PPC/OMM Exam 1

HVLA (High Velocity Low Amplitude)

direct and passive; "thrust treatment method"; restrictive barrier is directly engaged in one or more planes of motion; fast a short force is applied; patient often says "it feels like it needs to pop"

exaggeration technique

indirect procedure that involves carrying the dysfunctional part away from the restrictive barrier, then applying a high velocity low amplitude force into ease

CS (counterstrain)

indirect and passive

1) identify the tender point which is a reflection of SD (locally or elsewhere)

2) establish a relative pain scale with the patient and aim to reduce it by 70%, while aiming for 100%

3) place patient passively in a position resulting in the greatest reduction of tenderness and tissue texture changes

4) maintain the position for 90 seconds

6) slowly and passively return to pretreatment position

still technique

passive and combined; manipulative method utilizing both indirect and direct components; SD is placed in an indirect position of ease and an activating force is added and directed at the dysfunctional area; SD is carried past neutral, toward and through the restrictive barrier

lymphatic technique

can be either Passive or Active and either Direct or Indirect, depending on the approach used

1) consider the thoracic inlet (terminal drainage site for entire body) as a starting point

2) remove impediments to lymphatic flow

3) enhance mechanisms involved in respiratory-circulatory homeostasis

4) extrinsically augment the flow of lymph and immune system

5) further mobilize lymphatic fluids from local or regional tissues that would benefit from decongestion

ST (soft tissue)

passive and direct; perpendicular traction-kneading, parallel traction, or direct inhibition (direct sustained pressure at a musculotendinous junction until a release is appreciated - softening-warming pulsation)

OCMM (Osteopathic Cranial Manipulative Medicine)

direct or indirect and passive; uses the primary respiratory mechanism and balanced membranous tension of the cranium

SOAP note

organized by subjective and objective evaluation, assessment of the patient's problem, and development of a plan for treatment

interviewing and collecting information

category in standardized patient testing:

-flow and pace of interview

-question style (open ended!! avoid leading or biased questions)

-clarity of questions

-listening skills

4 tenets of osteopathic medicine

1) the human being is an integrated, dynamic unit of function

2) the body posses self-regulatory mechanisms that are self-healing in nature

3) structure and function are interrelated at all levels

4) rational treatment is based on the application of these principles

physiologic motion

normal motion; changes in position of body structures within the normal range

physiologic barrier

the limit of active motion

merkel disc

neurological mechanoreceptor; degree of pressure

meisner corpuscle

neurological mechanoreceptor; detects light touch (not pressure/vibration)

pacinian corpuscle

neurological mechanoreceptor; detects pressure and vibrations; felt up to 200 micrometers

layer palpation

important technique in determining which layer has dysfunction so you can diagnose SD; you must be able to engage the dysfunctional layer when treating with OMT

MET (muscle energy technique)

direct and active; the key is localization, correct muscle activation, and picking up the edge of the restrictive barrier slowly to stretch the hypertonic muscle

5 styles: post-isometric relaxation, reciprocal inhibition, joint mobilization using muscle force, respiratory assistance, oculocephalogyric

joint mobilization

MET using knowledge of anatomy and biomechanics to push or pull a structure into a more normal pattern

respiratory assistance

MET where you have the patient breathe

ART-LVHA (articulatory technique - low velocity high amplitude)

passive and direct; applies low velocity high amplitude force to a dysfunctional joint; rhythmic oscillating/pulsing, warms joint up

BLT-LAS (balanced ligament tension - ligamentous articular strain)

indirect and passive; minimization of peri-articular tissue load and the placement of the affected ligaments in a position of equal tension in all appropriate planes so that the body’s inherent forces can resolve the somatic dysfunction; disengagement, exaggeration and taking the dysfunctional opposing ligaments to a point of balance

FPR (facilitated positional release)

indirect and passive; after holding the patient in the position of maximum ease for 3-5 seconds, immediately introduce several, alternating direct and indirect low-amplitude pulses; mixed method

MFR (myofascial release)

direct or indirect, active or passive; emphasizes biomechanics, anatomic relationships, and ease and bind relationships; indicated by the presence of myofascial/connective tissue SD with no other SD

FDM (fascial distortion model)

combined; the patient is the expert of their own body and can tell you the answer with gestures

6 distortions: Herniated trigger point (HTP), Trigger band (TB), Continuum distortion (CD), Folding distortion (FD), Cylinder distortion, Tectonic fixation

comprehensive, focused

while a ______ patient assessment is used for new patients, a ______ patient assessment is appropriate for established patients, especially during routine or urgent visits

CH PMA HSFSR

(-chief complaint (CC)

-history of present illness (HPI)

-past medical history

-medications

-allergies

-hospitalizations

-surgeries

-family history

-social history

-review of systems (ROS))

patient history components (mnemonic)

CC (chief complaint)

primary reason why a patient is being seen

HPI (history of present illness)

history of the patient's problem; location, quality, quantity/severity, onset, duration, frequency, modifying factors, associated manifestations

FED TTTACOS

(food, exercise, drugs (used incorrectly), tobacco, travel (at risk areas), treatment (home environment), alcohol, caffeine, occupation, sexual activity)

social history (mnemonic), part of patient history

ROS (review of systems)

documentation of patient's response to questions organized by a head-to-toe review of the function of all body systems (may encourage patient to recall and report symptoms not previously mentioned); any "yes" responses should be followed up

heart disease, cancer

two leading causes of death

opening encounter

category in standardized patient testing:

-eye contact with patient

-confirm patient's name > how would they like to be addressed?

