Didactic_Lecture 2

Question 1

The 5 Osteopathic Models In Patient Assessment & Treatment

Answer 1

• are specific care approaches to the patient
• represent physiological functions that maintain health
• the 5 models play key roles in:
  
  1. Adaptation to stressors
  2. Recovery & repair from illness and disease

Question 2

Osteopathic Philosophy & the 5 Models

Answer 2

the physcial musculoskeletal system often will reflect signs of internal diseases

5 models provide framework for interpreting significance of somatic dysfunction

Question 3

Biomechanical Anatomical Correlates

Question 4

Respitory-Circulatory Anatomical Correlates

Answer 4

1. Thoracic inlet
2. Thoracic & pelvic diaphragms
3. Tentorium cerebelli
4. Costal cage

Question 5

Metabolic-Energy Anatomical Correlates

Answer 5

1. Internal organs
2. Endocrine glands

Question 6

Neurological Anatomical Correlates

Answer 6

1. Head (organs of special senses)
2. Brain
3. Spinal cord
4. Autonomic nervous system (ANS)
5. Peripheral nerves

Question 7

Behavioural Anatomical Correlates

Answer 7

Brain

Question 8

Biomechanical Physiological Functions

Answer 8

1. Posture
2. motion

Question 9

Respiratory-Circulatory Physiological Functions

Answer 9

1. respiration
2. circulation
3. venous & lymphatic drainage

Question 10

Metabolic-Energy Physiological Functions

Answer 10

• Metabolic processes:
  
  1. homeostasis
  2. energy balance
  3. regulatory processes
• Immunological activities and inflammation & repair
• Digestion, absorption of nutrients, waste removal
• Reproduction

Question 11

Neurological Physiological Function

Answer 11

1. Control & coordination
2. Integration of body functions
3. Protective mechanisms ( i.e. fight or flight)
4. Sensation

Question 12

Behavioural Physiological Function

Answer 12

1. Psychological & social activities (e.g., stress, work, family)
2. Habits (e.g., sleep, exercise, drug abuse)
3. Values, attitudes, beliefs

Question 13

Biomechanical Model OMT Techniques

Answer 13

Objective: Optimize patient’s adaptive potential through restoring structural integrity & functio

1. Assess patient for structure abnormality (somatic dysfunction)
2. Use OMT to correct somatic dysfunction = patient regains associated structural, vascular, neurologic, metabolic, & behavioral functions.

EX) Whiplash

Question 14

Biomechanical Dysfunctions

Answer 14

Structural impediment via dysfunction of muscles, joints, connective tissue

• Can compromise vascular or neurological structures
• ↓↓↓ patient’s homeostatic capacity (Patient’s ability to adapt to insults & stressors)

Question 15

Respiratory-Circulatory Central Processes

Answer 15

Tissues that screw the circulation of body fluids can affect health of tissues

1. Central neural control
2. CSF fluid flow
3. Pulmonary & cardiovascular function

Question 16

Respiratory-Circulatory Peripheral Processes

Answer 16

Delivery of oxygen & nutrients
Removal of cellular waste products via

1. Arterial supply
2. Venous & lymphatic drainage

Question 17

Respiratory-Circulatory OMT Techniques

Answer 17

Objective: Maximize capacity & efficiency of respiratory- circulatory functions

OMT addresses dysfunction in:

1. Respiratory mechanics
2. Circulation
3. Flow of body fluids

Ex) Pneumonia

Question 18

Neurological Model OMM

Answer 18

There is a relationship between somatic & visceral autonomic systems

This model consides the neuroendocrine immune network by:

– Spinal facilitation
– Proprioceptive function
– Autonomic nervous system (ANS)
– Activity of nociceptors (pain fibers)

Question 19

Neurological Model OMT Methods

Answer 19

Objective: re-establish optimal neural function

• Attain autonomic balance
• Address neural reflex activity
• Remove facilitated segments
• ↓↓↓ afferent nerve signals
• pain relief

OMT focuses on:

• ↓↓↓ of mechanical stresses
• Balance of neural inputs
• Elimination of nociceptive drive

Question 20

Neurological Model Example

Answer 20

example: patient with peristalsis (lack of intestinal motion) after surgery

OMT focus:

• release paraspinal tensions & spasms

= ↓ sympathetic hyperactivity & ↑↑↑ parasympathetic activity

= Restoring normal intestinal motility

Question 21

Metabolic-Energy Model OMT

Answer 21

Model requires energy-efficient response to infectious agents & repair of injuries

OMT REPAIRS SOMATIC DYSFUNCTION = OPTIMAL ENERY ECONOMY

• Adequate nutrition = normal biochemical processes, cellular functions, & neuromusculoskeletal activity
• INJURY (somatic disfunction) to musculoskeletal system burdens body’s energy economy
  
  1. Dysregulate production, distribution, or expenditure of energy
  2. Increase allostatic load
  3. Interfere w/ immunological & endocrine regulatory functions

