Steele Taylor presents: A Neuro-Endocrine Approach to The Obstetric and Pediatric Applications of Tactile-Kinesthetic Stimulation Therapy questions/complaints:

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  • Steele Taylor presents: A Neuro-Endocrine Approach to The Obstetric and Pediatric Applications of Tactile-Kinesthetic Stimulation Therapy questions/complaints: jstaylor@uvm.edu slide show: www.uvm.edu/~jstaylor/TKST.ppt notes and citations: www.uvm.edu/~jstaylor/TKST.doc
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  • The Touch Research Institute Research designs explore the following benefits that might be derived from massage: Research designs explore the following benefits that might be derived from massage: Alleviation of depression and anxiety Improved quality of sleep Pain reduction on neurological and soft-tissue levels Prevention of premature delivery Weight gain and cognitive/behavioral advances in premature infants Improved immune function and reduction of symptoms in auto-immune disorders Alleviation of eating disorders and dissonant body-perceptions Reduced anxiety and sense of empowerment in the practitioner or parent Improved social dynamic between practitioner and recipient (mother-infant, etc.) Studies that compare massage to general relaxation methods demonstrate that tactile- kinesthetic pathways are somehow involved to produce an effect that is beyond that of relaxation Studies that compare massage to general relaxation methods demonstrate that tactile- kinesthetic pathways are somehow involved to produce an effect that is beyond that of relaxation Inadequate elucidation of the physiological underpinnings, yet valuable information such as changes in hormone and neurotransmitter levels in response to massage so that outsiders may produce their own hypotheses and interpretations as to the underlying mechanisms Inadequate elucidation of the physiological underpinnings, yet valuable information such as changes in hormone and neurotransmitter levels in response to massage so that outsiders may produce their own hypotheses and interpretations as to the underlying mechanisms http://www.miami.edu/touch-research/http://www6.miami.edu/touch-research/research.htm
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  • Some Complicating Endocrine Considerations Receptor Type+Expression+Signal Cascades Determine the Response Receptor Type+Expression+Signal Cascades Determine the Response Selective Estrogen Receptor Modulation Cardiovascular Epinephrine Receptors Duration of the Signal Can Alter Feedback and Response Duration of the Signal Can Alter Feedback and Response Estrogen feedback to hypothalamus becomes positive to initiate ovulation Clearance of steroid hormones Genomic Versus Non-Genomic Effects Genomic Versus Non-Genomic Effects Non-genomic: Open/ close ion channels, activate/deactivate enzymes, perform exocytosis Genomic: protein synthesis, cellular proliferation, cellular differentiation Inter-Hormonal Interactions Inter-Hormonal Interactions Glucocorticoid (GC) permissive effects @ epinephrine binding sites Action of estriol to influence oxytocin receptor expression during parturition Temporary Endocrine Glands Temporary Endocrine Glands Fetal-Placental unit: substrates, precursors, active hormones Levels are difficult to measure because activity is primarily local Behavioral/Environmental Activators Behavioral/Environmental Activators Stress responses and coping behaviors Placebo and somatoform phenomena Endocrine Regulation of Brain/Behavior Endocrine Regulation of Brain/Behavior Thyroid, Adrenal Cortex, and Gonads profoundly impact brain development and function Might be considered as peripheral-diffuse-modulatory-systems Adipose, GI, and other tissues also hormonally regulate behavior
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  • Obstetric/Pediatric Complications Treatable with Massage and Explainable via Neuro-Endocrine Principles 1) Back Pain / general discomfort during pregnancy 2) Depression/anxiety/stress during and/or after pregnancy 3) Premature or low birth weight delivery Alex Grey www.alexgrey.com
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  • Pain During Pregnancy: Back pain affects over half of all pregnant women and may significantly impact outlook, mood, daily activities, and sleep Back pain affects over half of all pregnant women and may significantly impact outlook, mood, daily activities, and sleep Back Pain: Two Types Back Pain: Two Types 1)Lower Back Center of gravity moves anteriorlyCenter of gravity moves anteriorly Loss of abdominal tone lumbar lordosis and spasmLoss of abdominal tone lumbar lordosis and spasm Increased pressure on intervertebral discsIncreased pressure on intervertebral discs 2)Pelvic Relaxin - induced softening of pelvic ligaments and pubic symphysis to produce pelvic wideningRelaxin - induced softening of pelvic ligaments and pubic symphysis to produce pelvic widening Crucial for successful delivery, not very convenient otherwiseCrucial for successful delivery, not very convenient otherwise Walking, lifting, rotating can become painfulWalking, lifting, rotating can become painful Referred pain from inferior vena cavaReferred pain from inferior vena cava Proper positioning to alleviate pressureProper positioning to alleviate pressure
