OS Approach To Pulmonary Patient

Question 1

What are MSK structure changes in COPD?

Answer 1

Barrel chest
Hypertrophied accessory muscles
Increased kyphosis
T spine immobility and dysfunction
Rib and diaphragm restriction

Question 2

In the pathophys of COPD, hypertrophy of the mucosa, increased goblet cells, and increased secretion of mucous is due to increased ___ tone

Answer 2

Sympathetic

Question 3

Overused of accessory muscles in COPD leaves to ___ somatic dysfunctions

Answer 3

Cervicothoracic and rib

Question 4

In COPD, irritation of the __ nerve from cervical somatic dysfunction can reduce diaphragm function

Answer 4

Phrenic

Question 5

OMT tx for COPD should focus on these models:

Answer 5

Biomechanical
Neurologic 
Behavioral
Metabolic/energy
Resp/circulatory

Question 6

Where are Chapman’s reflex points for lungs, viscerosomatic reflexes?

Answer 6

T1-6 region b/l

Question 7

OMT tx in resp disorders can normalize sympathetic tone with these 2 OMT techniques:

Answer 7

Rib raising

Paraspinal inhibition

Question 8

OMT tx can normalize parasympathetic tone by using this OMT tx:

Answer 8

Suboccipital release

Question 9

OMT can be used for resp disorders by addressing lymphatics with these 2 lymphatic tx:

Answer 9

Thoracic inlet MFR

Diaphragmatic release

Question 10

OMT can be used to tx resp disorders by addressing specific somatic dysfunctions wit the use of:

Answer 10

Normalize rib motion

Thoracic dysfunction

Question 11

What are some specific areas of need to tx with OMT?

Answer 11

Upper T spine, ribs, sternum
T1-6
OA/Vagus n course
Accessory muscles
Anterior cervical fascia
Thoracic diaphragm
Chapmans reflexes 
Cranial mechanism
T10-L2/lower ribs/quadratus lumborum

Question 12

What are some contraindications for OMT tx in resp disorders?

Answer 12

Dont tx in supine position (relative)
Avoid forceful direct methods acutely
Do not over treat and tire the pt
Avoid positions that may restrict resp efforts

Question 13

How do you want to hold the pt when tx with thoracic inlet MFR?

Answer 13

Hold pt into restrictive barrier

Question 14

Thoracic pump w/ vacuum is relatively contraindicated in ___

Answer 14

COPD

Question 15

Where are sympathetics to the pulmonary system coming from?

Answer 15

T2-7
Upper thoracic sympathetic chain ganglion
Ipsilateral

Question 16

Where are parasympathetics to the pulmonary system coming from?

Answer 16

Midbrain (medulla oblongata)
Vagus n
Ipsilateral

Question 17

What is chapmans reflex for the upper lung and lower lung anteriorly?

Answer 17

Upper lung=between rib 3-4 costochondral

Lower lung=between rib 4-5 costochondral

Question 18

What are some cranial parasympathetic tx techniques for resp disorders?

Answer 18

CV4
V spread
Sphenopalatine ganglia tx
Tx vagus n in OA and AA regions

Question 19

What are some Biomechanical model tx’s to improve resp efforts

Answer 19

Scalene stretch
MFR to scalene muscles, thoracic spine
ME to ribs

Question 20

What are some OMT tx’s for the Neurological model (tx autonomics)?

Answer 20

Sympathetics –> Rib raising
Relax thoracolumbar junction
Tx anterior and posterior cervical soft tissue
Chapmans reflexes
Cranial techniques for parasympathetics –> CV4, V spread, sphenopalatine ganglia, tx vagus n.

Question 21

What some OMT tx’s for the fluid and resp model (Lymphatic tx)?

Answer 21

Thoracic inlet MFR
Thoracic pump w/ vacuum (contraindicated in COPD)
Tapotement
Pedal pump
Dome the diaphragm

Question 22

The osteopathic tx of pulm infx must address the patient needs from many directions, including:

Answer 22

• O2 and pharm support
• address lymphatic system
• address somatic system –> increase thoracic cage compliance and motion
• address symp/parasymp systemes –> viscerosomatic reflexes