Complementary and alternative medicine CAM is a group of diverse medical and healthcare systems practices and products that are not presently considered to be part of conventional medicine ID: 778760
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Slide1
Integrative medicine
in rehab
Slide2Complementary and alternative medicine (CAM) is a group of diverse medical and healthcare systems, practices, and
products that
are not
presently considered to be part of
conventional medicine.
Alternative medical
systems
Mind-body
interventions
Biologically based
therapies
Manipulative and body-based
therapies
Energy therapies
Slide3ALTERNATIVE MEDICAL SYSTEMS
Alternative medical systems often incorporate concepts
and ideas
that are foreign or antithetic to conventional medicine
.
They are generally based on
empiric observation
, and
underlying scientific
principles often have yet to be verified
through well-designed
scientific studies.
Slide4Chiropractic
Chiropractic is a profession founded on the theory that
minor spinal
misalignments
can detrimentally affect the
neurologic function
of spinal nerves and the organs and structures
supplied by
those
nerves
.
These misalignments
are often
called
subluxations
.
Chiropractors treat
subluxations
with
various interventions, the most common
being
spinal manipulation(
active
intervention
)
Chiropractors often incorporate other techniques, such
as
massage
and exercise prescription
, in treatment.
They
also utilize
radiography
to aid in diagnosis and treatment.
Chiropractors
do
not dispense prescription medication or perform
surgery or
invasive treatments.
Slide5Osteopathy
focuses on utilizing the bones as manual levers to remove
bony and
myofascial
entrapment of nerves and vascular
structures, thus
restoring normal function
.
Today, osteopathic physicians (DOs)
and allopathic
physicians (MDs) are relatively indistinguishable
in that
both are fully licensed in all realms of medicine
including
surgery
, obstetrics, and the prescription of medications
.
Slide6Homeopathy
Homeopathy's central tenets are the principle of
similars
and the principle of dilution.
The principle of
similars:small
quantities of an agent can ameliorate the same symptoms that are evoked in a healthy patient when given in larger quantities.
The principle of dilution states that highly dilute solutions have biologic activity and the more dilute the solution, the more potent the
remedy activity
. Others might be diluted to the point that conventional science has difficulty explaining their efficacy
While most of these remedies are safe, their potential for interaction with other ingested substances can be difficult to predict.
this study suggests that homeopathic treatments might have a place in the treatment of
brain injury.
Slide7Naturopathy
Most of the principles espoused by naturopaths are familiar to physicians: do no harm, identify and treat causes of disease, disease prevention, and treatment of the whole individual
.
They range from the mundane, such as
diet and lifestyle
counseling, to more unusual modalities such as acupuncture and homeopathy
Slide8Ayurveda
Ayurvedic
medicine (literally means 'the science of life') developed in India.
relationship between all the matter in the universe.
There are three
doshas
(life forces or energies),
which must be at equilibrium for good health.
Diet, sleep, sexual activity, personal hygiene, and exercises such as yoga are used to
physical
fitness
Mental discipline and
spirituality
are
also
inportant
components to maintaining good health.
Slide9Traditional
Chinese medicine
One of the fundamental principles of this system is that two opposite forces
(yin and yang) balance in nature
The
TCM examination
might include determining the characteristics of pulses at specific locations on the body, the appearance of the tongue, characteristics of olfaction, and careful palpation of the body
.
This rebalancing can be achieved through a number of different therapeutic options, including diet, exercise, herbal medicines, massage, and acupuncture.
Qi
gong and
t'ai
chi
were developed as methods of strengthening the
qi
or energy of the body to prevent disease and prolong life.
Slide10Mind-body therapies
Cognitive behavioral therapy
:
A therapist typically works with the patient to identify thoughts and behaviors that are maladaptive; and attempts to change the thought patterns, leading to a change in behavior.
Successfully employed for :insomnia,
fibromyalgia, headache, and pain
Slide11Meditation
defines the act of meditation as 'to train, calm, or empty the mind, often by achieving an altered state, as by
focusing on a single object
Meditation is also frequently described as
self-regulation of attention.
There are numerous types of meditation (e.g. transcendental, mindfulness, and focused meditation)
manage stress and anxiety,
deal
with pain,
improving
quality of life after brain injury, and improving
irritable bowel syndrome.
Slide12Guided imagery
This is a technique that employs images or symbols to train the mind to create a physiologic or
psychologic
effect
reduce anxiety and pain, and to relieve physical problems caused by stress
headaches
.
recurrent abdominal pain in children, depression, and fibromyalgia
Slide13Spirituality
Spirituality has been described as an awareness of something greater than the individual self.
reduction of stress and anxiety, positive effect of prayer on illness severity ratings in
AIDs
patients and a positive effect of church
attendence
on
immune function
.
