Message from the President

President's Report
If you are not attending conferences, regrettably you are not up to date. I have been doing this work for decades and every month, every year I am learning how to be better and improve my reductions. All of this is work in progress, or it should be. It has been said that you cannot stand still; you are either improving or regressing. We have new instructors teaching things with a fresh look. We have our "super adult" instructors working on how better to teach the subtleties and nuances of this work we love so much. If you are not attending the conferences you do not know what the FEM model is telling us about what we are doing. Is it showing that what we do is correct or that we have to rethink how we look at things? If you are not attending the conferences you have no idea. So, go to the website and register. Book your flight and hotel, and be there. It really will not be the same without you and neither will the care that you are providing your patient

Board Activities
Your board has been preparing for the upcoming Fusion program at Life West at the end of this month September the 23-25th and the NUCCA conference in

Atlanta next month October 14 -16th. We will be unveiling new examinations for the Certification written portion. There will be a special meeting of the doctors for reviewing films submitted for certification reviewing standards and getting everyone on the same page.

Office Visit- Dr. Berti's Office
Dr. Berti is a rare example of someone who has been an Upper Cervical Practitioner for over 60 years. The first year and half he practiced using the toggle recoil technique and since then it has been Grostic/NUCCA. He served as Vice President to Dr. Gregory on both the NUCCA and NUCCRA boards for years. He assisted Dr. Gregory in providing Professional Services to attending doctors year after year. Following the passing of Dr. Gregory, he took over the reigns as President of both NUCCA and NUCCRA, and he chaired the Standards Committee. He is responsible for developing the vertex square, the alignment mask, designing the Uniline X-ray Frame, was very involved in developing the design of Dr. Seemann's Orthometric Chair and was the prime designer of the Stein headpiece. He has taught programs to professionals for decades and has taught the only program exclusively for Certified NUCCA Instructors. I have been privileged to assist him in teaching both of these programs. To visit his office is an opportunity to touch shoulders with one of the true greats in the NUCCA procedure.

When one first steps into Dr. Berti's office the professionalism and class immediately impact you. The reception room features a front desk area that allows for two CA's to register and process patients. There is seating for 16 or so patients, and the literature reflects the latest in quality magazines. As one sits in the reception room, you may notice that although the phone is being answered, you never hear it ring. I had to ask how this worked, and it was simply because they had the volume so low that those in the reception room were unaware of it. Dr. Berti has always been keenly sensitive to the visual and auditory environment to which he exposes his patients. A ban on cell phone use and computers is vigorously enforced.

In years past, his office has been large by any standards. It is about 1500 square feet and features three adjusting rooms, an anatometer room, x-ray room with a sitting area that functions as an x-ray lounge, a private office and a staff area. The 9-foot ceilings give a feeling of spaciousness and a lighting system in each adjusting room is connected to the front desk which alerts the CA to his whereabouts at any time. The beautiful emerald green carpeting with the lighter tones of the wall have a very calming feeling. At Christmas the most gorgeous Christmas tree appears in the reception room. Each adjusting room is equipped with a thermal scanner, a NUCCA table, a desk with a computer on it and a chair. The middle room is larger and comes with an executive desk and this room serves for consultations and ROFs.

The office is in a professional building on the ground floor. Each adjusting room, the reception area and Dr. Berti's private office virtually have a wall of widows. These are dressed with window treatments that offer both decoration and privacy. The walls are decorated with classical pieces of art, demonstrating a subtle theme of service to humanity. At the front desk is voice for health and the NUCCA brochures. The layout of the office consists of a hallway from the reception room to the adjusting rooms and Dr. Berti's office which are on the right side of the hallway accessing the windows. The anatometer, x-ray & staff area are on the left side with no window access. Overall an example of a professional NUCCA office to be proud of and a credit to our profession.

Technical Tip
As always, I give credit to my teacher and mentor, Dr. Berti. Today's tip is something he taught me a number of years ago. When taking the vertex view after you have completed the positioning, move the tube forward an inch or two, adjust the angle, and this will allow you to better view the neural canal especially of C2. Small things done right add up great corrections. Try it.

All the best & I look forward to seeing you in Atlanta.

What Do Patients Ask?

Why should my child get checked?
There is a real reason to take care of children. Spinal misalignments are progressive and degenerative. A lot of times the child will be will be misaligned and it will affect things that are not necessarily related to neck pain and back pain.

What kind of symptoms do you see in children with spinal misalignment?
The primary symptoms that children are going to show up with from the very beginning are ear infections or crankiness (ill at ease) after birth. And as the child grows, there are going to be digestive issues; there are going to be leg cramps, which a lot of people call growing pains. It can affect their ability to learn, and to understand what is going on around them, including their ability to socialize, and to feel comfortable in social situations. Spinal misalignments can affect the central and peripheral nervous system.

