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Manzotti A, Panisi C, Pivotto M, Vinciguerra F, Benedet M, Brazzoli F, Zanni S, Comassi A, Caputo S, Cerritelli F, Chiera M. An in-depth analysis of the polyvagal theory in light of current findings in neuroscience and clinical research. Dev Psychobiol 2024; 66:e22450. [PMID: 38388187 DOI: 10.1002/dev.22450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 09/04/2023] [Accepted: 12/01/2023] [Indexed: 02/24/2024]
Abstract
The polyvagal theory has led to the understanding of the functions of the autonomic nervous system in biological development in humans, since the vagal system, a key structure within the polyvagal theory, plays a significant role in addressing challenges of the mother-child dyad. This article aims to summarize the neurobiological aspects of the polyvagal theory, highlighting some of its strengths and limitations through the lens of new evidence emerging in several research fields-including comparative anatomy, embryology, epigenetics, psychology, and neuroscience-in the 25 years since the theory's inception. Rereading and incorporating the polyvagal idea in light of modern scientific findings helps to interpret the role of the vagus nerve through the temporal dimension (beginning with intrauterine life) and spatial dimension (due to the numerous connections of the vagus with various structures and systems) in the achievement and maintenance of biopsychosocial well-being, from the uterus to adulthood.
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Affiliation(s)
- Andrea Manzotti
- Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy
- RAISE Lab, Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy
- Research Department, SOMA Istituto Osteopatia Milano, Milan, Italy
| | - Cristina Panisi
- Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Micol Pivotto
- Research Department, SOMA Istituto Osteopatia Milano, Milan, Italy
| | | | - Matteo Benedet
- Research Department, SOMA Istituto Osteopatia Milano, Milan, Italy
| | | | - Silvia Zanni
- Research Department, SOMA Istituto Osteopatia Milano, Milan, Italy
| | - Alberto Comassi
- Research Department, SOMA Istituto Osteopatia Milano, Milan, Italy
| | - Sara Caputo
- Research Department, SOMA Istituto Osteopatia Milano, Milan, Italy
| | - Francesco Cerritelli
- RAISE Lab, Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy
| | - Marco Chiera
- RAISE Lab, Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy
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Manzotti A, Cerritelli F, Lombardi E, La Rocca S, Biasi P, Chiera M, Galli M, Lista G. Newborns' clinical conditions are correlated with the neonatal assessment manual scorE (NAME). Front Pediatr 2022; 10:967301. [PMID: 36160780 PMCID: PMC9500432 DOI: 10.3389/fped.2022.967301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the relationship between the Neonatal Assessment Manual scorE (NAME) and newborns' clinical condition on a large number of infants. The NAME model was developed as an instrument to assess the infant's general conditions, especially in NICUs, by evaluating how the infant's body responds to an external stressor such as static touch. Previous studies, employing experienced assessors, showed good validity indices as well as high inter-rater reliability. STUDY DESIGN Newborns were recruited at the "Vittore Buzzi" Pediatric Hospital NICU ward in Milan and their clinical conditions were collected through a standardized form-the complexity index. Two manual practitioners assessed all eligible newborns using the NAME scores. Data was analyzed using Kendall's τ correlation and odds ratio (OR) to assess the relationship between the NAME scores and the complexity index. RESULTS Two hundred two newborns (46% female; 34.1 w ± 4.3; birth weight of 2,093.4 gr ± 879.8) entered the study. The Kendall's correlation between the clinical conditions (complexity index) and the NAME score was -0.206 [95% CI: (-0.292, -0.116), p-value < 0.001], corresponding to an OR of 0.838 [95% CI: (0.757, 0.924), p-value < 0.001]. Further exploratory analyses showed significant correlation between gestational age, birth weight and NAME scores. CONCLUSION The present paper adds evidence to the NAME model validity by demonstrating its applicability in the clinical neonatological context.
