Professional Documents
Culture Documents
Mobility y
Mobility is the state of being in motion. Mobility In physics, motion is a change in position of an object with respect to time. j p Motion is typically described in terms of velocity, acceleration, displacement, time and y, , p , speed. Mobility, for some reason, is not defined in our Osteopathic Glossary.
Motility
Motility is a biological term which refers to the ability to move spontaneously and actively actively, consuming energy in the process. Again this term is absent from our Osteopathic Again, glossary So the brain and fluids move with motility and So, motility, the container, the skull, needs to be able to accommodate to this, and thoracic respiration. p
Articular Mobility
A ti l mobility occurs i th b il Articular bilit in the basilar area, and that of the facial bones; such basilar mobility being accommodated through compensatory expansile and g p y p contractile service at the vault sutures So the question is: Is the mobility So, responsive to primary respiration, or thoracic respiration, or b th? It a th i i ti both? Its question of distance and distensabilty.
The Cranial Bowl, 1939, W.G. Sutherland 6
Mental Picture
The formation of a mental picture of the articular surfaces of the cranial and facial bones, is the first necessity for recognizing the fact of cranial articular mobility. y The picture should be like that of a watchmaker watchmaker So, we need to know the whole thing!
The Cranial Bowl, 1939, W.G. Sutherland 7
Stress loading
Strain
unloading E 1
E= elastic modulus The angle of the curve reflects the stiffness of the tissue. A tissue that is stiff will have a line to the left, and a tissue that is less stiff will have a line to the right.
Strain
Fundamentals of Biomechanics,Ozkaya
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SBS
Beryl Arbuckle
Since she wanted objective evidence of what she palpated while treating patients, she attended nearly every autopsy ( estimated at about 200) on cranial pathology at a hospital in Philadelphia over a many year time span span. Observed fiber strands in specific directions, which she called stress bands. Used positional and motion testing diagnosis. As she treated mostly children, she used direct technique, with respiratory assistance when possible ( step breathing or holding of breath as long as possible) possible).
The Selected Writings of Beryl Arbuckle 16
Beryl Arbuckle
Presented her finding of stress fibers to the study group of the teachers around t d f th t h d Sutherland. S th l d h d no problem with thi or with Sutherland had bl ith this, ith Arbuckle. Shortly afterward, she started teaching on her afterward own, with the assistance of Paul Kimberly had been on Sutherlands teaching staff, who also Sutherland s did direct cranial.
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Robert Fulford
Observed that Arbuckle came the closest to reproducing the clinical results that Sutherland did, so he went to study with her. We tried to absorb his teaching (Sutherland) We (Sutherland), but it didnt take well. I left the Cranial academy, went to Philadelphia, studied with Dr. Arbuckle, and got a degree of understanding of stress bands of the dura mater and really understood the th cranial concept. i l t Then, after years of practice, it started to work.
Robert Fulford,D.O. and the Philosopher Physician, Zachary Comeaux 19
Unlocking technique
Facing the patient, place a hand on each side of the head Do layer palpation into the dural head. layer. Fuford paraphrased: I Dr. Fuford-paraphrased: I place my hands on the head, I feel the membranes wind up, until they bust themselves loose. Sometimes it is so strong it knocks my hands clean off the t k k h d l ff th head. Afterwards, you can do what you want with the head.
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Variations
Pt supine, their hands connected to your arms. Pt seated. Pt seated, you stand or sit behind, make contact with posterior cranium.
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A 1 2 3
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The question is: How can we get the cranial mechanism optimal function?
Answer: Get the container moving well, so the contents can express themselves. Mobilize the sacrum, upper cervical spine, then unlock the bones/sutures, bones/sutures then unlock the membranes. q The most frequent locked sutures are: Left occipitalpetrosal, right pterygo-palatine, left fronto-ethmoid . KL fronto ethmoid
Osteopathy in The Cranial Field, Magoun 26
Occipitopetrosal Manipulation
Contacts: posterior to mastoid tip on the fixed side-W/R-anterolaterally Anterior to the mastoid tip on the unaffected side-W1/4Rposterlaterally Note: you can also use your 4th and 5th finger pads on the occiput to lift a low side Arbuckle side.
