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APPLIED KINESIOLOGY RELATED RESEARCH LITERATURE CONCERNING CRANIAL THERAPY AND THE STOMATOGNATHIC SYSTEM

-- Edited by Scott Cuthbert, D.C.

MEASUREMENTS OF CNS, BRAIN, SPINAL CORD AND CSF MOTILITY

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.

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

Abstract: 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.

The cytological implications of primary respiration, Crisera, P.

Medical Hypotheses, Jan 2001; 56(1):40-51

Abstract: 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 Metazoan, 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, and propagated and transduced within the infrastructure of the cytoskeleton as wave harmonics. 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

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into a vital network. 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 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 of the zygote could project itself throughout the cytoskeleton and modify the electromechanical properties of the plasma lamella, establishing the primordial axial-voltage gradients for the physiological control of development.

The periodic mobility of the cranial bones in man, Moskalenko IuE, Kravchenko TI, Gaidar BV, Vainshtein GB, Semernia VN, Maiorova NF, Mitrofanov VF (article in Russian)

Fiziol Cheloveka, 1999 Jan-Feb;25(1):62-70..Abstract: Serial X-rays and magnetic resonance tomograms of the human skull demonstrated changes in intracranial dimension of about 0.38 millimeters, which alternated between sagittal and frontal (anterior to posterior) expansions.

Raised intracranial pressure increases CSF drainage through arachnoid villi and extracranial lymphatics, Boulton M, Armstrong D, Flessner M, Hay J, Szalai JP, Johnston M.

Am J Physiol. 1998 Sep;275(3 Pt 2):R889-96.

Abstract: We demonstrated previously that about one-half of cerebrospinal fluid (CSF) removed from the cranial vault was cleared by extracranial lymphatic vessels. In this report we test the hypothesis that lymphatic drainage of CSF increases as intracranial pressure (ICP) is elevated in anesthetized sheep. Catheters were inserted into both lateral ventricles, cisterna magna, cervical lymphatics, and jugular vein. A ventriculocisternal perfusion system was employed to regulate CSF pressures and to deliver a protein tracer (125I-labeled human serum albumin) into the CSF compartment. 131I-labeled human serum albumin was injected intravenously to permit calculation of plasma tracer loss and tracer recirculation into lymphatics. ICP was controlled by adjusting the height of the inflow reservoir and the cisterna magna outflow catheter appropriately. The experimental design consisted of a 3-h period of lower pressure followed by a 3-h period of higher pressure in the same animal (10-20 or 20-30 cmH2O). We determined that incremental changes in ICP were associated with higher CSF transport through lymphatic and arachnoid villi routes in all eight animals tested (P = 0.004).Comment: This paper demonstrates the relationship between the lymphatic system and the cranial system. The implications of lymphatic drainage of the head to the movement of CSF should be explored further, and the methods of diagnosis and treatment of lymphatic function in AK could be an excellent modality for use in this investigation.

Cycle-to-cycle variability attributed to the primary respiratory mechanism,Lockwood MD, Degenhardt BF.

J Am Osteopath Assoc. 1998 Jan;98(1):35-6, 41-3.

Abstract: Wave forms attributed to the primary respiratory mechanism (PRM), as published by Viola Frymann, DO, in JAOA June 1971, were analyzed for an undescribed parameter, cycle-to-cycle variability. Tracings from this paper were independently measured by two physicians focusing on the duration of each cycle. Consistency of the measurements and interexaminer agreement were shown. The duration of individual cycles demonstrated significant cycle-to-cycle variability ranging from 0.6 second up to 6.3 seconds. The reason for variability as well as its clinical significance is unknown. The minute rate of each tracing ranged from 6.5 to 13.8 cycles per minute (0.108 to 0.230 Hz [corrected]), mean 10.8 +/- 2.3 (0.180 +/- 0.038 Hz [corrected]). (Different minute rates attributed to the PRM have been reported in other studies.) Although variability is an

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innate characteristic of biologic cycles, this phenomenon has not been previously reported for the PRM. The authors suggest that this variability has likely confounded previous interexaminer reliability studies and should be considered in any future studies of this type. Determination of causes of this variability present timely and fruitful avenues of research.

Assessment of the biomechanical state of intracranial tissues by dynamic MRI of cerebrospinal fluid pulsations: a phantom study,Chu D, Levin DN, Alperin N.

Magn Reson Imaging. 1998 Nov;16(9):1043-8.

Abstract: We used a cranial phantom to investigate how intracranial mechanical factors [brain compliance and the resistance to the flow of cerebrospinal fluid (CSF)] affect the way in which CSF pulsations are driven by pulsatile transcranial blood flow. Dynamic phase-contrast magnetic resonance imaging (MRI) was used to measure the transfer function between vascular pulsations and pulsatile response of the CSF below the foramen magnum of the phantom. We found that the coupling between the high frequency components of cervical CSF flow and transcranial blood flow was decreased when the phantom was modified to simulate increased brain compliance and increased resistance to CSF flow.

A new view on the CSF-circulation with the potential for pharmacological treatment of childhood hydrocephalus, Greitz D, Greitz T, Hindmarsh T.

Acta Paediatr. 1997 Feb;86(2):125-32.

Abstract: A new model of the cerebrospinal fluid (CSF) circulation is proposed, implying that the main absorption of CSF occurs through the brain capillaries. This model is based on recent observations of CSF dynamics using radionuclide cisternography and cardiac gated magnetic resonance imaging. Magnetic resonance imaging of communicating hydrocephalus has demonstrated a highly significant decrease of CSF flow through the foramen magnum, which is explained by decreased expansion of the intracranial arteries. This invariable finding in combination with the new view of the CSF-circulation makes a hemodynamic pathogenesis of hydrocephalus very probable. Communicating hydrocephalus may be caused by any process that restricts the arterial pulsations and is therefore termed restricted arterial pulsation hydrocephalus. In obstructive hydrocephalus, the ventricular dilatation leads to a compression of the cortical veins and consequently is termed venous congestion hydrocephalus. Based on these considerations, a new concept of pharmacological treatment of hydrocephalus is proposed by using a selective venous constrictor.

Update on osteopathic medical concepts and the lymphatic system, Degenhardt BF, Kuchera ML.

J Am Osteopath Assoc, 1996 Feb;96(2):97-100.

Abstract: The osteopathic medical profession has long recognized the importance of the lymphatic system in maintaining health. A review of scientific studies shows much information on the mechanisms and importance of lymph circulation. Many osteopathic manipulative techniques designed to treat patients with tissue congestion are based on early research recognizing that lymph flow is influenced by myofascial compression. Osteopathic manipulative treatment of the diaphragm was substantiated when pressure differentials created by the thoracic diaphragm were shown to influence lymph flow. Current research demonstrates that autonomically mediated, intrinsic lymphatic contractility plays a significant role in lymph propulsion, supporting the use of osteopathic manipulative techniques directed at influencing the autonomic nervous system to improve lymphatic circulation. Although research provides an explanation of how osteopathic manipulative techniques influence the lymphatic system, experimentation to test the direct influence of manipulation on lymph circulation is needed. Clinical outcomes studies are also necessary to substantiate the clinical efficacy of osteopathic manipulative techniques. This paper also proposes that intrinsic lymphatic contractility (distention of vessel walls, mediated neurally and hormonally) could cause a fascial impulse, palpated as the cranial rhythmic impulse (CRI) throughout the body.

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Intracranial volume receptors: possible role on ADH homeostatic control, Satta A, Palomba D, Demontis MP, Varoni MV, Faedda R, Ginanni A, Anania V.

J Endocrinol Invest. 1996 Jul-Aug;19(7):455-62.

Abstract: Volume receptors are situated in many organs and are capable of modulating ADH secretion. We have evaluated the variation of plasma ADH concentration after an experimentally induced increase of cerebrospinal fluid (CSF) pressure (PCSF). The experiment was performed in controlled environmental conditions to avoid pain or stress-related ADH release. In 15 rats (10 experimental, 5 control) a cannula was positioned in the left cerebral ventricle: in the experimental group artificial CSF was infused at a rate of 0.6 (microliter/min for 6h: this manoeuvre, in a separate set of animals obtained an increase from 13.03 +/- 0.8 to 25.4 +/- 2.5 cmH2O of PCSF. The same conditions were reproduced in the control group without infusion into lateral ventricle. At the end of the experiment, plasma ADH had fallen significantly in the experimental group from 18.9 +/- 4.8 to 11.9 +/- 2.3 pg/ml (p < 0.05), while it was not changed in the control group (from 25.5 +/- 13.7 to 23.7 +/- 16.2 pg/ml). Heart rate, arterial pressure, plasma Na+ and osmolality, did not change significantly. Plasma K+ fell significantly in both groups: from 5.5 +/- 0.6 to 4.3 +/- 0.3 (p < 0.05) and from 5.4 +/- 0.7 to 4.3 +/- 0.15 mEq/l (p < 0.05) in the experimental and control group respectively. Plasma creatinine was normal, checked only at the end of the experiment. Our results demonstrate that a relationship exists between PCSF variations and plasma ADH concentration. We believe this relationship is due to the pressure receptors in the cerebral ventricles or in structures connected to it, such as the inner ear, and we hypothesize the existence of a control system of body fluids, more diffused than thought to be, up till now.Comment: An important goal of AK practitioners is to consider the whole patient. This study demonstrates that there is a specific relationship between the cranial-meningeal-CSF system and the endocrine system. Endocrine assessments as well as cranial structural assessments should be considered for patients who have cranial faults from the evidence presented in this study.

Hemodynamically independent analysis of cerebrospinal fluid and brain motion observed with dynamic phase contrast MRI,Alperin N, Vikingstad EM, Gomez-Anson B, Levin DN.

Magn Reson Med. 1996 May;35(5):741-54.

Abstract: Brain and cerebrospinal fluid (CSF) movements are influenced by the anatomy and mechanical properties of intracranial tissues, as well as by the waveforms of driving vascular pulsations. The authors analyze these movements so that the purely hemodynamic factors are removed and the underlying mechanical couplings between brain, CSF, and the vasculature are characterized in global fashion. These measurements were used to calculate a set of impulse response functions or modulation transfer functions, characterizing global aspects of the vasculature's mechanical coupling to the intracranial tissues, the cervical CSF, and the cervical spinal cord. These functions showed that a sudden influx of blood into the head was rapidly accommodated by some type of intracranial reserve or capacity. After this initial response, an equal volume of CSF was driven through the foramen magnum over the next 200-300 ms as the intracranial reserve relaxed to its base-line state.

Brain and cerebrospinal fluid motion: real-time quantification with M-mode MR imaging, Maier SE, Hardy CJ, Jolesz FA.

Radiology, 1994 Nov;193(2):477-83.

PURPOSE: To assess motion of brain parenchyma and cerebrospinal fluid (CSF) with magnetic resonance (MR) phase imaging in real time. MATERIALS AND METHODS: Repetitive excitation of a cylinder with two-dimensional selective excitation followed by one-dimensional imaging along the cylinder axis yielded profiles analogous to those of M-mode echography. Bipolar gradients provided velocity sensitivity in an arbitrary spatial direction. RESULTS: Brain and CSF of healthy volunteers exhibited periodic motion in the frequency range of normal heart rate. Both brain hemispheres showed periodic squeezing of the ventricles, with peak velocities up to 1 mm/sec followed by a slower recoil. Superimposed on the regular displacement of the brain stem was a slow, respiratory-related periodic shift of the neutral position. During the Valsalva maneuver,

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the brain stem showed initial caudal and subsequent cranial displacement of 2-3 mm. Coughing produced a short swing of CSF in the cephalic direction. CONCLUSION: Real-time MR phase imaging allows observation of non-periodic events in brain and CSF motion.

Origin of lumbar cerebrospinal fluid pulse wave, Urayama K.

Spine, 1994 Feb 15;19(4):441-5.

Abstract: System analysis was performed on 16 adult mongrel dogs to determine the origin of the lumbar cerebrospinal fluid pulse wave. The descending thoracic aorta was occluded to evaluate the effects of the spinal arterial pulsations, and the thoracic aorta and inferior vena cava were simultaneously occluded to evaluate the effects of the spinal venous pulsations. It was concluded that, in the first harmonic wave, the components of the lumbar cerebrospinal fluid pulse wave are as follows: spinal arterial pulsations, 39.4%; spinal vascular (arteries and veins) pulsations, 77%; venous pulsations in the spinal canal, 37.6%; and the intracranial pressure pulse wave transmitted through the spinal canal from the intracranial space to the lumbar level, 23%.

Cerebrospinal fluid circulation and associated intracranial dynamics. A radiologic investigation using MR imaging and radionuclide cisternography, Greitz D.

Acta Radiol Suppl, 1993;386:1-23.

AIMS OF THE PRESENT INVESTIGATION. Observations made in a preliminary study of pulsatile cerebrospinal fluid (CSF) and brain motions using MR imaging called for a reconsideration of the CSF flow model currently accepted. The following questions were addressed: 1) The nature of the CSF-circulation, e.g., the magnitude and pattern of pulsatile and bulk flow; 2) The driving forces of the CSF circulation and assessment of the role of associated hemodynamics and brain motions; 3) The major routes for the absorption of CSF. MATERIAL AND METHODS. CSF flow and associated hemodynamics were studied using gated MR imaging, in 26 healthy volunteers, 5 patients with communicating hydrocephalus and 10 with benign intracranial hypertension. Radionuclide cisternography was performed in 10 individuals with venous vasculitis. RESULTS AND CONCLUSIONS. 1) The CSF-circulation is propelled by a pulsating flow, which causes an effective mixing. This flow is produced by the alternating pressure gradient, which is a consequence of the systolic expansion of the intracranial arteries causing expulsion of CSF into the compliant and contractable spinal subarachnoid space. 2) No bulk flow is necessary to explain the transport of tracers in the subarachnoid space. 3) The main absorption of the CSF is not through the Pacchionian granulations, but a major part of the CSF transportation to the blood-stream is likely to occur via the paravascular and extracellular spaces of the central nervous system. 4) The intracranial dynamics may be regarded as the result of an interplay between the demands for space by the four components of the intracranial content, i.e. the arterial blood, brain volume, venous blood and the CSF. This interaction is shown to have a time offset within the cerebral hemispheres in a fronto-occipital direction during the cardiac cycle (the fronto-occipital "volume wave"). 5) The outflow from the cranial cavity to the cervical subarachnoid space (SAS) is dependent in size and timing on the intracranial arterial expansion during systole. Similarly, the outflow from the aqueduct mirrors the brain expansion. The brain expansion is typically very small as evident from the minute aqueductal flow observed in healthy individuals. This expansion occurs simultaneously with an inflow of CSF and will be directed inwards towards the ventricular system. The brain expansion is of decisive importance for the formation of the normal transcerebral pressure gradient. 6) The instantaneous increase of flow in the superior sagittal sinus at the beginning of the systole reflects a direct pressure transmission via the SAS from the expanding arteries to the cerebral veins. It is contended that this early increase in venous pressure together with the volume wave is most likely an important prerequisite for sustaining normal intracranial pressure (ICP) and normal cerebral blood flow. This counter pressure should be reduced in hydrocephalus due to the decreased arterial expansion and could explain the reduced blood flow as well as an increased transmantle

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pressure gradient causing the ventricular dilatation. An increased pressure in the venous system is likely to be the cause of increases in ICP, including the increased pressure observed in benign intracranial hypertension (BIH).

CSF drains directly from the subarachnoid space into nasal lymphatics in the rat. Anatomy, histology and immunological significance, Kida S, Pantazis A, Weller RO.

Neuropathol Appl Neurobiol. 1993 Dec;19(6):480-8.

Abstract: Cerebrospinal fluid (CSF) drainage pathways from the rat brain were investigated by the injection of 50 microliters Indian ink into the cisterna magna. The distribution of the ink, as it escaped from the cranial CSF space, was documented in 2 mm thick slices of brain and skull cleared in cedar wood oil and in decalcified paraffin sections. Following injection of the ink, deep cervical lymph nodes were selectively blackened within 30 min and lumbar para-aortic nodes within 6 h. Within the cranial cavity, carbon particles accumulated in the basal cisterns but were also distributed in the paravascular spaces around the middle cerebral arteries and the nasal-olfactory artery. Carbon particles in the subarachnoid space beneath the olfactory bulbs drained directly into discrete channels which passed through the cribriform plate and into lymphatics in the nasal submucosa. Although ink was distributed along the subarachnoid space of the optic nerves and entered the cochlea, the nasal route was the only direct connection between cranial CSF and lymphatics. Arachnoid villi associated with superior and inferior sagittal sinuses were identified and a minor amount of drainage of ink into dural lymphatics was also observed. This study demonstrates the direct drainage of cerebrospinal fluid through the cribriform plate in anatomically defined channels which connect with the nasal lymphatics.Comment: This paper shows the functional integration of the CSF with the lymphatic system, a concept that has been important in AK thinking for over 30 years.

Pulsatile brain movement and associated hydrodynamics studied by magnetic resonance phase imaging. The Monro-Kellie doctrine revisited, Greitz D, Wirestam R, Franck A, Nordell B, Thomsen C, Stahlberg F.

Neuroradiology,1992;34(5):370-80.

Abstract: Brain tissue movements were studied in axial, sagittal and coronal planes in 15 healthy volunteers, using a gated spin echo MRI sequence. All movements had characteristics different from those of perfusion and diffusion. The highest velocities occurred during systole in the basal ganglia (maximum 1.0 mm/s) and brain stem (maximum 1.5 mm/s). The movements were directed caudally, medially and posteriorly in the basal ganglia, and caudally-anteriorly in the pons. Caudad and anterior motion increased towards the foramen magnum and towards the midline. The resultant movement occurred in a funnel-shaped fashion as if the brain were pulled by the spinal cord. This may be explained by venting of brain and cerebrospinal fluid (CSF) through the tentorial notch and foramen magnum. The intracranial volume is assumed to be always constant by the Monro-Kellie doctrine. The intracranial dynamics can be viewed as an interplay between the spatial requirements of four main components: arterial blood, capillary blood (brain volume), venous blood and CSF. These components could be characterized, and the expansion of the arteries and the brain differentiated, by applying the Monro-Kellie doctrine to every moment of the cardiac cycle. The arterial expansion causes a re-moulding of the brain that enables its piston-like action. The arterial expansion creates the prerequisites for the expansion of the brain by venting CSF to the spinal canal. The expansion of the brain is, in turn, responsible for compression of the ventricular system and hence for the intraventricular flow of CSF.

Brain motion: measurement with phase-contrast MR imaging,Enzmann DR, Pelc NJ.

