MXPA98007682A - Method to evaluate the efficacy of manipulat therapy - Google Patents

Abstract

The present invention relates to a method for objectively verifying the efficacy of manipulative therapy. The method includes carrying out a first test of dermatomal somatosensory evoked potentials on a patient to establish a baseline response of the latency period of the nerve. A manipulative therapy technique is then carried out on the patient to relieve compression of the nerve root. A second test of dermatomal somatosensory evoked potentials is then carried out to establish a second nerve latency period after manipulation.

Description

METHOD FOR EVALUATING THE EFFICACY OF MANIPULATIVE THERAPY TECHNICAL FIELD OF THE INVENTION This invention relates to manipulative medicine in general and more particularly to a method for verifying the effectiveness of manipulative therapy using dermatomal somatosensory evoked potentials.

BACKGROUND OF THE INVENTION Somatosensory Evoked Potential Tests (EPS) have been used for at least 20 years to monitor spinal cord function during surgical procedures. Surgical procedures or instrumentation can produce tension on the spinal cord. The repeated measurement of somatosensory evoked potentials during surgery provides electrophysiological data that can be used by the team of surgeons to make diagnostic decisions regarding global spinal cord function and nerve root trauma.

However, somatosensory evoked potentials are not specific to the roots of the individual nerve because they use peripheral nerves that comprise nerve fibers that enter the spinal cord through several adjacent nerve roots. Consequently, the somatosensory evoked potential waveforms are often not sufficiently specific to identify the pathologies associated with the roots of individual nerves.

A Dermatomal Somatosensory Evoked Potential (DSEP) is produced by placing a surface electrode stimulating in a dermatomal field, such as an approved dermatome site and recording the signature electrical response of the scalp electrodes placed on the head of a patient on the somatosensory cortex of the patient. patient. The response evoked for this peripheral stimulus can theoretically be used to evaluate the sensory input through the roots of individual sensory nerves.

Dermatomal somatosensory evoked potentials have been successfully used to monitor spinal cord function during spinal surgery and to document successful final root decompression. In contrast to somatosensory evoked potentials, the evoked response measured by dermatomal somatosensory evoked potentials can be used to evaluate the sensory input through the roots of individual sensory nerves.

Patients with a radicular pain often choose to take a conservative course of therapy that may initially include a combination of physical therapy and spinal manipulation. Such therapy may include the use of equipment such as ACTIVATOR, or other similar equipment. Because the sensory components of nerve roots, especially the dorsal root ganglion, may be anatomically more vulnerable to mechanical or chemical pathology, patients may exhibit root pain and / or sensory loss without significant motor involvement. Although physical therapy and spinal manipulation can sometimes alleviate these examples, there are currently no methods that can be used to correlate the resolution of problems with the functioning of physical therapy using objective measurements.

SYNTHESIS OF THE INVENTION Therefore, a need has arisen for a method for evaluating the operation of a manipulative therapy that essentially eliminates or reduces the disadvantages and problems associated with the evaluation of the operation of the manipulative therapy.

In particular, a method is required to objectively evaluate the operation of manipulative therapy that eliminates the uncertainties associated with carrying out manipulative therapy to alleviate radicular pain and / or sensory loss.

One aspect of the present invention is a method for objectively verifying the efficacy of manipulative therapy. The method includes conducting a first approval of dermatomal somatosensory evoked potentials on a patient to establish a baseline response of the latency period of the nerve. A manipulative therapy technique is then carried out on the patient to relieve compression of the nerve root in the affected segment. A second test of dermatomal somatosensory evoked potentials is then carried out to establish a nerve latency period of subsequent manipulation.

The present invention provides many important technical advantages. An important technical advantage of the present invention is a method for evaluating the effectiveness of manipulative therapy using dermatomal somatosensory evoked potentials. The method of the present invention provides objective and repeatable results that identify particularly parts of the spine that may require manipulative therapy. In addition, the present invention can be used to verify the effectiveness of manipulative therapies.

