J chiropr humanit2006-13-2-11

Journal of Chiropractic Humanities 2006 © NUHS Mind Map D’Antoni and Pinto Zipp2
Applications of the Mind Map Learning Technique in
Chiropractic Education: A Pilot Study and Literature
Review
Anthony V. D’Antoni, DC, MSa
, Genevieve Pinto Zipp, PT, EdDb
ABSTRACT
Objective: To present a review of the literature and survey results of student
satisfaction after using the mind map learning technique.
Methods: Fourteen third-year physical therapy students enrolled in a doctoral
neurorehabilitation course were required to create a mind map based upon the
lecture presentation and assigned reading for 6 diagnoses. The students were
asked to complete a post-course survey to assess their perceptions of the
usefulness of the mind map learning technique in improving organization and
integration of course material.
Results: Although the subject pool was limited to 14 students, 10 out of 14
agreed that the mind map learning technique enabled them to better
organize/integrate material presented in the course, while only 2 disagreed. The
final 2 students responded neutrally when asked if the mind map learning
technique assisted them in organizing/integrating course material. However, these
2 students did agree the technique enabled them to recognize areas in which
further study was necessary for them to adequately master the course material.
Conclusion: While the data obtained from this limited educational experience
offers some support for the use of the mind map learning technique in promoting
course material integration and learning in physical therapy education, further
work is needed to explore its usefulness in chiropractic education. (J Chiropr
Humanit 2006;13:2-11)
Key Indexing Terms: Chiropractic; Education, Professional; Learning; Problem-
Based Learning
INTRODUCTION
Recently there have been numerous
publications on learning strategies used in
chiropractic education that include case-
studies,1
information technology,2
didactic
learning, and problem-based learning
(PBL).3
These approaches have been
implemented in chiropractic education to
various degrees. For example, case-studies
a. Assistant Professor, Department of
Morphological Sciences and Department of Medical
Sciences, New York College of Podiatric Medicine,
1800 Park Ave, New York, NY 10035, and a PhD
student, Department of Graduate Programs in
Health Sciences, School of Graduate Medical
Education, Seton Hall University, South Orange,
NJ. Email: avdantoni@si.rr.com
b. Chair and Associate Professor, Department of
Graduate Programs in Health Sciences, School of
Graduate Medical Education, Seton Hall University.
Source of support: none declared.
Paper submitted April 24, 2006, in revised form
August 10, 2006.

have been used to enhance integration skills
in chiropractic students; whereas, PBL has
been used to teach students to become
lifelong, self-directed learners.4
One learning
strategy, which at present, has not been
widely used in chiropractic education is the
mind map learning technique, despite recent
research5
suggesting that mind mapping
improves long term memory in medical
students.
Mind mapping is a learning technique that
was developed by Tony Buzan.6
The
inspiration for this technique arose from the
notebooks of Leonardo da Vinci.7
Unlike
most learners, da Vinci’s notes were not
linear but elliptical—he used pictures and
text to illustrate ideas and often connected
different concepts together on the same
page. While this method of note taking was
confusing to read (especially since he wrote
backwards), it provided an opportunity to
integrate ideas, which allowed da Vinci to
effectively use both hemispheres of his
cerebrum to problem solve. Mind maps, like
da Vinci’s notes, are multi-sensory tools that
use visuospatial orientation to integrate
information and therefore help students
organize and retain information.8
Mind maps
are different than concept maps. The latter
are flow charts that use branch-like
architecture, usually in a superior-to-inferior
orientation, to organize information.9
In
addition, concept maps are devoid of
pictures and color.
Since problem solving is integral to the
practice of chiropractic, the mind map
learning technique can be an important
learning strategy to use in chiropractic
education. However, the efficacy of this
approach has yet to be demonstrated in
chiropractic education.
Because chiropractic students are considered
adult learners, learning strategies such as the
mind map technique may be applicable to
this group of students. Figure 1 illustrates
how adults acquire new knowledge; this
knowledge can be learned while reading a
Previous
factual
knowledge
Non-
academic life
experiences
Linear
approach
to learning
Non-linear
approach
to learning
Acquisition of
new
knowledge
Figure 1. Adults learn most effectively when they form a connection between newly and
previously acquired knowledge.11
The model above illustrates how previous factual knowledge
(acquired from academic pursuits) and life experiences (acquired from non-academic pursuits)
overlap to form a learning foundation. The learner will then use either a linear or non-linear
approach to acquire new knowledge. An example of a linear approach is the traditional outline
and an example of a non-linear approach is the mind map learning technique, which relies upon
visuospatial relationships. As depicted above, the learner may use both a linear and non-linear
approach to learn, and the percentage of each differs with each learner.

