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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.
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So, let's take a look at Parkinson’s disease. Parkinson’s disease is a neurologic disease that
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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.
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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.
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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.
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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.