Lecture # 2. P. Noto, D.O. (PPT).pdf

Osteopathic Introduction to the Autonomic Nervous System and Spinal Facilitation Philip Noto, D.O. Assistant Professor Department of Osteopathic Manipulative Medicine [email protected] Department of Osteopathic Manipulative Medicine  Preparation If you have not read the scholar Rx...

Osteopathic Introduction to the Autonomic Nervous System and Spinal Facilitation Philip Noto, D.O. Assistant Professor Department of Osteopathic Manipulative Medicine [email protected] Department of Osteopathic Manipulative Medicine  Preparation If you have not read the scholar Rx brick on the Autonomic Nervous System, please do so before proceeding with this lecture. Department of Osteopathic Manipulative Medicine  Autonomic NS Motor innervation Controls organ and vessel activity Cardiac muscle, smooth muscle and glands Largely outside of voluntary control Sympathetic and parasympathetic Department of Osteopathic Manipulative Medicine  Reflex arc Spine Afferent nerve Efferent nerve Receptor Effector (from a joint, (to a joint, muscle or muscle or organ) organ) Department of Osteopathic Manipulative Medicine  Afferent Somatic Sensory nerve fibers (mechanoreceptors, thermoreceptors, proprioceptors, nociceptors, chemoreceptors) in muscles, joints and skin Visceral Sensory nerve fibers (nociceptors, mechanoreceptors, chemoreceptors) in organs Majority of vagus nerve is afferent fibers Dorsal root  dorsal horn Department of Osteopathic Manipulative Medicine  Efferent Ventral horn  ventral root Somatic Motor signals to limbs and body wall structures (generally skeletal muscle) Autonomic Motor signals to visceral structures (cardiac muscle, glands and smooth muscle-including blood vessels) Department of Osteopathic Manipulative Medicine https://www.researchgate.net/figure/Schematic-representation-of-a-spinal-reflex-arc-A-pin-in-the-skin-produces-an-input_fig1_327199446  Reflexes Somatosomatic Withdrawal reflex Knee jerk reflex Viscerovisceral Gastro-colic reflex Vasoconstriction in an inflamed organ Department of Osteopathic Manipulative Medicine https://aneskey.com/thoracic-t2-3-ganglion-block/ https://aneskey.com/thoracic-t2-3-ganglion-block/  Reflexes Somatovisceral Somatic afferents Autonomic efferents Somatic dysfunctions (as a cause of visceral dysfunction) Viscerosomatic Visceral afferents Somatic (and sympathetic) efferents to limb / body wall structures of related levels Somatic dysfunctions (as a result of visceral dysfunction) Department of Osteopathic Manipulative Medicine  Somato-visceral Reflex arc Spine Afferent nerve Efferent nerve Receptor (from a joint, Effector muscle) (to a an organ) Department of Osteopathic Manipulative Medicine  Viscero-somatic Reflex arc Spine Afferent nerve Efferent nerve Receptor Effector (from an (to a joint or organ) muscle) Department of Osteopathic Manipulative Medicine  Reflex Changes (visceral) Cardiac Muscle Sympathetic dominant tone: rapid heart rate, palpitations Parasympathetic dominant tone: slow heart rate, dizziness, low energy Smooth Muscle E.g. Lungs (airway constriction), GI (altered intestinal motility/poor digestion), Blood vessels (decreased blood flow/poor visceral function) Glands E.g. Airway (mucous production), pancreatic (blood sugar regulation), adrenal (epinephrine/stress response) Department of Osteopathic Manipulative Medicine  Reflex Changes (somatic) Tissue texture changes Acute: Increased blood flow- red, warm, boggy, swollen Chronic: Decreased blood flow- pale or ashen, cool, doughy, ropy, fibrotic Asymmetry Swelling, muscle hypertonicity on side of reflex changes Range of motion Muscle stiffness, somatic dysfunction Tenderness Inflammation (acute)/decreased blood flow(chronic), muscle tension Department of Osteopathic Manipulative Medicine https://europepmc.org/article/med/17786266  Facilitation Reflex loops Normally reflexes act and terminate spontaneously Pathological conditions  feedback loops that perpetuate the reflex activity Intervening Normalizing the somatic part of a reflex arc helps break the feedback loop OMM can leverage this somatic to visceral relationship in removing barriers to innate homeostatic mechanisms Department of Osteopathic Manipulative Medicine  Somatovisceral reflex Trauma induced rib and vertebral somatic dysfunction at levels T5-8… Afferent signal: nociceptive and/or proprioceptive Efferent signal:  spasm of paraspinal muscles at levels T5-8 (Somatosomatic) Sympathetic activity in visceral structures of T5-T8 (somatovisceral) Somatovisceral effect: persistent indigestion, acid reflux, abdominal discomfort Treating the somatic dysfunctions relieves GI structures of sympathetic overstimulation Department of Osteopathic Manipulative Medicine  Viscerosomatic reflex ”Walking” pneumonia: lung parenchymal inflammation (T1-6)… Afferent signal: nociceptors, chemoreceptors Efferent signal:  parenchymal vasoconstriction and mucous thickening (viscerovisceral) muscle spasm somewhere In T1-T6 paraspinal region (viscerosomatic) Viscerosomatic effect: upper to mid back pain and stiffness; somatic dysfunctions T1-6 (clue to cough being more than upper respiratory infection, esp. T5 &T6) Not just diagnostic; treating the somatic dysfunction along with standard treatment (i.e. antibiotics) helps relieve rib splitting (to facilitate breathing) and pulmonary sympathetic feedback effects (which are a barrier to disease resolution) Department of Osteopathic Manipulative Medicine  Another Consideration Autonomic reflexes pass through a relay point on their way to organs Sympathetic chain Sympathetic chain is in close proximity to the ribs heads and costovertebral articulations Somatic dysfunctions here (i.e. rib somatic dysfunctions) can also influence these nerves and cause visceral disturbance Department of Osteopathic Manipulative Medicine https://aneskey.com/thoracic-t2-3-ganglion-block/ https://aneskey.com/thoracic-t2-3-ganglion-block/  References: Seffinger MA, ed. Foundations of osteopathic medicine, 4th ed. Philadelpha, PA: Lippincott Williams & Wilkins; 2018. Kuchera WA, Kuchera ML. Osteopathic principles in practice. 2nd ed. Columbus, OH: Grayden Press.; 1994. DiGiovanna E, Amen CJ, Burns, DK. An osteopathic approach to diagnosis and treatment. 4th ed. Philadelphia, PA: Wolters Kluwer Health; 2021 Department of Osteopathic Manipulative Medicine Lecture and Lab Feedback Form: https://comresearchdata.nyit.edu/redcap/surveys/?s=HRCY448FWYXREL4R