M.Tech. (Chiropractic) / The most accepted method of identifying the second sacral spinous process is by using an accepted landmark known as the Posterior Superior Iliac Spines (PSIS). The PSIS lies about 4cm lateral to the second spinous tubercle of the sacrum (Williams and Warwick, 1980). However, in a search of published work, no evidence could be found of any study which established these generally accepted statements (Stonelake, 1983). This was an inter-examiner reliability study aimed to determine whether palpation of the PSIS was a reliable and accurate method of determining the location of the second sacral spinous process (S2) in participants experiencing lumbosacral joint dysfunction. Thirty participants were marked by three examiners in the prone position using the PSIS to locate S2. An x-ray was taken of each participant in the prone position, after being marked by all three examiners. Measurements were then made on the x-rays to assess the location of the markers on the sacral anatomy. The reliability. of palpation of anatomical landmarks needs to be validated further in future studies, as motion palpation and the palpatory assessment of effectiveness of treatment, applied to correct motion restrictions, are predicted- upon accurate localisation of anatomical landmarks (O'Haire and Gibbons, 2000).

A dissertation proposal presented in partial fulfillment of the requirement for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1999. / The purpose of this study was to evaluate the efficacy and reliability of motion palpation as a post-adjustive diagnostic tool in the evaluation of the cervical spine. This study attempts to assess motion palpation's ability to determine change in a motion segment fixation following manipulation / M

Thesis (Ph. D.)--Victoria University (Melbourne, Vic.), 2007. / Includes bibliographical references.

M.Tech. / Manual medicine practitioners rely on clinical skills to diagnose and treat patients with musculoskeletal complaints. Palpatory analysis of a patient is used to identify their problem, treat the problems found and evaluate the result of the treatment (Ward 1996). Despite this reliance on palpation as a clinical tool, the reliability of palpation remains to be proven (O'Haire & Gibbons 2000). Chiropractors' and other manual medicine practitioners' ability to accurately identify bony anatomical landmarks needs to be validated as static palpation, followed by motion palpation are based on the assumption of this ability (O'Haire & Gibbons 2000). The most common method of identifying lumbar interspaces is to use the intercrestal line, which is drawn between the two iliac crests (Reynolds 2000). The intercrestal line is reported to most frequently cross the vertebral column at the L4-5 disc (Mac Gibbon & Farfan 1979; Quinelle & Stockdale 1983), L4 spinous process (Cunningham & Romanes 1979; Nimmo et al 1994), or L4-5 interspinous space (Render 1996). From this it is clear that no clear consensus exists, at least not in the literature, as to where exactly the intercrestal line intersects the spine. This study aimed to determine whether palpation of the superior aspect of the iliac crest is a reliable, accurate and/or valid method of determining the location of the spinous process of the fourth lumbar vertebra in the standing, seated and prone positions. Thirty participants were marked by three examiners in the standing, seated and prone positions, using the iliac crests to locate the fourth lumbar vertebra. An X-ray was taken of each participant in each of the three positions, after being marked by all three examiners. Measurements were then made on the x-rays, as well as visual assessments by examiners to assess the location of the markers on the lumbar anatomy. The results demonstrated consistent inter-examiner reliability, however the accuracy of using the iliac crest to locate the fourth lumbar vertebra was poor. This is disappointing as the ability to palpate spinal levels is a basic skill and a pre-requisite to more complex palpatory tasks within manual medicine. As for the validity aspect of using the iliac crests to locate the fourth lumbar vertebra, this method was found to be valid in locating the spinous process of the fourth lumbar vertebra. However, it is not a very reliable method, considering that there is only a 53.3% chance of locating the spinous process of L4 once in three attempts in the standing and seated positions and only a 46.7% in the prone position. The reliability of palpation of anatomical landmarks needs to be validated further in future studies as motion palpation and the palpatory assessment of effectiveness of treatment applied to correct motion restriction are predicted upon accurate localization of anatomical landmarks The large variation in intersection points of the intercrestal line does however possibly explain the different opinions found in the literature, and it can be said that to a certain degree all of them are correct.

