RVU opp exam 1

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RVU opp exam 1
2010-09-20 03:05:14
RVU OPP exam Dr Gish

RVU OPP exam 1
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  1. Define TART for chronic problem
    • Tissue Texture changes
    • Decreased/no edema, no erythema, cool dry skin with slight tension, decreased muscle tone (flaccid, ropy, fibrotic)

    • Asymmetry
    • Present with compensation in other areas of the body

    • Restriction
    • Present; decreased/no pain

    • Tenderness
    • Dull, achy, burning
  2. Define 10 step Sreening exam and tell when you'd use
    • •Walking
    • –Gait analysis
    • •Standing
    • –Posture, standing flexion test
    • •Seated
    • –UE motion testing, seated flexion test
    • •Supine
    • –Rib motion, LE motion testing, Pelvic landmarks
    • •Prone
    • –Pelvic/Sacral landmarks

    Initial visit = start with ten-step screening exam
  3. Define TART for acute
    • Findings
    • Acute <3 weeks

    • Tissue Texture changes
    • Edematous, erythematous, boggy with increased moisture. Muscles hypertonic.

    • Asymmetry
    • Present

    • Restriction
    • Present, painful with movement

    • Tenderness
    • Severe, sharp
  4. Describe screening for Lateral Alignment
  5. Chapman points
    • A system of reflex points that present as predictable anterior and posterior fascial tissue texture abnormalities (plaque-like changes or stringiness of the involved
    • tissues) assumed to be reflections of visceral dysfunction or pathology. 2.
    • Originally used by Frank Chapman,DO, and described by Charles Owens,
    • DO.
  6. Define bogginess:
  7. A tissue texture abnormality
    • characterized principally by a palpable
    • sense of sponginess in the tissue,
    • interpreted as resulting from
    • congestion due to increased fluid
    • content.
  8. Describe barriers
    • barrier (motion barrier): The limit to motion; in defining barriers, the palpatory end-feel characteristics are useful. (Fig. 5)
    • anatomic b.- the limit of motion imposed by anatomic structure; the limit of passive motion.
    • elastic b., the range between the physiologic and anatomic barrier of motion in which passive ligamentous stretching occurs before tissue disruption.
    • pathologic b., a restriction of joint motion associated with pathologic change of tissues (example: osteophytes). See also barrier, restrictive b.
    • physiologic b.-the limit of active motion.
    • restrictive b., a functional limit that abnormally diminishes the normal physiologic range.
  9. Chapman reflex:
  10. 1. A system of reflex points that present as predictable anterior and posterior fascial tissue texture abnormalities (plaque-like changes or stringiness of the involved tissues) assumed to be reflections of visceral dysfunction or pathology. 2. Originally used by Frank Chapman, DO, and described by Charles Owen, DO
  11. define contractions and the various types
    • contraction: Shortening and/or development of tension in muscle.
    • concentric c., contraction of muscle resulting in approximation of attachments.
    • eccentric c., lengthening of muscle during contraction due to an external force.
    • isokinetic c., 1. A concentric contraction against resistance in which
    • the angular change of joint motion is at the same rate. 2. The counterforce is
    • less than the patient force.
    • isolytic c., 1. A form of eccentric contraction designed to break adhesions using an operator-induced force to lengthen the muscle. 2. The counterforce is greater than the patient force.
    • isometric c., 1. Change in the tension of a muscle without approximation of muscle origin and insertion. 2. Operator force equal to patient force.
    • isotonic c., 1. A form of concentric contraction in which a constant force is applied. 2. Operator force less than patient force.
  12. fascial patterns:
  13. 1. Systems for classifying and recording the preferred directions of fascial motion throughout the body. 2. Based on the observations of J. Gordon Zink, DO, and W.
    Neidner, DO.
  14. common compensatory pattern (CCP):
  15. the specific finding of alternating fascial motion preference at transitional regions of the body described by Zink and Neidner.
  16. uncompensated fascial pattern:
  17. the finding of fascial preferences that do not demonstrate alternating patterns of
    findings at transitional regions. Because they occur following stress or trauma, they tend to be symptomatic
  18. gravitational line:
    • Viewing the patient from the side, an imaginary line in a coronal plane which, in the theoretical ideal posture, starts slightly
    • *anterior to the lateral malleolus passes across the
    • *lateral condyle of the knee
    • * the greater trochanter through the
    • *lateral head of the humerus at the tip of the shoulder to the
    • *external auditory meatus;

    • if this were a plane through the body, it would intersect
    • *the middle of the third lumbar vertebra and the
    • *anterior one third of the sacrum.

