Newborn OMT Module

1
Newborn OMT Module

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

edited by Eric Hegybeli, DO, FACOP
2
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.
3
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.

4
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

5
Osteopathic Tenets (there are 4 main ones)

• The bodys inherent ability for self-repair
• The interrelatedness of body systems
• The body possesses self-regulatory healing
  mechanisms
• The interrelatedness of structure and function

6
Newborn OMT
7
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

8
Review Neuroembryology

• Neuroembryology
• Neural ridge
• Neural tube
• Dematomal development

9
Review Neuroanatomy
10
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)
Adult
Pediatric
11
Note differences of adult and infant skull
12
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

13
Blood-Brain Barrier
14
Review CSF circulation
15
Developmental Relationship Structure?Function

• Rams Horn Shape Embryologic CNS grows faster
  than cranium
• Foramina Cranial Bones are in multiple parts at
  birth (nerves dont poke through bones)
• Suture types for motion develop as plates meet
• Wolffs Law Cartilage is laid down along lines
  of stress

16
Osteopathy in the Cranial Field
ReminderS

• Cranial Bone Movement
• Midline Flexion/Extension
• Paired External/Internal Rotation

Common Patterns of Cranial Plagiocephaly
17
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

18
CN IX - Glossopharyngeal Nerve
Jugular Foramen
19
CN IX - Glossopharyngeal Nerve

• 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

• Function
• Structure
• Dysfunction
• History
• Physical examination

20
CN XI - Accessory Nerve
SCM
Foramen Magnum
21
CN XII - Hypoglossal Nerve
Hypoglossal canal
22
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

23
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

24
Prevalent Pediatric Problems

• Musculoskeletal System
• Torticollis
• Scoliosis

25
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

26
Torticollis SBS CN XI

• Parallelogram Pattern

• Lateral Strain Deformity

27
Gastrointestinal SystemPoor 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

28
Occipital Release Technique for Newborns and
Infants

• Support the patients 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.

29
Demonstrate the procedure on patient in front of
director
30
Innervation Table
31
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 Children
• Individual 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

32
Print out the answer sheet to use with the
following questions.
33
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.

34

• Which nerve if in dysfunction will cause
  difficulties in swallowing and excessive gag
  reflex
• A. CN VII
• B. CN XI
• C. CN XII
• D. CN IX
• E. CN VI

35

• 2. Which nerve when in dysfunction will cause
  dysphagia, poor tongue function (latch-suckle)
• A. CN XI
• B. CN XII
• C. CNV
• D. CN VI
• E. CN VII

36

• 3. Which pattern of Cranial Plagiocephaly will
  present with a flat head
• A. Flexon
• B. Extension
• C. SBS strain
• D. Torsion
• E. Rotation

37
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.)

38
Congratulations