The benefits of authorisation of osteopaths
- sivu 6-7
Osteopathy in Sports Medicine – an integral part of the team
- sivu 15-16
The EFFO: united across borders
- sivu 22-23
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AIKAKAUSLEHTI SUOMEN OSTEOPAATTILIITTO RY • NRO. 1 • 2020 Hallituksen yhteystiedot:
Editor´s corner Puheenjohtaja: Laura Lee Kamppila
Hietalahdenranta 19, 00180 Helsinki as well as all the presidents of the nation- al osteopathic communities. This would not +358 (0)50 568 6823 have been possible without your effort and osteopaattiliitto.fi contributions. If you feel like contributing to osteopatia.fi our next edition in 2021, please contact me for more information.
Dear readers and Colleagues, Please do not hesitate to contact me in case of any questions or comments. • Sihteeri: A year ago, we published the first ever Nordic And lastly, I wish you all Merry Christmas and Taina Tiura Osteopathic Journal. We proudly present to a Happy New Year! [email protected] you our second edition. It has been a tough and complicated year for us all. Due to the cir- • Rahastonhoitaja: cumstances, we have lost the opportunity to Best regards, Laura Korhonen physically meet and exchange knowledge. We Ingrid Nicander [email protected] hope this will give you a sense of unity. You Osteopath and editor will find a variety of articles, and I hope you [email protected] • Kurssitoimintavastaava: will find something that catches you. I wish Volkan Aktas to extend my thanks to all our contributors, [email protected]
Lisätietoa opiskelusta: [email protected]
Matkustuskiellot ja rajoitukset ovat värittäneet kansainvälistä työtä hyvin radikaalisti. Vaikka lähietäisyydellä ei ollakaan päästy kokoustama- an, on yhteistyö ja yhteydenpito ollut tiiviimpää kuin koskaan ennen. Tämä lehti on yksi osoitus yhteistyöstä, syksyllä 2021 muodossa tai toisessa pidettävä kongressi toinen. Lehden sivuilta välit- tyvät uudet, isotkin suunnitelmat ja toteutuvat projektit. On hienoa saada näkökulmaa naapu- rimaiden osteopatiakenttään, on hyvä pysyä ajantasalla ja kehittää alaa eteenpäin yhdessä. Tässä lehdessä esitellään ensimmäinen pohjo- Arvoisa lukija, ismainen englanninkielinen maisterintutkinto. On upea saavutus polkaista tällainen projekti Luettavanasi on nyt järjestyksessään toinen käyntiin, vaikka ajat ovatkin erityiset. Lehdestä yhteispohjoismainen Nordic Osteopathic Jour- löytyy myös maailman suurimman organisaation nal (NOJ). Teimme ensimmäisen yhteisen lehden OIA:n puheenjohtajan tervehdys. Keväästä 2021 tasan vuosi sitten. Aivan kuten viime vuonna, on tulee Osteopaattiliitto olemaan tämän organ- tästä lehdestä viisi eri versiota; kullakin maalla isaation täysjäsen. Mielenkiinnolla odotamme, Jäseneksi: omansa, omalla kielellään. Kaikki tässä leh- mitä yhteistyömahdollisuuksia tämä meille avaa. dessä olevat englanninkieliset artikkelit ovat Paikka WHO:n kanssa yhteistyötä tekevässä ni- näkyvillä noissa eri maiden versioissa. Lehden mikkeistötyöryhmässä Suomella jo onkin! Ollessasi Valviran rekisterissä oleva os- versiot taitetaan ja viimeistellään norjalaisen teopaatti, sinulla on mahdollisuus hakea Suomen Osteopaattiliiton täysjäsenyyt- kustannustoimittajan toimesta, ja kollegamme Suomen Osteopaattiliiton hallituksen puoles- tä. Jäsenmaksu sisältää osteopaatin ta toivotan kaikille antoisia lukuhetkiä tämän Norsk Osteopatforbundista ovat olleet jälleen yhteystiedot liiton nettisivuilla olevaan hyvin aktiivisia lehden ilmestymisen mahdollis- uuden lehden parissa sekä voimia ja terveyttä hakemistoon ja liiton järjestämän 3- tamisessa. Siitä iso kiitos! vuodelle 2021! päiväisen kevätkoulutuksen/vuosi. Jäsenet saavat liiton uutiskirjeen, pääsyn jäsenten Kuluva vuosi on ollut hyvin haastava kaikille, omaan FB- ryhmään sekä mahdollisuuden myös jäsenille ja liiton toiminnalle. Moni pitkälle osallistua muihin liiton järjestämiin koulu- suunniteltu tapahtuma tai tilaisuus on jouduttu tuksiin ja tapahtumiin joko veloituksetta tai perumaan. Samalla kuitenkin opimme uutta jäsenhintaan. Myös opiskelijoilla on mah- dollisuus liittyä liittoon opiskelijajäsenenä- ja kehitymme. Löydämme erilaisia tapoja kok- Laura Lee Kamppila lisää tietoa liiton sivuilta! oustaa, pitää kursseja ja ylläpitää ammattitaitoa. Puheenjohtaja [email protected] Kansainvälisellä tasolla webinaareja ilmestyy Hae jäsenyyttä osoitteesta: valtava määrä ja niiden laatu kehittyy koko ajan, www.osteopaattiliitto.fi kun kokemus ajan myötä kasvaa. Suomen osalta tulevan vuoden suunnitelmat ovat vielä osittain eopaa st tt O il n ii auki. Tapahtumiin ja koulutuksiin valmistaudu- e t m t o taan jo valmiiksi A- ja B- suunnitelmin, sillä viime o
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2 Nordic Osteopathic Journal www.osteopaattiliitto.fi 3 20 21
13 6 15
Index:
4 Nordic Osteopathic Alliance 18-19 Osteopathy – A natural fit
The Birth of the first Osteopathic 5 Words from OIA 20 Master’s Program based in Northern Europe
The benefits of authorisation Digital leap in a workshop 6-7 of osteopaths 21 setting- preparing to adapt
Neuromusculoskeletal pain syndromes associated with The EFFO: united across borders 8-9 hyper-and hypothyroidism 22-23 – a bachelor thesis Case Study: Do chronic pain patients experi- Response of Infant Gastroe- ence personality changes as their 10-12 sophageal Reflux (GER) 24-25 condition persists? Kollektiivinen älykkyys ja luovuus Response of Plagiocephaly - Visio osteopatian alan tutkimus- to Pediatric Osteopathic ja kehittämisverkoston raken- 13-14 Treatment: A Case Study 26-27 tumisesta Osteopathy in Sports Toinen suomalainen koulu Medicine – an integral hyväksytty Euroopan 15-16 part of the team 27 ammatilliseen verkostoon
International Osteopathy 16 Research Leadership and 3rd Nordic Osteopathic Congress Capacity Building Program 28
2 Nordic Osteopathic Journal www.osteopaattiliitto.fi 3 Nordic Osteopathic Alliance
Haraldur Magnússon Laura Lee President of the Icelandic Kamppila Osteopathic Association President of the Finnish Osteopathic Association Regulated since 2005, protected title and fully www.osteopaattiliitto.fi licensed health professional. [email protected] Number of members: 3 and Regulated since 1994 a few more pending Number of members: 208 Student members: 49
Tomas Collin President of the Norwegian Osteopathic Association
www.osteopati.org
Number of members: 407 Student members: 37
Petra Nordlund Acting President of the Swedish Osteopathic Association
[email protected] www.osteopatforbundet.se
Number of members: 363 Student members: 83
Hanna Tómasdóttir President of the Danish Osteopathic Association
[email protected] www.danskeosteopater.dk
Regulated since: 1. July 2018 Number of members: 217
Follow ”Nordic Osteopathic Alliance” on Facebook to keep updated nordic_osteopathic_alliance
4 Nordic Osteopathic Journal www.osteopaattiliitto.fi 5 Dear colleagues, This year has taken its toll, but we are still standing. There are many great developments to applaud. One is the establishment of a joint MSc programme in Finland and Sweden, which you can read more about On behalf of the five presidents of the Nordic oste- in this edition of Nordic Osteopathic Journal. You opathic associations, I am proud to say that we con- can also read up on osteopathy in sports medicine, tinue to move forwards, despite the many challenges paediatrics, and much more. Enjoy! we have faced this year. This magazine is one of sev- Finally, I am also proud to announce that on 1st eral products to emerge based on our cooperation December, the Norwegian government reached an and joint strive for the osteopathic community. We agreement with the major opposition to regulate are in contact regularly, sometimes daily, to discuss, osteopathy in Norway. It has been a long and wind- share and assist each other. The Nordic Osteopathic ing road to reach this goal, and there are still many Alliance represents a useful resource, not only by challenges to face. All in all, this represents a turning arranging webinars and sharing media campaigns, but point for osteopathy in Norway, and the Nordics. also as a platform to connect with great colleagues Stay safe, and hope to see you at next year’s Nordic and friends. Osteopathic Congress in Finland! The Nordic stands out as a strong and unified voice in Europe. Together we are heavily involved with EFFO, and processes regarding regulation and standards for education in the wider community. We have also Kind regards, contributed with a series of CPD activities presented Tomas Collin, president, NOF to the EFFO membership in the format of live we- binars, which have also been made available via the EFFO Youtube channel.
Words from OIA
Text: William J. Burke
On behalf of the Osteopathic International Alliance (OIA) Board of Directors, I would like to bring greetings to the Nordic Osteopathic Alliance and congratulate you on the collab- oration between your five Nordic Osteopathic associations in order be “strong together!”. Our global osteopathic profession is stronger and more dynamic when we work together to advance and advocate for our profession, our colleagues and our patients.
For those less familiar with the OIA, we are the leading organization for the advancement and unity of the global osteopathic profession. As an “organization of organizations,” the OIA unifies the profession by connecting schools, regulatory bodies, and regional, national, and multi-country groups in order to advocate for high-quality osteopathic healthcare. Since our establishment in 2003, the OIA has maintained an active program of work with Profession, 2. The development of an Oste- I find interactions with my colleagues to be a the World Health Organization (WHO), sup- opathic Glossary, and 3. An updated Bench- source of energy and rejuvenation. Perhaps you porting WHO policies and programs, advising marks in Training for Osteopathy. will consider joining us for learning and resto- on matters relative to the osteopathic pro- ration at the OIA’s next conference in May of fession, and through attendance at annual This is a difficult time for all of us as human 2021 taking place at the beautiful Copacabana and other meetings. As a result, the OIA was beings and as healthcare providers. The COV- Hotel in Rio de Janeiro, Brazil! admitted into official relations with the WHO as ID-19 pandemic has led to personal and pro- a non-governmental organization in February fessional challenges as we struggle to maintain 2018. This summer, we agreed to renew our our own health and that of our families, as well partnership for another three-year term (2021- as the health of our patients. It is my hope William J. Burke 23). This allows us to complete our ongoing that you are finding time to focus on your own D.O collaborative projects: well-being. In addition to exercising, eating a Chair OIA 1. An updated Survey of the Global Osteopathic healthy diet and finding time to rest and relax, 4 Nordic Osteopathic Journal www.osteopaattiliitto.fi 5 The benefits of authorisation of osteopaths
Text: Hanna Tómasdóttir
Osteopathy has been an ‘auth- Today, almost 2½ years later, the Danish Patient Safety Authority has issued 140 official licences orised’ healthcare profession to practice as an osteopath in Denmark, which in Denmark since 1 July 2018. means that about 75% of Danske Osteopater’s membership have now received their authori- The authorisation of osteopathy sation to practice. means that an official licence is required to practice as an osteo- What are the real benefits of authorisation? There are many. One of them is establishing path in Denmark, and the title an appropriate level of professional education ‘osteopat’ is protected by law. to secure the quality of clinical practice, and even more importantly, to assure patient safety.
6 Nordic Osteopathic Journal www.osteopaattiliitto.fi 7 The Nordic region will become the most sustainable and integrat- ed region in the world in 2030.
All persons who apply for an official authori- sation to practice as an osteopath in Denmark must have completed healthcare training in os- teopathy, corresponding to the level of a pro- fessional bachelor’s degree, according to the Danish ‘Executive Order on the Authorisation of Osteopaths’. Defining a level for education is an important step, as too many institutions, globally, offer osteopathic training which does not comply with the two international stand- ards for osteopathy: the WHO Benchmark for Training in Osteopathy, published in 2010, and the European Standard, Comité Européen de Normalisation (CEN), on Osteopathic Healthcare Provision, published in 2015. These standards define the benchmark for high quality clinical practice, education, safety and ethics for os- teopathy. opater have also been represented in the na- We need an official authorisation of our pro- Authorisation also means that osteopaths in tional reference and working groups, alongside fession in both Norway and Sweden, both with Denmark are now recognised as part of the with other authorised healthcare professionals, respect to the described benefits for patients primary healthcare sector, and are therefore developing new National Clinical Guidelines for and the profession, but also to improve and involved in all communications and regular examination and treatment of breastfeeding facilitate free mobility to practice as an oste- meetings with the Ministry of Health, and the children with posterior tongue-tie (ankyloglos- opath in all the Nordic countries. As stated in whole primary healthcare sector, which has sia), and non-medical treatment of headache the aim of the Nordic co-operation between been very valuable in dealing with the current (migraine and tension-type headaches). Denmark, Finland, Iceland, Norway, Sweden, the COVID-19 pandemic situation. Danske Oste- Faroe Islands, Greenland and Åland: “The Nordic region will become the most sus- tainable and integrated region in the world in 2030. The co-operation in the Nordic Council of Ministers must serve this purpose.”