-introduce self with last name and title

-sanitize hands before touching patient

personal manners/clinical courtesy

category in standardized patient testing:

-beginning of physical exam

-clarity of communication

-assisting patient and sensitivity to discomfort (get consent!!)

-exposure (expose only what is necessary for exam)

-personal space

rapport

category in standardized patient testing:

-eye contact attentiveness

-professional behavior

-confidence

-addressing patient concerns (validate, realistic reasoning)

-nonjudgemental (mind facial expressions)

-praising patient (substance use, diet, exercise)

information delivery and counseling

category in standardized patient testing:

-assessment and treatment plan (make sure patient understands)

-clarity of information (avoid medical jargon)

-understanding and agreement (make sure patient understands and will adhere to the plan)

-pace and tact

-patient's support system

motivational interviewing

collaborative, evidence-based technique to help motivate the patient to change their behavior, and ultimately commit to change; evoke change rather than education

1. Roll with resistance: can be particularly useful with clients who present in a highly oppositional manner and who seem to reject every idea or suggestion

2. Express empathy through reflective listening

3. Avoid argument and direct confrontation

4. Develop discrepancy between goals and current behavior

5. Support self-efficacy and optimism.

pre-contemplation

readiness for change; not considering change, in denial, given up; educate patient on risks

contemplation

readiness for change; uncertain about change; help the patient by identifying barriers/misconceptions, addressing concers, and identifying support systems

preparation

readiness for change; prepared to experiment with small changes; develop realistic goals with the patient

action

readiness for change; patient takes definitive action to change behavior; provide positive reinforcement to encourage them

maintenance and relapse prevention

readiness for change; strives to maintain change longterm; help patient by providing encouragement and support

resistance to change

arguing, interrupting, ignoring, and denying are all signs of ________

1892, missouri

when and where was the first osteopathic college founded?

biomechanical, respiratory-circulatory, metabolic, neurologic, psychosocial-behavioral

5 models of osteopathic care

biotensegrity

the balance between tension and compression elements in the body, resulting in a mechanically stable system that balances mechanical stress; each member operates with the maximum efficiency and economy; equal distribution of energy

tension, compression

in the concept of biotensegrity, the muscles, fascia, tendons, and ligaments provide continuous ________ and the bones represent the discontinuous ________; balance between the two is incredibly important

SD (somatic dysfunction)

impaired or altered function of related components of the somatic system; medical diagnosis in the ICD 10 and one of the primary factors influencing body energy economy and a cohort in disease states

acute, chronic

classification of SD by duration

______ short term, immediate

______ prolonged, generally greater than 3 months

primary, secondary

classification of SD by etiology (cause)

______ often traumatic, sudden trauma, postural imbalances, microtrauma, repetitive trauma; cause

______ compensation for primary or MSK problem, reflex response to visceral/emotional; not the cause

TART (tissue texture changes, asymmetry, restricted range of motion, tenderness)

4 physical exam criteria for SD

acute

(SD) increased temperature, boggy/rough texture, increased moisture and tension, high tenderness, edema, lasting redness

chronic

(SD) cold temperature, thin/ropey/stringy texture, dry, lower tenderness, possible edema, little to no redness

inherent motion

spontaneous motion of every cell, organ system, and their component units within the body

respiratory motion

motion of breathing

active motion

movement produced voluntarily by the patient

passive motion

motion induced by the physician while the patient remains passive or relaxed; involuntary

allostasis

the physiological cost of chronic exposure to fluctuating or heightened neural or neuroendocrine response that results from repeated or chronic stress; opposite of homeostasis; results in SD

restrictive barrier

a functional limit that abnormally diminishes the normal physiologic range; caused by SD and resolved by OMT

anatomic barrier

the limit of motion imposed by anatomic structure; the limit of passive motion beyond which serious injury occurs

elastic barrier

the range between the physiologic and anatomic barrier of motion; can be assessed with passive motion only

pathologic barrier

a restriction of joint motion associated with pathologic change of tissues; caused by pathologies/diseases and cannot be resolved with OMT

free nerve endings

neurological mechanoreceptor; pain and temperature

ruffini corpuscle

neurological mechanoreceptor; detects stretch

direct

going into the restrictive barrier

indirect

going away from the restrictive barrier

combined

mix of indirect and direct and/or passive and/or active

post-isometric relaxation

MET where you have the patient recreate the SD

reciprocal inhibition

MET based on the agonist-antagonist theory

oculocephalogyric reflex

MET as the eyes go, so goes the body

closure

category in standardized patient testing:

-follow-up (include time frame of next communication)

-questions (be sure to leave time for questions and discussion)