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OS Final - JLJ > Osteopathic Reflexes > Flashcards

Osteopathic Reflexes Flashcards

1
Q

Define a myotactic reflex

A

Tonic contraction of the muscles in response to a stretching force, due to stimulation of muscle receptors

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2
Q

T/F: Some dorsal horn neurons respond to visceral as well as somatic stimuli

A

True

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3
Q

What area of the spinal cord processes information?

A

Gray matter

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4
Q

What is the grey matter of the spinal cord divided into?

A

Rexed layers 1-10; upper layers are 1-6

Afferents from body synapse here

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5
Q

What is the function of layer 3 and 4 of the grey matter?

A

Mechanoreceptors

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6
Q

What is the function of layers 1 and 5 of the grey matter?

A

A-delta fast pain fibers

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7
Q

What is the function of layer 2 in the grey matter?

A

Small C fibers of slow pain

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8
Q

What is found in the lower layers of the grey matter?

A

Inter neurons and motor neuron cell bodies

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9
Q

Where do afferent fibers (visceral and somatic) mostly end?

A

1 and 5

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10
Q

What percentage of inter neurons receive input from both visceral and somatic afferents?

A

70-80%

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11
Q

T/F: Musculoskeletal palpatory findings may correlate with visceral disturbances

A

True

This is the somatic component of disease

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12
Q

Define sensitization

A

Stable response level is reached to a repeated stimulus that can continue but not change in intensity as long as the stimulus is continued

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13
Q

Define habituation

A

Process of decreasing response of a neural pathway with a continuous stimulation; opposite of sensitization

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14
Q

What is the nociception theory?

A

Once a stimulus is strong enough to activate (depolarize) nociceptive pathways, impulses travel to the cord and then branch to multiple sites; results in release of peptides at the motor neuron level in the peripheral tissues

No nociceptors in brain or hyaline cartilage

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15
Q

Define facilitation

A

Maintenance of a pool of neurons in a state of sub threshold excitation; less afferent stimulation is required to trigger the discharge of impulses

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16
Q

The peptides released in a nociceptive pathway initiate the release of what?

A

Prostaglandins, bradykinins, etc.; results in lowering nociceptor thresholds, thus increasing input to the cord

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17
Q

What does inflammation do to the balance between sensitization and habituation?

A

Disrupts the balance and results in larger than normal motor outputs to the autonomics and somatic systems; this is thought to set up the low-threshold spinal reflexes called “the facilitated segment”

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18
Q

Define short term excitability (sensitization)

A

1-2 seconds of afferent input; excitability lasts for 90-120 seconds

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19
Q

Define long term sensitization

A

Inputs of several minutes; excitability lasts for hours

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20
Q

Define fixation

A

15-40 minutes of afferent input; excitability lasts for days or weeks

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21
Q

Define permanent excitability

A

Input lasts forever? - long time; death of inhibitory inter neurons

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22
Q

Who was the first to show reflex changes using EMG?

A

Denslow

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23
Q

What did Denslow find?

A

Found long-lasting, low threshold areas to afferent inputs; stimulus was same level, other spinal levels, and psychological stress; Denslow correlated these excitable areas with injury and disease

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24
Q

What is the facilitated segment concept?

A

Korr suggested these low threshold spinal reflexes represented pathways in a hyper-excited state by a continuous bombardment of inputs

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25
Q

What makes up the facilitated segment?

A

Skeletal muscle and the sympathetic nervous system

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26
Q

What is allostasis?

A

Stimulus (insult) applied to tissues; develop chemical soup of inflammation that causes primary afferent sensitization; results in hyperalgesia (exaggerated response to a noxious stimulus)

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27
Q

What develops in central sensitization (CNS)?

A

Secondary hyperalgesia

28
Q

What aids in maintaining facilitation in the dorsal horn neurons?

A

Ca channels, phosphorylation cascades, and the loss of inhibitory neuron function

29
Q

Describe allostasis in the ventral horn

A

When facilitation outflows to the autonomics, this affects visceral function

When facilitation outflows to the soma, this leads to muscle spasm (asymmetry, altered range of motion)

30
Q

What does allostasis in the brain stem do?

A

Facilitation decreases endogenous descending pathways

31
Q

Describe the arousal system

A

Uses catocolamines/glucocorticoids; long term facilitation damages this system and leads to loss of control of protective mechanisms (allostasis overload)

32
Q

Define a somatosomatic reflex

A

Localized somatic stimuli producing patterns of reflex response in segmentally related somatic structures

33
Q

Define a somatovisceral reflex

A

Localized somatic stimulations producing patterns of reflex response in segmentally related visceral structures

34
Q

Define a viscerosomatic reflex

A

Localized visceral stimuli producing patterns of reflex response in segmentally related somatic structures

35
Q

Define a viscerovisceral reflex

A

Localized visceral stimuli producing patterns of reflex response in segmentally related visceral structures

36
Q

Define the withdrawal response

A

Somatosomatic reflex response that occurs when a noxious stimulus is applied to a somatic structure (complex withdrawal due to pain)

37
Q

Define a myotactic response

A

Somatosomatic reflex response that occurs when a stretch receptor is stimulated and the stretched muscle receives the impulse to fire, while its antagonist receive an inhibitory message

38
Q

Define a somatocardiac reflex

A

Nociceptive somatic stimuli results in elevation of heart rate and blood pressure

39
Q

Define a somatogastric reflex

A

Nociceptive somatic stimuli results in inhibition of peristalsis in the stomach

40
Q

Define a somatoadrenal reflex

A

Nociceptive somatic stimuli results in the release of catecholamines from the adrenal medulla

41
Q

What percent of the vagus nerve is sensory?

