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OMM: Spinal Facilitation w/ Burns

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    Define: Sympatheticatonia
    Sympathetictonia: a stimulated condition of the sympathetic nervous system marked by vascular spasm, heightened blood pressure, and the dominance of other sympathetic functions.
    What 3 principles are considered in rational treatment?
    Rational treatment considers the following 3 principles:
    1. The body is a unit
    2. It has it’s own self-protecting & self-regulating mechanisms
    3. Structure & function are reciprocally related
    Define: Somatic Dysfunction
    Somatic Dysfunction: Impaired or altered function of related components of the somatic (body framework) system: skeletal, arthroidal and myofascial structures, and their related vascular, lymphatic, and neural elements.
    Define: Reflex
    Reflex: An involuntary nervous system response to a sensory input — the sum total of any particular involuntary activity
    Define: Red Reflex
    Red Reflex: The erythematous biochemical reaction (reactive hyperemia) of the skin in an area that has been stimulated mechanically by friction.
    True or False? The red reflex is lesser in degree & duration in an area w/ acute somatic dysfunction compared to an area of chronic somatic dysfuntion
    False. The red reflex is GREATER in degree & duration in an area of acute somatic dysfunction as compared to an area of chronic somatic dysfunction
    Red reflex is a reflection of the segmentally related sympathicotonia commonly observed in the __________ area.
    Red reflex is a reflection of the segmentally related sympathicotonia commonly observed in the paraspinal area.
    Describe the 5 steps in a simplified spinal reflex arc
    Describe the 5 steps in a simplified spinal reflex arc
    True or False? All reflexes have an Efferent arm bringing impulses to CNS, a central arm w/in the CNS that is more than just 1 interneuron, & an Afferent arm taking impulses to peripheral structures
    False! All reflexes have an AFFERENT arm bringing impulses to CNS, a central arm w/in the CNS that is more than just 1 interneuron, & an EFFERENT arm taking impulses to peripheral structures
    True or False? Afferent neurons enter dorsally & Efferent neurons exit ventrally
    True or False? Afferent neurons enter dorsally & Efferent neurons exit ventrally
    True
    Describe how the multiple pathways of Interneurons affect sensory input & what this means for reflex pathways
    Interneurons have multiple pathways:
    *They process & complicate the sensory input*They can ascent/descend, branch & crossover

    *This overlap of inputs onto common interneurons is the basis for reflex pathways

    *Explains how visceral disturbance can activate skeletal muscle & vice-versa

    True or False? Almost every interneuron that receives visceral nociceptive input also receives input from a somatic source
    True
    True or False? Only 20% of interneurons that receive input from somatic structures also receive visceral input
    False. Almost 80% of interneurons that receive input from somatic structures also receive visceral input
    Define the Viscero-somatic reflex pathway
    Viscero-somatic: visceral sensory input produces a reflex response in a segmentally related somatic structure
    Define the Somato-visceral reflex pathway
    Somato-visceral: Somatosensory input produces a reflex response in a segmentally related visceral structure
    Define the Somato-somatic reflex pathway
    Somato-somatic: Somatosensory input produces a reflex response in a segmentally related somatic structure
    Define the Viscero-visceral reflex pathway
    Viscero-visceral: Visceral sensory input produces a reflex response in a segmentally related visceral structure
    Provide an example of Viscero-somatic reflex
    A Viscero-somatic reflex: Asthma causing TART in upper-mid Thoracic facilitated segments
    Describe the Viscero-somatic reflex
    Describe the Viscero-somatic reflex
    Provide an example of a Somato-visceral reflex
    Somato-visceral reflex: Somatic dysfunction in upper-mid Thoracic spine T-2-T6 exacerbating asthma
    Describe the Somato-visceral reflex
    Describe the Somato-visceral reflex
    Provide an example of a Viscero-visceral reflex
    Viscero-visceral: Distension of gut results in increased contraction of gut muscles
    Describe the Viscero-visceral reflex
    Describe the Viscero-visceral reflex
    Provide an example for Somato-somatic reflexe
    Somato-somatic: defensive withdrawal of limb from hot object
    Describe the Somato-somatic reflex
    Describe the Somato-somatic reflex
    To what does the Dorsal ramus supply mixed nerve fibers to?

