VSR And Chapman Reflex

Question 1

Chapman reflex definition

Answer 1

A group of palpable points occurring in predictable locations on the anterior and posterior surfaces on the body that are reflections of visceral dysfunctions or disease.

also area sometimes called gangliform contracted lymphoid tissue nodules

Question 2

Neurolymphatic postings

Answer 2

Commonly congested lymphatic areas that help viscerosomatic relief when treated

Question 3

Proposed physiologic mechanisms of Chapman reflex

Answer 3

Sympathetic nerve fibers and lymph vessels travel together Through the same muscle/fascia
- therefore restriction causes pain and lymph congestion and ultimately a Chapman point

Question 4

Reflex point characteristics

Answer 4

Edematous

Ropey

Fibrospongy

Shorty

Sharp

Very tender

DOES NOT RADIATE

Question 5

Anterior Chapman reflex points details

Answer 5

Typically found in the intercoastal spaces UNDER the respective superior rib

• typically bilaterally
• tend to be more tender than posterior
• typically help diagnose organ/system dysfunctions

Question 6

Posterior Chapman reflex points details

Answer 6

Typically located on the corresponding transverse processes

• normally found bilaterally
• tender to be less tender than anterior, but still tender
• typically used to treat the organ/system dysfunction

Question 7

How to identify Chapman reflex points

Answer 7

Requires a thorough and relevant history
- physcial examination via history can point to possible Chapman point locations

If a Chapman point is present, it aids w/ diagnosis of the medical problem and helps narrow down the differential diagnoses

Using palpation w/ relaxed fingers and assess the anterior point locations first always. If none are found, then move to the posterior points for assessment

Question 8

Treatment of Chapman reflex points

Answer 8

Begin by identifying the corresponding posterior reflex points associated w/ either the medical continues and/or the anterior reflex points
- identify anterior -> posterior, but always treat posterior -> anterior

1) use finger pad and apply firm pressure to the point being treated
2) slowly move the finger in a circular motion as to flatten the mass
3) continues for 10-30 seconds or until either the point is no longer palpable or the patient cant tolerate.

Question 9

How to find intercostal site Chapman points

Answer 9

Finger pads directed postero-superiorly along the undersurface of the rib W/ deep firm rotation movement

Question 10

Value of Chapman points

Answer 10

Essential part of a through OMM physical exam

Aids w/ diagnosis of disease

Treated autonomic system balance

May improve immune system efficiency

Improves lymphatic flow

Can improve medical conditions relating to the following:

• Asthma
• HTN
• cardiac dysrhythmia
• renal and bladder dysfunctions

Question 11

Parasympathetic vs sympathetic routes to effector organs from brain

Answer 11

Parasympathetic
- brainstem and lateral horn of the sacral spine -> organ ganglia -> effector organs

Sympathetic
- lateral horn of the thoracic-lumbar spine -> prevertebral ganglia -> effector organs

Question 12

Fiber differences in sympathetic vs parasympathetic ANS

Answer 12

Sympathetic

• short preganglionic
• long postganglionic

Parasympathetic

• long preganglionic
• short postganglionic

Question 13

Sympathetic ganglia #s

Answer 13

All are lateral except the coccygeal ganglion and the stellate ganglion

Stellate ganglion
- fusion of the inferior cervical (4-7) and T1 ganglion

3 cervical

10-11 thoracic

3-5 sacral

Coccygeal ganglion
- site of sympathetic and parasympathetic fusion

Question 14

Visceral parasympathetic nerves

Answer 14

CN10

S2-4
- pelvic splanchnic

Question 15

Parasympathetic nerves in the head and the cranial nerve they ride on to get to their target

Answer 15

Ciliary -> CN3

Pterygopalatine and submandibular -> CN7

Otic -> CN9

Question 16

Sympathetic trunk

Answer 16

The main carrier and site of sympathetic ganglion
- carries the thoracic, lumbar and sacral splanchnic sympathetics to the paravertebral ganglia in respective plexuses

From there the postganglionic fibers leave and enter the specific intrinsic organ ganglion

Question 17

What are the main parasympathetic nerve carriers

Answer 17

Vagus nerve for anything superiorly

Pelvic splanchnic for anything inferiorly

Question 18

Difference between General Somatic Efferent neurons (GSE) and General Visceral Efferent neurons (GVE)

Answer 18

GSE:
- motor components that directly innervate the skeletal muscle

GVE:
- motor components that indirectly innervate visceral structures via post ganglion is fibers

Question 19

Physiology of reflex arches

Answer 19

1) Begins with nociceptive from viscera initiates impulses due to a stimulus
2) impulse synapses w/ interneurons and becomes a visceral stimulus
3) visceral stimulus travels to both the motor and sympathetic efferent nerves to generate an effect
4) visceral reflex imputes elicits both a sympathetic and motor response of the segmental area of the origination of the stimulus

Question 20

Sites of efferent and Afferent spinal reflexes

Answer 20

Efferent

• blood and lymph vessels
• muscles
• viscera

Afferent

• blood and lymph vessels
• skin
• joints
• muscles
• viscera

*only the skin and joints have only afferent reflexes (cant generate a reflex, but can react)

Question 21

Types of reflexes

Answer 21

Viscerosomatic
- localized visceral stimuli producing a pattern of reflex responses in segmentally somatic structures

Somatovisceral
- localized somatic stimulation producing a pattern of reflex responses in segmentally related visceral structures

