4 Flashcards
What is a reflex?
the relationship between an input to the body and an output action to either a muscle or a secretory organ.
what is Myotatic Reflex?
Stretching of a muscle causes stimulation of a muscle receptor => tonic contraction of the muscle
Do dorsal horn neurons respond to
visceral or somatic stimuli?
both
Some dorsal horn neurons respond to
visceral as well as somatic stimuli
what is the gray matter of the SC?
Processing area of cord. The upper 6 are where afferents from the body synapse.
- Layer 1 and 5: a delta fast pain fibers
- Layer 2: small c fibers
- Layer 3-4: mechanoreceptors
Lower layers are interneurons and motoneuron CB.
Visceral and somatic afferent fibers terminate mostly in what layers?
1 and 5 onto interneurons. The interneurons can then branch off to brain, body and other areas of the cord, acting as amplifiers or inhibitors.
why may visceral pain be so diffuse and poorly localized?
70-80% of interneurons receive input from both visceral and somatic afferents and many branches go caudad and cephalad
what creates localized pattern we see in pain?
interaction between the afferents, interneurons and SOMATIC EFFERENTS
_________ is the basis for activation of the somatic
muscle activity seen with visceral disturbances
overlap between visceral and somatic afferents binding onto interneurons
The ______ afferents activate _______ outflows and skeletal muscle motor neurons (ego. Increase tone)
visceral afferents
sympathetic outflows
There are descending influences on these reflexes, which do what?
- they affect the long-lasting excitability of the outflows by maintaining the reflex.
- inhibit somatic and autonomic outflows
______ disturbances reflexly cause activation in the somatic musculature.•
Somatic disturbances can reflexly alter visceral function
visceral
how does decompensation of homeostasis occur
visceral disturbances reflexively cause activation in somatic musculature and somatic disturbances can affect visceral function, which can cause LOSS OF HEALTH
What is the Somatic Component of Disease
MSK palpatory findings can correlate with visceral disturbances
What is the path from afferent => efferent?
Visceral and somatic afferent fibers terminate. The interneurons can then branch off to brain, body and other areas of the cord, acting as amplifiers or inhibitors. Input then goes to the motorneurons, which can respond to many afferents, of autonomics and MSK system
What is the Facilitated Segment Concept
Denslow found long-lasting, low threshold areas that respond to afferent inputs; whether they came from the same level, other levels or were d/t psychological stress and assx with disease or injury on EMG
Korr then said that these low threshold reflexes were hyperexcitation d/t continous input, and coined the term facilitated input.
Denslow found long-lasting, low threshold areas that respond to afferent inputs; whether they came from the same level, other levels or were d/t psychological stress.
He correlated these areas of excitation with disease and injury on the EMG.
Korr then said that these low threshold reflexes were hyperexcitation d/t continous input, and coined the term facilitated input.
WHAT DID FURTHER STUDIES SHOW?
skeletal muscles respond to spinal cord AND sympathetics.
a ubiquitous process of decreasing response of a neural
pathway with a continuous stimulation
habituation
when a response to a stimulus presented every sec or 2 grows for 20 seconds or more before finally reaching a stable response level that can continues until the stimulus is removed
Sensitization
Habituation and Sensitization exist together to do what
help maintain homeostasis between over-reaction and under-reaction to a stimulus
what is Nociception
Once a stimulus is strong enough to activate
(depolarize) nociceptive pathways, impulses travel to the cord and then branch to multiple sites, releasing peptides at the motorneuron in the peripheral tissues.
These then initiate inflammatory cascade and releases prostaglandins, bradykinins => which lower nociceptor thresholds =>
increase input to the cord
Nociception then causes what?
a disruption in the balance between sensitization and habituation => causing our interneurons to shift towards sensitrization and become more hyperexitable, which causes larger than normal motor outputs to the autonomics and somatic systems.
Korr and Denslow called what the faciliatted segment?
the interneurons that shifted towards sensitization that are hyperexcitable, WHICH CAN THEN CAUSE SD
Stimulus (insult) to the tissues causes inflammation.
Inflammation then causes primary afferent sensitization, which results in hyperalgesia, the exaggerated response to a noxious stimulus.
