13 - OMT & the Geriatric Patient (Boesler)

Question 1

[TQ] Which of the following is not true regarding the changes in aging?

a) You will find the most difficult and prominent dysfunctions in the geriatric population because results and somatic dysfunctions are cumulative.
b) The elderly have decreased height, increased body fat, sarcopenia, and loss of contractility
c) Decrease in bone mineral density leading to osteroporosis and fractures
d) Decreased in T-Cell functions and antibody production
e) decrease in autoantibodies

Answer 1

e) decrease in autoantibodies and infections and autoimmune disease

You will see an INCREASE in AUTOANTIBODIES and INFECTIONS.

Question 2

[TQ] Which of the following helps distinguish a V/S reflex from a somatic dysfunction due to postural influence or trauma?

a) increased temperature and sweat
b) Unusual resistance to OMT (i.e. it will come right back or doesn’t respond normally)
c) Firmness to the tissue, but no firm stiff end point to the articular tissue
d) a linkage of the of a thoracic vertebral and rib motion
e) all of the above

Answer 2

e) all of the above

Question 3

The Sicker the patient, the ______ the OMT at any time.

Answer 3

The SICKER the patient, the LESSER the OMT at any time.

Too much may overstimulate the tissues.

Question 4

A 388 year old patient comes into your office. What do you want to treat?

a) sympathetics
b) parasympathetics
c) lymphatics
d) structural
e) all of the above

Answer 4

e) all of the above:

One technique for each area.

Question 5

SALT!  
S = structure
A = autonomics
L = lymphatics
T = time

What do you use SALT for?

Answer 5

A way to remember how to treat geriatric patients on the OPP table.

Question 6

How do you treat the Vagus with OMT?

Answer 6

OA Decompression and V-spread of the cranial suture.

Question 7

A 88 yo patient comes in with pneumonia. How can you treat the consolidation with OMT?

Answer 7

Structural = Ribs
Sympathetics = Rib raising; 
Parasympathetics = ??
Lymph = rib raising, open thoracic inlet, pec tractions; thoracic pump

Question 8

Viscerosomatic and somatoverisceral reflexes are initiated through _________ fibers.

Answer 8

pain-carrying fibers

Question 9

Which area do you need to treat first in pain?

Answer 9

facilitated areas first!

Question 10

Direct or Indirect in very very sick patients?

Answer 10

Generally indirect, but do more direct articulatory because the sickest patients are unable to generate enough force to accomplish the desired effect from an indirect method.

Question 11

What are key dysfunctions in the elderly?

Answer 11

Generally the same in the most people?

Question 12

What are ABSOLUTE contraindications for HVLA in the elderly?

Answer 12

• RA in the cervical spine
• Down’s syndrome
• Fracture
• Ankylosing spondylitis
• Bone cancer

Question 13

Why is RA and Down’s syndrome in the cervical spine an absolute contraindication for HVLA?

Answer 13

weakened of ligament around the dens (alar ligament?)

Question 14

Which of the following is not an absolute contraindication for HVLA in the elderly?

a) RA in the cervical spine
b) Down’s syndrome
c) Fracture
d) Ankylosing spondylitis
e) Osteoporosis

Answer 14

e) Osteoporosis [ though this is debatable.

Question 15

Which of the following is not an absolute contraindication for cranial in the elderly?

a) Intracranial bleed
b) acute CVA
c) skull fracture
d) hypotension
e) increased intracranial pressure

Answer 15

d) hypotension