Beruflich Dokumente
Kultur Dokumente
Management on Neurologic
Development in Children
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255
Mental r e t a r d a t i on
Mental d e f i c i e n c y
Behavior problems
motional
j s t u r b ance
Autism
Disorders of
perception
Hearing lossl
,
n,. -,
>central
Blindness J
Learning disability
Dyslexia
Hyperkinesis
Speech d i s o r d e r s
Cerebral palsy
Spasticity
Athetosis
He
Flaccidity
Epilepsy
Down s y n d r o me
Genetic defect
Biochemical
insufficiency
Intrauterine
malnutrition
Drug i n f l u e n c e s
Rh i n c o m p a t i b i l i t y
Kernicterus
Damage
Nonprogressive
brain pathology
Prematurit y
False labor
Traumatic labor
Biochemical
changes
gia
emipI
Encephalitis
Trauma
Drowning
IHYPOXIA
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Figure Etiologic influences clinical dysfunctions, relation strain pattern amenable manipulative
treatment. A distinction should be made between visible organic histopathologic change and the more subtle
neurochemical pathophysiologic change.
Table 1
Profile of Development: Sensory Input *
36
and
Auditory
96
72
Excellent: months
Average: months
Satisfactory:
months
Tactile
Visual
Scale/age range
Excellent: 22 months
Average: 48 months
Satisfactory:
months
Excellent: 13 months
Average: 24 months
Satisfactory: 45
months
Understands 25 words
Excellent 8 months
Average: 12 months
Satisfactory: 26
months
Excellent: months
Average: months
Satisfactory: 13
months
in
of
to
Excellent: 1 month
Average: 2. 5 months
Satisfactory: 4.5
months
Pupils~respond to light
Birth
67
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Houle's3 Profile Development (POD), based earlier studies LeWinn,4 used estimate neurologic developmental status children. profile
includes three measures sensory performance (visual,
auditory, and tactile competence) (Table 1) and three of
motor performance (manual competence, mobility, and
agebyth
and
en-
ma-
72
ob-
on
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tohe
not
forthe
forthe
the
and
or
to
forthe
weeks' delay waiting-list group. This assignment start-first waiting-list group based
the physician's (V.M.F.) appointment schedule. Osteopathic palpatory examination treatment data
tained at research treatment visits were coded and entered into computer data base.
Assessments of neurologic development were made
by a co-researcher (P.S.) before the series of osteopathic
manipulative treatments, once start-first group
twice waiting-list group. These data were
tered into the computer data base, but data and analysis
were available physician administering
nipulative treatment (V.M.F.) until the child had completed the treatment schedule.
ThePOD
Adapted from "Profile Development." American Academy for Human Development, Piqua, Ohio, 1989.
257
of
Table 2
Profile Development: Motor Input*
Language
Manual
Excellent: 36 months
Average: 72 months
Satisfactory: 96
months
Excellent: 22 months
Average: 48 months
Satisfactory: 67
months
Excellent: 13 months
Average: 24 months
Satisfactory: 45
months
Excellent: months
Average: 12 months
Satisfactory:
months
Excellent: months
Average: 8 months
Satisfactory:
months
Excellent: month
Average: 2. 5 months
Satisfactory:
months
Consistently vital
response to threatening sounds
or events
Birth
and
to
to
in
has
13
4.5
Has
for
26
and
cryin
and
Mobility
Scale/age range
'Adapted from "Profile of Development" American Academy for Human Development, Piqua, Ohio, 1989.
at
at-
tolienh
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onthe
of
and
whoad
is
itwas
so
the
The
the
ofthe
and
Al
the
POD
at
by
The
and
Research design
andthe
be
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258
the
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be
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The
bya
The osteopathic palpatory diagnosis and manipulative treatments were provided single physician
(V.M.F.). objective treatment program
restoration unrestricted, symmetric, physiologic
inherent mobility in all parts of the body. Manifest
clinical change in symptoms was of secondary consideration. The individual treatment was tailored to the
needs particular child might administered
part body from head feet. Each
treatment was a completed experience whereby changes
occurring in one area would be compatible with responses elsewhere, and bilateral symmetry of function
would established area treatment. feel
of the tissues is the ultimate guide to the procedure performed point conclusion.
