Intro to Cranial Osteopathic Manipulative Medicine

Question 1

William G. Sutherland, D.O.

Answer 1

For what Dr. Still did for the body, Sutherland did for the cranium

• ROM; vectors of motion; physiologic dynamics of cranial bones and intracranial structures
• observed a disarticulated skull and its beveled surfaces in the sutures and wanted to know why they hand the design he noted
• described a slow oscillating force in the cranial structures that would cause movement in the cranial bones
• described the CNS, CSF, and the dural membranes a functional unit (primary respiratory mechanisms)

Question 2

Harold Magoun, D.O

Answer 2

further expanded the concepts behind cranial OMT in 1996

Question 3

Sutherland introduced his ideas to the profession in

Answer 3

1943 at Eastern Osteopathic Association Convention

-JAOA published April 1944

Question 4

Prior to Sutherland’s teaching, the head..

Answer 4

the head was considered as not having the ability to have somatic dysfunction

Question 5

Sutherland Cranial Teaching foundation established in

Answer 5

1953

Question 6

Primary Respiratory Mechanisms

Answer 6

-main internal tissue process of metabolism; exchange of gases; movement of tissue and fluid for a purpose

Question 7

confluence of temporal, parietal and occiput
confluence of frontal, temporal parietal, sphenoid
where coronal and sagittal suture meet
where sagittal suture meets lamdoidal suture

Answer 7

asterion
pterion
bregma (in the front)
lambda (in the back of head)

Question 8

Basic tenets of the classical cranial model

Answer 8

• inherent motility of the CNS
• plasticity and elasticity of the intracranial and intraspinal membranes
• fluctuation of the CSF
• articular mobility and involuntary motion of the cranial bones
• articular mobility and involuntary motion of the sacrum between the ilia

Question 9

Structures of the PRM (Sutherland)

Answer 9

Brain/spinal cord

• CSF
• Intracranial membranes
• Intraspinal membranes
• articular mechanisms of cranial bones

Question 10

Modern interpretation of PRM structures

Answer 10

• elements for biophysical structures

- determine interaction between the volume and pressure of the liquid media of the cranium–blood and CSF

Question 11

Dynamic Relations of the PRM (Sutherland)

Answer 11

• bone mobility is related to and controlled by reciprocal tension membrane
• cranial and spinal dura
• falx cerebri and cerebelli
• tentorium cerebelli

Question 12

Dynamic relations of the PRM modern interpretation

Answer 12

• change in distance of fixed points are due to CSF fluctuations
• reciprocal motions are determined by the modulatory role of the membranes

Question 13

Functioning of the PRM (Sutherland)

Answer 13

the brain is the motor for the PRM

Question 14

Function of the PRM modern interpretation

Answer 14

• slow periodic fluctuations of blood volume and CSF pressure (support brain metabolic supply and water balance of brain tissue)
• these are responsible for the motion of brain tissue and skull bones
• the fluctuations are functionally connected to chemical and physical homeostatic mechanisms of the brain tissue

Question 15

Cranial Rhythmic Impulse (CRI)

Answer 15

• palpable biphasic rhythmic pattern of motion within cranium
• flexion of midline bones with external rotation of paired bones
• extension of midline bones with internal rotation of paired bones
• present in living individuals
• normal rate is 10-14 times a minute (range 6-14)

Question 16

CRI characteristics

Answer 16

-rate, rhythm, amplitude, strength, direction

Question 17

SBS flexion

Answer 17

• sphenoid will rotate about a transverse axis so that the algae (wings) will move anterior/inferior and the motion of 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 the occiput will move posterior/inferior
• head gets shorter in the AP diameter and wider in the transverese diameter

Question 18

Heisey and Adams studies

Answer 18

• showing compliance in cat model
• skull bones moved with force from outside and inside
• 30-70 microns of lateral movement at the sagittal suture
• 250 microns of rotational movement at the parietal bones

Question 19

Fryman study

Answer 19

• Measured motion of the human skull
• pick mounted on the parietal bones
• found rhythm of bones which varied with subjects
• in most cases, rhythm not syncrhonized with breathing
• problems with pick-offs and artifacts

Question 20

A Zanakis and colleagues

Answer 20

• recording device used infrared device
• measured to 10 microns
• computer canceled out common movement between markers
• recorded most data from parietals with reference at bregma
• average movements independent of breathing or heart rate about 7 per minute
• sometimes fairly symmetrical and sometimes asymmetrical
• amplitudes from 0 to 400 microns of motion; usually 100-200 microns
• palpators could accurately detect movements shown by system
• amplitutde usually increased with palpation

Question 21

Pledger study in 1977

Answer 21

• Moran and Gibbons
• journal of manipulative and phyiological therapeutics, 2001
• showed poor inter examiner reliability in simultaneous palpation of head and sacrum

Question 22

Kenneth Nelson, D.O. et all

Answer 22

• JAOA june 2006
• inter-examiner 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 instrument is explained by the observation that clinicians correlated flexion with one TH oscillation and extension with one oscillation
• therefore the palpated CRI to recorded ratio is 1:2

Question 23

Moskalenko (1999 and 2001)

Answer 23

• in healthy people found continuous changes in cranial dimensions (Frontal and sagittal sections) with biphasic characteristics using 2-channel bioimpedence imaging
• 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)

Question 24

Greenblatt, J, Sandhouse, M, et al.

Answer 24

• JAOA Aug 2002
• the effects of cranial manipulation on visual function
• a pilot study
• differences in distance visual acuity and mergence recovery (p

Question 25

Kenneth Nelson, D.O 2001 and 2006

Answer 25

• Traube-Hering-Meyer oscillations correlated highly with CRI
• used laster doppler flowmetry
• rates of 5-10 cycles/min
• felt the CRI occurs simultaneously but may represent a different phenomenon

Question 26

Thomas Crow DO et al 2008

Answer 26

MRI imagery of healthy human subjects

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