Osteopathic clinical reasoning

Traumatic brain injury (TBI) has a complex pathophysiology that has historically been poorly understood. New evidence on the pathophysiology, molecular biology, and diagnostic studies involved in TBI have shed new light on optimizing rehabilitation and recovery. The goal of this study was to assess the effect of osteopathic manipulative treatment (OMT) on peripheral and central glial lymphatics in patients with severe TBI, brain edema, and elevated intracranial pressure (ICP) by measuring changes in several parameters regularly used in management. This was a retrospective study at a level II trauma center that occurred in 2018. The study enrolled patients with TBI, increased ICP, or brain edema who had an external ventricular drain placed. Patients previously underwent a 51-minute treatment with OMT with an established protocol. Patients received 51 minutes of OMT to the head, neck, and peripheral lymphatics. The ICP, cerebrospinal fluid (CSF) drainage, optic nerve sheath diameter (ONSD) measured by ultrasonography, and Neurological Pupil Index (NPi) measured by pupillometer were recorded before, during, and after receiving OMT. A total of 11 patients were included in the study, and 21 points of data were collected from the patients meeting inclusion criteria who received OMT. There was a mean decrease in the ONSD of 0.62 mm from 6.24 mm to 5.62 mm (P = 0.0001). The mean increase in NPi was 0.18 (P = 0.01). The mean decrease in ICP was 3.33 mmHg (P = 0.0001). There was a significant decrease in CSF output after treatment (P = 0.0001). Each measurement of ICP, ONSD, and NPi demonstrated a decrease in overall CSF volume and pressure after OMT compared to CSF output and ICP prior to OMT. This study demonstrates that OMT may help optimize glial lymphatic clearance of CSF and improve brain edema, interstitial waste product removal, NPi, ICP, CSF volume, and ONSD. A holistic approach including OMT may be considered to enhance management in TBI patients. As TBI is a spectrum of disease, utilizing similar techniques may be considered for all forms of TBI including concussions and other diseases with brain edema. The results of this study can better inform future trials to specifically study the effectiveness of OMT in post-concussive treatment and in those with mild-to-moderate TBI.

Aim: To compare optic nerve sheath diameter (ONSD) in primary open angle glaucoma (POAG), primary angle closure glaucoma (PACG) and normal tension glaucoma (NTG). Material and Methods: Patients with POAG (n=38), PACG (n=32), NTG (n=18) and con-trols (n=48) underwent B-scan ultrasound and computed tomography scan (CT scan) measurement of ONSD. Intraocular pressure (IOP) was measured in all groups and was correlated with ONSD. Results: ONSD was significantly (p=

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The preliminary data collected with 16 enrolled subjects were analyzed thus far. Ultrasound measurements revealed mean left to right depth difference ranging from 0.38-0.26cm between the designated sacral bony landmarks. When the subjects were transitioned from prone to sphinx position, the mean depth difference ranged from 0.23-0.06cm (±0.46-0.68). Sonography before and after physician palpation showed a depth difference of the designated landmarks range from 0.37-0.07cm (±0.6-0.42). Physician palpation data have not shown a high degree of interrator reliability with the 16 subjects studied.

Enactivism is a philosophical and scientific approach that emphasizes the role of the body and its interactions with the environment in shaping cognitive processes and subjective experiences. Meanwhile, osteopathy is a person-centered health care discipline, highlighting the structure-function interrelationship of the body and its selfregulation mechanisms. Both approaches value the body and the environment in health. Several authors have been discussing the urgent need for a reconceptualization of osteopathy and also suggesting integrate biological, psychological and social aspects. Thinking osteopathy as a Therapeutic Rationality, implies recognize its fundamental dimensions: Human Morphology, Vital Dynamics, Medical Doctrine, Diagnostic System and Therapeutic System, all integrated by a philosophical Cosmology, as the original term Medical rationality states, but also embrace a broader perspective allowing an individual and unique process of each person, reflecting the transformation of contemporary medicine to a person approach. Enactivism principles can serve as a basis for a reconceptualization of osteopathy, integrating environmental, psychological, social, and spiritual factors. Osteopathic concepts can probably be updated through the convergence between enactivism and osteopathy, promoting more meaningful and evidence-based clinical practice. Advancing in this direction requires a collaborative dialogue between researchers, health professionals and interested people, seeking an integrated understanding of the relationship between body, mind, environment and health.