Techniques used included measures to influence
bone articulations, membranes fascia, muscle
activity, lymphatic drainage cerebrospinal fluid
The
Sixto12
and
the
Table 3
Research Design and Number of Participants in Each Testing*
Medical problems
Neurologic problems
Groups
Pretest
Post-test
Follow-up
Baseline
12
10
11
8
8
3
4
3
3
2
1
1
0
22
20
16
12
~T
23
11
21
11
8
3
15
20
14
18
6
13
34
31-32*
11
35
32
19
Research Groups
Waiting-list
Boys
Girls
Total
Start-firstT
Boys
Girls
Total
Comparison groups5
Incomplete
Boys
Girls
Total
Follow-up
Baseline
Drop-out
Boys
Girls
Total
12
6
14
13
18
27
17
11
9
6
28
15
Post-test
Pretest
1 86
the
who
al
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and
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for
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The
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not
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and
(V.MF)
in
is
calnd
tohe
asthe
No
was
of
neurologic problems. This classification, however, shown Table because later proved
important.
The POD scores for individuals were not available
treating physician before initial
evaluation assignment treatment schedules.
Changes these scores were known physician until after all treatments were completed.
The assignments of participants to the waiting-list
and start-first groups and types of presenting problems
were available co-investigator research
design data analysis (R.E.C.) until after treatments were
completed data been entered into
data base. co-investigator testing
scoring (P.S.) was also blind to the group and type-ofproblem assignments until all testing was completed.
Both co-investigators were blind to demographic background medical history of participants until completion treatments.
All data entered into the data base were analyzed by
of
dinot
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Asa
on
259
andSex
of
by
Table 4
Age-Adjusted Total Profile of Development (POD) Scores and those for Mobility and Manual Dexterity from
Initial Testing, Group, Type Problem,
Medical problems
Neurologic problems
Boys
Girls
Mean
SD
Mean
SD
Mean
SD
Mean
SD
0.673
0.735
0.809
0.178
0.172
0.092
0.770
0.745
0.808
0.351
0.272
0.289
0.738
0.714
0.842
0.007
0.297
0.197
1.126
0.937
0.969
0.838
0.991
0.543
0.763
0.758
0.826
0.353
0.346
0.241
(n = 10)
0.340
0.282
0.308
(n = .22t)
0.414
0.523
0.622
0.525
0.619
0.633
0.488
0.535
0.614
0.296
0.242
0.213
(n = 11)
0.368
0.297
0.251
(n = 13)
Incomplete
(baseline)
Mobility
Manual
Total
Total Group
SD
0.501
0.728
0.717
Dropout
(baseline)
Mobility
Manual
Total
Girls
Mean
(n = 12)
Start-first
(pretest)
Mobility
Manual
Total
Boys
0.512
0.702
0.635
0.230
0.327
0.207
1.045
0.980
1.061
(n = 10)
0.632
0.692
0.771
0.495
0.500
0.471
(n = 6)
0.646
0.378
0.445
(n = 15)
1.007
1.272
1.216
(n = 8)
0.336
0.292
0.312
(n == 3')
(n = 3)
0.365
0.309
0.258
(n == 20)
0.524
0.377
0.371
(n = 9)
0.788
0.944
0.955
0.879
1.002
1.071
0.710
0.927
0.873
0.193
0.126
0.111
(n = 3)
0.379
0.240
0.287
(n = 13)
0.994
1.069
1.048
0.480
0.472
0.276
(n == 11)
(n == 28)
0.730
0.833
0.881
0.480
0.349
0.368
(n == 68)
0.626
0.807
0.810
0.443
0.437
0.379
(n == 33)
0.756
0.859
0.875
0.440
0.401
0.354
(n == 40)
for
of
of
the
and
of
Results
260
of
of.06t1
ofthe
the
using SPSS PC-Plus programs.5 A multivariate analysis of variance (MANOVA) was carried out to determine contributions different variables their
combinations (interactions) to the variance and the statistical significance contributions. Significance
levels were considered worthy further
investigation, whereas levels of .05 or less were judged
to be fully acceptable evidence for the research hypothesis being tested (for rejecting a null hypothesis of no
significant outcome).
The
and
and
*Mobility: section of POD score measuring only mobility, Manual: section of POD score measuring only manual dexterity, Total:
POD score including mobility, manual dexterity, speech, visual ability, auditory competence, perceptive tactility.
'Small discrepancies between n value here and in Table 3 were produced because some children were not measurable on mobility
and manual scales only complete data these scales were analyzed.
Mean age-adjusted
Profile of Development Score
1.1-
1.00.9-
0.8-
0.7-
0.6-
Test 1
Test 2
Time of testing
Start-first group/
neurologic problems
Start-first group/
medical problems
o Waiting-ljst group/
neurologic problems
O Waiting list/
medical problems
Jun
thewo
2,
and
Figure 2. Comparison of changes in average total Profile of Develop-ment scores between first
and second testings for children classified by research group, waiting-list (wait) or start-first
(start), and by type of problem, neurologic (neuro) or medical (med). Test 1 for the wait subgroups
is baseline and test 2 is pretest with no treatment between testings. Test 1 for the start subgroups is
pretest, test post-test with treatment between testings.
