• What to expect from this module.
• How your mindset and attention to detail during the first few days can affect the patient’s outcome.
• How to think: focuses on putting the student into a mindset where they are open to possibilities rather than locked into their preconceived notions.
• Just the facts; focusing on the injury/subluxation complex and justifying your diagnosis and treatment plan based on published science rather than opinions.

• The importance of prior history and collecting prior records
• Differentiating prior conditions from acute injuries
• Understanding the greater susceptibility to further injury with prior conditions
• A picture is worth a thousand words or with PI thousands of dollars
• Using Matchbox cars and trucks to reconstruct the crash mechanism

• What information you must attain.
• How to question a concussed patient who is not clear on what happened.
• How to question a child.
• Communication at the patient’s level of understanding.
• Communication with a non-English speaking patient.

• OPQRST
• Onset
• Palliative/Provocative
• Quality of pain
• Region/Radiation
• Severity
• Timing

• Common contusions, abrasions, and lacerations
• Edema
• Observing patient reactions

• Dermatomes; knowledge of these essential for establishing radiculopathy. The student will learn the importance of testing each function of the dermatomes.
• Muscle atrophy as a radicular finding
• Dermatomes and how these findings relate to spinal injuries

• Defining traumatic subluxation v. sprains and strains
• Common spinal subluxation and sprain/strain
• Common extremity subluxations and sprain/strain

• C1 & C2 fractures
• Posterior arch fractures
• Uncinate fractures
• Compression factures

• ROM done correctly; understanding the difference between observational and measured ROM testing. Emphasis will be on digital measuring with the need to allow the patient to loosen up before three measurements are taken and how those measurement must correlate.
• Spinal & Extremity range of motion testing and its value in an injury case
• Muscle testing done correctly; this involves first allowing the patient to loosen up, followed by testing each isolated muscle 3 times or for 3 seconds.
• Digital measurement of muscle strength
• Measuring muscle atrophy

• Proper use of axial loading tests; focused on understanding what is being tested with each position of axial loading
• Understanding the differences between axial and localized complaints
• Deep tendon reflexes
• Orthopedic and neurologic testing
• Two-point discrimination testing
• Facet syndrome
• Straight Leg Raiser Test; taught in terms of the AMA Guides standard of positive radicular complaints at 35-70 degrees. Also taught in terms of a comparison of a seated SLR

• Anatomy and physiology review of TMJ
• Mechanism of injury of TMJ in motor vehicle collisions

• History and Examination of TMJ
• Outcome Assessment Tools for TMD

• Migraines
• Cervical tension headaches
• traumatic headaches
• Occipital neuralgia

• Shoulder testing including ROM, MM testing, orthopedic tests, SPADI and QuickDASH
• Elbow testing including ROM, MM testing, and orthopedic tests.
• Hand & wrist testing including ROM, MM testing, and orthopedic tests.
• Hip testing including ROM, MM testing, and orthopedic tests.
• Knee testing including ROM, MM testing, and orthopedic tests.
• Ankle & foot testing including ROM, MM testing, and orthopedic tests.

• Goals of this presentation
• Dynamic Assessment of the 12 pairs of cranial nerves
• The foundation of life essential functions for each pair
• The parts of the brainstem and the cranial nerve organization
• The impact of the diminished function of each nerve on healing outcomes
• Nerve activation strategies to support a return to proper functioning
• Frequency of neuron firing and spontaneous firing

• Anatomy of brainstem
• Midbrain
• Pons
• Medulla
• Cranial nerve origins on the brainstem
• Anatomy where the cranial nerves exit the skull
• Anatomy and functions of cranial nerves
• Anatomy of injury sites

• Cardiac function
• Blood pressure
• Pulse
• Respiratory function
• O2 saturation
• CO2 how level affects the sympathetic response
• Breaths per minute
• Digestion
• Organ function
• Consciousness
• Sleep Cycles

• Sympathetic dominance with concussions
• Shallow respiration with Shoulder activity
• Cold feet
• Eyes uneasy, timid
• Cold hands
• Wide and vigilant eyes
• Disrupted digestion
• Constipation
• Sleep alteration
• Lowered Pain Threshold
• Altered smell
• Altered taste
• Altered breathing sounds
• Altered saliva
• Altered swallowing
• Mouth breathing

• CN I olfactory
• Nasal reflexes
• Sympathetic dominance
• Cortex response
• CN II optic
• Snellen eye chart
• Ishihara color test
• Visual fields
• PERLA

• How to create a safe and comfortable environment
• How to minimize questioning for patient comfort
• Patient comfort is of the utmost importance
• The importance of having the patient’s feet on the floor
• Examiner scripting
• Testing preparation equipment
• Disposable items
• Testing ergonomics

• CN XII
• CN XI
• CN X
• CN IX
• CN VII
• CN V

• CN II
• CN III
• CN IV
• CN VI

• CN VII
• CN IX
• CN X
• CN VIII
• CN V
• CN I

• Breathing to increase O2 for healing
• 12 steps protocol for cranial nerve activation and stimulation
• Humming to increase NO production
• Gag minimization

• Coordinating aspects of the History into shaping the clinical picture of the injury, developing a working differential diagnosis list, formulating a care plan and establishing a prognosis
• Coordinating aspects of the Examination into shaping the clinical picture of the injury, developing a working differential diagnosis list, formulating a care plan and establishing a prognosis
• Differentiating pre-existing vs predisposing history and exam findings related to injury in the overall Clinical Impression.
• Case example of integrating the collected information into a cohesive patient record