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International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. After two treatments for back pain, a patient presents for a third session complaining of rapid breathing and wheezing that is made worse during cold weather.
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
July, 2005, Vol. 05, Issue 07
Amyotrophic Lateral Sclerosis: Part 1 of 2
By Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President
In my last article I put out a call for massage therapists who work with Amyotrophic Lateral Sclerosis (ALS) patients to get in touch with me. I hoped to share some of their stories with Massage Today readers. Well, the response was amazing. I have lots of information to share, both on the development and latest research into this disease (part 1), and on what therapists are doing to help improve the quality of life of their clients who have it (part 2).
Amyotrophic Lateral Sclerosis: What Is It? Also known as Lou Gehrig's Disease, ALS is a rapidly progressive, irreversible condition that destroys motor neurons in the central and peripheral nervous systems, leading to the atrophy of voluntary muscles. ALS usually affects people between 40 and 70 years old; the average age at diagnosis is 55. It can occur in higher rates within families, but the distribution and incidence of this disease is usually random. Men have it slightly more often than women. Approximately 20,000 people in the U.S. are living with ALS at this time, and life expectancy between diagnosis and death for most patients is two to 10 years.
Etiology: What Happens? The primary feature of ALS is the destruction of motor neurons. In most cases, it begins in the anterior horn cells and the descending tracts in the spinal cord. Large motor axons degenerate and are replaced with fibrous astrocytes, a type of glial cell. This is the derivation of the name of the disease: "lateral sclerosis" refers to the scarring of the motor tracts on the lateral aspects of the spinal cord. Without stimulus from the upper motor neurons, lower motor neurons (that take messages from the spinal cord to the neuromuscular junction) atrophy. Ultimately, the skeletal muscles deteriorate without sufficient motor stimulus: "amyotrophic" refers to muscle wasting.
While we have a reasonably clear idea about how this disease progresses and changes function, its causes are still unknown. At this point in time, the features of ALS that are being intensively studied include abnormal glutamate levels (this is an excitatory neurotransmitter that accumulates in the synaptic cleft, killing the affected neurons); exposure to neurotoxins (including lead, agricultural chemicals and others); free radical activity (this is an issue especially when ALS runs in families); a deficiency of neurotrophic factors (these are chemicals that allow for healing or new growth of nerve tissue); and a new avenue of inquiry: Almost half of all ALS patients show signs of retroviral exposure. Further explorations of these factors may eventually open new doors to effective treatments to stop or even reverse this mysterious disorder.
Signs and Symptoms. ALS presents different early symptoms in different people. The most common pattern is stiffness, weakness and awkwardness in one body part, which slowly spreads to other parts of the body. About two-thirds of ALS patients have their first symptoms in the arms or legs; these cases are called spinal ALS. The final third will begin with "thick speech," excessive salivation, and difficulty with swallowing. This implies damage to cranial nerves rather than spinal nerves and is called the bulbar form of ALS. Fasciculations, or visible muscle twitching, may be present, along with painful cramping. One side is typically worse than the other, and the stiffness eventually moves proximally up the limbs, eventually to affect the trunk muscles for breathing. The leading cause of death for ALS patients is respiratory failure.
The nerve damage seen with ALS is to motor neurons only; sensory neurons are not affected. This can be a painful disease, however, as the body gradually collapses and gravity puts musculoskeletal stresses on muscles that have no power to respond. ALS does not influence intellectual capacity at all. While depression and anxiety are certainly a part of the process, the disease itself does not affect cognition or awareness.
How Is It Treated? Traditionally, treatment for ALS has been strictly palliative; that is, aimed at managing the severity of the symptoms only. Recently, some medications have been developed that can slow but not stop or reverse the progress of the disease. Other interventions include drugs for muscle spasms, along with moderate exercise and speech, and physical and occupational therapy to maintain muscle strength as long as possible. (This turns out to be a delicate balance. Too little exercise allows muscles to degenerate; too much exercise puts a dangerous demand on low-functioning neurons - which can also cause muscles to degenerate.)
Assistive devices such as leg braces, arm braces or wheelchairs can improve a patient's ability to function. In advanced cases, swallowing may be so difficult that the insertion of a stomach tube (gastrostomy) may be recommended. Since this disease does not impede cognitive or emotional processes at all, psychological therapy for ALS patients and their families is an important part of the treatment plan.
Massage? We'll get into specific ideas about massage techniques for clients with ALS in part 2. In the meantime, bear in mind that this is a disease that involves the degeneration of motor neurons but not sensory ones, and the client is fully aware of the changes occurring in his or her body. This combination of factors makes massage a great choice for many ALS clients because sensation is intact and the client can communicate (until he or she is very advanced) about how the massage feels and what is needed. Massage therapists who work with a client who has ALS are probably going to be working with someone in the process of dying. What a gift and privilege to be invited into this holy process.
I'm still accepting communications from therapists about their experiences with clients who have ALS - please share your wisdom with other readers through this column.
Until then, many thanks, and many blessings,
Ruth Werner, LMP, NCTMB
Editor's note: Read part 2 of Ruth Werner's article in the Sept. issue.
Click here for previous articles by Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President.
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