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Affiliation(s)
- Andrea Manzotti
- Research and Assistance for Infants to Support Experience (RAISE) Lab, Foundation Centre for Osteopathic Medicine (COME) Collaboration, Pescara, Italy.,Division of Neonatology, "V. Buzzi" Children's Hospital ASST-FBF-Sacco, Milan, Italy.,Research Department, SOMA Istituto Osteopatia Milano, Milan, Italy
| | - Francesco Cerritelli
- Research and Assistance for Infants to Support Experience (RAISE) Lab, Foundation Centre for Osteopathic Medicine (COME) Collaboration, Pescara, Italy
| | - Erica Lombardi
- Research and Assistance for Infants to Support Experience (RAISE) Lab, Foundation Centre for Osteopathic Medicine (COME) Collaboration, Pescara, Italy.,Research Department, SOMA Istituto Osteopatia Milano, Milan, Italy
| | - Simona La Rocca
- Research and Assistance for Infants to Support Experience (RAISE) Lab, Foundation Centre for Osteopathic Medicine (COME) Collaboration, Pescara, Italy.,Research Department, SOMA Istituto Osteopatia Milano, Milan, Italy
| | - Pamela Biasi
- Research and Assistance for Infants to Support Experience (RAISE) Lab, Foundation Centre for Osteopathic Medicine (COME) Collaboration, Pescara, Italy.,Research Department, SOMA Istituto Osteopatia Milano, Milan, Italy
| | - Marco Chiera
- Research and Assistance for Infants to Support Experience (RAISE) Lab, Foundation Centre for Osteopathic Medicine (COME) Collaboration, Pescara, Italy
| | - Matteo Galli
- Research and Assistance for Infants to Support Experience (RAISE) Lab, Foundation Centre for Osteopathic Medicine (COME) Collaboration, Pescara, Italy.,Research Department, SOMA Istituto Osteopatia Milano, Milan, Italy
| | - Gianluca Lista
- Division of Neonatology, "V. Buzzi" Children's Hospital ASST-FBF-Sacco, Milan, Italy
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Baroni F, Tramontano M, Barsotti N, Chiera M, Lanaro D, Lunghi C. Osteopathic structure/function models renovation for a person-centered approach: a narrative review and integrative hypothesis. J Complement Integr Med 2021; 0:jcim-2021-0430. [PMID: 34758518 DOI: 10.1515/jcim-2021-0430] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/02/2021] [Indexed: 06/13/2023]
Abstract
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.
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Affiliation(s)
- Francesca Baroni
- Clinical-Based Human Research Department, Research Division, Foundation COME Collaboration, Pescara, Italy
| | | | - Nicola Barsotti
- Clinical-Based Human Research Department, Research Division, Foundation COME Collaboration, Pescara, Italy
- Research Commission on Manual Therapies and Mind-Body Disciplines, Società Italiana di Psico Neuro Endocrino Immunologia, Rome, Italy
| | - Marco Chiera
- Clinical-Based Human Research Department, Research Division, Foundation COME Collaboration, Pescara, Italy
- Research Commission on Manual Therapies and Mind-Body Disciplines, Società Italiana di Psico Neuro Endocrino Immunologia, Rome, Italy
| | - Diego Lanaro
- Clinical-Based Human Research Department, Research Division, Foundation COME Collaboration, Pescara, Italy
- Research Commission on Manual Therapies and Mind-Body Disciplines, Società Italiana di Psico Neuro Endocrino Immunologia, Rome, Italy
| | - Christian Lunghi
- Clinical-Based Human Research Department, Research Division, Foundation COME Collaboration, Pescara, Italy
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Cerritelli F, Frasch MG, Antonelli MC, Viglione C, Vecchi S, Chiera M, Manzotti A. A Review on the Vagus Nerve and Autonomic Nervous System During Fetal Development: Searching for Critical Windows. Front Neurosci 2021; 15:721605. [PMID: 34616274 PMCID: PMC8488382 DOI: 10.3389/fnins.2021.721605] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/19/2021] [Indexed: 12/17/2022] Open
Abstract
The autonomic nervous system (ANS) is one of the main biological systems that regulates the body's physiology. Autonomic nervous system regulatory capacity begins before birth as the sympathetic and parasympathetic activity contributes significantly to the fetus' development. In particular, several studies have shown how vagus nerve is involved in many vital processes during fetal, perinatal, and postnatal life: from the regulation of inflammation through the anti-inflammatory cholinergic pathway, which may affect the functioning of each organ, to the production of hormones involved in bioenergetic metabolism. In addition, the vagus nerve has been recognized as the primary afferent pathway capable of transmitting information to the brain from every organ of the body. Therefore, this hypothesis paper aims to review the development of ANS during fetal and perinatal life, focusing particularly on the vagus nerve, to identify possible "critical windows" that could impact its maturation. These "critical windows" could help clinicians know when to monitor fetuses to effectively assess the developmental