Hi, my name is Jennifer Kackelmeyer. I'm an OMS 3 at Lee Common Elmira. Hi, I'm Ryan Witzak, and I'm also an OMS 3 at Lee Common Elmira. And today we'll be presenting impact of suboccipital released osteopathic manipulative treatment on cardiac control in healthy adults, where we worked with Dr. Krasta on this project. So the study focused mainly on the technique of suboccipital release, which is a long held technique within the osteopathic community, and you can actually see it here on the little picture there, involves gently using both hands to pull on the suboccipital region of the neck to influence the vagus nerve. And in this study, we tried to look at vagal nerve impact on parasympathetic activations within the heart. And we used the QT interval mainly as our parameter, but we did look at all aspects of the EKG. And as you can see here within the QT interval, it also corresponds well to phases two and three of the ventricular action potential, which will come into play a little later. In short, the objective of our study was to examine how suboccipital release impacts cardiac control using QT variability as a surrogate measure. So we enrolled 24 first and second year medical students at Leigh Common Elmira. We subsequently had to exclude three students due to ineligibility criteria due to an abnormal baseline EKG. So our final analysis included 21 students. The eligibility screening included screening for medical conditions that precluded enrollment, such as taking medications that would interfere with the cardiac action potential or neuromuscular functioning. After an eligibility screening, we obtained informed consent and collected demographic and baseline health data such as height, weight, BMI, as well as blood pressure readings. This was a prospective crossover and single blinded study, meaning that we, the students performing the maneuvers knew what was coming next and what the treatment was that the students were receiving. However, the students didn't know which treatment they would be receiving in which order and the purpose of the treatment. And with it being a crossover study, each student served as their own control. The intervention started with a 15 minute rest period, followed by the baseline 12 lead EKG. Then we performed the sham treatment, which was a five minute treatment of holding our hands on the occipital condyles, but without applying pressure to the vagus nerve. And this served as our touch or sham control. A second EKG was taken after that, then the students received a 15 minute washout period where they just laid still. Then we did a five minute suboccipital release and did the final third EKG. We looked at the different EKG data points that were mentioned on the first slide, as well as nonova, Bonferroni's method for multiple comparisons, as well as a bland ultimate limit of agreements to look at the differences between the sham and the suboccipital release treatment. Looking at our results here on this graph, we can see QTC, which is a measure of variability of the QT interval. The B just signifies that we used Bassett's formula to calculate the QTC interval. From this plot, we can see that we found statistically significant results, both between the control and suboccipital release, as well as the sham treatment and suboccipital release. And the tendency that we see here is that there is an increase in the central tendency of the QTC variability. It shows that it appears per the data that the suboccipital release was effective in moderating individual variations within the QT interval. Now it was important for the study that we were able to determine that the other studies who have kind of been done about similar things regarding this study have shown that touch does have an impact on the parasympathetic activation. So we wanted to make sure that our study clarifies that suboccipital release was doing more than simply touch. So what we did was we ran a Van Altman plot to look at the two values associated there and look at the difference at the very end of them to what their statistical significance was. And we found that value to be negative 0.86, which shows that there's minimal difference between the two groups in terms of their QT end. So that shows that they both arrived at the same point. So the differences that we saw earlier must have occurred within that QTC variable data, which shows again that it was the suboccipital release that was responsible for the differences observed rather than simply touch. In conclusion, we found that suboccipital release resulted in variations of QT and QT shortening of the QT end intervals, which corresponded with the phase three of the cardiac action potential, which could potentially have some therapeutic implications for patients with arrhythmia. The decreased QT end and QTCB ratio is likely due to an increase in the parasympathetic activity due to the stimulation of the vagus nerve in the suboccipital region. And additionally, the Van Altman index helped us achieve different significant differences observed in the QT end of the suboccipital release group that they were caused by the suboccipital release treatment itself and not touching the patient in and of itself. Future directions, we'd love to continue this work in a larger sample size and a more diverse patient population to help confirm and expand the results and potentially see some clinical implications long term. Additionally, we administered the Maslock Burnout Inventory Student Survey to students before the intervention to gauge a standardized view of how they were doing with burnout and stress related to their studies at the time of their study visit. So in the coming months, we hope to do a secondary analysis of this project to see if there are any implications in those students that were more stressed at the time of their study. Jed and I and the entire research team would also like to extend our huge gratitude to the Lake Erie College of Medicine for their generous financial support and grants, as well as the Leigh Common Institutional Review Board for their approval of our project. And of course, to all the students who were able to take part in it.

suboccipital release

osteopathic manipulative treatment

QT interval variability

vagus nerve

cardiac control