Didactic_Lecture 2 Flashcards
The 5 Osteopathic Models In Patient Assessment & Treatment
- are specific care approaches to the patient
- represent physiological functions that maintain health
- the 5 models play key roles in:
- Adaptation to stressors
- Recovery & repair from illness and disease
Osteopathic Philosophy & the 5 Models
the physcial musculoskeletal system often will reflect signs of internal diseases
5 models provide framework for interpreting significance of somatic dysfunction
Biomechanical Anatomical Correlates
Respitory-Circulatory Anatomical Correlates
- Thoracic inlet
- Thoracic & pelvic diaphragms
- Tentorium cerebelli
- Costal cage
Metabolic-Energy Anatomical Correlates
- Internal organs
- Endocrine glands
Neurological Anatomical Correlates
- Head (organs of special senses)
- Brain
- Spinal cord
- Autonomic nervous system (ANS)
- Peripheral nerves
Behavioural Anatomical Correlates
Brain
Biomechanical Physiological Functions
- Posture
- motion
Respiratory-Circulatory Physiological Functions
- respiration
- circulation
- venous & lymphatic drainage
Metabolic-Energy Physiological Functions
-
Metabolic processes:
- homeostasis
- energy balance
- regulatory processes
- Immunological activities and inflammation & repair
- Digestion, absorption of nutrients, waste removal
- Reproduction
Neurological Physiological Function
- Control & coordination
- Integration of body functions
- Protective mechanisms ( i.e. fight or flight)
- Sensation
Behavioural Physiological Function
- Psychological & social activities (e.g., stress, work, family)
- Habits (e.g., sleep, exercise, drug abuse)
- Values, attitudes, beliefs
Biomechanical Model OMT Techniques
Objective: Optimize patient’s adaptive potential through restoring structural integrity & functio
- Assess patient for structure abnormality (somatic dysfunction)
- Use OMT to correct somatic dysfunction = patient regains associated structural, vascular, neurologic, metabolic, & behavioral functions.
EX) Whiplash
Biomechanical Dysfunctions
Structural impediment via dysfunction of muscles, joints, connective tissue
- Can compromise vascular or neurological structures
- ↓↓↓ patient’s homeostatic capacity (Patient’s ability to adapt to insults & stressors)
Respiratory-Circulatory Central Processes
Tissues that screw the circulation of body fluids can affect health of tissues
- Central neural control
- CSF fluid flow
- Pulmonary & cardiovascular function
Respiratory-Circulatory Peripheral Processes
Delivery of oxygen & nutrients
Removal of cellular waste products via
- Arterial supply
- Venous & lymphatic drainage
Respiratory-Circulatory OMT Techniques
Objective: Maximize capacity & efficiency of respiratory- circulatory functions
OMT addresses dysfunction in:
- Respiratory mechanics
- Circulation
- Flow of body fluids
Ex) Pneumonia
Neurological Model OMM
There is a relationship between somatic & visceral autonomic systems
This model consides the neuroendocrine immune network by:
– Spinal facilitation
– Proprioceptive function
– Autonomic nervous system (ANS)
– Activity of nociceptors (pain fibers)
Neurological Model OMT Methods
Objective: re-establish optimal neural function
- Attain autonomic balance
- Address neural reflex activity
- Remove facilitated segments
- ↓↓↓ afferent nerve signals
- pain relief
OMT focuses on:
- ↓↓↓ of mechanical stresses
- Balance of neural inputs
- Elimination of nociceptive drive
Neurological Model Example
example: patient with peristalsis (lack of intestinal motion) after surgery
OMT focus:
- release paraspinal tensions & spasms
= ↓ sympathetic hyperactivity & ↑↑↑ parasympathetic activity
= Restoring normal intestinal motility
Metabolic-Energy Model OMT
Model requires energy-efficient response to infectious agents & repair of injuries
OMT REPAIRS SOMATIC DYSFUNCTION = OPTIMAL ENERY ECONOMY
- Adequate nutrition = normal biochemical processes, cellular functions, & neuromusculoskeletal activity
-
INJURY (somatic disfunction) to musculoskeletal system burdens body’s energy economy
- Dysregulate production, distribution, or expenditure of energy
