clinical application of cranial manipulative medicine

Question 1

what are the goals of craniosacral treatments?

Answer 1

reduce venous congestion

mobilize articular restrictions

balance the SBS

enhance any reduced force, rate or amplitude of the cranial ryhtmic impulse (CRI)

Question 2

any dyfunctional bone position places stress on the brain, _ , _ and _ sinuses through direct connections to the dura and _

Answer 2

arteries
veins
venous sinuses

and arachnoid

Question 3

treatment of the cranium can be aimed at (3 locations)?

Answer 3

outer fascial layers
sutural ligaments
intracranial membranes

Question 4

sutural ligaments are?

Answer 4

fibrous joints connected by dense connective tissues : synarthrosis

Question 5

treatment of the cranium influences structures that pass through, between or out of bones, has a subtle and indirect effect on the brain

Answer 5

just know

Question 6

palatine SD may produce _ _ involvement and a _ _ reflex

Answer 6

pterido/sphenopalatine ganglion

somato-somatic reflex

Question 7

pteriogopalatine ganglia influences _ output

Answer 7

trigeminal

Question 8

trigeminal output as _ function that activates the muscles of _ and tensor tympani, tensor veli palatini, mylohyoid, and the _ belly of the digastric

Answer 8

motor

mastication

anterior belly

inhbition of the gaglion will decrease output to the trigeminal and aid in TMJ, swallowing and speech

Question 9

the estachian tube passes within the _ bone and exits in the _ _

the tube lies in between the _ _ bone and the _

Answer 9

temporal

auditory canal

petrous portion of the temporal bone and the greater wing of the sphenoid

Question 10

if there is SD involving the temporal bone what can happen

Answer 10

ETD- fluid buildup and reduces motion of the tympanic membrane for hearing or an infection may occur

otitis media- impaired drainage from the tube (improve drainage the infection will clear)

Question 11

SD of the palatine bone can cause

Answer 11

TMJ, chewing disorders, swallowing, and speech problems

Question 12

cephalgia

Answer 12

headache

Question 13

what is known to cause headaches

2 well known arteries known to cause headaches

Answer 13

distention, traction or dilation of intracranial oe extracranial arteries

arteries: middle meningeal and superficial temporal

Question 14

the _ lies right over major arteries like the internal carotid and cerebral arteries

Answer 14

dura

Question 15

impaired _ drainage will also cause headaches

Answer 15

venous

Question 16

cranial strains can cause traction or displacement of large intracranial _ or _ through their dural envelope

Answer 16

veins or sinuses

Question 17

what bones does the facial nerve pass through

Answer 17

the temporal bone

Question 18

what can temporal bone torsion cause

Answer 18

bell’s palsy

Question 19

symptoms of bells palsy

Answer 19

weakness on one side of the face exluding the frontalis

may have a change in taste due to chorda tympani involvement on the anterior 2/3 of the tongue

Question 20

how can OMT help bells palsy

Answer 20

realign the temportal bone
release tissue strain and improve lymphatic flow

Question 21

what is trigeminal neuralgia

Answer 21

this is really bad facial pain that lasts for a few seconds that is incapacitating

it can be stimualted by chewing or brushing your teeth

has V2 distribution

can cause cephalgia (headaches)

Question 22

where does the trigeminal ganglion rest

Answer 22

in meckels cave on the superior surface of the petrosal ridge of the temporal bone and is covered by dura

affected by temporal, sphenoid, or occipital position change

Question 23

the tentorium cerebri is tightly attached at the

Answer 23

petrosal ridge

Question 24

if the temporal bone is rotated this would put pressure on the structures deep to the tentorium cerebelli including

Answer 24

the trigeminal nerve

Question 25

what did the study of rythmic motions of the living cranium find (1971)

Answer 25

they used a pick to touch the parietal bones of the human skull and measured its motion it found: rthym of bones that varied between subjects with an average of 1mm change thar was independent of breathing articfacts limitied study

Question 26

what did the parietal bone mobility in an anesthized cat study show

Answer 26

motion was spontaeous in the skull and can be induced or modified, it changed in respect to CO2 levels, CSF pressurem blood pressure and could inducea apnea

Question 27

external pressure on temportal bones caused

Answer 27

observable changes in respiration, blood pressure, and csf pressure

Question 28

external pressure on sagitial suture showed

Answer 28

no change in blood pressure or respiration but lateral and rotation movement of the parietal bones

Question 29

what did the nasa research do

Answer 29

confirmed cranial bone motion that the AP distance increased - ICP increased amplitude of the cranial motion

Question 30

what did the russian cosmonaut research do

Answer 30

stated that cranial dimensions are continuosly changing from A-P and side to side with up tp 1mm incracranial volume increases by 12 mm and moves the bones CRI was 6-14 cycles per minute

Question 31

mobility of the cord and membranes is witnessed in cranial _ and _ (1978)

Answer 31

extension (relax) and flexion (tension)

Question 32

what is the traube hering meyer wave

Answer 32

this is a pattern of changes in the blood pressure found to be synchronous to occillations of the sympathetic nervous system

Question 33

when was the traub hering wave compared to the CRI

Answer 33

2001

Question 34

what is a still point

Answer 34

a period where there is decrease in the traube-hering amplitude after treatment

Question 35

post treatment there shows changes in the _ wave

Answer 35

TH (traube-hering-myer) ## Footnote greater amplitude

Question 36

there is continuous _ changes in cranial dimensions and there is also cranial _ changes that pump CSF to bathe the rest of the CNS

