Exam 1 Flashcards
AT still’s birthday
August 6, 1828
What year did three of Still’s children die?What did they die of?
1864
spinal meningitis
infant Marcia pneumonia
What date did AT Still MD fling to the breeze the banner of osteopathy?
June 22, 1874
Four principles
- the body is a unit; the person is a unit of body, mind, and spirit
- the body is capable of self-regulation, self-healing, and health maintenance
- structure and function are reciprocally interrelated
- rational treatment is based on an understanding of the basic principles of body unit, self regulation, and the interrelationship of structure and function
What day did the first school of osteopathy open
october 3, 1892
What was the name of the first school of osteopathy?
American School of Osteopathy (ASO)
Host + disease =
illness
Treating both the host and disease is what?
osteopathic
Treating just the disease is what?
allopathic
What are environmental factors
structural, medical, surgical, psychosocial, ETOH/smoking/drugs, allergens
Illness leads to?
decompensation
How do osteopaths treat the host? How do we treat disease?
OMT
medical treatment
Treating of the host and disease by osteopaths leads to what?
homeostasis
What was A. T. Still’s and his father’s jobs?
m&m
medicine and ministry
What happened that allowed Dr. Still to have access to so many cadavers in his study of anatomy?
in 1855 there was a cholera epidemic that wiped out a bunch of indians and tribe gave him permission
What duties die Dr. STill do during the Civil War?
ardent abolitionist
combat officer
wrote he did duties of a surgeon but was officially recorded as hospital steward
Be able to briefly discuss the Battle of Westport
“gettysburg of the West” Oct 23, 1864 at the Big Blue River
ended the last significant confederate operation west of the mississippi
one of the largest mcivil war battles fought west of the mississippi
30,000 soldiers 3000 casuals total
and NO he did not use soldiers as cadavers
What happened to 4 of Dr. Still’s children and how did these events shape his thoughts on medicine of the day?
three died due to spinal meningitis and infant of pneumonia
he returned to farming and was dissatisfied with orthodox medicine and its failures and felt there must be a better way to treat patients
What significance did the events of his children play in the founding of osteopathy?
led him to come up with osteopathy
What were some of the discoveries of medicine and science in the world during the times of the development of Osteopathic Medicine? How did they relate to Dr. Still’s though processes?
heroic medicine- every effort made to preserve the life force
stimulants if patient drowsy- alcohol
hypnotics if patient agitated- opium
effort was aimed at conquering disease- enough force, enough drugs would cast out the demons
AT was well trained in these and did not believe they worked
Explain the basic philosophy of osteopathic medicine as noted in the Kirksville consensus of 1953.
“osteopathy, or osteopathic medicine, is a philosypy, a science, and an art. its philosophy embraces the concept of the unity of the body structure and function in health and disease”
Where did Dr. Still first introduce his ideas and how were they received?
Baker University (he helped found it)
preacher declared him satanic declaring only Christ heals with the laying of the hands
Still was evicted from the church and moved to Kirksville
What was the response to Dr. Still’s way of practice after going to Kirksville, MO?
accepted him and overwhelmed him quickly
called him magnetic healer and lightning bone setter
How did Dr. Still deal with Kirksville response to his practice?
tried to train apprentices but this failed because they lacked knowledge of anatomy and body function
Who were the faculty of the first school?
Still and William Smith MD
What was the name of the organization that preceded the American Osteopathic Foundation?
American Association for Advancement of Osteopathy (AAAO)
Who is Dr. Adam Flexner and what is the significance of his contribution to medical education?
authored a report on the state of medical education in US (including DO) resulted in closure of a great number of schools and stricter requirements
8 DO schools were left and he labeled offered instruction in 8 schools as worthless
How did the osteopathic profession respond to the changes related to Dr. Flexner’s contribution?
