TESTING, TESTING
Which diagnostics are best for your clinic — and why?
By Roger Titone, BSME

Patients take an active role in their healthcare today. They ask questions, demand proof, and tune in to everything visual. They want to “see” what you are talking about.

How do you “show” your patients what you are doing? How do you engage them in understanding the importance of chiropractic and its core principle — the health of the nervous system?

The most basic tool in your diagnostic arsenal is the x-ray machine. Radiography gives patients a picture of their spinal system. With your help, they can see problems and improvements.

But, a number of other instruments are available to you today. Some of the instruments used in patient diagnostics include:

• Paraspinal thermography,
• Needle EMG (electromyography)/NCV (nerve conduction velocity),
• Surface EMG (sEMG),
• Dynamic EMG,
• Somatosensory evoked potentials (SSEP),
• Computerized muscle-strength testing,
• Current perception threshold testing, and
• Computerized inclinometers.

Some of these instruments test for neurological functions, but fail on a broad scale because the segmental neural pathway measurement is not sufficient to make a global neuropathophysiology determination.

Many of these devices are also not sensitive enough to detect minute neurological changes — a critical factor for wellness care. Most also require your attention and time, as well as patient compliance.

MATCH INSTRUMENTS TO NEEDS

Which instruments, then, should you have in your clinic? The type of practice, your personal interests, a need to show medical necessity, and the expectations of your patients all play a part in determining which instruments best fit your needs (and budget).

For example:

• A PI or workers’ compensation clinic. This type of clinic would benefit from the use of dynamic EMG, computerized ROM (range of motion), and thermography. All three instruments provide an objective measure of the physiological status of the patient. This gives you the ability to pinpoint care, monitor the healing process for possible treatment changes, and provide for the impairment assessment. This level of objective analysis also supports your care in the eyes of insurance carriers.

• A family chiropractic practice. In a family practice, it is important to engage each patient on his or her own level.

Patients in a family practice need a visual means of understanding not only why they need care, but also why their children and friends do. Combining radiology with paraspinal thermography gives you exactly what you need for analysis and treatment of a subluxation. The technologies also offer a visual explanation of what chiropractic has to offer.

Reports generated from these instruments can also be a powerful method of increasing referrals.

• A sports chiropractic clinic. Chiropractors specializing in sports injuries need a technical approach with a specific aim toward rehab-ilitation and recovery. Athletes want their injuries healed in record time so they can return to their sport.

Once patients are “back in the saddle,” it’s all about recovery. The use of radiology, surface EMG, and thermography fits the bill perfectly to provide both injury management and recovery. The technologies allow for an analysis of specific injury sites, treatment monitoring, and physiological tracking of training and recovery.

Thermography has the unique ability to detect not fully healed injuries, warn of impending injury, and inform the athlete of poor recovery.

Having objective data in several different areas places you in a better position to monitor the effectiveness of care in an attempt to promote healing in the most efficient manner possible. In the end, this tactic also supports the patient’s case.

MEDICAL NECESSITY

Regardless of the type of practice you have, objective testing (pre- and post-adjustment) helps establish medical necessity. A doctor with a high-volume practice must also employ an instrument that is fast and easy to use. Computerized ROM, surface EMG, and paraspinal thermography provide an analysis that supports the need for care by providing an analysis that objectively aids you in the treatment process. Paraspinal thermography also has the unique capability of offering the easiest and fastest method for examining for spinal neuropathophysiology.

PATIENT EDUCATION

Testing can also aid you in redirecting your patients’ concept of chiropractic from a back pain discipline to the arena of wellness. Changing a patient’s perception requires three things:

1. The ability to analyze and objectively show when nerve interference is present;

2. The ability to correct the interference; and

3. The ability to objectively demonstrate when the adjustment has restored homeostasis.

This is achieved in four steps:

1. Test the patient. Preadjustment testing is vital because it provides visual feedback you can use to educate your patients about the care they will receive and why it is necessary.

Patients don’t want to be “sold” on chiropractic, but they do want to be involved in their healthcare. A test, such as a paraspinal thermograph, can show current status and identify problem areas. For example: A thermogram can isolate, in less than 15 seconds, areas of asymmetry, as well as indicate areas that may be warm due to acute soft-tissue damage.

2. Adjust. Using information from the test, adjust the patient to correct problem areas.

3. Test again. Post-adjustment testing aids you in evaluating the adjustment you delivered. For example: A paraspinal thermograph done after the adjustment shows improvement and documents your care. Once patients look at a graph of their spine and see their health improve, they look forward to their next visit to see how they are progressing. Remember, today’s patient tunes in to everything visual.

4. Provide a healthcare report. A healthcare report or similar handout that provides customized educational and health information is another way to improve patient engagement.

Use a history of the tests to demonstrate the positive results of care over time. Patients learn about thermal “patterns of interference,” radiological signs of degeneration, or asymmetrical muscle tensions from the tests you run.

When taught about early warning systems, patients fully appreciate the importance of frequent, routine scans and will voluntarily seek chiropractic care to keep their nervous system function healthy.

Roger Titone, BSME, is a bioengineer with more than 37 years of experience researching and developing instrumentation. He can be contacted by e-mail at roger@titronics.com, by phone at 800-705-2307, or through the Web site, www.titronics.com.