DETAILED DESCRIPTION OF THE DRAWINGS For a more complete understanding of the present invention and the advantages thereof, reference is now made to the detailed description taken in conjunction with the accompanying drawings in which like reference numerals indicate like characteristics and wherein: Figure 1 is a diagram showing the placement of electrode on the head of a patient; Figure 2 shows connections between the electrodes for a test of dermatomal somatosensory evoked potentials and a patient; Figure 3 is a flow chart of a method for performing a dermatomal somatosensory evoked potential test involving concepts of the present invention; Fig. 4 is a flow diagram of a method for performing a dermatomal somatosensory evoked potential test including concepts of the present invention; Figure 5 is a method for using dermatomal somatosensory evoked potentials to verify the effectiveness of the concepts involving manipulative therapy of the present invention; Figure 6 is a graph of dermatomal somatosensory evoked potential latency as a function of the spinal segment; Y Figure 7 is a graph showing the dermatomal somatosensory evoked potential as a function of the lumbar spine segment.

DETAILED DESCRIPTION OF THE INVENTION Preferred embodiments of the present invention are illustrated in the figures. Like numbers are used to refer to the same and corresponding parts of the various drawings.

Figure 1 is an electrode placement showing the diagram on the head of a patient for use in dermatomal somatosensory evoked potential tests according to the teachings of the present invention. The placement of the test 10 includes the patient 12, the standard 9 mm diameter disc electrodes 14, 16, 18, 19, 20, 21 and 35, the conductors 22, 24, 26, 28 and 36, the electrodiagnostic 30, the stimulator electrode 32 and the conductor 34. The electrodes 14, 16, 18, 19, 20, 21 and 35 are recording electrodes of electroencephalogram (EEG) type disk diameter of 9 millimeters standard, and are applied to predetermined registration sites on the scalp and the patient's head. Alternatively, the electrodes 14, 16, 18, 19, 20, 21 and 35 may comprise other suitable electrode numbers.

In order to apply the electrodes, 14, 16, 18, 19, , 21 and 35 to the patient, the patient's skin at each of the registration sites is slightly pink to provide a skin resistance of less than 5 ohms. The electrodes 14, 16, 18, 19, 20, 21 and 35 are secured to the head of patient 12 with a self-adhering electrode cream. The electrodes 14, 18, 19, 20 and 21 are placed on the parietal scalp over the primary somatosensory areas in a coronal arch two centimeters posterior to Cz. Cz is the point defined by the intersection of the line dividing the left and right aural cavities and the line dividing the patient's nose that extends across the top of the patient's head to the base of the patient's skull.

The electrode 14 is placed in C2. , which is the point 2 centimeters after Cz. The electrodes 18 and 20 are placed on an arc that extends through the right and left aural cavities of the patient at a point equal to 20 percent of the distance between the left and right aural cavity. The electrodes 19 and 21 are placed on an arc extending through the left and right aural cavities of the patient at a point equal to 10% of the distance between the left and right aural cavity. The electrodes 18 and 20 may alternatively be referred to as the C3 electrodes, (left) and C4, (right), respectively, and electrodes 19 and 21 can alternatively be referred to as electrodes Cx, (left) and C2, (right), respectively.

During a dermatomal somatosensory evoked potential test, electrodes 18 and 20 will typically be used when 9 roots that extend through the cervical vertebrae are being tested. Electrodes 19 and 21 will typically be used when the nerve roots that extend through the lumbar vertebrae are being tested.

The electrode 35 is placed on the neck or chin of patient 12 and is mentioned as Fz,. The electrode 16 can also be mentioned as F2,. A ground electrode (not shown explicitly in Figure 1) was placed on the chest of patient 12 on the handlebar. The ground electrode can also or alternatively be placed in other suitable locations. Standard skin abrasion and other techniques can be used to bond the electrode to the ground to the patient.

The electrodes 14, 16, 18, 19, 20, 21, 32 and 35 are coupled to the electrodiagnostic unit 30 through the conductors 22, 24, 26, 26, 28, 28, and 36, respectively, thus forming a study of four-channel dermatomal somatosensory evoked potentials. The electrodes 14, 16, 18, 19, 20, 21 and 35 are disk electrode terminals of 9 millimeters in diameter. Alternatively, other suitable numbers of channels and electrodes may be used. The number of channels typically varies between one and eight.

