This past year was an eye-opening one for me, especially from an international perspective. It all started with the World Federation of Chiropractic’s biennial congress in Rio de Janeiro, Brazil, in April 2011.

More than 1,000 enthusiastic attendees participated, and what particularly impressed me was the representation from the World Congress of Chiropractic Students.

Students from all over the world traveled to the congress, led by WCCS President Dr. Stanton Hom from California. Dr. Hom is a West Point graduate and completed his chiropractic studies at the Southern California University for Health Sciences. His natural leadership skills helped bring a large body of energetic chiropractic students together, all of whom were hungry to learn about chiropractic and other health care disciplines that complement it.

Their energy was contagious. Sometimes I meet people who seem to have forgotten their passion for chiropractic, so I enjoyed meeting students from every corner of the world whose hearts are still full of love for the profession.

In October, I returned to Brazil to host a seminar in Sao Paulo at the Universidade Anhembi Morumbi, part of Laureate International Universities, a vast network of colleges with campuses in more than 70 locations around the world. The Sao Paulo location features a multidisciplinary health care facility that includes chiropractic, medicine, physical therapy, massage therapy, and other services. The facility itself has 47 treatment rooms, and all the disciplines collaborate with one another in their studies and in their delivery of care.

The common thread in my conversations with students at each of these stops was this: The multidisciplinary model of both learning and treating patients that I observed in Sao Paulo is spreading like wildfire around the world. Practitioners are accepting the model as an effective way to improve their own skills and to enhance the patient experience by creating a one-stop destination to manage all patient health concerns. International students are being exposed to this model without awareness of how things might have worked historically, which is accelerating its integration into the health care landscape.

We have been relatively slow to adopt this structure in the U.S., but we need to take note of the enthusiasm and satisfaction of students and practitioners who are following this model in their daily studies and practices. My international travels have demonstrated to me that this model is the one we should follow, and I hope that our U.S. chiropractic contingent will continue to experiment with a multidisciplinary approach to discover its true benefits.

In economies around the world, this model is working and chiropractors are thriving, which is why the student population continues to grow. Let’s learn from our colleagues in other nations and leverage those opportunities here in the U.S. to continue elevating our profession among all health care disciplines.

Silent brain infarcts (subclinical strokes) “have an increased risk of dementia and a steeper decline in cognitive function than those without such lesions” for older people. This study found that “engaging in moderate to heavy physical activities may be an important component of prevention strategies aimed at reducing subclinical brain infarcts.”

Abstract

BACKGROUND:

Silent brain infarcts are frequently seen on magnetic resonance imaging (MRI) in healthy elderly people and may be associated with dementia and cognitive decline.

METHODS:

We studied the association between silent brain infarcts and the risk of dementia and cognitive decline in 1015 participants of the prospective, population-based Rotterdam Scan Study, who were 60 to 90 years of age and free of dementia and stroke at base line. Participants underwent neuropsychological testing and cerebral MRI at base line in 1995 to 1996 and again in 1999 to 2000 and were monitored for dementia throughout the study period. We performed Cox proportional-hazards and multiple linear-regression analyses, adjusted for age, sex, and level of education and for the presence or absence of subcortical atrophy and white-matter lesions.

RESULTS:

During 3697 person-years of follow-up (mean per person, 3.6 years), dementia developed in 30 of the 1015 participants. The presence of silent brain infarcts at base line more than doubled the risk of dementia (hazard ratio, 2.26; 95 percent confidence interval, 1.09 to 4.70). The presence of silent brain infarcts on the base-line MRI was associated with worse performance on neuropsychological tests and a steeper decline in global cognitive function. Silent thalamic infarcts were associated with a decline in memory performance, and nonthalamic infarcts with a decline in psychomotor speed. When participants with silent brain infarcts at base line were subdivided into those with and those without additional infarcts at follow-up, the decline in cognitive function was restricted to those with additional silent infarcts.

CONCLUSIONS:

Elderly people with silent brain infarcts have an increased risk of dementia and a steeper decline in cognitive function than those without such lesions.

