Viscerosomatic and Chapmans Flashcards
A ______ is the relationship between an input stimulus to the body and an output action to a muscle or an organ
reflex
Briefly describe the myotactic reflex
- Afferent impulses from a stretch are sent to the cell body of a sensory neuron
- Efferents are triggered that cause contraction of the muscle that resists or reverses the stretch
2 SIMULTANEOUS: efferents also inhibit contraction of the antagonist muscles (reciprocal inhibition)
Some dorsal horn neurons respond to _____ and ______ stimuli
Visceral and somatic
This is the processing area of the spinal cord
Gray matter
How many layers are in the spinal cord gray matter? Describe them!
10 Upper layers are 1-6: 1. A(delta) fibers: fast pain 2. small c fibers (slow pain) 3, 4. mechanoreceptors 5. A(delta) fibers: fast pain 6. afferent
7-10 are the lower layers where interneurons and motoneuron cell bodies are
The afferents from the body synapse in layers ___ to ___ of the spinal cord gray matter
1 to 6
This is where the interneurons and the motoneuron cell bodies are
In the lower layers of the gray matter; 7-10
________ of interneurons receive input from both visceral and somatic afferents
70-80%
What could be an explanation of visceral pain being diffuse and poorly localized?
Because the interneurons get both somatic and visceral information, so it cannot figure out what the heck is going on or where the pain is coming from
It is the interaction of the ______ efferents that give the localized pain pattern seen
somatic
Given that there is afferent visceral and somatic innervation, what can be seen with a visceral disturbance?
The somatic muscle activity can be seen with disturbances of the visceral organs; ie people can get back pain or something when they are having visceral problems and cause hypertonicity of the muscle
***RMR Dr. Joys story about how she treated somebody with heart issues and only came to that conclusion after she was not adequately able to treat her back and ordered more testing and boom… heart stuff
Describe the descending influences on the visceral and somatic reflexes
Effects the long-lasting excitability of the outflows and maintains the reflex: AMPLIFIES
can inhibit the somatic and autonomic outflow if needed
The sensitization of the interneurons act as an _____ of the inputs; hence more output is expected
amplifier
Describe the relationship between somatic and visceral reflexes- how do they affect each other
A visceral problem can cause a somatic response; hypertonicity, somatic dysfunctions, etc
But somatic can also reflexively alter visceral function: decompensation of homeostasis
The musculoskeletal palpatory findings may correlate with visceral disturbances which is called the….
Somatic component of disease
When a stimulus is repeated at a rate of about 1-2 seconds, and the response grows for about 20 seconds and then stabilizes, this is called _____
Sensitization
When a stimulus is repeated but there is a decreased response in the neural pathway, this is called ______
Habituation
What is the relationship between habituation and sensitization
They are opposite! Or inversely proportional for the math nerds
Why do habituation and sensitization happen together?
To maintain the homeostasis between habituation and sensitization so that there is a homeostasis between over and under reaction of the reflexes
_______ is the maintenance of a pool of neurons in a state of sub threshold excitation
Facilitation
*** a little bit of action causes stimulation (facilitation is a middle school aged boy)
What are the causes of facilitation?
Sustained increase of afferent input
Aberrant patterns of afferent input
Changes in the afferent neurons or the chemical environment
What theory does sensitization, habituation, and facilitation fall under?
The theory of nociception
Altering ______ stimuli will alter facilitation
nociceptive
Describe the method of action of nociception
The stimulus depolarizes the nociceptive pathway
The impulse travels to the spinal cord
Branches to multiple sites
Peptide release at motoneurons in peripheral tissues
Peptides cause the inflammatory cascade to occur
THIS lowers the nociceptor threshold and increases input to the SC
True/False There are nociceptors in the brain and hyaline cartilage
FALSE: THERE ARE NOT NOCICEPTORS IN THE BRAIN AND HYALINE CARTILAGE
What does inflammation do the balance between habituation and sensitization?
Inflammation disrupts the balance (she’s a home wrecker) and causes larger than normal motor outputs to the autonomics and somatic systems leading to low threshold spinal reflexes
When the threshold of the spinal reflexes are lowered, like seen in inflammation, this is called what?
The facilitated segment
People named Korr and Denslow talked about this apparently; idk could be a dumbass question so rmr those names
Describe Short Term excitability
Sensitization
1-2 seconds of afferent input
Excitability lasts 90-120 seconds
Describe Long term sensitization
Input is several minutes
Excitability lasts for hours
Describe fixation
afferent input for 15-40 minutes
excitability lasts for days or weeks
Describe permanent excitability
Lasts for forever and causes death of the inhibitory neurons
What are the steps for increasing the sensitivity of the neurons?
Short term excitability
Long term sensitization
Fixation
Permanent Excitability
What was DEnslow’s contribution to the facilitated segment concept?
He tested the afferent inputs using and EMG
Basically he discovered long lasting low threshold afferent inputs that were all at the same level and noticed associated physiological stress which brought him to the conclusion that
These excitable areas that he found were associated with injury and disease
How did Korr build on Denslow’s discovery?