    The Dorsal ramus supplies mixed nerve fibers to:

    *Vertebral column

    *Deep back muscles

    *Overlying skin

    Identify the spinal nerve on a X-section of thoracic vertebra
    Identify the spinal nerve on a X-section of thoracic vertebra
    Sympathetic innervation of the Head & Neck come from where?
    Sympathetic innervation of the Head & Neck come from where?

    Sympathetic innervation of the Head & Neck:

    *T1-T4

    Parasympathetic innervation of the head & neck come from Cranial Nerves III, VIII, IX, XI. True or False?
    Parasympathetic innervation of the head & neck come from Cranial Nerves III, VIII, IX, XI. True or False?

    False. Parasympathetic innervation of the head & neck come from Cranial Nerves:

    *III, VII, IX, X

    From where does sympathetic innervation of the Trachea & bronchi come from?
    From where does sympathetic innervation of the Trachea & bronchi come from?

    Sympathetic innervation of the Trachea & bronchi come from:

    *T1-T5

    True or False? The Vagus nerve supplies parasympathetic innervation for the trachea & neck.
    True or False? The Vagus nerve supplies parasympathetic innervation for the trachea & neck.
    False. The Vagus nerve supplies parasympathetic innervation to the trachea & bronchi (and many, many other organs, but not the neck)
    True or False? Sympathetic innervation of the lung parenchyma is from T1-T6
    True or False? Sympathetic innervation of the lung parenchyma is from T1-T6
    True.
    True or False? Sympathetic innervation for the distal 2/3s of the Esophagus comes from T1 or T2 - T6 or T10
    True or False? Sympathetic innervation for the distal 2/3s of the Esophagus comes from T1 or T2 – T6 or T10
    False! Sympathetic innervation for the distal 2/3s of the Esophagus comes from the T1 or T2 – T6 or T8
    True or False? Only the distal 2/3 of the Esophagus is supplied parasympathetic innervation via the Vagus nerve
    False. With the exception of some excretionary organs & genitalia, most everything south of the head is supplied parasympathetic innervation via the Vagus nerve.
    True or False? Parasympathetic innervation of the Lung Parenchyma, Visceral Pleura & Parietal Pleura is done via the Vagus nerve
    True.

    True or False? Sympathetic innervation of these structures is such:

    *Lung Parenchyma: T1-T7

    *Lung Visceral Pleura: T1-T11

    *Lung Parietal Pleura: T1-T6

    False.

    *Lung Parenchyma: T1-T6

    *Lung Visceral Pleura: T1-T7

    *Lung Parietal Pleura: T1-T11

    Identify where Sympathetic innervation for the heart comes from. Parasympathetic innervation?

    The Heart:

    Sympathetic innervation: T1-T5 or T6

    Parasympathetic innervation: Vagus Nerve

    True or False? Sympathetic innervation for the proximal stomach & duodenum comes from T5-T9
    True or False? Sympathetic innervation for the proximal stomach & duodenum comes from T5-T9
    True.
    True or False? Parasympathetic innervation for the Intestinal tract comes exclusively from the Vagus nerve.
    True or False? Parasympathetic innervation for the Intestinal tract comes exclusively from the Vagus nerve.
    False. Vagus nerve & Sacral Plexus
    Describe, in general, the organization of the autonomic innervation in terms of Parasympathetic & Sympathetic
    Describe, in general, the organization of the autonomic innervation in terms of Parasympathetic & Sympathetic
    True or False? Tissue texture changes (the 1st T in TART) can include:
    *Red Reflex
    *Increased skin drag (moisture)
    *Edema
    *Nociceptive reflex dynamic
    False. Tissue texture changes can include:
    *Red Reflex
    *Increased Skin Drag (moisture)
    *Edema
    *Muscular Hypertonicity
    Concerning evidence for SD, what did Louisa Burns, DO, do?
    Louisa Burns, DO:
    *SD of vertebral column = reproducible effects on visceral function & morphology
    Concerning evidence for SD, what did Wilbur Cole, DO, do?
    Wilbur Cole, DO:
    *Delineated the pathway for effects of SD on visceral function
    Concerning evidence for SD, what did J.S. Denslow, DO, do?
    J.S. Denslow DO:
    *Documented that areas of palpable TART showed histopathological changes of Edema & Inflammatory processes (mediated by: bradykinins, serotonin, histamines, potassium, substance P, leukotrienes, calcitonin gene related peptide)
    Concerning Denslow’s research using EMG, describe the findings with the spinal segments.
    Spinal segments with increased EMG had measurable TART:
    *Red Reflex, increased sweat (skin drag) which are signs of increased sympathetic tone
    Concerning Denslow’s research using EMG, describe the findings with the spinal cord

