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Cranial Rhythm

Discussion in 'Medical Students - DO' started by vietcongs, Oct 15, 2001.

  1. vietcongs

    vietcongs Senior Member
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    I worked with a DO (OMM specialist) who used cranial rhythms alot in craniosacral techniques. I had a very difficult time feeling cranial rhythms in patients. (actually, I thought he was making it up). Cranial rhythms seem to be used more frequently by European DO's. Anyone have experience with cranial rhythms? Heres some info for those interested :
    ------------------------------------- http://www.osteopathonline.com/cranial.htm

    What is the Cranial Rhythm?

    It is a cyclical expansion and contraction of all the tissues of the body, which occurs 8-18 times a minute, is distinct from all other known body rhythms ( i.e. heartbeat, breathing rate) and can be felt in all parts of the body.

    The movement is of very small amplitude, therefore it takes practitioners with a very finely developed sense of touch to feel it. This rhythm was first described in the early 1900's by Dr. William G. Sutherland and its existence was confirmed in a series of laboratory tests in the1960's and '70's.

    There is much debate as to what causes the rhythm and why it is there; it has often been observed to continue for a few minutes after the heart and breathing stops when someone dies, leading us to presume it is a movement of a very primitive or basic level of body function; some have compared it to the inherent movement of singled celled organisms ( e.g. amoebas ), suggesting that the cells of the body still behave, individually, in this way even though they are part of a far more complicated and organised system.
     
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  3. Mr. happy clown guy

    Mr. happy clown guy Senior Member
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  4. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    Here are some references to get you started:

    : J Am Osteopath Assoc 2001 Mar;101(3):163-73 Related Articles, Books


    Cranial rhythmic impulse related to the Traube-Hering-Mayer oscillation: comparing laser-Doppler flowmetry and palpation.

    Nelson KE, Sergueef N, Lipinski CM, Chapman AR, Glonek T.

    Department of Osteopathic Manipulative Medicine, Chicago College of Osteopathic Medicine of Midwestern University, USA.

    The primary respiratory mechanism (PRM) as manifested by the cranial rhythmic impulse (CRI), a fundamental concept to cranial osteopathy, and the Traube-Hering-Mayer (THM) oscillation bear a striking resemblance to one another. Because of this, the authors developed a protocol to simultaneously measure both phenomena. Statistical comparisons demonstrated that the CRI is palpably concomitant with the low-frequency fluctuations of the THM oscillation as measured with the Transonic Systems BLF 21 Perfusion Monitor laser-Doppler flowmeter. This opens new potential explanations for the basic theoretical concepts of the physiologic mechanism of the PRM/CRI and cranial therapy. Comparison of the PRM/CRI with current understanding of the physiology of the THM oscillation is therefore warranted. Additionally, the recognition that these phenomena can be simultaneously monitored and recorded creates a new opportunity for further research into what is distinctive about the science and practice of osteopathic medicine.

    PMID: 11329812 [PubMed - indexed for MEDLINE]

    --------------------------------------------------------------------------------
    Role of cranial bone mobility in cranial compliance.

    Heisey SR, Adams T.

    Department of Physiology, College of Human Medicine, Michigan State University, East Lansing.

    Increases in intracranial pressure are normally buffered by the displacement of blood and cerebrospinal fluid from the cranium when there is an increase in intracranial volume (ICV). How much pressure increases with an increase in ICV is expressed in the calculation of cranial compliance (delta ICV/delta P, where delta P is change in pressure) and elastance (delta P/delta ICV). Data reported here indicate that the movement of the cranial bones at their sutures is an additional factor defining total cranial compliance. Using controlled bolus injections of artificial cerebrospinal fluid into a lateral cerebral ventricle in anesthetized cats and a newly developed instrument to quantify cranial bone movement at the midline sagittal suture where the bilateral parietal bones meet, we show that these cranial bones move in association with increases in ICV along with corresponding peak intracranial pressures and changes in intracranial pressure. External restraints to the head restrict these movements and reduce the compliance characteristics of the cranium. We propose that total cranial compliance depends on the mobility of intracranial fluid volumes of blood and cerebrospinal fluid when there is an increase in ICV, but it also varies as a function of cranial compliance attributable to the movement of the cranial bones at their sutures. Our data indicate that although the cranial bones move apart even with small (nominally 0.2 ml) increases in ICV, total cranial compliance depends more on fluid migration from the cranium when ICV increases are less than approximately 3% of total cranial volume. Cranial bone mobility plays a progressively larger role in total cranial compliance with larger ICV increases.


    Intraexaminer and interexaminer reliability for palpation of the cranial rhythmic impulse at the head and sacrum.

