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The following information was gained by scanning the program of the continuing education course in Bürgenstock Hotels and Resorts which took place from September 11th - 13th. Misspellings can occur and might lead to errors as regards content. Please let us know if that is the case somewhere so we can correct it. SCG/ASC Program Dr Peter Aker, M.Sc., D.C., FCCS(C ), FCCRS(C) Dr Michel Aymon, D.C. Dr Kovilijka Barisnikov, Ph.D. (Special Education) Prof Fredi P. Büchel, Ph.D. (Special Education and Experimental Psychology) Prof Pierre Dayer, M.D. Dr André Deom, M.D., Ph.D. Prof Krystina Dobosievics, M.D., Ph.D. Dr Eric Faigaux, D.C. Prof Denis Hochstrasser, M.D. Dr Dominique Hort, D.C. Prof Sigrid Jéquier-Kuhn, M.D. Dr Udo Kastner, M.D., D.C. Dr Hans-Peter Kind, M.D., Pediatrics FMH Dr Peter Kränzlin, D.C. Dr Jean-Paul Laedermann, D.C. Dr Charles Lantz, D.C., Ph.D. Prof Remo Largo, M.D. Dr Charlotte Leboeuf-Yde, D.C. M.P.H. (Master in Public Health) Ms Maruska Massera, MA (Science of Education) Dr Marco Nardini, D.C. Dr Jean-François Pages, M.D. (Pedo-Psychiatrist) Prof Claude Perret, Ph.D. (Biology and Neurophysiology) Dr Jean-Luc Rime, M.D. Dr Jean Robert, D.C. Dr Kurt von Siebenthal M.D. Dr Jesper Wiberg, D.C. Abstracts Dr Peter Aker: Night-time bedwetting in children is common, with about 20 % of children wetting the bed at age five While the etiology is not fully understood, it is most commonly thought to be related to functional bladder capacity. In general, the rate of maturity of the nervous system, which may be genetically controlled, has been implicated. A thorough understanding of the epidemiology and natural history of this condition is essential for those considering intervention. Primary noctumal enuresis is a benign, developmental condition with a high spontaneous cure rate Between 10 % to 20 % of cases per year resolve after age six, and by age fifteen the prevalence of enuresis is only about 1 %. A complete clinical evaluation, including a thorough history and physical examination together with a urine culture, should be aimed at ruling out pathological causes for the bed-wetting. Good rapport with the child and family together with insight into the self-limiting nature of the condition have been shown to produce a noticeable improvement in up to 70 % of children. Over-investigation, over-treatment and ineffective or irrational treatment should be avoided Asthma Chiropractic espouses a system of management for asthma that does not use drug therapies, and anecdotally has recorded successful treatment results. This is important, since the prevalence, morbidity and mortality related to asthma is increasing in spite of advances in drug therapy and more aggressive medical approaches. Health care expenditures for asthma in the US exceed $4 billion. In the US, 11 % of patients with pulmonary problems seek care from practitioners of alternative medicine, the most popular of which is chiropractic. In Australia, 30 % of asthmatic families see chiropractors, and in Denmark 3 % of new chiropractic patients were treated for respiratory disorders. Seven percent of asthmatics see a chiropractor in Ontario, although it is unclear whether this is for management of asthma or for other health problems. In light of these utilization figures, and the demands on professions to establish evidence-based approaches to practice, we conducted a randomized, controlled clinical trial of chiropractic care in 91 children with chronic asthma. Children were randomized to receive real or simulated adjustments for four months, during which time they kept a daily diary of symptoms, medication use and peak flow readings. Objective lung function tests were conducted at baseline, two and four months. The results of this study will be presented and discussed.
