Osteopathic Reflexes Lecture Flashcards
What is a reflex?
relationship between an input stimulus to the body & an output action to either a muscle or secretory organ
What are interneurons?
neurons that take in information from body or viscera & send out that info (stay w/ in brain)
What is found in lower layers of spinal cord gray matter?
interneurons
motorneuron cell bodies
Why do we see a localized pain pattern?
interaction of somatic efferents with visceral & somatic afferents
Basis for activation of somatic muscle activity
visceral afferents activate sympathetic outflows & skeletal muscle motor neurons
Descending influences on reflexes
effect long-lasting excitability of outflows by maintaining the reflex
will either increase, decrease, or sensitize neurons
What produces dysfunction?
visceral disturbances reflexively cause activation in somatic musculature
somatic disturbances can reflexively alter visceral function
What does dysfunction lead to?
loss of health & decompensation of homeostasis
Somatic component of disease
MSK palpatory findings may correlate w/ visceral disturbances
normalization of autonomic outflows results in restoration of homeostasis
Facilitated segment concept
afferent input comes into cord interacting w/ interneuron chains
interneurons can act as amplifiers or inhibitors
Habituation
process of decreasing response of neural pathway w/ continuous stimulation
Nociception Theory
Habituation & sensitization
2 processes exist together to help maintain a homeostasis btwn over-reaction & under-reaction to a stimulus
What happens in facilitation?
less afferent stimulation required to trigger discharge of impulses (go off no matter what)
Nociception steps
once stimulus is strong enough to depolarize nociceptive pathways, impulses travel to spinal cord & branch to multiple sites
release of peptides @ motorneuron level in peripheral tissues
peptides involved in inflammatory cascade & initiate release of prostaglandins
chemical soup spreads in tissues
What does NOT have nociceptors?
brain or hyaline cartilage
What is the result of the chemical soup of proteins?
lowers nociceptor threshold which increases input to spinal cord
inflammation results in larger than normal motor outputs to autonomics & somatic systems
Outline steps that increase sensitivity of neurons
Short term excitability
Long term sensitization (minutes to hours)
Fixation (longer output)
Permanent excitatbility (death of inhibitory interneurons)
Facilitated Segment Concept
excitable areas assoc w/ injury & disease
low threshold spinal reflexes represent pathways in hyper-excited state
relates to skeletal muscle & sympathetic nervous system
Allostasis
long term neural effect of segmental facilitation on what your body wants to maintain
stimulus to tissues
develop chemical soup of inflammation
causes primary afferent sensitization
results in hyperalgesia
Hyperalgesia
exaggerated response to noxious stimulus (so do not engage that stimulus again)
Allostasis in spinal cord
Dorsal horn: lose inhibitory neuron function (lots of Ca2+)
Ventral horn: outflows to soma & autonomics (muscle spasms & affects visceral fxn)
Allostasis in brainstem
arousal system leads to loss of control of protective mechanisms=allostasis overload
Somatosomatic reflex
localized somatic stimuli producing patterns of reflex response in segmentally related somatic structures
Somatovisceral reflex
localized somatic stimulation producing patterns of reflex response in segmentally related visceral structures
ex: somaticocardiac, somatogastic, somatoadrenal
Viscerosomatic reflex
localized visceral stimuli producing patterns of reflex response in segmentally related somatic structures
Viscerovisceral reflex
localized visceral stimuli producing patterns of reflex response in segmentally related visceral structures
Somatocardiac reflex
injury/pain is source of nociceptive somatic stimuli that elevate HR & BP
Somatogastric reflex
nociceptive somatic stimuli results in increased inhibition of peristalsis in stomach
Somatoadrenal reflex
nociceptive somatic stimuli results in release of catecholamines from adrenal medulla (movement of inflamed knee)
Viscerosomatic reflexes
somatic pain referral due to visceral nociceptive stimuli
heart attack pain that radiates in different direction
Visceral sensory systems
all visceral nerves contain sensory fibers & cells bodies located in DRG
numerous interneuron connections in DRG that creates complex network connecting visceral & somatic systems
Head/neck
T1-T5
Upper GI
T5-10
Small intestine/ascending colon
T9-11
ascending & transverse colon
T10-L2
descending colon & sigmoid
T12-L2
upper extremity
T2-T7
lower extremity
T11-L2
parasymp upper GI
vagus N
parasymp small intestine/ascending colon
vagus N
parasymp ascending & transverse colon
vagus N
parasymp descending & sigmoid
S2-S4
sympa & parasymp for heart
T1-T6
Vagus N
sympa & parasymp for adrenals
T5-T10
Vagus N
sympa & parasymp for lungs
T1-T7
Vagus N
sympa & parasym for genitourinary tract
T10-L2
S2-S4 (repro organs)
sympa for genitourinary tract
T10-L2
sympa & parasympa for upper ureter
T10-T11
Vagus N
sympa & parasymp for lower ureter
T10-L2
S2-S4
parasymp for bladder & repro organs
S2-S4
Chapman’s reflexes
group of palpable points occurring in predictable locations on anterior & posterior surfaces of body that are considered to be reflections of visceral dysfunction or disease
3 component characteristics of Chapman’s reflexes
Viscerosomatic reflex
Gangliform contraction (blocks lymphatic drainage & causes SNS dysfunction)
consistent reproducible series of points both ant & post related to specific organs or conditions
Palpatory features
deep to skin in subcut areolar tissue on deep fascia or periosteum
small, smooth & firm nodule
may be confluent
dense but not hard
descriptions for palpatory features
gangliform, edematous, ridge like or ropey, fibrospongy, shotty
what is the pain usually assoc w/ reflex?
pinpoint, sharp & non-radiating
located under physicians finger tip
pain is GREATER than expected (pt usually previously unaware of sore spot)
Indications for treatment of chapman reflex
part of screening exam when clinically indicated from pt history & if clinically relevant to pt
Contraindications for treat of chapman reflex
emergent care
pt refusal
relatively contraindicated w/ fracture, cancer & other instability
What is some evidence for chapman reflex studies?
in pulmonary system (pts w/ pneumonia)
SD correlated to GI endoscopy findings
What results from host + disease?
illness
what does osteopathy look @ from host perspective?
enviro factors (structural, medical, surgical, psychosocial, alcohol & drugs & smoking)
What happens when host affected by illness?
decompensation which disrupts homeostasis
what is the goal of OMT?
re-obtain homeostasis
use of OMT
break cycle of facilitation then homeostasis & health could be restored to pt
