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Letters to the Editor  |   June 2019
Osteopathic Cranial Manipulative Medicine as an Adjunct for Concussion Management
Author Notes
  • Riverside Methodist Hospital Family Medicine Residency Program, Columbus, Ohio 
Article Information
Emergency Medicine / Neuromusculoskeletal Disorders
Letters to the Editor   |   June 2019
Osteopathic Cranial Manipulative Medicine as an Adjunct for Concussion Management
The Journal of the American Osteopathic Association, June 2019, Vol. 119, 342. doi:10.7556/jaoa.2019.061
The Journal of the American Osteopathic Association, June 2019, Vol. 119, 342. doi:10.7556/jaoa.2019.061
To the Editor: 
Patel and Sabini1 provide new insight to the benefits that the osteopathic medical profession has to offer for patients with concussion, an injury that often causes significant morbidity. I have concerns, however, regarding the exclusion criteria of this study. According to the criteria, patients with “active or marked depression, anxiety, or psychosis” were not permitted to participate, and there was no explanation provided for the exclusion of this population. The psychological symptoms of depression and anxiety are common sequelae of concussion. Therefore, the results of this pilot study may not be generalizable for patients who have sustained concussions and have subsequent psychological symptoms. 
Concussions and psychological symptoms are intricately related.2 The prevalence of depression after concussion is approximately 35%,3 and not addressing psychological symptoms can limit recovery.2 As a osteopathic family medicine resident with an active patient population, I encounter patients on a regular basis who are seeking care for acute concussions or postconcussion sequelae. The majority of these patients have concomitant psychological symptoms, typically in the forms of anxiety and depression, which I manage in addition to their concussions. Data supporting the use of osteopathic cranial manipulative medicine (OCMM) would be of great value for these patients. 
This study has the potential to benefit many patients who are struggling to heal from a debilitating injury. Data supporting the use of OCMM also benefit the field of osteopathic medicine. Even though there may have been a valid explanation for excluding patients with depression and anxiety in this pilot study, future studies on OCMM for the treatment of patients with concussion should include patients with ongoing active psychological symptoms. 
References
Patel KG, Sabini RC. Safety of osteopathic cranial manipulative medicine as an adjunct to conventional postconcussion symptom management: a pilot study. J Am Osteopath Assoc. 2018;118(6):403-409. doi: 10.7556/jaoa.2018.061 [CrossRef] [PubMed]
Broshek DK, De Marco AP, Freeman JR. A review of post-concussion syndrome and psychological factors associated with concussion. Brain Inj. 2015;29(2):228-237. doi: 10.3109/02699052.2014.974674 [CrossRef] [PubMed]
Busch CR, Alpern HP. Depression after mild traumatic brain injury: a review of current research. Neuropsychol Rev. 1998;8(2):95-108. [CrossRef] [PubMed]