Want to read more about the demands and premises to obtain an authorisation as an osteopath in Denmark?
Here is a link to information in both Danish and English: https://www.danskeosteopater.dk/ autorisation/
Hanna Tómasdóttir President of the Danish Osteopathic Association President of the European Federation & Forum for Osteopathy
6 Nordic Osteopathic Journal www.osteopaattiliitto.fi 7 Neuromusculoskeletal pain syndromes associated with hyper-and hypothyroidism – a bachelor thesis
Text: Charlotte Nelin
Introduction normalization or euthyroidism), the diagnosis and neuropathies. Myopathy, muscle weakness, The Swedish Thyroid Association (Sköld- and treatment guidelines are being questioned stiffness and atrophy were very common. 76% körtelförbundet) published a bachelor thesis and discussed. suffered from tremor and 38% had hyperre- which investigated the association between flexia. The soft tissue diagnoses tended to be neuromusculoskeletal pain syndromes and The purpose of the bachelor thesis was to located in the upper extremities and the skeletal hyper-and hypothyroidism (hyper-and hypose- investigate which neuromusculoskeletal pain issues related to osteopenia and osteoporosis cretion of thyroid hormones). syndromes could be associated with hyper-and had a very wide prevalence range (3,5-50%). The results of the thesis showed that the only hypothyroidism, both before diagnosis of the Figure 1 is the overview for patients with hy- manifestations of a thyroid disorder could be thyroid disorder and during treatment. The the- perthyroidism. neurological, muscular or skeletal symptoms. sis focused on the neuromusculoskeletal com- The majority of patients with hyper-or hypo- plaints and diagnoses in patients before or in For patients with hypothyroidism, the neuro- thyroidism have neuromuscular complaints, connection with their thyroid disorder diagnosis, muscular complaints were even more common and many experienced clinical weakness and or as a residual symptom during their treatment. than in patients with hyperthyroidism, the con- neuropathies. A large group of these patients firmed weakness was less, and the neuropathies also suffer from residual symptoms related to The results were twice as prevalent. The diagnoses of hypo- neuromusculoskeletal issues. The result of the study was summarized in thyroid myopathy and hypothyroid arthropathy two overviews, where both those pain syn- were described and linked to clinical representa- Background & purpose dromes which could be indicating hyper-or tion. The prevalence of soft tissue diagnoses According to statistics from the National Board hypothyroidism as well as those associated was higher, sometimes 2-3 times higher, than of Welfare (Socialstyrelsen) in 2018, approxi- with a confirmed diagnosis were included. The in patients with hyperthyroidism. The joint and mately 4,5% of the Swedish population were most commonly associated diagnoses for both skeletal issues besides hypothyroid arthropathy, diagnosed with and treated for thyroid disor- hyper-and hypothyroidism were carpal tunnel were more varied than in patients with hyper- ders, whereof 82% were female. The yearly syndrome, adhesive capsulitis (frozen shoulder) thyroidism, with irregular epiphyses, aseptic increase of new patients with hypothyroidism, and Dupuytren’s contracture (flexion contrac- necrosis and erosive osteoarthritis. Figure 2 is i.e. without prior thyroid treatment, was 8%. ture in the hand, usually affecting the little & the overview for patients with hypothyroidism. Considering that up to 30% of patients were ring fingers). reporting residual symptoms, even though on For patients with hyperthyroidism a vast majority medication and with what is regarded to be reported neuromuscular symptoms, most of normal thyroid hormone levels (biochemical which was confirmed to be clinical weakness
Figure 1. Overview of neuromusculoskeletal pain syndromes associated with hyperthyroidism
8 Nordic Osteopathic Journal www.osteopaattiliitto.fi 9 Figure 2. Overview of the neuromusculoskeletal pain syndromes associated with hypothyroidism
make the correct diagnosis and ultimately provide better total care. Research included Why is this important for osteopaths in the thesis showed that for 36% of patients Link and manual therapy? with hyperthyroidism, and 16% with hypothy- https://skoldkortelforbundet. The identification and recognition of neuro- roidism musculoskeletal complaints where se/which-neuromusculoskele- musculoskeletal signs and symptoms which their reason for the visit to the doctor. These tal-pain-syndromes-are-associat- could be either the initial manifestation of figures could be an indication that the patient ed-with-hyper-and-hypothyroid- a thyroid disorder or an associated issue is would instead contact an osteopath, with the ism-kandidatuppsats-i-osteopati/ of importance for all potential health care same complaint, so increased awareness and contacts, including osteopaths, to provide knowledge about the coexistence of various fast and correct treatment. neuromusculoskeletal disorders with thyroid Scan the QR-code dysfunction is essential. to read the article. A skeletal, muscular or neurological symptom could be the only manifestation of a thyroid Final comment disorder, and if caught early and investigated, In the process of writing my thesis, I was in recovery was usually quick and more com- regular contact with the Swedish Thyroid As- plete. If the patient already was diagnosed, sociation (Sköldkörtelförbundet) and also under treatment, confirmed to be biochemi- used information from their website to get cally compensated and stable, it was however more details about the patient community in also of clinical relevance to note and act on Sweden, current discussions and background. any residual skeletal, muscular or neurological I am grateful for their support and coopera- issues that might be related to the patient’s tion in the process as well as their decision thyroid disorder. to publish the thesis.
Charlotte Nelin By integrating the knowledge of these associ- Osteopathic student at ations into clinical practice and decision-mak- Skandinaviska Osteopat- ing, it could provide an opportunity to quicker högskolan, Göteborg, Sweden
8 Nordic Osteopathic Journal www.osteopaattiliitto.fi 9 Case Study: Response of Infant Gastroesophageal Reflux(GER)
Text: Didde Thorsted
Didde Thorsted Case 1 DO PEAD PANTA RHEI
Written and signed patient consent form was are still diagnosed on the Legends: obtained base symptoms reported Table A Schedule translated to danish from GER vs. GERD in INFANTS. MODIFIED ORENSTEIN’S INFANT GER QUESTIONAIRE by the parents and exper- Key words: gastroesophageal reflux, GER, imental use of PPI. Today Paediatric, Osteopathic treatment, Infant, the primary treatment is still Nexium Abstract or Lansoprazol despite Introduction: This case report will discuss the studies proving them in- role of pediatric osteopathic treatment in solv- effective and a cause of ing gastroesophageal reflux (GER) in an infant. serious side effects 4,5,6) No dietary advise is offered Case Presentation: The mother of an 6 despite studies showing a weeks old infant presented her infant for high correlation between osteopathic treatment with a diagnosis of GER symptoms and cows GER. The mothers complaint also included milk intolerance 7,8,9) and fussiness, excessive crying, constant hyperex- even tethered oral tissue tension, interrupted sleep,and troublesome could play a role in GER breastfeeding. After the first treatment the and should be ruled out mother reported, by mail, improvements in before medicating an in- sleep and crying. Because of a positive test fant 10,11,12,13,14). A few for lip and tongue tie the infant was referred studies show good effect back to the MD. The response was a referral to on GER using manual physiotherapy. After a series of unsuccessful treatment 15,16) and more treatments the infant was again effort should be put into presented for osteopathic treatment at age 12 proving the effect of os- weeks with the same primary and secondary teopathic treatment as a complaints now accompanied by weight loss non invasive efficient and and motor skill development concerns. safe 17) treatment for GER and GERD. Management and Outcome: A course of 6 osteopathic treatments and revision of the Case Presentation: tethered oral tissue in Holland was applied A 6 weeks old infant pre- over a period of 2,5 months around revision. sented for pediatric oste- Consisting of spinal adjustments adapted for opathic treatment for the infant use, cranial osteopathic techniques, fa- diagnosis of cial and muscular release techniques, viscer- GER. Secondary complaint !7 al mobilization and mobilizing exercises for included fussiness, exces- home use. Using I-GER-Q (table A) and Thrive sive crying, constant hyper- eyes, coughing, wheezing and snoring sounds. schedule (table B) to asses progress notable extension, interrupted sleep, and troublesome improvements were attained throughout the breastfeeding. The Infant had fallen one percentile from birth- treatment period with full recovery of primary The pregnancy was good both physical, emo- weight, breathing, tone, reflexes were all normal and secondary complaints. tional and mentally. but leaned towards a more sympathetic state, The mother followed a vegetarian diet with with wet and cold hands and feet. The contact Discussion: This case showed an improve- some fish, supplemented with probiotics and was short but intense. ment on GER after osteopathic treatment. The Omega 3. She was physically active doing yoga I-GER-Q is accessed to be an efficient tool when and walking throughout the pregnancy. The A general hyperextension was noted from the assessing GER and differentiating between GER delivery was a home birth with natural onset, pelvis to the skull with elevated membranous and GERD 1,2). When using I-GER-Q as assess- with acupuncture assistance, week 41+6 and tension. An anteriorisation of the pelvis and a ment tool the infant suffered from GERD but the no medical intervention. The Infant was born compression on the sacrum was evident. Ele- medical diagnosis was GER. This stresses a need after 9 hours labour after a 45 minutes pushing vation of the lower ribs affected the diaphrag- for diagnosis consensus between therapists period. Apgar score of 10/10. matic ROM and the ability to stabilize the trunk. to provide the optimal treatment. The thrive The breastfeeding was troublesome from the Tension in the deep front line, central fascial schedule has not been validated. Osteopathic start with sores, lipstick shaped nibbles and se- chain and cervical fascial system. Increased treatment is tailor made to each individual and vere pain when feeding. The feedings were short muscle tone in supra and infrahyoid mm, mas- therefore a golden standard for treating this and often with the infant dozing of while eating ticatory mm and sub occipital mm. Hyoid was diagnosis is impossible to set. or getting angry and arcing away, screaming, retracted and placed superior. High tension fussing at the breast, pushing and pulling. The was found in the TMJ, with retraction of the Introduction: breastfeeding consultant expressed concern mandible and a high palate. Anteriorisation of Infants suffering from GER and GERD is one of and supervised in alternative feeding positions. the head was noted and condylar compression. the most common reasons for parents seeking The infant was in general fussy, crying exces- Tension was found in ligamentum terres, treatment. Many parents are still meet with the sively and had to be carried in an elastic wrap to omentum minor and around cardia. statement that infant GER is a “fashion diagno- sleep. Even in the wrap the sleep was short and Evident limitation of tongue movement and sis” and not a real problem despite the ongoing interrupted. The infant was in constant hyperex- upper lip flexibility. research trying to uncover the cause and op- tension and preferred an upright position. It also timize the diagnosis tools 3). The majority of presented with excessive hiccups, irritated mu- Assessing GER on the I-GER-Q the infant infants that receive the diagnosis in Denmark cosa in the nose, regurgitations, periods with red obtained a score of 17 (Table A). Assessing
10 Nordic Osteopathic Journal www.osteopaattiliitto.fi 11 Didde Thorsted Case 1 DO PEAD PANTA RHEI
Table B Schedule translated and modified from Anja Caers www.happybabycoach.com
Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 fussiness at the breast, a more strong and Dag flexible infant. Still better sleep, no crying, 1 spontaneous leg lift and more stable in prone Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 position. The infant could now be placed Dag on a blanket to play. Mother was given DNS 2 exercises for the motor skill development. Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 Dag Second treatment after revision the mother 3 reported a 75% improvement in GER, after Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 last treatment the infant was no longer fussy Dag 4 when eating and started rolling from supine to prone. Sleep and crying was normal. Mother Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 was given DNS exercises for the prone position Dag 5 working to stabilize the scapula and increase
Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 paraspinal activity and decrease cervical exten-
Dag sion. The scar had to be manually reopened 6 because of early closure despite aftercare ex- Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 ercises. Weight gain was noted by the health
Dag nurse. 7 Third treatment after revision primary and Søvn Gråd kan trøstes Gråd utrøstelig Spiser = S Afføring = A Tis = T Reflux = R secondary complaints was resolved. Table B Schedule translated and modified from Anja Caers www.happybabycoach.com A need for motor skill stimulation was still needed and slight tension was still evident in and around the mouth, central fascial system the tethered oral tissue the infant scored 3 and stretch of diaphragm, cervical muscles , and diaphragm. An ongoing weight gain on BTAT (Table C) and with HALFF (Table D) suboccipital muscles, mastication muscles, was noted. appearance 6 and function 6 leading to a submandibular muscles, the cervical fascias diagnosis of Ankyloglossia. The frenulum of and central fascial system and release of the Fourth treatment the assessment of the the lip showed an immobile class 3 ULT. The scartcissue from revision. GER on the I-GER-Q the infant obtained a mother was asked to use the Thrive schedule Massage of cervical, suboccipital, supra and score of 0 (Table A). Assessing the tethered (Table B) to assess the infants progress and infra hyoid muscles and paraspinal muscles. oral tissue the infant scored 7 on BTAT (Table were referred back to the MD because of the Cranial techniques including Infant CBR , con- C) and with HALFF (Table D) appearance 9 structure restraints that could be a course of dylar decompression with oral fixation, lift and function12 leading to a diagnosis of no Aerophagia Induced Reflux (AIR). The mother procedure, five star membranous release. Re- ankyloglossia. The infants weight was now
reported an improvement in sleep and crying lease of the palate. Visceral techniques for stable. The mother was instructed in home by mail. MD referred to physiotherapy. ligamentum terres, omentum minor and cardia. exercises and stretches.