Purpose Malfunction of the lymphatic or glymphatic system recently shown in the brain, seems to play an important role in central neurodegenerative pathologies through a build-up of neurotoxins. Recent studies have shown functional links between aqueous humour and cerebrospinal fluid via the glymphatic system, offering new perspectives and unifying theories on the vascular, biomechanical and biochemical causes of chronic and open angle glaucoma (POAG). The aim of this randomized pilot study is to compare the variations in intraocular pressure between 20 cases of compensated POAG under pharmacological therapy and 20 glaucoma patients undergoing osteopathic treatment, hypothesizing that this manipulation can influence intraocular pressure. Materials and Methods The 40 patients under study, all covered by the Helsinki convention, were randomly divided into 2 groups (treated group or TG and control group or CG). The 40 patients were chosen from compensated glaucoma sufferers, who requir...

Osteopathy is categorized as complementary and alternative medicine. It is a profession which is present in most countries, with a variety of practices and regulations. While it is sometimes integrated within other disciplines of manual therapy, such as physiotherapy, unlike the latter, osteopathy continues to be based on philosophical principles that shape its identity, anchoring it to the 19th century. However, these osteopathic tenets do not meet the criteria of representativeness and truthfulness and thus, cannot coexist with a science-based medical practice. This commentary analyzes the underlying theoretical principles that dictate osteopathic care, its deficiencies and weaknesses and why they might place osteopathy in the realm of pseudoscience.

Background and Objectives: The techniques directed to the cranial field in osteopathy are the most questioned due to the lack of scientific evidence. In osteopathic practice, manual palpation is essential and, therefore, measuring reliability is fundamental. The objective of this study is to assess the precision and objectification of an educational model in cranial osteopathy based on experience. Materials and Methods: A reliability study was conducted in a cadaver skull where a strain gauge was placed on the sphenobasilar synchondrosis (SBS) of the base of the skull. Three cranial osteopathic techniques (lateral compression, anteroposterior compression, and compression maneuver of the mastoids) were performed 25 times by osteopaths with different degrees of experience (5–10 years, 1–5 years, <1 year). Measurements were computed for each of the three techniques of each group in comparison with the osteopath with >15 years of experience. Data were analyzed to check for inter- ...

Context: Interest in osteopathic manipulative medicine (OMM) among first- and second-year osteopathic medical students typically declines toward the end of the second year of medical school. An osteopathic philosophy and manipulation enhancement (OPME) program was implemented for osteopathic medical students to gain additional exposure to OMM at the Touro College of Osteopathic Medicine in New York, New York. Objective: To assess how additional exposure to OMM through the OPME program influenced first- and second-year students’ interest in using OMM. Methods: A survey of first- and second-year osteopathic medical students was conducted at the end of the school years to evaluate students’ demographics, exposure to OMM before matriculation, reasons for participating in the OPME program, and level of interest in OMM before and after participating in the OPME program. Results: Of 390 students, 204 returned the survey. Respondents reported that their exposure to OMM before enrollment was...

BACKGROUND AND OBJECTIVES: Neck range of motion may be decreased by vertebral and myofascial dysfunctions, which may be treated with osteopathic manipulation through the cervical rhythmic articulatory technique. This study aimed at verifying whether osteopathic manipulation with rhythmic articulatory technique improves cervical rotation range measured by fleximetry. METHODS: The group was made up of 58 individuals of both genders, mean age of 36±6.5 years, with chronic mechanical neck pain, who were randomized to cervical rotation control fleximetry, to osteopathic manipulation through the rhythmic articulatory technique, to 5-minute rest and to cervical rotation study fleximetry. RESULTS: The comparison of cervical rotation fleximetry means through Student's t test for paired data at significance level of 0.05 (5%) has shown significant cervical rotation improvement in all cases (p<0.05), going from 151.4º to 162.5º in total movement arch (7.3% improvement). CONCLUSION: Results were as expected, confirming that osteopathic manipulation using the rhythmic articulatory technique generates significant improvement of cervical rotation range in all cases and may be an alternative to treat diseases related to vertebral mobility reduction, such as neck pain and cervical osteoarthritis.

