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APPENDIX A

CONSENT FOR PATICIPANTION IN AN EDUCATIONAL STUDY

DO CHILDREN WITH LEARNING DIFFICULTIES HAVE REDUCED MOBILITY IN THE NECK?
Investigator :
FRANCE CHAMPAGNE, Student of Osteopathy
132 Melvin Ave Hamilton, ON L8H 2J8
1(866)320989

25 Coach House Gate, Nepean, Ontario, K2E 7N1

1475 rte 133, Grand Barachois, N.B., E4P 8C9
1-506-532-9396

Faculty Supervisor :
Brandon Stevens, DO-MTP, M.OMSc., MICO.
Vice-Principal of the CAO
You are invited to participate in this voluntary study conducted by France Champagne observing the neck and
upper back in students with learning difficulties.
Contents:
Purpose of the Study /Research
Certificate of Consent
Purpose of the Study
This study is meant to discover whether children with learning difficulties have some changes in their
neck and upper back movement.
This knowledge may lead to future studies and treatments meant to improve learning ability in these individuals.
The initial investigation will fulfil the researchers educational requirement toward a Master of Osteopathic
Manipulative Sciences at the Canadian Academy of Osteopathy.
Procedures involved in the Research

Evaluation of participant following principles of Osteopathy.

Participant will wear loose clothing; move gently as instructed by researcher to assess mobility.
Researcher will palpate (touch) participants muscles and bones to determine location and flexibility

Treatment of the participant following principles of Osteopathy

Participant will be positioned as needed for appropriate therapy.
Researcher will discuss all treatment procedures prior to applying therapy.

Potential Risks
There should be no pain involved in this evaluation and treatment. Some mild discomfort could occur
during or after therapy and the researcher should be told if this happens. While there have been no reported bad
effects from an Osteopathic treatment, if any discomfort is felt the researcher should be told immediately.

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Potential Benefits
Participant may feel rested after a treatment, and have relief from mild aches and pains. Participant will
have Osteopathic treatments during the study period at no cost.
Participants and their parents/guardians will be given full access to the final thesis results as submitted to
the academic institution of the researcher.
The research is meant to help identify whether physical mobility/flexibility in the neck area is normal or
reduced in youth who show learning difficulties. Should limitations be demonstrated, follow up may lead to
osteopathic therapies to reduce learning deficiencies in these individuals. The overall research is meant to inform
relationships between physical attributes and learning difficulties.
Confidentiality
All identifying information related to the participant will be removed from the submitted report to
maintain confidentiality of all participants.
Participation and Withdrawal
Participation in this study is voluntary. Withdrawal from the study at any time is fully at the discretion
of the participant and/or their parent or guardian.
Questions about the Study
Any participants or parents/guardians who want more information about the study can contact the
researcher at: 1-506-532-9396 , or france-champagne@hotmail.com.
This study has been reviewed and approved by the Canadian Academy of Osteopathy Ethics Board. Any
concerns or question about potential risks or about the study methodology can be referred to:
CAO Research Ethic c/o Canadian Academy of Osteopathy
132 Melvin Ave Hamilton, ON L8H 2J8, 1(866)320989

