Osteopathic Reflexes Flashcards
Define a myotactic reflex
Tonic contraction of the muscles in response to a stretching force, due to stimulation of muscle receptors
T/F: Some dorsal horn neurons respond to visceral as well as somatic stimuli
True
What area of the spinal cord processes information?
Gray matter
What is the grey matter of the spinal cord divided into?
Rexed layers 1-10; upper layers are 1-6
Afferents from body synapse here
What is the function of layer 3 and 4 of the grey matter?
Mechanoreceptors
What is the function of layers 1 and 5 of the grey matter?
A-delta fast pain fibers
What is the function of layer 2 in the grey matter?
Small C fibers of slow pain
What is found in the lower layers of the grey matter?
Inter neurons and motor neuron cell bodies
Where do afferent fibers (visceral and somatic) mostly end?
1 and 5
What percentage of inter neurons receive input from both visceral and somatic afferents?
70-80%
T/F: Musculoskeletal palpatory findings may correlate with visceral disturbances
True
This is the somatic component of disease
Define sensitization
Stable response level is reached to a repeated stimulus that can continue but not change in intensity as long as the stimulus is continued
Define habituation
Process of decreasing response of a neural pathway with a continuous stimulation; opposite of sensitization
What is the nociception theory?
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
Define facilitation
Maintenance of a pool of neurons in a state of sub threshold excitation; less afferent stimulation is required to trigger the discharge of impulses
The peptides released in a nociceptive pathway initiate the release of what?
Prostaglandins, bradykinins, etc.; results in lowering nociceptor thresholds, thus increasing input to the cord
What does inflammation do to the balance between sensitization and habituation?
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”
Define short term excitability (sensitization)
1-2 seconds of afferent input; excitability lasts for 90-120 seconds
Define long term sensitization
Inputs of several minutes; excitability lasts for hours
Define fixation
15-40 minutes of afferent input; excitability lasts for days or weeks
Define permanent excitability
Input lasts forever? - long time; death of inhibitory inter neurons
Who was the first to show reflex changes using EMG?
Denslow
What did Denslow find?
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
What is the facilitated segment concept?
Korr suggested these low threshold spinal reflexes represented pathways in a hyper-excited state by a continuous bombardment of inputs
What makes up the facilitated segment?
Skeletal muscle and the sympathetic nervous system
What is allostasis?
Stimulus (insult) applied to tissues; develop chemical soup of inflammation that causes primary afferent sensitization; results in hyperalgesia (exaggerated response to a noxious stimulus)
What develops in central sensitization (CNS)?
Secondary hyperalgesia
What aids in maintaining facilitation in the dorsal horn neurons?
Ca channels, phosphorylation cascades, and the loss of inhibitory neuron function
Describe allostasis in the ventral horn
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)
What does allostasis in the brain stem do?
Facilitation decreases endogenous descending pathways
Describe the arousal system
Uses catocolamines/glucocorticoids; long term facilitation damages this system and leads to loss of control of protective mechanisms (allostasis overload)
Define a somatosomatic reflex
Localized somatic stimuli producing patterns of reflex response in segmentally related somatic structures
Define a somatovisceral reflex
Localized somatic stimulations producing patterns of reflex response in segmentally related visceral structures
Define a viscerosomatic reflex
Localized visceral stimuli producing patterns of reflex response in segmentally related somatic structures
Define a viscerovisceral reflex
Localized visceral stimuli producing patterns of reflex response in segmentally related visceral structures
Define the withdrawal response
Somatosomatic reflex response that occurs when a noxious stimulus is applied to a somatic structure (complex withdrawal due to pain)
Define a myotactic response
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
Define a somatocardiac reflex
Nociceptive somatic stimuli results in elevation of heart rate and blood pressure
Define a somatogastric reflex
Nociceptive somatic stimuli results in inhibition of peristalsis in the stomach
Define a somatoadrenal reflex
Nociceptive somatic stimuli results in the release of catecholamines from the adrenal medulla
What percent of the vagus nerve is sensory?
80-90%
For sympathetic ENT viscerosomatic reflexes, what vertebral levels correlate to the head/neck and upper esophagus?
T1-T5
For sympathetic GI viscerosomatic reflexes, what vertebral levels correspond to the upper GI/upper esophagus?
T5-T10
For sympathetic GI viscerosomatic reflexes, what vertebral levels correspond to the small intestine/ascending colon?
T9-T11
For sympathetic GI viscerosomatic reflexes, what vertebral levels correspond to the ascending and transverse colon?
T10-L2
For sympathetic GI viscerosomatic reflexes, what vertebral levels correspond to the descending and sigmoid colon/rectum?
T12-L2
For parasympathetic GI viscerosomatic reflexes, what corresponds to the upper GI, upper esophagus, small intestine, ascending colon, and transverse colon?
Vagus nerve (OA, AA)
For parasympathetic GI viscerosomatic reflexes, what vertebral level corresponds to the descending and sigmoid colon/rectum?
S2-S4 (sacrum)
For sympathetic extremity viscerosomatic reflexes, what vertebral level corresponds to the upper and lower extremities?
T2-T7/T11-L2
For sympathetic CV viscerosomatic reflexes, what vertebral level corresponds to the heart? Adrenals?
Heart: T1-T6
Adrenals: T5-T10
For parasympathetic CV viscerosomatic reflexes, what vertebral level corresponds to the heart? Adrenals?
Heart/Adrenals: vagus nerve (OA, AA)
For sympathetic pulmonary viscerosomatic reflexes, what vertebral level corresponds to the lungs? Parasympathetic?
Sympathetic: T1-T7
Parasympathetic: vagus nerve (OA, AA)
For sympathetic OB/GYN viscerosomatic reflexes, what vertebral level corresponds to the genitourinary tract?
T10-L2
For parasympathetic OB/GYN viscerosomatic reflexes, what vertebral level corresponds to the reproductive organs and pelvis?
S2-S4 (sacrum)
For sympathetic urology viscerosomatic reflexes, what vertebral level corresponds to the genitourinary tract (includes bladder)? Upper ureter? Lower ureter?
Genitourinary tract/bladder: T10-L2
Upper ureter: T10-T11
Lower ureter: T12-L2
For parasympathetic urology viscerosomatic reflexes, what corresponds to the upper ureter? Bladder? Lower ureter? Reproductive organs?
Upper ureter: vagus nerve (OA, AA)
Bladder/lower ureter/reproductive organs: S2-S4 (sacrum)
Define Chapman’s reflexes
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
What are Chapman’s reflexes manifested by?
Gangliform contractions, which are believed to be congestion’s within fascia due to lymph stasis secondary to visceral dysfunction
What are the 3 component characteristics of Chapman’s reflexes?
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
Describe the palpatory features of Chapman’s reflexes
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
Describe Chapman’s reflex diagnosis and testing
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
The pain in a Chapman’s reflex is characteristically…..
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
Describe Chapman’s point treatment
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
What are the indications for diagnosis of a Chapman’s reflex? Treatment?
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
There are 2 things you should never do concerning a Chapman’s reflex. What are they?
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
What are the contraindications for a Chapman’s reflex?
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
