Category: Technology

Choosing the right laser for your light therapy can be extremely confusing, because the literature available on light therapy is not only confusing but contradictory.  Laser light has unique physical properties that no other light source or LED has. There is a big difference between a colorful brochure and the clinical efficacy of the unit being sold.  To date, laser instruments have been sold which do not even contain a laser. To help you make the right choice, this article defines the common terms used in light therapy and presents the biological basis of the unique clinical efficacy of Low Level LASER Therapy.

The word LASER is an acronym for Light Amplification by Stimulated Emission of Radiation.  Scientists recognize lasers by two parameters.  Laser light is coherent (single wavelength) and collimated (focused).  Coherent light means waves of the light quanta or photons are synchronous and move in the phase with each other.  By collimating or focusing a specific wavelength of light, energy can broadcast great distances and remain a focused dot of energy.  Advertised light therapy units, such as the LED, CO2, infrared or near-infrared lasers, are, in general, not collimated.  Removing the collimator from a laser will cause the light array to look just like an LED or any other colored light, but the biological and clinical effects are not the same. Laser light is the only source of coherent and collimated light.  This underlies the biological basis of light therapy.

While there is no legal definition for “Low-Level Laser Therapy (LLLT), most scientists and clinicians agree that Low-Level means that the power output is low enough not to raise the temperature of the tissue being irradiated by more than 1 degree.  The FDA classifies lasers with this power output as Class IIIa lasers.  Any potential danger from a Class IIIa laser results from direct irradiation of the eyes. Thermal damage is not possible. Class IIIa lasers allow LASERS to be used as therapeutic tools to, “… relieve pain and suffering and above all else, DO NO HARM….”

Low-level light therapy works by stimulating a cell’s innate metabolism.  Again, the effects are biochemical, not thermal and, therefore, cannot damage living cells.  The therapeutic effects of LLLT result from biomodulation of a tissue. Low-Level Laser Therapy is safe for both operator and patient.  LLLT lasers are therapeutic, because they allow living tissue to maintain or return to homeostasis without damaging tissue.

Four distinct biological effects occur when using LLLT, i.e., when photon energy is transferred to a biological chromophore.  These include:

1. Growth factor production occurs within cells and tissue in response to increased ATP and protein synthesis.

2. Pain relief results from suppression of the nociceptor response mediated by increased serotonin and endorphin release.

3. Immune-modulation and mitigation of the inflammatory response occur because the mononuclear phagocytic cells, mast cells, and leukocytes are stabilized, preventing the release of harmful inflammatory mediators. In addition, vasodilatation and increased microcirculation allows a rapid return to homeostasis and promotes first intention healing.

4. Direct trigger point stimulation allows direct release of endorphins and other endogenous pain mediators, such as serotonin, VIP, substance P, prostaglandins, etc.

Propagation of light though tissue is regulated by reflection, penetration, or absorption and transfer of energy of light quanta to the cell.  This is laser dependent.

Reflected energy becomes scatter radiation and is dangerous to both operator and patient.  This is a natural protection mechanism. The body could never control its internal environment, temperature, and, therefore, cellular metabolism, if all exposed photon energy was transferred to the tissue. The majority of energy from uncollimated and noncoherent light sources is reflected off the skin surface.  Most infrared light sources are uncollimated or noncoherent, or both, and depend on scatter or reflection to reduce the thermal damage due to irradiation.  Therefore, very little photon energy is transferred to the tissue.

As advertised, photon energy from high-power infrared lasers penetrates deep into the tissue.  Again, this is a physical and thermal phenomenon, not a therapeutic phenomenon.  Energy is dissipated as heat.  Thermal activation overrides the cells homeostatic metabolic state.  The cell may be turned on or off, but not in a functional manner. This can cause damage deep in tissues, out of sight of the clinician.  Furthermore, energy transfer to a biological chromophore does not occur.

When light quanta are absorbed, energy is transferred to water, some organic molecule, or to one or more chromophores within tissue, thereby producing a cellular response which changes the cell’s homeostatic set point.

Within the cell, the signal is transduced and amplified by a photon acceptor (chromophore).  When a chromophore first absorbs light, electronically excited states are stimulated, and primary molecular processes are initiated which lead to measurable biological effects.  These photobiological effects are mediated through a secondary biochemical reaction, photosignal transduction cascade, or intracellular signaling which amplifies the biological response.

The ionizing effects of LLLT allow photon acceptors to accept an electron. This turns on the oxidation-reduction cycle of the stimulated chromophores, such as Cytochrome oxidase, hemoglobin, melanin, and serotonin.  Changing the re-dox state of the chromophore changes the biological activity of that chromophore; e.g., hemoglobin changes its oxygen carrying capacity. This is in contrast to the destructive ionizing effects of X-rays, which remove or disrupt electrons from an atom or molecule and damage tissue.

When photon energy breaks a chemical bond, changes occur in the allosteric proteins in cell membranes (cell, mitochondrial, nuclear) and monovalent and divalent fluxes activate cell metabolism and intracellular enzymes directly.  Direct activation of cell membranes alters ion fluxes, particularly calcium, across that membrane.  Changes in intracellular calcium alter the concentrations of cyclic nucleotides, causing an increase in DNA, RNA, and protein synthesis, which stimulate mitosis and cellular proliferation.

When all of the above occur correctly, the photon activates a chromophore and that single enzyme molecule rapidly catalyzes thousands of other chemicals similar to the well known, calcium regulated, 2nd messenger cAMP cascade. This biological amplification process explains how low-power laser therapy can produce such profound systemic, cellular, and clinical effects.

One of the most confusing aspects of light therapy is dozens of published reports, which fail to find any effect from LLLT.  As with any treatment, clinical efficacy depends on diagnosis, dosage, treatment technique and individual reaction.  Similarly, each stage of the biomodulation cascade depends on additional laser specific factors, including the light source, wavelength, irradiation dose, power density, and tissue specific factors.  Alterations in any of these parameters can minimize or cancel the effects of light therapy. Here are some basic examples:
 
Light sources: A cell’s response to light differs markedly in vivo and in vitro.  The coherent properties of laser light are not important in cell suspensions or tissue culture monolayers.  In vitro, coherent or noncoherent light (both lasers and LED’s) with the same wavelength, intensity, and dose can stimulate the same biological response.  However, in vivo, in living tissue, only photons of coherent light are able to pass through optical windows in cell membranes to become accepted by photon acceptors (chromophores).

Coherent light is only created by a LASER light source, not from LED or SLD light sources.  Even coherent light, if left uncollimated, will, for the most part, reflect off the skin as dangerous scatter radiation. Coherent, collimated, laser light has, by far, the greatest therapeutic potential.  Because laser light triggers the cells own homeostatic mechanism, only low intensities and doses are required for dramatic biological responses.