DO schools didn’t have luxury to merge with large institutions so it put them behind in educational reform but curriculum was 4 year program by 1915
by 1930s schools required 2 years of undergrad studies
How did the osteopathic way of treating patients help in treating patients during the influenza pandemic of 1917-1918?
osteopathic care- 0.486% death rate
medical/osteopathic care- 1.08% death rate
Be able to explain the contrast difference between the osteopathic philosophy to approaching a patient’s medical problem to the allopathic philosophical approach.
we treat the host not just the disease
In what year did congress legalize the right of DOs to serve in the civil service and armed forces?
1957
Who was the first woman to receive the DO degree and in what year?
Jeanette Bolles
1892
Who was the foremost research in osteopathic medicine?
Louisa Burns
What year was the first charter of the American School of Osteopathy (ASO) issued by the State of Missouri?
1892
What year was Kansas City College of Osteopathy and Surgery established?
1916
Who was Kansas City College of Osteopathy and Surgery established by?
A.A. Kaiser DO and George Conley DO
What committee did the AMA use to inspect osteopathic schools and determine the education is comparable to most medical schools and recommend to remove the cult label? What year?
Cline committee
1955
During what decade did six new osteopathic colleges become university affiliated?
1970s
What was the first university for an osteopathic college become affiliated with? What month and year?
Michigan State
July 1971
What year and in what state was osteopathy first recognized as a practice?
1896
Vermont
In what year and in what state did a public referendum prohibit the granting of new licenses to DOs in the state? the College of Osteopathic Physicians and Surgeons was converted to what?
1961
The California Incident
allopathic medical school
Following the California Incident, in what year did the College of Osteopathic Medicine of the Pacific open?
1977
What state was the last to extend full practice rights to DOs? In what year?
Mississippi
1973
In the 2000s about how many DOs were there? How many students?
60,000
13,000 students
About how many DOs were board certified but an AOA board in the 2000s?
15,000
What percentage of DOs prated in family medicine in the 2000s? About what percent were in non-primary care specialities?
45%
35%
80% of DOs are younger than
55 years
About how many active DOs does Missouri have? Kansas?
1800
600
How can we figure out if a somatic lesion is a somatic dysfunction?
if it is treatable by using OMT
Which will be greater PROM or AROM?
PROM
What three planes do we use to define joint motion?
sagittal, frontal (coronal), horizontal (transverse)
What are three types of joints and examples of each?
fibrous- skull articulations
cartilaginous- discs between vertebra
synovial- extremities
What is an anatomic barrier?
limit of motion imposed by anatomic structure, limit of passive motion
what’s the limit of a passive motion called?
anatomic barrier
What’s the limit of an active motion called?
physiologic barrier
What is the range between he physiologic and anatomic barrier of motion in which passive ligamentous stretching occurs before tissue disruption?
elastic barrier
What is a pathologic barrier?
PERMANENT restriction of joint motion associated with pathologic change of tissues
What is the functional limit within the anatomic range off option, which abnormally diminishes the normal physiologic range called?
restrictive barrier
What movement is in the sagittal plane?
lumbar flexion
What movement is in the horizontal plane?
rotation
What movement is in the frontal plane?
sidebending
How do you assess the range and quality of a motion? What is another characteristic of a motion?
range- visual
quality- visual and palpation
direction
If the feel of end ROM is bouncy or rubbery what is that indicative of?
viscerosomatic reflex
If the end feel of ROM is firm what is that indicative of?
micro traumatic (overuse)
IF the end feel of ROM is sloppy?
ligamentous laxity
What does a normal end feel feel like?
elastic
How does an osteoarthritis end feel feel?
abrupt
How does somatic dysfunction end feel feel?
hard
How does an end feel feel if you stop due to pain?
empty
How does an end feel that is involuntary muscle guarding feel?
crisp
Presence of normal passive motion in one direction of one plane and restiance in the other is presumptive evidence of what?
a somatic dysfunction
You can tell in what direction the somatic dysfunction has occurred because
the joint will move farther in that direction
With neuromusculoskeletal dysfunction you will see a decreased overall what?
