Robin Shapiro, MSW, LICSW, the editor of two EMDR Solutions books and The Trauma Treatment Handbook, is in private practice in Seattle. She is known for her informative, user-friendly workshops, insightful clinical consultation, and her popular blog Trauma & Attachment Therapy. She is proud to serve on the board of the EMDR Humanitarian Assistance Program.

For more information visit www.EMDRSolutions.com.

OBJECTIVE: Muscle thickness is a widely used parameter for quantifying muscle function in ultrasound imaging. However, current measurement techniques generally rely on manual digitization, which is subjective, time consuming, and prone to error. The primary purposes of this study were to develop an automated muscle boundary tracking algorithm to overcome these limitations and to report its intraexaminer reliability on pectoralis major muscle.

METHODS: Real-time B-mode ultrasound images of the pectoralis major muscles were acquired by an integrated data acquisition system. A transducer placement protocol was developed to facilitate better repositioning of an ultrasound transducer. Intraexaminer reliability of the tracking algorithm for static measurements was studied using intraclass correlation coefficient based on the thickness data from 11 healthy subjects recruited from a chiropractic college measured at 3 independent sessions. Standard error of measurement and minimal detectable change were calculated. Feasibility of using the tracking algorithm for dynamic measurements was also evaluated.

RESULTS: All calculated intraclass correlation coefficients were larger than 0.96, indicating excellent reliability of the sonomyographic measurements. Minimal detectable changes were 9.7%, 6.7%, and 6.8% of the muscle thickness at the lateral, central, and medial aspects, respectively. For a 400-frame image stack with 3 pairs of 40 x 40 pixels tracking windows, the tracking took about 80 seconds to complete.

CONCLUSIONS: The tracking algorithm offers precise and reliable measurements of muscle thickness changes in clinical settings with potential to quantify the effects of a wide variety of chiropractic techniques on muscle function.

Koo TK, Wong C, Zheng Y. J Manipulative Physiol Ther. 2010 Jun;33(5):386-94. Foot Levelers Biomechanics Research Laboratory, New York Chiropractic College, Seneca Falls, NY 13148, USA. tkoo@nycc.edu

Full Title The effect of mindfulness meditation on painful diabetic peripheral neuropathy in adults older than 50 years.

This pilot study explored the effect of mindfulness meditation for diabetic neuropathy. Twenty participants (10 in each group) completed the study. No significant differences were found between the groups. However, differences between the means were found on 2 constructs: pain quality of life and symptom-related quality of life. Further studies may show efficacy.

Teixeira E. Holist Nurs Pract. 2010 Sep-Oct;24(5):277-83. College of Nursing and Health Professions, Drexel University, 245 N 15th Street, Philadelphia, PA 19102, USA. met42@drexel.edu

Physicians commonly recommend 'placebo treatments', which are not believed to have specific efficacy for the patient's condition. Motivations for placebo treatments include complying with patient expectations and promoting a placebo effect. In this article, we focus on two key empirical questions that must be addressed in order to assess the ethical legitimacy of placebo treatments in clinical practice: 1) do placebo treatments have the potential to produce clinically significant benefit? and 2) can placebo treatments be effective in promoting a therapeutic placebo response without the use of deception? We examine evidence from clinical trials and laboratory experiments bearing on these two questions. The conclusion is reached that based on currently available evidence, it is premature to judge whether placebo treatments are ethically justifiable, with the possible exception of acupuncture for pain relief.

Am J Bioeth. 2009 Dec;9(12):39-47. Miller FG, Colloca L. Department of Bioethics Clinical Center, National Institutes of Health, Bethesda, MD 20892-1156, USA. fmiller@nih.gov

Full Title Reestablishment of Hope as an Intervention for a Patient with Cystic Fibrosis Awaiting Lung Transplantation

Abstract Patients with cystic fibrosis (CF) experience a progressive deterioration in health leading to a shortened life expectancy with concomitant psychologic challenges that also may require intervention. Approaches to address psychologic dysfunction include insight-oriented therapy, cognitive-behavioral therapy, biofeedback, hypnosis, massage, music therapy, relaxation, and family therapy. Patients who learn to use coping strategies are more likely to adhere to treatment, which helps improve both their physical and psychologic well-being. Unique stressors arise for patients awaiting lung transplant as a result of their advanced state of disease along with their fear of death before donor lungs become available. This case report demonstrates some of the psychologic struggles faced by a 10-year-old with CF as he awaited lung transplantation, which led to a loss of hope and his request for withdrawal of care. Encouraging of the patient to express how his life might be improved yielded changes in his management that restored his hopefulness, and allowed him to survive long enough to undergo successful lung transplantation. Thus, reestablishment of hope might be studied as an additional intervention to help improve the well-being of patients who are seriously ill.

