Osteopathic psychiatry, cerebral palsy, neuro cases Flashcards
psychiatry
the medical specialty concerned with the prevention diagnosis and treatment of mental illness
elements of philosophy
body mind spirit reciprocally interrlated synergy - whole greather than sum of parts
what are some characteristic somatic dysfunctions in psychiatry pts
SD at C2, T4-6
Cranial rhythmic impulse altered
schizo- occiptial
manic depressives- SBS
AD- - frontosphenoid
autonomics
cranial strain patterns
what are the 4 tenets
body is a unit- body, mind, spirit
structure and function are interrelated
self healing mechanisms
include all three in treatment of each pt
wide dynamic range neurons
interneurons in the spinal cord that receive a variable amount of input (types of sensory information)
primary afferents release inflammatory polypeptides locally leading to facilitations of the interneurons - firing sooner than it should
what treatments are less effective in psychiatry
HVLA
how does OMM help in psychic pt’s
decreased psychotic inpatient days
remission of depression
reduced anxiety
what can we do with OMT in a pt with cerebral palsy
address muscle tone b/c this affects both cortical and postural function
address proprioceptive input to affect motor output
- joints, CT, muscle
- limit or prevent contractures (common in wheel chair bound child you will find hip dislocation)
Decrease pain
-chronic muscle spasms are painful
how does Dr. Ferril classify CP
by Motor function
spastic or non spastic
Spastic CP (pyramidal)
Upper motor neuron damage hypertonic and spastic most common type stiff rigid limbs, resistant to relaxing and flexing exaggerated reflexes Jerky movements
Most often arms and legs affected ***, but can affect tongue, mouth, larynx, causing abnormal speech, eating, breathing and swallowing
what are the associated pathologies seen with spastic CP x3
hip pathology
scoliosis
limb defomrities
Non spastic CP\Extrapyramidal
floppy babies
Two types - Ataxic and dykinetic
decreased or fluctuating muscle tone
impairments in involuntary movements ***
- dyskinesia
- dystonia- affects trunk - twisted posture
- athetosis
Mental impairment, limb deformities and seizures are less likely
speech may be affected
where is the location of injury in extrapyramidal CP
basal ganglia, thalamus, cerebellum
how do spastic and non spactic CP compare in terms of posture and baseline tone
Spastic :
spasticity in muscle groups affects postural and cortical function
baseline tone is often much lower than what they function with daily
-daily muscle challenge makes the muscle tighter than baseline
Non spastic
- lower baseline tone than normal
- hypotonia and increased DTR’s
- sensorineural hearing oss, nystagmus, strabimus
Myotactic reflex in CP
it is altered and there is impaired down regulation of the descending modulating pathways of this reflex
leads to hypertonicity and spasticity
leads to uncoordinated movements:
muscle agonist/antagonists don’t work well together
what are some common postural compensations seen in spastic CP
lower extremity most commonly affected
- hamstring hypertonicity
- posterior innominate
- decreased lumbar lordosis
- extended OA
- extended thoracolumbar junction
HIPS
-increased propensity for hip dislocation, fractures or avascular necrosis
ALWAYS evaluate new onset of pain or changes in function
what type of MET do we perform and in what pt’s is it not usually efficient
isometric
MET is not best choice for kids under 8 years old
MET used in CP
isolytic
-small motions, good for adhesions, fibrosis from long term contraction
Reciprocal inhibition
- decrease tone to hypertonic muscles using muscles that may be under better voluntary control of the pt
- hemiplegias and unilateral contractures
