AOBNMM NMM/OMM cheat sheet

Somatic dysfunction criteria (TART): Tissue texture abnormality, Asymmetry, Restriction of motion, Tenderness; at least one must be present for diagnosis.

Viscerosomatic reflexes: sympathetic facilitation typically produces T1-T4 (heart), T5-T9 (GI), T10-L2 (pelvic/renal) segmental findings; parasympathetic via vagus (cranial) and S2-S4.

Chapman's points: anterior points are associated with visceral dysfunction; posterior points are located on the spinous processes or transverse processes; treat with inhibitory pressure.

Facilitated segment: a spinal segment with lowered threshold for afferent input, often due to sustained noxious stimulation; diagnosed by tissue texture changes and tenderness.

Muscle energy technique (MET) principles: use patient's own muscle contraction against a counterforce; post-isometric relaxation for restricted motion; direct or indirect.

Myofascial release: direct technique engages the restrictive barrier and holds until release; indirect follows the tissue into ease and waits for release.

Cranial osteopathy: primary respiratory mechanism includes inherent motility of CNS, fluctuation of CSF, mobility of intracranial membranes, mobility of cranial bones, and involuntary motion of sacrum.

Lymphatic treatment: thoracic pump, pedal pump, and lymphatic drainage techniques enhance flow; indicated for edema, infection, and detoxification.

Counterstrain: uses a position of ease (tender point reduced by 70%) held 90 seconds to reset muscle spindle reflex; avoids direct pressure on the tender point.

Oral exam structure: case-based presentations with standardized patients or vignettes; candidates must demonstrate differential diagnosis, treatment planning, and OMT technique selection.

Somatic dysfunction diagnosis: must describe TART findings and relate them to the patient's presenting complaint; include segmental level and laterality.

Treatment plan: justify choice of OMT technique based on patient age, diagnosis, contraindications, and preference; include expected outcomes and follow-up.

Contraindications to OMT: absolute (fracture, dislocation, malignancy at site, infection, hemorrhage) vs relative (osteoporosis, anticoagulation, pregnancy) must be articulated.

Documentation: SOAP note format; include objective findings (TART), assessment (somatic dysfunction and medical diagnosis), and plan (OMT technique, frequency).

Osteopathic philosophy: body unity, self-regulation, structure-function interrelationship, and rational treatment; apply to case discussion.

Visceral-somatic integration: explain how visceral dysfunction creates somatic dysfunction and vice versa; use Chapman's points and viscerosomatic reflexes in reasoning.

Pediatric considerations: modify OMT for infants (cranial, lymphatic, myofascial) and avoid high-velocity thrust; obtain parental consent.

Geriatric considerations: use gentle techniques (myofascial, cranial, MET) due to decreased bone density and tissue elasticity; screen for osteoporosis and medication effects.

Set-up: position patient comfortably, explain procedure, obtain consent, wash hands, and ensure privacy; use proper body mechanics.

Palpation: use light touch (skin), then deep touch (muscle, fascia, bone); assess tissue texture, temperature, moisture, and tenderness.

Segmental motion testing: assess flexion, extension, rotation, sidebending at each spinal level; note restriction and end-feel.

High-velocity low-amplitude (HVLA): engage restrictive barrier, apply a quick, low-amplitude thrust; avoid in osteoporosis, fracture, or inflammatory arthritis.

Muscle energy: patient contracts muscle from a controlled position against operator force; use for restricted motion; post-isometric relaxation.

Counterstrain: place patient in position of comfort to reduce tender point by 70%; hold 90 seconds; reassess.

Myofascial release: direct or indirect; use gentle sustained pressure to release fascial restrictions; monitor tissue response.

Cranial technique: assess cranial rhythmic impulse (CRI) at 10-14 cycles/min; use gentle traction or molding; contraindicated in acute intracranial hemorrhage.

Lymphatic pump: thoracic and pedal pump techniques; rhythmic compression of thorax or lower extremities to enhance lymphatic flow; avoid in acute infection or fracture.