    Moran RW, Gibbons P.

    School of Health Sciences, Victoria University, Melbourne, Australia.

    BACKGROUND: A range of health care practitioners use cranial techniques. Palpation of a cranial rhythmic impulse (CRI) is a fundamental clinical skill used in diagnosis and treatment with these techniques. There has been little research establishing the reliability of CRI rate palpation. OBJECTIVE: This study aimed to establish the intraexaminer and interexaminer reliability of CRI rate palpation and to investigate the "core-link" hypothesis of craniosacral interaction that is used to explain simultaneous motion at the cranium and sacrum. DESIGN: Within-subjects, repeated-measures design. SUBJECTS: Two registered osteopaths, both with postgraduate training in diagnosis and treatment, using cranial techniques, palpated 11 normal healthy subjects. METHODS: Examiners simultaneously palpated for the CRI at the head and the sacrum of each subject. Examiners indicated the "full flexion" phase of the CRI by activating silent foot switches that were interfaced with a computer. Subject arousal was monitored using heart rate. Examiners were blind to each other's results and could not communicate during data collection. RESULTS: Reliability was estimated from calculation of intraclass correlation coefficients (2,1). Intrarater reliability for examiners at either the head or the sacrum was fair to good, significant intraclass correlation coefficients ranging from +0.52 to +0.73. Interexaminer reliability for simultaneous palpation at the head and the sacrum was poor to nonexistent, ICCs ranging from -0.09 to +0.31. There were significant differences between rates of CRI palpated simultaneously at the head and the sacrum. CONCLUSIONS: The results fail to support the construct validity of the "core-link" hypothesis as it is traditionally held by proponents of craniosacral therapy and osteopathy in the cranial field.

    Simultaneous palpation of the craniosacral rate at the head and feet: intrarater and interrater reliability and rate comparisons.

    Rogers JS, Witt PL, Gross MT, Hacke JD, Genova PA.

    US Air Force Academy Cadet Physical Therapy Clinic, US Air Force Academy, CO 80840, USA. [email protected]

    BACKGROUND AND PURPOSE: The main purpose of this study was to determine the interrater and intrarater reliability of measurements obtained during palpation of the craniosacral rate at the head and feet. Palpated craniosacral rates of head and feet measured simultaneously were also compared. Subjects. Twenty-eight adult subjects and 2 craniosacral examiners participated in the study. METHODS: A within-subjects repeated-measures design was used. A standard cubicle privacy curtain, hung over the subject's waist, was used to prevent the examiners from seeing each other. RESULTS: Interrater intraclass correlation coefficients (ICCs) were .08 at the head and .19 at the feet. Intrarater ICCs ranged from .18 to .30. Craniosacral rates simultaneously palpated at the head and feet were different. CONCLUSION AND DISCUSSION: The results did not support the theories that underlie craniosacral therapy or claims that craniosacral motion can be palpated reliably.


    J Orthop Sports Phys Ther 1998 Mar;27(3):213-8 Related Articles, Books


    Craniosacral rhythm: reliability and relationships with cardiac and respiratory rates.

    Hanten WP, Dawson DD, Iwata M, Seiden M, Whitten FG, Zink T.

    Texas Woman's University, Houston 77030, USA.

    Craniosacral rhythm (CSR) has long been the subject of debate, both over its existence and its use as a therapeutic tool in evaluation and treatment. Origins of this rhythm are unknown, and palpatory findings lack scientific support. The purpose of this study was to determine the intra- and inter-examiner reliabilities of the palpation of the rate of the CSR and the relationship between the rate of the CSR and the heart or respiratory rates of subjects and examiners. The rates of the CSR of 40 healthy adults were palpated twice by each of two examiners. The heart and respiratory rates of the examiners and the subjects were recorded while the rates of the subjects' CSR were palpated by the examiners. Intraclass correlation coefficients were calculated to determine the intra- and inter-examiner reliabilities of the palpation. Two multiple regression analyses, one for each examiner, were conducted to analyze the relationships between the rate of the CSR and the heart and respiratory rates of the subjects and the examiners. The intraexaminer reliability coefficients were 0.78 for examiner A and 0.83 for examiner B, and the interexaminer reliability coefficient was 0.22. The result of the multiple regression analysis for examiner A was R = 0.46 and adjusted R2 = 0.12 (p = 0.078) and for examiner B was R = 0.63 and adjusted R2 = 0.32 (p = 0.001). The highest bivariate correlation was found between the CSR and the subject's heart rate (r = 0.30) for examiner A and between the CSR and the examiner's heart rate (r = 0.42) for examiner B. The results indicated that a single examiner may be able to palpate the rate of the CSR consistently, if that is what we truly measured. It is possible that the perception of CSR is illusory. The rate of the CSR palpated by two examiners is not consistent. The results of the regression analysis of one examiner offered no validation to those of the other. It appears that a subject's CSR is not related to the heart or respiratory rates of the subject or the examiner.

