Special Needs: Timely
Your article on special-needs patients was timely and very welcome. Dr. Fava’s and Dr. Epstein’s understanding of the problems these patients face and the sensitivities and preparedness of the doctors who treat them were excellent. People with mental and physical disabilities are now the largest minority group in this country. They outnumber Latinos, African-Americans, and Asians.
People with Down syndrome, for instance, are now living at home within our communities. They are growing up asamg with their peers at school and at play, working side by side, dating and living independently, and growing old. Their lives now present new opportunities and challenges for people with Down syndrome and for those who work and live with them every day.
Other neurological problems such as learning disabilities, ADHD, dyslexia, autism (ASD), and uncontrolled aggression currently affect an estimated 12 million children under age 18 in the U.S.-almost one child in five. This estimate may be conservative, and it is a growing problem. Millions of children exhibit developmental disabilities because of abnormal cranial and neuromuscular mechanics and the corresponding disturbed neurophysiology.
“Down syndrome” was a term formerly used to describe these cases, but that is not the proper terminology. The use of People First Terminology is important when working with these patients and their families and advocates. People First Terminology encourages us to refer to the person first, and the disability second. Down syndrome does not define these children or adults. It is not their identity. It is only one thing about them. So we do not say, “Down syndrome people.” We say “a child with Down syndrome” today.
I have been very fortunate in the past two years to know 20 families whose children have Down syndrome. I have written about these cases in several journals and presented my findings to the SOTO-USA organization. (The essay is online at The International journal of Kinesiologic Medicine, or Kinmed.com.)
People with physical and mental disabilities are going to be seen, increasingly, as the individuals they are-with individual abilities that are going to be nurtured and enhanced. I think we are going to recognize that they have individual personalities to be appreciated, individual lifestyles to be lived fully and with gusto-just like everybody else. And, frankly, with our gifts in the healing arts, chiropractic physicians should be on the front lines of the coming renaissance for these people! If you can make contact with a few of these patients or their advocates in your community and increase their level of health by your service, you will open a doorway that will increase your reputation and your practice.
Children with Down syndrome will be developmentally slower than their siblings and peers and have intellectual functioning in the moderately disabled range, but the range is enormous and the distance from their peers is the crucial factor where our chiropractic therapeutics can make a profound difference.
The ability we chiropractors possess to repair the neurological disorganization in these children (clumsiness, the “floppy baby” phenomenon, sensory and motor disorganization, going from labored crawling to normal creeping to walking) can be affected rapidly with the proper treatment to the neuraxis of these children. Patients are frequently amazed (and very grateful) at the speed with which this happens. Once the cranial mechanism is repaired in children with Down syndrome and it begins to move freely, the child becomes a new creature with his or her potentialities greatly improved for normal function. Parents who understand the importance of this work to the development of their children will refer other children as well as adults to the knowledgeable doctor of chiropractic for care. Fathers, mothers, brothers, and sisters of these children with Down syndrome become patients and receive the benefit of whole-body chiropractic treatment.
Thank you for your splendid and timely article on this critically important subject.
Scott Cuthbert, DC
Raising Our Awareness
I enjoyed the December 2003 article entitled, “Meet Them Where They Are: Chiropractic & Special-Needs Patients.” As a parent of a special-needs daughter, a chiropractor, and vice-chairman of the Governor’s Commission on Mental Retardation for the Commonwealth of Massachusetts, I found it refreshing to see the journal’s focus on a segment of our society that is underserved and that would benefit from the delivery of chiropractic services. Kudos to those chiropractors who are currently involved in the care of this population. The rewards are exciting when you can make a positive difference in the life of someone less fortunate than yourself.
There is much more that we can do for this population, but in order to do so, we must recognize that many people with special needs are not able to articulate and advocate for themselves, being dependent on their parents, guardians, or governmental agencies to make health care decisions for them. When it is said to “meet them where they are,” it means that you have to also meet parents, guardians, or case workers where they are, as well, and lead them up the learning ladder to an understanding and commitment to the inclusion of chiropractic as part of the clinical support received by the individual.
While many people with special needs enjoy stable health and require only routine and episodic health care interventions, a small percentage of that population have complex health issues or newly diagnosed conditions that require a more sophisticated clinical review and in-depth care management planning. Every effort should be made by the chiropractor to work collaboratively with other caregivers to provide the best outcome.
