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\headery720\footery720\pgwsxn12240\pghsxn15840\marglsxn1440\margtsxn1440\margrsxn1440\margbsxn1440\pard\itap0\nowidctlpar\tx2350\tx2375\tx3050\tx3750\tx5125\tx6250\plain\f1\fs24\cf3{\txfielddef{\*\txfieldstart\txfieldtype0\txfieldflags130\txfielddata 4800450041004400450052007e0050007e005300750062006a006500630074006900760065007e007e007e000000}{\*\txfieldtext SUBJECTIVE:{\*\txfieldend}}}\plain\f1\fs20  \par\plain\f1\fs20\cf3{\txfielddef{\*\txfieldstart\txfieldtype0\txfieldflags240\txfielddata 530043005200450045004e007e0050007e005300750062006a006500630074006900760065007e00460061006c00730065007e0030007e000000}{\*\txfieldtext Ms. Beane indicated on her visit today that there is a significant improvement in the degree of her low back pain.  She related that she is experiencing pain in the area of the cervical spine.  This is further described as dead sensations, pins and needles and prickly sensations.  She also stated today that she's been having a coughing condition.  The patient evaluated her pain and discomfort on a 1 to 10 pain scale and reported her low back pain at 4 and neck pain at 5 and coughing at 7.{\*\txfieldend}}}\plain\f1\fs20  \par\par\plain\f1\fs24\cf3{\txfielddef{\*\txfieldstart\txfieldtype0\txfieldflags130\txfielddata 4800450041004400450052007e0050007e005300700069006e0061006c0020004500780061006d007e007e007e000000}{\*\txfieldtext OBJECTIVE:{\*\txfieldend}}}\plain\f1\fs20  \par\plain\f1\fs20\cf3{\txfielddef{\*\txfieldstart\txfieldtype0\txfieldflags240\txfielddata 530043005200450045004e007e0050007e005300700069006e0061006c0020004500780061006d007e00460061006c00730065007e0030007e000000}{\*\txfieldtext Examination for altered spinal motion revealed a severe degree of joint fixation at C4 - T13.  Tenderness present at C4 - T13 bilaterally was elicited on examination of the spine.  An analysis of the spinal tissues by digital palpation showed a severe degree of swelling at C4 - T13 bilaterally.  On palpation examination a coolness present in the tissue at C4 - T13 bilaterally was found.  In checking for muscular hypertonicity, severe hypertonicity of the cervical paraspinal muscles, upper thoracic muscles, mid thoracic muscles and lower thoracic muscles bilaterally was found.  {\*\txfieldend}}}\plain\f1\fs20  \par\par\plain\f1\fs20\cf3{\txfielddef{\*\txfieldstart\txfieldtype0\txfieldflags240\txfielddata 530043005200450045004e007e0050007e00450078007400720065006d00690074006900650073007e00460061006c00730065007e0030007e000000}{\*\txfieldtext Examination of the head & neck was performed:\par Evidence of superior deviation of the forehead.  {\*\txfieldend}}}\plain\f1\fs20  \par\par\plain\f1\fs24\cf3{\txfielddef{\*\txfieldstart\txfieldtype0\txfieldflags130\txfielddata 4800450041004400450052007e0050007e00430061007200650020004100730073006500730073006d0065006e0074007e007e007e000000}{\*\txfieldtext ASSESSMENT:{\*\txfieldend}}}\plain\f1\fs20  \par\plain\f1\fs20\cf3{\txfielddef{\*\txfieldstart\txfieldtype0\txfieldflags240\txfielddata 530043005200450045004e007e0050007e00430061007200650020004100730073006500730073006d0065006e0074007e00460061006c00730065007e0030007e000000}{\*\txfieldtext The symptoms reported by the patient are acute in nature.  {\*\txfieldend}}}\plain\f1\fs20  \par\par\plain\f1\fs24\cf3{\txfielddef{\*\txfieldstart\txfieldtype0\txfieldflags130\txfielddata 4800450041004400450052007e0050007e0050006c0061006e007e007e007e000000}{\*\txfieldtext PLAN:{\*\txfieldend}}}\plain\f1\fs20  \par\plain\f1\fs20\cf3{\txfielddef{\*\txfieldstart\txfieldtype0\txfieldflags240\txfielddata 530043005200450045004e007e0050007e0050006c0061006e007e00460061006c00730065007e0030007e000000}{\*\txfieldtext The patient's condition indicates the need for a visit frequency of three times per week, until reexamination.  \par\par PROCEDURES:\par Low voltage galvanism was administered to the thoracic area.  This treatment is given to decrease pain and discomfort, and to reduce tissue inflammation.{\*\txfieldend}}}\plain\f1\fs20  \par\par\plain\f1\fs24\cf3{\txfielddef{\*\txfieldstart\txfieldtype0\txfieldflags130\txfielddata 4800450041004400450052007e0046007e005300700069006e0061006c002000410064006a007500730074006d0065006e0074002000500072006f0063006500640075007200650073007e007e007e000000}{\*\txfieldtext SPINAL ADJUSTMENT PROCEDURES:{\*\txfieldend}}}\plain\f1\fs20  \par\plain\f1\fs20\cf3{\txfielddef{\*\txfieldstart\txfieldtype0\txfieldflags240\txfielddata 530043005200450045004e007e0046007e005300700069006e0061006c002000410064006a007500730074006d0065006e0074002000500072006f0063006500640075007200650073007e00460061006c00730065007e0030007e000000}{\*\txfieldtext Cervical chair was used on left C3.  Diversified adjustment was performed on the SAR of the sacrum.  Active release technique was performed in spinal regions, including right multifidus (lumbar) and left intertransverse (lumbar).  Motion palpation of the C3 segments revealed normal movement upon left lateral flexion and left lateral bending.  During the course of evaluation, revealed short leg on Ms. Beane's left side.  This patient does have an anatomically short leg, independent of clinical findings that may contribute.  Measurement of short leg:  3 cm.  sdfgsdfg  {\*\txfieldend}}}\plain\f1\fs20  \par\par\plain\f1\fs20\cf3{\txfielddef{\*\txfieldstart\txfieldtype0\txfieldflags234\txfielddata 4c004900430055005300450052007e007e007e007e000000}{\*\txfieldtext Al Sample, MD{\*\txfieldend}}}\plain\f1\fs20  \par\par\plain\f1\fs20\cf3{\txfielddef{\*\txfieldstart\txfieldtype0\txfieldflags234\txfielddata 55005300450052007e007e007e007e000000}{\*\txfieldtext Jon Amdall, MS{\*\txfieldend}}}\plain\f1\fs20  \par\par\par }