Radiology. 1992 Dec;185(3):653-60.

Abstract: Brain motion during the cardiac cycle was measured prospectively in 10 healthy volunteers by using a phase-contrast cine magnetic resonance (MR) pulse sequence. The major cerebral lobes, diencephalon, brain stem, cerebellum, cerebellar tonsils, and spinal cord were studied. The overall pattern of brain motion showed caudal motion of the central structures (diencephalon, brain stem, and cerebellar tonsils) shortly

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after carotid systole, with concurrent cephalic motion of the major cerebral lobes and posterior cerebellar hemisphere. Peak brain displacement was in the range of 0.1-0.5 mm for all the structures except the cerebellar tonsils, which had greater displacement (0.4 mm +/- 0.16 [mean +/- standard error of mean]). Caudal motion of the central structures did not occur simultaneously but progressed in a caudal-to-rostral and posterior-to-anterior sequence, being seen first in the cerebellar tonsils and then later in the diencephalon (hypothalamus). Caudal motion of the low brain stem and cerebellar tonsil was simultaneous with caudal motion of cerebrospinal fluid in the cervical subarachnoid space. Oscillatory flow in the aqueduct was delayed compared with brain stem motion.

Hydraulic regulation of brain parenchymal volume, Winston KR, Breeze RE.

Neurol Res. 1991 Dec;13(4):237-47.

Abstract: A mechanism for the hydraulic regulation of brain parenchymal volume is hypothesized. Ventricular fluid pressure is transmitted to parenchymal capillaries and affects the pressure difference across the capillary wall, thereby influencing the rate of movement of fluid from the capillary lumen to interstitial fluid. The tendency for brain parenchyma to expand results from the resistance encountered by interstitial fluid as it slowly passes through the complex interstices of extracellular space. The tendency for the brain parenchyma to become smaller results, not from compression of tissue by ventricular fluid, but from an inherent elasticity of brain tissue. The parenchymal volume is stable only when the opposing tendencies are balanced. The critical site of action for the hydraulic control of parenchymal volume is the capillary wall, and the fundamental relationship governing this can be expressed mathematically.Comment: For proper venous drainage of the brain, there should be a reducing gradient pressure from cranial perfusion pressure (about equal to mean arterial pressure), to interstitial fluid pressure in the brain, to CSF pressure, to superior sagittal sinus venous pressure, to the negative interstitial fluid pressure in the body. In AK it is suspected that improving cranial sutural movement and reciprocal membrane tension will enhance venous flow, reduce neural entrapment, and permit a normal cranial rhythmic impulse rate, rhythm, and amplitude…all of which benefit the homeostatic mechanisms of the nervous system.

Alternative pathways for drainage of cerebrospinal fluid in the canine brain, Leeds SE, Kong AK, Wise BL.

Lymphology. 1989 Sep;22(3):144-6.

Abstract: Although the brain has no formal lymphatic system, a substantial quantity of cerebrospinal fluid (CSF) has nonetheless been shown to drain via cervical lymphatics. To pursue further the issue of alternative drainage pathways for CSF, we infused a solution of Ringer's lactate (RL) into the cisterna magna of the dog brain and monitored both the flow and concentration of total protein of cervical lymph. This maneuver promoted a nearly three-fold rise in intracranial pressure and was accompanied by a rise in cervical lymph flow and fall in its protein content. In addition, a profuse nasal discharge (11.4 ml/hr) developed with a moderately high protein content of the rhinorrhea fluid (1.8 g/dl), along with similar appearance times of Evans blue dye (instilled in the cisterna magna) in both cervical lymph and the rhinorrhea fluid (48-70 minutes after infusion). These findings suggest alternative drainage pathways for CSF besides the arachnoid villi (Pacchionian bodies) including connections with lymphatics in the neck and along the olfactory nerve, and around the cribriform plate to the nasal submucosa, and with proptosis, perhaps also through the aqueous humor-canal of Schlemm and nasolacrimal duct.

Dynamics of the junction between the medulla and the cervical spinal cord: an in vivo study in the sagittal plane by magnetic resonance imaging, Doursounian

Surg Radiol Anat. 1989;11(4):313-22.

Abstract: Sagittal sections of the brain-stem made by MRI reveal differences in the angle formed by the medulla and the cord. In order to study the normal mobility of this region of the CNS during flexion and extension of the head, sagittal MRI studies were made in the sagittal plane in 18 young volunteers. The volunteers were in dorsal decubitus with the

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L, Alfonso JM, Iba-Zizen MT, Roger B, Cabanis EA, Meininger V, Pineau H.

cervical spine first flexed and then extended, with the movement localized to the cranio-cervical junction as far as possible. T1-weighted sequences were used, with body coils in 16 cases and surface coils in two. Measurements were related to global cranio-cervical range of movement, movement at the cranio-cervical junction and spino-medullary movement. Variations in the depth of the free space in front of the medulla, pons and spinal cord during movement were also noted. We also checked for downward shift of the lower part of the 4th ventricle and modification of the shape of the ventricle during flexion-extension. The global range of cranio-cervical movement was between 31 and 100 degrees (average 63 degrees). The range between the cranium and C1C2 was 4 to 39 degrees (average 19 degrees) and the spino-medullary range was from 1 to 32 degrees (average 14 degrees). During flexion, the free space narrowed in front of the pons 11 times, in front of the medulla 14 times and in front of the cervical cord 11 times. There was a downward shift of the lower part of the 4th ventricle during flexion in 4 cases but no change in shape was noted. Though this study is open to criticism from several aspects, it may be concluded that variations of the spino-medullary angle in the sagittal plane during flexion-extension do occur, that they are closely correlated with movements at the cranio-cervical junction, moves forward during flexion.Comment: This research study confirms the observations made by Dr. A. Brieg, the neurosurgeon, in his 1960 work Biomechanics of the Central Nervous System. Studies like this one portrays the nervous system as one organ, which spreads out like a cobweb in the body so that tension anywhere along the dural tract may refer symptoms anywhere.

The Relationship Between CSF and Fluid Dynamics in the Neural Canal, Flanagan, M.

J Manipulative Physiol Ther, Dec 1988;11(6):489-92

There is a relationship between fluid dynamics in the neural canal and cranial vault. This relationship can be affected by posture, respiration and pathology. In addition, several chiropractic disciplines [including applied kinesiology] have advocated that axial skeletal improprieties may also affect fluid dynamics in the canal and vault. This paper reviews literature pertinent to these issues. The information it contains is relevant to those disciplines that attempt to manipulate fluid dynamics in the canal and vault, as well as to those that treat neurological disorders.

Fixed spinal cord: diagnosis with MR imaging,Levy LM, Di Chiro G, McCullough DC, Dwyer AJ, Johnson DL, Yang SS.

Radiology. 1988 Dec;169(3):773-8.

Abstract: Pulsatile motion of the spinal cord was examined with phase imaging techniques. Sagittal images of the spinal cord were obtained at different times of the cardiac cycle in healthy volunteers, as well as in patients in whom the spinal cord either was tethered, was compressed, or contained an intramedullary lesion. Pulsatile velocity changes of the spinal cord, observed on the phase images, were most marked at the cervical-upper thoracic level. Cord motion was found to be significantly decreased in cases in which the cord was either tethered or compressed. Cord enlargement due to an intramedullary lesion generally did not lead to decreased cord motion. Imaging of pulsatile cord motion may be clinically useful in evaluating diseases restricting cord motion or changing the status of parenchymal compliance.

Low-frequency oscillations of cortical oxidative metabolism in waking and sleep, Vern BA, Schuette WH, Leheta B, Juel VC, Radulovacki M.

J Cereb Blood Flow Metab.1988 Apr;8(2):215-26.

Abstract: To study the changes in cortical oxidative metabolism and blood volume during behavioral state transitions, we employed reflectance spectrophotometry of the cortical cytochrome c oxidase (cyt aa3) redox state and blood volume in unanesthetized cats implanted with bilateral cortical windows and EEG electrodes. Continuous oscillations in the redox state and blood volume (approximately 9/min) were observed during waking and sleep. These primarily metabolic oscillations of relatively high amplitude were usually synchronous in homotopic cortical areas, and persisted during barbiturate-induced electrocortical silence. Their mean amplitude and frequency did not vary across different

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behavioral/EEG states, although the mean levels of cyt aa3 oxidation and blood volume during rapid eye movement (REM) sleep significantly exceeded those during waking and slow-wave sleep. These data suggest the existence of a spontaneously oscillating metabolic phenomenon in cortex that is not directly related to neuroelectric activity. A superimposed increase in cortical oxidative metabolism and blood volume occurs during REM sleep. Experimental data concerning cerebral metabolism and blood flow that are obtained by clinical methods that employ relatively long sample acquisition times should therefore be interpreted with caution.

Human brain motion and cerebrospinal fluid circulation demonstrated with MR velocity imaging, Feinberg DA, Mark AS.

Radiology, 1987 Jun;163(3):793-9.

Abstract: Present theory holds that pulsatile pressure of cerebrospinal fluid (CSF) is driven by the force of expansion of the choroid plexus. Alternate theories postulating that a possible movement of the brain is involved in pumping CSF have not, to the authors' knowledge, been substantiated heretofore. In this study, in vivo, quantitative magnetic resonance (MR) imaging methods were developed to show reproducible magnitudes and directions of CSF flow. Measurements were obtained with a new MR velocity imaging technique at high resolution (0.4 mm/sec), requiring 64 cardiac cycles per image. Twenty-five healthy volunteers and five patients were studied. Observations of pulsatile brain motion, ejection of CSF out of the cerebral ventricles, and simultaneous reversal of CSF flow direction in the basal cisterns toward the spinal canal, taken together, suggest that a vascular-driven movement of the entire brain may be directly pumping the CSF circulation. The authors describe what they believe to be the first observations and measurements of human brain motion, which occurs in extensive internal regions (particularly the diencephalon and brain stem) and is synchronous with cardiac systole.

Evidence for a 'paravascular' fluid circulation in the mammalian central nervous system, provided by the rapid distribution of tracer protein throughout the brain from the subarachnoid space, Rennels ML, Gregory TF, Blaumanis OR, Fujimoto K, Grady PA.

Brain Res. 1985 Feb 4;326(1):47-63.

Abstract: The protein tracer, horseradish peroxidase (HRP), was infused into the lateral cerebral ventricles or subarachnoid space of anesthetized cats and dogs after insertion of a cisternal cannula to permit drainage of cerebrospinal fluid (CSF) and tracer solution. The intracerebral distribution of the tracer was then determined by light microscopy of serial brain sections after postinfusion intervals of 4 min-2 h. For the localization of HRP, sections were incubated with diaminobenzidine (DAB) or the much more sensitive chromogen, tetramethylbenzidine (TMB). The TMB reaction showed a consistent 'paravascular' distribution of tracer reaction product, within the perivascular spaces (PVS) around large penetrating vessels and in the basal laminae around capillaries, far beyond the termination of the PVS. After infusion of HRP over 4 min, arterioles were surrounded by the tracer, but capillaries and venules were usually less densely demarcated; by 6 min, however, the intraparenchymal microvasculature was outlined in toto throughout the forebrain and brainstem. Electron microscopy of sections incubated in DAB after 10 or 20 min HRP circulation confirmed the paravascular location of the reaction product, which was also dispersed throughout the extracellular spaces (ECS) of the adjacent parenchyma. Our results demonstrate that solutes in the CSF have access to the ECS throughout the neuraxis within minutes via fluid pathways paralleling the intraparenchymal vasculature. The rapid paravascular influx of HRP could be prevented by stopping or diminishing the pulsations of the cerebral arteries by aortic occlusion or by partial ligation of the brachiocephalic artery. The exchange of solutes between the CSF and the cerebral ECS has generally been attributed to diffusion, however, HRP enters the neuraxis along the intraparenchymal microvasculature far more rapidly than can be explained on this basis. This apparent convective tracer influx may be facilitated by transmission of the pulsations of the cerebral arteries to the microvasculature. We postulate that a fluid circulation through the CNS occurs via paravascular pathways.

Computed tomography studies of S Afr J Surg, 1984 Feb-Mar;22(1):57-63.

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human brain movements, Podlas H, Allen KL, Bunt EA Abstract: Tomographic studies of the ventricular system showed 2-dimensional display

of lateral and third ventricles with a rhythmical dilatation and contraction in a normal adult at the rate of approximately 8 cycles per minute. In a child with hydrocephalus the rate was irregular and approximately 4 cycles per minute.

Continuous and intermittent measurement of intracranial pressure by Ladd monitor,Walsh P, Logan WJ.

J Pediatr. 1983 Mar;102(3):439-42.

Abstract: Controversy exists as to whether the force of application of the sensor of the Ladd monitor to the anterior fontanel affects the accuracy of measurements of intracranial pressure. To resolve this problem, an artificial fontanel was constructed and fontanel pressure measurements were recorded at varying forces of application of the sensor. This in vitro technique demonstrated that anterior fontanel pressure measured with the Ladd monitor is dependent on the force of application. Measurements of anterior fontanel pressure were made in 17 infants and were correlated with simultaneous direct intracranial pressure measurements. These in vivo measurements confirmed the findings on the artificial fontanel. Both the in vivo and in vitro measurements suggest that an application force of 7 to 10 gm on the sensor will produce an accurate reflection of intracranial pressure. We describe two devices with which the sensor may be applied to the fontanel with constant measurable force: one for intermittent measurement and another for continuous recording.

Quantitative analysis of methods for reducing physiological brain pulsations, Britt RH, Rossi GT.

J Neurosci Methods. 1982 Sep;6(3):219-29.

Abstract: Normal movements of the mammalian brain, caused by the arterial and venous pressure fluctuations of each cardiac and respiratory cycle, have made obtaining stable intracellular recordings from neurons difficult. This study quantitated the movements of the cats' brainstem and examined the effects of traditional neurophysiological techniques used to reduce pulsation. Two components of brain movement were recorded: (1) an arterial component--relatively low amplitude (110-266 micrometers) and short duration (330-400 ms) excursions corresponding to the pressure wave of each cardiac systole [A-wave]; and (2) a pulmonary component--slower (10-12/min), high amplitude plateau-like displacement (300-950 micrometers) lasting for a time (2.4-5.1 s) corresponding to the inspiration of each respiratory cycle [P-wave]. Pneumothoraces and mechanical ventilation combined with elevating the animal's head reduced the pulmonary component by an average of 68% and the arterial component by 40%. Cerebrospinal fluid drainage could reduce the P-wave component of movement by as much as 50%. To reduce arterial pulsations below 100 micrometers, the mean arterial pressure (MAP) had to be lowered to less than 40 mm Hg, which was not compatible with maintaining normal brainstem auditory evoked responses. Residual movements at MAPs greater than 50 mm Hg were still sufficient to make stable intracellular penetration of small neurons difficult. The authors suggest the solution to this problem is the development of a cardiopulmonary bypass system which generates a non-pulsatile flow of oxygenated blood, described in a companion paper.

[Effect of osmotic shifts in cerebrospinal fluid on lymph flow and lymph formation], Demchenko GA.

Fiziol Zh SSSR Im I M Sechenova. 1980 Mar;66(3):387-93.

Abstract: Administration of 0.865 M sodium chloride, 0.1 ml, into the lateral ventricle of anesthetized dogs increased the drainage of lymph from the thoracic and jugular lymph vessels, increased blood plasma volume, and decreased the total protein content in the lymph, blood plasma and interstitial fluid. Within first minutes after the administration the ratio of protein fractions in blood plasma and lymph was altered and the osmotic blood and lymph pressure decreased. The data obtained indicate the reflex elimination of osmotic shifts in the C. S. F.Comment: This paper demonstrates the relationship between the biochemistry of the CSF

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and the lymphatic system. The implications of the biochemistry of the CSF on total body function should be explored further, and the methods of diagnosis and treatment of oral nutrient testing on the CSF and lymphatic function in AK could be an excellent modality for use in such an investigation.

Evidence for passage of cerebrospinal fluid among spinal nerves, Steer JC, Horney FD.

Can Med Assoc J. 1968 Jan 13;98(2):71-4.

This paper demonstrates that CSF is transmitted throughout the body, and its trophic function is important to the health of nerves throughout the body. CSF pressure changes within the CNS may be transmitted throughout the whole body, and may explain some of the palpatory findings reported by those working in the cranial field.

Ultrasonic techniques for measuring intracranial pulsations. Research and clinical studies,Wallace WK, Avant WS Jr, McKinney WM, Thurstone FL.

Neurology. 1966 Apr;16(4):380-2.

This investigation reported an apparently nine-cycle-per-minute intracranial pulsation observed by ultrasound in the brain and membrane tissues of a human subject.

Circulation of the cerebrospinal fluid. Demonstration of the choroid plexuses as the generator of the force for flow of fluid and ventricular enlargement,Bering EA, Jr.

J Neurosurg. 1962 May;19:405-13.

Circulation of the Cerebrospinal Fluid through the Connective Tissue System, Erlingheuser, R.F.

American Academy of Osteopathy Yearbook, 1959:77-87

Abstract: Much of the fascia and connective tissue in the body is made of tubular structures. This study demonstrates that lymph and cerebrospinal fluid spreads throughout the body via these channels. Connective tissue may have an important nutritive function.

The penetration of particulate matter from the cerebrospinal fluid into the spinal ganglia, peripheral nerves, and perivascular spaces of the central nervous system, BRIERLEY JB.

J Neurol Neurosurg Psychiatry. 1950 Aug;13(3):203-15.

THE OSSEOUS-ARTICULAR MECHANISM OF THE CRANIAL SYSTEM

Radiographic Evidence of Cranial Bone Mobility, Oleski, S, Smith G, Crow W

Cranio: The Journal of Craniomandibular Practice; Jan 2002;20(1):34-8

Abstract: The purpose of this retrospective chart review was to determine if external manipulation of the cranium alters selected parameters of the cranial vault and base that can be visualized and measured on x-ray. Twelve adult patient charts were randomly selected to include patients who had received cranial vault manipulation treatment with a pre- and post-treatment x-ray taken with the head in a fixed positioning device. The degree of change in angle between various specified cranial landmarks as visualized on x-

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ray was measured. The mean angle of change measured at the atlas was 2.58 degrees, at the mastoid was 1.66 degrees, at the malar line was 1.25 degrees, at the sphenoid was 2.42 degrees, and at the temporal line was 1.75 degrees. 91.6% of patients exhibited differences in measurement at three or more sites. This study concludes that cranial bone mobility can be documented and measured on x-ray.

