Jennifer Foucart, Maxime Etenaille, Noelle Junod-Perron
Objective: This study aims to develop and evaluate an Immersive Learning (IL) to enhance healthcare communication skills training. Methods: The IL consisted of a digital tool using a branching scenario model for six clinical themes with feedback provided to students at each critical point. A pre-post-trial design was conducted comparing the IL program against traditional role-playing exercises at Brussels University. Third year physiotherapy students were randomly assigned to an experimental IL group or a control group. Outcomes measures included students' self-perceived communication skills, satisfaction with the IL as well as its usability. Statistical analyses included Wilcoxon tests for skill progression. Results: The IL group showed significantly improved self-perceived communication skills compared to the control group (p ≤0.001). Students considered IL program to be highly usable (satisfaction = 82) and strongly recommended its use (NP score = 63.83). Conclusion: The IL program enhanced students' self-perceived communication skills, offering a supportive, engaging, and safe learning environment. IL is a valuable complement to traditional methods in healthcare education. Innovation: This study introduces an innovative IL tool that provides personalized, interactive, and scenario-based learning, fostering autonomy and skill development in a low-pressure environment.
Joyaa B. Antares, Mark A. Jones, Nga Ting Natalie Chak
et al.
Abstract Background Congenital Muscular Torticollis (CMT) is the third most common musculoskeletal condition in infancy, and if untreated can lead to significant disability. While a range of conservative treatments are commonly used in the management of CMT, an understanding of their efficacy and safety is limited. This systematic review and meta-analysis, without language or discipline restriction, was conducted to address this knowledge gap. Methods Electronic searches of CENTRAL, PubMed, 22 other electronic databases, three trials registers and Google Scholar, were conducted for randomised controlled trials, which examined any non-surgical, non-pharmacological interventions, including but not limited to manual treatments, movement therapy, acupuncture, adjunctive therapies and physical support, in children aged 0 to 5 years with CMT. Two reviewers independently assessed the risk of bias of the included studies using the Cochrane Risk of bias 1 tool, rated their certainty of evidence using grading of recommendations assessment, development and evaluation (GRADE) framework, and performed random-effects meta-analyses. Results One hundred studies (80 from China) involving 8125 participants published between 1990 and 2023 were included. Adding manual therapy to an active control resulted in short-term improvements in passive cervical rotation (odds ratio (OR) 9.79, 95%CI 4.26,22.50), passive cervical lateroflexion (OR 2.66, 95%CI 1.17,6.04), active cervical rotation (OR 3.94, 95%CI 1.08,14.35), symmetric head posture (OR 4.55, 95%CI 2.57,8.05), sternocleidomastoid tumour thickness (mean difference (MD) -2.12 mm, 95%CI -2.98,-1.26) and development of symmetrical movement (standardised MD -0.70, 95%CI -0.95,-0.45). The addition of an electrophysical agent to an active control reduced sternocleidomastoid tumour thickness (MD -2.03 mm, 95%CI -2.67,-1.39) and optimised Tuina reduced tumour thickness more than traditional Tuina (MD -1.20 mm, 95%CI -1.80,-0.59). Adverse events were uncommon but poorly reported, with 71 (71%) of studies providing no data. Study heterogeneity limited pooling of data for meta-analysis, and there was very low to low certainty evidence for all results, due to high risk of bias, small sample sizes and study heterogeneity. Conclusions This review found that non-surgical, non-pharmacological treatments may be effective for CMT, but the certainty of evidence is very low to low. These findings are important in informing clinical guidelines and management for CMT and highlight an urgent need for large definitive trials that address the limitations of current studies. Protocol registration Cochrane Database of Systematic Reviews (No.: CD012987).
Veronica Vernon, Brian W. Skinner, Patricia S. Devine
et al.