Dr Koviljka Barisnikov: Dyslexia may be defined as a disorder affecting competence in reading and spelling. It is well known that damage to the language hemisphere of the adult brain can cause such a deficit. In these cases it is appropriate to speak of an acquired dyslexia or dysgraphia. Childhood dyslexia is a disorder affecting the initial development of literacy. Although there is some evidence of a genetic or neurological basis there is no consensus that the disorder is a physical problem which can be treated by medical procedures. Indeed most specialists share the view that developmental dyslexia is a specific cognitive disability. Therefore most recent research is directed towards the analysis of specific cognitive errors of dyslexic persons These specific patterns of errors can be interpreted by reference to a diagrammatic model of the normal process of reading which allows us to identify: 1) a visual process; 2) a phonological process; 3) a semantic process; 4) a speech production process, which correspond to different types of dyslexia
Prof Fredi P. Büchel: Most of these studies are guided by research plans as proposed by Campbell and Stanley (1963) These authors distinguish pre-experimental, quasi-experimental and experimental designs Most of these designs require the application of pre- and post-tests in at least one experimental and one control group. The application of these methods in clinical and other special populations is confronted with specific problems: Generally it is almost impossible to form homogeneous groups with respect to the dependent variables. The composition of control groups is difficult and can often only be realized if compromises are accepted. Another problem is the definition of the dependent variables. Clinical interventions are sometimes more driven by eclectic conceptions than by clearly formulated theories As a consequence of this fuzzy theoretical background, the measures that are taken often lack construct validity because measurement methods are not sufficiently related to the dependent variables. In the present lecture, these problems are presented and discussed in a more systematic way, and with the help of some examples, suggestions of how to deal with them are made.
Prof Pierre Dayer: Pain is a subjective sensation elicited either by an actual tissue injury (nociception) or by damages on the pain conduction/integration system (neuropathic pain). Appropriate drug treatment must take into account a structured and standardised assessment, a therapeutic choice according to the mechanism at the origin of pain, the duration and intensity of pain, and a close monitoring of the treatment impact.
Dr André Deom: For the medical profession, the recent revision of the Swiss laws brought a certain number of new obligations in the field of laboratory medicine. The most important topics for the doctor's office laboratory level will be presented They include in particular the following points:
Prof Krystina Dobosievics: The unloading reflex can be evoked in all the skeletal muscles through a sudden shortening of voluntary innervated muscles. When a muscle is unloaded during an isometric contraction the normal reaction is an electrical silent period followed by a burst of action potentials called a rebound. Overview of present medical treatments with an emphasis on conservative approach The main method of treatment in idiopathic scoliosis is a conservative approach based on bracing as the application of physical exercises has so far received little attention, since the techniques used do not always take into consideration the biomechanics of the scoliotic spine.
Prof Denis Hochstrasser: In the presentation, we will discuss the elements which help to decide whether or not a laboratory test is required.
Dr Dominique Hort: In this brief presentation I will propose a method for the analysis and treatment of patients (with special attention to children) suffering from Neurological Disorganisation which I will define as an inability of the subject to fully use his/her potential physically, mentally, biochemically and emotionally. This condition or disease will explain, when applied to children, most of the difficulties they suffer when confronted with challenges: in learning in school (learning disabilities, attention deficit disorders, dyslexia, etc.) in social relationships (inadequate or counter productive behavior towards family, teachers, friends, etc.) and in adapting to their environment (psychosomatic dysfunctions, depressions, scoliosis, allergies, etc.)
Prof Sigrid Jéquier-Kuhn: Classical infantile, juvenile or adolescent scoliosis is usually detected by a parent, a pediatrician or by school screening. There is a deformity of the spine of which the patient is completely unaware. Pain is not a feature of idiopathic classical scoliosis. When a child complains of backpain, or, when too young to complain verbally, manifests pain when being picked up or being seated, something is wrong and action is needed. Painful scoliosis may be the sign of a serious underlying problem. Minimum laboratory tests include a blood formula and a sedimentation rate or CRP. Imagingwise, if the clinical examination does not lead to the diagnosis and explanation of the symptoms, a conventional radiograph of the spine should be obtained initially, in upright position if possible, p/a and lateral. Sometimes, this is sufficient to make the diagnosis (spondylo-discitis, tumors such as osteoid osteoma, osteoblastoma, hemangioma etc.).
