Jonathan Rouffe, DC

The role of scientific research conclusions with contemporary documentation to effectively support the necessity for clinically indicated care. The role of timely evaluations and re-evaluations in coordinating care inclusive of history, physical and evaluation report and concludes with the correlation of the SOAP Note and HCFA that correlates the conclusion of the evolutionary findings. Coordinating research and clinical findings with primary care providers and medical specialists in the rehabilitation process inclusive of insurance requirements and contemporary MRI research nomenclature.

Magnetic fields, T1 and T2 relaxations, nuclear spins, phase encoding, spin echo, T1 and T2 contrast, magnetic properties of metals and the historical perspective of the creation of NMR and MRI.

Normal anatomy of axial and sagittal views utilizing T1, T2, 3D gradient and STIR sequences of imaging. Standardized and desired protocols in views and sequencing of MRI examination to create an accurate diagnosis in MRI.

MRI interpretation of bulged, herniated, protruded, extruded, sequestered and fragmented disc pathologies in etiology and neurological sequelae in relationship to the spinal cord and spinal nerve roots.

MRI interpretation of bone, intradural, extradural, cord and neural sleeve lesions. Tuberculosis, drop lesions, metastasis, ependymoma, schwanoma and numerous other spinal related tumors and lesions.

MRI interpretation sequencing of the cervical, thoracic and lumbar spine inclusive of T1, T2, STIR and 3D gradient studies to ensure the accurate diagnosis of the region visualized.

The clinical application of the results of space occupying lesions. Disc and tumor pathologies and the clinical indications of manual and adjustive therapies in the patient with spinal nerve root and spinal cord insult as sequelae.

MRI slices, views, T1, T2, STIR axial, stacking, FFE, FSE and sagittal images. Clinical indication for the utilization of MRI and pathologies of disc in both trauma and non-trauma sequellae, including bulge, herniation, protrusion, extrusion and sequestration.

MRI slices, views, T1, T2, STIR axial, stacking, FFE, FSE and sagittal images in the interpretation of lumbar degeneration. With the co-morbities and complications of stenosis, pseudo-protrusions, cantilevered vertebrate, Schmorl's nodes and herniations. Central canal and cauda equina compromise interpretation with management.

MRI slices, views, T1, T2, STIR axial, stacking, FFE, FSE and sagittal images in the interpretation of lumbar herniations. With the co-morbities and complications of stenosis, pseudo-protrusions, cantilevered vertebrate, Schmorl's nodes and herniations. Morphology of lumbar disc pathologies of central and lateral herniations, protrusions, extrusions, sequestration, focal and broad based herniations are defined and illustrated. Central canal and cauda equina compromise interpretation with management.

MRI slices, views, T1, T2, STIR axial, stacking, FFE, FSE and sagittal images in the interpretation of cervical degeneration. With the co-morbidities and complications of stenosis, pseudo-protrusions, cantilevered vertebrate, Schmorl's nodes and herniations. Spinal cord and canal compromise interpretation with management.

MRI slices, views, T1, T2, STIR Axial, FFE, FSE and sagittal images in the interpretation of cervical herniations. With the comorbidities and complications of stenosis, pseudo-protrusions, cantilevered vertebrate, Schmorl's nodes and herniations. Morphology of cervical disc pathologies of central and lateral herniations, protrusions, extrusions, sequestration, focal and broad-based herniations are defined and illustrated. Spinal cord and canal compromise interpretation with management.

MRI slices, views, T1, T2, STIR Axial, FFE, FSE and sagittal images in the interpretation of degenerative spondylolesthesis, spinal canal stenosis, Modic type 3 changes, central herniations, extrusions, compressions, nerve root compressions, advanced spurring and thecal sac involvement from an orthopedic, emergency room, chiropractic, neurological, neurosurgical, physical medicine perspective.

An in-depth understanding of the protocols in triaging and reporting the clinical findings of the trauma patient. Maintaining ethical relationships with the medical-legal community.

