Chiropractor / Applied Kinesiology test

Re: chiropractor test

My view also. I'm A skeptic. That means I don't believe anything unless I have evidence, or unless there is a good reason for doing so. That is not the same as being a cynic, who will not believe anything new anyway. I have an absence of believe in AK as advertised. That is not to say that I'm not open to the idea. Our test will provide some very interesting data on the the sharp end of the application which will hopefully help on our understanding.

For example, I anticipate that we wil show that the arm DOES appear to weaken, that less quantified force is required in the test states. What I question is WHY the arm weakens. But if we can show the amounts of force involved we can start to hone in on where to look for the mechanism.

And if it turns out that the weakness in the subject is actually nothing more than increased force applied by the tester, well, that will be interesting too.

Now here is fun. We've been taking a modest amount of the piss out of using pencils to test for the Trans arch trigger. And no, we don't use pencils, nor (generally) 6 -8 mm of mortons extension, or reverse mortons extension. But that said, when I do a NWB I move joints to end range, far beyond what the patient will when they walk.

So. Serious question. Should we be testing the subject on insoles such as we might use in vivo (standard size met dome vs standard mortons extension with or without a 5th met shaft) or with the amplified repositioning in order to get a clear response...

And even more interestingly (if you're a sad act like me) would the one predict the other. Would we see a weak response with the amplified 1 5 shafts, a less weak response with a mortons extension stronger with the dome and strongest with the amplified dome?

Or would we see weak with the amplified dome and amplified 1 5 shafts and strong with the standard 1st met shaft or a standard met dome?

I reckon the latter. I reckon ANY extreme displacement or stimulation would be interpreted as a test state and give a weak response.

What do you reckon Ted?

 

I love the sounds of this to provide a basis for further investigations.

I'm interested in this too. I've never done the muscle testing being blind to the conditions so this will be insightful (even if my eyes are closed).

Rather than 1 or the other, can we do both and observe what happens with each?

...because of the changed afferent neurological feedback due to the extreme displacement. Hmmm, that's what I've been suggesting all along. But then, how would you interpret when the following happens:

1. Baseline test; resistance level established
2. Subject's own custom orthoses; weak (compared to baseline)
3. Preform with standard met dome; strong (compared to baseline)
4. Repeat orthoses; weak
5. Repeat preforms; strong

I'm jumping ahead a bit here, but this is the type of scenario that got Deborah starting this thread in the first place. This is also a relatively common observation in my clinical experience. I'm looking forward to us establishing a reason/mechanism that explains this type of phenomenon. Does my unconscious presupposition generate the ideometer effect? Gee, I'd love to know for sure Robert. It could save me 50 quid.

Ted.

 

Agreed. My point was that exteroceptive cues influence testing such as AK. I know you have thought this through though and will remove this from your testing. In the clinical setting though, I see AK practitioners cue the subject verbally and visually which pollutes the outcome obviously. This can also be a physical challenge, regardless they incorrectly refer to this as proprioception all the time.

I'm really looking forward to the results of your experiement Robert

Ted I admire the work that you do with manipulation. That said I look forward to your interpretation of the experiment and how that affects your assessment protocol. One very key item missing from virtually every lower extremity manipulation course in my opinion is a standardized protocol for evaluating the changes and benefits of that treatment.

I expect you'll be the shining light in this process!

Regards

 

Agreed. We shall try to remove this so far as possible, but I have immense respect for people's ability to give out and receive information subconciously having played with that in the past. We can test the effect, but not the cause.

Could be.
Or it could be that there is a subconcious association that weakness and pain are both negatives and therefore that if something feels uncomfortable it is associated that way. Thats the thing. We can test what happens, but we can't test the reason. We can only test for consistancy within a model.

So if it is afferent feedback then it will behave in a manner consistant with that model. If its psychological then it will behave in a different pattern. The bugger is avoiding the gunslinger fallacy, that is to find the pattern then interpret the cause to fit the pattern. One can tie ones brain in knots trying to plumb the depth of ones own irrationality.

Depends on the conditions. Are we talking test conditions here or typical in vivo clinical conditions.

If it was the latter I would say this pattern would tell us absolutely nothing useful because it would be consistant with both hypotheses. Assuming the question has been raised about insoles the suggestion has already been planted, in both the subject and the tester, that the insoles are, or could be, a problem. By inference it could also be deduced that the preforms are the solution. So the pattern you descibe would be consistant with the ideomotor thesis.

Of course it is ALSO consistant with the proprioceptive physiological effect thesis.

Be like saying, "I went to a fast food outlet and came out with a burger and chips. Was it a burger king or a mcdonalds?" You can't say because either fits the available data.

Likewise if you did that 500 times it would STILL not tell you which burger you'd bought.

