Pediatric OMT Chest Module

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Pediatric OMT Chest Module

• American College of Osteopathic Pediatricians
• Robert Hostoffer, DO,FACOP, FAAP

edited by Eric Hegybeli, DO, FACOP
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Background Influenza

• A world wide influenza epidemic occurred during
  the years of 1918-1919. The estimated death toll
  for the world was anywhere from 21-30 million
  people.

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Background

• Over 28 of the population in the US died during
  the epidemic. The mortality rate in US military
  hospitals was 36 as opposed to the rate in
  civilian hospital, 30-40. In New York the rate
  of death was 68.

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Background

• An accumulated effort of 2,445 DO physicians
  treating 110,112 patients with influenza reduced
  the mortality rate to 0.25. A 400 bed
  Massachusetts Osteopathic hospital in Boston also
  reduced the mortality to 0.25.

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Background Asthma

• Amusement often accompanies annoyances.  An Irish
  lady came to me with great pain under her
  shoulder-blade, and asked me if I could make her
  shoulder easy.  She had asthma in a bad form,
  though she had only come to be treated for the
  pain in her shoulder.  I found she had a section
  of the upper vertebrae out of line, and stopping
  the pain I set the spine and a few ribs.  In
  about a mouth she came back to see me without any
  pain or trace of asthma.  Her superstitious
  nature was aroused, and she asked if I had
  "hoodledooed her.
•     "Me pain is all gone from around me shoulder
  and divil the bit of asthma have I felt since you
  trated me first."
•     This was my first case of asthma treated in
  the new way, and it started me into a new train
  of thought.  Since I have made a careful study of
  the disease, and do not hesitate to repeat that
  Osteopathy is king of asthma.
• Andrew Taylor Still, D.O. 1897 CHAPTER VIII

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Review Anatomy
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Review Function
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Review Flow Loops
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Respiratory SystemAsthma/RAD/Bronchiolitis

• Goals Considerations
• Balance autonomic tone
• Maximize airflow (sympathetics)
• Maintaining thin, watery secretions
  (parasympathetics)
• Increase lymphatic flow to decrease tissue
  congestion
• Free fascial intersegmental restrictions
• Maximize thoracic respiratory excursion
• Restore respiratory diaphragm integrity
• Promote appropriate depth of inhalation and
  exhalation
• Release tense accessory muscles of breathing

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Hands-On Approach TreatingAsthma/RAD/Bronchioliti
s

• Treatment Options
• Cervical and Thoracic Muscular Assessment and
  Treatment
• Sternal Release
• Respiratory Diaphragm Release
• Doming of the Diaphragm
• Thoracic Inlet/Outlet Release
• Rib Raising (T2-7)
• Occipitoatlantal (OA) Release
• Cervical (C3-5 Phrenic Nerve)
• Chapmans Reflexes

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Rib-raising

• Patient is supine
• The physician is at the side
• Physicians hands are under the near side-palms
  up
• Fingers are close to the spinous processes
• The pads of the fingers elevate as the forearms
  are used as the fulcrum

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Rib-Raising
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Demonstrate the procedure on patient in front of
director
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Thumb Pressure

• Patient is prone
• Physician is at head of table
• Thumbs close to spinous process
• Fingers splayed
• Pressure and kneading with thumbs
• Progress down spine

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Thumb Pressure
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Demonstrate the procedure on patient in front of
director
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Lymphatic Drainage

• The patient is supine with knees flexed
• The physician is had the head
• The physician hands are spread over the chest
  wall
• The pressure is equally distributed over the
  entire surface with both hands
• Apply in a downward and caudad rhythmic manner

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Lymphatic Drainage
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Demonstrate the procedure on patient in front of
director
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Thoracic Myofacial
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Thoracic myofacial
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Demonstrate the procedure on patient in front of
director
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Mid and Lower Thoracic Technique
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Demonstrate the procedure on patient in front of
director
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Mid and Lower Thoracic Technique
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(No Transcript)
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Demonstrate the procedure on patient in front of
director
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Lateral Recumbent under the shoulder
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Demonstrate the procedure on patient in front of
director
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Innervation Table
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Print out the answer sheet to use with the
following questions.
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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.

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• A 10 year old male presents with mild chest
  tightness and cough. The patient has asthma and
  is on the appropriate medicines. You plan to
  increase his maintenance medicines. What OMT
  procedure would be helpful
• A. Drainage of Galbreath
• B. Auricular pull
• C. Lymphatic drainage
• D. Pedal pump
• E. Cranial occipital release

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• 2. A 7 year old female presents with fever and
  cough. A CXR shows a left lower lobe pneumonia.
  Which OMT procedure would be of benefit.
• A. Mandibular thrust
• B. Sacral release
• C. HVLA cervical manipulation
• D. Thoracic lymphatic pump
• E. Myofacial release

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• An 18 year old male present to your office with
  cough and resolving bronchitis. All of the
  procedures would be appropriate except
• Thoracic myofacial
• Lateral Recumbent under the shoulder
• Mid and Lower Thoracic Technique
• Lymphatic Drainage
• E. Solar plexis release

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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.)

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Congratulations