Long-term developmental outcomes in patients with deformational plagiocephaly, Miller RI, Clarren SK.

Pediatrics, 2000 Feb;105(2):E26.

OBJECTIVES: To determine whether there was an increased rate of later developmental delay in school-aged children who presented as infants with deformational plagiocephaly without obvious signs of delay at the time of initial evaluation. METHODS: A retrospective medical record review of 254 patients evaluated at the Craniofacial Center of the Children's Hospital and Regional Medical Center in Seattle, Washington, from 1980 through 1991 was completed. Consenting patient families were interviewed via telephone to determine what, if any, special medical or educational problems had occurred for the children who had had plagiocephaly in infancy or their siblings with normal head shapes. RESULTS: A total of 181 families from the medical record review could be notified about the study and 63 families agreed to participate in a telephone interview. The sample of participants for the telephone interview was random to and representative of the group as a whole. The families reported that 25 of the 63 children (39.7%) with persistent deformational plagiocephaly had received special help in primary school including: special education assistance, physical therapy, occupational therapy, speech therapy generally through an Individual Education Plan. Only 7 of 91 siblings (7.7%), serving as controls, required similar services (chi(2) = 21.24). Delays could not be specifically anticipated at the time of the diagnosis of deformational plagiocephaly from any simple set of factors including treatment with helmet therapy, although effected males with reported uterine constraint were at the highest risk for subsequent school problems. CONCLUSIONS: Infants with deformational plagiocephaly comprise a high-risk group for developmental difficulties presenting as subtle problems of cerebral dysfunction during the school-age years. There is a need for additional research on the long-term developmental problems in infants with deformational plagiocephaly, facial asymmetry, torticollis, developmental delay.Comment: The cranial mechanism must be included in the practice of chiropractic care for the physically and mentally challenged because it is in fact the headquarters for all the functions that operate within the child. This is the part of the body with the greatest disturbances in cases of plagiocephaly; to ignore it or not treat it amounts to major neglect in therapy (mal-practice). Clinical researchers record many instances of success in treating dysfunctional children, some with severe learning and behavioral problems as well as a host of physical complaints, utilizing cranial techniques. Some of the methods currently employed by orthopedic surgeons to “correct” cranial distortions involve surgical removal of plates of bone from the skull, fusion of sutures and the imposition of irreversible damage to the cranial mechanism. An alternative therapy is to fit growing infants with a “helmet” to be worn for years, day and night, which forcibly molds deviant skulls into cosmetically acceptable shapes, with little regard for functional integrity (and with an enormous degree of discomfort). It was also noted in the present study that use of helmet therapy to correct the distortion did not seem to affect the rate of developmental delay, almost half of the delayed patients having worn helmets.

Attachments of the ligamentum nuchae to cervical posterior spinal dura and the lateral part of the occipital bone, Mitchell BS, Humphreys BK, O'Sullivan E.

J Manipulative Physiol Ther. 1998 Mar-Apr;21(3):145-8.

OBJECTIVE: To describe previously unrecorded attachments of the ligamentum nuchae to the cervical posterior spinal dura, and to posterolateral parts of the occipital bone in an anatomical study, with particular reference to the deep aspects of the suboccipital triangle and upper cervical region. DESIGN: Dissections of 10 heads and necks from embalmed cadavers were made in the suboccipital and upper cervical region, either in whole

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specimens or in parasagitally sectioned specimens. RESULTS: In parasagittally sectioned material, continuity was observed between the ligamentum nuchae and the posterior cervical spinal dura as the latter passed deeply from the midline toward the dura, but only at the first and second cervical vertebral levels. The ligamentum nuchae also passed bilaterally on to the occipital bone as far as the sutures between the occipital bone and the temporal bones, approaching the inferior nuchal line superiorly. CONCLUSION: The present study is the first to describe the full morphology of the relationship between the ligamentum nuchae and the cervical posterior spinal dura and the lateral aspects of the occipital bone. This is of significance for understanding the biomechanics of the cervical spine, particularly rotational movements of the head in the sagittal or transverse planes. This may have implications in manipulative therapy for conditions as cervicogenic headache and for various degenerative disorders affecting the cervical spine.

Kinematic system demonstrates cranial bone movement about the cranial sutures, Lewandoski MA, Drasby E, Morgan M, Zanakis M

J Am Osteopath Assoc, 1996;96(9):551.

(http://www.jaoa.org)

Abstract: Utilizing infrared markers and a kinematic system, demonstration of cranial bone movement at cranial sutures was possible. Range of motion was in the region of 250 microns and was not simply due to malleability.

Cranial sutures require tissue interactions with dura mater to resist osseous obliteration in vitro, Opperman LA, Passarelli RW, Morgan EP, Reintjes M, Ogle RC.

J Bone Miner Res, 1995 Dec;10(12):1978-87.

Abstract: A chemically defined serum-free medium, which supports the development of bones and fibrous tissues of rat calvaria from nonmineralized mesenchymal precursor tissues, was employed to investigate tissue interactions between the dura matter and overlying tissues. Fetal calvarial rudiments from stages prior to bone and suture morphogenesis (fetal days 19 and 20) and neonatal calvarial rudiments with formed sutures (day 1) were cultured with and without associated dura mater. Removal of calvaria for in vitro culture allowed the examination of suture morphogenesis in the absence of tensional forces exerted on the sutures via fiber tracts in the dura mater originating in the cranial base. Ossification of frontal and parietal bones proceeded in a fashion comparable to development in vivo, but the cranial (coronal) sutures--primary sites for subsequent skull growth--were obliterated by osseous tissue union in the absence of dura mater. Bony fusion did not occur when rudiments were cocultured with dura mater on the opposite sides of 0.45 microns polycarbonate transwell filters, suggesting that the influence of dura mater on sutural obliteration was mediated by soluble factors rather than cell-cell or cell-matrix interactions. These results indicate that cell signaling mechanisms rather than biomechanical tensional forces are required for morphogenesis of the calvaria.

Role of cranial bone mobility in cranial compliance, Heisey, SR, Adams, T.

Neurosurgery, 1993;33(5):869-876.

Abstract: 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

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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.

Parietal bone mobility in the anesthetized cat, Adams T, Heisey RS, Smith MC, Briner BJ

J Am Osteopath Assoc, 1992 May;92(5):599-600, 603-10, 615-22.

Abstract: To quantify parietal bone motion in reference to the medial sagittal suture, a newly developed instrument was attached to the surgically exposed skull of anesthetized adult cats. The instrument differentiated between lateral and rotational parietal bone movements around the fulcrum of the suture. Bone movement was produced by external forces applied to the skull and by changes in intracranial pressure associated with induced hypercapnia, intravenous injections of norepinephrine, and controlled injections of artificial cerebrospinal fluid into the lateral cerebral ventricle. Responses varied considerably among test animals. Generally, lateral head compression caused sagittal suture closure, small inward rotation of the parietal bones, increased intraventricular pressure, transient apnea, and unstable systemic arterial blood pressure. Graded increases in intracranial volume produced stepped increases in pressure, lateral expansion at the sagittal suture, and outward rotation of the parietal bones. We attribute variations in animal response largely to differences in intracranial and suture compliance among them. Cranial suture compliance may be an important factor in defining total cranial compliance.

Sutural complexity in artificially deformed human (Homo sapiens) crania, Anton SC, Jaslow CR, Swartz SM.

J Morphol. 1992 Dec;214(3):321-32.

Abstract: The pattern of complexity of cranial sutures is highly variable both among and within species. Intentional cranial vault deformation in human populations provides a controlled natural experiment by which we were able to quantify aspects of sutural complexity and examine the relationship between sutural patterns and mechanical loading. Measures of sutural complexity (interdigitation, number, and size of sutural bones) were quantified from digitized tracings of 13 sutures and compared among three groups of crania (n = 70) from pre-European contact Peru. These groups represent sample populations deformed in 1) anteroposterior (AP) and 2) circumferential (C) directions and 3) an undeformed population. Intergroup comparisons show few differences in degree or asymmetry of sutural interdigitation. In the few comparisons which show differences, the C group is always more interdigitated than the other two while the AP group has more sutural bones. The sutures surrounding the temporal bone (sphenotemporal, occipitotemporal, and temporoparietal) most frequently show significant differences among groups. These differences are related to the more extreme binding of C type deformation and are consistent with hypothesized increases in tension at coronally oriented sutures in this group. The larger number of sutural bones in the AP group is consistent with the general broadening of the cranium in this group and with experimental evidence indicating the development of ossicles in areas of tension. We suggest that so few changes in sutural complexity occurred either because the magnitude of the growth vectors, unlike their direction, is not substantially altered or because mechanisms other than sutural growth modification are responsible for producing the altered vault shapes. In addition, the presence of fontanelles in the infant skulls during binding and the static nature of the binding may have contributed to the similarity in complexity among groups.

Sutures and forces: a review,Wagemans PA, van de Velde JP, Kuijpers-Jagtman AM.

Am J Orthod Dentofacial Orthop. 1988 Aug;94(2):129-41.

Abstract: This review gives a description of the biologic significance of craniofacial sutures with respect to growth and to growth corrections. Sutural growth and its regulation

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are discussed briefly. Morphogenesis of sutures, sutural morphology, both microscopic and macroscopic, the structure and function of the sutural periosteum and secondary cartilages, and the biochemical composition of sutures are described. Furthermore, in vivo and in vitro experiments, including transplantation experiments, are discussed. The relationship between extrinsic mechanical forces and the resulting tissue responses in sutures is given special attention. The present article describes the state of our knowledge on the interaction between sutures and forces, and indicates problems that need to be investigated.

Biodynamics of the Cranium: A Survey, Blum, C.

The Journal of Craniomandibular Practice, Mar/May 1985:3(2):164-71.

Abstract: Revamping a possible archaic view of normal cranial physiological biodynamics is a challenging undertaking. New ideas lie fragile for years awaiting the slow accumulation of evidence. This article presents substantial research answering the questions: (1) Is it possible for the cranial bones to move? (2) Do intracranial pressure changes actually translate into cranial motion? (3) Are there pressure changes of cerebrospinal fluid occurring intracranially due to vascular, pulmonary, and other theorized pulse waves? (4) What can interfere with the transmission of these pressure waves?(5) What could be the consequences of increased and/or decreased cranial motion to the health of the body?

The author presents literature noting that dural tension and/or brain/spinal cord tension reflecting in the neural substance, nerves and associated blood vessels could well lead to changes of a pathological nature. This could be separate or could be in conjunction with associated CSF buildup of catabolites and resultant patho-physiological changes. The effect of cranial bone stasis or tension is clinically alleviated through gentle subtle manipulations of the cranial bones. The treatment is focused towards obtaining relaxation of the soft tissues of the brain and spinal cord in situ, through the dural extension into the sutures and cranial bones.

Zygomaticomaxillary suture adaptations incident to anteriorly-directed forces in rhesus monkeys,Nanda R, Hickory W.

Angle Orthod. 1984 Jul;54(3):199-210.

Abstract: Histologic and radiographic studies of controlled force application to the maxillae of monkeys show varying rotational effects on the maxilla, dependent on the direction of force application.

Occlusal Changes Related to Cranial Bone Mobility, Libin, B.

International Journal of Orthodontics, 20(1), March 1982

This study reports that the author was able to change the transverse dimension across the maxillae as measured at the second molars by two and sometimes three millimeters using craniosacral therapy.

Detection of skull expansion with increased cranial pressure, Heifitz, MD, Weiss M.

J Neurosurg, 1981;55:811-812

Age changes in the human frontozygomatic suture from 20 to 95 years, Kokich VG.

Am J Orthod, 1976 Apr;69(4):411-30.

Abstract: The frontozygomatic suture of human cadaver material was examined by a combination of histologic, radiographic, and gross techniques to determine the aging changes in the suture and the approximate age at which sutural fusion occurs. The sample consisted of sixty-One specimens of human beings ranging in age from 20 to 95 years. Observations were made on specimens at age intervals of 5 years. Since the

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frontozygomatic suture is bilateral, one suture from each specimen was used for radiographic and gross examination for synostosis, and the opposite side was subjected to histologic analysis. The findings of this study have lead to the following conclusions: 1. The human frontozygomatic suture undergoes synostosis during the eighth decade of life, but does not completely fuse by the age of 95 years. 2. Synostosis is a progressive process which commences as small areas of bony union that occur initially within the internal portion of the suture and then progresses to the orbital periosteal surface. Bony union is not found at or near the facial periosteal surface. 3. The bony surfaces of the frontozygomatic suture become increasingly irregular with advancing age as a result of the formation of projections or interfixations.Comment: This paper (as well as the papers of Opperman and Retzlaff and others cited in this section) shows that the assertion that all cranial sutures eventually fuse can be dismissed.

Morphological cerebral asymmetries of modern man, fossil man, and nonhuman primate.LeMay M.

Ann N Y Acad Sci. 1976;280:349-66.

Abstract: Cerebral asymmetries are common in modern and fossil man and the great apes. Those occurring most often are listed here: 1. The left sylvian fissure in man is longer than the right and in both fetal and adult brains the posterior end of the right sylvian fissure is commonly higher than the left. Associated with these findings, the left planum temporale is usually longer than the right. 2. The left occipital pole is often wider and usually protrudes more posteriorly than the right. 3. The left lateral ventricle, and especially the occipital horn, is usually larger than the right. 4. If one frontal pole extends beyond the other it is usually the right. 5. On X-ray computerized axial tomograms (CT) of the brain the right frontal lobe and the central portion of the right hemisphere more often measure wider than the left. 6. The CT studies commonly show a Yakovlevian anticlockwise torque (taking the nose as 12 o'clock), with the left occipital pole longer and often extending across the midline toward the right and a wider right hemisphere in its central and frontal portions and frequent forward protrusion of the right frontal pole. This is found also in newborns. 7. The posterior end of the sagittal sinus usually lies to the right of the midline and the sinus flows more directly into the right transverse sinus than into the left. 8. The right transverse sinus is usually higher than the left. 9. In left-handed and ambidextrous individuals the posterior ends of the sylvian fissures are more often nearly equal in height and the occipital regions are more often equal in width or the right may be wider. 10. The torque of the pyramidal tract and the hemispheral torque cannot at present be related to right- or left-handedness. Statistics concerning left-handedness are somewhat confounded, because it is likely that not a few individuals are left-handed because of an early injury of the left hemisphere in a normally right-handed individual. 11. Cerebral asymmetries are found in fossil man similar to those in modern man. 12. Asymmetries of the sylvian fissures similar to those of modern man have been found in the great apes and are particularly common in the orangutan. 13. The most striking and consistently present cerebral asymmetries found in adult and fetal brains are in the region of the posterior end of the sylvian fissures-- the areas generally regarded as a major importance in language function.

Head posture and craniofacial morphology, Solow B, Tallgren A.

Am J Phys Anthropol. 1976 May;44(3):417-35.

Abstract: The associations between craniofacial morphology and the posture of the head and the cervical column were examined in a sample of 120 Danish male students aged 22-30 years. Two head positions were recorded on lateral cephalometric radiographs, one determined by the subject's own feeling of a natural head balance (self balance position), and the other by the subject looking straight into a mirror (mirror position). Craniofacial morphology was described by 42 linear and angular variables, and postural relationships by 18 angular variables. A comprehensive set of correlations was found between craniofacial morphology and head posture. The correlations were similar for both head

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positions investigated. Of the postural variables, the position of the head in relation to the cervical column showed the largest set of correlations with craniofacial morphology. Extension of the head in relation to the cervical column was found in connection with large anterior and small posterior facial heights, small antero-posterior craniofacial dimensions, large inclination of the mandible to the anterior cranial base and to the nasal plane, facial retrognathism, a large cranial base angle, and a small nasopharyngeal space. The possible role of functional factors in mediating the relationship between morphology and posture was discussed.Comment: There exists a large body of work supporting a relationship between the cervical spine, head posture, and craniomandibular function. The integration of these three areas in AK diagnosis is an important factor in AK therapy.

Cranial bone mobility, Retzlaff EW, Michael DK, Roppel RM.

J Am Osteopath Assoc, 1975 May;74(9):869-73.

Abstract: Retzlaff (along with Mitchell and Upledger) have been responsible for some of the most diligent research in the area of cranial motion state: “Whether cranial sutures in primates are ever obliterated by ossification remains unanswered. However histological studies suggest that there may be partial sutural fusion, but only at a relatively old age. Cranial sutures in the pigtail macaque are not fused by the 20th year and in humans by the 90th year.

Histological studies of tissues of living patients aged 7-57 examined and found to show capability of motion within cranial sutures – with abundance of collagen, elastic fibers, vascular networks. No calcifications were noted in living subjects – this only appeared post mortem with the use of preservative chemicals. Numerous studies by these and associated researchers showed patent cranial sutures, with demonstrable motion capabilities into advanced old age.

Temporary widening of cranial sutures during recovery from failure to thrive. A not-uncommon clinical phenomenon,Pearl M, Finkelstein J, Berman MR.

Clin Pediatr (Phila). 1972 Jul;11(7):427-30.

Alteration in Width of Maxillary Arch and its Relation to Sutural Movement of Cranial Bones, Baker, E.

Journal of the American Osteopathic Association, Feb 1971;70:559-564

Abstract: A case is reported in which cooperation between a dentist and a physician schooled in cranial therapy improved the treatment of a patient with severe traumatic malocclusion. The patient appeared with a severe headache. Although there had been no recent trauma, the patient had sustained fractures in the foot in a parachute jump several years before. The physician found that the parachute jump had compressed the patient’s occlusion to the left at the midline of the mandible. The dentist confirmed the presence of severe malocclusion, with open bite and deviation of the median line to the left during retraction to hinge centric jaw relation. Treatment by occlusal equilibrium and cranial adjustment for six months brought relief of pain and established centric jaw relation. Serial measurements of models of maxillary teeth showed the maximum lateral dimensional change between permanent maxillary second molars was 0.0276 inch, which is about nine times the possible error in measurement. The patient’s head bones moved along their sutures.

Roentgen Findings in the Craniosacral Mechanism, Greenman, P.

Journal of the American Osteopathic Association, 1970;70:24-35

Abstract: Although the craniosacral mechanism has been of great interest to physicians in

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many professions, a search of the literature failed to yield many reports of the x-ray appearance of altered cranial structure. This article describes efforts to develop a method of identifying altered craniosacral mechanics and of correlating the findings with clinical observations. Good correlation was found between specific x-ray findings and clinical observations made independently by a physician schooled in the cranial concept of osteopathy.

