John Chappel, MA, PT San Jose, California

1. Understanding the role of the cervical spine and upper extremities in the synactive development of the preterm and term infantsLooking into the Future John Chappel, MA, PT San Jose, California

2. - Anne Geddes

3. In the fields of observation chance favors the prepared mind. Louis Pasteur, 1822-1895

5. The ELBW infant lives in a world of "co-morbidities", which is in essence is a "network" of dysfunction.  A non-Cartesian analysis of these dysfunctions is what today is all about. THEY ARE NOT CO-MORBIDITIES BUT A WEB OF SYNACTIVE DYSFUNCTION INVOLVING THE WHOLE ECOLOGY OF THE INFANT. nothing less than that

6. Thoughts on "Co-morbidities“ You cannot have "co-morbidities" without stress. Stress makes every human condition worse. Stress is a force that causes distortion and reaction of a "system" or function.

7. Thoughts on "Co-morbidities“ Many of the "co-morbidities" we see in ELB infants is acute inflammation and stress becoming chronic. You can't have inflammation without stress. You can't have pain without inflammation.

8. Any movement or change in postural tone demands a requisite change in physiologic equilibrium. These must be facilitated automatically by the infant or maladaptation occurs .

10. Movements made in the direction of gravity acquire added impetus and sensory input that makes them hard to change once acquired - for better or worse.

11. Many postures and movements of the ELBW infant’s are concerned with using compressive joint forces (CPP) to “bond” with gravity to achieve and hold stable postures - at the expense of physiologic control. Remember Selye’s GAS.

15. Wisdom consists of the anticipation of consequences Norman Cousins 1912-1990

16. - Anne Geddes

21. Need a quiet baseline and good alignment for cranial nerve functions like swallowing, balance, pharyngeal competencies, to occur. Because all soft tissue anteriorally at TMJ have to adapt to structural dysfunction in the cervical spine.

22. Swallowing and Occlusal Patterns Audience Participation Head straight, open and close mouth Now Side Bend Now Side Bend and Rotate Now Extend

30. Thoughts on Co-morbidities Abnormal alignment, postures and movement changes the body's ability to move all fluids to some degree. This creates fluid stosis which creates and exacerbates all inflammation. During the course of today keep thinking "how can I help this baby manufacture, move, excrete and re-claim its precious bodily fluids?“ This is the essence of physiologic synactive care

31. Thoughts It's not "Fight or Flight“ It's "Flight and Fight“ And sympathetic tone always wins, which, sooner or later, in the ELBW always becomes the problem and not the solutions. How do you help your baby "FLOW" in the NICU.

41. Scapula – Omo The key to making the chest work is restoring the motion to the scapula and clavicle. Until this is done, full range of the ribcage or humerus cannot happen (L. Rex, URSA, 09) Amen! 18 muscles attach to the scapula Levator scapula attaches to atlas

42. Ribcage / Thorax – changing ANS tone T1 – T5 fibers ascend in the symp cervical chain to synapse in; SCG, MCG and ICG. This is their sympathetic feed T2 – T6 overlap heart, lungs, stomach et al. So alter ANS activity by (decrease symp tone), treating here normalizes somatic – visceral tone.

44. The role of the upper symp chain ganglia is to relay vasoconstrictor impulses to the pulmonary blood vessels and upper limbs. Saluting, Airplane, and clasp, fingersplay, HTM etc, etc. UE Postures to change Pulmonary Physiology? With and Without Resp Pause or change in Rate?

45. Vagal Treatment Control – so many possibilities Right recurrent laryngeal nerve branches off to ascend between the esophogus and trachea. One monitors Air One monitors Food Pulmonary an GI functions are constantly tied together especially here with L vagus in a plexus on the esophogus. Remember swallowing smoothness pharnygeal arches 4 and 6!

46. Treating Sympathetic Tone Cardiac T1 – T5 Pulmonary T2 – T6 Digestive T5 – T9 (at least) The Right Vayus is 80% Motor and 20% Sensory Motor changes tone and produces substances.

48. When a system is stressed it adapts by ultimately changing shape to assist at all levels with the balance and flow of resources and energies first. If an infant is placed in a stress situation where rigid, incorrect, or ineffective compensatory movements are selected (or dictated) then maladaptation in all areas of it’s life process will occur.

49. Compliance and BPD The change between a high compliance chest wall (Basilar vs. Apical, Left vs. Right) and low compliance will occur overnight, over days, over weeks but it will occur. But if you are not evaluating it and treating it all your respiratory care, by definition, will be at best maladaptive, at worst incomplete.

50. Chronic Lung Disease – “Does anyone really know what time it is?” Chicago ’70. The single fundamental short coming of BPD care (“neo” and “paleo”) is that we never take note on how and where the infants chest wall compliance affects the respiratory process. How do you account for this in your Positioning and Developmental Care?