Intro to OCMM

Question 1

OCMM was first described by what physician?

Answer 1

William G. Sutherland, DO

Question 2

5 components of the Primary Respiratory Mechanism

Answer 2

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

Question 3

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

Answer 3

Traube-Hering Wave

Glial

Question 4

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

Answer 4

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

Question 5

Motion characteristics of the CRI

Answer 5

Rate (10-14)
Rhythm
Amplitude
Strength
Direction (longitudinal and symmetric)

SD can negatively affect any of these

Question 6

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

Answer 6

The sutherland fulcrum

Question 7

What is the RTM?

Answer 7

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

Question 8

Main poles of RTM attachment

Answer 8

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

Question 9

Bones that make up the pterion

Answer 9

Frontal
Parietal
Temporal
Sphenoid

[sutures include coronal, sphenosquamous, parietosquamous]

Question 10

Bones that make up the asterion

Answer 10

Parietal
Occipital
Temporal

Question 11

What is bregma vs. lambda

Answer 11

Bregma = old anterior fontanelle

Lambda = old posterior fontanelle

Question 12

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

Answer 12

Basi-occiput and basisphenoid move superiorly

Occipital squama move inferiorly and posteriorly

Greater wings of the sphenoid move inferiorly and anteriorly

Question 13

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

Answer 13

Basiocciput and basisphenoid move inferiorly

Occipital squama moves superiorly and anteriorly

Greater wing moves superiorly and posteriorly

Question 14

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

Answer 14

Exhalation

transverse

Question 15

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?

Answer 15

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

Question 16

Axes of motion of the sacrum

Answer 16

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

Question 17

Nutation is matched with SBS ______

Answer 17

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

Nutation = nodding of base anteriorly

Question 18

Sacral _____ is matched with SBS flexion

Answer 18

Counternutation (base moves posteriorly)

Question 19

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

Answer 19

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

Question 20

Describe flexion dysfunction of the SBS

Answer 20

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

Question 21

Describe extension dysfunction of the SBS

Answer 21

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

Question 22

Steps in treating cranial dysfunction with BMT

Answer 22

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

Question 23

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 ______

Answer 23

Wide; prominent

Flattened

Posterolateral

External

Increased

Question 24

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

Answer 24

Extension SD

Question 25

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 _____

Answer 25

Narrow; retruded

Prominent;anterior

Decreased

Question 26

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

Answer 26

Extension

Question 27

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

Answer 27

SBS cephalad

Occiput inferior/posterior

Greater wings inferior/anterior

Question 28

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?

Answer 28

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

Paired bones externally rotated

Corresponds with inhalation

AP diameter of the cranium shortens

Question 29

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

Answer 29

SBS caudad

Occiput superior/anterior

Greater wings superior/posterior

Question 30

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?

Answer 30

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

Paired bones are internally rotated

Corresponds with exhalation

AP diameter of the cranium lengthens