Physical Medicine / OMM

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    Infant Somatic Dysfunction and Breastfeeding LATCH Assessments following Osteopathic Manipulative Treatment
    (2024-03-21) Murray, Cameron; Morse, Katelyn; Roop, Jay P.; Miller, Courtney; Griner, Stacey; Hensel, Kendi
    Purpose Importance: Breastmilk is known to be beneficial for newborns but challenges with latching can provide a significant barrier for breastfeeding. Such challenges may possibly stem from biomechanical and neurological restrictions inhibiting proper latching and sucking in infants. Osteopathic Manipulative Treatment (OMT) may address somatic dysfunctions associated with these restrictions and improve breastfeeding outcomes. Objective: To evaluate changes in infant somatic dysfunctions after a single OMT treatment and assess correlation with changes in latching using the LATCH assessment tool. Methods OMT was performed on 40 participants seen at the For Babies’ Sake clinic in Fort Worth, Texas between October 2022-July 2023. Eligible patients under 6 months old met at least one of the following criteria: feeding difficulty, ankyloglossia, or difficulty maintaining weight. Exclusion criteria included neurologic conditions, cleft lip or palate, lingual frenectomy within 72 hours of visit, hospital admission, and any conditions in which OMT would be contraindicated. Intervention: During two visits 1 week apart, an Osteopathic physician assessed participants’ somatic dysfunctions in the following regions: OA/condyles, occiput and OM, frontal bones, nasion, maxilla/premaxilla, zygomas/TMJ/temporals, tongue/pterygoids, anterior cervical muscles/hyoid, trunk/viscera, ribs/mediastinum, sacrum, pelvis, hips, knees, and navicular regions. Somatic dysfunctions were rated as 0=no somatic dysfunction, 1=mild, 2=moderate, 3=severe, marked or resistant. Somatic dysfunctions were addressed with treatments including: myofascial release, balanced ligamentous tension, balanced membranous tension, osteopathic cranial manipulative medicine, or vibratory treatment by percussion hammer. Parents completed a standardized LATCH assessment during visits 1 and 2, and responded to a LATCH questionnaire after visit 2. The LATCH questionnaire was shown to be a validated measure of latch, audible swallowing, nipple type, comfort, and hold and results in scores of 0-10, with higher scores indicating better breastfeeding outcomes. Main Outcomes and Measures: Rated somatic dysfunctions were compared between visit 1 and 2 to assess for statistically significant improvement. Changes in somatic dysfunction and LATCH scores were also assessed for correlation using t-tests. Results Mean age was 7.14 weeks (standard deviation=4.44). The following regions showed significant reduction in somatic dysfunction (p<.05) from visits 1 to 2, with mean change values shown here: OA/Condyles: -.75, Tongue/Pterygoids: -0.58, Trunk/viscera: -0.50, and Navicular: -0.38. The mean sum of all somatic dysfunctions was also significantly reduced by 4.15 between visit 1 and 2 (p<.01). The sacrum region was related to LATCH score change, with lower sacrum improvement across visits negatively correlated to more improvement LATCH scores from visits 1-3 (p<.01) and visits 2-3 (p<.05). Conclusions These results suggest that a single osteopathic treatment may reduce somatic dysfunction in newborns in multiple body regions. The connection of somatic dysfunctions and LATCH scores needs further research. Though helpful for assessing latch quality, the LATCH assessment does not assess actual infant milk intake or weight gain. Future studies could compare weight gain between OMT treated infants and a control group. It would also be beneficial to replicate this study with additional Osteopathic physicians to determine if improved somatic dysfunction results are repeatable between physicians.