Reprinted with permission from JAOA 92(6): 729-744, 1992
for
no
and
for
POD
the
was
the
the
schedule (dropout group) and 45 failed to take a posttest after completing treatments (incomplete group).
follow-up test was completed by only 43 of the original 186. In the waiting-list group only 13 completed
follow-up testing.
3)is
the
to
3,4
POD
The
The
forthe
to
for
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and
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261
Tables
Mean Profile of Development (POD) Scores from Tests 1 and 2,
by Group, Type of Problem, Scale, and Time of Testing
Waiting-list group
Test and
scale*
Neurologic problems
Mean
Mobility
Manual
Total
SD
Mean
SD
0.705
0.578
0.777
0.156
0.303
0.212
0.489
0.665
0.678
Mean
0.329
0.290
0.289
Pretest
0.341
0.205
0.202
0.801
0.826
0.872
Total sample
Medical problems
Mean
SD
SD
Pretest
0.280
0.228
0.197
0.724
0.737
0.815
Test 2
Mobility
Manual
Total
Neurologic problems
Baseline
Test
Medical problems
Mean
SD
Start-first group
0.973
0.986
1.071
0.514
0.341
0.360
0.733
0.793
0.858
1.115
1.087
1.151
0.523
0.375
0.356
0.872
0.937
0.977
0.437
0.330
0.338
Post-test
0.716
0.788
0.943
(n = 20)
0.693
0.877
0.872
0.164
0.264
0.160
0.395
0.424
0.379
(n=31 -32T)
(n =:6)
0.464
0.371
0.350
(n = 88)
(n = 32)
POD
ofPOD
ofPOD
* Mobility, section score measuring only mobility; Manual, section score measuring only manual dexterity; Total.
score including mobility, manual dexterity, speech, visual ability, auditory competence, and perceptive tactility.
T
0ne child had incomplete data on some scales.
Table 6
F-Ratios (MANOVA) for Profile of Development (POD) Scores: Test 1 Versus Test 2
n
Group (G)
Type of problem (7P)
G*7P1
Test (T) (1,2)
GxT
TPxT
GxTPxT
/t
1.15
4.33
3.55
29.61
0.30
0.00
5.97
.29
.04
.06
.00
.59
.96
.02
Manual
Mobility
Total*
Comparison
df
1/84
0.54
3.28
5.20
12.91
4.27
1.15
0.00
df
P
.47
.07
.03
,00
.04
.31
.97
2.24
0.96
4.54
18.86
0.01
0.01
2.74
1/85
df
.14
.33
.04
.00
.92
.94
.10
1/84
<
forthe
the
are
The
262
of
the
twoPOD
and
aP
.05is
by
ofPOD
POD
, manual dexterity, speech, visual ability, auditory competence, and perceptive tactility. Mobility.
*Total: score including mobility
section of POD score measuring only mobility. Manual: section score measuring only manual dexterity.
t
ratio compares mean differences t< > error
^Probability of the mean difference re<;urring chance only. z considered significant; P.00 means value .005.
'The number of degrees of freedom, based on the number of mean differences (numerator) and scores in the error term (denominator) of
theFratio.
'Two or more symbols with a times si pi between them represent the joint effect of two or more variables (an interaction).
Table?
Waking-list group
Test and
scale*
Neurologic problems
Mean
Medical problems
SD
Mean
Mobility
Manual
Total
0.187
0.393
0.276
0.673
0.657
0.783
0.226
0.456
0.735
0.729
0.226
0.113
Pretest
Test
Mobility
Manual
Total
0.794
0.825
0.865
0.176
0.239
0.160
0.650
0.713
0.870
0.706
0.994
0.931
0.272
0.375
0.241
Post-test
Mobility
0.929
0.884
0.969
Manual
Total
0.350
0.158
0.236
SD
0.868
0.970
1.001
0.389
0.301
0.275
0.714
0.823
0.863
1.031
1.034
1.086
0.452
0.348
0.300
0.857
0.937
0.966
0.433
0.261
0.286
1.005
0.997
1.061
0.348
0.288
0.250
Post-test
0.379
0.183
0.281
Test 3
Mean
SD
Pretest
0.306
0.237
0.215
0.712
0.739
0,807
Mean
SD
Baseline
Test
SD
Mean
Total Group
Medical problems
Neurologic problems
0.399
0.315
0.268
Follow-up
0.124
0.289
0.223
0.755
0.970
1.020
(n = 16)
(n == 3)
1.143
1.083
1.159
0.535
0.291
0.304
0.946
1.021
1.036
(n = 49)
(n = 19)
(n = 11)
0.428
0.249
0.276
POD
ofPOD
ofPOD
* Mobility: section score measuring only mobility; Manual, section score measuring only manual dexterity; Total.
and
score including mobility, manual dexterity, speech, visual ability, auditory competence, perceptive tactility.