Anbar RD, Murthy VV. J Altern Complement Med. 2010 Aug 28. Department of Pediatrics, State University of New York Upstate Medical University , Syracuse, NY.

Background The use of complementary and alternative medicine (CAM) in paediatric populations is common yet, to date, there has been no synthesis of the evidence of its effectiveness in that population. This overview of systematic review evaluates the evidence for or against the effectiveness of CAM for any childhood condition. Methods Medline, AMED and Cochrane were searched from inception until September 2009. Reference lists of retrieved articles were hand-searched. Experts in the field of CAM were contacted. No language restrictions were applied. Results 17 systematic reviews were included in this overview, covering acupuncture, chiropractic, herbal medicine, homeopathy, hypnotherapy, massage and yoga. Results were unconvincing for most conditions although there is some evidence to suggest that acupuncture may be effective for postoperative nausea and vomiting, and that hypnotherapy may be effective in reducing procedure-related pain. Most of the reviews failed to mention the incidence of adverse effects of CAMs. Conclusions Although there is some encouraging evidence for hypnosis, herbal medicine and acupuncture, there is insufficient evidence to suggest that other CAMs are effective for the treatment of childhood conditions. Many of the systematic reviews included in this overview were of low quality, as were the randomised clinical trials within those reviews, further reducing the weight of that evidence. Future research in CAM for children should conform to the reporting standards outlined in the CONSORT and PRISMA guidelines.

Arch Dis Child. 2010 Jul 6. Hunt K, Ernst E. Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, UK.

A previous study has shown that laser acupuncture is a useful healing method for the treatment of visceral postmenopausal obesity in combination with a low-calorie diet. We observe and evaluate the therapeutic effect of laser acupuncture in subjects of simple obesity with a non-restrictive diet protocol. Subjects included 73 women and 22 men with simple obesity and body mass indices >/= 27 kg/m(2). Daily energy intake recommendations for obese females and males were 1620.0 and 1894.2 kcal in average, respectively. The gallium aluminum arsenide Handylaser Trion was used to apply 0.25 J of energy to each of the following acupuncture points three times per week for four consecutive weeks: Stomach, Hunger, ST25, ST28, ST40, SP15, and CV9. The subjects' body weights and body mass indices were recorded before treatment, and four weeks after treatment, and the percent reduction in each parameter was calculated. Statistically significant reductions in body weight and body mass index were detected after four weeks of treatment. The mean reduction and mean percent reduction in body weight were 3.17 kg and 3.80% (p < 0.0001), respectively. The corresponding values for the body mass index were 1.22 kg/m(2) and 3.78% (p < 0.0001), respectively. We concluded that laser acupuncture was found to exert a therapeutic effect on simple obesity by reducing both body weight and body mass index. Moreover, subjects showed good compliance with this comfortable and non-restrictive diet protocol.

Hu WL, Chang CH, Hung YC. Am J Chin Med. 2010;38(5):861-867. Department of Chinese Medicine, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan.

by Alexander Lees, DCH, RCC

The client had refused to fill out the Intake form and was equally adamant about offering her name. My wife Berit (she manages our business) created a file under the name Mrs. X, which I changed to Yana to share her story with you. We join her during her third appointment, which demonstrates the value of learning and applying two NLP techniques (pace and lead, and calibration) which are very useful additions to the application of EFT.

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Full Title The CDC fourth national report on human exposure to environmental chemicals: what it tells us about our toxic burden and how it assist environmental medicine physicians.

The Centers for Disease Control (CDC) conducts ongoing assessments of the levels of environmental chemicals in the U.S. population. This ongoing study utilizes lab samples from the individuals who are part of the National Health and Nutrition Examination Survey (NHANES). The NHANES samples from the years 1999-2000, 2001-2002, and 2003-2004 (each representing about 2,400 individuals) were used for the CDC's national reports. In the CDC Fourth National Report on Human Exposure to Environmental Chemicals ("the fourth report") complete data from the above sample years were included. Each year additional chemicals are measured; the fourth report contains information on 75 previously untested compounds, for a total of 212 compounds measured. In the fourth report, blood and urinary levels of eight different forms of arsenic are reported. The fourth report, for the first time, also includes levels of solvents (30 different compounds) and provides adult rather than juvenile values for mercury. In the majority of individuals tested, acrylamides, cotinine, trihalomethanes, bisphenol A, phthalates, chlorinated pesticides, triclosan, organophosphate pesticides, pyrethroids, heavy metals, aromatic hydrocarbons, polybrominated diphenyl ethers, benzophenone from sunblock, perfluorocarbons from non-stick coatings, and a host of polychlorinated biphenyls and solvents were found. This review provides many of the ranges for xenobiotic toxins so a clinician can identify a patient's current exposure and toxic load compared to the national averages and monitor the effectiveness of prescribed treatments.