CLINICAL RESEARCH IN CRANIAL THERAPY

Cranial Therapeutic Care: Is There any Evidence? Blum CL, Cuthbert S.

Chiropractic & Osteopathy 2006, 14:10 

Background: In the commentary by Hartman, (Cranial osteopathy: its fate seems clear, Chiropractic & Osteopathy 2006, 14:10.) he has attempted to elicit a response by making far overreaching statements, which are ironic since Hartman thinly veils himself in a gossamer cloak of science, research, and evidenced-based healthcare.  Hartman has picked an isolated diagnostic procedure or treatment, cerebrospinal fluid (CSF) pulsation palpation, questioned its reliability and validity, and then used this fractional aspect of a method of care to condemn all of cranial therapy.  What can be said by Hartman and fairly so, is that from his review of selected studies regarding CSF palpation as discussed in cranial therapeutic care, further study to investigate its validity and reliability is warranted and this component of cranial diagnosis should not be used at this time as a sole criteria for cranial diagnosis or treatment. Discussion Much of Hartman’s position is refuted by, at the very least, reviewing the difference between the gross mechanical aspects of cranial care, which has documentation, and the subtle mechanical aspects, which remain controversial. A comprehensive evidenced based rationale of cranial therapeutics is presented along with three tables listing pertinent studies relating to cranial bone dynamics and the efficacy of cranial manipulative therapy. Conclusion While the onus to do the research is upon those who are proponents of a method of care, there is also an onus upon those who call for its virtual abolition to be familiar with all the published research on the topic and how evidenced based clinical practice is formulated.

Symptomatic Arnold-Chiari malformation and cranial nerve dysfunction: a case study of applied kinesiology cranial evaluation and treatment, Cuthbert, S., Blum, C.

J Manipulative Physiol Ther. 2005 May;28(4):e1-6.

(www.journals.elsevierhealth.com/periodicals/ymmt)

Objective: To present an overview of possible effects of Arnold-Chiari malformation (ACM) and to offer chiropractic approaches and theories for treatment of a patient with severe visual dysfunction complicated by ACM. Clinical Features: A young woman had complex optic nerve neuritis exacerbated by an ACM (Type I) of the brain. Intervention and Outcome: Applied kinesiology chiropractic treatment of the spine and cranium was used for treatment of loss of vision and nystagmus. After treatment, the patient’s ability to see, read, and perform smooth eye tracking showed significant and lasting improvement. Conclusion: Further studies into applied kinesiology and cranial treatments for visual dysfunctions associated with ACM may be helpful to evaluate whether this single case study can be representative of a group of patients who might benefit from this care.

Cranial and Other Chiropractic Adjustments in the Conservative Treatment of Chronic Trigeminal Neuralgia: A Case Report, Pederick, F.

Chiro J Aust, 2005; 35:9-15.

ABSTRACT: Trigeminal neuralgia, sometimes called tic douloureux, is characterized by episodes of electric-shock-like pain in areas of the face where branches of the trigeminal nerve are distributed. Medical treatment includes pharmaceuticals, analgesics, surgery,

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radiosurgery, low-powered lasers, TENS, acupuncture and biofeedback. Manipulative approaches have been used successfully in a medical center in China, and reports of successful treatment with chiropractic techniques have been published. The patient in this report had a history of right-sided facial pain, diagnosed as trigeminal neuralgia, over a 6-year period with remissions after dental or medical treatment and exacerbations, the most recent of 2 months duration. Prior to cranial and other chiropractic adjustments, the patient had continuous pain that she rated at 9.5 on the visual analogue scale, and after 4 consultations over an 11-day period, pain had reduced to 0.5. Spinal and cranial adjusting potentially affects a wide range of causes of trigeminal neuralgia and offers a conservative, low-cost, low technology initial approach which, if ineffective, will not greatly delay or inhibit other treatment. Occasional maintenance care may be required in some instances to reduce occurrences.

Treatment of an Infant with Wry Neck Associated with Birth Trauma: Case Report, Pederick, F.

Chiro J Aust, 2004; 34:123-8.

ABSTRACT: This paper describes the successful treatment of an infant with wry neck associated with birth trauma using low-force, relatively long-duration cranial adjusting, and soft-tissue techniques to the whole body with special attention to the cervical region, and parental management of home care procedures. Wry neck, or congenital muscular torticollis (CMT), has been a well-recognized condition for centuries. CMT is often associated with plagiocephaly, which has long-term adverse effects on physical and mental functions. A review of some of the literature relating to this condition is provided.

The functional relationship between the craniomandibular system, cervical spine, and the sacroiliac joint: a preliminary investigation, Fink M, Wahling K, Stiesch-Scholz M, Tschernitschek H.

Cranio. 2003 Jul;21(3):202-8.

Abstract: The hypothesis of a functional coupling between the muscles of the craniomandibular system and the muscles of other body areas is still controversial. The purpose of this pilot study was to examine whether there is a relationship between the craniomandibular system, the craniocervical system and the sacropelvic region. To test this hypothesis, the prevalence and localization of dysfunction of the cervical spine and the sacroiliac joint were examined in a prospective, experimental trial. Twenty healthy students underwent an artificial occlusal interference, which caused an occlusal interference. The upper cervical spine (CO-C3) and the sacroiliac joint were examined before, during and after this experimental test. The primary outcome with these experimental conditions was the occurrence of hypomobile functional abnormalities. In the presence of occlusal interference, functional abnormalities were detected in both regions examined and these changes were statistically significant. The clinical implications of these findings may be that a complementary examination of these areas in CMD patients could be useful.

Increased responses in trigeminocervical nociceptive neurons to cervical input after stimulation of the dura mater, Bartsch T, Goadsby PJ.

Brain. 2003 Aug;126(Pt 8):1801-13. Epub 2003 Jun 23.

Abstract: Pain referral and spread in headache patients may be attributed to a sensitization of central nociceptive neurons with an increased excitability to afferent input. We investigated if noxious dural stimulation evokes sensitization of second-order neurons that leads to an increased responsiveness to stimulation of cervical afferents. Recordings were made from 29 nociceptive neurons in the C2 dorsal horn of the rat that received convergent synaptic input from trigeminal and cervical afferents. Trigeminal afferents of the supratentorial dura mater were activated by mustard oil (MO) and the responses of second-order neurons to stimulation of the greater occipital nerve (GON) were studied before and after dural stimulation. Projection sites to the contralateral thalamus were determined by antidromic stimulation. After dural application with MO, mechanical thresholds of the dura significantly decreased (P < 0.05) and an enlargement of the trigeminal and cervical cutaneous mechanoreceptive fields was observed in 71% of neurons. The responses to noxious mechanical stimulation of deep paraspinal muscles

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increased after MO application (P < 0.001). Similarly, an increase in the excitability to electrical stimulation of the GON was observed in C-fibre responses (P < 0.001). These results suggest that stimulation of nociceptive afferent C-fibres of the dura mater leads to a sensitization of second-order neurons receiving cervical input. This mechanism might be involved in the referral of pain from trigeminal to cervical structures and might contribute to the clinical phenomena of cervical hypersensitivity in migraine and cluster headache. Understanding this interaction is likely to be pivotal in characterizing the physiology of treatment with manipulations involving cervical input, such as GON injection.Comment: This article describes the neurologic rationale for considering dural tension a causative factor in total spinal function. Dural tension in the head is transmitted into the neck and increases the vulnerability of the neck to pain and dysfunction. A comprehensive examination of patients with neck pain must involve an evaluation of intracranial dural tension and structures.

The neuroanatomical basis of oculomotor disorders: the dual motor control of extraocular muscles and its possible role in proprioception, Buttner-Ennever JA, Horn AK.

Curr Opin Neurol. 2002 Feb;15(1):35-43.

Abstract: Current investigations show that two separate sets of motoneurons control the extraocular eye muscles, and that is there is a dual final common pathway. We propose that one set of motoneurons are the major source of tension generating eye movements, whereas the other may participate in a proprioceptive system concerned more with the exact alignment and stabilization of the eyes. In this article we discuss the structures that may participate in the proprioceptive circuits; and consider several recent publications in the light of this sensory feedback hypothesis, emphasizing the relevance to eye movement disorders.Comment: This article provides several neurological rationales for the specific testing of the eyes in visual, proprioceptive and neuromuscular disorders. In applied kinesiology chiropractic methodology, a means for testing the integration of the muscles in the body with the visual reflexes has been termed ocular lock. (This paper has 88 papers listed in the reference section alone dealing with the neurology involved in the ocular lock phenomenon). Ocular lock testing demonstrates the failure of the eyes to work together on a binocular basis through the cardinal fields of gaze. This is usually not gross pathology of cranial nerves III, IV, and VI; rather it is poor functional organization. Mechanical irritation of cranial nerves III, IV, or VI (usually VI) may be responsible for disturbed binocular function leading to discordant sensory inputs from the visual righting reflex. When the eyes are turned in a specific direction, a previously strong indicator muscle will weaken when the ocular lock test is positive, and there is probably disturbance in the visual righting, vestibulo-ocular, or opto-kinetic reflexes.

Intraexaminer and interexaminer reliability for palpation of the cranial rhythmic impulse at the head and sacrum, Moran RW, Gibbons P.

J Manipulative Physiol Ther. 2001 Mar-Apr;24(3):183-90.

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

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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.Comment: Many experts and research studies in the cranial field have described the difficulty of detecting the subtle dynamics of the CRI. The ability to effectively and reproducibly demonstrate the cranial faults found during examination are therefore an important consideration in therapy. The use of AKs cranial challenge and therapy localization procedures, producing inhibition on MMT, allows cranial faults to be made more evident to both the doctor and the patient. The chiropractic profession has discovered many other objective signs of cranial faults, but changes of muscle strength on MMT with specific challenges to the cranial mechanism is perhaps the most objective sign of all in the arena of cranial therapy.

Intracranial pressure accommodation is impaired by blocking pathways leading to extracranial lymphatics, Mollanji R, Bozanovic-Sosic R, Silver I, Li B, Kim C, Midha R, Johnston M.

Am J Physiol Regul Integr Comp Physiol, 2001 May;280(5):R1573-81.

Abstract: Tracer studies indicate that cerebrospinal fluid (CSF) transport can occur through the cribriform plate into the nasal submucosa, where it is absorbed by cervical lymphatics. We tested the hypothesis that sealing the cribriform plate extracranially would impair the ability of the CSF pressure-regulating systems to compensate for volume infusions. Sheep were challenged with constant flow or constant pressure infusions of artificial CSF into the CSF compartment before and after the nasal mucosal side of the cribriform plate was sealed. With both infusion protocols, the intracranial pressure (ICP) vs. flow rate relationships were shifted significantly to the left when the cribriform plate was blocked. This indicated that obstruction of the cribriform plate reduced CSF clearance. Sham surgical procedures had no significant effects. Estimates of the proportional flow through cribriform and noncribriform routes suggested that cranial CSF absorption occurred primarily through the cribriform plate at low ICPs. Additional drainage sites (arachnoid villi or other lymphatic pathways) appeared to be recruited only when intracranial pressures were elevated. These data challenge the conventional view that CSF is absorbed principally via arachnoid villi and provide further support for the existence of several anatomically distinct cranial CSF transport pathways.Comment: This paper shows the functional integration of the CSF and cranial system with the lymphatic system, a concept that has been important in AK thinking for over 30 years. The implications of lymphatic congestion upon the CRI and the movement of CSF are explored in this paper.

Vagal modulation of responses to mental challenge in posttraumatic stress disorder, Sahar T, Shalev AY, Porges SW.

Biol Psychiatry. 2001 Apr 1;49(7):637-43.

BACKGROUND: Studies of the autonomic nervous system in posttraumatic stress syndrome (PTSD) have focused on the sympathetic modulation of arousal and have neglected the parasympathetic contribution. This study addresses the parasympathetic control of heart rate in individuals who have survived traumatic events. METHODS: Twenty-nine survivors, 14 with current PTSD and 15 without, participated in the study. The groups were comparable with regard to age, type of trauma, time since the latest traumatic event, and lifetime exposure to traumatic events. Electrocardiograms were recorded during rest and an arithmetic task. Heart period, respiratory sinus arrhythmia (RSA), and the amplitude of the Traube-Hering-Mayer wave were quantified. RESULTS: The groups did not differ on resting measures. During the arithmetic task, the past trauma group showed a significant increase in RSA (p <.007), whereas the PTSD group did not. In the past trauma group only, RSA and heart period were highly correlated (r =.75), thereby suggesting that the response to challenge was under vagal control.

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CONCLUSIONS: Trauma survivors who develop PTSD differ from those who do not in the extent to which their heart rate response to challenge is controlled by vagal activity. Responses to challenge in PTSD may be mediated by nonvagal, possibly sympathetic mechanisms.

Osteopathic Manipulative Medicine Approaches to the Primary Respiratory Mechanism, Friedman, H.D., Gilliar, W.G., Glassman, J.H.

San Francisco International Manual Medicine Society; 2000. p. 221-253.

A list of over 400 papers related to the cranial concept, and over 30 books explaining this therapeutic modality.

Resolution of suckling intolerance in a 6-month-old chiropractic patient, Holtrop DP.

J Manipulative Physiol Ther. 2000 Nov-Dec;23(9):615-8.

OBJECTIVE: To discuss the management and resolution of suckling intolerance in a 6-month-old infant. CLINICAL FEATURES: A 6-month-old boy with a 4(1/2)-month history of aversion to suckling was evaluated in a chiropractic office. Static and motion palpation and observation detected an abnormal inward dishing at the occipitoparietal junction, as well as upper cervical (C1-C2) asymmetry and fixation. These indicated the presence of cranial and upper cervical subluxations. INTERVENTION AND OUTCOME: The patient was treated 5 times through use of cranial adjusting; 4 of these visits included atlas (C1) adjustment. The suckling intolerance resolved immediately after the first office visit and did not return. CONCLUSION: It is possible that in the infant, a relationship between mechanical abnormalities of the cervicocranial junction and suckling dysfunction exists; further research in this area could be beneficial. Possible physiological etiologies of painful suckling are presented.

Developments in the Cranial Field, Pederick FO

Chiropractic Journal of Australia, Mar 2000;30(1):13-23.

Abstract: The first part of this paper is a detailed review of Leon Chaitow's latest textbook on cranial manipulation. The second part comments on developments in the cranial field using observations on Chaitow's writings as a starting point. The commentary looks at papers relevant to the cranial field which have not been discussed by Chaitow and provides the author's insights into matters he raises, based on information collected over several years, much of it in the past three years via the internet.

Relationship between craniomandibular disorders and poor posture, Nicolakis P, Nicolakis M, Piehslinger E, Ebenbichler G, Vachuda M, Kirtley C, Fialka-Moser V.

Cranio. 2000 Apr;18(2):106-12.

Abstract: The purpose of this research was to show that a relationship between craniomandibular disorders (CMD) and postural abnormalities has been repeatedly postulated, but still remains unproven. This study was intended to test this hypothesis. Twenty-five CMD patients (mean age 28.2 years) were compared with 25 gender and age matched controls (mean age 28.3 years) in a controlled, investigator-blinded trial. Twelve postural and ten muscle function parameters were examined. Measurements were separated into three subgroups, consisting of those variables associated with the cervical region, the trunk in the frontal plane, and the trunk in the sagittal plane. Within these subgroups, there was significantly more dysfunction in the patients, compared to control subjects (Mann-Whitney U test p < 0.001, p < 0.05, p < 0.01). Postural and muscle function abnormalities appeared to be more common in the CMD group. Since there is evidence of the mutual influence of posture and the craniomandibular system, control of body posture in CMD patients is recommended, especially if they do not respond to splint therapy. Whether poor posture is the reason or the result of CMD cannot be distinguished by the data presented here.

A Kaminski-type evaluation of Chiropractic Technique, 1997;9(1):1-15.

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cranial adjusting, Pederick F.O. Abstract: Models for the evaluation of chiropractic methods have been proposed in the past. This paper uses one model as a framework for the evaluation of cranial adjusting. Chiropractors and osteopaths have been involved in the cranial field for almost 70 years. Over this time, a body of literature has been amassed on clinical experience and research. This article defines and describes one type of cranial adjusting technique and develops a hypothetical model of effects influencing cranial motion. It also discusses measurable observation, particularly in relation to cranial bone motion, and reviews the available literature about experimentation and testing of the technique. Although further experimentation and clinical trials are needed, the type of cranial adjusting technique described has a sound scientific basis as mainstream chiropractic techniques and should receive provisional acceptance within the chiropractic and other professions as an integral part of the chiropractic armamentarium.

Entrainment and the cranial rhythmic impulse, McPartland JM, Mein EA.

Altern Ther Health Med, 1997 Jan;3(1):40-5.

Abstract: Entrainment is the integration or harmonization of oscillators. All organisms pulsate with myriad electrical and mechanical rhythms. Many of these rhythms emanate from synchronized pulsating cells (e.g., pacemaker cells, cortical neurons). The cranial rhythmic impulse is an oscillation recognized by many bodywork practitioners, but the functional origin of this impulse remains uncertain. We propose that the cranial rhythmic impulse is the palpable perception of entrainment, a harmonic frequency that incorporates the rhythms of multiple biological oscillators. It is derived primarily from signals between the sympathetic and parasympathetic nervous systems. Entrainment also arises between organisms. The harmonizing of coupled oscillators into a single, dominant frequency is called frequency-selective entrainment. We propose that this phenomenon is the modus operandi of practitioners who use the cranial rhythmic impulse in craniosacral treatment. Dominant entrainment is enhanced by "centering," a technique practiced by many healers, for example, practitioners of Chinese, Tibetan, and Ayurvedic medicine. We explore the connections between centering, the cranial rhythmic impulse, and craniosacral treatment.

This paper proposes that entrainment used therapeutically involves the “rhythms” of the ‘centered’ practitioner dominating those of the subject, harmonizing into a composite ‘new’ CRI.

Cranial findings and iatrogenesis from craniosacral manipulation in patients with traumatic brain syndrome, Greenman PE, McPartland JM.

J Am Osteopath Assoc. 1995 Mar;95(3):182-8; 191-2.

Abstract: Craniosacral findings were recorded for all patients with traumatic brain injury entering an outpatient rehabilitation program between 1978 and 1992. The average cranial rhythmic impulse was low in all 55 patients (average, 7.2 c/min). At least one cranial strain pattern was exhibited by 95%, and 87% had one or more bony motion restrictions. Sacral findings were similar to those in patients with low back pain. Although craniosacral manipulation has been found empirically useful in patients with traumatic brain injury, three cases of iatrogenesis occurred. The incidence rate is low (5%), but the practitioner must be prepared to deal with the possibility of adverse reactions.

