Cranial Rhythmic Impulse (CRI) Flashcards
ECOP definition of OCMM
- System of diagnosis and treatment by an osteopathic physician using the primary respiratory mechanism (PRM) and balanced membranous tension
- first described by William Garner Sutherland, DO.
Mechanisms of OCMM technique:
The interdependent functions among five body components as follows….
- The _____ _____ of the brain and spinal cord
Mechanisms of OCMM technique:
The interdependent functions among five body components as follows:
- The inherent motility of the brain and spinal cord
Mechanisms of OCMM technique:
The interdependent functions among five body components as follows….
- _____ of the cerebrospinal fluid
Mechanisms of OCMM technique:
The interdependent functions among five body components as follows:
- Fluctuation of the cerebrospinal fluid
Mechanisms of OCMM technique:
The interdependent functions among five body components as follows….
- _____ of the intracranial and intra-spinal membrane
Mechanisms of OCMM technique:
The interdependent functions among five body components as follows:
- Mobility of the intracranial and intra-spinal membrane
Mechanisms of OCMM technique:
The interdependent functions among five body components as follows….
- _____ _____ of the cranial bones
Mechanisms of OCMM technique:
The interdependent functions among five body components as follows:
- Articular mobility of the cranial bones
Mechanisms of OCMM technique:
The interdependent functions among five body components as follows….
- The _____ _____ of the sacrum between the ilia (pelvic bones)
Mechanisms of OCMM technique:
The interdependent functions among five body components as follows:
- The involuntary mobility of the sacrum between the ilia (pelvic bones)
Primary Respiratory Mechanism
(CNS + CSF + Dural Membranes + Cranial Bones + Sacrum)
Primary because ?
Primary because its directly related to the internal tissue respiration of the CNS
Primary Respiratory Mechanism
(CNS + CSF + Dural Membranes + Cranial Bones + Sacrum)
Respiratory because ?
Respiratory because it involves the exchange of fluids necessary for normal metabolism & biochemistry in all cells of the body
Primary Respiratory Mechanism
(CNS + CSF + Dural Membranes + Cranial Bones + Sacrum)
Mechanism because ?
Mechanism because all parts work together as a unit
Cranial rhythmic impulse (CRI)
CRI is?
CRI is the fluctuation of motion felt on the cranial bones
Cranial rhythmic impulse (CRI)
Indications
- Headaches secondary to non-life-threatening biomechanical somatic dysfunction
- Mild to severe whiplash strain and sprain injuries
- Vertigo
- Tinnitus
- Otitis media with effusion and serous otitis media
- TMJ dysfunction
- Sinusitis
Cranial rhythmic impulse (CRI)
Relative Contraindications
- Coagulopathies
- Space-occupying lesion in the cranium
Cranial rhythmic impulse (CRI)
Absolute Contraindications
- Acute intracranial bleeding and hemorrhage
- Increased intracranial pressure
- Acute skull fracture
- Certain seizure states
Classic Cranial Vault Hold
Purpose ?
*** dont forget to HIP FLOP ***
- To address the strains at the SBS
- Can use a direct or indirect method of treatment
-
Most common: indirect method
- use to balance membranous tension
-
Most common: indirect method
Classic Cranial Vault Hold
Finger placement ?
*** dont forget to HIP FLOP ***
- Thumbs should not touch the skull
- Index: greater wing of the sphenoid
- Middle: temporal bone in front of the ear
- Ring: mastoid region of temporal bone
- Pinky: squamous portion of the occiput (medial to OCM suture)
Classic Cranial Vault Hold
Why hip flop ?
*** dont forget to HIP FLOP ***
Involuntary Mobility of the Sacrum between the Ilia
- Cranial dura is continuous with the C2/3 Vertebral Spinal Dura.
- The spinal dura extends through the Vertebral Canal into the Sacral Canal.
- It attaches to the posterior aspect of S-2.
Reciprocal Tension Membrane: Core Link
- The inferior attachment of the dural tube is to the posterior aspect of the body of S2
- The sacrum is suspended between the ilia by anterior, posterior, and intra-articular ligaments
Craniosacral Motion
Cranial Flexion movements ?