By the time the child moves into the teenage years, some symptoms show up that more directly related to the nervous system like headaches, and allergy problems. An extreme form of this would be migraines or seizures. If these misalignments end up left unchecked and uncorrected, they end up being a way of life for many people as an adult.

How old do you have to be received NUCCA care?
You have to be born, have a spine, and have a misalignment for us to help you.

One of my fondest memories involves parents I was taking care of in my practice. When their son Nick was born, he was born after 27 hours of labor. And when he came, he came out screaming. He basically screamed for the first 22 hours of his life without sleeping for a minute. His parents invited me into the hospital, and I was actually able to go into the hospital and get some x-rays of his neck, and make that first correction. And within five minutes Nick was asleep and slept for the next 12 hours.

What about the use of x-rays with children?
I've been in practice for 39 years, and I will tell you just as candidly as I can that the known risks of allowing your child's spine to remain misaligned is much greater than the potential risk of using the x-rays to determine the misalignment and determine exactly how to correct it. Once the x-rays are taken and the correction is determined, then a set of post x-rays will help verify that everything internally is back where it belongs, and those bones have been moved off the nervous system, and life is back to the way it's supposed to be.

Contributed by Dr. Robert Brooks in conversation with Dr. Zachary Ward
Certification Candidate - Passed Level II
Brooks Spinal Care
1722 South Carson Suite 3100
Tulsa, OK 74119-4643
Phone: 918-587-7111   Fax: 918-587-1177
Email: drbrooks@brooksspinalcare.com
Member Type: Established Member
Years In Practice: 32
http://www.brooksspinalcare.com

Research Update

Supine Leg Check Pilot Study Results
This study conducted May 22, 2010 at Life West, successfully demonstrated that impeccable data collection while maintaining the integrity of the dataset is feasible for planned future SLC investigation. Assurance data is free from possible alteration, provides solid support to study conclusions and published manuscripts.

The secondary goal was in calculating an accurate sample size for a follow up interexaminer reliability study. This pilot also provided needed information for protocol revision. Note that sample size requirements depend on the research question being asked and underlying assumptions. Retrospective review and analysis of how the study progressed compared to the written protocol helped in reframing sample size for the future project.

When using experienced examiners, as in this study, percentage agreement provides solid information. However, percentage agreement does not account for the possibility that examiners were unable to determine the presence of an apparent short leg, so they guessed, and guessed correctly, matching the other examiner. Guessing by examiners is difficult to document in a research study. Statisticians have developed the Kappa (?) Statistic to account for the possibility of examiners guessing during the study. This increases accuracy in reporting examiner agreement.

This sample size figure compensates for a 15% non-inclusion (or exclusion) of observations made. Non-inclusion, not including or using, for example, occurs when examiners had difficulty placing patients in the supine position. From pilot data analysis, we discovered that any time there were issues placing subjects on the table, examiner agreement was nonexistent. By limiting participation of subjects who most likely would have problems lying on the table, we prevent this lack of agreement from occurring during the next study. Excluding results of subjects having difficulty assuming the testing position allows for an accurate calculation of reliability statistics reflecting the true ability of examiner's to determine an apparent short leg.

The pilot study results allowed for discovery of solutions to minimize factors that impact precise calculations of interexaminer reliability. When subjects presented with poor shoes, examiners were required to place the correct shoes on subjects to perform the SLC with the needed accuracy. This increased examination time, stressing the examiner, leading to further nonexistence of agreement between the examiners. Challenges with subject's footgear can be eliminated or reduced by supplying generic bowling shoes for everyone in the larger study.

The SLC results of thirty-nine subjects presenting with a leg length disparity at a threshold of 1/8-inch or more showed a 72% agreement between examiners in identifying the apparent short leg. When data were analyzed using a LLI threshold of 1/4-inch or more there was 100% agreement. This means for the follow-up study exacting definitions of leg length inequality, including a strict definition of even legs must be determined and agreed upon. Using a threshold of 1/4-inch or more will yield higher reliability results. The established threshold for determining existence of Atlas misalignment and possible ASC in new patients is 1/4-inch inequality. Patients that present with symptoms of a condition such as headache are more likely to have a leg length inequality greater than 1/4-inch. By using subjects that are symptomatic, more like real patients presenting to NUCCA Doctors, may yield higher reliability results.

Congratulations are in order to Dr. Lee Yardley and Dr. Michael Zabelin for volunteering to serve as study examiners. Achieving a 73% agreement using the unusual study population examined, reflects excellence in utilizing their skills to perform the SLC with precision.