Chiropractic care, including craniosacral therapy, during pregnancy: a static-group comparison of obstetric interventions during labor and delivery, Phillips CJ, Meyer JJ.

J Manipulative Physiol Ther. 1995 Oct;18(8):525-9.

OBJECTIVE: To determine whether the addition of chiropractic care including craniosacral therapy to a regimen of standard obstetric pregnancy results in fewer obstetric interventions during labor and delivery. DESIGN: Retrospective, case-matched, static-group comparison. SETTING: The study group was obtained from a college faculty-based clinic and received chiropractic care in addition to their routine obstetrical care. The setting for the comparison group was unknown, but the care rendered was presumed to be primary medical obstetric care only. PATIENTS: A consecutive sample of 63 pregnant

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women who sought chiropractic care within the period under study. The reason for seeking care was not necessarily related to the pregnancy. The sample was primarily between 18 and 35 yr, non-Hispanic caucasian and primiparous. After selection and matching criteria, 35 patients remained in the study group. INTERVENTION: Chiropractic care and craniosacral therapy delivered during pregnancy vs. unknown care within the same county. MAIN OUTCOME MEASURES: Obstetric interventions during labor and delivery as reported by the birth attendant on the certificate of live birth. RESULTS: No statistical differences were detected in the rates of obstetric interventions used during labor or delivery between the two samples. Approximate large-sample 95% confidence intervals are provided. CONCLUSION: Because of the limitations in the design of the project, this study provides no evidence that the addition of chiropractic care and craniosacral therapy during pregnancy results in any observable benefit or detriment with regard to obstetric interventions used during labor and delivery and that chiropractic care for pregnancy-related neuromusculoskeletal disorders should not complicate labor or delivery.

Nasal specific technique as part of a chiropractic approach to chronic sinusitis and sinus headaches, Folweiler DS, Lynch OT.

J Manipulative Physiol Ther. 1995 Jan;18(1):38-41.

OBJECTIVE: To demonstrate the use of nasal specific technique in conjunction with other chiropractic interventions in managing chronic head pain. CLINIC FEATURES: A 41-yr-old woman was treated for chronic sinusitis and sinus headaches. She had suffered weight loss and pain over a 2-month period. INTERVENTION AND OUTCOME: Chiropractic manipulation and soft tissue manipulation administered 2-6 times per month for approximately 1 yr had minimal long-term effect on the patient's head pain. When additional interventions (nasal specific technique and light force cranial adjusting) were added to the treatment regimen, significant relief of symptoms was achieved after the nasal specific technique was performed. The duration of the relief increased with successive therapeutic sessions, with minimally persistent symptoms after 2 months of therapy. CONCLUSION: The nasal specific technique, when used in conjunction with other therapies, may be useful in treating chronic sinus inflammation and pain. Further investigation is needed to identify the usefulness of the nasal specific technique as an independent intervention, the use of the technique in other types of patients and presentations, and the mechanism of therapeutic benefit.

A Preliminary Single Case Magnetic Resonance Imaging Investigation into Maxillary Frontal-Parietal Manipulation and Its Short-Term Effect upon the Intercranial Structures of an Adult Human Brain, Pick, M.

J Manipulative Physiol Ther. 1994;17(3)

Objective: To investigate the hypothesis that external cranial manipulation can cause change within the structures of the human brain. (42 y/o subject). Results: Second MRI showed elimination of a 5-mm peak along the superior border of the corpus collosum and a 4 - mm reduction in the width of the fornix column. The exposed anterior posterior wall of the lateral ventricle posterior to the fornix col. increased 51 degrees cephalad with the application (to the bregma and the maxillary palate). The angular surface of the central lobule altered by minus 7 degrees. The subject experienced no change in his asymptomatic condition as a result of this study. Conclusion: The present study supports the theory that external cranial manipulation affects the structure of the brain. It also suggests support for the theory regarding suture mobility.

Interrater reliability of craniosacral rate measurements and their relationship with subjects' and examiners' heart and respiratory rate measurements, Wirth-Pattullo V, Hayes KW.

Phys Ther, 1994 Oct;74(10):908-16; discussion 917-20.

BACKGROUND AND PURPOSE. The evaluation of craniosacral motion is an approach used by physical therapists and other health professionals to assess the causes of pain and dysfunction, but evidence for the existence of this motion is lacking and the reproducibility of the results of this palpatory technique has not been studied. This study examined the interexaminer reliability of craniosacral rate and the relationships among craniosacral rate and subjects' and examiners' heart and respiratory rates. SUBJECTS.

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Participants were 12 children and adults with histories of physical trauma, surgery, or learning disabilities. Three physical therapists with expertise in craniosacral therapy were the examiners. METHODS. One of three nurses recorded heart and respiratory rates of both subject and examiner. The examiner then palpated the subject to determine craniosacral rate and reported the findings to the nurse. Each subject was examined by each of the three examiners. RESULTS. Reliability was estimated using a repeated-measures analysis of variance and the intraclass correlation coefficient (2,1). Significant differences among examiners and the scatter plot of rates showed lack of agreement among examiners. The ICC was -.02. The correlations between subject craniosacral rate and subject and examiner heart and respiratory rates were analyzed with Pearson correlation coefficients and were low and not statistically significant. DISCUSSION AND CONCLUSIONS. Measurements of craniosacral motion did not appear to be related to measurements of heart and respiratory rates, and therapists were not able to measure it reliably. Measurement error may be sufficiently large to render many clinical decisions potentially erroneous. Further studies are needed to verify whether craniosacral motion exists, examine the interpretations of craniosacral assessment, determine the reliability of all aspects of the assessment, and examine whether craniosacral therapy is an effective treatment.Comment: Many experts in the cranial field have described the difficulty of detecting the subtle dynamics of the CRI. The ability to effectively and reproducibly demonstrate to the patient the cranial faults found during examination are therefore an important consideration in therapy. The use of cranial challenge and therapy localization procedures, producing obvious inhibition on MMT, allows cranial faults to be made more evident to both the doctor and the patient. The chiropractic profession has discovered many objective signs of cranial faults, and changes on MMT with specific challenges to the cranial mechanism is perhaps the most objective sign in the arena of cranial therapy.

Finite element analysis for stresses in the craniofacial sutures produced by maxillary protraction forces applied at the upper canines, Miyasaka-Hiraga J, Tanne K, Nakamura S.

Br J Orthod. 1994 Nov;21(4):343-8.

Abstract: The purpose of this study was to investigate the nature of stress distributions in the craniofacial sutures produced by orthopaedic maxillary protraction forces applied to the upper canines. A three-dimensional finite element model of the craniofacial complex was developed for finite element analysis. An anteriorly directed force of 1.0 kg was applied to the upper canines in three different directions, i.e. parallel, 30 degrees upwards and downwards to the functional occlusal plane. Normal stresses acting on the sutural systems were greatest when force was applied in the 30 degrees upward direction. Furthermore, relatively large compressive stresses were induced in the frontonasal and frontomaxillary sutures, indicating that forward and upward rotation of the nasomaxillary complex was produced with substantial distortion of the complex, by the forces applied in both parallel and 30 degrees upward directions. A 30 degrees downward force produced almost uniform tensile stresses in the zygomaticotemporal and zygomaticomaxillary sutures, with least compressive stresses in the frontonasal and frontomaxillary sutures located in the superior region of the complex. This would indicate a uniform stretch of the nasomaxillary complex in both anterior and inferior directions, with negligible distortion of the complex and would be appropriate for accelerating natural growth of the nasomaxillary complex.

For Debate: Cranial Adjusting -- An Overview, Pederick FO

Chiropractic Journal of Australia, Sept 1993; 23(3):106-12.

Abstract: Cranial adjusting procedures have been a part of osteopathic and chiropractic therapeutic repertoires for over 60 years. Although the osteopathic literature is extensive, there is no known chiropractic peer reviewed literature on this field. This paper seeks to change this situation and begin the process of examining cranial concepts in the chiropractic peer reviewed literature. Cranial adjusting appears to be soundly based in anatomy, physiology and histological studies as well as clinical results. It may be likened

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to spinal adjusting in that "scientific" definition and demonstration of the subluxation may at present be beyond our technology. As with spinal adjusting unless there is evidence which absolutely refutes the current literature on cranial adjusting, it could be accepted as a part of mainstream chiropractic, be included in the curriculum of chiropractic schools and become part of the therapeutic repertoire of most chiropractors.

Changes in Magnitude of Relative Elongation of the Falx Cerebri During the Application of External Forces on the Frontal Bone of an Embalmed Cadaver, Kostopoulos, D., Keramidas, G.

Journal of Craniomandibular Practice, January 1992.

Craniosacral therapy hypothesizes that light forces applied to the skull may be transmitted to the dural membrane having a therapeutic effect on the cranial system. This study examines the changes in elongation of falx cerebri during the application of craniosacral therapy techniques to the skull of an embalmed cadaver. The study demonstrates that the relative elongation of the falx cerebri changes as follows: for the frontal lift, 1.44 mm; for the parietal lift, 1.08 mm; for the sphenobasilar compression, -0.33mm; for the sphenobasilar decompression, 0.28 mm; and for the temporal ear pull, inconclusive results. Results showed that an elastic response began at 140 grams of frontal bone traction. At 642 grams the elastic response ended and viscous changes began. The present study offers validation for the use of craniosacral therapy and the hypothesis of cranial suture mobility.

Kinematic imbalances due to suboccipital strain, Biedermann H.

J Man Med, 1992;31:92-95

Abstract: This paper suggests a term to describe children in whom the main clinical feature is torticollis, often combined with an asymmetrical cranium, postural asymmetry and a range of dysfunctional symptoms. The term KISS is an acronym for Kinematic Imbalances due to Suboccipital Strain. KISS imbalances are regarded as one of the main reasons for asymmetry in posture and consequently asymmetry of the osseous structures of the cranium and the spine. Among the many symptoms reported in this paper in KISS children are torticollis, reduced range of head/neck motion, cervical hypersensitivity, opisthotonos, restlessness, inability to control head movement and one upper limb underused (based on statistical records of 263 babies treated in one calendar year up to June 1995. Of the 263 babies treated, 213 required only one treatment, 41 were treated twice and the remainder more often, with just two requiring 4-5 treatment sessions.

A tissue pressure model for palpatory perception of the cranial rhythmic impulse, Norton JM.

J Am Osteopath Assoc, 1991 Oct;91(10):975-7, 980, 983-4 passim.

Abstract: A tissue pressure model was developed to provide a possible physiologic basis for the manifestation of the cranial rhythmic impulse (CRI). The model assumes that the sensation described as the CRI is related to activation of slowly adapting cutaneous mechanoreceptors by tissue pressures of both the examiner and the subject, and that the sources of change in these tissue pressures are the combined respiratory and cardiovascular rhythms of both examiner and subject. The model generates rhythmic impulses with patterns similar to those reported for the CRI. Also, a significant correlation was found between frequencies calculated from the model and published values for CRI obtained by palpation. These comparisons suggest that the CRI may arise in soft tissues and represents a complex interaction of at least four different physiologic rhythms.

Cranial osteopathy: a new perspective, Ferguson A.

Academy of Applied Osteopathy Journal, 1991;1(4):12-16

Abstract: This paper hypothesizes that since the cranial rhythmic impulse is palpable throughout the body – simultaneously – and therefore was unlikely to relate to a hydraulic ‘pressurestat’ mechanism in the cranium. This suggested a muscular origin for palpable CRI rhythm.

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The inability of the sphenobasilar synchondrosis to flex and extend – following fusion by age 25 – points to a need for an alternative motive force of the CRI, externally driven, possibly by muscular involvement. What we are feeling when we palpate the CRI, this paper suggests, is a function of the dynamic neuromuscular system – Irwin Korr’s ‘primary machinery of life.’ The importance of this to AK treatment of the cranial mechanism should not be overlooked.

To quote from the paper: “The body as a whole shows patterns of tension/relaxation, strength/weakness, bind/ease and integration/loss of awareness. These are individual, often complex and superimposed, and are reflected throughout the whole body including the cranium. It is also dynamic. There is constant movement or tone in innervated muscles…. It is also important to remember the complete functional integration of the neuromuscular system and visceral systems via the autonomic nervous system. Alterations in blood circulation level under the influence of the sympathetic nervous system contribute to some effects of somatic dysfunction, and of treatment, and may be relevant to some fluctuating fluid changes in the body.”

Postural differences between asymptomatic men and women and craniofacial pain patients,Braun BL.

Arch Phys Med Rehabil. 1991 Aug;72(9):653-6.

Abstract: A forward head position and rounded shoulders have been implicated in the development or perpetuation of craniomandibular disorders. Since women seek treatment for these problems more frequently than men, postural differences may account for the increased incidence of symptoms in women. The purposes of this study were (1) to compare the sagittal head and shoulder posture of asymptomatic men and women and (2) to compare the posture of asymptomatic and symptomatic women to determine differences in sagittal plane posture. Subjects were 20 asymptomatic men and women volunteers and nine consecutive women patients presenting for evaluation and treatment of craniomandibular pain. The subjects were compared using a valid, reliable, computer-assisted slide digitizing system called the Postural Analysis Digitizing System (PADS). Asymptomatic men and women did not differ in the postural characteristics associated with craniomandibular disorders. Sagittal posture does not appear to be a gender-related factor in these disorders. Symptomatic women, however, do display these postural characteristics to a greater extent than asymptomatic women. Evaluation and treatment of postural dysfunction should be included in the management of these patients.Comment: AK, because it is holistic, attempts to coordinate cranial therapeutics with whole body procedures, using specific vertebral adjustments, blocking procedures, muscle receptor and other soft tissue techniques, plus a range of reflex techniques including meridian patterns in order to address the complete neural, chemical, and mechanical aspects thought to be affecting cranial structures. The importance of integrating the whole person into the treatment of the craniofacial area is highlighted by this study.

The Colorado Board of Medical Examiners vs. W.M. Raemer, D.D.S. Court of Appeals, State of Colorado, Case No. 87CA1589, March 22, 1990

The unanimous ruling of the Appellate Court in favor of W.M. Raemer, D.D.S., states that cranial therapy is an effective form of treatment for TMJ dysfunction. As such, it was ruled that dentists in Colorado are allowed to use cranial therapy for treatment in the scope of their practice.

The cranium and its sutures, Retzlaff, E.W., Mitchell, F.W.

Berlin: Springer-Verlag; 1987.

An annotated bibliography of over 250 papers relating to cranial manipulative therapy.

The Effect of Movement, Stress and Mechanoelectric Activity Within the Cranial Matrix, Blum

International Journal of Orthodontics, Spring 1987;25(1-2): 6-14.

This study presents substantial research supporting the premise that: (1) Cranial sutures and bones are capable of flexibility and slight movement. (2) Mechanical stresses can

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C. affect the sutures on a short-term basis. (3) Mechanical stresses can affect the sutures on a long-term basis. (4) An interrelationship exists between cranial sutures and the structures transmitting mechanical forces; this relationship has a matrix/holographic organization. (5) Mechanical stresses within the cranial bones and sutures are capable of creating a piezoelectric effect. This piezoelectric effect is of a magnitude sufficient to create changes within the associated cranial bones and soft tissues to affect enzymatic changes, osteoblastic/osteoclastic activity and neuroelectric dynamics. The author concluded that in light of the advances in orthodontics, temporomandibular joint treatment, and cranial manipulative therapy, we must view cranial motion as part of a dynamic and kinetic, physiological, cranial matrix. The ability for cranial bones to move, or not move, plays a part in the transmission of stress within the cranium and could have far reaching effects.

A Review of Cranial Mobility, Sacral Mobility, and Cerebrospinal Fluid, Peterson K

Journal of the Australian Chiropractic Association. 1982 Apr;12(3):7-14.

Abstract: The literature review examines and lends credibility to the existence of cranial and sacral mobility. These normal life long activities occur in response to respiratory movement, arterial pulsations, physical movement and to an innate frequency. This article presents some of the past and present research concerned with the cranium, sacrum, and cerebrospinal fluid (CSF) in an historical perspective for such a re-evaluation. Even though some of the research is still in an embryological stage, the available data should enable the practitioner to judge the importance of CSF to health and how chiropractic adjustments can affect CSF.

"The Reproducibility of Craniosacral Examination Findings: A Statistical Analysis", Upledger, John E

Journal of the American Osteopathic Association, Aug 1977; 76: 890/67 - 899/76.

Abstract: A statistical analysis of the data from 5- craniosacral examinations on 25 preschool children is presented. These data would seem to support the reliability and reproducibility of the examination findings when the examinations are performed by skilled examiners. During all 50 examinations, the rate of cranial rhythmic impulse (CRI) was counted and compared with the pulse and respiratory rates of both the subject and the examiner. The results of this comparison would tend to help establish the CRI as an independent physiologic rhythm. A single-blind protocol was employed. All reasonable precautions were taken to control variables.

"The Trauma of Birth", Frymann, Viola M.

Osteopathic Annals, May 1976:197-205.

Abstract: Musculoskeletal strains on the newborn during delivery can cause problems throughout life. Recognizing and treating these dysfunctions in the immediate postpartum period is one of the most important phases of preventive medicine.

"The Growing Skull and the Injured Child", Dovesmith, Edith E,

Academy of Applied Osteopathy (AAO Yearbook) 1967: 34-39.

"Subclinical Signs of Trauma", Arbuckle, B. E.

Journal of the American Osteopathic Association, Nov 1958; 58: 160-166.

"The Value of Occupational and Osteopathic Manipulative Therapy in the Rehabilitation of the Cerebral Palsy Victim", Arbuckle, B.E.

Journal of the American Osteopathic Association, 1955 Dec; 55(4).

"Effects of Uterine Forces Upon Journal of the American Osteopathic Association, May 1954; 53(9): 499-

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the Fetus", Arbuckle. B. E. 508.

"Fetal Cranial Stresses During Pregnancy and Parturition", Pinder, D. E. & Mines, J. L.

Journal of the American Osteopathic Association, Nov 1954;  54(3): 164-167.

"The Infant - An Entity", Arbuckle, B.E.

Journal of the American Osteopathic Association, 1954 May; 49: 474-477.

"The Cranial Aspect of Emergencies of the Newborn", Arbuckle, B. E.

Journal of the American Osteopathic Association, May 1948; 47: 507-511.

THE CLINICAL EFFECTS OF CRANIAL FAULTS

Cranial Therapeutic Care: Is There any Evidence? Blum CL, Cuthbert S.