Tables
F-Ratios (MANOVA) for Profile of Development (POD) Scores: Tests 1, 2, and 3
Comparison
(G)
Group
Type of problem (TP)
GxTPl
Test (T) (1,2)
G*T
TPxT
GxTPxT
Mobility
Total*
Ft
df
1/45
0.74
0.58
2.93
12.00
2.44
1.24
0.11
1.46
1.26
0.99
27.06
0.74
0.39
1.87
.23
.27
.33
.00
.48
.73
.16
2/90
3.54
0.00
.07
.98
1/25
1/20
Manual
df
1/45
.39
.45
.09
.00
.09
.29
.90
2/90
df
3.81
0.18
0.68
15.01
1.27
1.36
2.38
.06
.67
.41
.00
.29
.26
.10
1/45
2/90
&
Neurologic
Medical
and
POD
*7bto/: score including mobility, manual dexterity, speech, visual ability, auditory competence, perceptive tactility. Mobility.
section of POD score measuring only mobility. Manual: section of POD score measuring only manual dexterity.
T
<
aP
.05is
by
to
ofthe
The number of degrees of freedom, based on the number of mean differences (numerator) and scores in the error term (denominator) of
the F ratio.
'Two or more symbols with a times sign between them represent the joint effect of two or more variables (an interaction).
263
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Variations in neurologic performance have been related neurophysiologic measures central nervous
system functions. Pinkerton and associates6 compared
18 "good readers" with "poor readers" ordinary classroom of 8- and 9-year-old children. Brainstem auditory evoked potentials right were
significantly different from those in the left in the good
readers, such asymmetry found children
with learning difficulty. Small and coworkers7 demonstrated similar electroen-cephalographic findings in
children with attention deficit. Beckett,8 Sklar9
Satterfield,10 Murdoch,11 Van Mechelse,12 Rebert,13 and
Gasser14 their respective coauthors have identified
increased low-frequency electroencephalographic
power children with various learning problems.
These reports reflect an interaction between some
aspect of behavior and the presence of asymmetric or
altered nervous system conduction transmission
afferent nerve impulses (or both). To what extent those
differences in central nervous system measurements
would present asymmetry somatic function,
dysfunction, what extent they might improved
by osteopathic manipulative treatment that changes the
neurologic developmental profile remains to be determined.
The Millennium Yearbook
AO
no
Review of literature
be
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The
in
and
in
for
POD
the
is
The
Table 9 shows the mean POD scores for the 13 children waiting-list group completed four
possible testings. Scores for the total group steadily
increased from first third test. This trend
highly significant (P<.001). sample small
test between patterns type-of-problem categories. performance scale increases this
sample during follow-up period, found
the start-first group between their post-test and followup testings (Table Because pattern between tests
1 and 3 for the waiting-list group was similar whether
or group continued test final outcome
was unlikely reduced sample size.
The
onthe
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inthe
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who
no
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one
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onal
1and2re
and
the
264
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and
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The
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POD
are
are
was
al
and
andforthe
POD
and
Total Group
Medical problems
Neurologic problems
and
Test scale*
for
of
Table 9
Mean Age-Adjusted Profile Development (POD) Scores Tests through
for Waiting-List Group
SD
Mean
SD
Mean
SD
Test 1 (baseline)
Mobility
Manual
Total
0.735
0.736
0.812
0.348
0.246
0.244
0.765
0.961
1.005
0.000
0.000
0.000
0.738
0.753
0.826
0.334
0.244
0.240
Test (pretest)
Mobility
Manual
Total
0.813
0.835
0.880
0.435
0.192
0.246
0.729
0.916
L041
0.000
0.000
0.000
0.807
0.842
0.892
0.417
0.185
0.240
Test (post-test)
Mobility
Manual
Total
0.937
0.901
0.980
0.402
0.166
0.263
0.885
1.126
1.247
0.000
0.000
0.000
0.933
0.919
1.000
0.385
0.170
0.262
Test 4 (follow-up)
Mobility
Manual
Total
1.086
0.951
1.042
0.525
0.217
0.291
0.859
1.327
1.420
0,000
0.000
0.000
1.068
0.983
1.072
0.507
0.232
0.297
Mean
(n = 12)
(n =
1)
(n = 13)
to
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of
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the
of
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in the immediate area and in viscera at the nerve's ending and reduce venous and lymphatic drainage. Furthermore, as Hix17 indicates, the transport of an axoplasm along an axon to a terminal end organ is essential complete growth maintenance norfunction. concludes: "The inability visceral nerve to exert its early trophic influence on the
organ it innervates may have meaningful consequences
on ability denied organ metamorphose
full anatomic physiologic maturity." This statement suggests importance treating
musculoskeletal problems children.
