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This in Brent of the Brookbush
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Institute, and in this video we're going to go
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over the Wallenberg's position and vertebral basilar insufficiency or
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ischemia testing, commonly known as VBI testing. I'm going to have my friends Sonya
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come out, she's going to help me demonstrate this. Now of course if we were doing this
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test we would have some reason to believe that Sonya here had cervical
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complaints, or maybe some neurological signs accompanying her orthopedic
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cervical complaints. Or we're trying to clear Sonya here for us to be able to do
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high-velocity manipulations. Although I'm going to get back to that in a second
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because there is some weirdness with that. Now the tests themselves are not
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that hard; however, you do have to memorize some symptoms that you're
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looking for. The test goes like this, I'm going to test the extreme of rotation with
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the extension to see if Sonya here still gets good blood flow to her brain
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essentially. Alright that's that vertebral basilar ischemia, we're trying
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to make sure that we don't cut off her vertebral artery when she goes back into
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rotation and extension. So I'm going to have her rotate as far as she can to look at
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me, and then she's going to go back into extension and now I need to start
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testing her for various symptoms. So I'm going to look her in the eyes and
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see if she has nystagmus. I might go hey do I have two faces? No I
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only have one face right, double vision would be another thing that we were
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looking for. Can she speak clearly? So usually what I'll have somebody do
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rather than go talk to me, right which gets people a little on edge, I'll go hey
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can you just tell me that tell me the alphabet real quick (ABCD), and I'll be
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listening to see if there's any slurred speech any stuttering. Another
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thing that we might want to look for is does she have problems swallowing, can
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you just take a gulp for me. Make sure swallowing is okay, everything's cool
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there, nauseous? No. Of course we know she's not having a
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drop attack, we know that she's not having any other strange symptoms,
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lightheadedness, no none of that right cool. So that was the list of symptoms I
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just went down, and noticed they're just they're
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neurological symptoms that might be related to this insufficiency of these
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arteries. So now I'm going to have her do it to the other side, good right so she'd
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rotate and then tilt back, and I go through the same thing. Look her in the
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eyes: ask her if she's seeing two of me, ask her to say her alphabet, ask her to
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take a quick swallow, make sure I'm watching her for a nystagmus. Is she
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going to pass out on me? Is she losing her balance? Is she having a hard time
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sitting here? These are the symptoms that were looking for to make sure that she's
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still getting good blood flow via the vertebral arteries. Now this is the
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Wallenberg's position, the other thing you could do is just commonly referred
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to as VBI testing which I'm going to go ahead and have Sonya spin around and
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she's going to lay down for me, she's going to back up off the table, alright. Now this
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test is kind of convenient because usually this would be the position that
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we did a cervical manipulation in. So it's very common for people to
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state that you should do these tests before to doing a cervical manipulation.
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All I'm going to do is rotate, drop her head back and now I can do the same thing
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right, swallow for me, good, tell me your
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alphabet. She has nice clear speech I'm looking her in the eyes to make her
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absolutely uncomfortable and be creepy, no I'm looking her in the eyes for a
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nystagmus, and then of course I can ask her you know do you see two of me or am
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i blurred at all? No and you're fine, you don't feel like you're going to
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pass out? No not dizzy in this position, and you're
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not nauseated? Cool and then I could do the other side and
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then if I was going to do a cervical manipulation of course I could go ahead
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and do that. Now you can go ahead and sit up Sonya. The one thing I want to mention,
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and this is important, there are a couple practice acts that talk
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about doing these upper-cervical spine stability tests and things like the VBI
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tests before we do cervical manipulations. But this particular test
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has zero sensitivity. I'm not kidding, so far the studies show that this test is
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not sensitive it is specific. Now if you are following along in
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our special test courses, you know that screens actually need to be highly
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sensitive, and specificity matters less So this test is absolutely backwards.
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Does that mean we shouldn't do it? I don't totally know in the sense that I
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guess if we caught one person it would be worth it, because obviously damaging
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somebody's vertebral artery can be very serious. But we also don't have any
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evidence to suggest that this would catch anybody who had vertebral artery
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insufficiency, and I think we need more research on that before we start
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dictating to practitioners what they should be doing as far as their
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assessments so keep that stuff in the back of your head. If you'd rather play
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it safe than sorry then do the assessment, but if you see people doing
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manipulations for people who are relatively asymptomatic for neurological
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symptoms, and they're young and they're healthy and they don't have a history of
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smoking or artherosclerotic disease and they've done us good subjective exam,
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don't judge them too harshly We don't have enough data on these
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particular special tests for us to dictate what should and shouldn't be
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done. If you have any questions or comments please leave them below. I