Question 22

Behavioral Model OMT

Answer 22

Objective: improve body’s ability to effectively manage, compensate, or adapt to stressors (maximizing coping abilities)

• Musculoskeletal system can express emotions
• Stress = ↑↑↑ neuromuscular tension

OMT: Somatic dysfunction affects musculoskeletal system’s reaction to biopsychosocial stressors

Provide patient education on:

• Health
• Disease & lifestyle choices
• Mental outlook
• Preventative care
• Helps Patient Trust/ build Rapport

Question 23

Neuroendocrine-Immune System Response

Answer 23

body has homeostatic rhythms (maintain appropriate changes necessary for promoting survival)

• immune response sensitizes the PAN = to ↑↑↑ release of neurotransmitters & neuromodulators
  
  • Activation of primary afferent nociceptor (PAN) and release of pro-inflammatory compounds into surrounding tissue
  • Repetitive stimuli = PANs to be ↑↑ sensitive to low thresholds of energy
• = greater pain sensation: primary hyperalgesia
• = Allodynia: non-noxious stimuli elicits sensation of pain– Neurogenic inflammation

Question 24

The Arousal System and Sickness Behaviours

Answer 24

Triggers of the arousal system:

1. Somatic dysfunction (stress)
2. Visceral dysfunction (stressors)
3. Emotional dysfunction (stress)

Leads to Sickness Behaviour (Changes in Acute-Phase Response)

Question 25

Neuroendocrine-Immune Network

Answer 25

## Footnote Physical (**somatic** or **visceral**) & **Emotional** stimuli **triggers** the **arousal** system = impacted homeostasis via triggering **strong** **synpathetic** **response** = **release** of **adrenal** cortical steroid **hormones** **NEURAL** and **ENDOCRINE** systems interact with **IMMUNE** system = ↑↑↑ cytokines, cortisol, & catecholamines

Question 26

Homeostasis

Answer 26

Tendency of the body to seek and **maintain** a condition of **balance** or equilibrium **_within its internal environment_**, even *_when faced with external changes_*

Question 27

Allostasis

Answer 27

**Maintenance** of **stability** **through** **change**: bring the body **back** to **homeostasis** **Disease processes will _ACTIVATE_ allostatic response** * As threat diminishes, **feedback** **control** **systems** should suppress levels of allostatic compounds * = returning body to normal function

Question 28

Allostasis Arousal System

Answer 28

Question 29

Somatic stressors

Answer 29

trauma or **injury** including **somatic** **dysfunction**

Question 30

Visceral stressors

Answer 30

traumatic injury, **infection**, or inflammation of **visceral** **organs** • More **subtle**, **diet**-related **events**

Question 31

Emotional stressors

Answer 31

STRESS RESPONSE Frequent activation of stress response = * _damages body_ **chronically** through **activation** of the hypothalamic-pituitary adrenal (**HPA**) axis * **Effects** add up progressively (**cumulative**)

Question 32

Allostatic load

Answer 32

*chronic compensatory state* **price paid** for chronic exposure to stress-mediated neuroendocrine adaptations * **Long-term exposur**e to allostatic chemical environment **(catecholamines, cortisol, cytokines)** Gradual loss of effectiveness of feedback pathways to reestablish normal homeostasis

Question 33

Allostatic Load Disease

Answer 33

– **Degenerative** & inflammatory **diseases** may have roots in this mechanism – Correlated to increased occurrence of **cardiovascular** dx – Memory & **depression** (central nervous system) – Multiple, complex effects on immune system

Question 34

Screening

Answer 34

FAST & NONSPECIFIC test to locate dysfunction area **Static Postural Exam** 1. Observation of skin 2. Observation of static landmarks 3. Observation of asymmetry **Dynamic Postural Exam** 1. Gait 2. Range of Motion: Cervical, Thoracic, Lumbar, Ribs, Sacrum 3. Special Tests: Upper Extremity Quick Tests, Squat Test, Standing/Seated Flexion Tests

Question 35

Anterior Mid-Gravity Line

Answer 35

1. Glabella 2. Symphysis menti 3. Episternal notch 4. Mid-sternum 5. Xiphoid process 6. Umbilicus 7. Pubic symphysis 8. Mid-heel point

Question 36

Posterior Mid-Gravity Line + Landmarks

Answer 36

Posterior Mid-Gravity Line 1. Inion 2. Spinous processes of: * Cervical vertebrae * Thoracic vertebrae * Lumbar vertebrae * Sacral vertebrae 3. Gluteal crease 4. Mid-heel point

Question 37

Lateral Landmarks

Answer 37

Lateral Mid-Gravity Line 1. External auditory meatus (canal) 2. Greater tuberosity of the humerus (on lateral head) 3. Mid-body of L3 4. Sacral promontory (anterior third of sacrum) 5. Greater trochanter of the femur 6. Lateral condyle of the knee 7. Lateral malleolus (slightly anterior to)