Wavelengths: Every chromophore has an absorption coefficient for peak activation, which is wavelength specific. However, each chromophore has a wide range of wavelengths in which it will accept or donate electrons. Within living tissue, peak activation of a chromophore can occur within a broad range of wavelengths (e.g., oxygenated hemoglobin has absorption peaks at 420 and 577 nm; reduced hemoglobin at 560nm).  Wavelengths longer than 1200 nm (infrared) and shorter than 200 nm (ultraviolet) are absorbed by inter- and intracellular water.

Wavelengths of 620-720 nm are typi-cally better able to penetrate optical windows in cellular membranes because their photons are not easily absorbed by living tissue which, on average, are composed of 70-80% water. Chromophores found in eukaryotic (mammalian) tissue have peak activation spectra between 600 nm to 720 nm.   Since laser light acts as a trigger for normal cellular metabolism, it is not necessary to utilize a wavelength that strikes the peak activation of each chromophore.  It is only necessary for the wavelength to fall within the spectra of the chromophore.  The wavelength of 635 nm is contained within the spectra of the chromophores found in mammalian tissue and, therefore, has the potential to biomodulate all eukaryotic tissue.

Irradiation Dose: The product of power density (mW) and exposure time defines the irradiation dose and is measured in Jules of energy per square centimeter (J/cm2).  This is an extremely important parameter for laser treatment and biomodulation.  Scientists have shown the therapeutic efficacy of LLLT is enhanced by repetitive low doses within a specific time, in contrast to the same total dose in a single treatment. In addition, the biomodulation effects of LLLT are cumulative.  Repeated doses, within relatively short intervals, produce greater biological responses than single frequency lasers. Doses which are too low produce no effect.  Doses which are too high produce no effect or dampen biological activity.  Each biological tissue has an optimal dose, which is laser dependent.

Power density from 2 to 5 mW is adequate to activate mammalian chromophores. Power higher than 5 mW may exceed the activation levels of some chromophores. The greatest biomodulation is created with repeated doses of pulsed collimated laser light at or around 5 mW of power.

Chromophore response is dependent upon the functional metabolic state and composition of the tissue at the time of irradiation. LLLT produces separate responses in separate tissue based on the active chromophore within that tissue, e.g. bronchial tissue (mast cells), skin (melanin).  Healthy, injured, and malignant tissues absorb light, or transfer energy differently, because they contain different chromophores, and are in different metabolic states.  This explains the wide array of therapeutic effects of the LLLT in damaged tissue and the lack of response in healthy tissue.

The most dramatic examples include the different effects of LLLT irradiation on healthy tissue, inflamed tissue, and malignant tissue. Healthy tissue does not contain a high concentration of biologically active chromophores (e.g., biogenic amine, histamine, serotonin, VIP, substance P), while inflamed tissue does. LLLT can mitigate the inflammatory response by stabilizing mononuclear phagocytic cells, stimulating leukocyte chemotaxsis, and preventing mast cell degranulation.  This prevents the release of histamine, and other biogenic amines, which cause the cellular infiltration responsible for the four cardinal signs of inflammation: redness, heat, pain, and swelling.  LLLT dampens the inflammatory cascade, mitigates inflammation, and allows first intention healing.  Similarly, malignant tissue is defined by its high mitotic index, which supports the rapid, uncontrolled growth of cancer.  Mitotic cells appear insensitive to LLLT irradiation while injured and dormant cells can be stimulated to divide.

While LLLT may have no effect on a healthy, normal cell, it has profound biological and therapeutic effects on inactive, sick or injured cells.  The power of LLLT lies in the fact that injured cells respond to irradiation, turning on or off, allowing the cell to return to, or maintain, cellular homeostasis.  In short, LLLT allows the cell to heal itself.
 
In conclusion, for safe and effective light therapy, the ideal therapy device should be a low powered (between 2 and 5 mW), laser (capable of producing collimated and coherent light), which produces wavelength between 600 than 720 nm, and is capable of rapidly delivering pulsed frequencies to tissue.

R. Gerry Graham, DC, is a licensed chiropractor, graduate of Logan College of Chiropractic and practices in Aurora, Colorado. Dr. Graham is President of LED Healing Light LLC.

Joan M. Murnane holds a PhD from Emory University School of Medicine, a DVM from the College of Veterinary Medicine, University of Georgia and a Masters in Pharmacology and Physiology from Washington State University College of Veterinary Medicine, Pullman, Washington.

For additional information or dates for upcoming seminars, please email [email protected].

Dr. Peter Fernandez, a 1961 Logan College graduate, is past president of the Florida Chiropractic Association, and past chairman of the Chiropractic Knights of the Roundtable, an organization of the world’s most successful chiropractors.  His practice, with 5 staff chiropractors and 12 satellite offices, was, at one time, one of the country’s largest all referral, high income chiropractic clinics.

Dr. Fernandez has been a practice consultant for the last 24 years and, in this capacity, has consulted with approximately 5,000 DC’s, as well as in the opening of over 3,000 new practices.

In an interview with The American Chiropractor, Dr. Fernandez describes his latest project, bringing chiropractic continuing education into the internet age on a very unique level.

TAC: With your history of more than 24 years as a practice management consultant, describe the major changes you’ve seen in chiropractic technology over the years and how  this technology has helped the chiropractic profession?

Fernandez: First of all, the development and usage of mechanical instruments for the correction of spinal subluxations is revolutionizing our profession.  There was a time when only brute strength could make spinal corrections but, now, even the most petite doctor can render care to any size individual.

Computer technology has increased our ability to diagnose and document spinal aberrations, i.e., range-of-motion analysis and muscle testing can now be done by pushing a button.  And, since insurance companies believe computers first and doctors second, these instruments are a real plus for validating chiropractic care.

Outsourcing of services, such as insurance billing, accounting services, etc., is made much easier by the electronic broadcasting of data between doctors’ offices and these service providers.  This technology frees up the doctor to do what he/she does best—treat patients.

Computerized patient education aids, such as the Neuropatholator, make it much easier to explain chiropractic to our patients; thus, when used regularly, they will increase a doctor’s practice.

There is no question that “Knowledge is Power.”  The more knowledge a doctor acquires on how to fix patients’ health problems, the quicker his/her patients recover and the more referrals the doctor will receive. Today, doctors all over the world can research any health problem by clicking a button and logging onto the Internet. 

TAC: With this issue of TAC’s focus on Technology, tell us how your latest venture, MBAChiropractic.com, is revolutionizing the way chiropractors access continuing education, license renewal and consulting services.

Fernandez: The strategy of any good pathfinder is to first understand the changing external elements that are affecting his or her industry and then develop a plan to prosper within those changes. Tom Cavanaugh, D.C., M.B.A., and I have researched and understand the changing external environment that affects chiropractic and have assembled the technology to deal with these changes.