At the age of 12 weeks the infant was pre- The treatment was accompanied by aftercare Discussion sented for osteopathic treatment a second for the tethered oral tissue, home exercise and In this case a good effect was noted on the infants primary and secondary complaints time. Primary and secondary complaints was massage to decrease extension and strengthen with osteopathic treatment. The fact that os- unchanged!8 and now accompanied by weight flexors. Additional advice was provided con- teopathy is more a treatment philosophy than loss and motor skill development concerns. cerning holding, handling and feeding po- a few specific manual techniques and that a sitions. The parents were also instructed in revision of the tethered oral tissue was need- When accessing the infants motor skill de- optimal sleep position. The crying and sleep ed makes it hard to conclude what part of the velopment in supine it presented with a full 8 were measured by the parents on a schedule treatment provided the results. weeks normal development with no attempt (table B) A part of the osteopathic philosophy is that to do leg lift without stimulation on lower ribs. all treatments are tailor made to fit the unique When testing in prone position the infant pre- After the first treatment before revision the individual and we treat the specific findings -in stead of following a specific regime. Therefore sents with a development equalling 6-8 weeks mother reported improvements in sleep and a golden standard is hard to set. This infant with a cervical hyperextension, lack of scapula crying with unchanged GER. Assessment on had many secondary complaints linked to the stabilization and paraspinal action. An SLR into I-GER-Q and BTAT and HALFF was unchanged. musculoskeletal restrictions witch also clutter extension was still evident and not yet fully the picture. converted, when testing the primary reflexes. After the second treatment before revision the mother again reported improvements in This case demonstrates that a multiple angel Management and Outcome: sleep, crying and more mobility in the TMJ, a approach combining osteopathic treatment Didde Thorsted Case 1 DO PEAD PANTA RHEI The course consisted of 6 osteopathic treat- slight improvement on the hyperextension and with revision, home exercise and advice had the desired effect on the infants complaints. This ments, the first at 6 weeks the second at 12 abdominalTable C strength but with unchanged GER. study suggests to the possibility that similar weeks. A revision of the tethered oral tissue The Bristol Tongue Assessment Tool (BTAT) was advised. The infant was revised in Holland First treatment after revision the mother patients may benefit from osteopathic treat- Scores of 0–3 indicate more severe reduction of tongue function. at 15 weeks. The infant was treated 4 times reported a 60% improvement in GER, less ment when suffering from GER and GERD. Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 over a period of 7 weeks after revision. First Dag 1
treatment 1 week after revision, second treat- Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7
ment 2 weeks after, third treatment 4 weeks Dag after and fourth treatment 7 weeks after. 1 Measurements were taken at the 1st, 2nd and Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 Dag 6th treatment. 1 Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7
Dag The choice of techniques used was based on 1
current findings at the time of the appointment Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 therefore not all techniques were applied at Dag every treatment. The techniques consisted of : 1 Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 Manipulative release techniques for the SI Dag joints, mid and high thoracic spine and ribs 1 Mobilization of the sacrum, Ilium, cervical Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 Dag spine, thoracolumbar junction, lower ribs, 1 diaphragm, mid and high thoracic spine, Søvn Gråd kan trøstes Gråd utrøstelig Spiser = S Afføring = A Tis = T TMJ, hyoid, muscles of mastication, supra Table C: The Bristol Tongue Assessment Tool (BTAT) and infrahyoid muscles. Soft tissue release ScoresTable of D 0–3 indicate more severe reduction of tongue function. Hazelbaker Assessment tool 10 Nordic Osteopathic Journal www.osteopaattiliitto.fi 11
NEWBORN TRIAD - OCTOBER 2011 Hazelbaker Assessment for Lingual Frenulum Function*
Appearance Items Function Items Appearance of the tongue when lifted
The elasticity of the frenulum is determined by inspecting the anterior Appearance of tongue when lifted Lateralization edgeelasticity of the while tongue lifting as the the infant infant’s cries tongue. or tries to lift or extend the tongue. The length of the lingual frenulum is determined by palpating the frenulum for 2: Round or square 2: Complete 1: Slight cleft in tip apparent 1: Body of tongue but not tongue tip Attachment of the frenulum to the tongueis determined by noting its approximate 0:Elasticity Heart- or of V frenulum-shaped 0:Lift None of tongue length in centimeters as the tongue is lifted. is determined by noting its origin on theThe inferior attachment aspect of of the the lingual tongue. frenulum It should beto approximatelythe inferior alveolar 1 cm posterior ridge to the 2: Very elastic 2: Tip to mid-mouth tip. 1: Moderately elastic 1: Only edges to mid-mouth is 0: Tip stays at lower alveolar ridge or rises 0:Length Little ofor lingual no elasticity frenulum when tongue determined by noting the location of the anterior attachment of the frenulum. It lifted toExtension mid-mouth of tongue only with jaw closure shouldLateralization insert proximal to or into the genioglossus muscle on the floor of the mouth. 2: > 1 cm 2: Tip over lower lip examiner’s finger.is measured by eliciting the transverse tongue reflex by tracing 1: 1 cm 1: Tip over lower gum only theLift lowerof the gum tongue ridgeis andnoted brushing when the the finger lateral is edgeremoved of the from tongue the infant’swith the mouth. If 0:Attachment <1 cm of lingual frenulum to 0: Neither of the above, or anterior or mid- tongue tongue Spread humps of anterior tongue Extension of the tongue the infant cries, then the tongue tip should lift to mid-mouth without jaw closure. is measured by eliciting the tongue extrusion reflex by 2: Complete Spread of anterior tongue 2: Posterior to tip brushing the lower lip downward toward the chin. 1: At tip 1: Moderate or partial is determined by first eliciting a rooting reflex, just 0:Attachment Notched tip of lingual frenulum to 0:Cupping Little or none inferior alveolar ridge beforeCupping cupping, by tickling the upper and lower lips and looking for even thinning of the anterior tongue. 2: Entire edge, firm cup Peristalsis is a measure of the degree to which the tongue hugs the finger as the 2: Attached to floor of mouth or well below 1: Side edges only, moderate cup infant sucks onte it. at the tip of the tongue and is felt with the back of the examiner’s ridge 0:Peristalsis Poor or no cup is a backward, wave-like motion of the tongue during sucking that 1: Attached just below ridge shouldSnapback origina 0:-Significant Attached ankyloglossia at ridge is diagnosed when the finger. ______appearance score total is 8 or less and/or function 2: Complete, anterior to posterior is heard as a clucking sound when the tethered tongue loses it grasp score total was 11 or less. 1: Partial, originating posterior to tip -Severe maternal nipple pain during breastfeeding, 0: None or reverse motion onBallard, the finger J.L., Aue or breastr, C.E., whenKhoury, the J.C. infant (2002). tries Ankyloglossia: to generate Assessment,negative pressure. Incidence, and without alternate explanation as assessed by a Snapback Effect of Frenuloplasty on the Breastfeeding Dyad. Pediatrics 2002;110;e63 Lactation Consultant, is also grounds to consider frenotomy if a tight anterior frenulum is noted. 2: None Subscribe to frenotomy procedure note in Webcis by going to: Ankyloglossia Grading: 1: Periodic Class I: mild ankyloglossia, 12 -16 mm 0:SCORE: Frequent or with each suck Class II: moderate ankyloglossia, 8-11mm Class III: severe ankyloglossia, 3-7 mm Administration My Forms Procedure notes Miscellaneous Procedure Class IV: complete ankyloglossia, less than 3 mm note Add new Author= Steiner
!9 Appearance:______(<8 = ankyloglossia) Function:______(<11 = ankyloglossia)
*Adapted with permission from Hazelbaker. Didde Thorsted Case 1 DO PEAD PANTA RHEI
Table C The Bristol Tongue Assessment Tool (BTAT) Scores of 0–3 indicate more severe reduction of tongue function. Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7
Dag 1
Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7
Dag 1
Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7
Dag 1
Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7
Dag 1
Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 Dag 1
Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7
Dag 1
Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7
Dag 1
Søvn Gråd kan trøstes Gråd utrøstelig Spiser = S Afføring = A Tis = T
Table D Hazelbaker Assessment tool
Table D: Hazelbaker Assessment tool
NEWBORN TRIAD - OCTOBER 2011 Hazelbaker Assessment for Lingual Frenulum Function*
Appearance Items Function Items Appearance of the tongue when lifted
The elasticity of the frenulum is determined by inspecting the anterior Appearance of tongue when lifted Lateralization edgeelasticity of the while tongue lifting as the the infant infant’s cries tongue. or tries to lift or extend the tongue. The length of the lingual frenulum is determined by palpating the frenulum for 2: Round or square 2: Complete 1: Slight cleft in tip apparent 1: Body of tongue but not tongue tip Attachment of the frenulum to the tongueis determined by noting its approximate 0:Elasticity Heart- or of V frenulum-shaped 0:Lift None of tongue length in centimeters as the tongue is lifted. is determined by noting its origin on theThe inferior attachment aspect of of the the lingual tongue. frenulum It should beto approximatelythe inferior alveolar 1 cm posterior ridge to the 2: Very elastic 2: Tip to mid-mouth tip. 1: Moderately elastic 1: Only edges to mid-mouth is 0: Tip stays at lower alveolar ridge or rises 0:Length Little ofor lingual no elasticity frenulum when tongue determined by noting the location of the anterior attachment of the frenulum. It lifted toExtension mid-mouth of tongue only with jaw closure shouldLateralization insert proximal to or into the genioglossus muscle on the floor of the mouth. 2: > 1 cm 2: Tip over lower lip examiner’s finger.is measured by eliciting the transverse tongue reflex by tracing 1: 1 cm 1: Tip over lower gum only theLift lowerof the gum tongue ridgeis andnoted brushing when the the finger lateral is edgeremoved of the from tongue the infant’swith the mouth. If 0:Attachment <1 cm of lingual frenulum to 0: Neither of the above, or anterior or mid- tongue tongue Spread humps of anterior tongue Extension of the tongue the infant cries, then the tongue tip should lift to mid-mouth without jaw closure. is measured by eliciting the tongue extrusion reflex by 2: Complete Spread of anterior tongue 2: Posterior to tip brushing the lower lip downward toward the chin. 1: At tip 1: Moderate or partial is determined by first eliciting a rooting reflex, just 0:Attachment Notched tip of lingual frenulum to 0:Cupping Little or none inferior alveolar ridge beforeCupping cupping, by tickling the upper and lower lips and looking for even thinning of the anterior tongue. 2: Entire edge, firm cup Peristalsis is a measure of the degree to which the tongue hugs the finger as the 2: Attached to floor of mouth or well below 1: Side edges only, moderate cup infant sucks onte it. at the tip of the tongue and is felt with the back of the examiner’s ridge 0:Peristalsis Poor or no cup is a backward, wave-like motion of the tongue during sucking that 1: Attached just below ridge shouldSnapback origina 0:-Significant Attached ankyloglossia at ridge is diagnosed when the finger. ______appearance score total is 8 or less and/or function 2: Complete, anterior to posterior is heard as a clucking sound when the tethered tongue loses it grasp score total was 11 or less. 1: Partial, originating posterior to tip -Severe maternal nipple pain during breastfeeding, 0: None or reverse motion onBallard, the finger J.L., Aue or breastr, C.E., whenKhoury, the J.C. infant (2002). tries Ankyloglossia: to generate Assessment,negative pressure. Incidence, and without alternate explanation as assessed by a Snapback Effect of Frenuloplasty on the Breastfeeding Dyad. Pediatrics 2002;110;e63 Lactation Consultant, is also grounds to consider frenotomy if a tight anterior frenulum is noted. 2: None Subscribe to frenotomy procedure note in Webcis by going to: Ankyloglossia Grading: 1: Periodic Class I: mild ankyloglossia, 12 -16 mm 0:SCORE: Frequent or with each suck Class II: moderate ankyloglossia, 8-11mm Class III: severe ankyloglossia, 3-7 mm Administration My Forms Procedure notes Miscellaneous Procedure Class IV: complete ankyloglossia, less than 3 mm note Add new Author= Steiner
!9 Appearance:______(<8 = ankyloglossia) Function:______(<11 = ankyloglossia)
*Adapted with permission from Hazelbaker.