Dr Udo Kastner: Growing pains have a reported incidence of 4,2% to 33,ó%. The etiology is unclear and there is agreement that the term growing pains is a misnomer. Recurrent otitis media: rationale and anatomical considerations The osseous part of the Eustachian tube is made of the squamous and the petrous part of the temporal bone, which are seperate at birth. Muscle-tension or muscle related torque at the base of the skull might therefore also compromise the bony part of the tube.
Dr Peter Kränzlin, Dr Hans-Peter Kind: 16 pediatric practitioners participated in a field-study collecting epidemiological data on the newborn torticollis and investigating in a controlled case study the efficacy of different types of therapeutical interventions such as specific manipulation versus physiotherapy. A total of 3143 newborns have been registered; out of these 267 showed a positive cervical finding and 82 have been referred to the controlled study group. The prevalence of newbom torticollis in the controlled group is 8%. 69% of the cases heal spontaneously or with conventional treatment by the age of ó months. In the group of the persistent cases, 69 % showed an arthrogenic etiology, 28% showed a muscular dysbalance and only 3% were in connection with a muscular contracture. The arthrogenic torticollis is more frequently found in male infants (66%). In the cases with an arthrogenic etiology, the specific mobilisation proved to be a safe and effective form of therapy. In 95% of these cases only one manipulative intervention had to be performed.
Dr Charles Lantz: Scoliosis is classified according to several overlapping schemes that often confuse our understanding of the condition. 85% of all scoliosis is considered to be idiopathic or of unknown cause. These are classified according to curve severity and curve location. We will discuss the various classification systems in the context of their etiologies and associated conditions and discuss prognosis Identification of associated conditions or observation of progression largely dictates the likely course of the condition. We will discuss the importance of scoliosis classification and monitoring in the context of chiropractic management of scoliosis and the role of the chiropractor in directing the management of scoliosis. An essential element in this discussion will be the identification of patients with scoliosis, including general screening as well as x-ray analysis.
Dr Charles A. Lantz, Jasper Chen, Trent Bachman: This is a cohort study (no control group) to evaluate the effect of chiropractic on mild adolescent idiopathic scoliosis. Subjects were accepted into the study if they were between the ages of ó-17 years at the time of initial screening and had curves less than 20°. There was no attempt to distinguish between structural and functional curves in this study. The primary outcome measure in this study was the change in Cobb angle as determined by x-ray analysis, with follow-up studies made about one year following the initial evaluation. For this purpose, we utilized a rigorous positioning procedure to assure reproducibility of positioning between evaluations. All x-rays were taken posterior to anterior in order to provide maximum protection to developing breast tissue. Upon entry into the study, subjects were provided osseous, full-spine adjustments 1-3 times per week for one year. In addition, those with significant pelvic tilt were provided with heel lifts on the low side of the pelvis. Subjects were also provided advice regarding posture and activities of daily living as well as informal advice on exercise. Of the 150 children who qualified for the study, 38 completed the one year course of care and received follow-up x-rays. Preliminary analysis indicated an average of 1,4° reduction in curvature. Children less than 10 years old (n=11, mean age = 8,5t 1,4°, mean Cobb angle = 8,8 +- 2,9°) had an average of 2,6° reduction while those over 10 years (n=27, mean age = 13,5 +- 1,7, mean Cobb angle = 12,6 +- 4,6°) had an average improvement of 0,9°. These differences vanished, however, when the two groups were matched by curve size. There was no apparent pattern of effect relative to curve size; when grouped in 5° intervals, the greatest improvement was seen in curves 11 -1 5° (n=11 ), with the 6-10° and 16-20° curves showing about the same degree of improvement (-1,2° and -1,1°, respectively), while two subjects with curves less than 6° showing the most progression (+3,5°). Improvement was not statistically significant for any of the changes. Almost 1/3 of the subjects (n=12) showed improvement in their curves, with the largest being 12°; 50 % of the subjects (n=19) showed no change (+-2°) and 7 subjects (18%) progressed more than 2°.
