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Daily Archives: March 20, 2011

Recognizing Subdural Hemorrhage in Older Adults

By |March 20, 2011|Education|

Recognizing Subdural Hemorrhage in Older Adults

The Chiro.Org Blog


SOURCE:   Topics in Integrative Health Care 2010; 1 (2)

By: Mark T. Pfefer, RN, MS, DC and Richard Strunk MS, DC


The Abstract:

A subdural hematoma, also known as a subdural hemorrhage (SDH) is caused by a post-traumatic accumulation of blood within the potential space between the dura mater and the arachnoid layer covering the brain. Chronic SDH is much more common in the elderly. Patients can have a good outcome with neurosurgical management if the conditions is promptly recognized. All health care providers, as well as nursing home staff, should be aware of this condition because older patients presenting with headache and/or other neurologic complaints need careful assessment to identify SDH.

Keywords: subdural hematoma; subdural hemorrhage; chronic subdural hemorrhage; headache

Definition and Etiology

A subdural hematoma, also known as a subdural hemorrhage (SDH) is caused by a post-traumatic accumulation of blood within the potential space between the dura mater and the arachnoid layer covering the brain. All health care providers, especially those who frequently treat patients with musculoskeletal complaints, as well as nursing home staff, should be aware of this condition because older patients presenting with headache and/or other neurologic complaints need careful assessment. SDH should be considered in the differential assessment of any older patient presenting for care following trauma as it has been associated with minor head injury or falls, even those not involving direct trauma to the head. [1] In fact, absence of direct trauma to the head is associated with up to half of all cases of SDH, and a case has been reported in an adult following a roller coaster ride. [2] Based upon this it should be assumed that motor vehicle collisions could generate forces sufficient to cause SDH in older patients. (more…)

The Art of the Chiropractic Adjustment: Part V

By |March 20, 2011|Education, Technique|

The Art of the Chiropractic Adjustment: Part V

The Chiro.Org Blog


SOURCE: Dynamic Chiropractic

By Richard C. Schafer, DC, FICC


You may also enjoy:

Part I and

Part II and

Part III and

Part IV and

Part VI

This series of articles has strived to define certain general principles that underlie almost all chiropractic adjustive technics. Parts I and II reviewed depth of drive, the articular snap, segmental distraction, timing the adjustment, the advantages of placing the patient’s spine in an oval posture, correct table height, and patient positioning objectives. Part III summarized the factor of time in the clinical approach and its underlying biomechanical principles of tissue viscoelasticity, fatigue, creep, and relaxation. Part IV reviewed the need to visualize the loading effects on articular cartilage, joint lubrication, action of the intra-articular synovial tabs, and the articular planes to deliver a corrective thrust most effectively. Here we shall describe the fundamental types of contact, contact points and their options, securing the contact hand and direction of drive.

Types of Contact

The type of contact used in applying a chiropractic adjustment is optional in most situations. The broadest contact that is efficient should be used, because the force will be directed through a larger surface area. For example, a force applied by a fairly open palm against the skin is perceived by the patient far differently than a force applied by a pointed finger against the skin. Thus, a palm-heel, thenar or knife-edge (medial edge of the hand) contact produces less patient discomfort than a pisiform or thumb contact. There are times, however, when a pisiform or thumb contract on a spinous process is necessary to get the job done quickly and efficiently.

Contact Points and Their Options (more…)