Autonomic and Chapman Points Flashcards
What is a reflex?
A relationship b/w an input stimulus to the body and an output action to either a muscle or a secretory organ
What is a myotatic reflex?
Tonic contraction of the muscles in response to a stretching force due to stimulation of muscle receptors
What fibers are in the upper layers 1-6 in the spinal cord gray matter?
Afferents from body synapse here
What fibers are located in lower layers of spinal cord gray matter?
Interneurons and motor neuron cell bodies
70-80% of interneurons receive input from what?
Both visceral and somatic efferents
Describe excitation of cortical influence
The sensitization of interneurons increases throughput and amplifies output
Results in maintaining the reflex reactions
Describe inhibition of cortical influences
Reduces the somatic and autonomic outflows
What is the facilitated segment?
Constant afferent barrage by injured somatic or visceral structures would lead to segmental excitation, facilitating neuronal transmission and in turn producing excessive efferent response by the segment in question
What is sensitization?
The process of increasing response of a neural pathway with repetitive stimulation
What is habituation?
Opposite of sensitization
The process of decreasing response of a neural pathway with a continuous stimulation
What is the nociception theory?
Habituation and sensitization exist together to help maintain a homeostasis b/w over reaction and under reaction to a stimulus
Current theory as to cause for the facilitation involves alteration of nociceptive input
What is facilitation?**
Maintenance of a pool of neurons in a state of subthreshold excitation
Less afferent stimulation is required to trigger the discharge of impulses
Once established can be sustained by normal CNS activity (self sustaining process)
Facilitation may be due to what?
Sustained increase in afferent input
Aberrant patterns of afferent input*
Changes within the participating neurons themselves
The neuron chemical environment
What are the steps of increasing sensitivity of neurons?
Short term excitability (sensitization)
-1-2 seconds of afferent input; excitability lasts for 90-120 seconds
Long term sensitization
-inputs of several minutes; excitability lasts for hours
Fixation
-15-40 mins of afferent input; excitability lasts for days or weeks
Permanent excitability
-2-3 weeks of afferent input; lasts forever
What is allostasis?
The response to stress in attempt to regain homeostasis
What are commonly observed effects associated with allostasis overload?
HTN, increased risk of MI, depression, anxiety, memory loss, decreased cognition, immunosuppression, autoimmune diseases
What is a somatosomatic reflex?
Localized somatic stimuli producing patterns of reflex response in (segmentally related) somatic structures
What is a somatovisceral reflex?
Localized somatic stimulation producing patterns of reflex response in (segmentally related) visceral structures
Ex: somatocardiac, somatogastric, somatoadrenal
What is a viscerosomatic reflex?
Localized visceral stimuli producing patterns of reflex response in segmentally related somatic structures
Somatic pain referred due to visceral nociceptive stimuli (ex. Cardiac visceral pain in the chest wall)
What is a viscerovisceral reflex?
Localized visceral stimuli producing patterns of reflex response in segmentally related visceral structures
What is the withdrawal response of a somatosomatic reflex?
A noxious stimulus (pain, heat) is applied to a somatic structure
Withdrawal including contraction of flexors and relaxation of extensors
Avoidance of further injury
What is the mytotactic response in a somatosomatic reflex?
A stretch receptor is abruptly stimulated
The stretched muscle receives the impulse to fire while its antagonist receives an inhibitory message
What is the somatovisceral reflex?
Nociceptive somatic stimuli (pain) result in elevation of HR and BP
What is the somatogastric reflex?
Nociceptive somatic stimuli (activity) results in inhibitor of peristalsis in the stomach
What is the somatoadrenal reflex?
Nociceptive somatic stimuli results in the release of catecholamines from the adrenal medulla
E.g. Adrenalin release from movement of inflamed knee
What is the sympathetic reflex level for the head and neck (including the upper esophagus)?
T1-5
What are the reflex levels for the upper GI (including lower esophagus)?
T5-10
What are the sympathetic reflex levels for the SI/ascending colon?
T9-11
What are the sympathetic reflex levels for the ascending and transverse colon?
T10-L2
What are the sympathetic reflex levels for the descending and sigmoid colon?
T12-L2
What are the parasympathetic reflex levels for the Upper GI, SI/ascending colon, ascending and transverse colon?
OA, AA - vagus nerve
What are the parasympathetic reflex levels for the descending and sigmoid colon?
S2-4
What is the sympathetic reflex level for the UE and LE?
T2-7/T11-L2
What are Chapman’s reflexes?
A group of palpable points occurring in predictable locations on the anterior and posterior surface of the body that are considered to be reflections of visceral dysfunction or disease
What is the parasympathetic output for the lower and upper extremity?*
None
What is the sympathetic reflex level for the heart?
T1-6
What are the sympathetic reflex levels for the adrenals?
T5-10
What provides parasympathetics to the heart and adrenals?
OA, AA - vagus N
What is the sympathetic reflex level for the lungs?
T1-7
What is the parasympathetic level for the lungs?
OA, AA - vagus N
What are the sympathetic levels of the genitourinary tract (includes bladder)?
T10-L2
What provides parasympathetics to the reproductive organs and pelvis?
S2-4 (Sacrum)
What are the sympathetic reflex levels for the upper ureter?*
T10-11
What is the sympathetic reflex level for the lower ureter?*
T12-L2
What provides parasympathetics to the upper ureter?
OA, AA - vagus N
What provides parasympathetics to the lower ureter, bladder and reproductive organs?
S2-4 (sacrum)
What are the 3 component characteristics of Chapman reflexes?
Viscerosomatic reflex of both diagnostic and tx value
Gangliform contraction that blocks lymphatic drainage and causes sympathetic dysfunction (neurolymphatics)
A series of consistent reproducible anterior and posterior points related to specific organs or conditions
What are the palpatory features of Chapman reflexes?
Located deep to skin in the subcutaneous, areolar tissue on deep fascia, or at the periosteum
Paired anterior and posterior points in most cases
Small smooth and firm nodule
Approx 2-3 mm in diameter
May be confluent, ovoid, >1cm, linear ridge like 5-7cm, soft tapioca or hard BB like
What are the characteristics of CP induced pain?
Pinpoint located under the tip of the physicians finger
Sharp and non-radiating (somatic)
Pain is greater than is expected
Pt is usually previously unaware of the tender spot
What are the principles for using Chapman points for diagnosis?
Never make a dx based solely on a non tender SR (a non tender CR by itself indicates nothing)
Never ignore or trivialize a tender CR unless you have a good explanation for the findings
What are the contraindications for CP tx?
Anytime a pt needs emergent care the emphasis is always on airway, breathing and circulation, not OMT
Pt refusal
Relatively contraindicated with a local cancer or tissue instability like Fx, etc