Our new technology is a futuristic advance, which helps chiropractors grow their practices in spite of our changing health care environment. Actually, we may be the first company in any profession to bring continuing education, license renewal, and practice building seminars to doctors by video streaming classes over the Internet. As easy and convenient as it is for doctors to view these classes, the process in making it happen was not. Being a brand new concept, it required massive research and development efforts on our part.

Our research was conclusive in that most doctors felt they were in a “Catch 22” situation.  They want to attend seminars, but are concerned about expenses, time out of the office and loss of patients from being gone on Fridays or Saturdays.  But, if they didn’t attend seminars, they wouldn’t get the knowledge or expertise needed to build and maintain a successful practice.  Their concerns became our primary focus.  How could we help doctors get continuing educational, license renewal and practice-building seminars without having to close their practices or incur a lot of expense?  We also determined that the greatest expense in attending seminars was not the seminar registration fees, but the associated travel, lodging and food expenses.  (See Seminar Expense Chart.) Our answer to these legitimate needs and concerns ($250,000 later) was to merge advanced technology with our professional practice building seminars; in other words, put our seminars online. From that, www.MBAChiropractic.com was born!

Now doctors can put the majority of what it used to cost them to attend seminars back in their own pockets. They can also have their chiropractic assistants trained online—no more travel, lodging and food expenses.  And, as the reader knows, attending seminars is not only costly financially, it can also put a strain on personal relationships and family matters.  By taking our practice-building and post-graduate education classes on line, the doctor’s family will be happier, because the doctor doesn’t have to leave home!  That alone is revolutionary!

We found that, not only is there a huge savings when attending seminar classes online, there is also a valuable comfort factor, as well. Think of the tremendous convenience for doctors by having expert classes video taped live at actual seminars available to them online—anywhere, anytime.

An admitted “seminar junkie,” I know that seminars typically mean wading through about 80 percent of what you’re not interested in to get to the 20 percent that you truly need or want to hear.  In offering video seminars “by the class”, we have solved that problem.  Now, doctors essentially customize their own practice building, post graduate and license renewal seminars by selecting only those classes that interest them …and, they get to stay home and save money, too.

Our online video seminar classes also solved two other problems.  Every weekend there are dozens of seminars available on a smorgasbord of subjects.  Most doctors want to attend a number of these great seminars, but just can’t fit all of them into their schedules. At www.MBAchiropractic.com doctors can take all the classes they want (we currently offer over 145 classes on a wide range of subjects) and never have to leave home.  

TAC: Sounds great. What do you think the long-term implications are for chiropractic and chiropractors for utilizing this type of technology?

Fernandez: What we have accomplished is truly innovative and revolutionary.  Our site will become the “vehicle” in which practice management consultants, license renewal firms, vendors and post-graduate educators will deliver their courses and seminars.  Viewing seminars and classes online is the future of chiropractic education.  Just as our profession evolved from manual, intensive labor to computer technology in their offices, so it will evolve from going to seminars to having seminars come to them via their home or office computer.

This new advance will not only make it easier for doctors to enhance their knowledge of the philosophy, art and science of chiropractic as well as their management and practice-building skills, but it will also save them 70-80 percent of the associated travel costs.  As doctors increase their personal skills and knowledge, their practices will grow and so will the chiropractic awareness within their communities.

Our www.MBAchiropractic.com site also gives beginning doctors the business skills they will need to run and market their new practices.  This site gives them affordable access to the “hows” of the best practice consultants, and allows them to start learning these vital principles months before they actually graduate from chiropractic college.  The quicker a doctor can “come out of the shoot” with this knowledge, the less money he or she will lose through “trial and error.”

TAC: Anything else about MBAchiropractic.com you want to add?

Fernandez: Our site includes the talents and expert knowledge of accomplished instructors who teach classes on technique, nutrition, rehab, X-ray, wellness, sports, personal injury, workers’ compensation injury and a number of other subjects. Doctors throughout the United States, Canada, Europe, Australia, England, New Zealand, Japan and any other country will now be able to tap into this enormous library of talent for pennies.  (Doctors from these countries are already experiencing the benefits of using www.MBAchiropractic.com).

I would like to make another important point.  Many vendors have developed great products that can help chiropractors in their practice.  However, it is very difficult for doctors to sort through and find those new products that best serve their patients.  And, before www.MBAchiropractic.com, it was pretty much impossible for doctors to learn about those great products developed outside of their own country.  While some vendors exhibit their products at seminars, they can only talk to one doctor at a time; and the amount of time a doctor can spend at one booth is also limited.  Therefore, we are making our site available to companies wanting to demonstrate their products in video format so that doctors all over the world can become more intimately acquainted with them and be able to make better choices.

Many products also require instructions on how to use them.  Vendors are using our site to teach doctors how to effectively use their products.  This service saves vendors millions of dollars, which results in lower prices for our doctors.

Just imagine these scenarios.  Beginning doctors want to know the “A through Z’s” on how to open a practice.  Now they can sit on the couch, put their one-year-old in their arms, eat a hot dog and learn how to open their practices…all at the same time!

An established doctor has an important deposition tomorrow, but his/her consulting firm doesn’t teach that particular subject for four months.  All the doctor has to do is “click” on our deposition video before going to bed that night and he/she is prepared in the morning.  Doctors are always hiring CA’s, but few understand the intricacies of finding, hiring and training them.

In growing a practice, most doctors will also need to eventually find, hire and train an associate.  Colleges want and need to expand their post-graduate education programs to all chiropractors worldwide.  All of this has been made possible through www.MBAchiropractic.com. The possibilities are unlimited!

Dr. Fernandez can be reached by email at [email protected]; or, for more information, visit www.DrFernandez.com, or www.MBAChiropractic.com.

Imagine a paperless office.  Handheld computer terminals contain all your patients’ records for instant access and quick-touch information entry.  Conferring with other doctors or obtaining treatment guidelines all can be had at your fingertips.  Patient check out and billing can be done electronically.  Appointments can be made online and products can be purchased by patients through your website.

It’s not hard to imagine all this technology, because it all exists for the doctor’s office, but the adoption of this technology by chiropractors to support patient care is slow.  According to the Center for Studying Health System Change (HSC), a non-partisan policy research organization, larger physician practices tend to be more rapid adopters of office technology but, with group practices still rarely found in chiropractic, many chiropractic offices have few, if any, of these technological features.

HSC’s 2001 Community Tracking Study Physician Survey of 12,400 physicians examined the forms of information technology (IT) used in practice to support five distinct clinical functions: obtaining treatment guidelines, exchanging clinical data with other physicians, accessing notes on individual patients, generating treatment reminders for the physician’s use, and writing prescriptions.  The results of the survey showed that the vast majority of the physician practices lacked significant IT support for patient care.  Nearly one in four physicians surveyed was in practice with no computer or other form of IT support for any of the five clinical functions.  Another quarter of the doctors only had IT available for one function.  Only 27 percent of the doctors were in offices with IT support for three or more of the functions.  Interestingly, of those physicians who had IT support, only 37 percent used technology to access patient records.