Slide14Aromatherapy
This modality uses
essential oils
distilled from plants to improve
mood and/or health.
Scents can be inhaled or applied in oil during massage.
reducing stress, pain, and depression.
Slide15Expression- or art-based therapies
art therapy
as the 'therapeutic use of art making, within a professional relationship, by people who experience illness, trauma, or challenges in living, and by people who seek personal development.
Music therapy
is the use of specific music (with specific vibration
freque
ncies
) to promote relaxation and healing.
It is helpful in treating
autism
; mentally or emotionally disturbed children and adults; elderly and physically challenged people; and patients with schizophrenia, nervous disorders, or stress.
Dance therapy
is 'the psychotherapeutic use of movement as a process which furthers the emotional, cognitive, social and physical integration of the individual
.
Slide16Biologically based therapies
Chondroitin
sulfate:
Proponents believe that
chondroitin
acts as a substrate needed for joint matrix structure
it could require at least
2-4 months
of therapy before significant improvement is noted is not surprising
adding
chondroitin
sulfate to conventional analgesic or non-steroidal
antiinflammatory
drugs (
NSAlDs
) is synergistic
, possibly allowing reduction or
elimination
of those agents.
(Oral: Doses of 200-400 mg 2-3 times/day or 800-1200 mg once daily have been used. Higher doses (up to 2000 mg) appear to have similar efficacy.)
Adverse effects:
nausea and
epigastric
discomfort.
Slide17Glucosamine sulfate
efficacy have been centered on
knee osteoarthritis
.
effective for osteoarthritis of the lumbar spine in one study·
Some studies suggest efficacy equivalent to that of certain NSAIDs
Like
chondroitin
, onset of relief is generally delayed, requiring up to
8 weeks
for full effect.
Long-term studies suggest that glucosamine might result in significantly
less
joint space narrowing and knee joint degeneration than with placebo
(Oral: 500 mg 3-4 times/day)
Adverse effects Mild gastrointestinal symptoms (e.g. nausea,
heartburn, diarrhea, and constipation)
Slide18S-adenosyl
-l-
methionine
is superior to placebo and comparable with NSAIDs for decreasing symptoms associated with
osteoarthritis.
The full effect might require up to
1 month
of treatment.
Mechanism of action could include stimulation of
articular
cartilage growth and repair.
Adverse effects These are gastrointestinal symptoms (e.g. flatulence,
nausea, diarrhea, and constipation), dry mouth, headache, mild insomnia, and nervousness.'
Slide19Bromelain (
Ananas
comosus
)
In a single study,
bromelain
taken in conjunction with
trypsin
and
rutin
resulted in decreased pain and improved knee function in patients with osteoarthritis
Adverse effects Gastrointestinal upset and
diarrhea
can occur
in patients taking
bromelain
Slide20Camphor (
Cinnamomum
camphora
)
A topical cream containing camphor, glucosamine
sulfate, and
chondroitin
sulfate was found to provide
reduction in pain due to osteoarthritis
Slide21Cat's claw (Uncaria
tomentosa
)
The mechanism of action might be inhibition of the production of prostaglandin E2, and tumor necrosis factor-a.
One study found that a freeze-dried cat's claw extract relieved knee pain related to physical activity but
did not affect pain at rest.
Adverse effects are headache, dizziness, and vomiting
Slide22Devil's
claw (
Harpagophytum
procumbens
)
when taken in conjunction with NSAIDs, devil's claw decreases osteoarthritis-related pain.
As with glucosamine and
chondroitin
, a reduction in the need for NSAIDs might be possible with devil's claw
after several weeks of use
.
Adverse effects:
diarrhea
,nausea
, vomiting, and abdominal pain.
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Use of devil's claw is
contraindicated in pregnancy and lactation
Use caution in individuals with diabetes as devil's claw may lower blood glucose levels. Use with caution in patients with gallstones as devil's claw may increase bile production
Osteoarthritis: 2-9 g/day crude extract or 600-1200 mg 3 times/day, standardized to contain 50-100 mg of
harpagoside
, for 2-3 months
Back pain: 2-9 g/day of crude extract or 600-1200 mg 3 times/day, standardized to contain 50-100 mg of
harpagoside
Harpagoside
has been shown to inhibit COX-2 expression
Slide23Evening primrose oil (Oenothera
biennis
)
In a double-blind, placebo-controlled study of
rheumatoid arthritis
patients, a 12-month trial of evening primrose oil resulted in significant reduction of symptoms.