The conductors 22, 24, 26, 28 and 36 can be copper conductors, coaxial conductors, pairs of twisted shielded conductors or other suitable conductors. The electrodiagnostic unit 30 comprises a multi-channel electric potential measuring device such as a MISTRAL, manufactured by TECA Corporation. Alternatively, the electrodiagnostic unit 30 may comprise other suitable measuring devices. The conductors 26 and 28 are coupled to the electrodes 18 and 20, respectively, when a cervical nerve root is being tested and to the electrodes 19 and 21 respectively, when a lumbar nerve root is being tested. Other nerve roots can also be tested where appropriate, such as the roots of the sacrum and thoracic nerve.

The electrodiagnostic unit 30 is coupled to the stimulator electrode 32 through the lead 34, and is operable to apply a controlled current in a variable continuous manner to control predetermined durations. For example, an electrodiagnostic unit may be operable to apply a variable current signal comprising square wave pulses with a frequency of 2 to 5 hertz and an amplitude ranging from 0 to 50 milliamps for a duration of 0.1, 0.3 and one millisecond to stimulate electrodes 32, and may further be operable to read the voltages of electrodes 14, 16, 18, 19, 20, 21 and 35 at a sensitivity varying from one microvolt per division to 5 millivolts per division. Alternatively, other suitable currents, voltages, waveforms, and frequencies can be used. The electrodiagnostic unit 30 is further operable to produce a graph or other useful data derived from the voltages read at the electrodes 14, 16, 18, 19, 20, 21 and 35, such as a scheme of a voltage at an electrode in relation to to the voltage in any other electrode.

In operation, the stimulator electrode 32 is used to apply a stimulus to approved dermatome sites to stimulate the nerves projecting through the roots of cervical nerves bilaterally into C6, C7 and C8. For example, the nerve projecting through the cervical nerve root bilaterally into C6 can be stimulated by applying an electric current to the thumb of patient 12, which is a dermatome site approved for the corresponding nerve. Similarly, an approved dermatome for the nerve projecting through the cervical nerve roots bilaterally in C7 is the middle finger, and an approved dermatome site for the nerve that projects through the roots of cervical nerves bilaterally in C8 it is the fifth digit.

Applying an electric current to these appropriate dermatomes stimulates the corresponding nerve. The stimulator electrode 32 may comprise a ring electrode when the electric current is applied to the dermatomes on the patient's fingers or thumbs. Alternatively, other suitable dermatomes can be stimulated.

If the test is being carried out to determine possible lumbosacral problems, the stimulating electrode 32 may comprise a bar electrode with 9-millimeter disc electrodes fixed at a distance of 3 centimeters. The dermatomes that correspond to nerves that project through the lumbosacral nerve roots bilaterally are then stimulated by applying an electric current to an approved corresponding dermatome site. For example, the middle calf, the middle greater toe, and the dorsolateral foot are appropriate dermatome sites that correspond to the lumbosacral nerve roots L4, L5, and SI.

For each dermatome, the sensory threshold is evaluated with square wave pulses of 0.1 to 0.3 milliseconds applied at two to five hertz. The amplitude of the current is also increased until the sensory threshold for that patient is determined. The subsequent test is carried out at twice the sensory threshold with square wave pulsations of constant current. This level of stimulation produces an optimal evoked response while reducing both the patient's discomfort and the spreading potential of the stimulus to adjacent dermatomes. Other levels of stimulation can also be used where appropriate, including but not limited to the stimulus below the sensory threshold. Similarly, other forms of stimulation, including but not limited to air and heat, can also be used where appropriate.

The applied signals from the stimulator electrode 32 cause a nerve response that is transmitted by the patient's nervous system to the somatosensory cortex of the patient, thus causing nerve stimuli that will be felt in the primary somatosensory areas. These nerve stimuli cause voltages to be generated in the electrodes 14, 16, 18, 19, 20, 21, and 35. These generated voltages are transmitted to the electrodiagnostic unit 30 by the conductors 22, 24, 26, 26, 28 , 28 and 36, respectively. The electrodiagnostic unit 30 then displays these measured voltages and registers them for a subsequent analysis. Typically, the electrodiagnostic unit exhibits the voltages measured at electrodes 14, 18, 19, 20 and 21 in relation to the voltage measured at electrode 16. This is typically mentioned as a four-channel dermatomal somatosensory evoked potential test, since electrode 16 is used in conjunction with any electrodes 14, 18 and 20 or electrodes 14, 19 and 21.