textbook during self-study, listening to a
lecture, or reviewing data obtained from a
patient history in the clinical setting.1,10,11
Factual knowledge obtained in academia
and life experiences of a non-academic
nature form a foundation for learning. The
overlap between these 2 components differ
among learners. For example, take 2
students enrolled in a doctor of chiropractic
(DC) program: one is 40 years old and the
other 20 years old. The 40-year-old
chiropractic student, who has worked as an
administrator for 2 decades, has a broader
repertoire of life experiences and potentially
less factual knowledge because he has been
out of academia for 2 decades. As a result,
his learning foundation for integrating new
knowledge is more likely to be based upon
life experiences rather than academic
knowledge. In contrast, the 20-year-old
student has been in academia for most of his
life and has limited work experience;
therefore, he may use more factual
knowledge and less life experiences as a
learning foundation. With their learning
foundations in place, both students will then
use either a linear or non-linear approach to
acquire new knowledge.
The predominant technique used by students
to learn is a linear approach, whereby the
student outlines information into categories
in a superior-to-inferior and left-to-right
spatial pattern. The mind map learning
technique is an example of a non-linear
approach to learning that forces the learner
to think radially using visuospatial
relationships.6,7
Some learners may use both
approaches to varying degrees to acquire
new knowledge whereas others may only
use one or the other. In this paper, we
describe how the mind map learning
technique can be used to teach chiropractic
students to become more balanced thinkers
and problem solvers.7,8
METHODS
The primary focus of this project was to
integrate the use of mind map learning
techniques into a professional education
program in an attempt to obtain pilot data
regarding the ability to enhance the
integration of knowledge through mind
mapping. In this initial attempt to utilize the
mind map learning technique, the doctor of
physical therapy (DPT) program at Seton
Hall University was utilized due to
feasibility. Specifically, post-lecture format
of mind mapping was introduced into the
neurorehabilitation course, which is offered
in the 3rd
year of the professional DPT
program. This format was chosen because it
allowed the students to gain knowledge of
the diagnosis from both lecture and assigned
readings, which theoretically, would make
the process of creating mind maps easier.
The fourteen students (n=14) enrolled in the
course were required to create a mind map
on the topic of stroke from the chapter in
their textbook12
and class notes. All students
were provided with reading materials and a
PowerPoint presentation on the mechanics
of creating a mind map (Fig 2). Students
were required to read all assigned readings
pertaining to the topic of stroke as outlined
in their syllabus and attend the lecture series
covering the topic of stroke rehabilitation
which was presented over a 3-week period.
Students were then instructed to complete
their mind maps after the lecture series and
submit them for review by the course
instructor.
The course instructor reviewed the mind
maps to ensure that major concepts
presented in the readings and lecture series
were represented in the student mind maps
regardless of their chosen format to display
them.