    It is used to evaluate the A-P (anterior-posterior) curves of the spine. See also midmalleolar line.
  19. Sherrington laws:
  20. 1. Every posterior spinal nerve root supplies a specific region of the skin, although fibers from adjacent spinal segments may invade such a region. 2. When a muscle receives a nerve impulse to contract, its antagonist receives, simultaneously, an impulse to relax. (These are only two of Sherrington’s contributions to neurophysiology; these are the ones most relevant to osteopathic
  21. Wolff law
  22. Every change in form and function of a bone, or in its function alone, is followed by certain definite changes in its internal architecture, and secondary alterations in its external conformations (Stedman’s, 25th ed.); (e.g., bone is laid down along lines of stress).
  23. mechanoreceptor:
  24. A receptor excited by mechanical pressures or distortions, such as those responding to touch and muscular contractions. (Dorland’s).
  25. myotome:
  26. 1. All muscles derived from one somite and innervated by one segmental spinal nerve. 2. That part of the somite that develops into skeletal muscle (Stedman’s).
  27. models of osteopathic care:
  28. Five models
    • that articulate how an osteopathic
    • practitioner seeks to influence a
    • patient’s physiological processes.
    • structural model, the goal of the
    • structural model is biomechanical
    • adjustment and the mobilization of
    • joints. This model also seeks to address
    • problems in the myofascial connective
    • tissues, as well as in the bony and soft
    • tissues to remove restrictive forces and
    • enhance motion. This is accomplished
    • by the use of a wide range of
    • osteopathic manipulative techniques
    • such as high velocity-low amplitude,
    • muscle energy, counterstrain,
    • myofascial release, ligamentous
    • articular techniques and functional
    • techniques.
  29. Osteopathic Manipulative Treatment (OMT):
  30. technique (FOR), 1. A technique
    • intended to normalize neuromuscular
    • function by applying a manual
    • oscillatory force, which may be
    • combined with any other ligamentous
    • Figure 23. Neutral spinal
    • position.
  31. Define FPR
  32. Earl Miller, DO
    • thrust technique (HVLA), See
    • osteopathic manipulative treatment,
    • high velocity/low amplitude technique
    • (HVLA).
    • toggle technique, short lever technique
    • using compression and shearing forces.
    • traction technique, a procedure of
    • high or low amplitude in which the
    • parts are stretched or separated along a
    • longitudinal axis with continuous or
    • intermittent force.
    • v-spread, technique using forces
    • transmitted across the diameter of the
    • skull to accomplish sutural gapping.
    • ventral techniques, See osteopathic
    • manipulative treatment, visceral
    • manipulation.
    • visceral manipulation (VIS), a system
    • of diagnosis and treatment directed to
    • the viscera to improve physiologic
    • function. Typically, the viscera are
    • moved toward their fascial attachments
    • to a point of fascial balance. Also
    • called ventral techniques.
    • osteopathic musculoskeletal evaluation:
    • The osteopathic musculoskeletal
    • evaluation provides information
    • regarding the health of the patient.
    • Utilizing the concepts of body unity,
    • self-regulation and structure-function
    • interrelationships, the osteopathic
    • physician uses data from the
    • musculoskeletal evaluation to assess
    • the patient’s status and develop a
    • treatment plan. (AOA House of
    • Delegates)
    • osteopathic philosophy: a concept of
    • health care supported by expanding
    • scientific knowledge that embraces the