status of both ANS and specifically the vagus nerve. In addition, this paper will focus on which factors-i.e., fetal characteristics and behaviors, maternal lifestyle and pathologies, placental health and dysfunction, labor, incubator conditions, and drug exposure-may have an impact on the development of the vagus during the above-mentioned "critical window" and how. This analysis could help clinicians and stakeholders define precise guidelines for improving the management of fetuses and newborns, particularly to reduce the potential adverse environmental impacts on ANS development that may lead to persistent long-term consequences. Since the development of ANS and the vagus influence have been shown to be reflected in cardiac variability, this paper will rely in particular on studies using fetal heart rate variability (fHRV) to monitor the continued growth and health of both animal and human fetuses. In fact, fHRV is a non-invasive marker whose changes have been associated with ANS development, vagal modulation, systemic and neurological inflammatory reactions, and even fetal distress during labor.
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Affiliation(s)
- Francesco Cerritelli
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Martin G. Frasch
- Department of Obstetrics and Gynecology and Center on Human Development and Disability, University of Washington, Seattle, WA, United States
| | - Marta C. Antonelli
- Facultad de Medicina, Instituto de Biología Celular y Neurociencia “Prof. E. De Robertis”, Universidad de Buenos Aires, Buenos Aires, Argentina
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Chiara Viglione
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Stefano Vecchi
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Marco Chiera
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Andrea Manzotti
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
- Department of Pediatrics, Division of Neonatology, “V. Buzzi” Children's Hospital, Azienda Socio-Sanitaria Territoriale Fatebenefratelli Sacco, Milan, Italy
- Research Department, Istituto Osteopatia Milano, Milan, Italy
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Cerritelli F, Chiera M, Abbro M, Megale V, Esteves J, Gallace A, Manzotti A. The Challenges and Perspectives of the Integration Between Virtual and Augmented Reality and Manual Therapies. Front Neurol 2021; 12:700211. [PMID: 34276550 PMCID: PMC8278005 DOI: 10.3389/fneur.2021.700211] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/07/2021] [Indexed: 12/17/2022] Open
Abstract
Virtual reality (VR) and augmented reality (AR) have been combined with physical rehabilitation and psychological treatments to improve patients' emotional reactions, body image, and physical function. Nonetheless, no detailed investigation assessed the relationship between VR or AR manual therapies (MTs), which are touch-based approaches that involve the manipulation of tissues for relieving pain and improving balance, postural stability and well-being in several pathological conditions. The present review attempts to explore whether and how VR and AR might be integrated with MTs to improve patient care, with particular attention to balance and to fields like chronic pain that need an approach that engages both mind and body. MTs rely essentially on touch to induce tactile, proprioceptive, and interoceptive stimulations, whereas VR and AR rely mainly on visual, auditory, and proprioceptive stimulations. MTs might increase patients' overall immersion in the virtual experience by inducing parasympathetic tone and relaxing the mind, thus enhancing VR and AR effects. VR and AR could help manual therapists overcome patients' negative beliefs about pain, address pain-related emotional issues, and educate them about functional posture and movements. VR and AR could also engage and change the sensorimotor neural maps that the brain uses to cope with environmental stressors. Hence, combining MTs with VR and AR could define a whole mind-body intervention that uses psychological, interoceptive, and exteroceptive stimulations for rebalancing sensorimotor integration, distorted perceptions, including visual, and body images. Regarding the technology needed to integrate VR and AR with MTs, head-mounted displays could be the most suitable devices due to being low-cost, also allowing patients to follow VR therapy at home. There is enough evidence to argue that integrating MTs with VR and AR could help manual therapists offer patients better and comprehensive treatments. However, therapists need valid tools to identify which patients would benefit from VR and AR to avoid potential adverse effects, and both therapists and patients have to be involved in the development of VR and AR applications to define truly patient-centered therapies. Furthermore, future studies should assess whether the integration between MTs and VR or AR is practically feasible, safe, and clinically useful.