If the segmental facilitation is not treated, the patient can develop a secondary hyperalgesia in the CNS called central sensitization.
What is this process called?
allostasis, a loss of protective mechanisms
ppl who have chronic back spasms with little stimulus have what?
they underwent allostasis and developed central sensitization
what are the affects of allostasis on the brainstem?
- Facilitation decreases endogenous descending pathways
2. Damages our arousal system (gluco/catecholamines)
Allostasis has effects on what body systems
- CV: HTN, increased risk of MI,
- Neuro: depression, anxiety, mem loss
- Immune: immunosupression
local visceral stimuli produce patterns in segmentally related somatic structures
Viscerosomatic reflexes
somatic stimuli produce patterns in somatic structures
Somatosomatic
somatic stimuli produce patters in segmentally related visceral structures
Somatovisceral
visceral stimuli, patterns in visceral structures
Viscerovisceral
What are the viscerosomatic reflexes for head and neck?
sympathetic
parasympathetic
T1-T5
What are chapmans reflexes?
a group of palpable points that are gangliform contractions in the fascia on anterior and posterior parts of the of the body that are congested with lymph d/t visceral SD.
Chapmens reflexes were originally used by _________, DO and described by
_________, DO.
Frank Chapman, DO
Charles Owens, DO.
When I entered the American School of Osteopathy in 1897 the prevailing thought in the school was there was no sickness without bony lesion. 30 years as an DO in the field have, however, convinced me that bony lesions will account for only about 20% of our ailments…
Frank Chapman said this
What observation led Chapman to a more detailed study of the lymphatic system and its role in health and disease
Chapman had a patient with severe
adenitis who responded slowly to OMT of the spine.
He noticed that the groin glands and those on the medial side of the thighs were indurated and painful, and he decided to manipulate ONLY these glands. When the patient returned, his improvement was so good he only had to manipulate these areas. of “congested lymph”.
Chapman referred to these areas as what?
neurolymphatic points, bc that had a
physiological relation to the lymphatic and NS.
What are the 3 Components of chapmans points
- Viscerosomatic reflex
- Gangliform contractions that block lymph drainage and cause SNS dysfunction
- they are consistent points on the anterior and posterior part of the body that correspond to a specific organ or condition
what are the 5 palpatory features as described by owens
- gangliform
- edamatous
- ridge like or ropy
4 shotty - fibrospongy
chapments points are
located _____ to the skin in the
subcutaneous areolar tissu
____ mm
Hard?
size?
deep
2-3 mm
DENSE, not hard
small, smooth and firm like boba tea
how to diagnose chapmans points
- apply GENTLE but FIRM pressure, causing deep pain (some may show no pain but have a palpable mass). normal tissue should only cause mild distress
- check anterior first, then confirm with posteior
- PAIN SHOULD BE: pinpoint, sharp, NON-radiating, pain greater than expected
is pt usually aaware of chapmans point
no
how to treate chapmans points
- apply firm pressure w 1 finger that is heavy and even on the mass.
- move finger in a circular motion for 10-30 seconds alternating clockwise and counter
- stop when mass disappears or when pt can not tolerate
For a CR point to be
positive, both the anterior and the
posterior CR should be painful
T or F
T
what is an indication for diagnosis?
screen if needed based off patients history
what is an indication for tx?
finding a CR that is possibly clinically relevant to the patient
can we make a diagnosis based on a non-tender CR?
NO. NEVER. It tells us nothing
can we ignore a tender CR?
NO. unless you have a GOOD EXPLANATION
what is an absolte contraindication for Chapmans points
pt needs emergent care (Thus, focus on airway, breathing and circulation) or refuses
What is a RELATIVE contraindication for chapmans
local fracture, metastasis, or other instability.
Documentation of Chapman’s reflexes
OBJ: Musculoskeletal: Chapman’s reflex on right for lower lung
Assessment: Somatic dysfunction, other (ICD10 M99.09)
Plan: OMT done using Soft Tissue, Lymphatic
after tx, what should we tell paitents
drink water, rest (ALWAYS A precaution) and take normal pain meds as needed