Total knee arthroplasty (TKA) is a very common surgical treatment approach for severe osteoarthritis. Complications of TKA include loss of range of motion and prolonged analgesic requirement for pain control. Osteopathic manipulative techniques (OMT) have been utilized to address localized muscular stiffness to improve range of motion; however, limited studies directly correlate OMT and TKA recovery. This review highlights the therapeutic benefits OMT can have in the postoperative management of arthroplasty with respect to range of motion, edema, pain perception, and ability to perform activities of daily living. This review revealed the use of OMT would positively influence range of motion by manipulation of localized musculature and can result in decreased demand for analgesics. This can, in turn, shorten hospital stay and return the ability of patients to perform activities of daily living earlier than without OMT. Increased research is needed to strengthen these findings on the benefits of OMT in the postoperative management of arthroplasty.

Compression of the fourth ventricle (CV4) is a well-known osteopathic procedure, utilized by osteopaths, osteopathic physicians, craniosacral therapists, physical therapists, and manual therapists as part of their healthcare practice based on some evidence suggesting impact on nervous system functions. The main objective of the study was to identify randomized controlled trials (RCTs) assessing the clinical benefits of CV4 and to show the evidence supporting clinical prescriptions, guides, and advice in treating. A computerized search of the PubMed, CINAHL Complete, Scopus, Web of Science, and ScienceDirect databases was performed. Two filters were used (article type: RCTs; species: humans). The methodological quality of the trials was assessed using the Downs and Black quality checklist for healthcare intervention studies. Only six studies met the inclusion criteria, of which four were RCTs and two were observational studies. The Downs and Black score ranged from 17 to 24 points ou...

Questo libro assolvere all’accezione di manuale in quanto fornisce le informazioni di base a chi intende avvicinarsi al mondo delle attività motorie e dello sport per persone con disabilità. Nelle prime pagine, vengono puntualizzati alcuni aspetti che si ritengono imprescindibili per lo sviluppo della cultura della disabilità, a partire dalla definizione di persona con disabilità alla luce dei dettami della Convenzione Onu, caposaldo del terzo millennio, che la individua come soggetto di diritti. Sul piano del linguaggio, viene evidenziato il valore etico della modalità che pone enfasi sulla persona, poiché colloca la disabilità proprio all’interno del tema del rispetto dei diritti. Dello sport paralimpico viene enfatizzato il ruolo di strategia di innesco del processo di resilienza, e della disabilità viene presentato il modello concettuale dato dal- la Classificazione Internazionale del Funzionamento, della Disabilità e della Salute (ICF) dell’OMS che la definisce come il risultato di una complessa relazione tra la condizione di salute di un individuo, e l’ambiente, fisico e relazionale, in cui vive. Il manuale passa poi a dare informazioni generali sulle varie tipologie di disabilità, che ne profilano gli aspetti fondamentali e, con il focus sull’attività motoria ne evidenzia le caratteristiche specifiche individuando, in riferimento alla letteratura esistente, quali le esperienze più significative anche in ambito sportivo.

Background: Palpation constitutes a central element of osteopathic diagnosis and therapy. It is a complex tactile performance and as such also depends on cognitive factors. References by experienced osteopaths (EOs) suggest that the ability to visualise anatomical structures is essential during palpation. Scientific studies in this field can hardly be found. This study aimed to systematically determine what role mental imagery (MI) plays for osteopaths and especially what the benefits are when it is used spontaneously and deliberately. Material and Methods: The present study is a qualitative study. Nine interviews with EOs were carried out with the help of an interview guideline and analysed using a qualitative analysis of content using the software MAXQDA. Results: All EOs regarded MI as a tool as well as an interfering factor for palpation. Its supporting role was associated with the identification, recognition and comparing of anatomical conditions, with directing attention, with navigation and orientation. The limiting character showed up in distraction and deception by mental images. The results also revealed the situational use of MI as well as different mental images and influencing factors (e.g. visualisation training). Discussion: The study provides an insight into the application knowledge of EOs and shows some aspects of palpation, which have been subject to little research so far. Being aware of and understanding the role of MI as a top-down process in tactile-haptic perception should change the focus in palpation. The findings can be incorporated in daily practice as well as in the training system. To regard MI as a possible bias can lead to reassessment and realignment of reliability studies. This study offers a basis for other studies to work from to explore the nature of MI in the tactile-haptic perception of osteopaths.