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UNDERAGE MINOR CONSENT

1. What will happen to me in this study?

- You have been identified as someone who sometimes struggles to learn.
- This study will find out what movement you have in neck.
- You will wear loose clothing and flex and bend to see how well your bones and muscles move.
- You will lie down; the therapist will gently flex your muscles and bones to help them move
better. ( example : lifting your arm or leg )
- These treatments are not experimental. Only the relationship to learning is experimental.
2. Can anything bad happen to me?
- You may have some slightly sore muscles or joints.
- There are no known risks apart from discomfort for some people as mentioned above.
- If you have any discomfort either during or after any treatment you should tell the therapist
immediately or you should tell your parent or guardian if you are sick or in pain.
3. Can anything good happen to me?
- You may find you are more relaxed after a treatment.
- Please tell the therapist if being in school or sports is different after your treatments.
- This study may help researchers find ways to improve learning disabilities with osteopathy.
- At this time there is no known relationship between neck movement and learning. This is what
we are trying to find out in the study.
4. Will anyone know I am in the study?
- Only you, the researcher and your parent or guardian will know you are in the study. Your name
will be kept off the report that France Champagne submits for her Osteopathy degree.
- The information on the report will be shared in ways that your information will not be
recognized. For example, there may be graphs and tables that show the number of study
participants, the number who had movement limitations, and the number who moved better after
treatment, the number who reported a noticeable change, and the number who reported no
noticeable change. This example helps you see that any information about you will be private.
5. Who can I talk to about the study?
- If you have any questions about the study or any problems to do with the study you can contact
France Champagne at: : 1-506-532-9396 , or france-champagne@hotmail.com
- If you have questions about the study and want to talk to someone else who is not a part of the
study, you can call the CAO Research Ethic c/o Canadian Academy of Osteopathy, 132 Melvin
Ave Hamilton, ON L8H 2J8 , 1(866)-3209898
6. What if I do not want to do this?
- You can stop being in the study at any time you like.

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CONSENT FORM FOR UNDERAGE MINOR TO PARTICIPATE IN STUDY:

SIGNATURE OF CHILD
I have read the information presented about a study being conducted by France Champagne for her school.
I have had the chance to talk to France Champagne about the information in this document. France has also told
me I can talk to people on the Ethics committee of her school if I have any more questions or worries about
participating in the study. I have been given a copy of this form and I agree to participate in the study.
Printed name of Child ____________________________________________ Date ____________________

Signature of Child

____________________________________________ Date ____________________

SIGNATURE OF PARENT or GUARDIAN

I have read the information presented above about the study being conducted by France Champagne toward her
degree as a Master of Osteopathic Manipulative Sciences at the Canadian Academy of Osteopathy.
I have had the chance to discuss this study with France Champagne. France has provided me the opportunity to
communicate with the Ethics committee of the Canadian Academy of Osteopathy if I have further questions or
concerns about my childs participation in the study. I have been given a copy of this form and I agree to my
childs participation in the study.

Name of participating child: printed ___________________________________

Printed name of parent /guardian: __________________________________
Signature of parent/guardian: _____________________________________
Date________________________________________

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APPENDIX B

Clinique Thrapeutique Clinic,France Champagne RMT, CRT

1475 rte 133 Grand-Barachois & 667 rue Champlain Dieppe, tl: 506 532-9396

Osteopathie Classique ,

France Champagne
1475 rte 133
Grand Barachois
NB E4P 8C9

January 21, 2012

Object : study on somatic dysfunction in student diagnosed with learning disabilities

Good Day
I am presently doing a research on somatic dysfunction in student diagnosed with learning
disabilites. This research is to complete my academic requirement for a Master of Osteopathic
Manipulative Science ( M.OMSc) at the ''Canadian Academy of Osteopathy''
This research target student age 6 to 21, diagnosed with learning disabilities. The research will be
looking at the somatic dysfunctions in relation to the learning difficulties.
I would like to have volunteer for this research which meet the following criteria
student age between 6 and 21
having a diagnostic of learning disabilities ( dyslexia, dysgraphia, ADD/ ADHD,autism etc
The participant will have an osteopathic evaluation ( postural and structural ) followed by an
osteopathic treatments
The object is to find out if student diagnosed with learning difficulties display somatic dysfunction.
The results may demonstrate that osteopathic treatments could be added to the services offer to
student diagnosed with learning difficulties

France Champagne RMT, CRT

en instance de thse Master of Osteopathic Manipulative Sciences
@Canadian Academy of Osteopathy

1475 rte 133 Grand-Barachois, NB E4P 8C9, phone/ tl/ 506-532-9396, DDieppe:
667 rue Champlain suite 125