It should be noted study goals were not to calculate percent agreement or Kappa but to determine what conditions prevent an accurate interpretation of actual agreement between examiners. That is the primary goal of the follow-up large scale investigation, to accurately determine how well examiners agree under optimal conditions and to be sure results truly represent the skills Board Certified NUCCA Doctors possess.

Dr. Dickholtz, Sr. Works with Cancer Patients
Dr. Dickholtz started with four cancer patients in his new research project to see if the immune system could improve with an atlas subluxation correction. In one case, a 52 year old male with colon cancer who already had a resection of the colon had a low killer T cell count after correction. Just after thirty days, his T cells were normal along with other improvements in the blood tests.

Dr. Dickholtz expects to meet with a researcher from the Cancer Treatment Center of America this month to discuss these profound results.

Practice Based Research
NUCCA's Practice Based Research Initiative is now active. This project is co-chaired by Drs. Reney and Scholten and much work has been put into creating a user friendly site for you and your patients to easily participate in clinical research from wherever you are. Start by using this website to source your clinical intake forms and help strengthen our position on NUCCA care while improving an understanding of what happens in NUCCA practices.

This is just Phase 1 of the project and if the NUCCA membership participation is strong, we will be able to take this study into its next phases and likely answer many of the questions you may have had about patient responses to NUCCA. The stronger the number of participants, the stronger case we can make relative to securing future funding as well as increasing the quality of information we will have about the benefits our procedure brings to patient communities. Our world needs NUCCA and your organization needs you to take part in creating the evidence as to why we know that to be true.

Try the site by visiting www.NUCCAforms.com and choose 'test clinic'. If you use your real name, you will be sent the report that is generated when a patient visits the site and fills out the questionnaire. Please keep in mind that this is a patient oriented site. Each patient will have his/her own user name and password.

The PBR project will make your participation in research easy with no extra staff attention or double entry necessary. To sign up as a participating clinic go the bottom of the home page and click on the "To Join This Project" link or click on http://www.nuccaforms.com/joinnuccaforms.htm. For more information please contact Dr. Scholten at drscholten@hotmail.com or Dr. Reney at mr@kiro.ca.

Don't Miss the Atlanta NUCCA Conference!

The Autumn NUCCA conference, slated for October 14th through the 16th, will be held at the beautiful Doubletree Buckhead-Atlanta Hotel. In addition to our semi-annual Job Fair, complimentary Wine and Cheese, VIP event, and President's reception, our guest speaker will be Paul Chek, a prominent expert in the field of holistic health, posture, and corrective high-performance exercise.

For more than twenty-five years, Paul's unique, holistic approach to treatment and education has changed the lives of countless clients, students and peers. By treating the body as a whole system and finding the root cause of a problem, Paul has successfully coached clients toward complete resolution of their health and performance challenges. Paul is the founder of the C.H.E.K (Corrective Holistic Exercise Kinesiology) Institute, based in California, and a licensed Holistic Health Practitioner

You can register online at www.nucca.org/conferences.php or by call the NUCCA office at 800/541-5799

Student Scholarship Program

This is the last week to enter the Student Scholarship Contest for students who can answer the question "What is the Future of NUCCA?" Complimentary conference fees will be awarded to one student winner per chiropractic college. Entries can be emailed as a word document or video to: Dr. Stan Dombroski at drstan@myamazingspine.com or 300 South State St., Ste. 4, Zeeland, MI 49464, to be received no later than September 24, 2010. Contestants must be sure to include their name, address, school, anticipated graduation date and phone number.

New Gregory Circle Benefits

It's now easier than ever to step into the prestigious Gregory Circle as three new categories have been created making it more affordable and even more appealing with two new exciting membership benefits. Please visit the NUCCA website for specific membership pricing detail at www.nucca.org/become_member.php.

The first new benefit is the introduction of an online interactive leadership program facilitated by Dr. Gordon Hasick. Its roots go back to Dr. Ralph Gregory who saw the need to help support NUCCA practitioners in providing the best care through well-managed clinics. As a result, he invited Dr. Hasick to create and teach a class called "Practice Principles". Since 1990, this class has been offered to the NUCCA organization at the conferences and has helped support many NUCCA doctors. Now, to supplement this program and expand on additional areas to help build self-awareness and shape your practice in our rapidly changing times, this new online feature, "Building Personal and Practice Capacity™" is now being made available to Gregory Circle members beginning this October.

