Volume 113, Issue 1

Falls, gait disturbances, and balance disorders are common clinical problems for the elderly, and these problems are associated with considerable morbidity. However, the literature reports relatively few effective treatment options, such as vitamin D replacement, exercise and physical therapy, and tai chi. Because of the limited number of available effective interventions, there is a need to explore other approaches, such as osteopathic manipulative treatment. The author reviews the limited body of literature relating to the use of manipulation for reducing fall events and improving gait and balance in the elderly. At this time, there are new opportunities for clinical and basic science research to investigate emerging uses of osteopathic manipulative treatment for managing falls, gait disturbances, and balance disorders.

Context: Residents play an integral role in educating junior residents, medical students, and patients. Objective: To determine how residents describe their training, proficiency, and comfort level in teaching before and after receiving instruction in clinical teaching. Methods: Emergency medicine residents at a 980-bed suburban hospital system filled out a 12-question survey on their training as teachers and their self-perceptions of themselves as teachers. The residents then participated in a 2-hour education session on adult learning principles, methods of clinical teaching, and how to give effective feedback. After the session, participants completed a second, 11-question survey on the effectiveness of the session. Results: Thirty-seven residents completed the presession survey and 33 completed the postsession survey. In the presession survey, 23 residents (62%) identified their proficiency as a teacher and ability to give feedback as that of a novice or beginner. Fourteen (38%) felt competent or proficient as teachers. Twenty-six (70%) reported never receiving instruction in clinical teaching during their residency, and 33 (89%) were interested in learning these skills. In the postsession survey, 28 (85%) described the teaching module as very helpful to their training, and 33 (100%) reported feeling more prepared to teach. Twenty-six (79%) stated they were very likely to teach students more often, and 33 (100%) reported a better understanding of how to give effective feedback. Conclusion: The majority of the residents surveyed expressed an interest in learning teaching skills and felt that completing the training was helpful to their education. After instruction, this cohort of residents felt more prepared and reported they were more likely to teach.

Since its inception, osteopathic medicine has sought to identify the mechanical causes of disease and to understand the body's structure-function relationship. Research conducted during the past 25 years has demonstrated that the architectural principles of tensegrity can be applied to biological organisms (termed biotensegrity ) and that these principles can demonstrate the mechanical structure-function relationship at all size scales in the human body. Further, biotensegrity at the cellular level allows the cell to mechanically sense its environment and convert mechanical signals into biochemical changes. When applied to the principles of osteopathic medicine, biotensegrity provides a conceptual understanding of the hierarchical organization of the human body and explains the body's ability to adapt to change. Further, biotensegrity explains how mechanical forces applied during osteopathic manipulative treatment could lead to effects at the cellular level, providing a platform for future research on the mechanisms of action of osteopathic manipulative treatment.

Shoulder impingement syndrome (SIS), a chronic shoulder pain condition, often stems from repetitive overhead activities. In the current report, the author presents 2 cases of SIS. In the first, a woman with a history of SIS found that physical therapy and subacromial steroid injections, while effective, were problematic for long-term use. Previous use in the author's practice demonstrated convenient shoulder pain relief using the heated lidocaine 70 mg-tetracaine 70 mg topical patch. She initially used the heated lidocaine-tetracaine patch twice daily and tapered over 4 weeks to as-needed use for successful pain control. In the other case, a female adolescent athlete with a history of SIS tried, on the recommendation of the author, using the heated transdermal patch instead of steroid injections. Her pain was successfully controlled during activity and at rest with 12 hours-on/12 hours-off patch application. The heated lidocaine-tetracaine topical patch may be an early conservative treatment for patients with acute pain from SIS and warrants examination in controlled studies.