MOA 118 th Annual Spring Convention

Transcription

1 MOA 118 th Annual Spring Convention OMT In the Geriatric Patient Hollis H. King, DO, PhD May 19, 2017

2 Learning Objectives: After receiving the presentation the participant will be able to: 1. Describe the OMT research on a number of conditions frequently encountered in geriatric practice 2. Describe directions for research on OMT in geriatric conditions

3 Shannon s. A rising tide of older patients: Preparing future DOs. J Amer Osteopath Assoc. 2013;113: [Editorial] ~ Number of US citizens aged 65 increasing (baby boomer born ) ~ 2010 older adults = 13% of population 40.2M ~ By 2050 will be 20% M All physicians and other health care professional need more extensive training and experience with the geriatric population. Given current trends, training focused on diseases associated with obesity, such a diabetes, should be a priority.

4 Shannon (2013) cited Noll DR, Channell MK, Basehore PM, et al. Developing osteopathic competencies in geriatrics for medical students. J Amer Osteopath Assoc. 2013;113: Identify posture and gait abnormalities that contribute to gait and balance disorders. 2. List and explain the relative contraindications and adverse effects of specific OMT techniques in the elderly. 3. Apply OMT as a nonpharmaceutical treatment of somatic manifestations of physical, cognitive and behavioral disorders, including pain relief and common end-of-life symptoms (eg, nausea, constipation, anxiety). 4. Describe and demonstrate the positional modifications of PE and OMT for use in elderly patients with limited or minimal mobility such as in the hospital or nursing home. 5. Evaluate and treat somatic dysfunction that limit patient range of motion and the ability to perform ADL.

5 Channell MK, Wang Y, McLaughlin, et al. Osteopathic manipulative treatment for older patients: a national survey of osteopathic physicians. J Amer Osteopath Assoc. 2016;116: ~ AOA survey to determine use of OMT by DOs in older patients compared to younger patients. ~ Anonymous online survey how many provide OMT and what techniques used? ~ Response rate 197 of 629 AOA members (31.3%) ~ OMT used at same rate for all ages. ~ Used most in respiratory and neurological conditions in elderly ~ HVLA was avoided in patients 65.

6 Pulmonary & Respiratory Conditions

7 Preliminary Studies 1990 s Noll D, Shores J, Bryman P, Masterson E. Adjunctive osteopathic manipulative treatment in the elderly hospitalized with pneumonia: A pilot study. J Amer Osteopath Assoc. 1999;99: Donald Noll, D.O. F.A.C.O.I Noll DR, Shores JH, Gamber RG, Herron KM, Swift J Jr. Benefits of osteopathic manipulative treatment for hospitalized elderly patients with pneumonia. J Am Osteopath Assoc.2000; 100:

8

9

10 Pneumonia Noll et al. 2010

11 11

12 12

13 MOPSE Protocol

14 Noll DR, Degenhardt BF, Johnson JC, et al. Immediate effects of osteopathic manipulative treatment in elderly patients with chronic obstructive pulmonary disease. J Amer Osteopath Assoc. 2008;108: Age 65, N = 35 (OMT = 18, Sham = 17) OMT showed a statistically significant decrease in forced expiratory flow at 25% and 50% of vital capacity and at the midexpiratory phase. OMT group also had significant increase in the residual volume. Data suggested an overall worsening of air trapping during the 30 minutes immediately following one OMT session relative to sham group.

15 Falls and Fall Management

16 Fraix M. Role of the musculoskeletal system and the prevention of falls. J Amer Osteopath Assoc. 2012;112(1): Noll DR. Management of falls and balance disorders in the elderly. J Amer Osteopath Assoc. 2013;113(1): ~ Approximately 30% of older adults fall at least once per year. ~ Falls are the leading cause of fatal and nonfatal injuries for people 65. ~ Annual cost of fatal and nonfatal fall-related injuries is estimated to reach $32.4 billion in ~ Falls like due to an interaction of multiple risk factors ~ Vitamin D deficiency ~ Diminished strength and coordination ~ Depression ~ Multiple medications ~ Home hazards

17 J Am Osteopath Assoc. 2011;111: N = 40, Healthy elders age 65 years old OMT Group N = 20 No OMT N = 20 Each group had 4 OMT or No OMT visits in which balance was measured.

18 Measurements Center of Pressure (COP) average of the pressure between the feet. AMTI Model #OR , Advanced Mechanical Technology, Inc., Watertown, MA They were barefoot in a self-chosen foot position (not wider apart than the distance between their hip joints). Their chosen foot stance was traced on paper to ensure subsequent balance trials maintained similar foot positioning 3 balance tests: Eyes open, Eyes closed With arms extended 90 degrees in front of them and their eyes closed (modified Rhomberg).

