OMT for Neurologic Presentations

by Sheldon C. Yao, DO

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    00:00 The role of OMT in Neurologic Disorders. So, there are many different neurologic presentations where OMM could be integrated into the care of patients. By understanding the anatomy of the nerves, how it travels throughout the body, we could identify possible regions of compression and help utilize OMT to reduce those compressions and potentially help with different neurologic presentations.

    00:23 So, let's take a look at Parkinson’s disease. Parkinson’s disease is a neurologic disease that 00:30.553 --> 00:35.096 affects the substantia nigra of the brain and so what happens is there is decreased production of dopamine. Dopamine is an important neurotransmitter that helps to coordinate movements and affects muscle. So, certain symptoms of Parkinson’s disease; patients may present with tremors, stiffness, slowness of their movements and poor balance and coordination. As the symptoms get worse, patients may have trouble with walking, talking and doing simple tasks, activities of daily living. They may have problems such as depression, sleep, or trouble chewing, swallowing or speaking.

    01:07 Because of the decrease in dopamine levels, patients will present with certain biomechanical presentations and motor symptoms that OMM could potentially help with. So, patients will present with bradykinesia, tremor, rigidity and stiffness, postural instability and shuffling of gait. All of these things are important because they add up to increasing the incidence of falls and when you have an older population and when they fall there is increased risk of injury, change of life, hip fractures and once you have a hip fracture there is increased risk of mortality and morbidity.

    01:45 Patients also complain of pain. Greater than 67% of Parkinson’s patients will have some sort of complaint of pain and of those complaints about 50% of them will be of some sort of musculoskeletal origin. Parkinson’s disease treatment. So there are many different types of treatments for Parkinson’s disease. There are medications that help try to boost levels of dopamine such as carbidopa-levodopa. There are different dopamine agonists and these medications help to increase the levels of dopamine. There is MAO inhibitors to also help decrease the breakdown and then in special instances when it's indicated there is deep brain stimulation. There are different supportive treatments that could be applied to help patients with Parkinson’s including speech therapy to help them with speech and swallowing, physical therapy to help them with their joints and muscles, stiffness and their gait, occupational therapy for more small motions and movements, fine motor coordination and then there is OMM. So, utilizing OMM we could help address musculoskeletal dysfunctions in the body. With Parkinson’s disease, remember there is increased muscle rigidity which then leads to increased pain, pain then leads to increased muscle spasms which then leads to more rigidity. So, in looking at the biomechanical model approach what we want to do is to try to increase joint motion and function, normalize muscle tone and thus decrease the amount of pain that the patient may be having. So, muscle energy technique is a great biomechanical approach in Parkinson’s patients. It's relatively important to try to help with improving coordination. So remember with Parkinson’s, patients have difficulty with initiating motion, having shuffling gait and with muscle energy technique based on its principles the patient has to activate their muscles and so it helps to reinforce their use of the muscle. So, muscle energy technique could help with improving range of motion, help with decreasing muscle spasms and then improving that hypokinesia. We could also utilize articulatory and range of motion techniques.

    03:56 These techniques are utilized to help prevent muscle spasms, improve joint restriction, decrease the development of adhesions. We could also utilize balanced ligamentous tension. So balanced ligamentous tension is a great technique to utilize to try to decrease any sort of tension within the ligaments which then restricts joint motion so we could normalize the different joint mechanics by resending the proprioceptors in the ligaments using balanced ligamentous tension. Counterstrain is a great approach to try to decrease any sort of musculoskeletal pain that the patient might be having and then we could also utilize myofascial release and facilitated positional release to try to decrease any muscle spasms that the patients may be suffering with. There have been some studies looking at how OMT could affect Parkinson’s disease. So, in one study they looked at how treating Parkinson’s patients utilizing the biomechanical model could help improve their range of motion so they utilize different articulatory techniques to the spine and the shoulders and the extremities. Muscle energy was used also for the upper extremity and lower extremities to try to decrease muscle spasms, increased joint range of motion and then they also utilize different myofascial stretches to the muscles in the neck, head and back. And so they utilize a gait analysis system and they looked at Parkinson’s patients before and after the OMT protocol treatment and what they noticed was that the patients that normally had like a shuffling gait were able to take bigger steps. So they had larger improvement in their stride and because of that they also were able to take more steps in the same allotted time. Since then, there has been additional follow-up studies using the similar protocol to also show that osteopathic manipulation could help with balance and also with other motor functions.

    About the Lecture

    The lecture OMT for Neurologic Presentations by Sheldon C. Yao, DO is from the course Osteopathic Treatment and Clinical Application by System.

    Author of lecture OMT for Neurologic Presentations

     Sheldon C. Yao, DO

    Sheldon C. Yao, DO

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