[Dysphagia] physios/chiropractors in swallowing rehab

[LOBSTERPAM at aol.com (LOBSTERPAM@aol.com)]

In a message dated 10/6/05 1:33:01, DRolfe@nsccahs.health.nsw.gov.au writes:

<< A colleague spoke with a private physiotherapist who does "cranio-sacral" 
therapy (I hope I got the term right), who said he could fix the dysphagia 
with 1 manipulation! >>

I did a search on craniosacral therapy, and this is the first site that came 
up.  Steve Barrett maintains a terrific site on objective evaluations of 
questionable medical practices.  He presents scientific evidence which does not 
make some people happy - the Cheers and Jeers section is recommended as 
interesting reading.  
http://www.quackwatch.org/01QuackeryRelatedTopics/cranial.html
http://www.quackwatch.org/00AboutQuackwatch/comments.html

The next site was from the International Alliance of Healthcare Educators.  
The section on craniosacral therapy has co-referenced topic called 
SomatoEmotional Release (SER).  http://www.iahe.com/html/therapies/cst.jsp

It states that SER is a "therapeutic process that uses and expands the 
principles of craniosacral therapy to help rid the mind and body of residual effects 
of trauma.  SERI offers applications designed to enhance results using CST 
and other complementary therapies.
    Assess and mobilize the Avenue of Expression working through more than 10 
body components, including the thoracic inlet, hard palate, and hyoglossal 
tissues.
    Locate and release Energy Cysts
    Release suppressed emotions that may be inhibiting complete structural 
releases.
    Refine listening and comprehension skills
    Improve palpation and whole-body evaluation skills."

I have no idea what an Avenue of Expression or an Energy Cyst is, so I went 
to Medline.  Neither phrase is found.  So I searched for CranioSacral Therapy.  
There is a letter to the Journal of the American Physical Therapy Association 
 - http://www.ptjournal.org/Nov2002/Nov02_Letters.cfm  - must scroll down to 
the third letter, by Steve E Hartman, PhD and James M Norton, PhD, professors 
in the 
Department of Anatomy, College of Osteopathic Medicine, University of New 
England, discussing that the method is not medicine, but a belief system.  It is 
interesting to consider that "belief systems" are difficult for proponents to 
reject, despite the presentation of evidence, because by their very nature 
(they are beliefs!) they didn't require evidence to be assumed in the first 
place.  Faith, by definition, is belief without direct evidence.

See also the following:

Green C, Martin CW, Bassett K, Kazanjian A.   A systematic review of 
craniosacral therapy: biological plausibility, assessment reliability and clinical 
effectiveness.Complement Ther Med. 1999 Dec;7(4):201-7. 

BC Office of Health Technology Assessment, University of British Columbia, 
Vancouver, Canada.
OBJECTIVES: The objective of this research was to review critically the 
scientific basis of craniosacral therapy as a therapeutic intervention. DESIGN: A 
systematic search for and critical appraisal of research on craniosacral 
therapy was conducted. Medline, Embase, Healthstar, Mantis, Allied and Alternative 
Medicine, Scisearch and Biosis were searched from their start date to February 
1999. MAIN OUTCOME MEASURES: A three-dimensional evaluative framework with 
related appraisal criteria: (A) craniosacral interventions and health outcomes; 
(B) validity of craniosacral assessment; and (C) pathophysiology of the 
craniosacral system. RESULTS: The available research on craniosacral treatment 
effectiveness constitutes low-grade evidence conducted using inadequate research 
protocols. One study reported negative side effects in outpatients with traumatic 
brain injury. Low inter-rater reliability ratings were found. CONCLUSIONS: 
This systematic review and critical appraisal found insufficient evidence to 
support craniosacral therapy. Research methods that could conclusively evaluate 
effectiveness have not been applied to date.

In short, there is no science to support the method.  But that doesn't mean 
some will believe it works. 

One could have a discussion over the placebo effect or the impact of one's 
faith on healing one's own body, but that is a different issue. IMO it does NOT 
warrant teaching, providing, and charging patients for a therapeutic approach 
which science cannot support.  

I would keep my mother far away from any practitioner who claimed to be able 
to cure dysphagia via cranio sacral therapy.

Pam Smith