(SBS, midline bones, paired bones, PRM, Sacral base, AP diameter of cranium)
*** dont forget to HIP FLOP ***
- SBS: SBS Rises
- Midline Bones: Flexion
- Paired Bones: External Rotation + Superior
- PRM: Inhalation
- Sacral Base: Posterior base (Counternutation)
- AP Diameter of Cranium: Decreased
Craniosacral Motion
Cranial Extension movements ?
(SBS, midline bones, paired bones, PRM, Sacral base, AP diameter of cranium)
*** dont forget to HIP FLOP ***
- SBS: SBS Falls
- Midline Bones: Extension
- Paired Bones: Internal Rotation + Inferior
- PRM: Exhalation
- Sacral Base: Anterior base (Nutation)
- AP Diameter of Cranium: Increased
Craniosacral Motion
Cranial Flexion hand / finger movements ?
*** dont forget to HIP FLOP ***
Cranial Flexion:
the AP diameter of the skull shortens and widens laterally
- External rotation of temporal bones
-
Sphenoid bone tilts forward & occiput tilts backward
- Fingers should move forward and spread out
-
Axis: 2 parallel transverse axis → rotate OPPOSITE
- Sphenoid: through sphenoid body at S/S pivot
- Occiput: cephalad to jugular process at level of SBS
Craniosacral Motion
Cranial Extension hand / finger movements ?
*** dont forget to HIP FLOP ***
Cranial Extension:
the AP diameter of the skull lengthens & narrows laterally
- Internal rotation of temporal bones
-
Sphenoid bone tilts backward & occiput tilts up
- Fingers should move back and come together
-
Axis: 2 parallel transverse axis → rotate OPPOSITE
- Sphenoid: through sphenoid body at S/S pivot
- Occiput: cephalad to jugular process at level of SBS
Craniosacral Strain Patterns
Physiologic
Describe Torsion using hands and verbalize
Torsion
-
Axis: 1 AP axis
- Direction: sphenoid + occiput → rotate OPPOSITE
-
Named: for the greater wing of the sphenoid that is more superior
- Ex: right torsion feels as if the greater wing of the sphenoid on the right elevates and rotates to the left
Craniosacral Strain Patterns
Physiologic
Describe Sidebending Rotation using hands and verbalize
Sidebending Rotation
- Axis + Direction: 3
-
Rotation:
- Egg analogy: Dump the egg
- 1 AP axis: sphenoid + occiput → rotate SAME
-
Sidebending:
- Egg analogy: Crack the egg
-
2 Parallel verticle axis: → rotate OPPOSITE
- Base body of sphenoid
- Foramen magnum
- Named: for the side of convexity
-
What is the motion?
- Right Sidebending/Rotation (picture)
- Right hand: Fingers should move forward and spread out (feels full)
- Left hand: Fingers should move back and come together and move superiorly
- Right Sidebending/Rotation (picture)
Craniosacral Strain Patterns
Physiologic
Describe Lateral strain using hands and verbalize
Lateral strain
-
Axis: 2 parallel vertical axis → rotate SAME
- Base body of sphenoid
- Foramen magnum
- Named: for the position of basi-sphenoid
- Head appears “parallelogram”
Craniosacral Strain Patterns
Physiologic
Describe Vertical strain using hands and verbalize
Vertical strain
-
Axis: 2 parallel transverse axis → rotate SAME
- Sphenoid: through sphenoid body at S/S pivot
- Occiput: cephalad to jugular process at level of SBS
- Named: for the position of basi-sphenoid
-
What is the motion? “Jump Under/Over the Fence”
-
Superior (OVER):
- FLEX @ sphenoid + EXTEND @ occiput
- Index fingers move DOWN + pinky fingers more UP
-
Inferior (UNDER):
- Extend @ sphenoid + FLEX @ occiput
- Index fingers move UP + pinky fingers move DOWN
-
Superior (OVER):
Craniosacral Strain Patterns
Physiologic
Describe Compression strain using hands and verbalize
Compression strain
- occurs when the occiput and sphenoid are pressed together
- preventing motion (or void of any motion)
- feels rock hard like a bowling ball, jammed together
- CRI can be almost completely gone
CV 4
Technique
- Pt supine, phys seated at head with both forearms resting on the table, establishing a fulcrum.
- Interlaces the fingers, cradling the pt’s occipital squama.
-
Thenar eminences postero- medial to the pt’s occipitomastoid sutures.