By measuring the time difference between the application of a signal on the stimulator electrode 32 to the measurement of a voltage response at the electrodes 14, 16, 18, 19, 20, 21 and 35, it is possible to determine the time required for the transmission of a nerve impulse signal through the patient's body 12 and up to the cerebral cortex. The measured transmission times can then be used for various diagnostic purposes. One such diagnostic purpose is to determine the affected lumbosacral or cervical nerve region that requires manipulative therapy. A second diagnostic purpose is to compare the measured transmission time with a previously measured transmission time taken before performing the manipulative therapy technique on the patient, in order to verify if the manipulative therapy procedure was effective.

In general, the term "manipulative therapy" refers to any form of physical manipulation of a patient that is carried out for the purpose or with the possible effect of relieving nerve root compression. Similar terms refer to the physical manipulation of a patient including, but not limited to physical therapy, spinal manipulation, adjustment, mobilization or massage.

In addition, the average transmission times can be used for a non-diagnostic purpose, such as to verify whether a particular manipulative therapy technique is effective. For example, a new technique of manipulative therapy can be carried out on a sample population of patients having a known lumbosacral or cervical condition. The transmission times measured for these patients before and after performing the manipulative therapy technique can then be compiled and analyzed to determine if the manipulative therapy technique was effective or to determine the potential alterations that can be made to the manipulative therapy technique. to improve its effectiveness.

The second dermatomal somatosensory evoked potential test can be carried out at any time after manipulative therapy, including, but not limited to, immediately after manipulative therapy, several hours after manipulative therapy, or several days after manipulative therapy. . Similarly, tests of additional dermatomal somatosensory evoked potentials can be carried out at these or other times to verify the patient's condition.

Figure 2 shows a front view of a patient 12 while being tested by means of an electrodiagnostic unit 30 according to the concepts of the present invention. The electrode 44 is applied to the patient's chest 12 and is coupled to the electrodiagnostic unit 30 via the lead 46. The electrode 44 is a standard EEG type electrode-to-ground electrode recording electrode, which is secured with cream of self-adhering electrode to the skin of patient 12. As previously noted, the skin of patient 12 may be lightly abraded to provide a skin resistance of less than 5 ohms.

The stimulator electrode 32 as shown in Figure 2 is applied to the dermatome 42 L4 on the left side of patient 12 in the middle calf. When an electrical current is delivered to dermatome 42 L4, a generated nerve impulse travels through the leg of patient 12 until it reaches the spinal column of patient 12. This nerve impulse enters the spinal column at the root of lumbosacral nerve L4 and proceeds to the spinal column of patient 12 until it reaches the cerebral cortex. The nerve impulse is carried to the cerebral cortex and generates a voltage at electrodes 14, 16, 19, 21 and 35 upon reaching the cerebral cortex.

The electrodiagnostic unit 30 measures the voltages at the electrodes 14, 16, 19, 21 and 35 and uses the voltage of the electrode 44 as a common voltage reference point (patient land). The nerve signals generated by the stimulator electrode 32 in dermatome L4 42 on the left side will enter the right side of the cerebral cortex and are therefore detected by electrodes 14, 19, and 21.

If the patient 12 is not experiencing a nerve injury, the time required for transmission of the signal generated by the application of the stimulating electrode 32 should fall within normative values and should be detected at electrodes 14, 16, 19 and 21. By drawing the received signal at electrodes 14, 16, 19 and 21 against time, it is possible to determine the nerve impulse displacement time, also known as latency.

Figure 3 is a flow chart of a method 50 for measuring dermatomal somatosensory evoked potentials to be used in conjunction with manipulative therapy. The method of Figure 3 is used repeatedly, at predetermined locations and at predetermined times, according to the teachings of the present invention. In step 52, the electrodes are installed on a patient in a manner similar to that described above. In step 54, the test signals, such as current pulses are applied to standard dermatomes, such as the thumb for dermatome C6, the middle finger for dermatome C7, the fifth finger for dermatome C8, the middle calf for dermatome L4, middle big toe for dermatome L5 and lateral dorsal foot for dermatome SI.