    The cytological implications of primary respiration.

    Crisera PN.

    [email protected]

    Observing the macroscopic complexities of evolved species, the exceptional continuity that occurs among different cells, tissues and organs to respond coherently to the proper set of stimuli as a function of self/species survival is appreciable. Accordingly, it alludes to a central rhythm that resonates throughout the cell; nominated here as primary respiration (PR), which is capable of binding and synchronizing a diversity of physiological processes into a functional biological unity. Phylogenetically, it was conserved as an indispensable element in the makeup of the subkingdom Metazoa, since these species require a high degree of coordination among the different cells that form their body. However, it does not preclude the possibility of a basal rhythm to orchestrate the intricacies of cellular dynamics of both prokaryotic and eukaryotic cells. In all probability, PR emerges within the crucial organelles, with special emphasis on the DNA (5), and propagated and transduced within the infrastructure of the cytoskeleton as wave harmonics (49). Collectively, this equivalent vibration for the subphylum Vertebrata emanates as craniosacral respiration (CSR), though its expression is more elaborate depending on the development of the CNS. Furthermore, the author suggests that the phenomenon of PR or CSR be intimately associated to the basic rest/activity cycle (BRAC), generated by concentrically localized neurons that possess auto-oscillatory properties and assembled into a vital network (39). Historically, during Protochordate-Vertebrate transition, this area circumscribes an archaic region of the brain in which many vital biological rhythms have their source, called hindbrain rhombomeres. Bass and Baker (2) propose that pattern-generating circuits of more recent innovations, such as vocal, electromotor, extensor muscle tonicity, locomotion and the extraocular system, have their origin from the same Hox gene-specified compartments of the embryonic hindbrain (rhombomeres 7 and 8) that produce rhythmically active cardiac and thoracic respiratory circuits. Here, it implies that PR could have been the first essential biological cadence that arose with the earliest form of life, and has undergone a phylogenetic ascent to produce an integrated multirhythmic organism of today. Finally, in its full manifestation, the breathing DNA (1) of the zygote could project itself throughout the cytoskeleton and modify the electromechanical properties of the plasma lamella (26), establishing the primordial axial-voltage gradients for the physiological control of development (53).
     
  5. Mr. happy clown guy

    Mr. happy clown guy Senior Member
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    Hmmmm...what is the inter-rater and intra-rater reliability of ANY of these studies and what is the power of these studies...hmmmm.
     
  6. vietcongs

    vietcongs Senior Member
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    Mr. Happy Clown, I love you man!!!
     
  7. Billie

    Billie An Oldie but a Goodie...
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    Well, I can feel the cranial rhythm, but that is it. I don't see any purpose in it other than I can do it.
     
  8. David511

    David511 Ponch's Illegitimate Son
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    ...yeah, I'm still 'up in the air' on this one...I've tried to get one in OMM lab but haven't had much luck yet.

    As for the rest of OMM, that sh!t is DOPE!
     
  9. Mr. happy clown guy

    Mr. happy clown guy Senior Member
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    So, you can feel the CSI eh?? Well, if you turn off all the lights, put your finger on a table and be very still...you can probably feel the furnace turn on...and undoubtedly your pulse. Because you feel a movement does not mean you feel CSI...that is called validity. Does the "test" test what it is supposed to? For a test to be valid, it must also be reliable and that is something supporters of the so-called CSI have NEVER been able to prove.

    Yet they are able to make claims that effecting the CSI may change the course of illness. obsurd.

    Of course, I am not stating that perhaps a suture may not move. But the inherent mobility of the CNS is something I cannot subscribe to.
     
  10. sean

    sean Senior Member
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    Finally, an actual osteopathic medical discussion. Here is my question.
    What exactly is it a practitioner look for when they look for a rhythem? Is it the absence of a rhythem that indicates disease, the rate of the rythem or something else? There have been many studies done on the presence of biological rhythems in animals, eg circadian rhythems and the entrainment of such rhythems to exogenous stimuli eg light, which have unequivocally been proven to exist. But the existance of a rhythem does not prove its ability to be medically exploited. I am interested to know what the application of information, that a practitioner "feels" upon palpation, is. Whether they can or cannot "feel" a rhythem is another issue.
     
