About Dr. Don Capoferri

Fellow, Primary Spine Care, 2-year program on spinal trauma, spinal management, advanced imaging, electrodiagnostics, accident engineering, spinal biomechanical engineering, triaging the injured, stroke diagnosis, demonstrative documentation, connective tissue pathology, ligament pathology diagnosis and management, and spinal treatment evidence-based outcome studies. The program requires collaboration in advanced imaging for spinal and MSK radiology and being published in case studies. Certified in Joint Providership from the State University of New York at Buffalo, Jacobs School of Medicine, Office of Continuing Medical Education, Cleveland University

Kansas City, College of Chiropractic, and the Academy of Chiropractic, Long Island, New York 2023

Clinical Instructor, Coding, Documentation and Compliant Coding, Ensuring the correct codes are utilized in an evaluation and management encounter. The correct elements are utilized to support the level of E&M coded along with a self-audit program to ensure ethical billing occurs. Guidelines for history of present illness, primary complaint, review of systems, family, social and past histories are discussed and how to document the same, Cleveland University, Kansas City, Academy of Chiropractic, PACE Recognized by the Federation of Chiropractic Licensing Boards, Commonwealth of Pennsylvania, Department of State Bureau of Professional and Occupational Affairs, Index # #CHPR004511, Harrisburg PA, 2022-2024

Clinical Instructor, Primary Spine Care 12 Case Management and Documentation, Cleveland University, Kansas City, Academy of Chiropractic, PACE Recognized by the Federation of Chiropractic Licensing Boards, Commonwealth of Pennsylvania, Department of State Bureau of Professional and Occupational Affairs, Index # #CHPR004515, Harrisburg PA, 2022-2024

Clinical Instructor, Pathobiomechanics and Documentation Webinar, Cleveland University, Kansas City, Academy of Chiropractic, PACE Recognized by the Federation of Chiropractic Licensing Boards, Commonwealth of Pennsylvania, Department of State Bureau of Professional and Occupational Affairs, Index # #CHPR004517, Harrisburg PA, 2022-2024

Clinical Grand Rounds – Atlanto-axial Pannus with and without rheumatoid arthritis – detailed overview of the anatomy and mechanics of the Atlanto-axial space in both diagrams and MRI studies. Overview of the clinical and laboratory diagnosis of rheumatoid arthritis and MRI as the imaging modality of choice for pannus formation in the upper cervical spine. Discussion on pannus formation being more common in non-rheumatoid arthritis patients. Overview of theories relating pannus formation to spinal instability at the C1-2 joint and identification of pannus as a common trait in the elderly. Spine Management Group, LLC, Federation of Chiropractic Licensing Boards – PACE, State University of New York at Buffalo Jacobs School of Medicine, and Biomedical Sciences – 2022.

Clinical Grand Rounds – Chiropractic Management of Head and Neck

Trauma – review of types of tissue injured in head and neck trauma including muscle, nerve, intervertebral disc, ligament, spinal cord, vertebral body, artery, or vein was presented. Clinical correlation of mechanism of injury, patient history, subjective complaint, physical examination, advanced imaging findings and electrodiagnostic testing was emphasized. Interprofessional communication and review of any diagnostic dilemmas was reviewed. Spinal compressive radiculopathy versus acute nerve injury without prolonged compression was presented. Differential diagnosis between ligament, intervertebral disc and nerve pathology was outlined in depth and presented. Emphasis was presented on spinal nerve manifestations of ligament injury in the cervical spine. Spine Management Group, LLC, Federation of Chiropractic Licensing Boards – PACE, State University of New York at Buffalo Jacobs School of Medicine, and Biomedical Sciences – 2022.

Clinical Grand Rounds – Chiropractic and the MS Patient – review of prodromal symptoms relating to the typical presentation of the multiple sclerosis patient as a novel update in clinical diagnosis. Recognition of subtle symptoms was emphasized. Multiple sclerosis as the leading cause of neurological disability in young adults was outlined and the importance of early recognition and prompt intervention. Overview of prodromal symptom trends occurring years before full symptoms appear and emphasis was placed on the Doctor of Chiropractic as a front-line provider it their recognition, clinical referral pathways were discussed. Spine Management Group, LLC, Federation of Chiropractic Licensing Boards – PACE, State University of New York at Buffalo Jacobs School of Medicine, and Biomedical Sciences – 2022.

Histology and Physical Tolerance of Spinal Ligaments – presentation of the histological structural organization of spinal ligaments including analysis of tropocollagen as the basis for anatomical structure. Review of the structural hierarchy of the spinal ligament from microscopic to macroscopic was included. Anisotropic properties of spinal ligaments were defined, and examples presented. Detailed review of spinal entheses was presented with emphasis on advanced imaging and chronic enthesopathy. New insights into the pathogenesis, diagnostic modalities, and treatment of spinal enthesis was outlined and presented. Specific focus was on traumatic injury to the spinal entheses and the difference in formation of spinal osteophytes and enthesophytes. Biomechanics of the degenerative spine was detailed and reviewed in terms of clinical spine management. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University Kansas City, College of Chiropractic – Ft. Lauderdale, Florida 2022.

Accident Reconstruction and Expert Reporting – Crash dynamics and basic physics formulas were presented and detailed. Review of biomechanical expert reports and included mathematics was discussed with context given to data collection and accuracy. Spinal injury thresholds were reviewed as well as the Law of Conservation of Energy and its relationship to crash dynamics. Specific mathematical examples were presented including workflows to review the accuracy of biomechanical expert reporting and mathematical formulas. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University Kansas City, College of Chiropractic – Ft. Lauderdale, Florida 2022.

Degenerative versus Acute Ligament Laxity – an updated scientifically validated grading system for the identification of degeneration of the intervertebral disc and motion segment was presented. Details such as radiographic signs of disc degeneration including loss of disc height, osteophyte formation and diffuse sclerosis were provided. Grading examples were provided in radiographic and gross specimen form starting with Grade 0 (no degeneration) to Grade 3 (severe degeneration). Outline of the validity and interobserver agreement of this grading system was shown for both the cervical and the lumbar spine. Review and emphasis on the difference between osteophyte formation and enthesophytes was again outlined. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University Kansas City, College of Chiropractic – Ft. Lauderdale, Florida 2022.

Chiropractic Science Research – review and presentation of updated peer-reviewed medically indexed research supporting chiropractic management of spine pain was detailed. Timeline of publication was emphasized with three years being the maximum timeframe for up-to-date data. Comprehensive review of evidence supporting chiropractic management of the spine pain patient in the Pain Management, Corrective, and the Health Maintenance Phases of care. Methods to communicate this evidence to the medical and legal communities was presented in the context of compliant patient centered clinical documentation. Efficiency of a Spine Management Physician versus conventional primary care was presented. Emphasis on the hierarchy of published evidence starting with Foundational Evidence up to Level 1 evidence was presented. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University Kansas City, College of Chiropractic – Ft. Lauderdale, Florida 2022.

Medical and Interprofessional Communication – detailed overview of medial legal communication in relation to patient subjective and objective clinical findings. Outline of direct and cross-examination techniques were presented. Overview of Voir Dire and Daubert hearings were outlined. Discussion of examination of proof in relation to causality, bodily injury, and persistent functional losses was reviewed. Court testimony flow, professional expectations, and court room etiquette was presented and emphasized. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University Kansas City, College of Chiropractic – Ft. Lauderdale, Florida 2022.

Spine Management – discussion and outline of case management workflows related to the management of acute and chronic spine pain with a particular focus on pain of traumatic origin. Evidence-Based communication and Electronic Health Record processes were emphasized and presented. Patient management and triage based on patient history, physical examination and imaging findings was outlined. Overview of interprofessional referral options including physical therapy, interventional pain management and spine surgery was discussed in detail. Spine Management as concept was discussed by Dr. John Edwards, neurosurgeon in relation to reducing escalation of non-urgent cases as well as creating space for patients with urgent need.

National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University Kansas City, College of Chiropractic – Ft. Lauderdale, Florida 2022.

Documentation and Communication in Spine Management – presentation of compliant healthcare documentation including E/M initial and re-evaluations, daily progress notes and medical-legal narrative reports was provided. Workflows detailing interprofessional referral language, advanced imaging requests and patient communication were detailed. Streamlined processes for creating and maintaining compliant, evidence based, patient centered clinical reporting was given. Emphasis was placed on the role of a Spine Management Physician in the processes of interprofessional communication and case management. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University Kansas City, College of Chiropractic – Ft. Lauderdale, Florida 2022.

Diagnosis and Management of Persistent Spine Pain – overview and discussion of spinal anatomy including intervertebral discs, ligaments, spinal nerves, spinal cord, and facet capsule was presented. Emphasis was placed on differential diagnosis, physical examination and clinical correlation of injury mechanism and patient complaint. Specific outline of facet joint injury and joint effusion was demonstrated and discussed using T1, T2 and STIR weighted MRI scans of the lumbar spine with specific attention paid to the right L3 face joint. Interprofessional communication in documentation and referral for interventional pain management consulting was presented with emphasis on facet or medial branch block injections. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards – PACE, State University of New York at Buffalo Jacobs School of Medicine, and Biomedical Sciences – 2022.

Spinal Biomechanical Engineering and Sagittal Balance of the Spine – discussion of spine care in terms of engineering principles was presented. Biomechanical parameters such as pelvic incidence, sacral slope, pelvic tilt, and sagittal balance were outlined and presented. Spinal curvature and load distribution was presented mathematically and outlined using full spine plain film radiography. Comparative anatomy between primates and humans as well as humans of different ages was presented as examples of spinal compensation. Spinal rehabilitative principles were provided in group discussion. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards – PACE, State University of New York at Buffalo Jacobs School of Medicine, and Biomedical Sciences – 2022.

Diagnosis and Management of Synovial Cyst of the Spine – review and outline of the diagnosis and management of a spinal synovial cyst was presented. Discussion surrounding patient history, physical examination and advanced imaging findings was outlined. Structure and appearance of synovial cyst on T1 and T2 weighted MRI was presented, and the benign nature of these lesions was

reviewed. Indications for specialist referral and patient centered management raging from watchful waiting to surgical intervention due to neurologic compromise was reviewed. Advanced imaging differences between plain film radiographs, CT and MRI was outlined and discussed. MRI signal on T2 weighted image in relation to cerebral spinal fluid was highlighted. Spine Management Group, LLC, Federation of Chiropractic Licensing Boards – PACE, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2022.

Diagnosis and Management of Schwannoma – discussion of a case pertaining to traumatically induced pathology to the spine of a 59-year-old female. Outline of pathological reflexes and detailed physical examination best practices. Review of important imaging included CT axial, CT sagittal and CT coronal views as well as T2 FSE sagittal, T2 FSE axial and STIR Sagittal MRI studies were reviewed and clinically correlated. Relevant cervical and lumbar spinal anatomy in in the sagittal, axial, and coronal planes was detailed on MRI and CT studies. Interprofessional communication with the spine surgeon was presented and review of surgical intervention including ACDF (anterior cervical discectomy and fusion) procedure to the patient’s cervical spine. Spine Management Group, LLC, Federation of Chiropractic Licensing Boards - PACE. State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2022.

Diagnosis and Management of Vertebral Osteomyelitis – review of the causes of vertebral osteomyelitis was presented including findings on patient subjective complaint and objective findings on physical examination. Differentiation between plain film radiographs, T1, T2, Flair and STIR weighted imaging was presented and discussed. Associated clinical findings including infections in adjacent areas including intervertebral discitis areas was presented. Causes of osteomyelitis including past surgical procedure, frequent injections, infection in an adjacent tissue, IV drug use and long-term corticosteroid use were presented. Anterior elements of the functional motor unit were outlined as the primary location of osteomyelitis. Correlation clinically to difficulties in identifying this clinical entity in its early stages was reviewed. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards - PACE. State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2022.

Diagnosis and Management of Lumbar Arachnoiditis – outline of the causes of arachnoiditis in the human spine was presented. Specific focus was on a case of lumbar arachnoiditis involving the cauda equina evidenced on T1, T2 sagittal and axial MRI. Treatment options and lack of curative interventions was presented. Relevant anatomy of the lumbar spine including cauda equina, conus medullaris, filum terminable, dura mater, pia mater and arachnoid mater were reviewed in detail. Review of arachnoiditis and chiropractic adjustment were discussed as well as interprofessional coordination of care with interventional pain management and surgical consultation. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards - PACE. State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2022.

Diagnosis and Management of Anterior Sacral Contusion – overview and discussion of contusion of the anterior sacral ala in an elite college cross-country runner. Physical examination outlining range of motion, neurological and orthopedic examination was reviewed and correlated to the subjective complaint of right sided lower back pain. Misdiagnosis was presented and long-standing symptoms resulting in possible cessation of play for this athlete. Discussion of interprofessional communication with the neuroradiologist and subsequent MRI order with slices through the anterior sacrum was reviewed and presented. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards - PACE. State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2022.

Chiropractic Diagnosis and Management of Non-Specific Spine Pain – outline and discussion of the mechanical origins of spine pain emphasizing common biomechanical parameters was presented. Review of chiropractic-based maintenance care in the management of patient centered spine pain was introduced. Introduction of a Spine Management Physician was presented outlining the natural history of spine pain in the human population. Interprofessional communication and case management was emphasized with focus on societal burden of mismanagement was presented. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards - PACE. State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2021.

Chiropractic Diagnosis and Management of Vertebral Compression Fracture – review of the influence of osteoporosis on development of vertebral compression fracture was reviewed and detailed in comparison to neoplasm. Utilization of MRI as the gold standard for evaluating the age of and pathophysiology was discussed and presented. Absorptiometry was outlined and presented in relation to monitoring bone density. Interprofessional communication of absolute versus relative contraindications to conservative care and spinal manipulation was outlined and reviewed. Review of the three columns of vertebral architecture was detailed. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards - PACE. State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2021

Chiropractic Diagnosis and Management of the Pre-Surgical Patient – outline and analysis of spinal biomechanical parameters in a whole spine model of care. Review of the details of measuring Pelvic Incidence and discussion of history of its analysis. Outline of movement from a regional model of spine care to a full spine model was presented. Analysis of the components of the pre-surgical patient including muscle movement patterns, segmental mobility, spinal curvature and rotation in the coronal, sagittal and axial planes was presented. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards - PACE. State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2021.

Chiropractic Diagnosis and Management of Lumbar Ligament Laxity – detailed outline of injury thresholds of the anterior longitudinal, posterior longitudinal and ligamentum flavum was presented in the lumbar spine. Review of structural and physiological properties relating to stress/strain curve of the above ligaments. Outline of the toe region, linear region and failure region was demonstrated. Transversely isotropic material properties of spinal ligaments were included and correlated to chiropractic care and impairment rating using the AMA Guides to the Evaluation and Management 5th and 6th editions. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards - PACE. State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2021

Clinical Grand Rounds – Chiropractic Diagnosis and Management of Cervical Ligament Laxity – detailed outline of injury thresholds of the anterior longitudinal, posterior longitudinal and ligamentum flavum was presented. Review of structural and physiological properties relating to stress/strain curve of the above ligaments. Outline of the toe region, linear region and failure region was demonstrated. Transversely isotropic material properties of spinal ligaments were included and correlated to chiropractic care and impairment rating using the AMA Guides to the Evaluation and Management 5th and 6th editions. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards - PACE. State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2021.

Clinical Grand Rounds – Chiropractic Management of Cervical Myelopathy – review of all relevant spinal anatomy in the cervical and lumbar spine including vertebral bodies, central canal, neuroforamen, ligamentum flavum, anterior and posterior longitudinal ligaments, facet capsule, interspinous ligament, supraspinous ligament, and spinal cord anatomy. Review of spinal cord anatomy included white and gray matter, ventral and dorsal nerve roots, spinal nerve including the dura mater, arachnoid mater, and pia mater. Specific review of patient history, mechanism of injury, physical examination including neurological and orthopedic evaluation as well as criteria for ordering and reading advanced imaging such as MRI and CT were presented in relation to cervical myelopathy, spinal cord compression and myelomalacia. Patient centered; consensus driven clinical diagnosis including interprofessional communication was presented, specific presentation relating to diagnostic outcomes and management. Attention was given to MRI and CT myelogram in both the uncomplicated and complicated patient. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards - PACE. State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2021.

Clinical Grand Rounds – Chiropractic Management of Lumbar Disc Herniation – review of the pathogenesis and morphological presentation of lumbar intervertebral disc herniation. Outline of patient history, physical examination including neurological and orthopedic evaluation as well as criteria for ordering and reading advanced imaging such as MRI and CT were presented. Plain film static and dynamic radiographic studies were reviewed. Patient centered; consensus driven clinical diagnosis including interprofessional communication was presented. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2021.

Clinical Grand Rounds – Chiropractic Management of Cervical Radiculopathy – characterization of cervical radiculopathy in terms of neurological dysfunction including compression and inflammation of the spinal nerves was reviewed. Cervical spondylosis and intervertebral disc herniation as causative factors were presented and discussed. Conservative care as well as surgical intervention were presented and correlated to response to care and clinical findings. Outline of patient history, physical examination including neurological and orthopedic evaluation as well as criteria for ordering and reading advanced imaging such as MRI and CT were presented. Plain film static and dynamic radiographic studies were reviewed. Patient centered; consensus driven clinical diagnosis including interprofessional communication was presented. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2021.

Clinical Grand Rounds – Importance of Interprofessional Healthcare Communication and Teamwork – Discussion of the history of interprofessional healthcare and the acknowledgement by the World Health Organization was presented. Specific detail on chiropractic academia and student perception of its importance was outlined. The growth and importance of both interprofessional education and communication was stressed and reviewed. Need for a clear

professional identity to facilitate interprofessional education and communication was presented. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2021.

Clinical Grand Rounds – Cervical Spinal Alignment and Knee Replacement Revision Rates – Review of the most common cervical spinal sagittal alignment parameters and their relationship to interprofessional communication was presented. Discussion of rationale for knee replacement revision surgery including aseptic loosening, fracture and prosthetic joint infection was reviewed. Specific statistical review on revision surgery and effective treatment of end-stage knee osteoarthritis was presented. Details of evidence-based research outlining patients with cervical degenerative disorders having a higher rate of total knee replacement revisions than those without degenerative changes. Analysis of the benefit of radiographic studies looking at the mechanical relationship between the cervical spine and knee composition was outlined and reviewed. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2021.

Spine Management Conference – West – The Spine Management Physician – discussion of the Spine Management Physician concept utilizing supportive evidence was presented. Outline of trends in spinal pain management versus a curative model was discussed. Credentials, training, and triage methods were demonstrated for the Doctor of Chiropractic to increase proficiency in spine management. Scientific evidence supporting the need for a portal of entry physician dedicated to spine management oversight was outlined. Key differences between Spine Management Physician and Primary Spine Care were discussed. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University of Health Sciences, College of Chiropractic, Kansas City 2021 Spine Management Conference – West.

Chiropractic Evidence – Pain Management Care – outline of neurological mechanisms of central nervous system modulation of pain in the human body was demonstrated. Specific peer-reviewed, medically indexed evidence was presented starting with 2012 Systematic Review outlining spinal manipulation’s effectiveness in pain management. Current evidence as well as future trends were discussed and presented. Neurological downregulation was discussed including afferent and efferent neurological pathways regulated by the dorsal horn of the spinal cord. Interprofessional communication and compliant documentation of the pain management phase of care was emphasized. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University of Health Sciences, College of Chiropractic, Kansas City 2021.

Spine Management Conference – West – Physical Examination Workflows – Cervical Spine – detailed review of cervical spinal physical examination with emphasis on clinical triage between anatomical and biomechanical sources of spine pain. Neurological evaluation of the neck and surrounding structures was reviewed including pathological reflexes, assessment of vascular compromise and myelopathic findings. Detailed patient screening was stressed and its correlation to physical examination, red flags and relative vs absolute contraindications to chiropractic care was presented. Patient positioning and efficient processes were reviewed and demonstrated. Details relating to cervical spine and orthopedic testing was discussed. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University of Health Sciences, College of Chiropractic, Kansas City 2021

Spine Management Conference – West – Physical Examination Workflows – Thoracic and Lumbar Spine and Pelvis – outlines of thoracic, lumbar and pelvis physical examination were presented. Neurological evaluation of the lumbar spine and surrounding structures was reviewed including pathological reflexes, assessment of cauda equina syndrome and triage processes for neurologically compromised patients. Detailed screening was stressed and its correlation to physical examination, red flags and relative vs absolute contraindications to chiropractic care was reviewed. Patient positioning and efficient processes was reviewed and demonstrated. Details relating to lumbar spine and pelvic orthopedic testing was discussed. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University of Health Sciences, College of Chiropractic, Kansas City 2021

Spine Management Conference – West – Interprofessional Communication and Reporting – review of electronic health record workflows was presented and discussed with emphasis on CPT compliant and efficient reporting. The importance of communication with the patient’s other healthcare providers was outlined and discussed. Specific needs of the primary care physician, pain management physician and spine surgeon were outlined and reviewed. Details of simplified vocabulary and necessity of thoroughness were emphasized. Administrative workflows ensuring regular and continued communication of clinical documentation was provided. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University of Health Sciences, College of Chiropractic, Kansas City 2021

Spine Management Conference – West – Patient Communication – communication techniques were discussed with emphasis on patient comprehension to increase compliance and reduce patient anxiety. Details were presented on simplification of complex medical terminology to ensure understanding at the initial visitation as well as throughout the patient’s care plan. Conversational interaction and dissemination of health information at the appropriate comprehension level was provided. Proper reporting and interprofessional communication were emphasized in a wholistic approach to supporting the patient’s needs. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University of Health Sciences, College of Chiropractic, Kansas City 2021

Spine Management Conference – West – Intervertebral Disc Morphology – detailed discussion of the morphological descriptions of intervertebral disc pathology in the cervical, thoracic, and lumbar spine was presented. Differential diagnosis of disc bulge, herniation, protrusion, extrusion, and sequestration were presented. Attention was given to the five grades of annular fissure associating circumferential, radial, and transverse morphology. High intensity zone (HIZ) was discussed in detail as well as its correlation to acute inflammatory fluid. Specific MRI images were presented and correlated to consensus driven definitions of intervertebral disc pathology. Pre-existing degenerative changes in the human spine such as disc osteophyte complex, spondylosis, increased innervation of the intervertebral disc and endplate changes were discussed and correlated to acute findings on MRI. In depth discussion of the difference between morphology and etiology of intervertebral disc pathology was outlined. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University of Health Sciences, College of Chiropractic, Kansas City 2021

Spine Management Conference – West – Ligamentous Response to Traumatic Injury – anatomical review of spinal ligaments including nerve supply and formation of scar tissue post injury was presented. Function and histological composition were detailed and clinically correlated to physiological thresholds. Injury thresholds were also outlined and compared to the AMA Guides to the Evaluation of Permanent Impairment 5th and 6th edition. Detailed review of radiographic findings in the cervical and lumbar spine in the presence of ligamentous injury was reviewed and presented. Clinical criteria supporting the diagnosis of ligament injury and ligament laxity including patient history, physical examination, radiographic findings, and advanced imaging was presented. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University of Health Sciences, College of Chiropractic, Kansas City 2021

Spine Management Conference – West – Causality and Spinal Ligamentous Injury - detailed outline of acute versus chronic spine injury findings were presented. Reliable grading systems for phases of spinal degeneration was reviewed and discussed. Scientifically validated measuring process for intervertebral disc height and the 5 Grades of spinal degeneration proposed by Kettler were outlined. Specific discussion was presented in the differential diagnosis of ligament laxity due to degenerative process and acute ligamentous injury in the functional spinal unit with specific examples of radiographic and advanced imaging findings. Clinical correlation with Modic I, Modic II and Modic III endplate changes including cadaver specimens was presented. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University of Health Sciences, College of Chiropractic, Kansas City 2021

Spine Management Conference – West – Differential Spinal Tissue and Spinal Injury Triage – review of spinal tissue types and their response to physical stress and injury was presented. Prognostic factors in patient management were presented in relation to injury to spinal musculature, nerve tissue, ligamentous tissue, intervertebral disc, and bone. Tissue based triage, patient and interprofessional communication was emphasized and stressed. National

National Spine Management Group, LLC - Copyright 2021 Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University of Health Sciences, College of Chiropractic, Kansas City 2021

Spine Management Conference – West – Innervation of Spinal Structures – specific reviewed of the anatomical innervation of pain generating structures in the human spine was presented. Scientific chronology of nerve supply discovery was presented and discussed. Increased innervation of the degenerating interverbal disc was presented and supported with contemporary scientific evidence. Spinal ligamentous structures as pain generating entities were also reviewed including anterior longitudinal ligament, posterior longitudinal ligament, supraspinous ligament, interspinous ligament and facet capsule. Clinical correlation to patient history, physical examination and imaging findings was emphasized with specific discussion on interprofessional triage and patient management. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, Cleveland University of Health Sciences, College of Chiropractic, Kansas City 2021

Clinical Grand Rounds – Aberrant Spinal Motion and Degenerative Disc Disease research analysis of mechanic factors as etiology of intervertebral disc degeneration. Review of spinal tissue mechanics and their relation to mechanical stress was discussed and corelated to abnormal changes in the structure and composition of the intervertebral disc. Detailed discussion of ingrowth of pain transmitting nerve fibers into degenerative intervertebral discs and their relationship to acute and chronic pain was presented. Clinical correlation between congenital malformations of the spine, including scoliosis, kyphosis, spina bifida, spondylolysis and Klippel Feil syndrome), accidental back injury or ligament injury, occupational exposure and causing aberrant mechanical loading of lumbar spine, and intervertebral disc degeneration visible on T1, T2 and STIR MRI, sagittal and axial sequences was presented. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2021.