Introduction Medication errors can lead to significant adverse events. Nearly 50% of medication errors occur during the prescription-writing stage of the medication use process, and effective interprofessional collaboration and communication are key to reducing error in this process. Methods We developed a three-part, 60-minute, interprofessional education activity providing medical, physician assistant, and pharmacy students the opportunity to practice collegial interprofessional communication surrounding prescribing practices. Learners met virtually initially as a large group and divided into small groups facilitated by a health professional. Part 1 involved reviewing two prescriptions prepared by learners; part 2 was a discussion about the education, roles, and responsibilities of each profession; and part 3 focused on identifying prescription errors in examples provided by faculty. Students completed a post-pre survey measuring their perception of learning the Interprofessional Collaborative Competency Attainment Survey (ICCAS) areas. Results Of 317 participants (151 doctor of osteopathy, 68 master of physician assistant studies, and 98 doctor of pharmacy students), 286 completed the post-pre survey, for a 90% response rate. Students reported statistically significant (p < .001) increases in all 20 questions spanning the six ICCAS areas. Discussion The virtual format allowed multiple institutions to participate from various locations. It broadened the learners’ experience by fostering interaction among those with varied perspectives and allowed collaboration between locations and programs that otherwise could not have participated. The activity introduced students to virtual collaboration and key telehealth skills, enhancing their confidence and familiarity with virtual interactions in a professional setting.
Fátima Frade, Lurdes Neves, Fátima Florindo-Silva
et al.
This paper presents a case report of a child with Neonatal Brachial Plexus Palsy on the right arm, with C5, C6, and C7 nerve injuries. The symptoms presented at birth and at the time of diagnosis were absence of movement in the right arm but with mobility of the fingers; internal rotation of the injured limb with elbow extension; active flexion of the wrist and fingers; and ulnar deviation of the hand. The rehabilitation plan followed the conservative approach and included different intervention strategies (passive and active mobilisation, kinesio tape, use of splints, bimanual stimulation, etc.) carried out by the occupational therapist and the physical therapist. The rehabilitation allowed the child to have a functional limb for daily activities, with bimanual motor integration and coordination; passive and active range of motion in the different joints except for pronation, sensibility, and maintained strength. In conclusion, it can be said that this case report describes a set of rehabilitation strategies that were used in the conservative treatment of a child with NBPP and the functional gains they allowed. Early intervention, parental involvement in the rehabilitation process, and continuous follow-up of the child favoured the prognosis and allowed the prevention of functional sequelae of the limb.
Shimaa A. Ezzeldein, Yasmin Bayoumi, Eslam F. Eisa
et al.
Hypertrophic osteopathy (HO) is a diffuse periosteal reactivity of long bones and of poor prognosis as most cases died after short time or euthanized at the time of diagnosis. Early diagnosis is greatly important. Therefore, the present study aimed to investigate the clinical and different imaging features of HO in 12 dogs and hematological and biochemical changes. Twenty-two dogs were included in this study; 10 apparently healthy dogs were used as controls, and 12 dogs were diagnosed with HO. Diagnosis of HO-affected cases was based on a range of clinical, laboratory, and histopathological examinations as well as different imaging techniques. Two forms of HO were diagnosed: pulmonary (n=5) and extrapulmonary (n=7) HO. In pulmonary HO, pneumonia was recorded in five dogs. However, in extrapulmonary HO, mammary gland tumors and skin tumors were recorded in five and two dogs, respectively. Symmetrical non-edematous soft tissue swelling at the lower parts of the limbs with intensive bone proliferation and periosteal reactivity in the tubular long bones was observed. Anemia and leukocytosis, mainly lymphocytosis 50% or neutrophilia 45%, and elevated serum globulin, alkaline phosphatase, and C-reactive protein levels were the significant associated laboratory findings. The use of different diagnostic techniques was greatly important in the diagnosis of HO in dogs and provided information on the prognosis of such cases.
