Effect of Cranial Osteopathic Manipulative Medicine on cerebral tissue oxygenation

1. Robert Kawa, OMS III Pre-doctoral OPP Fellow DidacticsOnline.com Effect of Cranial Osteopathic Manipulative Medicine on cerebral tissue oxygenation

2. Context: The use of cranial OMM to alter cerebral tissue oxygenation could play a role in maintaining cerebral homeostasis. Objective: Examine the effects of cranial OMM on cerebral tissue oxygen saturation (CTO2) and cardiac autonomic function in healthy adults. Abstract

3. Methods: Cranial OMM augmentation, suppression, and sham therapy randomly applied to healthy adults. The CTO2 of the prefrontal cortex was determined bilaterally using near-infrared spectroscopy. HR, BP, and SaO2 were also measured. Power spectral analysis was applied to continuous 4-minute R-R intervals. Measurements were made at 2-minute baseline periods, during 4-minute applications of techniques, and 5-minute recovery periods. Abstract

4. Results: • Twenty-one adults (age 23-32) participated. • Differences in mean baseline measurements for the augmentation, suppression, and sham therapies were not statistically significant for HR, BP, SaO2, left CTO2, or right CTO2. • During the suppression technique there was a statistically significant decrease in both left (P=.026) and right (P=.007) CTO2 with increased cranial OMM time. • Decreases in normalized low frequency power of R-R interval variability and enhancements of its high-frequency power were statistically significant (P=.05) during OMM and sham therapy, indicating a decrease in cardiac sympathetic influence. abstract

5. Conclusion: Cranial OMM suppression effectively and progressively reduced CTO2 in both prefrontal lobes with the treatment time. abstract

6. Cranial OMM and Headaches Cranial articular motion Augmentation Technique Suppression Technique Introduction

7. The augmentation technique would increase CTO2, and the suppression technique would decrease CTO2. Cranial OMM would balance the cardiac autonomic nervous function, as reflected by change in HR or R-R interval variability. Hypothesis

8. HR, BP, CTO2, SaO2 all continuously monitored via ECG, pulse oximetry, and BP tonometry. CTO2 of the prefrontal lobes was measured with near-infrared spectroscopy using two sensors on the forehead with output analog samples at 1Hz. Measurements

9. 2 Novel Findings: • Cranial OMM suppression technique decreased CTO2 • Cranial OMM and Sham therapy relax cardiac sympathetic modulation and enhance vagal modulation as reflected by power spectral analysis of R-R interval variability. Discussion/conclusion

10. No observable increase in CTO2 during augmentation technique. Decrease CTO2 in suppression technique no placebo. Decreased CTO2 likely due to reduced oxygen delivery resulting from depression of blood flow. Discussion/conclusion

11. Findings support application of cranial OMM when cerebral blood flow or pressure is excessive, such as migraine headaches. Suppression is benign in healthy adults. R-R Interval variability findings suggest that the autonomic nervous system could be more readily affected by psychological influence Discussion/conclusion

12. LIMITATIONS? QUESTIONS?