MRI Interpretation Review Qualified, recognized by Cleveland University-Kansas City, Chiropractic and Health Sciences with courses recognized by the ACCGME in conjunction with the State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences. Qualification approved by the American Chiropractic College of Radiology (ACCR) and the American Chiropractic Board of Radiology (ACBR) 2021-Present

Clinical Grand Rounds – Pelvic Incidence, Chiropractic, and the Spine Surgeon – detailed analysis of the historical publication of Pelvic Incidence as an integral part of the sagittal spinal balance. Inter-professional communication with the surgeon using peer-reviewed medically indexed biomechanical parameters was outlined and presented. Functional interaction between the spine and pelvis was demonstrated and discussed. Components of Pelvic Incidence, sacral slope, pelvic tilt, and femoral heads were reviewed and demonstrated on plain film radiographs. Specific updated research regarding spinal pelvic balance and pelvic incidence measurements was provided. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2021.

Clinical Grand Rounds – Patient Triage – testing and physical examination workflows – evidence-based evaluation of the spine pain patient was outlined and presented. A thorough review of criteria for ordering plain film and advanced imaging was discussed and demonstrated. Clinical rationale for ordering electrodiagnostic testing and patient referral criteria overview was demonstrated. EMR and documentation workflows were discussed, and efficiency protocols were outlined and applied to evidence-based physical examination procedures with and without a medical scribe. Details of re-evaluations and clinical outcomes were reviewed and discussed. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2021.

MRI Spine Clinical Grand Rounds, Interpretation sequencing of STIR, T1, T2, Axial and Sagittal acquisitions. Landmarks, physics, and literature-based definitions of disc and osseous pathology, Visualizing, diagnosing, and documenting cervical and lumbar anatomy vs. pathology. Academy of Chiropractic Post-Doctoral Division, Accreditation Council for Continued Medical Education in conjunction with The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Cleveland University - Kansas City, Long Island, NY, - 2021

MRI Spine Clinical Grand Rounds, Visualizing, diagnosing, and documenting lumbar spine sequencing, disc herniations, neural canals, cauda equina, conus medullaris, nerve sleeves, canal stenosis grading, and vertebral width vs. height in determining segmental remodeling. Diagnosing thecal sac abutment, central canal root compression and ligamentum flava involvement. Academy of Chiropractic Post-Doctoral Division, Accreditation Council for Continued Medical Education in conjunction with The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Cleveland University - Kansas City, Long Island, NY, - 2021

MRI Spine Clinical Grand Rounds, Case study visualizing, diagnosing, and documenting cervical spine sequencing, disc herniations, neural canals, cauda equina, conus medullaris, and vertebral width vs. height in determining segmental remodeling. Identifying the Pons, Occipital junction, and spinal cord to identify Chiari 1 malformations. Academy of Chiropractic Post-Doctoral Division, Accreditation Council for Continued Medical Education in conjunction with The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Cleveland University - Kansas City, Long Island, NY, - 2021

MRI Spine Clinical Grand Rounds, Visualizing, diagnosing, and documenting lumbar spine sequencing, disc extrusion type herniations, neural canals, cauda equina, conus medullaris, spondylolisthesis, degenerative spondylolisthesis, disc degeneration, neural canal and central root compressions, central canal stenosis. Varices vs. herniations, and multiple level disc pathology with biomechanical failures. Academy of Chiropractic Post-Doctoral Division, Accreditation Council for Continued Medical Education in conjunction with The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Cleveland University - Kansas City, Long Island, NY, 2021

MRI Spine Clinical Grand Rounds, Visualizing, diagnosing, and documenting cervical spine sequencing, disc extrusion type herniations, neural canals, disc degeneration, thecal sac compression, central canal stenosis, cord displacement, reversal of cervical curve, Chiari 1 malformation. Identifying spinal biomechanical failure in MRI sequencing, with visualizing ligamentous pathology as cause for failure. Differentially diagnosing recent vs. older trauma based upon edematous signal in T1, T2, and STIR images. Academy of Chiropractic Post-Doctoral Division, Accreditation Council for Continued Medical Education in conjunction with The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Cleveland University - Kansas City, Long Island, NY, 2021

MRI Spine Clinical Grand Rounds, Visualizing, diagnosing, and documenting cervical spine sequencing, multiple disc extrusion type herniations, vertebral remodeling, intradural tumor displacing the spinal cord visualized in T1, T2, and STIR sequences, neural canal stenosis, disc degeneration, thecal sac compression, central canal stenosis, cord displacement, reversal of cervical curve, Chiari 1 malformation, and identifying of inferior brain structures. Academy of Chiropractic Post-Doctoral Division, Accreditation Council for Continued Medical Education in conjunction with The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Cleveland University - Kansas City, Long Island, NY, - 2021

 

MRI Spine Clinical Grand Rounds, Visualizing, diagnosing, and documenting 1) improper sequence acquisitions invalidating interpretation 2) incomplete study invalidating interpretation 3) visualizing, diagnosing, and documenting lumbar spine sequencing, multiple disc extrusion type herniations, vertebral remodeling, multiple thecal sac compressions, neural canal stenosis, disc osteophyte/ridging complex, central canal stenosis, spondylolisthesis. Identifying the spleen, liver, kidneys, inferior vena cava, and psoas musculature on imaging. Academy of Chiropractic Post-Doctoral Division, Accreditation Council for Continued Medical Education in conjunction with The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Cleveland University - Kansas City, Long Island, NY, - 2021

 

MRI Spine Clinical Grand Rounds, Visualizing, diagnosing, and documenting cervical spine sequencing, cervical spondylosis, pathological spinal biomechanics, reversal of lordotic curve, and vertebral width vs. height in determining segmental remodeling, central herniation, thecal sac compression of the cord, identifying tongue, epiglottis, hyoid cartilage, pharynx, thyroid. Reviewing fat saturation sequences for osseous metastatic tumors and advanced degeneration. Academy of Chiropractic Post-Doctoral Division, Accreditation Council for Continued Medical Education in conjunction with The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Cleveland University - Kansas City, Long Island, NY, - 2021

 

MRI Spine Clinical Grand Rounds, Visualizing, diagnosing, and documenting lumbar spine sequencing, degenerative disc disease, nerve root sleeve abutment, far lateral herniations vs. bulges, normal vs. dissected inferior vena cava aneurism, epidural fat as a space-occupying lesion, facet arthropathy and edema, hypertrophy of ligamentum flava, and pseudo disc at the S1-S2 level. Academy of Chiropractic Post-Doctoral Division, Accreditation Council for Continued Medical Education in conjunction with The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Cleveland University - Kansas City, Long Island, NY, 2021

 

MRI Spine Clinical Grand Rounds, Visualizing, diagnosing, and documenting cervical spine sequencing utilizing T1 weighted images for pathology, inclusive of advanced degeneration and tumor detection. STIR in a fat-saturated image for ligamentous pathology inclusive of the posterior longitudinal, ligamentous flava and interspinal ligaments. Normal clivus and odontoid for cerebellar tonsil location. Cerebral spinal fluid (CSF) flow and the utilization of the spinal cord’s central canal for CSF transport. Academy of Chiropractic Post-Doctoral Division, Accreditation Council for Continued Medical Education in conjunction with The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Cleveland University - Kansas City, Long Island, NY, -2021

 

Clinical Grand Rounds – Diagnosis of Lumbar Facet Syndrome – overview of the most common pain syndrome in the lumbar spine, including societal burdens, was presented. Discussion of facet joint arthrosis being the most frequent facet joint pathology in the human spine. An outline of the level of correlation between clinical symptoms, physical examination findings, and degenerative spinal conditions was discussed. Presentation of diagnostic facet block and the medical necessity of such a referral, when indicated, was outlined. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2021.

 

Clinical Grand Rounds–Inter-professional Communication with the Personal Injury Attorney – review of the outlined of the initial and re-evaluation E/M reporting in an injured patient. Discussion targeted compliant reporting and interprofessional communication with the attorney. Specific methods of ensuring compliant reporting were discussed and outlined. The statutory language, permanency determination and impairment were presented and reviewed in contact of the final narrative report. Emphasis was placed on the objectification of persistent functional loss and causal relationship in the personal injury patient. Supporting medical evidence of intervertebral disc pathology including disc herniation, disc bulge and annular tear was provided. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2021.

 

Clinical Grand Rounds – Chiropractic Professional Liability Litigation – Discussion of thirty years of jury verdict data was reviewed and presented. Focus was on the rationale for claims against Doctor of Chiropractic and overall decisions rendered by jury pools. Outlining the risk factors associated with overly aggressive treatment, failure to diagnose, and lack of interprofessional referral when medically necessary was presented with statistics. Comparisons between chiropractic management and surgical management were outlined and detailed. A detailed analysis of causality versus correlation was presented and discussed. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2021

 

Documentation and Coding, CPT Coding Guidelines for Initial and Established Patients with particular attention paid to Patient History, Review of Systems, Social and Family History, Physical Examination, and Medical Decision making. Specific differences in coding levels and required elements for a 99202-99203-99204-99205 and a 99212-99213-99214-99215. Academy of Chiropractic Post-Doctoral Division, Cleveland University – Kansas City Long Island, NY, 2021

 

Demonstrative Documentation and Ethical Relationships, Pathways to improve coordination of care, and interprofessional communication with collaborating physicians. Maintaining ethical relationships in the medical-legal community through documentation and communication of demonstrable diagnosis, prognosis, and treatment plans. Academy of Chiropractic Post-Doctoral Division, Cleveland University – Kansas City Long Island, NY, 2021

 

MRI Spine Interpretation, Clinical case review of MRIs including sagittal, axial, T1, T2, STIR, and proton density sequences. Identified will be the vertebrate, spinal cord, discs, nerve roots, thecal sac, posterior longitudinal ligament, epidural veins, and fat saturation pulses. Pathology will include bulges, herniations, protrusions, extrusions, myelomalacia, cord edema, and Schmorl’s nodes. Academy of Chiropractic Post-Doctoral Division, Cleveland University – Kansas City Long Island, NY, 2021

 

Spinal Biomechanical Engineering Clinical Grand Rounds, Case reviews utilizing E/M, MRI, and x-ray mensuration report to conclude an accurate diagnosis, prognosis, and treatment plan. Common diagnosis requiring interprofessional collaboration with a discussion of diagnostic dilemmas and proper communication methods. Academy of Chiropractic Post-Doctoral Division, Cleveland University – Kansas City Long Island, NY, 2021

 

Clinical Grand Rounds – Biomechanical Analysis in Patient Crash Injuries – Detailed review of the difference between biomechanical and biomedical analysis of injuries was presented. Outline of necessity of the use of properly credentialed biomechanical and crash investigation professionals in the diagnosis, management and reporting of crash injuries. Review of specific research related to forces during Activities of Daily Living and those sustained in

 

Clinical Grand Rounds – Advanced Imaging Upper Cervical Spine and Documentation – Discussion and review of ligament injury in the upper cervical spine. Focus was on missed diagnosis due to a lack of imaging and interprofessional communication. Discussion of upper cervical anatomy including occipital condyles, C1/C2 articulation in both MRI, plain film and CT scanning was presented using imaging slides. Clinical documentation was reviewed with particular attention paid to clinical documentation errors form other providers. Discussion on case management and interprofessional communication to correct documentation errors was emphasized. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2021.

 

Mini-Fellowship in Musculoskeletal Radiology – MSK Extremities, Identifying arthritis, advanced cartilage pathology, rotator cuff tears, labral tears, tendon injuries and degeneration, meniscal tears, ligamentous injuries, common fractures, sports related injury patterns, and plantar fasciitis in both upper and lower extremities, Academy of Chiropractic Post-Doctoral Division, Accreditation Council for Continued Medical Education in conjunction with The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, PACE Approved for the Federation of Chiropractic Licensing Boards, Cleveland University, Kansas City, -2021.

 

Mini-Fellowship in Musculoskeletal Radiology – MSK Extremities – Clinical Research, Contemporary literature based evidence with rheumatoid, osteo, spondylar, gouty, and Psoriatic arthritides, advanced cartilage pathology, rotator cuff tears, labral tears, tendon injuries and degeneration, meniscal tears, ligamentous injuries, common fractures, sports related injury patterns, and plantar fasciitis in both upper and lower extremities, Academy of Chiropractic Post-Doctoral Division, Accreditation Council for Continued Medical Education in conjunction with The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, PACE Approved for the Federation of Chiropractic Licensing Boards, Cleveland University, Kansas City, - 2021.

 

Clinical Grand Rounds – Facet Joint Thresholds and Alteration of Motion Segment Integrity – discussion of the predominant mode of joint loading of the cervical facet joints during whiplash injury related to retraction tension on the facet joint capsule. Review of shear forces, translation of the inferior and superior facet joint as well as injury risk due to excessive stretching of spinal ligaments was presented. Overview and discussion of mechanical trauma to ligament tissue and subsequent microstructural damage not visibly detected was outlined. Threshold for microstructural changes during retraction, reduced ligament stiffness and unrecovered strain was discussed in detail. Individual response to facet joint capsule response supported in the medical literature was presented. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2021.

 

Clinical Grand Rounds – Mechanical Response of Damaged Human Cervical Spine Ligaments – discussion of the biomechanical properties of cervical spinal ligaments under sub-failure loads. Ligaments discussed were the Anterior Longitudinal Ligament, Posterior Longitudinal ligament and the Ligamentum Flavum. Deformations exceeding physiological limitations were presented and reviewed. Grade I and Grade II injuries were outlined and discussed. Presentation included observed ligamentous injury significantly compromising ligament ability to give tensile support within physiological spinal motion. Findings were clinically correlated to long term sequalae in Alteration of Motion Segment Integrity and the AMA Guides to the Evaluation of Permanent Impairment 5th and 6th Editions. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2021

 

Clinical Grand Rounds – Classification of Degenerative Cervical Degenerative Disc Disease – review of a radiographic rating system for objective assessment of intervertebral disc degeneration in the cervical spine. The degree of degeneration was organized based on loss of disc height, formation of osteophytes and the presence of diffuse sclerosis of adjacent vertebral bodies. Specific details of assessment were outlined and presented. Comparison of plain film radiographs to cadaver specimens was demonstrated and discussed. Review of interobserver validity of the grading system between observers was presented. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2021.

 

Clinical Grand Rounds – Biomechanical Compensation and Intervertebral Disc Extrusion detailed review of MRI documented lumbar disc extrusion measuring 12mm including STIR, T1 and T2 sagittal and axial images. Presentation of radiographic biomechanical analysis outlining sagittal alignment and vertebral body rotations. Discussion of co-management of spinal pathology while considering both the biomechanical and anatomical components of spine pain. Radiographic review included lateral neutral, lateral flexion, lateral extension and AP views. Clinical correlation and discussion of pre and post-surgical care was outlined. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2021.

Clinical Grand Rounds – Diagnosing Mechanical Spine Pain – review of specific cervical anatomy in the spine pain patient. Clinical correlation between plain film radiographs and MRI studies was reviewed including radiographic motion studies. Computerized Mensuration Analysis was outlined and discussed with findings correlating with normative translation and angular motion data. Review of the AMA Guides to the Evaluation of Permanent Impairment 5th and 6th Editions was presented. National Spine Management Group, LLC, Federation of Chiropractic Licensing Boards, State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences – 2021.

Spine Management Clinical Workflows – in-depth review and discussion of the Doctor of Chiropractic as a Spine Management Physician with specific focus on the diagnosis and management of spine pain of mechanical origin. Details were outlined in relation to triage of anatomical causes of spine pain such as fracture, tumor, infection. National Spine Management Group, Cleveland University Kansas City, Chiropractic and Health Sciences, Federation of Chiropractic Licensing Boards, Buffalo, NY, Lehi, UT 2021.

Pain Management and the Chiropractic Adjustment – Current peer reviewed indexed research demonstrating the chiropractic adjustment’s effect on the central nervous system and pain threshold was outlined and reviewed. Anatomical review and contemporary supportive research were discussed. Details of central nervous system response to the chiropractic adjustment was reviewed and demonstrated. National Spine Management Group, Cleveland University Kansas City, Chiropractic and Health Sciences, Federation of Chiropractic Licensing Boards, Buffalo, NY, Lehi, UT 2021.

Corrective Spinal Care and Chiropractic Case Management - Current peer reviewed indexed research demonstrating the chiropractic adjustment’s effect on the biomechanical structure of the human spine during the corrective/rehabilitative phase of care. Basic outline of biomechanical parameters in symptomatic and asymptomatic patients was reviewed with particular focus on pathobiomechanics in chiropractic practice. National Spine Management Group, Cleveland University Kansas City, Chiropractic and Health Sciences, Federation of Chiropractic Licensing Boards, Buffalo, NY, Lehi, UT 2021.

Health Maintenance Care and Chiropractic Case Management - Current peer reviewed indexed research demonstrating the chiropractic adjustment’s effect on the maintenance of the human spine. Details of indexed research reviewing Chiropractic’s role in the reduction of narcotic utilization and decreased absenteeism from work due to disability. Communicating Health Maintenance Care to the medical profession and the public was emphasized. National Spine Management Group, Cleveland University Kansas City, Chiropractic and Health Sciences, Federation of Chiropractic Licensing Boards, Buffalo, NY, Lehi, UT 2021.

Evidence-Based Clinical Reporting – overview of current CPT and ICD-10 coding guidelines pertaining to the evaluation and management of spine pain patients was presented. Timed codes and relevant diagnosis related to injured tissue was presented. A specific discussion of the proper format of the Assessment portion of clinical documentation was presented. A review of the difference between daily progress notes and Evaluation and Management [E/M] reporting was provided. National Spine Management Group, Cleveland University Kansas City, Chiropractic and Health Sciences, Federation of Chiropractic Licensing Boards, Buffalo, NY, Lehi, UT 2021.

Cervical Spine Clinical Workflows – detailed review of workflows of thorough patient history and identification of clinical red flags related to relative and absolute contraindications to chiropractic care was presented. An outline of neurological examination, including pathological reflexes present during spinal cord compression, cervical stenosis, and cervical myelomalacia, was discussed. Normal vs abnormal measurement of range of motion objectifying spinal dysfunction was presented. Specific orthopedic testing related to specific muscle, nerve or intervertebral disc injury was discussed. A review of interprofessional triage and imaging decision tree was outlined with a specific focus on the pain management physician and spinal surgeon. National Spine Management Group, Cleveland University Kansas City, Chiropractic and Health Sciences, Federation of Chiropractic Licensing Boards, Buffalo, NY, Lehi, UT 2021.

Lumbar Spine Clinical Workflows - detailed review of workflows of thorough patient history and identification of clinical red flags related to relative and absolute contraindications to chiropractic care was presented. An outline of neurological examination, including pathological reflexes present during cervical and lumbar stenosis, was discussed. Normal vs abnormal measurement of range of motion objectifying spinal dysfunction was presented. Specific orthopedic testing related to muscle, nerve or intervertebral disc injury was discussed. A review of interprofessional triage and imaging decision tree was outlined with a specific focus on the pain management physician and spinal surgeon. National Spine Management Group, Cleveland University Kansas City, Chiropractic and Health Sciences, Federation of Chiropractic Licensing Boards, Buffalo, NY, Lehi, UT 2021.

Interprofessional Clinical Documentation for the Primary Care Physician – contemporary techniques to best communicate chiropractic care to the Primary Care Physician was discussed and presented. Analysis of the depth and scope of communication was emphasized with direct focus on the proper documentation management system, including demographic sheet, imaging reports, most recent evaluation, and management reports. A discussion of appropriate timing for phone consultation was presented. National Spine Management Group, Cleveland University Kansas City, Chiropractic and Health Sciences, Federation of Chiropractic Licensing Boards, Buffalo, NY, Lehi, UT 2021.