Golden Jackal expansion in Romania is increasing, starting in the southern and south eastern regions to the central regions. This is based on the ability of this species to adapt to different areas and varied diets. In these circumstances, its ecological niche is very broad, favoring the spread. The detailed anatomical descriptions of this species are few, lacking a fair characterization. The aim of this paper is to describe the anatomical peculiarities of the mediastinum in order to compare with scientific reports related to domestic species. Seven specimens were examined. The thoracic cavity was elongated, the lungs and pleural cavities occupying the most part. The mediastinum was referred as a region with three divisions: cranial, middle and caudal. Due to the obvious delineation of its components, the middle mediastinnum was further subdivided in: ventral, middle and dorsal subregions. Due to the caudal position of the heart in the thoracic cavity, the cranial divisions of the m...

Setting & participants Osteopathy Australia (formerly Australian Osteopathic Association) members were sent an email explaining the project and a link to the electronic survey. The majority of osteopaths who received the email were practicing and were requested to forward the email to any colleagues or friends that they personally knew were no longer practicing (snowball sampling). Design & methods A retrospective quantitative electronic survey was used to gather information regarding demographics, financial aspects and work hours. Likert-type scales were employed to gather perceptions across health, lifestyle, financial and other factors, and their potential relationship with the decision to leave practice. Results Complete responses were received from 29 osteopaths. Common factors identified by respondents for ceasing practice included family commitments (20%), dissatisfaction with osteopathic practice (20%), and boredom with osteopathic practice (20%).

Cervical artery dysfunction is a reported potential risk associated with manual therapy applied to the cervical and cervicothoracic spine. While a variety of physical examination tests have been advocated to screen patients who may be at risk of adverse events during or after manipulation, their clinical utility is limited. This paper provides an overview of the literature and current thinking with regard to risk assessment and clinical action related to the application of manual and exercise therapy for the cervical and upper thoracic spine. * A collection of signs and symptoms including partial ptosis, miosis, anhydrosis as the result of interruption of the sympathetic nerve supply to the eye. Also referred to as Bernard-Horner syndrome. Persistent night pain Constant unremitting pain Pain that does not change with position/movement Loss of appetite Unexplained weight loss Past history of malignancy Shortness of breath Constant unexplained fatigue Chest pain Constant and severe extremity pain Swelling in the extremities and abdomen with history of injury Changes in colour of the hands/feet Frequent or severe abdominal pain Changes in bladder function Frequent nausea and/or vomiting Fever and/or night sweats Recent onset headache (with no previous history) Sudden onset severe neck pain (with no history of injury or trauma) Changes in vision, speech and/or hearing Changes in balance and coordination Sudden weakness Progressive neurological symptoms Neurological symptoms over more than one dermatome Bilateral neurological symptoms

Context: Despite the documented effectiveness of highvelocity, low-amplitude (HVLA) treatment of the cervical spine, concerns about patient safety potentially limit didactic instruction and use in clinical practice. Understanding how cervical HVLA is taught and employed is of interest to osteopathic educators and clinicians. Objectives: To characterize the perspectives of osteopathic manipulative medicine/osteopathic principles and practices (OMM/OPP) departments within colleges of osteopathic medicine (COMs) in the US regarding patterns of teaching and practice of HVLA treatment of the cervical spine. Methods: A questionnaire was distributed on April 11, 2019 in paper format to OMM/OPP department chairs or designated faculty member attendees at the Educational Council on Osteopathic Principles biannual meeting. If the department chair was not available, the survey was provided to the faculty member designated to represent the Chair of the institution at ECOP. All respondents in this category returned the survey in paper before they left the meeting. The OMM/OPP department chairs who did not attend or send representatives to the ECOP meeting were sent the survey by email on April 11, 2019 and given three opportunities over 6 weeks at 2-week intervals to reply to this voluntary online survey. The survey was given or sent to a total of 51 OMM/OPP department chairs or representatives. Six questions elicited demographic information pertaining to status, age, gender, ethnicity, boardcertified specialty, and COM affiliation. Nine questions examined perspectives related to the instruction of cervical HVLA manipulation and treatment. Results: Of the 51 OMM/OPP department chairs surveyed, 38 (74.5%) responded, 32 to the paper survey at the ECOP meeting and six to the digital survey. Respondents were primarily dual Board-certified in Family Medicine and Neuromuscular Medicine (55.3%). At over 90% (35) of the COMs for which department chairs responded to the survey, cervical HVLA instruction occurs in the curriculum primarily during program years 1 and 2. Instruction in cervical HVLA to the 2nd through 7th cervical vertebral levels occurred in 97% (37), while 11% (4) of the COMs excluded the occipital-atlanto (OA) and atlanto-axial (AA) joints. A high percentage (81.6%; 31) of the OMM/OPP department chairs or representatives reported employing cervical HVLA techniques within their practice. Among the respondents, 40.5% (15) reported that 0-25% of their school's medical school class could perform cervical HVLA competently upon graduation, whereas 27% (10) said that 51-75% of their class could perform cervical HVLA. Conclusions: A majority of COMs provide education in their curricula related to cervical HVLA primarily in the first 2 years of medical education. However, instruction often excludes cervical HVLA to the upper regions of the cervical spine. At COMs where HVLA to the cervical spine is not taught, that decision is because the techniques are thought to be too difficult and the attendant medicolegal risk perceived to be too high. OMM/OPP department chairs expressed confidence in only a small proportion of their graduates having the ability to competently apply HVLA to the cervical spine immediately after completing their predoctoral medical training.