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Affiliation(s)
| | | | - Marco Abbro
- Foundation COME Collaboration, Pescara, Italy
| | | | | | | | - Andrea Manzotti
- Foundation COME Collaboration, Pescara, Italy
- RAISE Lab, Foundation COME Collaboration, Milan, Italy
- SOMA Istituto Osteopatia Milano, Milan, Italy
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Manzotti A, Chiera M, Galli M, Lombardi E, La Rocca S, Biasi P, Esteves J, Lista G, Cerritelli F. The neonatal assessment manual score (NAME) for improving the clinical management of infants: a perspective validity study. Ital J Pediatr 2021; 47:53. [PMID: 33678165 PMCID: PMC7938573 DOI: 10.1186/s13052-021-01012-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/26/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The Neonatal Assessment Manual scorE (NAME) was developed to assist in the clinical management of infants in the neonatal ward by assessing their body's compliance and homogeneity. The present study begins its validation process. METHODS An expert panel of neonatal intensive care unit (NICU) professionals investigated the NAME face and content validity. Content validity was assessed through the content validity index (CVI). Construct validity was assessed using data collected from 50 newborns hospitalized in the NICU of "Vittore Buzzi" Children Hospital of Milan, Italy. Kendall's τ and ordinal logistic regressions were used to evaluate the correlation between the NAME scores and infants' gestational age, birth weight, post-menstrual age, weight at the time of assessment, and a complexity index related to organic complications. RESULTS The CVIs for compliance, homogeneity, and the whole scale were respectively 1, 0.9, and 0.95. Construct validity analysis showed significant positive correlations between the NAME and infants' weight and age, and a negative correlation between the NAME and the complexity index (τ = - 0.31 [95% IC: - 0.47, - 0.12], p = 0.016 and OR = 0.56 [95% IC: 0.32, 0.94], p = 0.034 for categorical NAME; τ = - 0.32 [95% IC: - 0.48, - 0.14], p = 0.005 for numerical NAME). CONCLUSIONS The NAME was well accepted by NICU professionals in this study and it demonstrates good construct validity in discriminating the infant's general condition. Future studies are needed to test the NAME reliability and predictive capacity.
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Affiliation(s)
- Andrea Manzotti
- RAISE lab, Foundation COME Collaboration, Corso Europa 29 - 66054 Vasto (Italy), Pescara, Italy
- Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy
- Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Marco Chiera
- RAISE lab, Foundation COME Collaboration, Corso Europa 29 - 66054 Vasto (Italy), Pescara, Italy
| | - Matteo Galli
- RAISE lab, Foundation COME Collaboration, Corso Europa 29 - 66054 Vasto (Italy), Pescara, Italy
- Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Erica Lombardi
- RAISE lab, Foundation COME Collaboration, Corso Europa 29 - 66054 Vasto (Italy), Pescara, Italy
- Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy
- Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Simona La Rocca
- RAISE lab, Foundation COME Collaboration, Corso Europa 29 - 66054 Vasto (Italy), Pescara, Italy
- Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy
- Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Pamela Biasi
- RAISE lab, Foundation COME Collaboration, Corso Europa 29 - 66054 Vasto (Italy), Pescara, Italy
- Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy
- Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Jorge Esteves
- RAISE lab, Foundation COME Collaboration, Corso Europa 29 - 66054 Vasto (Italy), Pescara, Italy
| | - Gianluca Lista
- Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy
| | - Francesco Cerritelli
- RAISE lab, Foundation COME Collaboration, Corso Europa 29 - 66054 Vasto (Italy), Pescara, Italy.
