Intro To Cranial Osteopathic Manipulative Medicine Flashcards
Describe what Dr. William G. Sutherland did for the cranium
Determined range of motion, vectors of motion, and physiologic dynamics of cranial bones and intracranial structures
Observed a disarticulated skull and its beveled surfaces in sutures and wanted to know they had that design: reminded him of gills of a fish (mobility for respiratory mechanism)
Described a slow oscillating force in cranial structures that would cause movement in cranial bones
Described CNS, CSF, and dural membranes as a functional unit: Primary respiratory mechanism
When did Sepp describe fluctuations in CV and CSF? When and how long did Sutherland study cranium? When did Harold Magoun, DO further expand on this concept?
1928
1930’s for 30 years
1966
When did Sutherland introduce his ideas to the profession? What was the head though of before then? What happened after?
Introduced his ideas in 1943 at Eastern Osteopathic Association Convention. JAOA published in April 1944.
Prior to his teaching, head was considered as not having ability to have somatic dysfunction. Although Dr. Still noted that CSF was important to function of CNS
Established Sutherland Cranial Teaching Foundation in 1953
Research is ongoing and increasing in this area
Describe the primary respiratory mechanism
Primary: main internal tissue process of metabolism
Respiratory: exchange of gases
Mechanism: movement of tissue and fluid for a purpose
Describe the tenets of the classical cranial model
- Inherent motility of CNS
- Plasticity and elasticity of intracranial and intraspinal membranes
- Fluctuation of cerebrospinal fluid
- Articular mobility and involuntary motion of cranial bones
- Articular mobility and involuntary motion of sacrum between ilia
What paper covered the modern physiologic interpretation of Dr. Sutherland’s thoughts using modern knowledge of cranial CV and CSF flows and traced the history of the research and discussed the application of current research to the cranial concept?
Moskalenko Y. Et al
AAO Journal, Vol 13, No. 2, Summer 2003
Physiological premises: CRI and PRM
Describe Sutherland’s observation and modern interpretation of structures of the PRM
Sutherland: Brain/spinal cord CSF Intracranial membranes Intraspinal membranes Articular mechanism of cranial bones
Modern interpretation:
Elements from biophysical structures
Determine interaction between volume and pressure of liquid media of cranium: blood and CSF
Describe Sutherland’s observation and modern interpretation of dynamic relations of PRM
Sutherland: Bone mobility is related and controlled by *reciprocal tension membrane* -cranial and spinal dura -falx cerebri and cerebelli -tentorium cerebelli
Modern:
Change in distance of fixed points are due to CSF fluctuations
Reciprocal motions are determined by modulatory role of membranes
Describe Sutherland’s observation and modern interpretation of functioning of PRM
Sutherland:
Brain is motor for PRM
Modern:
Slow periodic fluctuations of blood volume and CSF pressure
-support brain metabolic supply and water balance of brain tissue
These are responsible for motion of brain tissue and skull bones
The fluctuations are functionally connected to chemical and physical homeostatic mechanisms of brain tissue
Describe the cranial rhythmic impulse (CRI)
Palpable biphasic rhythmic pattern of motion within cranium
- flexion of midline bones with external motion of paired bones
- extension of midline bones with internal rotation of paired bones
Present in living individuals
What is the normal rate for CRI?
10-14 times a minute
Range 6-14
How can you palpate the CRI?
You must be relaxed in order to palpate. Contact of hands is very light
Not a visible motion but is palpable
Separate of respiratory and circulatory physiologic mechanism
What are the characteristics of the CRI?
