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OPP > Week 15: Didactic: Introduction to the Facilitated Segment and Viscerosomatic Reflexes > Flashcards

Week 15: Didactic: Introduction to the Facilitated Segment and Viscerosomatic Reflexes Flashcards

1
Q

What does the nervous system do?

A

It enables the body to react to continuous changes in its internal and external environments and controls and integrates the body’s various activities.

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2
Q

What does the CNS consist of?

A

The brain and spinal cord.

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3
Q

What does the PNS consist of?

A

Everything but the brain and spinal cord.

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4
Q

What does the Somatic NS do?

A

Innervates the skeletal muscles.

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5
Q

What does the Autonomic NS do?

A

Innervates other tissues such as smooth muscle, cardiac muscle, glands, connective tissue, and cells in the immune system.

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6
Q

What are the three major divisions of the peripheral autonomic NS?

A
  1. Sympathetic NS “Fight-or-Flight”
  2. Parasympathetic NS “Rest and Digest”
  3. Enteric NS
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7
Q

What is the Enteric NS?

A

A special division involved in regulating the gastrointestinal system and capable of acting independently of the sympathetic and parasympathetic NSs, although it is often influenced by them.

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8
Q

In general, where do organs receive innervation from?

A

The sympathetic and parasympathetic divisions.

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9
Q

Describe the sympathetics of the thoracolumbar ANS, including the spinal nerves.

A

T1-L2. They excite the organs that are needed during physical activity (heart, lungs, muscles), inhibit organs whose activity is needed at rest, and innervate the limbs.

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10
Q

What nerve roots innervate the upper limb?

A

T1-T7(8)

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11
Q

What nerve roots innervate the lower limb?

A

T10(11)-L2(3)

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12
Q

Describe the pathway of the sympathetic chain ganglia.

A

Autonomic sympathetic neurons leave the CNS as motor roots of spinal nerves T1-L2(3) and enter the paravertebral ganglia/sympathetic chain.

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13
Q

What are the four possible courses of preganglionic sympathetic neurons after they enter the sympathetic chain?

A
  1. Ascend to synapse
  2. Descend to synapse
  3. Synapse immediately
  4. Pass through the sympathetic trunk without synapsing
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14
Q

Describe the course of a presympathetic neuron when it ascends to the synapse.

A

It ascends to a synapse with a postsynaptic neuron of a higher paravertebral ganglion.

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15
Q

Describe the course of a presympathetic neuron when it descends to the synapse.

A

It descends to a synapse with a postsynaptic neuron of a lower paravertebral ganglion.

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16
Q

Describe the course of a presympathetic neuron when it synapses immediately.

A

It synapses immediately with a postsynaptic neuron at that level.

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17
Q

Describe the course of a presympathetic neuron when it passes through the synaptic trunk without synapsing.

A

It continues through an abdominopelvic splanchnic nerve to reach the prevertebral ganglion

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18
Q

What cranial nerves and sacral segments are included in the parasympathetic cranio-sacral ANS?

A

CNs III, VII, IX, and X and sacral segments S2-4.

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19
Q

What do the parasympathetics do?

A

Excite organs that are stimulated when the body is at rest, and inhibits organs that are stimulated by physical activity.

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20
Q

Do parasympathetics have significant innervation to the extremities?

A

No

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21
Q

What are the parasympathetic DUMBBELS?

A

Diarrhea/Defecation
Urination
Meiosis - Pupils Contract
Bradycardia
Bronchospasm
Emesis - Vomiting
Lacrimation - Flow of tears
Salivation

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22
Q

What cranial nerves passes through the jugular foramen?

A

CNs IX, X and XI (Glossopharyngeal, vagus, and accessory)

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23
Q

What movement occurs at the occipito-atlantal (OA) joint?

A

Movement of the occiput (C0) on the axis (C1).

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24
Q

What movement occurs at the atlanto-axial (AA) joint?

A

Movement of the atlas (C1) on the axis (C2).

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25
Q

What will treating the OA and AA assist in treating?

A

The parasympathetics by optimizing structure and function which balances the autonomic system.

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26
Q

Where do the pelvic splanchnic nerves arise from?

A

The anterior rami of S2-S4 spinal nerves.

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27
Q

How does the osteopathic tenet, the body has self-healing, self regulatory mechanisms, connect with the body’s strive for autonomic balance?

A

There are negative feedback loops and checks and balances in out neuroendocrine system.

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28
Q

How does the osteopathic tenet, structure and function are interrelated, connect with the autonomic NS?

