Name: assessment of the efficacy of an osteopathic treatment in infants with biomechanical impairments to suckling
Uploaded: 2019-02-05T14:30:00
Description: Watch this Scientific Journal Video about Assessment of the Efficacy of An Osteopathic Treatment in Infants with Biomechanical Impairments to Suckling at JoVE.com

The authors acknowledge Ost&#233;opathie Qu&#233;bec for a grant to publish this paper.

This randomized controlled trial protocol was approved by the Comit&#233; d&#8217;&#233;thique et de la recherche en sant&#233; de L&#8217;humain at the Centre hospitalier Universitaire de Sherbrooke and the Comit&#233; d&#8217;&#233;thique et de la recherche at the Centre int&#233;gr&#233; de sant&#233; et services sociaux de la Capitale Nationale in Qu&#233;bec City, Canada.
1. Identification of Collaborators and the Preparation of Recruitment
<ol>
	<li>Network with LCs and/or a local moth...

<ol>
	<li>World Health Organization. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Global Strategy for Infant and Young Child Feeding. , (2003).</li><li>. Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months &#8211; Canada.ca Available from: <a target="_blank" href="https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/infant-feeding/nutrition-healthy-term-infants-recommendations-birth-six-months.html">https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/infant-feeding/nutrition-healthy-term-infants-recommendations-birth-six-months.html</a> (2015)</li><li>Haute Autorit&#233; de Sant&#233;. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Favoriser l&#39;allaitement maternel: Processus - &#201;valuation. , (2006).</li><li>. Your breastfeeding questions answered - NHS. How long should I breastfeed for? Available from: <a target="_blank" href="https://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/your-breastfeeding-questions.aspx#howlongshould">https://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/your-breastfeeding-questions.aspx#howlongshould</a> (2017)</li><li>Victora, C. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Breastfeeding+in+the+21st+century:+epidemiology,+mechanisms,+and+lifelong+effect.">Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect.</a> The Lancet. 387 (10017), 475-490 (2016).</li><li>Turck, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Plan d&#39;action: allaitement maternel. Propositions d&#8217;actions pour la promotion de l&#8217;allaitement maternel. , (2010).</li><li>Homdrum, A. K. S., Miller, A. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Maternal+report+of+feeding+practices:+a+cross-sectional+survey+of+1753+mothers+presenting+infants+to+a+chiropractic+teaching+clinic.">Maternal report of feeding practices: a cross-sectional survey of 1753 mothers presenting infants to a chiropractic teaching clinic.</a> Journal of Clinical Chiropractic Pediatrics. 15 (1), 1198-1202 (2015).</li><li>Genna, C. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Supporting Sucking Skills in Breastfeeding Infants. , (2013).</li><li>Jensen, D., Wallace, L., Kelsay, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=LATCH:+A+breastfeeding+charting+system+and+documentation+tool.">LATCH: A breastfeeding charting system and documentation tool.</a> Journal of Obstetrics, Gynecologic and Neonatal Nursing. 23 (1), 27-32 (1994).</li><li>Matthews, M. 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Frymann, D.O. L&#39;ost&#233;opathie en hommage aux enfants. , (2000).</li><li>Cornall, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+review+of+the+breastfeeding+literature+relevant+to+osteopathic+practice.">A review of the breastfeeding literature relevant to osteopathic practice.</a> International Journal of Osteopathic Medicine. 14 (2), 61-66 (2011).</li><li>Wescott, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+use+of+cranial+osteopathy+in+the+treatment+of+infants+with+breast+feeding+problems+or+sucking+dysfunction.">The use of cranial osteopathy in the treatment of infants with breast feeding problems or sucking dysfunction.</a> Australian Journal of Holistic Nursing. 11 (1), 25-32 (2004).</li><li>Lund, G. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Osteopathic+Manipulative+Treatment+for+the+Treatment+of+Hospitalized+Premature+Infants+With+Nipple+Feeding+Dysfunction.">Osteopathic Manipulative Treatment for the Treatment of Hospitalized Premature Infants With Nipple Feeding Dysfunction.</a> Journal of the American Osteopathic Association. 111 (1), 44-48 (2011).</li><li>Summers, J., Ludwig, J., Kanze, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pierre+Robin+Sequence+in+a+Neonate+With+Suckling+Difficulty+and+Weight+Loss.">Pierre Robin Sequence in a Neonate With Suckling Difficulty and Weight Loss.</a> Journal of the American Osteopathic Association. 114 (9), 727-731 (2014).