Current Issue:  Vol. 19, Issue 2 ( 2020)

A turning of the page…2020 to 2021

By Sharon A. Vallone, DC, FICCP

“This is going on and on and on…when will this end?” Is that the echo of my patients, friends and families voices or is it my own voice? Who knew we’d be here today when this all started like a tsunami in March of this year? One of my colleagues, describing her emotional turmoil during the last 10 months, coined the phrase, “Roller-Covid”, liking the experience to an amusement park ride that scares the living daylights out of you. We were taken by storm. An overabundance of “news” with little science at the ready. We were caught unprepared for what was to ensue despite watching our European neighbors struggle through it in Italy. Then, when the fear settled and we had made our decisions about our family, our patients, our protocols and practice guidelines, my hope is that you recognized that the level of patient care was going to shift into high gear as stress levels escalated and the experience of daily trauma, toxin and thought would increase the demand for what you, as their chiropractor, could offer your patients when you were ready, while keeping yourself, your staff and your patients, safe, healthy and educated.

By Hazel Mellars, MSc, Jasper Durville, MSc, Rogier Koel, MSc, Agnes Laan, MSc, Kristoffer Sandhauge, MSc and Joyce Miller, DC, PhD

Objective: There have been few investigations into parent report of outcomes for chiropractic care for infants. The goal of this survey was to implement an infant outcomes instrument in a teaching clinic along with private chiropractic practices to observe the demographic profile of patients and any unique observations in outcomes. Method: Infants aged up to 12 months presenting to the AECC University College (AECC) teaching clinic and to private chiropractic practices in the UK were eligible for inclusion. Mothers completed valid and reliable questionnaires which measured characteristics before and after chiropractic care. Results: A total of 479 infants from the AECC were included, and 19 from private clinics. Of these, 297 (61%) completed follow up forms at the teaching clinic and 15 (79%) completed follow up forms in the private clinics. The most common complaint for patients presented to the teaching clinic was a feeding problem (40%) compared to private clinics where the main complaint was a difficult birth (27%). The AECC had a mean satisfaction score of 9.5/10 (10 being completely satisfied) and the private clinics had a mean satisfaction score of 8.3/10. Scores of Parent Global Impression of Change (PGIC) showed that at least 86% of infants improved. There were no adverse events. Conclusion: Overall the parents in this study reported high satisfaction with the care their infant received, along with improvement in their infant’s complaints. However, there were insufficient numbers from private clinics to make any representative conclusions about similarities or differences between a teaching clinic and private chiropractic clinics. Implementation of a parent report of outcomes in infant practice was feasible.

Key words: PROMs (patient reported outcome measures), infants, chiropractic, outcomes instrument

Maternal perceptions of a breastfeeding clinic: A protocol for a service evaluation

By Emily Norton, DC, IBCLC

Introduction
There is increasing interest in the collection of data from routine practice. This provides information from a key area of Evidence Based Practice, the patient’s point of view. All chiropractic offices, no matter how small, can participate in improving the understanding of their patient’s viewpoint. Nowhere is this more important than in collecting the mother’s perception when treating the infant with suboptimal breastfeeding. This protocol for a service evaluation is presented so that other clinicians can see that this type of research can be implemented into routine practice and lead to a better understanding of what is important to the mother and her satisfaction rate with the clinical encounter.

A risk too great? Stroke implications with manual therapy for the pregnant patient: A scoping review

By Sue Weber Hellstenius, DC, MSc (Paeds), FEAC, FRCC

Purpose
Although chiropractic care typically includes the care of pregnant patients, the research literature on safety for this patient group is relatively sparse. Pregnancy and particularly the puerperium are associated with an increased risk for stroke.1 Recent new evidence suggests less obvious risks for stroke, including the near-epidemic of obesity along with the Covid-19 pandemic. A systematic review of COVID-19 risks described how this infection activates coagulation pathways and thrombosis, with pregnancy possibly acting as a trigger increasing the risk for stroke.2 The purpose of this scoping review is to update and address the potential stroke risks in an effort to improve safety and efficacy when treating this population. A scoping review is an overview of the current background evidence relevant for clinical practice.

Do probiotics benefit new-borns and especially colic babies? A clinical opinion of the evidence

By Susanne Williams-Frey, DC, MSc, Sharon Vallone, DC, FICCP and Joyce Miller, DC, PhD

Purpose
Parents often present their infant for chiropractic care. In the therapeutic encounter there are often questions about the use of probiotics for their baby. There has been considerable research in the area of probiotics for infant colic. The goal of this opinion piece is to explore and interpret the research literature and help to clarify when probiotics may best serve the baby and mother.

Key words: Probiotics, prebiotics, microbiome, neonates, infants, infant colic

Families and babies: An ergonomic and postural guide during the COVID -19 Pandemic

By Anna E. Papadopoulou, MChiro, DC, DACNB, MRCC

This article was created to help clinicians better communicate with new parents and family members on everyday posture and ergonomic advice when looking after young children. This information is particularly useful in the current COVID-19 pandemic as the lockdown situation can exacerbate previous injuries or result in new musculoskeletal complaints. Additionally, this article aims to provide useful websites and links for additional information to help parents purchase appropriate furniture for their children based on EU safety law and recommendations.

Keywords: Ergonomic, Pediatric, EU law and regulations, safely and spinal hygiene

A clinician’s guide to pediatric oral motor development

By Karen Peck, CTRS, CST, IBCLC, CSOM, QST and Sharon A. Vallone, DC, FICCP

Purpose: Collaboration between healthcare disciplines is the foundation of a wholistic approach to a child’s optimal health. For example, chiropractors have linked temporomandibular joint dysfunction to postural strain. Forward head carriage and associated changes in the anterior to posterior curves of the spine can result in an alteration in muscle length and function shifting stress to the face and jaw resulting in headaches or facial pain. This is one of the reasons pediatric chiropractors emphasize development of postural stability and closely monitor development and attainment of motor milestones. The authors of this paper propose that the effect of oral motor function may directly influence posture and as a result, should also be taken into consideration when working with the pediatric patient. In clinical practice with infants and children, it is imperative that pediatric health care professionals are aware of the developmental milestones children should be meeting so that they are able to support and guide families to navigate what is “normal” when assessing and understanding their child’s growth and development. This is especially important as it relates to oral development. This paper will attempt to provide practitioners some assistance and resources for parents of children with oral motor dysfunction with an emphasis on appropriate and timely collaborative referrals.

Key words: oral motor function, breastfeeding dysfunction, feeding disorder, pediatric, developmental milestones, chiropractic, oromyofunctional therapy