The test signal applied in step 54 is initially calibrated to determine a sensory threshold. For example, if the test signal is a current pulse, the current can be applied in magnitudes of increasing current amplitude until a sensory threshold response is noted by the patient. The subsequent test is then carried out at a current pulse magnitude that is twice the patient's sensory threshold, or other suitable stimulating levels.

The test then continues by applying the test signals and recording the corresponding transit time in step 56. For example, the electrodiagnostic unit 30 is designed to measure the time difference between the application of a test signal comprising a current pulse in dermatome 42 and measurement of a response voltage at electrodes 14, 16, 18, 19, 20, 21 and 35. This information is displayed to the user through an electrodiagnosis unit display 30. Test is completed when a set of measurements is taken that can be used to measure the transit time between the application of the test signal and the measurement of a voltage response at electrodes 14, 16, 18, 19, 20 and 21 and 35 Figure 4 is a flow chart of a method 60 for performing a dermatomal somatosensory evoked potential test on a patient in conjunction with a manipulative therapy technique. In step 62, the test is carried out on dermatomes corresponding to the lumbar region on the right side of a patient. For example, as described above in order to determine a patient's response, a bar electrode comprising two 9-millimeter disc electrodes fixed at a distance of 3 centimeters can be used to apply an electrical current impulse to the middle calf. , to the middle big toe, and to the nerves of the dorsal lateral foot. The corresponding nerve impulse transit times are then measured in order to determine the state of lumbosacral nerve roots L4, L5 and SI.

In step 64, the test is carried out on the roots of the cervical nerve on the right side. For example, as described above in order to determine the response of a patient, a ring electrode can be used to apply an electric current pulse to the thumb, middle finger and fifth finger of the patient. The corresponding nerve impulse transit times are then measured in order to determine the state of the cervical nerve roots C6, C7 and C8.

In step 66, the test is carried out for the lumbar region on the left side of the patient. Similarly, in step 68, the test is carried out on the left side of the patient for the cervical region. All these tests can be done through a method to measure dermatomal somatosensory evoked potentials similar to those shown in Figure 3.

In the operation, method 60 provides data that can be used to evaluate the dermatomal somatosensory evoked potential latency period, which is the transmission time required for a nerve impulse to reach the cerebral cortex of a patient from a dermatome region. of the patient. Dermatomal somatosensory evoked potentials must follow known rules of physiological behavior. For example, pulses applied to the left side of a patient should have a main response on the right side of a patient. Similarly, the dermatomal somatosensory evoked potential latency period for left-sided dermatomes must be equal to that for dermatomes on the right side, in the absence of problems or spinal injury.

Figure 5 is a flow chart of a method 80 for using dermatomal somatosensory evoked potentials to determine the efficacy of manipulative therapy procedures, encompassing concepts of the present invention. In step 82, preliminary dermatomal somatosensory evoked potential data for a patient is generated. For example, preliminary data for the patient can be generated by performing a dermatomal somatosensory evoked potential test using a method similar to that shown in Figures 3 and 4.

In step 84, the test results of the right side and the left side are compared. For example, the data may be stored in the electrodiagnostic unit 30 and may be superimposed or otherwise presented to the user in a form that allows the user to determine the dermatomal somatosensory evoked potential latency period for each cervical and lumbar spinal segment. In step 86, the appropriate manipulative therapy technique, if any, is determined by the patient based on the preliminary data. For example, if the data indicate a potential source of radicular pain in the lumbar region of the L5 vertebra, a manipulative therapy technique can be chosen that realizes the L5 lumbar vertebrae in order to alleviate the impact on the roots of the lumbosacral nerves.

In step 88, the chosen manipulative therapy technique is carried out to alleviate any potential source of nerve compression. After completion of the manipulative therapy technique, the method proceeds to step 90. In step 90, dermatomal somatosensory evoked potential data after the test is compiled, such as by performing a dermatomal somatosensory evoked potential test. according to a method similar to that shown in Figure 4. In step 92, the results of the data after the test and of the data before the test are compiled and compared to determine whether the manipulative therapy carried out in Step 88 has been successful. For example, the improvement can be shown by a decrease in the period of potential dermatomal somatosensory evoked dormancy.