A study published and widely reported by mainstream media suggests conservative care consisting of either spinal manipulation or home exercise is more effective than over-the-counter and prescription medication for relieving acute and subacute neck pain.

Spinal manipulative therapy was more effective than medication in both the short and long term, as was home exercise in the form of self-mobilization of the neck and shoulder joints – a point media outlets were quick to emphasize in a classic attempt to downplay the value of the chiropractic intervention.

The study involved 272 adults ages 18-65 with nonspecific mechanical neck pain of two to 12 weeks’ duration. Participants were recruited from a university research center and a pain management clinic in Minnesota. Other inclusion criteria included pain equivalent to grade I or grade II according to the Bone and Joint Decade’s Task Force on Neck Pain and Its Associated Disorders; and neck pain score of 3 or greater on a 0-10 scale. Exclusion criteria included cervical spine instability, fracture, neck pain referred from peripheral joints or viscera, progressive neurologic deficits, diffuse idiopathic hyperostosis, inflammatory or destructive changes of the cervical spine, previous cervical spine surgery, and blood-clotting disorders, among other criteria.

 Subjects were randomized at their second baseline appointment to one of three groups for 12 weeks:

• A spinal manipulative therapy group, which received “manipulation of areas of the spine with segmental hypomobility by using diversified techniques, including low-amplitude spinal adjustments … and mobilization.” According to the study, six chiropractors, each with at least five years’ experience, provided treatment, with the specific spinal level to be treated and the number of treatments rendered left to the discretion of the individual chiropractor.
• A home exercise advice group, “with advice provided [by six therapists] in two 1-hour sessions one to two weeks apart. Recommended mobilization exercises included “neck retraction, extension, flexion, rotation, lateral bending motions, and scapular retraction, with no resistance.” Participants received a booklet and laminated cards of prescribed exercises, and were advised to perform 5-10 repetitions of each exercise six to eight times daily.
• A medication group monitored by a licensed medical physician, with nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or both serving as the first line of pharmacological therapy. With patients who did not respond to or could not tolerate these drugs, narcotic medications and muscle relaxants were prescribed. With each patient, the MD determined the type of medication administered and the number of patient visits.

Self-reported outcomes, including pain, were measured six times during the 12-week treatment period in all three groups: at both baseline appointments; two, four, eight and 12 weeks after randomization; and on two occasions post-treatment (weeks 26 and 52). Objective measures of cervical spine motion were measured at four and 12 weeks by seven trained examiners blinded to treatment assignment.

Of the 272 participants, essentially equally assigned to the three treatment groups (91 SMT, 91 home exercise and 90 medication), “improvement in participant-rated pain significantly differed with SMT compared with medication at 12 weeks … and in longitudinal analyses that incorporated pain ratings every two weeks from baseline to 12 weeks. At 12 weeks, a significantly higher proportion of the SMT group experienced reductions of pain of at least 50% [compared to the medication group]. Differences in participant-related pain improvement between the SMT and [home exercise] groups were smaller and not statistically significant.”

Specifically, at week 12, more than 82 percent of the SMT group reported a 50 percent or greater reduction in pain; 57 percent reported at least a 75 percent reduction and 32 percent reported a 100 percent reduction. By comparison, the home exercise group reported pain reductions of 77 percent, 48 percent and 30 percent, respectively, while the medication group reported reductions of only 69 percent, 33 percent and 13 percent.

In terms of long-term improvement, 75 percent of the SMT group reported at least a 50 percent reduction in pain after 26 weeks, while nearly 81 percent reported at least a 50 percent reduction at 52 weeks. At 26 and 52 weeks, 71 percent and 69 percent of the home exercise group, respectively, reported at least a 50 percent reduction in pain. In long-term follow-up, the medication group’s improvement fluctuated from 59 percent reporting pain reduction of 50 percent or more at 26 weeks to 69 percent reporting the same reduction at 52 weeks.

“Spinal manipulation therapy and [home exercise advice] led to similar short- and long-term outcomes,” stated the authors, “but participants who received medication seemed to fare worse, with a consistently higher use of pain medications for neck pain throughout the trial’s observational period.”