Efficacy of Osteopathic Manipulative Treatment in Post-Stroke Recovery Patients

Date

2024-03-21

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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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