Cranial Sutures, Marc Pick 27
Sphenopalatine Manipulation
Contacts: Bilateral maxillas, inside of mouth near last molars W medial molars-W-medial Pterygoid process, anterior tip-W1/4Rtip W1/4R posteromedial. Note: the most common side is the right, but I treat both. KL
Cranial Sutures, Marc Pick 29
Frontoethmoid Manipulation
To release lateral surfaces and close the anterior surfaces Frontals metopic suture, extending laterally over e tending laterall o er supercilliary arches and maxillas-W1/3R-posterior Occiput-W/R anterior Note: you are done when the ethmoid is rocking well, and the upper face translation test is normal.
Cranial Sutures, Marc Pick 30
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Sacrum, Arbuckle
The lower limbs of the L shaped sacroiliac articulation is divergent anteriorly. The upper and lower limbs meet at S2, the axis of rotation is here. here Below this the lateral articulations converge inferiorly inferiorly.
The Selected Writings of Beryl Arbuckle 32
Sacrum, Arbuckle
Use thumb on base and apex of the same side. Compress b C base t toward th d the greater trochanter, then apex toward the ASIS, compare distensabilty. distensabilty Then check other side the same way. On the most moveable quadrant, placed a thumb, other thumb behind for reinforcement. reinforcement Exaggerate the strain. Have Pt take deep breath and hold. Sacrum should release with a jerk.
The Selected Writings of Beryl Arbuckle 33
Stress Fibers
There are white fibrous strands, known as stress fibers throughout the otherwise yellow fibers, elastic tissue. Theses Theses stress fibers which follow a very definitely consistent pattern, are arranged in horizontal, vertical, transverse, circular, and spinal groups. i l There is no definite break in these fibers but an intermingling or continuation of one group with another so that forces may be directed and controlled throughout this mechanism.
The Selected Writings of Beryl Arbuckle 34
Stress fibers
For descriptive purposes origin and termination of the various groups of fibers is given but it must be remembered that these fibers are continuous and their firm boney attachments must be thoroughly understood with all possible movements thereof in order to change the planes and tensities of these various diverging fans of fibers throughout the dura to achieve the th necessary forces in the desired di ti f i th d i d directions.
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Intracranial Dura
The torcular mass is quite an extensive dense fibrous mass about the confluence of sinuses. From this mass diverge four horizontal groups of fibers, namely: Inferior horizontal fibers of falx cerebri Horizontal fibers of the falx cerebelli Horizontal group in the under layer of each side of the tent tent.
The Selected Writings of Beryl Arbuckle 36
Primal Pictures
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Half a world away, Dr. Erich Blecshmidts dissections show : Dural Girdles
These are areas where the dura is thickened, thought to be due to a reaction to the brain growing, a restraining f function. 1-retromesencephalic dural girdle i dl 6-premesencephalic dural girdle 12- falx ( Arbuckle called this the falx ceribri anterior vertical fibers)
The Stages of Human Development before Birth, 1960, Erich Blechschmidt 39
The dura forms a restraining function to the f ti t th more rapid growth of the brain. Symposium on the Development p of the Basicranium
The Biokinetics of the Basicranium, Blechschmidt
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Study info
20 fresh cadavers, no , pathology 0-92 years old Less than 24 hours postmortum S Superior sagittal sinus i itt l i and calvarial section o tissue of t ssue Placed in saline and frozen.
Hamann, Sacks, Malinin, J of Anat Jan 1998 44
Study Information
Tissue looked at using small angle light scattering HeNe lazer, has optics between optical miscroscopy and i d gross visual analysis.