Objective The use of Patient Reported Outcome Measures (PROMs) to evaluate care is being advocated increasingly in clinical settings. Electronic data capture is both resource and environmentally friendly and convenient. This purpose of this study was to test and implement a nationwide system to collect routine PROM data from osteopathic patients using a web and mobile app. Methods A prospective study design was used to monitor outcomes of care for patients attending osteopathic clinics. Demographic and service data were collected, the primary outcomes were the Bournemouth Questionnaire and a Global Rating of Change score. Data concerning patients’ satisfaction and experience of care were collected also. Data were collected at baseline, one week, and six weeks post-treatment. Results A total of 1721 patients completed the PROM app questionnaire. The majority (65.8%) of patients who used the PROM app were between 40 and 69 years old with 11% being 70 years and over. At baseline 39.8% of patients reported they’d had their symptoms for 13 weeks or more. Low back pain was the most common symptom (55.8%). Patients reported high scores for both satisfaction and experience of osteopathic care: 88.1% were very satisfied at six weeks post-baseline and 93.5% reported very good experience at six weeks post-baseline. Data from the Global Rating of Change scale indicated that at one week post-baseline 89.1% of patients reported some measure of improvement, and at six weeks this figure rose to 92.8%. The mean sum score for the Bournemouth Questionnaire went from 30.8 at baseline to 13.3 at six weeks post-baseline. This represented a significant and clinically meaningful positive change score of 56.8%. Conclusion The app was well-completed and the data very encouraging. These data will help to form the basis for standards of care for patients attending osteopathic practices.
Introduction: In Germany in recent years, a growing number of parents are seeking help from osteopaths for the perceived health complaints of their infants and children. However, reliable evidence for the effectiveness of osteopathic interventions for this group of patients is largely lacking. Objective: To observe and document changes in the symptoms of certain health disturbances, as perceived by parents, during the course of an osteopathic treatment of their baby, and associated side effects. Methods: A single-arm, prospective, multicenter, observational study was chosen as the study design. Parents who contacted an osteopathic practice with any of the following 5 health disturbances were invited to include their baby into the study: idiopathic infant asymmetry (IA), deformational plagiocephaly (DP), feeding disorders (FD), excessive crying (EC), and sleep disorders (SD). Osteopaths performed osteopathic treatment as usual for these conditions, and the parents were asked to rate the perceived severity of symptoms on standardized forms including numerical rating scales (NRS 0–10). In DP, the head circumference of the child’s skull was measured with a craniometer, and the cranial vault index (CVAI) was calculated. Results: 230 osteopaths agreed to participate, 151 osteopaths returned parental ratings. 1,136 infants were treated 2.8 ± 1.1 times (mean ± SD). IA was the most prevalent disturbance (48%), followed by EC (18%), FD (15%), DP (14%), and SD (4%). In IA, perceived asymmetry as rated on the NRS improved from 6.1 to 1.1, a mean improvement of 82%. In DP, the CVAI improved from 8.0 to 4.0%, a mean improvement of 51%. FD improved by 77%, EC by 70% (from 7.7 to 2.3 on the NRS) and SD by 56%. Adverse reactions with a timely association with osteopathic treatments were reported in 3.5% of all treatments, probably reflecting typical day-to-day variations in symptoms. In a total of 3,212 treatments, there was not a single serious adverse reaction affecting infant health. Conclusions: This is one of the largest studies worldwide to date on the osteopathic treatment of infants. Osteopathic treatment was associated with major positive changes in the severity of perceived health complaints as assessed by parents, which in most cases were resolved as a matter of concern, and was proved to be a safe treatment modality among a large number of therapists. Based on these results, confirmatory intervention studies can and should be planned and conducted.
Background: Patients with fibromyalgia (FM) frequently resort to osteopathic or chiropractic treatment, despite very weak supporting evidence. We aimed to assess the efficacy of osteopathic manipulation in FM in a properly controlled and powered randomized clinical trial. Methods: Patients were randomized to osteopathic or sham treatment. Treatment was administered by experienced physical medicine physicians, and consisted of six sessions per patient, over 6 weeks. Treatment credibility and expectancy were repeatedly evaluated. Patients completed standardized questionnaires at baseline, during treatment, and at 6, 12, 24, and 52 weeks after randomization. The primary outcome was pain intensity (100-mm visual analog scale) during the treatment period. Secondary outcomes included fatigue, functioning, and health-related quality of life. We performed primarily intention-to-treat analyses adjusted for credibility, using multiple imputation for missing data. Results: In total, 101 patients (94% women) were included. Osteopathic treatment did not significantly decrease pain relative to sham treatment (mean difference during treatment: −2.2 mm; 95% confidence interval, −9.1 to 4.6 mm). No significant differences were observed for secondary outcomes. No serious adverse events were observed, despite a likely rebound in pain and altered functioning at week 12 in patients treated by osteopathy. Patient expectancy was predictive of pain during treatment, with a decrease of 12.9 mm (4.4–21.5 mm) per 10 points on the 0–30 scale. Treatment credibility and expectancy were also predictive of several secondary outcomes. Conclusion: Osteopathy conferred no benefit over sham treatment for pain, fatigue, functioning, and quality of life in patients with FM. These findings do not support the use of osteopathy to treat these patients. More attention should be paid to the expectancy of patients in FM management.
