Professional Referrals

WHAT IS A BOARD CERTIFIED CHIROPRACTIC NEUROLOGIST?

This is a specialty within chiropractic that specifically addresses a variety of neurological concerns. Training is usually consists of 3 years of postdoctoral study and passage of both a written and practical board examination administered by the American Chiropractic Neurological Board (acnb.org). Dr. Powell teaches diplomate coursework on caring for patients with difficult neurological presentations throughout the country (carrickinstitute.org).

WHAT CONDITIONS DOES DR. POWELL HAVE EXPERIENCE WITH?

Dr. Powell has worked with a very broad variety of patients who range from a few months old to quite elderly. Some of the presentations are listed below. The clinic is equipped with a ramp to accommodate those with wheelchairs or walkers.

HOW DO I MAKE A REFERRAL?

Simply call the clinic at (319) 366-2518. The doctor or patient may call to arrange this. The patient should bring any health records they feel are relevant (reports from other specialists, imaging or testing). Very often the most valuable material is a written note that describes when the concerns began, the course of its progression with an approximate timeline and what types of care have been involved up until now. After the visit at our clinic the doctor will send a report with all diagnostic information and specific recommendations. The referring doctor is also welcome to discuss the patient’s progression with Dr. Powell by calling our clinic.

WHAT DOES A NEUROLOGICAL CONSULTATION CONSIST OF?

• Detailed patient history and review of records
• Extensive neurological examination is performed to locate as precisely as possible the level of the lesion and to assess what parts of the system may be most viable for care
• Once an assessment is made, a therapeutic trial is performed. This usually involves increased afferent stimulation specific to the lesion site. Immediately after this a re-examination is performed to identify whether improvement in function has occurred. This provides instant feedback to help decide if the patient is a good candidate for care or not

HOW IS THIS DIFFERENT FROM A MEDICAL NEUROLOGIST OR OCCUPATIONAL THERAPIST?

• Treatment is non-drug and non-surgical
• Therapeutics are individual and target specific
• Pre and post testing is done multiple times on the initial consultation and every visit thereafter
• The location of the lesion is of vital importance since the treatment will attempt to specifically target that area. For example- if a patient is found to have a left inferior parietal lobe lesion, then treatment will involve activities known in textbook literature, recent research and clinical experience to promote increased function in that area. In this example it may involve a right inferior quadrant visual stimulation or language based activities involving the right hand. Regardless, the patient will be retested immediately after the trial of care to assess the benefit.

WHAT REPORTING IS PRODUCED?

• History and exam findings are documented
• Assessment is usually anatomically specific
• Theraputic trial is described as are the post testing results
• Discussion includes evidence for the assessment, basis for decision-making in treatment, indications for any special testing and prognosis
• MOST IMPORTANT are clinical recommendations. These are specific to the individual treatment plan addressing adjustments, frequency/intensity/duration of rehab activities in the clinic, home program and proper pre and post testing procedures.
• Often times the exam and treatment are videotaped (with the patient’s written consent) so the referring doctor can see what was done. This also has proved quite useful when documenting a case involved in a legal proceeding. Additionally, since the cases are quite complex and some of the responses so dramatic, the video may be used in teaching other doctors.

WHAT PATIENTS ARE APPROPRIATE FOR REFERRAL?

Proper referrals are any patient that has not continued to make progress toward recovery. Medical doctors may refer patients who have neurological presentations, but whose imaging or electrodiagnostics are negative. These make up a large portion of our patients. We also see patients who no longer are improving with their medications or may not be good candidates for medications or surgery. These include those who choose not to, those who have contraindications and pregnant women.

Physical, occupational and speech therapists as well as psychologists refer patients for an evaluation to better identify the location of a neurologic problem. This can greatly help in therapy as there may be certain activities, a specific direction of movement or just one side of the body that should be addressed. Also, they find that therapy programs that work well with most patients, don’t work with some. For many of these the program can be modified to fit their individual neurologic needs, or some previously unidentified neurologic problems can be addressed first and then the therapy program works with greater success.

Dr. Powell receives a great many referrals from other Chiropractors. These patients have neurologic problems that have not fully responded to care. Often they have undergone failed surgeries, trials of medication or other interventions that have not worked. After the initial examination (if traveling a great distance they usually stay overnight to accommodate 2 visits) the referring chiropractor is provided a detailed reporting of what needs to be done differently when the patient returns back to their home clinic. Also, many chiropractors are not comfortable with working with patients who have suffered a stroke, have a shunt, Chiari malformation, spinal cord injury or other neurological conditions. Dr. Powell specializes in caring for these patients and teaches other doctors around the country how to work with and help them.