newborn omt module american college of osteopathic pediatricians robert hostoffer, do,facop, faap...
TRANSCRIPT
Newborn OMT Module
American College of Osteopathic Pediatricians
Robert Hostoffer, DO,FACOP, FAAP
edited by Eric Hegybeli, DO, FACOP
Background:
Andrew Taylor Still, was born in Virginia in 1828, the son of a Methodist minister and physician. At an early age, Still decided to follow in his father's footsteps as a physician. After studying medicine and serving an apprenticeship under his father, Still became a licensed M.D. in the state of Missouri. Later, in the early 1860's, he completed additional coursework at the College of Physicians and Surgeons in Kansas City, Missouri. He went on to serve as a surgeon in the Union Army during the Civil War.
Background:
After the Civil War and following the death of three of his children from spinal meningitis in 1864, Still concluded that the orthodox medical practices of his day were frequently ineffective, and sometimes harmful. He devoted the next ten years of his life to studying the human body and finding better ways to treat disease.
Background:
His research and clinical observations led him to believe that the musculoskeletal system played a vital role in health and disease and that the body contained all of the elements needed to maintain health, if properly stimulated. Still believed that by correcting problems in the body's structure, through the use of manual techniques now known as osteopathic manipulative treatment, the body's ability to function and to heal itself could be greatly improved. He also promoted the idea of preventive medicine and endorsed the philosophy that physicians should focus on treating the whole patient, rather than just the disease.
http://www.aacom.org/OM/history.html
Osteopathic Tenets (there are 4 main ones)
The body’s inherent ability for self-repair The interrelatedness of body systems The body possesses self-regulatory healing
mechanisms The interrelatedness of structure and
function
Review of Structural Basis
Neuroembryology– Neural ridge– Neural tube
Neuroanatomy – Ventricles– Central spinal canal– Choroid plexus– CSF– Cauda equina– Dura mater– Arachnoid villi– Individual cranial bones– Skull
Review Bones and sutures of the Skull(make note of the difference in angle from horizontal of the cranial base (a line from the eye socket to base of occiput) – it is about 30 degrees in child (more horizontal) and 50 degrees in the adult)
Pediatric Adult
Physiological Basis
Blood-brain barrier Primary respiratory mechanism Craniorhythmic impulse Circulation of the CSF Axes of motion in the cranium Axonal transport “The rule of the artery is supreme.” Active labor, transition and delivery
Developmental Relationship Structure↔Function
““Ram’s Horn” ShapeRam’s Horn” Shape Embryologic: CNS grows faster than cranium
Foramina:Foramina: Cranial Bones are in multiple parts at birth (nerves don’t poke through bones)
Suture typesSuture types for motion develop as plates meet
Wolff’s Law:Wolff’s Law: Cartilage is laid down along lines of stress
Osteopathy in the Cranial Field
Cranial Bone Movement Midline: Flexion/Extension
Paired: External/Internal Rotation
ReminderSReminderS
Flexion (Fat Head) Extension (Cone Head)LATERAL SBS Strain (Parallelogram Head)
Common Patterns of Cranial Plagiocephaly
Cranial Somatic DysfunctionAffects Function
Ophthalmologic– CN II, III, IV, VI
Gastrointestinal– CN IX, X, XII
Respiratory– CN X
Musculoskeletal– XI
Parasympathetics with III, VII, IX, X
CN IX - Glossopharyngeal Nerve
Function
Structure Dysfunction
History
Physical examination
Motor to muscle; Parasympathetic to glands; Sensory to palate
Jugular foramen
Difficulties swallowing, excessive gag reflex
Trauma to occiput &/or temporals
Test gag reflex Evaluation of temporals, occiput,
occipitomastoid suture
CN XII - Hypoglossal Nerve
Function Structure Dysfunction
History
Physical examination
Motor to Tongue
Hypoglossal canal Dysphagia, tongue function
(latch-suckle) Occipital condyle trauma;
intraosseous strain
Test tongue motions Test neonatal suck Evaluate occiput (condyles),
top cervicals
Prevalent Pediatric Problems
Musculoskeletal System– Scoliosis– Torticollis
Respiratory System– Otitis Media (Acute vs.