</li><li>Fraval, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+pilot+study:+osteopathic+treatment+of+infant+with+a+sucking+dysfunction.">A pilot study: osteopathic treatment of infant with a sucking dysfunction.</a> Journal of the American Academy of Osteopathy. 8 (2), 25-33 (1998).</li><li>Woodward, D. R., Rees, B., Boon, J. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+fat+content+of+suckled+breast+milk:+a+new+approach+to+its+assessment.">The fat content of suckled breast milk: a new approach to its assessment.</a> Early Human Development. 20 (3-4), 183-189 (1989).</li><li>Herzhaft-Le Roy, J., Xhignesse, M., Gaboury, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+of+an+osteopathic+treatment+coupled+with+lactation+consultant+for+infants'+biomechanical+sucking+difficulties.">Efficacy of an osteopathic treatment coupled with lactation consultant for infants' biomechanical sucking difficulties.</a> Journal of Human Lactation. 33 (1), 165-172 (2017).</li><li>Jensen, D., Wallace, L., Kelsay, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=LATCH:+a+breastfeeding+charting+system+and+documentation+tool.">LATCH: a breastfeeding charting system and documentation tool.</a> Journal of Obstetrics, Gynecologic and Neonatal Nursing. 23 (1), 27-32 (1994).</li><li>. Management of acute malnutrition in infants (MAMI) Project. Technical Review Available from: <a target="_blank" href="https://reliefweb.int/sites/reliefweb.int/files/resources/8A7E77D26B35660F492576F70010D7DF-mami-report-complete.pdf">https://reliefweb.int/sites/reliefweb.int/files/resources/8A7E77D26B35660F492576F70010D7DF-mami-report-complete.pdf</a> (2010)</li><li>Chapman, D. J., Kuhnly, J. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lactation+Assessment+Tools:+A+Qualitative+Analysis+of+Registered+Nurses'+Perceptions+of+Tool+Limitations+and+Suggested+Improvements.">Lactation Assessment Tools: A Qualitative Analysis of Registered Nurses' Perceptions of Tool Limitations and Suggested Improvements.</a> Journal of Human Lactation. , (2018).</li><li>Kuhnly, J. E., Chapman, D. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Qualitative+Analysis+of+Registered+Nurses'+Perceptions+of+Lactation+Assessment+Tools:+Why+and+How+They+Are+Completed.">Qualitative Analysis of Registered Nurses' Perceptions of Lactation Assessment Tools: Why and How They Are Completed.</a> Journal of Human Lactation. 34 (1), 32-39 (2018).</li><li>Sowjanya, S. V. N. S., Venugopalan, L. L. A. T. C. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Score+as+a+Predictor+of+Exclusive+Breastfeeding+at+6+Weeks+Postpartum:+A+Prospective+Cohort+Study.">Score as a Predictor of Exclusive Breastfeeding at 6 Weeks Postpartum: A Prospective Cohort Study.</a> Breastfeeding Medicine. 13 (6), 444-449 (2018).</li><li>Riordan, J. M., Koehn, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+and+Validity+Testing+of+Three+Breastfeeding+Assessment+Tools.">Reliability and Validity Testing of Three Breastfeeding Assessment Tools.</a> Journal of Obstetric, Gynecologic and Neonatal Nursing. 26 (2), 181-187 (1997).</li><li>Riordan, J., Bibb, D., Miller, M., Rawlins, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Predicting+breastfeeding+duration+using+the+LATCH+breastfeeding+assessment+tool.">Predicting breastfeeding duration using the LATCH breastfeeding assessment tool.</a> Journal of Human Lactation. 17 (1), 20-23 (2001).</li><li>Cheng, J. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sternocleidomastoid+pseudotumor+and+congenital+muscular+torticollis+in+infants:+a+prospective+study+of+510+cases.">Sternocleidomastoid pseudotumor and congenital muscular torticollis in infants: a prospective study of 510 cases.</a> The Journal of Pediatrics. 134 (6), 712-716 (1999).</li><li>Farooq, M. N., Mohseni Bandpei, M. A., Ali, M., Khan, G. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+the+universal+goniometer+for+assessing+active+cervical+range+of+motion+in+asymptomatic+healthy+persons.">Reliability of the universal goniometer for assessing active cervical range of motion in asymptomatic healthy persons.</a> Pakistan Journal of Medical Sciences. 32 (2), 457-461 (2016).</li><li>Schaal, J. -. P., Riethmuller, D., Maillet, R., Uzan, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> M&#233;canique et Techniques Obst&#233;tricales. , (2012).</li><li>Chila, A. 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This study is one of the first randomized controlled trials to assess the efficacy of an osteopathic treatment for infants with biomechanical suckling difficulties. When performed promptly, this intervention might reduce the risk of stopping breastfeeding earlier than originally intended.
With no prior models, this trial was designed pragmatically, including the need to act quickly to address breastfeeding difficulties and nipple pain that may be experienced with a newborn. The protocol also m...