Evening primrose oil contains a significant amount of
y-
linolenic
acid
, and it is this component that is thought to provide the
antiinflammatory
action
.
Slide24Manipulation and body-based therapies
Manipulation or mobilization:
Manipulation (typically inferring high-velocity thrust techniques applied to a joint) and mobilization (non-thrust, oscillatory techniques)
There is no evidence that manipulation or mobilization applied by one profession is more or less beneficial than when provided by a competing profession.
The goal of these therapies is to normalize motion and tension about a joint
Slide25Side effects of spinal manipulation
:
at
least one unpleasant reaction was experienced after manipulation by more than half of patients
The most common side effects were
local discomfort (53%)
, headache (12%), tiredness (11%), and radiating discomfort (1O%).
Reactions were mild or moderate in 85%, and most were short-lived (
74% resolved within 24 h
).
Uncommon reactions, such as dizziness and nausea, accounted for less than 5% of the symptoms and no serious complications were reported
Slide26Spinal manipulation, although generally safe, is not risk-free
Complications of thoracic and lumbar manipulation are rare, and investigators agree that the
risk: benefit ratio
of manipulation for low back pain is acceptable in most patients
The most serious complication of lumbar manipulation is
cauda
equina
syndrome.
About half the reported cases occurred during manipulation under anesthesia
The frequency of
cauda
equina
syndrome has been estimated to be
one in several million treatments
.
Complications of cervical manipulation Although relatively rare, they are more common and often more serious than those from lumbar or thoracic manipulation.
One of the most controversial issues concerning spinal manipulation is the relationship between cervical manipulation and
stroke
.
Cervical manipulation can cause mechanical stress on the vertebral arteries, resulting in
vertebrobasilar
stroke
. The most common site of injury appears to be the
extracranial
third segment of the vertebral artery
.
Slide27For this reason, some have argued that the
risk:benefit
ratio
of cervical manipulation is unacceptable.
it
has been estimated to be 1:400000 to 1:3 million
A screening test using
neck extension and rotation
has been thought to predict patients at risk of
vertebrobasilar
stroke, but its value is questionable at best
disk
herniation
is often listed as a contraindication For lumbar manipulation, but chiropractors and therapists
commonly
use it to treat persons with disk
herniation
. Another possible contraindication is lumbar
spondylolisthesis
, but these patients appear to respond as well as those with normal spinal anatomy
Slide28It is sufficient to say that the best evidence supports the use of manipulation for most types of uncomplicated low back pain, but there is no compelling evidence that it is more efficacious than other commonly used therapies.
About cervical manipulation and mobilization:
there are very few high-quality studies;
there is some evidence for the effectiveness of manipulation and mobilization for neck pain;
the rate of complications and side effects is very low
.
The use of spinal manipulation as treatment for headaches is predicated on the cervical spine being a contributing factor in the etiology of headaches.(
two peripheral
nociceptive
convergence
)
Another possible connection between the cervical spine and headache is an anatomic connection between the rectus
capitus
posterior minor and the spinal
dura
via a dense connective tissue bridge at the level of the
atlantooccipital
junction.
When compared with some forms of medical prophylaxis for both
tension-type and migraine headaches
, spinal manipulation appears to offer similar relief
Manipulation does not appear to be effective in aborting headaches.
Slide29There is little evidence to suggest that manipulation and mobilization can correct or reduce an
idiopathic
scoliotic
curvature
.
There is, however, a suggestion that spinal manipulation therapy is helpful in controlling chronic mechanical back pain associated with
scoliosis
Davis et al. compared medical treatment of
carpal tunnel syndrome
(ibuprofen and nocturnal wrist splinting) to chiropractic treatment (spine or extremity manipulation, wrist ultrasound and nocturnal wrist splinting) in an uncontrolled randomized trial. Both groups improved, with no difference between them.
Randomized controlled trials of chiropractic treatment for
asthma
have demonstrated no change in measured lung functions in either children or adults
.
otitis
media
is sometimes treated by chiropractors,
A review of the literature concluded that the effect of spinal manipulation on
enuresis
is similar to the natural remission rate
Primary
dysmenorrhea
has been reported to respond to spinal manipulative therapy
There is no evidence that manual therapies are beneficial for central nervous system-based disorders such as
epilepsy.
Slide30Slide31Slide32Movement therapies
Feldenkrais
method
:
The
Feldenkrais
method is a system of body movement education that is believed to enhance awareness of movement and improve functional movement.
