psychosocial interventions, should work together to address both the physical and emotional aspects of function to optimize treatment (Bordoni & Marelli, 2017). Physical therapists are beginning to make connections between the mind and the body, and how emotions relate to the interstitial system, body pains, autoimmune responses, and ROM limitations with sclerodermic conditions (Ballantyne et al., 2019; Bordoni & Marelli, 2017; Myers, 2016). Occupational therapy practitioners are exploring mindfulness therapies for their many benefits, and evidence is emerging to show how physical and emotional pain relate to one another, for example, how doing yoga can reduce anxiety (AOTA, 2017; Ballantyne et al., 2019; White et al., 2020). There is evidence that mindfulness therapies work, that physical domains and how they function can be addressed through CHAIHs. The above described CHAIHs are all missed opportunities for therapy practitioners to help patients who have GVHD, cancer, type 2 diabetes, human immunodeficiency virus (HIV), and other disorders with neuropathic pain, sclerodermic changes, and autoimmune issues (Mohammed et al., 2019; Rosenthal et al., 2019; White et al., 2020). Interventions and changes within the interstitial system also impact the endocrine and musculoskeletal systems. The interstitial system changes with age, as described earlier, with beneficial and detrimental cellular senescence; most research has looked at the affected lymphatic system. Older adults have up to a 70% reduction of circulating lymphocytes as compared to young adults (Filelfi et al., 2021). Apoptosis (cell death), which occurs as a normal and controlled part of an organism's growth and development, increases with age in all body systems, including the interstitial system (Davan-Wetton et al., 2021). Cells lose the power to divide and grow. The lymphatic system has active and passive parts, which are both affected with aging. The active part is from lymphatic muscle contractions— specifically, activity from lymphatic vessels—and muscle contractions knead the lymphatic valves of the lymphangions (Filelfi et al., 2021). The passive part is extrinsic contractions from all other forces that influence lymphatic flow such as the force of gravity, muscle contractions, artery pulsations, and respiratory activity (Filelfi et al., 2021). Aging has been associated with alterations in muscle strength and function, and can be associated with all organ systems. The lymphatic system is interwoven through all systems. It is responsible for sensing damage to body tissues, containing damage, and clearing damaged cells (Davan-Wetton et al., 2021). If the lymphatic system is compromised, tissue repair is slowed or halted; homeostasis cannot be achieved through necrotized cell clearance; and cell apoptosis and failed resolution can be seen through chronic inflammation, which is referred to as lymphedema (Filelfi et al., 2021). Participation in moderate exercise improves senescence, reduces edema, and improves adapted immunity even in people who were previously sedentary (Papp et al., 2021). range of motion, standing, and movement tolerance. These changes affect a person’s ability to perform many activities of daily living (ADL) as well as participate in many tasks that require functional mobility (Frontera, 2017). However, many musculoskeletal changes can be ameliorated with appropriate exercise training and a physically active lifestyle (Frontera, 2017). Many ADL can also be adapted if an individual has orthopedic limits due to pain or joint deterioration, or if they need to follow postsurgical orthopedic restrictions. According to Frontera, in his
and fascia is still in its infancy, as therapy practitioners who are ready to measure the effectiveness of interventions are still waiting on crowdsourcing to get more data on what an actual map of a normal human fascia would look like in living tissue (Myers, 2016; Tkaczyk et al., 2019). For now, physical and occupational therapy practitioners must rely on their vision and sense of touch, observing only the superficial dermal layer’s response to tissue mobilization, along with patient reports of “better,” “worse,” or “no change” after an intervention. Or they can use a handheld ultrasound system to assess deeper dermal layers, but this is expensive and time consuming (Tkaczyk et al., 2019). In the clinical world, there are content providers who are well known for their specialized training in manual and hands- on complementary health approaches and integrative health (CHAIH) treatment techniques, publications, and trainings in the treatment of fascia as well as the myofascial and interstitial systems. But most of the data they use are anecdotal, experiential, and/or from books by respected authorities (Davis, 2017; Myers, 2016; Tkacyk et al., 2019). Patients with graft versus host disease (GVHD), a condition that includes induration of fibrotic lesions throughout the interstitial system, seek out practitioners with such certifications to help address painful symptoms associated with tissue induration, to improve their range of motion (ROM), and to increase energy and activity tolerance by improving their interstitial system response (R. Jordan, personal communication, March 10, 2020). The predicament related to focusing on the interstitial system is that it is not well understood beyond the cadaver, and an understanding of the sclerotic changes associated with GVHD is limited to our knowledge of the living interstitial/myofascial system; only partial models of this body system have developed with live tissue (Myers, 2016; Tkaczyk et al., 2019. According to Bordoni and Marelli (2017), “There are numerous articles in the literature dealing with the myofascial system . . . yet, we still do not have a thorough knowledge of its functions, just as there is no shared vision on how to classify it” (p. 110). Not one year after this problem was defined, Benias et al. (2018) answered the demand for a unified vision by proposing that the myofascial system, the interstitial space between dermal layers, and the lymphatic space need to be classified as an organ, the interstitium. There is a connection between the myofascial system and the brain, the body and emotion (Bordoni & Marelli, 2017). Physical therapy practitioners have very recently explored mind– body connections and manual therapies related to the interstitium, and both occupational therapy and physical therapy have proven the benefits of meditation related to pain performance and improved mind–body connections (Davis, 2017; White et al., 2020). Many developing manual therapies can help with the myofascial system, as can new parameters for measuring ROM improvements in GVHD (Bordoni & Marelli, 2017; Davis, 2017; Inamoto et al., 2014). Holistic practitioners with skill sets in CHAIH, such as manual therapies and Musculoskeletal system changes As with the other body systems, aging brings about numerous significant changes in the musculoskeletal system, which includes skeletal muscle, tendons, ligaments, bone, and articular cartilage. While changes in all body systems may impair mobility and function in older adults, decline in musculoskeletal system function may be especially harmful. Most components of the musculoskeletal system show significant losses of structural and functional properties, with aging affecting joint changes such as pain and stiffness (Frontera, 2017). Joint pain and stiffness lead to decreased
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