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Manzotti A, Cerritelli F, Lombardi E, La Rocca S, Biasi P, Chiera M, Galli M, Lista G. The Neonatal Assessment Manual scorE: A Reliability Study on Hospitalized Neonates. Front Pediatr 2021; 9:715091. [PMID: 34631618 PMCID: PMC8492991 DOI: 10.3389/fped.2021.715091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/18/2021] [Indexed: 01/20/2023] Open
Abstract
Despite clinical improvements in neonatal intensive care units (NICUs), prematurity keeps causing several comorbidities. To enhance the management of such conditions, in previous studies we devised the Neonatal Assessment Manual scorE (NAME) model, a structured touch-based assessment that aims to evaluate how newborns respond to gentle touch-based stimuli. The present study aimed to begin assessing the NAME interrater reliability and specific agreements. At the "Vittore Buzzi" Pediatric Hospital NICU ward in Milan, Italy, we enrolled 144 newborns, 85 male and 59 female, with a mean age of 35.9 weeks (±4.1) and a weight of 2,055.3 g (±750.6). Two experienced manual professionals performed the NAME procedure on all the infants. Regarding the total sample and the analysis by sex, we found moderate and statistically significant results for the interrater reliability (p < 0.001) and the specific agreements (p < 0.05), in particular for the "Marginal" score. Furthermore, interrater reliability significantly (p < 0.05) increased as age and weight increased, whereas there was an almost constant moderate and significant (p < 0.05) agreement especially for the "Marginal" score. Therefore, we found preliminary results showing that the NAME could be a reliable diagnostic tool for assessing the newborns' general condition.
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Affiliation(s)
- Andrea Manzotti
- RAISE lab, Foundation COME Collaboration, Pescara, Italy.,Division of Neonatology, Department of Pediatrics, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy.,Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | | | - Erica Lombardi
- RAISE lab, Foundation COME Collaboration, Pescara, Italy.,Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Simona La Rocca
- RAISE lab, Foundation COME Collaboration, Pescara, Italy.,Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Pamela Biasi
- RAISE lab, Foundation COME Collaboration, Pescara, Italy.,Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Marco Chiera
- RAISE lab, Foundation COME Collaboration, Pescara, Italy
| | - Matteo Galli
- RAISE lab, Foundation COME Collaboration, Pescara, Italy.,Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Gianluca Lista
- Division of Neonatology, Department of Pediatrics, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy
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Barsotti N, Chiera M, Lanaro D, Fioranelli M. Impact of stress, immunity, and signals from endocrine and nervous system on fascia. Front Biosci (Elite Ed) 2021; 13:1-36. [PMID: 33048774 DOI: 10.2741/870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The stress response, by virtue of release of glucocorticoids and catecholamines and by modifying the endocrine, neural, and immune responses, can impact the function of the fibroblasts and myofibroblasts that reside throughout the body and more specifically in the fascia, a ubiquitous and multi-functional connective tissue that supports the body. In the present paper, we review these stress-induced responses relying on psychoneuroendocrineimmunology.
