Competency 2

Question 1

2a. Describe and demonstrate ethmoid motion when SBS moves into cranial flexion and extension

Answer 1

1. State that the ethmoid is influenced by sphenoid and falx cerebri
2. State that the ethmoid rotates about transverse axis (through middle of bone) in same direction as occiput. This is in the sagittal plane
3. Lateral masses motions behave as paired bones into external rotation during cranial flexion and internal rotation during cranial extension
4. Flexion ethmoid dysfunction will be noted by ease of motion toward flexion and restriction to extension
5. Extension ethmoid dysfunction will be noted by ease of motion toward extension and restriction to flexion
6. Documented in objective portion of SOAP note

Question 2

2b. Student will demonstrate and describe SBS lateral strain patterns utilizing a skull, sphenoid, and occiput

Answer 2

1. State that the sphenoid and occiput rotate in same direction about two vertical axes that run through sphenoid and occiput, respectively. This motion occurs in transverse plane
2. State that this is a side-to-side (lateral) shearing of sphenobasilar symphysis
3. State that this is usually caused by trauma
   3i. Lateral force to one side of anterior cranium or opposite side of posterior cranium
4. State that the head takes on resemblance of a parallelogram
5. State that the strain pattern is named for the position of basi-sphenoid relative to basi-occiput
6. Describe a left lateral strain:
   6i. Basi-sphenoid is shearing to left around a vertical axis.
   6ii. Occiput and sphenoid both rotate to right (or posteriorly) around their individual vertical axes
   6iii. Demonstrate the following motion of physician’s hands in a vault hold: left hand slides over right hand
7. Describe a right lateral strain
   7i. Basi-sphenoid is shearing to right around a vertical axis.
   7ii. Occiput and sphenoid both rotate to left (or anteriorly) around their individual vertical axes
   7iii. Demonstrate following motion of physician’s hands in a vault hold: right hand slides over left hand

Question 3

2c. Demonstrate and describe SBS vertical strain pattern utilizing a skull, sphenoid, and occiput

Answer 3

1. State that the sphenoid and occiput rotate in same direction about two right-left (transverse) axes that run through sphenoid and occiput, respectively. This motion occurs in sagittal plane
2. State that as the sphenoid moves into cranial flexion, it is accompanied by extension motion at occiput and is defined as superior vertical strain
3. State that as sphenoid moves into cranial extension, it is accompanied by flexion motion at the occiput and is defined as an inferior vertical strain
4. State that the strain pattern is named for position of basi-sphenoid relative to basi-occiput
   4i. Basi-sphenoid moves relatively superior or inferior
   4ii. Side-to-side findings are symmetrical
5. Describe superior vertical strain
   5i. Basi-sphenoid is shearing superiorly around described transverse axis
   5ii. Occiput and sphenoid both rotating anteriorly around individual transverse axes
   5iii. Demonstrate following motion of hands in a vault hold: thumbs move away from doc toward patient
6. Describe an inferior vertical strain
   6i. Basi-sphenoid is shearing inferiorly around described transverse axis
   6ii. Occiput and sphenoid both rotate posteriorly around their individual transverse axes
   6iii. Demonstrate the motion of hands in a vault hold: thumbs move toward dc

Question 4

2d. Demonstrate and describe SBS torsion strain patterns utilizing skull, sphenoid, and occiput

