The Neurovisceral Integrative Model (NVIM) and its application in Osteopathy

Pascal Grolaux, BSc, DO. M.OSt, Dr (Hon) MACoPM. will present you this very original course already offered for osteopaths in Europe in several countries but now, he is organized it for the first time in Canada!

The course will focus on the complex neuromodulation of the neurovisceral integrative model that intimately connects the brain to the heart, as enunciated more than 160 years ago by Claude Bernard and reviewed recently to detail the role of the central autonomic network described as an integrated functional unit through which the brain controls visceromotor, neuroendocrine, neuroimmune, behavioral and emotional responses that are critical for psychophysiological and general physiology adaptability.

OBJECTIVES, PURPOSE, RELEVANCE FOR THE PUBLIC TO WHICH THE COURSE IS REFLECTED

In this 3-day course, you will learn how stressors (internal and external) affect the sympatho-vagal balance, modulates cognitive, behavioral, emotional, visceral and endocrine-immune processes, and disrupt the body stability hence heterostasis. You will also discover how the principle of inhibition (already highlighted by JM Littlejoh) is governing our central regulatory process through adapted cortical and sub-cortical neuromodulation.

At the end of the course the student will be able to:

• Understand the principles of inflammation related to neuroendocrineimmunology

• Understand the "anti-inflammatory reflexes"

• Understanding the intestines-brain and heart-brain connections in relation with the vagus nerve

• Understand the functions and roles of brain structures of the autonomic central network as well as the limbic system

• Understand the principles of HRV as a non-invasive biomarker and how can sympathovagal balance predict disease or health?

• Understand the osteopathic centers in relation to the autonomic nervous system and key immunological organs

• Set up an osteopathic treatment focused on osteopathic centers related to the endocrine system, immune system (including lymphatics) and autonomic nervous system

• Use HRV data to objectify effects on the neuroendocrine-immune system of osteopathic treatment

This course is designed for osteopathic practitioners and last year students in an official osteopthic program.

TOTAL CEUs EARNED at the end of the course: 2 CEUs (21h) with a certificate issued at the end of the course.

!!! Note: language will be English with French translation if needed.

SKILLS THAT WILL BE ACQUIRED

You will learn how to analyze the sympatho-vagal balance, based on short-term EKG record, and why and how an osteopathic treatment, focused on the person’s body, mind and spirit, could affect it in order to restore and maintain body stability towards heterostasis.

You will learn how an effective, targetted osteopathic treatment can modulate psychophysiologic and general physiologic processes and can be objectivate via heart rate variability analysis.

You will understand the principle of inhibition and how to promote it by specific OMT in order to regulate accordingly the symptho-vagal balance and to promote psycho-neuroendocrine-immune processes.

We will demonstrate the physiological effects of Osteopathic Manipulative Treatment compared to baseline physiological status.

In fact you will realize, by physiological biomarkers, the accepted definition of osteopathy that is :"to convert a mechanical action into its physiological equivalent".

Why to follow this course?

With specific-orientated osteopathic treatment and techniques, general and specific, the participant will be able to manage complex cases of chronic disorders (from depression to auto-immunes diseases and complex chronic pain syndrome) when there is evidence of neuroimmune and autonomic nervous system (SNS) dysfunctions, e.g., uncontrolled inflammation, dysautonomia by imbalance with over activity of the sympathetic nervous system and altered modulation of the vagal tone, that could be measured by heart rate variability (HRV) analysis.

Non-specific and specific OMT  known to alter the vagal activity, directly or indirectly will be seen and explained.

Other possible non-manual approaches to modulates the vagus nerve will also be discussed.

There is growing evidence that manual approach can have a direct or indirect effect on the vagal tone as shown by HRV analysis.

COURSE PROGRAM

Day 1:

• Applied neuro anatomy and physiology of the central vagal complex
• Applied neuro anatomy and physiology of the Central Autonomic Network and the Limbic system
• The autonomic anti-inflammatory pathways and introduction to cellular immunology
• The osteopathic centers
• Discussion and resume of the day

Day 2:

• The gut-brain and heart-brain axis, introduction to the gut-lungs axis
• Heart rate variability (HRV) as a biomarker of the sympatho-vagal balance
• The neurovisceral integrative model and Heart Rate Variability
• Analyzing Heart Rate Variability with portable ECG : normal ECG, arrhythmias, correction of ectopic beats and ECG derived respiration frequency to influence HRV results
• Practicing short term HRV analysis by group of two
• Applied osteopathic treatment to influence the sympatho-vagal balance. Practice by group of two
• HRV analysis post osteopathic treatment
• Discussion and resume of the day

Day 3:

• Review of HRV analysis. Practice by group of two
• Osteopathic treatment guidelines and practice to mediate better self-regulation of the neurovisceral integrative model to improve the sympatho-vagal balance and visceromotor, neuroendocrine, neuroimmune, emotional and behavioral responses for a better adaptability and body heterostasis. Practice by group of two
• HRV analysis post osteopathic treatment. Practice by group of two
• Discussion and resume of the course

LEARNING TYPE

The course is a course which, in addition to osteopathic treatment with adequate techniques for the modulation of the vagus nerve and neuroendocrine-immune system, includes the simple practice of ECG, reading and analysis of the HRV.