M.Tech. / Palpation is a skill taught to manual practitioners on a daily basis. This skill is used by health care professionals, including chiropractors, to examine patients complaining of spinal pain. It is the chiropractor’s responsibility to have the ability and experience to locate and identify individual spinal levels, as well as any changes in tissues affected, to accurately diagnose and treat their patients (Downey, Taylor and Niere, 1999). The inability of the therapist to have this skill, can lead to incorrect diagnosis, and in turn, incorrect treatment being provided (Downey et al, 1999). Numerous research studies have been conducted to determine how significant clinical experience is in terms of reliable palpation being achieved. Researchers such as Koran (1975) and McConnell (1980), Simmonds and Kumar (1993), McKenzie and Taylor (1997), Burton and Edwards (1990) have all been unable to support the hypothesis that experience plays a significant role in improving inter-examiner or intra-examiner reliability in their research studies. This study aims to determine the inter-examiner reliability of locating the spinous process of the seventh cervical vertebra by palpation, and to explore the role that clinical experience plays upon efficacy. Thirty participants were recruited to become part of this study. The 6 examiners chosen consisted of two 5th year and two 6th year chiropractic students as well as two qualified chiropractors. A random allocation was used which ensured that every participant was examined by 3 examiners, each from the different clinical experiences. Examiners were provided with instructions before proceeding with the study. Each participant was palpated to locate the C7 spinous processes and once located, the level was marked with a UV pen. The UV marks were located by illuminating with a UV light and these were replaced with metal markers. Each participant was then positioned to have both the AP and lateral x-ray views done. vii Once all participants were x-rayed, horizontal lines were drawn through the C7 spinous processes and metal markers on both the AP and lateral x-ray films. Distances from the lines through the spinous processes to each metal marker, were measured. The provided statistical tests were used to analyse the data. According to the Pearson Chi-square test used, there was no statistically significant difference amongst all examiners on the ability to correctly palpate, locate and mark the C7 spinous processes. Results further showed that the 6th year students correctly identified more levels on the AP x-ray films, whilst both 6th year students and the qualified chiropractors correctly located more and equal levels on the lateral x-ray films. This study showed that there were difficulties amongst all examiners across all levels of clinical experience and this important role of experience is therefore not fully understood.

Thesis (MScIng)--University of Stellenbosch, 2007. / Bibliography. Also available via the Internet.

Thesis (M.S.)--Ohio University, June, 2005. / Includes bibliographical references (p. 75-80)

Thesis (M.S.)--Ohio University, June, 2005. / Title from PDF t.p. Includes bibliographical references (p. 75-80)

Mémoire de sage-femme : Médecine : Nancy 1 : 2009. / Titre provenant de l'écran-titre. Bibliogr.

L’objectif de cette thèse est de comprendre et de mesurer le processus d’appropriation des étudiants masseurs-kinésithérapeutes de premier cycle d’études en ce qui concerne la compétence du toucher thérapeutique. Les travaux de la neuropsychologie montrent un enchaînement de gestes haptiques en six habiletés quel que soit l’objet à reconnaître perceptivement. En amont, nous avons montré que les étudiants en masso-kinésithérapie n’utilisent pas cette stratégie perceptive, bien qu’ils aient validé cette compétence. Notre interrogation se porte alors, sur ce que les étudiants utilisent pour répondre à la prescription palpatoire. Et en quoi une pédagogique de type socioconstructiviste peut-elle être source de développement des styles afin de répondre aux exigences du genre métier ? À la suite des résultats d’un questionnaire différentiel préalable, deux méthodes de recherche ont été réalisées. Une analyse de contenu (2010) fait émerger des paradoxes dans le genre métier et ce, indépendamment des styles. Une étude expérimentale monocentrique, randomisée montre qu’une pédagogie par imitation-modélisation-interactive à l’aide du modèle de « transposition didactique » est plus performante qu’un apprentissage constructiviste. Ce résultat est statistiquement significatif (p < 1%) dans l’acquisition de cinq habiletés sur les six et ce, indépendamment du genre et des connaissances théoriques anatomiques préalables. En perspective, cette stratégie pédagogique contributive à l’élaboration du massage haptique profond est-elle source de performances sur l’expression douloureuse de patient fibromyalgique ? / The objective of this thesis is to understand and measure the process of appropriation of physiotherapists undergraduate studies regarding the competence of therapeutic touch. The work of neuropsychology show a sequence of actions in six haptic skills regardless of the object to be recognized perceptually. Upstream, we have shown that students in physiotherapy do not use this perceptual strategy, though they validated this skill. Our question then this door, on what students use to answer the Palpatory prescription. And what kind of a social constructivist teaching styles can it be the source of development to meet the requirements of the job like that? Following the results of a preliminary survey differential, two research methods were performed. A content analysis (2010) brings out the paradoxes in the business kind, regardless of styles. An experimental single-center, randomized study shows that teaching by imitation-interactive-modeling using the model of "didactic transposition" is more efficient than a constructivist learning. This result is statistically significant (p <1%) in the acquisition of five of the six skills, regardless of gender and anatomical prior theoretical knowledge. In perspective, this contribution to the educational strategy of developing deep haptic massage is it a source of performance on the expression of painful fibromyalgia patient?