Journal of Osteopathic Medicine最新文献

Context: No study has systematically measured somatic dysfunction (SD) in patients with acute cerebral ischemia or tested the reliability of a new osteopathic diagnostic construct, called the Functional Pathology of the Musculoskeletal System (FPMSS) model. The methodology assesses the musculoskeletal system (MSS) as an integrated organ system, shifting emphasis of examination away from structural/postural malalignment to whole systemic motion and allows quantification, prioritization, and profiling of disproportionate motion imbalances as compared to traditional diagnostic criteria.

Objectives: This study aims to assess the reliability of a novel, systematic musculoskeletal examination model to identify SD after stroke or transient ischemic attack (TIA) and in healthy participants.

Methods: Asymptomatic participants and patients admitted with acute brain ischemia were recruited from an academic tertiary referral center to undergo standardized examinations. Participants were anticipated to undergo paired, blinded ratings by two independent raters on the same day. Paired ratings were performed twice in healthy participants (2 weeks apart), once in those with transient cerebral ischemia, and up to three paired instances, 48-72 hours apart, for patients admitted with acute stroke. Each musculoskeletal assessment consisted of 80 unique physical examination tests performed on each participant focusing on specified body regions: innominate, leg, cephalic extremities, spine, hip, and ankles/feet. Diagnostic assessments were performed by passive, specified linkage testing for available motion, and all examiners were required to participate in standardized consensus training of the FPMSS model. The methodology provides a quantifiable scale to measure grades of restricted motion. Inter-rater reliability was estimated by intraclass correlation coefficient (ICC) analysis.

Results: A total of 120 participants were enrolled (20 healthy controls, 20 with TIA [disease controls], and 80 with ischemic stroke). A total of 246 examinations were performed by seven examiners with 80 unique paired assessments across the three participant groups. Nearly two-thirds of stroke participants had hemiparesis with, on average, moderate degrees of neurologic disability. By the end of the study, acceptable inter-rater reliability was attained with: moderate agreement testing the innominate and leg; good agreement of the cephalic extremities, spine, and hip; as well as excellent agreement among raters with examination of the ankles/feet.

Conclusions: Examiners achieved acceptable levels of inter-rater reliability applying the FPMSS diagnostic construct in asymptomatic participants and in those with acute cerebral ischemia following standardized consensus training.

Osteopathic manipulative medicine (OMM) is a hands-on approach utilized by physicians to diagnose, treat, and prevent various conditions through the application of muscle manipulation techniques. It has been applied in managing chronic musculoskeletal (MSK) pain, headaches, migraines, Parkinsonian gait, and psychological conditions such as stress, anxiety, and depression. In our narrative review, we aim to integrate both direct clinical studies of OMM in cerebral palsy (CP) and supportive literature on mechanisms and related conditions. A comprehensive literature search was conducted utilizing PubMed and Google Scholar to identify relevant studies on OMM in CP management. Search strategies were intentionally broad to capture mechanistic, supportive, and clinical evidence. Representative terms included "osteopathic manipulative medicine and cerebral palsy," "osteopathic treatment and neurological disorders," and "manual therapy and cerebral palsy." Additionally, reference lists of relevant articles were manually reviewed to identify additional studies. Overall, we found that integrating OMM into CP management may offer a noninvasive approach to improving MSK function and neuromuscular control while alleviating the emotional and physical challenges, as well as increasing movement to reduce joint contractures associated with the condition. OMM techniques may also help reduce stress, anxiety, and constipation, which are prevalent among CP patients due to the psychological and physiological burdens of the disorder. OMM's holistic approach has the potential to enhance outcomes for individuals with CP by addressing their multifaceted needs. While further research and advocacy are necessary to fully integrate OMM into mainstream CP management, existing evidence suggests that OMM may improve patient outcomes and quality of life. However, the current evidence has remained somewhat limited.

Most adult mental health conditions begin in early childhood and adolescence, the most common being anxiety and behavioral disorders. Early intervention can improve outcomes and may reduce the risk of developing a clinical disorder in the future. However, children may not have the communication or understanding to share their symptoms with those around them, leaving pediatric primary care providers responsible for identifying concerning signs. This paper reviews both general symptoms that suggest possible mental health conditions as well as specific correlations between symptoms and psychiatric diagnoses. A literature search utilizing PubMed identified nine relevant articles that were supplemented with additional sources. The findings found that impaired coordination or balance, weakness, paralysis or loss of sensation, seizure-like activity, blindness, double vision, deafness, or one severe symptom, typically pain, were general signs that may indicate a psychiatric illness. More specific associations were also identified. For instance, children who report somatic complaints and school refusal have been linked to anxiety; in addition, reported stress, anger, and worries about family alcohol and drug use have been linked to depression, among many others. Awareness of the somatic and social concerns presented by children to primary care can reduce the delay from the onset of symptoms to diagnosis, leading to earlier identification, treatment, and improved outcomes. Early intervention may delay or prevent symptoms from developing into a diagnosable psychiatric disorder and/or may reduce the severity of symptoms in a child who already has a psychiatric condition.