Answer 4

1. State that the sphenoid and occiput rotate in opposite directions about the anterior/posterior axis that runs through the sphenoid and occiput from nasion to opisthion. Motion occurs in coronal plane
2. State that the strain pattern is named for more cephalad greater wing of sphenoid
   2i. Basi-sphenoid twists around anterior/posterior axis in opposite directions
3. Demonstrate and explain that as the SBS moves into cranial flexion, the right greater sphenoid wing moves cephalad, while the right occiput moves caudad. This is defined as right torsion strain pattern
   3i. Abnormal flexion/extension while sphenoid twists L (greater wing elevates on R), occiput twists R at SBS with R basi-sphenoid superior
   3ii. Demonstrate following motions of hands in a vault hold: hands twist on each other with right thumb pointing toward doc and left thumb moving away from doc
4. Demonstrate and explain that as the SBS moves into cranial flexion, the left greater sphenoid wing moves cephalad, while the left occiput moves caudad. This is defined as a left torsion strain pattern
   4i. Abnormal flexion/extension while sphenoid twists R (greater wing elevates on L), occiput twists L at SBS with L basi-sphenoid superior
   4ii. Demonstrate following motions of hands in a vault hold: hands twist on each other with left thumb pointing toward doc and right thumb moving away from doc
5. State that relative changes are taking place in other bones and membrane
   5i. Temporal and parietal bones - relative external rotation on side of torsion
   5ii. Mandible - shifted toward side of torsion
   5iii. Orbit - smaller on side of torsion
   5iv. Membranes
   5iva. Falx cerebri: anterior end rotates with sphenoid; posterior end rotates with occiput
   5ivb. Tentorium cerebelli: sidebent same direction as occiput rotates
   5ivc. Spinal dura: inferior on side of low occiput

Question 5

2f. Demonstrate and describe SBS compression strain pattern utilizing a skull, sphenoid, and occiput

Answer 5

1. State that this dysfunction is a result of pressure or trauma to front of head or face, to back of head, or entire periphery (infant cranium in birth)
2. State this strain pattern manifests as a restriction (mild to severe) of all motions at SBS
   2i. With severe compression, cranium feels rigid
3. State that the CRI will be slow, low amplitude, difficult to feel, and weak
4. Describe BMT technique treatment for this strain pattern, using a frontal-occipital hold
5. State that after strain is released, diagnosis of other strain patterns will be more readily palpable

Question 6

2e. Demonstrate and describe SBS side-bending/rotation strain pattern utilizing a skull, sphenoid, and occiput

Answer 6

1. State that there are two distinct motions of SBS that occur simultaneously for this strain pattern
2. Describe side-bending as rotation of occiput and sphenoid around their individual vertical axes. This motion occurs in transverse plane.
   2i. Axes run through center of body of sphenoid and through cneter of foramen magnum (occiput)
   2ii. Sphenoid and occiput rotate in opposite directions on these axes causing side-bending at SBS
3. Describe that rotation occurs on same AP axis as torsion
   3i. Sphenoid and occiput rotate in same direction as opposed to torsion where they rotate in opposite directions
   3ii. Rotation occurs toward side of convexity produced by change in position of sphenoid and occiput due to side-bending. This is relatively in an inferior or caudad direction
4. State that side-bending/rotation dysfunctions are named for side of convexity (wider side) of side-bending motion
5. Demonstrate and explain that as the SBS moves into cranial flexion, sphenoid rotates left around sup/inf axis, the occiput rotates right around a sup/inf axis, which is defined as right side-bending. Both occiput and sphenoid rotate right around A/P axis, which is defined as right rotation. Two motions together are defined as a right side-bending/rotation strain pattern
   5i. Demonstrate the following motions of hands in a vault hold: right hand moves caudad, and distance increases between index and little finger (“right hand moves down and spread out” with left hand moving “up and in”)
6. Demonstrate and explain that as SBS moves into cranial flexion, sphenoid rotate right around sup/inf axis, occiput rotates left around a sup/inf, which is defined as left side-bending. Both occiput and sphenoid rotate left around A/P axis, which is defined as left rotation. Two motions together are defined as left side-bending/rotation strain pattern
   6i. Demonstrate following motions of hands in a vault hold: left hand moves caudad, and distance increases between index and little finger (“left hand moves down and spread out” with right hand moving “up and in”)
7. State that relative changes are taking place in other bones and membranes
   7i. Temporal and parietal bones: externally rotated on convex side
   7ii. Mandible: shifted to convex side
   7iii. Frontal bone and orbit: anterior on convex side
   7iv. Membranes
   7iva. Falx cerebri: side-bent, following convexity of SB of SBS
   7ivb. Tentorium cerebelli: follows occipital motion
   7ivc. Spinal dura: inferior on side of convexity (inferior occiput), dropping sacral base inferiorly on that side