Lecture #13: OMM Lab #32 Prep lecture -Introduction to Cranial Diagnosis and Treament - Landmarks, Vault Contacts, Strain Patterns, and OA

What are the five phenomena of the Primary Respiratory Mechanism (PRM)?

Inherent motility of the brain and spinal cord, fluctuation of CSF and potency of the Tide, mobility of the dural membranes, mobility of the cranial bones, and involuntary mobility of the sacrum between the ilia.

Who is associated with development of the cranial concept and PRM?

William Garner Sutherland, a student of Andrew Taylor Still.

What is meant by inherent motility of the CNS?

The brain and spinal cord undergo intrinsic coiling and uncoiling derived from developmental motion and synchronized with the phases of the PRM.

What is the role of the dural membranes in cranial motion?

They act as check ligaments that guide and limit cranial bone motion and move in an arcing, sickle-like fashion.

Where is the fulcrum of the dural membrane system described in the lecture?

Along the straight sinus.

What is the reciprocal tension membrane?

The dural membrane system, including the falx and tentorium, that maintains balanced tension and helps coordinate cranial motion.

What is the core link?

The dural connection extending from the cranium through the spinal canal to the sacrum, linking cranial and sacral motion.

How does the sagittal suture accommodate cranial motion?

Its serrate interlocking spicules permit a rocking movement that allows widening of the parietal bones.

How does the squamous suture accommodate cranial motion?

Its overlapping configuration permits gliding movement as the transverse cranial diameter increases and decreases during inhalation and exhalation.

What happens to the cranium during the inhalation phase of the PRM?

The cranium widens transversely while the anteroposterior and vertical dimensions narrow.

What happens to the cranium during the exhalation phase of the PRM?

The transverse diameter narrows while the anteroposterior and vertical dimensions increase.

How do midline cranial bones move during the PRM?

They rotate around transverse axes in a gearlike fashion, with adjacent bones moving in opposite directions.

What is cranial flexion?

The inhalation phase of the PRM in which the midline bones move into flexion.

What is cranial extension?

The exhalation phase of the PRM in which the midline bones move into extension.

What happens to the sphenobasilar junction during flexion?

The SBJ moves superiorly.

What happens to the sphenobasilar junction during extension?

The SBJ moves inferiorly.

How do paired cranial bones move during inhalation?

They externally rotate.

How do paired cranial bones move during exhalation?

They internally rotate.

What happens to the sacral base during inhalation?

The sacral base moves posterosuperiorly.

What happens to the sacral base during exhalation?

The sacral base moves anteroinferiorly.

What happens to the CNS during inhalation?

The CNS shortens and widens as it coils.

What happens to the CNS during exhalation?

The CNS lengthens and narrows as it uncoils.

What happens to the tentorium during inhalation?

It flattens transversely.

What happens to the tentorium during exhalation?

It tents transversely.

What happens to the falx during inhalation?

It sickles and shortens in the anteroposterior direction.

What happens to the falx during exhalation?

It lengthens in the anteroposterior direction.

What is the cranial rhythmic impulse (CRI)?

The palpable rhythmic expression of cranial flexion/external rotation and extension/internal rotation assessed for rate, amplitude, regularity, and symmetry.

What should be assessed when palpating the CRI?

Rate, amplitude, regularity, symmetry, and whether individual bones show altered motion.

What is the correct patient position for a Vault Contact?

The patient lies supine while the physician sits at the head of the table with forearms comfortably supported on the table.

Where are the index fingers placed in a Vault Contact?

On the greater wings of the sphenoid.

Where are the middle fingers placed in a Vault Contact?

On the temporal bones anterior to the ears.

Where are the ring fingers placed in a Vault Contact?

On the temporal bones posterior to the ears.

Where are the little fingers placed in a Vault Contact?

On the squamous portion of the occiput.

Where should the thumbs be during a Vault Contact?

They may touch or cross comfortably but should not contact the patient's cranium.

What is felt during flexion with a Vault Contact?

A subtle swelling: the coronal/transverse diameter widens while AP diameter and height decrease.

What is felt during extension with a Vault Contact?

A subtle receding: the coronal/transverse diameter narrows while AP diameter and height increase.

What is the hand placement for a Fronto-Occipital contact?

The caudad hand supports the occipital squama and the cephalad hand bridges the frontal bone, with the thumb and little finger contacting or approximating the greater wings of the sphenoid.

What additional diagnostic goal is emphasized with the Fronto-Occipital contact?

Direct palpatory attention toward the SBS to determine whether the sphenoid and occiput demonstrate any preferred motion.

How is the Becker Hold performed?

The thumbs gently contact the sphenoid greater wings while the remaining fingers cradle the temporal bones and occiput.

What is assessed with the Becker Hold?

The cranial rhythmic impulse for rate, amplitude, and symmetry.

How is the Modified Becker/temporal contact performed?

The hands gently cradle the posterior cranial fossa while the thumb tips slide anteroinferior to the mastoid tips to avoid compressing them.

What qualities should the physician bring to cranial sensing?

Mindfulness, respect for the patient's mechanism, humility, patience, relaxation, courage, confidence, and awareness of both patient and physician comfort.

What landmarks define the OA decompression technique?

The occipital condyles and atlas, with the inion and C1 posterior tubercle used for orientation.

Why is the OA joint clinically important in this lecture?

The occipitoatlantal joint is described as the first cranial joint formed and as a region that absorbs initial forces of labor and delivery.

Should the OA decompression technique in this lab be used on infants and small children?

No. The lecture states that this specific technique should not be used on infants or small children; it may be considered around ages 8–10 and older.

How is the treating finger positioned for OA decompression?

Start at the inion and slide caudally to the C1 posterior tubercle; if the C2 spinous process is reached, the contact has gone too far.

What movement does the patient perform during OA decompression?

The patient flexes the head by tucking the chin toward the chest without flexing the neck.

What is the treatment endpoint of OA decompression?

Hold until muscle and soft tissue relaxation is felt and there is a sense that the occipital condyles decompress from the superior facets of C1, then reassess.

What clinical functions may be affected by dysfunction at the OA region?

Swallowing through CN IX and X, visceral function through CN X, SCM and trapezius function through CN XI, and general craniocervical function.

What happens during the alternative OA decompression technique?

Both middle fingers contact the posterior arches of the atlas and apply caudad pressure while the patient performs a nodding motion at the OA joint.

How can deep inspiration assist the alternative OA decompression technique?

The position is maintained while the patient takes one or more deep inspirations to the limit, which the lecture states can enhance articular release.

How is OA decompression reassessed?

Recheck CRI rate and amplitude in the basioccipital region and reassess occipitoatlantal motion for normalization.

What is the asterion?

The junction of the temporal, parietal, and occipital bones; it can be palpated by following the temporal bone superiorly from the mastoid process until a depression is felt.

What is the nasion?

The landmark at the junction between the frontal and nasal bones.

What landmark list is especially important for this lab?

Bregma, lambda, pterion, asterion, spheno-squamous pivot, major sutures, greater wing of sphenoid, mastoid process, inion, occipital condyles, and major cranial foramina.