ROM for affected joint
Define TART
t-tissue texture changes
a- asymmetry
r- restriction of motion
t- tenderness
What is the ROM commonly present in a joint or group of joints that allows normal and unimpaired function?
flexibility
What is the maximal ROM a joint can achieve with an externally applied force?
static flexibility
What is ROM an athlete can produce and speed at which he/she can produce it?
dynamic flexibility
What is the physical measurement of a reduced ROM of a join or group of joints?
stiffness
What do you call the relationship of joint mechanics with surrounding structures?
linkage
What are examples of linkages?
should-spine
spine-hip/pelvis
What is important to do to get an accurate measurement and evaluation of a particular joint?
isolate the joint
What is the devices used for the actual measurement of a ROM? What are the greek origin?
goniometer
gonia- angle
metron- measure
What’s the placement for the goniometer?
stationary part over the “body”
moveable arm over the moving part
What is usually the “body” when using the goniometer?
proximal portion of the joint
What serves as the baseline or 0 degree for the goniometer?
stationary arm (on the “body”)
What is the zero starting position for using the goniometer?
extended anatomic position
The goniometer should be parallel to the?
bone
What are some uses for goniometer measurements?
pre vs post-op
disability physicals
during and after PT
research
What do you compare goniometer measurements with?
contralateral side and/or normative values
What do you call two vertebrae, their associated disc, neuromuscular and other soft tissues?
functional unit
C-spine passive rotation
70-90 each way
C-spine whole rotation
140-180
C-spine passive sidebending
20-45 each way
C-spine whole sidebending
40-90
C-spine flexion
45-90
C-spine extension
45-90
C-spine whole motion flex/extend
90-180
What are the four articulations of the pectoral girdle?
glenohumoral, acromioclavicular, sternoclavicular, scapulothoracic (not a true but indirect via muscles)
shoulder actie flexion
180
shoulder active extension
60
shoulder active abduction
180
shoulder active horrid adduction
40-50 or 130-140
shoulder active horiz abduction
130-145 or 40-55
shoulder active external rotation
90
shoulder active internal rotation
90
three articulations of the elbow
humeroulnar, humeroradial, proximal radioulnar
elbow active flexion
140-150
elbow active extension
0-5
forearm pronation
90
forearm supination
90
wrist active flexion
80-90
wrist active extension
70
wrist active abduction
20-30
wrist active adduction
30-40
What causes significant variance in biomechanics from person to person when it comes to the hip?
angular structure between pelvis, femur, and knee can vary a lot
hip active flexion w/ knee straight
90
hip active flexion w/knee flexed
120-135
hip active extension
15-30
hip passive external rotation
40-60
hip passive internal rotation
30-40
hip passive abduction with knee extended
45-50
hip passive abduction with knee flexed
30-50
hip passive adduction with knee extended
20-30
hip passive adduction with knee flexed
60-70
What are the articulations of the knee?
tibiofemoral and patellofemoral
What plane is the knee motion primarily limited to?
sagittal plane
What motions are associated with the frontal plane?
abduction and adduction
What limits almost any motion in transverse or frontal plane for the knee?
full extension
knee passive flexion
145-150
ankle passive dorsiflexion
15-20
ankle passive plantarflexion
50-65
ankle active inversion
35
ankle active eversion
20
What type of motion does soft tissue preparation facilitate?
articular (historically fundamental to OMT)
What technique is directly applied to the muscular and fascial structures of the body and affect the associated neural and vascular elements?
soft tissue techniques
What all does soft tissue entail?
living tissues of the body other than the bone
fascia, muscles, organs, nerves, vasculature, lymphatics
muscle fascia are layers that are composed of ______ in an amorphous matrix of ______?
collagen fibers (also elastin fibers) hydrated proteoglycans
What are not fascia?
tendons, ligaments, aponeuroses
What is the function of fascia?
involved in tissue protection and healing of surrounding systems
How is fascia analogous to a deity for the body?
omnipresent, omnipotent, omniscient
How is fascia omnipresent?
there is a myofascialarthrodial continuity throughout the body
perimysiem (fascia) is anatomically continuous with ___ which is anatomically continuous with ___ on bone
peritendlium
periosteum
What is the outermost layer of fascia called?
pannicular fascia
Where do you not find pannicular fascia?
orifices
The outer layer of pannicular fascia is generally what?