References: served Salvatore, S. and Y. Vandenplas, Gastroe- ophagia? International Journal of Child Health sophageal reflux and cow milk allergy: is there a and Nutrition, 2016, 5, 10-16 1) Orenstein SR, Shalaby TM, Cohn JF. Reflux symp- link? Pediatrics, 2002. 110(5): p. 972-984. 14) Scott A. Siegel. Aerophagia Induced Reflux in toms in 100 normal infants: diagnostic validity of 7) Cavataio F, Carroccio A, Iacono G. J Milk-induced Breastfeeding Infants With Ankyloglossia and the infant gastroesophageal reflux questionnaire. reflux in infants less than one year of age. Pediatr Shortened Maxillary Labial Frenula (Tongue and Clin Pediatr. 1996;35:607-14. Gastroenterol Nutr. 2000;30 Suppl:S36-44. Lip Tie). Int J Clin Pediatr. 2016;5(1):6-8 2) Orenstein SR. Symptoms and Reflux in Infants: 8) Iacono G, Carroccio A, Cavataio F, Montalto G, 15) Alcantara J. Et al . Chiropractic care of a pedi- Infant Gastroesophageal Reflux Questionnaire Kazmierska I, Lorello D, Soresi M, Notarbartolo A . atric patient with symptoms associated with gas- Revised (I-GERQ-R)—Utility for Symptom Tracking Gastroesophageal reflux and cow's milk allergy in troesophageal reflux disease, fuss-cry-irritability and Diagnosis Current Gastroenterology Reports. infants: a prospective study. J Allergy Clin Immunol. with sleep disorder syndrome and irritable infant December 2010, Volume 12, Issue 6, pp 431–436 | 1996 Mar;97(3):822-7. syndrome of musculoskeletal origin. J Can Chiropr 3) Sunku et al. A primary care approach to pediatric 9) Semeniuk J, Kaczmarski M. Acid gastroesopha- Assocv.52(4); 2008 DecPMC2597889 gastroesophageal reflux. JAOA, geal reflux and intensity of symptoms in children 16) M. GemelliL. UlbrichtE. F. R. Romaneli. Evaluation Vol 100, No 12, Supplement to December 2000, with gastroesophageal reflux disease. Comparison of Gastroesophageal Reflux in Infants Treated with p11-15 of primary gastroesophageal reflux and gastro- Osteopathy Using the I-GERQ-R Questionnaire. XIII 4) Rachel J. van der Pol, Marije J. Smits, Michiel esophageal reflux secondary to food allergy. !5 Mediterranean Conference on Medical and Bio- P. van Wijk, Taher I. Omari, Merit M.Tabbers, Marc Didde Thorsted Case 1 DO PEAD PANTA RHEI logical Engineering and Computing 2013 pp 1067- A. BenningaEfficacy of Proton-Pump Inhibitors Adv Med Sci. 2008;53(2):293-9. doi: 10.2478/ 1070 . Part of the IFMBE Proceedings book series in Children v10039-008-0053-5. Abstract. (IFMBE, volume 41) WithGastroesophagealReflux Disease: A System- 10) Ghaheri BA. Breastfeeding Improvement Fol- 17) Hayes NM, Bezilla TA. 2006 Incidence of iatro- atic ReviewPediatrics, 2011 May; 127(5):925-35 lowing Tongue-Tie and Lip-Tie Release: genesis associated with osteopathic manipulative 5) Mattos AZ, Marchese GM, Fonseca BB, Kupski C, A Prospective Cohort Study. Laryngoscope, treatment of pediatric patients. J Am Osteopath Machado MB. Antisecretory treatment for pediatric 127:1217–1223, 2017 Assoc Oct;106(10): 605-8 gastroesophageal reflux disease – a systematic 11) Manuscript Aerophagia Induced Reflux (AIR) 18) Ingram J, et al. The development of a tongue review. Arq Gastroenterol, 2017. v. 54 nº 4 Out/ in Breastfeeding Infants with Ankyloglossia and assessment tool to assist with tongue-tie identifi- Dez, 271-280. Shortened Maxillary Labial Frenula (tongue and cation. Arch Dis Child Fetal Neonatal Ed 2015;0:F1– 6) Mark Safe, Wei H Chan, Steven T Leach, Lee lip-tie).Teddy Performances F5. doi: 10.1136/archdischild-2014-307503 Sutton, Kei Lui, Usha 12) Kotlow,L. Infant Reflux and Aerophagia Asso- Krishnan.Widespread use of gastric acid inhibitors ciated with the Maxillary Lip-tie and Didde Thorsted in infants: Are they needed? Are they safe? World Ankyloglossia (Tongue-tie). Clinical Lactation, 2011, Aut. Osteopath DO J Gastrointest Pharmacol Ther 2016 November Vol. 2-4, 25-29 M.R.O.DK & DPO, Auth. 6; 7(4): 531-539 ISSN 2150-5349 (online) © 2016 13) Kotlow L. Infant Gastroesophageal Reflux Physiotherapist & Baishideng Publishing Group Inc. All rights re- (GER): Benign Infant Acid Reflux or just Plain Aer- Naturopath
12 Nordic Osteopathic Journal www.osteopaattiliitto.fi 13 Response of Plagiocephaly to Pediatric Osteopathic Treatment: A Case Study
Text: Didde Thorsted
Written and signed patient consent form was 5) and that it is a marker of elevated risk for temporal and condylar compression dexter obtained neurodevelopmental delays when evaluated and membranous tension. on The Bayley Scales of Infant Development Restrictions were found in sinistre SI, sinistre Key words: Plagiocephaly, Paediatric, Os- III (BSID-III) 6) , it seems evident that more concave lateral bending with apex in the thora- teopathy, Infant, Treatment effort should go into researching methods to columbar junction affecting the lower ribs and remedy the problem. Studies show effect of diaphragmatic ROM and extension of the spine Abstract osteopathic intervention 7) This case study in prone. Restrictions of upper cervical spine Introduction: This case report will discuss the is not comparative but a presentation of the rotation sinistre, and light restriction of lateral role of pediatric osteopathic treatment in solv- effect of osteopathy on plagiocephaly and bending dexter in the mid to lower cervical ing plagiochephaly in an infant support the findings of Lessard et al. spine. Increased tone in cervical muscles and Case Presentation: fascias. Fascial tension sinistre in the upper Case Presentation: The mother of an 8 An 8 week old infant presented for pediatric abdominal quadrant , IC valve and abdominal weeks old infant presented her infant for osteopathic treatment for the diagnosis of distention dexter. osteopathic treatment with a diagnosis of plagiocephaly. Plagiocephaly. The mothers complaint also The Mother had a good pregnancy both physi- Management and Outcome: included lack of cervical mobility, interrupted cal and mentally, was well nourished and The treatment consisted of 4 treatments with sleep, excessive intestinal gas and excessive physically active throughout the pregnancy. a 2 weeks interval and one treatment 4 weeks crying. Previous unsuccessful treatment in- The delivery was a home birth with natural after. Measurements were taken at the 1st, volved stretching and onset week 40+2 with no medical intervention. 3rd and 5th visit. positioning the infant on a beanbag. The Infant was born after 7 hours labour, in The treatment consisted of : water, after a 15 minutes pushing period. Manipulative release techniques for the SI Management and Outcome: A course of joint, cervical spine and thoracolumbar 5 osteopathic treatments was applied over The Mother reported that the head was round junction. Mobilization of the SI joint, cervical a period of 3 months. Consisting of spinal and fine at birth. The onset of the plagioceph- spine, thoracolumbar junction, lower ribs, di- adjustments adapted for infant use, cranial aly was gradual. The infant also developed a aphragm, lower thoracic spine. osteopathic techniques, facial and muscular favorite side and an aversion of lying prone. Soft tissue release and stretch of diaphragm, release techniques, visceral mobilization and The Mother could manually turn the head but cervical muscles (with focus on SCM, small ex- mobilizing exercises for home use. Using ca- the infant turned it right back. She had previ- tensors and trapezius) and fascias, para spinal liper measurements to asses CVAI notable ously been advised to stretch the infants neck, muscles, treitz, colon desendens flexura sin- improvements were attained throughout the do tummy time and position the infant on a istre, upper part of radix mesenterica, IC valve treatment period with normalization of head beanbag. She had applied this treatment for and fascias of the upper abdominal quadrant. shape and ear position. 4 weeks without results. Soft tissue techniques of cervical and para spinal muscles. Discussion: This case showed an improvement The infant presented with a plagiocephaly dex- Cranial techniques including Infant CBR , con- on the plagiocephaly after osteopathic treat- ter at level 3 with a: two quadrant involvement, dylar decompression with oral fixation, lift ment . The Caliper is accessed to be an efficient moderate posterior quadrant flattening in the procedure, five star membranous release, su- tool when measuring cranial asymmetries but occipital region, an ear shift of 1 cm, no anterior ture distraction, ear pull and remolding it is still depending on the preciseness of the involvement and CVAI 6.25. 8,9) or type II after therapist 1). Osteopathic treatment is tailor Agenta 10). Other complaints included lack of Not all techniques were applied every time, made for each individual and therefore a gold- cervical mobility, interrupted sleep, excessive but the use was based on the current en standard for treating this diagnosis is chal- intestinal gas and excessive crying. findings at the time of the appointment. lenging to set. The Infant was in good health, color, breathing, tone, contact and reflexes were all normal. The treatment was accompanied by home Introduction: When accessing the infants motor develop- exercise and massage to increase mobility in Since the “back to sleep” to prevent SIDS was ment in supine it presented with a full 8 weeks the cervical and thoracic region. Additional ad- introduced the amount of infants presenting normal development with cervical rotation vice was provided concerning holding, handling with plagiocephaly has risen 2). The use of dexter. When testing supine position with cer- and feeding positions. The parents were also helmets versus manual treatment is a topic vical rotation sinister and prone position the instructed optimal sleep position. of great interest. Some articles points to that infant presented with a development equalling The crying and sleep were measured by the natural skull growth will correct the skull as 4-6 weeks with a clear cervical rotation dexter. parents on a schedule (table A) well as a helmet intervention 3) others that both manual stretching and the use of pil- Palpation and form of the skull gave no suspi- Cervical mobility improvement lows can be a solution for plagiocephaly 4). cion to craniosynostosis but a dexter nonsyn- At the second treatment the infant had ob- With the knowledges that the condition “can ostotic plagiocephaly affecting the occipital tained full rotation with cheek to surface to effect health outcomes related to growth and parietal suture with slight bulging of the sinistre both sides, but a preference was still seen development, vision, hearing and oral health” parietal region, anterior ear shift dexter with when sleeping, with lack of stimulation and
12 Nordic Osteopathic Journal www.osteopaattiliitto.fi 13 Didde Thorsted Case 1 DO PEAD PANTA RHEI
Table B Schedule translated and modified from Anja Caers www.happybabycoach.com
in prone position. Parents were given exercise Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7
to increase rotation in prone. Dag At third treatment the baby was seen to choose 1 rotation sinistre willingly. A few times the in- Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 fant was seen sleeping on the sinitre side. The Dag 2 mother also reported an improvement of mo- Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 bility and strength in prone. At 4th and 5th Dag treatment no preference were found passive 3 or active. Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 Dag 4 Excessive crying, sleep and intestinal gas im- Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 Diddeprovement. Thorsted At the 2nd treatment the parents Case 1 DO PEAD PANTA RHEI Dag reported a rapid improvement in the excessive 5
crying. The red mark (inconsolable) decreased Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7
overLegends: the first 3 days and the orange (consol- Dag able)Table also A Scheduledecreased translatedbetween the from two treatAnja- Caers6 www.happybabycoach.com ments to what the parents described as only a Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 little more than normal for an infant. The green Dag 7 (sleep periods) were still frequent and disrupt- Søvn Gråd kan trøstes Gråd utrøstelig Spiser = S Afføring = A Tis = T Reflux = R edKl. with8 only9 10 a little11 12 improvement13 14 15 16 but17 18were19 seen20 21 22 23 24 1 2 3 4 5 6 7 to Dagcorrelate with the passing of intestinal gas. 1 Table A :Schedule translated from Anja Caers www.happybabycoach.com ProbioticsKl. 8 9 were10 11 recommended.12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 At Dag3rd treatment parents reported normal cry- 2 ing with improvements in both sleep and Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22Discussion23 24 1 2 3 4 5 6 7 intestinalDag gas. The infant still pressed a lot to with home exercise and advice had the de- 3 In this case a good effect was noted on the pass gas but without crying. Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22infants23 24 primary1 2 3 and4 5 secondary6 7 complaints with sired effect on correcting the plagiocephaly At 4th treatment the crying was still normal. Dag osteopathic treatment. The fact that osteopa- and thereby eliminating the cosmetic problem The4 sleep cycles were longer and with less Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22thy23 is24 more1 2 a treatment3 4 5 6 philosophy7 than a few as well as decreasing the risk of viserocarnial disruption. The pressing had ceased. Probiotic Dag specific manual techniques makes it hard to and neurodevelopmental problems. This study 5 intake were adjusted to every 2nd day. suggests to the possibility that similar patients 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22conclude23 24 1 what2 3 part4 5 of6 the7 treatment provided AtKl. 5th treatment the crying, sleep and intestinal Dag the results. A part of this philosophy is that the may benefit from osteopathic treatment when gas6 was no longer a problem. A light increase treatment is always tailor made to fit the unique suffering from nonsynostotic plagiocephaly. in Kl.gas 8was9 noted10 11 after12 13 the14 probiotic15 16 17 adjustment18 19 20 21 22 23 24 1 2 3 4 5 6 7 Dag individual and that we treat the specific findings but7 was quickly normalized again. The Mother instead of following a specific regime. Therefore alsoøvn reported Gråd kan trøstesa decrease Gråd in utrøstelig stools pr day Spiser from Afføring Tis S = S a golden = A standard = T for treating plagiocephaly is Didde Thorsted stool in every diaper to 3 times pr day and more hard to set. Aut. Osteopath DO effective feeding without interruptions. M.R.O.DK & DPO, Auth. This case demonstrates that a multiple angel !8 Physiotherapist & approach combining osteopathic treatment Naturopath ChangePicture in I CVAI 2. Measure 4.70 References:
1) Siegenthaler M.H. Methods to Diagnose, Classify, Deformational plagiocephaly delays motor skill and Monitor Infantile development in 6-month-old infants Deformational Plagiocephaly and Brachycephaly: Case-control study of neurodevelopment in A Narrative Review. Journal of deformational plagiocephaly. Pediatrics Chiropractic Medicine (2015) 14, 191–204 2010;125:e537-42.
