Review: ANS and Homeostatic Clinical Examples, Chapmans Flashcards
Define the ANS
Two-neuron chain connecting preganglionic neurons through ganglia to visceral target tissues
Components of sympathetic ANS
Cervical ganglia (superior, middle, stellate)
Paravertebral ganglia (thoracolumbar)
Prevertebral ganglia (celiac, superior mesenteric, inferior mesenteric)
Components of parasympathetic ANS
CN3 — eye
CN7 — lacrimal, palatine, and submandibular
CN9 — parotid
CN10 — cardiopulm, GI
Sacral (S2, S3, S4) — colon, rectum, GU
What are paraganglia?
Extrasuprarenal aggregations of chromaffin tissue — abdominal, adrenal, and paraspinal
Synthesize and store catecholamines
[pheochromocytoma sxs = HA, sweating, and tachycardia]
Distribution of sympathetic vs. parasympathetic in terms of vascular and visceral supplies
Sympathetic: vascular includes fascia, smooth muscle and sweat glands + trunk and extremities; visceral includes smooth muscle, cardiac, nodal and glandular tissue in thoracoabdominopelvic cavity
Parasympathetic: no extremities! Visceral — same as sympathetic but also in viscera of head and neck
What is meant by “allostatic load”?
Frequent activation of allostatic systems — continuation of feedback pathways meant to reestablish normal homeostasis
Longterm exposure may cause atrophy of hippocampus affecting feedback, memory, and autonomic function
[allostasis = adaptation in the face of potentially stressful challenges involves activation of neural, neuroendocrine and neuroendocrine-immune mechanisms]
A facilitated segment is also known as somatic dysfunction — what are 2 hallmarks of a facilitated segment?
Lowered neuronal threshold
Hypersensitivity of receptive fields
Goals of OMT in reestablishing homeostasis
Reduce allostatic load by balancing ANS
Reduce postural strain
Improve biomechanics of gait
Remove obstructions to fluid flow and drainage, augment fluid flow
Improve biomechanics of respiration
Optimize tissue healing and homeostatic reserve
Limbic system —> hypothalamus —> sympathetic nervous system —> ???
SNS —> lateral horn of the thoracolumbar spinal cord —> paravertebral and prevertebral ganglia —> end organ
Limbic system —> hypothalamus —> parasympathetic nervous system —> ???
PNS —> brainstem nuclei and lateral horn of sacral SC —> organ ganglia —> end organ
Thoacolumbar (T1-L2) system arising from the intermediolateral cell column of the lateral horn of the SC acting through chain ganglia and collateral ganglia
SNS
Craniosacral system arising from brainstem nuclei associated with CNs III, VII, IX, and X and from the intermediate gray in the S2-S4 SC
PNS
Sympathetic innervation of head/neck, heart/lungs, and upper GI
Head/Neck = T1-4
Heart lungs = T1-6
Upper GI = T5-9
Sympathetic innervation of small intestine+right colon, appendix, and left colon+pelvis
Small intestine+right colon = T10-11
Appendix = T12
L colon/pelvis = T12-L2
Sympathetic innervation of adrenals, GU tract, and upper/lower ureter
Adrenals = T10-T11
GU tract = T10-L2
Upper/lower ureter = T10-11/T12-L2
Sympathetic innervation of bladder and upper/lower extremities
Bladder = T12-L2
Extremities upper/lower = T2-8, T11-L2
Parasympathetic innervation of vagus n. (CN X) involves what structures?
Heart, lungs, thyroid, carotids
Upper/middle GI, liver
Kidney, upper ureter
Ovaries/testes
S2-4 Pelvic splanchnic nn. of parasympathetic nervous system innervate what structures?