Chiropractic & Osteopathy 2006, 14:10 

Background: In the commentary by Hartman, (Cranial osteopathy: its fate seems clear, Chiropractic & Osteopathy 2006, 14:10.) he has attempted to elicit a response by making far overreaching statements, which are ironic since Hartman thinly veils himself in a gossamer cloak of science, research, and evidenced-based healthcare.  Hartman has picked an isolated diagnostic procedure or treatment, cerebrospinal fluid (CSF) pulsation palpation, questioned its reliability and validity, and then used this fractional aspect of a method of care to condemn all of cranial therapy.  What can be said by Hartman and fairly so, is that from his review of selected studies regarding CSF palpation as discussed in cranial therapeutic care, further study to investigate its validity and reliability is warranted and this component of cranial diagnosis should not be used at this time as a sole criteria for cranial diagnosis or treatment. Discussion Much of Hartman’s position is refuted by, at the very least, reviewing the difference between the gross mechanical aspects of cranial care, which has documentation, and the subtle mechanical aspects, which remain controversial. A comprehensive evidenced based rationale of cranial therapeutics is presented along with three tables listing pertinent studies relating to cranial bone dynamics and the efficacy of cranial manipulative therapy. Conclusion While the onus to do the research is upon those who are proponents of a method of care, there is also an onus upon those who call for its virtual abolition to be familiar with all the published research on the topic and how evidenced based clinical practice is formulated.

Chiropractic Evaluation and Treatment of Musculoskeletal Dysfunction in Infants Demonstrating Difficulty Breastfeeding, Vallone S.

Journal of Clinical Chiropractic Pediatrics, 2004; 6(1):349-61.

Objective: Breastfeeding during the first year of an infant's life is currently supported and promoted by lactation consultants, midwives, naturopaths, chiropractors, and allopathic physicians.  In 1997, the American Academy of Pediatrics and in 1998, the World Health Organization published their position papers that advocated breastfeeding as the optimal form of nutrition for infants.  This study was to investigate problems interfering with a successful breastfeeding experience and to see if proper lactation management, with the chiropractor acting as a member of a multidisciplinary support team, can help to assure a healthy bonding experience between mother and infant. Methods: 25 infants demonstrating difficulties breastfeeding were evaluated for biomechanical dysfunction potentially resulting in an inability to suckle successfully.  The biomechanics of 10

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breastfeeding infants without complaint were also evaluated fro comparison. Results: An overview of the infants with breastfeeding difficulty revealed imbalanced musculoskeletal action as compared to the infants without difficulty breastfeeding.  Utilization of soft tissue therapies and chiropractic adjustment of the cranium and spine resulted in improved nursing in over 80% of the patients. Conclusions: The results of this study suggest that biomechanical dysfunction based on articular or muscular integrity may influence the ability of an infant to suckle successfully and that intervention via soft tissue work, cranial therapy, and spinal adjustments may have a direct result in improving the infant's ability to suckle efficiently.

A retrospective study of cranial strain patterns in patients with idiopathic Parkinson’s disease, Rivera-Martinez, S., Wells, M., Capobianco, J.

Journal of the American Osteopathic Association, August 2002;102(8):417-422

Abstract: While providing osteopathic manipulative treatment to patients with Parkinson's disease at the clinic of the New York College of Osteopathic Medicine of New York Institute of Technology, physicians noted that these patients may exhibit particular

cranial findings as a result of the disease. The purpose of this study was to compare the recorded observations of cranial strain patterns of patients with Parkinson's disease for the

detection of common cranial findings. Records of cranial strain patterns from physician-recorded observations of 30 patients with idiopathic Parkinson's disease and 20 age-matched normal controls were compiled. This information was used to determine whether different physicians observed particular strain patterns in greater frequency between Parkinson's patients and controls. Patients with Parkinson's disease had a significantly higher frequency of bilateral occipitoatlantal compression (87% vs. 50%; P < .02) and bilateral occipitomastoid compression (40% vs. 10%; P < .05) compared with normal controls. Over subsequent visits and treatments, the frequency of both strain patterns were reduced significantly (occipitoatlantal compression, P < .01; occipitomastoid compression, P < .05) to levels found in the control group.

Chiropractic Care For Infants with Dysfunctional Nursing: A Case Series, Hewitt EG.

Journal of Clinical Chiropractic Pediatrics. 1999 May ; 4(1): 241-4.

Objective: To present the cases of two infants with dysfunctional nursing who were able to breastfeed normally after receiving chiropractic care. Physiological mechanisms are presented explaining how chiropractic care may restore normal suckling. Clinical features: The first case involves an 8-week-old girl unable to maintain suction while breastfeeding since birth. She was diagnosed by a chiropractor with cranial subluxations. The second infant, a 4-week-old boy, had been unable to suckle effectively since birth. He was diagnosed with spinal and cranial subluxations. Intervention and outcome: Each infant received diversified spinal adjusting and / or craniosacral therapy based on the clinical findings. The first was able to nurse normally after receiving 2 chiropractic adjustments over 14 days. The second infant suckled immediately following his first adjustment and received a total of 4 adjustments in 21 days. Conclusions: This paper reports two cases in which chiropractic care was followed by immediate resolution of dysfunctional nursing. Further research is needed to determine the role of the chiropractic adjustment in normalizing neonatal suckling.

Colic With Projectile Vomiting: A Case Study, Van Loon M.

Journal Of Clinical Chiropractic Pediatrics. 1998 Aug; 3(1): 207-10.

Objective: The purpose of this case study is to discuss the chiropractic care of a patient who presented to the author's office with a medical diagnosis of colic, with additional projectile vomiting. The proposed etiology, the medical approach to colic, and the chiropractic care for this infant is detailed. Also examined is the connection between birth trauma and non-spinal symptoms. Design: a case study. Setting: private practice. Patient: a three-month-old Caucasian male presenting with medically diagnosed colic. Symptoms had been increasing in severity over the previous two months despite medical

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intervention. Results: the resolution of all presenting symptoms within a 2-week treatment period is detailed. Care consisted of chiropractic spinal adjustments and craniosacral therapy. Conclusion: this case study details the chiropractic management of a three-month-old male with a medical diagnosis of colic who also exhibited projectile vomiting. Complete resolution of all symptoms was achieved. Proposed cranial and spinal etiologies are discussed, as well as the connection between birth trauma and non-spinal symptoms.

Chiropractic Care Of A Pediatric Glaucoma Patient: A Case Study, Conway CM.

Journal of Clinical Chiropractic Pediatrics. 1997 Oct; 2(2): 155-6.

Abstract: This case study involves a 17-month-old female presenting with glaucoma and recurrent, chronic sinus infections. This study addresses the reduction of infections as well as the restoration of normal intraocular pressure to the patient using chiropractic adjustments and nutritional therapy. Techniques were also used to influence the cranial-sacral primary respiratory mechanism in an effort to influence the cranium through the connection of the dura mater.

Disturbed eye movements after whiplash due to injuries to the posture control system, Gimse R, Tjell C, Bjorgen IA, Saunte C.

J Clin Exp Neurophychol, 1996;18(2):178-86.

Abstract: Self-reports after whiplash often indicate associations with vertigo and reading problems. Neuropsychological and otoneurological tests were applied to a group of whiplash patients (n = 26) and to a carefully matched control group. The whiplash group deviated from the control group on measures of eye movements during reading, on smooth pursuit eye movements with the head in normal position, and with the body turned to the left or to the right. Clinical, caloric, and neurophysiological tests showed no injury to the vestibular system or to the CNS. Test results suggest that injuries to the neck due to whiplash can cause distortion of the posture control system as a result of disorganized neck proprioceptive activity.Comment: Central to the concept of applied kinesiology chiropractic evaluation and treatment is the consideration that the senses of seeing, hearing, smelling, tasting, feeling, and balance are not simple, specific sensations; rather they are sensory systems closely interrelated among themselves and intimately linked with motor functions. In applied kinesiology chiropractic methodology, a means for testing the integration of the muscles in the body with the visual reflexes has been termed ocular lock. It demonstrates the failure of the eyes to work together on a binocular basis through the cardinal fields of gaze. This is usually not gross pathology of cranial nerves III, IV, and VI; rather it is poor functional organization. Mechanical irritation of cranial nerves III, IV, or VI (usually VI) may be responsible for disturbed binocular function leading to discordant sensory inputs from the visual righting reflex. When the eyes are turned in a specific direction, a previously strong indicator muscle will weaken when the ocular lock test is positive, and there is probably disturbance in the visual righting, vestibulo-ocular, or opto-kinetic reflexes.

Occipital plagiocephaly: deformation or lambdoid synostosis? II. A unifying theory regarding pathogenesis, Dias MS, Klein DM.

Pediatr Neurosurg. 1996 Sep;25(3):164.

Abstract: Occipital plagiocephaly is characterized by both unilateral occipital flattening and ipsilateral frontal prominence with anterior deviation of the ipsilateral ear, yielding a characteristic parallelogram shape to the cranium. Radiographic changes in the lambdoid suture are often evident, but the lambdoid suture is usually patent over most or all of its length on skull X-rays and/or CT scans. Both lambdoid synostosis and deformational forces have been implicated as potentially causal in the pathogenesis of this deformity. We proposed a unifying theory which incorporates a common pathogenesis for both deformational plagiocephaly and most cases of lambdoid 'synostosis'. According to this hypothesis, intrauterine and/or postnatal deformation forces are responsible for the primary calvarial deformation. These forces initially act in reversible manner to

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produce the typical parallelogram-shaped skull deformity. However, with continued deformation, more enduring secondary pathological changes may eventually occur in the lambdoid suture and basicranium which are more difficult to correct even if the offending deformational forces are subsequently removed or reversed.

Ocular findings in children operated on for plagiocephaly and trigonocephaly, Denis D, Genitori L, Conrath J, Lena G, Choux M.

Childs Nerv Syst. 1996 Nov;12(11):683-9.

Abstract: Clinical examination of patients affected by plagiocephaly or trigonocephaly reveals evident malformation of the orbits, and the ocular repercussions are pronounced when children are operated on at an advanced age. Since it is generally accepted that binocular vision is fully developed by approximately 6 months of age, a late correction of plagiocephalic or trigonocephalic skull deformities may be an obstacle to the development of normal visual function. For the present report we investigated astigmatism and strabismus in 53 children, 39 of whom were operated on for plagiocephaly and 14 for trigonocephaly. Traction on the ocular globe induced by the bony deformation caused by the craniosynostosis may explain astigmatism and strabismus.Comment: In applied kinesiology chiropractic methodology, a means for testing the integration of the muscles in the body with the visual reflexes has been termed ocular lock. In this study, one of the repercussions of plagiocephaly is strabismus, which is commonly found in cases demonstrating the ocular lock phenomenon. Ocular lock testing demonstrates the failure of the eyes to work together on a binocular basis through the cardinal fields of gaze. This is usually not gross pathology of cranial nerves III, IV, and VI; rather it is poor functional organization. The ocular lock phenomenon is theorized to be a consequence, most frequently, to cranial faults. There has been some substantiation for this premise, which demonstrates the possible effects of dural tension on the cranial nerves. The cranial nerves carry dural sleeves with them for some distance; therefore any abnormal meningeal tension may be transmitted to a nerve and affect its function.

An increase in infant cranial deformity with supine sleeping position, Argenta LC, David LR, Wilson JA, Bell WO.

J Craniofac Surg. 1996 Jan;7(1):5-11.

Abstract: Abnormalities of the occipital cranial suture in infancy can cause significant posterior cranial asymmetry, malposition of the ears, distortion of the cranial base, deformation of the forehead, and facial asymmetry. Over the past 2 years, we have noted a dramatic increase in the incidence of deformation of the occipital skull in our tertiary referral center. Our patient referral base has not changed appreciably over the past 5 years and patients have been referred from the same primary practitioner base. The timing of this increase correlates closely with the acceptance in our area of recommended changes in sleeping position to supine or side positioning for infants because of the fear of sudden infant death syndrome (SIDS). A total of 51 infants with occipital cranial deformity, with a mean age of 5.5 months at presentation, have been evaluated and treated by a single craniofacial surgeon in the 16-month period from September 1993 to December 1994. Older infants were treated with continuous positioning by the parent keeping the infant off the involved side. Younger infants and those with poor head control were treated with a soft-shell helmet. Mean timing of initial diagnosis and start of treatment was 5.5 months. Mean duration of helmet for positional treatment was 3.8 months. To date, only 3 of 51 patients have required surgical intervention, and other patients demonstrated spontaneous improvement of all measured parameters. Follow up has ranged from 8 to 24 months. We believe that most occipital plagiocephaly deformities are deformations rather than true cranio-synostoses. Despite varying amounts of suture abnormality evidenced on computed tomographic scans, most deformities can be corrected without surgery. In cases where progression of the cranial deformity occurs, despite conservative therapy, surgical intervention should be undertaken at approximately 1 year of age. The almost universal acceptance in the State of North Carolina of positioning neonates on their backs to avoid SIDS, may well increase the incidence of these deformities in the future.

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Changes in neck electromyography associated with meningeal noxious stimulation, Hu JW, Vernon H, Tatourian I.

J Manipulative Physiol Ther. 1995 Nov-Dec;18(9):577-81.

OBJECTIVE: To determine if the activity of jaw and neck muscles in a rat model is influenced by the application of small-fiber irritant mustard oil to meningeal/dural vascular tissues. DESIGN: Controlled animal experiment. SETTING: University neurophysiology laboratory. INTERVENTIONS: Applications of mineral oil (vehicle control) and mustard oil to exposed meningeal/dural vascular tissues. MAIN OUTCOME MEASURE: Electromyographic (EMG) recordings from deep suboccipital muscles, bilaterally, and the left trapezius and left masseter muscles. RESULTS: Mineral oil evoked no EMG responses in any muscles. The incidences of mustard oil-evoked EMG increases were 100%, 100%, 89% and 78% for left deep neck, right deep neck, left trapezium and left masseter muscles, respectively. The durations of EMG responses were (mean +/- SD) 19.2 +/- 6.6 min, 17.3 +/- 7.5 min, 14.5 +/- 6.8 min and 12.7 +/- 8.5 min, respectively. CONCLUSIONS: These results document that meningeal/dural vascular irritation leads to sustained and reversible activation of neck and jaw muscles that may be related to the clinical occurrence of muscular tension and pain associated with certain types of headaches, particularly migraine.

Otitis media with effusion and craniofacial analysis-II: "Mastoid-middle ear-eustachian tube system" in children with secretory otitis media, Kemaloglu YK, Goksu N, Ozbilen S, Akyildiz N.

Int J Pediatr Otorhinolaryngol. 1995 Apr;32(1):69-76.

Abstract: Secretory otitis media (SOM) is a disease of childhood, and this period is characterized by active growing of the craniofacial skeleton (CFS). In this study, we purposed to answer the question 'how deviations in CFS play a role in ethiopathogenesis of SOM'? Therefore, we evaluated the 'mastoid-middle ear-Eustachian tube (M-ME-ET) system' in 30 SOM cases and 30 healthy children by using lateral cephalographies on which reference points and one line related to CFS and 'M-ME-ET system' were pointed. The results disclosed that the bony Eustachian tube, the vertical portion of the tensor veli palatini (TVP) muscle and the mastoid air cell system were smaller in SOM cases. In the view of the statements of Enlow (1990) on craniofacial growth, we suggest that the deviations in the growth process of the nasomaxillary complex lead to corresponding imbalances in the bony tube and vertical portion of the TVP. However, since regional imbalances often tend to compensate for one another to provide functional equilibrium (Enlow, 1990), improvement of the tubal function occurs with age.

Ocular manifestations of deformational frontal plagiocephaly, Fredrick DR, Mulliken JB, Robb RM.

J Pediatr Ophthalmol Strabismus. 1993 Mar-Apr;30(2):92-5.

Abstract: Frontal plagiocephaly can be caused by two mechanisms: craniosynostosis and external deformational pressure. Synostotic plagiocephaly is known to be associated with vertical strabismus and contralateral head tilt. Thirteen patients with deformational frontal plagiocephaly were examined to evaluate head position, ocular motility, and alignment. Nine of the patients (70%) were found to have ipsilateral torticollis, but only one patient had strabismus and this was a horizontal deviation not obviously associated with head position. The clinical features of synostotic and deformational plagiocephaly are discussed to distinguish the two conditions, which have a different treatment and outcome.Comment: This paper documents the effects, specifically, of the frontal bone cranial fault. In AK, this cranial fault would be called an interosseous cranial fault of the frontal bone, and the underlying mechanism of the ocular problems resulting from it involves traction on the ocular globe induced by the frontal bone deformation.

Traumatic brain injury and chronic pain: differential types and rates by head injury severity,Uomoto JM, Esselman PC.

Arch Phys Med Rehabil. 1993 Jan;74(1):61-4.

Abstract: Traumatic brain injury has been associated with many physical and neurobehavioral consequences, including pain problems. Documented most has been the presence of posttraumatic headaches that are associated with the postconcussion syndrome. This study therefore examined types and rates of chronic pain problems in

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patients seen in an outpatient brain injury rehabilitation program. A total of 104 patients were evaluated, 66 of whom were male and 38 female, and the average time postinjury was 26 months. Headaches were the most frequent chronic pain problem across both mild and the moderate/severe groups, although in the former, a significantly higher frequency was noted (89%) when compared against the latter group. The same relative rates were seen for chronic neck/shoulder, back, and other pain problems. The mild group also showed a higher frequency of concurrent pain problems, whereas in the moderate/severe group only one patient had more than one chronic pain problem. Results also showed that in the mild group neck/shoulder accompanied headaches 47% of the time, and back pain coexisted with headaches 44% of the time. These results underscore the high frequency of chronic pain problems in the mild head injury population and implicate the need for avoiding the mislabeling of symptoms such attentional deficits or psychological distress as attributable only to head injury sequelae in those with coexisting chronic pain. Early identification and intervention of pain syndromes in the mild head-injury population is also suggested.

Chiropractic Treatment Of A 7-Month-Old With Chronic Constipation: A Case Report, Hewitt, E.

Chiropractic Technique, 1993 Aug; 5(3):101-3.

Abstract: A 7-month-old girl suffering from chronic constipation since birth a history of painful staining and hard, pellet-like stools. Stools ranged in frequency from once per day to once every 3 days. After treatment consisting of full spine and cranial adjusting, the patient's bowel function normalized to one to two soft, effortless stools per day. Maintenance of these improvements was confirmed at a 1-year follow-up visit.