19

20

21 OMT Protocol Lopez et al Soft tissue and myofascial release T 1 to L 5 and sacral rock - prone (3-4 minutes) 2. Shoulders and scapulae myofascial release bilaterally- lateral recumbent (4-5 minutes) 3. Cervical spine myofascial, counterstrain, muscle energy or soft tissue for release and correction- patient supine (3-4 minutes) 4. Occipito-atlantial (OA) and condylar decompression (1-2 minutes) 5. Venous sinus technique (5-6 minutes) 6. V-spread and/or frontal and parietal lifts (2-3 minutes) 7. CV 4 (3-4 minutes) 8. Recheck 2-3 minutes for other key tender points and treat findings

22 J Am Osteopath Assoc. 2013;113(5): Ave age = 49 N = 16

23 A composite score

24

25

26 Musculoskeletal Conditions

27 Knebl JA, Shores JH, Gamber RG, et al. Improving functionality in the elderly via the Spencer technique, an osteopathic manipulative treatment: a randomized controlled trial. J Amer Osteopath Assoc. 2002;102: ~ N = 29 with pre-existing shoulder somatic dysfunction (OMT = 16, Control = 15) ~ OMT received Spencer s techniques. Placebo shoulder placed in same positions as Spencer but no activation of OMT Treated weekly for 14 weeks ~ Assessment done blind to the patient s experimental group Outcome measures: 1) ROM, 2) physical functioning (dressing, bathing, grooming, 3) perceived pain ~ Results: ROM: all planes of motion improved for OMT group (P.05) Function: improved for OMT group (P.05) Pain: reduced for OMT group (P.05)

28 Noll DR. Leg length discrepancy and osteoarthritic knee pain in the elderly: an observational study. J Amer Osteopath Assoc. 2013;113(9): N = 32 who had reported osteoarthritic knee pain (Male = 4; Female 28) Results: Right knee pain = 17; 10 had right short leg & 7 left leg Left knee pain = 15; 13 had short left leg & 1 had right leg & 1 was equal Knee pain was most severe in the short leg for 23 of 32 participants (71.9%) The most common pattern was for both iliac crests to be equal and the short leg to be concordant with a superior ASIS 23 of 32 (71.9%). LLD range: 0 to 2.1 cm

29 Snider KT, Snider EJ, Johnson JC, et al. Preventive osteopathic manipulative treatment and the elderly nursing home resident: a pilot study. J Amer Osteopath Assoc. 2012;112(8): N = 21 (OMT = 8; light touch (LT) = 6; treatment as usual (TAU) = 7) Interventions delivered twice a month for 5 months for total of 10 treatments. TAU no TX Results: OMT and LT had fewer hospitalizations (P =.04) and decreased medication usage (P =.001) compared to the TAU group.

30 Parkinson s Disease

31 Wells MR, Giantinoto S, D Agate D, et al. Standard osteopathic manipulative treatment acutely improves gait performance in patients with Parkinson s disease. J Amer Osteopath Assoc. 1999;99(2): Ten patients with idiopathic Parkinson's disease and a group of eight agematched normal control subjects were subjected to an analysis of gait before and after a single session of an OMT protocol. A separate group of 10 patients with Parkinson's disease was given a sham-control procedure and tested in the same manner. In the treated group of patients with Parkinson's disease, statistically significant increases were observed in stride length, cadence, and the maximum velocities of upper and lower extremities after treatment. There were no significant differences observed in the control groups. The data demonstrate that a single session of an OMT protocol has an immediate impact on Parkinsonian gait. Osteopathic manipulation may be an effective physical treatment method in the management of movement deficits in patients with Parkinson's disease.

32 Yao S. Effects of osteopathic manipulative medicine on Parkinson s disease. U.S National Institutes of Health. New York Institute of Technology, n.d. Web. 11 Apr AOA has funded two clinical trials on the impact of OMT on Parkinson s disease. One to Dr. Sheldon Yao at NYIT One to Dr. Kendi Hensel at UNTHSC-TCOM

33 DiFrancesco-Donoghue J, Apoznanski T, de Vries K, et al. Osteopathic manipulation as a complementary approach to Parkinson s disease: a controlled pilot study. NeuroRehabilitation 2017;40(1): A randomized controlled trial to test OMM on balance and motor function in PD measured by the Mini-Balance Evaluation Systems Test (Mini-BESTest), Sensory Organization Test (SOT), and Movement Disorder Society- Unified Parkinson s Disease Rating Scale MDS-UPDRS. 11 Subjects (age 75±16) were randomly assigned to either bi-weekly OMM treatments first for 6 weeks or weekly counseling sessions from a medical provider for 6 weeks as a placebo-control. 9 subjects completed this study. RESULTS: There were no significant changes in SOT or Mini BESTest in either group (p < 0.05). There was significant improvement in the OMM group for MDS-UPDRS.

34 Promising Areas of Research Any TBI Dementia/Alzheimers Stimulation of Glymphatic System

35

36

37

38 Then Lymphatic Vessels Were Found In The Brain Also

39 Antoine Louveau, Igor Smirnov, Timothy J. Keyes, Jacob D. Eccles, Sherin J. Rouhani, J. David Peske, Noel C. Derecki, David Castle, James W. Mandell, Kevin S. Lee, Tajie H. Harris, Jonathan Kipnis. (2015). "Structural and functional features of central nervous system lymphatic vessels.". Nature Aleksanteri Aspelund, Salli Antila, Steven T. Proulx, Tine Veronica Karlsen, Sinem Karaman, Michael Detmar, Helge Wiig, Kari Alitalo. (2015). "A dural lymphatic vascular system that drains brain interstitial fluid and macromolecules.". The Journal of Experimental Medicine.

40