2) Mawji A, Vollman AR, Hatfield J, et al. The in- 7) Lessard S, Gagnon I, Trottier N. Exploring the cidence of positional plagiocephaly: a impact of osteopathic treatment on cohort study. Pediatrics. 2013;132:298-304 cranial asymmetries associated with nonsynos- totic plagiocephaly in infants . Article 3) Rowland K, Das N. Helmets for positional skull in Complementary therapiesKl. in clinical8 9 practice10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 deformities: A good idea , or not ? 17(4):193-8 · November 2011 Dag 1 The Journal of Family Practice, JANUARY 2015, 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 Vol 64, No 1 8) Plagiocephaly SeverityKl. Scale, Children’s Healthcare of Atlanta Dag 1 4) A Prospective Randomized Trial on Preventative Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 Methods for Positional Head 9) Holowka M el al.Plagiocephaly Severity Scale to Aid in Clinical Treatment Dag Deformity: Physiotherapy versus a Positioning 1 Recommendations.The Journal of Craniofacial Pillow . Article in The Journal of Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 pediatrics 162(6), January 2013 Surgery, Volume 00, Number 00, Dag Month 2017 1
5) Steinmann L. et al. Nonsynostotic Deforma- Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 10) Agenta L. Clinical Classification of Positional tional Plagiocephaly: Understand, Dag Screen and Intervene. June 17 2014. www,med- Plagiocephaly. The Journal of1 scape.com 1/11-2016 Craniofacial Surgery, VolumeKl. 15, Number8 9 10 2, May11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 2004 Dag 6) Speltz ML, Collett BR, Stott-Miller M, Starr JR, 1 Picture 1 Heike C, Wolfram-Aduan AM, et al. Kl. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5 6 7 Dag !5 1 3. Measure 3.10 (Picture I) Søvn Gråd kan trøstes Gråd utrøstelig Spiser = S Afføring = A Tis = T 14 Nordic Osteopathic Journal www.osteopaattiliitto.fi 15 Osteopathy in Sports Medicine – an integral part of the team
Text: Martin Stav Engedahl
Osteopathy is increasing in sports. Os- issues regarding the injury and rehabilitation teopaths are working with elite athletes with the athlete and let the athlete take part and public health in, professional and in the decision making. Including the athlete amateur clubs, and with athletes com- in the decision making will make a greater ing to the clinic. Working in sports is commitment to the plan and the athlete will exciting, fun and challenging. It is an feel ownership to the process. Shared deci- important job that should not be han- sion making will also empower the athlete dled easily. As an osteopath working to take charge in process, have confidence to with youth, elite or professional sports rehabilitation and adhere to plan (5, 6). you have a great responsibility as a part of the medical team. The athlete in focus Every athlete is a unique individual. As sports You are a health professional clinicians it is important to develop a good Whether you are working as the only health relationship with your athletes. Mutual trust professional or working in a medical team and confidence are of great importance. The you are first of all a health professional. As a athlete must feel they can confide in the cli- health professional you have certain respon- nician and be confident in advice they get. The sibilities. The main task is to take care of the clinician must be sure that the athlete will be athletes and be the link between the trainer honest and comply with advice they get (2). and the athlete in health-related issues. As health professional working in sports we To be a successful sports and exercise clini- offer a unique competence for our athletes. cian you need qualifications in sports medi- Our job is to put the athlete’s health first. We cine. Both athletes, coaches, managers, par- cannot expect neither the athletes them- Photo: Solveig Stav Engedahl ents, the sports medical team and others selves, coaches, managers, parents or others have high expectations to sports clinicians. In to do so. The athlete always wants to com- addition to this, you need exceptionally good pete and will sometimes play through severe communication and collaboration skills (1, 2). pain and functional limitations. Coaches and Biography It is also essential to have good knowledge managers are responsible for the team’s re- of the sport you are working with. If you un- sults and want to use the best players avail- able (5, 6). If the athlete says she or he can Martin Stav Engedahl is an osteopath and derstand the physical demands, the technical play despite injury and pain, coaches often physiotherapist with a Master of Science aspects and the mentality of the sport, you will let them. Someone needs to be on the in sports physiotherapy from The Oslo will be better prepared to understand pos- sible causes of injury, how to prevent them athlete’s side. Someone needs to make the Sport Trauma Research Centre (OSTRC). and how you can contribute to the rehabil- unpleasant decisions. That someone is you. itation (3). He works as a assistant professor at Kris- Osteopathic reasoning in sports tiania University College. He has in more Working in a team medicine than 10 years worked in elite sports for When working in sports medicine you are As osteopaths, we add something differ- both youth and adults. He mainly worked always part of a team. The team might be ent to the sports medicine team. Reasoning with the Norwegian junior national team small and with you as the only health pro- based on the five conceptual models is a in ice hockey and with the Norwegian fessional working with coaches, managers good starting point and gives an overview male national team in floorball. He has and athletes, or you might be part of a sports over the injured athlete. Combining this with also worked with elite teams in both ice medicine team with a team physician, physi- evidence-based practice is truly biopsycho- hockey and floorball and has participat- otherapist, psychologist, masseur and others social reasoning (6). Osteopathic reasoning ed as part of the sports medicine team (2, 4, 5). Anyway, you must understand your creates an understanding of the complexity in several international championships. role as an osteopath as part of the medical of the athlete’s problem and should guide team. Sports injury rehabilitation requires the treatment approach (7). From the rea- In addition to this, he contributed to the an interdisciplinary approach including both soning it is important to define both modi- fiable and non-modifiable factors, and how development of Fit To Play (no. Ska- medical and performance team (Figure 1) (2, to manage the modifiable factors (8). As part defri) and Get Set – Train Smarter (an 5, 6). It is crucial for effective rehabilitation of an interdisciplinary rehabilitation team the evidence-based resource developed for that everyone working with the athlete have clearly defined roles and are cooperating for osteopathic treatment is a part of the puzzle anyone who engage in or facilitate sport. the best of the athlete (6). It is important to working for the same goal (Figure 1). The oste- Fit To Play provide information on com- establish what is expected from you as an opath should be included in the rehabilitation mon sports injuries, injury risk factors, osteopath as part of the sports medical team. process from the start. As an osteopath it is and specific injury prevention exercises necessary to understand how the osteopathic for the sport of choice) The athlete is an important part of this team treatment can enhance the rehabilitation and as well and should always be included in both contribute to a safe and effective process to discussions and decision making (2, 6). Edu- return to sport and performance. cate and inform the athlete, discuss different 14 Nordic Osteopathic Journal www.osteopaattiliitto.fi 15 Figure 1. The interdisciplinary approach to sports injury rehabilitation. The athlete is at the centre of the process with the athlete, sports medicine team and performance team working together to optimize a safe and effec- tive return to sport and performance. The re- sponsibility for the rehabilitation and training should gradually shift from the medical team to the performance team when the athlete is returning to sport.
Martin Stav Engedahl Osteopath MSc and assistant professor at School of Health Sciences, Kristiania University College, Oslo Norway.
References: Med. 2016;50(14):853-64. Brukner P, O'Sullivan PP. There is more to pain than 3 Bahr R, Krosshaug T. Understanding injury mech- tissue damage: eight principles to guide care of 1. Ekstrand J, Lundqvist D, Davison M, D'Hooghe M, anisms: a key component of preventing injuries in acute non-traumatic pain in sport. British Journal Pensgaard AM. Communication quality between sport. Br J Sports Med. 2005;39(6):324-9. of Sports Medicine. 2020:bjsports-2019-101705. the medical team and the head coach/manager 4 Hainline B, Derman W, Vernec A, Budgett R, Deie 7. Grace S, Orrock P, Vaughan B, Blaich R, Coutts is associated with injury burden and player avail- M, Dvořák J, et al. International Olympic Committee R. Understanding clinical reasoning in osteopa- ability in elite football clubs. Br J Sports Med. consensus statement on pain management in thy: a qualitative research approach. Chiropr Man 2019;53(5):304-8. elite athletes. Br J Sports Med. 2017;51(17):1245-58. Therap. 2016;24:6. 2. Ardern CL, Glasgow P, Schneiders A, Witvrouw 5. O'Sullivan K, O'Sullivan PB, Gabbett TJ. Pain and 8. O'Sullivan P, Caneiro JP, O'Keeffe M, O'Sullivan E, Clarsen B, Cools A, et al. 2016 Consensus state- fatigue in sport: are they so different? Br J Sports K. Unraveling the Complexity of Low Back Pain. J ment on return to sport from the First World Con- Med. 2018;52(9):555-6. Orthop Sports Phys Ther. 2016;46(11):932-7. gress in Sports Physical Therapy, Bern. Br J Sports 6. Caneiro JP, Alaiti RK, Fukusawa L, Hespanhol L,
International Osteopathy Research Leadership and Capacity Building Program
Text: Robert Shaw
The program is designed to provide research support and help to develop research leaders in the field of oste- opathy. The intention is that this will support the development of a research culture within osteopathy. These could be a crucial steps towards raising awareness of the profession, and pro- vide better inter-disciplinary health- care communication.
The key benefits of this program are:
• Production of peer-reviewed manuscripts raising awareness of the profession both na- tionally and internationally. (ATS), Australia. This involves formal input happen until 2021. However, we had our first • Creation of a group of osteopathy-focused from guest speakers and senior academics Zoom meeting on 20 May 2020 to introduce researchers. from both ATS, and the wider osteopathic and ourselves (see Zoom picture of participants • Helping develop the confidence, experience health-care research community. They have below). It is a diverse group with some of the and skills for a next generation of osteopathy experience of organising a similar successful leading osteopathic researchers from around research leaders. and now self sustaining program for Chiro- the globe. There are a lot of mutual interests • Developing a sustainable research culture practors. and a wide range of expertise. As we will be nationally with international connections unable to meet up in person, we are going to The program was opened up for applications The idea is that participants develop their own meet over Zoom and start to develop research at the end of 2019 and there were 40 applica- research ideas, and work together in groups to questions. The next meeting is scheduled for tions from around the world and 14 have now answer these questions thus sharing the work December this year. been chosen. The group is made up of a mix load. The overall aim is to produce a sustaina- of nationalities from Australia, Brazil, Canada, ble international osteopathic leadership group. Robert Shaw Italy, New Zealand, Sweden and UK. PhD, Program Leader, The program will initially run over three years. Covid-19 has of course had an impact on the Skandinaviska Osteopathög- There is one five day residential event every program. The residential planned for June skolan, Göteborg, Sweden year held at University of Technology Sidney 2020 has had to be postponed. It may not now 16 Nordic Osteopathic Journal www.osteopaattiliitto.fi 17 Master’s Degree Programme in Osteopathy
The first of its kind in the Nordic countries, developed in collaboration between Skandinaviska Osteopathögskolan, Göteborg, Sweden and Metropolia University of Applied Sciences, Helsinki, Finland.
This is a 2- year program (90 ECTS). The common threads that run throughout the curriculum are clinical, research, service and management aspects of modern day osteopathic practice.
As well as providing a focused continuing professional development opportunity, there are other benefits with participation in this program:
• International networking forum for osteopathic graduates, which will encourage further exchange and collaboration • Higher degree studies become possible for example to study at doctoral level • An advantage to those practitioners who want to develop a teaching career • Opens up opportunities for other positions in the health care sector.