Head posture and cervicovertebral and craniofacial morphology in patients with craniomandibular dysfunction, Huggare JA, Raustia AM.

Cranio. 1992 Jul;10(3):173-7; discussion 178-9.

Abstract: A relationship between particular characteristics of dental occlusion and craniomandibular disorders (CMD) has been reported, while less attention has been focused on the possible effect of dysfunction of the masticatory system on head posture or cervicovertebral and craniofacial morphology. Natural head position roentgen-cephalograms of 16 young adults with complete dentition taken before and after stomatognathic treatment displayed an extended head posture, smaller size of the uppermost cervical vertebrae, decreased posterior to anterior face height ratio, and a flattened cranial base as compared with age- and sex-matched healthy controls. The lordosis of the cervical spine straightened after stomatognathic treatment. The results are an indication of the close interrelationship between the masticatory muscle system and the muscles supporting the head, and lead to speculation on the principles of treating craniomandibular disorders.

Case Study: The effect of utilizing spinal manipulation and craniosacral therapy as the treatment approach for attention deficit-hyperactivity disorder, Phillips, C.

Proceedings of the National Conference on Chiropractic, 1991 Nov:57-74

ABSTRACT: Due to the subjective nature of this disorder, evaluations and treatment results have considerable limitations and cannot be generalized to the entire population. It is this author's intent to describe an alternative treatment protocol and its effect on one subject. In this particular case, initial chiropractic spinal adjustive care was effective in reducing the frequency of ear infections, allergic reactions, and headaches, but was ineffective at decreasing the severity of ADHD characteristics. Incorporation of craniosacral therapy with spinal adjustive therapy resulted in a positive alteration in the ADHD symptomatology. The teacher's report of improvement in performance skills was significant as teacher ratings have been found to have empirical corroboration of ADD. While conclusions cannot be drawn based on a single case report, it was the opinion of this author that the results justified a more detailed analysis of this treatment protocol for ADD/ADHD. The NWCC Center for Clinical Studies has begun treatment on 17 additional patients with this disorder. If results are similar, a large scale research project will be implemented to investigate further the role that chiropractic spinal and cranial

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therapy may play in the treatment of Attention Deficit Hyperactivity Disorder.

Upper airway obstruction and craniofacial morphology, Principato JJ.

Otolaryngol Head Neck Surg. 1991 Jun;104(6):881-90.

Abstract: Otolaryngologists are being asked with increasing frequency to assess adequacy of the upper airway and to treat upper airway obstructive problems in orthodontic patients. The incentive has been provided by recent studies that purport to relate upper airway obstruction to dental and craniomorphologic changes. It is hypothesized that prolonged oral respiration during critical growth periods in children initiates a sequence of events that commonly results in dental and skeletal changes. In the chronic mouth-breather excessive molar tooth eruption is almost a constant feature, causing a clockwise rotation of the growing mandible, with a disproportional increase in anterior lower vertical face height. Such increases in anterior lower vertical face height are often associated with retrognathia and open bites. Low tongue posture seen with oral respiration impedes the lateral expansion and anterior development of the maxilla. Otolaryngologists have the ability to objectively and accurately assess upper airway patency. Rhinometric assessment before and after application of topical nasal decongestant, in conjunction with clinical examination, provides valuable information regarding upper airway patency and the cause of any existing obstructive pathologic condition. Studies should be designed carefully to control the numerous variables that have an impact on the growing face of a young child so that meaningful data can be obtained in our own field regarding this challenging topic.

Biomechanics of head injury, Demann D, Leisman G.

Int J Neurosci. 1990 Sep;54(1-2):101-17.

Abstract: The enormous incidence of closed head injury has resulted in employing the field of biomechanics as a means of predicting the site of a lesion, discovering, and understanding the forces acting during cranial impact. This paper indicates that the possibilities associated with trauma-induced lesions include: the establishment of large pressure gradients associated with damage resulting from absolute motion of the brain and its displacement relative to the skull; flexion-extension of the upper cervical cord; skull deformation and/or rotational acceleration. Analytical representations, inanimate and cadaver models and, experimental paradigms are presented and their behavioral implications discussed.

The long face syndrome and impairment of the nasopharyngeal airway, Tourne LP.

Angle Orthod. 1990 Fall;60(3):167-76.

Abstract: Experimental evidence suggests that altered muscular function can influence craniofacial morphology. The switch from a nasal to an oronasal breathing pattern induces functional adaptations that include an increase in total anterior face height and vertical development of the lower anterior face. While some animals studies have suggested predictable growth patterns may occur, studies in human subjects have been much more controversial. Therefore, individual variations in response should be expected from the alteration of a long face syndrome patient's breathing mode.

Craniofacial skeleton of 7-year-old children with enlarged adenoids, Tarvonen PL, Koski K.

Am J Orthod Dentofacial Orthop. 1987 Apr;91(4):300-4.

Abstract: In a radiocephalometric study of 7-year-old children, it was found that a diagnostically useful characteristic associated with the presence or past history of enlarged adenoids is a dorsal rotation of the mandibular ramus relative to the palate. This feature may also be common to other obstructions of the nasopharyngeal space. A possible mechanism causing this growth deviation and some methodological problems involved in its detection are discussed.

Persisting symptoms after mild J Clin Exp Neuropsychol. 1986 Aug;8(4):323-46.

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head injury: a review of the postconcussive syndrome,Binder LM.

Abstract: Seemingly mild head injuries frequently result in persisting postconcussive syndromes. The etiology of these symptoms is often controversial. Neuropsychological, neurophysiological, and neuropathological evidence that brain damage can occur in the absence of gross neurological deficits after mild injuries is reviewed. Direct impact to the head is not required to cause brain injury. Understandably, psychological factors also play a role in post-head-injury disability, but the effect of compensation claims and preinjury psychopathology is often secondary to organic factors. Persons over age 40 or with a history of previous head injury are more vulnerable to protracted symptomatology.

Autism and unfavorable left-right asymmetries of the brain,Hier DB, LeMay M, Rosenberger PB.

J Autism Dev Disord. 1979 Jun;9(2):153-9.

Abstract: Utilizing computerized brain tomography, left-right morphologic asymmetries of the parietooccipital region were judged in 16 autistic patients, 44 mentally retarded patients, and 100 miscellaneous neurological patients. In 57% of the autistic patients the right parietooccipital region was wider than the left, while this pattern of cerebral asymmetry was found in only 23% of the mentally retarded patients and 25% of the neurological patients. It is suggested that unfavorable morphologic asymmetries of the brain near the posterior language zone may contribute to the difficulties autistic children experience in acquiring language.

"The Relationship of Craniosacral Examination Findings in Grade School Children with Developmental Problems", Upledger, J.

Journal of the American Osteopathic Association, June 1978; 77: 760/69 - 776/85.

Abstract: A standardized craniosacral examination was conducted on a mixed sample of 203 grade school children. The probabilities calculated supported the existence of a positive relationship between elevated total craniosacral motion restriction scores and the classifications of “not normal,” “behavioral problems,” and “learning disabled,” by school authorities, and of motion coordination problems. There was also a positive relationship between an elevated total craniosacral motion restriction score and a history of an obstetrically complicated delivery. The total quantitative craniosacral motion restriction score was most positively related to those children presenting with multiple problems.

Developmental dyslexia. Evidence for a subgroup with a reversal of cerebral asymmetry, Hier DB, LeMay M, Rosenberger PB, Perlo VP.

Arch Neurol. 1978 Feb;35(2):90-2.

Abstract: The computerized brain tomograms of 24 patients with developmental dyslexia were analyzed for cerebral asymmetry. Ten patients showed a reversal of the pattern of asymmetry regularly observed in normal right-handed individuals so that the right parietooccipital region was wider than the left. The ten dyslexic patients with this reversal of cerebral asymmetry had a lower mean verbal IQ than the other 14 dyslexic patients in this study. The reversal of cerebral asymmetry that occurred in ten of the dyslexic patients may result in language lateralization to a cerebral hemisphere that is structurally less suited to support language function and thus act as a risk factor for the development of reading disability.

Asymmetries of the skull and handedness. Phrenology revisited,LeMay M.

J Neurol Sci. 1977 Jun;32(2):243-53.

Abstract: Some of the asymmetries noted in cerebral computerized transaxial tomography (CTT) studies are reflected in the shape of the skull resulting most often in backward protrusion of the occipital bone on the left and a less striking forward protrusion of the right frontal bone. Asymmetries are less marked in left-handed individuals but the opposite features, i.e. forward protrusion of the left frontal bone and posterior protrusion of the right occipital bone, are more frequent in left handers than in right handers.

"Learning Difficulties of Children Journal of the American Osteopathic Association, Sept 1976; 76: 46-61.

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Viewed in the Light of the Osteopathic Concept", Frymann, Viola M.

Children between 18 months and 12 years of age with and without recognized neurologic deficits were studied at the Osteopathic Center for Children. Their response to 6 to 12 osteopathic manipulative treatments directed to all areas of impaired inherent physiologic motion was estimated from changes in three sensory and three motor areas of performance. Houle's Profile of Development was used to compare neurologic with chronologic age and rate of development, and scores were age-adjusted. Results in children after treatment were compared with those following a waiting period without treatment. Neurologic performance significantly improved after treatment in children with diagnosed neurologic problems and to a lesser degree in children with medical or structural diagnoses. The advances in neurologic development continued over a several months' interval. The results support the use of manipulative treatment as part of pediatric integrative healthcare.

"Structural Normalization in Infants and Children with Particular Reference to Disturbances of the Central Nervous System", Woods, R.

Journal of the American Osteopathic Association, May 1973; 72: 903-908.

Abstract: The reason why there are “bent twigs” and why improvements that can be made in management of the mother both before and during delivery for preventing some of the deformities of the head of the neonate are discussed. Methods of examining the newborn infant so that early help can be given if needed are considered. Signs in the older infant that point to the need for structural normalization are discussed, and case histories substantiating both the need for and the method of help are presented. Treatment is best begun with the maternal pelvis before delivery. Cranial manipulation is not a replacement for other therapies, but it can be a very effective additional therapy.

"Relation of Disturbances of Craniosacral Mechanisms to Symptomatology of the Newborn, Study of 1,250 Infants", Frymann, Viola M.

Journal of the American Osteopathic Association, June 1966; 65: 1059-1075.

Abstract: This study explores the possibility of a relation between symptomatology in newborn infants and anatomic-physiologic disturbances of the craniosacral mechanism. The primary respiratory mechanism hypothesis postulates a rhythmic cranial motion, palpable externally, that is the combined effect of the inherent motility of the central nervous system, fluctuation of the cerebrospinal fluid, the reciprocal tension mechanism of the dural membranes and their folds, and articular mobility of the cranial bones and of the sacrum between the ilia. Labor apparently has a traumatic effect on the craniosacral mechanism in some circumstances. Strain patterns within the developmental parts of the occiput appear significant in producing nervous symptoms. Flexion strain at the sphenobasilar symphysis, sacral extension strain, and compression of the sphenobasilar symphysis were noted in nervous infants. A significant relation is suggested between torsion strain of the sphenobasilar symphysis with restriction in temporal mobility and respiratory and circulatory symptoms.

Physical findings related to psychiatric disorders, Woods JM, Woods RM

Journal of the American Osteopathic Association, Aug 1961;60

Drs. Woods used manual palpation techniques to evaluate 102 psychiatric patients and 62 normal persons. The average rate of CRI in the 62 normal persons was 12.47 cycles per minute. In the 102 psychiatric patients the average rate was 6.7 cycles per minute. Two patients who had received frontal lobotomies were also evaluated. These frontal lobotomy patients presented with CRI rates of 4 cycles per minute.

The role of binocular stress in the post-whiplash syndrome, Roy, R.

Am J Optometry & Arch Am Acad Optometry, Nov. 1961

Electromyographic evidence for ocular muscle proprioception in

Archives of Ophthalmology, 1957;57:176-180

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man, Breinin, GM. In this study, eye motion and position are factors shown as integrated with proprioceptors throughout the body, as well as those of the vestibular apparatus and head-on-neck reflexes. In applied kinesiology chiropractic methodology, a means for testing the integration of the muscles in the body with the visual reflexes has been termed ocular lock. The ocular lock phenomenon is theorized to be a consequence, most frequently, to cranial faults. There has been some substantiation for this premise, which demonstrates the possible effects of dural tension on the cranial nerves.

THE T.M.J. AND THE STOMATOGNATHIC SYSTEM

"Applied kinesiology" in medicine and dentistry--a critical review,Tschernitschek H, Fink M.

Wien Med Wochenschr. 2005 Feb;155(3-4):59-64.

Abstract: The "Applied Kinesiology" evolved in the USA is increasingly being used in Central Europe. In this review the development of the method and its practical application in medicine and in dentistry are elucidated. Furthermore the propagation of the method by the International College of Applied Kinesiology (= ICAK) and the "Touch for Health" (=TFH) is described. School medicine's criticism of "Applied Kinesiology" as well as the methodological replies from "Applied Kinesiologists" are outlined. It is important to realise that there is to date a lack of evidence for the effectiveness, validity and reliability of "Applied Kinesiology". The following requirements are thus vital: "Applied Kinesiologists" must develop clear criteria for single subgroups of "Applied Kinesiology", prove the effectiveness of their methods, and explain their findings in agreement with current medical knowledge.Comment: The ICAK-D (Deutschland) has 248 members who are practicing dentists. The research activities of the ICAK-USA and ICAK-International are now being presented to the public and scientific community at large. The requirements desired by the authors of this review are being accomplished by the concerted efforts of the ICAK.

Assessing the Need for Dental – Chiropractic TMJ Co-Management: The Development of a Prediction Instrument, Blum CL, Globe G.

Journal of Chiropractic Education, Sum 2005;19(2).

Abstract: Historically the evolution of interdisciplinary care of temporomandibular joint (TMJ) began in the last 20th century. It may be that for some proportion of patients who eventually develop a full-blown TMJ disorder, there is an adaptive stage whereby the related musculature in the cervical spine and other posturally related muscles may be able to accommodate so as to mitigate TMJ restriction or crepitus. The challenge for dentists, planning to treat a patient with TMD, remains a guessing game as they continue unaided in attempting to determine whether or not a patient would prophylactically benefit from chiropractic co-treatment in order to prevent the onset or minimize the effect of musculoskeletal symptoms secondary to dental TMD intervention. The purpose of this paper is to help begin the process of developing an assessment tool for dentists to assist them in determining when a patient might not be able to easily adapt to related postural changes that may occur secondary to dental modifications of occlusion or TMJ balancing. Qualitative Assessment of Risk Factors: In-depth interviews were conducted with groups of dentists specializing in the treatment and the consistent request from the vast majority was the need for a tool to guide them in determining which patient’s would best benefit from chiropractic co-treatment. Development Of A Predictive Tool: Based on the preliminary interviews and a review of existing, valid and reliable measures, a preliminary assessment tool that measures the following five domains was developed; (1) musculoskeletal manifestations (2) the patient’s perception of pain, (3) somaticization of

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psychological stress, (4) physiological reserves to deal with stress and (5) the patient’s self-reported quality of life. Preliminarily Selected Instruments: The preliminary assessment tool will be composed of three instruments:. (1) A general questionnaire which will address the patient’s physiological reserve, level of pain tolerance, level of psychological health and their fear avoidance behavior. (2) The general symptom survey for musculoskeletal dysfunction determines if the patient has had a history or is currently suffering from cervical (headaches, neck, shoulder, and hand pain) or locomotive or balance (lower back, knee, or foot pain) dysfunction(s). (3) The functional evaluation form tests proprioceptive abilities, static and dynamic postural balance tests and cervical ranges of motion. Discussion: The interviewed dental professionals observed that posture can be a determinant of occlusion functionality outcomes in some of their patients. They have identified a need for an assessment instrument that would help them to identify patients who may be at risk so that referral could be made before the initiation of occlusion modification. The goal of the assessment form, which includes functional analysis tests, is to help determine which “appropriate situations” or conditions are best for referral for chiropractic care.CONCLUSIONWhile the selected assessment instruments were not originally developed or validated for their predictive capabilities, they are posited to measure health domains that may have some transferability to measuring predictive factors associated with the development of musculoskeletal reactions secondary to dental TMJ treatment. As new data becomes available, this instrument will be modified to reflect improved understanding of predictive elements. Concomitant with the development of a predictive assessment tool is the process goal of expanding interdisciplinary dialogue, which may help lead to standardization of TMJ dysfunction terminology and a “common language.” A starting point is needed and a reasonable attempt has been made to begin the daunting process of developing an instrument that would help inform dentists as to which patients may be likely to become symptomatic to peripheral musculoskeletal regions secondary to occlusion modification.

The effect of condyle fossa relationships on head posture,Olmos SR, Kritz-Silverstein D, Halligan W, Silverstein ST.

Cranio. 2005 Jan;23(1):48-52.

Abstract: Although it is commonly accepted that there is an interrelationship between the temporomandibular joint (TMJ) and head posture, few, if any, previous studies have quantified this effect. The purpose of this study is to quantify the effect of a change in the condyle fossa relationship of symptomatic temporomandibular joints on head posture. Charts of 51 patients (N=10 men and N=41 women) with symptomatic TMJ pathology were reviewed. The condyle fossa relationships were measured pre- and posttreatment using sagittal corrected hypocycloidal tomography. The amount of slant between the shoulder and external auditory meatus (EAM) was measured in pre- and posttreatment photographs as an indicator of forward head posture; less slant indicates better posture. Subjects ranged in age from 13-74 years (mean=43.1) and had been treated for an average of 5 months. Comparisons with pre-treatment measures showed that after treatment, the amount of retrodiskal space was significantly increased by an average of 1.67 mm on the left side (t=-10.11, p<0.0001) and 1.92 mm on the right (t=-9.62, p<0.0001). Comparisons also showed that after treatment, the amount of slant between the shoulder and EAM decreased by 4.43 inches on average which was also significant (t=13.08, p<0.0001). Improvement in the condyle fossa relationship was related to decreased forward head posture. This suggests that optimizing mandibular condyle position should be considered in the management of forward head posture (adaptive posture).

Chiropractic and Dentistry in the 21st Century, Blum CL.

The Journal of Craniomandibular Practice, Jan 2004; 22(1): 1-3.

Abstract: As interdisciplinary healthcare matures, understanding that patient care should ultimately be our focus, hopefully differences can be put aside in light of our common goal.  Within the cranial manipulative field mutual research cooperation between

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chiropractors, osteopaths, and physical therapists will hopefully be imminent in the 21st Century.  This is presently happening with the multi-divisions of dentistry as relating to the field of craniomandibular/temporomandibular dysfunction (TMD/CMD) and conditions affecting condylar positions, functional orthodontic care, and the relationship of occlusion to the stomatognathic system and posture.  The best way for us all to proceed is with an open mind and heart and willingness to learn and work together.