A. F. Belyaev, T. S. Kharkovskaya, O. Fotina
et al.
Introduction. The 2019 coronavirus infection (COVID-19) pandemic caused by a novel coronavirus strain (SARS-CoV-2) posed a serious threat to public health around the world. Postcoid syndrome (post-COVID-19 condition, according to ICD-10 code U09 State after COVID-19 or Postcoid state, Postcoid syndrome) is a pathological condition after a coronavirus infection, accompanied by cardio-respiratory, neurological, musculoskeletal, metabolic disorders. According to a number of studies, osteopathic methods of correction increase the lymph flow, immunological protection of the body, help to reduce pain, reduce the restriction of mobility in the chest, and therefore improve the function of external respiration. There are practically no studies that allow assessing the effect of osteopathic correction methods on the function of external respiration at the modern evidence-based level in patients who have undergone COVID pneumonia.The aim was to study the effect of a single procedure of osteopathic correction on the function of external respiration in patients during the rehabilitation period after coronavirus pneumonia.Materials and methods. On the basis of the Primorsky Institute of Vertebroneurology and Manual Medicine (Vladivostok) the rehabilitation of patients after coronavirus pneumonia was carried out using osteopathic correction. The study included 73 patients over the age of 60 years with varying degrees of lung damage and impaired respiratory function. To assess the function of external respiration, spirometry was performed and the vital capacity of the lungs was assessed; pulse oximetry was performed to measure the saturation of arterial blood hemoglobin with oxygen (SpO2). Osteopathic testing and treatment were carried out according to clinical guidelines, and the biomechanics of the chest was additionally investigated. The Statistica-10 software package was used for the statistical analysis of the obtained data.Results. Osteopathic examination revealed the presence of local somatic dysfunctions in 98,8 % of patients (spinal dysfunction, rib dysfunction, diaphragm dysfunction). 87,6 % of patients were diagnosed with regional somatic dysfunctions of thoracic region. Global somatic dysfunctions were diagnosed in 78,4 % of patients. After a single procedure of osteopathic correction, patients had a statistically significant improvement of the external respiration function, manifested in an increase in vital capacity from 78,27±2,79 to 85,36±3,38 % (p=0,0006). Also, the effectiveness of osteopathic correction is confirmed by a significant increase in the average hemoglobin saturation of arterial blood with oxygen. Thus, in patients with low SpO2 levels, the index increased from 94,21±0,21 to 95,09±0,3 % (p=0,02). After a single osteopathic correction procedure, the number of patients with local somatic dysfunctions decreased from 98,8 to 17,7 %; global somatic dysfunctions were revealed only in 16,3 % of patients. All patients noted an improvement in their general condition, a decrease in symptoms of respiratory discomfort and shortness of breath, and an increase in chest excursion.Conclusion. A single procedure of somatic dysfunctions' osteopathic correction in patients after coronavirus pneumonia leads to a statistically significant improvement in respiratory function. The vital capacity and the oxygen saturation of the blood increase in patients. This is caused by the increase of the mobility of the chest (increase in its excursion), diaphragm, ribs, spine. The obtained results allow recommend the inclusion of osteopathic correction in the rehabilitation programs for patients who have undergone coronavirus infection.
The Educational Council on Osteopathic Principles (ECOP) annually renews and reviews the fundamental osteopathic principles that Dr. Still left behind for osteopathic medicine (OM). These tenets represent a guide and rationale for the osteopathic manual approach. The non-profit research organization, Foundation of Osteopathic Research and Clinical Endorsement (FORCE), which was founded in 2013 under the auspices of different international professionals, wishes to propose changes to these principles based on scientific knowledge, which did not exist in the nineteenth century, as well as all the information discovered subsequently. The proposal is not a constraint, but a further stimulus to improve the vision of OM. We believe, in fact, that a principle or a point of view never ceases to evolve: the inspiration of every science is its change.