“Computerized patient records can be one of the most important ways to use technology to improve patient care,” according to Craig Oberfeld, CEO of QuickNotes, Inc., a leading chiropractic documentation software company.  “It took a big push from Medicare toward requiring electronic billing to get chiropractors to switch from paper to digital claims submission; but, now that they are familiar with handling digital patient billing records, it is only natural that they are considering the move to digital treatment records. Chiropractors are realizing the benefits of using technology to manage more of their patients’ care.  Hand-held documentation systems can be faster than hand-written notes, and the generated typed notes are more easily deciphered by claims adjusters for faster payment.”

Today’s handheld computers and touch-screens have enormous memory capacity and can hold vast amounts of patient records.  Running from treatment room to treatment room, a doctor can carry the handheld unit, access patient records and record subjective, objective, assessment, and plan (SOAP) notes and reminders, by touching a screen or using handwriting recognition technology.  Some systems even offer voice recognition for instant dictation and note generation, although there are some talking-speed and enunciation limitations.

Chiropractors may hesitate to purchase technology because of the cost, but they would be failing to recognize the long-term cost savings.  Using an electronic patient documentation system can reduce the need for a staff member whose responsibility is typing up patient notes, dictation, or photocopying records to mail to insurance companies.  Special report-generating programs can also transcribe SOAP and exam notes into legal care reports.  Entering notes electronically can take the doctor less time than it takes to write them by hand or even to dictate, so the total money saved in one year can be as much as $40,000!

“Websites are the number one online marketing tool for chiropractors, but a website should be the beginning, not the end, of an online marketing program,” explains Asaf Ben-Haim, CEO of iMatrix, Inc., a chiropractic website development company.  “A standard website, by itself, is only a digital brochure and not much of a new patient generator.  However, by leveraging the search engine technologies and offering services like appointment scheduling and an online product store, chiropractors can make their websites more interactive, and attract both new and current patients.”

Online marketing is much more cost effective than mailings or print versions.  Electronic patient newsletters, patient reminders and birthday cards can be emailed to patients at no cost, instead of paying 37 cents for a stamp.  Online promotions are a fraction of the cost of similar print promotions to reach the same audience.  For an office with a limited marketing budget, online marketing makes much more economic sense than local print advertising.

Mark Mandell, DC, MBA is the Director of Business Development at Foot Levelers and was the Medical Staff Chairman of the 1994 World Cup Opening Ceremonies.  Dr. Mandell is a popular educator on the business of chiropractic and how to grow the profession.  He can be reached at 800-553-4860.

Practicing chiropractors are faced with the challenge of determining when to adjust.  Trying to apply examination procedures, such as medical orthopedic tests, which do not indicate the presence or correction of vertebral subluxations, has frustrated many doctors.

The concept of nerve interference is often challenging to patients.  Their confusion is compounded when the chiropractor claims to be subluxation based, but bases care on the presence or absence of symptoms.

The ideal clinical examination procedure:

• Will provide objective measurements.
• Is completely non-invasive.
• Provides a reliable and valid assessment of the functional status of the nervous system.
• Provides a means of re-examination to track progress.
• Is time and cost effective.
• Uses protocols supported by peer-reviewed publications.
• Is applicable to persons of all ages, including infants, toddlers, children, adolescents and adults.
• Facilitates patient education by providing easy-to-understand, tangible evidence.
• Is suitable for spinal screening.
     
Advances in technology, such as electromyography (EMG) and thermal scanners that are designed especially for chiropractors, have resulted in instrumentation that empowers the chiropractor with objective evidence of nervous system function.  Enabling the chiropractor to evaluate aspects of functional integrity, which are related to the analysis of vertebral subluxation, is essential.  For instance:

1. Static surface EMG (sEMG) measures the electrical activity in the muscles surrounding the spine.  This test enables the chiropractor to objectively evaluate the innate response of the paraspinal muscles to gravity.  Tonic muscle activity is assessed with static sEMG.

2. Dynamic surface EMG allows the chiropractor to graph up to four channels of sEMG activity as the patient goes through ranges of motion.  The result is an objective assessment of voluntary motion.

3. Paraspinal Infrared Temperature analysis evaluates the integrity of the autonomic nervous system, which controls organs, glands, and blood vessels.  It allows the chiropractor to relate vertebral subluxation to autonomic function.  A rolling thermal scanner allows the doctor to examine infants, children, and adult patients in a single pass.

4. Computerized inclinometry measures ranges of spinal motion.  These measurements relate to the biomechanical component of vertebral subluxations.

5. Pressure algometry evaluates sensory function by measuring the pressure/pain thresholds of tender regions along the spine.

Having the ability to display dramatic color graphics in a format that is easy to apply clinically and to communicate effectively and objectively to patients, is the goal of every chiropractor.  Seeking technical certainty through advanced methods and technologies should be the path for each of us.  Improve your patient communication and commit to the vision of lifetime, subluxation-based wellness care and raise your practice to a higher level.

Bibliography

1. Saur PM, Ensink FB, Frese K, et al: Lumbar range of motion: reliability and validity of the inclinometer technique in the clinical measurement of trunk flexzibility.  Spine 1996;21(11):1332.
2. Whatmore GB, Kohi DR: Dysponesis: A neurophysiologic factor in functional disorders.  Behav Sci 1968;13(2):102.
3. Kent C: Surface electromyography in the assessment of changes in paraspinal muscle activity associated with vertebral subluxation: a review.  Journal of Vertebral Subluxation Research 1997;1(3):15.
4. Uematsu S, Edwin DH, Jankel ER, et al: Quantification of thermal asymmetry.  J Neurosurg 1988;69:552.
5. Kent C, Gentempo P: Instrumentation and imaging in chiropractic: a centennial retrospective.  Today’s Chiropractic 1995;24(1):32.
6. Kelly S, Boone WR: The clinical application of surface electromyography as an abjective measure of patient progress: a pilot study.  Journal of Vertebral Subluxation Research 1998;2(4):175.800-892-6463 or 201-368-9600.
7. Kent C: Instrumentation and imaging.  In: Masarsky C, Todres-Masarsky M: Somatovisceral Aspects of Chiropractic—An Evidence-based Approach.  New  York.  Churchill-Livingstone.  2001.

Christopher Kent, DC, is a 1973 graduate of Palmer College of Chiropractic.  The author of numerous professional publications, Dr. Kent has been recognized nationally as “chiropractor of the year” and “chiropractic researcher of the year.”  He is co-founder of the Chiropractic Leadership Alliance, Inc.  For further information, contact Chiropractic Leadership Alliance, Inc., 1 International Blvd., Mahwah, NJ  07495 or phone 800-892-6463 or 201-368-9600.