Lower GI, uterus/cervix, penis/clitoris
Lower ureter, bladder
Assessment of sympathetics
Appropriate spinal levels
Paraspinal muscle spasms
Rib restrictions
Distant ganglia — cervical, celiac, mesenteric
Parasympathetic assessment
Vagus — look for condylar compression, OM suture restrictions, OA/AA SDs
Sacrum (S2-4) — sacral somatic dysfunction
Define somatic dysfunction
Impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, myofascial structures, and their related vascular, lymphatic, and neural elements
Important people = J.S. Denslow, DO, and Irvin Korr, PhD
Define spinal facilitation
The maintenance of a pool of neurons in a state of partial or subthreshold excitation; in this state, less afferent stim is required to trigger discharge of impulses
Facilitation may be d/t sustained increase in afferent input, aberrant patterns of afferent input, or changes within affected neurons themselves or their chemical environment — once established, facilitation can be sustained by normal CNS activity
General technique for balancing the ANS
CV4 OCMM
Regional techniques for balancing the ANS
Rib raising Paraspinal muscle inhibition Abdominal collateral ganglia techniques Target type II SDs if present Suboccipital inhibition Sphenopalatine ganglia release Sacral inhibition and rocking SI joint gapping
OMT used to decrease sympathetic activity
Rib raising Paraspinal muscle inhibition Cervical ganglia inhibition Abdominal collateral ganglia technique Target non-neutral (type II) SD if present
OMT to normalize parasympathetic tone
Suboccipital inhibition Sphenopalatine ganglion release Sacral inhibition and rocking SI joint gapping BLT Gentle muscle energy
Who performed the prospective controlled study with rabbits in which SD was induced weekly at atlas, C6, and T3 with subsequent measurement of pulse, response to exercise, EKG, and tissue sample?
Louisa Burns, DO
What were the results of Dr. Burns’ research in terms of functional changes as a result of T3 SD?
Immediate: rapid, weak, and somewhat irregular pulse
10 minutes later: slightly stronger, slower an dmore regular, but did not return to normal as long as SD persisted
2 months later: gradually weaker with staccato quality similar to that found in elderly [this was not present in rabbits without T3 SD]
What were the results of Dr. Burns’ research in terms of functional changes as a result of atlas SD?
Immediate: stronger and irregular pulse
10 minutes later: closer to normal as long as SD persisted
2 months later: developed arrhythmias [theorized to be d/t vagal n. facilitation]
Cardiac cross section findings in rabbits after atlas and T3 induced SD
Abnormalities in muscle patterns — abnormal color, cross striations, abundant fibrils, variable nuclear relations
Edema
Hemorrhagic areas
Overgrowth of CT
[neurotrophic findings]
What type of reflex?
Localized somatic stimuli producing patterns of reflex response in segmentally related somatic structures
Somatosomatic reflex
What type of reflex?
Localized somatic stimulation producing patterns of reflex response in segmentally related visceral structures
Somatovisceral reflex
What type of reflex?
Localized visceral stimuli producing patterns of reflex response in segmentally related somatic structures
Viscerosomatic reflex
What type of reflex?
Localized visceral stimuli producing patterns of reflex response in segmentally related visceral structures
Viscerovisceral reflex
A 35 y/o female d/c yesterday s/p smoke inhalation presents with cough and mild SOB. She has a hx of asthma x20 years.
Where might she have dysfunction and what are some OMT options?
Lungs are T2-4 and CN X
OMT with indirect tx of cervical, thoracic, rib, and lumbar SD — quiet the aberrant neural input from pre-existing SDs
OMT to open the lymphatic system — No pumps!!
Be careful bc she is only 1 day out of the hospital
72 y/o male hospitalized s/p abdominal surgery resecting malignant tumors from his large and small bowel now c/o ileus and cramping abdominal pain 5d s/p surgery…what are some possible areas of ANS findings?
SI = T9-10, CN X
Ascending and transverse: T11-L1, CN X
Descending, sigmoid: L1-2, S2-4
67 y/o male 7d hospitalized with complaints of inability to urinate s/p TURP twice and has LBP. What are some possible areas of ANS findings?
Kidneys: T10-L1, CNX
Ureters: T11-L2, CN X
Bladder: T10-L1, S2-4
40 y/o female with c/o carpal tunnel syndrome, scleroderma, Raynaud’s disease. After your OSE you find significant TART findings (edematous, boggy, tender) in bilateral lower cervical and upper thoracic spine…why is that?
UE sympathetic supply to vascular is via upper thoracics
Hand dermatomal and myotomal nerve supply via C6-C8
What are the 5 models of the osteopathic approach to tx?
