexes
Biceps Triceps Brachioradialis Patellar Ankle MSR: Reinforced (Jendrasik)
Jendrasik on upper extremities Jendrasik on lower extremities Pathologic Reflexes
Do you evaluate for Hoffman's reflex? Do you evaluate for a Plantar response (Babinski)? If the Plantar response elicited is extensor (non-infant), do you evaluate for: Chadock's Cerebellum/Vestibular Testing
Rhomberg eyes open & closed; with head positioning Tandem Stance Right leg forward & then left leg forward Tandem Gait One leg standing eyes open & eyes closed Finger to Nose eyes closed Heel to shin Arm raise Finger to Finger eyes open & eyes closed Finger to Finger moving target Alternating hand movement; extended and elbow flexed Thumb to each finger Hypermetric saccade testing OPK VOR Vestibular Ocular Response Testing with & without fixation Canal related eye weakness-hypo or hypertropia OPK, head position Rebound and check Positional testing (Dix-Hallpike, etc.) Basal Ganglia Testing
Speech Finger coordinating movement (piano playing) Observation of movement at rest Eyes closed-observe for eye blepharospasm Observation of initiation of movement Observation of spontaneous saccades Muscle tone Pupillary light response Gait/shuffling steps/turning Limbic System Testing
Social testing-answer questions reasonably Normal questioning without outbursts Emotional responses to sensory input (light, smell, pinwheel) Affect-inappropriate for situation Cognitive Assessment
History responses Memory of sequencing Oriented X3 Mathematical Calculations Right & left brain questioning Conversational assessment of hyperactivity General questions regarding attention and hyperactivity General questions
Long term versus short term versus immediate recall memory (not immediate but what did you have for breakfast) Field of Vision Blind Spot Mapping Hemisphericity Mood Appendix D: References

Biller, J, Biller, J., Gruener, G., & Brazis, P. (2011) DeMyer's Technique of the
Neurologic Examination, 6th Edition. McGraw Hill. Campbell, William W. (2012) DeJong's The Neurologic Examination, 7th Edition. Castle, R.A., Nettles, S.S., Leahy, J.M., Naylor, P.D., & Wood, L.J. CLEAR (2003) Pre- conference Workshop: Testing Essentials. Kandel, E., Schwartz, J., Jessell, T., Seigelbaum, S. & Hudspeth, A.j. (2013) Principles of Neural Science, Fifth Edition. McGraw-Hill Ryerson. Knapp, Joan E. and Knapp, Lenora G. (1995) Practice Analysis: Building the Foundation for Validity. Licensure Testing: Purposes, Procedures and Practices. Buros Institute of Mental Measurements, Lincoln, Nebraska. Nolte, John (2002) The Human Brain: An Introduction to its Functional Anatomy, 5th Edition. Elsevier Science. Patten, John P. (1998). Neurological Differential Diagnosis, 2nd Edition. Springer. Porter, R., Yatsu, F. M., & Grotta, J.P. (1995) 100 Maxims in Neurology: Stroke. Shapiro, B. & Preston, D. (2005). Elyctromyography and Neuromuscular Disorders: Clinical-Electrophysiologic Correlations:2nd Edition. Elsevier Health Sciences.

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