For updated information, please visit:
https://www.metropolia.fi/en/academics/masters-degrees/osteopathy
Or contact us via email:
[email protected] [email protected]
16 Nordic Osteopathic Journal www.osteopaattiliitto.fi 17 Osteopathy – A natural fit
Text: Øystein Tronstad
from countries like Switzerland, Italy and France, they are all familiar with it. Often it is their primary muscle and health resource back home.
Not yet authorized The Norwegian association Norsk Osteopat- forbund (NOF) has been fighting for author- ization for quite some time. Askjem believes the profession would benefit from being au- thorized in Norway.
– It could make it a bit more known and ac- cepted. There are not that many osteopaths here compared to like physical therapists, so it is important that we get the information out there and let people know who we are and what we do. I am certain that we, with our approach, are a good addition to the other health professions.
A small part of a big job Traveling is a natural part of working with elite sports, so is almost everything else. Kai Lexberg, Askjems point of contact with the Norwegian National Team, says it is a complex job and not necessarily for everybody.
– The typical areas for cyclists are the hips, neck, knees and the back, but you have to be open to the fact that there is so much more to it than doing the treatments. Driving the car, preparing food and bottles, washing Henrik Askjem has been working with clothes, there are many tasks to be taken professional cyclists for several years. care of so that the team can function the way In the world of professional cycling, it needs to. For osteopathy is as natural as water bot- Henrik it is an tles and sports bars. advantage that he knows the sport himself, – I did not have very specific plans, but it how the riders was my goal to work with cycling. I like the think and what variation and I am not suited to work at an it takes, says office all day. It was a bit random at first. I had some connections within cycling and one of the coaches had noticed that I was studying osteopathy. He asked me if I wanted to come along for a trip, and now I have been working with the national team since 2016, says Nor- wegian osteopath Henrik Askjem. – It is a very classic story. I was doing the sport myself and enjoyed cycling. When I got a knee From bike to bench injury, I had a quality experience going to an Pro cycling has had a resurgence in Norway in osteopath for examination and treatment. recent years with athletes like Thor Hushovd, That is how I got into osteopathy myself. Alexander Kristoff, Edvald Boasson Hagen and Kurt Asle Arvesen making a name for From his work with pro cycling he has experi- themselves all over Europe. For Askjem it all enced how common it is for team and riders started on the saddle before he got on to the to benefit from osteopathic care. other side of the bike handle. – On a professional level it is so established, especially in our sport. When I meet riders
18 Nordic Osteopathic Journal www.osteopaattiliitto.fi 19 Lexberg who became aware of the benefits Communication is key – Some physical therapists are very hands-on, of osteopathy because his brother was an When you work in the field of professional others focus more on the training part. The same early student. sports medicine there are many factors and applies for osteopaths. We also need to consider points of view to take into consideration, like that some parts, like the cranial and visceral – Every professional team has at least one athletes, media, coaches, sponsors, sports di- osteopathy, are not as established or accepted osteopath. In my mind osteopathy looks at the rectors and other health professions. Of all among other professions. Again, the way we entire system, It is not «just» a massage» and the details the one that Askjem highlights is communicate and explain is so essential. that is perfect for cycling. It is easy to just look communication. at the spot that is bothering you, but at times we need to address where it is coming from too. With cycling there is a high total load. At the same time it is different from contact sports like handball or football.
When I got a knee injury, I had a quality experience going to an osteopath for examination and treatment. That is how I got into osteopathy myself.
The small adjustments According to Lexberg the athletes are really Osteopathy for professionals pleased and appreciate getting a full treat- and amateurs ment, when needed. One of the top Norwe- Over the year Askjem has worked with the gian cyclists today is Carl Fredrik Hagen. In Norwegian National Team, different Pro Cycling the 2019-edition of the Grand Tour Vuelta a Teams, the private sport school NTG Kongs- España he finished in 8.-place. It is the best vinger and at the clinic Sandefjord Fysikalske. overall finish by a Norwegian athlete in a Grand Tour. – It is a bit different to work with a professional athlete compared to the everyday patient. You – I did not know much about osteopathy might have to explain things in another way before I entered a high level of cycling. You for the «normal» patient. With professional know the title «physical therapist», but after sports you also have a different focus and some years you get familiar with the distinct perspective on performance. The cyclists know professions. I think there should be room for their bodies really well. If they have been rid- everybody, different methods for different ing for several years it is more common with individuals. For me, osteopathy is a natural problems related to stress and overuse. It is part of the team. It keeps my body prepped Henrik Askjem rarely acute, says Askjem who graduated as and ready. Age: 29 an osteopath in 2017. From: Tønsberg, Norway What Hagen wants and needs depends on Osteopath: Sandefjord Fysikalske, He then spent time building relations and the condition of his body that particular day. Norwegian National Team Cycling, experience within the community, held pres- A Grand Tour race lasts for three weeks. It can Uno-X Pro Cycling Team entations and talked to coaches and people be frying sun or windy and rain. The riders can who worked in the field of cycling. crash and there is little time for rest. It is safe to say that the small details matter. – The education was great and I felt that I had the tools I needed to start working. But, it is – Luckily I have not had many injuries the last – There are many different relations within also a field where one door will open ten new seasons. It does not have to be a problem a cycling team. You can be skilled but not ones. You have to implement what you learned if you ride with a «skewed» hip for a race, fit into the group. Communication is key. It at school with sports medicine and the unique but if you do that over an entire season it is crucial to know the sport and to be able premises and demands of the sport. And you could be a problem. Injury prevention is of to explain things in more ways than one. It is need some patience. You cannot start at the course important. So is assisting the restitu- a different story if you are working with a 17 highest level, but build from the ground up. tion process, says Hagen who uses the phrase year old athlete compared to 35 year old who Experience, modesty and hard work will get «fine-tuning». is doing his last championship. You have to you far. establish a bond with the athletes and make – One day I could be doing a time trial stage them trust you. Explain your expertise so that where you are extremely tense in the aero- they actively can seek you out for assistance. dynamic position, then it is back to the road Manual therapy can be a broad subject. If you the next day. Time is also limited so it is about are part of a medical team you need to have Øystein Tronstad «fine-tuning», small details or something you respect and understanding for the variety of Osteopathy student and can work a bit on to bring out the last percent. professions and therapists. journalist in Norway
18 Nordic Osteopathic Journal www.osteopaattiliitto.fi 19 The Birth of the first Osteopathic Master’s Program based in Northern Europe
Text: Robert Shaw / Sandra Rinne
The pathway to achieving a proper recognition of osteopathy as an independent and devel- oping profession, a master’s level (EQF level 7) qualification has long been seen as a necessary step. Relevant qualifications within a sound educational framework are the foundation of being a serious and worthy healthcare profes- sion. Europe-wide only a few institutions have been able to offer an academic master´s degree so far. There have been few possibilities for osteopathic graduates to continue their path in the academic world.
During the last decade, the cooperation be- tween SKOHS and Metropolia consisted among others of exchanging examiners for the final clinical exam and cross-evaluation. The collaboration intensified further through the validation process of the program in Goth- enburg. For many years the dream to create an international master´s programme in osteop- athy existed. It was included in the long-term Clinical: exploring explanations for osteo- It is expected that students will draw upon ev- plans and it was encouraged by both the CEN pathic treatment effects within an evidence idence from other disciplines. They are sup- standard as the OsEAN audit. Both institu- informed and critical thinking perspective, ported in this endeavour from the beginning tions were recently audited by the Austrian and advanced practitioner skills. Experienced of the program. There is a strong emphasis Standards Institute and again encouraged to practitioners will lead courses that will enable on developing good competence in research pursue this endeavour. However, the creation students to engage in these processes. and development. These competences are of a master´s programme based in North- supported throughout and culminate in a ern Europe has long remained but a dream. Research: building a constructive forum for Master’s Thesis. This year the opportunity opened up as the open inquiry, discussion and development Skandinaviska Osteopathögskolan, Gothen- through expanding knowledge on research Our aim is that graduates from this programme burg, Sweden and the Metropolia University methods and skills and creating a master’s will have gained a valuable insight into what of Applied Sciences, Helsinki, Finland, joined thesis. A team of experienced research su- they can achieve and what their professional forces to create a unique program designed pervisors will help support the thesis process. potential is, a valuable group of people to refer for practising osteopaths. to and continue sharing knowledge with and Service and management: developing an in- that they will feel competent and encouraged. There are many valid reasons for building tegrated, safe, person-centred approach to this brand-new program. The curriculum has osteopathic service as a whole including skills Originally, the program was intended to be been developing over the course of a year. in leadership, management and service design. a combination of on campus meetings and Both institutions conducted surveys with good The program is fortunate to draw upon the online/virtual learning. In the face of the new response rates, and we were thus able to take skills, and experience of the Master’s Degree situation we all are in, the focus has shifted into consideration the feedback and wishes Programme in Health Business Management to creating a valuable online experience for of alumni and the need of the profession for team. Courses of this thread will be together everyone. renewal and development. The program will with the Health Business Management- stu- provide a springboard for osteopaths in gaining dents from Metropolia. This novel master’s program may help shape the skills needed to engage in the fields of the future of osteopathy in the Nordic Coun- research, education, business development All three aspects are considered essential to tries and beyond and we hope it will be an and healthcare collaboration. develop the osteopathic profession’s ability to exciting experience for both students and staff communicate and work with other healthcare alike. Stay tuned! Over a two-year-period students will have the professional both nationally and internation- exciting opportunity to explore and develop ally. their osteopathic career potential. There will be the possibility to delve into the latest think- Evidence informed practice approach is the ing around osteopathic theory. Students will bedrock of the program. The rationale here then explore new ways of incorporating these is that there is a necessity for the osteopathic theories into contemporary osteopathic prac- profession to reflect upon its theoretical mod- tice. This program will play a significant part in Robert Shaw els and integrate the most recent and relevant PhD, Program Leader, developing a rich research culture within our research. In order to meet these goals, the pro- profession. We will then be able to develop a Skandinaviska Osteopathögskolan, gramme aims is to build a constructive forum Göteborg, Sweden stronger professional identity and raise aware- for open inquiry, discussion, and development ness of osteopathic healthcare within society. of novel theoretical constructs. Students will be encouraged to explore, and critically reflect, Sandra Rinne Three common threads of modern day oste- on explanations for osteopathic treatment ef- Head of Osteopathy, Metropolia opathic practice run throughout the program: fects within an evidence informed perspective. University of Applied Sciences, Helsinki, Finland
20 Nordic Osteopathic Journal www.osteopaattiliitto.fi 21 Digital leap in a workshop setting - preparing to adapt
Text: Eero Palevaara
Every spring the Finnish osteopathic do this practical training from there offices • You have no idea if the participants join the association organizes its annual gen- or homes, as long as they had an internet lesson or join the nacho plate eral meeting coupled with a 3-day connection, a training table and someone post-graduate course for the members. to practice on. Remember: • Test the devices, connections (audio/video), This year, in March 2020 we obviously could The start was a bit weird when you can’t see camera-angles and so on in advance do nothing else but cancel our plans due the people behind their treatment tables. • Schedule wisely- be effective but remember to the Covid-19- situation. We, like most of ”Can you hear me...? Can you see me...?” Good! to take brakes and avoid too long periods of the world were caught by surprise. The dis- Let’s go! When teaching without seeing the passive sitting appointment was especially outstanding, as participants you don’t know how they are • Involve participants with questions and make we have never had to cancel a course before. doing. You have to describe everything you it interactive. We were not prepared for any alternative do in an even more detailed and clear way approaches. than you would do in a face-to-face situation. Tips: • Ask for help if you need support with the Now, after almost a year down the road we The teaching went really well and this on- digital equipment have turned our eyes to next spring. This time line teaching is something that we all should • Learn how to use Zoom etc applications want to be ready, no matter what the situ- consider, at least for a back-up. With a large in advance ation will be, so we decided that we’ll ask space and good camera-angles the practi- • There are profesionals who can run your our teachers to ready themselves to be also cal demonstrations were easy to follow. It stream. You will save costs when going on- ”digi-ready” if needed. also makes me wonder if we should add the line, so why not hire a pro if you can? possibility to participate via streaming to all To be prepared, we decided to test how it goes our courses. It is hard to say how the future looks like. But and perform a test run of on-line practical now we are more ready and more comfortable teaching. To do that, we had the amazing fa- Pros: with the online options. This kind of streaming cilities at the Metropolia University of Applied • Teaching without interuptions (but do re- could be used in a larger conference space Sciences with all the up-to-date equipment- member to stop and ask questions) when dividing people in smaller groups in maybe even too modern for us- in our hands. • Via online streaming you can reach people case for instance the corona guidelines re- The space looked like a real tv- studio that who can’t otherwise join the live teaching strict larger gatherings in the long run. Let’s we could project the video from. We used the • It is possible to have a recording from the see how 2021 will look like! Zoom Webinar as our software. I also had a session and use it later (If you don’t mess colleague at hand who assisted me by reading with the microphones like we did) all the comments from the attendants during Cons: the session, which was super helpful. Eero Palevaara • It is harder to teach without eye- and body Osteopath, Attendants were informed that they could contact with the participants Board member Finnish • Talking only to a camera can be difficult Osteopathic Association
20 Nordic Osteopathic Journal www.osteopaattiliitto.fi 21 The EFFO: united across borders
Text: Frances Cholerton & Hanna Tómasdóttir
The continued development of a sense of community is an essential feature for the growth, recognition and regulation of the oste- opathic profession. In Europe the body working towards a greater vision where, regardless of borders, osteopathy stands together is the European Federation & Forum for Osteopathy (EFFO). Hanna Tómasdóttir, President of the EFFO, sets out the inner workings of this ‘or- ganisation of organisations’ and how through shared learnings and values, a greater vision for osteopathy across Europe is being inspired.
