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The use of osteopathic manipulative medicine in the treatment of headaches for a patient with subdural hematomas in the setting of traumatic brain injury

Journal: The Journal of Head Trauma Rehabilitation Date: 2018/06, 33(3):Pages: E99-E100. doi: Subito , type of study: observational study

Full text    (https://journals.lww.com/headtraumarehab/Fulltext/2018/05000/North_American_Brain_Injury_Society.16.aspx)

Keywords:

nervous system [169]
hemiplegia [2]
lymphatic system [40]
orbit [4]
Hoffmann reflex [1]
viscera [113]
rib cage [3]
headache [127]
medication therapy management [1]
traumatic brain injury [15]
osteopathic manipulative treatment [2973]
OMT [2951]
observational study [126]

Abstract:

Osteopathic manipulative medicine (OMM) is a nonsurgical, interventional, hands-on approach to diagnosis and treatment of somatic dysfunction (physiological lesion). It may serve as primary or adjunctive therapy in addressing a wide range of visceral, neurological, myofascial, skeletal, and ligamentous conditions, in combination with other interventions. OMM techniques target lesion patterns in the muscles, bones, fascia, ligaments, dura, fluids, viscera, and neural circuitry, and utilize a fulcrum for change to restore motion, balance, and maximal health. A 61-year-old Caucasian male with history of HTN, CAD s/p CABG and mechanical mitral valve replacement (2015) on chronic warfarin anticoagulation, presented on 9/12/17 for progressive bilateral lower extremity weakness and mild decrease in mental acuity. He had two prior falls with loss of consciousness when traveling to Mexico on 9/8/17 when intoxicated. Symptoms of bilateral leg weakness, decreased mental acuity, and urinary incontinence progressed over 2-3 days until he was unable to stand from a seated position. CT head revealed a right parafalcine and para tentorial subdural hemorrhage with anterior focal hematoma and a small subarachnoid hemorrhage. No surgical intervention was taken, and patient was transferred to The Institute for Rehabilitation and Research on 9/16/17 for functional deficits related to his subdural hematoma. Pertinent positives on his neurologic exam included: positive left hoffman's sign, positive left babinksi sign, and left sided hemiplegia. He was able to ambulate 5-15 feet upon admission with moderate assistance. Patient complained of moderate retro-orbital headaches since his trauma and was started on scheduled Tylenol and gabapentin, and prn Tylenol and tramadol. Despite medication management, patient continued to have worsening headaches. Patient was taking up to 50 mg QID tramadol prn and 1-3 tabs hydrocodone 5-325 mg daily from 9/21/17-9/26/17 without adequate pain control. OMM treatments were started on 9/23/17 as an adjunct therapy for headache management. Treatments focused on the following: somatic dysfunction involving the cranial vault, lymphatic system, bilateral rib cages, and viscera. Treatments lasted between 10-15 minutes and were administered between 9/23/17-10/3/17. Patient experienced a decrease in overall headache symptoms and a decrease in both scheduled and prn pain medications. Upon discharge on 10/13/17 patient no longer required scheduled or prn pain medications and was able to ambulate around the medical center while following a map with no cues. Patient experienced no adverse reactions to OMM treatments and progressed well with therapy. He was discharged home with a modified independent to independent level of functioning. This case illustrates the safety of using OMM to treat patients with headaches in traumatic brain injury. Patient experienced no adverse reactions to treatment, had a decrease in headache symptoms and participated in therapy without barriers.


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