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The Influence of Osteopathic Manipulative Treatment (OMT) on Cognitive Performance and Recovery Following a Sport-Related Concussion

Journal: Journal of Osteopathic Medicine Date: 2023/12, 123(12):Pages: A49-A50. doi: Subito , type of study: randomized controlled trial

Full text    (https://www.degruyter.com/document/doi/10.1515/jom-2023-2000/html)

Keywords:

athletes [16]
concussion [29]
injuries [66]
OMT [2951]
osteopathic manipulative treatment [2973]
randomized controlled trial [710]
sports [103]

Abstract:

Statement of Significance: The research literature on the efficacy of OMT during concussion recovery is in its infancy, with previous studies primarily testing its influence on post-concussion symptomatology. Despite a scarcity of studies, research has generally suggested modest improvements in post-concussion symptoms.1-3 Thus, the effect of OMT on neuropsychological test performance and duration of recovery represents an important gap in the literature. To investigate the influence of OMT on performance on a cognitive screening tool in a sample of student athletes recovering from a sports-related concussion. Research Methods: Participants (N= 22) consisted of high school and collegiate athletes recruited from a university sports medicine clinic. All participants were administered the ImPACT cognitive screening tool during each post-injury testing session. Athletes were randomly assigned into either the OMT or control group. The OMT group consisted of athletes receiving OMT in addition to cognitive screening and symptom monitoring (n= 11, 62.5% female, Mage=16.53, Medu=9.32). The control group (n= 11, 45.5% female, Mage=17.91, Medu=11.4) received standard concussion protocol consisting of cognitive screening and post-concussion symptom monitoring. Data were included from each post-injury testing session. Groups did not statistically differ in age, sex, or education. ANCOVA was used to test for differences in cognitive performance between the OMT and control group. Data Analysis: ANCOVA indicated a significant main effect of OMT on visual-motor speed performance (F = (1, 40) = 8.104, p=.007, ηp2 = .18). Mean comparisons of visual-motor composite scores revealed that the OMT group performed significantly worse (M = 37.97, SD = 6.4 than the control group (M = 43.44, SD = 5.4) with a medium effect size (η2 = .136). In addition, ANCOVA indicated a significant main effect of OMT on verbal-memory performance (F = (1, 40) = 7.739, p=.008, ηp2 = .17). Mean comparisons of verbal-memory composite scores revealed that the OMT group performed significantly worse (M = 83.86, SD = 9.4) than the control group (M = 90.45, SD = 8.6) with a medium effect size (η2 = .134). There were no significant differences observed in any other composite scores including visual memory, reaction time, or impulse control. Chi-square analysis indicated that the OMT and control groups did not significantly differ in reported post-concussion symptoms (p = .62). Additionally, descriptive statistics indicated that the OMT group took 18.43 days on average to recover while the control group took 10.9 days on average to recover. Conclusion: Preliminary findings are not indicative of an added benefit associated with supplementing standard concussion recovery protocol with OMT. Interestingly, our data suggested that athletes who received OMT in addition to the standard concussion recovery protocol performed significantly worse on measures of visual-motor speed and verbal memory when compared to athletes receiving the standard protocol without OMT. These findings may be explained by previous research conducted by Tamburella et al, which found that OMT had immediate effects on brain perfusion, specifically decreased perfusion in the posterior cingulate cortex (PCC) and the superior parietal lobe (SPL). Given that the SPL has been primarily implicated in visuomotor functions, spatial cognition, and working memory, it follows that a decrease in perfusion of this region may account for the worse performance on both the visual-motor speed tasks and the verbal memory tasks in the treatment group when compared to the control group. In addition, the decreased perfusion seen in the PCC, being implicated in memory processes and visual-spatial processing, may further explain the differences seen in performance on the verbal-memory and visual-motor speed tasks. It is important to note, however, that these changes in brain perfusion were described in the study as immediate and were unlikely to persist for more than three days post-treatment, with the PCC showing enhanced perfusion three days post-treatment. Notably, we observed that receiving OMT was associated with a longer recovery duration. Our preliminary findings suggest that administering OMT during the acute phase of recovery from sports-related concussion may yield lower performances on cognitive screening measures and worse outcomes such as a protracted recovery. More research is needed to better understand the efficacy of OMT as a treatment for sports-related concussion, its effect on cognitive performance, and potential adverse effects in this population.


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