An erratum was issued for: <a href="https://www.jove.com/video/58740/assessment-efficacy-an-osteopathic-treatment-infants-with">Assessment of the Efficacy of An Osteopathic Treatment in Infants with Biomechanical Impairments to Suckling</a>.&#160; An author name was&#160;updated.
One of the authors&#39; names was corrected from:
Juliette&#160;Herzaft-LeRoy
to:
Juliette Herzhaft-Le Roy

An erratum was issued for: <a href="https://www.jove.com/video/58740/assessment-efficacy-an-osteopathic-treatment-infants-with">Assessment of the Efficacy of An Osteopathic Treatment in Infants with Biomechanical Impairments to Suckling</a>.&#160; An author name was&#160;updated.

Erratum: Assessment of the Efficacy of An Osteopathic Treatment in Infants with Biomechanical Impairments to Suckling

Over the last thirty years, international recommendations from the World Health Organization1, followed by national recommendations in many countries2,3,4, have advocated for breastfeeding. Its health benefits are now well-known5,6 and breastfeeding exclusively for the first six months of the infant&#39;s life and maintaining it for two years or longer is described as the norm1.
As highlighted by Homdrum and Miller7, more than half of the mothers who stop breastfeeding within the first month reported biomechanical difficulties. Suckling biomechanical issues typically include suboptimal head extension and rotation, restricted mouth opening or jaw stiffness, biting the nipple, restricted tongue mobility, and inefficient mouth vacuum to stimulate the release of milk from the mother&#39;s breast8. Any neurological impairment also affects the optimal function of the normal primitive reflexes, crucial to an optimal latch.
The emergence of LCs worldwide has provided a great source of breastfeeding support for mother-infant dyads and has contributed to increasing the scientific knowledge in this specific field. For example, LCs have studied extensively the biomechanics of suckling from birth to weaning. In parallel, they have created tools to assess the function of breastfeeding and to efficiently detect dyads with special needs9,10.
Osteopathy is a manual practice meant to restore normal functions of the human body, based on the body&#39;s capacity for self-regulation11 and structure-function relationship1. During an osteopathic consultation, various palpation techniques are used, based on thorough knowledge of human anatomy and physiology12. Some scholars have linked physical restrictions with suckling dysfunction13,14,15,16,17. Restrictions of skull sutures or motility of skull bones have also been described to impact an infant&#39;s ability to latch13,14,15,16,17,18. However, research on the efficacy of osteopathy techniques on biomechanical suckling difficulties is scarce19,20.
Aside from a few case reports describing an osteopathic intervention to improve an infant&#39;s ability to latch21,22, only one pilot study23 documented the impact of such interventions. Six infants between three to six weeks of age were recruited and assessed by an LC. Mothers were given breastfeeding advice and then met the osteopath. Four treatments (once a week for four weeks) were performed. Treated infants were compared with six control infants whose mothers received only LC support. The authors found improvement in the milk fat content, which has been shown to be a marker for effective feeding24. Due to its small sample, these pilot study results are not generalizable but established the feasibility of a randomized controlled trial coupling the expertise of LCs and osteopaths.
These studies have paved the way for a single-blind randomized controlled trial to assess the efficacy of an osteopathic treatment coupled with lactation consultations on infants&#39; ability to latch. The protocol for this trial is presented herein. The trial took place in a mother-to-mother support group, where LCs provided lactation consultations three days a week, free of charge for parents25.
Assessment tools for the trial included 1) the LATCH Assessment Tool to measure the main aspects of the biomechanics of suckling26; 2) a VAS to assess the mother&#39;s nipple pain; 3) a goniometer, a soft plastic instrument to measure the rotation of the infant&#39;s head&#39;s angles; and 4) de novo questionnaires to assess the mother&#39;s perception of her infant&#39;s ability to latch, as well as sociodemographic data and potential intervention side-effects.
The LATCH Assessment Tool was chosen amongst several others for its specific assessment of the biomechanics of the suckling structures and the global ability of the mother-infant dyad to position themselves comfortably27. While breastfeeding assessment tools are currently discussed in the international lactation community28,29, the tool is easy to use in the clinic, reliable, and widely implemented among this community to detect early breastfeeding difficulties30. The choice of the tool also enables comparisons with other studies on breastfeeding. Each letter in &#34;LATCH&#34; corresponds to an item to assess an element of the biomechanics of suckling. &#34;L&#34; is for the ability of the infant&#39;s tongue, jaws, and lips to sustain the actions and vacuum, and to activate the milk let-down reflex efficiently (Latch). &#34;A&#34; is for Audible swallowing as it is evidence of suckling effectiveness, &#34;T&#34; is for the Type of the nipple at the end of the feed (inverted, flat, or everted), &#34;C&#34; is for the Comfort of the breast and nipple, and &#34;H&#34; is for the assessment of the ease with which the infant is Held in a comfortable and effective position at the breast. The result is a five-item score out of 10 (normal is 10 out of 10) with an interrater reliability of 0.9431,32.
The VAS is a 10 cm line to estimate the severity of pain felt by mothers, from 0 (no pain) to 10 (maximum pain). For this trial, the VAS was completed at the beginning of the feed, once the infant was latching on, and once the milk let-down had started.
A soft plastic goniometer was used to assess the passive rotation of the infant&#39;s head,&#160;as described by Cheng33. Assessments were completed immediately before and following the osteopathic assessment for the control group, and before the assessment and following the osteopathic treatment in the treatment group. Intrarater reliability has been reported to range from 0.83 to 0.98 for the head rotation assessment34.
Finally, a standardized assessment grid was completed by the osteopath for every infant involved in the study, documenting all of the areas exhibiting osteopathic lesions. Osteopathic lesions are areas with lack of mobility or motility, with excess rigidity, or with a lack of tone in the structure. Lesions are classified in three levels of severity, ranging from a structure with limited mobility to a stiff structure with no mobility. In the osteopathic treatment group, all structures addressed during the treatment were documented (Table 1).
Data were analyzed with an intention-to-treat analysis using descriptive statistics. Chi-square tests were used to explore potential correlations between all identified lesion sites and a one-point or more improvement on the LATCH Assessment Tool.