An organisation of organisations It took over a century, from osteopathy’s ar- rival in Europe in 1913, to the establishment of the European CEN Standard on Osteopathic Healthcare Provision (EN16686) in 2015, for the profession to have a wider sense of ac- knowledgement through a standardisation for high quality clinical practice, education, safety and ethics for Osteopathy in Europe. This European Standard was significant for Established in March 2018, the EFFO was born nen (Germany), Research; Lluís Horta (Spain), our profession to set a benchmark of care ex- when its two predecessors - the European Board Member and Maurice Cheng (UK), Chief pected of osteopaths in Europe, as well as to Federation for Osteopaths (EFO) and the Executive. generate a core framework for the community Forum for Osteopathic Regulation in Europe that exists today, and has already been proven (FORE) merged. The EFFO is currently made The Board is supported by four member driv- to be very useful when it comes to regulation. up of professional associations and regula- en Working Groups that represent the four tors from 22 European countries, with two pillars of the EFFO: Education, Regulation, The regulation process in Denmark was, for associate members (Canada and Israel) - as Research and Communication & Marketing. example, assisted by the establishment of the only those based in Europe can be considered These four Working Groups work towards a World Health Organisation (WHO) Benchmark full members - and represents over 25,000 deeper understanding, mission and objectives for Training in Osteopathy, published in 2010, practitioners in these countries. of their specialist areas, sharing their contri- and the CEN standard. These two benchmark bution and progress at our meeting, so that documents were of great assistance to the The four pillars of the EFFO collectively we can reach decisions about Danish government in their determinations, Our organisational model is member fo- what the EFFO does, and how we can best and for the Danish Patient Safety Authority, cussed, and member driven. The Board of the support the profession, and the members. where they served as a reference for basic level EFFO includes six members from six separate of education and as an overall qualification member countries and consists of: Hanna Meetings that embrace our community, framework for the osteopathic profession. Both Tómasdóttir (Denmark), President; Jonathan our vision and our goals standards are used as target standards by EFFO Bailey-Teyletche (UK), Vice President; Alex At our twice a year meetings, set up by the members and many of the osteopathic edu- Boon (Belgium), General Secretary; Dimitri Board, we aim to select a location which cation providers across Europe. Boulenger (Greece), Treasurer; Richard Wey- would benefit from our representation and support for the osteopathic profession in that country. For example, our Spring Con- ference and Annual General Meeting this year in March was held in Lisbon, Portugal and the 2019 Autumn Meeting was held in Madrid, Spain. By holding our conference alongside meetings with local politicians and stake- holders we are able to support the lobbying effort to further assist promotion, regulation and recognition of osteopathy in the respec- tive countries.
Our Autumn Conference and General Meeting in September 2020 was planned to take place in Oslo, Norway, but had to be held online due to COVID-19. Each meeting is attended by one or more national representatives of the respective organisations who contribute General meeting in Madrid 2019 to their knowledge and skillset. The structure
22 Nordic Osteopathic Journal www.osteopaattiliitto.fi 23 Follow us
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of those meetings are set by the Board with Through COVID-19: closer than ever Through navigating the changing face of contribution from all four Working Groups. During this year, as an organisation we have governmental guidelines and restrictions we At our last meeting, for example, the Educa- come closer together. At the start of lock- came closer together in an adverse, unpre- tion Working Group presented a draft state- down, when a lot of osteopaths in Europe dictable global situation never before seen. ment about where the EFFO would like to were forced to close their clinics, we set up a encourage and support the development of Task Force, consisting of all the four Working Expanding our European reach and osteopathic education to our membership. Group Chairs; Laura Lee Kamppila (Finland) regulation This statement is about the importance of Chair for the Communication & Marketing In total there are 44 countries in Europe, maintaining and developing high standards Working Group, Chiara Arienti (Italy) Chair for and one of the EFFO goals is to one day be for osteopathic education, as described by the Research Working Group, Tomas Collin formed by the whole European community, CEN for Type I and Type II programmes. Fur- (Norway) Chair for the Education Working because we need this greater community to thermore, the education programmes should Group, Hanna Tómasdóttir (Denmark) Chair for support each other and for the profession meet national requirements for recognised the Regulation Working Group and Maurice to evolve and thrive. Eleven countries in Eu- qualifications, where applicable. The state- Cheng (UK), representing the EFFO. rope have currently achieved regulation of the ment was approved by the EFFO membership osteopathic profession on a governmental and will be implemented as our vision and aim The Task Force, who communicated and level. Those countries are: Denmark, Finland, for education within our profession. worked on a daily basis during the first many France, Iceland, Lichtenstein, Luxembourg, Malta, Portugal, Switzerland, United Kingdom, At the same meeting the Regulation and most recently, Norway! Working Group introduced a draft of a document that provides an over- The way forward for the profession is view of regulation of the osteopathic to be fully regulated and recognised profession in Europe. This draft was as a primary healthcare profession shown to all our respective mem- in all European countries. The more bership who were able to provide we are able to represent osteopaths their comments and ideas. Yet to be together, the stronger we are. published, we are aiming for it to be a shared, editable and translatable Being an active part of the European publication to reflect the changing Federation & Forum for Osteopathy face of the regulation of the profes- supports the promotion and regula- sion. These member-driven contri- tion of the osteopathic profession, as butions from our Working Groups a recognised primary healthcare pro- acts as a valuable toolkit to all our fession, nationally and international- membership who are working to im- ly, while contributing to our thriving prove standards and recognition or and united European community. gain regulation of our profession in their home countries.
Our annual meetings are therefore much more than just a platform for net- months, established live webinars, provided working. We are sharing and learning about the national representatives with education Frances Cholerton our profession; improving Public Relations; in Social Media, and created our own You- Freelance journalist brainstorming future projects, establishing Tube Channel, where you can watch many of visions, aims and goal setting; and sharing our our webinars. Beside these contributions the ultimate passion: osteopathy. We are being EFFO Board has held regular online Network opened-minded and embracing all our mem- Members Meetings with the aim of sharing bership in a helpful, constructive manner. This national updates on restrictions, news and Hanna Tómasdóttir shared nature of working is at the heart of implications for osteopaths, and to inspire President of the European what we do and proliferates the community and engage our membership. Federation & Forum for of osteopaths that we are today. Osteopathy 22 Nordic Osteopathic Journal www.osteopaattiliitto.fi 23 24 Nordic Osteopathic Journal www.osteopaattiliitto.fi 25 Do chronic pain patients experience personality changes as their condition persists?
Text: Hilmar Þór Arnarson
Pain is very subjective as it cannot be When pain is experienced, the person shows to present fear avoidance (Kendall, McCreary, seen, but the consequences from living no fear, confronts the situation and recovers. Provance, Rodgers, & Romani, 2005). But it is with pain are very objective, they can These people do not typically develop chronic not that simple to label people as introverts pain. The other direction is where pain is ex- and extroverts, as extroverts can be introvert at be seen. But does pain change your perienced which leads to catastrophizing the some level and vice versa. Very few are com- personality, or can a person change situation and pain related fear. It stops them plete introverts or extroverts according to Carl their personality to increase their from being active and they become disabled Jung’s theory (Aquinas, 2006). well-being and happiness? and depressed. The circle then repeats itself and the person focuses more on the pain and From the osteopathic point of view, it helps to Personality is something everyone has, and it becomes less active and depression becomes be able to assess the patient’s personality to defines who you are. How a person reacts to more set in (J. W. S. Vlaeyen, Crombez, & Lin- provide the best care possible and engage the situations, makes decisions, and lives their life. ton, 2016). patient in the path for better health. Therefore People perceive pain in different ways accord- postural changes and openness of the patient ing to their personality. But what is the biggest Shuchang et al (2011) concluded in their study could be the most efficient tools to foster per- deciding factor in how people experience pain, that chronic pain patients showed more nega- sonality changes in the patient. and how do some people develop chronic pain tive emotions like anger, frustration and resent- It has been shown that personality can change while other do not? Do people with certain ment. All these factors reinforce pain reception in people with chronic pain. Introverted person- personality traits cope better with pain and are and negative thoughts which affect people’s ality and neuroticism are more likely to develop less likely to develop chronic pain? personality and are related to neurotic behav- chronic pain, so it might be assumed that that iour. People with introverted personalities were chronic pain exaggerates these kinds of per- Personality has been shown to change when also shown to have larger reactions to psycho- sonalities. Extroversion, openness, agreeable- associated with chronic illness or pain (Jokela, logical stress which influenced spinal loading ness and conscientiousness personalities are Hakulinen, Singh-Manoux, & Kivimäki, 2014). and function of the biomechanics (Guimond less likely to change towards negative person- People who suffer from chronic pain have the & Massrieh, 2012). alities and develop chronic pain. On the other tendency to develop depression and might hand, people with more negative personalities focus more on the things they cannot do, such Patient’s beliefs in chronic pain is considered to can adapt to more positive personality traits. as everyday house work, the inability to attend be an important factor in the ability to control Therefore, it can be assumed that personali- children’s activities and dependency on other the pain and the situation. The belief that activ- ty does not change from positive to negative people to assist with various chores that are ity might aggravate the symptom prevents the with chronic pain. Chronic pain might reinforce considered normal everyday chores to oth- person in engaging in rehabilitation treatments. negative emotions in those who score higher ers. This can lead to resentment towards the This kind of behaviour can increase disability towards introversion and negativity. Further chronic pain, patient guilt, hopelessness and and lead to resentment and depression, which studies might be needed to confirm this, but anger towards the pain from the person living contributes to further problems. would be complicated to measure for the fact with the pain (France, 1987; Herr & Mobily, that it is hard to predict who develops chronic 1992). Sadness can be confused with depres- Hudson and Fraley (2015) studied whether pain before an accident or injury occurs, al- sion but is not the same. Sadness is a human personality can change, for example for an in- though there seems to be a window for an emotion that everybody can experience in spite troverted person to become more extroverted. assessment and intervention to do so. of their personalities and depression is mental In their conclusion it is possible to do so, if a illness that could develop from long term sad- person wants to make changes to their person- ness and chronic pain, for example. ality, they can make desired changes if they put in the effort. Other traits can be changed, like Biopsychosocial model proposed by Engel agreeableness and conscientiousness (Hud- 1977 (Inerney, 2016) shows how a person can son & Fraley, 2015). According to the study, develop as a chronic pain patient, where many people can make changes to their personality factors psychological, social and biological play as they desire. Agree to make the change and an important role. One aspect of this model are challenge yourself to step out of the comfort psychological factors which contain personality zone or the environment you have created. elements such as how people perceive pain, their thoughts and actions. The fear avoidance Personality has a significant input to chronic model is another model introduced by Lethem pain and depression, according to the evidence. et al in 1983 (J. W. Vlaeyen & Linton, 2000) People with extroverted personalities are con- and explains differences in how people can sidered less likely to develop chronic pain. They Hilmar Þór Arnarson develop chronic pain and differences in the are considered to have better posture, be more M. Ost perception of pain. According to the fear avoid- relaxed, open to changes and more acceptable ance model, people can take two directions. to different situation and therefore less likely
