Competency 1

Question 1

1a. Describe and demonstrate the 2 basic COMM hand holds for cranium, and state the 5 qualities of the CRI

Answer 1

1. Demonstrate the vault hold by bilaterally placing index fingers on greater sphenoid wings. Middle and ring fingers are placed in front and back of ear respectively. Little fingers are placed on occiput with thumbs off of the calvarium
2. Demonstrate frontal-occipital hold by placing thumb and long or little finger over greater sphenoid wings, and other hand cups occiput.
3. State that the 5 qualities are rate, rhythm, amplitude, direction, and strength

Question 2

1b. Demonstrate and describe motion of sacrum, sphenoid, and occiput during cranial flexion and extension

Answer 2

1. State and show that the greater sphenoid wings move anterior/inferior around a right-left axis (running through center of body at level of the floor of the sella turcica) during cranial flexion, and they move posterior/superior during cranial extension
2. Membranous portion of occiput moves posterior/inferior around a right-left axis (directly superior to foramen magnum at level of confluence at sinuses) during cranial flexion and anterior/superior during cranial extension
3. State that the SBS moves cephalad during flexion and caudad during extension phases
4. States that the cranial diameters change during flexion and extension:
   4i. Cranial flexion: decreasing A/P diameter, increasing right/left diameter, and decreasing superior/inferior diameter
   4ii. Cranial extension: increasing A/P diameter, decreasing right/left diameter, and increasing superior/inferior diameter
5. Demonstrate and explain that the sacrum is connected to SBS by spinal membranes. State that the membranes are attached to posterior aspect of S2 body and a foramen magnum
   5i. During flexion, the pull on the spinal membranes pulls sacral base posterior around superior sacral transverse axis and is called counternutation.
   5ii. During extension, decreased tension on spinal membranes allows sacral base to fall anteriorly around superior sacral transverse axis and is called nutation

Question 3

1c. Using bones provided, demonstrate motion of sphenoid and occiput for a SBS flexion somatic dysfunction and SBS extension somatic dysfunction. Describe how to perform a Balanced Membranous Tension (BMT) treatment to either of these dysfunctions

Answer 3

1. Demonstrate and state that the sphenoid and occiput move farther into their cranial flexion motions and have less motion (restriction) into their extension motion. The ease of motion is to flexion, and restriction of motion is to extension. This is defined as flexion SBS somatic
2. Demonstrate and state that the sphenoid and occiput move farther into their cranial extension motions and have less motion (restriction) into their flexion motion. Ease of motion is to extension, and restriction of motion is to flexion. This is defined as extension SBS somatic dyfunction.
3. State that the BMT treatment involves using either a frontal occiput hold or vault hold. SBS dysfunction is evaluated for extremes of motion between cranial flexion and extension. SBS is held in midpoint of two extremes of available motion until a still point (inability to feel CRI) is obtained. Concentration is maintained until CRI motion begins to return and is noted to be more symmetrical than before, and normal motion is restored.
   3i. During still point, some membranes stretch, while others contract. Once the tensions balance out, the CRI becomes more symmetrical, and the ability to feel the CRI returns.
   3ii. This same technique may be used for any other cranial bone dysfunction (midline or paired). Principle of technique is applied to boney dysfunction. Find the midpoint of motion, hold it there until a still point is felt and maintain until CRI returns. Note that it has returned in a more symmetrical pattern than before the procedure was performed, and normal motion of CRI is restored.