There is a need to rate and classify injuries in a manner which would allow any knowledgeable observer to reference a standardized set of guidelines.  Due to the controversies involving whiplash type injuries, a number of organizations and individuals have conducted and compiled studies to attempt to explain the nature of the so called "soft tissue injury," or whiplash injuries, as well as attempt to explain the functional losses that can occur from those injuries and to delineate and describe chronic human pain and suffering culminating from accelerated gravitational (G) force insults.

Sometimes disputes arise from independent medical evaluations performed for insurance companies, and the assessments of the patient's injuries, as they were determined by the treating physician.

The Pairs Scale represents the "pain and impairment rating scale".  There have been many researchers who have done studies in an attempt to offer solutions or suggestions in representing mechanisms of soft tissue injury and the establishment of a prognosis scale to accurately depict and represent a future sequela of the injuries, which may be inflicted upon individuals in the whiplash type accident.

A study published in the British Journal of Bone and Joint Surgery, 1983, by Norris and Watt, utilizes Major Injury Categories (MIC's), and demonstrates the efficacy of this widely accepted system of classification which tends to eliminate a doctor's subjective opinion.

Foreman and Croft are two researchers who have compiled a system of rating injuries with regard to future pain & suffering resulting from the Cervical Acceleration/Deceleration (C.A.D) injury.  They developed a numbering system, in the form of a scale, which is used to objectively quantify and classify mechanisms of the whiplash trauma resulting in the injuries.  The examiner utilizes his findings to ascertain the information which allows the patients to be classified into these categories.

The explanation of a rating system based on "Scales" (Scales of Objective Data), or "Prognosis Scales", utilizes a numerical point value classification system, along with modifiers from objective data based on: radiographic findings, patient history and examination findings.  The purpose is to accurately assess the probability of long term residuals and the need for medication or surgery.

In addition to Major Injury Categories (MIC’s), there has been a rating system designed to comprise five groups of long-term prognosis.

The groups are divided into point grading systems which utilize a scale of modifiers.  The modifiers are generally assessed from the radiographic findings (and any loss of consciousness occurring from head injuries).

The Major Injury Categories (MIC’s) are as follows:

MIC #1:  Value = Ten (10) Points
(56%) of all patients suffer subjective symptoms and have no objective findings on physical examination.  This system carries 10 (ten) points of value.  You may still use the individual modifiers available in addition to the ten points given to MIC #1.