Plagiocephaly is a term used here to describe
membranous articular strains that distort cranial
mechanism impair symmetric inherent physiologic motility. In a study of 1250 newborn babies,18
such strains were found in nearly 90% of neonates.
Children with learning problems exhibit a wide range
of somatic strain patterns related to trauma.19 New
technology, such computed tomography
brain magnetic resonance imaging, provides
ditional evidence brain injury.
Somatic dysfunction is not confined to the cranial
mechanism. It may be found throughout the musculosk-
its
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is
the
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on
The
is,t
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ive
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are
The osteopathic medical approach to health and disease is founded on the concept that structure and function interdependent. important concept stated
by Korr,15 that the musculoskeletal system is "the primary machinery life," implicit this approach.
The autonomic nervous system fine tunes this supportapparatus body meet ever-changing
demands of that primary machinery. The parasympathetic division protects internal environment, that
trophotropic because nutritional function.
The sympathetic division, by contrast, is ergotropic,
influencing the performance of the whole body in response to the environment.
studies microcirculation nerves
Sjostrand and coworkers16 demonstrate that slight
trauma, that is, moderate nerve compression, might
induce microvascular injury limited superficial
nerve layers indicated microbleedings edema
formation epineurium. This reversible situation duration compression limited.
lieve that impairment of physiologic inherent motility
of any part of the musculoskeletal system will adversely
affect nerve pathways passing through region. This
adverse effect in turn will induce capillary congestion
POD
ofPOD
ofPOD
*Mobility: section score measuring only mobility; Manual: section score measuring only manual dexterity; Total:
score including mobility, manual dexterity, speech, visual ability, auditory competence, and perceptive tactility.
265
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Conclusion
on
of
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as
theusof
This controlled study provides quantitative descriptive data support osteopathic manipulative treatment part pediatric health care based
osteopathic philosophy and principles. The management used for children in this research study provides
significantly improved sensory and motor performance
in children with neurologic problems.
to
by
tohe
ofthe
the
of
ofal
isthe
and
in
the
of
of
and
for
ofthe
the
are
to
the
to
for
There is a dynamic unity of the body. The fascia, one contributing influence on body unity, provides
continuity structure from soles feet
top of the head. Every musculoskeletal change results
in widespread adjustments mediated throughout
fascial system.
of
in
The
25,
WG.
2.
N.
13.
MJ.
EB.
LeWinn, Human Neurological Organization. Springfield, IL. Charles Thomas Publisher. 1977. 72-154.
Norusis, SPSS/PC+, chap 7-11, Advanced Statistics
SPSS/PC+, chap 4, 5. Chicago, IL. SPSS, Inc. 1986.
and
RJ.A
DR,
of
F,
Pinkerton Watson McClelland neurophysiological study children with reading, writing spelling diffi-
4.
5.
Houle, Profile of Development, ed Piqua, Ohio. American Academy for Human Development. 1980. Appendix 1.
of
of
RG,
Beckett, PGS, Bickford, Keith, electroencephalogram various aspects mental deficiency. / Disabil
and
of
in
in
inthe
6.
of
and
orthe
of
to
for
LM.
2.
A number of factors affected the outcome of this research. At the time of the initial visit to the Center,
factors in the history, the course of the disability, the
dysfunction, disease, memories previous
experiences in diagnosis or treatment contribute to a child's
potential initial participation program. Gaining
the cooperation and confidence of a child and inspiring 7.
that child participate treatment have major impact
on outcome care. Delay initiation osteopathic
8.
manipulative treatment may have contributed negatively
to this outcome or to failure to complete a treatment pro9.
gram or to return for the final assessment. Because many
patients come from distant parts, these geographic factors often contributed to dropping out.
the
Sutherland, Final lecture. Seminar Cranial Osteopathy. Moines. April 1948. Contributions Thought.
1967. p 147.
Agresti, Attention deficit disorder. hyperactive child.
Des
1.
3.
Comment
References
267
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of
of
mal
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268
the
the