Meet Them Where They Are: Chiropractic & Special-Needs Patients

Journal of the American Chiropractic Association, Dec 2003

Joanne Fava, DQ CCSP, can still recall the first moment she got involved with special-needs athletes. She was a sophomore at a high school that had a large academic program for students with special needs. "Every time I went to gym class, I'd see a group of these students bouncing balls and not really having an organized gym program," she recalls. "I went up to the gym teacher and asked if I could become involved. By my senior year; we had an organized special-needs gym program that included basketball, floor hockey Volleyball, and so on. They had a gym class just like any other students, and my gym class acted as their coach."

Years later, Dr. Fava has a chiropractic practice in Florida. She's a member of the US. Sports Chiropractic Federation, as well as president of the Florida Sports Chiropractic Injury Council. Dr. Fava still devotes much of her time to coaching and providing chiropractic care for special-needs athletes as a track and field coach and comedical coordinator for the Sarasota County Special Olympics team. She's one of a small, but dedicated, number of chiropractors around the country who devote significant amounts of time to caring for special-needs patients within the practice, as volunteers for Special Olympics teams, or both.

"My spin on it is that there is no difference between dealing with special-needs patients from a chiropractic standpoint versus a medical standpoint," says William Kyle Nevius, DC, who has long been involved with Florida's Special Olympics program and trained many chiropractors in the state to work with special-needs children. "Many chiropractors fulfill the primary care provider role for patients with special needs, unless those patients are specifically degraded in their medical status, because most of these patients are challenged in their musculoskeletal function. Who better to manage their care than a chiropractor?"

Exactly SQ says Eric Epstein, DQ a chiropractor and member of the board of the pioneering Kentuckiana Children's Center, which in 1957 opened its doors as the first institution to provide totally free chiropractic care for the financially indigent special-needs child. "We're seeing so many more people diagnosed with specialneeds conditions. Every single year, it's going up and up. Many of them are shunted aside when medical doctors don't know how to deal with them. It's not what you learn in a standard education, and somebody has to step up to the plate and say 'We're willing to take on this challenge.' Why not chiropractic?" he asks. "It's the best way to engage the central nervous system, which is what most of these patients need."

One way for chiropractors to begin working with special-needs patients is through involvement with local Special Olympics programs. "Special Olympics is very open to chiropractic participation," says Dr Fava. "Here in Florida, our forms for high school athlete pre-participation examinations have just changed to include DCs as examining clinicians. We've been allowed to perform school sports exams in the past, but we had to cross out 'DO' or 'MD' and write in 'DC.' Special Olympics, on the other hand, has specifically included DCs on pre-participation exam forms for quite a while now, which seems to exemplify the organization's attitude toward chiropractic. I think Special Olympics is much more open to it than some others are."

Of course, the term "special needs" encompasses a wide variety of conditions in both pediatric and adult patients, including physical, mental, and emotional disabilities that can range from traumatic brain injury to muscular dystrophy to Down syndrome to autism. Patients with all of these conditions, Dr Fava says, can benefit from chiropractic. "We don't do anything special for them; they're people just like everybody else," she says.

Comorbid Conditions

That said, there are clearly things that the DC who treats special-needs patients must be aware of. That's true whether he or she is providing ongoing care or simply conducting a pre-participation physical for activities like Special Olympics. With these populations, a comprehensive, wide-ranging medical history-though always important-should be stressed even more. "With a special-needs patient, even if he or she just has a sprained ankle or low-back pain, the chiropractor can't just do a minimal localized examination, adjust, and send the patient out the door. You really need a comprehensive exam and history, as well as awareness of all the disease processes these patients can suffer from, because they tend to have a more significant medical history than the rest of your patients," Dr. Fava says. "I can't stress that enough. Typically what happens is that if you have one congenital anomaly you also have others. Doctors of chiropractic need to be aware of all the copresenting conditions, as well as the immediate injury a patient might present with."

"The person who wants to focus all or part of a practice on special-needs patients should collect information about the patient's entire life and family. DCs need to know about things like the mother's health, any history of birth trauma, nutritional issues in the family and so on," Dr Epstein agrees. "Not only is a traditional interview and exam not adequate in these cases, but also with our patients, we will often send packets of information to their homes to be filled out and sent back. That's how much information we need to treat these patients properly."