To choose the right computer software for your office, answer these ESSENTIAL questions:

• What features in the software are essential to my practice?
• How will this software enhance my practice?
• How easy is it to learn the program?
• What do I want to accomplish with this software?
• How will  the program save time?
• How will the program increase  income?
• How can the program be used to increase patient retention?
• In what way will the program make my staff more productive?
• How will the program save money?
• Do I need  a  limited program for only one task, or do I need a comprehensive integrated program to handle every office task  that can be computerized?

The answers to these questions provide the basis to decide which program is right for you.

Before you purchase:

1. Get a demonstration—use the words “SHOW ME.”
 
2. Make sure the software does everything its manufacturer claims. (Some companies base their advertising on planned development, and the feature you need now may not yet be functional. Reliable companies advertise only what already works, and tell you what is in development only when you ask).

3. Get information on the company itself. Has the company been in business for more than 10 years? Is it owned by a doctor that is familiar with your professional needs? Was the program designed by a practicing doctor?

Once you have all this information, it will be easy to choose the program that is best for you.

Dr. Paul Bindell began Life Systems Software so that the profession would have reliable computer programs based on real chiropractic practice. Dr. Bindell can be reached by email at [email protected].

The holidays have passed. We celebrated the national holiday of Thanksgiving and the religious holidays of Chanukah, Christmas and New Years. Valentine’s Day is here and now is the time to give a gift of love. The appropiate gift of love for you and your office is a first quality computer program.

What is so important about this? It keeps on giving to you as long as you use it. How is it possible that a computer gives back to you? All you have to do is look at the features of a complete, fully integrated program.

First: A full-featured, integrated software package liminates 90% or more of the paper in your office. Your staff no longer need to pull out and put away files. The one-to-two hours a day spent in filing is now spent doing recalls, reactivation, collections and practice building.

Second: The proper program enters your examination and SOAP findings rapidly, and converts them into dictation quality notes and narratives. You no longer have to translate your special shorthand every time an insurance company or attorney requests notes. All you do is print and mail.

Third: A single entry places patient data in both the documentation and billing programs. A diagnosis entered in the documentation and billing program automatically appears in the billing. The treatment plan in your documentation generates the charges for services to your patients, verifying that SOAP notes and billing always match.

Last, but not least: An additional feature in top quality software is patient letters. These personalized letters, mailed at intervals, educate your patients and increase the respect and value for you and your services. The result is increased patient retention, more referrals, and more income.

Dr. Paul Bindell, President of Life Systems, Inc., is a 1975 Palmer graduate, in practice in Rockaway, NJ, since 1976. In 1991, he began Life Systems so that the profession would have reliable computer programs based on chiropractic practice. Dr. Bindell can be reached by email at [email protected].

Vertebral subluxation represents the heart and soul of chiropractic. It is our raison d’etre as a profession. Yet, to many chiropractors, it remains a clinical conundrum. I believe that the controversy and confusion surrounding the chiropractic concept of vertebral subluxation is due to the lack of an operational definition that is compatible with most techniques.

A review of models of vertebral subluxation has been published elsewhere.¹ However, regardless of the elegance of a theoretical model, it must be capable of being operationalized, if it is to be used to develop clinical strategies.

The three-dimensional model was developed as an initial step in the operational definition of vertebral subluxation. It incorporates traditional chiropractic constructs, and serves as a bridge to contemporary technology.

As Lantz noted, “Common to all concepts of subluxation are some form of kinesiologic dysfunction and some form of neurologic involvement.”²
The 3-D model of vertebral subluxation has three components. Each component may be reliably measured using appropriate instrumentation. These measurements provide objective evidence concerning manifestations of vertebral subluxation. The three components are:

1. DYSKINESIA. Dyskinesia refers to distortion or impairment of voluntary movement.³ Spinal motion may be reliably measured using inclinometry.⁴ Alterations in regional ranges of motion are associated with subluxation.⁵

2. DYSPONESIS. Dysponesis is abnormal involuntary muscle activity. Dysponesis refers to a reversible physiopathologic state, consisting of errors in energy expenditure, which are capable of producing functional disorders. Dysponesis consists mainly of covert errors in action potential output from the motor and premotor areas of the cortex and the consequences of that output. These neurophysiological reactions may result from responses to environmental events, bodily sensations, and emotions. The resulting aberrant muscle activity may be evaluated using surface electrode techniques.⁶ Typically, static SMEG with axial loading is used to evaluate innate responses to gravitational stress.⁷

3. DYSAUTONOMIA. The autonomic nervous system regulates the actions of organs, glands, and blood vessels. Acquired dysautonomia may be associated with a broad array of functional abnormalities.^{8,9,10,11,12,13} Autonomic dystonia may be evaluated by measuring skin temperature differentials.¹⁴ Uematsu, et al., determined normative values for skin temperature differences based upon asymptomatic “normal” individuals. The authors stated, “These values can be used as a standard in assessment of sympathetic nerve function, and the degree of asymmetry is a quantifiable indicator of dysfunction… Deviations from the normal values will allow suspicion of neurological pathology to be quantitated and, therefore, can improve assessment and lead to proper clinical management.”¹⁵ Skin temperature differentials are associated with vertebral subluxation.¹⁶

This three-dimensional model may be used with any technique which has, as its objective, the detection, management, or correction of vertebral subluxation. Correction of vertebral subluxation facilitates the restoration of proper tone throughout the nervous system.

Health is dependent upon maintaining appropriate tone in the nervous system. As D.D. Palmer explained, “Life is action governed by intelligence. Intelligent life, the soul, depends upon the execution of functions. Function performed by normal energy is health. Disease is the result of the performance of functions above or below a normal degree of activity. Impulses properly transmitted through nerves, result in functions being normally performed, a condition which results in health.”¹⁷

The ability to maintain tone requires a nervous system free of interference. Restoration of tone is dependent upon correction of vertebral subluxations. Alterations in the tone of the somatic system may be objectively evaluated using surface EMG. Altered autonomic tone may be evaluated using skin temperature measurements. Changes in ranges of motion may be measured to assess dyskinesia. Such objective assessments have the potential to make chiropractic the dominant strategy of 21st century health care, and are available today.

Christopher Kent, DC, is a 1973 graduate of Palmer College of Chiropractic.  The author of numerous professional publications, Dr. Kent has been recognized nationally as “chiropractor of the year” and “chiropractic researcher of the year.”  He is co-founder of the Chiropractic Leadership Alliance, Inc.  For further information, contact Chiropractic Leadership Alliance, Inc., 1 InternationalBlvd., Mahwah, NJ  07495 or phone 800-285-2001.

References:

1. Kent C: Models of vertebral subluxation: a review. Journal of Vertebral Subluxation Research 1996;1(1):11.

2. Lantz CA: The subluxation complex. In: Gatterman MI (ed): Foundations of Chiropractic Subluxation. Mosby, St. Louis, MO, 1995.

