Pediatrics – Page 2 – The American Chiropractor

The Safety of Chiropractic Adjustments for Children

An article recently published in the January 1, 2007, issue of the journal Pediatrics (a journal of the American Academy of Pediatrics) addressed the issue of pediatric safety as it pertains to spinal manipulative therapy. The study by Vohra, et al., entitled, “Adverse Event Associated with Pediatric Spinal Manipulation,” has incited questions and undue concern from the general public from news headlines that have misinterpreted this article. Our Research Director, Dr Joel Alcantara, has critically appraised the study by Vohra, et al., and the immediately retrievable supporting articles. His findings, thus far, are very revealing about the true nature of this publication, which he will address in a Letter to the Editor of Pediatrics and in articles to be published within our own profession. We will keep you updated.

As the largest pediatric chiropractic organization in the world, the International Chiropractic Pediatric Association is making these comments immediately to the profession (particularly to practicing chiropractors) to assure them that chiropractic care of children is safe. The ICPA is making these comments:

“In a review of the scientific literature spanning a period of 104 years, Vohra, et al., ultimately could only identify fourteen cases involving adverse events associated with spinal manipulation. Of these, ten were associated with chiropractic care. Of the ten cases, five patients experienced only minor adverse events (i.e., sore and stiff neck, sore back) that were self-limiting, did not require medical attention and were cared for successfully by the treating chiropractor. Incidentally, two of the five cases were incorrectly sub-typed by Vohra, et al. Of the articles documenting the five cases associated with severe adverse events (i.e., required medical care) as a result of chiropractic care, four were immediately retrievable. What does the data really show?

What becomes apparent after reading these articles is the following: The patients all had a pre-existing condition that was associated with the adverse event and/or had a history of significant trauma (i.e., gymnastic somersaults and falling on their heads and necks) prior to presenting to the chiropractor. To make cause and effect inferences (i.e., chiropractic care directly caused the adverse events) from these case reports is inappropriate. Furthermore, Vohra, et al.,’s cited cases involving delayed diagnosis and/or inappropriate provision of chiropractic care were based on testimonials and anecdotal evidence. Vohra, et al.,’s conclusion that “serious events may be associated with pediatric spinal manipulation” is unsubstantiated by the scientific literature and reflects a suspicious agenda against chiropractic by those who interpret it otherwise.”

The ICPA recognizes the need and is committed to performing research on the safety and effectiveness of chiropractic care for children. Based on our Research Department review, we have prepared a statement for your concerned patients, a press release for your local papers and a news alert for your office newsletters. To stay tuned to all ICPA reports on this paper and future research projects that accurately assess the safety of chiropractic care for children, visit the ICPA website and sign up for our complimentary newsletter: http://www.icpa4kids.com/pedEx/.

Dr. Jeanne Ohm instructs internationally on the topic “Chiropractic Care for Pregnant Women and Children.” She is Executive Coordinator of the International Chiropractic Pediatric Association: www.icpa4kids.com and can be reached at: [email protected].

Educating the Pediatricians in Our Community

The other day, our office assistant informed us that a particular parent had decided to stop having her baby adjusted. When the mother and I discussed this, she told me she had taken her baby to the pediatrician and was told that “there was no reason the baby should need chiropractic care,” and that the baby would “outgrow” the head tilt.

I was not surprised about the pediatrician’s erroneous comment that children “outgrow” postural compensations. I was more concerned with the fact that, by recommending the infant discontinue care, she was speaking completely out of her scope of practice on a topic about which she had not received any formal education.

I looked at the mother and responded, “I am disappointed that a doctor would step out of her expertise into the specialty of another with an unfounded recommendation to discontinue care. Pediatricians have no training in the biomechanics of the spine, in postural compensations and the long term neurological effects this may have on the infant’s overall health and well-being. A pediatrician has no clinical experience with chiropractic spinal correction and its efficacy in infants. A similar scenario would be if you asked your pediatrician if she thought your child needed dental care. If you did and she responded that she didn’t think so, she, again, would be completely out of her scope of practice by suggesting you avoid care. So, too, her response about the importance of chiropractic care came from ignorance, not clinically based knowledge.”

