Neurophysiology, Neuro-Immune Interactions, and Mechanobiology in Osteopathy in the Cranial Field: An Evidence-Informed Perspective for a Scientific Rationale

Barsotti, Nicola; Casini, Alessandro; Chiera, Marco; Lunghi, Christian; Fornari, Mauro

doi:10.3390/healthcare11233058

Cited by 3 publications

(1 citation statement)

References 160 publications

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“…However, contemporary evidence challenges the efficacy of solely biology-focused models, prompting a shift towards person-centered models in education and practice [ 16 , 17 , 20 ]. Recently, there has been an emphasis on the complexity of patients’ pain experiences, which involve intricate neural processes encompassing sensory, emotional, and cognitive components, both theoretically [ 18 , 49 , 50 ] and with concrete clinical osteopathic proposals that renovate some distinctive elements of the osteopathic profession (e.g., somatic dysfunction and osteopathic treatment of the head region) [ 39 , 51 , 52 , 53 ]. Considering this understanding, contextual factors have been integrated into manual therapies to align more closely with patient values and expectations, as they have been shown to significantly impact clinical outcomes [ 54 ].…”

Section: Resultsmentioning

confidence: 99%

Epistemological Flexibility in Person-Centered Care: The Cynefin Framework for (Re)Integrating Indigenous Body Representations in Manual Therapy

Zegarra-Parodi,

D’Alessandro,

Baroni

et al. 2024

Healthcare

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Background: Chiropractic, osteopathy, and physiotherapy (COP) professionals regulated outside the United States traditionally incorporate hands-on procedures aligned with their historical principles to guide patient care. However, some authors in COP research advocate a pan-professional, evidence-informed, patient-centered approach to musculoskeletal care, emphasizing hands-off management of patients through education and exercise therapy. The extent to which non-Western sociocultural beliefs about body representations in health and disease, including Indigenous beliefs, could influence the patient–practitioner dyad and affect the interpretation of pillars of evidence-informed practice, such as patient-centered care and patient expectations, remains unknown. Methods: our perspective paper combines the best available evidence with expert insights and unique viewpoints to address gaps in the scientific literature and inform an interdisciplinary readership. Results: A COP pan-professional approach tends to marginalize approaches, such as prevention-oriented clinical scenarios traditionally advocated by osteopathic practitioners for patients with non-Western sociocultural health assumptions. The Cynefin framework was introduced as a decision-making tool to aid clinicians in managing complex clinical scenarios and promoting evidence-informed, patient-centered, and culturally sensitive care. Conclusion: Epistemological flexibility is historically rooted in osteopathic care, due to his Indigenous roots. It is imperative to reintroduce conceptual and operative clinical frameworks that better address contemporary health needs, promote inclusion and equality in healthcare, and enhance the quality of manual therapy services beyond COP’s Western-centered perspective.

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Section: Resultsmentioning

confidence: 99%

Epistemological Flexibility in Person-Centered Care: The Cynefin Framework for (Re)Integrating Indigenous Body Representations in Manual Therapy

Zegarra-Parodi,

D’Alessandro,

Baroni

et al. 2024

Healthcare

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Applicability of using dynamic MRI to evaluate alleged cranial rhythmic impulse (CRI)

