Autonomic and Chapman Points Flashcards

1
Q

What is a reflex?

A

A relationship b/w an input stimulus to the body and an output action to either a muscle or a secretory organ

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2
Q

What is a myotatic reflex?

A

Tonic contraction of the muscles in response to a stretching force due to stimulation of muscle receptors

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3
Q

What fibers are in the upper layers 1-6 in the spinal cord gray matter?

A

Afferents from body synapse here

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4
Q

What fibers are located in lower layers of spinal cord gray matter?

A

Interneurons and motor neuron cell bodies

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5
Q

70-80% of interneurons receive input from what?

A

Both visceral and somatic efferents

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6
Q

Describe excitation of cortical influence

A

The sensitization of interneurons increases throughput and amplifies output
Results in maintaining the reflex reactions

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7
Q

Describe inhibition of cortical influences

A

Reduces the somatic and autonomic outflows

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8
Q

What is the facilitated segment?

A

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

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9
Q

What is sensitization?

A

The process of increasing response of a neural pathway with repetitive stimulation

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10
Q

What is habituation?

A

Opposite of sensitization

The process of decreasing response of a neural pathway with a continuous stimulation

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11
Q

What is the nociception theory?

A

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

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12
Q

What is facilitation?**

A

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)

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13
Q

Facilitation may be due to what?

A

Sustained increase in afferent input
Aberrant patterns of afferent input*
Changes within the participating neurons themselves
The neuron chemical environment

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14
Q

What are the steps of increasing sensitivity of neurons?

A

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

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15
Q

What is allostasis?

A

The response to stress in attempt to regain homeostasis

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16
Q

What are commonly observed effects associated with allostasis overload?

A

HTN, increased risk of MI, depression, anxiety, memory loss, decreased cognition, immunosuppression, autoimmune diseases

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17
Q

What is a somatosomatic reflex?

A

Localized somatic stimuli producing patterns of reflex response in (segmentally related) somatic structures

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18
Q

What is a somatovisceral reflex?

A

Localized somatic stimulation producing patterns of reflex response in (segmentally related) visceral structures
Ex: somatocardiac, somatogastric, somatoadrenal

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19
Q

What is a viscerosomatic reflex?

A

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)

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20
Q

What is a viscerovisceral reflex?

A

Localized visceral stimuli producing patterns of reflex response in segmentally related visceral structures

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21
Q

What is the withdrawal response of a somatosomatic reflex?

A

A noxious stimulus (pain, heat) is applied to a somatic structure
Withdrawal including contraction of flexors and relaxation of extensors
Avoidance of further injury

22
Q

What is the mytotactic response in a somatosomatic reflex?

A

A stretch receptor is abruptly stimulated

The stretched muscle receives the impulse to fire while its antagonist receives an inhibitory message

23
Q

What is the somatovisceral reflex?

A

Nociceptive somatic stimuli (pain) result in elevation of HR and BP

24
Q

What is the somatogastric reflex?

A

Nociceptive somatic stimuli (activity) results in inhibitor of peristalsis in the stomach

25
Q

What is the somatoadrenal reflex?

A

Nociceptive somatic stimuli results in the release of catecholamines from the adrenal medulla
E.g. Adrenalin release from movement of inflamed knee

26
Q

What is the sympathetic reflex level for the head and neck (including the upper esophagus)?

A

T1-5

27
Q

What are the reflex levels for the upper GI (including lower esophagus)?

A

T5-10

28
Q

What are the sympathetic reflex levels for the SI/ascending colon?

A

T9-11

29
Q

What are the sympathetic reflex levels for the ascending and transverse colon?

A

T10-L2

30
Q

What are the sympathetic reflex levels for the descending and sigmoid colon?

A

T12-L2

31
Q

What are the parasympathetic reflex levels for the Upper GI, SI/ascending colon, ascending and transverse colon?

A

OA, AA - vagus nerve

32
Q

What are the parasympathetic reflex levels for the descending and sigmoid colon?

A

S2-4

33
Q

What is the sympathetic reflex level for the UE and LE?

A

T2-7/T11-L2

34
Q

What are Chapman’s reflexes?

A

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

35
Q

What is the parasympathetic output for the lower and upper extremity?*

A

None

36
Q

What is the sympathetic reflex level for the heart?

A

T1-6

37
Q

What are the sympathetic reflex levels for the adrenals?

A

T5-10

38
Q

What provides parasympathetics to the heart and adrenals?

A

OA, AA - vagus N

39
Q

What is the sympathetic reflex level for the lungs?

A

T1-7

40
Q

What is the parasympathetic level for the lungs?

A

OA, AA - vagus N

41
Q

What are the sympathetic levels of the genitourinary tract (includes bladder)?

A

T10-L2

42
Q

What provides parasympathetics to the reproductive organs and pelvis?

A

S2-4 (Sacrum)

43
Q

What are the sympathetic reflex levels for the upper ureter?*

A

T10-11

44
Q

What is the sympathetic reflex level for the lower ureter?*

A

T12-L2

45
Q

What provides parasympathetics to the upper ureter?

A

OA, AA - vagus N

46
Q

What provides parasympathetics to the lower ureter, bladder and reproductive organs?

A

S2-4 (sacrum)

47
Q

What are the 3 component characteristics of Chapman reflexes?

A

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

48
Q

What are the palpatory features of Chapman reflexes?

A

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

49
Q

What are the characteristics of CP induced pain?

A

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

50
Q

What are the principles for using Chapman points for diagnosis?

A

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

51
Q

What are the contraindications for CP tx?

A

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