(Test #1) Intro to OCMM Lecture Flashcards
William G. Sutherland D.O.
- For What Dr Still did for the body, Sutherland did for the cranium
a) Range of motion
b) Vectors of motion
c) 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 had the design he noted
a) Thought it reminded him of the gills of a fish (mobility for respiratory mechanism) - 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 MECHANISM
William G. Sutherland D.O. Cont 1
- 1928 Sepp described fluctuations in the CV and CSF
- Did original research on himself and observations of his patients – 1930’s
a) 30 years of study before talking about his findings - Harold MAGOUN, D.O further expanded the concept in 1966
William G. Sutherland D.O. Cont 2
- Introduced his ideas to the profession
a) 1943 at Eastern Osteopathic Association Convention
b) JAOA published April 1944 - Prior to his teachings the head was considered as not having the ability to have somatic dysfunction
a) Although Dr Still noted the CSF was important to the function of the CNS - Established the Sutherland Cranial Teaching Foundation in 1953
- Research is ongoing and increasing in this area
Primary Respiratory Mechanism
- Primary
a) Main internal tissue process of metabolism - Respiratory
b) Exchange of gases - Mechanism
c) Movement of tissue and fluid for a purpose
Basic Tenets of the Classic Cranial Model
A. Inherent MOTILITY of the Central Nervous System
B. PLASTICITY and ELASTICITY of the intracranial and intraspinal membranes
C. FLUCTUATION of the cerebrospinal fluid
D. Articular MOBILITY and involuntary motion of
the CRANIAL BONES
E. Articular MOBILITY and involuntary motion of
the SACRUM BETWEEN THE ILIA
PRM
- MOSKALENKO Y. et al
- The AAO Journal , Vol. 13 No. 2 Summer 2003, page 21-33.
a) Physiological premises: CRI and PRM - Complex article covering modern physiologic interpretation of Dr. Sutherlands thoughts using modern knowledge of cranial CV and CSF flows
- He traces the history of research in this arena, and discusses the application of current research to the cranial concept.
PRM
Southerland vs Moden Interpretation
Structures
1) Sutherland: A) STRUCTURES OF THE PRM: - Brain/Spinal cord - CSF - Intracranial Membranes - Intraspinal membranes - Articular mechanism of cranial bones
2) Modern Interpretation
- Elements form the biophysical structures
- Determine INTERACTION BETWEEN THE VOLUME AND PRESSURE OF THE LIQUID MEDIA of the cranium – blood and CSF
PRM
Southerland vs Moden Interpretation
Dynamic Relations
1) Southerland: A) DYNAMIC RELATIONS OF THE PRM - Bone mobility is related to and controlled by RECIPROCAL TENSION MEMBRANE a) Cranial & Spinal dura b) Falx Cerebri and cerebelli c) Tentorium cerebelli
2) Modern Interpretation:
- Change in distance of fixed points are due to CSF fluctuations
- Reciprocal motions are determined by the modulatory role of the membranes
PRM
Southerland vs Moden Interpretation
Functioning PRM
1) Southerland:
A) FUNCTIONING OF THE PRM
- The brain is the MOTOR for the PRM
2) Modern Interpretation
- SLOW PERIODIC FLUCTUATIONS OF BLOOD VOLUME AND CSF PRESSURE!!!
a) 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
Cranial Rhythmic Impulse (CRI)
- Palpable BIPHASIC rhythmic pattern of motion within the cranium.
a) FLEXION of midline bones with EXTERNAL rotation of paired bones
b) 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*
CRI
- Must be relaxed in order to palpate and contact of the hands is very light
- Not a visible motion - palpable
- Separate of the respiratory and circulatory physiologic mechanism
CRI Characteristics
- Rate
- Rhythm
- Amplitude
- Strength
- Direction
Basic Motion of SBS
1) FLEXION:
- SPHENOID will rotate about a transverse axis so that the alae (wings) will move anterior/inferior and the motion at the SBS will be superior or cephalic
- 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
2) Extension is OPPOSITE Directions
3) Flexion – head gets shorter in the AP diameter and WIDER in the TRANSVERSE DIAMETER
4) Extension is OPPOSITE
Hersey and Adams Studies (1993)
- Showing compliance in CAT MODEL
- SKULL BONES MOVED WITH FORCES FROM FROM THE OUTSIDE AND INSIDE!!!!
- 30-70 microns of lateral movement at the sagittal suture
- 250 microns of rotational movement at the parietal bones
Frymann Study (1971)
- MEASURED THE MOTION OF THE HUMAN SKULL
- Pick mounted on the parietal bones
- Found rhythm of bones which varied with subjects
- In most cases, rhythm not synchronized with breathing
- Problems with pick-offs and artifacts
