One of the major concerns for chiropractors are stroke patients. Current research associates the risk of stroke after a cervical manipulation as about 1 in a million. However, these stats may be artificially high, since often people who seek chiropractic care for neck & head pain often have these symptoms because they are currently in a stroke status.
That makes it critical, both for patient safety, and our professions reputation to establish methods to detect a stroke patient before any manipulation is provided. In the past, orthopedic tests have been notoriously inaccurate (Drift Test, George’s, etc..) and thus many doctors do not even use them. To date, our best indicator was the patient’s presenting history.
But in addition to a proper history, a new serious of neurological bedside tests finally provide some solid clinical data. Dr. David Newman-Toker recently presented a short series of examinations that proved to be 100% sensitive and 96% specific. Of course further testing needs to be done, as this was a single center study of high risk patients, but regardless it is quite promising.
Newman’s tests included:
- Strong Horizontal head impulse (a normal patient & a stroke patient’s eyes stays stable during the impulse, an inner ear complication would result in an ‘eye flick’).
- Nystagmus (Lateral in the same direction as the patient is looking, occurs when the patient looks in either direction)
- Downward alignment of the eyes when one is rapidly covered and uncovered.
As I research continues on this subject I will update this article.
View the demonstration here… http://www.medscape.com/viewarticle/710698 (you may be required to sign up to view it).
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