Now you make an estimate based on what mechanism is best understood / which chain owns more stores. I understand a bit about psychology. I've tested ideomotor effect many times and I've read a lot of literature on it. So, by occams razor, I tend to trust that one more. But that could be dead wrong because my / our lack of understanding / research on the proprioceptive mechanism means I have inherent bias. I know there are loads of mcdonalds, i've seen few burger kings. Doesn't make our metaphorical burger a big mac.

Under test conditions? Trickier but still a very clear "test state" and "base state" with the data you describe. The subject, if they are evenly dimly aware of the purpose or nature of the test, could interpret the conditions and act, subconciously or conciously according. So even then it fits both theses and thus tells us little.

Thats why that does not work as a test. But we can remove a good deal of the ideomotor effect. Blind the clinician. Tightly control the script to control the suggestions given to the patient. And most importantly offer different types of insole as the "alternative". You specify the pre met dome, but not the pre fab which suggests to me that you consider that to be the important element. So if you got a strong response from the prefab WITHOUT the dome, or with a pre fab with a mortons extension that would be inconsistant with the physiological mechanism right? The physiological model states that there is significance to WHAT is done, not merely that SOMETHING is done. So, if the tests are consistant within several different stimuli, rather than just with any stimuli then that would not fit the psychological concept.

Thats whyThere needs to be multiple test states apart from the base state.

So, for eg.

base state strong or weak
insole 1 weak
insole 2 weak
insole 3 weak
insole 1 weak
insole 2 weak
insole 3 weak
insole 1 weak
insole 2 weak
insole 3 weak


Would suggest that (assuming the insoles are different) it is the fact of a new insole, not the nature of said insole, which dictated the effect.

Whereas

Base state strong or weak
Insole 1 strong
Insole 2 weak
Insole 3 Strong
Insole 1 strong
Insole 2 weak
Insole 3 Strong
Insole 1 strong
Insole 2 weak
Insole 3 Strong

Would ONLY fit the physiological model UNLESS there was something distinctive and obvious about insole 2. Like it hurt.

Base state strong or weak
Insole 1 strong
Insole 2 weak
Insole 3 weak
Insole 1 strong
Insole 2 weak
Insole 3 Strong
Insole 1 weak
Insole 2 strong
Insole 3 Strong

Would suggest no correlation with either model. If the responses correlate neither with the Different = weak pattern Nor the Specific design = weak pattern then it would suggest to me that we should look to the tester for the predictive factor.

This has got way out of hand! I was planning a quick piss about at the front of a lecture, just for fun. Every time I come back to this I'm making it ever more intricate and getting ever more excited about the potential for study! We're not going to have that kind of time!

I think we all are now!!

 

Oh, how true! Every course I have taken has relied on the subjective, or symptomatic results only. This is why I have spent a lot of time testing objective assessment methods as well as subjective recordings.

Our advanced trainings where practitioners come to our practice and spend a week or 2 with us, go through these analysis methods in great detail. It's too important to ignore as you have astutely identified David.

In every case we accept, we use 2 objective measuring protocols before and after the 'corrective phase' of their treatment.

1. The Foot Health Status Questionnaire (FHSQ) which is a tested method of recording a patient's symptomatic results.

2. Standardised weight bearing DP and Lat foot x-rays recording subluxation or displacements before (a key part of our assessment process) and after the treatment plan has been completed. We use Christman's and Gamble & Yale's parameters.

Here's a Case Study article that illustrates how we apply these methods.

Cheers,
Ted.

 

I am impressed with that case study!

 

I'm ever more intrigued and excited too! We are going to be limited with time in April but hopefully we can get things rolling. I will be back in the UK in September with more time flexibility/options. Perhaps we could have a more extensive session together then Robert?

Thank you Robert.

Ted.

 

Ted nicely done study. I especially like the rationale portion, sorely missing from extremity manipulation submission that I encounter. That and the fact that you address describing the treatment and outcome.

I wish you were in the U.S., we could probably aid in advancing this practice, defining its usage and gaining insurance reimbursement for it. Goals, rationale and documentation are big bone of contention right now with Medicare (does not consider this medically necessary at this time) and private insurers over extremity manipulation here. We should talk sometime my friend. Well done!

Regards,

 

Regarding Manipulation, I recently purchased a great book on foot manipulation

http://fibromyalgiafreelife.com/dr-howard-g-groshell-jr

The Master of Foot manipulation was Robert Crotty, DPM who passed away without writing a book. Dr. Howard Groshell was one of his students and in his book he provides all the gems on foot manipulation. He also provides a CD with the book which is very informative.

The book is written for the lay person, but the important gems are there.

Steven

 

What ever happened to this "test"?

 

The test is alive and well but those that understand the Ideomotor effect know that the test is completely unreliable.

ideomotor effect - The Skeptic's Dictionary - Skepdic.com

Steven

 

Thanks Steven, I am well aware of the lack of evidence surrounding AK testing. To be more specific - what evere happened to the proposed "study" involving Ted and Robert? Did it occur? Even in a more social manner at all?