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105 Cards in this Set
- Front
- Back
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Dr. Graham:
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fresh air, exercise, bland diet, abstinence from sex , promote health, 1830
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Schleiden and Schwann
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developed Cell theory
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Virchow
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cellular pathology , recommended hygenic measures, defended pasteur, criticized semmelweis. 1848
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Darwin
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1859
origin of the species |
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Louis Pasteur
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bacteriology, paper on spontaneous generation and vaccinations and hydrophobia
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Mendel
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hybridization of peas,
paper published in obscure paper, unnoticed for 35 years |
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lord joseph lister
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1845
45% surgical mortality carbonic acid criticized from complexity of bandages, franco prussian war |
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major contributions of semmeilwies
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handwashing, didn't get credit till his death when pasteur proved germ theory
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rush
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copius blood letting, amercian clinician of his time, ablest, calomel and jalop, attended to GW
fist leaches in 1833. then asperin in 1899 then pennicellen in 1948 |
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heroic medicine
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blood letting purgatives, emetics , sialogogues
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homeopathey
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disease could be cured by drugs the smaller the dose, the more effective in stimulating vital force
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chiropractic
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disease joint oriented nerve interference, innate intelligence
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Stills life
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born 1828
married 1849, lost two children and wife within one month helped kansas become a state lost three children in same someth to encephalitis osteopathy banner 1874 |
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osteoapthy concepts first formulated
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1888 started teaching it when he was 63
established infiermary graduated first class in 1893 died at age 89, 5,000 D.O's in practice |
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landmarks in osteopathy
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school grows in 1899
1893 first class graduates founded in 1892 in missouri |
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cells duty and osteopathy
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- cellls duty to maintain themselves
-secondary duty is to contract, secret, syenthesize, phagocytize, and pump -when stressed, they go inert and stop working -stressed by inadequate oxeygon, CO2, inadequate sugar, temp changes, p h changes, shearing forces, sub optimal ECF environment -function in peristalis, ciliary clearance, wound healing GI barrier, maintenance, nt synthesisis, phagocytosisi, proton pumping |
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causes of somatic dysfunction
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-trauma
-ergonomics -overuse -birth -gestation -visceral pain - |
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cause of skeletal dysfunction
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-arthrodial dysfunctions that are caused by:
-myofascial dysfunctions -vascular fluid dysfunctions -neurologic dysfunctions |
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TART findings by clinical description associated with Acute or chronic
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Acute- causes increased sweating and reduced blood flow to skin and other organs
Chronic- causes skin leasions and thoracic cage damage, cool, stringy appearrance |
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Tenderness , TART
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hyperalgesia:pain in excess of stimulus
-local: -diffuse: entire limb involved -position dependent; strain , counterstrain modality of OMM |
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Asymmetry , TART
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-left side , right side not mirrored
-elevated 1st rib -short leg -orbits, ear, bone eminences, unlevel -ASIS,PSIS,ILA, pubes |
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Reduced range of motion, TART
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-rotate more to one side than the other
-can flex but not extend -joint can glide anterior but not posterior -encounter restrictive barriers |
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Tissue texture changes, TART
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edema-swelling
-nodules fashial bands: extra tight strips within a sheet of connective tissue -acute injury: edema with warm moist red skin, muscle spasm, increased tone -chronic: skin cool, pale, muscles stringy, thickened , adhered -imparied lympathic drainage |
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cause of skeletal dysfunction
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-arthrodial dysfunctions, which are caused by myofascial dysfunctions, which are caused by vascular fluid dysfunctions, which are caused by neurologic dysfunctions
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Arthrodial dysfunctions
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joint function in only one direction, joint locks, motions limited or absent, uneven weight distribution, wearing of cartilage
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Myofascial dysfunctions
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-spasm, hypertonicty, traction on fascial web, adhesions between adjacent structures, cause and maintain arthrodial dysfunctions
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Vascular and lympathic
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- arterial; direct compression or vasoconcstriction
venous; direct compression which is common or suction failure -lympathic; compression on lympathic vessel -ECF; stasis, can contribute to myofascial dysfunctions and tissue texture changes |
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Nuerologic
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- hyperaglesia
-vasoconstriction -hypersecretion -disordered GI -uterine peristalsis -referred pain at adjacent innervations -contributes to dysfuntctions of myofascia |
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five motion barriers
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anatomic-bones restrict motion
physiologic-as far as patient can move it elastic-between physiologic and anatomic pathologic-restiction of motion associated with patho changes such as ligaments, foreign bodies, ect restrictive-a fucntional limit that abnomrally dminishes the normal physolgic range, imposed by somatic dysfunction |
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OMM techniques and abbreviations
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-dir
-ind -st -art -lar/blt -me -cs -hvla -cr/bmt |
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direct
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can be on any tissue type
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indirect
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can be on any tissue type
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soft tissue
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soft tissue; passive, usually direct, muscle fascia
