The Effects of Intervertebral Differential Dynamics on Spinal Injuries - Dissertation Example

The Effects of IDD on Spinal Injuries 2 Introduction The internship offers unique opportunity to be exposed to non-surgical clinical applicationsof therapies to cure illnesses, most especially with the use of Invertebrate Differential Dynamic (IDD) Therapy, which is categorized as non-surgical and non-invasive therapy that applies the principles of mechanical traction on patients’ muscles. This kind of treatment has been used to help patients suffering from chronic low back pain or spinal cord injury to recover over the course of time. My internship is designed to familiarize me and other participants to the practice of non-surgical clinical treatment. It covers about 200 hours of practical exposure to interesting clinical therapies, experiences that I could not get from my classroom. During the internship, I treated a patient for spinal injury using IDD. This paper is about the effects of Invertebrate Differential Dynamic (IDD) Therapy on Spinal injuries. 3 Literature Review Several studies have been carried out in the area of using non-clinical therapies to cure spinal cord injuries or chronic low back pain in medical and clinical practices. This effort is essential in reducing the amount of exposure patients have to clinical operations, and promote natural wellness even in the medical field. Low Back Pain and Spinal Injury Low back pain has become a prevalent condition that reportedly affects about 40% in the United States within a specified period of one month interval. This statistics points to seriousness of this situation as it prevents adult population from contributing enough at their respective workplaces (Deyo et al., 2006). However, it is worrisome that most of the low back pain (LBP) suffered by people today have no apparent pathoanatomic cause; and this has increased the grave concern among practitioners as they scramble to find the best treatment for LBP. Although, the known cause of low back pain is the disorder of the lumbar intervertebral disks which often leads to irritation of the lumbar nerve roots. —a known symptom of spinal injury. Research findings have revealed that nerve root linkage is responsible for exactly 10% cases of low back pain with a projected prevalence range starting from 12% to 43% (Stafford et al., 2007). Understandably, the low back pain caused by involvement of nerve root (spinal injury) has been found to only responsible for a fraction of low back pain; other related factors include but are not restricted to severe symptoms, increased danger of becoming a chronic LBP and the absence of work or failure 4 to cater for the condition due to lack of sufficient financial capability (Konstantinou and Dunn, 2008). Treating low back pain and spinal injury Previously, patients suffering from low back pain and spinal injury have solely relied on surgery to recover from their painful condition. Nowadays, there is another option of utilizing non-surgical method or technique to help patients recover. Although there are different kinds of non-surgical treatment procedures used for these patients, the major concern is that there is no definite regulatory standards required for patients to make the appropriate decisions about which strategies they are going to use (Atlas et al., 2005). It is no longer new that a lot of patients with LBP and nerve root involvement (spinal injury) get physical therapy; however, there is still much to be done in detecting the exact benefits patients derive from using physical therapy when compared with other non-surgical management strategies. Although practitioners emphasize the usefulness of physical therapy being cost-effective, there are little or no convincing evidence that one form of physical therapy is better than the others, as far as patients with low back pain and spinal injuries are concerned. This issue has created a vacuum of information that needs to be filled with quantifiable results from practices. Despite this dearth of practicable information, many patients suffering from spinal injuries and low back pain still rely on physical therapies to receive treatment to recover from their conditions. 5 Mechanical Traction: Treatment for Low Back Pain with Nerve Root Involvement Before Cyriax popularized it, axial traction has been applied for years in treating patients suffering from LBP with nerve root involvement (spinal injury) caused by lumbar intervertebral disk herniation (Crisp et al., 1955). Despite its popularity, no specific evidence or findings have completely supported the fact that mechanical traction strategyis generally useful for all patients. But this has not discouraged practitioners from using mechanical traction to treat low back pain and other spinal injury. There are actually different types of mechanical tractions that are used today, with relatively similar outcomes or results (Crisp et al., 1955). The supporters of mechanical traction often deride the research methodology used to test the efficiency of mechanical traction