    • concept of the unity of the living
    • organism’s structure (anatomy) and
    • function (physiology). Osteopathic
    • philosophy emphasizes the following
    • principles: 1. The human being is a
    • dynamic unit of function. 2. The body
    • possesses self-regulatory mechanisms
    • that are self-healing in nature. 3.
    • Structure and function are interrelated
    • at all levels. 4. Rational treatment is
    • based on these principles.
  33. Define Reflex
  34. stimuli producing patterns of reflex
    • response in segmentally related
    • visceral structures.
  35. Rule of 3:
  36. T1 to T3, TP is at the same level as tip of the SP
    • T4 to T6, TP is one half vertebral level above the tip of the SP
    • T7 to T9, TP is one full vertebral level above the tip of the SP
    • T10, TP is one full vertebral level above the tip of the SP
    • T11, TP is one half vertebral level above the tip of the SP
    • T12, TP is at the same level as tip of the SP.
  37. Lovett (French usage).
    • type II s. d., 1. Thoracic or lumbar
    • somatic dysfunction of a single
    • vertebral unit in which the vertebra is
    • significantly flexed or extended with
    • sidebending and rotation in the same
    • direction (rotation occurs into the
    • concavity of the curve) based upon the
    • Principles of Fryette (American usage).
    • 2. First degree dysfunction based upon
    • the Laws of Lovett (French usage).
  38. spondylolisthesis:
  39. Anterior displacement
    • of one vertebra relative to one
    • immediately below (usually L-5 over
    • the body of the sacrum or L-4 over L-
    • 5).
    • spondylolysis: Dissolution of a vertebra,
    • aplasia of the vertebral arch, and
    • separation at the pars interarticularis;
    • platyspondylia, pre-spondylolisthesis.
    • spondylosis: 1. Ankylosis of adjacent
    • vertebral bodies. 2. Degeneration of the
    • intervertebral disk.
  40. T.A.R.T.: A mnemonic for four
    • diagnostic criteria of somatic
    • dysfunction: tissue texture abnormality,
    • asymmetry, restriction of motion and
    • tenderness, any one of which must be
    • present for the diagnosis.
  41. tender points:
    • 1. Small, hypersensitive points in the myofascial tissues of the body that do not have a pattern of pain radiation. These points are a manifestation of somatic dysfunction and are used as diagnostic criteria and for monitoring treatment. 2. A system of diagnosis and treatment originally described by Lawrence Jones, DO,
    • FAAO. See also osteopathic manipulative treatment, counterstrain
  42. S.T.A.R.:
    • A mnemonic for four diagnostic
    • criteria of somatic dysfunction:
    • sensitivity changes, tissue texture
    • abnormality, asymmetry and alteration
    • of the quality and quantity of range of
    • motion.
  43. Still, MD, DO:
  44. Andrew Taylor. Founder
    • of osteopathy; 1828-1917. First
    • announced the tenets of osteopathy on
    • June 22, 1874, established the
    • American School of Osteopathy in
    • 1892 at Kirksville, MO.
  45. trigger point (myofascial trigger point):
    • 1. A small hypersensitive site that,
    • when stimulated, consistently produces
    • a reflex mechanism that gives rise to
    • referred pain and/or other manifestations
    • in a consistent reference zone
    • that is consistent from person to
    • person. 2. These points were most
    • extensively and systematically
    • documented by Janet Travell, MD, and
    • David Simons, MD.
  46. allostatic load
    The term allostatic load, coined by McEwen and Stellar in 1993, is defined as the physiological costs of chronic exposure to fluctuating or heightened neural or neuroendocrine response that results from repeated or chronic stress.

