Physical Medicine / OMM

Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21666

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    Defining Muscle Energy: A Multidisciplinary Approach
    (2018-03-14) Son, David; Patterson, Rita; Hensel, Kendi; Newey, Carter
    Title: Defining Muscle Energy: A Multidisciplinary Approach Author: David Son, DO, MPH, Carter Newey, OMS-3, Kendi Hensel, DO, PhD, and Rita M. Patterson, PhD Abstract Purpose: Manual manipulation is predominantly practiced among three professions: osteopathic medicine, chiropractic, and physical therapy. One treatment modality involves patients’ muscle contraction against practitioners’ counterforce. It is known as Muscle Energy Technique (MET) by osteopathic physicians, Autogenic Inhibition (AI) by chiropractors, and Proprioceptive Neuromuscular Facilitation (PNF) by physical therapists. Although these techniques involve the same principles, little is known about how each profession perceives and applies it to their practice. Understanding the approaches of each field can not only clarify patients’ past treatment histories but also yield opportunities for effective co-management. The objective of this project is to discuss the similarities and differences of this type of manipulative therapy. Methods: Gathering and utilizing information obtained online and in written literature, this study compares treatment steps and applications of this form of muscle-based manual manipulation among osteopathic medicine, chiropractic, and physical therapy. Results: Osteopathic MET – 1) Affected segment taken to restrictive barrier 2) Sub-maximal isometric contraction 3) Relaxation for 3-5 seconds 4) Segment taken to new restrictive barrier 5) Repeat 3-5 times Chiropractic AI – 1) Post-Isometric Relaxation (PIR), which is identical to Osteopathic MET 2) Post-Facilitation Stretch (PFS): 2a) Maximal muscular contraction for 5-10 seconds 2b) Complete relaxation 2c) Rapid maximal stretch for 10 seconds 2d) Relaxation for 20 seconds Physical Therapist PNF – One continuous spiral motion of extremity in diagonal pattern via: 1) Passive range of motion 2) Active range of motion 3) Sustained isotonic contraction on full range of motion Conclusions: Understanding these variations in technique maximizes its potential to be taken into a more comprehensive and advanced treatment modality that can be communicated and utilized by all three professions. This can augment the quality of manual medicine in patient care.
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    Evaluation of current educational methods incorporating Osteopathic Manipulative Medicine (OMM) into family medicine and internal medicine residency programs.
    (2018-03-14) Kasinc, Krista DO; Passmore, Cindy; Nichols, Jared
    Abstract Purpose: Osteopathic manipulative treatment (OMT) is one distinctive feature of osteopathic medical education and practice. Over the past two decades, multiple studies have cited concern over the decreased use of OMT by practicing osteopathic physicians [1, 2]. Some surveys of third- and fourth-year osteopathic medical students have shown that a majority of them intend to use OMT in their future practices [3, 4], but multiple surveys of practicing osteopathic physicians have shown low rates of OMT utilization in practice: over half of respondents used OMT for fewer than 5% of their patients; and 44% reported not using OMT at all [2, 5, 6]. Respondents indicated that their use of OMT in practice correlated with the extent of their clinical training, particularly during residency [2]. Therefore, the purpose of this study is to evaluate the barriers of OMT utilization by residents, and to determine potential changes needed in current and future osteopathic education to increase OMT’s use. Methods: A 28 question survey using the survey tool Qualtrix was sent to AOA and ACGME family medicine and internal medicine programs in the United States using an email link. Contacts of the programs coordinators and directors were obtained from public databases courtesy of the AOA and ACGME. Program contacts were asked to forward the survey link to the applicable residents (FM and IM residents only). Other residents that may have taken the survey unintentionally were excluded. Three reminders were sent via email 2 weeks apart. Participation was voluntary and participants could choose not to complete the survey without penalty. No incentive was offered for completion of the study. Information received in this study was reported out in anonymous form only through the use of a generic hyperlink in the recruitment email that gave subjects access to the survey instrument. No names or personally identifying information was gathered through the survey. Only the named study investigators have access to the data. Results: (Data collection is still ongoing and final numbers may change.) In the survey, 93% of Osteopathic respondents in the survey believed OMT to be an effective treatment for somatic dysfunction. However, out of these same respondents, 79% stated one of the barriers to preforming OMT on their patients was lack of time. Another large minority also noted lack of skill, and lack of supervision as obstacles. Conclusion: In conclusion, osteopathic education seems to be valuable in teaching the influence osteopathic manipulation may have. However, osteopathic educators may not be emphasizing how to incorporate OMT into the primary care setting. Therefore it may be beneficial to incorporate more case driven scenarios in undergraduate osteopathic education.