Crinnion WJ. Altern Med Rev. 2010 Jul;15(2):101-9. Environmental Medicine, Southwest College of Naturopathic Medicine, Tempe AZ, USA. w.crinnion@scnm.edu

Previous studies have shown increased false memory effects in older compared to younger adults. To investigate this phenomenon in event memory, in the present study, the authors presented younger and older adults with a robbery. A distinction was made between verbal and visual actions of the event, and recognition and subjective experience of retrieval (remember/know/guess judgments) were analyzed. Although there were no differences in hits, older adults accepted more false information as true and, consequently, showed less accurate recognition than younger adults. Moreover, older adults were more likely than younger adults to accompany these errors with remember judgments. Young adults accepted fewer false verbal actions than visual ones and awarded fewer remember judgments to their false alarms for verbal than for visual actions. Older adults, however, did not show this effect of type of information. These results suggest that aging is a relevant factor in memory for real-life eyewitness situations.

J Gen Psychol. 2009 Oct;136(4):428-41. Aizpurua A, Garcia-Bajos E, Migueles M. Psychology Faculty, University of the Basque Country, Avda. Tolosa 70, Donostia-San Sebastian 20.018, Gipuzkoa, Spain. aaizpurua012@ikasle.ehu.es

Dr. Lambrou is an accomplished speaker, presenter, and workshop leader. He has been an invited speaker and presenter at the Pacific College of Oriental Medicine 13th Annual Symposium, the International Congress of Aesthetic Medicine in Ixtapa, Mexico; 2nd Annual International Energy Psychology Conference; International Forum for New Science; The Ken Blanchard Companies, The Anthony Robbins Companies, Apple Computers, American Airlines, and many other organizations.

As a clinical instructor for the San Diego University for Integrative Studies, the University of California at San Diego, and other learning institutions, Dr. Lambrou blends experiential learning, case studies, and dynamic lectures and presentations to make the learning experience robust and fun.

He's Certified in Medical Hypnotherapy by the American Psychotherapy and Medical Hypnosis Association and a Clinical Member and Past President of the American Psychotherapy and Medical Hypnosis Association.

For more information about Dr. Lambrou, please visit his website at: http://www.peterlambrou.com/

Although not typical, there appears to be a growing trend of chiropractors working within collaborative care settings. We use a case report to highlight features of patient care and education related to chiropractic practice within a collaborative care model. This paper hopes to offer some insight into how a chiropractor might fit into a collaborative setting and what training might help them to function effectively. The case report used is an example where a chiropractor provided a secondary diagnosis and complementary care not previously considered by the allied team resulting in symptom control and return to work by the patient. By the nature of a chiropractor's ability to provide a primary or secondary musculoskeletal diagnosis, they have the capacity to offer an additive approach to patient care within collaborative care models. However, chiropractors wishing to work in these environments, such as a family health team, would benefit from further education.

Riva JJ, Muller GD, Hornich AA, Mior SA, Gupta A, Burnie SJ. J Can Chiropr Assoc. 2010 Sep;54(3):147-54. Department of Family Medicine, McMaster University, Hamilton, Ontario

The understanding of migraine has moved well beyond its traditional characterization as a "vascular headache." In considering the basic neurobiology of migraine, it is important to begin with the concept of migraine as not merely a headache, but rather a heterogeneous array of episodic symptoms. Among the array of phenomena experienced by migraine patients are visual disturbances, nausea, cognitive dysfunction, fatigue, and sensitivity to light, sound, smell, and touch. These symptoms may occur independently or in any combination, and in some patients occur even in the absence of headache. The diversity and variability of symptoms experienced by migraine patients belies a complex neurobiology, involving multiple cellular, neurochemical, and neurophysiological processes occurring at multiple neuroanatomical sites. Migraine is a multifaceted neurobiological phenomenon that involves activation of diverse neurochemical and cellular signaling pathways in multiple regions of the brain. Propagated waves of cellular activity in the cortex, possibly involving distinct glial and vascular signaling mechanisms, can occur along with activation of brainstem centers and nociceptive pathways. Whether different brain regions become involved in a linear sequence, or as parallel processes, is uncertain. The modulation of brain signaling by genetic factors, and by sex and sex hormones, provides important clues regarding the fundamental mechanisms by which migraine is initiated and sustained. Each of these mechanisms may represent distinct therapeutic targets for this complex and commonly disabling disorder.