- Increase allostatic load
- Interfere w/ immunological & endocrine regulatory functions
Behavioral Model OMT
Objective: improve body’s ability to effectively manage, compensate, or adapt to stressors (maximizing coping abilities)
- Musculoskeletal system can express emotions
- Stress = ↑↑↑ neuromuscular tension
OMT: Somatic dysfunction affects musculoskeletal system’s reaction to biopsychosocial stressors
Provide patient education on:
- Health
- Disease & lifestyle choices
- Mental outlook
- Preventative care
- Helps Patient Trust/ build Rapport
Neuroendocrine-Immune System Response
body has homeostatic rhythms (maintain appropriate changes necessary for promoting survival)
-
immune response sensitizes the PAN = to ↑↑↑ release of neurotransmitters & neuromodulators
- Activation of primary afferent nociceptor (PAN) and release of pro-inflammatory compounds into surrounding tissue
- Repetitive stimuli = PANs to be ↑↑ sensitive to low thresholds of energy
- = greater pain sensation: primary hyperalgesia
- = Allodynia: non-noxious stimuli elicits sensation of pain– Neurogenic inflammation
The Arousal System and Sickness Behaviours
Triggers of the arousal system:
- Somatic dysfunction (stress)
- Visceral dysfunction (stressors)
- Emotional dysfunction (stress)
Leads to Sickness Behaviour (Changes in Acute-Phase Response)
Neuroendocrine-Immune Network
Physical (somatic or visceral) & Emotional stimuli triggers the arousal system = impacted homeostasis
via triggering strong synpathetic response = release of adrenal cortical steroid hormones
NEURAL and ENDOCRINE systems interact with IMMUNE system
= ↑↑↑ cytokines, cortisol, & catecholamines
Homeostasis
Tendency of the body to seek and maintain a condition of balance or equilibrium within its internal environment, even when faced with external changes
Allostasis
Maintenance of stability through change: bring the body back to homeostasis
Disease processes will ACTIVATE allostatic response
- As threat diminishes, feedback control systems should suppress levels of allostatic compounds
- = returning body to normal function
Allostasis Arousal System
Somatic stressors
trauma or injury including somatic dysfunction
Visceral stressors
traumatic injury, infection, or inflammation of visceral organs
• More subtle, diet-related events
Emotional stressors
STRESS RESPONSE
Frequent activation of stress response =
- damages body chronically through activation of the hypothalamic-pituitary adrenal (HPA) axis
- Effects add up progressively (cumulative)
Allostatic load
chronic compensatory state
price paid for chronic exposure to stress-mediated neuroendocrine adaptations
- Long-term exposure to allostatic chemical environment (catecholamines, cortisol, cytokines)
Gradual loss of effectiveness of feedback pathways to reestablish normal homeostasis
Allostatic Load Disease
– Degenerative & inflammatory diseases may have roots in
this mechanism
– Correlated to increased occurrence of cardiovascular dx
– Memory & depression (central nervous system)
– Multiple, complex effects on immune system
Screening
FAST & NONSPECIFIC test to locate dysfunction area
Static Postural Exam
- Observation of skin
- Observation of static landmarks
- Observation of asymmetry
Dynamic Postural Exam
- Gait
- Range of Motion: Cervical, Thoracic, Lumbar, Ribs, Sacrum
- Special Tests: Upper Extremity Quick Tests, Squat Test, Standing/Seated Flexion Tests
Anterior Mid-Gravity Line
- Glabella
- Symphysis menti
- Episternal notch
- Mid-sternum
- Xiphoid process
- Umbilicus
- Pubic symphysis
- Mid-heel point
Posterior Mid-Gravity Line + Landmarks
Posterior Mid-Gravity Line
- Inion
- Spinous processes of:
- Cervical vertebrae
- Thoracic vertebrae
- Lumbar vertebrae
- Sacral vertebrae
- Gluteal crease
- Mid-heel point
Lateral Landmarks
Lateral Mid-Gravity Line
- External auditory meatus (canal)
- Greater tuberosity of the humerus (on lateral head)
- Mid-body of L3
- Sacral promontory (anterior third of sacrum)
- Greater trochanter of the femur
- Lateral condyle of the knee
- Lateral malleolus (slightly anterior to)
