The PT With Lower Resp Tract Problems DSA Flashcards
Osteopathic in pneumonia– classical
primary problem: vascular stasis as secondary to decreased neural function
“when the ribs are adjusted and the blood and nerve supply freed from pressure, the fever generally goes down and ease will follow” (Still)
Hazzard: begin with cervical treatment (OA) for vagal release, scalenes as secondary muscles of respiration, ribs and vertebrae and also release of abdominal tension.
Barber: begin with lateral recumbent soft tissue work from cervical to lumbar spine
supine cervical articulatory and soft tissue
next rib raising (using arm as lever in fll inspiration)
2 minutes of thoracic manual vibration
sub ox pressure for 5 minutes
osteopathic in pneumonia– contemporary consideration
Rib raising with paraspinal muscle stretch
OA inhibition and compression of fourth ventricle (CV-4) to control fever
2nd stage: myofascial release of fascia associated with periscapular muscles and anterior cervical fascia associated with respiratory drive
lymphatic pump procedures
outcome studies: OMT and pneumonia
shorter reliance on IV abx
shorter hospital stay
COPD, pediatric lower respiratory tract infections, cholecystitis, hysterectomies decreased hospital stay with integration of OMT
OMT- mechanisms of action: neuroreflexive
pneumonia patient is stressed
sympathetic hyperarousal
Viscerosomatic/ somatovisceral reflexes: T2-6
Postural reflexes- optimize thoracic expansion
OMT- mechanisms of action: Biomechanical
Articular- costovertebral contacts and intervertebral facet joints, mobility of the spinal column –> accommodate lung expansion
myofascial- distensibility of the horizontal diaphragms, tentorium cerebellae, thoracic inlet, thoracoabdominal and pelvic floor, and the fascial elements of hte accessory muscles of respiration
OMT- mechanisms of action: vascular
lymphatic- major route of lymph drainage from the lower body - through the posterior of the thoracic cavity, to return to the left subclavian.
lymph flow dependent on thoracic pressure gradient
Venous- dependent upon the activities of daily living, suspended by acut illness. Venous stasis of pulmonary disease in conjunction with inactivity from hospitalization- enefit from manipulative assistance.
Interstitial: to clear tissue edema, fluids must find their way to vascular system. External pressure, including myofascial efflurage, assists.
OMT mechanisms of action: pneumatic
respiratory- unobstructed respiratory cycle assists bronchial ciliary clearance of debris in the mucous layer, resorption of transudates, gas exchange, adn processes dependent on the alternating positive and negative intrathoracic pressures.
Evaluation of pneumonia patient
cultures –> abx of choice
CXR–> shows amount of pulmonary edema
ABG: compromise to oxygen exchange
skin tone, consciousness- severity
quality of thoracic compliance (rib mobility and spinal symmetry/ flexibility) describe physiologic status, chronic host susceptibility, degree of physiologic stress
rib assessment and segmental spinal dx–> predisposing and obstructive factors, organ involvement
diaphragmatic excursion- amount of potential gain from MFR
thoracic inlet- may offer a point of entry to optimize fxn
Posture, tissue quality, psoas muscle tone, abdominal girth suggest aspects of wellness and prognosis
Emphysema
rib raising is effective
and lateral mobilization to complement the mobilization at the costo-transverse jxn
Chronic asthmatic bronchitis/ acute exacerbations
tense trapezius and SCMs
2dary muscles of respiration AND share afferent and efferent fibers by adjacent nuclei of CN X and XI in the brain stem
crosstalk in the interneuronal matrix of the cord- facilitated segment and visceral-somatic dysfunction
Stretch and deep tissue massage of these muscles and fascia –> relief from cycle of constriction and anxiety
Treat what you find
observation and palpation rib raising rib articulation paraspinal muscle stretch lymphatic pum occipitoatlantal release cervical articulatory release diaphragmatic release oscillatory release
the first rib
has complex associations and, if restricted, can impede the pump handle respiratory excursion of all the ribs below it. This rib is embedded in the middle cervical fascia that blends with the dome of the lung. Checking tension in the space between the clavicle and the anterior border of the trapezius allows one to affect tension on the dome of hte lung.