<table>
	<tbody>
		<tr>
			<td>sofa or armchair</td>
			<td></td>
			<td></td>
			<td>comfortable enough for a new mother with potential ceasarean section scar to stay half an hour with the infant in her arms and comfortable enough for the osteopath to perform the intervention</td>
		</tr>
		<tr>
			<td>cushion</td>
			<td></td>
			<td></td>
			<td>to put the infant on it and helpful if required,&#160; to breastfeed the infant</td>
		</tr>
		<tr>
			<td>Goniometer</td>
			<td>Dufort et Lavigne or similar</td>
			<td>ALM 324000</td>
			<td>in smooth plastic, not too long to be handle with one hand</td>
		</tr>
	</tbody>
</table>

assessment of the efficacy of an osteopathic treatment in infants with biomechanical impairments to suckling

Breastfeeding can be challenging for mother-infant dyads experiencing biomechanical suckling difficulties. Although lactation consultants (LCs) all over the world have increased their skills in this field and can provide support to help position the infant at the breast, the impact of their intervention might be limited in the presence of stiff structures in the infants. Here we present a protocol for a randomized controlled trial to assess the efficacy of osteopathic treatment, coupled with lactation consultation, for infants&#39; biomechanical suckling difficulties. It proposes a set-up and a sequence of actions to ensure an optimal context for treatment, as well as a blinding of parents and LCs to the intervention. Data such as the infant&#39;s latch ability measured with the LATCH Assessment Tool, the mother&#39;s nipple pain with a visual analog scale (VAS), and the mother&#39;s perceptions are collected by LCs four times over a 10-day period. Osteopathic lesions are documented by the osteopath, using a standardized assessment grid. Structures of interest are coherent with the anatomical zones involved in latching onto the breast. This protocol also proposes a strategy to document systematically an osteopathic profile of infants with biomechanical suckling difficulties in their first weeks of life. The implementation of this protocol confirms its feasibility for osteopathic assessment and treatment and paves the way for future trials to further explore the efficacy of osteopathic techniques for infants with biomechanical suckling difficulties.

Ninety-seven mother-infant dyads were recruited and randomly assigned to one of the two study groups. The participants&#39; characteristics and delivery mode are summarized in Table 2. Only 1/3 had a natural birth, meaning that the other 2/3 experienced epidural and vacuum (15.9%), forceps-assisted (2.9%), or C-section (18.8%) births. In this study, all infants had skull lesions (Table 3). The posterior quarter represented by the occipital and the tempora...

Watch this Scientific Journal Video about Assessment of the Efficacy of An Osteopathic Treatment in Infants with Biomechanical Impairments to Suckling at JoVE.com

Assessment of the Efficacy of An Osteopathic Treatment in Infants with Biomechanical Impairments to Suckling

Osteopathy is an emerging field of clinical research. Here we present a protocol to assess the efficacy of an osteopathic intervention coupled with lactation consultation, in infants with biomechanical issues impeding breastfeeding.

Breastfeeding can be challenging for mother-infant dyads experiencing biomechanical suckling difficulties. Although lactation consultants (LCs) all over ...

