Cranial RTM, Spreads, Lifts, CV4, VSD Flashcards
Contraindications for OCMM
Acute intracranial bleeding
Increased intracranial pressure
Skull fracture
Strokes/TIA
Coagulopathy RS (relative)
Space occupying lesions in cranium (relative)
The inherent rhythmic motion of the brain and spinal cord
1 of the 5 anatomic-physiologic components of OCMM
Subtle, wave like movements in a biphasic cycle
- flexion: CNS shortens and thickens
- extension: CNS lengthens and thins
Fluctuation of the CSF
1 of the 5 anatomic-physiologic components of OCMM
As the CNS changes in flexion and extension, the ventricles move fluid concurrently
- manifests as a hydrodynamic activity as well as a bio electric interchange throughout the body
Mobility of intracranial and intra-spinal membranes
1 of the 5 anatomic-physiologic components of OCMM
The spinal column and dural responses to the inherent motion of the CNS and fluctuation of the CSF
- is considered a “core link” since it transmits biomechnaical forces between the cranium and sacrum
- trauma to one of the sacrum/cranium often affects movement of the other
Articular mobility of the cranial bones
1 of the 5 anatomic-physiologic components of OCMM
Sutures between the cranial bones allows for a minimal amount of motion between cranium bones
- this is the most debated phenomenon
Involuntary mobility of the sacrum and ilia
1 of the 5 anatomic-physiologic components of OCMM
Cranial dura is continuous with the spinal dura, which attaches at the sacral segments
- this allows movements from one or the other to occur in relation with each other along the transverse respiratory axis
Flexion OCMM movements
SBS: rises
Midline bones: flex
Paired bones: external to rotation
Motion of the sacrum: counter-nutation
Thoracic respiratory phase: inhalation
Extension OCMM movements
SBS: falls
Midline bones: extend
Paired bones: internal rotation
Motions of sacrum: nutation
Thoracic respiratory phase: exhalation
Indirect action method of OCMM
Also called “exaggeration”
Increase the abnormal relationship at the joint by moving the articulation further towards malalignment
Commonly done on patients age 5 and up and CANT be used in acute trauma to the head cases
- also CANT use on children under 5 yrs
Direct action method of OCMM
Attempt to realign the bones and is used when exaggeration is not desirable
- used in younger children <5 yrs and in incidence of over-riding sutures
Disengagement method of OCMM
Used when force or excessive membranous tension exists and impacts the osseous components
seperates opposing surfaces within the anatomic and physiological limits of permitted motion
Opposite physiologic motion technique of OCMM
very rarely used and only used for experienced hangs
Used to release a strain when a traumatic force has severely violated the physiologic pattern
- hold bones towards a position they would not physiologically assume
What are the activating forces in OCMM treatments?
Primary = inherent motion of the CNS
Secondary = respiratory assistance
- inhalation enhances flexion and external rotation
- exhalation enhances extension and internal rotation
Tertiary = dural tension enhancement via application of effort at the sacrum/feet
4th activating force = CV4 procedure
Describe Balanced membranous tension (BMT)
The point at which the inherent force can move through the involved tissues at its maximum efficiency
varies based on individual strain
Examples of secondary causes of primary respiratory mechanism (PRM)
PRM increased
- fever
- following vigorous exercise
- after OMT
PRM decreased
- stress
- chronic infections
- chronic poisoning
- mental depression
- chronic fatigue
What is the reciprocal tension membrane?
The combination of:
- falx cerebri
- tentorium cerebelli
- diaphragmatic sellae
- falx cerebelli
- spinal dura
**all assist in the movement of cranial bones and the sacrum
Where does 95% of the venous blood from the brain drains into?
Drains into the jugular vein
How is the CSF produced?
70% = formed in the lateral/3rd and 4th ventricles
30% = formed in the CNS extracellular fluid moves into he subarachnoid space
What nuclei are near the 4th ventricle
Dorsal vagal nucleus:
- controls parasympathetic effects of the vagal nerve in the GI tract/lungs/abdominal region
Solitary nucleus:
- controls afferent information from stretch receptors and chemoreceptors in the cardiovascular, respiratory and GI tracts.
Nucleus ambiguus:
- contains cell bodies for the preganglionic parasympathetic vagal nerves to the heart
What is CV4?
Slight mechanical compression of the 4th ventricle for a period of time
- done via bringing the occiput into the extension phase
Positioning:
- patient is supine
- cup one hand inside the other so the thenar eminences are about an inch apart
- ask the patient to lift the head and place your thenar eminences under the Supraocciput below the inion and medial to the occiptomastoid sutures
- *dont cross the occipitomastoid suture with your thumbs**
Treatment:
- palpate to feel the CRI
- follow occiput into extension by sliding the heads slightly towards you (superior)
- resist the return motion of the flexion phase
- *hold this position until the CRI appears to stop ** (still point)
- wait for the CRI to resume on its own and allow the occiput to move into flexion and extension
allow for 2-3 full flexion/extension cycles
Other signals of end points of CV4 treatment
Noticeable increase in warmth of tissues
Softening of tissues
Change in respiration of patient
Sighing
Perspiration on patient forehead or moisture of tissues
No occipital motion is palpable
Mean time is roughly 3 minutes
VSD treatment
- used in:
- congestive headaches
- migraines
- chronic fatigue
need to treat thoracic inlet, cervical and OA joints
Steps:
- physician sits at the head of the table with forearms comfortably resting and goo posture is maintained
- patient is supine while the physician places two middle fingers tip-tip with the pads on the inion
- thumbs are placed on the top of the head to maintain balance (DONT PRESS)
- maintain support until softening or warmth is felt on finger pads
