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*OSII > Final- 3. Chapman's Points (lecture) > Flashcards

Final- 3. Chapman's Points (lecture) Flashcards

1
Q

What fibers do the upper layers of spinal cord gray matter contain?

A

A delta fast pain fibers

Small C slow pain fibers

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2
Q

What fibers do the lower layers of Spinal cord gray matter contain?

A

Efferents: interneurons, motor neuron cell bodies

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3
Q

What function do interneurons serve for sensory input?

A

Amplify or inhibit output

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4
Q

What effect does visceral disturbance have on somatic musculature?

A

Activates it => Facilitated segment => alter visceral function => decompensation of homeostasis

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5
Q

How long does short term excitability last?

A

90-120 seconds

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6
Q

What are the steps for increasing sensitivity of neurons?

A
  1. Sensitization (short term excitability)
  2. Long term sensitization
  3. Fixation
  4. Permanent excitability
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7
Q

What phase of increased neuron sensitization causes death of inhibitory interneurons?

A

Permanent excitability

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8
Q

Who were the scientists involved with identifying Facilitated Segments?

A

Denslow - 1st to associate excitable changes w/ injury and disease

Korr - Suggested that low level spinal reflex represented pathways in hyperexcited state because they were constantly bombarded w/ input

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9
Q

Who coined the term Facilitated Segment?

A

Dr. I.M. Korr

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10
Q

What is the Nociceptive theory of facilitated segments?

A
  1. Stimulus depolarizes nociceptive pathways =>
  2. Impulse travels to spinal cord (SC) =>
  3. Branch to multiple sites =>
  4. Release peptides at motorneuron level in peripheral tissues =>
  5. Inflammatory cascade, release of prostaglandins, bradykinins =>
  6. Lower nociceptor thresholds =>
  7. Increased input to SC =>
  8. Larger than normal motor output to autonomic and somatic systems =>
  9. Facilitated segment
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11
Q

What is allostasis?

A

The process by which the body responds to stressors in order to regain homeostasis = long-term neural effect of segmental facilitation

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12
Q

What is the allostatic process on facilitated segments?

A

Stimulus applied to tissues => release of cytokines and peptides => inflammation => primary afferent sensitization => hyperalgesia (exaggerated response to noxious stimulus) => secondary hyperalgesia

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13
Q

What is the dorsal horn involvement in allostasis?

A

Open Ca++ channels, initiate phosphorylation cascades

Lose inhibitory neuron fxn

Aid in maintaining facilitation

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14
Q

What is the ventral horn involvement in allostasis?

A

Facilitation outflow to autonomics => affect visceral fxn

Facilitation outflow to soma => muscle spasm, asymmetry, altered ROM

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15
Q

What is the brainstem involvement in allostasis?

A

Facilitation decreases endogenous descending pathways

Facilitation decreases arousal system (glucocorticoids, catecolamines) => loss of protective mechanisms => allostasis

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16
Q

What is the withdrawal response? What type of reflex is this?

A

Noxious stimulus (heat from oven) is applied to somatic structure (skin of hand)

Somatosomatic

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17
Q

What is the myotatic reflex? What type of reflex is this?

A

Stretch receptor is stimulated and stretched muscle receives impulse to fire, while antagonist is inhibited

Somatosomatic reflex

18
Q

What is the somatocardiac reflex? What type of reflex is this?

A

Nociceptive somatic stimuli => elevated heart rate and BP

Somatovisceral

19
Q

What is the somatogastric reflex? What type of reflex is this?

A

Nociceptive somatic stimuli => inhibition of peristalsis in stomach

Somatovisceral

20
Q

What is the somatoadrenal reflex? What type of reflex is this?

A

Nociceptive somatic stimuli => release of catecholamines from adrenal medulla

Somatovisceral

21
Q

What is the physiological basis for viscerosomatic reflexes?

A

Localized visceral stimuli producing patterns of reflex response in segmentally related somatic structures (e.g. Chest pain => L arm pain)

All visceral nerves contain sensory fibers, cell bodies located in DRG or vagal ganglia

There are numerous interneuron connections in DRG => complex communication network connecting visceral and somatic systems

22
Q

What viscerosomatic regions are parasympathetically innervated by pelvic splanchnics?

A

Descending and sigmoid colon/Rectum

Bladder, lower ureter

23
Q

What viscerosomatic regions are parasympathetically innervated by the vagus nerve?

A

Upper GI

SI/Ascending colon

Ascending and transverse colon

Heart, Lungs, Adrenals

Reproductive organs

Upper/Lower Ureter

Bladder

24
Q

Sympathetic viscerosomatic reflexes: What levels are head and neck located?

A

T1-T5

25
Q

Sympathetic viscerosomatic reflexes: What levels are upper GI (upper esophagus) located?

A

T5-T10

26
Q

Sympathetic viscerosomatic reflexes: What levels are SI/ascending colon located?

A

T9-T11

27
Q

Sympathetic viscerosomatic reflexes: What levels are descending and transverse colon located?

A

T12 - L2

28
Q

Sympathetic viscerosomatic reflexes: What levels are upper extremities located?

A

T2-T7

29
Q

Sympathetic viscerosomatic reflexes: What levels are lower extremities located?

A

T11-L2

30
Q

Sympathetic viscerosomatic reflexes: What levels is heart located?

A

T1-T6

31
Q

Sympathetic viscerosomatic reflexes: What levels are adrenals located?

A

T5-T10

32
Q

Sympathetic viscerosomatic reflexes: What levels are lungs located?

A

T1-T7

33
Q

Sympathetic viscerosomatic reflexes: What levels is the GU tract (including bladder) located?

A

T10-L2

34
Q

Sympathetic viscerosomatic reflexes: What levels is upper ureter located?

A

T10-T11

35
Q

Sympathetic viscerosomatic reflexes: What levels is lower ureter located?

A

T12-L2

36
Q

Distention of the gut causing contraction of gut muscle is an example of what kind of reflex?

A

Viscerovisceral

Afferent activity flowing from receptors into spinal cord through interneurons => efferent or outflow activity w/in sympathetic and/or parasympathetic motoneurons

37
Q

What are the 3 component characteristics of Chapman Reflexes?

A
  1. Viscerosomatic reflex of both diagnostic and treatment value
  2. Gangliform contraction that blocks lymph drainage and causes SNS dysfunction
  3. Consistent reproducible series of points both A/P related to specific organs or conditions
38
Q

What are the palpatory features of Chapman’s Reflexes?

A
  1. Located deep to skin in subcutaneous areolar tissue on deep fascia or periosteum
  2. Usually both anterior and posterior points are palpable
  3. Small, smooth, firm nodule (bobaaa)
  4. 2-3 mm in diameter, confluent, dense but not hard
39
Q

What are the main indications for Chapman’s reflexes?

A

For diagnosis: as part of a screening exam when clinically indicated from pt history

For treatment: upon finding a CR that is possibly clinically relevant for pt

  • Never make a diagnosis based solely on nontender CR, may indicate nothing, especially by itself
  • Never ignore or trivialize a tender CR unless you have good explanation
40
Q

What are the main contraindications of Chapman’s reflexes

A

Any time a pt needs emergent care => emphasize Airway, Breathing, Circulation (not OMT)

Pt refusal (absolute)

Relatively contraindicated w/ fx, CA, other pt instability

41
Q

What are the general characteristics of a Chapman’s point when palpated?

A

Pain is generally pinpoint, sharp, non-radiating, greater than expected

Pt is usually previously unaware of sore spot

*OSII (39 decks)

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