A

Optimizing the structures that affect the autonomic NS can optimize their function.

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29
Q

What is an afferent nerve?

A

A nerve carrying impulses toward the CNS

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30
Q

What is an efferent nerve?

A

A nerve carrying impulses away from the CNS

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31
Q

What is a ventral (anterior) horn?

A

The anterior portion of the gray matter in the spinal cord where efferent motor neurons leave the spinal cord.

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32
Q

What is a dorsal (posterior) horn?

A

The posterior portion of the gray matter of the spinal cord where afferent sensory nerves enter the spinal cord.

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33
Q

What is a reflex?

A

An involuntary and nearly instantaneous NS response to a sensory input/stimulus

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34
Q

What is the pathway of a reflex?

A
  1. Stimulus
  2. Afferent neuron (sensory) through the dorsal root
  3. Synapse in dorsal horn
  4. Efferent neuron (motor) through ventral root
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35
Q

What does viscera mean?

A

Organs

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36
Q

Describe visceral afferents.

A
  1. Message of irritation travels back on bifurcating neuron
  2. Synapses on somatic motor neurons and causes muscle contraction
  3. Releases proinflammatory polypeptides at that level
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37
Q

What does prolonged stimulation in visceral afferents lead to?

A

Facilitation

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38
Q

What is a spinal facilitation?

A

Altered or enhanced neuronal activity resulting in a change in outflow over both somatic and autonomic routes from the spinal cord and maintenance of a pool of neurons in a state of subthreshold excitation.

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39
Q

What occurs in the state of spinal facilitation?

A

Less afferent stimulation is required to trigger discharge of impulses.

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40
Q

What does spinal facilitation release?

A

Signals leading to alteration of activity in the NS, endocrine system, and immune system.

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41
Q

Where can manifestations of spinal facilitation be seen in?

A

Target peripheral tissue

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42
Q

What may facilitation be due to?

A
  1. Sustained increase in afferent input
  2. Aberrant patterns of afferent input
  3. Changes within the affected neurons themselves or their chemical environment
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43
Q

What does prolonged stimulation of nociceptive fibers (visceral or somatic) lead to?

A
  1. Increased dynorphin production = increased excitability
  2. Destruction of inhibitory interneurons with the proliferation of excitatory interneurons
  3. Activation of Glial Cells amplifies inflammation
  4. Neuropeptide and AA neurotransmitters
  5. Spinal memory - pain patterns can be reactivated by milder stimuli later
44
Q

Once established, what is facilitation sustained by?

A

Normal CNS activity

45
Q

What is segmental facilitation?

A

Reflex interactions (somatosomatic, somatovisceral, and viscerosomatic) and their impact on normal vascular and lymphatic elements of the lower extremity.

46
Q

What is enhanced homeostasis associated with in regards to an integrated osteopathic treatment regimen?

A

Vascular and lymphatic elements

47
Q

What type of SD is described in histological signs of inflammation and edema?

A

Palpable SD

48
Q

What is one of the criterion for diagnosis of SD in regards to segmental facilitation?

A

Tissue texture changes

49
Q

What influence is related to neural, vascular, and lymphatic elements?

A

Removal of SD

50
Q

How can facilitation lead to SD?

A

Excessive or repeated injury can cause long-term changes in spinal cord neural circuitry leading to pain states.

51
Q

How can altered segmental activity in the spinal cord lead to somatic responses?

A
  1. It can manifest as altered ease or ROM in skeletal muscles and anatomical asymmetries in joint position
  2. Can involve changes in spinal cord sympathetic outflow (somatovisceral reflexes)
52
Q

What are the TART findings of SD?

A

Tissue texture changes
Asymmetry of the anatomically effected region
Restriction leading to altered ease or range of motion (ROM)
Tenderness leading to increased sensitivity to touch (hyperalgesia)

53
Q

What is the basic concept of facilitation?

A
  1. Peripheral irritation
  2. CNS sensitization
  3. Sensitization of neighboring neurons
  4. Disseminated sensitivity throughout all tissues served by that area
54
Q

What is a somatosomatic reflex?

A

Localized somatic stimuli producing patterns of reflex response in segmentally related somatic structures

55
Q

What is a somatovisceral reflex?

A

Localized somatic stimuli producing patterns of reflex response in segmentally related visceral structures

56
Q

What is a viscerosomatic reflex?

A

Localized visceral stimuli producing patterns of reflex response in segmentally related somatic structures

57
Q

What is. viscerovisceral reflex?

