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Flashcards in Intro to OCMM Deck (30)
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OCMM was first described by what physician?

William G. Sutherland, DO


5 components of the Primary Respiratory Mechanism

1. Inherent mobility of the brain and SC

2. Fluctuation of CSF

3. Mobility of the intracranial and intraspinal membranes

4. Articulatory mobility of the cranial bones

5. Involuntary mobility of the sacrum between the ilia


Contributers to cranial motion have been recognized. The ______ ____ is d/t changes in blood flow velocity and is measurable by laser Doppler flowmetry

____ cells contribute to neurovascular coupling and regulate blood flow in the brain

Traube-Hering Wave



The ____ refers to the rhythmic CSF impulses on the human skull which exhibit an average of 10-14 cycles/minute in normal adults

CRI = cranial rhythmic impulse [note that typical accepted range is between 6-14]


Motion characteristics of the CRI

Rate (10-14)
Direction (longitudinal and symmetric)

SD can negatively affect any of these


A point of function generally located in the region of the straight sinus (junction of falx and tentoria); represents a point of rest (stillness) around which motion occurs

The sutherland fulcrum


What is the RTM?

Reciprocal tension membrane — refers to the idea that meninges and cord constitute link between the cranium and sacrum

The RTM itself is made up of the tentorium, falx cerebri, and cerebellum. It attaches to the bones of the vault and base, holding them under constant tension, allowing for change of shape of the vault while maintaining a relatively constant volume

In other words, it allows but limits motion


Main poles of RTM attachment

Anterior/superior pole = crista galli

Anterior/inferior pole = clinoid process of sphenoid

Lateral pole = mastoid angles of parietals and petrous ridges of temporal bones

Posterior pole = internal occipital protruberance and transverse ridges


Bones that make up the pterion


[sutures include coronal, sphenosquamous, parietosquamous]


Bones that make up the asterion



What is bregma vs. lambda

Bregma = old anterior fontanelle

Lambda = old posterior fontanelle


SBS physiologic motion in flexion in terms of motion of the basi-occiput, basisphenoid, occipital squama, and greater wings of the sphenoid

Basi-occiput and basisphenoid move superiorly

Occipital squama move inferiorly and posteriorly

Greater wings of the sphenoid move inferiorly and anteriorly


SBS physiologic motion in extension in terms of motion of the basi-occiput, basisphenoid, occipital squama, and greater wings of the sphenoid

Basiocciput and basisphenoid move inferiorly

Occipital squama moves superiorly and anteriorly

Greater wing moves superiorly and posteriorly


SBS extension is paired with respiratory ________; the face elongates and the cheekbones are prominent

The SBS moves inferiorly; the sphenoid and occiput each have _____ axes of rotation




Inherent motion of the sacrum occurs with flexion/extension of the occiput d/t PRM tractional forces upon the dura that translate to the sacrum

What are the dural attachments that contribute to this inherent motion?

Dural attachment to foramen magnum as well as posterior body and disc of S2 in spinal canal


Axes of motion of the sacrum

Superior transverse = respiratory axis — transverse axis about which sacrum moves during respiratory cycle and inherently d/t PRM in OCMM; passes from side to side through the articular processes posterior to the point of attachment of the dura at S2

Middle transverse = postural axis — functional transverse axis of nutation and counternutation in the standing position, passing through the anterior aspect of S2

Inferior transverse = pelvic/ilial axis — functional transverse axis at the level of S3 through the inferior auricular surface and represents axis of movement of ilia on the sacrum


Nutation is matched with SBS ______

Extension [sacral base is anteroinferior, apex posterior, paired with exhalation]

Nutation = nodding of base anteriorly


Sacral _____ is matched with SBS flexion

Counternutation (base moves posteriorly)


Moskalenko described changes in CSF flow as related to what physiologic phenomena?

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


Describe flexion dysfunction of the SBS

The sphenoid and occiput move further during flexion and have less motion into extension

“Stewie head” — increased transverse diameter; forehead wide and sloping; AP diameters the same on both sides; sagittal suture flat or even slightly depressed


Describe extension dysfunction of the SBS

Sphenoid and occiput move further during extension and have less motion in flexion

“Bert head”— the long, narrow head; decreased transverse diameter; AP diamter is the same in the sagittal (AP) and coronal (L/R) plane; sagittal suture may be rigid


Steps in treating cranial dysfunction with BMT

Using frontal occipital hold or vault hold, SBS is held in the midpoint of the available motion until a still point is obtained

Position is maintained until CRI motion begins to return and is noted to be more symmetrical than before and normal motion is restored


With physiologic flexion:

Both orbits are _____ and eyeballs are _____

Both zygomatic tuberosities are ______

Pterygoid processes are equally _______

There is a low wide palatine arch with tendency for alveolar process to flare — a manifestation of ______ rotation of the maxillae

Both frontozygomatic angles are ______

Wide; prominent






Asthma and nasopharyngeal complaints may suggest what type of cranial SD?

Extension SD


With physiologic extension of the SBS:

Both orbits ___ and the eyeballs are _____

Both zygomatic tuberosities are ____ while the pterygoid processes are _____

High, narrow palatine arch with alveolar processes more vertical

Both frontozygomatic angles _____

Narrow; retruded




Would the following be indicative of SBS extension or flexion:

Midline symphysis menti, ears close to the head, mastoid portions posteromedial, mastoid tips anterolateral, and elevated condylosquama



With SBS flexion — what is the motion of the SBS, occiput, and greater wings of the sphenoid?

SBS cephalad

Occiput inferior/posterior

Greater wings inferior/anterior


With SBS flexion — what is the motion of the sacrum and cranial paired bones; and what respiratory cycle and change in AP diameter is taking place?

Sacrum extends (i.e.,base is posterior/counternutation)

Paired bones externally rotated

Corresponds with inhalation

AP diameter of the cranium shortens


With SBS extension, what is the motion of the SBS, occiput, and greater wings of the sphenoid?

SBS caudad

Occiput superior/anterior

Greater wings superior/posterior


With SBS extension — what is the motion of the sacrum and cranial paired bones; and what respiratory cycle and change in AP diameter is taking place?

Sacrum flexed (i.e.,base is anterior/nutation)

Paired bones are internally rotated

Corresponds with exhalation

AP diameter of the cranium lengthens