In the above scenario, you can replace the word chiropractic with the word homeopathy, naturopathy, acupuncture or midwifery and the word biomechanics with the word remedies, nutrition, meridians or natural birthing, respectively. The fact of the matter is that most pediatricians are becoming aware of holistic care, but remain limited in their knowledge of the care. The comments made about these types of care are often based on personal opinion. As a result, most parents are receiving “professional” advice based on assumptions, not clinical experience or education.

When reading current surveys and papers published by the American Academy of Pediatrics, it is clear that a large percent of today’s pediatricians are curious about holistic care but do not know where to begin to learn about it. Although some medical schools are beginning to offer classes on Complimentary and Alternative Medicine (CAM), they are simply courses on theory, not practice, and are, of course, subject to the knowledge and perspective of the instructor.

As practitioners, here are some suggestions we can give our patients when discussing holistic modes of care with their pediatricians.

1. Ask them what they know about it.

2. Ask them how they have come to that conclusion.

3. Ask them about their clinical experience with it.

4. Ask them if they are interested in learning more.

If their conversation is progressing and they are offering the parent an interested ear, have your patient suggest to the pediatrician that he or she meet with you. I know that any doctor member of the International Chiropractic Pediatric Association, for example, would be willing to meet with a pediatrician in their community and take the time to explain the importance of chiropractic care in infancy to them.

If your patient’s conversation with the pediatrician is not progressing well and there seems to be no interest, or even resistance to their health care choices for their family, it may be time for that patient to find a new pediatrician. According to numerous studies, many pediatricians are interested in learning and supporting more holistic models of care. Parents may need to be reminded that it is their right to choose providers that support their choices in health.

As for the mother and infant in our practice? The mother also realized that the pediatrician’s personal opinion was just that: a personal opinion outside her scope and experience. Her daughter will continue under regular care with us. Next week, I will call this pediatrician’s office and invite her to lunch. If we have the opportunity to meet, I will prepare myself with articles and information published in textbooks on adjusting children. If she is open to a new perspective on helping the infants in her practice—great! I will be supportive of her practice and probably subscribe her to the ICPA Pathways to Family Wellness Magazine so she can continue to learn more about the vital services we provide.

ICPA Presents at International Holistic Pediatriac Conference

There is much talk today about the integration/collaboration among chiropractors and other practitioners. It is important for us to realize that our future success with these collaborations depend on the underlying philosophy from which these practitioners base their care. Because the principles of chiropractic are based on a vitalistic philosophy, it makes most sense to form alliances with providers outside of chiropractic who also practice from the vitalistic perspective. With this in mind, the International Chiropractic Pediatric Association (ICPA) has moved ahead to initiate presence and collaboration with holistic practitioners in various fields.

On Thursday, October 26, 2006, the ICPA had the privilege of presenting two case studies at the recent Pangea Conference on Pediatric Wellness in Chicago. The Pangea Conference is a multi-track integrative program, with the intent of creating new partnerships that support research and clinical practice. Annually, the Pangea Conference provides a forum to discuss research, accepted practices and change, in order to foster comprehensive care for all children.

The conference was cosponsored by The Judith Nan Joy Integrative Medicine Initiative at Children’s Memorial Hospital in Chicago. The Integrative Medicine Initiative (IMI) of Children’s Memorial Hospital is a philanthropically supported research initiative for pediatric clinical care, scientific research, and education. All submitted articles were peer reviewed and published in the course syllabus for the weekend. Northwestern University School of Medicine was the accredited provider for the 2006 Pediatric Integrative Medicine Conference. The vitalistic healing models represented by presenters and attendees included chiropractic, homeopathy, naturopathy, acupuncture, osteopathy, energy therapeutics and holistic pediatrics.

On behalf of chiropractic the ICPA presented the following case studies:

• Chiropractic care of a pediatric patient with growing pains, by Joel Alcantara, DC, and Tricia L. Arndt, DC, DACCP and

• The role of chiropractic in the care of a four-year-old boy diagnosed with Autism Spectrum Disorder (ASD), by Joel Alcantara, DC, and Kim McCann-Swanson, DC, DACCP.

The ICPA Diplomates, Dr. Arndt and Dr. McCann, each delivered an outstanding oral presentation, which raised significant interest for the collaboration of chiropractic care in the field of holistic pediatric wellness.