Prof Remo Largo: Objective: Study on timed performance and quality of movements from early schoolage to adulthood. Results: 1)There was a continuous increase of speed and a discontinous decrease of frequency/extent of associated movements during the prepubertal period. No further changes were noted during puberty. There was a considerable interindividual variability of speed and frequency/extent of associated movements at all ages.
Dr Charlotte Leboeuf-Yde: Low back pain and headaches are by many considered to occur mainly in adults. Because of this and because children may have difficulties in describing their symptoms, the diagnosis of such conditions in the young is problematic. This is a brief presentation of the epidemiology of low back pain and headaches in the young
Ms Maruska Massera: In this study ten children with reading and writing difficulties were followed for a period of seven months under a Neurological Reorganisation Therapy plan.
Dr Jean-François Pages: The intricacy of body and mind makes it difficult for the child to build up a representation of his own body. We will propose to study a few aspects of the history of the body in a child's life, emphasizing the fact that he discovers through his body both pain and dependence. Then we will see the different interpretations a child gives to illness and the psychological incidences that symptoms may have on the child's mind, but also on his parent's mind We will consider then the situation where the parents and their ill child come to the doctor and ask for help And finally we will mention the special situation when the parents are not ready to accept their child being ill or when they are unable to fathom the possible communicative purpose of symptoms.
Prof Claude Perret: - N.O.T. Basic procedures Examples taken in these papers will show how to build a new religion and make people believe that it is a new therapy, using a pseudoscientific presentation. The recipe is the following: - Take a few more or less known previous religions (Applied Kinesiology, acupuncture, etc.) and avoid discussing the fact that they are unproved theories. The same methods are used for acupuncture, homeopathy and many other alternative medicines. The result is that real scientists refuse them; but at the same time they refuse to look for the (few) interesting facts that can be hidden among the wrong ones; e.g. psychological influences (placebo effect, suggestion) which are real even if their physiological mechanisms remain to be identified.
Dr Jean-Luc Rime: The federal law (22.3.91), the order (22694) and the directive (1.1095) on radioprotection imposes a three-yearly cycle of quality control of the entire RX-installation on all health professionals using X-rays (RX), including a complete revision and state control of the RX generator and the film-developing devices on year 1, and a control of the constancy on years 2 and 3. Whereas some of these controls can be done by the practitioners themselves - as the constancy of the RX-generator and the quality of the film-developing process - the controls at year 1 are to be executed by specially trained personal in RX-technique and radiophysics. As quality assurance in radiology (QAR) represents an important financial market, the GP's of Switzerland have felt the need to protect the consumer and have founded the Society for Economical Management of the Medical Office (SEMMO), which in turn has chosen QMT (Quality assurance in Medical Techniques) as its partner to defend the practitioner's interests in the field of QAR. Whereas one can assume that the majority of the enterprises of the radiologic industry are serious enough to deserve the confidence of the health professionals, experience up to this time with QMT has shown that more than one colleague has been able to save thousands of SFr by taking QMT's advice.
Dr Jean Robert: Taking into account the need for a precise index of progressive idiopathic scoliosis, we duplicated the experiment described by Prof Dobosievics. Using the same postural perturbation we studied the responses of thoracic and lumbar erector spinae on normal (n=4) and scoliotic (n=11) subjects. 1. We could observe long latencies (SP?), between the initiation of the postural perturbation and the first electrical activation, and a reduced number of late components (R?) in normal and scoliotic subjects both evolutive and nonevolutive.
Dr Kurt von Siebenthal: The neurological examination of newborns means to adapt to the infant's behaviour and its needs The examiner has to know the main differences between the neurologial examination of an older infant and a newborn.
Dr Jesper Wiberg: A prospective clinically controlled randomised study of the changes in infantile colic behaviour by the two forms of treatments. One page back
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