*Significant difference between T1 and T2 (p<0.05). ** Due to the number coding system where the response 'Competent' scored a value of 1, any value less than this would mean the participants rated themselves as incompetent for that area. Therefore individual competencies were viewed as only just competent when the mean approached 1.

Heart rate variability (HRV) is the change in frequency from one heartbeat to the next, due to the adaptation of the heart’s rhythm in response to an internal or external stimulus. Increased HRV has been reported as a potential indicator of general health. The relationship between structure and function is one of the guiding principles of osteopathy; it considers anatomy essential for explaining physiological dysfunction. There is a paucity of research on the effects of Osteopathic manipulative medicine (OMM) on the effects of HRV. We hypothesize that OMM can be used safely and to help promote healthier HRV. We herein report on a case of improved HRV after serial OMM sessions.

The article explains the scientific reasons for the diaphragm muscle being an important crossroads for information involving the entire body. The diaphragm muscle extends from the trigeminal system to the pelvic floor, passing from the thoracic diaphragm to the floor of the mouth. Like many structures in the human body, the diaphragm muscle has more than one function, and has links throughout the body, and provides the network necessary for breathing. To assess and treat this muscle effectively, it is necessary to be aware of its anatomic, fascial, and neurologic complexity in the control of breathing. The patient is never a symptom localized, but a system that adapts to a corporeal dysfunction.

A theoretical model that does not evolve with new information deriving from scientific research, by changing the assumptions from which it was born, becomes a philosophy; the scientist becomes a scholarch. Cranial manual osteopathic medicine is very controversial, although it is commonly practiced, from the clinician to the nonmedical health worker. The article, divided into two parts, reviews the assumptions with which the cranial model was created, highlighting the scientific innovations and new anatomicalphysiological reflections. In the first part we will review the synthesis and movement of cerebrospinal fluid (CSF), the movement of the central and peripheral nervous system; we will highlight the mechanical characteristics of the meninges. The aim of the article is to highlight the need to renew the existing cranial model.

In a companion paper, we proposed that cognitive debiasing is a skill essential in developing sound clinical reasoning to mitigate the incidence of diagnostic failure. We reviewed the origins of cognitive biases and some proposed mechanisms for how debiasing processes might work. In this paper, we first outline a general schema of how cognitive change occurs and the constraints that may apply. We review a variety of individual factors, many of them biases themselves, which may be impediments to change. We then examine the major strategies that have been developed in the social sciences and in medicine to achieve cognitive and affective debiasing, including the important concept of forcing functions. The abundance and rich variety of approaches that exist in the literature and in individual clinical domains illustrate the difficulties inherent in achieving cognitive change, and also the need for such interventions. Ongoing cognitive debiasing is arguably the most important feature of...

Numerous studies have shown that diagnostic failure depends upon a variety of factors. Psychological factors are fundamental in influencing the cognitive performance of the decision maker. In this first of two papers, we discuss the basics of reasoning and the Dual Process Theory (DPT) of decision making. The general properties of the DPT model, as it applies to diagnostic reasoning, are reviewed. A variety of cognitive and affective biases are known to compromise the decision-making process. They mostly appear to originate in the fast intuitive processes of Type 1 that dominate (or drive) decision making. Type 1 processes work well most of the time but they may open the door for biases. Removing or at least mitigating these biases would appear to be an important goal. We will also review the origins of biases. The consensus is that there are two major sources: innate, hard-wired biases that developed in our evolutionary past, and acquired biases established in the course of develop...