Viscerovisceral
- localized visceral stimuli that produces a pattern of reflex responses in segmentally visceral structures

Somatosomatic
- localized somatic stimuli producing patterns of reflex responses in segmentally related somatic structures

Question 22

Who coined the discover of viscerosomatic reflexes

Answer 22

Louisa burns (1907)

Question 23

Kehrs sign

Answer 23

Palpable tissue texture changes from T1-5 (upper shoulder) that is caused by the presence of blood in the peritoneal cavity
- this an example of both referred pain and viscerosomatic reflexes

Question 24

Spinal facilitation

Answer 24

The maintenance of a pool of neurons in a state of partial excitation

• this allows smaller stimuli to trigger an impulse
• a possible theory for describing the underlying neuronal activity in somatic dysfunctions

Question 25

Features of viscerosomatic reflex as it relates to OMT

Answer 25

Deep muscle reaction usually occurring through 2 or more adjacent spinal segments that have Somatic dysfunction Resistance to segmental joint motion w/ a rubbery end feel compared to a hard end feel. Skin and subcutaneous TART varies between acute or chronic Does not manifest an asymmetric position most of the time Causes somatic dysfunctions to resist normal OMT - keeps coming back after OMT Only treated via treating the causative visceral pathology

Question 26

Where to find tissue texture abnormalities of Viscerosomatic reflexes?

Answer 26

Bilateral or symmetrically at the affected spinal segments | - except is asymmetrical organs, which will case asymmetrical ipsilateral reflexes

Question 27

Both divisions of the vagus nerve

Answer 27

Left division - innervates the AV node And everything above the duodenum that receives vagal parasympathetics Right division - innervates the SA node and everything above the transverse colon that revives vagal parasympathetics *the jejunum, ilium and ascending and descending colons are innervates only by the right decision of the vagus nerve*

Question 28

What do pelvis splanchnics innervate?

Answer 28

Parasympathetic to the descending and sigmoid colon Parasympathetic to the pelvic region

Question 29

Viscerosomatic reflex locations w/ respect to the diaphragm

Answer 29

Organs ABOVE the diaphragm have reflex ganglia above T5 Organ BELOW the diaphragm have reflex ganglia below T5

Question 30

common TART criteria for viscerosomatic reflexes chronic vs acute

Answer 30

Acute: - warm and red - sweating - red reflex - increased skin drag - edema - skin thickening - hypertonicity - not overall sensative Chronic: - vasospasms - cool - low seating and skin drag - sensation of fibrotic tissue (ropeyness) - hardness - hypersensitivity or hyposensativity

Question 31

Common sympathetic OMT techniques

Answer 31

Rib raising ST paraspinal relaxation Lymphatic techniques Sacrum and pelvic releases

Question 32

Common parasympathetic OMT techniques

Answer 32

Cranial manipulation - specifically OA,AA and C2 Sacral and pelvic releases

Question 33

Why does treating the pelvis/sacrum affect both parasympathetic and sympathetic responses?

Answer 33

The ganglion impair is near and located at the sacrocoxxygeal joint (the site where the sympathetic and parasympathetic nerves meet)

Question 34

Anterior Chapman points

Answer 34

1st intercostal space - correlates w/ middle ear (superior clavicle) - correlates with nasal sinus (Inferior clavicle) Border of the sternum above the sternal notch - correlates w/ tongue, tonsils, pharynx 2nd intercostal space (2-3 rib) - correlates w/ bronchus, esophagus, thyroid and heart 3rd intercostal space (3-4 rib) - correlates w/ upper lung 4th intercostal space (4-5 rib) - correlates w/ lower lung 5th intercostal space (5-6) - correlates w/ stomach 6th intercostal space (6-7) - correlates w/ liver and gall bladder 7th intercostal space (7-8) - correlates w/ spleen and pancreas 8th-10th intercostal spaces (8-10) - correlates w/ small intestines Tip of the 12th right rib - correlates w/ appendix 1cm superior and lateral to the umbilicus - correlates w/ the kidneys 2cm superior and 1cm lateral to the umbillicus (just superior to kidney point) - correlates w/ adrenal glands Anterior-lateral thigh (at the distal femur) - correlates w/ colon bilaterally Right lateral knee - correlates w/ hepatic flexure Left lateral knee - correlates w/ splenic flexure and sigmoid colon Supero-lateral humerus - associated w/ retina and conjunctive Tip of the coracoid process - associated w/ cerebellum

Question 35

Posterior chapman points

Answer 35

Mastoid process - associated w/ retina and conjunctive AC 1 occiput - associated w/ Middle ear (left) - associated w/ nasal sinuses (left) Superior nuchal line - associated w/ cerebellum C2 lateral to the spinous process - associated w/ larynx, sinuses and arms C2-5 transverse processes - associated w/ cerebrum C3-7 lateral to the spinous process - associated w/ neck Medial border of the scapula ABOVE the scapula spine - associated w/ arms and pectoralis minor Medial border of the scapula BELOW the scapular spine - associated w/ pectorals minor T2 lateral to the spinous process - associated w/ esophagus and thyroid T3 lateral to the spinous process - associated w/ upper lung and myocardium T4 lateral to the spinous process - associated w/ upper and lower lung T5 lateral left and right to the spinous process - assocaited w/ stomach (left) and liver (right) T6 lateral left and right to the spinous process - associated w/ stomach (left) and liver/gallbladder (right) T7 lateral left and right to spinous process - assocaited w/ spleen (left) and pancreas (right)