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    Effects of Osteopathic Manipulative Treatment on Breastfeeding LATCH Assessments in Infants
    (2024-03-21) Morse, Katelyn; Murray, Cameron; Miller, Courtney; Griner, Stacey; Hensel, Kendi
    Importance: Effective suckling is crucial for infants to gain nutrition, grow, and bond with their mothers. Suckling difficulties within the first month can put infants at a higher risk of early weaning. Successful suckling involves coordinated movements of the lips, tongue, and jaw which rely on input from cranial nerves. Half of mothers who stop breastfeeding in the first month report biomechanical issues, highlighting the need to address these challenges for successful breastfeeding. Osteopathic Manipulative Treatments (OMT) have been utilized to treat the infant population for a variety of somatic dysfunctions and may be effective for suckling difficulties. Objective: To evaluate infants’ LATCH assessment scores before and after OMT sessions in the term infant population with feeding difficulties. Design, Settings, and Participants: This was a longitudinal prospective study conducted between October 2022 and July 2023 of 40 term infants <6 months of age with at least one of the following conditions: feeding difficulty, ankyloglossia (tongue tie), difficulty gaining and/or maintaining weight. After completing an initial eligibility screening, patients and their parents attended two clinic visits one week apart. Parents completed a LATCH questionnaire to evaluate infant latching at the beginning of each visit (visits 1-2). A phone follow up was conducted two weeks after the second visit to collect the LATCH survey over the phone (visit 3). Interventions: Participants received two full body OMT treatments one week apart, done by two different osteopathic physicians. Main Outcomes and Measures: LATCH assessment tool assigns a score of 0, 1, or 2 for five components (Latch, Audible swallowing, Type of nipple, Comfort, Hold) of feeding for a possible total score of 10 points, with higher scores indicating better outcomes. LATCH numerical scores were compared between the two visits to gauge improvement of the infant’s feeding abilities following OMT. LATCH scores were compared between the first and second visit, the second and third visit, and from visit 1 to visit 3 using independent samples t-tests. Results: Infants in the study were an average of 7.1 weeks old (standard deviation (SD)=4.4), an average weight of 3.6kg (SD=0.4) and an average length of 20.4 inches (SD=0.9). The majority were of white ethnicity (80%), possessed medical insurance coverage (92%), and had insurance covering lactation consultants (61%). Statistical analyses revealed a significant improvement in the LATCH scores between Visit 1 (8.01) and 2 (8.47; p=0.012); a significant improvement in LATCH scores between Visit 2 (8.47) and Visit 3 (9.11; p=.005); and an overall significant improvement from Visit 1 to Visit 3 (p<.001). The improvement at Visit 2 compared to Visit 1 was significantly larger among those who were bottle-fed (change=1.35) compared to those who were breastfed (change=0.21; p=.004). Conclusions and Relevance: In term infant populations with feeding difficulties, OMT significantly improved the LATCH scores over the course of the study. There are specific subpopulations, such as infants who were bottle-fed, who may have greater improvement in LATCH scores following OMT. OMT remains strongly recommended in this patient population to help with difficulties pertaining to latching.
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    Efficacy of Osteopathic Manipulative Treatment in Post-Stroke Recovery Patients
    (2024-03-21) Vu, Patrick; Walker, Alexis; Dalton, Dakota
    Background: Each year, an estimated 795,000 people report having a stroke. Stroke is the 5th leading cause of death and the 10th leading cause of adult disability in the United States, leading to significant physical impairment. Stroke patients specifically suffer from pain related to positional changes, muscle contractures, and somatic dysfunctions. Beneficial stroke rehabilitation begins within the first three months following presentation, in the subacute setting. Current literature has primarily addressed pain and musculoskeletal limitations in patients in a post-acute stroke setting. Case Information: HPI: A 53 y/o Caucasian female presented to the emergency department for a 6-hour history of slurred speech and right-sided arm and leg weakness. She suddenly lost the ability to speak and felt right-upper-extremity and right-lower-extremity weakness. She denied any falls or trauma during this period. She reported her speech improved in the ED but had no improvement in her right-sided weakness. Physical Exam: An examination of her extremities showed a bilateral ulnar deviation of the MCP joints with swan neck deformity and diffuse finger and hand joint enlargement. The musculoskeletal exam showed her LUE and LLE had 5/5 strength at all nerve roots. Her RUE only had limited thumb adduction. Her RLE had 0/5 strength. The neurological exam showed right-sided facial muscle weakness; otherwise, the patient had bilaterally intact cranial nerves. Light touch sensations were intact bilaterally on her upper and lower extremities. On day 3 of her hospitalization, the osteopathic neuromusculoskeletal medicine (ONMM) hospital service was consulted for generalized whole-body aches with significant pain in her left shoulder and neck. The initial session included the use of counterstrain (CS), balanced ligamentous tension (BLT), and myofascial release (MFR) to help reduce muscle strain and tension. On day 8, the patient was transferred to the Rehabilitation Unit where she received daily Physical Therapy and Occupational Therapy sessions. Goals of OMT shifted from symptomatic treatment to augmenting the patient’s ability to participate in PT and OT. Throughout her stay in the Rehabilitation Unit, the patient notified the ONMM team of increased participation in PT and OT and increased movement of her right side. Therapy sessions lead to right-sided pain primarily in her shoulder and knee. OMT was performed daily, focusing on her various right-sided restrictions. The patient was treated with OMT a total of 14 times across 36 days. The patient reported improvement of pain in all treated regions as well as increased motor function in her paralyzed side. Conclusions: Her improvements highlight the importance of early consultation of the ONMM services in post-stroke patients with functional impairment. The case demonstrates that in conjunction with evidence-based PT/OT, subacute stroke OMT can increase biomechanical functionality as demonstrated by the increased functionality of both the paralyzed extremities. Further research should focus on the use of OMM and other osteopathically informed approaches in stroke rehabilitation as well as the long-term effects of initiating OMT in stroke patients within this subacute window. Studies have demonstrated that the optimal therapeutic window is within the first 3 months following a stroke.