Abstract Context Movement and loading asymmetry are associated with an increased risk of musculoskeletal injury, disease progression, and suboptimal recovery. Osteopathic structural screening can be utilized to determine areas of somatic dysfunction that could contribute to movement and loading asymmetry. Osteopathic manipulation treatments (OMTs) targeting identified somatic dysfunctions can correct structural asymmetries and malalignment, restoring the ability for proper compensation of stresses throughout the body. Little is currently known about the ability for OMTs to reduce gait asymmetries, thereby reducing the risk of injury, accelerated disease progression, and suboptimal recovery. Objectives To demonstrate whether osteopathic screening and treatment could alter movement and loading asymmetry during treadmill walking. Methods Forty-two healthy adults (20 males, 22 females) between the ages of 18 and 35 were recruited for this prospective intervention. Standardized osteopathic screening exams were completed by a single physician for each participant, and osteopathic manipulation was performed targeting somatic dysfunctions identified in the screening exam. Three-dimensional (3-D) biomechanical assessments, including the collection of motion capture and force plate data, were performed prior to and following osteopathic manipulation to quantify gait mechanics. Motion capture and loading data were processed utilizing Qualisys Track Manager and Visual 3D software, respectively. Asymmetry in the following temporal, kinetic, and kinematic measures was quantified utilizing a limb symmetry index (LSI): peak vertical ground reaction force, the impulse of the vertical ground reaction force, peak knee flexion angle, step length, stride length, and stance time. A 2-way repeated-measures analysis of variance model was utilized to evaluate the effects of time (pre/post manipulation) and sex (male/female) on each measure of gait asymmetry. Results Gait asymmetry in the peak vertical ground reaction force (−0.6%, p=0.025) and the impulse of the vertical ground reaction force (−0.3%, p=0.026) was reduced in males following osteopathic manipulation. There was no difference in gait asymmetry between time points in females. Osteopathic manipulation did not impact asymmetry in peak knee flexion angle, step length, stride length, or stance time. Among the participants, 59.5% (25) followed the common compensatory pattern, whereas 40.5% (17) followed the uncommon compensatory pattern. One third (33.3%, 14) of the participants showed decompensation at the occipitoatlantal (OA) junction, whereas 26.2% (11), one third (33.3%, 14), and 26.2% (11) showed decompensation at the cervicothoracic (CT), thoracolumbar (TL), and lumbosacral (LS) junctions, respectively. Somatic dysfunction at the sacrum, L5, right innominate, and left innominate occurred in 88.1% (37), 69.0% (29), 97.6% (41), and 97.6% (41) of the participants, respectively. Conclusions Correcting somatic dysfunction can influence gait asymmetry in males; the sex-specificity of the observed effects of osteopathic manipulation on gait asymmetry is worthy of further investigation. Osteopathic structural examinations and treatment of somatic dysfunctions may improve gait symmetry even in asymptomatic individuals. These findings encourage larger-scale investigations on the use of OMT to optimize gait, prevent injury and the progression of disease, and aid in recovery after surgery.
Abstract Background Clinical reasoning is a vital competency for healthcare providers. In 2014, a clinical reasoning assessment rubric (CRAR) composed of analysis, heuristics, inference, information processing, logic, cognition and meta-cognition subdomains was developed for osteopathy students. Methods This study was conducted to verify the validity and reliability of the CRAR in nursing education. A total of 202 case vignette assessments completed by 68 students were used for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The Cronbach’s α coefficient of the CRAR was calculated. Results The content validity indices ranged from 0.57 to 1.0. The EFA resulted in three factors: assessment in nursing, nursing diagnosis and planning, and cognition/meta-cognition in nursing. The CFA supported a 3-factor model. The Cronbach’s α coefficient of the CRAR was 0.94. This study confirmed the content validity, construct validity, and reliability of the CRAR. Therefore, the CRAR is a useful rubric for assessing clinical reasoning in nursing students. Conclusions The CRAR is a standardized rubric for assessing clinical reasoning in nurses. This scale will be useful for the development of educational programs for improving clinical reasoning in nursing education.