  11. Mr. happy clown guy

    Mr. happy clown guy Senior Member
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    The answer to your question is literally "all of the above". Each practitionor (not held to objective data) uses the information gathered (ie strain, shear patterns, decreased movements left vs right, stuck movements etc)and treats such deficiencies until a "normal" pattern is attained. The equilibration of such patterns is thought to provide treatment...but yet the central premise much be true...the CNS has an inherent rhythm...and removing the barrier to such movement "heals". Unfortunately, their are NO STANDARDS OF PRACTICE and ultimately no norms or ways to objectively measure (ie see Auras or energy therapies).
    Once again, the idea of inter/intra rater reliability comes into play...how do you know your exam is correct???
    The quick comeback answer is sometimes "the testing alone of the CSI may provide treatment" or "you can't feel the movement because it may have already changed patterns". Where have we heard that type of excuse before??
    Many of the movements supposedly affect many of the facial bones, particularly eye movements. This has been a thought of mine for a while, if these movements of the cranial bones affect facial bones...why not test the movement WITHOUT involving human touch? IE use set measurements of the eyes and test movements of exopthalmos etc. This is easy!! Or how about videotaping the movement of the ear over a span of an hour...I mean, the ear HAS to move if the temporal bone is to enter external rotation or internal rotation...right?!!

    That will never happen, becuase they are afraid of what they will find.
     
  12. Billie

    Billie An Oldie but a Goodie...
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    Well, in my house, I can sense when the furnace turns on, I don't have to touch a table to do it. And sometimes I can sense my pulse without checking my wrist or carotids, though I can't do that all the time. So while I agree with you that perhaps the "mvt" that I am sensing may not be what the OMT dept is calling Cranial rhythm, is sure as hell ain't my furnace turning on :D

    As as for the test testing what it is supposed to do? I don't know what you mean. I don't see any reason for this "test" or knowledge either. All I was trying to say was that I feel this damn thing. Is it a cranial rhythm? Is is fluctuations in the earth's crust? Is it contact from spirts beyond? I don't know, and to be honest I don't care. Personally I think it would be much more fun if it was contact from beyond, but oh well. :)
     
  13. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    Contractile proteins in pericytes at the blood-brain and blood-retinal barriers.

    Bandopadhyay R, Orte C, Lawrenson JG, Reid AR, De Silva S, Allt G.

    Weston Institute of Neurological Studies, Windeyer Building, University College Medical School, Cleveland Street, London W1P 6DB, UK.

    Evidence from a variety of sources suggests that pericytes have contractile properties and may therefore function in the regulation of capillary blood flow in the CNS. However, it has been suggested that contractility is not a ubiquitous function of pericytes, and that pericytes surrounding true capillaries apparently lack the machinery for contraction. The present study used a variety of techniques to investigate the expression of contractile proteins in the pericytes of the CNS. The results of immunocytochemistry on cryosections of brain and retina, retinal whole-mounts and immunoblotting of isolated brain capillaries indicate strong expression of the smooth muscle isoform of actin (alpha-SM actin) in a significant number of mid-capillary pericytes. Immunogold labelling at the ultrastructural level showed that alpha-SM actin expression in capillaries was exclusive to pericytes, and endothelial cells were negative. Compared to alpha-SM actin, non-muscle myosin was present in lower concentrations. By contrast, smooth muscle myosin isoforms, were absent. Pericytes were strongly positive for the intermediate filament protein vimentin, but lacked desmin which was consistently found in vascular smooth muscle cells. These results add support for a contractile role in pericytes of the CNS microvasculature, similar to that of vascular smooth muscle cells.

    Brain parenchyma motion: measurement with cine echo-planar MR imaging.

    Poncelet BP, Wedeen VJ, Weisskoff RM, Cohen MS.

    MGH-NMR Center, Department of Radiology, Massachusetts General Hospital, Charlestown 02129.

    With echo-planar magnetic resonance (MR) imaging, the authors measured the intrinsic pulsatile motion of brain parenchyma. Phase-sensitive, electrocardiography-gated, two-dimensional cine images were acquired throughout the cardiac cycle by using a spin-echo, blipped echo-planar MR pulse sequence. Transverse and coronal planes were obtained in 14 healthy volunteers. Corrections were made for gross head motion. Brain motion consisted of a rapid displacement in systole, with a slow diastolic recovery. The motion occurred chiefly in the cephalocaudal and lateral directions; the anteroposterior motions were relatively small. Cephalocaudal velocities increase with proximity to the foramen magnum. The lateral motion is mainly a compressive motion of the thalami. Brain parenchymal velocities were as high as 2 mm/sec caudally in the brain stem and 1.5 mm/sec medially in the thalami. Net parenchymal excursions were at most 0.5 mm. Phase-based echo-planar velocity measurements agreed well with echo-planar Fourier velocity zeugmatography measurements and were consistent with reported values. Velocity mapping with echo-planar imaging offers a rapid and flexible method of assessing the pulsation velocities of the human brain.
     
