Viscerosomatic & Chapman Take 2

Question 1

Myotatic reflex

Answer 1

tonic contraction of muscle in response to stretching force, due to stimulation of muscle receptors

agonist is contracted while antagonist muscle is relaxed

Question 2

What is a reflex?

Answer 2

relationship between an input stimulus to the body & output action to muscle or secretory organ

Question 3

What is important about spinal cord gray matter?

Answer 3

processing area of cord

Question 4

What is located in the lower layers of spinal cord gray matter?

Answer 4

interneurons

motorneuron cell bodies

Question 5

Where do afferent fibers into spinal cord terminate?

Answer 5

end in layers 1 & 5

Question 6

What input do interneurons receive?

Answer 6

70-80% of interneurons receive input from both visceral & somatic afferents

may account for visceral pain being so diffuse & poorly localized

Question 7

What is responsible for localized pain pattern we see?

Answer 7

interaction of interneurons w/ somatic efferents

Question 8

What is significant about the overlap of visceral & somatic afferent fibers?

Answer 8

basis for activation of somatic muscle activity seen w/ visceral disturbances

visceral afferents activate sympathetic outflows & skeletal muscle motor neurons

Question 9

How do descending influences impact reflexes?

Answer 9

affect long-lasting excitability of outflows by maintaining reflex (sensitization of interneurons acts as amplifier of input so more output expected)

Question 10

What is the basis for decompensation of homeostasis?

Answer 10

visceral disturbances reflexively cause activation in somatic musculature & produces dysfunction (facilitated segment)

somatic disturbances can reflexively alter visceral function

Question 11

What is the somatic component of disease?

Answer 11

MSK palpatory findings may correlate w/ visceral disturbances

normalizing MS component may normalize autonomic outflows (leading to restoration of homeostasis)

Question 12

What is habituation?

Answer 12

process of decreasing response of a neural pathway w/ a continuous stimulation

Question 13

What is sensitization?

Answer 13

when a stimulus is repeated, response may grow for longer

a stable response level is reached that can continue @ increased level as long as stimulus is continued

Question 14

How do habituation & sensitization contribute to homeostasis?

Answer 14

habituation & sensitization processes exist together to help maintain a homeostasis between over-reaction & under-reaction to a stimulus

Question 15

What is the concept of facilitation?

Answer 15

maintenance of a pool of neurons in a state of subthreshold excitation

less afferent stimulation is needed to trigger discharge of impulses

Question 16

Nociception theory

Answer 16

a stimulus activates nociceptive pathways that travel to spinal cord & branch to many sites

results in release of peptides @ motorneuron level in peripheral tissues

peptides lead to inflammatory cascade & initiate release of “chemical soup” that spreads in tissues

Question 17

What is the main result of chemical soup in peripheral tissues?

Answer 17

lowers nociceptor threshold which INCREASES input to spinal cord

Question 18

Where are nociceptors NOT found?

Answer 18

in brain or hyaline cartilage

Question 19

What is the result of inflammation in tissues?

Answer 19

disrupts balance between habituation & sensitization

larger than normal motor outputs to autonomics & somatic systems

Question 20

Steps for increasing sensitivity of neurons

Answer 20

short term excitability (sensitization)
long term sensitization (lasting for hours)
fixation (lasts for days-weeks)
permanent excitability (w/ death of inhibitory interneurons)

Question 21

Who was the main person behind the facilitated segment concept?

Answer 21

Denslow showed reflex changes (long lasting, low threshold areas to afferent inputs)

correlated excitable areas w/ injury & disease

Question 22

Facilitated segment concept

Answer 22

includes skeletal muscle & sympathetic nervous system

Question 23

What is allostasis?

Answer 23

the long term neural effect of segmental facilitation

Question 24

What is the process that leads to allostasis?

Answer 24

stimulus (insult) is applied to tissues
develop chemical soup of inflammation
causes primary afferent sensitization
results in hyperalgesia
secondary hyperalgesia develops

Question 25

What is hyperalgesia?

Answer 25

exaggerated response to noxious stimulus

Question 26

Effect of allostasis on dorsal horn neurons

Answer 26

Ca2+ channels open
phosphorylation cascades
lose inhibitory neuron function

all lead to maintaining facilitation

Question 27

Effect of allostasis on ventral horn neurons

Answer 27

facilitation outflows to autonomics (affects visceral function)

facilitation outflows to soma (muscle spasm=asymmetry & altered ROM)

Question 28

Effect of allostasis on brain stem

Answer 28

facilitation decreases endogenous descending pathways

over release of catecholamines & glucocorticoids which damages system

Question 29

Allostasis overload

Answer 29

ultimate result of loss of control & protective mechanisms from brainstem

Question 30

What are the main effects of allostasis on body systems?

