OMM: Initial Patient Assessment
-
Upload
cameran-barrett -
Category
Documents
-
view
58 -
download
4
description
Transcript of OMM: Initial Patient Assessment
![Page 1: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/1.jpg)
OMM: Initial Patient Assessment
Jessica Heintzelman, OMS VMSU PM&R presentation
9-17-12Partially adapted from Dr. Cain
![Page 2: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/2.jpg)
OMM Fellowship Aug 2011- Aug 2012
![Page 3: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/3.jpg)
What I like about Osteopathy
![Page 4: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/4.jpg)
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.
![Page 5: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/5.jpg)
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.
![Page 6: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/6.jpg)
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
![Page 7: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/7.jpg)
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
![Page 8: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/8.jpg)
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
![Page 9: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/9.jpg)
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.
![Page 10: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/10.jpg)
![Page 11: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/11.jpg)
• 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.
![Page 12: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/12.jpg)
These concepts are difficult to incorporate
![Page 13: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/13.jpg)
Why is it so difficult to incorporate?
![Page 14: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/14.jpg)
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.
![Page 15: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/15.jpg)
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.
![Page 16: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/16.jpg)
• These are tough challenges!
![Page 17: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/17.jpg)
• 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!
![Page 18: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/18.jpg)
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
![Page 19: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/19.jpg)
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
![Page 20: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/20.jpg)
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
![Page 21: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/21.jpg)
• Osteopathic medicine stands at a crossroads. A very important point in our history of what was, what is, and what will be.
![Page 22: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/22.jpg)
• It is important that we go down the right path at this point and continue the work started by AT Still.
![Page 23: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/23.jpg)
• 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
![Page 24: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/24.jpg)
![Page 25: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/25.jpg)
![Page 26: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/26.jpg)
![Page 27: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/27.jpg)
![Page 28: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/28.jpg)
![Page 29: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/29.jpg)
![Page 30: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/30.jpg)
• 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
![Page 31: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/31.jpg)
• 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
![Page 32: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/32.jpg)
A Starting Point
• Introduce approaches to initially assessing a patient
• 3 options
![Page 33: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/33.jpg)
Option 1
![Page 34: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/34.jpg)
OU-HCOM – Johnston Functional Methods Screening
• 8 body regions: Head, Cervicals, Thoracics, Ribcage, UE, LE, SP, Lumbars
• 2 tissue texture• 2 motion
![Page 35: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/35.jpg)
![Page 36: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/36.jpg)
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)
![Page 37: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/37.jpg)
OU-HCOM
• Is there a problem?
Screen
• Where is the problem?
Scan • What is the characteristics/ nature of that problem?
Segmental Definition
![Page 38: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/38.jpg)
Functional Methods Screen
• However, this screening exam is not generally used in clinic, in its entirety, for several reasons (time, multiple patient positions)
![Page 39: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/39.jpg)
Option 2
![Page 40: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/40.jpg)
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
![Page 41: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/41.jpg)
Option 3
![Page 42: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/42.jpg)
General Listening
• 3 day visceral manipulation course• German osteopathic physicians– Dr. med. Johannes Mayer MD, DOM– Dr. med. Bernhard Ewen MD, DOM
![Page 43: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/43.jpg)
![Page 44: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/44.jpg)
General listening – standing
• Sense the myofascial pulls from the center of the head
• Pulls in certain directions indicate dysfunction in certain body regions/areas
![Page 45: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/45.jpg)
General listening – seated
• Standing vs. seated helps to determine how much of an influence the LE has on the dysfunctional pull
![Page 46: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/46.jpg)
![Page 47: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/47.jpg)
![Page 48: OMM: Initial Patient Assessment](https://reader035.fdocuments.us/reader035/viewer/2022062407/56812cab550346895d915897/html5/thumbnails/48.jpg)
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