Autonomic rehabilitation: Vagal and sympathetic impacts of modified occipitomastoid suture V-spread.

IF 2.2 4区医学 Q1 REHABILITATION PM&R Pub Date : 2024-10-23 DOI:10.1002/pmrj.13268

Austin Miller, Daniel Gustin, Jonathan Wilson, Jeffery Johns, James Burch, Thomas Fotopoulos, Rahul Garg, Audrey Vasauskas

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Abstract

Background: Autonomic rehabilitation using osteopathic manipulative treatment (OMT) to stimulate the vagus nerve may be a good adjunct therapy by physiatrists who treat dysautonomia. Heart rate variability (HRV) may provide quantitative evidence for the benefits of OMT on autonomic nervous system function. Elevated HRV indicates optimal health and reduced mortality risk, whereas low HRV is associated with stress, pain, and chronic disease pathology.

Objective: To analyze the impact of modified occipitomastoid suture v-spread OMT technique on vagal tone by measuring HRV.

Design: Within-participant design with 5-minute HRV measurement pre- and post-OMT treatment.

Setting: Clinical examination suites.

Participants: Thirty healthy osteopathic medical students.

Interventions: A modified occipitomastoid suture v-spread treating somatic dysfunction by osteopathic physicians trained in osteopathic neuromusculoskeletal medicine.

Main outcome measures: HRV variables related to vagal tone including root mean square of successive differences (RMSSD), percentage of successive normal sinus RR intervals >50 ms (pNN50), high frequency (HF), Parasympathetic Nervous System Index (PNSI), and Sympathetic Nervous System Index (SNSI). Repeated measures t-test analyzed the difference in mean HRV values after OMT.

Results: There were statistically significant increases in each of the HRV measures after OMT. Participants had a mean (95% confidence interval) RMSSD of 50.5 ms (38.3-62.8) at baseline and 55.0 ms (41.2-68.7, p = .013) post-OMT. pNN50 was 24.5% (17.6-31.3, n = 30) at baseline and 28.2% (20.8-35.6, p = .003) post-OMT. HF was 1549.6 ms² (389.8-2709.4) at baseline and 1901.8 ms² (618.2-3185.4, p = .103) post-OMT. PNSI was -0.1 (-0.5 to 0.2) at baseline and 0.1 (-0.3 to 1.5, p < .01) post-OMT, and SNSI was 0.2 (-0.1 to 0.6) at baseline and 0.05 (-0.3 to 0.4, p < .01) post-OMT. Normalization, due to high baseline variance, results include RMSSD 1.1 ms (1.0 to 1.1, p = .012), pNN50 1.3 (1.1 to 1.4, p = .011), and HF 1.2 ms² (1.1 to 1.4, p = .018).

Conclusions: Modified occipitomastoid suture v-spread may provide clinical benefit through increased vagal tone and decreased sympathetic activity.

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自主神经康复：改良枕骨乳突缝合V形扩张术对迷走神经和交感神经的影响。

背景：利用整骨疗法（OMT）刺激迷走神经的自律神经康复疗法可能是治疗自律神经失调症的物理治疗师的一种很好的辅助疗法。心率变异性（HRV）可为整骨疗法对自主神经系统功能的益处提供量化证据。心率变异性升高表明最佳健康状态和死亡风险降低，而心率变异性低则与压力、疼痛和慢性疾病病理相关：通过测量心率变异，分析改良枕骨缝v-spread OMT技术对迷走神经张力的影响：设计：参与者内设计，在 OMT 治疗前后进行 5 分钟心率变异测量：临床检查室：30名健康的骨科医学生：主要结果测量指标：与迷走神经张力相关的心率变异变量：与迷走神经张力有关的心率变异变量，包括连续差值均方根（RMSSD）、连续正常窦性RR间期大于50毫秒的百分比（pNN50）、高频（HF）、副交感神经系统指数（PNSI）和交感神经系统指数（SNSI）。重复测量 t 检验分析了 OMT 后心率变异平均值的差异：结果：经 OMT 治疗后，各项心率变异测量值均有统计学意义的增长。基线时，参与者的平均（95% 置信区间）RMSSD 为 50.5 ms (38.3-62.8)，OMT 后为 55.0 ms (41.2-68.7, p = .013)；基线时，pNN50 为 24.5% (17.6-31.3, n = 30)，OMT 后为 28.2% (20.8-35.6, p = .003)。基线时，HF 为 1549.6 ms2 (389.8-2709.4)，OMT 后为 1901.8 ms2 (618.2-3185.4，p = .103)。PNSI基线为-0.1（-0.5至0.2），OMT后为0.1（-0.3至1.5，p 2（1.1至1.4，p = .018）：结论：改良的枕骨乳突缝合 V 形扩张术可通过增加迷走神经张力和减少交感神经活动而带来临床益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

PM&R REHABILITATION-SPORT SCIENCES

CiteScore

4.30

自引率

4.80%

发文量

187

审稿时长

4-8 weeks

期刊介绍： Topics covered include acute and chronic musculoskeletal disorders and pain, neurologic conditions involving the central and peripheral nervous systems, rehabilitation of impairments associated with disabilities in adults and children, and neurophysiology and electrodiagnosis. PM&R emphasizes principles of injury, function, and rehabilitation, and is designed to be relevant to practitioners and researchers in a variety of medical and surgical specialties and rehabilitation disciplines including allied health.