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

Descartes' Influence on

Neuroanatomy Education

...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