After our candidates presented, I was asked about the direction of the ICPA Research Department. I explained to the audience that one purpose of the ICPA Research Department is to gather individual case studies from our members, assess the predominate cases that are presenting in our practices and obtain preliminary data to establish which childhood cases are most relevant. With this information, we then have a clear direction to institute full scale Practiced Based Research Networks (PBRN’s) with our 2,000 members. I explained that PBRN’s offered significant data relevant to the doctor of chiropractic, the services provided and fulfillment of the population’s needs for chiropractic care. I further explained that, very similar to the American Academy of Pediatric’s PBRN’s, the goal of our PBRN is to meet the health needs of children and pregnant women with services in accordance with our findings.

Information about upcoming events can be found on the ICPA website: www.icpa4kids.com.

Family Wellness: The Evolving Paradigm

These days, you only need to be remotely tuned to the news media to realize that the use of prescriptions and over-the-counter drugs is frequently more hazardous to our health than helpful. When government agencies are no longer considered capable of overseeing multi-billion dollar pharmaceutical industries and families’ lives and health are in jeopardy because of it—we have a serious crisis at hand.

Thankfully, parents are no longer trusting that agencies and industries are working in their best interest. Informed parents are taking the initiative to seek natural, safe ways to restore health and well being for themselves and their children. Tired of the dying paradigm—suppressing symptoms with drugs and surgery—today’s parents want solution-based wellness care that is safe and effective.

We are truly living in the age of information; parents are privy to knowledge previously kept from the public. The Internet allows the public to explore and research information on their own—as opposed to being misled by persuasive advertisements on TV. Practitioners and consumers are challenging the legitimacy of the entire system as numerous drugs and procedures “proven safe and effective” are turning out to be not-so-effective and—even worse—unsafe. “Evidenced-based” research and practices based on it no longer carry authority because the foundation of their integrity is in question. Rather than relying on industries that substantiate their own products/interests through biased trials, consumers are demanding care that offers their families true results with improved quality of life.

Additionally, it is becoming evident that the insurance industry is not supporting our rights to choose wellness for our families. The question arises: Why are they not covering wellness care that prevents further sickness and disease and rather continuing to cover services with questionable efficacy that frequently lead to greater health problems? Faced with this industry’s reluctance to provide benefits for true health care, parents are opting out of policies covering drug and unused visits. By doing so, they are saving on monthly premiums and investing these dollars into more holistic and safer family care.

Natural-based care cannot compete with the pharmaceutical industries’ seemingly unlimited ability to advertise on TV. It is through testimonials from satisfied people whose quality of life has been improved that the life changing results of natural care are promoted. Hearing personal experiences often propels individuals to step away from slick pharmaceutical advertising ploys and search for real practical health care. What each and every one of us has experienced with wellness care needs to be made known.

It is truly a time of change and momentum in the right direction. Parents are claiming the rights and responsibilities for their families’ health. Today’s families are participating in wellness lifestyle changes that are making a huge impact on their present and future well-being. We doctors of chiropractic should be proud to play our unique role in offering information and services that support the family wellness lifestyle. Our respect and appreciation of parents’ rights to choose wellness will keep us in the forefront of the evolving public demand for wellness care.

The Chiropractic Wellness

The International Chiropractic Pediatric Association recently sent out a survey to its members asking for the reasons why parents bring their children in for chiropractic care. The number one reason reported was “wellness.” Parents are recognizing the importance of chiropractic care and the significant role it plays in the family wellness lifestyle.

The term wellness is becoming common and being used by many holistic care groups to describe the type of care they are offering. In an effort to better understand its definition, I looked it up in various dictionaries. Merriam Webster defines wellness as “the quality or state of being in good health, especially as an actively sought goal.” From Wikipedia, the free encyclopedia, I read, “Wellness is generally used to mean a healthy balance of the mind, body and spirit that results in an overall feeling of well-being… In other words, wellness is a view of health that emphasizes the state of the entire being and its ongoing development.”

How do we contribute to wellness as Doctors of Chiropractic? As nerve system stress is reduced through the adjustment, all systems and functions of the body are improved. Additionally, doctors of chiropractic offer their patients lifestyle options that contribute to their well-being. Improved posture, suggestions for body movement and exercise significantly contribute toward our overall health. Awareness of the foods we consume and their effects on our health are another way that Doctors of Chiropractic guide their patients to a healthier lifestyle. Chiropractors have always offered these suggestions to their patients, even before other professions saw the importance of these factors in health. These physical components are vital for wellness.