The student will be shown optimal conditions for the analysis of heart rate variability, before and after treatment, using osteopathic maneuvers to modulate the neuroendocrine-immune system and the sympatovagal balance. Different modalities will be used to facilitate learning, such as:

• Reading and demonstration (typical osteopathic treatment targeting the neuroendocrine-immune system, use of ECG and manipulation of HRV data)
• Discussions
• Practice in groups of two (osteopathic treatment, ECG and HRV reading pre and post treatment evaluation)

SELECTED READINGS

Bowler et al. The effects of cervical sustained natural apophyseal glides on neck range of movement and sympathetic nervous system activity. International Journal of Osteopathic Medicine. February 23, 2017

Chippendale, Emma. Upper cervical manual techniques and measures of autonomic nervous system control. International Journal of Osteopathic Medicine, Volume 16, Issue 2, 123 – 124

Giles PD, Hensel KL, Pacchia CF, Smith ML. Suboccipital decompression enhances heart rate variability indices of cardiac control in healthy subjects. J Altern Complement Med. 2013 Feb;19(2):92-6. doi: 10.1089/acm.2011.0031. Epub 2012 Sep 20. PMID: 22994907; PMCID: PMC3576914.

Henley CE, Ivins D, Mills M, Wen FK, Benjamin BA. Osteopathic manipulative treatment and its relationship to autonomic nervous system activity as demonstrated by heart rate variability: a repeated measures study. Osteopath Med Prim Care. 2008 Jun 5;2:7. doi: 10.1186/1750-4732-2-7. PMID: 18534024; PMCID: PMC2442110.

Carnevali L, Lombardi L, Fornari M, Sgoifo A. Exploring the Effects of Osteopathic Manipulative Treatment on Autonomic Function Through the Lens of Heart Rate Variability. Front Neurosci. 2020 Oct 7;14:579365. doi: 10.3389/fnins.2020.579365. PMID: 33117124; PMCID: PMC7575744

Ruffini N, D'Alessandro G, Mariani N, Pollastrelli A, Cardinali L, Cerritelli F. Variations of high frequency parameter of heart rate variability following osteopathic manipulative treatment in healthy subjects compared to control group and sham therapy: randomized controlled trial. Front Neurosci. 2015 Aug 4;9:272. doi: 10.3389/fnins.2015.00272. PMID: 26300719; PMCID: PMC4523739.

Fornari M, Carnevali L, Sgoifo A. Single Osteopathic Manipulative Therapy Session Dampens Acute Autonomic and Neuroendocrine Responses to Mental Stress in Healthy Male Participants. J Am Osteopath Assoc. 2017 Sep 1;117(9):559-567. doi: 10.7556/jaoa.2017.110. PMID: 28846122.

Cerritelli F, Chiacchiaretta P, Gambi F, Saggini R, Perrucci MG, Ferretti A. Osteopathy modulates brain-heart interaction in chronic pain patients: an ASL study. Sci Rep. 2021 Feb 25;11(1):4556. doi: 10.1038/s41598-021-83893-8. PMID: 33633195; PMCID: PMC7907192.

Żurowska A, Malak R, Kołcz-Trzęsicka A, Samborski W, Paprocka-Borowicz M. Compression of the Fourth Ventricle Using a Craniosacral Osteopathic Technique: A Systematic Review of the Clinical Evidence. Evid Based Complement Alternat Med. 2017;2017:2974962. doi: 10.1155/2017/2974962. Epub 2017 Oct 18. PMID: 29234380; PMCID: PMC5664229.

Tracey, K. J. (2002). "The inflammatory reflex." Nature 420(6917): 853-859.

Buschman, H. P., et al. (2006). "Heart rate control via vagus nerve stimulation."

Neuromodulation 9(3): 214-220.

Voss, A., et al. (2015). "Short-term heart rate variability--influence of gender and age in

healthy subjects." PloS One 10(3): e0118308.

Shaffer, F. and J. P. Ginsberg (2017). "An Overview of Heart Rate Variability Metrics and

Norms." Front Public Health 5: 258

Laborde S, Mosley E, Thayer JF. Heart rate variability and cardiac vagal tone in

psychophysiological research - Recommendations for experiment planning, data analysis,

and data reporting. Front Psychol. 2017;8(FEB):1–18

Burns L. Studies in Osteopathic Sciences, the Nerve Centres. Vol II. 1911.

Tasker DL. Principles of Osteopathy. Berkley & Elson Printing Co., editor. Los Angeles,

California; 1903.

Wernham SGJ. The Art and the Science of Osteopathy. Yearbook TMC, editor.

Maidstone, UK: Maidstone Osteopathic Clinic; 1988.

Bezilla T. The Effects on Stress on the Hypothalamus and Neuro-Endocrine System. An

Osteopathic Perspective. In: Osteopathy TI of C, editor. Yearbook - A Collection of

Articles, Lectures and Essays. 2018. p. 138–55.

Batten C. Physiological Principles in the Classical Osteopathic Treatment of Disease. In:

The Institute of Classical Osteopathy, Dorking U, editor. Yearbook. 1st Editio. 2018. p. 64–

99.

Littlejohn JM, meyran, LS. Principles of Osteopathy. JM Littlejohn Lectures notes.

Chicago, IL. American College of Osteopathic Medicine and Surgery. 1911.