The use of osteopathic techniques for breastfeeding biomechanical difficulties is widely spread in practice, but until this trial, there's been no empirical evidence that it works. Breastfeeding difficulties are encountered by many mothers during the first weeks of the postpartum period. The collaborative setup of this intervention is very pragmatic for these parents.On the first appointment following the referral, welcome the mother and infant and explain the full study process. After obtaining written consent, administer a baseline questionnaire for sociodemographic data, breastfeeding data, and maternal perceptions of biomechanical difficulties. Next, ask the mother to give one breast and observe the infant's suckling rhythm.Right at the beginning of the feed, have the lactation consultant use the latch assessment tool to assess the infant's baseline ability to latch and request that the mother complete a visual analog scale right at the beginning of the feed. When the suckling movement begins to slow, have the mother remove the infant from the breast. Before you perform the osteopathic assessment, open the sealed and opaque envelope with the corresponding study number for the mother-infant dyad.Assigning the dyad to the control or treatment group, and ask the mother to sit on a couch with a cushion on her knees and the infant lying back on it. Sitting next to the mother, connect with the infant by making eye contact and talk to the infant before putting hands on their body. Begin with a general observation of the infant's posture, tone, and any asymmetries.Next, use a goniometer to assess the infant's passive left and right head rotation, noting any discomfort manifestation or limitation. Assess any osteopathic lesions for each part of the body regardless of the allocation group, using the standardized grid as described in the table. Begin with the pelvic area, assessing the tissue texture and tone in the lower limbs fascia, sacroiliac joints, sacrum and hips, as well as the range of motion of the pelvic sphere versus the lumbar spine and the structures up to the skull.Move the hands from the infant's pelvis to the skull and similarly assess the tissue texture and tone, and as appropriate, the range of motion of the abdominal cavity, spine, diaphragm, thorax, and cervical spine. Pay careful attention to the first cervical vertebrae and assess the anterior structures of the neck, hyoid bone, and sublingual muscles. Move forward from the base of the skull to the occipital, temporal, parietal, sphenoid and frontal bones, and features of the face including the jaw.As infants yawn frequently, observe the jaw movements and the symmetry of the face. For each structure, record the observations of the texture, tone, straining, and quality and range of motion on the standardized grid. For osteopathic treatment of the pelvic area, place hands on each side of the infant's pelvis, covering the iliac bones with the thumbs on the anterior part of the iliac bones and the fingertips at the sacroiliac joints on each side.Using the indirect technique, place the restricted structure in a comfortable position and use continuous feedback until a complete loosening of the structure is achieved. For treatment of the upper cervical spine, place the fingers of both hands around the occipital bone with the tips of the ring fingers contacting the condyles area, the index fingers contacting the mastoid area, and the middle fingers between the occipital bone and the first cervical vertebra. Then gently separate the fingers in the various spacial planes until the tissues soften and the condyles move freely.For treatment of the neurocranial region, place one hand under the occipital bone and the other on the frontal and sphenoidal bones, avoiding the eyes. In a frontal occipital hold, place the occiput and sphenoid in their position of least resistance, monitoring the decrease in resistance and readjusting the positioning of the structures until the release occurs. For treatment of the jaw region, cup one hand under the occipital bone and the first three cervical vertebrae, and the index finger and thumb of the other hand on each side of the hyoid bone.Wait until the release of the hyoid bone is felt through the structures of the other hand, monitoring and reassessing as for the myofascial release technique. End the osteopathic treatment by placing one hand on the pelvic area, and the other on the skull. To perform a sham intervention, place the hands on the areas far from those with detected dysfunctions without any intention of treatment, and answer any questions from the parent about osteopathy and the infant's psychomotor development.For either treatment, postpone the infant feed until the end of the intervention using a pacifier or the mother's finger as necessary to soothe the infant. Then assess the infant's left and right passive head rotation with the goniometer, and leave the room to record the details of the performed treatment in the standardized assessment grid. In this representative study, 97 mother-infant dyads were recruited and randomly assigned to one of the two study groups.Only one third had an intervention-free birth, and all of the infants had skull lesions. Make sure that the lactation consultant is well-trained to use the assessment tools and to respect the rhythm of the mother-infant dyad. Sometimes appointments will need to be rescheduled if the baby's too sleepy.Although we've demonstrated the most common techniques, additional treatments can be used for a moderate approach of the suckling dysfunction. One thing we haven't been able to assess with our trial is whether a single osteopathic treatment is sufficient. It will be useful to determine whether it is a dose-response effect.

assessment-efficacy-an-osteopathic-treatment-infants-with

Research

JoVE Journal

Medicine

The Measurement and Treatment of Suppression in Amblyopia

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current estimates put the prevalence of amblyopia at approximately 1-3%1-3, the majority of cases being monocular2. Amblyopia is most frequently caused by ocular misalignment (strabismus), blur induced by unequal refractive error (anisometropia), and in some cases by form deprivation.
Although amblyopia is initially caused by abnormal visual input in infancy, once established, the visual deficit often remains when normal visual input has been restored using surgery and/or refractive correction. This is because amblyopia is the result of abnormal visual cortex development rather than a problem with the amblyopic eye itself4,5 . Amblyopia is characterized by both monocular and binocular deficits6,7 which include impaired visual acuity and poor or absent stereopsis respectively. The visual dysfunction in amblyopia is often associated with a strong suppression of the inputs from the amblyopic eye under binocular viewing conditions8. Recent work has indicated that suppression may play a central role in both the monocular and binocular deficits associated with amblyopia9,10 .
Current clinical tests for suppression tend to verify the presence or absence of suppression rather than giving a quantitative measurement of the degree of suppression. Here we describe a technique for measuring amblyopic suppression with a compact, portable device11,12 . The device consists of a laptop computer connected to a pair of virtual reality goggles. The novelty of the technique lies in the way we present visual stimuli to measure suppression. Stimuli are shown to the amblyopic eye at high contrast while the contrast of the stimuli shown to the non-amblyopic eye are varied. Patients perform a simple signal/noise task that allows for a precise measurement of the strength of excitatory binocular interactions. The contrast offset at which neither eye has a performance advantage is a measure of the "balance point" and is a direct measure of suppression. This technique has been validated psychophysically both in control13,14 and patient6,9,11 populations.
In addition to measuring suppression this technique also forms the basis of a novel form of treatment to decrease suppression over time and improve binocular and often monocular function in adult patients with amblyopia12,15,16 . This new treatment approach can be deployed either on the goggle system described above or on a specially modified iPod touch device15.

Amblyopia is a developmental disorder of the visual cortex that is often accompanied by strong suppression of one eye. We present a new technique for measuring and treating interocular suppression in patients with amblyopia that can be deployed using virtual reality goggles or a portable iPod Touch device.

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current ...