Clinical Documentation for the Spine Surgeon - contemporary techniques to best communicate chiropractic care to the spine surgeon was discussed and presented. Analysis of the depth and scope of communication was emphasized with a direct focus on the proper documentation management system, including demographic sheets, imaging reports, most recent evaluations, and management reports. A discussion of appropriate timing for phone consultation was presented. National Spine Management Group, Cleveland University Kansas City, Chiropractic and Health Sciences, Federation of Chiropractic Licensing Boards, Buffalo, NY, Lehi, UT 2021.

Clinical Documentation for the Pain Management Physician - contemporary techniques to best communicate chiropractic care to the pain management physician was discussed and presented. Analysis of the depth and scope of communication was emphasized with a direct focus on the proper documentation management system, including demographic sheet, imaging reports, most recent evaluation and management reports. A discussion of appropriate timing for phone consultation was presented. National Spine Management Group, Cleveland University Kansas City, Chiropractic and Health Sciences, Federation of Chiropractic Licensing Boards, Buffalo, NY, Lehi, UT 2021.

Clinical Documentation for Attorney - contemporary techniques to best communicate chiropractic care and permanent injury to the personal injury attorney was discussed and presented. Analysis of the depth and scope of communication was emphasized with a direct focus on the proper documentation management system, including diagnosis, response to treatment, causality, and persistent functional loss was outlined. A discussion of appropriate timing for phone consultation was presented. National Spine Management Group, Cleveland University Kansas City, Chiropractic and Health Sciences, Federation of Chiropractic Licensing Boards, Buffalo, NY, Lehi, UT 2021.

Spinal Biomechanical Engineering – detailed presentation of the progression of laboratory-based biomechanics into the clinical realm was outlined. Evidence-based review of Pelvic Incidence and other sagittal balance parameters was presented. Regional sagittal balance and communication with the spine surgeon in the spine management practice was reviewed. Specific discussions were related to spinal sagittal balance and the non-surgical spine pain patient and correlated to the Corrective Care Phase of Chiropractic Care. An outline of the future of full spine biomechanical modeling was presented in relation to symptomatic and asymptomatic patients. National Spine Management Group, Cleveland University Kansas City, Chiropractic and Health Sciences, Federation of Chiropractic Licensing Boards, Buffalo, NY, Lehi, UT 2021.

Objectifying the Biomechanical Spine Lesion – review of ligament laxity and alternation of motion segment integrity was presented with specific correlation to the AMA Guides to the Evaluation of Permanent Impairment 5^th and 6^th Education. Correlation to bodily injury, causality and persistent functional losses in the personal injury patient and communication with the attorney was outlined. Attention was paid to the differences between vertebral body translation and angular motion deficits between adjacent motor units was presented. Specific details on measurement tools and analysis of the injured cervical and lumbar spines were discussed. National Spine Management Group, Cleveland University Kansas City, Chiropractic and Health Sciences, Federation of Chiropractic Licensing Boards, Buffalo, NY, Lehi, UT 2021.

Diagnosis of Cervical Radiculopathy – diagnosis of cervical acute and chronic cervical radiculopathy was reviewed and discussed. Emphasis on patient history, symptoms, physical examination, and clinical correlation to imaging and electrodiagnostic testing was presented. Clinical correlation to electrodiagnostic findings, advanced imaging and neurological examination was reviewed. Details regarding traumatic vs degenerative cervical radiculopathy etiology was presented as well as the difference between radiculopathy and radiculitis was discussed. State University of New York at Buffalo, Jacobs School of Medicine, Buffalo NY 2020

Interprofessional Management of Cervical Radiculopathy – review of interprofessional management of the cervical radiculopathy patient. Considerations for triage and referral were correlated to physical examination findings, the severity of the complaint, and findings on electrodiagnostic testing. Interventional pain management, including epidural injections, was outlined. Biomechanical analysis and chiropractic management were reviewed, including short- and long-term management of the cervical radiculopathy patient. State University of New York at Buffalo, Jacobs School of Medicine, Buffalo, NY, 2020

Clinical Case Management of Cervical Radiculopathy – evidence-based interventions related to cervical radiculopathy were outlined, including surgical intervention, interventional pain management, chiropractic, and supervised rehabilitation. Acute, subacute, and chronic stages of clinical intervention and case management were reviewed and presented. Functional assessment and activity modification were presented and correlated to clinical findings and the stage of the diagnosis. State University of New York at Buffalo, Jacobs School of Medicine, Buffalo NY, 2020

Diagnosis of Fracture of Par Interarticularis – presentation and discussion of the clinical diagnosis of fracture of the pars interarticular, detailed review of patient history, presenting symptomology, physical examination, and imaging review. Detailed analysis of radiographic evaluation using dynamic radiographs and advanced imaging of the lumbar spine. Differential diagnoses of pain patterns and neurological findings were presented and clinically correlated to anatomical findings. State University of New York at Buffalo, Jacobs School of Medicine, Buffalo, NY, 2020

Interprofessional Communication in Fracture of Pars Interarticularis – analysis and discussion of the interprofessional communication and triage of pars interarticularis fracture. Documentation processes and referral to medical specialty were reviewed with a detailed analysis of communicating spinal biomechanical pathology in conjunction with anatomical findings. Co-management processes were reviewed and discussed. Clinical correlation to case documentation was presented. State University of New York at Buffalo, Jacobs School of Medicine, Buffalo, NY, 2020

Clinical Case Management of Fracture of Pars Interarticularis – clinical case management, including both anatomical and mechanical features of fracture of pars interarticularis was presented and discussed. Surgical parameters were demonstrated and clinically correlated to physical examination and imaging findings. Roles of the surgeon, pain management, chiropractic, and physical therapy were reviewed and presented. Group consensus on the proper pre-surgical, surgical, and post-surgical of the patient was presented. The timeline on recovery and relevant future assessment was reviewed as its clinical correlation to both the acute and chronic pars interarticularis fracture. State University of New York at Buffalo, Jacobs School of Medicine, Buffalo, NY, 2020

Trends in Spinal Healthcare, analyzing spinal healthcare trends in both utilization and necessity and understanding the marketplace and how a level of clinical excellence is reflected in a doctor's documentation and credentials. Treatment pathways in triaging spinal pathobiomechanics. Academy of Chiropractic Post-Doctoral Division, Cleveland University – Kansas City, Long Island, NY, 2020

MRI Spine Interpretation, an evidence-based understanding of time-related etiology of disc pathology considering the American Society of Neuroradiology's designation of protrusion, extrusion, and sequestration of spinal discs, Considering the signal intensity of discs in age-dating pathology and acquisition protocols for advanced spinal imaging. Academy of

Chiropractic Post-Doctoral Division, Cleveland University – Kansas City, Long Island, NY, 2020

Spinal Biomechanics; A Literature Perspective, an evidenced-based model for spinal biomechanical engineering and pathobiomechanics considering the pathophysiological limits in translations, angular deviation, and rotational planes. Utilizing the Cartesian system in plotting vertebral points to demonstratively conclude an accurate diagnosis, prognosis and biomechanical treatment plan with the consideration of long-term care in the non-specific mechanical spine pain patient when necessary. Academy of Chiropractic Post-Doctoral Division, Cleveland University – Kansas City, Long Island, NY, 2020

Case Management of Mechanical Spine Pathology, Clinical Grand Rounds of herniated, protruded, extruded, sequestered, and bulging discs. Differentially diagnosing vascular vs. mechanical spinal lesions and the necessity for urgent vascular, and neurological intervention, collaborating in a team environment utilizing a neuroradiologist, electrophysiologist, and neurosurgeon with the chiropractor as the primary spine care provider. Academy of Chiropractic Post-Doctoral Division, Cleveland University – Kansas City, Long Island, NY, 2020

Pathobiomechanics and Documentation, CPT Coding Guidelines for Initial and Established Patients with particular attention paid to Patient History, Review of Systems, Social and Family History, Physical Examination, and Medical Decision making.  Specific differences in coding levels and required elements for a 99202-99203-99204-99205. Academy of Chiropractic Post-Doctoral Division, Cleveland University, Kansas City, Long Island, NY, 2020

Using Documentation and Ethical Relationships, Pathways to improve coordination of care, and interprofessional communication with collaborating physicians.  Maintaining ethical relationships in the medical-legal community through documentation and communication of demonstrable diagnosis, prognosis and treatment plans. Academy of Chiropractic Post-Doctoral Division, Cleveland University, Kansas City, Long Island, NY, 2020

Spinal Biomechanical Engineering Clinical Application, History of clinical biomechanics with an emphasis on the diagnosis and management of spine pain of mechanical/functional origin.  Evidence-based symptomatic vs. asymptomatic parameters using peer-reviewed medical index literature. Computerized mensuration analysis of spinal biomechanical pathology. Comparison of demonstrable spinal biomechanical failure on imaging to clinical evaluation and physical examination. Academy of Chiropractic Post-Doctoral Division, Cleveland University, Kansas City, Long Island, NY, 2020

Spinal Biomechanical Engineering Clinical Grand Rounds, Case reviews utilizing E/M, MRI, and x-ray mensuration report to conclude an accurate diagnosis, prognosis, and treatment plan. Common diagnosis requiring interprofessional collaboration with a discussion of diagnostic dilemmas and proper communication methods. Academy of Chiropractic Post-Doctoral Division, Cleveland University, Kansas City, Long Island, NY, 2020

Extremity MRI & Xray Interpretation of the Shoulder, Identifying normal anatomy on both MRI and x-ray, inclusive of osseous, connective tissue, and neurological structures. Identifying fractures in the adult and pediatric cases. Differentially diagnosing various arthritic etiologies of osseous derangement. Cleveland University Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, October 5, 2020

Extremity MRI & Xray Interpretation of the Shoulder, Identifying fractures in the adult and pediatric cases. Differentially diagnosing various arthritic changes vs. benign and metastatic Tumors. Cleveland University Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, October 5, 2020

Extremity MRI & X-ray Interpretation of the Elbow, identifying normal anatomy on both MRI and X-ray, inclusive of osseous, connective tissue, and neurological structures, identifying fractures in adult and pediatric cases. Differentially diagnosing various arthritic etiologies of osseous derangement. Differentially diagnosing various arthritic changes vs. benign and metastatic Tumors. Cleveland University Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY. October 5, 2020

Extremity MRI & X-ray Interpretation of the Wrist, identifying normal anatomy on both MRI and X-ray, inclusive of osseous, connective tissue, and neurological structures, identifying fractures in the adult and pediatric cases. Differentially diagnosing various arthritic etiologies of osseous derangement. Differentially diagnosing various arthritic changes vs. benign and metastatic Tumors. Cleveland University Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, October 5, 2020.

Extremity MRI & X-ray Interpretation of the Hand, identifying normal anatomy on both MRI and X-ray, inclusive of osseous, connective tissue, and neurological structures, identifying fractures in adult and pediatric cases. Differentially diagnosing various arthritic etiologies of osseous derangement. Differentially diagnosing various arthritic changes vs. benign and metastatic Tumors. Cleveland University Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, October 5, 2020.

Extremity MRI & X-ray Interpretation of the Hip, Identifying normal anatomy on both MRI and X-ray, inclusive of osseous, connective tissue, and neurological structures. Identifying fractures in adult and pediatric cases. Differentially diagnosing various arthritic etiologies of osseous derangement. Cleveland University Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, October 5, 2020.

Extremity MRI & X-ray Interpretation of the Hip, Identifying fractures in the adult and pediatric cases. Differentially diagnosing various arthritic changes vs. benign and metastatic Tumors. Cleveland University Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, October 5, 2020.

Extremity MRI & X-ray Interpretation of the Knee, Identifying normal anatomy on both MRI and X-ray, inclusive of osseous, connective tissue, and neurological structures. Identifying fractures in adult and pediatric cases. Differentially diagnosing various arthritic etiologies of osseous derangement. Cleveland University Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, October 5, 2020.

Extremity MRI & X-ray Interpretation of the Knee, Identifying fractures in the adult and pediatric cases. Differentially diagnosing various arthritic changes vs. benign and metastatic Tumors. Cleveland University Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, October 5, 2020.

Extremity MRI & X-ray Interpretation of the Hand, identifying normal anatomy on both MRI and X-ray, inclusive of osseous, connective tissue, and neurological structures, identifying fractures in adult and pediatric cases. Differentially diagnosing various arthritic etiologies of osseous derangement. Differentially diagnosing various arthritic changes vs. benign and metastatic Tumors. Cleveland University Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, October 5, 2020.

Extremity MRI & X-ray Interpretation of the Foot, identifying normal anatomy on both MRI and X-ray, inclusive of osseous, connective tissue, and neurological structures, identifying fractures in adult and pediatric cases. Differentially diagnosing various arthritic etiologies of osseous derangement. Differentially diagnosing various arthritic changes vs. benign and metastatic Tumors. Cleveland University Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, October 5, 2020

Case Management, Spinal MRI and Documentation Documenting Herniated Discs, Age-Dating Disc Pathology, and Connective Tissue Pathology as Sequella to Trauma, Herniated Discs and Connective Tissue Pathology, differentially diagnosing herniated discs vs. normal and bulging discs and protruded, extruded and fragmented discs. Normal vs. Pathological connective tissues and age-dating herniated discs. Cleveland University Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, September 1, 2020, September 1, 2020

Case Management, Spinal MRI and Documentation, Case Management of Traumatic Spinal Injuries, understanding flexion-extension cervical injuries and diagnosing connective tissue pathology. Determining impairments and the literature-based standard for permanent injuries. Cleveland University Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, September 1, 2020

Case Management, Spinal MRI and Documentation, Managing Herniated and Bulging Discs, Serious Injury in Non-Herniated Cases from Trauma, Spinal disc morphology, and innervation. Herniated, bulged, protruded, and sequestered disc characteristics and management. Literature-based documentation requirements for no-dis spinal injuries. Cleveland University Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, September 1, 2020

Case Management, Spinal MRI and Documentation, Herniated Discs, and Permanent Brain Malfunction & Biomechanical Failure, A case-study of a post-traumatic herniated disc and related brain malfunction supported by contemporary literature, MRI acquisition, and necessity protocols. Cleveland University Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, September 1, 2020

Case Management, Spinal MRI and Documentation, Demonstrative Documentation of Disc Herniation and MRI Physics, Understanding the documentation requirements to demonstratively show spinal disc lesions in reporting pathology. Understanding the physics of a nucleus resonating in T1 and T2 weighted imagery. Cleveland University Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, September 1, 2020

Case Management, Spinal MRI and Documentation, Post-Traumatic Herniated Discs, Related Migraines-Headaches & Strain/Sprain Permanencies, Relationship of headaches and migraines to cervical spine disc herniation, clinical rationale for ordering MRIs and the relationship of ligamentous pathology to spinal trauma. Cleveland University Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, September 1, 2020

Case Management, Spinal MRI and Documentation, Documentation of Low-Speed Crashes in Determining Etiology of Serious Bodily Injuries, Documentation requirements during the evaluation, and management encounter to understand the etiology of spinal injuries. Having a complete understanding the forces involved to conclude a differential diagnosis, while concurrent ruling malingerers, if applicable. Cleveland University Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, September 1, 2020

Specialty Research Rotation – Radiculitis vs Radiculopathy – evaluation and identification of chemical radiculitis through the analysis inflammatory mediators in the presence of normal imaging studies and persistent symptoms. Determination and discussion of lack of anatomical abnormalities are not required to cause radiculopathy. Review of biomechanical etiology and its role in the diagnosis and management of radiculopathy. National Spine Management Group. ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2020.

Specialty Research Rotation – Radiculitis vs Radiculopathy – American College of Radiology Appropriateness Criteria in the evaluation of cervical neck pain and radiculopathy. Discussion and review findings from an expert panel on neurological imaging with focus on evidence-based guidelines for the appropriateness of imagining. Radiography of the cervical spine, MRI cervical spine without contrast, MRI cervical spine with contrast, CT cervical spine without contrast, CT cervical spine with contrast, CT myelogram, CTA neck with contrast, Discography cervical spine, Facet Injection/medical branch block cervical spine, MRA neck with and without contrast appropriateness criteria were reviewed in relation to acute and chronic neck pain, radiculopathy and trauma. National Spine Management Group. ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2020.

Specialty Research Rotation – Radiculitis vs Radiculopathy – review of chemical radiculitis vs radiculopathy and diagnosis with gadolinium-enhanced Magnetic Resonance Imaging with comparison to non-gadolinium enhanced images. The anatomical distribution of symptoms in relation to single and multiple nerve roots and peripheral nerves was outlined. Onset, sensory changes, pathogenesis, and clinical investigation were detailed. National Spine Management Group. ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2020.

Specialty Research Rotation – Radiculitis vs Radiculopathy – the value of 3D MR lumbosacral radiography in the diagnosis of symptomatic chemical radiculitis. Discussion of imaging findings related to nerve root swelling without nerve root compression and in the presence of an annular tear as evidenced by imaging. Symptoms and clinical presentation of chemical radiculitis were presented in relation to intervertebral disc morphology, foramen or extraforaminal inflammation and imaging sequences, including 3D MR imaging fast low angle shot. Clinical correlation to physical examination findings and patient management was presented. National Spine Management Group. ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2020.

Specialty Research Rotation – Radiculitis vs Radiculopathy – chemical radiculitis theory was reviewed and outlined. Discussion of annular tears in painful intervertebral discs provided by discography as a cause of radiating leg pain in patients with discogenic back pain was presented. A review of the electromyogram and motor nerve condition velocity in relation to the evaluation of nerve root injury was outlined. An in-depth discussion of leakage of chemical mediators and inflammatory cytokines and its relationship to adjacent nerve roots was presented as a mechanics of radiating pain in patients with no disc herniation. National Spine Management Group. ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2020.

Specialty Research Rotation – Acute vs Chronic Schmorl’s Nodes – the pathogenesis of Schmorl’s Nodes in relation to acute trauma. Review of the mechanism of action to produce an acute Schmorl’s Node in the human spine. Diagnostic criteria including MRI evaluation using T1, T2, and STIR imaging sequences in addition to plain film radiographic interpretation. Discussion of prominent spinal areas, location, and patient susceptibility. National Spine Management Group. ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2020.

Specialty Research Rotation – Acute vs Chronic Schmorl’s Nodes – case review of acute calcific discitis and symptomatic Schmorl’s node in the upper thoracic spine. Analysis of diagnosis utilizing CT and MRI scanning to observe calcification of the intervertebral disc, reactive bone marrow edema. Discussion of pain management strategies and conservative management was presented. National Spine Management Group. ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2020.

Specialty Research Rotation – Acute vs Chronic Schmorl’s Nodes – detailed review of MRI examinations of patients with clinical diagnoses of acute, symptomatic thoracolumbar Schmorl’s nodes or vertebral body endplate fractures. Examination of signs of acute traumatic injury including bone marrow edema, MRI signal intensity, margin definition, extruded disc material and patterns of contrast enhancement were discussed. Outline of incidence and etiology of endplate fracture and associated Schmorl’s nodes was provided. National Spine Management Group. ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2020.

Specialty Research Rotation – Acute vs Chronic Schmorl’s Nodes – Clinical correlation between Schmorl’s node formation and lumbar intervertebral disc degeneration was presented and reviewed. Details included MRI T2 mapping in chronic lower back pain. Review of most common location for Schmorl’s nodes was presented and correlated to biomechanical factors such as mechanical stress zones, compressive loads on spinal ligaments and configuration of spinal curvature was outlined. National Spine Management Group. ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2020.

Specialty Research Rotation – Acute vs Chronic Schmorl’s Nodes – analysis of edematous Schmorl’s nodes on MRI study of the thoracolumbar spine with emphasis on characteristic changes over time was presented. Probability of evolution in both size and imaging signals was presented and discussed. Predictive indicators of idiopathic formation of Schmorl’s node was outlined. MRI evaluation included detailed review of T1 and T2 images and relationships between spinal pathology was presented. National Spine Management Group. ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2020.

Clinical Grand Rounds – Clinical and Advanced Imaging Presentation of Myelomalacia - Case review of the clinical presentation of spinal cord pathology, specifically myelomalacia.  Discussion of the progressive and degenerative nature of the pathology and interprofessional triage and communication was emphasized. Pathological reflexes including Hoffman’s sign, Tromner’s sign, Inverted Supinator Sign and Plantar Response was reviewed, discussed and presented as part of a comprehensive physical examination.  Comparison of plain film radiographs, CT and MRI analysis of spinal cord pathology was presented. Pre- and Post-surgical biomechanical diagnosis and conservative care was outlined. MDR Consulting, Buffalo, NY, 2019

Clinical Grand Rounds – Morphological versus Etiological Description of Intervertebral Disc Pathology in the Human Spine case analysis outlining morphological descriptions of the human spine including desiccation, herniation, extrusion, and bulge.  Outline and presentation of annulus fibrosis, nucleus pulposus and pain fiber innervation of both healthy and degenerative intervertebral discs was presented. Analysis of injury causation and its relation to MRI findings was detailed.  MDR Consulting, Buffalo, NY, 2019

Clinical Grand Rounds – Anatomical vs Mechanical Sources of Spine Pain in the Spine Pain Patient – case study presentation outlining risk factors for increased injury susceptibility including prior surgical fusion. Comparison between MRI and plain film radiographic objective data was outlined and presented. Importance of interprofessional communication and review of prior medical records. Analysis of spinal compression fracture and surgical hardware was outlined. MDR Consulting, Buffalo, NY, 2019

Clinical Grand Rounds – Clinical Diagnosis and Interprofessional Management of Thoracic and Lumbar Post-Traumatic Compression Fractures – a detailed review of physical examination and assessment of traumatic thoracic and lumbar spine fractures using plain film radiograph and CT scans with and without contrast. Detailed review of mechanism of injury, emergency department records and radiology reports were presented. Errors in fracture site, description, and omission on plain film study by the radiologist were reviewed. Analysis of potential spinal instability in the cervical spine was discussed and a detailed referral for computerized mensuration analysis was demonstrated. Academy of Chiropractic, Post-Doctoral Division, Buffalo, NY, 2019

Documentation, MRI Necessity and Trends in Spinal Treatment Protocols, correlating history and a thorough clinical evaluation in determining the necessity for x-ray and MRI evaluations in the trauma and non-trauma patient. Considering whole spine patho-biomechanics in formulating treatment plans and long-term supportive care. Documentation requirements in transitioning from telemedicine to in-office care.  Academy of Chiropractic Post-Doctoral Division, PACE Approved for the Federation of Chiropractic Licensing Boards, Cleveland University Kansas City, Long Island, NY, 2020

Specialty Research Rotation - Innervation and Blood Supply of the Intervertebral Disc – discussion of the distribution of nociceptive nerve fibers in the cervical intervertebral discs.   Correlation of chronic neck pain patients and the relationship to nociceptive nerve fibers and discogenic neck pain.  The role of nociceptive nerve fibers in the pathogenesis of neck pain of cervical disc origin was discussed and outlined. ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2020.

