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CRANIAL Jonathan Phillips, DO Vault Hold Patient: Dr: Seated & Resting forearms on table Supine Index finger: 2nd finger: 3rd finger: 4th finger: Greater wing of sphenoid Temporal Mastoid of Temporal Occiput Follow the CRI & evaluate rate, amplitude & symmetry VAULT HOLD Frontal-Occipital Hold Patient: Supine Dr: Rest forearms on table One hand contacts frontal bone Thumb on one greater wing of sphenoid Middle finger on one greater wing of sphenoid One hand allows occiput to rest in it, avoiding any pressure on the occipitomastoid suture Follow the CRI & evaluate for rate, amplitude and symmetry FRONTO-OCCIPITAL HOLD Sacral Assessment Patient: Dr: Supine Seated @ side of table Base of hand @ apex of sacrum Fingers @ base of sacrum Craniosacral flexion: Sacral base moves posterior Craniosacral extension: Sacral base moves anteriorly Functional/Nonpathological Strain Patterns PREDOMINANTLY FLEXION More flexion than extension during a cycle “Ernie” PREDOMINANTLY EXTENSION More extension than flexion during a cycle “Bert” Augmentation of the Cranial Rhythmic Impulse Use either vault or fronto-occipital hold Have patient take deep inspirations to augment the motion If in flexion, follow into flexion Inhibition of the Cranial Rhythmic Impulse Use either vault or fronto-occipital hold Gently follow hands into a more extension phase (if in flexion) FUNCTIONAL STRAIN PATTERNS: TORSIONS Axis: A/P Motion: Sphenoid & occiput rotate in occiput directions Nomenclature: Named by the side of higher wing of greater sphenoid Palpation: vault hold One hand rotates more posteriorly Index finger: Moves superiorly Little finger: Moves inferiorly Etiologies: Normal, Trauma, Postural strains TORSIONS: Cont. RIGHT TORSION R-GWS: Superior R-O: Inferior L-GWS: Inferior L-O: Superior *GWS = Greater wing of sphenoid *O = Occiput LEFT TORSION R-GWS: Inferior R-O: Superior L-GWS: Superior L-O: Inferior TORSIONS FUNCTIONAL PATTERNS: SIDEBENDING ROTATION Axes: (3) Two parallel vertical axes One A/P axis Motion: Sidebending: Sphenoid & occiput rotate in opposite directions about the parallel vertical axes Rotation: Sphenoid & occiput rotate the same direction about the A/P axis Nomenclature: Named by the side of the convexity Etiologies: Normal, Trauma, Postural strain SIDEBENDING ROTATION CONT. Palpation: Fingers approximate on side of concavity Fingers spread on side of convexity (the side it’s named for) Ex. Left sidebending rotation: left hand spreads wider & moves inferiorly SIDEBENDING ROTATION Cont. RIGHT SIDEBENDING ROTATION R-GWS: Ant/Inf R-O: Post/Inf L-GWS: Post/Sup L-O: Ant/Sup LEFT SIDEBENDING ROTATION R-GWS: Post/Sup R-O: Ant/Sup L-GWS: Ant/Inf L-O: Post/Inf SIDEBENDING ROTATION SIDEBENDING ROTATION SIDEBENDING ROTATION SIDEBENDING ROTATION Vertical Strains Superior Inferior Etiologies: Blow on top of the head posterior to the plane of the SBS Blow from below anterior to the plane of the SBS Palpation: Both hands move inferiorly Etiologies: Blow on top of the head anterior to the plane of the SBS Blow from below posterior to the plane of the SBS Palpation: Both hands move superiorly Vertical Strains Axes: Two parallel transverse axes Motion: Sphenoid & Occiput rotate in same direction (due to shearing force) One bone in flexion, the other in extension Nomenclature: Named according to direction the sphenoid is moving Etiology: Trauma VERTICAL STRAINS SUPERIOR R-GWS: Inferior R-O: Superior L-GWS: Inferior L-O: Superior INFERIOR R-GWS: Superior R-O: Inferior L-GWS: Superior L-O: Inferior VERTICAL STRAINS SUPERIOR & INFERIOR SHEARS Lateral Strains Axis: Two parallel vertical axes One through sphenoid One through foramen magnum Motion: Sphenoid & occiput rotate in same direction Nomenclature: Named by direction of the base of sphenoid Etiology: Trauma Lateral Strain Palpation: “Parallelogram Head” Forefingers shift one direction & little fingers shift to opposite side. Ex. Left lateral Strain: Forefingers shift right Little fingers shift left LATERAL STRAINS CONT. RIGHT LATERAL STRAIN R-GWS: Ant/Med R-O: Ant/Lat L-GWS: Post/Lat L-O: Post/Med LEFT LATERAL STRAIN R-GWS: Post/Lat R-O Post/Med L-GWS: Ant/Med L-O; Ant/Lat LATERAL STRAIN LATERAL STRAIN SBS Compression Sphenoid & Occiput: Little or no motion Etiologies: Trauma, Severe depression Competency Exam Question 1 Which finger position is wrong in the vault hold? A. Index finger- greater wing of the sphenoid B. 2nd finger- parietal bone C. 3rd finger mastoid of temperal D. 4th Occuput Question 1 Which finger position is wrong in the vault hold? A. Index finger- greater wing of the sphenoid B. 2nd finger- parietal bone C. 3rd finger mastoid of temperal D. 4th Occuput Question 2 Which does not CRI evaluate ? A. Rate B. Amplitude C. Symmetry D. Rhythm Question 2 Which does not CRI evaluate ? A. Rate B. Amplitude C. Symmetry D. Rhythm Question 3 Which is the correct matching with craniosacral flexion? A. Sacral bone moves posterior B. Sacral base moves anterior C. Sacral base moves caudal D. Sacral base moves Dorsal Question 3 Which is the correct matching with craniosacral flexion? A. Sacral bone moves posterior B. Sacral base moves anterior C. Sacral base moves caudal D. Sacral base moves Dorsal