Serous)– Pharyngitis– Bronchiolitis– Asthma & Reactive
Airway Disease (RAD)
Gastrointestinal System– Constipation– Poor Feeding/Sucking– GER & GERD
Neuro-Psycho-Social – Learning Disorders
(ADD/ADHD)– Strabismus
Torticollis = Twisted Neck
Common positioning in utero Prolonged or difficult labor
exacerbates dysfunction Risks
– Primiparous mother – LGA – Male – Breech – Multiples – Maternal uterine
abnormalities “Back to Sleep” effect
Gastrointestinal System:Poor Feeding/Sucking
Goals & Considerations– Patients present with poor growth or irritability– Prolonged or difficult labor; eventual c-section
preventing initial gasp– Improve restrictions impinging on responsible
cranial nerves by decompressing surrounding sutures
Occipital Release Technique for Newborns and Infants
Support the patient’s body by cradling it with your forearm Support the head and palpate for motion with the ipsilateral
hand Support the sacrum and palpate for motion with 2 or 3 fingers
of the contralateral hand Grasp the cranium with fingers evenly splayed “as firmly as you
would a ripe tomato so as not to leave impressions” Feel subtle release of muscles and watch newborns face
content. Give newborn back to parent and observe improvement with
feeding.
Innervation TableInnervation TableOrgan/System Parasympathetic Sympathetic Ant.
Chapman'sPost.
Chapman's
EENT Cr Nerves (III, VII, IX, X)
T1-T4 T1-4, 2nd ICS
Suboccipital
Heart Vagus (CN X) T1-T4 T1-4 on L, T2-3
T3 sp process
Respiratory Vagus (CN X) T2-T7 3rd & 4th ICS T3-5 sp process
Esophagus Vagus (CN X) T2-T8 --- ---
Foregut Vagus (CN X) T5-T9 (Greater Splanchnic) --- ---
Stomach Vagus (CN X) T5-T9 (Greater Splanchnic) 5th-6th ICS on L
T6-7 on L
Liver Vagus (CN X) T5-T9 (Greater Splanchnic) Rib 5 on R T5-6
Gallbladder Vagus (CN X) T5-T9 (Greater Splanchnic) Rib 6 on R T6
Spleen Vagus (CN X) T5-T9 (Greater Splanchnic) Rib 7 on L T7
Pancreas Vagus (CN X) T5-T9 (Greater Splanchnic), T9-T12 (Lesser Splanchnic)
Rib 7 on R T7
Midgut Vagus (CN X) Thoracic Splanchnics (Lesser)
--- ---
Small Intestine Vagus (CN X) T9-T11 (Lesser Splanchnic) Ribs 9-11 T8-10
Appendix T12 Tip of 12th Rib
T11-12 on R
Hindgut Pelvic Splanchnics (S2-4)
Lumbar (Least) Splanchnics --- ---
Ascending Colon Vagus (CN X) T9-T11 (Lesser Splanchnic) R Femur @ hip
T10-11
Transverse Colon Vagus (CN X) T9-T11 (Lesser Splanchnic) Near Knees ---
Descending Colon Pelvic Splanchnic (S2-4)
Least Splanchnic L Femur @ hip
T12-L2
Colon & Rectum Pelvic Splanchnics (S2-4)
T8-L2 --- ---
References:
Is their room for OMT therapy in your practice during the era of evidence-based medicine?– The Collected Papers of Viola M. Frymann, D.O.:
Legacy of Osteopathy to ChildrenIndividual copies are priced at $75 for the hardbound edition and $65 for the softbound edition. The
shipping and handling for mail orders is $7. Orders should be sent to: AAO, 3500 DePauw Boulevard, Suite 1080, Indianapolis, IN 46268-1136. Proceeds benefit the AAO and its programs.
– The Viscoplastic and Viscoelastic Axes of Motionin the Cranium/Documenting Cranial Dysfunction in Children
Circle the correct answer and review with director:
Question1: A, B, C, D, E. Question2: A, B, C, D, E. Question3: A, B, C, D, E.
1. Which nerve if in dysfunction will cause difficulties in swallowing and excessive gag reflex:A. CN VIIB. CN XI
C. CN XII D. CN IX
E. CN VI
2. Which nerve when in dysfunction will cause dysphagia, poor tongue function (latch-suckle):A. CN XIB. CN XIIC. CNV
D. CN VI E. CN VII
3. Which pattern of Cranial Plagiocephaly will present with a “flat head”:
A. Flexon
B. Extension
C. SBS strain
D. Torsion
E. Rotation
Certificate of Completion
I, _________________________, successfully completed the Pediatric OMT Module on __ __ 20__
Signatures: Pediatric Resident ____________________ Pediatric Residency Director____________
( Please print and give to program director.)