MIC #2:  Value = Fifty (50) Points
(81%) of patients have subjective symptoms and a loss of range of motion (primarily rated in the cervical region).  Point value assignment equals 50 points.  The lost range of motion should be performed with an inclinometer and done  in accordance with the AMA criteria.  The range of motion should be performed a minimum of three times and fall within 10 percent or five degrees of each reading.  The ranges of motion should be performed according to the validity of assessment criteria of the A.M.A. Guides.  General neurologic signs are absent in Major Injury Category #2.

MIC #3:  Value = Ninety (90) Points
Representing 90% of patients who suffer subjective complaints, loss of range of motion and objective neurological involvement.  The neurological involvement may be in a form of a sensory loss or motor loss, and may be graded and rated as an impairment per the A.M.A. Guides, of which there are numerous diagnostics which can be utilized to substantiate the neurologic involvement.  The examiner obviously should be familiar with the nerve plexus, roots and branches of involvement. Point value assignment of 90 points is awarded to major injury category #3.

According to the researchers, all patients may be classified into one of these three major injury categories.

These Major Injury Categories are modified by the following conditions which present a statistically poorer prognosis:

1.  Canal size 10-12mm:  Narrowed spinal canals have been shown to heighten neurological involvement.  Larger canal size offers the spinal cord component of the Central Nervous System more protection, in light of it's increased diameter. (20 points)

2.  Canal size 13-15mm:  These parameters offer more space, however degenerative changes may lead to future stenosis and additional problems. (15 points)

3.  Straight Cervical Spine:  Whether a result of spasm, muscular or ligamentous damage, or both, researchers Norris and Watt found this to be aligned with a poorer prognosis.  (10 points)

4.  Kyphotic Cervical Curve:  Affiliated with residual pain, increased degenerative changes, a poor prognosis often accompanies this. (15 points)

5.  Fixated Segments:  Whether a corollary affect due to congenital blocks or degenerative changes, these consequences impart a poorer clinical recovery and a significantly higher incidence of degenerative changes after the accident. (15 points)

6.  Pre-existing Degenerative Changes:  As visualized upon inspection of radiographic views.  Due to eminent arthropathy of the joints and associated laxity of ligaments, this pre-existing condition may amplify the consequences of the injury. It has been shown that "no matter how slight," these changes adversely affect the prognosis.  (10 points)

7.  Loss of Consciousness:  As an aftermath of head injury, this represents a separate additional form of injury.  Patients who suffer this state, statistically yield a far greater incidence of future degenerative changes.  (15 points)
When the modifiers and major injury categories are combined, they will yield the actual prognosis of the injured party, which fall into one of the following five prognosis groups.

The five categories of prognoses are as follows:

Prognosis Group 1 (10-30 points):  This is an excellent prognosis.  Prognosis group 1 is made up of MIC 1 patients who may have one major (high point) or two minor (low-point) modifiers.  Patients in this group have no objective findings and few modifiers.  The residual problems, if any, are typically occasional, mild muscle pain and/or occipital headaches.

Prognosis Group 2 (35-70  points):  The prognosis is generally good, and future neurological deficits are unlikely.  Prognosis group 2 is made up of either MIC 1 or MIC 2 patients.  The MIC 1 patients in this group have more modifiers than do patients in prognosis group 1.  Some modifiers may have been preexisting, but they still have a bearing on the future outcome of the case.  The increased number of modifiers places the patient in a higher risk position.  The MIC 2 patients in this group may have fewer modifiers but are classified in prognosis group 2 because they sustained a higher level of injury.  Residual symptoms, consisting of occasional to intermittent, moderate neck pain may be expected.  Residual objective findings, such as restricted cervical motion, may be expected in some of the patients in this group.

Prognosis Group 3 (75-100 points):  The prognosis is considered poor, and a number of these patients develop neurological deficits.  Prognosis group 3 is primarily made up of MIC 2 patients who have several modifiers.  The remainder of the group is composed of MIC 3 patients.  Because the MIC3 patients in this group have few modifiers, most of their initial neurological deficits may resolve.  Residual symptoms in this group, as well as in prognosis groups 1 and 2, include areas of numbness or, on rare occasions, muscle weakness.

Prognosis Group 4 (105-125 points):  The prognosis is considered guarded.  Prognosis group 4 is made up of MIC 2 patients who have many modifiers and MIC 3 patients who have few modifiers.  The probability of future or persistent neurological deficits is likely.  Neurological damage may cause symptoms such as significantly decreased grip strength, muscle atrophy, radiculitis, and myelopathy.  There is a fair probability that surgical intervention will be necessary in the future.