The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis

Psoriasis is a chronic, immune-mediated inflammatory skin disease affecting approximately 2-3% of the population. The Goeckerman regimen consists of exposure to ultraviolet B (UVB) light and application of crude coal tar (CCT). Goeckerman therapy is extremely effective and relatively safe for the treatment of psoriasis and for improving a patient's quality of life. In the following article, we present our protocol for the Goeckerman therapy that is utilized specifically at the University of California, San Francisco. This protocol details the preparation of supplies, administration of phototherapy and application of topical tar. This protocol also describes how to assess the patient daily, monitor for adverse effects (including pruritus and burning), and adjust the treatment based on the patient's response. Though it is one of the oldest therapies available for psoriasis, there is an absence of any published videos demonstrating the process in detail. The video is beneficial for healthcare providers who want to administer the therapy, for trainees who want to learn more about the process, and for prospective patients who want to undergo treatment for their cutaneous disease.

Psoriasis is a chronic, immune-mediated inflammatory skin disease. The Goeckerman regimen, formulated for the treatment of psoriasis, consists of exposure to ultraviolet B (UVB) light and application of crude coal tar (CCT). The following protocol is for the administration of Goeckerman therapy for the treatment of moderate-to-severe psoriasis.

Psoriasis is a  chronic, immune-mediated inflammatory skin disease affecting approximately 2-3%  of the population. The Goeckerman regimen consists of ...

Osteopathic Manipulative Treatment as a Useful Adjunctive Tool for Pneumonia

Pneumonia, the inflammatory state of lung tissue primarily due to microbial infection, claimed 52,306 lives in the United States in 20071 and resulted in the hospitalization of 1.1 million patients2. With an average length of in-patient hospital stay of five days2, pneumonia and influenza comprise significant financial burden costing the United States $40.2 billion in 20053. Under the current Infectious Disease Society of America/American Thoracic Society guidelines, standard-of-care recommendations include the rapid administration of an appropriate antibiotic regiment, fluid replacement, and ventilation (if necessary). Non-standard therapies include the use of corticosteroids and statins; however, these therapies lack conclusive supporting evidence4. (Figure 1)

Osteopathic Manipulative Treatment (OMT) is a cost-effective adjunctive treatment of pneumonia that has been shown to reduce patients&#8217; length of hospital stay, duration of intravenous antibiotics, and incidence of respiratory failure or death when compared to subjects who received conventional care alone5. The use of manual manipulation techniques for pneumonia was first recorded as early as the Spanish influenza pandemic of 1918, when patients treated with standard medical care had an estimated mortality rate of 33%, compared to a 10% mortality rate in patients treated by osteopathic physicians6. When applied to the management of pneumonia, manual manipulation techniques bolster lymphatic flow, respiratory function, and immunological defense by targeting anatomical structures involved in the these systems7,8, 9, 10.

The objective of this review video-article is three-fold: a) summarize the findings of randomized controlled studies on the efficacy of OMT in adult patients with diagnosed pneumonia, b) demonstrate established protocols utilized by osteopathic physicians treating pneumonia, c) elucidate the physiological mechanisms behind manual manipulation of the respiratory and lymphatic systems. Specifically, we will discuss and demonstrate four routine techniques that address autonomics, lymph drainage, and rib cage mobility: 1) Rib Raising, 2) Thoracic Pump, 3) Doming of the Thoracic Diaphragm, and 4) Muscle Energy for Rib 1.5,11

Pneumonia is one of the top ten leading causes of death in the U.S. Osteopathic manipulative techniques (OMT) may be utilized as an adjunctive therapy in the treatment of pneumonia to enhance biomechanical and immune function; and ultimately, to reduce hospital stay, duration of antibiotics, incidence of respiratory failure, and mortality. In this video-article, we will review randomized controlled studies on the use of OMT in pneumonia patients, as well as demonstrate specific hands-on techniques that are routinely practiced by osteopathic physicians when treating pulmonary infections.

Pneumonia, the inflammatory state of lung tissue primarily due to microbial infection, claimed 52,306 lives in the United States in 20071 and resulted in ...

The Multiple Sclerosis Performance Test (MSPT): An iPad-Based Disability Assessment Tool

Precise measurement of neurological and neuropsychological impairment and disability in multiple sclerosis is challenging. We report a new test, the Multiple Sclerosis Performance Test (MSPT), which represents a new approach to quantifying MS related disability. The MSPT takes advantage of advances in computer technology, information technology, biomechanics, and clinical measurement science. The resulting MSPT represents a computer-based platform for precise, valid measurement of MS severity. Based on, but extending the Multiple Sclerosis Functional Composite (MSFC), the MSPT provides precise, quantitative data on walking speed, balance, manual dexterity, visual function, and cognitive processing speed. The MSPT was tested by 51 MS patients and 49 healthy controls (HC). MSPT scores were highly reproducible, correlated strongly with technician-administered test scores, discriminated MS from HC and severe from mild MS, and correlated with patient reported outcomes. Measures of reliability, sensitivity, and clinical meaning for MSPT scores were favorable compared with technician-based testing. The MSPT is a potentially transformative approach for collecting MS disability outcome data for patient care and research. Because the testing is computer-based, test performance can be analyzed in traditional or novel ways and data can be directly entered into research or clinical databases. The MSPT could be widely disseminated to clinicians in practice settings who are not connected to clinical trial performance sites or who are practicing in rural settings, drastically improving access to clinical trials for clinicians and patients. The MSPT could be adapted to out of clinic settings, like the patient&#8217;s home, thereby providing more meaningful real world data. The MSPT represents a new paradigm for neuroperformance testing. This method could have the same transformative effect on clinical care and research in MS as standardized computer-adapted testing has had in the education field, with clear potential to accelerate progress in clinical care and research.