    • [1] It is used to explain how frequent activation of the body's stress response, essential for managing acute threats, can in fact damage the body in the long run.
    • Allostatic load is generally measured through a composite index of indicators of cumulative strain on several organs and tissues, but especially on the cardiovascular system.
    • The hormones and other physiological agents that mediate the effects of stress on the body have protective and adaptive effects in the short run and yet can accelerate pathophysiology when they are over-produced or mismanaged[2].
    • Adaptation in the face of stressful situations and stimuli involves activation of neural, neuroendocrine and neuroendocrine-immune mechanisms. This adaptation has been called "allostasis" or "maintaining stability through change", which is an essential component of maintaining homeostasis. The main hormonal mediators of the stress response, cortisol and epinephrine (adrenaline), have both protective and damaging effects on the body. In the short run, they are essential for adaptation, maintenance of homeostasis, and survival “allostasis”. Yet, over longer time intervals, when called upon frequently, they exact a cost “allostatic load” that can accelerate disease processes. Allostatic load can be measured in physiological systems as chemical imbalances in autonomic nervous system, central nervous system, neuroendocrine, and immune system activity as well as perturbations in the diurnal rhythms, and, in some cases, plasticity changes to brain structures.
    • Four conditions that lead to allostatic load are:

    • Repeated frequency of stress responses to multiple novel stressors;
    • Failure to habituate to repeated stressors of the same kind;
    • Failure to turn off each stress response in a timely manner due to delayed shut down; and
    • Inadequate response that leads to compensatory hyperactivity of other mediators.
    • The effects of these forms of dysfunctional allostasis cause allostatic load and this in turn leads over time to diseases. Allostatic load effects can be measured in the body. When tabulated in the form of allostatic load indices using sophisticated analytical methods, it gives an indication of cumulative lifetime effects of all types of stress on the body.[2]
  47. 1. Define and describe palpation.
    I. – palpation is the art of sensing, evaluating and knowing with the fingers. Strong palpatory skills are essential to evaluating and treating Osteopathically. This is a psychomotor skill that, like playing a musical instrument or a sport, takes time to develop.
  48. 2. Specify the average time and repetitions necessary to reach an expert level in any task requiring neuromusculoskeletal integration.
    Everyone learns at a different rate. The more you practice, the better you get. In general, it takes 10,000 repetitions and/or 10 years of practice to reach an expert level in any task requiring neuromusculoskeletal integration. Don’t get frustrated. Developing your skills will take time. If you practice, every week, month and year you will get better. You can always improve, no matter how good you are. Take time and work on each other outside of class. You need to experience Osteopathy in order to understand it! Approach these skills with an open mind because you cannot learn what you think you already know!
  49. How is palpation integral to many areas of medicine?
    Palpation is integral to many areas of medicine. Developing strong palpatory skills will make you a more effective clinician, whether using them for performing osteopathic manipulative medicine, giving an injection, inserting a central line, evaluating a suspected mass or suturing in the emergency department or surgery.
  50. 5. Specify what you are looking for when evaluating a patient Osteopathically.
    When evaluating a patient Osteopathically, you are evaluating for alterations in function and motion both locally and globally throughout the entire individual. You are looking for the presence or absence of somatic dysfunction, which is defined as “impaired or altered function of related components of the somatic (body framework) system: skeletal, arthroidal, and myofascial structures, and related vascular, lymphatic and neural elements.” Osteopathic manipulative medicine (OMM) is used to find the health in the individual. We interact with somatic dysfunction to improve function and motion and establish an environment where
  51. 6. Define somatic dysfunction.
    as “impaired or altered function of related components of the somatic (body framework) system: skeletal, arthroidal, and myofascial structures, and related vascular, lymphatic and neural elements.”
  52. 7. Specify the goal of osteopathic manipulative medicine.
    Osteopathic manipulative medicine (OMM) is used to find the health in the individual. We interact with somatic dysfunction to improve function and motion and establish an environment where the body can heal and exist in health.
  53. A.Chronic somatic dysfunction
    • 1.Pain quality – dull, achy, paresthesias (crawling, itching, burning, gnawing)
    • 2.Skin – cool, pale
    • 3.Musculature – decreased muscle tone, flaccid, mushy, limited range of motion due to contracture
    • 4.Mobility – decreased range of motion with normal quality of motion that remains
    • 5.Tissues – chronic congestion, doughy, stringy, fibrotic, ropy, thickened, contracted/contractures
  54. Define Acute Somatic Dysfxn
    • A. Acute somatic dysfunction
    • 1. Pain quality – acute pain, severe, cutting, sharp
    • 2. Skin – feels warm, moist, appears red, inflamed
    • 3. Musculature – increased muscle tone, muscle contraction, spasm
    • 4. Mobility – range of motion may be normal but quality “sluggish” (hesitancy to motion)
    • 5. Tissues – “boggy” edema (feels squishy), acute congestion
  55. Describe TART
    • T – tissue texture abnormalities
    • A – asymmetry (static, motion, tonicity, turgor, color, temperature). Can involve vertebral position, atrophy, hypertrophy, hypotonicity or hypertonicity
    • R – restriction of motion. This is where an area does not have free, unrestricted range of motion. It involves one or more planes and occurs within physiologic bounds. Evaluated through active and passive motion testing
    • T – tenderness (in the area of abnormality). This is a sensation of pain or soreness elicited during palpation. Is frequently found in the tissues associated with somatic dysfunction and may be associated with other subjective symptoms such as numbness, tingling, etc.

    One or more of the components TART is typically present with somatic dysfunction. An absence of TART is probably an absence of somatic dysfunction.

    I. Somatic dysfunction – what does it feel like? It has many of the qualities of acute and chronic inflammation.

    • B. Chronic somatic dysfunction
    • 1. Pain quality – dull, achy, paresthesias (crawling, itching, burning, gnawing)
    • 2. Skin – cool, pale
    • 3. Musculature – decreased muscle tone, flaccid, mushy, limited range of motion due to contracture
    • 4. Mobility – decreased range of motion with normal quality of motion that remains
    • 5. Tissues – chronic congestion, doughy, stringy, fibrotic, ropy, thickened, contracted/contractures
  56. 10. Specify the procedure for determining your dominant hand and eye.
    I. Dominant hand and eye - knowing your dominant hand and eye may make your findings more objective, reproducible and accelerate the development of good palpatory skills

    • A. Dominant hand – this is important to know and may be different than your “handedness.” A right handed person may be left hand dominant and vice versa. Why is this important? When palpating an area, your dominant and non-dominant hand may have different levels of perception and transmit different information. You may be able to perceive more information with the dominant hand. The ultimate goal is to become more ambidexterous and use both hands equally in osteopathic diagnosis and treatment
    • 1.While standing or sitting and without thinking about it, clasp your hands. You will usually put the dominant hand on top.
    • 2.While standing or sitting, without thinking about it, interlace the fingers of both hands. The thumb that is on top is usually your dominant hand.