Specialty Research Rotation - Innervation and Blood Supply of the Intervertebral Disc – Pathological mechanisms of discogenic low back pain including sensory nerve in growth into inner layers of the intervertebral disc, upregulation of neurotrophic factors and cytokines, and instability. Outline of the inhibition of these mechanisms and the treatment of discogenic low back pain.  Understanding the innervation and instabilities of diseased intervertebral discs and the role of inflammatory mediators was compared with healthy intervertebral disc anatomy. ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2020.

Specialty Research Rotation - Innervation and Blood Supply of the Intervertebral Disc – discussion of chronic low back pain and its socioeconomic burden was presented.  MRI findings and the diagnosis of MRI was outlined. Assessment of the sensory innervation of the vertebral endplate and degenerative intervertebral discs was outlined. Specific features highlighting the difference between healthy and degenerative intervertebral discs such as cartilage degeneration and subchondral bone defects was discussed. ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2020.

Specialty Research Rotation - Innervation and Blood Supply of the Intervertebral Disc –  Investigation of effects of inflammatory cytokines, IL-1b, and TNF-a, on the expression of an angiogenic factor, vascular endothelial growth factor (VEGF), and neurotrophic factors, nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF), in human IVD degeneration was presented.  Outline of Neurotrophins role in the survival, growth, differentiation, and function of neurons inside and outside of the intervertebral disc.  Further discussion was outlined relating to the process of IL-1B being generated during IVD degeneration and may stimulate the upregulation of VEGF, NGF, and BDNF expression, resulting in angiogenesis and nerve in-growth during intervertebral disc degeneration. ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2020.

Chiropractic as the First Option for Spine, A Literature-Based Standard, utilizing clinical findings in conjunction with advanced imaging and electrodiagnostic findings in managing collaborative relationships with medical specialists. Applying a literature standard to care to ensure conservative care as the first option. PACE Approved for the Federation of Chiropractic Licensing Boards, Cleveland University Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island NY 2020

Chiropractic as the First Option for Spine, A Literature-Based Standard, managing spinal related cases based upon MRI findings of herniations, bulges, protrusion, extrusions (comminuted and fragmented) utilizing thin-sliced acquisition protocols. When to consider ordering T1, T2, Short Tau Inversion Radiant, proton density and Dixon sequencing for spinal related pathology, PACE Approved for the Federation of Chiropractic Licensing Boards, Cleveland University Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island NY 2020

Chiropractic as the First Option for Spine, A Literature-Based Standard, creating literature-based documentation inclusive of history and a clinical examination that encompasses causality, diagnosis, prognosis and treatment plans. Ensuring the whole person impairment ratings are consistent with contemporary literature, PACE approved for the Federation of Chiropractic Licensing Boards, Cleveland University Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island NY 2020

Chiropractic as the First Option for Spine, A Literature-Based Standard, Spinal biomechanical engineering models related to pathobiomechanics and literature-based standards in creating an accurate diagnosis, prognosis, and treatment plan. Determining impairment ratings based upon alteration of motion segment integrity utilizing motion-imaging, and creating demonstrable evidence for continued treatment plans, PACE approved for the Federation of Chiropractic Licensing Boards, Cleveland University Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island NY 2020

Collision Reconstruction & Biomechanical Engineering - Part 1, Analyzing the integration of collision reconstruction and spinal biomechanics utilizing a mathematical model. Understanding the model and transference of energy from the bullet car to the target car to the occupant to aberrant spinal biomechanics. Cleveland University – Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2019

Collision Reconstruction & Biomechanical Engineering - Part 2, Understanding the mathematical models required to analyze a collision and create coefficients of forces transferred in a collision that effect the automobile and the occupant. Cleveland University – Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2019

Collision Reconstruction & Biomechanical Engineering - Part 3, Calculation worksheets in the mathematical models required to analyze a collision and create coefficients of forces transferred in a collision that effect the automobile and the occupant. Cleveland University – Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2019

Collision Reconstruction & Biomechanical Engineering - Part 4, An analysis of vehicle parts and construction design that contribute to the energy translated to the human body and spine inclusive of seatbelts, airbags, bumpers, event data recorders, tires, axles and auto frames. Cleveland University – Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2019

Collision Reconstruction & Biomechanical Engineering - Part 5, When correlating crash to injury, inspecting the vehicle for evidence of damage to verify causality and extent of malformation of the vehicle beyond that of the outer shell of the vehicle. Cleveland University – Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2019

Collision Reconstruction & Biomechanical Engineering - Part 6, Newton's laws of inertia and the determinant calculations required based upon the action of the vehicle and how spinal biomechanics are affected. Analyzing the vehicle and accident site to reconstruct the actions of the car to create a model. Cleveland University – Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2019

Collision Reconstruction & Biomechanical Engineering - Part 7, Reconstructing and calculating minimal speed and velocity as injury and damage factors based upon skid marks considering coefficients of friction based upon various road surfaces. Cleveland University – Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2019

Collision Reconstruction & Biomechanical Engineering - Part 8, Reconstructing and calculating speed and velocity as injury and damage factors based upon yaw marks considering coefficients of friction based upon various road surfaces. Cleveland University – Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2019

Collision Reconstruction & Biomechanical Engineering - Part 9, Coefficients of momentum and calculating plastic vs. elastic deformation. Direction of forces as mathematical determinants of collision and resultant bodily injury forces. Cleveland University – Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2019

Collision Reconstruction & Biomechanical Engineering - Part 10, Coefficients of acceleration, negative acceleration and G-forces in collisions that contribute to vehicular and bodily injuries. Analyzing time, speed and weight of bullet and target automobiles to reconstruct the energy of a collision and injury potential. Cleveland University – Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2019

Collision Reconstruction & Biomechanical Engineering - Part 11, The osseous and ligamentous structures that are subject to pathology in bodily injury. The pathological reaction of connective tissue when it exceeds its para-physiological limits and the bio-neuro-mechanical changes the connective tissue undergoes as sequella to trauma. Cleveland University – Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2019

Collision Reconstruction & Biomechanical Engineering - Part 12, Energy and momentum coefficients and data utilized as determinants and error ranges in calculations. Considering the stiffness of the vehicle, air bag function and formulation of timing in its release point and injury potential to facial and spinal structures. Cleveland University – Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2019

Collision Reconstruction & Biomechanical Engineering - Part 13, Mathematical worksheet reviewing kinetic and work energy, momentum, acceleration and G-forces in numerically quantifying a collision, the energy created to deform an automobile and the transference of forces creating connective tissue pathology and altered spinal biomechanics. Cleveland University – Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2019

Collision Reconstruction & Biomechanical Engineering - Part 14, Analyzing a sample accident (case 1) utilizing all the vehicle, road surface combining standardized calculation variables in reconstructing an accident and the resultant energy considered for connective tissue pathology and resultant aberrant spinal biomechanics. Cleveland University – Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2019

Collision Reconstruction & Biomechanical Engineering - Part 15, Analyzing a sample accident (case 2) utilizing all the vehicle, road surface combining standardized calculation variables in reconstructing an accident and the resultant energy considered for connective tissue pathology and resultant aberrant spinal biomechanics. Cleveland University – Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2019

Collision Reconstruction & Biomechanical Engineering - Part 16, Analyzing a sample accident (case 3) utilizing all the vehicle, road surface combining standardized calculation variables in reconstructing an accident and the resultant energy considered for connective tissue pathology and resultant aberrant spinal biomechanics. Cleveland University – Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2019

Computerized Mensuration of Spinal Biomechanical Pathology, Understanding the algorithmic interpretation of spinal biomechanical pathology in a 3-D model and creating treatment plans, impairment ratings and teaching models based upon the vertebral motor unit angles. Determining sagittal and axial alignments in creating a normative baseline for treatment goals and outcomes. Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2019

Neurosurgical-Chiropractic Collaboration on Spinal Pathology, utilizing x-ray, MRI and other modalities of advanced imaging in conjunction with spinal biomechanical failure and clinical evaluation to collaboratively create treatment protocols for patients in both the operative and non-operative cases. Determining the boundaries of scope of care for both the chiropractor and neurosurgeon based upon a definitive diagnosis of the mechanical vs. an anatomical lesion. Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2019

Documentation and Ethics in Medical-Legal Relationships, creating ethical relationships based upon accurate documentation reflective of the casually related condition of the injured. Ensuring accepted credentials of the doctor based upon Voir Dire standards reflected in an admissible curriculum vitae. How to present demonstrative documentation in the courts reflective of the patient’s pathology. Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2019

Coding, Documentation and Compliant Coding, Ensuring the correct codes are utilized in an evaluation and management encounter. The correct elements are utilized to support the level of E&M coded along with a self-audit program to ensure ethical billing occurs. Guidelines for history of present illness, primary complaint, review of systems, family, social and past histories are discussed and how to document the same. Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2019

Trends in Spinal Treatment, Migration of spinal care for mechanical spine issues from hospitals and medical specialists to trauma qualified chiropractors based upon published outcomes. Utilizing imaging studies in spinal biomechanics, pain models and clinical outcomes to determine a conclusive diagnosis, prognosis and treatment plan for triaging in a collaborative environment.  Cleveland University Kansas City, Chiropractic and Health Sciences, Academy of Chiropractic Post-Doctoral Division, Long Island, NY, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Neurology of Spinal Biomechanics, Understanding the normal of spinal biomechanics and the neurotransmitters required for homeostasis. The interconnected role of Pacinian Corpuscles, Ruffini Corpuscles, Golgi Organ Receptors, Nociceptors, Proprioceptors and Mechanoreceptors in maintaining sagittal and axial alignment in the presence of mechanical pathology. Cleveland University Kansas City, Chiropractic and Health Sciences, Academy of Chiropractic Post-Doctoral Division, Long Island, NY, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

MRI Age-Dating of Herniated Discs, The literature, academic and clinical standards to age-date herniated discs. The clinical correlation the pain patters with advanced imaging finings of bone edema, spurs based upon the Piezoelectric effect for remodeling, high signal on T2 weighted images, Vacuum Discs and disc heights in determining the time frames of the etiology of the spinal disc pathology. Cleveland University Kansas City, Chiropractic and Health Sciences, Academy of Chiropractic Post-Doctoral Division, Long Island, NY, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Creating Ethical Collaborative and Medical-Legal Relationships, Understanding the timely triage necessities based upon clinical and imaging outcomes and the documentation required for collaborative physicians to continue care. Ensuring that the documentation is complete, reflective of services rendered and clear for third party consideration in an admissible format to considered in a medical-legal environment. Cleveland University Kansas City, Chiropractic and Health Sciences, Academy of Chiropractic Post-Doctoral Division, Long Island, NY, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Central Innervation of Spinal Biomechanical Engineering, Understanding the lateral and ventral horn’s innovations of Pacinian Corpuscles, Ruffini Corpuscles, Golgi Organ Receptors, Nociceptors, Proprioceptors and Mechanoreceptors and the pathways through the spinal thalamic tracts through the periaqueductal region, the Thalamus into the Occipital, pre-frontal, sensory and motor cortexes and the efferently back through the Thalamus to disparate regions in creating spinal homeostasis, Pacinian Corpuscles, Ruffini Corpuscles, Golgi Organ Receptors, Nociceptors, Proprioceptors and Mechanoreceptors. Cleveland University Kansas City, Chiropractic and Health Sciences, Academy of Chiropractic Post-Doctoral Division, Long Island, NY, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Identifying Spinal Pathology of MRI, Utilizing T1, T2, STIR and Gradient studies in determining myelomalacia, intra and extra-dural tumors and systemic disease patterns affecting the spinal cord. When to use contrast post-operatively in identifying disc structures vs. adhesions on postoperative advanced imaging. MRI Interpretation of herniated, circumferential bulges, focal bulges, protruded, extruded, comminuted, sequestered and fragmented discs. When to consider a neurosurgical consultation based upon the correlation of imaging and clinical findings. Cleveland University Kansas City, Chiropractic and Health Sciences, Academy of Chiropractic Post-Doctoral Division, Long Island, NY, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Primary Care and Internal Medicine – Supply of Chiropractic Care and Visits to Primary Care Physicians for Neck and Back Pain discussion of primary care visits and lower back pain. Expenditures and contributions to disability data. Discussion of supply of chiropractic care in the context of visits for lower back pain and primary care physicians. The estimated national impact of primary care visits and expenditures was outlined with a focus on chiropractic assistance in managing lower back pain. Defining an “episode” of lower back pain and its relationship to the collection of epidemiological data. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Primary Care and Internal Medicine – Safety of Chiropractic Care in Lower Back Pain and Migraine Headaches – review of adverse events associated with chiropractic care in the treatment of migraine. Outline of a prospective 3-armed, single-blinded, placebo RCT. Discussion of transient and mild events following chiropractic intervention. Randomized clinical trials and meta-analyses reviewed and discussed relating to the diagnosis and management of lower back pain, including adverse event reporting. Risk of injury to the head, neck or trunk following an office visit for chiropractic spinal manipulation, as compared to an office visit for evaluation by a primary care physician.

Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Primary Care and Internal Medicine – Chiropractic and Pain Management in Primary Care – evaluation of the analgesic effects of spinal manipulation on both healthy and pain-inflicted patients. Discussion of evidence of increased in pressure pain thresholds in musculoskeletal pain at both local and remote sites. Detailed knowledge of patient population regarding demographics and socioeconomic factors as well as disease-specific characteristics. The suggestion is that lower back pain should not be seen as benign and self-limiting with a focus on management. Describe the communication system surrounding the management of chronic pain from the perspectives of allopathic providers, acupuncture and chiropractor providers, and chronic musculoskeletal pain patients. Chiropractic manipulative treatment (CMT) association with lower healthcare costs among multiply comorbid Medicare beneficiaries with an episode of chronic low back pain was reviewed. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Primary Care and Internal Medicine – Perceptions of Chiropractic Care – demographic review of data on the perceptions of chiropractic care. A review of patient interest, trustworthiness, costs, and frequency of visits was discussed. Nationally representative survey to compare characteristics and use of survey respondents with positive and negative perceptions of DCs and chiropractic care. Positive perceptions of DCs were more common than those for chiropractic care. US adults generally perceive DCs in a positive manner. Describe the preferences of older adults for low back pain co-management by MDs and DCs and identify their concerns for receiving care under such a treatment model. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Primary Care and Internal Medicine – Chiropractic and Post-Surgical Care and Care for Veterans – discussion of persistent post-surgical lower back and radicular pain response to chiropractic care. Relevant anatomy related to lower back pain and intervertebral disc injury was outlined and presented. Discussion and development of an integrated care pathway for Doctor of Chiropractic, primary care providers, and mental health professionals who manage veterans with low back pain, with or without mental health comorbidity, within Department of Veterans Affairs health care facilities. Support for the inclusion of chiropractic care as a component of multidisciplinary health care for low back pain, as currently recommended in existing guidelines with a focus on US Service Members. Discussion of availability of chiropractic care to military healthcare systems, referral and Interprofessional communication models. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Primary Care and Internal Medicine – Effects of Chiropractic Care Combined with Medical Care, First Contact and Provider Type – differences in outcomes, patient satisfaction, and related healthcare costs in spinal, hip, and shoulder pain patients who initiated care with medical doctors (MDs) vs those who initiated care with doctors of chiropractic (DCs). Pain of musculoskeletal origin and epidemiology of reduced productivity. Comparison of data on health outcomes, patient satisfaction, and related healthcare costs in patients consulting differing first-contact care providers for musculoskeletal pain. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Primary Care and Internal Medicine – Integrating Chiropractic Care into Primary Care and Private Sector Healthcare Facilities – suggestion of a diverse role for chiropractors within conventional healthcare facilities. Discussion of chiropractic’s effectiveness for managing musculoskeletal disorders, particularly spine-related pain and disability. Descriptions of Doctors of Chiropractic who work in nongovernmental, private sector health care settings in the United States. Shared electronic health records, face-to-face informal consultation methods for Interprofessional communication. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Primary Care and Internal Medicine – American College of Physicians – Guideline Recommendations – Non-Invasive and Non-Pharmacological - American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on noninvasive treatment of low back pain. Systematically review the current evidence on non-pharmacologic therapies for acute or chronic non-radicular or radicular low back pain. Comparative benefits of non-pharmacological therapies in acute/subacute low back pain, including exercise, spinal manipulation, lumbar supports, acupuncture, laser, ultrasound and traction. Discussion of first- and second-line therapies with a reduction in opioid prescription. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Emergency Medicine – Emergency Medicine and Spine Pain – review of lack of guidelines for the management of lower back pain in the ED. The frequency of lower back pain visitation in the emergency department, including environmental/sociocultural dimensions and physical/psychospiritual dimensions, were reviewed. Discussion of the utilization of significant healthcare resources with a complete description of lower back pain characteristics and health services use in non-urgent lower back pain patients presenting to the ED. Managing spine pain in the ED using usual and customary medical intervention. The extent of appropriate CT and MRI scans in the hospital setting and accessibility were reviewed in conjunction with presented national data. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Emergency Medicine – Medication Usage and Motor Vehicle Accidents – review of ADHD medication utilization and motor vehicle accident data and frequency of motor vehicle accidents sin this specific patient population. Review of the prevalent and preventable cause of morbidity and mortality among patients and concepts of restriction based on prognostic factors. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Emergency Medicine – Emergency Department Imaging Perspectives – review of imaging protocols among a spectrum of clinical indications, perspective on aging populations, and clinical complexity. Review of CT, MRI, plain film imaging and ultrasound and their relationships to internal medicine and musculoskeletal disorders examined on an emergency basis through patient-generated national survey data. Details of specific contexts in which imaging has become concentrated and targeted efforts for optimization of utilization. Considerations of utilization of CT in the emergency department and evaluation to increasing trends. Review of quality improvements in imaging utilization. Comparison between pediatric and adult imaging protocols and trends. Discussion and analysis of “Choose Wisely” recommendations and creation of guideline/policy/clinical pathways in New England Emergency Departments. MRI utilization in pediatric ED reviewed and analyzed. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Emergency Medicine – Cauda Equina Syndrome and Other Emergent Conditions – traumatic injuries to the thoracolumbar spine and overall impact on emergency services. Discussion of exact definitions of Conus Medullaris Syndrome (CMS) and Cauda Equina Syndrome (CES). Diagnosis in acute phase and radiological findings clinically correlating with physical examination findings. Parameters for spinal regions of traumatic injury were presented and reviewed. Case presentations for neck and spine were included and reviewed with particular focus on differential diagnosis and case uniqueness. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Emergency Medicine – Emergency Medicine Residency Curriculum – review of Ohio State University Emergency Medicine Residency Program Musculoskeletal Emergencies Curriculum. Outline of the significant nature of musculoskeletal emergency presentations to ED. Details in the training required to master clinical experience, self-directed learning and small group didactics. Case study reviews and discussion was presented with particular focus on infection vs non-infections and traumatic vs non-traumatic presentations in ED. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Emergency Medicine – Opioid vs Non-Opioid Medications in the Emergency Department – discussion of limited evidence of long-term outcomes of opioids with non-opioid medication for chronic pain. Literature review on effectiveness for opioid interventions. Discussion of alternative recommendations, evidence-demonstrating lack of benefit and poor long-term outcomes. Variation in physician opioid prescriptions discussed. Patterns of opioid initiation at first visits for pain in the ED in the United States including frequency and dosage. Emergency Department data concerning the persistent pain after motor vehicle accidents and comparison between opioid and NSAID prescribed in the ED. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Emergency Medicine – Concussion and Repeat ED visits – review of patients presenting to ED with concussion with re-visitation within 72 hours. Mechanism of injury including closed head injury, assault, fall and motor vehicle accidents discussed. Epidemiological evidence presented regarding number of visitations, characteristics and care paths reviewed. Discussion of adoption of a more comprehensive discharge plan to further prevent repeat visits was outlined. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Emergency Medicine – CDC Epidemiology of ED Visits in the United States, Adults Over 65 and Motor Vehicle Accidents – Evaluation of data from the National Hospital Ambulatory Medical Care Survey and frequency of ED visitation. Percentage of visits requiring hospital admission was reviewed along with patterns of need for critical care. Review of imaging ordering statistics and clinical diagnosis was discussed. Details of primary and secondary ED diagnosis presented in relation to sprain/strain, contusion and spinal pathology including herniated intervertebral disc, facture and spinal cord compression. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Emergency Medicine – National Hospital Ambulatory Medical Care Survey – a review of the current representative data on ambulatory care visits to hospital emergency departments in the United States. Demographics, residence, insurance class, chief complaint with focus on traumatic injury, diseases of the nervous and musculoskeletal systems were outlined. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Emergency Medicine – Lower Back Pain and Emergency Room Visits – detailed analysis of impact of lower back pain on ED globally. First systematic review of the trends in the literature including lower back pain as significant complaint and the variables in its definition. Discussion of the proper diagnosis and triage of lower back pain and its current impact on ED management was reviewed. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Emergency Medicine – Spinal Cord Injury without Radiographic Abnormality (SCIWORA) in Adults – case reports – detailed review of Spinal Cord Injury without Radiographic Abnormality was presented. Syndrome of posttraumatic myelopathy demonstrable on MRI with no evidence of osseous injury on plain film or CT scan. Reporting of incidence was included with detailed discussion of case presentations, accurate diagnoses and triage was reviewed. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Emergency Medicine – CDC Traumatic Brain Injury Data – Related Emergency Department Visits, Hospitalizations, Deaths – United States, 2007 and 2013 – traumatic brain injury, short and long term adverse clinical outcomes, death and disability reviewed and compared based on CDC data over a 7-year period. Mechanism of causation including motor vehicle accidents, falls and assault. Public health recommendations and interpretation of data was presented. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Emergency Medicine – CDC Data, Trends in Emergency Department Visits for Ischemic Stroke and Transient Ischemic Attack – relationship between stroke and statistical cause of death, type of stroke and prognosis related to recurrence was discussed. Specific definitions of ischemic stroke, transient ischemic attack with etiology and relationship to emergency visits were outlined and presented. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Emergency Medicine – US Emergency Department Use by Children – pediatric utilization of emergency medicine resources, description of trends on a national basis. Detailed analysis of specific demographics including race and resident status were reported and reviewed. Discussion in allocation of resources including insurance class and coverage were reviewed. Anticipated expansion of Medicaid was considered and reviewed. Estimates of nonurgent ED visits by children were presented and discussed. Academy of Chiropractic, State University of New York at Buffalo, Jacobs School of Medicine, 2019