In step 94, it is determined if there is an improvement in the test data. For example, a dermatomal somatosensory evoked potential test of pretreatment may have resulted in a latency period exceeding two standard deviations of a normal response. If the test of dermatomal somatosensory evoked potentials after treatment results in a latency period that is within two standard deviations of a normal response, improvement is noted and manipulative therapy is stopped. The method then proceeds to step 96, and the patient is allowed to recover.

Otherwise, the method proceeds to step 98 and it is determined whether the manipulative therapy technique has been repeated. If the technique of manipulative therapy has not been repeated, it is possible that the technique of manipulative therapy carried out in step 88 has been ineffective. The method then returns to step 88 and the manipulative therapy technique is carried out again. If it is determined in step 98 that the manipulative therapy technique has been repeated, the method proceeds to step 100.

In step 100, a determination is made as to whether the manipulative therapy technique is carried out in step 88 has been inadequate. As noted previously, method 80 can be used to evaluate a manipulative therapy technique, either to determine whether the technique is effective or to determine whether an improvement can be made to the art. If it is determined in step 100 that the manipulative therapy technique applied in step 88 is not effective, this information can be used for a non-diagnostic purpose, such as to determine in conjunction with other similar data whether a particular manipulative therapy technique It is effective for use with any patients.

Alternatively, a determination can be made in step 100 to carry out additional manipulative therapy techniques, such as those manipulating other parts of the patient or ones that provide the desired results under existing conditions. Similarly, if several manipulative therapy techniques have been tried, and it appears that manipulative therapy is not solving the problem, these results can be used to support a diagnosis to perform surgery.

The figure 6 is a graph of the results of the dermatomal somatosensory evoked potential dormancy before treatment and after treatment as a function of the cervical spinal segment for a population of sample patients. The images 102 represent measurements of dermatomal somatosensory evoked potentials from pretreatment of patients exhibiting latency periods of more than two times the standard deviation of normal healthy patients. The images 104 represent the dermatomal somatosensory evoked potential latency periods of post-treatment for the same group of patients after the manipulative therapy. As can be seen in figure 6, the dermatomal somatosensory evoked potential latency periods are significantly different for the post-treatment group than for the pre-treatment group.

As can be seen from the results shown in Figure 6, it is possible to determine whether a manipulative therapy technique has a physiological effect on the nerve impulse transmissions of the patient by measuring dermatomal somatosensory evoked potentials in conjunction with the operation of the technique of manipulative therapy. These results demonstrate that the methods shown in Figure 3 through Figure 5 can be used successfully to determine appropriate manipulative therapy based on the suspected location of nerve root compression, and can also be used to determine the effectiveness of the techniques of manipulative therapy that carried out to relieve the compression of the nerve root. Similarly, the methods shown in Figure 3 to Figure 5 can also be used to determine whether a new or experimental manipulative therapy technique is effective in relieving nerve root compression on patients with nerve root compression problems. known.

Figure 7 is a schematic showing the dermatomal somatosensory evoked potential latency period for the lumbar spinal segments. These measurements of dermatomal somatosensory evoked potentials, taken before and after performing the manipulative therapy techniques, indicate that the latency period for compression of the nerve root by the lumbar spinal segment L4 did not improve after the performance of the manipulative therapy technique for the lumbar spinal segment L4. These results indicative of an ineffective manipulative therapy. Therefore, the method of the present invention can be used to validate manipulative therapies, to determine whether manipulative therapies in fact decreasing the nerve impulse latency period.

In the operation, dermatomal somatosensory evoked potentials measured before carrying out a manipulative therapy technique to determine whether the nerve impulse latency period for the nerve roots entering a patient's spinal cord is greater than a predetermined amount such as twice the standard deviation of normal healthy patients. The technique of manipulative therapy is then carried out on the patient, and then dermatomal somatosensory evoked potentials measured again and comp with the initial results. A decrease in the nerve impulse latency period within the predetermined amount can be used to defer the successful completion of the manipulative therapy technique.

The present invention provides many important technical advantages. An important technical advantage of the present invention is a method for evaluating the effectiveness of manipulative therapy using dermatomal somatosensory evoked potentials. The method of the present invention provides objective and repeatable results that identify particularly parts of the spine that may require manipulative therapy.

