Osteopathic Considerations Research Articles

Osteopathic Considerations in the Medical Treatment of a Patient with COVID-Related Respiratory Distress

Abstract We present a case of a woman hospitalized for acute hypoxic respiratory failure secondary to suspected post coronavirus disease 19 (COVID-19) pneumonitis who clinically improved after addition of sequenced Osteopathic Manipulative Treatment (OMT) to her medical management. Objective signs (such as oxygen saturation, SPO2) improved, resulting in decreased oxygen volume requirements by 75% after 1 treatment of OMT, and by 97.5% over her remaining hospitalization. Subjective symptoms of dyspnea, chest tightness, fatigue and mental health also improved. Her most significant somatic dysfunctions (SD), which were primarily in her thoracic, ribcage and cervical regions, were correlated with her clinical presentation and disease process. This suggests that SD was likely a modifiable risk factor impairing her normal adaptive physiologic processes and therefore treating SD with sequenced OMT may have contributed to her realizing a higher health potential when combined with standard medical care.

Osteopathic Considerations in Pain Management

Chronic pain is defined as pain that has persisted for greater than 6 months. This type of pain may last longer than 6 months and can continue even after the injury or illness that has caused it has healed or resolved. Pain signals can remain active in the nervous system for weeks to months and even years. Individuals with a chronic pain syndrome can experience severe negative effects on their activities of daily living and their mental well-being. The osteopathic philosophy and osteopathic manipulative treatment (OMT) set the osteopathic physician up to provide a comprehensive treatment plan to manage patients with chronic pain. To direct osteopathic techniques to address pain, it is imperative to understand the anatomy and physiology of the way pain is signaled to the central nervous system. Pain can also be classified into multiple categories based on the origin of the signal, which is essential to decipher to direct therapy. The goal of osteopathic care in chronic pain syndrome is to relieve musculoskeletal somatic dysfunctions and to normalize sympathetic and parasympathetic neural tone. This would create the optimal environment to induce the body’s own self-healing capabilities.

Osteopathic considerations in pneumonia

Pneumonia contributed to nearly 3 million deaths worldwide in 2016 and 56,000 deaths in the United States alone in 2017, and as such, it is imperative for physicians to understand the causes, subtypes, associated risk factors and treatment options. This article will address each of these, as well as special consideration for the osteopathic approach to care.

Osteopathic considerations for breastfeeding women

Extensive benefits of breastfeeding have been identified and although many women initiate breastfeeding, discontinuation is common when problems arise. In this article, the authors review the pertinent anatomy of the breast with osteopathic considerations to help osteopathic physicians identify myofascial, vascular, lymphatic, or innervation somatic dysfunctions to support the breastfeeding mothers' long term breastfeeding goals, optimize breastmilk supply, and potentially prevent or treat problems that could interfere with lactation. Observations from the authors' academic mother-baby osteopathic manipulation clinic are also included.

Craniosacral Therapy Use in Normal Pressure Hydrocephalus

Nearly 700,000 adults in the US have normal pressure hydrocephalus (NPH), but it is often misdiagnosed as Alzheimer’s or Parkinson’s disease. In fact, a small percentage of people with the disease are properly diagnosed. NPH presents classically with a triad of symptoms: ataxic gait, dementia, and urinary incontinence. Diagnosis and treatment are provided together through a lumbar puncture. However, the only effective treatment that exists is a shunt insertion, which is a highly invasive procedure with uncertain responsiveness. As NPH is primarily diagnosed in those in advanced ages (60s and 70s), adjunctive treatment modalities should be further studied. Here we present a case of a patient diagnosed by a neurosurgeon and neurologist with NPH and a candidate for a shunt insertion whose symptoms substantially improved with one month of osteopathic manipulative treatment. Osteopathic considerations and literature are also reviewed in the broader context of craniosacral treatment.

