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OS IV Exam 1 > Principles of CRI/PRM > Flashcards

Principles of CRI/PRM Flashcards

1
Q

Definition of Cranial Manipulative Medicine

A

A system of diagnosis and treatment by DO using the primary respiratory mechanism and balanced membranous tension

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2
Q

Who “discovered” cranial?

A

William Garner Sutherland D.O.

Graduated from Kirksville in 1900

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3
Q

Sutherland’s Publishing Pathway

A

1931 - Published series of articles explaining concept of cranial = Pen name - Blunt Bone Bill

1939 - Published Cranial Bowl - Explaining treatments and mobility of cranium

1943 - Presented at Eastern Osteopathic Association Convention

1944 - Published in JAOA

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4
Q

When was the Sutherland Cranial Teaching Foundation established?

A

1953

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5
Q

What is the Primary Respiratory Mechanism?

A

“Fundamental life process”, “Breath of life”

Ebb and flow like breath with the movement of tissue and fluid for a purpose

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6
Q

Five Components of PRM

A
  1. Inherent mobility of the brain and spinal cord
  2. Fluctuation of CSF
  3. Mobility of the intracranial and intraspinal membrane
  4. Articulatory mobility of the cranial bones
  5. Involuntary mobility of the sacum between the ilia
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7
Q

What is thought to be responsible for PRM?

A

The contractile ability of elements within the brain

Traube-Hering Waves = Blood flow velocity changes

Glial cells = contribute to neurovascular coupling and regulates blood flow in the brain

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8
Q

Inherent Mobility and Amplified MRI Research

A

Methods: Compare aMRI of Chiari patients to aMRI of healthy individuals

Results: Abnormal biomechanics were seen on FFD maps of the Chiari I malformation patients

Conclusion: Phase-based a MRI could be used in the future to quantitatively analyze minute changes in brain motion. Preliminary data shows a potential phase-based aMRI to qualitatively assess abnormal biomechanic of Chiari I malformation - so basically nothing

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9
Q

What is Cranial Rhythmic Impulse (CRI)?

A

Rhythmic impulses on the human skull exhibits an average of 10-14 cycles/minute in normal adults

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10
Q

Key Concepts in Palpating the CRI

A

Physician must be relaxed with contant of the hands being very light

CRI is not visible motion

CRI is seperate from respiratory &/or circulatory physiology mechanisms, but they may influence each other

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11
Q

Motion Characteristics of CRIS

A

R-RADS

Rate - 10/14 bpm

Rhythm - palpated as regular

Amplitude - Significant SD diminishes movement

Direction - Healthy individuals have symmetrical movement

Strength - Significant SD and overally vitality of patient impacts strength

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12
Q

What is the Sutherland Fulcrum

A

The functional name given to the striaght sinus at the origin of the 3 sickle-shaped agents of the falx cerebri and tentorium cerebelli

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13
Q

What is Reciprocal Tension Membrane (RTM)?

A

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

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14
Q

What is the “core link”?

A

The importance in connecting the articular mechanism of the cranium with the sacrum to coordinate action

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15
Q

Changes in meninges with spinal flexion and extension

A

Extension - relaxes meninges and allows increased blood flow through the spinal column and the nerve roots are more relaxed and horizontal

Flexion - meninges are tight which decreases blood flow to the cord and causes tension on the spinal nerve roots which orients them more verticle/oblique

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16
Q

What is the composition of the intracranial membranes/dura folds?

A
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17
Q

What creates the Reciprocal Tension Membrane?

A

Tentorium

Falx Cerebri

Falx Cerebellum

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18
Q

What is the function fo the RTM?