Masoudi,

Karimi,

Abdollahi

et al. 2024

BMC Musculoskelet Disord

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Objectives To evaluate the feasibility of using dynamic MRI to measure the features of cranial rhythmic impulse (CRI). Design and setting Fifteen healthy participants (9 females and 6 males, aged 25 to 77) underwent dynamic MRI in a sagittal T2 HASTE view at a rate of 0.60 Hz for 30 s. The MRI videos were analyzed using video tracking software. Three points were marked: the glabella, the midpoint of the sella turcica, and a symmetrical point of the glabella on the occiput. The distances between these points were measured across 46 frames. Amplitudes and rates of asymmetrical CRI waves were calculated using Excel formulas. Results The mean wave frequencies were 5.65 Hz for the anteroposterior distance, 6.2 Hz from sella turcica to occiput, and 6.76 Hz from sella turcica to glabella. The mean wave amplitudes were 0.39 mm, 0.6 mm, and 0.49 mm for the respective distances. Both intraclass correlation coefficients (ICC) and reliability coefficient (R) indicated excellent reliability (R, ICC > 0.90). The technical error of measurement (TEM) exceeded 1 mm for the anteroposterior and sella-to-occiput distances, while it was 0.32 mm for the sella-to-glabella distance. Conclusions Dynamic MRI demonstrates potential in measuring the features of CRI, particularly in assessing CRI wave rate. While the ICC values indicate high reliability, the TEM values suggest that using MRI to measure CRI wave amplitude may only be dependable for the distance from the sella to the glabella. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-024-08064-y.

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Physiological Mechanisms Underlying the Primary Respiratory Mechanism (PRM) and Cranial Rhythmic Impulse (CRI) in Osteopathy: A Systematic Review

Mériaux,

Stubbe,

Guyon

2024

Healthcare

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Background: Cranial Rhythmic Impulse (CRI) or Primary Respiratory Mechanism (PRM), movement felt on the scalp or the rest of the body, respectively, is a fundamental concept used by osteopaths in their practice for their diagnosis and treatment. However, the physiological basis of this phenomenon remains unclear. Sutherland, the founder of cranial osteopathy, proposed in 1939 that PRM was due to the movement of the cranial bones pulled by the meninges, themselves pushed by the fluctuation of cerebrospinal fluid and the motility of the central nervous system. Since then, Sutherland’s theory has become dogma, despite scientific progress refuting it, and few osteopaths have attempted to find better explanations. Objective: This systematic review of Medline, Science Direct and the Cochrane Library indexed electronic databases explores current knowledge of the physiological mechanisms underlying the Primary Respiratory Movement (PRM) or Cranial Rhythmic Impulse (CRI). Methods: We entered the following identified keywords: “osteopathy in the cranial field”; “cranial rhythmic impulse”; and “primary respiratory mechanism”. We identified 193 studies, evaluated 115, and identified 28 articles that fulfilled our criteria. We classified the studies in terms of methodological rigor, types of studies and tools used. No study had three good-level items, and only five studies had two good-level items corresponding to the type of study and tools used. The protocol of the review has been registered on PROSPERO-CRD42023488497. Results: Out of the 28 articles, 20 referenced at least one of Sutherland’s hypotheses, often quoting the model to critique or challenge it, while 25 of them refer to other hypotheses and/or mechanisms underlying PRM/CRI: 11 concern vasomotion in blood vessels (7) and lymphatic vessels (6), 20 THM waves, 14 heart rate variability, 9 ventilation rate, 2 the extra-cellular matrix and 1 oxidative metabolism. Conclusions: Although Sutherland’s theory remains prevalent in general beliefs, in scientific literature, THM waves driven by autonomous system activity have gained prominence, emerging as the leading hypothesis. The results from this systematic review confirm the need for a paradigm shift for the CRI/PRM in osteopathy, and for more rigorous evaluation and communication on a model in step with evolving scientific data.

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Neurophysiology, Neuro-Immune Interactions, and Mechanobiology in Osteopathy in the Cranial Field: An Evidence-Informed Perspective for a Scientific Rationale

Cited by 3 publications

References 160 publications

Epistemological Flexibility in Person-Centered Care: The Cynefin Framework for (Re)Integrating Indigenous Body Representations in Manual Therapy

Epistemological Flexibility in Person-Centered Care: The Cynefin Framework for (Re)Integrating Indigenous Body Representations in Manual Therapy

Applicability of using dynamic MRI to evaluate alleged cranial rhythmic impulse (CRI)

Physiological Mechanisms Underlying the Primary Respiratory Mechanism (PRM) and Cranial Rhythmic Impulse (CRI) in Osteopathy: A Systematic Review

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