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APPENDIX C

Clinique Thrapeutique Clinic, France Champagne RMT, CRT

1475 rte 133 Grand-Barachois & 667 rue Champlain Dieppe, tl: 506 532-9396

Osteopathie Classique ,

France Champagne
1475 rte 133
Grand Barachois
NB E4P 8C9

Janvier 2012

Objet : tude sur les dysfonctions somatiques chez l'tudiant atteint de troubles d'apprentissage
Bonjour,
Je suis la recherche d'tudiants gs de 6 21 ans diagnostiqus de troubles d'apprentissage, afin
de complter les exigences de ma formation Master of Osteopathic Manipulative Science
( M.OMSc) au sein du ''Canadian Academy of Osteopathy''
Cette recherche consiste identifier les relations entre les dysfonctions somatique, principalement
celles de la colonne cervicale, chez les tudiants atteints de troubles d'apprentissage
Je recherche donc cette catgorie d'tudiants atteints soit de dyslexia, dysgraphie, TADHA avec ou
sens hyperactivit ou dautisme etc.
Les critres d'admissibilit pour cette tude sont les suivants:
tudiant g entre 6 et 21 ans
diagnostiqu d'un trouble d'apprentissage: dyslexie, dysgraphie, TADA/TADHA, autisme,
etc
ne souffrant aucunement de dficience intellectuelle
L'tude consiste faire un examen ostopathique postural et structural des participants suivie d'un
traitement dostopathie. Le but est de voir si les tudiants atteints de troubles d'apprentissage
dmontrent des dysfonctions somatiques .
Le rsultat de cette tude pourrait supporter l'utilisation de traitements ostopathiques comme
modalit additionnelles au soutient des tudiants atteints de troubles d'apprentissage.

France Champagne RMT, CRT

en instance de thse Master of Osteopathic Manipulative Sciences
@Canadian Academy of Osteopathy
1475 rte 133 Grand-Barachois,
667 rue Champlain suite 125

NB

E4P 8C9,

phone/

tl/

506-532-9396,

DDieppe:

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APPENDIX D
Learning Disability definition:
Learning disorder / Learning Disabilities or Specific Learning Disability is a group of disorders
characterized by difficulties in learning basic academic skills, that are not consistent with the person's
chronological age, educational opportunities, or intellectual abilities. Basic academic skills refer to
accurate and fluent reading, writing, and arithmetic. (DSM-5 development proposed revision)1
Learning disabilities: World Health Organization2
'' a state of arrested or incomplete development of mind''
Learning disability is a diagnosis, but it is not a disease, nor is it a physical or mental illness,
Unlike the latter, so far as we know it is not treatable.
Internationally three criteria are regarded as requiring to be met before learning disabilities can
be identified:

intellectual impairments ( mild: 50-70, moderate : 35-50, severe :20-35,

profound : below 20 IQ)

social or adaptive dysfunctions early onset

World Health Organization refers to ''Disorder of Psychological Development3

F81 - Specific developmental disorder of scholastic skills
F81.0 specific reading disorder
F81.1 specific spelling disorder
F81.2 specific disorder of arithmetical skills
F81.3 mixed disorder of scholastic skills
F81.8 other developmental disorders of scholastic skills
F81.9 developmental disorder of scholastic, unspecified
F82 Specific developmental disorder of motor function
F83 Mixed specific developmental disorders
F84.0-1-2-3-4-5-6-7-8-9 Pervasive development disorders
F88 Other disorders of psychological development
1 http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=429#
2 British Institute of Learning Disabilities http://www.bild.org.uk/docs/05faqs/Factsheet%20Learning%20Disabilities.pdf

3The ICD-10 Classification of Mental and Behavioural Disorders. Clinical description and diagnostic guidelines , World Health
Organization

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F90-F98 Behavioural and emotional disorders with onset usually occurring in childhood and
adolescence
F90- Hyperkinetic disorder (as ADD- ADH)
F99 - Unspecified mental disorder