Service to the special-needs community represents new opportunities and challenges for the chiropractic profession. Thank you to JACA for raising our awareness, and much gratitude to those chiropractors who currently make a difference in the world of people with special needs.
Richard E.Vincent, DC
In the December issue of JACA, Dr. George McClelland addressed chiropractic’s identity in the 21st century. This is my response:
Recently, I drove a friend’s two aunts to the San Francisco airport after a wedding in Napa Valley. I was struck by the stark contrast between these two ladies. Both women were in their 60s, yet one had been flying for years, while the other had never been on a plane before this trip. This turned out to be literally analogous to their health care choices. The one who was comfortable flying had been going to a doctor of chiropractic for years, while the other was petrified at the very thought.
Fairly regularly, I run into people who say they would rather drive than fly because they feel “it’s safer” or “less scary.” Yet the January-February 2003 issue of American Scientist Magazine2 showed that driving the length of a typical nonstop flight – 1,157 km, or 719 miles – is 65 times as risky as flying.
Even after taking undergraduate physics classes, I still marvel that a huge hunk of metal can remain airborne. To my rational mind, it’s impossible. The public’s fear of chiropractic, however, has no rational basis. Bonesetters have a long history in our health care system and have proven to be extremely safe with their evolution to chiropractic. The successful and systematic boycott of the medical profession against chiropractic, however, has defined the public roles of both chiropractic and allopathic medicine. While allopathic medicine represents the CARS that people do not fear, chiropractic is still considered the PLANES that some people do fear. It is our duty to re-educate them.
Like air travel, chiropractic can be a quicker, more efficient, safer, and (unlike planes) cost-effective option compared to car travel. Chiropractors will always bicker about philosophy and technique, just as airlines argue over who provides better customer service, more leg room, or whatever. Yet all airline companies will agree that flying is safe and that everyone should use airplanes! We should come to a similar agreement.
The following are my suggestions to open a dialogue so that our professional leaders can agree and formulate a public education campaign to ward off bad publicity and miseducation by the allopaths. If we don’t come to a general agreement, we will end up fighting each other in a public campaign (similar to what is being done legislatively now with Medicare). Let’s agree to create a public policy to educate others on these points:
1. Doctors of chiropractic are highly trained.
2. Chiropractic is safe.
3. Chiropractors deal with the muscles, bones, and nervous system to help restore health.
4. Chiropractors enhance wellness. Many help the body return to health and try to prevent future health issues through adjustments, nutrition, and enhancing biomechanics.
5. Chiropractors can specialize in areas much as medical doctors do (i.e., sports, pediatrics, geriatrics, neurology, acupuncture, etc).
6. Because drugs have side effects, conservative treatment should be encouraged. Chiropractic can increase function and decrease pain, rather than merely masking pain and other symptoms.
7. Research shows chiropractic can get patients back on the job or back to their sports quicker and cheaper after an injury.
8. Because chiropractors deal with the nervous system, chiropractic is more than just neck and back pain-although that is what we are best known for. Chiropractors have seen patients whose asthma, digestive problems and other conditions have been alleviated. We are still a young profession and don’t have enough research yet to know all that chiropractic can accomplish.
9. Spinal manipulation as provided by doctors of chiropractic is an LBP treatment supported by the federal government of the United States.
10. Chiropractors are educated to refer a patient to another health care provider as needed. Chiropractors work with everyone in the health care community.
Unfortunately, these points are not well understood by the public. Yet without this simple level of agreement among the members of our own profession, we will continue to fight among ourselves and the public will never have a clear definition of what we believe in. It is very exciting that on Nov. 8, 2003, the majority of the profession’s leaders signed a “Pledge of National Public Relations Unity,” yet many of the players were absent or refrained from signing this important document. Let’s work toward creating a formula that we can all stand behind. Let’s become more like the airline companies by agreeing on the important things. We need to educate the public about the safety and benefits of chiropractic.
Andrew C. Cohen, BA; Student, National College of Chiropractic; SACA National Chair
I. McClelland, George. Chairman’s Message: Chiropractic’s Identity in the 21st Century. JACA. December 2003; Vol 40 No 12, p8,9.
Copyright American Chiropractic Association Mar 2004
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