OMM: Initial Patient Assessment

OMM: Initial Patient Assessment

Jessica Heintzelman, OMS VMSU PM&R presentation

9-17-12Partially adapted from Dr. Cain

OMM Fellowship Aug 2011- Aug 2012

What I like about Osteopathy

What I learned

• Anatomy , Anatomy, Anatomy– OMM and anatomy go hand in hand. The more

thoroughly we understand the parts and layers we are working with, the more you are able to appreciate somatic dysfunction, decide which technique will work best, and determine the degree of change you accomplished.

What I learned

• Anatomy , Anatomy, Anatomy• We have options– A lot to remember, BUT there is more than one

way to do most techniques. APPLY the principles– What have you tried? What has been effective? – One way to start thinking about OMM again:

complaint driven sequences.

What I learned

• Anatomy , Anatomy, Anatomy• We have options• Cranial is not as difficult as I thought– Intimidating, neglected– Develop this skill for a more complete structural

exam and a complete set of tools to treat with

What I learned

• Anatomy , Anatomy, Anatomy• We have options• Cranial is not as difficult as I thought• OMM is integral to osteopathic medicine, and

WE need to bring it back

Why should we care about OMM?

• Remember, IATP!• We have an opportunity to make a difference

for our patients. Every patient, every time because of what we do.

• Stay focused on things YOU can do to improve patient care, one of which is OMM.– If we are not using OMM to the degree we have

been trained, we are missing opportunities

Why should we care about OMM?

• WE are the future of this profession. • Its ok to do things differently than they have

been done in the past few decades with the goal of improving patient care.

• Essentially, we are agreeing that everyone of us has a responsibility to develop this profession and what it does.

• That is a professional duty when you accept that degree.

• Far and away, this work is not done.

These concepts are difficult to incorporate

Why is it so difficult to incorporate?

Why is it so difficult to incorporate?

• Criticism– I understand that there are some people who

have great criticism of this profession, but don’t forget that you have decided to accept this philosophy of practice by coming into this form of medicine. And now we have the chance to develop it, for the sake of the patient.

Why is it so difficult to incorporate?

• Criticism• Time– We enter this world in the hospital and clinics and

find that the driving force for everything we do is getting through the day and getting patients seen. And the first thing that starts to disappear is the use of our principles and practices.

• These are tough challenges!

• YOU have to find a way to incorporate this back into patient care.

• Doesn’t have to be an entire visit. • 3 regions, 3 treatments, 3 minutes!

Sympathetic Nervous System

• Fight or Flight signaling• Thoracic chain ganglia

– Composed of sympathetic nerve fibers, carrying info…

– …from the spinal column to thoracic viscera

– CAN become a highway for misinformation, if the symp/parasymp balance is disrupted.

Clinically Oriented Anatomy, 5th Ed., p.63

Parasympathetic Nervous System • Cranial Nerve X is a

primary source for thoracic and abdominal visceral innervation

• The sacral level is another important source.

Clinically Oriented Anatomy, 5th Ed., p.65

Fluid Considerations

• Lymphatics are the ‘Overflow system’ of the body.

• Local drainage or lack thereof is only one component in the equation of fluid build up.

• Key Principle: Any blockage along the pathway of excess fluid will inhibit its drainage.

• Common choke points: joints, diaphragms

Clinically Oriented Anatomy, 5th Ed., p.45

• Osteopathic medicine stands at a crossroads. A very important point in our history of what was, what is, and what will be.

• It is important that we go down the right path at this point and continue the work started by AT Still.

• Our profession has a great deal of power. • Only degree in the US that is trained to do all

aspects of patient care. – Allopathic medicine– Chiropractics– PT/OT– Psychology

• 2 groups that offer fully licensed, unrestricted practice rights in the US, we are the more flexible, adaptable degree.

• We can help drive where things go during this healthcare reform

• We do not have to continue doing what everyone else is doing in America.

• We spend all this time learning the exam, only to find out we are going out and Not doing the exam.

• It has to come from all of us

A Starting Point

• Introduce approaches to initially assessing a patient

• 3 options

Option 1

OU-HCOM – Johnston Functional Methods Screening

• 8 body regions: Head, Cervicals, Thoracics, Ribcage, UE, LE, SP, Lumbars

• 2 tissue texture• 2 motion

Functional Methods Screen

• Great palpatory exercise for beginners• Provides a reproducible sequence so that

important regions are not neglected or forgotten

• Gives specific criteria for when (and where)to proceed to the next step (scan)

OU-HCOM

• Is there a problem?

Screen

• Where is the problem?

Scan • What is the characteristics/ nature of that problem?

Segmental Definition

Functional Methods Screen

• However, this screening exam is not generally used in clinic, in its entirety, for several reasons (time, multiple patient positions)

Option 2

Landmarks

• A more clinically efficient alternative

• Check landmarks before and after treatment

• Standing• Seated • Treating any aspect of

the body can (and does!) change the positions of these landmarks

Occipital condyles

Spine of scapula

Inferior angle

Iliac crest

Knee creases

Foot arches

Option 3

General Listening

• 3 day visceral manipulation course• German osteopathic physicians– Dr. med. Johannes Mayer MD, DOM– Dr. med. Bernhard Ewen MD, DOM

General listening – standing

• Sense the myofascial pulls from the center of the head

• Pulls in certain directions indicate dysfunction in certain body regions/areas

General listening – seated

• Standing vs. seated helps to determine how much of an influence the LE has on the dysfunctional pull

References

• Dr. Cain OU-HCOM OMM presentation 06/2012• Clinically Oriented Anatomy, 5th Edition• http://www.jaoa.org/content/

104/4/149.full.pdf• http://www.jaoa.org/content/

103/7/313.full.pdf• Dr. Mayer and Dr. Ewen visceral manipulation

course manual