A secondary objective of this pilot study
was to record the students’ perceptions of
the usefulness of mind maps in integrating
their thoughts, as well as, to document any
resistance on their part to the technique.
Because no surveys to assess the
effectiveness or usability of mind maps exist
in the literature, we created a non-validated
survey to address these issues. Students
were asked to complete the survey in an
attempt to secure feedback from the students
on the following items:
1. Did the mind map technique allow you to
think about the material in a more integrated
fashion?
2. Did the mind map technique help you to
organize the material presented in class?
3. Did the mind map technique help you to
organize the material presented in the
textbook?
4. Did the mind map technique enable you
to recognize areas in which further study is
necessary to master the material?
5. Did the effort expended to create the
mind map exceed the benefits of its usage in
promoting material integration?
6. Was the mind map technique superior in
promoting material integration when
compared to previous learning strategies
used?
7. Would the mind map technique be useful
in devising effective treatment plans?13
8. Would you recommend that other
professors utilize mind maps in their courses
for material integration?
A MEDLINE search for articles published
between 1970 and 2005 was performed
using the combined terms education,
methods, and mind map. A total of 5 articles
were retrieved and 2 were retained because
of their relevancy to the topic.5,13
A manual
search of the Journal of Chiropractic
Education revealed 1 abstract published on
the topic of mind maps.14
RESULTS
Appendix A is an example of a student’s
initial mind map. Mind maps should contain
key words instead of sentences. It is
interesting that this student still incorporated
notes in a list-like fashion under the heading
“Vascular Syndromes” and this highlights
the difficulty that some students have re-
organizing information in a novel way. As
the semester progressed, so did the
complexity of the mind maps, such that by
the end of the semester, the mind maps were
more consistent with traditional mind maps.
Upon review of the surveys, the instructor
was able to obtain a more objective analysis
of the students’ overall perceptions about the
technique and its effectiveness in integrating
material, which may lead us to further assess
its potential use in chiropractic education.
Figure 2. Guidelines for creating a mind map.
a. Begin with blank paper (preferably greater
than 8 ½ by 11 inches) in landscape format
b. Draw an image in the center of the paper
that represents the theme of the mind map
c. From the central image, draw main
branches with accompanying key words
that represent the major headings of the
topic
d. Further divide the main branches into sub-
branches that each contains key words
e. Begin to find associations between
different areas of the mind map and draw
connections between these associations
f. Always print 1 key word per line, allowing
the word to be the same length as the line
upon which it rests
g. Use different colors throughout the mind
map and include as many pictures as
possible

Although the subject pool was limited to 14
students, 10 out of 14 agreed that the mind
map learning technique enabled them to
better organize/integrate material presented
in the course, while only 2 disagreed. The
final 2 students responded neutrally when
asked if the mind map learning technique
assisted them to recognize areas in which
further study was necessary for them to
adequately master the course material.
DISCUSSION
How to Construct a Mind Map
According to Buzan and Buzan,6
a mind
map should be drawn on blank paper that is
larger than standard 8 ½ by 11 in paper.
However, if this is impractical, then standard
size paper can be used. The rationale behind
using larger paper is to allow the student to
break away from the boundaries inherent in
standard size paper and thus propagate
creativity. The use of lined paper is
discouraged because it theoretically restricts
thought.7
Once suitable paper is obtained, a
medium for drawing the mind map is
necessary, namely, colored pens or pencils.
The student begins by drawing an image in
the center of the paper that reflects the
central theme, or topic, of the mind map. For
example, a mind map on the rules of mind
mapping could have an image of the
cerebrum in the center of the page. This
central image allows the student 360 degrees
of freedom to develop the mind map. Next,
the student would draw the main branches
with key words extending from the central
image and these branches represent the
different categories relevant to the content of
the mind map. In the previous example,
some of the key words are start, connect,
print, and association. It is important to
print the words and ensure that their length
is the same as the lines underneath them so
that the completed map will be easier to
comprehend. From these main branches,
relevant sub-branches are created. Each of
the branches and sub-branches should
contain accompanying pictures to aid the
student in recalling the information.
The data of Farrand et al5
show that
visuospatial arrangement enhances recall
more than simple note taking. As more sub-
branches are created, the student will
recognize patterns between key words that
should be connected, resulting in the
integration of different parts of the mind
map.
Appendix B illustrates one type of mind
map on the assessment and treatment of
stroke from a rehabilitative perspective. The
central image is an inferior view of the brain
emphasizing the circle of Willis. This image
is appropriate because stroke is a result of
either ischemia or hemorrhage of an artery
that supplies blood to the brain. There is a
connection between the tests important in
the diagnosis of stroke, such as urinalysis
(UA), complete blood count (CBC), and
epidemiology. The sensitivity and
specificity of these tests are statistical
concepts, which are a basis of epidemiology.
Therefore, this connection reminds the
student that epidemiology not only has
global applications, but it also affects
decision making in the clinical setting.
Another link was made between a risk factor
for stroke (heart disease) and the proposed
reasons for the differences in prevalence of
stroke between the US and other countries.
This connection highlights the role of life-
style choices in the genesis of heart disease.
These are 2 examples of patterns that
emerge when a student begins to construct a
mind map and this is the most powerful
aspect of the mind map technique because it
promotes integration, which is a basis for
critical thinking. We hypothesize that the