  14. Mr. happy clown guy

    Mr. happy clown guy Senior Member
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    So, drusso, you are telling me that the "MONSTROUS" movement that was supposedly measured in perhaps 1,2, or 3 candidates is causing external rotation of the frontal bone around an axis of movement that is a long gone developmental suture???? Or are you saying that thalamic compression is easier palpable than the other gross movements made by a human laying supine on a table?

    Since you are looking through the JOSPT, why not highlight the resultant reliability statement "The rate of the CSR palpated by two examiners is not consistent. The results of the regression analysis of one examiner offered no validation to those of the other."

    ONce again I ask...take an injured man with a known diagnosis, and have him examined by 10 Cranial-sacral practionors and see if a single one agrees!!! Wow, that is pretty simple, we didn't need an MRI or anything to measure thalamic compression did we??

    Or, once again we can videotape or measure eye or ear movement. Supposedly "Monstrous" thalamic compression should be able to move them darn thingies!

    But I think we come to a point...if in the year 2020, millions of dollars spent in strict Osteopathic research, we find that there is a mystical CRI...just because it is there can you manipulate it? Do you affect the heart by palpating the pulse?

    By the way DRUSSO, you argue much like the chiropractors used to argue with me as Captain Freedom, giving me "conclusions" from articles...as if that is how one argues evidence based medicine...or even common sense.
     
  15. sean

    sean Senior Member
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    I have to assume that a DO evaluating a patient using all techniques at his/her disposal and so using CRT doesn't seem to cause a concern for misdiagnosis as it is but one tool of many. However, it seems that this style is based upon the intuitive feel of the DO involved but that nobody has quantified or standardized the actual rhythems yet. I for one am open to to the possibility that, even though it isn't yet standardised, it still could exist. However, it is difficult to teach a technique that is so subjective, especially if we consider the concept of circadian rhythems. These rhythems can be influenced by specific stimuli and have different activity level depending upon the time of day it is. For instance body temp fluctuates in a rhytmic fashion (within homeostatic values) low at night and higher in the day, cortisol levels have a specific rhythem as do many other body processes. This brings in the possibility that the rhythems could be different depending upon the time of day a patient is examined. In fact, the time of day that a medication is taken can profoundly influence the impact it has. So although I am open to the possibility that such work can be useful it would be difficult to use a technique that has not been properly documented. I hope the AOA is pursuing the study of a technique that seems very much a part of its medical practice.
     
  16. Dr. Evil

    Dr. Evil Member
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    Although I don't actually believe in it, I have no problem with postulating that the CRI exists, or theories that attempt to explain its existence (vibrating pericytes, thalamic expansion, the ghost of Elvis, etc.). The problem as I see it, and this holds true for the rest of OMT, is that there is no research indicating cranial manipulation is good for anything. Show me a study that suggests cranial OMT relieves headache, alleviates nausea and vomiting, or does anything therapeutic. To me, this would more impressive than trying to prove this "rhythym" actually exists.

    Think about this. There are a number of drugs out there that appear to work pretty well. We aren't even 100% certain as to why many of them work. We have "theories", and "proposed mechanisms of action". Yet people are convinced through research and experimentation that they work, and they are accepted. I think that if the profession could offer some evidence that OMT actually works, the "why it works" would seem more reasonable.

    So those of you who so boldly asked during your interview, "Are there any research opportunities at this school?", here is your chance. Conduct a study that attempts to prove cranial manipulation can treat disease. If you come up with some statistically significant data that it does, then share this information. I believe people would then be more willing to accept the idea of a CRI or moving sutures as an explanation for the success. But if cranial OMT is put to the test by the scientific method and fails, who really cares if the CRI even exists?
     
  17. DO/MBA

    DO/MBA Member
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    It actually is more important than at first glance for osteopathic research to get a move on. In the next few years evidence based medicine will dominate payments to doctors. Insurance Companies will only pay for what they know works. If cranial can be proved do it; if not drop it. We are here to help people get better Don't forget that we need to support our business or we can not help anyone. A move like this from PPO's will practically merge MD's and DO's. Don't believe that our "unique" philosphy will separate us. For proof just ask an MD if he believes in treating the whole person. I love the DO way that is why I went that way, however I was naive and didn't realize how similar the professions are.
     

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