as of low quality and poor external validity—their argument is based on the fact that mechanical traction in practical is quite different from the one researched about in the laboratory (Crisp et al., 1955). They often explain that external validity is based on the differences between the delivery of traction in research and clinical practice, raising the ubiquitous questions of dosage parameters (traction force and duration), the application of concomitant interventions, and patient selection. However, researchers have always studies traction in isolation without actually testing other parameters that would have contributed to its successful applications. There should have been some recognition of the impacts of other treatments in designing the final usability of mechanical traction; this include giving considerations to exercise interventions and other physical activities (Crisps et al., 1955). 6 Intervertebral Differential Dynamics (IDD) Therapy and Spinal Injury Spinal Decompression Therapy or IDD machines are used for taking pressure of damaged and degenerate spinal discs thus promoting healing, leading to improved disc health. Many clinics in the United States have recently installed an "SDS Spina" machine which provided a gold standard in Computerized Spinal Decompression Therapy or "Intervertebral Differential Dynamics" Therapy (IDD Therapy) as it is otherwise called today (Cummins et al., 2006). These machines are manufactured by North American Medical Corp. The good news is that there has been impressive track record for great results as shown by the machines before and after MRI scans. IDD Therapy is useful for patients suffering from persistent back pain or neck pain or suffering from any of the following medical conditions. (i) Herniated Disc (lumbar or cervical) (spinal injury) (ii) Degenerative Disc Disease (iii) Sciatica (iv) Chronic low back pain The IDD treatment is delivered by the SPINA machine which is an FDA certified medical device.  The efficiency of this machine is guaranteed when it is allowed to tilt in a particular angle so that patients can get onto it from the standing position without any additional pain or difficulty (Cummins et al., 2006). 7 In the process of administrating the therapy, patients puts on a new range of ergonomic harnesses which are connected to the pelvis and upper back; Then a computer-controlled pulling force is gently applied at a precise angle to gradually distract (draw apart) the vertebrae surrounding a targeted disc, in case of spinal injury. As the joints are distracted, pressure is taken off the disc, joints and nerves.  The targeted spinal segment is gently put under mobilization to create pressure differentials to help improve a flow of fluid and nutrients into the disc space, thereby healing the affected patients (Bombadier, 2000). These fluids and nutrients help with healing and repair and the gentle, oscillating movement helps the joints to become lubricated and to move more freely. Where a disc is pressing on a nerve and causing pain, this mobilization may help the body to retract a bulging disc and thus remove or reduce the pressure and therefore relieve pain. Therapy gently stretches tight muscles and stiff ligaments in a manner which is not possible with the hands alone. Working the soft tissues with the SPINA machine helps the body move more freely and as you get more mobility in the spine, this helps the body's natural healing mechanisms. For years now, patients have realized that IDD treatment is gentle and safe. There are built-in safety features that aim to help the patients be in relaxed position; many patients actually go to sleep during the treatment. However for caution purpose, patients are usually advised to stay awake during the entire treatment periods (Bombardier, 2000). 8 Each treatment on the SPINA machine reportedly lasts approximately 25 minutes; and this is the time required to work the spinal structures professionally to help energized the discs with some physiological changes (Cummins et al., 2006). Before treatment, some infrared heat is usually applied to the area to be treated to increase blood flow into the soft tissues. And cold treatment is applied after the IDD Therapy to cool down the tissues (Bombardier, 2000). Patients often complain that a part of their spine is stiff when they have a back or neck pain; however, movement is very important in helping the body's natural healing mechanisms to maintain a healthy spine. Normally, gentle exercise and activity are gradually encouraged for developing strength in the newly mobile soft tissues (Cummings et al, 2006). 