Background: Spine shape parameters, such as leg length and kyphotic or lordotic angle, are influenced by low back pain. There is also evidence that the thoracolumbar fascia plays a role in such pathologies. This study examined the immediate effects of a myofascial release (MFR) technique on the thoracolumbar fascia and of an osteopathic treatment (OMT) on postural parameters in patients with acute low back pain (aLBP). Methods: This study was a single-blind randomized placebo-controlled trial. Seventy-one subjects (43.8 ± 10.5 years) suffering from aLBP were randomly and blindedly assigned to three groups to be treated with MFR, OMT, or a placebo intervention. Spinal shape parameters (functional leg length discrepancy (fLLD), kyphotic angle, and lordotic angle) were measured before and after the intervention using video raster stereography. Results: Within the MFR group, fLLD reduced by 5.2 mm, <i>p</i> < 0.001 and kyphotic angle by 8.2 degrees, <i>p</i> < 0.001. Within the OMT group, fLLD reduced by 4.5 mm, <i>p</i> < 0.001, and kyphotic angle by 8.4°, <i>p</i> = 0.007. Conclusion: MFR and OMT have an influence on fLLD and the kyphotic angle in aLBP patients. The interventions could have a regulating effect on the impaired neuromotor control of the lumbar muscles.
Adam Sulewski, Dominik Sieroń, Karol Szyluk
et al.
<i>Background and objectives</i>: The course of SARS-CoV-2 (COVID-19) is still under analysis. The majority of complications arising from the infection are related to the respiratory system. The adverse effect of the viral infection on bone and joint tissue has also been observed. <i>Materials and Methods</i>: We present a group of 10 patients with degeneration of large joints and adjacent epiphyses of long bones and the spine, with a background of bone infarctions and avascular necrosis (AVN) immediately after infection with the COVID-19 virus. In MR imaging, changes in the characteristics of AVN were documented. <i>Results:</i> Observation of this group showed a clear correlation among the history of COVID-19 disease in the patients, moderately severe symptoms, high levels of IgG antibodies, and the time of occurrence of joint changes. No other clinically significant complications were observed following COVID-19 infection in the study group. No other risk factors for AVN or autoimmune or degenerative diseases were found in the study group. The group of patients responded well to empirical treatment with steroids, which normalized acute inflammatory symptoms and pain in the joints. <i>Conclusions:</i> During coronavirus (COVID-19) infection, there are complications in the locomotor system, such as microembolism and the formation of AVN; hence, more research is needed.
This article belongs to the interface of terminology and translation studies and aims to describe the principles of meaning construction in the translation of field-specific terms in biodynamic osteopathy. The central problem of the study presented in this paper deals with identification and analysis of measurable components of meaning of terminological units. The data for the study comprises a corpus of 210 English terms in the field of biodynamic osteopathy translated into French, Italian, Russian and Latvian. Following the analysis of the meanings of the terms through their contextual uses, it is possible to assess other factors that contribute to the content of these units.
Methodologically, we built a definition for each term based on its context. Next, we investigated the notion of semantic resonance that is relevant for terminological units derived from general language. The study suggests that even in the field of neology where the concepts are borrowed together with the terms, resonance can vary from one language to another, which, as a consequence, highlights the problem of cross-linguistic equivalence in the translation of texts in this field.
A six-month old, 24 kg, intact male Caucasian Shepherd crossbred dog was presented at the Sokoine University of Agriculture Teaching Animal Hospital with a history of difficulty standing and walking, and bilateral swelling of the distal antebrachial and crural metaphyeal region. The owner also reported prior calcium supplementation in form of dietary tablets. Upon physical examination; the animal was lethargic with fever, bilateral ocular discharge, tachypnea and reduced appetite. Hard painful bilateral swelling of the distal antebrachial and crural metaphyseal region was observed. Differential cell count showed neutrophilia and monocytosis. Sclerosis and paracortical cuffing of the distal antebrachial and crural metaphyseal region were seen on radiographic examination. Similar changes were also visualised in the proximal crural metaphyseal region. Further, cranial bowing of the radius with lateral deviation of the foot (carpal valgus) were also observed. Metaphyseal osteopathy was diagnosed based on the history, clinical and radiographic findings. The exact cause of metaphyseal osteopathy is unknown, however there have been reports linking it to breed predisposition and mineral over supplementation. Administration of corticosteroids and supportive care are recommended in dogs with metaphyseal osteopathy. However, a bony change that is paracortical cuffing requires several months for resorption.