    • B. Dominant eye – some believe that palpation and the interpretation of palpatory findings are more accurate if palpation is performed with the dominant eye over the area being palpated. Again, it is another way to make your findings more reproducible and objective.
    • 1.While sitting or standing, look at a distant object (clock) with both eyes open.
    • 2.Extend your dominant hand and make a circle with your thumb and index finger that encircles the object you are viewing.
    • 3.Close one eye, then open it and close the other eye. The eye that continues to see the distant object through the circle made by the thumb and index finger of your dominant hand is your dominant eye.

    II. Layer palpation - self

    Skilled palpation requires integrating your mind with your hands. It is not a mindless task where you are “feeling tissue” while thinking about what you are going to do the following weekend. Keep your mind relaxed yet focused on what you are palpating. Stress interferes with palpation. Keep your intention and attention in your hands and what they perceive. As your knowledge and skills grow, you will be able to use palpation to develop a 3- dimensional image of the area you are evaluating.

    We need to keep the room quiet during this exercise. Noise affects perception!

    A. Take a moment to sit with your eyes closed and relax. Tension affects perception and reduces effectiveness. You need to be relaxed. Find a seated position that is comfortable for you. Adjust the height of your chair or table if necessary. Learn to use your body wisely and ergonomically so that you don’t injure yourself while evaluating or treating a patient. “You can’t help others if you can’t help yourself.”

    B. Rest your nondominant arm on the table. Focus your attention through the palpating fingers of your dominant hand.

    C. Lightly palpate the dorsum (back) of the nondominant hand using the fingers of your dominant hand. Barely touch the surface. Feel the contour of the hand.