The Osteopathic Approach to Treating Depression in Children and Adolescents

Evidence confirms that children and adolescents can experience the whole spectrum of mood disorders and suffer from the significant morbidity and mortality associated with them. Effective treatment often relies on physicians developing advanced communication skills with their patients. Enhanced communication will help decipher the etiology of the patient’s depression and, in addition to serotonin-regulating medications, will optimize treatment. Osteopathic medicine offers an effective treatment model through osteopathic manipulative treatment (OMT) because of the inseparability of physical and mental health. Osteopathic medicine takes a holistic view in which somatic, visceral and psychological dysfunction are united. Thus, physicians who incorporate OMT into their practice will help treat psychopathologies, such as depression and its accompanying somatic dysfunctions. This paper discusses the epidemiology of depression, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) depression criteria, screening algorithms, current treatment protocols, osteopathic considerations to treating depression, and lastly, OMT and its role in treatment.

Osteopathic Manipulative Treatment in Tension Headaches

Tension-type headaches, associated with young age, poor health, sleep disturbances, anxiety, stress, and poor posture, account for 90% of all headaches diagnosed by healthcare professionals. Diagnosis and treatment of the various headache subtypes are often aimed at determining the underlying cause but commonly involve over-the-counter pain medication. Because recurrence is common in tension-type headaches, with a subsequent refractory response to over-the-counter medications, adjunctive and alternative treatment modalities should be further studied. Here we present a case of tension headache initially non-responsive to pain medication but resolved with osteopathic manipulative treatment and lifestyle modifications. Osteopathic considerations and literature are also reviewed in the broader context of headache management.

Puberty: An approach to diagnosis and management with an osteopathic component

Puberty is generally known as the emotional and physical maturation of a child to adulthood. This allows for sexual maturation and the means to reproduce. Children will undergo a pubertal growth spurt, as well as changes to the reproductive organs. While puberty is mostly associated with changes in reproduction and endocrine systems, it is multifaceted and affects the musculoskeletal, behavioral and vascular systems. Puberty occurs due to activation of the hypothalamic-pituitary-gonadal (HPG) axis and a progressive increase in the amount of gonadotropin-releasing hormone (GnRH) released. The average age of puberty is 13 years old in girls and 14 years old in boys. Associated pubertal diseases are usually split into two categories, based on whether the physical indicators appear earlier or later than expected. When these indicators occur at two standard deviations (SD) early, it is known as precocious puberty, and when they are 2–2.5 SDs late, it is known as delayed puberty. Because of the inseparability of physical and mental health, osteopathic medicine offers a practical approach for treatment of pubertal conditions using osteopathic manipulative treatment (OMT). Osteopathic medicine takes a holistic view of the person in which somatic, visceral and psychological dysfunction are united. Thus, physicians who incorporate OMT into their practice will be able to aid in promoting proper development during puberty as well as addressing accompanying somatic dysfunctions. In this paper, we will discuss the physiology of puberty, pubertal disorders, the epidemiology of puberty, current management protocols, osteopathic considerations in puberty and OMT’s role in treatment.

Telemedicine During a Pandemic with Osteopathic Considerations

Health care continues to make strides in the industry by incorporating technological innovation to capture consumer demand and financial growth. Over the past 10 years, significant technology advances in health care include developing electronic health records, patient portals, self-service kiosks, remote monitoring devices, genome sequencing and telemedicine. The topics covered include visit how-to's, presenting yourself professionally, displaying empathy and treating the whole person in the virtual platform. Practice management topics include benefits of telemedicine, billing and coding, reimbursement, and legal consideration. Multiple tables display various topics, including different types of telemedicine, different virtual platforms, CPT codes to code the visit and billing modifiers associated with telemedicine.

Osteopathic Considerations for the Pregnant Patient with COVID-19.

In any given year, approximately 130 million babies are born worldwide. Previous research has shown that pregnant women may be more severely affected and vulnerable to contracting emerging infections, making them a particularly high-risk population. Therefore, special considerations should be given to treatment methods for pregnant women with COVID-19. In this narrative review, the authors evaluate scholarly journal articles and electronic databases to determine what is known about the pathophysiology of COVID-19 in pregnancy and the associated mortality rate. Osteopathic manipulative treatment techniques to mitigate the underlying pathology were identified, and modifications for use in pregnancy and the critical care setting are described.