RRADS Rate Rhythm Amplitude Strength Direction
Describe flexion and extension of the SBS
Flexion: Sphenoid will rotate about a transverse axis so that the alae (wings) will move anterior/inferior, and the motion at the SBS will be superior or cephalad
- Occiput will rotate about a transverse axis so that the motion at the SBS will be superior or cephalad, and the bowl of occiput will move posterior/inferior
- Head gets shorter in AP diameter and wider in transverse diameter
Extension is opposite
Describe Heisey and Adams studies (1993)
Showing compliance in cat model
Skull bones moved with force from outside and inside
30-70 microns of lateral movement at sagittal suture
250 microns of rotational movement at parietal bones
Describe Frymann study (1971)
- Measured motion of human skull
- Pick mounted on parietal bones
- Found rhythm of bones which varied with subjects
- In most cases, rhythm not synchronized with breathing
- Problems with pick-offs and artifacts
Describe research done by Zanakis and colleagues (1995)
- Used recording device:
Used infrared device. Measured to 10 microns. Computer canceled out common movement between markers - Recorded most data from parietals with reference to bregma
- Data:
-Average movements independent of breathing or heart rate about 7/min
-sometimes fairly symmetrical
-sometimes very asymmetrical
-amplitudes of from 0-400 microns of motion; usually 100-200 microns - Palpators could accurately detect movement shown by system
- Amplitude usually increased with palpation
Describe Moran and Gibbons (Melbourne, Australia) study
Journal of Manipulative and Physiological Therapeutics, 2001
Showed poor interexaminer reliability in simultaneous palpation of head and sacrum
No statistical difference between of CRI rates in simultaneous palpation of head and sacrum
Describe Kenneth Nelson, DO et al. Study and interexaminer reliability
JAOA June 2006
Interexaminer reliability is impossible to establish due to irregularity of palpation records, perceived still points, and frequency modulation of CRI of 20%
Noted the inconsistency between palpation and instrumental measurements is explained by observation that clinicians correlated flexion with one TH oscillation and extension with one oscillation
Therefore, palpated CRI to recorded ratio is 1:2
Describe Moskalenko (1999 and 2001) studies
In healthy people, found continuous changes in cranial dimensions (frontal and sagittal sections) with biphasic characteristics using 2-channel bioimpedence imaging (mean amplitude 0.38 mm)
Also described cranial volume changes (12-15 ml of intracranial pressure)
Found a rate of 6-14 cycles/min
Describes interaction between intracranial hemodynamics and CSF circulation
Rate of 6-12 cycles/min
Intracranial origin of bioimpedence related to blood supply and oxygen consumption of cerebral tissue
Describe Greenblatt, J, Sandhouse, M, et al.
JAOA Aug 2002
The effects of cranial manipulation on visual function (pilot study)
Differences in distance visual acuity and vergence recovery (p
Describe Kenneth Nelson, DO 2001 & 2006 (CRI) study
Traube-Hering-Meyer oscillations correlated highly with CRI
Used laser doppler flowmetry
Rate of 5-10 cycles/min
Felt the CRI occurs simultaneously but may represent a different phenomenon
Describe the Thomas Crow DO et al 2008 study
MRI imagery of healthy human subjects
P
What are the principles of treatment for cranial?
Find the greatest restricted pattern of dysfunction
- Soma
- Cranium
Direct: force into barrier
Indirect:
- balanced membranous tension (still point)
- encourage amplitude of dynamic motion
Describe specific techniques for cranium dysfunctions
V-spread (Occipital mastoid suture)
Rocking the temporals
Balance the petrous portion of temporal bone
CV4
Condylar decompression
Apply techniques of choice to somatic dysfunctions
What is the lambda?
Point of meeting for sagittal and lambdoid suture
What is the asterion?
Point where the lambdoid, pariet-mastoid, and occipito-mastoid sutures meet
Or where parietal and occipital bones meet
What is the pterion?
Point where the sphenoparietal, coronal, and squamous sutures meet
Or where parietal bone, squamous part of temporal bone, greater wing of sphenoid bone, and frontal bone meet
What is the bregma?
Where coronal suture meets the sagittal suture
Or where frontal and parietal bones meet
Who is credited with the development of cranial manipulation concept?
William G. Sutherland, DO