A

Localized visceral stimuli producing patterns of reflex response in segmentally related visceral structures

58
Q

What are some examples of a somatosomatic reflex?

A
  1. Withdrawing hand from stove
    -Afferent: somatic receptors (hand)
    -Efferent: somatic structure (arm muscles)
  2. Quadratus Lumborum Muscle spasm causing rib SD
  3. Counterstrain tenderpoints
59
Q

What are some examples of a somatovisceral reflex?

A
  1. T2 injury leading to atrial fibrillation
    -Afferent: vertebral segment
    -Efferent: heart
  2. Midback injury (T5 ERLSL) leading to peptic ulcer disease
    -Afferent: somatic receptors (vertebral segment)
    -Efferent: visceral structure (goblet cells)
60
Q

What is an example of a viscerosomatic reflex?

A
  1. Facilitated vertebral segments at T1-T5
    -Afferent: cardiac irritation (visceral afferent nerves)
    -Efferent: T1-T5 muscle hypertonicity of rotatores, interspinales, intertransversarii, levatores costarum, and/or semispinalis
61
Q

What type of SDs are viscerosomatic facilitated segments generally?

A

Type II SDs

62
Q

What is an example of a viscerovisceral reflex?

A
  1. Gastro-colic reflex
    -Afferent: visceral afferent nerves on stretch receptors in stomach are triggered by food bolus
    -Efferent: parasympathetic motor neurons increase colon motility
63
Q

Describe the sympathetic reflex arc in relation to pain reflexes at the spinal cord.

A
  1. A visceral afferent pain fiber synapses at the dorsal horn.
  2. Both the lateral horn (which includes preganglionic sympathetic cell bodies) and the ventral horn (which includes cell bodies to skeletal muscle) are innervated.
  3. These lead to stimuli going to the paraspinal skeletal muscles, increasing in tone and tissue texture changes, and to arterial blood vessels, leading to vasoconstriction and the red reflex as well as bogginess.
64
Q

What are some examples of non-autonomic pathways?

A
  1. Shoulder pain due to diaphragmatic irritation
  2. Arm pain due to angina
  3. Rib pain due to pleuritis
65
Q

Describe the non-autonomic pathway involved in shoulder pain due to diaphragmatic irritation.

A

Phrenic nerve pathway

66
Q

Describe the non-automatic pathway involved in arm pain due to angina.

A

Spinal segmental facilitation (visceral and somatic afferents converge on the same or associated neurons or interneurons in the spinal cord).

67
Q

Describe the non-automatic pathway involved in rib pain due to pleuritis.

A

Intercostal innervation

68
Q

Describe the cardiac viscero-somatic reflex.

A
  1. Afferent autonomic sympathetic sensory innervation returns from the heart to T1-5 and is concentrated along the dorsal root ganglion
  2. Normal sensory input from T1-5 somatic afferents (along the same dorsal root ganglion) become amplified causing perception of pain while motor efferents result in increased paraspinal tension (TART changes)
  3. Increases in paraspinal muscle tension may result in subsequent SD with sidebending/rotation towards the left
69
Q

Describe the cardiac visceral-somatic reflex in a more simple way, by stages.

A

Stage 1: Nociceptive information from cardiac tissue
Stage 2: Sensitization of the spinal neurons that serve the heart: T1-5
Stage 3: Sensitization and facilitation of all neurons in the T1-5 area
Stage 4: Neuronal output to other areas serves by those segments - Paraspinal muscle hypertonicity resulting in Type II SD

70
Q

What is the importance of autonomic reflexs?

A

SDs can be due to visceral dysfunction or ADs can cause visceral dysfunctions

71
Q

What can treatment of SDs address?

A

Related visceral structures due to the somato-visceral reflex arc

72
Q

What can treatment of SDs affect?

A

Visceral structures by creating a more suitable environment for healing

73
Q

What can lack of treatment lead to?

A

Perpetual viscero-somatic circuit

74
Q

What needs to be considered if a SD repeatedly comes back?

A

Underlying visceral dysfunction

75
Q

OMM focuses on relieving drives on the allostatic mechanism and reestablishing baseline homeostatic values by doing what?

A

Balancing sympathetic and parasympathetic activity when treating disease states

76
Q

What pathway do both physcial (somatic and visceral dysfunction) and psychosocial (emotional and cognitive) drives work through?

A

The arousal-allostatic pathway

77
Q

What is the osteopathic approach to medicine?

A
  1. Assess a patient’s somatic and visceral status, in addition to specific complaint
  2. Integrate surrounding family, social, and work environments
78
Q

What is the sympathetic-mediated (thoraco-lumbar) paravertebral spinal facilitation of HEENT?