    Spinal cord levels innervating these segments were facilitated:

    *less pressure at these segments needed to produce EMG activity

    *stimulating other areas of the back or creating psychological stress produced EMG activity at these segments

    Identify 2 issues that arise from problems in the body’s communicating systems

    When a problem develops in the body’s communicating systems:

    *Function will be compromised

    *Setting the Stage for Disease

    True or False? Facilitation represents a serious problem with the communicating system
    True or False? Facilitation represents a serious problem with the communicating system
    True
    True or False? In the spinal cord, altered or enhanced neuronal activity is properly termed facilitation
    True or False? In the spinal cord, altered or enhanced neuronal activity is properly termed facilitation
    True.
    True or False? This is a part of the definition of Facilitation: The maintenance of a pool of neurons (premotor, motorneurons of preganglionic sympathetic neurons in one or more segments of the spinal cord) in a state of partial or sub-threshold excitation
    True.
    In Facilitation, why is less afferent stimulation required to trigger the discharge of impulses?
    A pool of neurons are maintained in a state of partial or sub-threshold excitation, which means that less stimulation is required to trigger the discharge of impulses

    True or False? Facilitation may be due to:

    *sustained increase in efferent input

    *abberant patterns of efferent input

    *changes w/in the affected neurons (or in chemical environment)

    False. Facilitation may be due to:

    *Sustained increase in AFFERENT input

    *Aberrent patterns of AFFERENT input

    *Changes w/in the affected neurons, or their chemical environs

    How can SD affect the chemical environment of a neuron?
    Suboptimal environment for cellular function:
    *lack of oxygen, buildup of metabolic wastes
    *increased lactic acid, causing ph decreases (altered enzyme function, altered threshold for nerve depolarization)
    Once facilitation has been established, it can be sustained by normal CNS activity even if the original injury has ________ or the insult has _________ .
    Once facilitation has been established it can be sustained by normal CNS activity, even if the original injury has healed or the insult has been removed.
    How does a cord segment become or remain facilitated?
    How does a cord segment become or remain facilitated?
    Provide examples of Primary Afferents
    Examples of primary Afferents:
    *Proprioceptors (muscle spindles, golgi tendon organs)*Mechanoreceptors (Pacinian/meissner’s corpuscles, ruffini endings, merkel’s discs)

    *Nociceptors

    *Sympathetic / Parasympathetic Afferents

    What is Nociception?
    Nociception: Excitation of the small-caliber primary afferent nerve endings by Mechanical, Thermal & Chemical stimuli
    True or False? Even if nociception input doesn't reach the conscious level as
    True or False? Even if nociception input doesn’t reach the conscious level as “pain” it can still facilitate spinal pathways
    True.
    Describe what Primary Afferent Nociceptors do (PANs)
    Describe what Primary Afferent Nociceptors do (PANs)
    Describe the structure of PANs. Where are they found?
    Describe the structure of PANs. Where are they found?
    Identify 4 ways that Facilitation correlates with SD

    Facilitation correlation w/ SD:

    *SD results in facilitation of spinal cord

    *A facilitated segment can lead to SD (TART)