Introduction: Health professionals and bodyworkers may be pivotal in promoting prevention programs, providing tailored advice and guidance to patients’ adherence to self-care strategies, such as physical activity. Contemporary evidence encourages manual therapists to involve patients in decision-making and treatment procedures integrating passive and active approaches in treatment planning. This manuscript provides a definition and applications of neuromyofascial movement patterns, discusses the significance of functional assessment, and gives an example of clinical applications in the osteopathic field to highlight how this assessment can promote interdisciplinarity. Methods: The reporting framework used in the current manuscript followed guidelines for writing a commentary. Results: The manuscript highlights the crucial role that the neuromyofascial system plays in human movement and overall well-being and the importance of a functional neuromyofascial activity assessment in the c...

Muscle energy technique is an established osteopathic manipulative intervention often used to treat somatic dysfunctions of the spine. There are little objective data to demonstrate its efficacy, however. To determine the efficacy of this osteopathic manipulative technique, the authors compared active cervical range of motion among asymptomatic young and middle-aged adults (n=18) before and after this treatment protocol, comparing those results against matched control subjects (n=14) who received sham manipulative treatment. Range of motion was measured in three planes (flexion/extension, lateral bending, rotation) on all subjects (N=32) using a motion-analysis system. Multiplanar gross cervical motion restrictions were diagnosed in this asymptomatic population. In the treatment group, cervical long restrictor muscles were treated with the muscle energy technique in the sagittal, frontal, and horizontal planes. The control group had relative restrictions addressed by means of a sham...

Riassunto-La neurofisiologia del basso apparato urinario rappresenta un capitola fondamentale per l'Urologo urodinamista. Nell'impostazione clinica e necessario correlare i dati anamnestico-clinici con i dati morfo-funzionali (quindi video-urodinamici) con 10 scopo di individuare la disfunzione neurologica e scegliere iI miglior trattamento. Gli Autori in questa lavoro propongono una rassegna aggiornata di alcuni solidi principi di neurofisiologia del basso apparato urinario e del lora possibile ruolo applicativo in termini diagnostico-clinici. Parole chiave: fisiologia-neurofisiologia-disfunzioni delle vie urinarie basse.

patients with CTS. These findings create several avenues for future research. Specifically, the effect of osteopathic manipulative treatment on patients with CTS should be studied and compared with the effects of surgical procedures and multimodal manual therapy.

patients with CTS. These findings create several avenues for future research. Specifically, the effect of osteopathic manipulative treatment on patients with CTS should be studied and compared with the effects of surgical procedures and multimodal manual therapy.

Traumatic vertebral artery (VA) dissection is a severe consequence of a cervical injury, which usually involves the vertebrae and spinal cord. Traumatic VA dissection has been frequently underdiagnosed or misdiagnosed, mainly because many patients remain asymptomatic. The consequence of VA dissection is ischemia in the territory supplied by the affected artery. The VA dissection presents most often as a vertebrobasilary transient ischemic attack or ischemic stroke, usually preceded by local symptoms such as neck pain or headache. Headache is a common symptom in patients with cervical artery dissection, but its characters are not specific. Diagnosis of VA dissection usually requires a CT-angiography. Delayed onset of symptoms with a variable asymptomatic interval, ranging from several days to 3 months, has been reported. The risk of stroke remains high, especially in the first weeks after the confirmation of VA dissection. Treatment of traumatic VA dissections include anticoagulation or antiplatelet therapy and revascularization techniques. We present the case of a patient with spinal cord injury and operated C5 fracture, who was diagnosed with unilateral VA dissection 6 months after the traumatic event, during the rehabilitation program.

The diaphragm muscle is the most important contractile district used for breathing. Like other muscles in the human body, it is subject to ageing and sarcopenia. Sarcopenia can be classified as primary (or age-related) when there are no local or systemic pathologies that cause a functional and morphological detriment of skeletal musculature. Secondary sarcopenia occurs when there is a cause or more pathological causes (illness, malnutrition, immobility) related or unrelated to ageing. In the elderly population, transdiaphragmatic pressure (Pdi) decreases by 20-41%, with a decline in the overall strength of 30% (the strength of the expiratory muscles also decreases). The article discusses the adaptation of the diaphragm muscle to ageing and some other ailments and co-morbidities, such as back pain, emotional alterations, motor incoordination, and cognitive disorders, which are related to breathing.