We know that, when we are physically healthier, our minds function more efficiently. In chiropractic, our specific work in reducing nerve system stress has a significant effect on our ability to affect thought and behavior. Pathways magazine, the ICPA public education magazine, has frequently published articles and testimonials supporting the positive effect the chiropractic adjustment has on people’s thoughts and emotions. In our most recent issue, one young boy diagnosed with ADHD says this to his mother about the adjustment: “It takes the noise out of my head.” How profound is his statement in expressing the direct correlation between nerve system function and its effect on the mind.

So, too, our thoughts and attitudes have a direct correlation to our physical health. Current science is demonstrating the relationship between our patterns of thinking and our physical health. We can eat the best food and exercise daily but, if our overall outlook on life is negative, these thoughts and emotions will adversely affect our ability to experience well-being. In this area, doctors of chiropractic offer a huge contribution toward fulfillment of wellness. The chiropractic profession has always provided patients with a unique perspective: recognizing, respecting and trusting in the body’s innate ability to heal and be well. It is exciting to see the current research being published in the scientific arena to substantiate the direct relationship between our outlook on life and our health.

Doctors of Chiropractic are leaders in the wellness movement. We have always emphasized whole body well-being and our core understanding of life and health promotes balance of the mind/body relationship. As a profession, we need to continue to emphasize our unique perspective and offer services consistent with this wellness model.

Dr. Jeanne Ohm instructs internationally on the topic “Chiropractic Care for Pregnant Women and Children.” She is executive coordinator of the International Chiropractic Pediatric Association and can be reached via their website at www.icpa4kids.com.
Information about the upcoming Pangea 2006 Conference, Oct. 26-28, can be found on the ICPA website: www.icpa4kids.com.

Safety in the Family Chiropractic Practice

I am frequently asked, “What are the safety concerns for children in the chiropractic practice?”

Having spoken with several chiropractic malpractice insurance carriers, the real issue of safety in the care of children comes outside the scope of care itself but, rather, in office equipment accidents. With that in mind, I will address some key safety standards for the office and adjusting room pertinent to the care of kids.

General:

1. Plants are wonderful. Make sure the ones you have are not poisonous. Even if they may be “out of the reach of children,” leaves may drop on to the floor.
2. All unused electrical outlets should have child safety covers.
3. The entire office should be examined for frayed wires.
4. All cabinets within children’s reach must have safety latches (regardless of what they contain).
5. Check all shelves, desktops, and windowsills for objects that hang down within a child’s grasp. If something is within their arm’s reach, they will pull on it. If it attaches to something that can get pulled down, they will pull it down.
6. Bulletin boards with tacks frequently “shed” tacks on to the floor. Be continuously vigilant of this, or use staples to secure your papers to the board. (This includes tacks for posters on the wall as well.)
7. Children’s play areas may have toys left behind that do not meet the “non-choke” standards. The toy room should be checked daily for these and other hazardous objects left behind.
8. All stairs accessible to children should have a child safety gate at each landing
9. You should not even consider having the “heated” water dispensers in your office near to public accessibility.
10.Bathroom cleaners need to be stored in an out of way place.
11.Chairs (or other climbable furniture) should be away from any unsecured, operable windows.
12.Make sure all bookshelves and other tall pieces of furniture are balanced and secured and cannot topple over if a child tries to climb up.
13.Coffee/magazine tables with extendable sides pinch little fingers.
14.X-ray darkrooms need to be locked from the outside so film chemicals are never accessible to a wandering child.
15.Important emergency numbers should be posted at the CA booth and a CPR/choking chart is equally important and well.

Specific to the adjusting room:

1. All hi-lo adjusting tables must have safety stop features.
2. With drop tables, when adjusting a parent or sibling and a child is standing close by to watch, be sure that their fingers are not anywhere near the table before you make the drop.
3. Warning signs about the potential dangers of children touching equipment allow parents to be aware of the potential hazards of your equipment.
4. As a general rule, children should never be left to wander into unsupervised adjusting rooms.
5. Never leave a child on a table unattended. Even infants who have never rolled over will find the most inappropriate times to take their first roll.
6. Older children should be assisted off the table so they do not loose their balance. Children will frequently make unexpected and erratic moves. Be prepared.
7. When using the infant toggle headpiece, especially if the child is seated, before you make the “drop,” be sure their little fingers are not reaching up and feeling for the headpiece as it is touching their ear.
8. Do not leave the headpiece on a counter with the strap hanging over the edge. It is very tempting for a child to pull it down onto their head.
9. Keep the headpiece out of reach. The knob on it unscrews and 3-7-year old boys love to explore this mechanism and unscrew it. The hazard comes with the tiny ball and spring that can fall out after the screw is taken out. If dropped on the floor, these become treasures for crawling infants who are also at the stage of putting everything into their mouths.

