Osteopathic Manipulative Treatment for Allostatic Load Lowering

Postoperative Osteopathic Manipulative Treatment in Children with Esophageal Atresia: Potential Benefits on the Anthropometric Parameters

Esophageal atresia (EA) is a congenital malformation that affects the normal esophageal development. Surgical treatment, although restoring the integrity of the alimentary tract, may lead to long-term sequelae-like developmental abnormalities and musculoskeletal deformities. We evaluated the effects of osteopathic manipulative treatment (OMT) on the recovery of the range of the right upper limb movement and on the rise of the auxological parameters. A case series of five children affected by type C EA were described. Six OMT sessions were performed over a 4-month period. At each treatment, height, weight, body mass index (BMI) and range of motion (ROM) in elevation of the right upper limb were assessed. OMT was applied to improve scar, larynx, rib cage, and sternum mobility. An average change of 2.3 cm in height and an average increase of 8° in the ROM of the upper limb in the period of study were detected. Additionally, OMT could improve the anthropometric data and the mobility of the right upper limb of children surgically treated for EA. Further studies that evaluate the effectiveness of OMT in post surgical treatment of congenital malformations of the thorax can be considered in the future.

Suicide: Allostatic regulation and resilience

Suicide is a complex public health problem that is the result of a number of intertwined biopsychosocial factors. The diathesis-stress model suggests that suicide is the result of an interaction between genetic vulnerability and environmental stressors. Chronic stress and trauma contribute to biologic adaptations, including hypothalamus-pituitary-adrenal axis dysregulation, that contribute to the degradation of regulatory mechanisms and promote wear and tear the body, represented by allostatic load (AL). AL has been associated with a number of negative outcomes, including mental health problems and suicide. Fortunately, there are pharmacological and non-pharmacological interventions that are effective at reducing AL and reversing its effects. Thus, AL may provide a construct for supporting early risk identification, prevention, and treatment of suicide. AL biomarkers that are amenable to measurable change, effective treatments to reduce AL and perhaps help prevent suicide, and how to best tailor them to the individual and societal levels are important avenues of therapeutic inquiry.

Osteopathic structure/function models renovation for a person-centered approach: a narrative review and integrative hypothesis

OBJECTIVES

The construct of the osteopathic structure-function models is reported as a cornerstone of clinical reasoning and treatment processes. Nevertheless, there are no shared procedures described for their use in clinical practice. The present narrative review aims to analyze a more comprehensive perspective on the phenomenon.

METHODS

A structured narrative review was conducted. A database search was conducted using Pubmed, ScienceDirect, and Google Scholar. Peer-reviewed papers without specifying limits on dates and design were included.

RESULTS

Twenty-five findings were reported and grouped into two main themes: 1) Debate on models and theoretical frameworks for osteopathic care; 2) Clinical reasoning and decision-making process in the osteopathic field.

CONCLUSIONS

An integrated osteopathic care approach based on the structure/function models represents a starting point to establish a shared osteopathic diagnostic and clinical reasoning and an evidence-informed practice promoting health in an interdisciplinary person-centered care process. The present review highlights the limited amount of literature on using osteopathic conceptual models in decision-making and treatment strategies. A research plan is required to develop a common framework for an evidence-based osteopathic practice that promotes well-being in an interdisciplinary person-centered care process.

Osteopathy and Mental Health: An Embodied, Predictive, and Interoceptive Framework

Globally, mental and musculoskeletal disorders present with high prevalence, disease burden, and comorbidity. In order to improve the quality of care for patients with persistent physical and comorbid mental health conditions, person-centered care approaches addressing psychosocial factors are currently advocated. Central to successful person-centered care is a multidisciplinary collaboration between mental health and musculoskeletal specialists underpinned by a robust therapeutic alliance. Such a collaborative approach might be found in osteopathy, which is typically utilized to treat patients with musculoskeletal disorders but may arguably also benefit mental health outcomes. However, research and practice exploring the reputed effect of osteopathy on patients with mental health problems lack a robust framework. In this hypothesis and theory article, we build upon research from embodied cognition, predictive coding, interoception, and osteopathy to propose an embodied, predictive and interoceptive framework that underpins osteopathic person-centered care for individuals with persistent physical and comorbid mental health problems. Based on the premise that, for example, chronic pain and comorbid depression are underlined by overly precise predictions or imprecise sensory information, we hypothesize that osteopathic treatment may generate strong interoceptive prediction errors that update the generative model underpinning the experience of pain and depression. Thus, physical and mental symptoms may be reduced through active and perceptual inference. We discuss how these theoretical perspectives can inform future research into osteopathy and mental health to reduce the burden of comorbid psychological factors in patients with persistent physical symptoms and support person-centered multidisciplinary care in mental health.

A scoping review of interventions targeting allostatic load

Allostatic load (AL) is the manifestation of cumulative responses to chronic stress exposure. Numerous studies have shown the importance of AL in understanding disease risks. Yet little is known about existing interventions that target AL specifically. We aimed to address this gap by identifying interventions targeting AL and determining the success of these interventions in improving biological functioning. We searched five electronic databases using variations of two concepts: AL and programs or interventions. We included original research reports that focused on AL as an outcome. We excluded work that focused on a single indicator, not written in English or did not implement an intervention. The Template for Intervention Description and Replication checklist guided our intervention critique and synthesis. Six articles were included, with sample size across the interventions ranging between 2 and 733. Despite inconsistencies in the selection of AL indicators and scoring of AL, all four body systems were represented in all the studies. Four interventions showed significant improvement in Al (as indicated by a decrease in AL score) as early as 7 weeks. More interventions targeting Al are needed. The reduction in AL scores among four of the six interventions suggests that Al could be a biological outcome measure that is sensitive to change in response to interventions. This has significant clinical and research implications. Future studies are needed to examine whether AL serves as a mediator in the effects of the intervention on improving clinical manifestations of diseases.