Effects of osteopathic manipulative treatment vs. osteopathic cranial manipulative medicine on Parkinsonian gait

Participants

• Number: 84 people (33 female and 51 male)

• Criteria of inclusion: adult patients (age ≥ 18 years), with idiopathic Parkinson’s disease Hoehn & Yahr Stages (H&Y) 1-3 only – diagnosed by a neurologist – or healthy subjects for the control group; not having received OMT or physical therapy in the 30 days prior to the study, and being able to walk independently without the aid of supports. The Parkinson’s patients were recruited in the clinic of the University of North Texas Health Science Center (UNTHSC) through events and local agencies.

• Criteria of exclusion: presence of other pathologies; presence of cognitive impairment, as shown by a Mini-Mental State Examination (MMSE) score <26 for the Parkinson's patients or <24 for the healthy patients.

• Groups of study: 2 age-matched groups divided into 3 subgroups obtained by randomization
  • Group 1: people with Parkinson’s disease, 41 people (16 female and 25 male)
    • Group 1.1: OMT “from the neck down”, 14 people (9 female and 5 male, mean age 70.2 years)
    • Group 1.2: OMT with OCMM, 15 people (5 female and 10 male, mean age 67.9 years)
    • Group 1.3: sham treatment, 12 people (2 female and 10 male, mean age 63.5 years)
    • group 1.3 showed greater severity of Parkinson’s disease than both group 1.2 and especially group 1.1
  • Group 2: healthy subjects acting as control groups, 43 people  (17 female and 26 male)
    • Group 2.1: OMT “from the neck down”, 15 people (8 female and 7 male, mean age 68.2 years)
    • Group 2.2: OMT with OCMM, 15 people (5 female and 10 male, mean age 66.9 years)
    • Group 2.3: sham treatment, 13 people (4 female and 9 male, mean age 65.2 years)

Interventions and evaluations

• Initial and post-treatment assessment of cognition by MMSE and Parkinson’s disease severity by Unified Parkinson’s Disease Rating Scale (UPDRS) and H&Y Scale
• Initial and post-treatment assessment of hip, knee, and ankle gait during a 30-second walk using a computerized motion analysis system
  • a first phase of calibration was performed to define each participant’s natural walking speed
• OMT “from the neck down”: standardized treatment lasting 20-25 minutes with techniques applied to both sides of the body
  • techniques used: myofascial release, articulatory, muscle energy and balanced ligamentous tension
  • areas treated: cervical, thoracic and lumbar spine, shoulder girdle, sacroiliac joint, hips, lower limb muscles and ankles
• OMT with OCMM: standardized treatment lasting 25-30 minutes with all the techniques of OMT mentioned above and the addition of techniques focusing on expected cranial dysfunctions
  • Techniques used: myofascial release, articulatory, muscle energy, balanced ligamentous tension, occipitoatlantal decompression, sphenobasilar synchondrosis decompression, occipitomastoid suture V-spread, temporal bone balancing, venous sinus drainage techniques.
• sham treatment: treatment lasting 20-25 minutes
  • people were in a similar position to the two OMT treatments and were only examined by active and passive ROMs
  • to mimic the OCMM, people were placed in a supine position with their heads held in the hands of the operator
• OMT, OCMM and sham treatment performed by two certified osteopaths

Results

• Primary outcomes: hip and knee ROM during the second half of the gait cycle were different between the Parkinson’s patients and the healthy people before treatment. The group that received both OMT and OCMM saw a statistically significant improvement in hip ROM.

Discussion

OMT with the addition of OCMM has been shown to improve hip ROM in people with Parkinson’s disease. However, other outcomes due to treatments did not emerge from the study.

OCMM may have had this positive effect by resolving cervical, occipital, and cranial somatic dysfunctions, dysfunctions that past studies have actually found in people with Parkinson’s disease. Since movement depends on central neurological control, solving cranial dysfunction can help promote better neural circulation and, therefore, better motor function.

Interesting was the difference found in the gait cycle, particularly in the middle and in its conclusion, between healthy people and people with Parkinson’s: the latter show a more conservative gait aimed at maintaining a certain degree of stability. Consequently, evaluating and treating any restrictions at the hip and knee level can be particularly helpful in improving walking and reducing the risk of falling.

A limitation of the study may have been the standardization of the treatments used, as OMT is by its nature a treatment personalized to the needs of the patient. However, standardization promotes repeatability of the study. Furthermore, the computerized analysis of the gait cycle may not have been completely accurate, as the trackers applied to the patients at the start of the study were removed during treatment and then reapplied after the end of the treatment. There is therefore the possibility that the detectors have been placed in positions that are not perfectly equal for each patient.

Finally, this study analyzed a single treatment session, while it would be useful to evaluate a longer path.