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  • Mechanisms of Referred Pain Visceral and cutaneous nociceptor axons converge on the same interneurons in the spinal cord Visceral and cutaneous nociceptor axons converge on the same interneurons in the spinal cord Signal becomes mixed and visceral pain is perceived as cutaneous Signal becomes mixed and visceral pain is perceived as cutaneous Important warning sign/diagnostic tool Important warning sign/diagnostic tool Angina pectoralis is the classic example Angina pectoralis is the classic example During pregnancy, pressure on the inferior vena cava produces referrals to the pelvic region and lower back During pregnancy, pressure on the inferior vena cava produces referrals to the pelvic region and lower back Immediate relief: positioning (left-side- lying) Long term relief: yoga, chi gung, etc. Ultimate relief: delivery! http://www.mona.uwi.edu/fpas/courses/physiology/ neurophysiology/ReferredPainMech.gif
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  • Pain Regulation in the Spinal Cord: The Gate Theory Cutaneous nociceptors (pain) and mechanoreceptors (touch, pressure) interact with gating interneurons in the dorsal horns Cutaneous nociceptors (pain) and mechanoreceptors (touch, pressure) interact with gating interneurons in the dorsal horns Mechanical stimulation at the site of pain may override/inhibit the projection of a pain signal up the spinothalamic tract Mechanical stimulation at the site of pain may override/inhibit the projection of a pain signal up the spinothalamic tract Instinctively rubbing/compressing bruised tissue Broad gliding, friction, and vibrating massage strokes www.burtonreport.com/images/GateTheory432GIF.gif http://www.nursece.com/onlinecourses/imagesPain/Fig2.gif
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  • Pain Regulation in the Brain: The Mothers Kiss and Placebo Mechanisms Cross-talk occurs between higher emotional regions, ascending pain-signals, ascending pressure signals, pain-localization regions, pain-anticipatory and avoidance regions, analgesia anticipatory regions (placebo regulators), and pain regulating pathways Cross-talk occurs between higher emotional regions, ascending pain-signals, ascending pressure signals, pain-localization regions, pain-anticipatory and avoidance regions, analgesia anticipatory regions (placebo regulators), and pain regulating pathways Emotional status powerfully influences the degree of pain that is perceived Emotional status powerfully influences the degree of pain that is perceived Sympathetically maintained pain = centrally produced hyperalgesia Sympathetically maintained pain = centrally produced hyperalgesia Nociceptors become sensitive to and activated by norepinephrine due to prolonged exposure Periaqueductal gray matter (PAG) of the midbrain, appears to be a critical mechanism in pain regulation, and may be innervated by endorphin producing neurons of the hypothalamus, as well as other regions Periaqueductal gray matter (PAG) of the midbrain, appears to be a critical mechanism in pain regulation, and may be innervated by endorphin producing neurons of the hypothalamus, as well as other regions Electrical stimulation of the PAG produces remarkable analgesic effects Top-Down Effect: PAG activates serotonergic cells in the rostral ventral medial nuclei (RVM) of the brainstem, which projects axons down the spinal cord that can effectively stifle pain signals Distracting tasks are highly effective analgesic tools Distracting tasks are highly effective analgesic tools Lamaze breathing, visualization, massage, other http://www.annkullberg.com/Shows/2003/Hild.jpg http://www.sciencemag.org/cgi/content/full/288/5472/1769
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  • Pain Regulation at the Soft Tissue Level Muscle tightness/spasm may compress nerves or obstruct vascular supply Muscle tightness/spasm may compress nerves or obstruct vascular supply Hypoxia / ischemia triggers pain pathways via vascular signals and irritating waste products from anaerobic muscle metabolism Hypoxia / ischemia triggers pain pathways via vascular signals and irritating waste products from anaerobic muscle metabolism Inflammation may also occur as a result, causing local hyperalgesia Massage therapy shuts off spasm/holding patterns on a neurological level Massage therapy shuts off spasm/holding patterns on a neurological level Golgi tendon organs reflexes inhibit muscle contraction Golgi tendon organs reflexes inhibit muscle contraction Disruption of holding patterns generated beneath the awareness of the brain Disruption of holding patterns generated beneath the awareness of the brain Massage therapy improves local circulation thus alleviating local ischemia Performed gradually and over a series of treatments to avoid reperfusion injury Performed gradually and over a series of treatments to a