mind map technique can assist chiropractic
students in integrating their course material.
Use of Mind Maps in Health Professions
Education
Michelini13
discussed potential uses of mind
maps in nursing practice, and suggested that
mind maps could be used by home health
care nurses to teach patients how to take
their medications.
While the efficacy of the mind map
technique has not been investigated in
chiropractic education, a recent study by
Farrand et al5
addressed this issue in medical
education. In order to study whether or not
the mind map technique leads to greater
factual recall of written information, 50
medical students were exposed to a 600
word sample of scientific text and given 3
short tests based upon the text. The purpose
of the first test was to establish baseline
data. The students were then randomly
divided into 2 groups: half were assigned to
a mind map group and the other half to a
self-selected study group. After a 30 minute
interval, both groups were again exposed to
the text and they were told to use either
mind map or self-study techniques to learn
the material depending on their particular
group. The mind map group was trained in
the technique during the 30 minute interval,
whereas the self-selected study group was
simply told to return to the classroom on
time. Following a mental arithmetic task to
prevent rehearsal of the text, the students
were given a second test. The students
reconvened a week later to take a third test,
which was used to evaluate the effects of
both techniques on long-term memory.
Recall of factual material by both groups
were nearly the same at the first test
(baseline), as determined by the number of
correct answers, and recall was only slightly
higher in the mind map group after the
second test. However, 1 week later the mind
map group had statistically significant
higher factual recall when compared to the
self-study group, suggesting that the mind
map technique improved long-term memory
of factual information in these medical
students.
Potential Uses of Mind Maps in
Chiropractic Education
Although Farrand et al5
investigated the
efficacy of mind mapping in medical
students and not chiropractic students, we
suggest that because similarities exist
between these 2 health care professions and
their academic preparations,15
the benefits of
mind mapping demonstrated in medical
education may also be observed in
chiropractic education.
The mind map learning technique can be
used in numerous ways by chiropractic
school faculty in an attempt to provide
diverse educational experiences. The authors
offer several options for utilization
including: 1) pre-lecture format: integrating
concepts from assigned readings prior to
material review by instructor; 2) post-lecture
format: integrating concepts from assigned
readings and material previously reviewed
by instructor; and 3) case presentations to
integrate knowledge to process through a
clinical case.
Some guidelines for implementing the
technique in chiropractic education are:
1) Spend ample time explaining the theory
and rules of mind mapping prior to
implementation so that students clearly
understand that the images in their mind
maps do not have to be of the highest quality
but are nonetheless mandatory.
2) Cultivate a positive learning environment
by utilizing alternate learning strategies
(including mind mapping) which address