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    Postural Sway in Back Pain Patients
    (2024-03-21) Black, Ethan; Kennedy, Shawn; Patterson, Rita
    Purpose: Fall risk prediction is an active area of research due to the devastating impact of falls. Millions of Americans are injured by falls every year, with a significant portion suffering serious injuries such as head trauma and hip fractures (Bergen). Studies have demonstrated that postural sway (PS) is a crucial predictor of fall risk and indicator of several disease processes, which has prompted The University of North Texas Health Science Center (UNTHSC) to research the relationship between PS and other variables. Back pain (BP) has been proposed as one of these potential variables due to its prevalence and association with posture and balance. The purpose of our study is to analyze the relationship between BP and PS. Methods: Balance testing was collected as a vital at the UNTHSC Geriatrics and Family Medicine clinics. As part of the collection process, cooperating patients were instructed to stand quietly on a Bertec dual-balance force plate (Bertec, Columbus, Ohio) with their hands by their sides for 2 trials, each lasting 30 seconds and divided into 3 intervals of 10 seconds. In the first trial patients were instructed to open their eyes (eyes open condition), while in the second trial patients were instructed to close their eyes (eyes closed condition). A chart review was then conducted to gather patients with back pain that also had a balance assessment, while a healthy control group was established using data from previous PS collection projects at UNTHSC. The data was processed and analyzed using statistical analysis in Microsoft Excel. Results: The range for the center of pressure in the anterior posterior (COP AP) direction, which measures the movement of the COP AP, was found to be statistically significantly decreased for the BP group versus the control for the eyes open condition. No statistically significant relationships were identified for the eyes closed condition. Conclusion: These results demonstrate that during the eyes open trial BP patients exhibited less PS. We postulate that this is due to factors such as decreased lumbar proprioception and reduced motor control caused by BP, leading patients to depend more on their vision for positional sense. In contrast, the lack of statistical significance for the eyes closed condition may be attributed to the increased difficulty in maintaining balance without visual input, potentially masking the impact of BP on PS. Another consideration is that the BP patients could have been in pain and therefore concentrated more on not moving, which may have been easier during the eyes open condition than the eyes closed condition. Possible limitations of the experiment include the duration of the balance testing, as 30 seconds per trial may not have been enough time to adequately measure each condition, and the grouping of all BP patients into one group without considering the pain characteristics, intensity, and duration. We recommend that additional studies be conducted to address these factors, while considering other relevant confounding variables as well, with the ultimate goal of better understanding and preventing falls.
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    Intraoperative Osteopathic Manipulative Therapy Used to Manage Acute Cervical Somatic Dysfunction During Deep Brain Stimulator Implantation for Parkinson’s Disease: A Case Report
    (2024-03-21) Hartley, Kristina; Nguyen, Michael; Lee, Yein; Siadati, Ab
    Background: Parkinson’s disease (PD) is a neurodegenerative disease characterized by motor and non-motor symptoms such as bradykinesia, resting tremors, and cognitive changes. Deep brain stimulation (DBS) is a surgical procedure used to control the motor symptoms of PD, where electrodes are placed inside the patient’s basal ganglia under conscious sedation. Of the documented complications directly attributable to DBS, intraoperative and postoperative musculoskeletal pain is currently not well reported on, and management of this pain is also not well established. In this case report, we describe the intraoperative osteopathic assessment and management with osteopathic manipulative treatment (OMT) of acute cervical and occipital somatic dysfunctions in a patient with PD who underwent a DBS implant. Case Information: A 72-year-old female with a five-year history of PD presented with worsening bradykinesia, dyskinesia, rigidity, balance issues, and bilateral lower extremity pain. The patient’s carbidopa/levodopa dosage effectively controlled her motor symptoms for 2 hours before symptoms returned. Her physical exam was unremarkable except for aspects of her neurological exam, which revealed resting tremors throughout her bilateral upper and lower extremities, a very unsteady, shuffling gait, and an inability to do tandem gait, heel, or toe walking. She could not squat or rise independently. DBS implantation was recommended as a palliative option. Preoperative brain magnetic resonance images revealed an arachnoid cyst on one side and multiple small vessels surrounding the target for her DBS lead positions, necessitating more planning and increased surgery duration than expected. During the procedure, she developed severe musculoskeletal neck pain, a rating of 8/10, that gradually worsened to involve her posterior occiput and right shoulder. An osteopathic examination of the neck region showed acute tissue texture changes in her cervical paravertebral, suboccipital, trapezius, and sternocleidomastoid (SCM) musculature with hypertonicity, bogginess to palpation, and multiple myofascial trigger points. OMT was used intraoperatively in an attempt to control the musculoskeletal pain after the implementation of traditional methods of warm compresses and extra support failed to alleviate the severity. OMT used included longitudinal soft tissue of the paravertebral, direct inhibition of myofascial trigger points, and indirect myofascial release of the suboccipital musculature and SCM, reducing pain to a reported 2/10 by the patient. OMT was well-tolerated and did not give rise to any adverse events as the DBS implant procedure proceeded and was completed successfully. Conclusions: This case illustrates how indirect and soft tissue techniques can effectively be used in close proximity to an area of operation without compromising the sterile field or displacing the patient with augmenting positional pain tolerance. Future studies should evaluate the safety and effectiveness of OMT under conscious sedation, intraoperatively, and its application as a treatment modality to augment patient tolerance of surgical procedures.