doi: http://dx.doi.org/10.1016/j.ijosm.2014.04.001

Abstract

Background

High-Velocity Low-Amplitude (HVLA) manipulation of the spine is a broadly used technique in Osteopathic Manipulative Treatment (OMT), and studies have shown that spinal manipulation might lead to transient decrease in motoneuronal activity assessed through Hoffmann Reflex (H-reflex) test. However, its physiologic response is not fully understood, and there is no consensus on H-reflex responses to spinal manipulation.

Objective

The purpose is to assess motoneuron excitability by the H-reflex test before and after HVLA manipulation of the lumbar spine of asymptomatic adults.

Design

Prospective controlled experimental study with pre and post-intervention measures.

Methods

The participants were first submitted to a sacrolumbar (L5-S1) control intervention and after an HVLA manipulation of the same vertebral segment. H-reflex amplitudes were measured before and after the procedures; the participants were positioned lying on their left side and they did not change the position during the experimental procedure.

Participants

Nineteen asymptomatic adults were recruited through public advertisements and referrals from healthcare professionals.

Results

There was a variation of the H-reflex amplitude; but with no systematic change across participants. Six out of 19 participants had a decrease on H-reflex greater than 20% after the manipulation, and no significant change in 13 participants.

Conclusion

The results hypothesize that the electrophysiological effects of HVLA manipulation have different results among participants, and that this variability may be due to dysfunction at the level manipulated, changes in autonomic tone and/or technical issues delivering the technique.

Full text available here.

doi: http://dx.doi.org/10.1016/j.ijosm.2014.04.004

Abstract

Background

Decision-making and reflective thinking are fundamental aspects of clinical reasoning. How osteopathy students think and make decisions will therefore have far-reaching implications throughout their professional lives. Models of decision-making are firmly established in cognitive science literature and their application is universal, yet the decision-making processes and thinking dispositions of osteopathy students remain relatively unexplored.

Objectives and method

Using the Cognitive Reflection Test (CRT) to measure decision-making preferences and the 41-item Actively Open-minded Thinking disposition scale (AOT), this study set out to explore how osteopathy students at the start (novice; n = 44) and end (intermediate; n = 32) of their pre-professional training make decisions and how reflectively they think.

Results

Intermediate level practitioners demonstrate significantly more analytical decision-making than their novice peers (p = 0.007; effect size = 0.31); however, reflective thinking dispositions do not change as participants progress through their training (p = 0.07). No significant association was found between analytical decision-making and reflective thinking (p = 0.85).

Conclusions

The trend for intermediate level practitioners to demonstrate more analytical decision-making than novices, without significant differences in reflective thinking processes, supports other research that suggests osteopathic education promotes deductive over inductive reasoning in its graduates and that reasoning and thinking dispositions may develop independently of each other, given the skills and knowledge-based requirements of osteopathic education.

Full text available here.