    D. Try palpating with both the dorsal and palmar aspects of the fingers of your dominant hand. Is one side more sensitive than the other?
  57. 11. Specify the causes of increased and decreased skin drag.
  58. 1.Increased skin drag may be due to excessive dryness, slight perspiration or edema.
    2. Decreased skin drag may be due to excessive perspiration, oiliness or atrophy.
  59. 12. Describe the consistency of normal “living” bone.
    Normal bone has a slight spongy quality. It should not feel hard like concrete.
  60. 13. Specify the palpatory differences in skin, subcutaneous tissue, fascia, muscle and tendon.
    Compare areas above with areas below. D. When you find an area that is firmer, move your thumbs 1-2 inches lateral to the spinous process. Palpate the various layers of tissue. Are there any changes. Compare both sides and areas located above with areas below. V. Large joint motion – shoulder A. Palpate the following structures (see demonstration). Pay attention to the various layers from skin to bone. Compare both shoulders 1. Sternoclavicular joint 2. Trace along the clavicle (collar bone) to the 3. Acromioclavicular joint 4. Anterior and posterior glenohumeral joint 5. Vertebral (medial) border of the scapula posteriorly B. Gently take each shoulder through its different motions (see demonstration) including 1. Flexion 2. Extension 3. Abduction 4. Adduction 5. External rotation 6. Internal rotation Communicate with your patient. Don’t hurt them. Pay attention to the quality and quantity of motion. Does one shoulder feel restricted? Are both tight? Does one arm feel heavier than the other, indicating a resistance to motion? C. Now let’s try introducing motion into the more restricted shoulder to change function and motion. 1. Patient seated at end of table 2. Place your non-dominant hand on top of the shoulder and use your thumb and fingers to stabilize the clavicle and scapula (collar bone and shoulder wing). 3. Grasp the patient’s forearm near the elbow with your dominant hand. 4. Gently and in a controlled fashion, circumduct the shoulder counterclockwise 10 times through a range of motion. Communicate with the patient and avoid producing pain. This requires 2-way communication. The patient should not allow the doc to hurt them. D. Reassess 1. Re-evaluate the various motions. Were there any changes? 2. Again, palpate over the sternoclavicular, acromioclavicular and glenohumeral joints, clavicle and vertebral border of the scapula. Are there any palpable changes in the tissues? Remember – something as simple as motion testing can alter the health, function, motion and palpatory findings in an area. VI. Homework – remember, the more you practice the better you become! Don’t cram the night before a practical exam – it doesn’t work! Try the above exercises at home. There are several more exercises that can be used to improve palpatory perception. A. Put a mixture of coins in a pocket or bag. Using only palpation, distinguish between heads and tails and differentiate pennies, dimes, nickels and quarters. Attempt to identify the date stamped onto the coin. B. Find a book with thin (like parchment) pages. Place a hair underneath 1 page and see if you can find it by palpation only. When you find it, add another page. C. Find a bone box/disarticulated skeleton (in library). Close your eyes and attempt to identify the various bones by palpation only. Try the exercise with both plastic and real bone. Do they feel different?
  61. 14. Describe the red reflex and what it indicates.
    B. Red reflex – locate the spinous processes of the upper thoracic vertebrae. Place each thumb 1-2 inches lateral (to the side of the spinous processes). Maintain contact with the skin, apply light pressure and rub your thumbs in unison down to the bottom of the spine. The skin will initially turn red, and then return to normal. Any area that remains red is probably an area of somatic dysfunction. C. Use your dominant hand to palpate over the spinous process of each thoracic and lumbar vertebrae. Remember, start at the skin surface and gradually palpate down to the bone.
  62. 15. Specify the location of the sternoclavicular joint, clavicle, acromioclavicular joint, glenohumeral joint and vertebral border of the scapula.
    • 1. Sternoclavicular joint
    • 2. Trace along the clavicle (collar bone) to the
    • 3. Acromioclavicular joint
    • 4. Anterior and posterior glenohumeral joint
    • 5. Vertebral (medial) border of the scapula posteriorly
  63. Identify the symmetrical features of the human body in the horizontal planes
  64. Identify the symmetrical features of the human body in the coronal planes.
    • Ideal standing posture in coronal plane
    • Center (Mid) gravity line
    • -midway between the feet
    • -extend superiorly up midline of spine
    • -divides body into 2 equal parts
    • -no rotation in horizontal plane
    • -no sidebending in the coronal plane
  65. Ideal posture alignment in sagittal plane
  66. Ideal posture alignment in sagittal plane
    • Center of gravity/weight bearing line travels through:
    • -just anterior to lateral malleolus
    • -just behind mid-knee
    • -femoral head
    • -ant 1/3 of sacral base
    • -middle of body of L3 vertebra
    • -external auditory meatus
  67. Explain the features of normal posture.
  68. Ideal postural alignment
    -Balancing cervical, lumbar, thoracic curves against gravity
  69. posture anomalies
    • A. Kypholordotic posture
    • -head forward, cervical lordotic, thoracic kyphotic, scapulae abducted, lumbar spine lordotic, anterior pelvic tilt, hip joint slightly flexed, knee joints extended, plantar flexion of ankle joints in relation to angle of legs

    • B. Swayback posture
    • -head forward, cervical spine lordotic, thoracic spine kyphotic, dec. lordosis of lumbar spine, post. tilt of pelvis, hips & knee joints hyperextended

    • C. Flat back posture
    • -head forward, cervical spine slight inc. lordosis, thoracic spine slight kyphotic in upper portion, then flattens in lower segments, lumbar lordosis flattened, hips/knees extended

    • D. Military –bearing posture
    • -head tilted slightly posteriorly, cervical curve & thoracic curve normal, chest elevated, creating ant. cervical & post. thoracic deviation of plumb line, inc. lordosis of lumbar curve, ant. pelvic tilt, knees extended, ankles plantar flexed

    • E. Anterior postural deviation
    • -entire body leans forward, deviating anteriorly from plumb line, pt’s weight supported by metatarsals

    • F. Posterior postural deviation
    • -entire body leans backward, deviating posteriorly from plumb line, balance maintained by ant. thrust of pelvis & hips, marked lordosis from midthoracic spine down

    • G. Rotary posture
    • -body rotated to right or left, entire body may be involved, with rotation beginning from ankles & proceeds up, lateral alignment appears completely different when viewing from right & left sides, in scoliotic posture, rotation primarily of thorax, in direction of scoliotic convexity
  70. Identify and describe component of a screening examination.
  71. Identify and describe the findings associated with scoliosis.
  72. Describe the common compensatory pattern.
  73. Describe factors that produce postural decompensation.
  74. Explain the components of an osteopathic structural examination and SOAP note.
    • Objective: Ht___ Wt___ Temp___ P___ R___ BP___/____ Perceived Pain Level: ___/10
    • Gen. Assess: __________________________________________________________________________

