Special Populations

Question 1

Name the foot bones on an XR

(been told this is HY, why? because 2020 sucks)

Answer 1

*specifically know navicular bone

Question 2

Know what spinal stenosis with spondylosis looks like on MRI

Answer 2

Question 3

Know what L4 on L5 spondylolisthesis with disc space narrowing and sondylosis looks like on MRI

Answer 3

Question 4

What is the location and positioning for pectoralis minor counterstrain?

Answer 4

f-F ADD

located inferior and medial to the coracoid process

Pt: supine

Doc: ipsilateral

Pt’s arm across chest, shoulder pulled anterior, inferior and medial to shorten muscle fibers

Question 5

What are the three steps of LAS?

Answer 5

1. Disengagement
2. Exaggeration
3. Balance and maintain balance until release occurs

Question 6

What is the seated innominate BLT/LAS position for posterior innominate?

Answer 6

Pt rotates toward affected side

Cephalad force to affected side

*note moving the left into abduction may help find the balance point

Question 7

What is the seated innominate BLT/LAS for anterior innominate?

Answer 7

patient rotates away

may add cephalad or caudad force to enhance balance

Question 8

What factors stay the same regardless of treating special populations or typical populations?

Answer 8

Careful and thorough evaluation and diagnosis

somatic dysfunction diagnosis

techniques

plan

addressing acute issues

Question 9

What things will change when treating special populations?

Answer 9

Palpation positioning and expected findings

Treatment technique may vary

Plan may include preventing further decline and addressing sequela of underlying disease

Question 10

What is the goal of treating special populations?

Answer 10

allow patient to function in their daily life with optimal comfort, safety, participation and QOL

Question 11

What is the incidence of MS?

What is the basic pathology?

Answer 11

3/1000

typically white young women

autoimmune attack on myelin sheath in brain and SC leading to permanent damage

Question 12

What kind of compensation patterns are seen in pt’s with MS?

What is the goal of treatment then?

Answer 12

loss of or shifting capacity leads to unusual compensation patterns and overuse strains

Modify these compensation patterns (may require pt to have help at home or work)

Question 13

Since the abnormal compensation patterns are likely to recur in MS due to the nature of the disease, what is recommended?

Answer 13

rehab PT to restore normal patterns by re-strengthening muscles

Question 14

What techniques are recommneded for MS?

Answer 14

MFR and ST

can try HVLA, ART, ?MET

diaphragm treatments may help improve lymphatic flow and fatigue

Question 15

What is the incidence of CVA?

What are the two types?

Answer 15

2nd major cause of death is US with 30% of pts having persistent deficits

hemorrhagic and ischemic

Question 16

What is the most common outcome of stroke?

Answer 16

hemiplegia

can also see spastic paralysis within one week

Question 17

What OMT is indicated hyperacutely for stroke (first 24hrs)?

What OMT is indicated acutely?

Answer 17

none

PT may help movement

increase cerebral perfusion, O2

reduce head associated strain patterns, treat upper thoracics, cervical and cranial

reduce sympathetic tone

Question 18

What is the goal of treatment subacutely, within 7 days?

Answer 18

reduce tissue reorganization to avoid contractures

Question 19

What is the treatment goal post-subacute, once the patient is home after a stroke?

Answer 19

improve sensorimotor integration

improve brain and peripheral function

reduce stroke associated strain patterns

reduce sympathetic tone

Question 20

What are the OMM treatment considerations for CVA?

Answer 20

may be a benefit of OMM in acute phase

integrated care with neurology, OT, and PT

choose direct MFR as collagen fibers are fragile

Question 21

What are some techniques that can treat a CVA patient?

Answer 21

direct MFR

HVLA (may improve sensorimotor integration…?)

ART (ROM, circles, figure 8s)

Sympathetic inhibtion

craniosacral

Question 22

What is the goal of treatment in patients who are wheelchair bound?

what is something to consider?

Answer 22

typically seek care for pain control

consider access limitations (ability to get to facility, get into facility, and may require extra time on the physician’s part that she might not have)

Question 23

What are some good techniques for the WC bound patient?

Answer 23

integratio with OT, PT

joint releases while seated

ME, ART, Still;s

Cervical HVLA, MET, ART, Stills

Soft tissue inhibition, MFR, MET, ST

Lymphatics, E/P, Thoracic outlet, diaphragm.

NO pedal pump, maybe thoracic pump

Question 24

The diaphragm may be restricted in the WC bound patient, why?

Answer 24

due to increased abdominal pressure

Question 25

When treating a trauma patient with OMT, what must be considerED?

Answer 25

timing has a major influence on technique selection

Question 26

What is the main treatment consideration for the trauma pt?

Answer 26

tension is the enemy of healing

reduce and maintain reduced global tension

Question 27

What treatments should be selected for in the trauma pt?

Answer 27

gentle ones

gentle ART

indirect BLT

Stills

Counterstrain

Proximal effleurage