The simulated early learning of cervical spine manipulation technique utilising mannequins

Abstract

BackgroundTrivial pain or minor soreness commonly follows neck manipulation and has been estimated at one in three treatments. In addition, rare catastrophic events can occur. Some of these incidents have been ascribed to poor technique where the neck is rotated too far. The aims of this study were to design an instrument to measure competency of neck manipulation in beginning students when using a simulation mannequin, and then examine the suitability of using a simulation mannequin to teach the early psychomotor skills for neck chiropractic manipulative therapy.MethodsWe developed an initial set of questionnaire items and then used an expert panel to assess an instrument for neck manipulation competency among chiropractic students. The study sample comprised all 41 fourth year 2014 chiropractic students at Murdoch University. Students were randomly allocated into either a usual learning or mannequin group. All participants crossed over to undertake the alternative learning method after four weeks. A chi-square test was used to examine differences between groups in the proportion of students achieving an overall pass mark at baseline, four weeks, and eight weeks.ResultsThis study was conducted between January and March 2014. We successfully developed an instrument of measurement to assess neck manipulation competency in chiropractic students. We then randomised 41 participants to first undertake either “usual learning” (n = 19) or “mannequin learning” (n = 22) for early neck manipulation training. There were no significant differences between groups in the overall pass rate at baseline (χ2 = 0.10, p = 0.75), four weeks (χ2 = 0.40, p = 0.53), and eight weeks (χ2 = 0.07, p = 0.79).ConclusionsThis study demonstrates that the use of a mannequin does not affect the manipulation competency grades of early learning students at short term follow up. Our findings have potentially important safety implications as the results indicate that students could initially gain competence in neck manipulation by using mannequins before proceeding to perform neck manipulation on each other.

A pilot study to determine the consistency of peak forces during cervical spine manipulation utilizing mannequins

“…This is similar to previous research for improved outcomes associated with using Dynadjust tools (LaBarge Inc, St. Louis, MO) for cervical manipulation as well as force-sensing technology for thoracic manipulation. 8,15,16 This study is unique in that the improvements in peak force control on the mannequin thrusts did not carry over to the human SM. Previous studies had differing methods on how to improve SM.…”

“…The only study that investigated the effectiveness of forcesensing technology on cervical SM utilized a Dynadjust for its practice. 8 This needed neither a force table nor a mannequin and instead used a tool that indicates if the student was successful in achieving the targeted force. Their outcomes were measured on the same tool.…”

“…The utilization of a practice mannequin demonstrated that there is no negative effect on subjective marking of cervical SM. 8,18 However, it did not evaluate the biomechanical parameters of the thrust itself, while the utilization of realtime feedback from inertial sensors demonstrated a decrease in thrust angular velocity. 19 Therefore, there needs to be additional research in the disparity of this paper and other research.…”

“…6 Recently, there has been work done examining the effect of utilizing a mannequin for cervical SM practice, which demonstrated positive effects in students' subjective scoring of cervical SM skills. 7,8 However, this did not include any examination of effects on a learners' objective outcome measures. 7,8 Therefore, the goal of this study was to examine the effectiveness of a 2-hour instructional strategy utilizing Force Sensing Table Technology (FSTT; Canadian Memorial Chiropractic College, Toronto, Ontario) and Human Analogue Mannequins (HAM; Canadian Memorial Chiropractic College, Toronto, Ontario) on the ability of students to achieve a targeted peak force in cervical SM.…”

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

“…One recent work used an expert to judge performance based on 12 criteria. 34 Three of the criteria judged adjustment force and speed and direction, but these were not measured, only assessed by the judge. We are moving toward using measured force feedback in a formative setting, giving student feedback and pointing toward target values.…”