Marinella Coco, Andrea Buscemi, Valentina Perciavalle
et al.
Nitrogen gas (N2), present in the normal atmospheric air, is a potential source of risk for scuba divers. It seems probable that myelin can represent, in hyperbaric conditions, a preferential site for the accumulation of N2 in central nervous system (CNS). The purpose of this study is to verify whether the practice of the scuba diving is capable to determine a damage of the brain white matter (WM) in a dose dependent manner and, consequently, possible deficiency of their cognitive abilities. For this purpose, 54 professional scuba divers (35 men and 19 women), with at least 2,000 dives in their careers, were studied. Possible alterations of brain WM were evaluated in terms of Fractional anisotropy (FA) by using Diffusion Tensor Imaging, whereas possible cognitive impairments were verified by means of neuropsychological testing, by studying: (1) General mental capability (2) Executive functioning; (3) Visuospatial construction such as Rey Complex Figure; (4) Attention and orientation: (5) Selective attention capacity and processing speed ability; (6) Memory. The results showed alteration of the WM in terms of changes in FA; these alterations, statistically significant but quantitatively quite modest, were mainly observed in the WM of the anterior part of the brain, whereas no differences were observed between left and right hemisphere. The alterations of the WM were associated with changes, also in this case statistically significant but quantitatively quite modest, of the cognitive functions, in particular of those dependent on the prefrontal cortex, such as attention and memory function. The present study leads to the conclusion that repeated dives, even performed in compliance with the current decompression tables, can progressively lead in the CNS to the formation of micro-lesions in the myelin sheet capable of altering the functioning of the neuron.
Bruno Bordoni,1 Bruno Morabito,2,3 Marta Simonelli,4 Luigi Nicoletti,5 Riccardo Rinaldi,5 Filippo Tobbi,6 Philippe Caiazzo5 1Foundation Don Carlo Gnocchi IRCCS, Department of Cardiology, Institute of Hospitalization and Care with Scientific Address, Milan 20100, Italy; 2Foundation Polyclinic University A. Gemelli University Cattolica Del Sacro Cuore, Rome, Italy; 3Department of Osteopathy, CRESO School, Gorla Minore, Piazza XXV Aprile 421055, Italy; 4French-Italian School of Osteopathy (SOFI), Pisa, Italy; 5Department of Osteopathy, Accademia Italiana Terapia Osteopatica Posturale (AITOP), Massa-Carrara, Italy; 6Poliambulatorio Medico E Odontoiatrico, Busto Arsizio, Varese, ItalyCorrespondence: Bruno BordoniFoundation Don Carlo Gnocchi IRCCS, Department of Cardiology, Institute of Hospitalization and Care with Scientific Address, Milan 20100, ItalyTel +39 02 349 630 0617Email bordonibruno@hotmail.comAbstract: The case report presents a patient with a possible neuropathic sternal pain associated with a recent heart transplant procedure. The patient could not breathe deeply and move the upper limbs, with a trunk torsion, feeling a sharp pain under and around the left breastbone. A fascial osteopathic approach in the treatment of the pelvic floor, the respiratory diaphragm, the thoracic outlet, the tongue and the tentorium cerebelli allowed the patient to access to a cardiovascular rehabilitation program. In osteopathic medicine, these anatomical parts of the body are called the five diaphragms. To our best knowledge, this is the first case report that uses osteopathic treatment in a patient with sternal pain associated with an undergoing cardiac transplantation. The clinical importance of the case report is added to other osteopathic research with patients undergoing cardiac surgery (coronary artery bypass graft) and with multiple benefits, without side effects. One of the main goals of osteopathic treatment is to provide the patient with well-being, from many clinical points of view, allowing the person to be discharged from the hospital more quickly and/or with less pain.Keywords: diaphragm, osteopathic, fascia, cardiac transplantation, pain, heart, case report