Specialty Research in Neurosurgery – Anatomy and Physiology of the Blood Brain Barrier – Review of consequences of alterations in homeostatic control of the neuronal environment. Discussion of blood flow alterations and altered vessel permeability as determinants in the pathophysiology of brain injury. Review present day literature on the anatomy, development and physiological mechanisms of the blood–brain barrier. The blood brain barrier’s role in the maintenance of the extracellular environment. Vascular anatomy of the spinal cord was review in relation to the physiology of the neural environment. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neurosurgery – Spinal Cord Anatomy, Physiology and Vascular Reactivity – detailed review of the blood supply of the spinal cord, anatomy of the vascular system and physiology of blood flow. Pathophysiology of various conditions including Thoracic Aortic Occlusion and Spinal Cord Injury were discussed with specific relation to risk of neurological deficit. Severity and duration as an effect was reviewed and correlated clinically. Cerebral circulation and aging, discussion of effects on cognitive functioning and cerebrovascular disease in aging. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neurosurgery – Upper Cervical Spine Anatomy and Cerebral Spinal Fluid Flow – MRI flow imaging and computational fluid dynamics in healthy patients with Chiari Malformations. Review of abnormal cerebral spinal fluid flow oscillations and their effects on healthy patients. Discussion of nonlaminar complex spatial and temporal variations with associated pressure waves and pressure gradients causing syringomyelia, headaches and other clinical manifestations in Chiari I malformation. Microsurgical anatomy and internal architecture of brainstem in 3D images and surgical considerations. CSF hydrodynamic changes, spinal cord injury and development of posttraumatic syringomyelia (PTSM). Impact of spinal cord nerve roots and denticulate ligaments on cerebral fluid dynamics in the cervical spine was reviewed and discussed. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neurosurgery – Compression and Degeneration in Chronic Nerve Root Entrapment – differentiation between peripheral nerves and spinal nerve roots and effects of electrostimulation. Discussion of various stimulating or recording neurosurgical implants and success vs failure rates. Review of the nerve root compression and its relation to consequences of disc herniation and acute compression during surgery. Maximum pressure level a spinal nerve root can sustain is reviewed. Discussion of microsurgical anatomy of lumbosacral nerve rootlets, Rhizotomy and chronic spinal cord injury. Review of qualitative grading of severity of lumbar spinal stenosis on morphology of dural sac on MRI studies, review of classification systems and the consideration of impingement of neural tissue. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neurosurgery – Anatomy of Circle of Willis, Cerebral Arteries and Stroke Etiology – discussion of stroke by embolism, source and cause in diagnosis and long-term treatment. Review of complex nature of embolus transport and its relation to etiology. Image based hemodynamics with discrete particle dynamics in relation to the distribution of emboli across the various cerebral arteries. Detailed anatomy of Circle of Willis reviewed and discussed with particular focus on size/inertia dependent trends in embolus distribution to the brain, distribution of cardiogenic versus aortogenic emboli among anterior, middle and posterior cerebral arteries, left versus right brain preference in cardio-embolus and aortic emboli transport and source-destination relationship for embolisms affecting the brain. Detailed review of the microsurgical anatomy of the posterior cerebral artery in three-dimensional images. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neurosurgery – Stroke Therapy, Implementation and Cost-Effectiveness – review of endovascular therapy in addition to standard care in acute ischemic vessel occlusion stroke. Comparison in National Institutes of Health Stroke Score (NIHSS) score, symptom onset, Alberta Stroke Program Early CT Score (ASPECTS) and occlusion location. Considerations in acute management and revascularization of tandem occlusions in acute ischemic stroke with literature review. Discussion of Transcirculation Pipeline embolization device deployment as a rescue technique. Specialty Research in Neurosurgery – Anatomy and Physiology of the Blood Brain Barrier – Review of consequences of alterations in homeostatic control of the neuronal environment. Discussion of blood flow alterations and altered vessel permeability as determinants in the pathophysiology of brain injury. Review present day literature on the anatomy, development and physiological mechanisms of the blood–brain barrier. The blood brain barrier’s role in the maintenance of the extracellular environment. Vascular anatomy of the spinal cord was review in relation to the physiology of the neural environment. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neurosurgery – Spinal Cord Anatomy, Physiology and Vascular Reactivity – detailed review of the blood supply of the spinal cord, anatomy of the vascular system and physiology of blood flow. Pathophysiology of various conditions including Thoracic Aortic Occlusion and Spinal Cord Injury were discussed with specific relation to risk of neurological deficit. Severity and duration as an effect was reviewed and correlated clinically. Cerebral circulation and aging, discussion of effects on cognitive functioning and cerebrovascular disease in aging. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neurosurgery – Upper Cervical Spine Anatomy and Cerebral Spinal Fluid Flow – MRI flow imaging and computational fluid dynamics in healthy patients with Chiari Malformations. Review of abnormal cerebral spinal fluid flow oscillations and their effects on healthy patients. Discussion of nonlaminar complex spatial and temporal variations with associated pressure waves and pressure gradients causing syringomyelia, headaches and other clinical manifestations in Chiari I malformation. Microsurgical anatomy and internal architecture of brainstem in 3D images and surgical considerations. CSF hydrodynamic changes, spinal cord injury and development of posttraumatic syringomyelia (PTSM). Impact of spinal cord nerve roots and denticulate ligaments on cerebral fluid dynamics in the cervical spine was reviewed and discussed. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neurosurgery – Compression and Degeneration in Chronic Nerve Root Entrapment – differentiation between peripheral nerves and spinal nerve roots and effects of electrostimulation. Discussion of various stimulating or recording neurosurgical implants and success vs failure rates. Review of the nerve root compression and its relation to consequences of disc herniation and acute compression during surgery. Maximum pressure level a spinal nerve root can sustain is reviewed. Discussion of microsurgical anatomy of lumbosacral nerve rootlets, Rhizotomy and chronic spinal cord injury. Review of qualitative grading of severity of lumbar spinal stenosis on morphology of dural sac on MRI studies, review of classification systems and the consideration of impingement of neural tissue. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neurosurgery – Anatomy of Circle of Willis, Cerebral Arteries and Stroke Etiology – discussion of stroke by embolism, source and cause in diagnosis and long-term treatment. Review of complex nature of embolus transport and its relation to etiology. Image based hemodynamics with discrete particle dynamics in relation to the distribution of emboli across the various cerebral arteries. Detailed anatomy of Circle of Willis reviewed and discussed with particular focus on size/inertia dependent trends in embolus distribution to the brain, distribution of cardiogenic versus aortogenic emboli among anterior, middle and posterior cerebral arteries, left versus right brain preference in cardio-embolus and aortic emboli transport and source-destination relationship for embolisms affecting the brain. Detailed review of the microsurgical anatomy of the posterior cerebral artery in three-dimensional images. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neurosurgery – Stroke Therapy, Implementation and Cost-Effectiveness – review of endovascular therapy in addition to standard care in acute ischemic vessel occlusion stroke. Comparison in National Institutes of Health Stroke Score (NIHSS) score, symptom onset, Alberta Stroke Program Early CT Score (ASPECTS) and occlusion location. Considerations in acute management and revascularization of tandem occlusions in acute ischemic stroke with literature review. Discussion of Transcirculation Pipeline embolization device deployment as a rescue technique. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neurosurgery – Surgical Approaches and Outcomes in Spine Surgery 1 – review of historical interventions, multilevel decompression and instrumented fusion in reduction of neural compression and spinal column stabilization. Discussion of morbidity and mortality in relation to surgical procedures. The use of the modified fragility index to predict 30-day morbidity and mortality from spine surgery. Differences in patient selection for minimally invasive versus open surgical procedures, and review of post-surgical outcomes. Morbidity, mortality and health care costs for patients undergoing spine surgery following ACGME resident duty-reform. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neurosurgery – Surgical Approaches and Outcomes in Spine Surgery 2 Predisposing factors for dural tears in lumbar spine surgery, including degenerative conditions, prior surgery and age-related indicators, were reviewed. Discussion and review of re-admission rate in spine surgery through meta-analysis and systematic review. Bibliometric study of the most important minimally invasive (MIS) spine surgery papers, including Level III and IV studies with a focus on moving toward Level I and Level II. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neurosurgery – Surgical Approaches and Outcomes in Spine Surgery 1 – review of historical interventions, multilevel decompression and instrumented fusion in reduction of neural compression and spinal column stabilization. Discussion of morbidity and mortality in relation to surgical procedures. The use of the modified fragility index to predict 30-day morbidity and mortality from spine surgery. Differences in patient selection for minimally invasive versus open surgical procedures and review of post-surgical outcomes. Morbidity, mortality and health care costs for patients undergoing spine surgery following ACGME resident duty-reform. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neurosurgery – Surgical Approaches and Outcomes in Spine Surgery 2 Predisposing factors for dural tears in lumbar spine surgery, including degenerative conditions, prior surgery, and age-related indicators, were reviewed. Discussion and review of re-admission rates in spine surgery through meta-analysis and systematic review. Bibliometric study of the most important minimally invasive (MIS) spine surgery papers, including Level III and IV studies with focus on moving toward Level I and Level II. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Orthopedic Spine Surgery – Fusion Surgery and Lumbar Stenosis – efficacy of fusion and decompression surgery in patients with lumbar spinal stenosis. Review of degenerative spondylolisthesis and patient selection criteria. Discussion of correlation of MRI, CT findings and clinical evaluation. Review of sedimentation sign on MRI and indications of prognostic factors. Surgery versus nonsurgical treatment outlined and outcomes discussed. Compensation for lumbar spinal stenosis and clinical sagittal plane deformity was presented. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Orthopedic Spine Surgery – Posterior Lumbar Interbody Fusion and Adjacent Segment Degeneration (ASD) – adjacent segment degeneration as major consequence of spinal fusion. Review of occurrence and location with correlation between surgical outcomes were discussed. Discussion of age, BMI, and pre-existing stenosis in cranial adjacent segment as risk factors. ASD prevalence in radiographic evidence between cranial and caudal segments were reviewed. Presentation of risk factors and pre-operative radiological features. Facet sagittalization and tropism were discussed. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Orthopedic Spine Surgery – Morbidity and Mortality Predictions in Spinal Surgery – Review of the Charlson Comorbidity Index (CCI) and the American Society of Anesthesiologist (ASA) Physical Status Classification System. Review of index outcomes and relation to costs of care. Discussion of index rating and likelihood of complications. Review of classification system in cerebral spinal fluid (CSF) leaks. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Orthopedic Spine Surgery – Spondylolisthesis, clinical and radiographic classifications - classification system that considers disc space height, sagittal alignment and translation, and the absence or presence of unilateral or bilateral leg pain was discussed. Detailed review of spondylolisthesis etiology, clinical presentation and imaging findings was reviewed. Review of inter and interobserver reliabilities of radiographic and clinical criteria. Review of consensus driven treatment options for degenerative spondylolisthesis presented. Transforaminal Lumbar Interbody Fusion (TLIF) in degenerative disc disease with associated spondylolisthesis grade I was reviewed and correlated. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Orthopedic Spine Surgery – Sagittal Alignment and Spinal Surgery, Clinical Outcomes and Follow up – discussion of outcomes and sagittal alignment in single unilateral transforaminal lumbar interbody fusion (TLIF). Detailed review of surgical TLIF procedure and associated mid and long-term clinical outcomes. Discussion and presentation of influence of pelvic incidents and lumbar lordosis mismatch and post-operative residual symptoms. Analysis of adjacent segment disease following fusion. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Orthopedic Spine Surgery – Complications and Outcomes in Adult Spinal Deformity Surgery – review of surgical approaches and complications in the correction of adult spinal deformity. Relevance of age, comorbidities, blood loss, osteoporosis, and smoking were discussed. Discussion of Cobb Angle, Sagittal Vertical Axis, Pelvic Tilt, and Thoracic Kyphosis was reviewed and examined in relation to trans-psoas lateral interbody fusion (LIF), percutaneous pedicle screw (PPS), transforaminal lumbar interbody fusion (TLIF). A comparison between minimally invasive and traditionally open procedures was provided and reviewed. Discussion of minimally invasive surgery options were emphasized, and outcomes were reviewed with correlation to diagnosis and procedural coding. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Orthopedic Spine Surgery – Surgical Interventions in Lumbar Disc Herniation – review of differences in surgical treatment of recurrent lumbar disc herniation. Clinical correlation between plain film radiography, MRI studies, and clinical presentation were reviewed. Data on frequency in the management of recurrent lumbar intervertebral disc herniations presented. Duration of symptoms and influence of patient outcomes in sciatica patients undergoing micro-discectomy and decompressions. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Orthopedic Spine Surgery – Length of Stay in Lumbar Spinal Surgery – discussion on the epidemiology of lumbar surgery outcomes and hospital stay. Correlation to clinical presentation and comorbidities were reviewed. Outline of decompression and instrumental fusion in the lumbar spine. Review of costs of lumbar surgery, trends in hospital stay and costs both on a cumulative and daily basis. Comparison of the nationwide inpatient sample and national surgical quality improvement program databases for lumbar spine fusion procedures was reviewed and presented. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Orthopedic Spine Surgery – Pre-Surgical Planning and Implant Design – 3-D printing and surgical planning discussion a variety of historical materials in the creation of patient specific implants based on unique individual anatomy. Historical trends in the creation of prosthetics with 3-D modeling software using neuroimaging data. Review of treatment complex spinal pathologies and surgical planning was discussed. Outline of current and future barriers to global implementation and commercialization was reviewed. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Orthopedic Spine Surgery – Spine Surgery Procedures in Medical Specialty Training – discussion of current spine surgery training including fellowship programming in the United States. Accreditation Council for Graduate Medical Education (ACGME) cases logs were reviewed and discussed. Variability of procedures within programs and between medical specialty programs were outlined. Differential utilization between orthopedic and neurosurgical fellows was reviewed. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Orthopedic Spine Surgery – Cerebral Spinal Fluid Dynamics, Central Nervous System Pathology and Intracranial Hypotension – pathophysiology and various craniospinal disorders. Directional phase contrast MRI (4D Flow) was reviewed along with the anatomical and physiological properties of cerebral spinal fluid. Specific disorders such as Alzheimer’s disease, hydrocephalus, Chiari Malformation and syringomyelia. Clinical correlation of CSF dynamics to understanding disease process was reviewed including normal and abnormal flow patterns. Recent advancements in fluid flow studies were outlined and presented. Signal intensity changes on MRI study in cervical spondylotic myelopathy was discussed and compared to normal parameters. Fluid dynamics patterns within syringomyelia and Chiari malformation was discussed and correlated to MRI findings and clinical presentations. Spinal microsurgical exploration surgery and resultant CSF leak and spontaneous intractable intracranial hypotension was reviewed and its pathoanatomical presentation outlined. Review of the natural and surgical history of Chiari malformation Type I in pediatric population and clinical correlation with MRI studies. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Orthopedic Extremity Surgery – Wrist Anatomy and Osseous Kinematics – normal kinematics using biplanar radiographic model were reviewed. Discussion of extensive database of carpal bone anatomy and kinematics from a large number of healthy subjects. 3-D motion of each bone was calculated for each wrist position and discussed. Database constructed including high-resolution surface models, measures of bone volume and shape, and the 3-D kinematics of each segmented bone. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Orthopedic Extremity Surgery – Normal Motion of the Shoulder and Glenohumeral Instability – normal motion of the shoulder joint compared with clinical implications of glenohumeral joint instability including surgical recommendations. Review and overview of the anatomy of the glenohumeral joint, emphasis on instability based on the current literature. Description of detailed anatomy and anatomical variants of the glenohumeral joint associated with anterior and posterior shoulder instability. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Orthopedic Extremity Surgery – Orthopedic Testing and Shoulder Pathology Diagnosis - use of orthopedic special tests (OSTs) to diagnose shoulder pathology and clinical examination. Review OST clusters, examination of methodology and illustration of their use in arriving at a pathology-based diagnosis. Discussion of examination of the biceps tendon and clinical relevance. Review of SLAP lesion and shoulder impingement syndrome were reviewed. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Orthopedic Extremity Surgery – Electrodiagnostic Testing and Carpal Tunnel Syndrome – Review of the most common mononeuropathy in the human body. Relationship between clinical findings, neurological examination and electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. Acute and chronic symptoms including progression of the disorder were reviewed. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Orthopedic Extremity Surgery – Current Concepts in Elbow Disorders – Detailed anatomy of osseus, ligamentous and muscular structure of the elbow was reviewed. Common disease of elbow disorders and their treatment was discussed. Lateral epicondylitis and medial collateral ligament injury of the elbow were outlined. Rheumatoid arthritis, posttraumatic osteoarthritis, and elderly patients with comminuted distal humeral fractures. Surgical design and technique were outlined. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Orthopedic Extremity Surgery – Differentiating Cervical Spine from Shoulder Pathology – anatomical review of cervical spine and glenohumeral joint focus on similarities and differences. Cervical disorders masking shoulder pain, cervical radiculopathy, cervical spondylotic myelopathy, facet and discogenic pain patterns were outlined. Details of shoulder pathology parsonage-tuner syndrome, subscapular neuropathy and thoracic outlet were presented. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Orthopedic Extremity Surgery – MRI of the Shoulder and Shoulder Girdle – review of MRI analysis of scapular fracture. Detailed review of scapular function rehabilitation and training on chronic pain syndromes. Reliability of magnetic resonance imaging versus arthroscopy for the diagnosis and classification of superior glenoid labrum anterior to posterior lesions. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Orthopedic Extremity Surgery -Cataloging Movements of the Ankle, Hip and Spine - Review Standardization and Terminology Committee (STC) of the International Society of Biomechanics (ISB) and classification of joint kinematics. Standard for the local axis system in each articulating bone is generated and presented. Rationale for international standards among researchers was presented. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Orthopedic Extremity Surgery -Cataloging Movements of the Shoulder, Elbow, Wrist and Hand - Review Standardization and Terminology Committee (STC) of the International Society of Biomechanics (ISB) and classification of joint kinematics. Standard for the local axis system in each articulating bone is generated and presented. Rationale for international standards among researchers was presented. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Orthopedic Extremity Surgery – MRI and Diagnosis of Shoulder Disorders – normal and abnormal shoulder anatomy as viewed on MRI was presented. Review and presentation of MRI in the diagnosis and treatment of brachial plexus injury. Discussion of preganglionic avulsions and muscular denervation. Comparison of CT myelography to MRI myelography were outlined. Enhanced three-dimensional T1 high-resolution isotropic volume excitation MR in the evaluation of shoulder pathology. Comparison with two-dimensional enhanced T1 fat saturation MRI were discussed. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Orthopedic Extremity Surgery – Clinical Evaluation of Upper and Lower Extremity Pathology – review of relevant anatomy in shoulder, elbow, wrist, hip, knee and ankle was presented. Physical examination including orthopedic, neurological and range of motion testing was presented and compared with findings on MRI results. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neuroradiology – radiographic evolution of a Schmorl’s node – acute Schmorl’s node and progression to chronic stage comparison to serial MRI. Endplate fracture and acute presentation and correlation to clinical findings and pain patterns. Presentation in plain film radiograph and MRI images were compared and contrasted in both acute and chronic stages. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neuroradiology – syringomyelia, fluid dynamics and spinal cord motion – scoliosis curve patters and syrinx characteristics versus Chiari I malformation. Normal MRI appearance and motion artifacts related to cerebral spinal fluid motion related phenomena and common appearances on MRI imaging. Syrinx wall and fluid motion and correlation to cardiac cycle with comparison between systolic and diastolic presentations. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neuroradiology – Spinal Biomechanics, Thoracolumbar Deformity and Surgical Outcomes – full spine analysis, adjacent spinal biomechanics and its impact on surgical outcomes. Sagittal alignment pelvis to cervical spine and association with kyphosis and lordosis mechanical positioning. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neuroradiology – MRI and EMG comparison in denervated muscle diagnosis – lumbar spine pathology and age in relation to paraspinal muscle size and fatty infiltration. Fatty degeneration of paraspinal muscle in degenerative lumbar kyphosis and CT versus MRI digital analysis. Positive correlations with edema on MRI and fibrillations, positive sharp waves, denervation and the level of reduced recruitment pattern. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neuroradiology – association between annular tear and disc degeneration – high intensity zone (HIZ) in lumbar disc and association to annular fissure on MRI. Identification of duel HIZ and its relationship to acute inflammation and calcified tissue and its association with discogenic pain patterns. Influence of phenotype, population size and inclusion sequence. T1, T2 and STIR imaging comparison and correlation. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neuroradiology – degenerative cervical myelopathy – paraspinal muscle morphology, clinical symptoms, and functional status. Review of fatty infiltration, asymmetry findings and correlation with clinical symptoms and functional scores. Review of complex anatomical arrangement of superficial and deep muscle layers in the cervical spine, correlation to MRI findings. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neuroradiology – MRI Neurography, Diffuse Tensor Imaging (DTI) – diagnostic accuracy and fiber tracking in spinal cord compression. Review of spinal cord structural integrity, peripheral neuropathy and correlation to diffuse tensor-imaging findings. Comparison in combining DTI with T2 and T2 alone and its value in magnetic resonance neurography. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neuroradiology – Nomenclature and Classification of Lumbar Disc Pathology – modified Pfirrmann grading system and lumbar disc degeneration. Consensus driven description of intervertebral disc nomenclature including intervertebral disc bulge, herniation, protrusion, broad based disc herniation, extrusion, and sequestration. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neuroradiology – MRI evaluation of intradural tumor – neuroimaging of spinal tumors and correlation to histological study. Determining method of choice for evaluation, review of numerous types of intradural-extramedullary masses including meningioma and schwannoma. Signal intensities, contrast enhancement patterns, presence of cysts and other key differentiation findings of spinal cord tumors. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neuroradiology – Spinal Cord Compression, Myelomalacia, MRI Imaging and Clinical Correlation – positional cervical spinal cord compression and fibromyalgia. T1 and T2 weighted images, comparison of hypo and hyperintense signals and extent of intramedullary changes on MRI. Review of MRI findings associated with myelomalacia and discussion of correlation with clinical findings. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neuroradiology – MRI Characteristics of Lumbar Facet Synovial Cyst – formation characteristics of synovial cyst, relation to degenerative changes in spinal facet joints as demonstrated on MRI. Pre and post-surgical procedural MRI were reviewed and compared. Surgical management and subsequent resection were demonstrated. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Neuroradiology – Variability in MRI Diagnostic Error Rates – in depth review of quality of MRI imaging and comparison to consistent MRI diagnosis between facilities. Errors of interpretation in the study examinations were considered and presented. Impact of radiological diagnosis, location of MRI study and reading radiologist and impact on treatment choice and clinical outcomes. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in MRI Physics – The Hardware – magnet types including permanent, resistive and superconducting magnets. Volume RF, surface, quadrature and phase array coils and other hardware necessary for the generation of MRI imaging. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in MRI Physics – Physics of Image Generation 1 – magnetization, excitation, relaxion, acquisition, computing and display. T1 relaxion and relaxation curves, T2 relaxation, phase and phase coherence, T2 relaxion curves. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in MRI Physics – Physics of Image Generation 2 – gradient coils, signal coding including slice encoding gradient, phase encoding gradient, Frequency encoding gradient. Gradient specifications and slice thickness. Filling k-space, k-space symmetry and k-space filling technique. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in MRI Physics – Physics of Image Generation 3 – pulse sequences, spine echo sequences including multi-slicing and multi-echo sequencing. T1, T2, proton density contrast and their applications. Turbo spine echo, fast advanced spine echo (HASTE) sequence and gradient echo sequence. Inversion recovery sequence including STIR and FLAIR sequence. Choosing the right sequence pros and cons, T1, T2 and PD parameters. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in MRI Physics – Physics of Image Generation – technical parameters and artifacts – repetition time, echo time, flip angle, inversion time, number of acquisitions, matric and field of view. Slice thickness, slice gap, phase encoding direction 1 and direction 2 and relation to bandwidth. Motion artifact, para-magnetic artifact, phase wrap artifact, susceptibility artifact, clipping artifact, spine and zebra artifacts. Effects on image quality and acquisition. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Pain Management – Clinical and Procedural – Growth of Interventional Pain Management Techniques and Current Trends in Pharmacological Management of Neuropathic Pain. ESI comparison to gabapentin in lumbosacral radicular pain – current trends and future progress of pain management interventions. Mode of action, required dosage, advantages and side effects profiles of currently available pharmacological approaches. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Pain Management – Clinical and Procedural – Therapeutic Effects of Spinal Injection Therapy - Facet, medial branch blocks, prolotherapy and epidural interventions utilization within the Medicare population, effectiveness on lumbar central canal stenosis with and without steroids and effect on prevention of spinal surgery, herniated disc, fibromyalgia and chronic musculoskeletal pain. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Pain Management – Clinical and Procedural – Adverse Events Associated with Injection Therapy – transforaminal and interlaminar epidural steroid injections, anesthesia technical considerations, effects on cervical radiculopathy midline versus paramedian approaches and perineurial injection of autologous conditioned serum. Review of FDA risk assessment. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Pain Management – Clinical and Procedural – Correlation of MRI Findings and Injection Outcomes - MODIC Changes on MRI and effectiveness of facet injection, facet joint signal change on MRI with fat suppression comparison with SPECT/CT. Discussion of Modic 1, 2 and 3 with correlation of clinical outcomes and patient selection criteria. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Pain Management – Clinical and Procedural – Therapeutic Effects of Botulinum Toxin and Dry-Needling in Myofascial Pain Syndrome – cost effectiveness, patient response and triage of therapeutic interventions. Physiological review of trigger point etiology and clinical presentation of acute and chronic pain. Functional response of intervention including relief and recurrence. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Pain Management – Clinical and Procedural – Systematic Review Technical Considerations in Cervical Epidural Analgesia - Chemical blockage of cervical nerve roots, review of anatomical structures and correlation with MRI imaging. Blockage effects on the respiratory, circulatory and neurological systems. Review of cervical epidural space (CES) borders and variants in patient population. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Pain Management – Clinical and Procedural – Trends in opioid analgesic abuse and mortality in the USA, Evaluation of Opioid Pain Management in Injured Children, assessment of opioid reporting in Veteran Affairs – Emergency visitation in pediatric injury, pain management and adoption of best practices. Trends in use of prescription opioid medication using RADARS (Research Abuse, Diversion and Addiction Related Surveillance System), comparison between legitimate pharmacy channels and diversion and abuse. Opioid use prevalence and incidents in Veteran Affairs, new prescriptions or long-term conversion and relationship to persistent growth in opioid use. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Pain Management – Clinical and Procedural – Electrodiagnostic Testing, Transforaminal Epidural Steroid Injection, Intra-articular Facet Joint Injection, Spinal Manipulation Post-Epidural Injection– Needle EMG, active versus chronic denervation in lumbar, cervical spinal pathologies and differential diagnosis of spinal stenosis and intervertebral disc herniation. Systematic review of facet joint injections, clinical trials and conservative therapy in lower back pain. Results of spinal manipulation post-epidural injection in the cervical spine. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Pain Management – Clinical and Procedural – Radiofrequency Ablation and outcome measures - medication, function and pain in relation to pain of spinal origin. Medial Branch Block as prognostic tool prior to lumbar facet radiofrequency denervation. Clinical comparison disc herniation, disc bulge, cervical and lumbar radiculopathy. Diagnosis and patient triage correlation to anatomical spine structures. Long, short term risk factors and outcomes in radiofrequency ablation. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Specialty Research in Pain Management – Clinical and Procedural – Role of Cannabinoids in Pain Management – review of pharmacological, botanical or synthetic origins of cannabinoids. Mechanism of action in alleviation of pain including analgesic, anti-inflammatory effects, modular actions on neurotransmitters and interactions with prescribed or endogenous opioids. Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2019.