The Multiple Sclerosis Performance Test MSPT: An iPad-Based Disability Assessment Tool

Precise measurement of neurological and neuropsychological impairment and disability in multiple sclerosis is challenging. We report methodologic details on a new test, the Multiple Sclerosis Performance Test (MSPT). This new approach to the objective of quantification of MS related disability provides a computer-based platform for precise, valid measurement of MS severity.

Precise measurement of neurological and neuropsychological impairment and disability in multiple sclerosis is challenging. We report a new test, the ...

Non-invasive Assessment of the Efficacy of New Therapeutics for Intestinal Pathologies Using Serial Endoscopic Imaging of Live Mice

Animal models of inflammatory bowel disease (IBD) and colorectal cancer (CRC) have provided significant insight into the cell intrinsic and extrinsic mechanisms that contribute to the onset and progression of intestinal diseases. The identification of new molecules that promote these pathologies has led to a flurry of activity focused on the development of potential new therapies to inhibit their function. As a result, various pre-clinical mouse models with an intact immune system and stromal microenvironment are now heavily used. Here we describe three experimental protocols to test the efficacy of new therapeutics in pre-clinical models of (1) acute mucosal damage, (2) chronic colitis and/or colitis-associated colon cancer, and (3) sporadic colorectal cancer. We also outline procedures for serial endoscopic examination that can be used to document the therapeutic response of an individual tumor and to monitor the health of individual mice. These protocols provide complementary experimental platforms to test the effectiveness of therapeutic compounds shown to be well tolerated by mice.

We describe methods for longitudinal monitoring of the efficacy of therapeutics for the treatment of colonic pathologies in mice using a rigid endoscope. This protocol can be readily used for the characterization of the therapeutic response of an individual tumor in live mice and also for monitoring potential disease relapse.

Animal models of inflammatory bowel disease (IBD) and colorectal cancer (CRC) have provided significant insight into the cell intrinsic and extrinsic ...

Evaluation of the Efficacy of the H. pylori Protein HP-NAP as a Therapeutic Tool for Treatment of Bladder Cancer in an Orthotopic Murine Model

Bladder cancer is one of the most common malignancies of the urogenital tract. Intravesical injection of Bacillus Calmette-Gu&#233;rin (BCG) is the gold standard treatment for the high-grade non-muscle invasive bladder cancer (NMIBC). However, since the treatment-related side effects are relevant, newer biological response modifiers with a better benefit/side effects ratio are needed.
The tumour microenvironment can influence both tumour development and therapy efficacy. In order to obtain a good model, it is desirable to implant tumour cells in the organ from which the cancer originates.
In this protocol, we describe a method for establishing a tumour in the bladder cavity of female mice and subsequent delivery of therapeutic agents; the latter are exemplified by our use of Helicobacter pylori neutrophil activating protein (HP-NAP). A preliminary chemical burn of the mucosa, followed by the injection of mouse urothelial carcinoma cell line MB49 via urethral catheterization, enables the cells to attach to the bladder mucosa. After a period, required to allow an initial proliferation of the cells, mice are treated with HP-NAP, administrated again via catheterization. The anti-tumour activity of HP-NAP is evaluated comparing the tumour volume, the extent of necrosis and the degree of vascularization between vehicle- and HP-NAP-treated animals.

Evaluation of the Efficacy of the H. pylori Protein HP-NAP as a Therapeutic Tool for Treatment of Bladder Cancer in an Orthotopic Murine Model

Here the method to establish a syngeneic mouse model of orthotopic bladder tumour to evaluate the anti-tumour efficacy of the bacterial protein HP-NAP is described.

Bladder cancer is one of the most common malignancies of the urogenital tract. Intravesical injection of Bacillus Calmette-Gu&#233;rin (BCG) is the gold ...

An Acute Retinal Model for Evaluating Blood Retinal Barrier Breach and Potential Drugs for Treatment

A low-cost, easy-to-use and powerful model system is established to evaluate potential treatments that could ameliorate blood retinal barrier breach. An inflammatory factor, histamine, is demonstrated to compromise vessel integrity in the cultured retina through positive staining of IgG outside of the blood vessels. The effects of histamine itself and those of candidate drugs for potential treatments, such as lipoxin A4, are assessed using three parameters: blood vessel leakage via IgG immunostaining, activation of M&#252;ller cells via GFAP staining and change in neuronal dendrites through staining for MAP2. Furthermore, the layered organization of the retina allows a detailed analysis of the processes of M&#252;ller and ganglion cells, such as changes in width and continuity. While the data presented is with swine retinal culture, the system is applicable to multiple species. Thus, the model provides a reliable tool to investigate the early effects of compromised retinal vessel integrity on different cell types and also to evaluate potential drug candidates for treatment.

A low-cost, easy-to-use and powerful system is established to evaluate potential treatments that could ameliorate blood retinal barrier breach induced by histamine. Blood vessel leakage, M&#252;ller cell activation and the continuity of neuronal processes are utilized to assess the damage response and its reversal with a potential drug, lipoxin A4.