This interactive, monthly online process is designed to help support the most successful and fulfilling experience possible and will include focus on the NUCCA work, tips and suggestions for patient communication, education, and office management and well as personal exploration into:

• Discovery of what is most important to you
• Identification of what is the most authentic expression of your unique practice
• Understanding the power of personal vision, values, ethics and choice
• Deepening your awareness of your personal practice style

Secondly, all Diamond, Platinum and Gold Gregory Circle members will receive complimentary registration to the 2011 Practice Innovation taking place in Newport Beach, California, February 4th and 5th. This seminar is ideal for those who want a stimulating, concentrated volume of information packed into a Friday evening all day Saturday event. Our most successful doctors will be sharing their personal methods for success. This is an outstanding $375 value. Schedule and registration information is coming soon via the NUCCA website at www.nucca.org and at the fall NUCCA conference.

NUCCA Patient Spotlight

NUCCA Magic!

Performers in one of the longest running amusement park magic acts say that they owe the survival of their show to NUCCA Chiropractic care. For three months of every year for the past 32 years, Ben and Margaret Ulin of central Iowa perform six shows per day, seven days per week just outside of Des Moines. Ben, a corporate entertainer is the magician and illusionist, and Margaret his wife, is his assistant.

Margaret was the first to discover NUCCA after waking one morning in with severe neck pain. "I woke up and I could not move my head. I was in excruciating pain. I had to do something." Margaret was recommended to the care of Dr. Lance Kellow in Urbandale, Iowa. "The next morning [after the first adjustment] I could move my neck. Nothing else was moving [laughs]. He had totally re-aligned me. My body had to learn how to walk straight again. Since then I am better than I have ever been."

Ben explained what his wife's ability to move means to their craft: "Margaret's job as a magic assistant is different than most peoples'...she has to do certain positions, be curled up, and hold her body for long periods of time. For her body it is important to have good flexibility, strength, and balance. Without that we have no show." Margaret explained that NUCCA has become for more than just her magic act. "I'm a household engineer. It's not just for my job [NUCCA care], but for my everyday life."

Margaret's success with NUCCA eventually convinced Ben, a chiropractic skeptic, to seek help for a strange cramping that developed after a back surgery. "The surgery took away all the [back] pain I was having. But I lost a lot of my ability to twist and to move my body the way that I want to. I was having this residual cramping in my calf...It was a strange cramp." Ben lived with the cramping for years, until it suddenly worsened after starting an intense work-out program. The ankle swelled and bruised, and the muscles of the calf twisted into a knot that would not release. Figuring the problem was a nerve issue, Ben went to Dr. Kellow.

"It was truly an overnight situation for me," Ben said. "The swelling was gone. The tightness in my calf was gone. I continued the exercise program. I ran another mile. No problems, no issues. The calf has felt the best it's ever felt since 2003. The evening cramps are completely gone."

How does Ben feel about NUCCA chiropractic now? "I'm a big convert here. I'm kind of zealous about it. I tell everyone. I knew it was a nerve thing — but I had no idea how you could adjust the body to help the nerves!"

Upcoming Events

September 23rd - 25th - Fusion San Jose, CA
Fusion: An Overview of Five Upper Cervical Perspectives, a unique first time conference. Click here to Register.
Dr. Robert Brooks will be making the opening presentation at Fusion, a synthesis of upper cervical perspectives.Speakers represent NUCCA, Advanced Orthogonal and Orthospinology from the orthogonal perspectives, and Blair, Knee Chest, Kale and Duff. Four NUCCA instructors will be presenting 12 hours of class instruction: Dr. Glen Cripe, Dr. Jack Manuel, Dr. Michael Zabelin and Dr. Stephen Nakano. The program will close with Michael Port, a New York Times bestselling author, marketing guru and motivator.

October 14th - 16th - NUCCA Fall Conference Atlanta, GA
Join us for an innovative academic program, Job Fair, Wine and Cheese event, VIP reception, Friday nite gala, and special guest speaker Paul Chek. Click here for information and registration.

November 12th & 13th - Dr. Robert Brooks will be presenting "The Upper Cervical Advantage" to the student NUCCA club at Palmer College of Chiropractic in Davenport, Iowa. Dr. Brooks is a frequent guest of the club and will be following the presentation with a weekend class "Taking Care of People". The weekend class presents patient communication, patient learning, office procedures and management principles for chiropractic practice. Click here for registration information.

February 4th & 5th - Practice Innovation 2011, Newport Beach, CA
Mark the date for our second annual Innovation seminar, a terrific opportunity for an intensive look at what our most successful doctors incorporate into their practices for personal and professional success! Schedule and registration are coming soon both on the NUCCA website and upcoming Atlanta conference. Stay tuned!