3. Dorland’s Pocket Medical Dictionary. 25th edition. WB Saunders Company. 1995.

4. Saur PM, Ensink FB, Frese K, et al: Lumbar range of motion: reliability and validity of the inclinometer technique in the clinical measurement of trunk flexibility. Spine 1996;21(11):1332.

5. Blunt KL, Gatterman MI, Bereznick DE: Kinesiology: An essential approach toward understanding the chiropractic subluxation. Chapter 11. In: Gatterman MI (ed): Foundations of Chiropractic Subluxation. Mosby, St. Louis, MO. 1995.

6. Whatmore GB, Kohi DR: Dysponesis: a neurophysiologic factor in functional disorders. Behav Sci 1968;13(2):102.

7. Kent C: Surface electromyography in the assessment of changes in paraspinal muscle activity associated with vertebral subluxation: a review. Journal of Vertebral Subluxation Research 1997;1(3):15.

8. Backonja M-M: Reflex sympathetic dystrophy/sympathetically mediated pain/causalgia: the syndrome of neuropathic pain with dysautonomia. Seminars in Neurology 1994;14(3):263.

9. Goldstein DS, Holmes C, Cannon III RO, et al: Sympathetic cardioneuropathy in dysautonomias. New Engl J Med 1997;336(10):696.

10. Vassallo M, Camilleri M, Caron BL, Low PA: Gastrointestinal motor dysfunction in acquired selective cholinergic dysautonomia associated with infectious mononucleosis. Gastroenterology 1991;100(1):252.

11. Baron R, Engler F: Postganglionic cholinergic dysautonomia with incomplete recovery: a clinical, neurophysiological and immunological case study. J Neurol 1996;243:18.

12. Soares JLD: Disautonomias. Acta Medica Portuguesa 1995;8(7- 8):425. Written in Portuguese. English abstract.

13. Stryes KS: The phenomenon of dysautonomia and mitral valve prolapse. J Am Acad Nurse Practitioners 1994;6(1):11

14. Korr IM. The Collected Papers of Irvin M. Korr. American Academy of Osteopathy. Indianapolis, IN. 1979.

15. Uematsu S, Edwin DH, Jankel ER, et al: “Quantification of thermal asymmetry.” J Neurosurg 1988;69:552.

16. Kent C, Gentempo P: Instrumentation and imaging in chiropractic: a centennial retrospective. Today’s Chiropractic 1995;24(1):32.

17. Palmer DD: Text-book of the Science, Art and Philosophy of Chiropractic for Students and Practitioners. Portland Printing House Company. Portland, OR. 1910. Page 661.

Each of us wants success. To most, this means helping the greatest number get and stay healthy. Management seminars teach us to bring in patients. But, without the right tools, we spend our income on many staff members, and time is wasted on paperwork. The tool that keeps the staff small and efficient is the computer. We just need the right computer with the right software. The right software touches most areas of practice, except for hands-on treatment of each patient.

Let’s start with documentation. Are records still in paper files? Are you required to print notes daily so someone can waste time filing them? The right software stores records in the computer. There is little or no filing. Instead of wasting time with files, the staff can concentrate on recalls, reactivation, collections, and practice building. And requests for notes or narratives are answered in minutes in dictation quality English.

Look at office management. The right software does electronic billing for free, and saves a copy of every claim sent out. Again, no paper to file. Missed appointments are tracked, so no patient is lost or forgotten. Statistics are as detailed as you want.

Finally, there is integration. The documentation and management software must interact. Entering information in one means that it automatically is present in the other. Why should new patient data, a diagnosis, or an appointment be entered twice? And when the right software is integrated, it makes sure that documentation and billing match. The front desk can never forget to enter charges, nor enter charges for services not performed. Add in all the other features of the right software, and your practice hums with success.

Dr. Paul Bindell, President of Life Systems, Inc., is a 1975 Palmer graduate, in practice in Rockaway, NJ, since 1976.  In 1991, he began Life Systems so that the profession would have reliable computer programs based on chiropractic practice.  Dr. Bindell can be reached by email at [email protected].

As a doctor of chiropractic, you probably don’t want to spend much time thinking about your office software. Well, now you don’t have to! To bring you up to date on the latest software programs and technological capabilities available today, we’ve gathered information from some of the most respected companies out there. And, we’ve even illustrated for you exactly where these products can benefit your practice, based on the 10 stations of patient care – from marketing to collections and everything in between. Take a look!

1. Marketing

Insight Subluxation Station™
By Chiropractic Leadership Alliance
Enables the doctor to identify nerve interference and provide appropriate care. In addition, the InsightTM objectively demonstrates to patients that chiropractic care works. On average, doctors have increased their PVA by over 40% implementing this tool into their practice.
Phone: 800-285-2001; Fax: 201-684-1396
Other Categories: 3, 5, 6 & 7

Now you Know-Internet Educational Services
Our services help educate doctors patients and community about health and chiropractic while giving the community contact information about the doctor. We do this with websites, email newsletters and online pamphlets called Echiropractic.
Phone: 800-695-8937
Other Categories: 6

Exercise Pro and Nutrition Maker
By Bio ExSystems
Exercise Pro creates exercise and information handouts with the power of the computer—the result is better patient understanding, better documentation of exercise programs and increased productivity for the doctor.
Nutrition Maker allows the chiropractor to establish calorie baseline requirements for the patient, perform dietary analysis, and print out built-in meal plans created by a registered Dietician.
Phone: 800-750-2756; Fax: 512-360-4098
Other Categories: 3 & 7.

ChiroTouch Paperless Office System
ChiroTouch Paperless Office System will improve the overall efficiency of your office while enabling you to deliver a higher quality of service to your patient. ChiroTouch puts all of your patient’s information right at your fingertips, allowing you to stay in better touch with your patient’s condition and financial situation.
Phone: 800-852-1771; Fax: 619-337-1635
Other Categories: 2, 3, 9 & 10

TyTron C-3000 Thermography
By Titronics
The patient can actually see the stress subluxation places on the nervous system by viewing the temperature “map” of their spine, before and after care. Objective, scientific proof that chiropractic works!
Phone: 800-705-2307
Other Categories: 3, 5 & 6

ChiroSuite (ChiroPad and ChiroOffice)
By Life Systems
The integrated computer software tool that saves time, improves collections, enhances practice growth, and eliminates time wasting activities such as filing and duplicate entries. ChiroSuite is a complete package that takes care of all the administrative items related to patient care including appointments, billing (paper and electronic), marketing letters and emails, examinations, SOAP notes, and narratives.
Phone: 800-543-3001; Fax: 973-625-2843
Other Categories: 2, 3, 4, 5, 6, 9 & 10

The Parian Company—Communication and Marketing Consultation
The Parian Company provides customized web site text development and editing. Create a more powerful web presence with our professional written marketing content.
Phone: 650-557-0071