    Body Region

    Palpatory Findings

    Other Objective Findings/Tests

    • Cranial/OA
    • Cervical
    • Thoracic
    • Lumbar
    • Sacrum
    • Pelvis
    • Lower Limb
    • Upper Limb
    • Ribcage
    • Abdomen /Other

    • Other Objective exam:__________________________________________________________________
    • _________________________________________________________________________________________________________________________________________________________________________
    • Assessment:

    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • ______________________________________________________________________________
    • Plan: (Tests, Treatment/OMT, Patient Education, Follow up)______________________________________________________________________________
  75. How does an osteopathic exam differ?
  76. Osteopathic exam encompasses more than standard history and physical exam with palpatory diagnosis of somatic dysfunction
  77. Components of a screening evaluation
    • Visual
    • 1)Landmark assessment*
    • 2)Postural analysis*
    • 3)Active ROM
    • 4)Gait analysis
    • Palpatory
    • Tissue texture changes
    • Asymmetry
    • Restriction
    • Tenderness
  78. Distribution of this weight depends on:
    • Integrity of musculoligamentous structures
    • Compensations that occur secondary to visual and/or balance functions of the body
    • Energy requirements- state of least expenditure
  79. Optimal posture depends on:
    • Balanced configuration of the body
    • Normal arches of feet
    • Vertical alignment of ankles
    • Horizontal orientation of sacral base
    • Equal distribution of body mass around the center of gravity
    • Compressive force on spinal discs is balanced by ligamentous tension
    • Minimal energy expenditure
  80. Distiguish between Fixed and FXN Scoliosis
    • Functional scoliosis
    • Spinal curves occurring from unilateral muscle contractions
    • Curve disappears when muscle hypertonicity resolves
    • Structural (Fixed) scoliosis
    • Involves long term adaptation associated with positional changes
    • Over time tissues associated with this curve change
    • Tissues lengthen/shorten and resist change to the neutral position
  81. Postural Decompensation:
    Decompensation is the functional deterioration of a previously working structure or system. Decompensation may occur due to fatigue, stress, illness, or old age. When a system is "compensated," it is able to function despite stressors or defects. Decompensation describes an inability to compensate for these deficiencies. It is a general term commonly used in medicine to describe a variety of situations.Occurs when individual’s self regulatory mechanism is overwhelmed

    • Traumatic decompensation
    • Macrotrauma or recurrent microtrauma disrupts ligamentous stability in spine
    • Chronic postural strain & decompensation
    • Congenital or acquired structural changes

    Chronic postural stress can foster structural changes
  82. 1.Define and apply the concepts of self assembly to cellular expression and function
    • *A phenomenon in which components join together to form larger, stable structures.
    • *Develops through an incredibly complex series of interactions
    • *Made up of components or subsystems that have their own behavioral properties
    • Once assembled, they have new properties that could not have been predicted based upon the characteristics of their individual parts
  83. Define and apply the concepts of pre-stress to cellular expression and function.
    Concept whereby a structure is placed in a balance between tension and compression before an external force is involved.