A

T1-4

79
Q

What is the sympathetic-mediated (thoraco-lumbar) paravertebral spinal facilitation of Heart?

A

T1-5

80
Q

What is the sympathetic-mediated (thoraco-lumbar) paravertebral spinal facilitation of Lungs?

A

T1-6

81
Q

What is the sympathetic-mediated (thoraco-lumbar) paravertebral spinal facilitation of Esophagus?

A

T2-8

82
Q

What is the sympathetic-mediated (thoraco-lumbar) paravertebral spinal facilitation of Foregut (lower esophagus to proximal duodenum)?

A

T5-9

83
Q

What is the sympathetic-mediated (thoraco-lumbar) paravertebral spinal facilitation of Midgut (distal duodenum to mid-transverse colon)?

A

T5-9

84
Q

What is the sympathetic-mediated (thoraco-lumbar) paravertebral spinal facilitation of Hindgut (mid-transverse colon to rectum)?

A

L1-L2

85
Q

What is the sympathetic-mediated (thoraco-lumbar) paravertebral spinal facilitation of Adrenals?

A

T8-10 (T7-11)

86
Q

What is the sympathetic-mediated (thoraco-lumbar) paravertebral spinal facilitation of Kidneys?

A

T11-L1

87
Q

What is the sympathetic-mediated (thoraco-lumbar) paravertebral spinal facilitation of Bladder?

A

T11-L2

88
Q

What is the sympathetic-mediated (thoraco-lumbar) paravertebral spinal facilitation of Gonads?

A

T10-11

89
Q

What is the sympathetic-mediated (thoraco-lumbar) paravertebral spinal facilitation of Uterus and Cervix?

A

T10-L2

90
Q

What is the sympathetic-mediated (thoraco-lumbar) paravertebral spinal facilitation of Prostate?

A

L1-2

91
Q

What is the sympathetic-mediated (thoraco-lumbar) paravertebral spinal facilitation of Upper Extremity?

A

T1-T7(T8)

92
Q

What is the sympathetic-mediated (thoraco-lumbar) paravertebral spinal facilitation of Lower Extremity?

A

T10-L2(3)

93
Q

What is the parasympathetic-mediated (cranio-sacral) paravertebral spinal facilitation of the HEENT?

A

CN III, VII, and IX

94
Q

What is the parasympathetic-mediated (cranio-sacral) paravertebral spinal facilitation of the Heart?

A

Occiput, C1, C2 (CN X)

95
Q

What is the parasympathetic-mediated (cranio-sacral) paravertebral spinal facilitation of the Lungs?

A

Occiput, C1, C2 (CN X)

96
Q

What is the parasympathetic-mediated (cranio-sacral) paravertebral spinal facilitation of the Lungs?

A

Occiput, C1, C2 (CN X)

97
Q

What is the parasympathetic-mediated (cranio-sacral) paravertebral spinal facilitation of the Esophagus?

A

Occiput, C1, C2 (CN X)

98
Q

What is the parasympathetic-mediated (cranio-sacral) paravertebral spinal facilitation of the Foregut (lower esophagus to proximal duodenum)?

A

Occiput, C1, C2 (CN X)

99
Q

What is the parasympathetic-mediated (cranio-sacral) paravertebral spinal facilitation of the Midgut (distal duodenum to mid-transverse colon)?

A

Occiput, C1, C2 (CN X)

100
Q

What is the parasympathetic-mediated (cranio-sacral) paravertebral spinal facilitation of the Hindgut (mid-transverse colon to rectum)?

A

S2-S4

101
Q

What is the parasympathetic-mediated (cranio-sacral) paravertebral spinal facilitation of the Kidneys?

A

Occiput, C1, C2 (CN X)

102
Q

What is the parasympathetic-mediated (cranio-sacral) paravertebral spinal facilitation of the Bladder?

A

S2-S4

103
Q

What is the parasympathetic-mediated (cranio-sacral) paravertebral spinal facilitation of the Gonads?

A

S2-S4

104
Q

What is the parasympathetic-mediated (cranio-sacral) paravertebral spinal facilitation of the Uterus and Cervix?

A

S2-S4

105
Q

What is the parasympathetic-mediated (cranio-sacral) paravertebral spinal facilitation of the Prostate?

A

S2-S4

106
Q

What areas of the body do not contain parasympathetic nerves or ganglia?

A

Upper and lower extremities, body wall, and adrenals

OPP (27 decks)

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