Clinical Grand Rounds – Traumatic Cervical Disc Herniation with Pre-existing Cervical Spinal Fusion – a case review of traumatically induced multi-level cervical disc herniation with below a pre-existing spinal fusion.  Review of case history, physical examination findings, plain film radiographs, cervical spine MRI with particular attention paid to osteophyte and modic changes.  Interprofessional communication both verbally and through proper evidence-based documentation was emphasized and discussed focusing on acute versus chronic spinal injury.  Academy of Chiropractic, Post-Doctoral Division, Buffalo, NY, 2019

Traumatic Brain Injury and Concussion Overview: This section is an in-depth overview of traumatic brain injury in concussion. It discusses that all brain injuries are traumatic and dispels the myth of a “mild traumatic brain injury.” Also, this covers triage protocols and the potential sequela of patients with traumatic brain injuries. Cleveland University, Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, 2019

Head Trauma and Traumatic Brain Injury Part 1: This section discusses gross traumatic brain injuries from trauma and significant bleeding with both epidural and subdural hematomas. There are numerous case studies reviewed inclusive of neurosurgical intervention and postsurgical outcomes. Cleveland University, Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, 2019

Head Trauma and Traumatic Brain Injury Part 2: This section continues with multiple case studies of gross traumatic brain injuries from trauma requiring neurosurgical intervention and also discusses recovery sequela based upon the significance of brain trauma. This module also concludes with concussion protocols in traumatic brain injury short of demonstrable bleeding on advanced imaging. Cleveland University, Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, 2019

Concussion and Electroencephalogram Testing: This this section covers concussion etiology and cognitive sequela where gross bleeding has not been identified on advanced imaging. It discusses the significance of electroencephalogram testing in determining brain function and pathology (if present). This module also covers the understanding of waveforms in electroencephalogram testing in both normal and abnormal scenarios. Cleveland University, Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, 2019

Concussion and Electroencephalogram Testing Pathological Results: This module covers amplitude, conduction and conduction delays as sequela to traumatic brain injury to diagnose concussion and traumatic brain injury in the absence of gross bleeding and advanced imaging. This section covers electroencephalograms and event-related potentials which measures the brain response that is a direct result of specific sensory or motor events. It is a stereotype electrophysiological response to a stimulus and provides a noninvasive means of evaluating brain function. In this module multiple case studies are discussed with ensuing triage protocols pending the results. Cleveland University, Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, 2019

Clinical Grand Rounds – Differentiating Pre-existing vs Causally Related Spinal Injury using MRI – case review of traumatic injury to the cervical spine with underlying pre-existing traumatic injuries. Physical examination, neurological and orthopedic testing was clinically correlated to mechanism of injury, plain film radiographs and MRI studies. Comparison of T1, T2 and STIR views were reviewed in relation to intervertebral disc bulge, intervertebral disc herniation, Modic 1, Modic 2 and Modic 3 changes. Comparative review of causally related versus pre-existing changes was demonstrated. Academy of Chiropractic, Post-Doctoral Division, Buffalo, NY, 2019

Clinical Grand Rounds – Compensatory Lower Back Pain Due to T2 Biomechanical Pathology – case review of spinal biomechanical engineering study in the care plan of non-responsive lower back pain. A review of medical care plan, epidural steroid injections and past medical history. Patient centered approach to full spine assessment in non-responsive chronic lower back pain with associated primary spinal mechanical lesion identified in upper thoracic spine. Academy of Chiropractic, Post-Doctoral Division, Buffalo, NY 2019

Clinical Grand Rounds – Thoracic Intervertebral Disc Herniation with Subsequent Four Level Spinal Fusion T6-T10 – case review of multilevel intervertebral disc herniations in the thoracic spine with clinical correlation to mechanism of injury, physical examination findings, neurological examination and range of motion analysis.  Differential diagnosis of facet syndrome, thoracic radiculopathy and discogenic pain including structural innervation of surrounding tissues and intervertebral discs with referral pattern was reviewed and discussed.  Subsequent failure of chiropractic care and rehabilitation leading to multilevel thoracic spinal fusion was demonstrated and reviewed.  Plain film radiographs and MRI evaluation of the thoracic spine sagittal and axial images in T1, T2 and STIR was demonstrated and clinically correlated to objective findings and subjective complaints. Interprofessional referral and documentation was outlined and discussed. Academy of Chiropractic, Post-Doctoral Division, Buffalo, NY 2019.

Electrodiagnostics: Electromyogram/Nerve Conduction Velocity (EMG/NCV), Diagnosis & Interpretation: Anatomy and Physiology of Electrodiagnostics: An in-depth review of basic neuroanatomy and physiology dermatomes and myotomes to both the upper and lower extremities and the neurophysiology of axons and dendrites along with the myelin and function of saltatory for conduction. The sodium and potassium pump’s function in action potentials. ACCGME Joint Providership with the State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences, Cleveland University Kansas City, Chiropractic and Health Sciences, PACE Recognized by the Federation of Chiropractic Licensing Boards, Academy of Chiropractic, Post-Doctoral Division, Long Island NY, 2019

Electrodiagnostics: Electromyogram/Nerve Conduction Velocity (EMG/NCV), Diagnosis & Interpretation: Nerve Conduction Velocity (NCV) Part 1: Nerve conduction velocity testing, the equipment required, and the specifics of motor and sensory testing. This section covers the motor and sensory NCV procedures and interpretation, including latency, amplitude (CMAP) physiology and interpretation, including the understanding of the various nuances of the waveforms. , Cleveland University Kansas City, Chiropractic and Health Sciences, PACE Recognized by the Federation of Chiropractic Licensing Boards, Academy of Chiropractic, Post-Doctoral Division, Long Island NY, 2019

Electrodiagnostics: Electromyogram/Nerve Conduction Velocity (EMG/NCV), Diagnosis & Interpretation: Nerve Conduction Velocity (NCV) Part 2: Compound motor action potentials (CMAP) and sensory nerve action potentials (SNAP) testing and interpretation, including the analysis and diagnosis of the waveforms. It also covers compressive neuropathies of the median, ulnar and posterior tibial nerves; known as carpal tunnel, cubital tunnel and tarsal tunnel syndromes. This section offers interpretation algorithms to help understand neurodiagnostic conclusions. ACCGME Joint Providership with the State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences, Cleveland University Kansas City, Chiropractic and Health Sciences, PACE Recognized by the Federation of Chiropractic Licensing Boards, Academy of Chiropractic, Post-Doctoral Division, Long Island NY, 2019

Electrodiagnostics: Electromyogram/Nerve Conduction Velocity (EMG/NCV), Diagnosis & Interpretation: Needle Electromyogram (EMG) Studies: The EMG process, inclusive of how the test is performed and the steps required in planning and electromyographic study. This covers the spontaneous activity of a motor unit action potential, positive sharp waves and fibrillations. The insertional activity (both normal and abnormal), recruitment activity in broad polyphasic presentation and satellite potentials. This covers the diagnosing of patterns of motor unit abnormalities including neuropathic demyelinated neuropathies along with acute myopathic neuropathies. This section also covers the ruling out of false positive and false negative results. ACCGME Joint Providership with the State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences, Cleveland University Kansas City, Chiropractic and Health Sciences, PACE Recognized by the Federation of Chiropractic Licensing Boards, Academy of Chiropractic, Post-Doctoral Division, Long Island NY, 2019

Electrodiagnostics: Electromyogram/Nerve Conduction Velocity (EMG/NCV), Diagnosis & Interpretation: Overview of EMG and NCV Procedures, Results, Diagnoses and Documentation. The clinical incorporation of electrodiagnostic studies as part of a care plan where neuropathology is suspected. It also covers how to use Electrodiagnostics in a collaborative environment between the chiropractor as the primary spine care provider and the surgeon, when clinically indicated. This section covers sample cases and concludes accurate treatment plans based upon electro-neurodiagnostic findings when clinically indicated. Cleveland University, ACCGME Joint Providership with the State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences, Cleveland University Kansas City, Chiropractic and Health Sciences, PACE Recognized by the Federation of Chiropractic Licensing Boards, Academy of Chiropractic, Post-Doctoral Division, Long Island NY, 2019

Documentation, Carrier Mandates and How to Guide Emergency Room and Lawyer Referrals, documenting Electrodiagnostics, concussion and disc pathology as reflective of clinical findings when collaborating with medical specialists in private practice and hospital settings or in the medical-legal arena. Ensuring complete documentation in the evaluation and management process for both the initial and re-evaluation processes. Academy of Chiropractic Post-Doctoral Division, Long Island, NY, 2019

Documenting & Credentials in Collaborative Health Care, History, past history, risk factors and review of systems in developing a differential diagnosis. The clinical correlation of clinical evaluation, advanced imaging and necessary Electrodiagnostics in concluding and accurate diagnosis, prognosis and treatment plan and indications for collaborative care, Academy of Chiropractic, PACE Approved for the Federation of Chiropractic Licensing Boards, Cleveland University, Kansas City Chiropractic and Health Sciences, 2019

Clinical Grand Rounds – Traumatic Cervical Disc Herniation and Associated Sternum Fracture – a case review of traumatically induced multi-level cervical disc herniation with associated Grade 2 Ligament Injury rated as sub-threshold. Review of case history, physical examination findings, plain film radiographs, cervical spine MRI and bone scan. Radiographic analysis and objectification of grade 2 sprain was presented and its correlation to the AMA Guides to the Evaluation of Permanent Impairment 5th edition was reviewed. Review of the purpose, function and positive findings on bone scan was reviewed and demonstrated using patient’s fractured sternum. Interprofessional communication both verbally and through proper evidence-based documentation was emphasized and discussed. Academy of Chiropractic, Post-Doctoral Division, Buffalo, NY 2019

Clinical Grand Rounds – Traumatic Disc Bulge and Associated Grade 2 Ligament Injury – a case review of traumatically induced cervical spine traumatic bulge of the intervertebral disc with concomitant grade 2 ligament injury was presented. Detailed anatomy and morphological presentation of normal and degenerative intervertebral disc presentation was demonstrated and reviewed. Review of morphological differences between disc bulge, disc herniation and disc protrusion were presented. Grade 1, Grade 2 and Grade 3 ligamentous sprains were reviewed and discussed. Radiographic analysis and objectification of grade 2 sprain was presented and its correlation to the AMA Guides to the Evaluation of Permanent Impairment 5th edition was reviewed. Interprofessional communication both verbally and through proper evidence-based documentation was emphasized and discussed. Academy of Chiropractic, Post-Doctoral Division, Buffalo, NY, 2019

Evaluation and Management, an overview of the evaluation and management process inclusive of utilizing electronic medical records to conclude evidenced-based conclusions with the utilization of macros. The importance of adhering to an academic standard and considering co-morbidities. Cleveland University, Kansas City, PACE Recognized by the Federation of Chiropractic Licensing Boards, Academy of Chiropractic, Post-Doctoral Division, Long Island NY, 2019

Evaluation and Management, concluding a chief complaint, history and what needs to be considered in a physical examination. This covers in depth the required elements for chief complain, history of present illness, review of systems, and past, family, and/or social history. This module also covers the following components of a physical examination: observation, palpation, percussion, and auscultation. Cleveland University, Kansas City, PACE Recognized by the Federation of Chiropractic Licensing Boards, Academy of Chiropractic, Post-Doctoral Division, Long Island NY, 2019

Evaluation and Management, Coding and Spinal Examination: Detailing 99202-99205 and 99212-99215 inclusive of required elements for compliant billing. It reviews the elements for an extensive review of systems, cervical and lumbar anatomy and basic testing. The course also covers the basics of vertebra-basilar circulation orthopedic assessment. Cleveland University, Kansas City, PACE Recognized by the Federation of Chiropractic Licensing Boards, Academy of Chiropractic, Post-Doctoral Division, Long Island NY, 2019

Evaluation and Management, Neurological Evaluation: Reviewing complete motor and sensory evaluation inclusive of reflex arcs with an explanation of Wexler Scales in both the upper and lower extremities. The course breaks down testing for upper and lower motor neuron lesions along with upper and lower extremity motor and sensory testing examinations. Cleveland University, Kansas City, PACE Recognized by the Federation of Chiropractic Licensing Boards, Academy of Chiropractic, Post-Doctoral Division, Long Island NY, 2019

Evaluation and Management, Documenting Visit Encounters: Forensically detailing the S.O.A.P. note process for visit encounters and discussing the necessity for clinically correlating symptoms, clinical findings and diagnosis with the area(s) treated. It also details how to modify treatment plans, diagnosis, document collaborative care and introduce test findings between evaluations.

Cleveland University, Kansas City, PACE Recognized by the Federation of Chiropractic Licensing Boards, Academy of Chiropractic, Post-Doctoral Division, Long Island NY, 2019

Evaluation and Management, Case Management and Treatment Orders: This module discusses how to document a clinically determined treatment plan inclusive of both manual and adjunctive therapies. It discusses how to document both short-term and long-term goals as well as referring out for collaborative care and/or diagnostic testing.  It also includes how to prognose your patient and determine when MMI (Maximum Medical Improvement) has been attained. Cleveland University, Kansas City, PACE Recognized by the Federation of Chiropractic Licensing Boards, Academy of Chiropractic, Post-Doctoral Division, Long Island NY, 2019

Clinical Grand Rounds – 14 mm Cervical Disc Herniation with Spinal Cord Compression – A case review of traumatically induced 14 mmm acute cervical intervertebral disc extrusions with inferior migration resulting in severe right lateral canal stenosis, foraminal stenosis and spinal cord impingement. A detailed review of physical examination findings, neurological evaluation, MRI images and surgical triage was presented. Interprofessional communication both verbally and through proper evidence-based documentation was emphasized and discussed. Academy of Chiropractic, Post-Doctoral Division, Buffalo, NY, 2019.

Forensic Documentation-Report Writing, Report writing in a medical-legal case inclusive of causality, bodily injury, persistent functional loss and restrictive sequela from trauma. Demonstratively documenting bodily injury utilizing models, graphs and patient image of x-ray and advanced imaging. Cleveland University, Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, April 1, 2019.

Forensic Documentation- Demonstrative Documentation, demonstratively reporting spinal biomechanical failure and spinal compensation. How in a medical-legal environment to ethically report pre-existing injuries vs causally related current injuries and what is permissible in a legal proceeding. Cleveland University, Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, April 1, 2019.

Forensic Documentation- Reporting Direct Opinions, Causality, bodily injury and persistent functional losses documented and reported in a medical-legal environment as your direct opinion. Avoiding hearsay issues to ensure ethical relationships. Cleveland University, Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, April 1, 2019.

Forensic Documentation- Initial, Final and Collaborative Reporting, preparing demonstrative documentation in a medical-legal case ensuring that you are familiar with all other treating doctor’s reports. Correlating your initial and evaluation and management (E&M) report and your follow-up E&M reports with the narrative upon maximum medical improvement documenting continuum of care. Cleveland University, Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, April 1, 2019.

Forensic Documentation- Qualifications and Preparation of Documentation, how to prepare your documentation for courtroom testimony and ensuring your qualifications are documented properly on an admissible, professional curriculum vitae. How to include indexed peer-reviewed literature in medical-legal documentation, Cleveland University, Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, April 1, 2019.

Forensic Documentation- Reporting Patient History and Credentials, preparing patient history in a medical-legal case based upon your initial intake forms and understanding the work, social, academic, household and social activities of your patient. Understanding and explaining your doctoral and post-doctoral credentials in the courtroom. Cleveland University, Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, April 1, 2019.

Forensic Documentation- Reporting Chiropractic Care and Injured Anatomy, preparing demonstrative documentation in a medical-legal case to report the bodily injuries of your patients, inclusive of loss of function and permanent tissue pathology. Cleveland University, Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, April 1, 2019.

Forensic Documentation- Reporting Temporary vs. Permanent Issues, preparing documentation in a medical-legal case ensuring that you can communicate permanent vs. temporary functional losses and permanent vs. temporary tissue pathology. How to maintain and explain ethical relationships in medical-legal cases, Cleveland University, Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, April 1, 2019.

Forensic Documentation- Reporting Bodily Injury, how to report bodily injury and functional losses as supported by your credentials in a medical-legal case. Clinically correlating causality and permanent tissue pathology as sequela to trauma, Cleveland University, Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, April 1, 2019.

Forensic Documentation- Record Review and Documentation Reporting, how to report records of collaborative treating doctors and communicating your scope of practice in the management of your case. How to ethically report your role as a doctor in medical-legal cases, Cleveland University, Kansas City, Academy of Chiropractic, Post-Doctoral Division, Long Island, NY, April 1, 2019.