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Affiliation(s)
- Nicola Barsotti
- Societa Italiana di Psiconeuroendocrinoimmunologia, Rome, Italy,
| | - Marco Chiera
- Societa Italiana di Psiconeuroendocrinoimmunologia, Rome, Italy
| | - Diego Lanaro
- Societa Italiana di Psiconeuroendocrinoimmunologia, Rome, Italy
| | - Massimo Fioranelli
- Department of nuclear physics, sub-nuclear and radiation, Guglielmo Marconi University, Rome, Italy
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Chiera M, Cerritelli F, Casini A, Barsotti N, Boschiero D, Cavigioli F, Corti CG, Manzotti A. Heart Rate Variability in the Perinatal Period: A Critical and Conceptual Review. Front Neurosci 2020; 14:561186. [PMID: 33071738 PMCID: PMC7544983 DOI: 10.3389/fnins.2020.561186] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/28/2020] [Indexed: 12/18/2022] Open
Abstract
Neonatal intensive care units (NICUs) greatly expand the use of technology. There is a need to accurately diagnose discomfort, pain, and complications, such as sepsis, mainly before they occur. While specific treatments are possible, they are often time-consuming, invasive, or painful, with detrimental effects for the development of the infant. In the last 40 years, heart rate variability (HRV) has emerged as a non-invasive measurement to monitor newborns and infants, but it still is underused. Hence, the present paper aims to review the utility of HRV in neonatology and the instruments available to assess it, showing how HRV could be an innovative tool in the years to come. When continuously monitored, HRV could help assess the baby’s overall wellbeing and neurological development to detect stress-/pain-related behaviors or pathological conditions, such as respiratory distress syndrome and hyperbilirubinemia, to address when to perform procedures to reduce the baby’s stress/pain and interventions, such as therapeutic hypothermia, and to avoid severe complications, such as sepsis and necrotizing enterocolitis, thus reducing mortality. Based on literature and previous experiences, the first step to efficiently introduce HRV in the NICUs could consist in a monitoring system that uses photoplethysmography, which is low-cost and non-invasive, and displays one or a few metrics with good clinical utility. However, to fully harness HRV clinical potential and to greatly improve neonatal care, the monitoring systems will have to rely on modern bioinformatics (machine learning and artificial intelligence algorithms), which could easily integrate infant’s HRV metrics, vital signs, and especially past history, thus elaborating models capable to efficiently monitor and predict the infant’s clinical conditions. For this reason, hospitals and institutions will have to establish tight collaborations between the obstetric, neonatal, and pediatric departments: this way, healthcare would truly improve in every stage of the perinatal period (from conception to the first years of life), since information about patients’ health would flow freely among different professionals, and high-quality research could be performed integrating the data recorded in those departments.
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Affiliation(s)
- Marco Chiera
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy.,Research Commission on Manual Therapies and Mind-Body Disciplines, Societ Italiana di Psico Neuro Endocrino Immunologia, Rome, Italy
| | - Francesco Cerritelli
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Alessandro Casini
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy
| | - Nicola Barsotti
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy.,Research Commission on Manual Therapies and Mind-Body Disciplines, Societ Italiana di Psico Neuro Endocrino Immunologia, Rome, Italy
| | | | - Francesco Cavigioli
- Neonatal Intensive Care Unit, "V. Buzzi" Children's Hospital, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Milan, Italy
| | - Carla G Corti
- Pediatric Cardiology Unit-Pediatric Department, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Milan, Italy
| | - Andrea Manzotti
- Research and Assistance for Infants to Support Experience Lab, Foundation Center for Osteopathic Medicine Collaboration, Pescara, Italy.,Neonatal Intensive Care Unit, "V. Buzzi" Children's Hospital, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, Milan, Italy.,Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