Urticaria: Diagnosis and Treatment with Osteopathic Considerations

Urticaria is a common benign dermatologic condition. It is primarily manifested by well marginated pruritic wheals typically surrounded by erythema caused by the release of histamine into the skin. Urticaria may occur with or without angioedema and typically resolves within 24 hours. Urticaria that persists or recurs past six weeks is known as chronic urticaria. Urticaria may be caused by various medications and illnesses, though in most cases, a trigger cannot be identified. Certain forms of urticaria may be triggered by physical stimuli such as pressure, heat, cold, water, or sunlight. Antihistamines are the mainstay of pharmacotherapy for acute and chronic urticaria. Trigger avoidance should be emphasized when a trigger is identified. Other treatments include oral steroids, doxepin and omalizumab. Topical steroids are ineffective. This article reviews the presentation, diagnosis and treatment of acute and chronic urticaria.

Approach To Joint Pain In The Elderly For Osteopathic Providers

Joint pain in the elderly is becoming ever more ubiquitous in the primary care setting. Primary care providers, especially in rural communities, may be required to manage patients with rheumatologic conditions because consultation is unavailable. Literature supporting the approach to the diagnosis of joint pain in the elderly population is limited. The purpose of this manuscript is to present a case-based learning opportunity for osteopathic primary care providers, residents, and medical students regarding an elderly male with joint pain. In this manuscript, the authors have presented an advanced organizer to be used in the medical education setting which differentiates patients suffering from joint pain based on timing, the number of joints involved, and the size of the joint affected. We conclude with osteopathic considerations in evaluating an elderly patient with joint pain and the tools available to appropriately evaluate and treat the patient.

Lymphatic Vessels Found in the Brain-Osteopathic Considerations, Part 2: Now in Humans and Monkeys.

Lymphatic Vessels Found in the Brain-Osteopathic Considerations, Part 2: Now in Humans and Monkeys.

Neurobiology of Sexual Assault and Osteopathic Considerations for Trauma-Informed Care and Practice.

Sexual assault is a traumatic event with potentially devastating lifelong effects on physical and emotional health. Sexual assault is associated with gastrointestinal, neurologic, and reproductive symptoms, as well as obesity, diabetes, and chronic pain. With 1 in 3 women and 1 in 6 men experiencing some form of unwanted sexual violence in their lifetime, sexual assault is a significant public health problem that necessitates attention in the medical community. This review discusses relevant literature on the neurobiologic changes that occur as a consequence of sexual assault, such as how the brain responds during a traumatic experience and the impact of trauma on memory. Osteopathic considerations for trauma-informed care and practice and how all physicians can better serve patients with a history of sexual assault are also discussed.

Entrustable Professional Activities for Entering Residency: Establishing Common Osteopathic Performance Standards in the Transition From Medical School to Residency.

Entrustable professional activities (EPAs) are measurable units of observable professional practice that can be entrusted to an unsupervised trainee. They were first introduced as a method of operationalizing competency-based medical education in graduate medical education. The American Association of Medical Colleges subsequently used EPAs to establish the core skills that medical students must be able to perform before they enter residency training. A recently published guide provides descriptions, guidelines, and rationale for implementing and assessing the core EPAs from an osteopathic approach. These osteopathically informed EPAs can allow schools to more appropriately assess a learner's whole-person approach to a patient, in alignment with the philosophy of the profession. As the single accreditation system for graduate medical education moves forward, it will be critical to integrate EPAs into osteopathic medical education to demonstrate entrustment of medical school graduates. The authors describe the collaborative process used to establish the osteopathic considerations added to EPAs and explores the challenges and opportunities for undergraduate osteopathic medical education.

Lymphatic Vessels Found in the Brain—Osteopathic Considerations

Lymphatic Vessels Found in the Brain—Osteopathic Considerations

Osteopathic Considerations in the Management of Migraine in Pregnancy

Osteopathic Manipulative Medicine OMM Migraine Headache Pregnancy Many women frequently suffer from migraines and require pharmacotherapy to alleviate and control their symptoms. Unfortunately, many of these therapies are contraindicated when a woman becomes pregnant leaving her to find alternative treatments to manage her symptoms. Osteopathic medicine provides a unique perspective for treating migraines without the use of medication. Osteopathic manipulative treatment (OMT) can provide hands–on treatment to help alleviate migraine symptoms and improve the quality of life as a woman’s body changes throughout her pregnancy.