Core: T4
By Performance Health Technologies
• Keeps patients engaged and motivated through game-like interface
• Wirelessly senses angular motion and transmits info to interactive software
• Use with other tools, techniques and existing equipment
• Delivers real-time feedback as well as printable charts and tables to trace patients’ progress
Phone: 303-527-0600; Fax: 303-527-1661
Other Categories: 2, 5, 6, & 7

Document Plus Technologies
Automated forms and a scanner enable the collection of comprehensive information that works with our system to produce the highest quality reports.
Phone: 770-814-2442; Fax: 770-814-9988
Other Categories: 2, 3, 4, 6, 7, & 10

N-Compass Health software
By Nutri-West
Generates patient fact sheets, prints questionnaire results, gives individualized nutritional protocols, provides drug-nutrient interactions/depletions, supplies an encyclopaedia of reference information on vitamins, mineral, herbs, nutrients, health concerns, etc.
Phone: 866-271-8888; Fax: 303-662-9998
Other Categories: 2, 3, 5, & 6

ChiroPulse…the Beat of the Future
By Pulse Software
ChiroPulse—intelligent software technology for efficient office management. It’s simply the easiest way to document and create office notes, SOAP’s, history and other data vital to your practice and defensibility. ChiroPulse reduces your overhead costs, lowers staff stress and frees up their time to interact more effectively with your patients.
Phone: 908-289-9613; Fax: 908-289-9744
Other Categories: 2, 3, 5, 6, & 9

MES 9000 Musculoskeletal Evaluation System
By Noromed
The MES 9000 allows the DC to document patient status before, during and after treatment. A necessary tool for patient education and objective documentation of function.
Phone : 800-426-0316; Fax: 206-243-3625
Other Categories: 5 & 6

Tracker Computerized Functional Testing
By JTech Medical
Tracker enables chiropractors to efficiently evaluate and document a patient’s range of motion, motor deficits, pain thresholds and trigger points, and to quickly create reports for patient education and third party reimbursement. Tracker documentation provides the necessary evidence to prove the functional effects of injury in personal injury cases. It’s easy to use, so it readily integrates into any practice.
Phone: 800-985-8324/801-478-0680; Fax: 801-478-0674
Other Categories: 2, 5, 6, &10

Foot Levelers’ The Associate™
The Associate™ is a portable patient screening tool that demonstrates postural imbalances, digitally scans feet in under a minute, and instantly e-mails electronic foot data to Foot Levelers.  From this information Foot Levelers creates the custom-made Spinal Pelvic Stabilizers you have selected for your patient.  Delivery time is slashed in half with the Associate!
Phone: 800-553-4860; (USA),
800-344-4860 (Canada)
Fax: 540-345-0202
Other Categories: 2, 3, 6, & 7

MyoVision System
Designed by NASA trained SEMG expert David Marcarian, MyoVision changes chiropractic by offering truly objective data displayed in the form of beautiful, colourful graphics for Standing Neutral Static SEMG, Dual inclinometry (meets AMA), Thermoglide and Dynamic SEMG.  MyoVision was recently credited with a  $650,000.00 jury award for Soft Tissue Injury, proving that MyoVision’s Dynamic SEMG has the power to prove injury like no other tool in the past. 
Phone: 800-969-6961; Fax: 650-508-2605
Other Categories: 3, 5, 6, & 10

TGI Autumn 8 Software
Our Autumn 8 software meets or exceeds current industry standards for chiropractic office management software including HIPAA compliancy. It is top of the line, fully featured and affordable.
Phone: 850-453-8089; Fax: 775-587-7107
Other Categories: 2, 3, 4, 5, 6, 7, 9, & 10

InPhase Practice Management Software
By InPhase Technologies Group
Not just solutions to your problems.…  We provide possibilities for your practice.
Phone: 800-282-9518
Other Categories: 2, 9, 10

2. Reception

Clinic Pro Software
Clinic Pro features an airtight appointment scheduler that keeps patients from falling through the cracks. The scheduler can be color-coded to your choice. You can set up treatment plans and schedule multiple appointments quickly.  Clinic Pro merges your letter with patients you specify. Free electronic billing, and numerous management reports that keep each practice on track.
Phone: 866-333-2776; Fax: 928-203-4120
Other Categories: 6, 9, & 10

Customer Appointment Manager™
By Atlas Business Solutions
Customer Appointment Manager helps doctors schedule and manage customer appointments quickly and easily. It will show you who’s available and when, and let you book appointments in seconds. Everything you’ll need to promptly schedule customer appointments is right at your fingertips in this easy-to-use, computer-based appointment book.
Phone: 800-874-8801; Fax: 701-280-0842

Pro-Soft
Pro-Soft is compliance, medical necessity treatment planning. Diagnosis and Software system that happens to do SOAP notes.
Phone: 800-409-1614; Fax: 724-942-8972
Other Categories: 3, 4, 5, & 6

PatientCall Appointment Reminder Service
An appointment reminder service that calls your patients in a human voice to remind them of their upcoming appointments. If the patient needs to reschedule, your staff is immediately notified. PatientCall interfaces with your appointment scheduler so it is completely automated or you can use the web page to enter your calls.
www.patientcall.com; Phone: 877-643-9314

E-Z BIS Office
E-Z BIS Office practice management software helps to automate time-consuming tasks so that chiropractors can maximize their time providing patient care. The modular concept of the software allows doctors to automate specific areas of the practice or to phase-in the computerization of manual processes.
Phone: 800-445-7816; Fax: 337-237-1251
Other categories: 6, 9 and 10

ECLIPSE® Practice Management Software
Software for patient rescheduling, etc. Eclipse® is a complete practice management system that handles patient & third party billing, electronic claims & remittance, appointment scheduling, daily notes and reminders, and document imaging. Robust security features, and a myriad of reports fine-tuned by almost 2 decades of client feedback.
Phone No: 800-966-1462
Other Categories: 9 and 10

3. Consultation

Lift Mates, Solo Lift
The Solo Lift from Lift Mates reduces compression forces on the spine by over 60% when one is lifting or moving boxes. Patients can buy this product from the chiropractor to use whenever they need to lift or carry boxes at work or at home.
Phone: 831-626-2986; Fax: 831-626-2988

4. Radiology

DXAnalyzer Professional© X-ray Digitizing Software
This high tech software attends to the concern of the chiropractor to identify permanent spinal ligament injuries and misalignments, document findings, and assist in designing an objective based treatment plan.  The production software model has been tested to be accurate to 0.0023mm to assure that injured patients receive the best digital spinal analysis available.  The software program can import any known form of X-ray format, static films, digital images, VHS, S-VHS Videos, AVI Movies, DVD’s and D.I.C.O.M-filmless X-ray.
Phone: 888-926-2774; Fax: 927-633-3857
www.dxanalyzer.com
Other Categories: 5 & 6