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Manzotti A, Cerritelli F, Lombardi E, La Rocca S, Chiera M, Galli M, Lista G. Effects of osteopathic treatment versus static touch on heart rate and oxygen saturation in premature babies: A randomized controlled trial. Complement Ther Clin Pract 2020; 39:101116. [PMID: 32379655 DOI: 10.1016/j.ctcp.2020.101116] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Osteopathic manipulative treatment (OMT) has been successfully tested in the context of preterm infants. No studies, however, have been conducted to investigate the OMT immediate effects on physiological measurements, such as partial oxygen saturation (SpO2) and heart rate (HR). The purpose of the present study was to assess the effect of osteopathic treatment on SpO2 and HR values and to compare it with 10 min of static touch. MATERIALS AND METHODS Ninety-six preterm infants (41 male), aged 33.5 weeks (±4.3) with mean weight at birth of 2067gr (±929) were recruited from the neonatal intensive care unit (NICU) of the Buzzi Hospital in Milan, and randomly allocated to two groups: OMT and Static Touch. Each protocol session consisted of: a) 5-min Pre-touch baseline recording, b) 10-min touch procedure, c) 5-min post-touch recording. Primary and secondary outcomes were, respectively, the baseline changes of HR and SpO2. RESULTS The 2 × 2 repeated measure ANOVA for HR showed a statistically significant effect (F (1,94) = 5.34; p < 0.02), revealing that the OMT group decreases the HR value at T2 (p = 0.006). In contrast, SpO2 analysis showed an increase of SpO2 value where the OMT group demonstrated higher values at T2 (p = 0.04). CONCLUSION Results from the present study suggest that a single osteopathic intervention may induce beneficial effects on preterm physiological parameters. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03833635 - Date: February 7, 2019.
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Affiliation(s)
- Andrea Manzotti
- RAISE Lab, Foundation COME Collaboration, Pescara, Italy; Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy; Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | | | - Erica Lombardi
- RAISE Lab, Foundation COME Collaboration, Pescara, Italy; Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Simona La Rocca
- RAISE Lab, Foundation COME Collaboration, Pescara, Italy; Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Marco Chiera
- RAISE Lab, Foundation COME Collaboration, Pescara, Italy
| | - Matteo Galli
- RAISE Lab, Foundation COME Collaboration, Pescara, Italy; Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Gianluca Lista
- Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy
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Demori I, Piccinno T, Saverino D, Luzzo E, Ottoboni S, Serpico D, Chiera M, Giuria R. Effects of winter sea bathing on psychoneuroendocrinoimmunological parameters. Explore (NY) 2020; 17:122-126. [PMID: 32224255 DOI: 10.1016/j.explore.2020.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/10/2020] [Accepted: 02/20/2020] [Indexed: 11/30/2022]
Abstract
CONTEXT Many people claim winter sea bathing gives them energy and health. According to the psychoneuroendocrinoimmunology (PNEI) paradigm, the stress response elicited by cold water immersion could indeed induce several beneficial psychophysical alterations. OBJECTIVE To determine the effects of winter sea bathing on psychological wellbeing, stress and immune markers. DESIGN A cross-sectional study. PARTICIPANTS 228 people, between 19 and 88 years, including 107 winter sea bathers and 121 controls. MAIN OUTCOME MEASURES A battery of questionnaires was administered to assess sociodemographic characteristics, self-perception of mental and physical heath, the number, duration and intensity of Upper Respiratory Tract Infections (URTIs) in the last year, and Big Five personality traits. 17 winter sea bathers and 15 controls (mean age 67 years) were further examined to evaluate physiological health, underwent one ear-nose-throat (ENT) examination, and provided saliva samples for measurements of biological markers (cortisol, sIgA, IL-1β, IL-6). RESULTS Winter sea bathing was associated with lower levels of self-reported stress and higher wellbeing. The ENT examinations did not reveal signs of URTIs in winter sea bathers, who exhibited significantly higher levels of salivary sIgA compared to controls. Neither salivary IL-1β nor cortisol levels were significantly different between the two groups. CONCLUSIONS Winter sea bathers (even the elderly) had a perception of higher wellbeing and reported better health: thus, they appeared to take advantage of potential distress (cold water exposure) to improve their health.