    *It’s a vicious cycle

    *PAN’s are involved in SD, Facilitation & and Allostasis

    True or False? The proximity of the Sympathetic Chain Ganglia to the manubrium is an example of how SD can correlate w/ Facilitation via the affected chemical environment.
    True or False? The proximity of the Sympathetic Chain Ganglia to the manubrium is an example of how SD can correlate w/ Facilitation via the affected chemical environment.
    False. Proximity of Sympathetic chain ganglia to the Costovetebral junction can be an example…
    Describe how Facilitation can work in the brain. What system is likely affected?
    Describe how Facilitation can work in the brain. What system is likely affected?
    True or False? The limbic system inludes the hypothalamus, hippocampus, amygdala, pituitary gland, and several other areas
    True.
    Define: Homeostasis
    Define: Homeostasis
    Define: Allostasis
    Define: Allostasis
    Define: Allostatic Load
    Define: Allostatic Load
    Describe the interplay between SD / Spinal Facilitation / Allostatic Load
    Describe the interplay between SD / Spinal Facilitation / Allostatic Load
    True or False? The Limbic systems is a key player in arousal response
    True or False? The Limbic systems is a key player in arousal response
    True.
    True or False? SD leads to inhibition of signals to the alteration of activity of the major communicating systems
    True or False? SD leads to inhibition of signals to the alteration of activity of the major communicating systems
    False.
    When stressed or threatened, the neuroendocrine immune system responds by rapidly releasing the “Three C’s.” What are they?

    The 3 C’s:

    *Catecholamines (Norepinephrine)

    *Cortisol (Adrenal Corticosteroids)

    *Cytokines

    Identify the biological markers of allostatic load
    Identify the biological markers of allostatic load
    What are some of the consequences of Allostasis & CV disease? What is happening to cause these things?
    What are some of the consequences of Allostasis & CV disease? What is happening to cause these things?
    What is Axoplasmic flow?

    Axoplasmic flow:

    *Neurons aren’t just for carrying electrochemical impulses

    *They carry Trophic substances that promote the health of the tissue that is being innervated — this is axoplasmic flow

    By existing at levels of pressure too low to cause perceived pain, altered sensory or motor symptoms SD and disrupt what?
    SD can disrupt axoplasmic flow via levels of pressure too low to cause perceived pain, altered sensory or motor symptoms
    Describe the impact of OMM on Facilitation
    Describe the impact of OMM on Facilitation
    Describe why OMM is directed toward the host. What are we trying to do?
    Describe why OMM is directed toward the host. What are we trying to do?
    Describe how to treat Facilitation w/ OMM in terms of Sympathetic & Parasympathetic tone
    Describe how to treat Facilitation w/ OMM in terms of Sympathetic & Parasympathetic tone
    Describe why upper cervical SD can interfere with the rest of the body
    Describe why upper cervical SD can interfere with the rest of the body
    How to tell if segmental TART is from Visceral or Somatic orgin? What is indicative of Somatic origin?
    How to tell if segmental TART is from Visceral or Somatic orgin? What is indicative of Somatic origin?
    True or False? Segmental tart from Visceral origin will have these symptoms: *No edema *More elastic end feel at the physiologic barrier of ROM *2 or more vertebral segments involved *Linkage phenomenon (vertebra & its associated rib have same findings w/ passive regional motion testing)

    True or False? Segmental tart from Visceral origin will have these symptoms:

    *No edema

    *More elastic end feel at the physiologic barrier of ROM

    *2 or more vertebral segments involved

    *Linkage phenomenon (vertebra & its associated rib have same findings w/ passive regional motion testing)

    True.
    Identify some factors that influence health and function
    Identify some factors that influence health and function
    Why is it of clinical importance to recognize & treat Facilitation w/ OMT?
    Why is it of clinical importance to recognize & treat Facilitation w/ OMT?
    Identify OMM mechanisms of Efficacy
    Identify OMM mechanisms of Efficacy

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    OMM: Spinal Facilitation w/ Burns. (2017, Dec 06). Retrieved from https://graduateway.com/omm-spinal-facilitation-w-burns-essay/

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