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DdDABCO: Diplomate of the American Board of Chiropractic Orthopedists. DACBR: Diplomate of the American Chiropractic Board of Radiology. DACS: Diplomate of Applied Chiropractic Science. Damages: Money or property a court or jury gives to an injured person. DC: Abbreviation for Doctor of Chiropractic. DDD: See Degenerative Disc Disease. Decerebrate Posture (Decerebrate Rigidity): Exaggerated posture of extension as a result of a lesion to the prepontine area of the brainstem, and is rarely seen fully developed in humans. In reporting, it is preferable to describe the posture seen. Decompression: In spine surgery, the term refers to the lessening of pressure on a nerve root, spinal nerve or the spinal chord. This is also a manual therapy term referring to the lessening of pressure on a nerve or joint through manual traction. De-conditioned: The loss of strength, flexibility and endurance due to long-term illness, injury, or lack of proper motion or exercise. Decorticate Posture (Decorticate Rigidity): Exaggerated posture of upper extremity flexion and lower extremity extension as a result of a lesion to the mesencephalon or above. In reporting, it is preferable to describe the posture seen. Decree: A judgment or order issued by a court. Decubitus: Pressure area, bed sore, skin opening, skin breakdown. A discolored or open area of skin damage caused by pressure. Common areas most prone to breakdown are buttocks or backside, hips, shoulder blades, heels, ankles and elbows. Deductible: An amount of money a person must pay for their health care costs before their health insurance company will begin to pay for any other health care costs. Generally, a person must pay a deductible every year. Deep Tendon Reflex Test: A physical exam technique used to determine the existence and functioning of the nerves connected to the tested muscle. With proper technique, in normal patients, striking the tendon of the muscle will elicit a standard contraction of the muscle, thus assuring the reflex “arc” is intact. Disruption of either the sensory or motor pathways will affect the reflex. Defamation: Injury to a person’s character, fame, or reputation by false and malicious statements. Default Judgment: When a defendant fails to formally answer a plaintiff’s complaint in a timely manner, the plaintiff may ask the court to enter a judgment against the defendant. Most often in personal injury cases, these judgments are set aside once the defendant begins to comply with the rules and initiates a formal defense by filing an answer. Defendant: The party the plaintiff claims is responsible for his/her damages and from whom the plaintiff seeks some form of relief. Deficit: A deficiency in amount or quality of functioning. Degenerative Changes: Degeneration of any joint due to wear and tear, trauma, or unusual postures. The degenerative changes include discspace narrowing, osteophytes or bony spurring. These type of changes can be seen both on x-ray and MRI imaging. Degenerative Disc Disease: An intervertebral disc, which has suffered the effects of the aging process or the effects of trauma. A disc becomes degenerated over time, often spanning years. Often there are small circumferential tears in the annulus fibrosis, the tough outer covering of the disc. A degenerated disc is also characterized by a loss of its height due to a drying-out of the nucleus pulposus, the gelatinous material inside the disc. It is often caused by a loss of motion between the vertebrae above and below, thus decreasing the mechanical flow of nutrients to the disc. Degenerative Facet Joints: Facet joints, which, as a result of age and time or trauma, have signs of arthritic changes. The degenerative arthritic changes may include thinning of joint spaces, changes in the joint and cartilage surfaces, and inflammation of the joint and connecting tissues of the joint. Degenerative facet joints may or may not be symptomatic. Degenerative Joint Disease: (DJD) In the spine, DJD refers to the inflammatory changes in the facet joint, also known as the zygapophyseal joints of the vertebral bodies. These changes often lead to bone changes and reduced range of motion at the joint. Degenerative joint disease is not limited to the spine. Degenerative Symptoms: Pain and physical restrictions are a result of degenerative changes usually in the weight-bearing joints of the body. Demand Letter: A letter expressly stating a legal right and an amount due as reasonable compensation for injuries to person and/or property. Denervation: The blocking of a nerve supply by trauma, degeneration or surgery. Deposition: A form of discovery whereby the attorney calling for the deposition has the right to ask questions and obtain answers from a party, witness, or expert while that individual is under oath. Notice of the deposition must be served on the party or witness five (5) days in advance of the date of the deposition unless the parties agree otherwise. A court reporter makes a word-for-word record of all that is said at the deposition. Dermatomal Somatosensory Evoked Potential: An electrical conductivity test specific to nerve (dermatome) patterns. See Somatosensory Evoked Potential, SSEP. Dermatome: A specific sensory nerve distribution pattern, which can be outlined or traced on the skin. Dessication: Dehydration of an intervertebral disc. Diffuse Axonal Injury (DAI): A shearing injury of large nerve fibers (axons covered with myelin) in many areas of the brain. It appears to be one of the two primary lesions of brain injury, the other being stretching or shearing of blood vessels from the same forces, producing hemorrhage. Diffuse Brain Injury: Injury to cells in many areas of the brain rather than in one specific location. Diplopia: Seeing two images of a single object; double vision. Direct Examination: The questioning of a witness by the attorney for the party on whose behalf the witness is called. Directed Verdict: At the close of a plaintiff’s case, a defendant asks the court to rule that the plaintiff has failed to put forth sufficient evidence, even when viewed in a light most favorable to the plaintiff, to support his/her claim. If the court so rules, the defendant is entitled to a dismissal without