neuroanatomy: an osteopathic...
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Neuroanatomy:
An Osteopathic Approach
Andrew Vosko, PhD
Associate Provost of Transdisciplinary StudiesClinical Assistant Professor
AAO Convocation
March 23rd, 2018
Tenets of Osteopathic Medicine
1. The body is a unit; the person is a unit of
body, mind, and spirit.
2. The body is capable of self-regulation,
self-healing, and health maintenance.
3. Structure and function are reciprocally
interrelated.
4. Rational treatment is based upon an
understanding of the basic principles of
body unity, self-regulation, and the
interrelationship of structure and
function.
Taking a transdisciplinary approach to
neuroanatomy: Osteopathy
http://w ww.osteopathic.org/inside-
aoa/about/leadership/Pages/tenets-of-osteopathic-
medicine.aspx
A.T. Still 1828-1917
Taking a transdisciplinary approach to
neuroanatomy:
Tenets of Osteopathic Medicine
1. The body is a unit; the person is a unit of
body, mind, and spirit.
2. The body is capable of self-regulation,
self-healing, and health maintenance.
3. Structure and function are reciprocally
interrelated.
4. Rational treatment is based upon an
understanding of the basic principles of
body unity, self-regulation, and the
interrelationship of structure and
function.
Claude Bernard Louis Sullivan Rene Descartes
Intersection of Sciences and Humanities
Modernism
Santiago
Ramon y Cajal A.T. Still
Descartes' Influence on
Neuroanatomy Education
Descartes' theories paved the way to explore our minds
as if they were part of a larger machine:
The mind was no longer a part of a
'black box' but instead was
synonymous with the brain
...assuming all visible light
is image forming
...assuming all reflexes
are acute and somato-
somatic
...assuming the brain is
comprised of discrete
functional units
Minding Reductionism
1. The body is a unit; the person is a unit of
body, mind, and spirit. Systems within
systems. These systems interact and are
dynamic.
2. The body is capable of self-regulation, self-
healing, and health
maintenance. Homeostasis and (Allostasis)
3. Structure and function are reciprocally
interrelated. Form follows function follows
form
4. Rational treatment is based upon an
understanding of the basic principles of body
unity, self-regulation, and the interrelationship
of structure and function. Osteopathic
manipulative treatments work through
multiple mechanisms
Applying osteopathic tenets &
Appreciating complexity
A.T. Still 1828-1917
1. The body is a unit; the person is a unit
of body, mind, and spirit. Systems
within systems. These systems interact
and are dynamic.
2. The body is capable of self-regulation,
self-healing, and health
maintenance. Homeostasis (and
Allostasis)
3. Structure and function are reciprocally
interrelated. Form follows function
follows form
The "anatomy" of neuroanatomy is not
confined to gross structures.
Neuroanatomy includes molecular
anatomy, cellular anatomy, circuit-level and
network-level anatomy.
Applying osteopathic tenets &
Appreciating complexity
http://www.fractal-recursions.com/fractals/fractal-
12951.jpg
Neurons are constantly deforming
because we are constantly in motion
1.Mazzuoli-Weber G, Schemann M
(2015) Mechanosensitivity in the enteric nervous system.Front Cell Neurosci 9:408.
Neurons change size
and shape to
different forces
Tyler WJ (2012) The mechanobiology of brain function. Nat
Rev Neurosci 13:867–878
• Axons deform during action potentials
• Dendritic Spines twitch during synaptic activity
• Plasma membranes change size during neurotransmitter release
• New dendritic and axonal branches grow based on stimulus frequencies
Tyler WJ (2012) The mechanobiology of brain function. Nat
Rev Neurosci 13:867–878Click to add text
All neurons also communicate mechanical
forces across Cell-Cell and Cell-ECM
The ECM is principal extracellular component of all tissues
• Scaffold• Regulates
biochemical signaling
• NOT static• Linked
by adhesions• Multimolecular
complexes which link the ECM to the actin cytoskeleton
• IntegrinsBalancing forces: architectural control of mechanotransduction.
DuFort CC; Paszek MJ; Weaver VM, Nature Reviews. Molecular Cell Biology [Nat Rev Mol Cell Biol], ISSN: 1471-0080, 2011 May; Vol. 12 (5), pp. 308-19
There is a tonic level of 'pre-stress' in
individual cells based on tissue organization
Focal adhesions Microtubules and actin
The tensegrity of each cell provides a means for local changes in shape to be computed by each cell as a whole.
Mechanical forces shape cell fate and behavior
The size of the ECM determines both:1) Morphology of the cell2) The survival of the cell
Prog Biophys Mol Biol. 2008; 97(2-3): 163–179
• Neurons, like other cells, are organized into tissues and are surrounded by ECM
• Cell:Cell and Cell:ECMconnections give cells structural stability, but also sensitivity and a mechanism to respond to mechanical stimuli
• Tonic stress on cells, in particular patterns and at particular levels, is important for normal cell functioning
• Changes in ECM, intracellular signaling and release of soluble factors will affect local and distal tissues in response to mechanical forces
Take-aways
1. The body is a unit; the person is a unit of
body, mind, and spirit. Systems within
systems. These systems interact and are
dynamic.