Progressive Diagnostic Imaging
The nation’s technological leader in X-ray interpretation and analysis reporting and documentation. PDI employs board certified radiologists (DC’s DACBR’s and MD’s) to read and interpret MRI’s, CT’s, scans, and ultrasounds. PDI prides itself on having the exclusive rights to the most advanced report generating applications.
Phone: 866-4PDI-PDI
Other Categories: 5,10

5. Diagnostic Testing

Quad Base Scale
By Mally Enterprises
This Quadrilateral Scale measures the patient’s Core Center of Gravity (COG), left and right weight bearing as well as forefoot and hind foot imbalances. Measured in % Kg and Lbs the Reports generated provide rapid, accurate diagnostics and outcomes. Documentation supports medical necessity and rehabilitation data. Scale and optional In-Service training complete the package.
Phone: 800-779-4263; Fax: 563-386-9184
Other Categories: 1

VeridianHealth, LLC
VeridianHealth, LLC, umbrella company to First Therapy Plus, First Diagnostics, and Diagnostic Testing Centers of America (DTCA), is the largest provider of on-site physical therapy and electrodiagnostic testing services in the country. This advanced testing modality benefits chiropractors by contributing to their overall scope of practice services and growth, while supporting better, more convenient care for their patients.
Phone: 877-837-4342; Fax: 866-836-3106
Other Categories: 7

SpineForce™
Spine Force is the only known machine in the world capable of precisely targeting, strengthening and conditioning the deep muscles of the spine. Working up to 180 muscles at once, it simultaneously optimizes coordination and balance while improving stability and posture. Billable, reimbursable codes are available for all states.  Practice management coaching included with purchase.
Phone: 800-222-3911; Fax: 305-375-0903
Other Categories: 1, 2, 3, 6, 7, 8 & 10

PulStarFRAS by Sense Technology
Phone: 1 800 628 9416
Other Categories:  1 & 8b

6. Report of Findings

PracticeStudio
By Micro 4
PracticeStudio is a fully integrated Practice Management and Electronic Medical Records system that helps the doctor “do a day’s work in a day”. With increasing pressures from insurance companies, the government, and referring doctors, the PracticeStudio system allows the chiropractor to quickly document patient encounters. The interface with the Practice Management portion of the system enables the doctor and the staff to bill in a more timely manner.
Phone: 800-235-1856; Fax: 806-463-7019
Other Categories: 9 & 10

NeuScan & NeuGraph
By Neumed
With our automated reporting capability, doctors save time in typing up the reports. Reports are in full color and easy to understand. Reports of findings can be printed or emailed to the patient. Neuro-Dyne Medical provides advanced instruments and a number of services to its customers, including FREE Patient Hand-outs, wall posters, FREE Website and an informative E-News Letter.
Phone: 800-963-8633 or 617-234-1104
Fax: 877-638-7693 or 617-234-1108
Other Categories: 1, 5

Myo-Logic System
By Myo-logic Diagnostics
The Myo-Logic System documents medical necessity simply and easily with ergonomic, wireless, hand-held unit that instantly transmits ROM, Muscle strength testing & Algometry data to your computer, then generates impressive reports and graphs using AMA guidelines. All this and more in “One System” that is easy use.
Phone: 800-768-7253

ReportMaster
ReportMaster software is a system that enables the doctor, assistant, or physical therapist to produce professional reports and daily SOAP notes easily. The input is simple—mouse, keyboard or touch screen. The system is very extensive and highly customizable. It is the result of the advice of thousands of clients over 9 years.
Phone: 727-449-0817

7. “Pre-Adjustment” Treatment/Therapy

Amrex Electrotherapy Equipment
Electrotherapy provides attended and unattended therapeutic options for the chiropractor. Amrex manufactures all the most popular modalities of electrotherapy.
Phone: 310-527-6868; Fax: 310-366-7343
Other Categories: 8b

3LT™ LASERS
By Erchonia:
Proven through double-blind studies , 3LT™ Laser made history , when it became the world’s first to receive FDA approval for the treatment of chronic pain.
Phone: 888-242-0571

8. Adjusting
8a. Traditional Adjustment

Ergostyle FX Automatic Flexion Table 
(January 2005)
By Chattanooga Group
The first step forward in making flexion distraction truly a diagnostic treatment.  Now you can diagnose the pain free range of motion in manual flexion and tell the Ergo FX what range and speed you would like to treat, with a touch of a button. The FX will reproduce your exact motion only, and will treat with the precision of our very popular knee and shoulder CPM devices.
Phone: 800-592-7329
Other Categories: 1 & 8b

Dynasty Chiropractic Equipment Corp.
Our tables provide a powerful & sturdy platform for the doctor to make their adjustments. Cushions are firm but comfortable. The Drops are crisp and the Head Piece adjusts for side posture. The hydraulic driven tables can lift in excess of 545 lbs.
Phone: 800-849-9547; Fax: 905-643-3724

Lloyd Galaxy Ultimate
The standard hylo feature is a must for patients that have trouble “crawling” onto a table due to pain. Doctors do not need to stoop and bend with the standard elevation feature, leaving them with more energy at the end of the day. Auto cocking drops and automatic flexion are also standard features of the Galaxy Ultimate.
Phone: 319-455-2110; Fax: 319-455-2166
Other Categories: 8b

8b. Electronic/Mechanical Assisted Adjustment

ArthroStim® Instrument
The ArthroStim® Instrument enables practitioners to do something they could never do on their own: Deliver 12 thrusts in the space of a single second! The rapid-fire thrusting action produces corrective changes using reduced amounts of force. This increases comfort for the patient and decreases stress on the practitioner.
Phone: 800-569-8624/503-581-3739
Other Categories: 8a

9. Payment & Rescheduling 

Chiro-8000
By Forte Systems Inc.
The Chiro-8000 automates all of your practice management and billing processes, allowing you to spend more time with your patients or see more patients in the same amount of time.
Phone: 800-456-2622; Fax: 916-673-1355
Other Categories: 10

Quixote: Business Software for the Private Practice
Quixote software enables a practice to conduct the “process” of scheduling patients, recording the encounter (in seconds), billing/adjudicating, and digitizing the entire patient record in a most remarkable way. Quixote is the most powerful practice management software available because it allows doctors to conduct analyses based on relevant business information. Quixote automatically updates itself daily and is supported in “real time”.
Phone: 619-299-2930; Fax: 619-923-3466
Other Categories: 10

10. Billing & Collections

Accountmaster™
By Accountmaster Chiropractic Software
Accountmaster software enables scheduling and record keeping to facilitate billing with both traditional paper forms and newer electronic means. This saves hours or days in billing and speeds up reimbursements to the chiropractor.
Phone: 800-658-3899; Fax: 605-886-2739
Other Categories: 2, 6, & 9