Herpes zoster (HZ) and herpes zoster ophthalmicus (HZO) are the result of reactivation of varicella-zoster virus (VZV) from a dormant condition. Although HZ symptoms typically subside after a few weeks, HZO and postherpetic neuralgia (PHN) can persist at least 90 days after the appearance of the HZ rash. Presently, there is no gold standard for a disease-modifying therapy for postherpetic neuralgia and the current treatment is focused on early intervention and management of symptoms and dermatological complications. In the present case, a 74-year-old Caucasian male initially developed severe right-sided eye pain and headache. He was diagnosed with HZO and treated with acyclovir, but later developed swelling over the right eye and skin rash over the right side of the forehead and face. He presented to the office after the acute manifestation of the infection disappeared, but the headache and scalp hypersensitivity persisted and increased. Osteopathic manipulative treatment (OMT) included correction of cranial strains, inhibition, myofascial release, balanced ligamentous tension, and facilitated positional release. In one week, the patient reported a reduction in pain from 10/10 to 2/10. Two weeks later, he reported complete resolution of his initial symptoms. There are a limited number of cases that illustrate the benefit of OMT in diminishing pain and associated symptoms in different types of neuralgias. OMT ensures the restoration of normal anatomical structure and associated function through correcting somatic dysfunction, normalization of blood supply, muscle tone, and lymphatic drainage, therefore, providing pain relief. Better documentation of case reports and more research in this area would greatly benefit the medical community. The present case demonstrates the successful treatment of PHN with OMT. OMT can be successfully used as an adjunct therapy in cases of HZ and PHN.

Bordoni et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

This work aims to describe a well standardized therapeutic path in reference to the article "Osteopathy and Emergency: A Model of Osteopathic Treatment Aimed at Managing the Post-Traumatic Stress-Part 1 in the form of a practical guide for manual therapist,

Objective-The purpose of this study was to develop a novel pelvic model and determine the accuracy, inter-and intra-examiner reliability of anterior superior iliac spine (ASIS) positional asymmetry assessment from both sides of the model by osteopathic pre-doctoral fellows and osteopathic physicians and to evaluate the effect of training. Methods-Five osteopathic pre-doctoral fellows and 5 osteopathic physicians assessed 13 settings of varied ASIS asymmetry of a novel pelvic model for superior/inferior positional asymmetry from both sides of the model in a random order. Assessment from the right and left sides of the model occurred on 2 separate days. Fellows were trained for a week and retested. Results-Average inter-examiner reliability was greatest from the left side of the model for physicians and right side for fellows (physicians k=0.46; fellows k=0.37 respectively) while intraexaminer reliability was greatest from the right in both groups (physicians k=0.49; fellows k=0.52). Following training of fellows, inter-examiner reliability remained highest from the right side of the model (right: k=0.48; left: k=0.36) while intra-examiner reliability was higher from the left side (right: k=0.53; left: k=0.59). Physicians and fellows before training were more accurate from the right side of the model (k=0.56 and k=0.52 respectively). Following training of fellows, accuracy increased from both sides of the model (right: k=0.59; left: k=0.53). Conclusions-A novel, pelvic model was developed to allow assessment of accuracy and reliability of ASIS asymmetry assessment. Individually, physicians and fellows varied in accuracy and inter-/intra-examiner reliability. Further investigation is warranted to understand the clinical and educational application of these results.

Background: Palpatory findings are considered a central element of osteopathic practice, especially when associated with a patient’s altered regulative functions than with named somatic dysfunctions. Although osteopathic theories for somatic dysfunction could be plausible, the clinical applicability of the concept is debated, especially because it is largely related to simple cause–effect models of osteopathic care. In contrast to a linear kind of diagnosis of a “tissue as a producer of symptoms”, this perspective article aims to provide a conceptual and operational framework in which the somatic dysfunction evaluation process is seen as a neuroaesthetic (en)active encounter between osteopath and patient. Subsections relevant to the subject: To summarize all concepts of the hypothesis, the enactive neuroaesthetics principles are proposed as a critical foundation for the osteopathic assessment and treatment of the person, specifically addressing a new paradigm for somatic dysfunction...