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articulary
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passive, direct, joint artic, low velocity, mod amplitude
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ligament art release
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pasive or active, indirect or direct
target tissue is ligaments and joints |
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muscle energy
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active, direct, tissue target is muscle joint
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counterstrain
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active direct, muscle joint
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high velocity
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pasive, direct, joint, high velocity, low amplitude
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ost cran feild
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direct or indirect, all tissues targetd
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myofascial relase
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pasive, direct or indirect, mucsle, fascia, joints
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still
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passive, direct and indirect, targets joints, direct and indirect release
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visceral
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passive or add active, direct or indirect, organs fascia
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chapmans
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passive, lymph, pelvic treatment
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lympathic
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passive, or add active, lympth, no barrier
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inhibitory
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INH, passive, direct, neuromuscular junctions, no barriers
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4 basic osteopathic tenets
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-body is a unit
-structure and function are reciprically interrelated -the body possesses self regulatory and self healing mechanissm and is capable of health maintenance -rational treatment is based on above principles |
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OMM corrollaries
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-movement of body fluid is essential
-nervous system plays crucial role -somatic components of disease are manifestations and factors -when normal adaptability is disrupted, disease may ensue |
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OMM prescription basis
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-awarenss of OMM
-history and physical exam -relevant testing results -accurate diagnosis -appropriate treatment goals -skilled application of treatment modalities -delivery of treatment -reevaluation and revistiing |
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sinuses
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frontal, maxillary, ethmoidal, sphenoidal
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upper respiratory systems
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-ehtmoid, sphenoid sinus
-maxillary sinus -nasal airway -pharyengeal airway -larnyx - |
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lympathic tissue organization
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-lympatic duct
-thoracic duct -cisterna chyli -thoracic duct inlet |
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clincial infectous symptoms manifest:
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-host defense breakdown leading to increased local tissue immunity and reaction
-increased local interstitial lymphatic fluid leukocyts -increased CNS sympathetic efferent tone back to initially infected inflamed target tissue |
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anatomaic structure of lympathic system
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-lymph fluid
-collecting ducts -lymph tissue |
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lymphoid organs
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-tonsils
-thymus -appendix -peyers patches -bone marrow -spleen -lymph node |
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tonsils
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ring of lymphoid tissue
-palatine tonsil with lymph tissue -soft palate is heavily infiltrated with lymphocytes -build immunity early in life |
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Thymus
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-maturation of T lymphocytes
-does not filter lymph -reaches greatest size at two |
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spleen
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largest mass of lymphoid tissue
-found in upper left quadrant -connects with vascular circulation, cleans blood -destroys damaged or deformed RBC and make IG |
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Peyers patches
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-clusters of follicles in intestines
-b cell proliferation -major source of antibody production |
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appendix
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-off of large intestine
-peyers patches |
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bone marrow
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-red; rbc,wbc,platelets
-yellow; fat |
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lymph node
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only tissue that filters lymph
-400-450 connected to lymphatic vessels, but not circulatory system |
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lymphatic organs excluding lymph nodes
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-connected by circulatory systems
-not lymphatic vessels -not located along the course of lymph ducts and do directly function in filtration of lymph |
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lymphocytes
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-T cells from thymus; directly attack and manage immune response
-B cells from bone marrow; make antibodies that immobilize antigens until they can be destroyed |
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Filter lymph
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-macrophages destroy and remove microrganisms and debris that enters the lymph
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protection via lymphatic system
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-activates immune response
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compostiion of lymph
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water, proteins, lipids, carbs, enzymes, urea, minerals, hormones, dissolved gases, cells, toxins, bacteria, body wast, cellular debris
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lymphatic vesels
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-interconnected cappilaries, collecting vessels, lymph nodes, trunks and ducts
-travel along veins or arteries -FORMS A ONE WAY SYSTEM THAT ENCOURAGES FLOW TOWARD THE HEART |
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Lymphatic system is NOT in:
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-brain
-spinal cord -epidermis -endomysium -bones, teeth, bone marrow |
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microstructure of lymph
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-formed by endothelial cells loosley joined and overlapping
-collagen filaments anchor the cells to surrounding trissues so that increase in interstitial fluid volume opens the mini valves -prevents vessels from collapsing |
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-right lymphatic duct
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-drain lymph from right upper arm, right side of head, and thorax
-formed by merger in the right jugular trunk, subclavian trunk, and right transverse cervical trunks |
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thoracic duct