In addition, the present invention can be used to verify the effectiveness of manipulative therapies.

Although the present invention has been described in detail, it should be understood that various changes, substitutions and variations may be made here without departing from the spirit and scope of the invention as defined by the appended claims.

Claims (29)

R E I V I N D I C A C I O N S

1. A method to verify the efficacy of manipulative therapy comprising: carry out a first test of dermatomal somatosensory evoked potentials on a patient to establish a baseline response; carry out a first technique of manipulative therapy of nerve root compression relief on the patient; carry out a second test of dermatomal somatosensory evoked potentials on the patient to establish a response after manipulation; Y compare the response after manipulation with the baseline response.

2. The method as claimed in clause 1, characterized in that carrying out a first dermatomal somatosensory evoked potential test further comprises carrying out a four-channel dermatomal somatosensory evoked potential test.

3. The method as claimed in clause 1, characterized in that carrying out a first test of dermatomal somatosensory evoked potentials further comprises carrying out a dermatomal somatosensory evoked potential test having a number of channels equal to one of one to eight channels.

4. The method as claimed in clause 1, characterized in that carrying out a first test of dermatomal somatosensory evoked potentials further comprises: place a first electrode on the right side of the patient's head; place a second electrode on the left side of the patient's head, - place a third electrode on the back side of the patient's head; place a fourth electrode on the front side of the patient's head; Y place a fifth electrode on a chin and the patient's neck.

5. The method as claimed in clause 1, characterized in that carrying out a first test of dermatomal somatosensory evoked potentials further comprises: apply one or more test signals to the patient; measure a corresponding response voltage for each application of a test signal; Y determine the period of time between the application of the test signal and the measurement of the corresponding response voltage for each application of a test signal.

6. The method as claimed in clause 5, characterized in that applying one or more test signals further comprises applying the test signals to two or more dermatome sites.

7. The method as claimed in clause 5, characterized in that applying one or more test signals further comprises: apply the test signals to two or more dermatome sites on the left side of the patient; and apply the test signals to two or more dermatome sites on the right side of the patient that correspond to two or more dermatome sites on the left side of the patient.

8. The method as claimed in clause 1, characterized in that carrying out a first manipulative nerve root compression relieving therapy further comprises manipulating certain predetermined locations of the patient to cause a movement of one or more spinal vertebrae such as to relieve any mechanical stress on one or more nerve roots of the patient.

. The method as claimed in clause 1, characterized in that it comprises carrying out a second dermatomal somatosensory evoked potential test comprising performing a four-channel dermatomal somatosensory evoked potential test.

10. The method as claimed in clause 1, characterized in that carrying out a second test of dermatomal somatosensory evoked potentials further comprises: placing a first electrode on a right side of the patient's head; place a second electrode on the left side of the patient's head; placing a third electrode on a back side of the patient's head; placing a fourth electrode on a front side of the patient's head; Y place a fifth electrode on the chin and neck of the patient.

11. The method as claimed in clause 1, characterized in that carrying out a second dermatomal somatosensory evoked potential test further comprises: applying one or more test signals to the patient; measuring a corresponding response voltage for each application of one or more test signals; and determining the period of time between the application of the test signal and the measurement of the corresponding response voltage for each application of the test signal.

12. The method as claimed in clause 11, characterized in that applying one or more test signals further comprises applying the test signal to two or more dermatome sites.

13. The method as claimed in clause 11, characterized in that applying one or more test signals further comprises: applying the test signals to two or more dermatome sites on the left side of the patient; Y apply the test signals to two or more dermatome sites on the right side of the patient that correspond to two or more dermatome sites on the left side of the patient.

14. The method as claimed in clause 1, characterized in that it comprises: carry out a second manipulative nerve compression compression therapy on the patient if the response after manipulation is not different from the baseline response; Y carry out a third test of dermatomal somatosensory evoked potentials.

15. The method as claimed in clause 14, characterized in that carrying out a second manipulative nerve root compression relieving therapy further comprises manipulating certain predetermined locations of the patient to cause the movement of one or more spinal vertebrae as to relieve any mechanical stress on one or more roots of the patient's nerve.