Although this list may not be complete for every office, it is a good start. If you have additional suggestions, please e-mail them to me: [email protected].

Information about the upcoming Pangea 2006 Conference, Oct. 26-28, can be found on the ICPA website: www.icpa4kids.com.

Essentials of the Case History for Children

When taking a case history on a child, especially an infant, the questions we are asking are a bit varied from those we ask the adult patient. Questions that address the birth process and the potential interventions that may have occurred are essential toward proper assessment. Additionally, postural and behavioral considerations, specific to the infant, must be addressed.

The following list of questions is derived from Dr. Heiner Biedermann’s work.1 The information gathered from these questions will offer you valuable insight in determining the need for specific spinal adjustments in the infant or child.

Delivery
Long or short duration of delivery?
Presentation at birth?
Twin?
Forceps or vacuum delivery?
Cesarean delivery?

Visible Immediately after Birth or Later
Lateral curvature of the cervical spine?
Rotation of the cervical spine?
Looks only to one side?
Moves only one arm/leg?
Face appears smaller on one side?
Back of the head flattened on one side?
Has a bald spot on the back of the head?

The First Months
Sleeping difficulties during first months, six to twelve months, or later?
Did/does the child often wake up at night?
Fixed sleeping pattern?
Arching of the spine?
Hypersensitivity of the neck region?
Orofacial hypotonus?
Persistent crying? How often?
Problems with breast-feeding on one side or latching on?
Signs of poor digestion and elimination?
General Health
Headaches?
Mouth is often open?
Postural adaptations?
Aberrant movement?
Cranial and structural asymmetry?
Sensorimotor development slower than expected?
Delayed language development?
Decreased ability for concentration?
Questionable social integration?1

Answers to the above questions assist the doctor of chiropractic in assessing aberrant spinal biomechanics and less than optimal nerve system function in the infant and/or child. Combined with a specific spinal exam including segmental motion and muscle palpation and, possibly, X-ray, the doctor of chiropractic will have significant indicators to determine the appropriate care.

Information about the upcoming Pangea 2006 Conference, Oct. 26-28, can be found on the ICPA website: www.icpa4kids.com.

References
1. Biedermann, H., Manual Therapy in Children, Journal of Manipulative and Physiological Therapeutics, Vol. 28, No. 3, 211.e9.

Functional Chiropractic Collaborations

This fall, the International Chiropractic Pediatric Association is pleased to announce its collaboration with Pangea, a holistic practitioner conference for pediatric wellness. From their conference overview, they distinctly recognize that, “Professionals who care for children and are involved in today’s healthcare system will need to rely upon supportive, collaborative relationships for the purpose of healing the child.”

On behalf of its members and the chiropractic profession, the ICPA is actively involved in this collaboration. We will be presenting research, participating in a round table discussion and, of course, have a booth. We encourage those doctors of chiropractic who are interested in fostering collaborations to attend this and other similar conferences on behalf of chiropractic. It is through these types of events we can offer practitioners of like minds the importance chiropractic plays in the family wellness movement.

I wholeheartedly support the need for collaboration in the healing arts and I recognize effective collaboration will only happen between groups of like minds and philosophies. There is much talk about the importance of chiropractic’s acceptance in the medical community. In our attempts to accomplish this, however, we have sometimes compromised the basis of our empirical core and have leaned toward mechanistic modes of practice and research for this validation. It is imperative that, in our efforts to collaborate, we remain consistent with our core empirical foundation by choosing practitioners that share our vitalistic approach to health.

The medical profession, itself, is experiencing an identity crisis. There is the traditional mechanistic sector that continues to treat conditions and diseases with suppressive, short-term treatments. There is also a strong emergence of a vitalistc sector, those practitioners who recognize and respect the process of healing from a non-invasive, ongoing, supportive manner. It is these practitioners who understand the basic principles of chiropractic, are not threatened by it, and who are interested in collaborating in practice and advanced care for their patients.