Clinical Grand Rounds – Interprofessional Management of Cervical Instability and Traumatic Brain Injury, Case review of traumatically induced cervical spine grade 2 ligament tear with associated underlying degenerative disc disease and traumatic brain injury. MRI review and discussion of axonal shearing findings on advanced imaging, evidenced based triage to neurology concussion clinic and documentation. Clinical correlation to pre-existing electrodiagnostic evidence. Surgical co-management of anatomical and biomechanical pathology with post-op follow up, focus on interprofessional communication. Academy of Chiropractic Post-Doctoral Division, Buffalo, NY, 2019

Connective Tissue Pathology, Spinal Biomechanics as Sequella to Trauma, MRI Spine Interpretation, Ordering Protocols & Triaging the Injure, The latest research on the 6 ways to age-date disc herniations and bulges from trauma inclusive of disc pathology nomenclature. MRI ordering protocols, inclusive of Dixon format and fat-suppressed images. The neurology and pathology of connective tissue and the sequella of trauma at the biomechanical level leading to bio-neuro-mechanical failure. Contemporary "evidenced-based building blocks" for triaging and in a collaborative environment. Cleveland University Kansas City, Chiropractic and Health Sciences, Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2018

Spinal Biomechanical Engineering Digitizing, integrating automated mensuration into creating treatment plans and determining maximum medical improvement. A literature-based study of normal vs. abnormal motor until function. Determining ligamentous laxity, alteration of motion segment integrity and pathological stress units and whole person impairments based upon the literature and academic standards, Cleveland University Kansas City, Chiropractic and Health Sciences, Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2018

Clinical Grand Rounds – Biomechanical Pathology Secondary to Cervical Fusion, Case review of traumatically induced cervical and lumbar spine. Prior cervical fusion C4-7 with a review of plain film radiographs, MRI studies, and neurological evaluation. The biomechanical assessment revealed significant compensation in the lumbar spine secondary to cervical disc herniation and grade 2 ligament injury above the prior fusion. Modic 2 changes on lumbar spine MRI. Care plan, interprofessional documentation and patient-centered education. Academy of Chiropractic Post-Doctoral Division, Buffalo, NY, 2019

Clinical Grand Rounds, Traumatically Induced Biomechanical Pathology with Secondary Underlying Multi-Level Cervical Intervertebral Disc Herniation – Case review of traumatically induced biomechanical pathology in the cervical spine in the absence of pre-existing degenerative change and ligament laxity. Review of underlying multi-level acute intervertebral disc herniation and clinical correlation to patient presentation. T1, T2, and STIR MRI review of acute intervertebral disc herniation in both sagittal and axial planes outlining correlation to radiologist report and electrodiagnostic findings. Academy of Chiropractic Post-Doctoral Division, Buffalo, NY, 2019

Science of the Chiropractic Spinal Adjustment and Vertebral Subluxation, the literature-based definitions of both the mechanisms the chiropractic adjustment and how it affects the central nervous system in pain pathways and systemic issues that is the arbiter for normal vs. abnormal function. The "physiological mechanisms" of how chiropractic spinal adjustment affects the peripheral and central nervous systems. Subluxation degeneration/Wolff's Law will be detailed from a literature perspective combined with the mechanism of subluxation (bio-neuro-mechanical lesion). A literature perspective on why "long-term" chiropractic care is clinically indicated as usual and customary to effectuate demonstrable biomechanical changes in the spine. An evidenced-based perspective of why physical therapy is a poor choice for the spine as a 1st referral option for any provider, inclusive of the literature. Cleveland University Kansas City, Chiropractic and Health Sciences, Academy of Chiropractic Post-Doctoral Division, Long Island, NY, 2018

Documentation, Collaboration, and Primary Spine Care, an academic basis for documentation that is usual and customary across professions in collaborative care. Maintaining ethical medical-legal relationships based upon Voir Dire and Daubert standards with ensuring a "4-corners" inclusive report. Ensuring Primary Care Status based upon academic standards. Cleveland University Kansas City, Chiropractic and Health Sciences, Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2018

Clinical Grand Rounds, Traumatically Induced Biomechanical Pathology with Secondary Underlying Multi-Level Cervical Intervertebral Disc Herniation – Case review of traumatically induced biomechanical pathology in the cervical spine in the absence of pre-existing degenerative change and ligament laxity. Review of underlying multi-level acute intervertebral disc herniation and clinical correlation to patient presentation. T1, T2 and STIR MRI review of acute intervertebral disc herniation in both sagittal and axial planes outlining correlation to radiologist report and electrodiagnostic findings. Academy of Chiropractic Post-Doctoral Division, Buffalo, NY, 2019

Clinical Grand Rounds – Biomechanical Pathology Secondary to Cervical Fusion, Case review of traumatically induced cervical and lumbar spine. Prior cervical fusion C4-7 with review of plain film radiographs, MRI studies and neurological evaluation. Biomechanical assessment revealed significant compensation in lumbar spine secondary to cervical disc herniation and grade 2 ligament injury above the prior fusion. Modic 2 changes on lumbar spine MRI. Care plan, interprofessional documentation and patient centered education. Academy of Chiropractic Post-Doctoral Division, Buffalo, NY, 2019

Clinical Grand Rounds – Traumatically Induced Cervical Central Canal Stenosis a case review of traumatically induced acute cervical intervertebral disc extrusion with superior migration resulting in severe central canal stenosis and spinal cord impingement. A detailed review of physical examination findings, neurological evaluation, MRI images and surgical triage. Interprofessional communication both verbally and through proper evidence-based documentation. Academy of Chiropractic, Post-Doctoral Division, Buffalo, NY, 2019

Fellowship in Spinal Biomechanics and Trauma, Cleveland University College of Chiropractic, Kansas City, Missouri, Academy of Chiropractic Post-Doctoral Division, Long Island, NY, 2018, ACCME Joint Sponsorship with the State University of New York at Buffalo, Jacobs School of Medicine, 2018.

Spinal Biomechanical Engineering Analysis, understanding spinal motor units as it relates to the Cartesian system and normal vs. pathological movement. Analyzing normal coupling functions of the spine in relations to gait and pelvic biomechanical function and determining stress units and standards of deviation of segmental dysfunction. Interpreting mensuration lines and block analysis beyond standards of deviation in spinal motor dysfunction about connective tissue failure.  Academy of Chiropractic Post-Doctoral Division, Long Island, NY, 2018

Spinal Biomechanical Engineering Pathology and Clinical Application, integrating pathological function based upon the Cartesian system and digital mensuration in developing treatment plans with diagnosed connective tissue failures. Diagnosing corrective vs. clinical management scenarios when considering maximum medical improvement in both the chronic and acute, insidious and traumatically induced patient. Academy of Chiropractic Post-Doctoral Division, Long Island, NY, 2018

Pain Management, Large and Small Nerve Fiber Electrodiagnostic Exams, Correlation to Radiographic and MRI Imaging Examinations The neurology and pathology of neural tissue and the sequella of trauma at the biomechanical level leading to bio-neuro-mechanical failure. American Association of Sensory Electrodiagnostic Medicine, ACCME, Little Rock Arkansas 2018.

Clinical Applications of Electrodiagnostic Exams of Upper and Lower Extremities utilizing Small Pain Fiber Nerve Conduction Exams. Utilizing Small Pain Fiber Testing to identify the source of chronic spinal and peripheral pain.  Contemporary research on anatomy and physiology of pain fibers. American Association of Sensory Electrodiagnostic Medicine, ACCME, Little Rock Arkansas 2018.

Contemporary Approaches to non-invasive pain management, Low back neurologic and orthopedic examinations. Pain neurophysiology, Pharmaceutical approaches to pain management, Electrotherapeutic pain management techniques. Fibromyalgia and small nerve fiber electrodiagnostic exams.  American Association of Sensory Electrodiagnostic Medicine, ACCME, Little Rock Arkansas 2018.

Small Pain Fiber Nerve Conduction Exam testing protocols and demonstration of clinical competency. American Association of Sensory Electrodiagnostic Medicine, ACCME, Little Rock Arkansas 2018.

Connective Tissue Pathology, Spinal Biomechanics as Sequella to Trauma, MRI Spine Interpretation, Ordering Protocols & Triaging the Injured, The latest research on the 6 ways to age-date disc herniations and bulges from trauma inclusive of disc pathology nomenclature. MRI ordering protocols, inclusive of Dixon format and fat-suppressed images. The neurology and pathology of connective tissue and the sequella of trauma at the biomechanical level leading to bio-neuro-mechanical failure. Contemporary evidenced-based building blocks for triaging and in a collaborative environment. Cleveland University Kansas City, Chiropractic and Health Sciences, Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2018

Spinal Biomechanical Engineering Digitizing, integrating automated mensuration into creating treatment plans and determining maximum medical improvement. A literature-based study of normal vs. abnormal motor until function. Determining ligamentous laxity, alteration of motion segment integrity and pathological stress units and whole person impairments based upon the literature and academic standards, Cleveland University Kansas City, Chiropractic and Health Sciences, Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2018

Science of the Chiropractic Spinal Adjustment and Vertebral Subluxation, the literature-based definitions of both the mechanisms the chiropractic adjustment and how it affects the central nervous system in pain pathways and systemic issues that is the arbiter for normal vs. abnormal function. The physiological mechanisms of how the chiropractic spinal adjustment affects the peripheral and central nervous systems. Subluxation degeneration/Wolffs Law will be detailed from a literature perspective combined with the mechanism of subluxation (bio-neuro-mechanical lesion). A literature perspective why long-term chiropractic care is clinically indicated as usual and customary to effectuate demonstrable biomechanical changes in the spine. An evidenced-based perspective of why physical therapy is a poor choice for spine as a 1st referral option for any provider inclusive of the literature. Cleveland University Kansas City, Chiropractic and Health Sciences, Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2018

Documentation, Collaboration, and Primary Spine Care, an academic basis for documentation that is usual and customary across professions in collaborative care. Maintaining ethical medical-legal relationships based upon Voir Dire and Duabert standards with ensuring an inclusive report. Ensuring Primary Care Status based upon an academic standard. Cleveland University Kansas City, Chiropractic and Health Sciences, Academy of Chiropractic Post-Doctoral Division, Long Island NY, 2018

Accident Reconstruction: Terms, Concepts and Definitions, the forces in physics that prevail in accidents to cause bodily injury. Quantifying the force coefficients of vehicle mass and force vectors that can be translated to the occupant and subsequently cause serious injury. Cleveland University – Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island, NY, 2018

Accident Reconstruction: Causality, Bodily Injury, Negative Acceleration Forces, Crumple Zones and Critical Documentation, Factors that cause negative acceleration to zero and the subsequent forces created for the vehicle that get translated to the occupant. Understanding critical documentation of hospitals, ambulance reports, doctors and the legal profession in reconstructing an accident. Cleveland University – Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island, NY, 2018

Accident Reconstruction: Skid Marks, Time, Distance, Velocity, Speed Formulas and Road Surfaces, the mathematical calculations necessary utilizing time, distance, speed, coefficients of friction and acceleration in reconstructing an accident. The application of the critical documentation acquired from an accident site. Cleveland University – Kansas City, Academy of Chiropractic Post-Doctoral Division, Long Island, NY, 2018

Accident Reconstruction: Research, Causality and Bodily Injury, Delta V issues correlated to injury and mortality, side impact crashes and severity of injuries, event data recorder reports correlated to injury, frontal impact kinematics, crash injury metrics with many variables and inquiries related to head restraints. Cleveland University – Kansas City, Academy of Chiropractic Post-Doctoral Division, Causality and Bodily Injury, Delta V issues correlated to injury and mortality, side impact crashes and severity of injuries, event data recorder reports correlated to injury, frontal impact kinematics, crash injury metrics with many variables and inquiries related to head restraints.

Documenting Trauma and Non-Trauma Cases & Triaging Disc Pathology, Triage, care, and collaboration for herniated, bulged, protruded, extruded and fragmented spinal discs. Compliant documentation of evaluation and management of new and established patients inclusive of chief complaint, history of present illness, review of systems, past-family-social histories with case management protocols and the required elements. Clinically coordinating treatment with subjective complaints, clinical findings and diagnosis for each encounter. Cleveland University-Kansas City Chiropractic and Health Sciences, Academy of Chiropractic Post-Doctoral Division, Long Island, NY, 2018

Triage and Management of the Trauma and Non-Trauma Patient, differentially diagnosing spinal issues in the trauma and non-trauma patient inclusive of spinal disc pathology utilizing x-ray, MRI, CAT Scan and clinical evaluations. Collaborative triaging protocols with neurologists, neurosurgeons, orthopedic surgeons, pain management and primary medical care providers with both mechanical and anatomical spinal pathologies. Academy of Chiropractic, Cleveland University - Kansas City Chiropractic and Health Sciences, Long Island, NY, 2018

Medical-Legal Ethical Relationships, Documentation and Legal Testimony, Report writing for legal cases, the 4 corners of a narrative and documenting damages with understanding defense medical documentation and consistent reporting of bodily injuries. Academy of Chiropractic, Post-Doctoral Division, Cleveland University-Kansas City, College of Chiropractic, Long Island, NY, 2018 

Medical-Legal Ethical Relationships, Documentation and Legal Testimony, Part 2, Understanding report writing and the types of medical reports required for court inclusive of diagnosis, prognosis and treatment plans with requirements of reporting causality and permanency. Academy of Chiropractic, Post-Doctoral Division, Cleveland University-Kansas City, College of Chiropractic, Long Island, NY, 2018 

Medical-Legal Ethical Relationships, Documentation and Direct Testimony, organizing your documentation and understanding all collaborative documentation and how it fits into your diagnosis, prognosis and treatment plan, Understanding the nuances of the functional losses of your patients related to their bodily injuries, Academy of Chiropractic, Post-Doctoral Division.  Academy of Chiropractic, Post-Doctoral Division, Cleveland University-Kansas City, College of Chiropractic, Long Island, NY, 2018 

Medical-Legal Ethical Relationships, Documentation and Direct Testimony Part 2, Utilizing demonstrative documentation in direct examination and communicating the results of your care concurrently with the written documentation and reporting an accurate diagnosis for all images. Academy of Chiropractic, Post-Doctoral Division, Cleveland University-Kansas City, College of Chiropractic, Long Island, NY, 2018 

Medical-Legal Ethical Relationships, Documentation and Direct Testimony Part 3, The evaluation, interpretation and reporting of collaborative medical specialists results and concluding an accurate diagnosis inclusive of all findings and reviewing all images to ensure an accurate diagnosis. Academy of Chiropractic, Post-Doctoral Division, Cleveland University-Kansas City, College of Chiropractic, Long Island, NY, 2018 

Medical-Legal Ethical Relationships, Documentation and Direct Testimony Part 4, Determining and documenting disabilities and impairments inclusive of loss of enjoyment of life and duties under duress and the evaluation and validation of pain and suffering. Academy of Chiropractic, Post-Doctoral Division, Cleveland University-Kansas City, College of Chiropractic, Long Island, NY, 2018 

Medical-Legal Ethical Relationships, Documentation and Cross Examination Testimony, reporting your documentation factually and staying within the 4 corners of your medical report and scope of practice inclusive of understanding how your credentials allow you to report your documentation. Academy of

Medical-Legal Ethical Relationships, Report Writing and Preparing for a Legal Case, Reviewing the facts of the case inclusive of your documentation, the defense medical examiner, medical specialists and the attorney to ensure accurate and consistent reporting. Academy of Chiropractic, Post-Doctoral

Division, Cleveland University-Kansas City, College of Chiropractic, Long Island, NY, 2018 

Medical-Legal Ethical Relationships, Report Writing and Preparing for a Legal Case, Creating demonstrative evidence, visuals of your patient's bodily injuries inclusive of x-rays, MRI's, CAT Scans and electrodiagnostic findings, the spinal biomechanics of herniated disc with ipsilateral findings and contralateral symptomatology.  Academy of Chiropractic, Post-Doctoral Division, Cleveland University-Kansas City, College of Chiropractic, Long Island, NY, 2018 

Evidenced Based Care in a Collaborative Setting; Primary Spine Care 5, A literature-based model for collaborating with hospitals, medical primary care providers and specialists. Reviewing the documentation requirements to communicate the diagnosis, prognosis and treatment plans with medical entities and having the evidence as a basis for those recommendations, Academy of Chiropractic Post-Doctoral Division, PACE Approved for the Federation of Chiropractic Licensing Boards, Cleveland University- Kansas City, College of Chiropractic, Long Island NY 2018

Current Literature Standards of MRI Spine Interpretation: Primary Spine Care 5, MRI. How to triage a trauma and non-trauma with advanced imaging and document the necessity. We will also cover the basics of MRI Spine Interpretation inclusive of all types of herniations, bulges, Academy of Chiropractic Post-Doctoral Division, PACE Approved for the Federation of Chiropractic Licensing Boards, Cleveland University- Kansas City, College of Chiropractic, Long Island NY 2018

Spine Brain Connection in Pain Pathways; Primary Spine Care 5, MRI Spine The spine-brain connection in managing chronic pain patients. Understanding how chronic pain negatively effects brain morphology and potential pathology as sequella. The role of chiropractic in preventing the loss of gray matter and the most recent evidence as outlined in indexed peer reviewed literature over the last 10 years verifying chiropractic’s role, Academy of Chiropractic Post-Doctoral Division, PACE Approved for the Federation of Chiropractic Licensing Boards, Cleveland University- Kansas City, College of Chiropractic, Long Island NY 2018

Bio-Neuro-Mechanical Mechanism of the Chiropractic Spinal Adjustment; Primary Spine Care 5, The biological, neurological and mechanical mechanisms and pathways from the thrust to the lateral horn and brain connection and how the brain processes the chiropractic spinal adjustment based upon the literature. Care paths of chiropractic and physical therapy from an outcome basis, Academy of Chiropractic Post-Doctoral Division, PACE Approved for the Federation of Chiropractic Licensing Boards, Cleveland University- Kansas City, College of Chiropractic, Long Island NY 2018

MRI Spine Interpretation and Spinal Biomechanics, Bulging, herniated, protruded and extruded disc contemporary nomenclature, analysis and differential diagnosis. Connective tissue physiology and pathology with aberrant biomechanical permanent sequelae, Texas Chiropractic College, Academy of Chiropractic, Melville NY, 2017

Medical-Legal Ethical Relationships, A Documentation Relationship Between the Doctor and Lawyer. The level of organization required in a medical-legal case accurately reflects the bodily injuries of your patients and the time constraints in rendering an accurate report. Academy of Chiropractic, Post-Doctoral Division, Cleveland University-Kansas City, College of Chiropractic, Long Island, NY, 2018 

Contemporary Literature in Spinal Biomechanics, Normal vs. pathological biomechanical spinal motion both in a single motor unit and coupling actions. Interdisciplinary approach to mechanical spine issues and evidenced-based care paths, Texas Chiropractic College, Academy of Chiropractic, Melville NY, 2017

Documentation of Spinal Trauma, Interdisciplinary approaches in the documentation of spinal related injuries inclusive of connective tissue disorders and biomechanical failure. Clinically correlating history, imaging, advanced imaging and clinical findings to conclude an accurate diagnosis, prognosis and treatment plan, Texas Chiropractic College, Academy of Chiropractic, Melville, NY, 2017

Contemporary Literature of the Chiropractic Spinal Adjustment, The bio-neuro-mechanical scientific foundation of the spinal lesion and the neurological pathways, both in the lower and upper motor neuron pathways. The autonomic sequella of the vertebral subluxation and the effects of the correction and maintenance of those lesions, Texas Chiropractic College, Academy of Chiropractic, Melville NY, 2017

Spinal Biomechanical Engineering Analysis, Normal vs. abnormal coupling motions in a mechanical model utilizing engineering principles in a predictive model. Applying the Cartesian nomenclature to normal and pathological sequella of the human spine, PACE approved for the Federation of Chiropractic Licensure Boards, Melville, NY, 2017.

Spinal Biomechanical Engineering Clinical Application. Creating treatment plans based upon predictive models in determining what is corrective vs. management of pathological spinal biomechanical behavior, PACE approved for the Federation of Chiropractic Licensure Boards, Melville, NY 017

Connective Tissue Spinal Disc Permanent Pathology, Primary Spine Care, Herniated, bulged, protruded and extruded discs, etiology and morphology. Age-dating disc pathology inclusive of Modic changes, piezoelectric effect, Wolff’s Law and radicular clinical presentation, Academy of Chiropractic Post-Doctoral Division, Texas Chiropractic College, Long Island NY 2017

Connective Tissue Pathology and Research, Primary Spine Care, Utilization in spinal models considering the opioid abuse and various spinal models in contemporary health care. Care paths for mechanical spine pain and the evidence for conservative chiropractic care, Academy of Chiropractic Post-Doctoral Division, Texas Chiropractic College, Long Island NY 2017

Bio-Neuro-Mechanical Lesions and Spine Care, Primary Spine Care, Mechanoreceptor, proprioceptor, nociceptor innervation and control of the spinal system with central nervous system action and interaction. The integration of the pain processing network and the HPA Axis (hypothalamus, adrenal and pituitary) with the chiropractic spinal adjustment, Academy of Chiropractic Post-Doctoral Division, Texas Chiropractic College, Long Island NY 2017

Ethics, Documentation and Research, Primary Spine Care. Maintaining ethical Interprofessional relationships based upon an evidenced based practice inclusive of triage, diagnostics and reporting. Creating thorough documentation that reflects your complete findings encompassing descriptive ICD-10 codes and concludes the presence or absence of pathology. Academy of Chiropractic Post-Doctoral Division, Texas Chiropractic College, Long Island NY 2017

Stroke Anatomy and Physiology: Brain Vascular Anatomy, The anatomy and physiology of the brain and how blood perfusion effects brain function. A detailed analysis of the blood supply to the brain and the physiology of ischemia. Texas Chiropractic College, ACCME Joint Providership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, Buffalo, NY, 2017

Stroke Anatomy and Physiology: Stroke Types and Blood Flow, Various types of stroke identifying ischemia, hypoperfusion, infarct and penumbra zones and emboli. Cardiac etiologies and clinical features as precursor to stroke with associated paradoxical emboli and thrombotic etiologies. Historical and co-morbidities that have etiology instroke inclusive of diabetes, coagulopathy, acquired and hereditary deficiencies. Texas Chiropractic College, ACCME Joint Providership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, Buffalo, NY, 2017

Stroke Principles of Treatment an Overview for the Primary Care Provider, Stroke type and treatments performed by vascular specialists. The goals of treatment with the physiology of the infarct and penumbra zones and the role of immediate triage in the primary care setting. Detailing the complications of stroke and future care in the chiropractic, primary care or manual medicine clinical setting. Texas Chiropractic College, ACCME Joint Providership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, Buffalo, NY, 2017

Clinical Evaluation and Protocols for Identifying Stroke Risk. The neurological history and examination for identifying stroke risks with a focus on supra and infratentorial regions, upper and lower motor lesions, cranial nerve signs, spinal cord pathology, motor and sensory pathology and gait abnormalities. Examining genetic and family histories along with dissection risk factors. Stroke orthopedic testing and clinical guidelines pertaining to triage for the primary care provider. Texas Chiropractic College, ACCME Joint Providership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, Buffalo, NY, 2017

Primary Spine Care Symposium 3- Connective Tissue and Spinal Disc Pathology. The morphology and pathology of connective tissue, inclusive of spinal disc disorders and prognosticating wound repair with permanency implications. Disc bulge, herniation, protrusion and extrusion classifications based upon contemporary literature and how to age-date disc pathology, Texas Chiropractic College Post-Doctoral Division, Academy of Chiropractic Post-Doctoral Division, Melville NY 2017

Primary Spine Care Symposium 3- Physiology and Anatomy of Spinal Manual Adjusting, Understanding the role of mechanoreceptors, proprioceptors and nociceptors with facets, ligaments, tendons, and muscles in aberrant spinal biomechanics. MRI and imaging studies of decompressing via a chiropractic spinal adjustment of the bio-neuro-mechanical lesion and its effects on the central nervous system both reflexively and supratentorally, Texas Chiropractic College Post-Doctoral Division, Academy of Chiropractic Post-Doctoral Division, Melville NY 2017

Primary Spine Care Symposium 3- Medical-Legal Documentation, the contemporary documentation required in a medical-legal environment that is evidenced based and meets the standards of the courts and academia. Utilizing the scientific data to support a diagnosis, prognosis and treatment plan while meeting the admissibility standards based upon a professional’s credentials. Texas Chiropractic College Post-Doctoral Division, Academy of Chiropractic Post-Doctoral Division, Melville NY 2017

Primary Spine Care Symposium 3 – Epidemiology of Spine Pain, Review of the current Centers for Disease Control [CDC} data on the frequency of musculoskeletal pain in the United States population with emphasis on pain of spinal origin.  CDC guidelines on opioid medication were discussed and correlated to persistent pain syndromes.  Research was reviewed showing the importance of managing the spine pain patient properly from the entry point of care with a concentration on maintenance of spinal biomechanics, Texas Chiropractic College Post-Doctoral Division, Academy of Chiropractic Post-Doctoral Division, Melville NY 2017

Primary Spine Care Symposium 3 – Interprofessional Spine Care, Clinical analysis of anatomic versus biomechanical spine pain and clinical triage protocols.  Relating current research trends in the Whole Spine Model of patient including normal versus abnormal sagittal curvature in the adolescent and adult spine, pelvic incidence as a parameter for sagittal balance in the human spine and current methods of assessment. Patient centered approach to Evidenced Based Spine care with a focus on diagnosis, prognosis and triage of the spine pain patient, Texas Chiropractic College Post-Doctoral Division, Academy of Chiropractic Post-Doctoral Division, Melville NY 2017

Do Opioids Effectively Treat Low Back Pain? The utilization of opioids, bed rest and other pharmaceutical agents for the treatment of chronic low back pain in outcome studies, Accreditation Council on Continuing Medical Education (ACCME) in cooperation with Medscape, 2016

Establishing Roles and Responsibilities for Interprofessional Care Team Members. Defining roles in a collaborative environment based upon skills, knowledge and abilities of each provider while engaging patients in the process, Accreditation Council on Continuing Medical Education (ACCME) in cooperation with Medscape, New York, NY, 2016

Interprofessional Collaboration to Improve Health Care: An Introduction. Creating patient centered approaches to healthcare to improve outcomes in treatment models while concurrently reducing risk, Accreditation Council on Continuing Medical Education (ACCME) in cooperation with Medscape, New York, NY, 2016.