9 Methods This experience was carried out some years ago on a patient I worked on at the clinic suffering from spinal injury. The IDD therapy generally target patients with signs and symptoms consistent with lumbar nerve root irritation. I made sure that my subject (patient) received individual treatment session while working with an experienced physical therapist for a period of 4 weeks. The outcomes of the IDD treatment were documented through the 4-week period to study how well the subject (my patient) was responding to the therapy. I strongly believed that based on the patient’s medical record, the IDD Therapy was going to help him alleviate the serious pain in his spinal cord, which has been caused by unattended to spinal injury. My subject (patient) has been a regular visitor to the clinic where I carried out the therapy. In fact, his medical record states that he visits the clinic twice every week to receive medical treatment for his low back pain with nerve root involvement (spinal injury). To determine the efficiency of my therapy, I strictly monitored the outcomes of the treatment and I used a Modified version of the Oswestry disability index (OSW) to monitor both suitability of my approach and its efficiency on the patient. The OSW consists of 10 items assessing different aspects of pain and function related to LBP. Each item is scored from 0-5 with higher scores representing greater disability. This OSW Model is a recommended and widely-used measure of outcome in clinical trials evaluating treatments 10 for patients with LBP in order to detect their responsiveness to change in individuals with respect to IDD therapy. Along the line, I also recommended physical therapy intervention for my patient so as to see that after 4 weeks, my patient should be able to have no spinal injury. It is important that I monitored any side effect that may occur during this treatment. So, I gave my patient some questionnaires for reporting any side effects he perceives to be related to treatment procedures during the 4-week treatment. The questionnaire is based on a questionnaire used previously to examine subjects with LBP receiving spinal injury treatment. I asked my patient if he experienced any generally-reported side effects following treatment including stiffness, muscle spasm, fatigue, or increased radiating symptoms. I also encouraged my patient to report other side effects not specifically identified in the questionnaire. For each side effect reported, I told my patient to report the time of onset relative to the precipitating treatment session (?24 hours or >24 hours), the duration of the side effect symptoms (?24 hours or >24 hours), and severity of symptoms (categorized from 1 "light" to 4 "severe"). The physical therapist I worked with during the 4-week treatment session was an experienced professional. She has handled similar processes before, so I strongly relied on her wealth of experience. 11 During this treatment session, I make sure that I double checked every result that came out of the process to make sure correct outcomes are perfectly obtained and analyzed so as to include them in the patient’s medical history. Hence, the integrity of the data collected throughout the treatment was monitored by regular review of the data collection forms for missing responses, errors, or out of range values. And with the help of the professionals at my clinic, we carried out data analysis. We strictly applied intention-to-treat principles to all our analyses. I was impressed by the complete cooperation I received from the professionals at my clinic as well as the willingness of the patient to supply all the information I needed to process his responsiveness to the IDD treatment. This unexpected good-natured experience offered me the unique opportunity to see firsthand how patients suffering chronic low back pain or spinal injury could receive treatment within a certain period of time if exposed to the appropriate IDD treatment. My clinic has great reputation for being one of the best places that offer IDD interventions in the entire area. Therefore, there was no need to doubt the efficiency of all the procedures described above to execute the treatment as well as monitoring the gradual recovery processes on the part of the patient. Throughout the 4-week period, it was great to see how my patient’s health improved considerably as he surrendered himself to IDD treatment and complying with every procedural requirement that the process expected. That is, he did not hold back any vital information that I needed to compute the outcomes of his treatment. 12 Results After 4-week session of IDD therapy, was patient was able to walk uprightly for the first time in 5 years, having been relieved of the sharp spinal pain that often made him to crouch like an old man. He was happy to drive around for a longer period; unlike before when a continuous three-hour drive is enough to cause an appreciable low back pain for him. Interestingly, the medical records revealed that he has also improved in other areas of his body: for examples, his tissues are soft, hence helping him to do his construction work with less pain after the therapy. The patient also enjoys good relationship with me and the clinic for the period I spent doing my internship at the clinic. He even promised to recommend our IDD treatment to one of his friends that was then suffering from similar low back pain. The patient was encouraged to attend weekly post-therapy follow-up, which will give him some encouragement about how to keep his spinal cord/discs in an upright position with less pressure so that he would not relapse to the same spinal injury that had kept him crouched for years. The other things the patients learnt from the follow-up sessions include learning how to regularly exercise, what part of the body requires certain level of pressure, and how best to carry out this activity. The purpose of this post-treatment advice is to help him stay healthy with apparently no low back pain or spinal injury. 