He said that the low threshold reflexes represented a hyper-excited state because they kept getting input; creating the term “facilitated segment”
What are the two components of the facilitated segment concept?
Skeletal muscle and the sympathetic nervous system
The nervous system keeps pinging the afferent inputs and results in the muscular hyper-excitability (hypertonicity)
_____ is the ability to maintain general health
allostasis
What is the method/mode of action of allostasis
- stimulus is applied to tissues (typically an insult)
- Inflammation from peptide release (chemical soup)
- Primary afferent sensitization
- Hyperalgesia: exaggerated response to noxious stimuli (me to staci when she hits me)
In english:
A nasty message is sent to the tissues causing the tissues to get defensive and release chemicals against the insult, then there is a sensitization in the tissues which causes an increased response causing increased pain from further insults.
Secondary hyperalgesia develops _____ _______
Central sensitization
After secondary hyperalgesia is initiated, what happens to the dorsal neurons?
Calcium channels open
Phosphorylation cascades
Inhibitory neurons lose function
HELP TO maintain facilitation
*** reminds us not to get injured agin so that we can maintain allostasis
After secondary hyperalgesia is initiated, what happens to the ventral neurons?
Facilitation outflows to the autonomics which affects the visceral function
Facilitation outflows to the soma which causes muscle spasms (asymmetry, altered ROM)
After secondary hyperalgesia is initiated, what happens to the brainstem?
Facilitation decreases the endogenous descending pathways which stimulates the arousal system
What is the function of the arousal system in the brainstem?
Releases catecholamines and glucocorticoids
The brainstem arousal system is damaged by _____ _____ _______
long term facilitation
*** causes the loss of control of protective mechanisms leading to allostasis overload
How can allostasis affect the CV system?
HTN and risk of MI: because you have an increase in norepinephrine and cortisol which will increase your blood pressure: this increase if prolonged can cause an MI (heart attack) because of the increased stress on the heart
How can allostasis affect the Neurological system?
Overstimulation can cause depression, anxiety, memory loss and decreased cognition
*** med school effect on us
How can allostasis affect the Immune system?
Immunosuppression: you get sick more because you are constantly on edge and anticipating a threat so when an actual pathogen comes in, your body is distracted and cannot react more
________ are localized somatic stimuli producing patterns of reflex responses in segmentally related somatic structures
Somatosomatic
_______ is the localized somatic stimulation producing patterns of reflex response in segmentally related visceral structures
Somatovisceral
_______ is the localized visceral stimuli producing patterns of reflex response in segmentally related somatic structures
Viscerosomatic
_______ is the localized visceral stimuli producing patterns of reflex response in segmentally related visceral structures
Viscerovisceral
What are the two components of the somatosomatic response?
Withdrawal response
Myotactic response
_______ _____ is a somatosomatic reposes that occurs when a noxious stimulus is applied to the somatic structure
Withdrawal response
_______ ______ is a somatosomatic response that occurs when a stretch receptor is stimulated and the stretched muscle receives the impulse to fire
Myotactic response
___________ reflexes involve afferent activity flowing from the receptors into the SC through interneurons to produce an efferent activity within the sympathetic or parasympathetic motoneurons
Viscerovisceral reflex
What reflex correlates with this example?
Distention of the gut causes contraction of the gut muscle
Viscerovisceral
What are some examples of the somatovisceral reflex?
Somatocardiac
Somatogastric
Somatoadrenal
The _______ reflex is the elevation in heart rate and blood pressure after a nociceptive stimulus
somatocardiac
The _______ reflex is the inhibition of peristalsis in the stomach after a noxious stimulus
somatogastric
The _______ reflex is the release of catecholamines from the adrenal gland after a noxious stimuli
somatoadrenal
*** after you get hurt, you want the sympathetic nervous system to be activated
________ reflexes are somatic pain referral due to visceral nociceptive stimuli
Viscerosomatic
***heart attack pain down left arm, right shoulder pain with gallbladder, etc
The interneuron connections that are present in the _____ _____ _____ connect the visceral and somatic systems via complex communication
Dorsal root ganglia
True/False: All visceral nerves contain sensory fibers
True
What are the ENT sympathetic reflexes? What spinal cord level does this include?
Head and Neck: T1-T5
What are the 4 sympathetic/parasympathetic reflexes of the GI viscerosomatic reflexes?