New Blood Biomarkers Useful for Concussion Diagnosis, The utilization of GFAP and UCH-l-1 in determining, traumatic brain injury, mild traumatic brain injury and mild-moderate traumatic brain injury as a triage tool to manage head trauma patients, Accreditation Council on Continuing Medical Education in Cooperation with Medscape, New York, NY, 2016

Primary Spine Care – Central Nervous System Processing of Pain and Physiology, Central neural pathways of pain and higher cortical responses to pain and the effect of high amplitude-low velocity forces on mechanoreceptors and proprioceptors. The effects of neuropeptides on the hypothalamus, pituitary and adrenal axis when treating patients. Texas Chiropractic College, Academy of Chiropractic, Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Melville NY, 2016

Primary Spine Care – MRI, Bone Edema and Degeneration, The effects of trauma on spinal vertebral segments and the short and long term sequella to morphology. Identifying and diagnosing bone edema, spurring, types of degeneration in assessing biomechanical stability in conjunction with Modic and Pfeiffer changes Texas Chiropractic College, Academy of Chiropractic, Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Melville NY, 2016

Primary Spine Care – Hospital and Emergency Room Care, Identifying spinal lesions inclusive of cord and root lesion through examination and advanced imaging in creating an accurate diagnosis, prognosis and treatment plan to effectively triage in collaboration and coordination with medical specialists and emergency department physicians. Differentially diagnosing and triaging disc degenerative bulges, traumatic disc bulges, protrusion herniations, extrusion herniations and fragmented herniations along with managing traumatically induced pain as sequella to degenerative disc trauma, Texas Chiropractic College, Academy of Chiropractic, Academy of Chiropractic, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Melville NY, 2016

Spinal Trauma Pathology, Triage and Connective Tissue Injuries and Wound Repair, Triaging the injured and differentially diagnosing both the primary and secondary complaints. Connective tissue injuries and wound repair morphology focusing on the aberrant tissue replacement and permanency prognosis potential. Texas Chiropractic College, ACCME Joint Providership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, Buffalo, New York, 2016

Spinal Trauma Pathology, Ligament Anatomy and Injury Research and Spinal Kinematics, Spinal ligamentous anatomy and research focusing on wound repair, future negative sequelae of abnormal tissue replacement and the resultant aberrant kinematics and spinal biomechanics of the spine. Texas Chiropractic College, ACCME Joint Providership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, Buffalo, New York, 2016

Spinal Trauma Pathology, Spinal Biomechanics, Central Nervous System and Spinal Disc Nomenclature, The application of spinal biomechanical engineering models in trauma and the negative sequelae it has on the central nervous system inclusive of the lateral horn, periaqueductal gray matter, thalamus and cortices involvement. Texas Chiropractic College, ACCME Joint Providership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, Buffalo, New York, 2016

Spinal Trauma Pathology, Biomechanics of Traumatic Disc Bulge and Age Dating Herniated Disc Pathology, The biomechanics of traumatic disc bulges as sequelae from trauma and the comorbidity of ligamentous pathology. Age-dating spinal disc pathology in accordance with Wolff’s Law. Texas Chiropractic College, ACCME Joint Providership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, Buffalo, New York, 2016

Spinal Trauma Pathology, Clinical Grand Rounds, The review of case histories of mechanical spine pathology and biomechanical failures inclusive of case histories, clinical findings and x-ray and advanced imaging studies. Assessing comorbidities in the triage and prognosis of the injured. Texas Chiropractic College, ACCME Joint Providership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, Buffalo, New York, 2016

Spinal Trauma Pathology, Research Perspectives, The review of current literature standards in spinal trauma pathology and documentation review of biomechanical failure, ligamentous failure and age-dating disc pathology. Texas Chiropractic College, ACCME Joint Providership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, Buffalo, New York, 2016

Hospital Based Spine Care Qualified, Credentialed in hospital protocols, emergency room protocols, acute and chronic patient triage inclusive of MRI spine interpretation, spinal biomechanical engineering, head trauma, concussion, mild traumatic and traumatic brain injuries, co-credentialed through the ACCME (Accreditation Council for Continuing Medical Education) Joint Sponsorship with the State University of New York at Buffalo, School of Medicine and Biomedical

Orthopedic Testing: Principles, Clinical Application and Triage, Integration of orthopedic testing in the clinical setting to develop a differential diagnosis. Utilizing radiographic and advanced imaging inclusive of MRI and CAT scan findings to verify tissue pathology suspected by orthopedic testing conclusions and developing a treatment plan as sequelae. Academy of Chiropractic Post-Doctoral Division, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Long Island, New York, 2015

Orthopedic Testing: Cervical Spine, Integration of cervical orthopedic testing in the clinical setting to develop a differential diagnosis. Utilizing radiographic and advanced imaging inclusive of MRI and CAT scan findings to verify tissue pathology suspected by orthopedic testing conclusions and developing a treatment plan as sequelae. Academy of Chiropractic Post-Doctoral Division, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Long Island, New York, 2015

Orthopedic Testing: Lumbar Spine, Integration of lumbar orthopedic testing in the clinical setting to develop a differential diagnosis. Utilizing radiographic and advanced imaging inclusive of MRI and CAT scan findings to verify tissue pathology suspected by orthopedic testing conclusions and developing a treatment plan as sequelae. Academy of Chiropractic Post-Doctoral Division, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Long Island, New York, 2015

MRI Spinal Anatomy, Protocols and Disc Pathology, Normal anatomy of axial and sagittal views utilizing T1, T2, gradient and STIR sequences of imaging. Degeneration and annular fissures of discs in both trauma and non-trauma patients and the biochemical properties of joints in age dating pathology. Disc bulges from degenerative and sequella to osseous issues, herniation pathology and protrusion, extrusion, migrated and sequestered variations. Clinical scenarios as sequella to disc and pre-existing pathologies. Academy of Chiropractic Post-Doctoral Division, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Long Island, New York, 2015

Documentation and Evidence in a Medical-Legal Practice, the role of scientific research conclusions with contemporary documentation to effectively support the necessity for clinically indicated care. The role of timely evaluations and re-evaluations in coordinating care inclusive of history, physical and evaluation report and concludes with the correlation of the SOAP note and HCFA that correlates the conclusion of the evolutionary findings. Coordinating research and clinical findings with primary care providers and medical specialists in the rehabilitation process inclusive of insurance requirements and contemporary MRI research nomenclature. Academy of Chiropractic Post-Doctoral Division, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Boca Raton, FL, 2015

Spinal Biomechanical Engineering: Cartesian System, The Cartesian Coordinate System from the history to the application in the human body. Explanation of the x, y and z axes in both translation and rotations (thetas) and how they are applicable to human biomechanics. ACCME Joint Sponsorship with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Buffalo, New York, 2014

Spinal Biomechanical Engineering: Cervical Pathobiomechanics, Spinal biomechanical engineering of the cervical and upper thoracic spine. This includes the normal and pathobiomechanical movement of both the anterior and posterior motor units and normal function and relationship of the intrinsic musculature to those motor units. Nomenclature in reporting normal and pathobiomechanical findings of the spine. ACCME Joint Sponsorship with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Buffalo, New York, 2014

Spinal Biomechanical Engineering: Lumbar Pathobiomechanics, Pinal biomechanical engineering of the lumbar spine. This includes the normal and pathobiomechanical movement of both the anterior and posterior motor units and normal function and relationship of the intrinsic musculature to those motor units. Nomenclature in reporting normal and pathobiomechanical findings of the spine. ACCME Joint Sponsorship with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Buffalo, New York, 2014

Spinal Biomechanics in Trauma, to utilize whiplash associated disorders in various vectors of impact and whiplash mechanisms in determining pathobiomechanics. To clinically correlate annular tears, disc herniations, fractures, ligament pathology and spinal segmental instability as sequella to pathobiomechanics from trauma. The utilization of digital motion x-ray in diagnosing normal versus abnormal facet motion along with case studies to understand the clinical application. ACCME Joint Sponsorship with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Buffalo, New York, 2014

Spinal Biomechanical Engineering & Organizational Analysis, Integrating spinal biomechanics and pathobiomechanics through digitized analysis. The comparison of organized versus disorganized compensation with regional and global compensation. Correlation of the vestibular, ocular and proprioceptive neurological integration in the righting reflex as evidenced in imaging. Digital and numerical algorithm in analyzing a spine. ACCME Joint Sponsorship with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Buffalo, New York, 2014

Spinal Biomechanical Engineering: Cervical Digital Analysis, Digitizing and analyzing the cervical spine in neutral, flexion and extension views to diagnose pathobiomechanics. This includes alteration of motion segment integrity (AMOSI) in both angular and translational movement. Ligament instability/failure/pathology are identified all using numerical values and models. Review of case studies to analyze pathobiomechanics using a computerized/numerical algorithm. ACCME Joint Sponsorship with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Buffalo, New York, 2014

Spinal Biomechanical Engineering: Lumbar Digital Analysis, Digitalizing and analyzing the lumbar spine images to diagnose pathobiomechanics. This includes anterior and posterior vertebral body elements in rotational analysis with neutral, left and right lateral bending in conjunction with gate analysis. Ligament instability/failure/pathology is identified all using numerical values and models. Review of case studies for analysis of pathobiomechanics using a computerized/numerical algorithm along with corrective guidelines. ACCME Joint Sponsorship with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Buffalo, New York, 2014

Spinal Biomechanical Engineering: Full Spine Digital Analysis, Digitalizing and analyzing the full spine images to diagnose pathobiomechanics as sequella to trauma in relation to ligamentous failure and disc and vertebral pathology as sequella. This includes anterior and posterior vertebral body elements in rotational analysis with neutral, left and right lateral bending in conjunction with gate analysis. Ligament instability/failure/pathology is identified all using numerical values and models. Review of case studies for analysis of pathobiomechanics using a computerized/numerical algorithm along with corrective guidelines. ACCME Joint Sponsorship with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Buffalo, New York, 2014

Certification in Spinal Biomechanical Engineering, ACCME Joint Sponsorship with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Buffalo, New York, 2014

Medical-Legal-Insurance Documentation, Accurate and compliant documentation of history and clinical findings inclusive of functional losses, loss of activities of daily living, duties under duress and permanent loss of enjoyment of life. Prognosing static vs. stable care, gaps in care both in the onset and in the middle of passive care with a focus on detailed diagnosing. The integration of chiropractic academia, the court system and the insurance reimbursor’s requirements for complete documentation. Academy of Chiropractic Post-Doctoral Division, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Long Island, New York, 2014

IME & Peer Review Documentation and Rebuttals, Medical-Legal documentation requirements and the utilization evidenced based findings in rebutting third party reporting when clinically indicated. The utilization of state regulations and legislation to ensure compliance in third party reporting. Management of all diagnostic testing and treatment protocols inclusive of functional losses in documentation. Academy of Chiropractic Post-Doctoral Division, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Long Island, New York, 2014

Trauma Based Diagnostics, the utilization and integration of advanced diagnostic modalities of MRI, Bone Scan, EMG-NCV, CAT Scan and x-ray digitizing in diagnosing the trauma-based patient. Clinically coordinating the trauma history, the patient's symptomatology and clinical examination findings with advanced diagnostic modality findings and co-managing the trauma case with medical specialists. Academy of Chiropractic Post-Doctoral Division, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Long Island, New York, 2014

Neuroradiology Mini-Fellowship, MRI Spine Interpretation, Robert Peyster MD, Neuroradiologist, Professor of Radiology and Neurology, Chief Division of Neuroradiology, Stony Brook University School of Medicine, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Stony Brook, New York, 2014.

Neurodiagnostics, Imaging Protocols and Pathology of the Trauma Patient, an in-depth understanding of the protocols in triaging and reporting the clinical findings of the trauma patient. Maintaining ethical relationships with the medical-legal community. Academy of Chiropractic Post-Doctoral Division, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Long Island, New York, 2013

Diagnostics, Risk Factors, Clinical Presentation and Triaging the Trauma Patient, an extensive understanding of the injured with clinically coordinating the history, physical findings and when to integrate Neurodiagnostics. An understanding on how to utilize emergency room records in creating an accurate diagnosis and the significance of “risk factors” in spinal injury. Academy of Chiropractic Post-Doctoral Division, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Long Island, New York, 2013

Crash Dynamics and Its Relationship to Causality, an extensive understanding of the physics involved in the transference of energy from the bullet car to the target car. This includes G's of force, newtons, gravity, energy, skid marks, crumple zones, spring factors, event data recorder, and the graphing of the movement of the vehicle before, during and after the crash. Determining the clinical correlation of forces and bodily injury. Academy of Chiropractic Post-Doctoral Division, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Long Island, New York, 2013

MRI, Bone Scan and X-Ray Protocols, Physiology and Indications for the Trauma Patient, MRI interpretation, physiology, history and clinical indications, bone scan interpretation, physiology and clinical indications, x-ray clinical indications for the trauma patient. Academy of Chiropractic Post-Doctoral Division, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Long Island, New York, 2013

Neurodiagnostic Testing Protocols, Physiology and Indications for the Trauma Patient, Electromyography (EMG), Nerve Conduction Velocity (NCV), Somato Sensory Evoked Potential (SSEP), Visual Evoked Potential (VEP), Brain Stem Auditory Evoked Potential (BAER) and Visual-Electronystagmography (V-ENG) interpretation, protocols and clinical indications for the trauma patient. Academy of Chiropractic Post-Doctoral Division, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Long Island, New York, 2013

Documentation and Reporting for the Trauma Victim: Understanding the necessity for accurate documentation and diagnosis utilizing the ICD-9 and the CPT to accurately describe the injury through diagnosis accurately. Understanding and utilizing state regulations on reimbursement issues pertaining to healthcare. Academy of Chiropractic Post-Doctoral Division, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Long Island, New York, 2013

Documenting Clinically Correlated Bodily Injury to Causality, Documenting Clinically Correlated Bodily Injury to Causality Academy of Chiropractic Post-Doctoral Division, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Long Island, New York, 2013

Head Trauma, Brain Injury and Concussion, Brain and head physiology, brain mapping and pathology as a sequella to trauma. Traumatic brain injury, mild traumatic brain injury, axonal shearing, diffuse axonal injury, and concussion are detailed in etiology and clinically. In the clinical presentation, advanced diagnostic imaging and electrodiagnostics are detailed in analysis to create a differential diagnosis. Balance disorders that often occur as a result of trauma are also explored from clinical presentation to advanced imaging and differential diagnosis. Academy of Chiropractic Post-Doctoral Division, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Long Island, New York, 2013

MRI History and Physics, Magnetic fields, T1 and T2 relaxations, nuclear spins, phase encoding, spin echo, T1 and T2 contrast, magnetic properties of metals and the historical perspective of the creation of NMR and MRI. ACCME Joint Sponsorship with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Buffalo, New York, 2013

MRI Spinal Anatomy and Protocols, Normal anatomy of axial and sagittal views utilizing T1, T2, 3D gradient and STIR imaging sequences. Standardized and desired protocols in views and sequencing of MRI examination to create an accurate diagnosis in MRI. ACCME Joint Sponsorship with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Buffalo, New York, 2013

MRI Disc Pathology and Spinal Stenosis, MRI interpretation of bulged, herniated, protruded, extruded, sequestered, and fragmented disc pathologies in etiology and neurological sequella in relationship to the spinal cord and spinal nerve roots. ACCME Joint Sponsorship with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Buffalo, New York, 2013

MRI Spinal Pathology, MRI interpretation of bone, intradural, extradural, cord and neural sleeve lesions. Tuberculosis, drop lesions, metastasis, ependymoma, schwannoma and numerous other spinal related tumors and lesions. ACCME Joint Sponsorship with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Buffalo, New York, 2013

MRI Methodology of Analysis, MRI interpretation sequencing of the cervical, thoracic and lumbar spine inclusive of T1, T2, STIR and 3D gradient studies to ensure the accurate diagnosis of the region visualized. ACCME Joint Sponsorship with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Buffalo, New York, 2013

MRI Clinical Application, The clinical application of the results of space occupying lesions. Disc and tumor pathologies and the clinical indications of manual and adjunctive therapies in the patient with spinal nerve root and spinal cord insult as sequella ACCME Joint Sponsorship with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, Recognized by the PACE Program of the Federation of Chiropractic Licensing Boards,, Buffalo, New York, 2013

MRI Protocols Clinical Necessity, MRI slices views, T1, T2, STIR axial, stacking, FFE, FSE and sagittal images. Clinical indication for the utilization of MRI and pathologies of disc in both trauma and non-trauma sequella, including bulge, herniation, protrusion, extrusion, and sequestration. ACCME Joint Sponsorship with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Buffalo, New York, 2013

MRI Interpretation of Cervical Herniation, MRI slices views, T1, T2, STIR Axial, FFE, FSE and sagittal images in the interpretation of cervical herniation. With the co-morbidities and complications of stenosis, pseudo-protrusions, cantilevered vertebrate, Schmorl's nodes and herniation, morphology of cervical disc pathologies of central and lateral herniation, protrusions, extrusions, sequestration, focal and broad-based herniation are defined and illustrated. Spinal cord and canal compromise interpretation with management. ACCME Joint Sponsorship with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Buffalo, New York, 2013

MRI Interpretation of Lumbar Herniation, MRI slices views, T1, T2, STIR axial, stacking, FFE, FSE and sagittal images in the interpretation of lumbar herniation. With the co-morbidities and complications of stenosis, pseudo-protrusions, cantilevered vertebrates, Schmorl's nodes, and herniation. Morphology of lumbar disc pathologies of central and lateral herniation, protrusions, extrusions, sequestration, focal and broad-based herniation are defined and illustrated. Central canal and cauda equina compromise interpretation with management. ACCME Joint Sponsorship with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Buffalo, New York, 2013

MRI Interpretation of Cervical Degeneration/Bulges, MRI slices, views, T1, T2, STIR axial, stacking, FFE, FSE, and sagittal images in the interpretation of cervical degeneration. With the co-morbidities and complications of stenosis, pseudo-protrusions, cantilevered vertebrates, Schmorl's nodes, and herniation. Spinal cord and canal compromise interpretation with management. ACCME Joint Sponsorship with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Buffalo, New York, 2013

MRI Interpretation of Cervical Herniation, MRI slices, views, T1, T2, STIR Axial, FFE, FSE and sagittal images in the interpretation of cervical herniation. With the comorbidities and complications of stenosis, pseudo-protrusions, cantilevered vertebrate, Schmorl's nodes and herniation. Morphology of cervical disc pathologies of central and lateral herniation, protrusions, extrusions, sequestration, and focal and broad-based herniation are defined and illustrated. Spinal cord and canal compromise interpretation with management. ACCME Joint Sponsorship with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Buffalo, New York, 2013

MRI Interpretation of Degenerative Spine and Disc Disease with Overlapping Traumatic Insult to Both Spine and Disc, MRI slices, views, T1, T2, STIR Axial, FFE, FSE and sagittal images in the interpretation of degenerative spondylolisthesis, spinal canal stenosis, Modic type 3 changes, central herniation, extrusions, compressions, nerve root compressions, advanced spurring and thecal sac involvement from an orthopedic, emergency room, chiropractic, neurological, neurosurgical, physical medicine perspective. ACCME Joint Sponsorship with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Academy of Chiropractic Post-Doctoral Division, recognized by the PACE Program of the Federation of Chiropractic Licensing Boards, Buffalo, New York, 2013

Certification in QEEG Testing and Analysis, University of Bridgeport, Bridgeport, Connecticut, 2012

Diplomate, Videofluoroscopic Studies of Spine, Palmer College of Chiropractic, Davenport, Iowa, 1992

Certification in Electro-Diagnostic Studies, Life College, Marietta, Georgia, 1991

Bone Tumors: Benign and Malignant, Bone tumor characteristics. Benign bone tumors, metastatic carcinoma, and sarcoma. Palmer College of Chiropractic, Davenport, Iowa, 1990

Pelvic - Sacroiliac - Hip Studies, Lumbar syndromes, spondylolisthesis, retrolisthesis, lumbar stenosis, genetic and congenital malformations. Palmer College of Chiropractic, Atlanta, Georgia, 1990

Cervical Studies, Whiplash syndromes, cervical spine fractures, Basilar impression, twelve signs of cervical spine trauma, and Klippel-Feil syndrome. Palmer College of Chiropractic, Atlanta, Georgia, 1990

Shoulder - Knee Paraspinal Soft Tissue Findings, Shoulder and knee disorders, dislocations, and fractures. Palmer College of Chiropractic, Atlanta, Georgia, 1990