Sheldon Yao

Resolution of Concussion Symptoms After Osteopathic Manipulative Treatment: A Case Report.

A concussion is the result of a biomechanical force directed toward the head, causing neurologic dysfunction. The inflammatory response and the production of reactive oxygen species are proposed mechanisms for the symptoms and long-term sequelae of concussion. Osteopathic manipulative treatment (OMT) may help reduce inflammation by improving glymphatic flow. The authors describe the effect of OMT on a patient with mild concussion symptoms, including nausea, dizziness, tinnitus, and imbalance. The patient was evaluated with the Sensory Organization Test before and after undergoing a 25-minute session of OMT. After the session, the patient reported resolution of symptoms, and his sensory organization test score improved by 6 points. The role of OMT must be further investigated as an essential and cost-effective tool in the management of concussions.

Resolution of dacryostenosis after osteopathic manipulative treatment.

Dacryostenosis is an obstruction of the nasolacrimal duct and is the most common cause of epiphora and ocular discharge in newborns. Whereas most cases resolve spontaneously, invasive treatment may become necessary if symptoms persist past age 6 to 12 months. In the present case, a 9-month-old boy with persistent dacryostenosis was scheduled for lacrimal duct probing after first-line treatments failed. After a single session of osteopathic manipulative treatment, the patients epiphora and other symptoms resolved, and he no longer needed surgical probing. A review of the literature highlights key pathophysiologic processes, management options, and musculoskeletal aspects of dacryostenosis. Physicians should consider osteopathic manipulative treatment in the management of dacryostenosis.

Efficacy of Osteopathic Manipulative Treatment for Management of Postpartum Pain.

CONTEXT Pain is one of the most common postpartum complaints by women in the United States, and the pain varies in its location. Research on intervention strategies for postpartum pain has focused primarily on the lower back, but pain management for other types of postpartum pain remains unclear. OBJECTIVE To investigate the effects of osteopathic manipulative treatment (OMT) on postpartum pain; the location, quality, and timing of pain; and the difference in pain between vaginal and cesarean delivery. METHODS Postpartum patients who reported having pain were recruited at St Barnabas Hospital in Bronx, New York. The short-form McGill Pain Questionnaire was administered along with a screening questionnaire. Second- or third-year residents in neuromusculoskeletal medicine and osteopathic manipulative medicine examined patients and then diagnosed and managed somatic dysfunction with OMT for approximately 25 minutes. The short-form McGill Pain Questionnaire was again administered after OMT. Paired t tests and McNemar tests were used to analyze changes before and after OMT for continuous and categorical variables, respectively. Differences in visual analog scale (VAS) pain scores between patients who had vaginal vs cesarean delivery were tested using analysis of variance, and group differences in pain location were tested using a Pearson χ2 test. RESULTS A total of 59 patients were included in the study. The mean VAS score for pain was 5.0 before OMT and 2.9 after OMT (P<.001). The VAS scores before OMT significantly differed between patients who had a vaginal delivery and those who had a cesarean delivery (P<.001), but the mean decrease in VAS score was similar in both groups. Decreases in low back pain (34 [57.6%] before and 16 [27.1%] after OMT), abdominal pain (32 [54.2%] before and 22 [37.3%] after OMT), and vaginal pain (11 [18.6%] before and 5 [8.5%] after OMT) were reported after OMT (P<.05). CONCLUSION Preliminary results demonstrate that OMT is efficacious for postpartum pain management. The lack of a control group precludes the ability to make causal claims. Future studies are needed to solidify OMT efficacy and generalizability.

Concussion Evaluation and Management: An Osteopathic Perspective

Concussions have been increasingly reported over the past decade, but the reported incidence likely minimizes the actual numbers of people affected. Associated symptoms include emotional, somatic, and cognitive complaints, which may be prolonged in patients with certain risk factors. Neurologic examination is necessary to exclude upper motor neuron lesions and thus the need for brain imaging. Cervical conditions are often found concurrently with head injury and displays a similar presentation to concussions. Therefore, determining symptom origin can be problematic. Neuropsychological, oculomotor, and balance evaluations expose specific deficits that can be successfully managed with rehabilitation. Osteopathic assessment of the cranium, spine, sacrum, and thorax for somatic dysfunctions allows for prudent interventions. Patients involved in sports may begin an established graduated return-to-play protocol once cleared by their physician. Concurrently, a parallel return-to-learn program, with applicable academic accommodations, is recommended.

A Short Review of the Treatment of Headaches Using Osteopathic Manipulative Treatment

Purpose of ReviewThis review highlights the importance of osteopathic manipulative treatment (OMT) in headache sufferers. OMT is a viable option for patients who either do not wish to use pharmaceuticals or who have contraindications to pharmaceuticals. Patients with headaches that are refractory to other treatment options may also be candidates for OMT. Multiple headache etiologies are amenable to this non-invasive treatment option and they will be reviewed here. Although there are advantages to using this treatment method, there are also shortcomings in the literature, which will be discussed.Recent FindingsRoughly 45 million Americans suffer from headaches every year. Many headache sufferers are unable to find relief through conventional treatment options. OMT is a useful non-invasive treatment option with little to no side effects. There are multiple headache types. Migraine, tension-type headache, combat-related events, post-traumatic headache, sinusitis, tooth extraction, concussions, and others have all shown benefit from OMT.SummaryOMT is a non-invasive treatment option for individuals suffering from various types of headaches. This treatment option is tailored to the individual needs of the patient and is delivered by licensed and experienced osteopathic physicians. This review of literature also highlights where there is need for further research in the field.

The Reliability of the Sensory Organization Test in Parkinson's Disease to Identify Fall Risk

The Sensory Organization Test (SOT) is an objective computer-based test used to quantitatively assess an individual’s ability to use visual, proprioceptive, and vestibular cues to maintain postural stability. The objective of this study was to determine the reliability of the SOT to differentiate fallers as compared to non-fallers in individuals with PD. This was a non-randomized single site controlled trial in a clinical setting. 39 subjects with PD (age 70.8 ± 9.9) were identified as fallers or non-fallers based on a history of two or more falls in the past six months. Balance was evaluated using the SOT, Mini-BESTest and MDS-UPDRS-III. Composite scores from the SOT, Mini-BESTest and MDS-UPDRS III were analyzed. There was a statistically significant difference in the mean Mini-BESTest score of 17.8 ± 5.6 for fallers compared to 24.8 ± 2.3 for nonfallers (p<0.05). There was a statistically significant difference in the mean SOT score of 61.8 ± 14.4 compared to 71.8 ± 9.4 for nonfallers (p<0.05). The mean MDS-UPDRS-III score for fallers was 33.6 ±11.6 and 27.8± 9.2 for nonfallers, this was not significant. An ROC curve was constructed to determine the optimal cut-off score for determining a high-risk faller with PD. Our data suggests the SOT is a reliable test to identify PD subjects at risk for falling with a cut-off score of < 67.