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    PM&R Case Study: Neuropsychological Effects Following Traumatic Brain Injury
    (2018-03-14) Wimmer, Michael; Schulze, David
    Abstract Background: According to the Center for Disease Control (CDC) close to 2.8 million people a year suffer from traumatic brain injuries (TBI) in the United States. Of that number, close to 96% will survive. The CDC estimates that medical costs as well as indirect costs, such as loss of productivity, nears almost 60 billion a year. With these staggering numbers, it is important to better understand the short term and long lasting effects of TBIs. TBIs can impair physical movement, vision, hearing, memory, thinking, and sensation. As well as cause depression and personality changes. Yet, some effects are less common such as verbal inhibition and emotional lability. Researching these unique cases can lead to better understanding of neuropsychology as well as better treatments to help those impacted. Case Information: A chart review was conducted with the assistance of medical records, including clinical summaries, surgery notes, and long term rehabilitation records. A 53-year-old man suffered a motorcycle accident in March of 2011. During this accident, his helmet suffered major damage, he lost consciousness, and had a Glasgow Coma Score of 4. At the scene, he required resuscitation several times and was intubated. Once at the hospital he was diagnosed with multiple rib fractures, an open left calcaneus and fifth metatarsal base fracture, as well as a severe traumatic brain injury with intracranial hemorrhage. He was in a coma for 13 days and underwent several surgeries within the hospital. Once he was released he began to notice chronic daily headaches, greatly impaired sleep duration/quality, and chronic pain in the left foot/ankle. In addition, he began to suffer from an impaired memory, increased impulsivity, increased distractibility, emotional lability, anxiety, and an inability to censor his verbal speech. While his physical ailments have decreased his quality of life they have not been as severe as his neuropsychological changes. Before the accident he was able to work a high paying job. Yet, after the accident his inability to curb his speech, remember important items, and his greatly increased anxiety have caused him to no longer be able to work. In addition, he has difficulty going to the gym or the supermarket because he is unable to stop conversations with strangers. While he used to spend 45 minutes at the gym he will now spend close to 5 hours due to his ongoing conversations. Conclusions: TBI is a major medical problem in the United States and while there can be great commonality among symptoms the ongoing sequela can be extremely varied. Yet, per the literature, there are very few cases on the loss of higher level filters on speech secondary to a TBI. Therefore, the specific mechanisms of this neurological injury as well as the ongoing rehabilitation and treatment are not well known. This case could provide an additional piece of the puzzle to potentially help advance the understanding of these rare long lasting effects as well as help provide a clearer picture of TBIs in general.
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    Effects of Practicing Osteopathic Manipulation Technique (OMT) on Hand Function
    (2018-03-14) Surve, Sajid; Patterson, Rita; Barnum IV, Frederick; Chang, Mary Ellen
    Effects of Practicing Osteopathic Manipulative Treatment (OMT) on Hand Function Sajid Surve, DO; Rita Patterson, PhD; Mary Ellen Chang, OMS-II; Frederick Barnum IV, PGY-1 Purpose: Physicians who practice osteopathic manipulative treatment (OMT) rely on their hands to diagnose and treat patients. Due to the nature of medical practice, OMT practitioners’ experience increases as a function of age. Conversely, the general population’s hand function decreases with age, but skilled finger movement training improves an aging population’s hand functionality. Therefore, we hypothesize that OMT practitioners’ hand grip strength is maintained, or even improved, over untrained individuals within the same gender and age bracket in spite of increasing age. Methods: 90 OMT practitioners at American Academy of Osteopathy’s 2017 Convocation self-reported demographic data via Qualtrics, such as age, gender, height, weight, and length of OMT practice. Then, we measured their intrinsic and extrinsic grip strength with a key pinch grip and Jamar dynamometer, respectively. Finally, participants allowed investigators to take photos of their hands with a ruler in-frame, so that anthropometric data including hand length and volume could be extrapolated. Results: Preliminary data analysis shows that male OMT practitioners’ grip strength improves with age and that females’ decreases minimally. Other collected data is currently undergoing analysis and significance has yet to be determined. After factoring in subjects’ BMI and hand volume and comparing these values with accepted standards, we believe the data will show that OMT practitioners outperform their non-practitioner counterparts in extrinsic and intrinsic grip strength. Conclusions: Our study paves the way for future tests in this population to determine if practicing OMT affects practitioners in quantifiable ways, such as increasing hand dexterity and tactile sensitivity.