A low-cost, easy-to-use and powerful model system is established to evaluate potential treatments that could ameliorate blood retinal barrier breach. An ...

A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition

Limited evidence exists to precisely estimate efficacy and safety differences between parenteral nutrition (PN) prepared using olive-oil-based three-chamber bags (3CBs) and soybean-oil-based compounded bags (CoBs) in hospitalized adult patients. We designed a multicenter, randomized, prospective, open-label, noninferiority protocol to compare the efficacy, safety, and distribution of olive-oil-based 3CBs and soybean-oil-based CoB formulations in adult Chinese patients requiring PN during surgical intervention. Subjects were randomized to receive either one of the study treatments using an interactive voice or web-based recognition system in accordance with the randomization code. Randomization was further stratified based on the study site and surgical category. Both treatment groups received similar amounts of calories and protein. In addition, the two study treatments contained a similar composition of the amino-acid component. The only difference between the two PN formulations was the lipid constitution. The duration of administration of study treatments was a minimum of 5 days up to a maximum of 14 days after the surgical procedure. The primary efficacy endpoint was serum prealbumin levels on day 5 of the study. Noninferiority was proved if the anti-log of the lower bound of the 95% confidence interval (CI) of the treatment difference was at least 0.80. Other efficacy measures included treatment preparation time; duration to achieve tolerability of oral nutrition; associated infectious complications; length of hospitalization; and laboratory assessment of markers of nutrition, inflammation, metabolism, and oxidative stress. A total of 458 patients were enrolled in the study. The results showed that olive-oil-based 3CBs were non-inferior to soybean-based CoBs, besides being well tolerated. The infection rate was found to be significantly lower in the olive-oil-based 3CB group. Thus, this study may be used as a reference for future research on lipid emulsion and 3CBs.

Here, we present a protocol for a study comparing the efficacy, safety, and delivery of olive-oil-based 3CB and soybean-oil-based CoB formulations in adults requiring parenteral nutrition. The results revealed that olive-oil-based 3CBs is non-inferior and well tolerated compared to soybean formulations.

Limited evidence exists to precisely estimate efficacy and safety differences between parenteral nutrition (PN) prepared using olive-oil-based ...

3D Reconstruction for the Diagnosis and Treatment of Pulmonary Nodules

A 3D Digital Model for the Diagnosis and Treatment of Pulmonary Nodules

The three-dimensional (3D) reconstruction of pulmonary nodules using medical images has introduced new technical approaches for diagnosing and treating pulmonary nodules, and these approaches are progressively being acknowledged and adopted by physicians and patients. Nonetheless, constructing a relatively universal 3D digital model of pulmonary nodules for diagnosis and treatment is challenging due to device differences, shooting times, and nodule types. The objective of this study is to propose a new 3D digital model of pulmonary nodules that serves as a bridge between physicians and patients and is also a cutting-edge tool for pre-diagnosis and prognostic evaluation. Many AI-driven pulmonary nodule detection and recognition methods employ deep learning techniques to capture the radiological features of pulmonary nodules, and these methods can achieve a good area under-the-curve (AUC) performance. However, false positives and false negatives remain a challenge for radiologists and clinicians. The interpretation and expression of features from the perspective of pulmonary nodule classification and examination are still unsatisfactory. In this study, a method of continuous 3D reconstruction of the whole lung in horizontal and coronal positions is proposed by combining existing medical image processing technologies. Compared with other applicable methods, this method allows users to rapidly locate pulmonary nodules and identify their fundamental properties while also observing pulmonary nodules from multiple perspectives, thereby providing a more effective clinical tool for diagnosing and treating pulmonary nodules.

Author Spotlight: A 3D Digital Model for the Diagnosis and Treatment of Pulmonary Nodules  

The objective of this study is to develop a novel 3D digital model of pulmonary nodules that serves as a communication bridge between physicians and patients and is also a cutting-edge tool for pre-diagnosis and prognostic evaluation.

The three-dimensional (3D) reconstruction of pulmonary nodules using medical images has introduced new technical approaches for diagnosing and treating ...

Surgical Treatment of an Endolymphatic Sac Tumor

Endolymphatic sac tumors (ELST) are low-grade papillary adenocarcinoma originating from the endolymphatic sac. Usually slow-growing, with local aggressiveness and a low risk of distant metastases, ELST can be sporadic but also frequently associated with von Hippel Lindau disease. The current treatment of ELST is primarily surgical resection. A 55-year-old woman accessed our otologic tertiary level referral center for a sudden worsening of hearing loss in her left ear and vertigo. A magnetic resonance (MRI) and computer tomography scan study subsequently showed a mass in the petrous bone; hence, the presence of an ELST was hypothesized. After embolization of the mass, the patient underwent surgical removal of the lesion. The resection of the mass was done through a translabirinthine approach, with an uneventful procedure. No residual disease remained after surgery. After 24 months of radiologic follow up with MRI, there are no signs of recurrence disease. This paper reports the management of this sporadic ELST, as well as the follow up results, providing clinicians this protocol for the handling of such a challenging otologic skull base surgery and rare disease.

Here, we discuss clinical and radiological features of endolymphatic sac tumors and report the methodology and results of a surgical removal in a case in care at our otologic referral center.