Intro to OCMM Flashcards
OCMM was first described by what physician?
William G. Sutherland, DO
5 components of the Primary Respiratory Mechanism
- Inherent mobility of the brain and SC
- Fluctuation of CSF
- Mobility of the intracranial and intraspinal membranes
- Articulatory mobility of the cranial bones
- Involuntary mobility of the sacrum between the ilia
Contributers to cranial motion have been recognized. The ______ ____ is d/t changes in blood flow velocity and is measurable by laser Doppler flowmetry
____ cells contribute to neurovascular coupling and regulate blood flow in the brain
Traube-Hering Wave
Glial
The ____ refers to the rhythmic CSF impulses on the human skull which exhibit an average of 10-14 cycles/minute in normal adults
CRI = cranial rhythmic impulse [note that typical accepted range is between 6-14]
Motion characteristics of the CRI
Rate (10-14) Rhythm Amplitude Strength Direction (longitudinal and symmetric)
SD can negatively affect any of these
A point of function generally located in the region of the straight sinus (junction of falx and tentoria); represents a point of rest (stillness) around which motion occurs
The sutherland fulcrum
What is the RTM?
Reciprocal tension membrane — refers to the idea that meninges and cord constitute link between the cranium and sacrum
The RTM itself is made up of the tentorium, falx cerebri, and cerebellum. It attaches to the bones of the vault and base, holding them under constant tension, allowing for change of shape of the vault while maintaining a relatively constant volume
In other words, it allows but limits motion
Main poles of RTM attachment
Anterior/superior pole = crista galli
Anterior/inferior pole = clinoid process of sphenoid
Lateral pole = mastoid angles of parietals and petrous ridges of temporal bones
Posterior pole = internal occipital protruberance and transverse ridges
Bones that make up the pterion
Frontal
Parietal
Temporal
Sphenoid
[sutures include coronal, sphenosquamous, parietosquamous]
Bones that make up the asterion
Parietal
Occipital
Temporal
What is bregma vs. lambda
Bregma = old anterior fontanelle
Lambda = old posterior fontanelle
SBS physiologic motion in flexion in terms of motion of the basi-occiput, basisphenoid, occipital squama, and greater wings of the sphenoid
Basi-occiput and basisphenoid move superiorly
Occipital squama move inferiorly and posteriorly
Greater wings of the sphenoid move inferiorly and anteriorly
SBS physiologic motion in extension in terms of motion of the basi-occiput, basisphenoid, occipital squama, and greater wings of the sphenoid
Basiocciput and basisphenoid move inferiorly
Occipital squama moves superiorly and anteriorly
Greater wing moves superiorly and posteriorly
SBS extension is paired with respiratory ________; the face elongates and the cheekbones are prominent
The SBS moves inferiorly; the sphenoid and occiput each have _____ axes of rotation
Exhalation
transverse
Inherent motion of the sacrum occurs with flexion/extension of the occiput d/t PRM tractional forces upon the dura that translate to the sacrum
What are the dural attachments that contribute to this inherent motion?
Dural attachment to foramen magnum as well as posterior body and disc of S2 in spinal canal
Axes of motion of the sacrum
Superior transverse = respiratory axis — transverse axis about which sacrum moves during respiratory cycle and inherently d/t PRM in OCMM; passes from side to side through the articular processes posterior to the point of attachment of the dura at S2
Middle transverse = postural axis — functional transverse axis of nutation and counternutation in the standing position, passing through the anterior aspect of S2
Inferior transverse = pelvic/ilial axis — functional transverse axis at the level of S3 through the inferior auricular surface and represents axis of movement of ilia on the sacrum
Nutation is matched with SBS ______
Extension [sacral base is anteroinferior, apex posterior, paired with exhalation]
Nutation = nodding of base anteriorly
Sacral _____ is matched with SBS flexion
Counternutation (base moves posteriorly)
Moskalenko described changes in CSF flow as related to what physiologic phenomena?
Intracranial origin of bioimpedence is related to blood supply and oxygen consumption of cerebral tissue
Describe flexion dysfunction of the SBS
The sphenoid and occiput move further during flexion and have less motion into extension
“Stewie head” — increased transverse diameter; forehead wide and sloping; AP diameters the same on both sides; sagittal suture flat or even slightly depressed
Describe extension dysfunction of the SBS
Sphenoid and occiput move further during extension and have less motion in flexion
“Bert head”— the long, narrow head; decreased transverse diameter; AP diamter is the same in the sagittal (AP) and coronal (L/R) plane; sagittal suture may be rigid
Steps in treating cranial dysfunction with BMT
Using frontal occipital hold or vault hold, SBS is held in the midpoint of the available motion until a still point is obtained
Position is maintained until CRI motion begins to return and is noted to be more symmetrical than before and normal motion is restored
With physiologic flexion:
Both orbits are _____ and eyeballs are _____
Both zygomatic tuberosities are ______
Pterygoid processes are equally _______
There is a low wide palatine arch with tendency for alveolar process to flare — a manifestation of ______ rotation of the maxillae
Both frontozygomatic angles are ______
Wide; prominent
Flattened
Posterolateral
External
Increased
Asthma and nasopharyngeal complaints may suggest what type of cranial SD?
Extension SD
With physiologic extension of the SBS:
Both orbits ___ and the eyeballs are _____
Both zygomatic tuberosities are ____ while the pterygoid processes are _____
High, narrow palatine arch with alveolar processes more vertical
Both frontozygomatic angles _____
Narrow; retruded
Prominent;anterior
Decreased
Would the following be indicative of SBS extension or flexion:
Midline symphysis menti, ears close to the head, mastoid portions posteromedial, mastoid tips anterolateral, and elevated condylosquama
Extension
With SBS flexion — what is the motion of the SBS, occiput, and greater wings of the sphenoid?
SBS cephalad
Occiput inferior/posterior
Greater wings inferior/anterior
With SBS flexion — what is the motion of the sacrum and cranial paired bones; and what respiratory cycle and change in AP diameter is taking place?
Sacrum extends (i.e.,base is posterior/counternutation)
Paired bones externally rotated
Corresponds with inhalation
AP diameter of the cranium shortens
With SBS extension, what is the motion of the SBS, occiput, and greater wings of the sphenoid?
SBS caudad
Occiput superior/anterior
Greater wings superior/posterior
With SBS extension — what is the motion of the sacrum and cranial paired bones; and what respiratory cycle and change in AP diameter is taking place?
Sacrum flexed (i.e.,base is anterior/nutation)
Paired bones are internally rotated
Corresponds with exhalation
AP diameter of the cranium lengthens