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Affiliation(s)
- Ilaria Demori
- Department of Earth, Environment and Life Sciences (DISTAV), University of Genoa, Corso Europa 26, 16132 Genoa, Italy; Italian Society of Psychoneuroendocrinoimmunology (SIPNEI), Rome, Italy.
| | - Tommaso Piccinno
- VIE - Valutazione Innovazione Empowerment s.r.l., Via della Libertà 9/3, 16129 Genoa, Italy
| | - Daniele Saverino
- Department of Experimental Medicine (DIMES), University of Genoa, Via Leon Battista Alberti 2, 16132 Genoa, Italy
| | - Erika Luzzo
- Italian Society of Psychoneuroendocrinoimmunology (SIPNEI), Rome, Italy
| | - Stefano Ottoboni
- Department of Surgery Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV 6, 16132 Genoa, Italy
| | - Davide Serpico
- Italian Society of Psychoneuroendocrinoimmunology (SIPNEI), Rome, Italy; Department of Classics, Philosophy and History, University of Genoa, Via Balbi 2, 16126 Genoa, Italy
| | - Marco Chiera
- Italian Society of Psychoneuroendocrinoimmunology (SIPNEI), Rome, Italy
| | - Roberto Giuria
- Italian Society of Psychoneuroendocrinoimmunology (SIPNEI), Rome, Italy
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Manzotti A, Cerritelli F, Chiera M, Lombardi E, La Rocca S, Biasi P, Galli M, Esteves J, Lista G. Neonatal Assessment Manual Score: Is There a Role of a Novel, Structured Touch-Based Evaluation in Neonatal Intensive Care Unit? Front Pediatr 2020; 8:432. [PMID: 32850545 PMCID: PMC7424031 DOI: 10.3389/fped.2020.00432] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/22/2020] [Indexed: 01/08/2023] Open
Abstract
Despite the technological improvements in monitoring preterm infants in the neonatal intensive care unit, routine care in the neonatal ward is primarily based on manual procedures. Although manual clinical procedures play a critical role in neonatology, little attention has been paid to palpation as a clinical assessment tool. Palpation is a clinical evaluation tool that relies mostly on the senses of touch and proprioception. Based on recent studies investigating the role and clinical effectiveness of touch in full-term and preterm babies, this paper proposes an evaluative touch-based procedure-the Neonatal Assessment Manual Score (NAME) model-that could be useful in the neonatal ward and describes its rationale. The operator applies gentle light pressures to the infant's body. In essence, the touch stimulates low-threshold afferent fibers that could influence the interoceptive cerebral network and the autonomic nervous system, thus altering the blood flow and breathing rhythm. These events could change how bodily fluids distribute among body segments and hence the body volume. The volume modification could be felt manually through haptic perception owing to the high sensitivity of the fingers. On the basis of their clinical conditions and stage of development, infants will respond differently to the applied pressures. Evaluating the infant's response, the operator produces a score of "bad," "marginal," or "good" for communicating quickly and clearly the infant's conditions to other professionals. Because the NAME model is intended for every professional who is used to touch-based procedures, if future studies confirmed its validity and reliability in clinical practice, the NAME model could become a part of the neonatal ward routine care for better assessing and managing the infant's conditions, even during emergencies.
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Affiliation(s)
- Andrea Manzotti
- RAISE Laboratory, Foundation COME Collaboration, Pescara, Italy.,Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy.,Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | | | - Marco Chiera
- RAISE Laboratory, Foundation COME Collaboration, Pescara, Italy
| | - Erica Lombardi
- RAISE Laboratory, Foundation COME Collaboration, Pescara, Italy.,Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Simona La Rocca
- RAISE Laboratory, Foundation COME Collaboration, Pescara, Italy.,Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Pamela Biasi
- RAISE Laboratory, Foundation COME Collaboration, Pescara, Italy.,Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Matteo Galli
- RAISE Laboratory, Foundation COME Collaboration, Pescara, Italy.,Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Jorge Esteves
- Gulf National Centre, Foundation COME Collaboration, Riyadh, Saudi Arabia.,Research Department, University College of Osteopathy, London, United Kingdom
| | - Gianluca Lista
- Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy
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