2. The body is capable of self-regulation, self-
healing, and health
maintenance. Homeostasis and (Allostasis)
3. Structure and function are reciprocally
interrelated. Form follows function follows
form
4. Rational treatment is based upon an
understanding of the basic principles of body
unity, self-regulation, and the interrelationship
of structure and function. Osteopathic
manipulative treatments work through
multiple mechanisms
Applying osteopathic tenets &
Preventing reductionism and oversimplification
A.T. Still 1828-1917
Neuroanatomy and Manual Therapies
Afferent Sensory Input
Efferent Motor Output
Understanding Mechanotransduction
Neurons responsive to touch
(mechanoreceptors) carry signals to central
nervous system
Information is taken from the skin, bone, muscle, or organ
…and sent to the spinal cord and/or brain for processing
Cutaneous and Subcutaneous Mechanoreceptors
Muscle spindles and Golgi Tendon Organs (Proprioceptors)
Free nerve endings (Nociceptors)
Back to muscles for reflexive movementThe human brain : an introduction to its functional
anatomy/John Nolte.—6th ed.
What does a mechanical stimulus do to
single neurons?
Movement of muscle spindles and nerve endings around hair cells are translated to action potentials
There are specialized cell types to detect mechanical stimuli in your skin, bones, muscles (and other connective tissues)
Neuroscience. Third Edition. Edited by Dale Purves, , George J
Augustine, , David Fitzpatrick, , William C Hall, , Anthony‐Samuel LaMantia, , James O McNamara , and , S Mark Williams. Sunderland (Massachusetts): Sinauer
Associates
The human brain : an introduction to its functional
anatomy/John Nolte.—6th ed.
Reflexes link
mechanotrans-
duction to many
different “whole
organism”
responses
• Reflexes are always making our muscles contract against opposing forces
– Reflex is carried by muscle spindles, using mechanotranscution
– Allows for standing, holding things
EMG measures muscle tone: following a spinal manipulation, paraspinal muscles reduced tone
• This is an example of a Somato-somatic reflex
• Changing the position of the muscle spindle by adjusting the spine (bone) changed the contraction of the muscle around the spine
• HVLA on the spine is a type of manual therapy
J Nov Physiother Phys Rehabil. 2015 Sep; 2(2): 20–27.
Published online 2015 Apr 6
What happens when there’s injury?
http://courses.washington.edu/conj/sensory/pain.htm
This is also a somato-somatic reflex
Ramping up the activity of nociceptive neurons releases Substance P, dilates blood vessels around area, recruits mast cells which release histamine
Inflammation
Inflammation is good because: it prepares your cells for a massive attack from the immune system
Inflammation is bad because: our bodies are bad at regulating it, can sit around for too long, not permissive for normal cell activities
Group data from 7 animals used in experiment 1 showing the effect of the Control (⋄) and
Injection (•) protocols on splenic and renal sympathetic nerve discharge (SND), heart rate
(HR) and blood pressure (BP).
Kang Y M et al. J Neurophysiol 2003;90:2548-2559
©2003 by American Physiological Society
• Activating nociceptors around the paraspinal muscles with a chemical, inflammatory agent results in changes in organ function
• This is an example of a Somato-visceral reflex
• Inflammation to: HR increase, BP increase, Renal and Splenic nerve activity increase
Inflammation can also lead to referred pain
Viscero-somatic reflexes in referred pain areas evoked by capsaicin stimulation of the human gut RSS
Lars Arendt-Nielsen, Klaus-Peter Schipper, Georg Dimcevski, Hiroyuki Sumikura, Anne Lund Krarup, Maria Adele Giamberardino and Asbjørn Mohr DrewesEuropean Journal of Pain, 2008-07-01, Volume 12, Issue 5, Pages 544-551, Copyright © 2007 European
Federation of Chapters of the International Association for the Study of Pain
• This is an example of a viscero-somatic reflex
– The increased blood flow and temperature change is causing pain
– How is this localized?
Massage reduces cellular
mediators of inflammation
Sci Transl Med 4, 119ra13 (2012);
Justin D. Crane et al.Massage Therapy Attenuates Inflammatory Signaling After Exercise-Induced Muscle Damage
Internal organs are “linked” to your skin, muscle, bone, connective tissue, etc. through neural wiring in the spinal cord and brain• Conscious processing
of touch leads to voluntary movement, emotional responses, more physiological changes
Basis for somato-visceral, viscero-visceral and viscero-somatic reflexes
Multiple pathways triggered in response to
mechanoreception
Cutaneous and Subcutaneous Mechanoreceptors
Muscle spindles and Golgi Tendon Organs (Proprioceptors)
Free nerve endings (Nociceptors)
Back to muscles for reflexive movement
Processing up to the other levels of the Spinal Cord
and Brain
• Archeo- and Paleospinothalamics
• Neospinothalamic• Spinocerebellar(s)• Dorsal Columns• Propriospinal
All at the same time as the spinal reflexes
The human brain : an introduction to its functional
anatomy/John Nolte.—6th ed.
Reductionism and
Complexity
– The nervous system is a really good explanation of how manual therapies are mechanistically effective: through reducing inflammation, contraction (spasm), etc.
– But many different cell types change in response to mechanical stimulus, including connective tissue, which affects wound healing, blood and lymphatic flow, etc.
• Keep in mind: knowing a single explanation doesn’t mean it’s the explanation. We’re working with systems within systems