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    Chronic Back Pain in a patient with Spontaneous Spinal Rod Malfunction: Case Study
    (2020) Lee, Yein; Do, Aivien; Hall, Marshall
    Background: Rod fractures are a common hardware malfunction of spinal rods that are used to treat scoliosis. Spinal rod malfunctions have been associated with pain, disability and decreased quality of life that may require further medical attention. Case Information: In this case we present a patient with scoliosis complicated by a rod fracture that was left uncorrected for many years that potentially augmented his chronic pain and disability. Due to chronic pain, the patient was referred to osteopathic manipulative medicine (OMM) for evaluation without known history of Harrington rod fracture. After initial evaluation, OMT was deferred and surgical intervention was recommended, which resulted in improvement of the patient's pain and function. Conclusion: It is important to consider possible spinal rod failure in patients with scoliosis presenting with increasing pain and disability. Treatment and management options for pain and disability caused by spinal rod fractures in scoliosis patients are limited and may be important to pursue for further investigation.
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    Botulinum Toxin Type A Induced Trapezius Atrophy: A Case Report
    (2020) Surve, Sajid; Koehler, Jonathan; Kramer, Andrew
    Botulinum Toxin Type A (Botox) has been well documented for its therapeutic role in managing migraines, contractures, and hyperhidrosis, with rather benign side-effects at therapeutic dosages such as weakness, dizziness and headaches. Although animal models have more extensively demonstrated the dose-dependent side effects such as weight loss, paralytic effects, and muscular atrophy, it has been rarely seen in therapeutic doses clinically in humans. We report a case of severe atrophy of the trapezius muscle in a patient following routine Botox injections for migraine prophylaxis. While cases of botox-induced atrophy have not been well-documented, it is crucial to be aware and prepared for any complications stemming from therapeutic doses of Botulinum toxin.
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    Efficacy of the Fascial Distortion Model in Treating Hand Injuries: A Case Study in Manual Therapy
    (2020) Qureshi, Sana; Hall, Marshall
    Background: Fascia is a network of fibrous tissue that surrounds and connects even the smallest structures in our body together. It is flexible, molding to the body's motion and tensions. Any twist, wrinkle or tear in the fascia can distort the tissue and surrounding structures. These changes in the fascial tissue may result in pain and limited motion. The Fascial Distortion Model (FDM) has identified six different fascial disruptions which can occur in isolation or combination with each other. This model aids in the evaluation and treatment of known fascial patterns to restore proper function to the tissue and decrease pain. Case information: In this case a 27-year-old male presented with acute pain in the left hand one day following a volleyball injury. On pinch grip strength testing, the patient exhibited about half the strength in the injured hand, relative to the non-injured extremity. The right hand was treated by applying the fascial distortion model resulting in decreased pain, improved motion and doubling of pinch grip strength. Conclusion: FDM is relatively new compared to other medical and manual therapies. This has limited the amount of evidence to support the efficacy of the model. In addition, due to the possible discomfort during treatment, there has been criticism on the use of the model in treating patients. This case provides an example of how FDM can be valuable in treating acute injuries by decreasing pain and allowing for a return in function and strength.
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    Perceptions of non-opioid treatment for pain in a homeless population
    (2020) Podawiltz, Alan; Bernal, Joshua; Nguyen, Harvard; Park, Flora; Westberg, Alexa; Fraser, Kristina
    Objective: Approximately 50% of the homeless population in the United States report chronic pain, and recent studies show the homeless population has sought over-the-counter medications, alcohol, and drugs, including prescription and illicit opioids to treat this pain. The aim of this study is to investigate the perceptions of the homeless population regarding non-opioid treatments for pain, including osteopathic manipulative treatment, physical therapy, massage therapy, and chiropractic treatment. Design: In-person surveys were conducted among three sessions over an eight-week period at True Worth Place Homeless Shelter. Responses were recorded through multiple choice, binary, and free-text components and transferred to a secure document. Results: Sixty-eight percent of subjects surveyed (n=200) indicated they believe a non-drug pain intervention could better treat their pain. When comparing treatment modalities, 7% of subjects previously received OMT treatment, whereas 59.5%, 39%, and 41% previously received PT, MT, or chiropractic treatment, respectively (n=200). Out of 194 participants, 150 believed that OMT would decrease their need for pain medication, and 44 believed it would not. Subjects reported the following as barriers to receiving care for pain relief: transportation (n=131), cost (n=100), appointment availability (n=29), nothing (n=8), or other (n=16). Conclusion: Our results demonstrate an opportunity to increase OMT exposure to the homeless population. Overall, the sample studied is open to OMT as an alternative treatment for pain. Therefore, OMT could serve as a novel treatment modality for this population.
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    Whole Body OMT as a Treatment for Postural Instability in Parkinson's Patients
    (2020) Hensel, Kendi; Patterson, Rita; Gibson, Keenan
    Background: Osteopathic Manipulation Treatment (OMT) is a manual therapy directed at relieving somatic dysfunction in patients. OMT has shown in previous studies to improve postural stability in specific patient groups and may be a treatment option for movement disorders. Parkinson's Disease (PD) is one such movement disorder where falls are a major cause of patient morbidity. However, an OMT protocol for PD has not been established. Methods: We performed a randomized control trial on PD and healthy patients to determine the efficacy of an OMT protocol. Group A received OMT treatment of the full body including cranial manipulation, Group B received OMT treatment from the neck down, and Group C received a "sham" OMT treatment. Pre- and Post-treatment clinical measurements of postural stability consisted of Functional Reach (FR) and Timed Up and Go (TUG) tests. Biomechanical measurements of quiet standing sway were observed using a 12 Camera motion analysis system and a force plate. Results: Patients showed improvement in the times to complete the TUG test across all three treatment groups with the greatest improvement (-0.52 s) demonstrated by Group A (p < 0.05). FR results showed improvement in all three treatment groups with the greatest change (+3.5cm) occurring in Group B (p< 0.05). Biomechanical data showed an increase in the RMS in the x and z directions following treatment (p >0.05). Conclusions: Full body OMT that includes cranial techniques may improve postural stability and be considered as part of a multi-therapy management of PD.