OMM: Neurologic Considerations

by Sheldon C. Yao, DO

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    00:00 Although Parkinson’s disease is usually considered a motor problem, there is also neurologic considerations to take into account. So, because of the dysautonomia in Parkinson’s disease, patients may suffer with issues with their gastrointestinal system, their urinary system, their ability to thermoregulate, they may suffer from sexual dysfunction, have cardiovascular problems and also problems with sensitivity to bright light. So in order to address neurologic issues with OMT, we could try to optimize neural function, try to improve autonomic balance and restore regulatory function. So, we could utilize OMM following the neurologic model to address dysautonomia. So to try to balance parasympathetics, what we want to try to do is to look for possible somatic dysfunctions that might be compressing on the vagus nerve or on the pelvic splanchnics. So, we want to look at the cranium, treat any somatic dysfunctions that you might find in the OM suture or the upper cervical and the suboccipital region to try to normalize vagal tone and you also want to look at the sacrum and the SI joints and the innominates to see if you could normalize parasympathetics. For sympathetics, you want to look for any restrictions that might be impinging on the sympathetic chain ganglion so anywhere from T1 down to L2. You could treat the structures in the area, you could utilize rib raising after you check for any restrictions or any viscerosomatic reflexes. We could also perform inhibition of the abdominal ganglia to help treat any sort of GI symptoms by inhibiting those ganglia and you could try to normalize sympathetics to the abdominal and pelvic organs.

    01:46 There are respiratory and circulatory considerations for Parkinson’s disease. Because of the muscle rigidity, Parkinson’s disease is associated with decreased rib cage excursion, patients may have increased morbidity and mortality because there is decreased ability for the rib cage to expand and move and there also may be an effect on the cardiovascular system. Patients may have a condition called camptocormia. Camptocormia is a condition where you have increased flexion of the spine, patients have difficulty straightening their spine and what that does is it causes a decrease in rib cage excursion. Patients may also have rigidity of the diaphragm which could lead to stasis of the lymphatic system. So our treatment goals with OMT is to try to improve that thoracic cage compliance, try to decrease the spasms that the patients may have around the rib cage and the spine, try to improve their posture and try to overall improve the movement of lymphatics by treating the different diaphragms, helping with different pumps and try to optimize their cardiovascular circulation. We could utilize OMT following the respiratory circulatory model to help decrease restrictions that may be impeding proper respiratory excursion or venous and lymphatic circulation.

    03:05 So some of the techniques that we could utilize include myofascial release. Treating the different muscles that might be restricting the thoracic cage could help with its excursion. We could look at the thoracic inlet and make sure we treat any sort of dysfunction surrounding the thoracic inlet.

    03:20 We could perform a pectoralis traction. This technique is really important because with Parkinson’s patients a lot of times they will have a really really tight pectoralis muscle spasm and what happens is that pulls the shoulders anterior, pulls the posture more forward and it also decreases terminal lymph drainage and so performing a pectoralis traction to try to decrease the spasms of the pectoralis muscles will help them with their posture and does also help them with respiration and lymph flow. We want to take a look at the diaphragm, we want to make sure that we address any sort of restrictions of the diaphragm to allow for proper excursion. We could perform rib raising to try to help loosen the restrictions surrounding the rib and the thoracic spine. We could also treat the pelvic diaphragm. The pelvic diaphragm is an important structure to look at because if the pelvic diaphragm is restricted this can prevent everything else above it from moving well including the abdominal diaphragm. So performing the pelvic diaphragm release will help with the entire container of the abdomen and pelvis to move more freely and does help with circulation and lymphatic return. So overall, these techniques can be utilized to augment lymph return, make make sure again that we cleared everything before performing any pumps and that there are no contraindications to pumps. So we could perform thoracic and pedal pumps, one of the pumps that really works well for, especially, Parkinson’s, is the side approach thoracic pump because you are mobilizing the shoulder and arm and the muscles around the shoulder also and also really getting the rib cage to move. You could also use the lymphatic duct siphoning technique. This technique will help try to promote lymph drainage back to the central venous system and also you could use the wobble technique for the extremities. So a very gentle wobble motion and movement of the extremities. If they have swelling, there it could help with returning lymph back to the venous circulation. So, here is a closer look at the circulatory lymphatic system and how the thoracic cage expansion and the descent of the diaphragm will help to draw air into the thoracic cage and so if you have restrictions of the thoracic cage and the diaphragm, it's going to prevent proper respiration and does also prevent proper circulation and lymph flow. So we definitely want to take a look at the diaphragm and help treat any restrictions in the diaphragm, the lower costal margin and the ribs and again make sure you treat the inlet, the pectoralis muscles to try to improve any sort of restrictions that may be in the upper region of the thoracic cage and the rib cage because those restrictions will decrease the ability for the patient to take a full deep breath in. Overall, we need to take a look at possible physical and psychosocial treatments also. We want to be able to counsel our patients especially about falls, care, and help them with activities of daily living and recommend that they try to stay active and move. One of the things with Parkinson’s is that they get very stiff and they don't want to participate and they become a little bit more fearful of being social and so as physicians we need to help counsel them and get them to be more interactive. We want to utilize OMT to articulate the thoracic spine and help decrease the work of breathing. We could utilize cranial techniques to help with rib raising and improve sleep and also perform pumps to help improve homeostasis and immune function. So there is bioenergetic and psychobehavioral considerations with Parkinson’s. So, bioenergetic, remember, is looking at the overall amount of metabolic energy that the patient has to utilize, their overall allostatic load and so Parkinson’s patients frequently have a complaint of fatigue. Goal is to try to restore balance between energy production and expenditure. So if you could utilize OMT to try to decrease some of the muscle spasms so they have to use less energy to ambulate and move and perform their activities of daily living, that could help them with improving their fatigue. So, psychosocial behavioral considerations with Parkinson’s, Parkinson’s is associated with high rates of disability and depression. So, we want to be able to counsel, help patients with coping with their pain, help them with developing more social environment, attending groups, interacting with others, participating in outside activities and then try to decrease their disability and have them be able to be more active.

    About the Lecture

    The lecture OMM: Neurologic Considerations by Sheldon C. Yao, DO is from the course Osteopathic Treatment and Clinical Application by System.

    Author of lecture OMM: Neurologic Considerations

     Sheldon C. Yao, DO

    Sheldon C. Yao, DO

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