The Chiropractic Leadership Association “CLA” is the company that produces the Insight Technology.

The Insight™ Inclinometer is used to perform accurate spinal range-of-motion (ROM) measurements. There are three market-leading features to the Insight Inclinometer:

[1] It is three dimensional – meaning you can do rotation with the patient in the upright position!
[2] It is hands-free which leads to a much faster and more accurate exam.
[3] It is wireless using Blue Tooth™ technology and has passed all wireless coexistence regulatory requirements. (Other wireless instruments on the market don’t have this level of independent lab testing and federal regulatory compliance.)
ROM measurements are widely employed in chiropractic practice for clinical assessment of spinal dysfunction and impairment rating.

If desired, the Insight™ Inclinometer can use a dual point measurement technique. Readings and reports use the three-trial protocol and reference norms defined in the AMA Guides (1). This enables doctors performing impairment evaluations to obtain fast, accurate, compliant reports. CLA’s Inclinometer adheres to AMA Permanent Impairment’s Range of Motion Protocol for the full spine. Although useful for impairment rating, the AMA norms have been criticized because they do not account for differences in age and gender (2). Another key distinction of the Insight™ is that the software gives you both the AMA norms for impairment rating, as well as other published norms from the medical journal, “Spine,” which are adjusted to age and gender to assist you in clinical decision making (3,4).

Inclinometry References
Sample Narrative Report on the Inclinometer

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The patented Insight™ Thermal Scanner utilizes data published in the Journal of Neurosurgery for normative comparison and reporting.

Normal Scan

Abnormal Scan

Science Behind the Thermography
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The Insight PWP allows you to monitor the autonomic nervous system in new ways by collecting Heart Rate Variability (HRV) data. This is a unique, extremely exciting, and powerful tool for the chiropractor. Heart Rate Variability is the beat-to-beat variation in heart rate. This natural rise and fall of heart rate is caused by several physiologic phenomena, including breathing and autonomic nervous system activity. Healthcare professionals utilize HRV for a wide variety of clinical applications. Chiropractors use HRV to get a window into how the autonomic nervous system (ANS) modulates heart rate in the baseline or resting state. Published research has demonstrated that chiropractic adjustments have favorable effects on HRV parameters. For the first time, instead of measuring parameters on or around the spine, we are able to directly measure the effect of chiropractic care on the function of a vital organ. This significant “proof point” catalyzes a patient’s understanding of the whole body health benefits of chiropractic care.

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The Instantaneous Heart Rate (IHR) – This view shows the actual heart rate over the entire data collection period. As you can see from this graph, the average heart rate over this period is around 67, but the actual values range from less than 55 to over 85 – this variability is exactly what we are measuring with this protocol. The blue line at the bottom indicates the SCR (Skin Conductance Response) values. In this scan, the SCR remains under the black line (threshold), indicating that there was no unexpected “spike” in nervous system arousal.

• Many clinicians view the heart as a periodic oscillator whose rate varies according to the demands of the organism. However, there is growing evidence that under physiologic conditions, the heart is not a periodic oscillator.
• Variability in heart rate reflects the vagal and sympathetic function of the autonomic nervous system, and has been used as a monitoring tool in clinical conditions characterized by altered autonomic nervous system function. Spectral analysis of beat-to-beat variability is a simple, noninvasive technique to evaluate autonomic dysfunction.
• Heart rate variability analysis has been used in the assessment of diabetic neuropathy and to predict the risk of arrhythmic events following myocardial infarction. The technique has also been used to investigate autonomic changes associated with neurotoxicity, physical exercise anorexia nervosa, brain infarction, angina, and panic disorder.
• Normative data on heart rate variability have been collected. This technology appears to hold promise for assessing overall fitness. Gallagher et al compared age-matched groups with different lifestyles. These were smokers, sedentary persons, and aerobically fit individuals. They found that smoking and a sedentary lifestyle reduces vagal tone, whereas enhanced aerobic fitness increases vagal tone. Dixon et al reported that endurance training modifies heart rate control through neurocardiac mechanisms. In occupational health, the effects of various stresses of the work environment of heart patients and asymptomatic workers may be evaluated using heart rate variability analysis.

Heart Rate Variability and Vertebral Subluxation
Zhang and Dean (20) reported the results of an study involving 520 subjects in a single-visit group, and 111 subjects in a four-week group. The purpose of the study was to investigate the effect of chiropractic care in a multi-clinic setting on the balance of the sympathetic and parasympathetic nervous system using HRV analysis. The study demonstrated consistent changes in HRV. The authors reported, “The decreased heart rate and increased total power from the HRV analysis indicated a healthy autonomic nervous system balance after correction of vertebral subluxation.”

Not A Stand-Alone Test
It is important to remember that we do not perform algometry as a stand alone test, but recommend that it be used in the determination of the Neurospinal Function Index (NSFi). Pain and tenderness are highly complex phenomena, which involve biopsychosocial as well as purely physiological processes. Therefore, algometry should not, in our opinion, be used without also looking at the function of the rest of the nervous system as well as ranges of motion.

2 Symmetry Graph
This scan of a patient’s muscle asymmetry depicts the amount of muscle pull from one side to another. Normal is marked by white spikes or no spikes at all. The same colors are used here – green, blue and red for mild, moderate and severe levels of muscle asymmetry respectively.