A

80-90%

42
Q

For sympathetic ENT viscerosomatic reflexes, what vertebral levels correlate to the head/neck and upper esophagus?

A

T1-T5

43
Q

For sympathetic GI viscerosomatic reflexes, what vertebral levels correspond to the upper GI/upper esophagus?

A

T5-T10

44
Q

For sympathetic GI viscerosomatic reflexes, what vertebral levels correspond to the small intestine/ascending colon?

A

T9-T11

45
Q

For sympathetic GI viscerosomatic reflexes, what vertebral levels correspond to the ascending and transverse colon?

A

T10-L2

46
Q

For sympathetic GI viscerosomatic reflexes, what vertebral levels correspond to the descending and sigmoid colon/rectum?

A

T12-L2

47
Q

For parasympathetic GI viscerosomatic reflexes, what corresponds to the upper GI, upper esophagus, small intestine, ascending colon, and transverse colon?

A

Vagus nerve (OA, AA)

48
Q

For parasympathetic GI viscerosomatic reflexes, what vertebral level corresponds to the descending and sigmoid colon/rectum?

A

S2-S4 (sacrum)

49
Q

For sympathetic extremity viscerosomatic reflexes, what vertebral level corresponds to the upper and lower extremities?

A

T2-T7/T11-L2

50
Q

For sympathetic CV viscerosomatic reflexes, what vertebral level corresponds to the heart? Adrenals?

A

Heart: T1-T6

Adrenals: T5-T10

51
Q

For parasympathetic CV viscerosomatic reflexes, what vertebral level corresponds to the heart? Adrenals?

A

Heart/Adrenals: vagus nerve (OA, AA)

52
Q

For sympathetic pulmonary viscerosomatic reflexes, what vertebral level corresponds to the lungs? Parasympathetic?

A

Sympathetic: T1-T7

Parasympathetic: vagus nerve (OA, AA)

53
Q

For sympathetic OB/GYN viscerosomatic reflexes, what vertebral level corresponds to the genitourinary tract?

A

T10-L2

54
Q

For parasympathetic OB/GYN viscerosomatic reflexes, what vertebral level corresponds to the reproductive organs and pelvis?

A

S2-S4 (sacrum)

55
Q

For sympathetic urology viscerosomatic reflexes, what vertebral level corresponds to the genitourinary tract (includes bladder)? Upper ureter? Lower ureter?

A

Genitourinary tract/bladder: T10-L2

Upper ureter: T10-T11

Lower ureter: T12-L2

56
Q

For parasympathetic urology viscerosomatic reflexes, what corresponds to the upper ureter? Bladder? Lower ureter? Reproductive organs?

A

Upper ureter: vagus nerve (OA, AA)

Bladder/lower ureter/reproductive organs: S2-S4 (sacrum)

57
Q

Define Chapman’s reflexes

A

Group of palpable points occurring in predictable locations on the anterior and posterior surfaces of the body that are considered to be reflections of visceral dysfunction or disease

58
Q

What are Chapman’s reflexes manifested by?

A

Gangliform contractions, which are believed to be congestion’s within fascia due to lymph stasis secondary to visceral dysfunction

59
Q

What are the 3 component characteristics of Chapman’s reflexes?

A

1) Viscerosomatic reflex of both diagnostic and treatment value
2) Gangliform contraction that blocks lymphatic drainage and causes SNS dysfunction (neurolymphatic)
3) Consistent reproducible series of points both anterior and posterior related to specific organs or conditions

60
Q

Describe the palpatory features of Chapman’s reflexes

A

Located deep to the skin in the subcutaneous areolar tissue on deep fascia or periosteum; paired anterior and posterior points in most cases; small, smooth, firm nodule, approximately 2-3 mm in diameter; may be confluent; dense but not hard

61
Q

Describe Chapman’s reflex diagnosis and testing

A

Once found, apply gentle but firm pressure; usually causes a deep, disagreeable pain in response in the patient; however, equivalent pressure on any adjacent normal tissue will produce one vague, mild, local distress

62
Q

The pain in a Chapman’s reflex is characteristically…..

A

Pinpoint, sharp, non-radiating; located under the physician’s finger tip; pain is greater than is expected; patient is usually previously unaware of the sore spot

63
Q

Describe Chapman’s point treatment

A

1) Firm pressure with the finger pad of one finger
2) Apply somewhat heavy and even uncomfortable pressure to gangliform mass
3) Slowly move tip of the finger in a circular fashion; attempt to flatten the mass
4) Continue the moving pressure for 10-30 seconds; can alternate clockwise/counterclockwise
5) Cease/stop treatment when the mass disappears or the patient/physician can no longer tolerate the procedure

64
Q

What are the indications for diagnosis of a Chapman’s reflex? Treatment?

A

Diagnosis: as part of a screening exam when clinically indicated from patient history

Treatment: upon finding a Chapman’s reflex that is possibly clinically relevant to the patient

65
Q

There are 2 things you should never do concerning a Chapman’s reflex. What are they?

A

1) Never make a diagnosis based solely on a non-tender Chapman’s reflex; this indicates nothing by itself
2) Never ignore or trivialize a tender Chapman’s reflex unless you have a good explanation for the findings

66
Q

What are the contraindications for a Chapman’s reflex?

A

1) Anytime a patient needs emergent care the emphasis is always on airway, breathing, and circulation; not OMT
2) Patient refusal
3) Relatively contraindicated with a fracture, cancer, and other patient instability

OS Final - JLJ (5 decks)

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