OS3 Flashcards
What is osteopathic cranial manipulative medicine
System of diagnosis and treatment by an osteopathic practitioner using the primary respiratory mechanism
What is the primary respiratory machismo
Diagnosis and treatment from WIlliam Sutherland
Tell me about William Sutherland
1900 graduate from American SChool of Osteopathy in Kirskville
Developed osteopathy in cranial field when was hit by lightning bolt thought where he related beveled edges of the skull and a thought struck him “beveled, like the Gills of a fish indicating a primary respiratoy mechamis for motility”
Made himself unconscious with a head contraption
What is primary respiratory mechanism
Primary-fundamental-was unconscious when shut his down
Respiratory-PRM has ebb and flow like the breath “breath of life”
Mecahnism-movement of tissue and fluid for a purpose
What are the five components of the primary respiratory mechanism
- Inherent mobility of brain and spinal cord
- Fluctuation of CSF
- mobility of intracranial and intraspinal membranes
- articulatory mobility of cranial bones
- Involuntary mobility of the sacrum between the ilia
Inherent mobility of brain
Glial cells contribute to neovascular coupling and regulate blood flow in brain (structurally and physiologically)
Traube-hering wave-changes in blood flow velocity and is measurable by laser Doppler flowmetery
Cranial rhythmic impulse
The rhythmic impulses on the human skull exhibit an average of 10-14 cycles/minute in normal adults 6-14
Can you see cranial rhythmic impulse
Nope, must be palpated
Rate of cranial rhythmic impulse
10-14
Rhythm
Usually palpated as regular, like the tide of the ocean; known to have some variation
Amplitude cranial rhythmic impulse
Significant Sd may diminish it
Strength cranial rhythmic impulse
Significant SD and vitality of the patient greatly impacts strength
Direction cranial rhythmic impulse
In healthy individuals it is palpated as longitudinal and symmetric, but SD may cause it to be asymmetric
Sutherland fulcrum
Functional name given the straight sinus as the origin of the 3 cikle shaped agents of the falx cerebri and the tentorium cerebellum
Reciprocal tension membrane
The meninges and the cord constitute a link between the cranium and the sacrum
Core link
This refers to its importance in connecting the articular mechanism of the cranium with the sacrum to coordinate action
Fascia is ___ head to toe
Continuous
What are the dural folds
Falx cerebri
Tentorium cerebelli
Falx cerebelli
What do the falx cerebri, tentorium and cerebellum create
Reciprocal tension membrane
- unit of function that attaches to the bones of the vault and base, holding them under constant tension
- allows for change of shape of vault, while maintaining a relatively constant volume
Reciprocal tension membraneanterior/superior pole
Crista Gallo
Reciprocal tension membrane anterior inferior pole
Clinic process of sphenoid
Reciprocal tension membrane lateral pole
Mastoid angles of parietal and petroud ridges of temporal bones
reciprocal tension membrane posterior pole
Internal occipital protuberance and transverse ridges
What are the five components of PRM
- The inherent mobility of brain and spinal cord
- fluctuation of the CSF
- Fascial mobility and continuity significantly impacts PRM
- Articulatory mobility of the cranial bones
- In life voluntary mobility of the sacrum between the ilia
What is the Sutherland fulcrum
Straight sinus at junction of falx and tentoria
-it is a point of function : a point of rest (stillness) around which motion occurs
What is SBS
Sphenobasilar symphysis
Where basisphenoid and the basiocciput join to form a synchondrosis
What is a synchondrosis
Almost immovable joint between bones bound by a layer of cartilage
Flexion SBS
Inhalation-SBS moves superiorly with increased angle inferiorly
SBS rises superiorly as the distance decreases between the inferior angle of the sphenoid and occipital decreases toward the mid position
- basi-occiput and basi-sphenoid move superiorly
- occipital squamous moves inferiorly and posteriorly
- greater wing moves inferiorly and anteriorly
SBS extension
Exhalation
-how die tall face. Elongates
SBS moves inferiorly
Sphenoid and occipital have transverse axes of rotation
Mobility of the sacrum between ilia is __-
Involuntary
The postural mobility of the sacrum between the ilia is __
Voluntary
How does the sacrum involuntarily move between ilia
Physical extension of the influence of the PRM by way of the spinal dura mater, whose lower attachments contribute to the guiding and limiting action
Inherent motion and core link
Dural atachment to the foramen magnum
Dural atachment to the posterior body and disc of S2 in the spinal canal
-so, get flexion and extension movement of the occipital due to the PRM creates fractional forces upon the dura and translated to the sacrum
What is the sacral superior transverse axis/respiratory
Transverse axis about which the sacrum moves during the respiratory cycle and inherently due to PRM in OCMM.
Where does the superior transverse/respiratory axis pass
From side to side through the articular processes posterior to the point of attachment of the dura at S2
Middle transverse axis/postural
Functional transverse axis of nutation and counternutation in the standing position, passing through the anterior aspect of S2
Where does the middle transverse axis pass
Through the anterior aspect of S2
Superior transverse.pelvic .iliac axis
Functional transverse axis at the level of s3 through the inferior auricular surface and represents the axis for movement of the ilia on the sacrum
Mutation
Nodding of base anteriorly
Nutation is matched with SBS ___
Extension (base anteroinferior, apex posterior)
Exhalation extension
Counternutation
Base moves posteriorly(base posterosuperior, apex anterior)
Counternutation is matched with SBS ___
Flexion
Inhalation flexion
Sacrum extends?
