Wetzler Gail, Roland Melinda, Fryer-Dietz Sally, Dettmann-Ahern Dee
Clinical Research, Barral Institute, West Palm Beach, FL.
Wetzler Integrative Physical Therapy, Denver, CO.
Med Acupunct. 2017 Aug 1;29(4):239-248. doi: 10.1089/acu.2017.1222.
Military service members and veterans face health issues related to traumatic brain injury (TBI), especially during combat, use of heavy equipment, and exposures to environmental hazards and explosives. There were 400,000 TBIs reported in deployed U.S. troops in 2012. Athletes are also subject to TBI. Studies have indicated that some manual therapies could be helpful for treating patients who have post-concussive syndrome. This case series report describes the effects of CranioSacral Therapy (CST), Visceral Manipulation (VM), and Neural Manipulation (NM) modalities for treating patients who have post-concussion syndrome. The goal of this study was to evaluate these effects on immobility, pain intensity, quality of life, sleep disorders, and cognition in these patients. This single-blinded case series was conducted at the Upledger Institute, in West Palm Beach, FL. The patients were 11 male retired professional football players from the National Football League and the Canadian Football League who had been medically diagnosed with post-concussion syndrome. Each participant received a morning and afternoon 2-hour session of these three specific manual therapies, which were capable of accessing and addressing the structural, vascular, and neurologic tissues of the cranium and brain-as well addressing far-reaching ramifications throughout the body following trauma. The main outcome measures were scores on the: Impact Neurocognitive Test; Dynavision Test; Short Form-36 Quality of Life Survey, Headache Impact Test, Dizziness Handicap Inventory; a numeric pain rating scale; orthopedic range of motion tests (ROM); and vestibular testing. Hours of sleep were also checked. These outcome measures were registered at baseline, after treatment, and after a 3-month follow up. Statistically significant differences were seen with a decrease in overall pain rating scale scores ( = 0.0448), and cervicogenic pain levels decreased ( = 0.0486). There were statistically significant increases in Dynavision Average Reaction Time ( = 0.0332), Memory Test ( = 0.0156) scores, and cervical ROM scores ( = 0.0377). Hours of sleep averaged 2 hours on the first day of treatment and increased to 4.0 hours at the end of treatment and were continuing to increase, as noted at a 3-month evaluation. Ten sessions of specific CST/VM/NM therapy resulted in statistically greater improvements in pain intensity, ROM, memory, cognition, and sleep in concussed patients.
军人和退伍军人面临与创伤性脑损伤（TBI）相关的健康问题，尤其是在战斗期间、使用重型装备以及暴露于环境危害和爆炸物的情况下。2012年，美国部署部队报告了40万例创伤性脑损伤。运动员也容易遭受创伤性脑损伤。研究表明，一些手法治疗可能有助于治疗患有脑震荡后综合征的患者。本病例系列报告描述了颅骶疗法（CST）、内脏手法治疗（VM）和神经手法治疗（NM）对治疗脑震荡后综合征患者的效果。本研究的目的是评估这些疗法对这些患者的活动障碍、疼痛强度、生活质量、睡眠障碍和认知的影响。这个单盲病例系列研究在佛罗里达州西棕榈滩的尤普勒格研究所进行。患者是11名来自美国国家橄榄球联盟和加拿大橄榄球联盟的男性退役职业橄榄球运动员，他们经医学诊断患有脑震荡后综合征。每位参与者每天上午和下午各接受一次为期2小时的这三种特定手法治疗，这些治疗能够触及并处理颅骨和大脑的结构、血管和神经组织，以及创伤后对全身产生的深远影响。主要观察指标包括：冲击神经认知测试得分；动态视力测试得分；简短健康调查简表36项生活质量得分、头痛影响测试得分、头晕残障量表得分；数字疼痛评分量表得分；骨科活动范围测试（ROM）得分；以及前庭测试得分。还检查了睡眠时间。这些观察指标在基线、治疗后和3个月随访后进行记录。总体疼痛评分量表得分下降（P = 0.0448），颈源性疼痛水平下降（P = 0.0486），差异具有统计学意义。动态视力平均反应时间得分（P = 0.0332）、记忆测试得分（P = 0.0156）和颈椎活动范围测试得分（P = 0.0377）有统计学意义的增加。治疗第一天平均睡眠时间为2小时，治疗结束时增加到4.0小时，并且在3个月评估时仍在继续增加。十次特定的颅骶疗法/内脏手法治疗/神经手法治疗在减轻脑震荡患者的疼痛强度、活动范围、记忆、认知和改善睡眠方面有统计学意义的更大改善。
