Osteopathic Approach to the Pulmonary Patient - Louise

Question 1

What happens with PSNS activity in a pulmonary infection?

Answer 1

Mucus secretion becomes more profuse and increased visceral afferent impulses to the spinal cord.

Question 2

What thoracic levels are visceral afferent impulses to sinuses and head structures.

Answer 2

T1-4

Question 3

Sympathetic innervation to the lungs.

Answer 3

T2-7

Question 4

In COPD, increased AP diameter to accommodate trapped air and increased lung capacity results in what change to diaphragm tone.

Answer 4

Increased resting daphragmatic tone

Question 5

Overuse of accessory muscles in COPD leads to what two types of somatic dysfunction?

Answer 5

Cervicothoracic and rib somatic dysfunction.

Question 6

What NS and lymphatic changes occur with asthma?

Answer 6

• Hyperparasympathetic drive

- Impaired lymphatic drainage.

Question 7

T1-6 Chapman’s reflex points are for what?

Answer 7

Lungs and viscerosomatic reflexes.

Question 8

What two OMT are used to normalize sympathetic tone?

Answer 8

1) Rib raising

2) Paraspinal inhibition

Question 9

What OMT is used to normalize parasympathetic tone?

Answer 9

Suboccipital release

Question 10

What two OMT address lymphatics?

Answer 10

1) Thoracic inlet MFR

2) Diaphragmatic release

Question 11

What two OMT address specific somatic dysfunctions?

Answer 11

1) Normalize rib motion

2) Thoracic dysfunction

Question 12

What are the contraindications and precautions of pulmonary OMT?

Answer 12

• Do not treat patient supine
• Avoid forceful direct methods (steroid induced osteoperosis)
• Do not over treat and tire the patient
• Avoid positions that may restrict respiratory efforts

Question 13

What are the lymphatic tx?

Answer 13

• Thoracic inlet - MFR
• Thoracic pump (CI in COPD)
• Pedal Pump
• Doming the Diaphragm
• Tapotement (hacking, slapping, cupping; **ensure no osteoperosis)

Question 14

What are tx for SNS for pulmonary pt?

Answer 14

• Rib raising
• Relax the thoracolumbar junction
• Tx anterior and posterior cervical soft tissue

Question 15

What four things does rib raising accomplish for the pulm pt?
What are the two types and when should each be used?

Answer 15

• Decrease facilitation
• Inc. motion of the thoracic cage
• Thin secretions
  1) Rib raising seated 2) Rib raising supine (for bed ridden pt)

Question 16

Tx of C3-5 addreses what nerve facilitation?

Answer 16

Phrenic

Question 17

What are cranial techniques for PSNS for pulmonary pt?

Answer 17

1) CV4

2) V-spread of frontal suture

Question 18

Function of CV4 technique (3)

Answer 18

• Relieves HA
• Relieve congestion in sinuses and lungs
• Reduces fever

Question 19

Function of V-spread of frontal suture (2)

Answer 19

• Est. good motion of the ethmoid bone in ethmoid notch of frontal bone
• Improves sinus congestion

Question 20

What is the function of the sphenopalatine G tx for PSNS for pulmonary pt?

Answer 20

• Thin secretion by influencing outflow to sinus and respiratory epithelium
• Tx with rhythmic intraoral pressure over the ganglia, aided by patient position and motion

Question 21

How do you tx the Vagus nerve for PSNS tx for pulmonary pt?

Answer 21

Normalizes PSNS influence on the lungs.
Tx OA and AA: 
- MFR (for C-spine)
- ME
- Still's technique

Question 22

HA often associated with what? How can you tx this?

Answer 22

Assoc with respiratory complaints dt association of Vagus with CN1 and CN2. Tx PSNS via Vagus

Question 23

Treatments to improve respiratory efforts

Answer 23

1. Scalene stretches
2. MFR to scalene
3. MFR of thoracic spine
4. ME for ribs

Question 24

What is the one rib ME where the pt is prone?

Answer 24

Rib 11 and 12 exhalation dysfunction