In the past few years, the ICPA has formed wonderful alliances with midwives, natural birth and parenting practitioners, psychologists, homeopaths, acupuncturists, osteopaths and holistic pediatricians. Coming from the common ground of empiricism, collaboration is easy and fruitful. The ICPA will continue to foster these important alliances on behalf of our practitioners and the whole chiropractic profession. We see that the public is becoming aware of the distinct differences between mechanistic and vitalistc care and are actively choosing more holistic practices for their families. As chiropractors, this is our opportunity to offer the empirical core values and services of chiropractic in cooperation with practitioners of like minds and services.

Information about the upcoming Pangea 2006 Conference can be found on the ICPA website: www.icpa4kids.com.

Assessing the Need for Chiropractic Care in Children

Many Doctors of Chiropractic become intimidated with the idea of working with children and often shy away from offering their services to this very needy population. Frequently, chiropractors do not care for children because the child cannot verbally express itself. Other doctors of chiropractic avoid caring for children because the assessment tools they use for adults are not applicable with children. The assessment of children for chiropractic care may seem to be a bit more subtle than that of the adult; however, once the skills pertinent to the care of children are mastered, the rewards are memorable and bring a whole new level of satisfaction to our practices.

The following suggestions are starters to lead you toward a successful relationship with the child, the parents and yourself, as a practitioner.

• Use an entrance form that is designed particularly for children. Pertinent questions are history of mother’s pregnancy, birth, nursing, sleeping and eating patterns.

• Make notations of physical, emotional and chemical stressors that the child has been exposed to.

• Take careful note of how the mother explains the case to you. Listen, not only to her verbal language; be conscious of her body language as well.

• If both parents are present, look for consistency in feelings and opinions.

• Ask about the whole family’s lifestyle: diet, employment, other siblings, schedules and note the stress levels of each one.

• If the child is an infant, hold it to get a good assessment of its sensitivity to touch, resistance to movements, fussiness and discomforts.

• Observe spinal tension, torsion, arching or fixed deviations to determine dural stress.

• Incorporate postural assessments in your exam relevant to the child’s age and development.

• Utilize specific motion and muscle palpation of the infant’s spinal segments to allow you to locate key areas of segmental spinal stress.

• Incorporate cranial examinations for asymmetry and distortions.

Providing quality care for children is a rewarding experience. I encourage all chiropractors to seriously consider caring for more children in their practices.

Making an Informed Choice

In the Western world, we pride ourselves on our freedom and ability to make choices in our lives. We can carefully evaluate many options in our lives and choose accordingly. Perhaps our greatest freedom (although not exercised by many) is our freedom to make choices that will affect our lives and our families’ lives for years to come.

As early as preconception, the choices we make for our own health and well being affect the future lives and health of our children. The physical, emotional and chemical stresses we are subjected to have their effects on a cellular level and may very well impair normal function. It is our responsibility, from the moment we are given these options, to make choices that lead us toward a more balanced lifestyle.

Parents face the right and responsibility to find out the many options available when it comes to choosing providers. They can solicit supportive health care providers who seek to give them valuable information and who empower them with the knowledge to make informed health care choices for their families.

In my twenty-eight years in chiropractic, I have discovered that, unlike practitioners in any other profession, Doctors of Chiropractic are an incredible resource of information for family wellness care. Had it not been for an amazing support team of chiropractors, I may have never known or chosen natural options for my pregnancies, my births and my on-going children’s well being.

In chiropractic, I discovered very basic, vitalistic principles and I learned to trust the body’s ability to function. I also learned that I could make choices to enhance my ability to function better. This knowledge gave me the strength, as a parent, to make decisions that supported my children’s potential to be well.

As Doctors of Chiropractic, we have the information that parents are seeking to make natural living choices for their families. Offering our services and knowledge to the families in our communities enhances their freedom and right to choose wisely. As more and more parents seek viable options for their families’ health, we, as chiropractors, can successfully fill this need.

As you begin to help more families in this way, you will realize the profound impact your knowledge and resources will have on the decisions parents make for their families. Along with your chiropractic adjustment, the education you offer provides a much-needed service that no other family provider is fulfilling. Truly, chiropractic care offers a unique and valuable role in the Family Practice realm.