the defendant ever having to put on his/her case. Also, at the close of defendant’s case, plaintiff can ask the court to rule in its favor with a directed verdict on liability or special damages. Disc: See Intervertebral Disc. Disc Bulge: A broad-based enlargement of the annulus fibrosis extending past the edges of the adjoining vertebral end plates with herniation of the nucleus pulposus into or through the annulus fibrosis. See Bulging Disc. Disc Herniation: See Herniated Disc. Discectomy: The surgical removal of the bulging or extruding disc material (nucleus pulposus). Access to the bulging or extruding disc material may be had by removal of the lamina of the vertebral body (laminectomy) or the cutting of an opening in the lamina (laminotomy). Discectomy may be done in conjunction with a foraminotomy and/or a fusion. Discogenic Pain: Pain coming from the nerves embedded in the annular wall of the disc. Pain can arise from chemical or mechanical irritation of these nerves as a result of damage to the intervertebral disc. The outer portion of the annulushas sensory nerves and trauma or degenerative changes to the annulus can cause pain. Discography: An imaging procedure which reveals the inner structure and condition of an intervertebral disc by injecting dye through a needle placed into the disc. A CT Scan is then performed to image the disc more precisely. Discography can also be used to determine if the disc is a source of pain, in addition to revealing the disc’s inner structure. Discography is often employed to determine a patient’s suitability for fusion surgery in the neck, mid back, or low back. Discovery Process: Procedure for examination of documentary and physical evidence, and questioning of witnesses and parties to uncover evidence which is reasonably calculated to lead to the discovery of admissible evidence. Discovery may be obtained by the parties through interrogatories, requests for production of documents, depositions, and defense medical examinations. Information that can be obtained in discovery is broader in scope than what is deemed to be admissible at trial. Discrimination, Sensory: A process requiring differentiation of two or more stimuli. Disc Space Narrowing: A narrowing of the space between the vertebrae, produced by disc dehydration (dessication) and is often imaged by x-rays. See Degenerative Disc Disease. Disinhibition: Inability to suppress (inhibit) impulsive behavior and emotions. Disorientation: Not knowing where you are, who you are, or the current date. Health professionals often speak of a normal person as being oriented “times three” which refers to person, place and time. Distraction: (1) Application of a force to mildly and temporarily release pressure from a joint. This tractioning of a joint space is for the purpose of releasing entrapped soft tissues, such as the joint capsule or spinal nerve roots. This may be performed manually, by application of weight, or mechanically; (2) An orthopedic test wherein the examiner places his/her hands under the chin/jaw and gently pulls up. This maneuver may relieve pressure from the nerve roots and discs. If the patient feels relief of symptoms, the test is “positive”; or (3) The diversion of a patient’s attention from the primary activity being performed during physical examination. District Court: These are courts of limited jurisdiction in Washington State which have jurisdiction over cases not involving real estate, false imprisonment, defamation, malicious prosecution, or actions against executors of wills, and which otherwise do not exceed $50,000.00 in claimed damages. Diversified Technique: A chiropractic technique in which the primary manipulative force is applied by the practitioner’s hands. See Manipulation, Chiropractic. DJD: See Degenerative Joint Disease. DO: A physician graduating from a medical school of osteopathic medicine. Osteopathic doctors can use manipulation of the spine and administration of medications as part of their treatment of spinal complaints. See Osteopathic Physician. Docket: A calendar or agenda of court proceedings prepared by the clerk of the court. For example, a trial docket is a list of cases set to be tried at a specified term. Dominant Hand: The hand one uses most often because it is usually more coordinated and stronger than the non-dominant hand. Dorsal: Reference to the back or upper aspect of the body. On occasion it refers to the thoracic spine. Double Crush Syndrome: A nerve entrapment at two or more places along a nerve. Most typically the diagnosis refers to a carpal tunnel syndrome, cubital tunnel syndrome, and/or ulnar neuropathy nerve compression at the elbow, co-existing with pressure on the spinal nerve in the neck, causing numbness or tingling, muscle weakness or loss of reflex in the arm or hand. Dura: The outermost, toughest, fibrosis layer covering of the brain, spinal cord and nerve roots. It also holds the brain in place and contains the cerebral spinal fluid. Durable Power of Attorney: A legal document that appoints a person or agency to use your money to pay your bills and make medical decisions. Nursing homes or service providers are often appointed durable power of attorney to handle money and other decisions for the people with disabilities whom they serve. Dural Impingement: Pressure or deformation of the dura caused by bulging disc, bone spurs, or thickened ligaments. Dynamometer: A device which measures grip strength. Dysarthria: Difficulty in forming words or speaking them because of weakness of muscles used in speaking. Speech is characterized by labored, imprecise articulation. Tongue movements are usually slurred and the rate of speaking may be very slow. Voice quality may be abnormal, usually excessively nasal; volume may be weak; drooling may occur. Dysarthria may accompany aphasia or occur alone. Dysesthesia: An abnormal sensation that a patient reports as uncomfortable that may include burning, tingling, numbness, or “pins and needles”. Dysphagia: A swallowing disorder characterized by difficulty in oral preparation for the swallow, or in moving material from the mouth to the stomach. This definition also includes problems in positioning food in the mouth. Dysthymia: A chronic depressed mood lasting more than two years. |
