Kinetic analysis of expertise in spinal manipulative therapy using an instrumented manikin

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Purpose:The goal of the present study was to quantify the high-velocity, low-amplitude spinal manipulation biomechanical parameters in two cohorts of students from different teaching institutions. The first cohort of students was taught chiropractic techniques in a patient-doctor positioning practice setting, while the second cohort of students was taught in a "complete practice" manipulation setting, thus performing spinal manipulation skills on fellow student colleagues. It was hypothesized that the students exposed to complete practice would perform the standardized spinal manipulation with better biomechanical parameters. Methods: Participants (n = 88) were students enrolled in two distinct chiropractic programs. Thoracic spine manipulation skills were assessed using an instrumented manikin, which allowed the measurement of applied force. Dependent variables included peak force, time to peak force, rate of force production, peak force variability, and global coordination. Results: The results revealed that students exposed to complete practice demonstrated lower time to peak force values, higher peak force, and a steeper rate of force production compared with students in the patient-doctor positioning scenario. A significant group by gender interaction was also noted for the time to peak force and rate of force production variables. Conclusion: The results of the present study confirm the importance of chiropractic technique curriculum and perhaps gender in spinal manipulation skill learning. It also stresses the importance of integrating spinal manipulation skills practice early in training to maximize the number and the quality of significant learner-instructor interactions. (J Chiropr Educ 2011;25(2):125-131)

Section: Discussionmentioning

confidence: 78%

Learning Spinal Manipulation

Harvey

Wynd

Richardson

et al. 2011

Self Cite

“…[2][3][4][5][6][7][8][9][10][11][12][13][14] More recently, those same tools are being used to augment the learning in chiropractic colleges in the United States and abroad, 11,[15][16][17][18][19][20][21][22][23][24] and in physical therapy programs as well. 25 Preload, peak loads, and speed have all been suggested as important performance factors.…”

Section: Introductionmentioning

confidence: 99%

Changes in adjustment force, speed, and direction factors in chiropractic students after 10 weeks undergoing standard technique training

Owens¹,

Russell²,

Hosek³

et al. 2017

Objective: To assess the force profiles of high-velocity low-amplitude thrusts delivered to a mannequin on a force platform by novice students given only verbal instructions. Methods: Student volunteers untrained in adjusting delivered a series of adjustments to a mannequin on a force platform. Participants performed 3 light, 3 normal, and 3 heavy thrusts on 5 listings specifying contact point, hand, and direction. Force profiles were analyzed for speed and amplitude, consistency, and force discrimination. Two recording sessions occurred 10 weeks apart. Results: Sixteen participants (11 females, 5 male) completed the study. Peak forces ranged from 880 to 202 N for heavy thrusts and 322-to 66 N for light thrusts. Thrust rate was from 8.1 to 1.8 Newtons per millisecond. Average coefficients of variability (CV ¼ STD/mean) at each load level (initial/final) were heavy: 17%/15%; normal: 16%/15%; and light: 20%/20%, with 0 as ideal. A force ratio measured students' abilities to distinguish thrust magnitude. The heavy/normal ratio (initial/final) was 1.35/1.39, and the light/normal ratio was 0.70/0.67. Conclusions: At this point, without force feedback being used in the classroom, novice students can produce thrusts that look like those of their teachers and of experienced practitioners, but they may not produce similar speed and force values. They are consistent within and between sessions and can discriminate between light and heavy loads. A natural next step in our educational research will be to measure adjustment factors on more experienced cohorts of students with and without the presence of force-feedback training apparatus.

“…1 It has been characterized by applying a dynamic highvelocity low-amplitude thrust into a specific contact on the patient's body. 2 Chiropractic students learn how to perform this skill during their training years at a chiropractic institution.…”

Section: Introductionmentioning

confidence: 99%

“…2 Chiropractic students learn how to perform this skill during their training years at a chiropractic institution. 1 The format and amount of time spent training to learn spinal manipulation skills can range from formalized curricula in professional programs to weekend seminars and individual demonstrations; however, each chiropractic college teaches core manipulation procedures. 3 In comparison to other professional programs that teach spinal manipulation, such as the doctor of osteopathy, doctor of medicine, and master of physiotherapy programs, doctor of chiropractic programs in both Canada and the United States offers extensive hours of training specifically in the skill of spinal manipulation in order to train chiropractors to be proficient.…”

Section: Introductionmentioning

confidence: 99%

“…4 For students to perform manual SMT properly, they must first learn how to control the amount of force applied and master overall body coordination. 1 In most chiropractic schools, the type of teaching method most utilized for accomplishment of these skills is known as knowledge of performance. 5 Historically, the usual teaching procedure begins with students learning the theoretical aspects of HVLA SMT, followed by a demonstration by an instructor performing a specific spinal manipulation and students imitating the instructed procedure on their fellow classmates.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Learning spinal manipulation: A best-evidence synthesis of teaching methods*

Stainsby¹,

Clarke²,

Egonia³

2016

Objective: The purpose of this study was to evaluate the effectiveness of different reported methods used to teach spinal manipulative therapy to chiropractic students. Methods: For this best-evidence literature synthesis, 5 electronic databases were searched from 1900 to 2015. Eligible studies were critically appraised using the criteria of the Scottish Intercollegiate Guidelines Network. Scientifically admissible studies were synthesized following best-evidence synthesis principles. Results: Twenty articles were critically appraised, including 9 randomized clinical trials, 9 cohort studies, and 2 systematic reviews/meta-analyses. Eleven articles were accepted as scientifically admissible. The type of teaching method aids included a Thrust in Motion cervical manikin, instrumented cardiopulmonary reanimation manikin, padded contact with a load cell, instrumented treatment table with force sensor/transducer, and Dynadjust instrument. Conclusions: Several different methods exist in the literature for teaching spinal manipulative therapy techniques; however, future research in this developing area of chiropractic education is proposed. It is suggested that various teaching methods be included in the regular curricula of chiropractic colleges to aid in developing manipulation skills, efficiency, and knowledge of performance.