16. The method as claimed in clause 1, characterized in that carrying out a first manipulation therapy of compression of the nerve root compression on the patient further comprises: determine a first manipulative therapy of nerve root compression relief based on the results of the first dermatomal somatosensory evoked potential test; Y carry out the first manipulative therapy of compression of nerve root compression on the patient.

17. A method to verify the effectiveness of a manipulative therapy technique comprising: carry out a first test of dermatomal somatosensory evoked potentials on a patient to establish a baseline response; carry out a technique of manipulative therapy to relieve compression of the nerve root on the patient; carry out a second test of dermatomal somatosensory evoked potentials; Y To compare the results of the first test of dermatomal somatosensory evoked potentials with the results of the second dermatomal somatosensory evoked potential test to determine if the technique of manipulation of nerve root compression relieving therapy caused a change in the results of the test. dermatomal somatosensory evoked potentials.

18. The method as claimed in clause 17, characterized in that carrying out a first test of dermatomal somatosensory evoked potentials comprises carrying out a four-channel dermatomal somatosensory evoked potential test.

19. The method as claimed in clause 17, characterized in that carrying out a dermatomal somatosensory evoked potential test further comprises carrying out a dermatomal somatosensory evoked potential test having a number of channels equal to one of the channels one to eight.

20. The method as claimed in clause 17, characterized in that carrying out a first test of dermatomal somatosensory evoked potentials further comprises: place a first electrode on the right side of the patient's head; place a second electrode on the left side of the patient's head; place a third electrode on the back side of the patient's head; place a fourth electrode on a front side of the patient's head; Y place a fifth electrode on one side of the chin and the patient's neck.

21. The method as claimed in clause 17, characterized in that carrying out a first test of dermatomal somatosensory evoked potentials further comprises: apply one or more test signals to the patient; measure a corresponding response voltage for each application of the test signal; Y determine the period of time between the application of the test signal and the measurement of the corresponding response voltage for each application of the test signal.

22. The method as claimed in clause 21, characterized in that applying one or more test signals further comprises applying the test signal to two or more dermatome sites.

23. The method as claimed in clause 21, characterized in that applying one or more test signals further comprises: apply the test signals to two or more dermatome sites on the left side of the patient; and apply the test signals to two or more dermatome sites on the right side of the patient corresponding to the two dermatome sites on the left side of the patient.

24. The method as claimed in clause 17, characterized in that to conducting an manipulative therapy relief root compression further comprises manipulating predetermined locations of the patient to cause movement of one or more spinal vertebrae to relieve any tension mechanics on one or more roots of the patient's nerve.

25. The method as claimed in clause 17, wherein the performing a second test dermatomal somatosensory evoked potential further comprises carrying out a test of somatosensory evoked potentials dermatomal four channels.

26. The method as claimed in clause 17, characterized in that carrying out a second test of dermatomal somatosensory evoked potentials further comprises: place a first electrode on the right side of the patient's head; place a second electrode on the left side of the patient's head; placing a third electrode on a back side of the patient's head; placing a fourth electrode on a front side of the patient's head; Y place a fifth electrode on the side of the chin and neck of a patient.

27. The method as claimed in clause 17, characterized in that carrying out a second dermatomal somatosensory evoked potential test further comprises: apply one or more test signals to the patient; measure a corresponding response voltage for each application of the test signal; Y determine the period of time between the application of the test signal and the measurement of the corresponding response voltage.

28. The method as claimed in clause 27, characterized in that applying one or more test signals further comprises applying the test signal to two or more dermatome sites.

29. The method as claimed in clause 27, characterized in that applying one or more test signals further comprises: apply the test signals to two or more dermatome sites on the left side of the patient; Y Apply the test signals to two or more dermatome sites on the right side of the patient that correspond to two or more dermatome sites on the left side of the patient. SUMMARY A method is provided to objectively verify the efficacy of manipulative therapy. The method udes conducting a first test of dermatomal somatosensory evoked potentials on a patient to establish a baseline response of the latency period of the nerve. A manipulative therapy technique is then carried out on the patient to relieve compression of the nerve root. A second test of dermatomal somatosensory evoked potentials is then carried out to establish a second nerve latency period after manipulation.