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Dura
The top picture is viewed with the eye, the bottom picture shows SALS applied to the th same area with the direction of the collagen fibers more apparent. pp
Hamann, Sacks, Malinin, J of Anat Jan 1998 46
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Buttresses
In the boney structure also p there are developed areas of greater density known as buttresses. Although this stage of development is not reached in infancy, the buttresses will be described here since understanding th i normal or d t di their l expected positions, slight deviations in the infant skull which may result in gross abnormalities are more easily recognized recognized
The Selected Writings of Beryl Arbuckle 50
Butresses
Anterior: across glabella g laterally, over superciliary ridges to zygomatic process of frontal. frontal Posterior: inion, most superior nuchal lines, mastoid process Inferior: inion to opisthion, foramen magnum, basion to magnum basion, posterior wall of sphenoidal sinus
The Selected Writings of Beryl Arbuckle 51
Buttresses
Superior: Inion, sagital suture, frontal crest, t f t l t glabella, crista galli Lateral Oval: mastoid process, EAM th 2 EAM, then ridges. Outer: zygomatic bone to zygomatic process of frontal Inner: frontal. pteryoid process and lesser wing Oblique basilar: Petrous ridges of temporals, point towards sphenoid sinus, the roof of which forms the floor of the sella turcica. The Selected Writings of Beryl Arbuckle 52
Buttresses
The various buttresses may be pictured as radiating f di ti from about th sella t i and i a b t the ll turcica d in manner similar to the stress bands of the reciprocal tension membranes membranes. 1. Straightening or flattening the anterior buttress will widen or cause the margins of the ethmoidal notch of the frontal to increase their p posterior divergence thus allowing for a g g widening of the upper part of the lateral masses.
The Selected Writings of Beryl Arbuckle 53
Median Buttresses
Increasing or decreasing the arc of the median buttress will allow the crista gali to fall or elevate depending upon the type of head. That is, in an extreme flexion head it would be wiser to attempt to lift the crista galli by increasing the arc of the anterior buttress thus narrowing the lateral masses of the ethmoid. ( Horizontal falx technique) In an extreme technique). extension head we would rather allow the crista galli to fall permitting widening of the lateral l t l masses off the ethmoid. (A/P ff th th id compression- face with inion)
The Selected Writing of Beryl Arbuckle 55
Treatment of Horizontal fibers of Falx Falx and increase the arc of Anterior Buttress
Lay the patient on their left side, a pillow under their head. Place your left index finger along the anterior falx, right index finger along the p g g g posterior falx. Follow the PRM into extension, dont allow if to go into flexion. After some time, maybe 5 minutes, the y system will become quiet, then go into flexion, and everything will soften.
Described by Robert Fulford 56
Buttresses
Zygomatic pillar of the face-from the first molar t th t the zygomatic angle of th l tooth to th ti l f the frontal B increasing or d By i i decreasing th i f i i the inferior convergence of the zygomatic pillars, change in the posterior divergence of the margins of the ethmoid notch of the frontal may be obtained.
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Frontoethmoidal Manipulation
To release anterior, and close laterally Bil contact superior to p sphenofrontal sutureW1/3R-medially. Lateral aspect of hard palate- W1/3Rlaterally, then pull l ll h ll anteriorly
The Cranial Sutured, March Pick The Selected Writings of Beryl Arbuckle 58
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Anterior Fontanelle
Anterior fontanelle becomes bregma after the fontanel g closes and the sutures form. It is between the 2 halves of the frontal bone (metopic suture) ( p ) and the 2 parietals. The metopic suture is open at birth, birth separating the frontal into 2 halves, from nasion to bregma. It ossifies during growth, growth but retains a natural malleability, moving during flexion-extension, aided by the attachment of the falx The falx. The cranial puzzle
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Bregma
Trauma at bregma. (trauma may be direct on area or indirect from a fall on the feet or buttock). The bone is pushed inferiorly at bregma and forced laterally at p g y pterion. This will restrict the great wing and the sphenobasilar. The sagittal suture will be depressed or one parietal lowered in relation to the other. The occipital condlyes may be moved back in the pits of the atlas (bilateral posterior occiput). OCF
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Beryl Arbuckle
Preserved Sutherlands earliest approaches to mobility, mobility diagnosis ( position and motion testing) and treatment (direct). Refined the view of the reciprocal tension membrane into 20 different directions of fibers, all of which are helpful in diagnosis and treatment (both by themselves and as handles for the bone). Described thickened areas of bone called buttresses, that can be used in diagnosis and treatment (by themselves and as handles to the membranes). membranes) 65 Was way ahead of her time.
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