13 Discussion The IDD therapy conducted on my patient and carefully detailed in the foregoing support the fact that IDD has some great benefits that other spinal injury treatments do not have. Some of the enviable merits of the Intervertebral Differential Dynamics (IDD) Therapy include but are not restricted to the following: (i) No surgery is involved—this indicates that some patients that are afraid of operations or other surgical procedures can easily aim for IDD therapy, which will provide them with the exact treatment they desired without thinking about after-effect of being operated. (ii) Medical procedure is non-invasive—this entails that patient’s body are not incised or broken into in order to heal the patient. Most of the processes used in IDD Therapy occur outside the body. This realization is one of the reasons many patients do not oppose using the therapy to cure their chronic low back pain and spinal injury. For some years, there has been increasingly much publicity for IDD treatment through word-of-mouth from patients who had successfully used the Therapy before. Hence, this creates an avenue for more patients to participate in the treatment as they aspire for the last and non-invasive technology to overcome the problem of intense low back pain or spinal injury. (iii) No recovery period is necessary, unlike surgery—this is another great advantage of IDD Therapy. Patients do not have to wait for months to completely recover 14 from their treatment, unlike patients that had undergone surgical operations. (iv) Cost of treatment is minimal compared to the cost of surgery—this is another comparative advantage of IDD therapy when compared with surgery. Patients do not have to pay a lot to get cured. Many families become bankrupt due to the huge medical costs they have to offset because of one surgery or the other; however, IDD treatments are generally affordable and patients can even offer the expenses out of their pockets—that means, without actually waiting for the insurance company to foot their medical bills. This demonstrates the fact that IDD therapies are indeed inexpensive. (v) Insurance companies will reimburse for this treatment depending upon policy coverage—however, the good news is that some insurance companies still happily reimburse the cost of undertaking IDD treatments. Though this depends on the kind of insurance policy the patients have with the insurance companies. (vi) Financing for treatment is available under most circumstances—it is also encouraging to state that the finances for IDD Therapy are mostly available under most insurance policy and state health policies. So, patients need to research what options and benefits they could derive from the treatment and how they could secure enough finances to pay for their IDD treatments. One important observation is that many patients in the United States do not understand what financing alternatives they have when it comes to paying their health bills; they need to work closely with their clinics to find out this 15 information. (vii) Treatments are not only safe and painless, but comfortable and relaxing as well—this is one of the main reasons patients are now flocking to IDD therapy. The procedures are generally safe, painless and give the patients the unique opportunity to relax. Most of the time during the treatment, patients are often tempted to sleep off because of the comfort of the entire process. However, practitioners often discourage patients from sleeping owing to the fact that their recovery process may not be properly monitored if they sleep off. (viii) Non-strenuous work can continue during the treatment regimen—this means that patients with less strenuous jobs may return to their offices during the treatment. This means that they would not be in a difficult situation of losing their jobs due to a long-time absence from office. My patient was able to go back to his normal life after the therapy. However, we encouraged him to have a change of career from being a construction worker to something that will exert less pressure on his back. We were happy when the patient took our advice and promised to find other less strenuous job in his surrounding so that he would not have to commute for a long distance from home every day. We also counseled some of his family members to keep an eye on him so that he does use his body in way that his spinal cord would be put under intense pressure. 16 Bibliography Atlas S.J., Keller, R.B., Wu, Y.A., Deyo, R.A., and Singer, D.E (2005). 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