Answer 30

CV (increased risk of MI)
neuro (depression, anxiety, decreased cognition)
immune (immunosuppression)

Question 31

Somatosomatic reflex

Answer 31

withdrawal response (when noxious stimulus is applied to somatic structure)

myotatic response (stretch receptor stimulated & agonist muscle receives impulse to fire)

Question 32

Viscerovisceral reflex

Answer 32

distention of gut results in increased contraction of gut muscle

reflexes involve afferent activity flowing from receptors into spinal cord thru interneurons to produce efferent or outflow activity w/ in sympathetic or parasympathetic motorneurons

Question 33

Somatovisceral reflex examples

Answer 33

somatiocardiac
somatogastric
somatoadrenal

Question 34

Somatiocardiac reflex

Answer 34

nociceptive somatic stimuli result in elevation of HR & blood pressure

Question 35

Somatogastric reflex

Answer 35

nociceptive somatic stimuli result in inhibition of peristalsis in stomach

Question 36

Somatoadrenal reflex

Answer 36

nociceptive somatic stimuli result in release of catecholamines from adrenal medulla (movement of inflamed knee)

Question 37

Viscerosomatic reflexes

Answer 37

somatic pain referral due to visceral nociceptive stimuli

Question 38

How are the visceral & somatic sensory systems related?

Answer 38

there are numerous interneuron connections in DRG creating complex communication network connecting visceral & somatic systems

Question 39

Chapman reflexes definition

Answer 39

used by Frank Chapman & described by Charles Owens

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

Question 40

What prompted Chapman to study more about the lymphatic system?

Answer 40

noticed groin glands on pt that were painful & tried to gently manipulate them which lead to major relief for the pt

Question 41

How did Chapman study the lymphatic system?

Answer 41

mapped congested lymphatic areas that he found in consistent locations close to body surface & referred to them as neurolymphatic points w/ physiological relation to lymphatic & neuro systems

Question 42

When did Chapman first publish his observations?

Answer 42

in 1929 text titled “Lymphatic reflexes”

Question 43

What are Chapman’s reflexes?

Answer 43

CRs are manifested by gangliform contractions which are believed to be congestions w/ in fascia due to lymph stasis secondary to visceral dysfunctions

3 components:
viscerosomatic reflex (of diagnostic & treatment value)

gangliform contraction that blocks lymph drainage

consistent reproducible series of points both anterior & posterior related to SPECIFIC ORGANS or conditions

Question 44

Describe the palpatory findings assoc w/ Chapman’s reflexes

Answer 44

located deep to skin in subcutaneous areolar tissue

PAIRED anterior & posterior points

small, smooth & firm nodule that are 2-3 mm in diameter

may be confluent, dense but not hard

Question 45

How did Owens describe these points?

Answer 45

in 1943 as gangliform, edematous, ropy, fibrospongy, shotty

Question 46

How can you treat a Chapman point?

Answer 46

apply gentle but firm pressure w/ 1 finger pad

slowly move tip of finger in circular fashion for 10-30 seconds (can alternate directions)

Question 47

How can you DX a Chapman point?

Answer 47

pain that is pinpoint, sharp & non-radiating

located under physician’s finger tips

pain is greater than expected & pt usually unaware of sore spot

Question 48

When do you stop treating a Chapman point?

Answer 48

the mass disappears to pt/phys can no longer tolerate the procedure

Question 49

Indications for treat of CP

Answer 49

to DX: is part of screening exam when clinically indicated from pt history

to treat: upon finding that CR is possibly clinically relevant for that pt

Question 50

Contraindications of CP treatment

Answer 50

pt needs emergent care

pt refusal

relatively contraindicated w/ fracture, cancer & other pt instability

Question 51

Where does osteopathic medicine come in for pt care?

Answer 51

at the host by looking @ environmental factors leading to illness

Question 52

What does illness cause in the host?

Answer 52

decompensation

Question 53

What can help improve decompensation of homeostasis?

Answer 53

OMT!

Question 54

Why is OMT important?

Answer 54

reasonable to conclude that using OMT to break cycle of facilitation, homeostasis & health can be restored to the pt