Biomechanical Psych/behavioral Respiratory/circulatory Metabolic Neurologic
Sympathetic findings and tx in acute bronchitis
Sympathetic innervation: T1-6
Paraspinal muscle inhibition, rib raising, OMT to appropriate region
Parasympathetic findings and tx in acute bronchitis
OA, AA
OMT: suboccipital inhibition
Lymphatic and vascular drainage associations and tx with acute bronchitis
Diagnose both thoracic inlet and abdominal diaphragm
Tx: Thoracic inlet release, abdominal diaphragm release, rib raising
Purpose of OA tx in the ANS
Free parasympathetic response to structures innervated by cranial nn. IX and X by freeing passage through jugular foramen — balance parasympathetic influence to the viscera
Condylar compression in newborns may cause suckling difficulties
Manipulation of OA, AA, or C2 joints will influence parasympathetic tone via vagus n
What are chapman’s reflexes?
Viscerosomatic reflex of both diagnostic and tx value
Gangliform contraction that blocks lymphatic drainage and causes SNS dysfunction (neurolymphatic)
A consistent reproducible series of points both anterior and posterior related to specific organs or conditions
Anterior Chapman’s reflexes of bronchus, upper lung, and lower lung
Bronchus = 2nd ICS
Upper lung = 3rd ICS
Lower lung = 4th ICS
Posterior Chapman’s reflexes for bronchus, upper lung, and lower lung
Bronchus = b/l TP2
Upper lung = b/l between TP3 and TP4
Lower lung = b/l between TP4 and TP5
Sympathetic findings and tx associated with chronic constipation
Sympathetic innervation: T10-L2
Tx: paraspinal muscle inhibition, collateral ganglia inhibition
Parasympathetic findings and tx associated with chronic constipation
Sacrum, OA, AA
Tx: suboccipital inhibtion, sacral inhibition and/or rocking
Lymphatic and vascular drainage findings and tx associated with chronic constipation
Diagnose thoracic inlet, abdominal diaphragm, pelvic diaphragm, and mesenteries
Tx: TI release, abdominal diaphragm release, mesenteric lifts, pelvic diaphgram release
What is the difference in terms of PNS with sacral rocking vs. sacral inhibition?
Sacral rocking increases parasympathetic tone
Sacral inhibition decreases parasympathetic tone
Anterior chapmans points for esophagus, liver, and GB
Esophagus: b/l 2nd ICS
Liver: R 5th ICS
GB: R 6th ICS
Anterior chapman points for pancreas, small intestines, and appendix
Pancreas = R 7th ICS
Small intestines = 8-10th ICS
Appendix = tip of R 12th rib
Anterior chapmans points for pylorus, stomach acidity, stomach, and spleen
Pylorus: sternal
Stomach acidity: L 5th ICS
Stomach: L 6th ICS
Spleen: L 7th ICS
List chapmans points on right and left thigh from superior to inferior
Right thigh: ileocecal valve, ascending colon, right 2/5 transverse colon
Left thigh: sigmoid colon, descending colon, left 3/5 of transverse colon
Posterior chapmans points for stomach acidity, GB, and spleen
Stomach acidity = L b/w T5 and T6
GB = b/l between T5 and T6
Spleen = L between T7 and T8
Posterior chapmans points for small intestine
Bilateral
Upper SI between T8 and T9
Middle between T9 and T10
Lower between T11 and T12
Posterior chapmans points for esophagus, liver, pancreas, and pylorus
Esophagus = b/l T2
Liver = R between T5 and T6
Pancreas = R between T7 and T8
Pylorus = R T10 a costotransverse joint
Sinuses Chapmans points
Anterior: Inferior to medial clavicles
Posterior: C2, midway between SP and TP
Middle Ear Chapmans points
Anterior: Superior anterior aspect of clavicles just lateral to where they cross first ribs
Posterior: tips of C1 transverse process
Pharynx Chapmans points
Anterior: 3-4 cm medial to where 1st ribs emerge from beneath clavicles
Posterior: C2 midway between SP and TP
Larynx Chapmans points
Anterior: 5-7 cm lateral to sternocostal junction upon 2nd ribs
Posterior: C2 between SP and TP
Tonsils Chapmans points
Anterior: Between 1st and 2nd ribs adjacent to sternum
Posterior: C1 midway between SP and TP
Eye Chapmans points
Anterior: anterior aspect of humerus at level of surgical neck
Posterior: squamous portion of occipital bone below superior nuchal line
