Ken Ansell Dr. Hugo Pinto Dr. Joseph Armour Richard Lebert Dr. Timothy Scherz Kyle Neagle and neurobiological approaches (i.e. Butler). Fischhoff: All the dynamic assess-ments are functional (rehab school, Exstore, dynamic imaging, gait analy-sis). The more we combine all this in-formation, the more we have a better idea of the global dynamic context. Martinow: When I start practising, I envision my assessments to include a detailed history with accompanying neuro and ortho testing to rule in/out any serious pathology, and then proceed to a functional exam. Depending on the region this can include the squat, bal-ance test, range of motion tests, Apley’s Scratch test, hip extension/abduction to name a few. I will correlate my ortho findings with my functional assessment and base my treatment on what I find in the functional assessment. I think it is very important to add in corrective exercises at the appropriate times dur-ing the healing phases. I believe core exercises are extremely important in rehabilitation. Armour: I use functional A-T daily in my practice, which helps me quickly evaluate and identify the patient’s dys-function or adaptive changes. I then typically target these areas with medical acupuncture or soft tissue techniques. I have found the Exstore program is by far the most effective and fastest at locating dysfunction/motor inhibition. Neagle: As far as approach, I like to apply what I have learned from Dr. Craig Liebenson’s Magnificent 7, some of Gray Cook’s Selective Functional Movement Assessment, McKenzie’s lumbar assessment, Dr. Stu McGill’s input on spine biomechanics and load-ing, and of course the work of Vladimir Janda. As long as I am continuously working on patients, I don’t think I will be able to say what my exact approach is. I will be constantly refining what I feel is an adequate functional assess-ment throughout my time in clinic and in practice. One thing I know for certain www.canadianchiropractor.ca is that almost all of my functional assess-ments will have some form of squat in it (unless absolutely contraindicated upon patient presentation). It is such a crucial movement in everyday life, but also, from a clinician standpoint, the squat tells so much about a patient. Jarvis: I use information gleaned from patients during the history, mus-cle strength testing and pain location to focus types of treatment on a patient. I feel that spinal and extremity adjust-ing, contemporary acupuncture and myofascial muscle work are very im-portant in removing musculoskeletal sources of chronic and acute pain in patients. Scherz: I prefer to use the Exstore system in clinical practice. KEY POINTS: • • • Recheck the failed functional as-sessments immediately following your treatment to look for im-provements in overall mechanics. Tissues that are inhibited will not respond to exercises until that neu-romuscular junction of the inhib-ited tissue is restored using manual techniques or acupuncture. Find a system you like and use it with consistency. DO YOU THINK SCHOOLS WILL BEGIN TO INCLUDE FUNCTIONAL ASSESSMENT/ TREATMENT APPROACHES IN THEIR CURRICULUM? Scherz: I believe learning functional assessment approaches would be an-other great tool that students could learn in school. I believe the limiting factors are that if you just use func-tional assessment as part of your exam-ination you may miss very important findings that you would find on palpa-tion and other forms of clinical assess-ment such as diagnostic testing. Ansell : I think that schools will even-tually include some fundamentals of this functional assessment and treat-ment in their curriculum but the more progressively thinking schools will see the increased benefits to treatment success and adopt these principles quicker than others. I think that limit-ing factors of using functional a/t in the school curriculum will be clinical ex-perience. Functional assessment and treatment is more successful, I think, when the clinician has some clinical experience to draw on. Lomond : Already is, to a certain de-gree (OT school uses functional assess-ment). Pinto : Being a medical doctor gave me a general view to almost all of the pathologies afflicting people. Unfortu-nately, in regards to neuromuscular, myofascial and even some organic dys-functions, it did not give me the tools to properly assess the patient, and investi-gate the cause of these types of pathol-ogies, and only gave the tools to treat the consequences. This approach should be mandatory in all health schools in the world – medical, physiotherapy, chiro-practic, nursing, massage therapy and others – because it focuses on properly assessing the individual on his/her envi-ronment to truly look at the probable causes that led to the problem the pa-tient presents to you. The limiting fac-tors are the marasmus present in all these schools, with all the teaching and non-clinical staff ruling the way the students should be reached. We should learn clinically and not theoretically. Armour : It appears the trend is head-ing more towards a functional A-T model, although I personally feel that it will not become part of the schools’ curriculums. Unfortunately, even though the majority of chiropractic schools do a great job covering a full range of topics, they are often focused on teaching a curriculum that is more focused to the board exams or a more generalized curriculum rather than specific assessment and treatment tech-February 2015 Canadian Chiropractor 35
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