    • *Interaction between the tension bearing and compression bearing elements.
    • *Rigid struts (Bones)stretch or oppose the tension bearing elements(skin,fascia).
    • *Tension bearing elements add compressive force to the rigid struts.
  84. 2.Devise a rationale for treatment utilizing the concepts of cellular structure, tensegrity and OMT.
  85. 3.Comprehend and apply to patient care the research associated with cellular morphology, cellular expression, and tensegrity.
    • Rounded cells underwent apoptosis
    • Flattened cells became more likely to undergo mitosis
    • Somewhere in between resulted in differentiation and neither divided nor died.
    • Capillary cells formed hollow capillary tubes
    • Hepatic cells secreted proteinsEt
  86. Continuous Tension Bearing Elements
    • Fascia
    • Muscles
    • Ligaments
    • Cytoskeleton
    • DNA
  87. Discontinuous Compressible Elements
    • Cell Membranes
    • Organelles
    • Bones
  88. In vitro Repetitive Motion Strain (RMS) model has a different effect on fibroblasts than IMFR.
    • RMS appears to reduce fibroblast proliferation and creates a delayed inflammatory response.
    • IMFR does not cause a reduction in fibroblast proliferation and:
    • Reverses inflammatory effects on repetitively strained cells
    • Causes fibroblast proliferation
    • Causes expression/secretion of proinflammatory and anti-inflammatory interleukins
  89. 10 Step
    • 1.Gait/Posture
    • 2.Standing Spine Sidebending Test
    • 3.Standing Flexion Test
    • 4.Seated Flexion Test
    • 5.Seated Upper Extremity Motion
    • 6.Seated Trunk Tests
    • 7.Seated Cervical Motion
    • 8.Supine Thoracic Cage Motion
    • 9.Lower Extremity Motion
    • 10.Pelvis Landmarks
  90. 1.Describe the different styles of soft tissue technique.
    • •Stretching (traction) – forces are along the longitudinal axis
    • •Kneading- forces are perpendicular to the longitudinal axis (like a bowstring)
    • •Inhibition – forces are directed superficial to deep ususally over a specific area of tension (tender point)
    • •Effleurage – lymphatic treatment superficially from distal to proximal and peripheral to central.
    • •Petrissage and skin rolling – deep kneading/squeezing of muscle tissue breaking adhesive bands from the skin to deeper tissue
    • •Tapotement – repetitively striking the belly of the muscle with the hypothenar edge of the hand.
  91. 2.Discuss the potential goals for soft tissue treatment.
    • 1.Relax hypertonic muscles
    • 2.Stretch passive fascial structures
    • 3.Enhance circulation to local myofascial structures
    • 4.Improve local tissue nutrition, O2, and removal of metabolic waste
    • 5.Identify somatic dysfunction
    • 6.Improve abnormal somato-somatic and somatovisceral reflex activity
    • 7.Observe tissue response to OMT
    • 8.Improve local and systemic immune responsiveness
    • 9.Provide general state of tonic stimulation
    • 10.Provide general relaxation
  92. 1.Discuss and apply the potential goals of treatment for muscle energy treatment in case based scenarios.
    • •Lengthen muscle fibers
    • •Decrease muscle hypertonicity
    • •Reduce the restraint of movement
    • •Produce joint mobilization
    • •Improve respiratory and circulatory function
    • •Strengthen asymmetrically weakened muscles
  93. 2.Describe the setup and localization for direct-muscle energy treatment.
  94. 3.Discuss the appropriate application of various types of muscle contractions utilized in muscle energy treatment.
    • •Accurate diagnosis
    • •Position to the point of initial barrier resistance (feather edge)
    • •Physician establishes appropriate counterforce
    • •Patient introduces appropriate muscle energy effort
    • –Direction
    • –Duration
    • –Amount of force
    • •Patient must completely and voluntarily relax
    • •Pause for neuromuscular adaptation (post-relaxation phase)
    • •Reposition to the new restrictive barrier
    • •Repeat until no futher change is obtained
    • •Reassess for appropriate change
  95. Key Concepts of Muscle energy
    • 1.This is not a wrestling match. Only use enough muscle strength to contract the muscles.
    • 2.Hold the isometric contraction at least 3-5 seconds.
    • 3.Be sure to wait for the involuntary second wave of relaxation (post relaxation phase) before repositioning.
    • 4.Reposition after each contraction (including the last).
    • 5.Remember, the correction occurs during repositioning and not during the isometric contraction.
  96. 4.Describe the basic physiologic theory behind the activating force of the isometric contraction
  97. Define Muscle Energy
    • •Most commonly used as a direct technique (a technique that is localized towards the restrictive barrier).
    • •After a isometric contraction, the muscle group is in a relaxed, refractory phase which allows the muscle to be passively stretched to a new restrictive barrier.
  98. 5.Discuss and apply the basic treatment concepts and principles of muscle energy to hypertonic musculature found in the lower limb.
  99. Isotonic
    • –The muscle is anchored only on one end and uses a consistent weight.
    • –Goal is to strengthen muscle by shortening origin and insertion of muscle under load.
    • –Clinically, the physician uses less force than the patient.
  100. Isolytic
    • –Contraction of a muscle against resistance while forcing the muscle to lengthen.
    • –The therapeutic goal is to stretch fibrotic or chronically shortened myofascial tissues.
    • –Clinically the physician’s force is greater than the patient’s
  101. Isometric
    • -Most common type used in muscle energy techniques.
    • –Muscle is contracted without shortening the muscle’s origin and insertion.
    • –Clinically, the physician’s force matches (or is the same as) the patient’s force.
  102. Osteopathic Tenets
    • The body is a unit; the person is a unit of body, mind, and spirit.
    • 2. The body is capable of self-regulation, self-healing, and health maintenance.
    • 3. Structure and function are reciprocally interrelated.
    • 4. Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function.