Context: Many studies have suggested that participation in pre-clerkship volunteering opportunities is associated with higher confidence in clinical skills, improved perspectives on social barriers, and greater soft skills and empathy. While these studies have described a positive impact on subjective qualities, few studies have investigated the impact on objective standards such as third-year evaluations.

Objectives: The aim of this study was to explore the relationship between volunteer hours and third-year evaluations, with the hypothesis being that these previously studied, perceived benefits of volunteerism would translate to better evaluations.

Methods: This retrospective cohort study stratified a class of 161 medical students by volunteer hours completed during pre-clerkship years and self-recorded into the Translating Osteopathic Understanding into Community Health (TOUCH) reporting system. Preceptor evaluations were gathered utilizing the school's report system and were analyzed in categories that included communication, problem solving, clinical skills, osteopathic manipulative medicine (OMM), medical knowledge, and professional/ethical standards. The statistical analyses utilized included Pearson and Spearman correlations.

Results: At the time of data accruement, only 127 of the 161 students had completed all required rotations and had completed evaluations. Therefore, the final sample size analyzed was 127 students and 1,321 evaluations. The average overall score on evaluations was 4.47, and the average number of logged TOUCH hours was 65.63. After Pearson and Spearman correlational analyses, no statically significant results were found (p>0.05).

Conclusions: Although previous studies suggest the positive impact of volunteering on confidence in clinical abilities, this study suggests no statistically significant correlation between TOUCH hours and preceptor evaluations. Current literature suggests that this may be due to preceptor subjectivity, evaluator and clinical engagement, and grade inflation. Given that evaluations are an important factor in residency interview selection, this study raises the question on how to adapt volunteerism and evaluation standards to better prepare osteopathic medical students for residency and beyond.

Context: The etiology of cranial base strains (CBS) in newborns is poorly elucidated in historical and current literature. There have only been a handful of studies examining the prevalence of CBS in newborns or vaginal birth presentation prevalence individually, let alone their relationship. Defining this link could help to further the applications of osteopathic manipulative medicine in neonates.

Objectives: The objective of this review was to consolidate all historical and current research on the potential link between vaginal birth presentation and CBS in infants.

Methods: A review of historical and current literature was completed in October 2023 by all authors utilizing the PubMed database and Google Scholar with the following search terms: cranial strain, osteopathy, fetal, molding, pediatric, birth presentation, delivery, and labor. These terms were utilized in various combinations and individually. Inclusion criteria included description of infant skull morphology, CBS patterns, and vaginal birth presentation. Exclusion criteria included studies with noninfant populations that did not address cranial morphology and/or discussed plagiocephaly unrelated to birth. There was no date range in the exclusion criteria due to the scarcity of research. Texts that included an evaluation and treatment of children at various ages were selected for partial reviews, only including the sections relevant to infancy. The best judgment of the authors was utilized to recognize reliable articles and texts. Extensive research returned very few recorded associations of CBS caused by vaginal birth and their accompanying mechanisms; thus, a review of citations in articles sought for retrieval was also completed. Most of the information procured was found in academic and historical texts rather than research articles.

Results: The results of this review are inconclusive and can only align with the theory that physiological CBS are the most common and that pathological CBS are uncommon; no relationship to vaginal birth presentation can be concluded with the available research. However, the literature reviewed illustrates a statistically significant increase in somatic dysfunction/cranial asymmetry in infants after prolonged labor, an increase in the rates of plagiocephaly in infants born to nulliparous women and/or the use of assistive devices, improvement of symmetry with the administration of osteopathic manipulative treatment (OMT), and the improvement of symptomatology after OMT.

Conclusions: More research needs to be completed on this topic to increase knowledge in the field of infantile CBS. A better understanding of the effect of vaginal birth presentation on infant CBS and occipital flattening could optimize infant development and the prevention of common diagnoses such as plagiocephaly, developmental delay, torticollis, colic, and feeding diffic