Systemic manual therapy to treat long term residuals following COVID-19-related ICU stay: A case report.

OBJECTIVE: The purpose of this case is to describe an outpatient treatment course using previously published systemic manual therapy protocol to treat a 65-year-old patient who, after prolonged COVID-related intubation, presented with polyneuropathy, organ failure and other residuals. DESIGN: A single-subject case study. METHODS: Review of clinical records and follow-up interview. RESULTS: The patient identified problem scale (PIP) had improved from a high score of 52 to 11; QUICKDASH score improved from 68 to 16. All individual problems had either resolved or remained at a minimal level and the patient had generally returned to his prior level of function including return to work. DISCUSSION AND CONCLUSION: It appears that Despite factors such as age, length of ICU stay, length of symptoms before initiation of physical therapy, and complicated hospital stay including multiple organ failure, after receiving physical therapy consists of the systemic manual therapy protocols, the patient rapidly improved during the outpatient episode.

Temporal model for central sensitization: A hypothesis for mechanism and treatment using systemic manual therapy, a focused review.

The purpose of this focused review is to develop a consolidated hypothesis as to the causes and mechanisms of central sensitization and a related model for a treatment approach using Systemic Manual Therapy (SMT). The key to understanding central sensitization is a firm grasp on structure and function of the Locus-coeruleus noradrenaline system (LC-NA). This system uses an elaborate switching mechanism to control the level and rate of activation of multiple systems. This review evaluates the mechanisms and temporal relationships behind four components: salient stimuli, threat coding, aberrant afferent input, and oxidative stress. The five-stage temporal model for central sensitization includes phasic activation of the LC-NA system, salient stimuli, threat coding of salient stimuli, central sensitization, and neural degeneration. The three components of treatment include temporarily reducing afferent visceral input, shifting humoral inflammatory activity away from the brain and outside the body, and reducing oxidative stress by making oxygenated blood more available around the LC and other stressed areas in the brain. The SMT protocols that could help in reduction of visceral afferent input are GUOU, Barral and LAUG. Protocols that should shift humoral inflammatory activity away from the brain or completely out of the body include UD and DCS. One protocol that can potentially reduce oxidative stress by making oxygenated blood more available around the LC is CCCV. Future research and hypothesis-testing strategies as well as limitations are further discussed.

Control of internal validity threats in a modified adaptive platform design using Halili Physical Therapy Statistical Analysis Tool (HPTSAT).

Some of the challenges in evaluating the effectiveness of physical therapy practice stem from the common lack of interventional standardization, as well as problems with both the availability and routine use of specific, valid outcome tools. But even if these issues are dealt with, there are still significant validity threats when trying to understand the effectiveness of physical therapy interventions. Among the most critical internal validity threats: repeated testing effect, study sample uniformity, and increase in type I or type II error. The purpose of this analysis is to illustrate how these internal validity threats were controlled using the Halili Physical Therapy Statistical Analysis Tool (HPTSAT). The original concept behind the HPTSAT tool was the adaptive platform design used in the PREVAIL I and II protocols(1,2,3). However, this concept has been significantly expanded upon in the HPTSAT design to allow for the simultaneous analysis of hundreds of treatment combinations while controlling for the above-mentioned critical internal validity threats.•HPTSAT allows for concurrent computerized analysis modeled and improved upon the adaptive platform design used in the PREVAIL I and II protocols.•This analysis is possible because the tool isolates the average rate of change (ARC5) instead of average change after treatment.•This paper provides the mathematical basis for the algorithm used in the tool to control for several internal validity threats including repeated testing effect, study sample uniformity, and increase in type I and II error.

Physical therapy for the treatment of respiratory issues using Systemic Manual Therapy protocols.

BACKGROUND: The emergence of the Coronavirus (COVID-19) pandemic increased the need for an effective treatment for respiratory conditions exponentially. To meet this challenge, we reevaluated the effectiveness of our physical therapy protocols for respiratory conditions. Protocols of interest were categorized as decongestive, neurogenic, mechanical, and immune modulating. OBJECTIVE: The objective of this study is to evaluate which of our existing treatment protocols or protocol combinations produce the best outcome. To do so, we analyzed which ones can meet the following criteria when compared to all other treatments: test statistic (>2.0) in parametric and non-parametric tests, [statistical significance (p < 0.05)], effect size larger than 0.2, difference in the Patient Identified Problem Scale (PIP) score above Minimal Clinically Important Difference (MCID), and sample size minimum 15 treatments. DESIGN: Retrospective multivariate analysis using a modified adaptive platform design. METHODS: A computerized sampling using respiratory related key words from a blinded dataset yielded 178 patients with respiratory complaints or pain in the chest area. Additional statistical analysis using parametric and non-parametric tests evaluated the difference between each treatment protocol and the rest of the treatments provided. RESULTS: Several protocol combinations and one individual protocol passed the study criteria. Cardiac vascular venous thoracic (CVVT) protocol was used most frequently within these combinations (7), followed by Urinary Drainage (UD) (4). Other protocols in this group were Cardiac Cervical Cranial Vascular (CCCV), Venous Thoracic Cardiopulmonary (VTCP), and Diaphragm Cranial Sinus (DCS). Among the respiratory specific protocols, CVVT was significantly better than VTCP (0.40, p < 0.001). DISCUSSION AND CONCLUSION: For the patient population studied, CVVT appears to be the primary protocol to consider, followed by UD, CCCV, VTCP, and DCS. Combining CVVT with Barral Abdominal Motility protocol (Barral) or VTCP with Lower Abdominal Urogenital (LAUG) on the same day might be required with acute patients.