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Question 1

Spinal Facilitation defined:

Answer 1

• 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

Question 2

Dorsal sensory neurons

Answer 2

-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)

Question 3

Ia sensory neuron

Answer 3

-primary afferent, most sensitive to rapid change

Question 4

II sensory neuron

Answer 4

secondary afferent, sensitive to change in length

Question 5

Ib sensory neuron

Answer 5

only afferent nerve associated with golgi tendon organ

Question 6

Ventral motor neurons

Answer 6

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

Question 7

Alpha motor neurons

Answer 7

stimulate large fibers

Question 8

Gamma motor neurons

Answer 8

innervate small fibers–intrafusal fibers

Question 9

Muscle spindles

Answer 9

• 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

Question 10

Muscle spindles send information about

Answer 10

• muscle length

- rate of change in muscle length

Question 11

Purpose of muscle spindles

Answer 11

• prevent tissue disruption

- has more interest in protecting the muscle belly

Question 12

Stimulation of the muscle spindle occurs with

Answer 12

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

Question 13

Stretching the muscle spindle increases

Answer 13

rate of firing, and shortening decrease the rate of firing

Question 14

Golgi tendon reflex (GTR) sends information about

Answer 14

-muscle tension or rate of change in tension

Question 15

GTR purpose

Answer 15

• 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

Question 16

Mechanism of GTR

Answer 16

• autogenic inhibition/negative feedback loop

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

Question 17

Abnormal function of either GTR or muscle spindle can lead to

Answer 17

abnormal muscle function/tone

Question 18

Gamma motor neuron

Answer 18

• efferent neuron which innervates muscle spindles

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

Question 19

Gamma Loop

Answer 19

-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)

Question 20

Gamma Motor Neuron: keep muscle spindle taut

Answer 20

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

Question 21

Causes of gamma loop dysfunction/gamma gain dysfunction

Answer 21

• 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

Question 22

FPR Definition

Answer 22

• 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.

Question 23

Stretch reflex

Answer 23

• 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)

Question 24

Primary Goal of FPR is

Answer 24

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

Question 25

Basic Steps of FPR

Answer 25

- 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

Question 26

Advantages of FPR

Answer 26

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

Question 27

FPR indications

Answer 27

- 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

Question 28

Relative contraindications to FPR

Answer 28

- 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

Question 29

FPR Use Caution in

Answer 29

- osteoporosis - malignancy - rheumatological disorders - congenital malformations - stenosis - other clinical diseases

Question 30

FPR Absolute contraindications

Answer 30

-lack of patient consent or cooperation

Question 31

FPR Theory

Answer 31

- 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

Question 32

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

Answer 32

- 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