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