An extensive understanding of the injured with clinically coordinating the history, physical findings and when to integrate neurodiagnostics. An understanding on how to utilize emergency room records in creating an accurate diagnosis and the significance of “risk factors” in spinal injury.

An extensive understanding of the physics involved in the transference of energy from the bullet car to the target car. This includes G's of force, newtons, gravity, energy, skid marks, crumple zones, spring factors, event data recorder and the graphing of the movement of the vehicle before, during and after the crash. Determining the clinical correlation of forces and bodily injury.

MRI interpretation, physiology, history and clinical indications, bone scan interpretation, physiology and clinical indications, x-ray clinical indications for the trauma patient.

Electromyography (EMG), Nerve Conduction Velocity (NCV), Somato Sensory Evoked Potential (SSEP), Visual Evoked Potential (VEP), Brain Stem Auditory Evoked Potential (BAER) and Visual-Electronystagmosgraphy (V-ENG) interpretation, protocols and clinical indications for the trauma patient.

Understanding the necessity for accurate documentation and diagnosis utilizing the ICD-9 and the CPT to accurately describe the injury through diagnosis. Understanding and utilizing state regulations on reimbursement issues pertaining to healthcare.

Understanding the necessity for accurate documentation, diagnosis and clinical correlation to the injury when reporting injuries in the medical-legal community. Documenting the kinesiopathology, myopathology, neuropathology, and pathophysiology in both a functional and structural paradigm.

Differential diagnosis and pathobiomechanics in the cervical, thoracic and lumbar spine as sequellae to micro and macro trauma and chronic biomechanic instabilities. Understanding the clinical implications of long term biomechanical failure in resulant disc pathology, ligament pathology and osseous pathology.

Buldge, herniated, protruded, extruded, sequestered discs, differential diagnoses, clinical triage implications, MRI physics and slice protocol.

Physicians management of acute episodes of back pain and tools to use to help influence patient recovery. Lifestyle factors that influence back pain, enabling physicians to provide advice and recommendations that will allow patients to recover from their acute back pain episode and make informed decisions about their behavior and lifestyle factors as it relates to back pain.

Determining the etiology of the patient's complaints in a traumatic or non-traumatic scenario. Analyzing the patient's past history and review of systems along with the performance of a complete　orthopedic, neurological and clinical examination to correlate both past, current and causality issues to formulate an accurate diagnosis, prognosis and treatment plan. There is an emphasis on triaging both the trauma and non-trauma patients.

Utilizing peer reviewed scientific literature in creating a diagnosis, prognosis and treatment plan for the chronic and acute patient. How to implement and stay current on techniques and technology in healthcare.

Correlating clinical findings and the patient history in determining the correct course of care in triaging the patient utilizing orthopedic and neurological evaluations in the clinical setting. Understanding the parameters for immediate referrals vs. following the continuum of care to determine the necessity for referrals.

Basic principles of ethics. Principles of professionalism which differentiate professions from vocations. Ethical challenges that confront the chiropractic profession and the chiropractor in today's practice environment.

Audits, denials and requests for refunds. Utilizing a checklist of minimum record keeping standards from the Florida DC licensing regulations, the Medicare Coverage Determinations and commonly accepted best practices. Self-audits, what to do with results and how to use process against unfavorable outside audits.

How all pertinent information should be documented and which code to use when billing for this service. E/M codes, accurate records, levels of care (focused, expanded, detailed, complex) and importance of relevant diagnoses in establishing the level of decision making.

Differential diagnosis, clinical assessments, and an evidence-based guide for primary care clinical management of chronic pain and inflammation. Assessments and therapeutic approaches using integrative chiropractic, naturopathic, osteopathic and functional medicine. Integrative orthopedics: concepts, algorithms, and therapeutics. Pathophysiology, differential diagnoses, clinical assessments and prevention of medical errors in providing primary care for pain and inflammation. Explore evidence-based, primary care treatment protocols for management of chronic pain.