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1
Q

What is osteopathic cranial manipulative medicine

A

System of diagnosis and treatment by an osteopathic practitioner using the primary respiratory mechanism

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2
Q

What is the primary respiratory machismo

A

Diagnosis and treatment from WIlliam Sutherland

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3
Q

Tell me about William Sutherland

A

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

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4
Q

What is primary respiratory mechanism

A

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

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5
Q

What are the five components of the primary respiratory mechanism

A
  1. Inherent mobility of brain and spinal cord
  2. Fluctuation of CSF
  3. mobility of intracranial and intraspinal membranes
  4. articulatory mobility of cranial bones
  5. Involuntary mobility of the sacrum between the ilia
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6
Q

Inherent mobility of brain

A

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

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7
Q

Cranial rhythmic impulse

A

The rhythmic impulses on the human skull exhibit an average of 10-14 cycles/minute in normal adults 6-14

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8
Q

Can you see cranial rhythmic impulse

A

Nope, must be palpated

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9
Q

Rate of cranial rhythmic impulse

A

10-14

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10
Q

Rhythm

A

Usually palpated as regular, like the tide of the ocean; known to have some variation

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11
Q

Amplitude cranial rhythmic impulse

A

Significant Sd may diminish it

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12
Q

Strength cranial rhythmic impulse

A

Significant SD and vitality of the patient greatly impacts strength

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13
Q

Direction cranial rhythmic impulse

A

In healthy individuals it is palpated as longitudinal and symmetric, but SD may cause it to be asymmetric

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14
Q

Sutherland fulcrum

A

Functional name given the straight sinus as the origin of the 3 cikle shaped agents of the falx cerebri and the tentorium cerebellum

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15
Q

Reciprocal tension membrane

A

The meninges and the cord constitute a link between the cranium and the sacrum

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16
Q

Core link

A

This refers to its importance in connecting the articular mechanism of the cranium with the sacrum to coordinate action

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17
Q

Fascia is ___ head to toe

A

Continuous

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18
Q

What are the dural folds

A

Falx cerebri
Tentorium cerebelli
Falx cerebelli

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19
Q

What do the falx cerebri, tentorium and cerebellum create

A

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
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20
Q

Reciprocal tension membraneanterior/superior pole

A

Crista Gallo

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21
Q

Reciprocal tension membrane anterior inferior pole

A

Clinic process of sphenoid

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22
Q

Reciprocal tension membrane lateral pole

A

Mastoid angles of parietal and petroud ridges of temporal bones

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23
Q

reciprocal tension membrane posterior pole

A

Internal occipital protuberance and transverse ridges

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24
Q

What are the five components of PRM

A
  1. The inherent mobility of brain and spinal cord
  2. fluctuation of the CSF
  3. Fascial mobility and continuity significantly impacts PRM
  4. Articulatory mobility of the cranial bones
  5. In life voluntary mobility of the sacrum between the ilia
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25
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
26
What is SBS
Sphenobasilar symphysis Where basisphenoid and the basiocciput join to form a synchondrosis
27
What is a synchondrosis
Almost immovable joint between bones bound by a layer of cartilage
28
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
29
SBS extension
Exhalation -how die tall face. Elongates SBS moves inferiorly Sphenoid and occipital have transverse axes of rotation
30
Mobility of the sacrum between ilia is __-
Involuntary
31
The postural mobility of the sacrum between the ilia is __
Voluntary
32
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
33
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
34
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.
35
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
36
Middle transverse axis/postural
Functional transverse axis of nutation and counternutation in the standing position, passing through the anterior aspect of S2
37
Where does the middle transverse axis pass
Through the anterior aspect of S2
38
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
39
Mutation
Nodding of base anteriorly
40
Nutation is matched with SBS ___
Extension (base anteroinferior, apex posterior) Exhalation extension
41
Counternutation
Base moves posteriorly(base posterosuperior, apex anterior)
42
Counternutation is matched with SBS ___
Flexion Inhalation flexion Sacrum extends?
43
Inherent motion
Flexion (inhalation) Base tips posteriorly Apex moves posteriorly Extension (exhalation) Base tips anteriorly Apex moves posteriorly
44
Postural motion
Counternutation Base tips posteriorly Apex moves anteriorly Nutation Base tips anteriorly Apex moves posteriorly
45
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
46
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)
47
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
48
External pressure on sagittal suture
No change observed change in respiration or bp | However it caused lateral and rotational movement at the parietal bones
49
Define pterion, asterion, Bergman, lamda
Ok
50
What are the main cranial sutures
Ok
51
Through what foramen do each of the cranial nerves exit the cranial vault
Ok
52
What is the clinical significance of occipital mastoid suture
Ok
53
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
54
What is the normal range for the CRI based on research
Ok
55
What is the CRI and how does it relate to the cranial concept
Ok
56
What is the current view as to what is causing the fluctuation of the CSF
Ok
57
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
58
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
59
Adams Hersey smith and briner
Did on cat
60
CRI rate
10-14 cpm
61
CRI rhythm: palpating
Regular, like a tide of the ocean
62
CRI amplitude
Significant SD may diminish
63
CRI direction
In health-longitudinal and symmetric | SD_asymmetric
64
Strength CRO
Significant SD and the overall vitality of the patient greatly impacts strength
65
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 ```
66
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
67
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
68
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
69
Extension cranium
Greater wings sphenoid-posterior superior Occipital-anterior superior SBS-caudad
70
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
71
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
72
Nutation
During cranial extension of the SBS the sacral base moves anterior around the transverse axis
73
Counternutation
During cranial flexion of the SBS the sacral base moves posteriorly aroudn a transverse axis
74
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
75
What is a still point
Can’t feel CRI
76
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
77
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
78
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

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