What about the inner layer?
adipose tissue
membranous and adherent generally to the outer portion
What fascia layer is just internal to the pannicular layer? what is it also called?
axial and appendicular fascia
investing layer
What does the investing layer surround?
muscles, periosteum of bone, peritendon of tendons
What is the fascia that surround the nervous system? What does it include?
meningeal fascia
dura
What fascia layer surround body cavities? What are examples?
body cavities
pleural, pericardial, peritoneum
How is fascia omnipotent?
provides for mobility and stability of the MSK system
What cells allow the fascia to be contractile?
myofibroblasts
What cells allow the fascia to help with healing?
macrophages and mast cells
75% of what consists of free ending in fascia?
stretch receptors for muscles and proprioception (balance)
80% of C fibers are
polymodal
What do you call liquid crystal-like properties?
piezoelectricity
What do you call any material that deforms according to rate of loading and deformity?
viscoelastic material
What is the force that attempts to deform a connective tissue structure?
stress
What is the percentage of deformation of a connective tissue?
strain
The difference between the loading and unloading characteristics represents energy that is lost in the connective tissue system. this energy loss is termed?
hysteresis
What do we call the elongation (deformation) of connective tissue in response to a sustained, constant load (below failure threshold)?
creep
What do we call the direction in which the connective tissue may be moved most easily during deformational stretching?
ease
How does ease of motion feel via palpation?
loose or laxity or a greater degree of mobility
What do you call a palpable restriction of connective tissue mobility?
bind
Fascial restrictions in one area of the body will create what in another area?
connective tissue restrictions (pulls)
What is Newton’s Third Law?
when two bodies interact, the force exerted by one is equal in magnitude and opposite in direction to the forces exerted by the other
What do you call “the strain (deformation) placed on an elastic body is in proportion to the stress (force) placed upon it”?
hooke’s law
What do you call “bone will develop according to the stresses placed upon it”? What does this concept extend to?
Wolff’s law
fascia
What techniques go towards and eventually through a restrictive barrier
direct
What techniques go away from the restrictive barreir
indirect
Any one of what must be present for the diagnosis of somatic dysfunction
T-tissue texture abnormalities
A-asymmetry of structure
R-restriction of motion
T-tenderness
What are the treatment goals for tissue texture abnormality and asymmetry of tissues?
stretch and increase elasticity to return to symmetry
improve local tissue nutrition and oxygenation and remove metabolic wastes to normalize tissue texture
what are treatment goals for asymmetry of muscles?
return symmetry and normalize tone
What are treatment goals for restricted motion of soft tissues?
set the fascia FREE!!!!!
What are treatment goals of tenderness?
normalize the euro activity and improve abnormal somato-somatic and tomato-visceral reflexes
What is common compensatory patterns?
L/R/L/R
What is uncommon compensatory patterns?
R/L/R/L
What is characteristic of uncompensated pattern? What is a common cause?
symptomatic
trauma
Where are transition zones of the spine?
OA, C1, C2
C7, T1
T12, L1
L5, sacrum
What are transverse restrictors at the transition zones?
tentorium cerebelli
thoracic inlet
thoracolumbar diaphragm
pelvic diaphragm
What is a system of diagnosis and treatment directed toward tissues other than skeletal or arthrodial elements?
soft tissue technique
What are indications for ST?
diagnostically- to identify areas of TART
feedback about issue response to OMT
improve local/systemic immune response
provide a general state of relaxation
enhance circulation
provide general state of tonic stimulation
What are ST absolute contraindications
fracture or dislocation neuralgic entrapment syndromes serious vascular compromise local malignancy local infection (abscess, cellulitis, septic arthritis, osteomyelitis) bleeding disorders
What re the four principles of ST technique?
patient comfort
physician comfort
forces are very gentle and low amplitude (rhythmical)
as tissues respond increase amplitude but RATE REMAINS THE SAME1
technique is continued until the desired effect is achieve
How do you know if you’ve achieved the desired effect of ST?
amplitude of excursion of the soft tissue has reached a maximum and has plateaued at that level
What do you call parallel traction? What is the purpose?
stretch
increase distance between origin and insertion
The taffy pull =
stretch
What do you call perpendicular traction? It’s known as the bowstring.
kneading
What do you call when you push and hold perpendicular to the fibers at the musculotendinous part of hypertonic muscle? How long do you hold it?
inhibition
relaxation of tissue
What is a treatment system in which combined procedures are designed to stretch and reflexively release patterned soft tissue and joint related restrictions?