3 Amplitude Graph
The patient’s sEMG scan is compared to normal. We are viewing the amplitude (amount of tension) of paraspinal muscle activity, along with hyper- or hypo-tonicity as it compares to a normal population. Green bars indicate one standard deviation over normal, or mild elevation. Blue bars indicate moderate elevation and Red bars indicate severe elevation. Yellow indicates one standard deviation below normal.

4 Dynamic Graph
The Dynamic EMG Scan can track up to four channels of muscle activity while the patient moves through various ranges of motion. The Insight ‘event marker’ feature assists interpretation by marking the position of the patient during the test. This graph is accompanied by a dynamic narrative report.

5 Quantifications Report
The Quantifications Report Graph documents each patient’s progress.

6 sEMG – an accepted technology for clinical use
According to other sEMG manufacturers who market to the medical profession, the following medical specialties have utilized surface EMG since the late 1980’s:

• Urologists for diagnosis and treatment of urinary incontinence
• Orthopedists for muscle rehab and training
• Physiologists for anxiety, tension/migraine headaches, rehab
• General practitioners for circulation problems, anxiety, desensitization, distonia [muscle tonus], incontinence, spasms, relaxation, psychosomatic symptoms
• Family practitioners for circulation problems, anxiety, desensitization, distonia [muscle tonus], incontinence, spasms, relaxation, psychosomatic symptoms
• Neurologists for anxiety, muscle training and rehab, spasms
• Speech pathologists for anxiety, relaxation
• Sports Medicine for muscle training and rehab
• Corporate Medicine for muscle training and rehab
• Psychiatrists and psychologists for anxiety, desensitization, psychosomatic symptoms, tortocollis, writer’s cramp, phobias
• Rehab centers for muscle training, relaxation, spasms, and urinary incontinence
• Occupational therapists for muscle training/rehab, relaxation, migraine headaches
• Dentists for TMJ, anxiety, tension/migraine headaches

Go to www.bio-medical.com to see how sEMG is currently being used by physical therapists, physiatrists, massage therapists, and RNs.

7 Independent Studies
Christopher Kent, DC, FCCI, JD, CLA Co-Founder and Research Director, and one of the chiropractic profession’s leading researchers, sums up the issue on reliability of sEMG: “Studies spanning decades consistently report high levels of reliability. Quite simply, no other procedure I am aware of in chiropractic, except measurements on x-rays, approach the reliability of sEMG. Studies from the Mayo Clinic to the NZ Chiropractic College have demonstrated this. NONE OF THESE STUDIES WERE PERFORMED OR FUNDED BY CLA.”

Price, Clare, Ewerhardt (1) observed that surface electrode paraspinal electromyography has been employed since 1948 to measure muscular activity.

Cobb et al (2) concluded that “…muscle spasm (even when mild) is accompanied by muscular hyperactivity which can be evaluated by suitable electromyographic techniques. Our data suggest that surface electrodes allow better sampling than Teflon coated needles…” and that “…integration procedures (surface EMG) allow better quantification than does the visual evaluation of a (needle) EMG…”

Surface electrode electromyography with attached electrodes exhibits very good to excellent test-retest reliability. Reliability is a measure of the ability to reproduce a measurement, which is expressed as a coefficient ranging from 0.00 to 1.00. Perfect reliability results in a coefficient of 1.00, while chance agreement would be 0.0. As presented below, research data indicates that the reliability of sEMG is clearly superior to palpation for muscle tension.

Spector (3) reported a surface EMG study performed at New York Chiropractic College which yielded correlation coefficients ranging from 0.73 and 0.97.

Komi and Buskirk (4) compared the test-retest reliability of surface electrodes vs. needle electrodes in the deltoid muscle. The test-retest reliability for surface electrodes was 0.88 compared to 0.62 for inserted electrodes.

Giroux and Lamontagne (5) compared the reliability of surface vs. intramuscular wire EMG of the trapezius and deltoid muscles during isometric and dynamic contractions. The statistical analysis on the integrated EMG was a factorial analysis model with repeated measures. They found that surface EMG was more reliable than inserted wire EMG on day-to-day investigations.

Andersson et al (6) compared the electrical activity in lumbar erector spinae muscles using inserted electrodes and surface electrodes. They found that the standard deviations and coefficients of variation for wire electrodes was greater than those for surface electrodes. They concluded, “Wire electrodes are more sensitive to electrode location and give estimates with less precision than surface electrodes.”

Thompson et al (7) found that the scanning electrode technique correlated well with the “gold standard” of attached electrode technique (The Insight sEMG has both static and attached electrode techniques).

Cram et al (8) evaluated the reliability of surface EMG scanning in 102 subjects in the sitting and standing positions. sEMG scans were performed on three occasions approximately one hour apart on the same day. The median correlation between hand-held and patch electrodes was high, with a correlation coefficient of 0.64. The authors concluded, “With adequate attention given to skin preparation, EMG sensors held in place by hand with a light pressure provide reliable results.”

Thermography has long been acknowledged in the scientific community as being an accurate and reproducible technology. In fact, there are over 5000 references to thermography onMedline.

The normative study used by the Insight is based on published scientific research done at JohnsHopkins University in 1988, in which a group of neurosurgeons used thermal scanning technology to determine temperature asymmetry protocols and their relationship to sympathetic dysfunction. In the abstract from the article, it states “Thermal values can be used as a standard in assessment of sympathetic nerve function, and the degree of asymmetry is a quantifiable indicator of dysfunction.”