- If thenar eminences on the mastoid processes, compression that will bilaterally externally rotate temporal bones
- may cause extreme untoward reactions
- If thenar eminences on the mastoid processes, compression that will bilaterally externally rotate temporal bones
- Phys encourages extension of the occiput by following the occiput as it moves into extension.
- Phys resists flexion by holding occiput in extension with bilateral medial forces.
- This force is maintained until the amplitude of the CRI decreases, a still point is reached IN EXTENSION, and/or a sense of release is felt.
- As the CRI resumes, the physician slowly releases the force, allowing the CRI to undergo newfound excursion into flexion.
- The rate and amplitude of the CRI are retested to assess the effectiveness of the technique.
- ***Video NOTE: Know the indications, know to stay midline, know what phase you are trying to accentuate. **
Venous Sinus Drainage
Technique location overview
*** REMEMBER RESPIRATORY ASSIST THROUGHOUT-may take 3-4 breath cycles to feel the softening ***
- Pt supine, phys seated at head both elbows resting on table establishing a fulcrum.
-
Inion (Confluence of Sinuses)
- PC1 Inion: Flex, Sara
- Occipital Sinus
- Condylar Decompression
- Transverse Sinus
- Superior Sagittal Sinus
- Metopic Suture
- RATE AND AMPLITUDE of CRI are RETESTED to assess the effectiveness of the technique.
Venous Sinus Drainage
Technique
Inion (Confluence of Sinuses)
*** REMEMBER RESPIRATORY ASSIST THROUGHOUT-may take 3-4 breath cycles to feel the softening ***
- Pt supine, phys seated at head both elbows resting on table establishing a fulcrum.
-
Inion (Confluence of Sinuses):
- Physician cradles back of the patient’s head and places middle finger on inion.
- Maintain pressure until softening is felt.
- PC1 Inion: Flex, Sara
Venous Sinus Drainage
Technique
Occipital Sinus
*** REMEMBER RESPIRATORY ASSIST THROUGHOUT-may take 3-4 breath cycles to feel the softening ***
- Pt supine, phys seated at head both elbows resting on table establishing a fulcrum.
-
Occipital Sinus:
- Physician cradles back of patient’s head and places the second and fourth fingers of both hands in opposition along midline from inion to the suboccipital tissues.
- Maintain pressure until softening is felt.
Venous Sinus Drainage
Technique
Condylar Decompression
*** REMEMBER RESPIRATORY ASSIST THROUGHOUT-may take 3-4 breath cycles to feel the softening ***
- Pt supine, phys seated at head both elbows resting on table establishing a fulcrum.
-
Condylar Decompression:
- Keep fingers in suboccip region.
- Bring elbows together, causing the fingers to spread out laterally.
- Let the head do all the work with the weight.
- Have them breathe in and out.
Venous Sinus Drainage
Technique
Transverse Sinus
*** REMEMBER RESPIRATORY ASSIST THROUGHOUT-may take 3-4 breath cycles to feel the softening ***
- Pt supine, phys seated at head both elbows resting on table establishing a fulcrum.
-
Transverse Sinus:
- Physician places the first and second finger pads of both hands across the superior nuchal line.
- The position is maintained with minimal pressure (weight of the patient’s head should suffice) until the release is felt bilaterally.
- This will feel like softening under the fingers.
Venous Sinus Drainage
Technique
Superior Sagittal Sinus
*** REMEMBER RESPIRATORY ASSIST THROUGHOUT-may take 3-4 breath cycles to feel the softening ***
- Pt supine, phys seated at head both elbows resting on table establishing a fulcrum.
-
Superior Sagittal Sinus (demonstrated with thumbs crossed and modified hand position):
- Placed 2 crossed thumbs on either side to disengage the suture. The head will be flexed.
- Once the release is felt, physician moves anteriorly and superiorly along the superior sagittal suture with crossed thumb forces, noting releases at each location toward the bregma.
Venous Sinus Drainage
Technique
Metopic Suture
*** REMEMBER RESPIRATORY ASSIST THROUGHOUT-may take 3-4 breath cycles to feel the softening ***
- Pt supine, phys seated at head both elbows resting on table establishing a fulcrum.
-
Metopic Suture:
- Once at the Bregma, place the second-fourth fingers of both hands in opposition along the midline of the frontal bone at the location of the metopic suture.
- Continue anteriorly, disengaging the suture by gently separating each finger on opposing hands.