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-recieves lymph from the rest of the body
-arises anterior to the first two lumbar vertebrae as a cisternachyli; this collects lymph from two large lumbar trunks that drain the lower limbs and from the interstinal trunk that drains digestive organs -empties into venous circulation at the junciton of the internal jugular vein and the subclavian vein on left side of body |
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functions of lymphatic system
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-interstitial trash and fluid collection
-conserves plasma protein -gaurdian of health -nutrient absorber |
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manifestations of clinical conditions due to poor lymphatic flow
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-impairment of diaphragm and restricted thoracic cage motion (asthma, emphysema, bronchitis, acute respiratory illnes)
-impariment of skeletal muscular system;(prlonged inactivity especially in supine position, leads to somatic dysfunctions) -hyersympathetic stimulation; stress -alteration of anatomy; lymph node removed, edema -impaired fluid dynamics - |
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clinical importance of lympathic flow
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-balanced system
-increased resorption of fluids -increased circualtion and respirations -decreased proteins interstitium |
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five contraindictions to OMM treatment of lymphatic system
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-fracture
-central line -infection, sepsis -malignancy |
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why use soft tissue treatment
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-screenign exmination for finding TART
-reduce muscle hypertonicity -stretch and increase elascitity -improve circulation -increase venous and lymphatic drainage -stimulate stretch reflex hypotonic muslces -promote patient relaxation -reduce patient guarding -potentiate the effect of other omm techniques -improve physician patient relationship |
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contraindictions to use soft tissue
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-sprain or strain
-fracture or dislocation -neurologic or vascular compromise -osteoperosis and osteopenia -malignancy -infection |
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7 basic manual techniques for soft tissue
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- inhibition
-stretching -kneading -petrissage/skin rolling -deep friction/deep muscle injuries -tapotement/striking muscle ot increase its tone and atrerial perfusion -effelurage/ stroking movement |
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what things to be aware of when doing manipulation
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-physician comfortable
-patient comfortable -physician minimize energy expindenture -force should not create pain -push pull muscle away from bone -dont irritate patient skin -use leverage -apply pressure with finger pads -counterforce with transverse motion -perpendicular stretch can be applied -compression for deeper tissues -monitor patient responses -listen with hands -be curious -become eclectic in style |
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muscle spindle reflex
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-stabilize and protect muscle
-senstive to changes in length |
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Golgi reflex
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-stabilize and protect
-senstive to changes in muscle tension caused by passive stretch or contraction |
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muscle stretch reflex
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-contraction in response to stretching within muslce, autonomic muscle regulation
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Sinus Drainage
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-frontal sinus duct
-nasolacrimal duct -anterior ethmoid drainage -maxillary sinus duct -posterior ethmoid drainage -spehnoidal sinus drainage |
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Trigeminal VI
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-supraorbital nerve exiting from supraorbital forament
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Trigeminal V2
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-infraorbital nerve exiting from infraorbital foramen
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CNX
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-heart, lung, stomach, liver, pancreas
-vagus nerve |
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CNIX
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-lacrimal salivary glands
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CNVII
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-lacrimal salivary glands
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cervical sympathetic chaing ganglion
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-internal carotid artery
-superior cervical ganglion |
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CNIII
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eye
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lymphatic treatment
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-decompress throracic and lympathic ducts at venous sites
-facilitate cervical lymphatic flow in a proximal to distal fashion employing effurage -facilitate thoracic excursion through rib raising on throacic pump -facilitate normalization of peripheral and CNS balance -remove or reduce cervical segmental and fascial sympathetic facilitiaton by doing suboccipital release -perform sympahtetic inhibitions to supra an dinvraorbital nerves at their sites |
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Osteopathy vs. allopathy
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-osteophaty offers a concise medical philosophy that can be clinically applied to any contemporary practice, and is articualted through the four principles
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osteopathy vs allopathy
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-offers distinctive integrative diagnositic and treatment modality that is OMM
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direct treaments of OMM
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soft tissue
ARt HVLA ME MFR osteopathy in cranial feild |
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Indirect
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CS
MFR OCF |
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osteopathy vs. allpathy
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OMM strives to find and facilitate patients health instead of focusing on disease
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Facitlitation-
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the muscoskeletal system allows us to act out our unique human experience. Requires supply and maintenance systems,CV,resp,GI. The communication systems connect the consumers with the
-when a problem develops in the body’s communicating system function will be compromised. -facilitation represents a serious problem with the communicating systems -1)The maintenance of a pool of neurons in a state of partial or subthreshold excitation, in this state, less afferent stimulation is required to trigger the discharge of impulses 2)May be due to: sustained increase in afferent input, aberrant patterns of afferent input, changes within the affected neurons themselves or their chemical environment. When muscles are tight, good blood can’t get in and bad blood can’t get out, muscles are stagnant, bad PH. Affects the neuronal transport systems. Stasis is bad. 3)Once established it can be sustained by normal CNS activity; even if the original injury has healed, or the insult has been removed. Involved in creating a memory in CNS. :inflammation is facilitation |
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Somatic Dysfunction
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- impaired or altered function of related components of the body framework.
