Lect - Viscerosomatic/Chapman Reflex

Question 1

What is a reflex in its very basic aspect?

Answer 1

you have an sensory afferent in –> directly responding is motor efferent out to the endpoint for a certain purpose.

Question 2

What’s to note about some dorsal horn neurons?

Answer 2

they respond to visceral and somatic stimuli

Question 3

In the spinal cord, where are most of the sensory aspects are coming in? (think layers)

where are the mechanoreceptors located?

what about the A(delta) fast pain fibers

what about the small C fibers of slow pain?

Answer 3

(Upper layers) Layers 1-6 of the Rexed Layers

Layers 3+4

Layers 1 and 5

Layer 2

Question 4

What is in the lower layers of the rexed layers?

Answer 4

Motoneuron cell bodies and interneurons

Question 5

Afferent fibers (visceral and somatic) always end mostly where?

Answer 5

layers 1 and 5

many areas overlap

from there they go cephalad for processing, or caudal.

Question 6

70-80% of interneurons receive input from what?

what can this account for?

Answer 6

both visceral and somatic efferents

visceral pain being so diffuse and poorly localized and super localized pain with somatic efferents.

Question 7

The overlap of the visceral and somatic afferent fibers is the basis for what?

what are two examples of it and why is it unique?

Answer 7

activation of the somatic muscle activity seen with visceral disturbances

visceral afferents activate sympathetic outflows and skeletal motor neurons (increase tone)

you can also reverse it too. somatic inputs alter sympathetic and parasymapthetic outflows

Question 8

What’s to know about the descending influences on reflexes? (2 things)

Answer 8

they effect the long-lasting excitability of the outflows by maintaining the reflex ( interneurons acts as an amplifier of input hence more output would be expected)

can also inhibit somatic and autonomic outflows through these interneurons as well

Question 9

clinical application of reflexes with the viscera and somatic systems?

Answer 9

visceral disturbances cause activation in the somatic musculature –> produces dysfunction at the facilitated segment

somatic disturbances can reflexly alter VISCERAL function

this all leads to the decompensation of homeostasis

Question 10

What is the somatic component of disease?

what does this mean for OMT?

Answer 10

musculoskeletal palpatory findings that correlate with visceral disturbances

so we can normalize the MS component that helps normalize autonomic outflows so we can restore homeostasis

Question 11

What are the steps for increasing sensitivity of the neurons?

Answer 11

Short term excitability – sensitization
*1-2 seconds of afferent input –> excitability lasts for 90-120s

long term sensitization
**inputs of several minutes –> excitability lasts for HOURS

Question 12

Fixation?

Permanent excitability?

Answer 12

15-40 minutes of afferent input that excitability lasts for days or WEEKS

Lasts forever(?) –> this can last for death of inhibitory interneurons.

Question 13

Facilitated Segment Concept?

Answer 13

“low threshold spinal reflexes represented pathways in a hyper excited state by a continuous bombardment of inputs”

called a facilitated segment

so facilitated segments are interneurons that are constantly being excited.

Question 14

Korr found that all diseases were accompanied by what (associated with facilitated segment concept)

Answer 14

hyper sympathetic tone.

Question 15

Nociception theory?

1) habituation?
2) sensitization
3) what about both with this theory

Answer 15

Habituation –> process of decreasing response of a neural pathway with a continuous stimulation

Sensitization –> continuous stimulus gives you a wind up response to where it stops and maintains. (so goes up and stabilizes)

these two processes exist together to maintain a homeostasis preventing and over or under reaction to a stimulus

Question 16

What causes nociception?

what happens because of this?

what is released?

what happens when this release happens?

how do we get pain?

how does this tie in with facilitated segment?

