Shari Wynd

Publications (7) View all

• Source

  Available from: Shari Wynd

  Article: The Quality of Reports on Cervical Arterial Dissection following Cervical Spinal Manipulation.

  Shari Wynd, Michael Westaway, Sunita Vohra, Greg Kawchuk
  [show abstract] [hide abstract]
  ABSTRACT: Cervical artery dissection (CAD) and stroke are serious harms that are sometimes associated with cervical spinal manipulation therapy (cSMT). Because of the relative rarity of these adverse events, studying them prospectively is challenging. As a result, systematic review of reports describing these events offers an important opportunity to better understand the relation between adverse events and cSMT. Of note, the quality of the case report literature in this area has not yet been assessed. 1) To systematically collect and synthesize available reports of CAD that have been associated with cSMT in the literature and 2) assess the quality of these reports. A systematic review of the literature was conducted using several databases. All clinical study designs involving CADs associated with cSMT were eligible for inclusion. Included studies were screened by two independent reviewers for the presence/absence of 11 factors considered to be important in understanding the relation between CAD and cSMT. Overall, 43 articles reported 901 cases of CAD and 707 incidents of stroke reported to be associated with cSMT. The most common type of stroke reported was ischemic stroke (92%). Time-to-onset of symptoms was reported most frequently (95%). No single case included all 11 factors. This study has demonstrated that the literature infrequently reports useful data toward understanding the association between cSMT, CADs and stroke. Improving the quality, completeness, and consistency of reporting adverse events may improve our understanding of this important relation.
  PLoS ONE 01/2013; 8(3):e59170. · 4.09 Impact Factor
• Source

  Available from: Carol Ann Weis

  Article: Adverse events from spinal manipulation in the pregnant and postpartum periods: a critical review of the literature.

  Kent Jason Stuber, Shari Wynd, Carol Ann Weis
  [show abstract] [hide abstract]
  ABSTRACT: The safety of spinal manipulation during pregnancy and the postpartum periods has been a matter of debate among manual therapists. Spinal manipulative therapy during these periods is a commonly performed intervention as musculoskeletal pain is common in these patients. To date there has not been an evaluation of the literature on this topic exclusively. A literature search was conducted on PubMed, CINAHL and the Index to Chiropractic Literature along with reference searching for articles published in English and French in the peer-reviewed literature that documented adverse effects of spinal manipulation during either pregnancy or postpartum. Case reports, case series, and any other clinical study designs were deemed acceptable for inclusion, as were systematic reviews. The appropriate Scottish Intercollegiate Guidelines Network (SIGN) tools were used to rate included articles for quality when applicable. Five articles identifying adverse events in seven subjects following spinal manipulation were included in this review, along with two systematic reviews. The articles were published between 1978 and 2009. Two articles describing adverse effects from spinal manipulation on two postpartum patients were included, while the remaining three articles on five patients with adverse effects following spinal manipulation were on pregnant patients. Injury severity ranged from minor injury such as increasing pain after treatment that resolved within a few days to more severe injuries including fracture, stroke, and epidural hematoma. SIGN scores of the prospective observational cohort study and systematic reviews indicated acceptable quality. There are only a few reported cases of adverse events following spinal manipulation during pregnancy and the postpartum period identified in the literature. While improved reporting of such events is required in the future, it may be that such injuries are relatively rare.
  Chiropractic & manual therapies. 03/2012; 20:8.
• Article: Learning spinal manipulation: a comparison of two teaching models.

  Marie-Pierre Harvey, Shari Wynd, Lance Richardson, Claude Dugas, Martin Descarreaux
  [show abstract] [hide abstract]
  ABSTRACT: The goal of the present study was to quantify the high-velocity, low-amplitude spinal manipulation biomechanical parameters in two cohorts of students from different teaching institutions. The first cohort of students was taught chiropractic techniques in a patient-doctor positioning practice setting, while the second cohort of students was taught in a "complete practice" manipulation setting, thus performing spinal manipulation skills on fellow student colleagues. It was hypothesized that the students exposed to complete practice would perform the standardized spinal manipulation with better biomechanical parameters. Participants (n = 88) were students enrolled in two distinct chiropractic programs. Thoracic spine manipulation skills were assessed using an instrumented manikin, which allowed the measurement of applied force. Dependent variables included peak force, time to peak force, rate of force production, peak force variability, and global coordination. The results revealed that students exposed to complete practice demonstrated lower time to peak force values, higher peak force, and a steeper rate of force production compared with students in the patient-doctor positioning scenario. A significant group by gender interaction was also noted for the time to peak force and rate of force production variables. The results of the present study confirm the importance of chiropractic technique curriculum and perhaps gender in spinal manipulation skill learning. It also stresses the importance of integrating spinal manipulation skills practice early in training to maximize the number and the quality of significant learner-instructor interactions.
  The Journal of chiropractic education 01/2011; 25(2):125-31.
• Article: The relation between the spatial distribution of vertebral artery compromise and exposure to cervical manipulation.

  Gregory N Kawchuk, Gian S Jhangri, Eric L Hurwitz, Shari Wynd, S Haldeman, Michael D Hill
  [show abstract] [hide abstract]
  ABSTRACT: The vertebral artery is made up of four segments, one of which (V3) is connected to highly mobile cervical vertebrae. This connection underlies the common assumption that persons with pre-event histories of mechanical neck movements, such as cervical spine manipulation (cSMT), should experience increased V3 dissection. Two of the largest case series of vertebral artery dissection describing subjects with and without a specific history of cSMT were reassessed to determine which segment(s) of the vertebral artery was most commonly compromised. The V3 segment was the most commonly involved vertebral artery segment in both the +cSMT group (e.g., V3 vs. V1 prevalence ratio (PR) = 8.46) and the -cSMT group (V3 vs. V1 PR = 4.00). However, V3 vulnerability was augmented by the effect of cSMT. The joint effect of V3 location and exposure to cSMT was greater than if each effect were simply combined. In addition,multiple site lesions were significantly more common than single sites in both the +cSMT group (PR = 2.67, p = 0.008) and the -cSMT group (PR = 2.44, p = 0.0008). In prior studies which identified vertebral artery compromise, those with a history of cSMT were more likely to have involvement of the V3 segment. Although this study does not identify a mechanism which relates vertebral artery dissection and exposure to cSMT, these data are compatible with a greater than additive relation between compromise of an arterial segment thought to be mechanically vulnerable and history of a mechanical event.
  Journal of Neurology 04/2008; 255(3):371-7. · 3.47 Impact Factor
• Article: Effect of cervical spine manipulation on a pre-existing vascular lesion within the canine vertebral artery.

  Shari Wynd, Todd Anderson, Greg Kawchuk
  [show abstract] [hide abstract]
  ABSTRACT: Serious adverse events such as cervical artery dissection (CAD) have been reported to occur following cervical spine manipulation therapy (cSMT). To investigate the relation between these events, we utilized an animal model to determine if vertebral arteries with a suspected susceptibility factor (wall lesion) could be injured further by cSMT. Lesions to the vertebral artery wall were created by angioplasty in 10 anesthetized canines. Resulting injury dimensions were quantified using intravascular ultrasound before and after cSMT. Student's t were performed to assess the significance of changes in arterial dimension. Statistical analysis demonstrated that the pre-cSMT and post-cSMT lesions did not differ significantly in their length, area or volume (p > 0.05). In this animal model, cSMT did not alter the dimensions of pre-existing vertebral artery lesions.
  Cerebrovascular Diseases 02/2008; 26(3):304-9. · 2.72 Impact Factor