Inherent motion
Flexion (inhalation)
Base tips posteriorly
Apex moves posteriorly
Extension (exhalation)
Base tips anteriorly
Apex moves posteriorly
Postural motion
Counternutation
Base tips posteriorly
Apex moves anteriorly
Nutation
Base tips anteriorly
Apex moves posteriorly
Adams, heist, smith and briner
Spontaneous motion objectively observed at parietal bones -(as described by Sutherland)
Parietal bones moved wth compressive force applied on temporal bones and sagittal suture
Baseline and spontaneous activity of parietal bones
Baseline-motion detectors turned on but not connected
Spontaneous activity-measured motion when attachment to parietal bones (we got 30-70 microns of lateral movement at the sagittal suture and 250 microns of rotational movement at the parietal bones)
External pressure on temporal bones
See observed change in respiration, bp, csf pressure
Also caused measured change at parietal bones that reflected motion in multiple planes-lateral and rotational movement
External pressure on sagittal suture
No change observed change in respiration or bp
However it caused lateral and rotational movement at the parietal bones
Define pterion, asterion, Bergman, lamda
Ok
What are the main cranial sutures
Ok
Through what foramen do each of the cranial nerves exit the cranial vault
Ok
What is the clinical significance of occipital mastoid suture
Ok
Trace the main sinuses that drain the venous blood fromt he cranium and where does the clear majority of this venous blood exit the cranium
Ok
What is the normal range for the CRI based on research
Ok
What is the CRI and how does it relate to the cranial concept
Ok
What is the current view as to what is causing the fluctuation of the CSF
Ok
Describe current intreptation of Sutherland’s ideas on the PRM as documented by moskalenko
In healthy people he found continuous changes in cranial dimensions (frontal and sagittal sections) with biphasic characteristics using 2 channel bioimpedence imaging (mean amplitude=.38 mm)
- also described cranial volume changes (12-15 ml of intracranial pressure)
- found a rate of 6-14 cycles / min
In summery he described 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
Physiological background of the CRI and the PMR
Review article examining Dr. Sutherlands original assumptions in light of ongoing research —examines CRI and PRM with respect to trouble hearing effects and the physics of fluid dynamics
Moskalenko trace the history of research in this area and discuss the application of current research to the cranial concept
Adams Hersey smith and briner
Did on cat
CRI rate
10-14 cpm
CRI rhythm: palpating
Regular, like a tide of the ocean
CRI amplitude
Significant SD may diminish
CRI direction
In health-longitudinal and symmetric
SD_asymmetric
Strength CRO
Significant SD and the overall vitality of the patient greatly impacts strength
How do you do a vault contact
Index-greater wing of sphenoid Middle-front of ear Ring finger-on mastoid process of temporal bone Pinky-on occipital Thumb-above calvaria
Frontal occipital contact
Side of head
One hand cups the occipital
The long or little finger of the other hand is on one greater wing of the sphenoid with the thumb on the opposite greater wing
Rest caudal elbow on the table
Becker contact
Thumbs on greater sphenoid wings(inferior to frontozygoamtic suture)
Index-rest on the mastoid processes
Middle to pinky-rest on occipital with middle finger posterior to OM suture
Palms-cup occiput and posterior aspect of the parietal
Cranial flexion
Sphenoid-greater wings move anterior/inferior during flexion and reverse during extension
Occiput-membranous portion of the occiput moves psoteriorinferior during flexion and reverses during extension
Sphenobasilar-SBS moves cephalad
Extension cranium
Greater wings sphenoid-posterior superior
Occipital-anterior superior
SBS-caudad
Flexion dysfunction of SBS
Sphenoid and occiput move further during flexion and have less motion into extension (ease of motion is to flexion and restriction of motion is to extension)
Increased transverse diameter;forehead wide and sloping:AP diameters the same on both sides;sagittal suture flat or even slightly depressed
Extension dysfunction SBS
Sphenoid and occiput move further during extension and have less motion in flexion (east of motion is to extension and restriction of motion is to flexion)
The long narrow head: decreased transverse diameter, AP diameter is the same int he sagittal(AP) and coronal (Left right ) plane; sagittal suture may be rigid
Nutation
During cranial extension of the SBS the sacral base moves anterior around the transverse axis
Counternutation
During cranial flexion of the SBS the sacral base moves posteriorly aroudn a transverse axis
BMT
Indirect treatment where evaluate SBS dysfunction for F and E it is held in midpoint of available motion until a still point is obtained
What is a still point
Can’t feel CRI
How long do we hold BMT for
Until the CRI motion begins to return and is noted to be more symmetrical than before and normal motion is restored
During the ___ ___, some membranes stretch while others contract. Once the tensions balance out, the CRI becomes more symmetrical and the ability to feel the CRI returns
Still point
What can we use BMT for and what is the principle technique
Any other cranial bone dysfunction (midline or paired). The principle of the technique is applied to the bones dysfunction: find the midpoint of motion, hold it there until a still point is felt, maintain until CRI returns and note that it has returned in a more symmetrical pattern than before and normal motion of the CRI is restored