Prognosis Group  5 (130-165 points):  The prognosis is considered clinically unstable. Patients in this group have suffered neurological deficits and have most of the modifiers in the scale.  Their clinical picture is not likely to improve much, and future surgical intervention will probably be necessary.  Radiculopathy and myelopathy are the primary complications.

The overall effectiveness of the utilization of such prognosis type scales,  lies in the fact that it can truly eliminate many of the opinions often rendered by doctors who assess prognoses.  The elimination of opinion will henceforth aid to eliminate adversarial situations.

In their 1983 study published in the British Journal of Bone and Joint Surgery, pages 608 through 611,  researchers Norris and Watt found a significant relationship between the Major Injury Category (MIC) and the presence of residual pain.The typical residual pain presented primarily as, neck pain, headache and paresthesia.

The reference of the Norris and Watts study, from 1983 can be found on pages 607 through 611 in the British Journal of Bone and Joint Surgery (1983), copies of which may be obtained at the Rutgers or Harvard Medical Schools, Med-line Computer Systems, local libraries, or Universities Medical libraries.  

Based on his history and the result of the physical and radiographic examinations, Mr. Amdall was diagnosed with the following conditions:

Major Injury Category 2	(50 points)
Canal size 10-12mm		(20 points)
Canal size 13-15mm		(15 points)
Straight cervical spine	(10 points)
Kyphotic cervical spine	(15 points)
Fixated segments		(15 points)
Pre-existing degenerative change	{10 points)
Loss of consciousness	(15 points)

Prognosis Group 3 (75-100 points):  The prognosis is considered poor, and a number of these patients develop neurological deficits.  Prognosis group 3 is primarily made up of MIC 2 patients who have several modifiers.  The remainder of the group is composed of MIC 3 patients.  Because the MIC3 patients in this group have few modifiers, most of their initial neurological deficits may resolve.  Residual symptoms in this group, as well as in prognosis groups 1 and 2, include areas of numbness or, on rare occasions, muscle weakness.

The extent of the treatment should be undetermined at this time.  The patient may or may not recover completely.  Jonathan is currently in the rehab phase of treatment.  This patient is progressing slower than anticipated.  I believe that Jonathan will show more progress but the length of time required is undetermined at this time.

Test post 2

I just have to say…I really enjoy animated .gif files.  Is that an odd statement?  Totally.  But it’s true.  I think they are fun!

I’m sort of a mid-tier nerd; I am not a programmer or intensely rabid Internet jockey, but I do have enough knowledge to understand software design/process basics and general subculture references.   Let’s put it this way; I am educated enough about the world of technology (and its various subcultures) to understand how much I don’t know.

I think it’s because of my incomplete immersion in this world that I find animated .gif files interesting.  To me, it’s fascinating to consider an image file that can actually contain animations.  Because of the potential for simple frame animation, they seem to be almost better than other formats like .jpg or .tiff.  Yet these .gif files contain a severely limited color spectrum in comparison, so the picture quality is much lower.  The technical details are explained on the wikipedia page (http://en.wikipedia.org/wiki/Graphics_Interchange_Format), but they are a bit beyond my grasp.

If you haven’t seen an animated .gif before (or don’t remember), here are some examples:

King of Koopas

This .gif shows Bowser from the Super Mario Bros. video game.  I can’t remember where I got the image; I’m pretty sure it was from a web forum user’s avatar, though.

Nyan Cat

This weird little Pop-tart cat is called the “Nyan Cat.”  He is apparently a current Internet sensation, as of this post.  There is a YouTube video that is just 4 minutes of the animated .gif, set to some repetitive electronic cat meowing/music.  This video has something like 24 million hits!

My animated .gif

Probably what interested me most about these animated .gif files is the prospect of learning how to make them.  I wanted to see if this was something I could try; sort of a fun little challenge.

I downloaded the Microsoft GIF Animator (a free and legitimate download from CNET.com), which was extremely easy to use.  Basically, you can just add frames from image files you already have, and just design your animation from there.  You set the frame speed for each, then save your new animation!

For this test .gif, I just took my avatar from this blog, and edited the mouth a bit, then added some speech bubbles.  I’m thinking this a basic summary of what people hear when I’m rambling on and on about nonsense!

Fun stuff, though!  I really enjoyed looking into this.  It’s not anything too advanced, but I had fun learning.