Scientific articles on effects of Osteopathic treatments on stroke patients' rehabilitation ?

Hi,

I'm making research on the effectiveness of osteopathic treatments on stroke patients' rehabilitation. Do you have any references I could use ?

Thanks,

Aurore Barea.

Treatments: 364

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Permalink Reply by Small Fry on February 27, 2012 at 8:20pm
Patrick, is ours the only system that has practical and conceptual limitations for stroke? Would you say then that nhs medicine has it sussed?
Permalink Reply by Patrick Morgan on February 27, 2012 at 8:39pm

Hi Indikate

...Just to finish my sentence I wouldn't mind either if my neuro-physio was also an osteopath....

Permalink Reply by Patrick Morgan on February 27, 2012 at 9:15pm

Hi Small Fry

I politely refer you back to my previous entries each health model or social welfare model including osteopathy has limitations both conceptually and in practice, depending on the patient's problem some models will take precedence over others. Because I am also a public health practitioner and I work closely with stroke survivors I am fortunate to have the opportunity to consider the concepts and scope of osteopathy as I understand them at least in this context.  Stroke is a medical emergency and stroke victims are well served by the medical model which, at present only the NHS has the resources and personnel to provide life saving care for them. But as I have previously tried to explain the care of stroke survivors post hospital remains a massive societal effort and osteopaths are welcome in fact they should be a part of that effort.

Permalink Reply by Roger Kingston on February 27, 2012 at 10:32pm

The intial question was searching for references in treating stroke with osteopathy.

Are there any?

Again this profession has a problem and all our evidence in empiracal (not saying physio or medicine is any better) and this is a huge problem for us in the broader picture.

GOstC should address this - oh Hi Jonathon - please pass the message on to them.

Permalink Reply by indikate on February 27, 2012 at 11:39pm

Thank you Patrick that was very interesting. You seem impressed by idea that the medical model is somehow effective in reducing cardiovascular disease when analysis of the evidence indicate it is a growing market for the phamaceutical business.
In your experience do you feel there is a place for osteopathy philosophically in the management of stroke patients as this is perhaps a more relevant question than the pedictable research based requests, to which the answer will probably remain no
Patrick Morgan said:

Hi Indikate

Stroke and its immediate rehabilitation where response time, surgery, pharmaceuticals and expensive rehab apparatus are crucial is treated very successfully under the medical model and this has led to thousands of stroke survivors. Stroke and cardiovascular disease prevention at the moment is a high priority and many Public Health local and national initiatives have been rolled out using health promotion theory, community outreach programs bring together a number of services to improve the health and well-being of stroke survivors, stroke incidence has declined although it remains stubbornly high in some populations. This demonstrates to me at least that a wide range of health and social welfare models and practices are required to successfully manage stroke patients. Certainly IMO osteopathic health models have a place but just like any another health model it has both conceptual and practical limitations, a practitioner would need to address those limitations and or become part of a multidisciplinary effort to safely practice among some patient demographics. So if I had a stroke I hope someone dials 999 pronto but when I leave hospital and go back into the community I would be delighted to have the services of an osteopath I wouldn't mind if my neu

Permalink Reply by Roger Kingston on February 28, 2012 at 3:42am

In the acute stage of a stroke there is evidence to show that Scalp acupuncture can be effective when performed by a paramedic. I'd then want coiling or clipping done by a neurosurgeon and or radiologist with follow up with anti free radical medication and intensive care.

Osteopathy / Cranial osteopathy does have a role in the post acute and rehabilitation phase but lets not loose sight of the fact that American osteopathic medicine evolved from a place we stayed static in. The fact that medicine is considerably better in certain areas is simply a fact that we haven't moved on. Yet the skills we have are under utilised which comes back tot he point that there is no research / audit available for an osteopath to take as eveidence in trying to become involved in a stroke management team.

Permalink Reply by Small Fry on March 5, 2012 at 1:28pm

All of which makes sense from one perspective.  In an acute emergency stage, where better could you be than an NHS hospital?  I don't think that's the main area of debate.

However, the reality for many is that the wait for multidisciplinary rehabilitation services can be extensive, all the while that various windows of opportunity are closing.  Furthermore, there is not nearly enough supply to meet the demand, and those facilities do cherry-pick patients on the basis of ability to benefit.  Which means of course the data on success are skewed.

However, much improvement may be in spite of treatment, not because of it.  According to one neuroscientist I know, the best predictor of stroke recovery is actually the motivation of the patient, maybe more so than the facility the enter.  Unfortunately, such facilities also tend not to have much to offer when motivation is poor, as they may be hamstrung by ethical concerns over usurping the free will of the patient if cajoling their participation in activities.  So the tendency is to say recovery is exhausted, withdraw therapy, and move them on to make way for somebody who will 'make better use' of the system.

Which is all very well except when problems with motivation and initiation are part of the residual impairment.  What then?  I did meet one consultant who was adamant that for many people, the best rehabilitation is to get home as quickly as possible to a supportive family.

Multidisciplinary settings can have a tendency to miss the particular needs of one patient, simply because they do not fall under the purvue of any one department in that setting - in other words, it may be important to Mrs X, but 'somebody else is responsible for that'.  And if they are not, it's Mrs X's fault for being different.  Don't laugh, I've seen it.

So it is a distinctively public health perspective that says there is one best practice for a given condition.  When allocating large budgets over a region, this may be true.  But as osteopaths we know that behind the graphs of populations are many unique and individual stories, falling between the gaps in the overall 'best' type of provision.  There are people left high and dry by the system who need something else.  What that leads me to wonder is, if that 'something else' is good for the most difficult non-responders, perhaps we should look for everybody's 'something else' - give everybody something better than the standard 'best practice' provision.

To all of this I would add, there is some confusion in the last few posts about the meaning of osteopathy.  Osteopathy begins with a way of understanding problems.  An overall medical understanding of health and disease, that engages the skills of an osteopath, is not allopathy mixed with a bit of osteopathy - it is just more allopathy with a few esoteric methods.

Similarly, it is possible for an overall osteopathic view of a case, to employ the skills of, say, a neuro physio in re-educating people to lost skills, and that can be pure osteopathy.  I have done this sort of thing in the past, and achieved great success where flagship multidisciplinary serivces have written off a case entirely.  Was it physio?  Was it osteopathy?  Was it a triumph of common sense over evidence-based ideology?  I don't know.  Unless we are clear about what we mean by these terms, it is misleading to discuss 'osteopathy's role' or 'best practice'.  But I'll say this with certainty, it was a lot less costly than an NHS rehab bed.


Patrick Morgan said:

Hi Small Fry

I politely refer you back to my previous entries each health model or social welfare model including osteopathy has limitations both conceptually and in practice, depending on the patient's problem some models will take precedence over others. Because I am also a public health practitioner and I work closely with stroke survivors I am fortunate to have the opportunity to consider the concepts and scope of osteopathy as I understand them at least in this context.  Stroke is a medical emergency and stroke victims are well served by the medical model which, at present only the NHS has the resources and personnel to provide life saving care for them. But as I have previously tried to explain the care of stroke survivors post hospital remains a massive societal effort and osteopaths are welcome in fact they should be a part of that effort.

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