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Neuro-Ocular Release

Purpose: To inform, educate and train the participants to be able to diagnosis and treat appropriate patients in the new Indirect Method of Osteopathic Manipulative Treatment (OMT) called Neuro-Ocular Release (NOR).

The participants-trained Osteopaths will be able to:
– Explain what NOR is.
– Describe and explain the neurophysiological principles, and biomechanical reasoning behind how and why NOR works to relieve pain and dysfunction.
– Determine and explain where and when NOR is indicated and contraindicated.
– Describe and preform NOR diagnostic and treatment procedures/technique on a patient in the axial.
– Describe and preform NOR diagnostic and treatment procedures/technique on a patient in the appendicular skeleton and cranium.

Programme

FIRST DAY

Goals
The participants-trained Osteopaths will be able to,
– Explain what NOR is.
– Describe and explain the neurophysiological principles, and biomechanical reasoning behind how and why NOR works to relieve pain and dysfunction.

Introduction – Preview:
– The NOR Course “the 3 Second Osteopathic Technique”
– Taking you from Zero to 200KM/HR in 3 days.

Pain – The most common complaint Osteopath’s see
– Definition, mechanisms of action, neurophysiology, biomechanical, biochemical, biopsycho-social
– The most common diagnosis by an Osteopath; Somatic Dysfunction
– Definition, neurological, biomechanical, biochemical/metabolic, respiratory-circulatory, behavioral

Lab – Identifying Somatic Dysfunction (SD)
– Palpatory examination skill development-The mechanism of touch, layered palpation, screening, regional joint and segmental examinations
– Postural and visceral signals of SD

Indications and contra indications for Osteopathic Manipulative Treatment (OMT)
– Writing an Osteopathic Manipulative Prescription (OMP)
– Diagnosis: medical codable; Osteopathic general/regional, specific/segmental/joint
– Situation: location, time,
– Patient situation: physical/mental/emotion condition, preferences, age, sex, weight, height
– Osteopath’s: physical/mental/emotional condition, knowledge, skill, ability, experience, preferences, age, sex, weight, height
– To treat the memory of somatic dysfunction or not? Treating the general afferent pain and efferent response pathways or to treat both ascending and descending motor tracts, thus resetting/restoring the cerebellum and cerebrum normalization of function.

NOR Neurophysiology-Theory of Mechanism
Ascending Pain Pathway
– Skin/joints-Nociceptors’ – proprioceptors’ – mechanoreceptors’
– General sensory afferent (GSA) – spinal ganglion – posterior horn – Rex laminae I, II, IV, V, VI
– Primary somatosensory (S1) cortex – pain localization, quality, intensity
– Secondary somatosensory (S2) cortex – memory
– Temperature, pain, and position
– Neospinothalamic tract – Thalamus – intralaminar nuclei – S1, S2, cingulate gyrus & prefrontal cortex
– Paleospinothalamic tract – Thalamus – intralaminar nuclei – hypothalamus – limbic system
– Rex lamina-Spinomesencephalic – Periaqeductal Gray (PAG)
– Rex lamina-Spinoreticulothalmic – reticulothalmic – medial thalamus – hypothalamus – reticular activating system
– Third Order Neurons – sensory – thalamus – postcentral gyrus of S1 cortex
– Pain and Temperature Pathway
– Skin – spinal ganglion – posterior horn of spinal cord gray matter – rex laminae – lateral spinothalamic tract – ventral-posterior nucleus of thalamus – postcentral gyrus of central sensory cortex.
– Unconscious Proprioception Pathway
– Muscle, spindles, tendon, joint, skin receptors – spinal ganglion – Primary neuron, afferent nerves -dorsal column gray matter – anterior spinocerebellar tract – cerebellum – cerebellum peduncle
– Posterior spinocerebellar tract – posterior horn gray matter – cerebellum peduncle
– Conscious Proprioception vibration, touch Pathway
– Vater-Pacini corpuscles in skin, muscles, tendons – spinal ganglion – nucleus Gracilis, nucleus cuneatus – medial lemniscus – ventral posterior lateral nucleus of Thalamus, postcentral gyrus sensory cortex.
– Vestibulo-ocular reflex (VOR) provides gaze stabilization when head is turning. Slow phase opposes head rotation to keep gaze steady, fast phase saccades allow for recentering if the slow phase overshoots. Reflex is initiated by semi-circular canals. Bipolar cells in canals via CN VIII synapse on premotor cells of vestibular nuclei.
– Oculocervical reflex connects vestibular system with proprioceptive afferent and efferent communication – spinal tract – producing trunk rotation as a response.
– Optokinetic reflex maintains a moving object on the retina while the head is stable. Optokinetic nystagmus is slow alternating, compensatory movement in line with the object movement, and fast anti-compensatory movement opposite the object movement. Mediated by geniculo-transcortical-floccular pathway and works in conjunction with VOR.

Descending Pain Pathway
– Cortex – PAG – Raphe Nucleus Magnus (RNM) – Rostroventromedial medulla (RVM)
– RNM monoamine pathways to dorsal horn = excitatory and inhibitory
– RVM facilitates or inhibits nociceptive input
– Visual activation and resting connectivity is present between PAG – visual cortex, S1, thalamus, medulla, prefrontal cortex, occipital cortex, cerebellar lobes.
– PAG-RVM is influenced by stress and emotions, it is the target for opioids The result is inhibition of presynaptic primary afferents and post synaptic inhibition at the spinal projections.
– Cortical areas, amygdala and hypothalamus exert top-down control modulating pain experienced by stress, emotion, and cognition.

SECOND DAY

Goals
The participants-trained Osteopaths will be able to:
– Explain what NOR is.
– Describe and explain the neurophysiological principles, and biomechanical reasoning behind how and why NOR works to relieve pain and dysfunction.
– Determine and explain where and when NOR is indicated and contraindicated.
– Describe and preform NOR diagnostic and treatment procedures/technique on a patient in the axial

NOR
Recap Neurophysiology
Indications
– Contraindications- Relative, Absolute
– NOR requirements- Patient, Osteopath
– Complications
– Effectiveness

Clinical integration
– How can I use this technique in case X, Y, Z?
– When is it most effective?

NOR Diagnosis and Treatment – Demonstrations – Lab
– Cervical Spine
– Thoracic Spine and Ribs
– Lumbar Spine
– S-I Joint/Pelvis

THIRD DAY

Goal
The participants-trained Osteopaths will be able to:
Describe and preform NOR diagnostic and treatment procedures/technique on a patient in the appendicular skeleton and cranium.

NOR Diagnosis and Treatment – Demonstrations – Lab

Recap: Indications-contraindications, NOR diagnostics and treatment to spine
Upper Extremity
– Sternoclavicular joint
– Acromioclavicular joint
– Glenohumeral joint
– Elbow
– Wrist and Fingers
Lower Extremity
– Hip
– Knee
– Ankle
– Foot and toes
Cranial
SBS restrictions
Review:
Preform NOR diagnostic and treatment procedures/technique on your partner’s S.D. in the axial, appendicular and cranium

Timetable

FRIDAY 10th FEBRUARY 2023
From 9 a.m. to 1 p.m. and 2 p.m. to 6 p.m.
SATURDAY 11th FEBRUARY
From 9 a.m. to 1 p.m. and 2 p.m. to 6 p.m.
SUNDAY 12th FEBRUARY
From 9 a.m. to 1 p.m. and 2 p.m. to 6 p.m.