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3 Flashcards

1
Q

Spinal Facilitation defined:

A
  • the maintenance of a pool of neurons (e.g., premotor neurons, motor neurons or preganglionic sympathetic neurons in one or more segments of the spinal cord) in a state of partial or sub threshold excitation; in this state, less afferent stimulation is required to trigger the discharge of impulses
  • facilitation may be due to sustained increase in afferent input, aberrant patterns of afferent input, or changes within the affected neurons themselves or their chemical environment.
  • Once established, facilitation can be sustained by normal CNS activity
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2
Q

Dorsal sensory neurons

A

-give rise to 2 classes of sensory neurons that enter through the posterior horn and terminate immediately on gray matter or terminate on higher levels of the nervous system (brainstem, cerebral cortex, etc)

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3
Q

Ia sensory neuron

A

-primary afferent, most sensitive to rapid change

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4
Q

II sensory neuron

A

secondary afferent, sensitive to change in length

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5
Q

Ib sensory neuron

A

only afferent nerve associated with golgi tendon organ

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6
Q

Ventral motor neurons

A
  • give rise to 2 primary nerve types that exit the anterior horn to innervate skeletal muscle
  • alpha motor and gamma motor neurons
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7
Q

Alpha motor neurons

A

stimulate large fibers

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8
Q

Gamma motor neurons

A

innervate small fibers–intrafusal fibers

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9
Q

Muscle spindles

A
  • intrafusal mechanoreceptors between skeletal fibers (in belly of muscle)
  • composed of specialized intrafusal fibers (nuclear bag fibers and nuclear chain fibers)
  • innervated by both sensory and motor nerve fibers
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10
Q

Muscle spindles send information about

A
  • muscle length

- rate of change in muscle length

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11
Q

Purpose of muscle spindles

A
  • prevent tissue disruption

- has more interest in protecting the muscle belly

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12
Q

Stimulation of the muscle spindle occurs with

A

-lengthening of the whole muscle or with contracting the endpoints of intrafusal fibers

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13
Q

Stretching the muscle spindle increases

A

rate of firing, and shortening decrease the rate of firing

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14
Q

Golgi tendon reflex (GTR) sends information about

A

-muscle tension or rate of change in tension

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15
Q

GTR purpose

A
  • prevent tissue disruption/tearing of muscle or avulsion of tendon from boney attachment
  • has more interest in protecting the tendon (unlike muscle spindle protecting muscle belly)
  • allows brain to improve accuracy and precision of movement
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16
Q

Mechanism of GTR

A
  • autogenic inhibition/negative feedback loop

- extreme tension–>activate GTR–>inhibitor effect in spinal cord–>muscle relaxation

17
Q

Abnormal function of either GTR or muscle spindle can lead to

A

abnormal muscle function/tone

18
Q

Gamma motor neuron

A
  • efferent neuron which innervates muscle spindles

- two primary functions: gamma look; keep muscle spindle taut

19
Q

Gamma Loop

A

-stretch/contraction of muscle-> activates gamma motor neuron-> causes intrafusal fibers to contract-> stretches muscle spindle-> activates sensory endings-> innervates and excites alpha motor neuron-> muscle contraction (thought to be responsible for maintaining our postural tone)

20
Q

Gamma Motor Neuron: keep muscle spindle taut

A

-cause intrafusal fibers to contract sufficiently to stretch the muscle spindle towards threshold-> increases sensitivity of the muscle spindle apparatus to stretch

21
Q

Causes of gamma loop dysfunction/gamma gain dysfunction

A
  • firing too frequently–>prolonged stimulus
  • stretch reflex
  • even if the muscle goes back to neutral, or actively to a shortened position, the abnormal gamma motor neuron stimulation can continue stretch reflex, maintaining the spasm
22
Q

FPR Definition

A
  • a modification of indirect myofascial release treatment
  • Restricted region of the body is placed into a neutral position to diminish tissue and joint tension in all planes.
  • Then an activating force (compression or torsion) is added.
23
Q

Stretch reflex

A
  • sudden stretch of muscle-> stretching of muscle spindle-> activation of innervate alpha motor neuron -> muscle contraction-> spasm
  • sensory signals also travel to higher centers of the CNS, which cannot interpret them-> respond with gamma stimulation which maintains spasm (causing tender point)
24
Q

Primary Goal of FPR is

A

-to reduce abnormal muscle hypertonicity (superficial and deep) and restore lost motion to a restricted articulation

25
Q

Basic Steps of FPR

A
  • monitor at hypertonic muscles and/or over inferior articular facet of dysfunctional segment
  • modify the sagittal posture: flatten the curve or place the region in neutral position
  • add facilitating force of compression or torsion
  • move into freedom of motion: larger muscles are shortened; segmental somatic dysfunction are passively placed into freedoms of motion
  • tissue relaxation: hold for 3-4 sec monitoring for tissue relaxation or release of dysfunction
  • return to neutral and release compression
  • palpate for TART changes
26
Q

Advantages of FPR

A
  • easily applied, effective, and time efficient
  • good patient satisfaction
  • patients often report: immediate relief of tension/tenderness and restoration of function
  • thorough
27
Q

FPR indications

A
  • acute or chronic somatic dysfunctions (can be used primary treatment or in conjunction with other approaches)
  • muscle spasticity
  • safe to use on patients of all ages
28
Q

Relative contraindications to FPR

A
  • if the patient cannot voluntarily relax or tolerate position
  • severe osteoporosis or joint instability
  • if patient experiences radicular pain, then repositioning or traction may be attempted
  • Fracture or disc herniation in region being treated
  • not advisable across recent wounds or fractures less than 6 weeks old
29
Q

FPR Use Caution in

A
  • osteoporosis
  • malignancy
  • rheumatological disorders
  • congenital malformations
  • stenosis
  • other clinical diseases
30
Q

FPR Absolute contraindications

A

-lack of patient consent or cooperation

31
Q

FPR Theory

A
  • somatic dysfunction is initiated or maintained by increased activity in the gamma motor neurons of the muscles of a particular segment
  • the gamma motor system stimulates the muscle spindles
  • the overall result is increased tension in the muscle, even in the neutral position
32
Q

FPR treatment theory: positioning the muscle in neutral position results in:

A
  • inverse spindle output, which eliminates the afferent excitatory input to the spinal cord through the Group 1a and II fibers
  • tension and hypertonicity of the extrafusal muscle fiber is reset
  • positive influence upon proprioceptive and nociceptive activity
  • unloading the joint, which enables a rapid response to 3-plane therapeutic position (shifted neutral)
  • initial response is soft tissue then articular

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