RESUMEN
CONTEXT: The effects of osteopathic cranial manipulative medicine (OCMM) on visual function have been poorly characterized in the literature. Based on a pilot study conducted by their research group, the authors conducted a study that examined whether OCMM produced a measurable change in visual function in adults with cranial asymmetry. STUDY DESIGN: Randomized, controlled, double-blinded clinical trial. The intervention and control (sham therapy) were applied during 8 weekly visits, and participants in both groups received 8 weekly follow-up visits. PARTICIPANTS: Adult volunteers aged between 18 and 35 years with unremarkable systemic or ocular history were recruited. Inclusion criteria were refractive error between 6 diopters of myopia and 5 diopters of hyperopia, regular astigmatism of any amount, and cranial somatic dysfunction. INTERVENTION: All participants were evaluated for cranial asymmetry and randomly assigned to the treatment or sham therapy group. The treatment group received OCMM to correct cranial dysfunctions, and the sham therapy group received light pressure applied to the cranium. OUTCOME MEASURES: Preintervention and postintervention ophthalmic examinations consisted of distance visual acuity testing, accommodative system testing, local stereoacuity testing, pupillary size measurements, and vergence system testing. A χ2 analysis was performed to determine participant masking. Analysis of variance was performed for all ophthalmic measures. RESULTS: Eighty-nine participants completed the trial, with 47 in the treatment group and 42 in the sham therapy group. A hierarchical analysis of variance revealed statistically significant within-groups effects (P<.05) from before the intervention to visit 16 in distance visual acuity of both eyes, local stereoacuity, Donder pushup in both eyes, and near point of convergence break and recovery. For treatment group vs sham therapy group, a statistically significant effect (P<.05) was observed from before the intervention to visit 16 in pupillary size under bright light in the left eye and in near point of convergence break. CONCLUSION: Osteopathic cranial manipulative medicine may affect visual function in adults with cranial asymmetry. Active motion testing of the cranium for somatic dysfunction may affect the cranial system to a measurable level and explain interrater reliability issues in cranial studies. (ClinicalTrials.gov number NCT02728713).
Asunto(s)
Hiperopía/terapia , Osteopatía , Miopía/terapia , Agudeza Visual , Adulto , Análisis de Varianza , Astigmatismo/terapia , Método Doble Ciego , Humanos , Cráneo/anatomía & histología , Adulto JovenRESUMEN
CONTEXT: Research studies have associated cranial strain patterns with a variety of neurologic disorders. However, baseline data on the prevalence of such patterns in a healthy population is lacking. OBJECTIVE: To determine the prevalence of cranial strain patterns in healthy subjects. METHODS: A retrospective analysis of cranial strain findings from healthy subjects who participated in two previous research projects. Data were collected for the following cranial strain patterns: torsion (left or right), sidebending rotation (left or right), lateral (left or right), and vertical (superior or inferior). RESULTS: Data from 142 healthy subjects--119 women and 23 men with a mean age of 24.5 years--were analyzed. Torsion and sidebending rotation were the most common cranial strain patterns observed, comprising 72% of all identified patterns. The most prevalent patterns when stratified by the side of dysfunction were right torsion (31%), left sidebending rotation (23%), and left lateral (19%). Left sidebending rotation with right torsion (17%); left lateral, left sidebending rotation, and right torsion (14%); and right sidebending rotation with right torsion (11%) were the most common combinations of cranial stain patterns. CONCLUSION: Although the present study identified common cranial strain patterns in a healthy population, future studies with broader patient populations and multiple observers are needed to confirm and further define these findings.