Upper GI (esophagus)
Small intestine/ascending colon
Ascending or transverse colon
Descending and sigmoidal colon
What are the levels of the sympathetic viscerosomatic reflexes: Upper GI
T5-T10
What are the levels of the sympathetic viscerosomatic reflexes: Small intestine/ascending colon
T9-T11
What are the levels of the sympathetic viscerosomatic reflexes: Ascending and transverse colon
T10-L2
What are the levels of the sympathetic viscerosomatic reflexes: Descending and sigmoid colon
T12-L2
What are the levels of the parasympathetic viscerosomatic reflexes: Upper GI
Vagus N: OA, AA
What are the levels of the parasympathetic viscerosomatic reflexes: small intestine/ascending colon
Vagus N: OA/AA
What are the levels of the parasympathetic viscerosomatic reflexes: Ascending and transverse colon
Vagus N: OA/AA
What are the levels of the parasympathetic viscerosomatic reflexes: Descending and sigmoid colon
S2-S4 sacrum
What are the levels of the sympathetic viscerosomatic reflexes for the extremities?
Upper and Lower Extremities: T2-T7(upper) and T11-L2(lower)
True/False: there are not parasympathetic reflexes for the extremities
True
What are the reflex regions that are present in the cardiovascular viscerosomatic reflexes?
Heart and adrenals
What are the levels of the sympathetic viscerosomatic reflexes of the heart?
T1-T6
What are the levels of the sympathetic viscerosomatic reflexes of the adrenals?
T5-T10
What are the levels of the parasympathetic viscerosomatic reflexes of the heart
Vagus n (OA/AA)
What are the levels of the parasympathetic viscerosomatic reflexes of the adrenals
Vagus N (OA/AA)
What are the levels for the sympathetic pulmonary viscerosomatic reflexes? (lungs)
T1-T7
What are the levels for the parasympathetic pulmonary viscerosomatic reflexes? (lungs)
Vagus nerve (OA/AA)
What are the levels for the OB/GYN viscerosomatic reflexes of the sympathetics of the GU tract?
T10-L2
What are the levels for the OB/GYN viscerosomatic reflexes of the parasympathetics of the reproductive organs and the pelvis?
S2-S4 (sacrum)
What are the three sympathetic regions that are present in the urology viscerosomatic reflexes?
GU tract
Upper ureter
Lower ureter
What are the 4 parasympathetic regions that are present in the urology viscerosomatic reflexes?
Upper ureter
Bladder
Lower ureter
Reproductive organs
What are the sympathetic urology viscerosomatic reflex levels of the: GU tract?
T10-L2
What are the sympathetic urology viscerosomatic reflex levels of the: Upper ureter
T10-T11
What are the sympathetic urology viscerosomatic reflex levels of the: Lower ureter
T12-L2
What are the parasympathetic urology viscerosomatic reflex levels of the: upper ureter
Vagus N (OA/AA)
What are the parasympathetic urology viscerosomatic reflex levels of the: bladder
S2-S4(sacrum)
What are the parasympathetic urology viscerosomatic reflex levels of the: Lower ureter
S2-S4(sacrum)
What are the parasympathetic urology viscerosomatic reflex levels of the: Reproductive organs
S2-S4(sacrum)
________ _______ are a group of palpable points in predictable locations on the anterior and posterior surfaces of the body that are considered to be reflections of visceral dysfunction or disease
Chapman’s points
***used by frank chapman and described by charles owens
What are the 3 component characteristics of Chapmans reflexes?
- Viscerosomatic reflex of diagnostic and treatment value
- Gangliform contraction
- consistent reproducible serious of points ant and post that are related to organs
What are the palpatory features of Chapmans points?
Deep to the skin in the subQ areolar tissue on the deep fascia or periosteum
Paired in anterior and posterior (usually)
Small and smooth firm nodule that is 2-3 mm in diameter
DENSE BUT NOT HARD
Describe the dx or testing of the Chapmans points
Found by the fingertips of the examiner
A gentle but firm pressure is applied (clockwise or counterclockwise direction for 10-30 seconds)
Disagreeable response from the patients
Stop when the lump goes away or the patient cannot tolerate anymore
Describe the pain that is felt by the patient during the treatment of a chapmans point
The pain is pinpoint, sharp, and non radiating
Typically more than expected underneath the physicians fingertip
Patient is previously unaware of the spot
When do you use a chapmans reflex?
- For diagnosis
- For treatment
- AS a screening exam if indicated from the history
2. If possibly clinically relevant to the patient
What are contraindications of using Chapmans reflexes?
- If the patient needs emergent care (airway, breathing and circulation)
- Pt refusal
- Fracture, cancer, or other patient instabilities
Where are the Chapmans reflexes in the pulmonary system? (anterior)
Bronchus- 2nd ICS (intercostal space)
Upper lung- 3rd ICS
Lower lung- 4th ICS
Where are the Chapmans reflexes in the pulmonary system? (posterior)
all B/L!!
Bronchus- TP2
Upper Lung- between TP 3 and TP4
Lower lung- between TP4/TP5
*** basically where the anterior ones were but on the back: think about it; anatomically the 3rd intercostal space is going to correlate with the TP3 and TP4 space because that would be between ribs 3 and 4
Review the pictures on slides 78-80 because I feel like we do not need to know every single point so I am not making flashies on them…
Sue me
What is the overall message of this entire lecture?
OMT CAN RESTORE THE BODY TO HOMEOSTASIS