Charles A, Brennan KC. Handb Clin Neurol. 2010;97C:99-108.

Brian Green is a Certified Clinical Hypnotherapist, a Chemical Dependency and Lifestyle Disorders Specialist, plus a Domestic Violence Counselor. He was trained at Gil Boyne's Hypnosis Institute. Where he was the Senior Staff Therapist and also in private practice for fifteen years. He is the author of the hypnosis manual, Mind-bending For Mind-mending, Wizard Ways With Words, the first installment of His Alchemy of Consciousness trilogy. His background in commerce, as a creative artist, and as a musician. This has given him a blend of intuition, inspiration and horse sense. He has presented workshops for the ACHE international Conference on "Hypno-linguistics" and Addictionology, taught at colleges and high schools. His practice is called – Holistic Hypnosis & Hypnotherapy, which is in Los Angeles, California.

Michael D. Yapko, Ph.D., is a clinical psychologist and marriage and family therapist residing in Fallbrook, California. He is internationally recognized for his work in clinical applications of hypnosis, treating depression, and developing strategic, outcome-focused psychotherapies. He routinely teaches to professional audiences all over the world. To date, he has been invited to present his ideas and methods to colleagues in 29 countries across six continents, and all over the United States.

Dr. Yapko is a member of the American Psychological Association, a clinical member of the American Association for Marriage and Family Therapy, a past Fellow of the Royal Society of Medicine's Division of Hypnosis and Psychosomatic Medicine (in England), a member of the International Society of Hypnosis, and a Fellow of the American Society of Clinical Hypnosis. He is a recipient of The Milton H. Erickson Lifetime Achievement Award (2007), twice a recipient of the Arthur Shapiro Award for the "best book of the year on hypnosis" from the Society for Clinical and Experimental Hypnosis for Treating Depression with Hypnosis (2001) and Hypnosis and Treating Depression (2006), and the 2003 Pierre Janet Award for Clinical Excellence from the International Society of Hypnosis, a lifetime achievement award honoring his many contributions to the field.

For more information visit http://www.yapko.com.

Full Title Physical examination and self-reported pain outcomes from a randomized trial on chronic cervicogenic headache.

OBJECTIVE: Objective clinical measures for use as surrogate markers of cervicogenic headache (CGH) pain have not been established. In this analysis, we investigate relationships between objective physical examination (PE) measures with self-reported CGH outcomes.

METHODS: This is an exploratory analysis of data generated by attention control PE from an open-label randomized clinical trial. Of 80 subjects, 40 were randomized to 8 treatments (spinal manipulative therapy or light massage control) and 8 PE over 8 weeks. The remaining subjects received no PE. Physical examination included motion palpation of the cervical and upper thoracic regions, active cervical range of motion (ROM) and associated pain, and algometric pain threshold evaluated over articular pillars. Self-reported outcomes included CGH and neck pain and disability, number of CGH headaches, and related disability days. Associations between PE and self-reported outcomes were evaluated using generalized linear models, adjusting for sociodemographic differences and study group.

RESULTS: At baseline, number of CGH and disability days were strongly associated with cervical active ROM (P < .001 to .037). Neck pain and disability were strongly associated with ROM-elicited pain (P < .001 to .035) but not later in the study. After the final treatment, pain thresholds were strongly associated with week 12 neck pain and disability and CGH disability and disability days (P < or = .001 to .048).

CONCLUSIONS: Cervical ROM was most associated with the baseline headache experience. However, 4 weeks after treatment, algometric pain thresholds were most associated. No one PE measure remained associated with the self-reported headache outcomes over time.

Vavrek D, Haas M, Peterson D. J Manipulative Physiol Ther. 2010 Jun;33(5):338-48. Center for Outcomes Studies, Western States Chiropractic College, 2900 132nd Avenue, Portland, OR 97230-3009, USA. dvavrek@wschiro.edu