different student learning styles and thus
improve motivation for learning.
Limitations
Since the mind map technique was
incorporated into a single course with a
small student pool, at this time applicability
across a chiropractic curriculum cannot be
justified. Moreover, the results cannot be
applied to chiropractic education because
the subjects were physical therapy students.
While the data obtained from this survey of
student perceptions does not lend support for
the hypothesis that the use of the mind map
learning technique promotes course material
integration, through visual analysis of the
student mind maps we can infer that as a
result of the depth of integration between the
lecture material and course readings,
students did engage in active learning and
thus the use of the mind map learning
technique may be beneficial in promoting
integration of course material.
CONCLUSION
While the data obtained from our survey of
this limited educational experience offers
some support for the use of the mind map
learning technique in promoting course
material integration and learning, further
work is needed to explore its efficacy
throughout chiropractic curricula and across
a larger more diverse student population.
Contrary to the findings of Farrand et al5
that most of the medical students in the mind
map group were initially hesitant to use the
technique and unmotivated to learn it, the
physical therapy students in this
neurorehabilitation course responded
positively towards using this technique. The
physical therapy students’ positive responses
may be due to the fact that ample time was
provided to explain the theory and rules of
mind mapping before requiring the students
to create their own maps. Based upon our
experience with the physical therapy
students and utilization of the mind map
technique, we recommend that chiropractic
educators begin to incorporate mind maps
into their curricula since it is easy to use and
involves no cost.14
REFERENCES
1. Talmage DM. Teaching with cases to
enhance the clinical problem-solving skills
and integration skills of fourth-term
chiropractic students. J Chiropr Educ
2001;15:53-60.
2. Jamison JR. The use of information
technology to teach differential diagnosis to
chiropractic students. J Manipulative
Physiol Ther 2002;25:277-82.
3. Jiang B. Implementation of basic
disciplines into a problem-based learning
curriculum for first trimester chiropractic
students. J Chiropr Educ 1997;11:60-8.
4. Barrows HS. Practice-based learning:
problem-based learning applied to medical
education. Springfield: Southern Illinois
University School of Medicine; 1994.
5. Farrand P, Hussain F, Hennessy E. The
efficacy of the ‘mind map’ study technique.
Med Educ 2002;36:426-31.
6. Buzan T, Buzan B. The mind map book.
London: BBC Books; 1993.
7. Gelb MJ. How to think like Leonardo da
Vinci: seven steps to genius every day. New
York: Dell; 1998.
8. McDermott P, Clarke DN. Mind maps in
medicine. Edinburgh: Churchill Livingstone;
1998.
9. Pinto AJ, Zeitz HJ. Concept mapping: a
strategy for promoting meaningful learning
in medical education. Med Teach
1997;19:114-21.
10. Russell IJ, Caris TN, Harris GD,
Hendricson WD. Effects of three types of

lecture notes on medical student
achievement. Acad Med 1983;58:627-36.
11. Bellezza FS. The spatial arrangement
mnemonic. J Educ Psychol 1983;75:830-7.
12. O’Sullivan SB, Schmitz TJ. Physical
rehabilitation: assessment and treatment. 4th
ed. Philadelphia: FA Davis Co; 2001.
13. Michelini CA. Mind map: a new way to
teach patients and staff. Home Healthc
Nurse. 2000;18:318-322.
14. D’Antoni AV, Pinto Zipp G.
Applications of the mind map learning
technique in chiropractic education. J
Chiropr Educ 2005;19:53-4.
15. Coulter I, Adams A, Coggan P, Wilkes
M, Gonyea M. A comparative study of
chiropractic and medical education. Altern
Ther Health Med. 1998;4:64-75.

AppendixA.Studentmindmap.Themaphasnopicturesandlittlecolor.Althoughthere
issufficientdetailinthemap,thereistoomuchinformation.

AppendixB.Instructormindmapregardingassessmentandrehabilitationtreatmentforstroke.Themapcanbe
visualizedashaving4quadrantsinaclockwisefashion:quadrant1focusesonepidemiology,quadrant2onanatomy,
quadrant3onrehabilitation,andquadrant4onhistory,physicalexamination,andimpairments.

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