Cranial RTM, Spreads, Lifts, CV4, VSD

Question 1

Contraindications for OCMM

Answer 1

Acute intracranial bleeding

Increased intracranial pressure

Skull fracture

Strokes/TIA

Coagulopathy RS (relative)

Space occupying lesions in cranium (relative)

Question 2

The inherent rhythmic motion of the brain and spinal cord

Answer 2

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

Question 3

Fluctuation of the CSF

Answer 3

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

Question 4

Mobility of intracranial and intra-spinal membranes

Answer 4

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

Question 5

Articular mobility of the cranial bones

Answer 5

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

Question 6

Involuntary mobility of the sacrum and ilia

Answer 6

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

Question 7

Flexion OCMM movements

Answer 7

SBS: rises

Midline bones: flex

Paired bones: external to rotation

Motion of the sacrum: counter-nutation

Thoracic respiratory phase: inhalation

Question 8

Extension OCMM movements

Answer 8

SBS: falls

Midline bones: extend

Paired bones: internal rotation

Motions of sacrum: nutation

Thoracic respiratory phase: exhalation

Question 9

Indirect action method of OCMM

Answer 9

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

Question 10

Direct action method of OCMM

Answer 10

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

Question 11

Disengagement method of OCMM

Answer 11

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

Question 12

Opposite physiologic motion technique of OCMM

Answer 12

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

Question 13

What are the activating forces in OCMM treatments?

Answer 13

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

Question 14

Describe Balanced membranous tension (BMT)

Answer 14

The point at which the inherent force can move through the involved tissues at its maximum efficiency

varies based on individual strain

Question 15

Examples of secondary causes of primary respiratory mechanism (PRM)

Answer 15

PRM increased

• fever
• following vigorous exercise
• after OMT

PRM decreased

• stress
• chronic infections
• chronic poisoning
• mental depression
• chronic fatigue

Question 16

What is the reciprocal tension membrane?

Answer 16

The combination of:

• falx cerebri
• tentorium cerebelli
• diaphragmatic sellae
• falx cerebelli
• spinal dura

**all assist in the movement of cranial bones and the sacrum

Question 17

Where does 95% of the venous blood from the brain drains into?

Answer 17

Drains into the jugular vein

Question 18

How is the CSF produced?

Answer 18

70% = formed in the lateral/3rd and 4th ventricles

30% = formed in the CNS extracellular fluid moves into he subarachnoid space

Question 19

What nuclei are near the 4th ventricle

Answer 19

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

Question 20

What is CV4?

Answer 20

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

Question 21

Other signals of end points of CV4 treatment

Answer 21

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

Question 22

VSD treatment

Answer 22

• 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