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Letters to the Editor  |   June 2019
Response
Author Notes
  • Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, New York 
  • Southside Hospital, Bay Shore, New York 
Article Information
Emergency Medicine / Neuromusculoskeletal Disorders / Psychiatry
Letters to the Editor   |   June 2019
Response
The Journal of the American Osteopathic Association, June 2019, Vol. 119, 342a-343. doi:10.7556/jaoa.2019.062
The Journal of the American Osteopathic Association, June 2019, Vol. 119, 342a-343. doi:10.7556/jaoa.2019.062
Dr Eakin brings to light the complexity of management regarding patients with concussion. The sequelae after a concussion are multiple and can lead to a number of symptoms, in particular, worsened or heightened anxiety, depression, or posttraumatic stress disorder.1 From what we currently understand about concussion recovery, individuals with psychiatric comorbidities seem to have the greatest risk of prolonged symptoms and prolonged recovery.1-4 
The goal and purpose of our pilot study5 was to understand the safety of osteopathic cranial manipulative medicine (OCMM) as an adjunctive therapy in postconcussion symptom management and at the same time exclude any confounding factors that may influence or bias our findings. Confounding factors included those who had active or marked anxiety, depression, or psychosis after a concussion. Given that this patient population is believed to have the greatest risk of prolonged symptoms and delayed recovery, our study looked to exclude this factor to ensure that self-reporting of adverse events was related to the OCMM treatments and not secondary causes. However, that is not to say that OCMM is not generalizable or appropriate for persons with heightened or novel symptoms of anxiety, depression, or psychosis after a concussion. 
In agreement with Dr Eakin, data supporting the use of OCMM in addition to the current standard of care would be of great value for all patients who have had a concussion. We understand the importance of therapeutic touch and how it may contribute to a patient's recovery.6,7 Given the small sample size included in our study, we cannot conclude with certainty that any adverse effects from this treatment are limited, but our data suggest that OCMM is safe as an adjunctive therapy in this population. The potential for future studies to build on these results and further the use and field of OCMM in this patient population is promising. We hope that future studies will look to evaluate the efficacy and ability of this treatment to help resolve postconcussive symptoms. 
References
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Iverson GL, Gardner AJ, Terry DP, et al Predictors of clinical recovery from concussion: a systematic review. Br J Sports Med. 2017;51(12):941-948. doi: 10.1136/bjsports-2017-097729 [CrossRef] [PubMed]
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Tabatabaee A, Tafreshi MZ, Rassouli M, Aledavood SA, AlaviMajd H, Farahmand SK. Effect of therapeutic touch in patients with cancer: a literature review. Med Arch. 2016;70(2):142-147. doi: 10.5455/medarh.2016.70.142-147 [CrossRef] [PubMed]