Answer 36

biphasic volume ## Footnote the cns movement can propell CSF

Question 37

CRi is a product of _ volume and _ and _ regulation

Answer 37

CSF pressure metabolite regulation

Question 38

stress of cranial nerves 9 and X at the _ _ and condylar compression causing cranial nerve _ dyfunction can cause sucking dyfunctions in the newborn

Answer 38

jugular foramen 12

Question 39

cranial nerve 9 vagal SD can be due to a _, _ or _ dysfunction

Answer 39

OA AA C2

Question 40

cranial nerve _ and _ _ strains may be related to the birthing process

Answer 40

11 brachial pleus

Question 41

_ compression is common in newborns

Answer 41

suture

Question 42

when do you use occipital condyle decompression

Answer 42

1. poor feeding 2. colic 3. head and neck pain 4. post trauma to head and neck

Question 43

what is occipital condylar decompression- how do you preform

Answer 43

this is when you contact as near to the foramen and condyles as possible and add slight OA flexion you then apply traction, then pull the occipital tissues in a posterior and lateral direction until you feel regional give *8reassess

Question 44

occipital condylar decompression before the age of 7 treats? after 7-adults treats

Answer 44

before 7- treats catilaginous and pre occification strains after 7- treats post fusion or interocceous strains

Question 45

when do you use balanced membranous tension?

Answer 45

abnormal CRI cranial nerve entrapment dural strain/venous sinus strain headaches

Question 46

how do you preform BMT

Answer 46

exaggerate membranous asymmetry until balance is noted (CRI will move against you but resist it- do not change position) hold until CRI stops gently release to CRI midpoint reassess

Question 47

when do you use SBS decompression how do you preform SBS decompression

Answer 47

when the head feels like a bowling ball diminished CRI mood disorders cranial nerve entrapment URI/head congestion pediatric developmental problems 1. BMT compression first, then release 2. direct : engage the frontal bones to distract against the occiput: pull in an anterior and slightly superior direction- then await release and reasses

Question 48

when do you use the frontal lift how do you preform the frontal lift

Answer 48

use: treating restricted frontal mobility and to augent SBS flexion- frontal headaches, sinus congestion, pediatric development issues treatment: engage lateral inferior edge of frontal bone and hook under the initiation of the sygomatic arch, apply anterior force with some anterior rotation until an elastic release is felt

Question 49

what is parietal lift used for and how do you preform it?

Answer 49

used for lack of parietal motion in TMJ, headaches, decompress squamosal suture compresed with trauma/grinding of teeth perform parieta traction until superior elastic release is noted: gently release the head

Question 50

when do you use sterigo/sphenopalatine ganglion inhibition/stimulation how do you preform it

Answer 50

contact posterior and lateral to the molar and medial to the pterygpod apply a superior and slightly medial and posterior with medial roated force- hold to await relaxation, or do rotary stimulation hold- motor output rotary stimulation- thins nasal mucus and increases tears use in TMJ, migraine, tension headaches, sinusitis

Question 51

when do you use the temporal pull how do you preform it

Answer 51

use: lack of temporal motion: temporal headache, vertigo, tinnitus, TMJ issues, balance the tentorium, disengage the jugular foramen, release sutures use a pincer grip on pinnae or antitragus as close to the temporal bone as possible apply gental lateral traction posteriorly and superiorly along a vetor that parallels the petrous ridge of the temporalis. maintain tension at the FEATHER EDGE of the restrictive barrier until release is felt on both sides.

Question 52

TMJ decompression use and how do you preform it

Answer 52

use: TMJ restrictions, mandible restriction, neck pain preform: begin indirect by balancing compression of the mandible towards the tmj until relaxation is felt switch to a direct release at the lateral manidble pushing inferior and slightly anterior until release is felt on both sides

Question 53

V spread use how to preform

Answer 53

use: any cranial vault suture restriction treatment: spreading pressure is used to monitor and encourage motion on the longest contralateral diameter encourage PRM with fluctuant flow between the opposing contact

Question 54

why do we use the occipitomastroid release and how do you preform it?

Answer 54

use: trauma, migraine, TMJ, vertigo preform: wrap contralateral hand under occiput with fingers posterior to suture, wrap ipsilateral hand around the mastoid process, roll head towards the affected side until the OM suture is most posterior traction mastoid anteriorly , hold until release

Question 55

sagital suture release use and how to preform

Answer 55

use: migrains, tension headaches, trauma treatment: fingers at inferior portion of parietal bone , cross thumbs across the sagital suture at the point of restrictions, gap suture with lateral thumb pressure, hold until release

Question 56

use of CV4 still point induction treatment

Answer 56

use: decreased CRI, URI, headache/migraine treatment: place thenar eminence inferior to the superior to the superior nuchal line and medial to the occipitalmastoid suture, encourgae extension by leaning back (superior and anterior force) - resist inferior motion. once motion diassapear you have reached a still point. release and await CRI to return

Question 57

use of CV4 pump and treatment

Answer 57

use: fatigue, depression, insomnia treatment: thenar eminences on the occiput, medial and cephalad compressing pressure through the flexion phase only, release pressure allowing full extension, repeat until there is decreased resistance to compression "pumps CSF from 4th ventricle to spinal cord"