A

Attaches to bones of the vault and base and holds them under contant tension

Allows for change of shape of vault while maintaining relatively constant volume

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19
Q

Anterior/Superior Attachment of the RTM

A

Crstia galli

20
Q

Anterior/Inferior Pole Attachment of RTM

A

Clinoid processes of the sphenoid

21
Q

Lateral Pole Attachment of the RTM

A

Mastoid angles of parietals bones

Petrous ridges of the temporal bones

22
Q

Posterior Pole Attachment of the RTM

A

Internal occipital protuberance

Transverse ridges of the occiput

23
Q

5 components of Primary Respiratory Mechanism (PRM)

A
  1. Inherent mobility of the brain and spinal cord
  2. Fluctuation of CSF
  3. Fascial mobility and continuity significantly impacts the PRM

Articulatory mobility of the cranial bones

Involuntary mobility of the sacrum between the ilia

24
Q

What is a fulcrum?

A

A point of rest around which motion occurs

25
Q

Movement of Sutherlands fulcrum (3)?

A

Suspended - moves but remains in the RTM

Automatic - moves with the motion of the CRI

Shifting - the straight sinus moves up and down

26
Q

What is the SBS?

A

The synchondrosis between the base of the sphenoid and the base of the occiput

Connected by a layer of cartilage

27
Q

Where is the Bregma suture?

A

Between the frontal and parietal bones

Used to be old anterior fontanelle

28
Q

Where is the lambda suture?

A

Between the occiput and the parietal bones

29
Q

Where’s the Sagittal suture?

A

Between the two parietal bones

30
Q

What does the head look like of someone with their cranium in extension?

A

Face in elongated and cheekbones are prominent

Head looks like Bert

Position of craium when people die

31
Q

What do peoples heads look like when their cranium is in flexion?

A

Head is wider and shorter

32
Q

Describe the inherent motion between the cranium and the sacrum?

A

Flexion of the occiput causes the sacrum sacrum to go into counternutation

Extension of the cranium causes the sacrum to go into nutation

33
Q

What are the transverse axis of motion of the sacrum and where are the located?

A

Superior Transverse Axis - Passes through the Posterior aspect of articular process of S2

Middle Transverse Axis - Passes through the anterior aspect of S2

Inferior Transverse Axis - Passes through the inferior auricular surface of S3

34
Q

What causes movement through the Superior Transverse Axis of the Sacrum?

A

Respiratory cycle and inherently due to PRM

35
Q

What causes movement through the Middle Transverse Axis of the Sacrum?

A

Axis around which nutation and counternutation occurs from standing

Known as postural axis

36
Q

What causes movement through the Inferior Transverse Axis of the Sacrum?

A

Axis of movement of the ilia on the sacrum

37
Q

What is sacral nutation?

A

Base of sacrum moves anteroinferior

Associated with exhalation/cranial extension

Nutation towards nuts

38
Q

What is sacral counternutation?

A

Base of the sacrum moves posterosuperior

Associated with inhalation/cranial flexion

39
Q

Parietal Bone Motion Research

A

Adams, Heisey, Smith and Briner (1992)

Studied cranial motion in cats

Results - Spontaneous motion objectively observed at patietal bones. Parietal bones moved with compressive force applied on temporal bones and sagittal sutures. Moved 30-70 microns laterally and 250 microns rotationally at parietal bones

40
Q

FIndings of External Pressure on Temporal Bones

Adams, Heisey, Smith and Briner (1992)

A

Pressure caused observed changes in respiration, blood pressure, and CSF pressure

Measured changes at parietal bones that reflected motion in multiple planes - lateral and rotational

41
Q

FIndings of External Pressure on Sagittal Suture

Adams, Heisey, Smith and Briner (1992)

A

No change observed in respiration or blood pressure

Caused lateral and rotational movement at the parietal bones

42
Q

JAOA Published Results of Finger sensation vs machines

A

Machines measure 2x as many impulses are fingers

43
Q

Moskalenko Research In Hemodynamics and CSF Circulation

A

In healthy people found continous changes in cranial dimesnions with biphasic characteristics

Intracranial origin of bioimpedence related to blood supply and oxygen consumption of the cerebral tissue

44
Q

What is the Asterion?

A

The point on the skull that corresponds with the end of the parietomastoid suture

45
Q

What is the pterion?

A

The region where the sphenoid, frontal, parietal, and temporal bones come together

OS IV Exam 1 (16 decks)

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