A small randomized study of the effect of
Feldenkrais
on pain found the affective dimension (
attitude toward the pain
) to be reduced, but no change was measured in other dimensions
A small randomized trial found patients with
neck and shoulder complaints
to benefit more from
Feldenkrais
than from physical therapy.
Slide33Slide34Alexander technique
The Alexander technique is a psychophysical reeducation method that proposes
to relieve muscular tension and improve the efficiency of movement
Alexander technique is often advocated in the treatment of asthma, headaches, arthritis, and pain, and
is
often used by performing artists·
examination of posture, breathing, balance, and coordination, and has three underlying principles
Slide35Slide36T'ai chi
advocated as a therapeutic exercise, particularly in the
elderly.
T'ai
chi has been reported to improve balance control, flexibility, and cardiovascular fitness in geriatric patients
Slide37Slide38Pilates
Pilates exercises were originally designed for and used by performance artists, but have enjoyed wider popularity in recent years.
suggest
pilates
exercises are beneficial for
various musculoskeletal conditions
, although they have been primarily used for dance-specific rehabilitation regimens.
Slide39Slide40Yoga
Although yoga is part mind-body therapy and part stretching and breathing exercise, it is most appropriately addressed with movement therapies.
It is commonly advocated as treatment for musculoskeletal conditions, including arthritis‘ and carpal tunnel syndrome.(asthma, hypertension and low back pain)
Slide41Energy therapies
Acupuncture:
Acupuncture consists of the insertion of thin flexible needles into the body at specific points to improve health
The needles are inserted to varying depths and angles, and typically are inserted superficially
The needle can be further stimulated in a number of different ways, including twirling the needles, electrical
stimulation,or
burning a herb placed on the end of the needle outside the patient.
used for
analgesia or relief of pain
, asthma, fatigue, gastrointestinal disturbance, and infertility.
Slide42Meridian-based acupuncture is invoked to alter the flow of qi
or energy through the body.
Qi
flows through the body in specific patterns, and these pathways are known as
meridians
.
Another common style of acupuncture is termed
neuroanatomic
acupuncture.
For example, the point stomach 31 can relieve lateral thigh pain and lies over the lateral femoral
cutaneous
nerve
Slide43Mechanism of action
:
direct local effects such as vasodilatation, direct torsion of the connective tissue, and changes in autonomic activity, to more remote endocrine effects
The endocrine effects include release of endorphins and an effect on the hypothalamic pituitary axis.
Remote neurologic effects can also occur, such as changes on functional magnetic resonance imaging of the brain from insertion of an acupuncture needle in the
first dorsal
interosseous
muscle (large intestine 4).
Slide44Risks of acupuncture include bleeding, infection, and organ puncture (including
pneumothorax
)
Needle shock is a side effect that is uncommon but typically occurs during a first acupuncture treatment.
Slide45Slide46Acupressure
Acupressure is similar to acupuncture in terms of its analysis of the human body, but it utilizes pressure rather than needles to achieve changes in the human body.
Direct manipulation of the tissues is believed to open up channels to the flow of
qi
.
Most obviously, the potential complications of bleeding and infection are eliminated.
patients who might benefit from this treatment, including individuals on
anticoagulants, the needle-phobic, or severely
immunosuppressed
patients.
There are some limited data to suggest that acupressure can be more effective than either acupuncture or physical therapy.
Slide47Slide48Reiki and healing touch
They both posit the ability of one human being to positively influence the energy field of another individual to improve their health.
Healing touch does require some specific hand positions for certain conditions, but this is not always necessary.
both of these modalities can be effective in reducing
psychologic
sequelae
of disease, as well as speeding
healing
Slide49Slide50Reflexology
This is a natural healing art, based on the theory that there are reflexes in the feet and hands which correspond to every part of the body.
One recent study found significant improvement in spasticity,
paresthesias
, and urinary symptoms of multiple sclerosis patients
it was
not helpful
in the treatment of irritable bowel
syndromew
Slide51Slide52Electromagnetic fields and magnets
Electromagnetic fields are very familiar to physical medicine and rehabilitation physicians and are used in testing, such as magnetic resonance imaging scans, electromyography, and electrocardiograms.
Magnets are commonly used in the relief of pain.
Recent
radomized
controlled trials showed that magnetic insoles had no significant beneficial effect in the treatment of plantar heel pain and nonspecific foot pain
Slide53summary
This would suggest that these modalities would be appropriate only as second-line therapies to be used when proven or better studied treatments have not been shown to be efficacious.
Slide54Masuleh-Gilan