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Nociceptors / PAN’s / Nociception
PAN- |
small or lightly unmyelenated
-distributed throughout tissues of body -Only tissues that are not innervated: articular and hyaline cartilage, nucleus pulposus and spinal discs, central nervous system parenchyma//KNOW THIS -activated by by mechanical , thermal, and chemical energy -repitive firing |
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NOCICEPTION
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the physical action of exciting the small caliber primary afferent nerve endings
-nociceptors(PANS) send impulses into the spinal gray matter where they synapse -PANs are involved in somatic dysfunction and facilitation and allostasis -even if nociception input does not reach the conscious level as pain it can still facilitate spinal pathways |
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Allostasis / Allostatic Load
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-the process of how the body responds to stressful situations; physical, psychosocial, acute, and chronic
-when stressed/threatened in the neuroendocrine immune system responds -rapidly releasing the three C’s: catelcholamines, cortisol, cytokines -long term acitivation of this wears you out: increased BP, obesity, increased acivity of fibrinogenic system, increased atherosclerosis |
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-Allostatic Load:adaptive condition
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summation of effects of exposure to stress
-accumulation of damage from prolonged altered chemical state -failure to restore homeostasis -the price paid for chronic exposure to stress mediated neuroendocrine adaptations -markers: systolic blood pressure, diastolic bp,waist to hip ratio, HDL cholesterol, total cholesterol HDL ratio, urinary cortisol, epinephrine and norepinephrine levels, DHEA -somatc dysfunction triggers the arousal system of the brainstem, nociceptors -SD is a noxious stimulus to the ANS whether perceived consciously or not -the arousal system of the brainstem is coupled to the allostatic response |
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. The following reflexes
-If a segmental tart is visceral origin, there is : no edema, more elastic end feel at the barrier of ROM, 2 or more vertebral segments involved , linkage phenomenon, vertebra and its associated rib have same findings with passive motion testing - If it is somatic in origin: there is edema, firmer end feel at the barrier of ROM, and may be limited to one vertebral segment. a. Somato-somatic (S-S) |
a. Somato-somatic (S-S)
-produces a reflex response in a segmentally related somatic structure b. Viscero-visceral (V-V) -vesceral sensory input produces a reflex response in a segmentally related visceral structure c. Somato-visceral (S-V) - produces a reflex response in a segmentally related visceral structure: the word that is first is where the signal starts from, and the second word is where the signal goes too. : input from somatic stimuli, send signal via afferent limb of the reflex into the spinal chord, synapses into interneurons on spinal cord, causes activity in a visceral organ through the sympathetic or parasympathetic efferent motor neurons./ex/ somatic dysfunction in upper mid thoracic spin exacerbating asthma d. Viscero-somatic (V-S) - produces a reflex response in a segmentally related somatic structure: input stimulus from a visceral structure. Send signal via afferent nerve of the reflex into the spinal chord. Synapses onto interneurons in spinal chord, activates sympathetic outflow back to visceral structures, and via motor neurons to skeletal muscle/ example asthma causing tart in upper mid thoracic facilitated segments |
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. Describe the relationship between, Somatic Dysfunction, Nociception, Facilitation, and Allostasis
- 8. Describe the relationship between Nociception, Facilitation, Allostasis, Homeostasis, and health & disease - 9. Describe the physiology of how OMM can impact Nociception, Facilitation & Allostatic load |
-correct the biomechanical insults to nerves and nerve cells that lead to disturbances in excitation, conduction, and trophic function
-alter the propioceptive and other discharges from somatic tissues to restore balanced intelligible reliable patterns of sensory feedback to the spinal chord -soften or silence the somatic input to the feedback loops initiated elsewhere to arrest or retardation of aberrant impulses. -OMM is directed toward the HOST: balancing of sympathetic and parasympathetic tone in order to enhance the self regulatory mechanisms of the body -changes CNS by decreasing afferent load |
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-Vagus nerve, CNX. Parasympathetic innervations to many viscera
-know the viscerosomatic reflex levels for sympathetic and parasympathetic innervations of: Lung parenchyma Heart Kidneys and adrenals |
READING ASSIGNMENT:
Attached article by Beau Branyon Other Answers for objectives can be found in: Ward, Foundations for Osteopathic Medicine, 2nd ed., pp137-145, 150-153 |
