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Patients benefit from the presence of empathic caregivers (CGs). In this regard, empathy toward the patient is one of the clinical targets for improving patient outcomes. However, relatively little is known about the impact of patients' empathic responses on the CGs' burden. Among people living with Parkinson's disease (PwP), care partners play a major role. This study involved 28 spouse-patient couples. Empathy, stress burden, and mood disorders (such as anxiety and depression) were assessed over a 6-month period, before and after the reported intervention. Our observation points out that the improvement of patient empathy is necessary for a significant burden reduction among spouses caring for PwP.

Bruno Bordoni,1–3 F Marelli,2,3 B Morabito,2–4 B Sacconi5 1Department of Cardiology, Foundation Don Carlo Gnocchi IRCCS, Institute of Hospitalization and Care with Scientific Address, Milan, 2CRESO, School of Osteopathic Centre for Research and Studies, Castellanza, 3CRESO, School of Osteopathic Centre for Research and Studies, Falconara Marittima, 4Foundation Polyclinic University A Gemelli, University Cattolica del Sacro Cuore, 5Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Rome, Italy Abstract: The respiratory diaphragm is the most important muscle for breathing. It contributes to various processes such as expectoration, vomiting, swallowing, urination, and defecation. It facilitates the venous and lymphatic return and helps viscera located above and below the diaphragm to work properly. Its activity is fundamental in the maintenance of posture and body position changes. It can affect the pain perception and emotional state. Many authors reported on diaphragmatic training by using special instruments, whereas only a few studies focused on manual therapy approaches. To the knowledge of the authors, the existing scientific literature does not exhaustively examines the manual evaluation of the diaphragm in its different portions. A complete evaluation of the diaphragm is mandatory for several professional subjects, such as physiotherapists, osteopaths, and chiropractors not only to elaborate a treatment strategy but also to obtain information on the validity of the training performed on the patient. This article aims to describe a strategy of manual evaluation of the diaphragm, with particular attention to anatomical fundamentals, in order to stimulate further research on this less explored field. Keywords: diaphragm, osteopathic evaluation, manual therapy, chiropractic, physiotherapy

Bruno Bordoni,1-3 Fabiola Marelli,2,3 Bruno Morabito2-4 1Department of Cardiology, Santa Maria Nascente IRCCS, Don Carlo Gnocchi Foundation, Institute of Hospitalization and Care with Scientific Address, Milan, 2CRESO, School of Osteopathic Centre for Research and Studies, Castellanza,3CRESO, School of Osteopathic Centre for Research and Studies, Falconara Marittima, Ancona, 4Foundation Polyclinic University A, Gemelli University Cattolica del Sacro Cuore, Rome, Italy Abstract: The tongue plays a fundamental role in several bodily functions; in the case of a dysfunction, an exhaustive knowledge of manual techniques to treat the tongue is useful in order to help patients on their path toward recovery. A 30-year-old male patient with a recent history of whiplash, with increasing cervical pain during swallowing and reduced ability to open the mouth, was treated with osteopathic techniques addressed to the tongue. The osteopathic techniques led to a disappearance of pain and the complete recovery of the normal functions of the tongue, such as swallowing and mouth opening. The manual osteopathic approach consists of applying a low load, in order to produce a long-lasting stretching of the myofascial complex, with the aim of restoring the optimal length of this continuum, decreasing pain, and improving functionality. According to the authors’ knowledge, this is the first article reporting a case of resolution of a post whiplash disorder through osteopathic treatment of the tongue. Keywords: tongue, indirect osteopathic techniques, fascia, fascial release

This study aimed to evaluate the relationship quality and satisfaction in couples, in which one partner had PD, obtaining the perspective of both patients and partner and to examine the impact of alexithymia, empathy, depression, and anxiety on ratings of relationship quality and satisfaction. Fifteen PD patients and partners completed the following scales: the Dyadic Adjustment Scale; Couple Satisfaction Index (CSI); the 20-item Toronto Alexithymia Scale; the Empathy Quotient; the Hamilton Depression and the Hamilton Anxiety Rating Scale (HAM-A). We evaluated patients' motor functions by means of Unified Parkinson's Disease Rating Scale and patients' quality of life by means of the PD Questionnaire. Patients were significantly less satisfied with the relationship than their partners as revealed by CSI (p = 0.031) and they were more depressed (p = 0.003) and anxious (p = 0.015). A negative correlation between measures of relationship quality and satisfaction and alexithymia was found in the patients group. No correlations were found between measures of relationship quality and satisfaction (both of patients and partners) and any other demographical and clinical variables. CSI and HAM-A were predictors of patient's social support evaluation. The presence of alexithymia in PD is an important factor affecting relationship quality and satisfaction.

Impaired emotional facial expressiveness is an important feature in Parkinson's disease (PD). Although there is evidence of a possible relationship between reduced facial expressiveness and altered emotion recognition or imagery in PD, it is unknown whether other aspects of the emotional processing, such as subjective emotional experience (alexithymia), might influence hypomimia in this condition. In this study wee aimed to investigate possible relationship between reduced facial expressiveness and altered emotion processing (including facial recognition and alexithymia) in patients with PD.