Answer 16

the idea is that alteration of nociceptive stimuli

sometiems the balance is shifted to the side of stimulation (facilitation).. once that stimulus (stretched muscle, fall, visceral problem) –> get a stimulus –> depolarization of nociceptive pathways –> to the afferents and branching to multiple sites going up and down the cord.

results in release of peptides at the motoneuron level at the peripheral tissues –> the peptides are the inflammatory cascade and initiate release of PGs, bradykinin, etc.

this results in lowering nociceptor thresholds thus increasing input to the cord. –> so way more pain, TART findings, somatic dysfunction.

low-threshold spinal reflex is the facilitated segment

Question 17

Pain is what?

Answer 17

conscious perception of nociception

Question 18

Allostasis?

how does it happen?

Answer 18

long term neural effect of segmental facilitation.

stimulus comes in –> chemical soup of inflammation –> primary afferent sensitization –> results in hyperalgesia (exaggerated response to noxious stimuli)… ALLOSTASIS

Question 19

What happens if the exaggerated response to noxious stimuli stays chronically?

Answer 19

you get secondary hyperalgesia –> called Central Sensitization

so neural pathways where these remain at the low level excitability threshold.

so doesn’t take much of a stimulus to fire this thing off again.

Question 20

What happens in the dorsal horn neurons during allostasis?

Answer 20

effects Ca channels, phosphorylation cascades, lose inhibitory neuron function (filter becomes bad)

all aid in maintaining facilitation of the interneurons.

Question 21

what happens if the facilitation is happening in the brainstem?

what does this affect?

what happens if you have long term facilitation here? what is the term?

Answer 21

it decreases the endogenous descending pathways including the AROUSAL SYSTEM

this lowers the catecholamines/glucocorticoids

long term facilitation damages this system

leads to loss of control of protective mechanisms called ALLOSTASIS OVERLOAD

Question 22

Allostasis effects?

Answer 22

effects on body systems affecting homeostasis

CV, Neuro, Immune problems

Question 23

Osteopathic Reflex definitions:

Somatosomatic

Somatovisceral

Viscerosomatic

Viscerovisceral

Answer 23

stimulus from somatic –> effecting other part of the somatic system

somatic –>effecting visceral

stimulus from viscera effecting somatic

visceral stimulus effecting viscera

Question 24

Somatosomatic reflex example?

Answer 24

Withdrawal response –> pulling away from heat.

Myotatic response

Question 25

Viscerovisceral reflex example?

Answer 25

eating food distends gut –> sends it to the brain and tells the organs to get some peristalsis going.

Question 26

Somatovisceral reflexes examples? (3 spots)

Answer 26

Somatocardiac reflex –> twist ankle results in increase HR and BP

Somatogastric reflex –> pinching skin results in inhibition of peristalsis in the stomach.

Somatoadrenal reflex –> somatic stimuli causes release of catecholamines from adrenal medulla.

Question 27

Viscerosomatic reflex examples

Answer 27

MI –> blocked heart –> pain in the left arm.

Question 28

What is Chapman’s Points?

Answer 28

a group of palpable points occurring in predictable locations on the anterior and posterior surface of the body that are considered to be reflections of visceral dysfunction or disease.

Question 29

what are the 3 component characteristics of chapman reflexes?

Answer 29

Viscerosomatic reflex

Gangliform contraction –> blocks lymphatic drainage and causes SNS dysfunction

consistently reproducible

Question 30

What are you feeling for chapman points?

Answer 30

pea shaped things –> 2-3mm in size

dense but not hard.

located in the deep subcutaneous tissue

Question 31

Chapman Reflex Dx / Testing

Answer 31

once found an isolated point –> apply gentle but firm pressure –> causes a deep, disagreeable pain response in the pt

sharp, non-radiating, pin-point.

clockwise or counterclockwise for 10-30 seconds

if mass disappears you’re done

Question 32

Indications for Chapman’s?

Answer 32

Diagnosis –> screening exam when clinically indicated from patient history

treatment –> finding a CR that is possibly clinically relevant to the patient

Question 33

Contraindications of Chapman’s?

relative contraindication?

Answer 33

emergent care, don’t do this, or patient refusal

fracture, cancer, patient instability

Question 34

post-treatment precaution side effects of Chapmans?

Answer 34

discomfort, drink tons of water.