24 Nordic Osteopathic Journal www.osteopaattiliitto.fi 25 Kollektiivinen älykkyys ja luovuus - Visio osteopatian alan tutkimus- ja kehittämisverkoston rakentumisesta
Text: Sandra Rinne
Osteopatia on erityisesti viimeisen kahden- Australiassa toimiva verkosto Osteopathic - ja kehittämisprojekteista. Verkkoalusta on kymmenen vuoden aikana kasvanut alana Research and Innovation Network ORION Terveyden ja hyvinvoinnin laitoksen, Sosiaa- niin kansainvälisesti kuin kotimaassakin. Uusia hyödyntää kliinikoista koostuvaa verkostoa li- ja terveysministeriön, Suomen sosiaali- ja osteopaatteja valmistuu vuosittain ja ammat- koostaakseen perustietoa osteopatian am- terveys ry:n sekä Kuntaliiton ylläpitämä. Tänä tia harjoittavien määrää rikkoo pian 500 rajan. mattikunnasta ja työskentelytavoista. Tut- keväänä perustettu Perustason Sote-palvelu- Kehitystä tapahtuu jatkuvasti ja osteopatian kimukseen sitoutuneiden ammattilaisten iden tutkimusverkosto on kaikille avoin, siihen aseman vakiinnuttamisen tueksi sekä näyt- joukon avulla on mahdollista tutkia use- voi liittyä Innokylän kautta ilmoittautumalla ja töä hyödyntävän työtavan edistämiseksi olisi ampia ammattialaan liittyviä näkökulmia näin seurata alan kehittämistarpeita ja kerätä olennaisen tärkeää, että tutkimusta syntyisi tehokkaasti. Australiassa on noin tuhat os- arvokasta tietoa tulevaisuutta ajatellen. Tämä myös Suomessa. teopaattia, joista suunnilleen puolet on si- voisi olla osteopaateille oiva ympäristö toimia. toutunut toimimaan tässä verkostossa. Tämä Suomen Osteopaattiliiton toiminnassa on jo mahdollistaa tehokkaan ja nopean tiedonk- Uuden kampuksen Innovaatiokeskit- jonkin aikaa ollut kehitteillä tutkimustyöry- eruun kohtuullisella vaivalla ja ilman hankalia tymän tarjoamat mahdollisuudet hmä. Sen varsinainen toiminta on kuitenkin tutkimuslupaprosesseja. Osteopatian tutkinto muutti vuoden vaihtees- jäänyt muiden akuuttien asioiden varjoon ja sa yhdessä kaikkien muiden terveysalan tut- keväälle suunniteltu tutkimuspäivä, kuten Englannista lähtöisin oleva Patient Re- kintojen kanssa saman katon alle Metropolia myös syksylle suunniteltu pohjoismainen ported Outcome Measures PROMs projekti Ammattikorkeakoulun uudelle kampukselle kongressi jouduttiin siirtämään eteenpäin puolestaan kerää tietoa osteopaattisessa Myllypuroon. Muutto on aidosti tuonut oste- tulevaisuuteen. Tapahtumia odotellessa on hoidossa käyneiden asiakkaiden kokemuk- opatian alana hyvin näkyväksi esille muiden vahvistunut ajatus tai lähinnä haave siitä, että sista ja tyytyväisyydestä hoitoon. PROMS, eli alojen keskuudessa. Kiinnostus yhteistyöhön Suomeen syntyisi ajan kanssa tutkimus- ja asiakkaan ilmoittama tulosmittari, on tällä ja yhteisiin projekteihin on kasvanut. Uudella kehittämisverkosto, joka saattaisi samasta hetkellä käytössä Iso Britanniassa, Ranskassa kampuksella moniammatillisessa oppimi- aiheesta kiinnostuneita ammattilaisia yhteen ja Saksassa. Parhaillaan sitä suunnitellaan sympäristössä toteutuva harjoittelu on osana jakamaan asiantuntijuuttaan ja verkostoitu- käyttöön otettavaksi useampaan maahan, uuden Innovaatiokeskittymän toimintaa. Asi- maan niin alan sisällä kuin sen ulkopuolellak- mukaanlukien Suomi. Sen avulla saisimme akaslähtöiset hyvinvointi- ja terveyspalvelut in. Yhteistyössä ja dialogissa voisivat löytyä järjestelmällisesti, pienellä vaivalla ja kus- innovaatiokeskittymän visiona on olla val- ne aihepiirit ja teemat, jotka innostaisivat use- tannustehokkaasti kerättyä anonyymia tyy- takunnallinen sosiaali- ja terveyspalveluiden ampia, ja joita kannattaisi tutkia ja kehittää tyväisyysdataa osteopatian asiakkaista jota kehittäjä ja suunnannäyttäjä. Tämä sisältää eteenpäin. voimme suoraan hyödyntää alan edistämi- uusien asiakaslähtöisten palvelujen kehit- sessä. PROMsia kehittää ja valvoo NCOR- tämistä, konseptointia ja testaamista. Inno- Tässä tekstissä ei ole tarkoitus esitellä mitään National Council for Osteopathic Research, vaatiokeskittymän moniammatillinen yhteisö valmista tuotosta tai rakennetta. Se on en- jonka tavoitteena on edistää ja tuoda yhteen sekä valmius ja kiinnostus näyttöä hyödyn- nemminkin kuvaus pitkän tähtäimen unel- osteopaattista tutkimusta. tävän toiminnan kehittämiselle tarjoavat oivat masta elävästä ja innostavasta yhteisöstä, puitteet tutkimusprojektien toteuttamiselle. joka mahdollistaa asioiden syvällisempää Vaikka tutkimus osteopatian alalla Suomessa ymmärtämistä ja uuden omaksumista. vielä etsii muotoaan, löytyy täältä osteopa- Ensimmäinen monialainen tutkimusprojekti tialle varteenoettavia mahdollisuuksia. Koko on tälle vuodelle suunniteltu tutkimus ko- Olemassa olevia verkostoja ja osteopatian alan historian ajan autonominen liikista kärsivien vauvojen hoidosta. Vauvojen projekteja hermosto on ollut erityinen kiinnostuksen hyvinvoinnin lisäksi Innovaatiokeskittymän jo olevista verkostoista on olemassa muuta- kohde. Neurotiede on yhä edelleen yksi os- moniammatillisiin teemoihin voisivat sopia es- mia hyvin toimivia esimerkkejä. Vuonna 2014 teopatian kannalta mielenkiintoisimmista ti- imerkiksi raskaana olevien ja synnyttäneiden perustettiin Pescaraan Italiaan osteopatian eteenaloista. Helsingin seudulle on perustettu hyvinvoinnin seuranta yhteistyössä kätilöiden lääketieteeseen omistautunut voittoa ta- Neurocenter Hub, joka yhdistää Aalto yliopis- ja terveydenhoitajien kanssa, tai urheilijoiden voittelematon tutkimusyhteisö Centre for ton, Helsingin yliopiston ja HUS:n toiminnan tutkiminen, hoito ja seuranta liikelaboratorion Osteopathic Medicine COME collaboration. eri projekteja. Kenties tässä yhtälössä olisi tarjoamien tutkimisvälineiden avulla. Come - italiaksi miten - on oiva lyhenne avo- sijaa myös osteopaattiselle tutkimukselle. imelle, kyselevälle ja tutkivalle foorumille, Verkostot kasvavat varmasti osittain luonnol- joka fokusoi tiettyihin tutkimusteemoihin, Innokylä on toinen kotimainen resurssi, joka listen kohtaamisten kautta, toisaalta niihin julkaisee artikkeleita ja järjestää vuosittain tarjoaa avoimen ympäristön kehittämiselle ja vaikuttavat myös tietoiset teot ja valinnat. konferensseja. paljon tietoa sosiaali- ja terveysalan tutkimus Olemme ammattikuntana jo kasvaneet sen 26 Nordic Osteopathic Journal www.osteopaattiliitto.fi 27 Lähteet ja linkit
Adams et al. (2018) A workforce survey of Australian osteopathy: analysis of a nationally representative sample of osteopaths from the Osteopathy Research and Innovation Network (ORION) project; BMC Health Services Research 18:352; https://doi.org/10.1186/s12913-018- 3158-y
Hakkarainen, Kai (painossa) Kollektiivinen luovuus, yhteisöllinen oppiminen, ja itsensä ylittäminen. Aikuiskasvatus.
Patterson, Michael (2011) Foundations of verran, että samasta aihealueesta kiinnos- Osteopathic Medical Research in Chila (toim.) Foundations of Osteopathic Medicine (3. pain- tuneet eivät välttämättä kohtaa toisiaan. os). Lippincott, Williams & Wilkins. Määrän kasvu merkitsee myös, että jou- kossamme on potentiaalisesti enenevissä COME - Centre for Osteopathic Medicine col- määrin tavalla tai toisella tutkimisesta ja ke- laboration hittämisestä kiinnostuneita osteopaatteja. https://www.comecollaboration.org/ On todella hienoa, että osa osteopaateista on hakeutunut jatko-opintoihin. Uuden os- Innokylä - Perustason Sote-palveluiden tutki- teopatian ylemmän ammattikorkeakoulu- musverkosto tutkinnon avulla toivottavasti yhä useampi https://innokyla.fi/fi/kokonaisuus/perusta- jatkaa polkuaan tutkimisen ja kehittämisen son-sote-palveluiden-tutkimusverkosto pariin. Verkostoajatuksen pohjalla on haave siitä, että se on avoin kehittävä, yhteisöllistä Innovaatiokeskittymät - Asiakaslähtöiset hyvin- oppimista tukeva verkosto, jossa ammattilai- vointi- ja terveyspalvelut set, kokeneet ja opiskelijat voisivat kohdata https://www.metropolia.fi/fi/tutkimus-kehi- ja yhdessä ylittää itsensä. tys-ja-innovaatiot/innovaatiokeskittymat/asi- akaslahtoiset-hyvinvointi-ja-terveyspalvelut Visioi tulevaa tutkimus- ja kehit- tämisverkostoa Neurocenter Finland https://neurocenterfinland.fi/en/researcher/ Suomen osteopatian tutkimus- ja kehit- helsinki-network-brain-and-mind-hnbm/ tämisverkosto on toistaiseksi visiotasolla, eikä varsinaista rakennetta ole vielä luo- ORION - Osteopathic Research and Innovation tu. Mahdollisia teemoja sen sijaan on jo Network olemassa. Tervetuloa luomaan, laajentama- http://www.orion-arccim.com/ an ja tarkentamaan tätä kuviota vastaamaan omia haaveitasi. Juuri tämä erityinen aika on PROMS - Patient Reported Outcome Measures haastanut meitä muokkaamaan toimintamme Sandra Rinne https://www.ncor.org.uk/practitioners/pa- niin monella tavalla. Nyt saattaa olla juuri tient-reported-outcomes/patient-report- Osteopatian tutkintovastaava, hyvä hetki katsoa pitkälle tulevaisuuteen ja ed-outcome-measures-in-osteopathy/ Metropolia haaveilla isosti - sillä isotkin unelmat voivat tulla toteen. Ammattikorkeakoulu
Toinen suomalainen koulu hyväksytty Euroopan ammatilliseen verkostoon
Text: Tiina Lehmuskoski
Osteopatiakoulu Atlas hyväksyttiin saattaa osteopatiakoulutusten laatu kaik- hyväksyy jäsenyyden virallisella äänestyk- Osteopathic European Academic Net- kialla Euroopassa osteopatian standardin sellä, johon osallistuvat kaikki OsEANin jäsen- work:n (OsEAN) jäseneksi marraskuus- mukaiseksi. OsEANiin kuuluu 33 jäsenkoulua. et; näin ollen varmistetaan vielä lopullisesti jäsenkoulun korkea taso. OsEANin jäsenyyden sa 2020. OsEANin jäsenenä koululla on mahdollisuu- sanotaankin vahvistavan koulutuksen korkean det kansainväliseen yhteistyöhön ja kokemus- laadun. Marraskuun äänestyksessä hyväksyt- Jäsenyys on merkittävä askel suomalaiselle ten jakamiseen. Kansainvälinen yhteisö var- tiin kolme uutta koulua verkoston jäseneksi. osteopatian koulutukselle, sillä näin kak- mistaa ajan tasalla pysymisen osteopatian si kolmesta Suomen kouluista on saanut ja opetuksen kehityksessä. Normaalioloissa Atlaksessa tieto jäsenyydestä otettiin ilolla kansainvälisen tunnustuksen niin koulutuk- jäsenkoulujen opiskelijat voivat osallistua ly- vastaan, sillä se on hieno osoitus pitkäjän- sen auditoinnista saadulla sertifikaatilla kuin hyisiin opiskelijavaihtoihin, ensi kevääksi on teisestä työstä koulutuksen kehittämisestä. jäsenyydellä kansainväliseen verkostoon. suunnitteilla ensimmäinen yhteinen virtu- Jäsenyys vahvistaa myös Suomen edustus- aalinen kurssipäivä. Syyskuussa on luvassa Osteopathic European Academic Network ta kansainvälisessä verkostossa Metropolian pedagoginen konferenssi teemana “Teaching OsEAN Ammattikorkeakoulun ollessa jo jäsenenä. the Working Principles of Osteopathy”. https://www.osean.com/
OsEANin tavoitteena on edistää osteopaat- OsEANin jäseneksi pääsy ei ole kovin yksinker- tisen hoidon laatua ja osteopatian asemaa tainen prosessi, sillä koulun on noudatettava Tiina Lehmuskoski koko Euroopassa sekä vahvistaa yhteistyötä sekä Osteopatian standardia, että OsEANin Rehtori, eri maiden koulujen välillä. Tavoitteena on standardia ennen jäseneksi hakua. OsEAN Osteopatiakoulu Atlas
26 Nordic Osteopathic Journal www.osteopaattiliitto.fi 27 28 Nordic Osteopathic Journal www.osteopaattiliitto.fi MB