INR
integrated neuromuscular release
What do you call the law “when a muscle receives a nerve impulse to contract, its antagonists, receive simultaneously an impulse to relax”
sherringtons law
What speed the INR treatment process?
REMs
breath holding, R/L cervical rotation, pendulum/swimming arm swinging maneuvers as direct and indirect barriers are released, isometric limb and neck movements against the table or chair are all examples of what
REMs
What are indications for MFR
somatic dysfunction-almost all soft tissue or joint restrictions
when HVLA or muscle energy is contraindicated- consider INDIRECT MFR
when counterstain may be difficult secondary to a patient’s inability to relax
What are absolute contraindications of MFR
lack of patient consent
absence of somatic dysfunction
What are relative contraindications of MFR
infection of soft tissue or bone
fracture, avulsion, dislocation
metastatic disease
soft tissue injuries: thermal, hematoma, open wounds
post-op patient with wound dehiscence
rheumatologic condition involving instability of c-spine
DVT or anticoag therapy
What is an inherent force for MFR?
using the body’s PRM (primary respiratory mechanism)
What refers to a physician directed, patient performed, inhalation or exhalation or a holding of the breath o assist with the manipulative intervention?
respiratory cooperation
What refers to the patient is asked to move in specific directions to aid in mobilizing specific areas of restriction?
patient cooperaion
What are three activating forces in MFR?
inherent forces
respiratory cooperation
patient cooperation
What are the 3D releases that is often palpated at the endpoint of MFR treatment
warmth
softening
increased compliance/ROM
How do you know when MFR treatment is done
continuous application of activating forces no longer produce change
When finished with MFR what should the tissue demonstrate
symmetry
When did Still return to farming and begin thinking about what would later become osteopathic medicine?
1864-1873
When was Still’s brother addicted to morphine and cause Still to become even more against medication?
1875
What year did Still move to Kirksville?
1876
When did Still die? At what age?
December 1917
89
What year did American Association for Advancement of Osteopathy form? When did it adopt standards for approving osteopathic colleges?
1897
1902
What year did Adam Flexner release his critical report?
1910
What year was the ban on teaching pharmacology lifted by the AOA even though Still was opposed to pharmacology?
1916
When was the influenza epidemic?
1917-1918
Who was the first minority-group president of the AOA and when did he serve?
Marcelino Olivo DO
1988-1989
Who was the first african-american president of the AOA and who did he work with?
William Anderson DO
MLK jr
When did DOs start serving in the military on equal footing as MDs?
1963
How many DO schools became university affiliated in the 1970s?
6
What plane is the change in spinal column that has scoliosis?
frontal/coronal plane
What is the term for the normal feel of muscle in a relaxed state?
tone
What is the term for a normal tone when muscle shortens or is activated against resistance?
contraction
What is the term for the abnormal shortening of a muscle due to fibrosis; muscle no longer can reach full length?
contracture
What is the term for an abnormal contraction maintained beyond physiologic need?
spasm
What is the term for increased fluid in hypertonic muscle?
bogginess
What is the term for hard, firm rope-like or cord-like tone which indicates a chronic condition?
ropiness
What is the space between what my body has adapted to and what my maximum potential is?
elastic barrier
“bone will develop according to the stresses placed upon it”
wolff’s law
If you are right eye and your patient is prone what side do you stand on?
left so your RIGHT eye is over their midline
what plane does vertebra rotate? On what axis?
transverse plane
superior-inferior axis
What is the axis of the sagittal plane? What’s an example?
right-left (transverse axis)
cervical flexion/extension
What’s the axis for the frontal plane? What’s an example?
anterior-posterior axis
cervical side bending