Comorbidity of internal derangement of the temporomandibular joint and silent dysfunction of the cervical spine, Stiesch-Scholz M, Fink M, Tschernitschek H.

J Oral Rehabil. 2003 Apr;30(4):386-91.

Abstract: The aim of this evaluation was to examine correlations between internal derangement of the temporomandibular joint (TMJ) and cervical spine disorder (CSD). A prospective controlled clinical study was carried out. Thirty patients with signs and symptoms of internal derangement but without any subjective neck problems and 30 age- and gender-matched control subjects without signs and symptoms of internal derangement were examined. The investigation of the temporomandibular system was carried out using a 'Craniomandibular Index'. Afterwards an examiner-blinded manual medical investigation of the craniocervical system was performed. This included muscle palpation of the cervical spine and shoulder girdle as well as passive movement tests of the cervical spine, to detect restrictions in the range of movement as well as segmental intervertebral dysfunction. The internal derangement of the TMJ was significantly associated with 'silent' CSD (t-test, P < 0.05). Patients with raised muscle tenderness of the temporomandibular system exhibited significantly more often pain on pressure of the neck muscles than patients without muscle tenderness of the temporomandibular system (t-test, P < 0.05). As a result of the present study, for patients with internal derangement of the TMJ an additional examination of the craniocervical system should be recommended.Comment: In AK there is recognition of the stomatognathic system, and of the importance of the cervical spine to the treatment of the TMJ. The stomatognathic system involves the complex interaction between structures and functions of the head and neck.

Evidence of an influence of asymmetrical occlusal interferences on the activity of the sternocleidomastoid muscle, Ferrario VF, Sforza C, Dellavia C, Tartaglia GM.

J Oral Rehabil. 2003 Jan;30(1):34-40.

Abstract: To investigate the hypothesis of a functional coupling between occlusion and neck muscles, the immediate effect of asymmetrical occlusal interferences on the pattern of contraction of the sternocleidomastoid muscles (SCM) during maximum voluntary clench (MVC) was analysed in 30 healthy subjects. All subjects had a complete and sound permanent dentition, without temporomandibular joint (TMJ) and craniocervical disorders. A 5-s surface electromyogram (EMG) examination of the SCM was performed during (1) MVC in intercuspal position and (2) MVC with a single 200-microm occlusal interference alternatively positioned on teeth 16, 13, 23, 26. All subjects had a symmetrical EMG activity during MVC in intercuspal position. For each subject, SCM potentials were standardized as percentage of the mean potentials recorded during the MVC on natural dentition and the EMG waves of left- and right-side muscles were compared by computing the relevant percentage overlapping coefficient (POC). For each subject, the best and the worst POCs computed during the four MVC tests with occlusal interferences were found and the percentage difference between them was calculated. In the four MVC tests with occlusal interferences, SCM symmetry was very different from that recorded during MVC on natural dentition. The difference between the best and worst POCs computed within each subject was very variable, ranging from 1.52 to 41.57%. In conclusion, when young healthy subjects with a normal occlusion clench on an asymmetrical occlusal interference, they have an altered left-right side pattern of contraction of their SCM. In almost all subjects, a previously symmetrical pattern became asymmetrical.

Chiropractic care of a patient with temporomandibular disorder and

J Manipulative Physiol Ther. 2002 Jan;25(1):63-70.

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atlas subluxation, Alcantara J, Plaugher G, Klemp DD, Salem C.

OBJECTIVE: To describe the chiropractic care of a patient with cervical subluxation and complaints associated with temporomandibular disorder. CLINICAL FEATURES: A 41-year-old woman had bilateral ear pain, tinnitus, vertigo, altered or decreased hearing acuity, and headaches. She had a history of ear infections, which had been treated with prescription antibiotics. Her complaints were attributed to a diagnosis of temporomandibular joint syndrome and had been treated unsuccessfully by a medical doctor and dentist. INTERVENTION AND OUTCOME: High-velocity, low-amplitude adjustments (i.e., Gonstead technique) were applied to findings of atlas subluxation. The patient's symptoms improved and eventually resolved after 9 visits. CONCLUSION: The chiropractic care of a patient with temporomandibular disorder, headaches, and subluxation is described. Clinical issues relevant to the care of patients with this disorder are also discussed.

Differences in the fatigue of masticatory and neck muscles between male and female, Ueda HM, Kato M, Saifuddin M, Tabe H, Yamaguchi K, Tanne K.

J Oral Rehabil. 2002 Jun;29(6):575-82.

Abstract: The purpose of this study was to investigate the nature of fatigue and recovery of masticatory and neck muscles and the differences between sexes in normal subjects during experimentally induced loading. Subjects consisted of eight males (mean age: 27.6 years) and eight females (mean age: 24.2 years) selected from the volunteers in the Faculty of Dentistry, Hiroshima University. The inclusion criteria for the subjects were as follows: (1) good general health, (2) normal horizontal and vertical skeletal relationships, (3) no severe malocclusions and (4) no complaints of temporomandibular disorders. Each subject was requested to bite an occlusal-force meter with 98, 196 and 294 N forces on the first molar region per side for 45 s. Activities of the masseter and sternocleidomastoid (SCM) muscles were recorded during these performances. Fatigue and recovery ratios were calculated with mean power frequency of power spectrum using a fast Fourier transform algorithm. Significant differences in the fatigue ratios between both sexes were found for the masseter muscle with 98, 196 and 294 N bite forces. Meanwhile, the SCM presented a significant difference between both sexes only at 98 N biting. Significant differences in the recovery ratios between both sexes were more prominent in the masseter muscle than in the SCM. These results suggest that the differences in muscle endurance between sexes may have some association with higher susceptibility of craniomandibular disorders in females than in males.

Relationship between dental occlusion and posture, Milani RS, De Periere DD, Lapeyre L, Pourreyron L.

Cranio. 2000 Apr;18(2):127-34.

Abstract: The purpose of this study is to show the effects of dental occlusion on postural position. Thirty subjects were divided into two groups: an experimental group who wore mandibular orthopedic repositioning appliances (MORA) and a control group who wore no oral device. All of the subjects underwent the same Fukuda-Unterberger experimental stepping test to check their postural attitude. Any deviation of the subject during the test from his initial position was analyzed. The results seemed to confirm that altering dental occlusion by wearing an oral appliance could induce some fluctuations in dynamic postural attitude. The phenomenon occurs after prolonged wearing of a MORA. Feedback effects are gradual after removing the mandibular splint.

Dental occlusion modifies gaze and posture stabilization in human subjects, Gangloff P, Louis JP, Perrin PP.

Neurosci Lett. 2000 Nov 3;293(3):203-6.

Abstract: Repercussion of dental occlusion was tested upon postural and gaze stabilization, the latter with a visuo-motor task evaluated by shooting performances. Eighteen permit holders shooters and 18 controls were enrolled in this study. Postural control was evaluated in both groups according to four mandibular positions imposed by interocclusal splints: (i) intercuspal occlusion (IO), (ii) centric relation (CR), (iii) physiological side lateral occlusion and (iv) controlateral occlusion, in order to appreciate the impact of the splints upon orthostatism. Postural control and gaze stabilization quality

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decreased, from the best to the worst, with splints in CR, IO and lateral occlusion. In shooters, the improvement in postural control was parallel to superior shooting performance. A repercussion of dental occlusion upon proprioception and visual stabilization is suggested by these data.Comment: Central to the concept of applied kinesiology chiropractic evaluation and treatment is the consideration that the senses of seeing, hearing, smelling, tasting, feeling, and balance are not simple, specific sensations; rather they are sensory systems closely interrelated among themselves and intimately linked with motor functions. The dental occlusion is part of the stomatognathic system, and exerts an influence upon the function of the eyes and posture, and these two functions influence one another. In applied kinesiology chiropractic methodology, a means for testing the integration of the TMJ and the other muscles in the body with the visual reflexes has been termed ocular lock.

[Influence of body posture in the prevalence of craniomandibular dysfunction], Fuentes R, Freesmeyer W, Henriquez J.

[Article in Spanish]

Rev Med Chil. 1999 Sep;127(9):1079-85.

BACKGROUND: Postural alterations of the shoulders, dorsal spine and hips could have an influence on the development of craniomandibular dysfunctions. AIM: To study the influence of body posture on the prevalence of craniomandibular dysfunction. SUBJECTS AND METHODS: One hundred thirty six dental students and 41 patients assisting to the temporomandibular joints (TMJ) clinic at the Freie Universitat at Berlin, were studied. Masticator, cervical muscles, temporomandibular joints and occlusions were clinically examined. The position of shoulders and hips was measured with the use of an acromiopelvimeter. RESULTS: No relationship was found between postural alterations of the hips and shoulders, articular noises and sensibility or pain while palpating the temporomandibular joints. Among students, a relationship between postural alterations of the shoulders and the sensibility or pain while palpating the TMJ, was observed. When all muscles were considered, a significant relationship between asymmetric shoulders or hips and muscular pain while palpating was observed among students. CONCLUSIONS: Some symptoms, especially muscular sensibility is more pronounced in people with hip and shoulder asymmetries. This relation is more pronounced in dental students than in patients.

Relationship between dental occlusion and visual focusing,Sharifi Milani R, Deville de Periere D, Micallef JP.

Cranio. 1998 Apr;16(2):109-18.

Abstract: The purpose of this study is to show the effects of dental occlusion on visual focusing. Thirty subjects were divided into two groups: an experimental group who had worn mandibular orthopedic repositioning appliances and a control group who had not worn any oral device. All of the subjects underwent the same visual focusing tests with a Maddox rod and the Berens prismatic bars, from over five meters to 30 centimeters. The results seemed to confirm that the alteration of dental occlusion can induce some fluctuations in visual focusing. The phenomenon occurs after wearing a MORA (Mandibular Orthopedic Repositioning Appliance) for a while. Feedback effects are gradual after removing the mandibular splint.

Complementary Therapies Chiropractic, Howat J, Varley P

Dentistry Monthly Feb 1998; 4(2): 16-25.

Abstract: The interdisciplinary collaboration between a dentist / orthodontist and a chiropractic craniopathy indicates that with a good working relationship between the two disciplines the required results can be achieved. The aetiology of a problem can be defined and diagnosed early so that the correct treatment can be applied. A descending major stress area is a primary dental problem requiring a chiropractic backup to ensure a return to biomechanical stability. An ascending major stress area is a primary chiropractic problem requiring dental backup to ensure that premature contacts of teeth, loss of dentition, and incisor interference can be monitored and corrected while the sacroiliac lesion is stabilized.

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Chiropractic/dental cotreatment of lumbosacral pain with temporomandibular joint involvement, Chinappi AS Jr, Getzoff H.

J Manipulative Physiol Ther. 1996 Nov-Dec;19(9):607-12.

OBJECTIVE: To demonstrate the concept of integrated dental orthopedic and cranio-chiropractic care for treating structural disorders of the jaw, neck and spine. CLINICAL FEATURES: A 33-yr-old woman sought chiropractic care for centralized lumbosacral pain that had persisted for 3 months. She exhibited pain on lumbopelvic extension and marked limitations on lumbopelvic flexion. In addition, cervical rotation and cranial sutural motion in the right malar maxillary suture were restricted. The left temporal mandibular joint also was limited in translation. Based on initial chiropractic sacro-occipital technique, she was diagnosed with Category III lumbopelvic dysfunction. X-ray examination revealed a lumbosacral angle of 39 degrees, with sacral displacement posterior to the weight-bearing line. In conjunction with the beginning of chiropractic care, she was encouraged to seek dental-orthodontic evaluation. After 30 months of chiropractic treatment, she was still experiencing some lower back pain and limited improvement. She finally agreed to see the orthodontist. Orthodontic evaluation revealed a Class I malocclusion with significant loss of vertical dimension, characteristic of bilateral posterior bite collapse. INTERVENTION AND OUTCOME: Initial orthodontic treatment began in September 1991 and was followed by restorative dentistry to replace the missing teeth. This cotreatment approach, which integrated dental orthopedic and craniochiropractic care, ameliorated the pain and improved head, jaw, neck and back function. CONCLUSION: The position of the jaw, head and vertebral column, including the lumbar region, are intricately linked. Orthodontic treatment improved the position of the mandible, which in turn enabled the body to respond to chiropractic care.

Body posture photographs as a diagnostic aid for musculoskeletal disorders related to temporomandibular disorders (TMD), Zonnenberg AJ, Van Maanen CJ, Oostendorp RA, Elvers JW.

Cranio. 1996 Jul;14(3):225-32.

Abstract: The purpose of this study was to test the hypothesis that body posture could be an etiologic factor in patients with temporomandibular disorders. "Faculty" body posture has been considered to be an initiating and perpetuating etiologic factor in some temporomandibular disorders (TMD). Although in patients with temporomandibular disorders a significant craniocervical dysfunction has been established, a causal relationship between posture and TMD has not yet been proved. Two samples of 40 subjects each were selected, age and gender matched. The experimental group consisted of 40 patients, who were not previously treated for temporomandibular dysfunction. TMD of these patients was diagnosed on the basis of a questionnaire and a thorough intra- and extraoral examination. The clinical symptoms of TMD were confirmed with transcranial x-rays and the condylar tracings of the performed axiography. A clinical examination was done to confirm the good health of the control group. In addition, symptoms of craniocervical dysfunction within the experimental group were evaluated to make a proper referral to a physical therapist. Four photographs of the orthostatic posture were taken. In accordance with anthropometric guidelines, the following anatomical landmarks were palpated and applied on the skin with a dark lipstick on forehand: both acromiones of the scapula and the anterior (ASIS) and posterior superior iliac spine (PSIS). Statistical testing was performed to confirm the data fit a normal distribution. The differences between the experimental group and the control group were tested with Student's two sample T-test. Within the experimental group, a significant correlation existed between the shoulder line and the pelvis line, on the frontal as well as on the dorsal photograph. The results suggest a somatic basis for the observed postural imbalances in patients with temporomandibular disorders. The results, however, must be interpreted with reservation.

TMJ Pain and Chiropractic Adjustment—A Pilot Study, O’Reilly A, Pollard H

Chiropr J Aust 1996; 26:125-9.

Objective: This project investigates the relationship between spinal adjustment and temporomandibular joint (TMJ) pain. Design: Controlled pilot trial. Setting: Private

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chiropractic practice. Patients: Twelve (12) patients assessed by dentists in private practice as having TMJ syndrome, randomly assigned to a chiropractic treatment or a placebo treatment (remote trigger point therapy) group. Intervention: Patients in the chiropractic group received weekly chiropractic adjustments for six weeks to correct cervical spine vertebral dysfunctions, and controls received weekly trigger point therapy to cervico-thoracic muscles for six weeks. Main Outcome Measure: McGill Pain Questionnaire administered before and after the trial. Results: Both groups demonstrated similar changes. Due to greater than anticipated reduction in pain in the trigger point therapy (control) group, the results were statistically the same using a Mann-Whitney non-parametric test (p = 0.9025), however a subjective, graphical comparison of results suggests that spinal adjustment may have some superiority over the trigger point method. Conclusions: Further investigation is warranted, but future studies should involve a larger sample, sham treatment other than cervico-thoracic trigger point therapy, and a pain assessment tool specifically designed for TMJ symptoms.

The relationship between forward head posture and temporomandibular disorders,Lee WY, Okeson JP, Lindroth J.

J Orofac Pain. 1995 Spring;9(2):161-7.

Abstract: This study investigated the relationship between forward head posture and temporomandibular disorder symptoms. Thirty-three temporomandibular disorder patients with predominant complaints of masticatory muscle pain were compared with an age- and gender-matched control group. Head position was measured from photographs taken with a plumb line drawn from the ceiling to the lateral malleolus of the ankle and with a horizontal plane that was perpendicular to the plumb line and that passed through the spinous process of the seventh cervical vertebra. The distances from the plumb line to the ear, to the seventh vertebra, and to the shoulder were measured. Two angles were also measured: (1) ear-seventh cervical vertebra-horizontal plane and (2) eye-ear-seventh cervical vertebra. The only measurement that revealed a statistically significant difference was angle ear-seventh cervical vertebra-horizontal plane. This angle was smaller in the patients with temporomandibular disorders than in the control subjects. In other words, when evaluating the ear position with respect to the seventh cervical vertebra, the head was positioned more forward in the group with temporomandibular disorders than in the control group (P < .05).

Chiropractic manipulation of anteriorly displaced temporomandibular disc with adhesion, Saghafi D, Curl DD.

J Manipulative Physiol Ther. 1995 Feb;18(2):98-104.

OBJECTIVE: This AB, single-subject case study was conducted to investigate the capability of chiropractic manipulation of the temporomandibular joint (TMJ) in treating unilateral anterior displacement of the articular disc with adhesion to the articular eminence. A specific joint manipulation was designed to reduce the anteriorly displaced and adhered TMJ disc. CLINICAL FEATURES: A 21-yr-old woman suffered from a four year history of right-sided temporomandibular joint pain and clicking, with limitation of mandibular opening. The patient reported previous unsuccessful treatments for her condition. An exhaustive history, a complete review of systems and a physical examination (including, but not limited to, eyes, ears, nose, throat and motor, sensory and reflex neurological tests) were obtained. Relevant or contributory findings are extracted for this article. A clinical diagnosis of left-sided anteriorly displaced TMJ disc with adhesion to the articular eminence was made. INTERVENTION AND OUTCOME: Patient's pain level, presence of joint clicking upon mandibular opening and the amount of mandibular opening were used as outcome measures for capability of treatments. An AB, single-subject study was used where A was the baseline period and B the therapeutic intervention period. The patient was treated twice a week for a total of 19 visits. During the baseline period no treatment was given to the TMJ (3 visits) where the patient received cervical manipulation alone. During the experimental period the patient received both cervical spine manipulation and a specific manipulation to the left mandible. There were no physical therapeutic modalities applied to the jaw. The specific TMJ manipulation used

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requires a very low-amplitude high velocity thrust parallel to the slope of the articular eminence. The results of this study show mandibular opening distance was returned to normal in addition to the abolition of the patient's TMJ pain and clicking. During the three baseline visits mandibular opening showed no significant change, with an average of 25.3 mm (range 25-26 mm). There was also no change in the patient's TMJ pain or clicking during this baseline period. The patient's TMJ clicking was absent following the third treatment and the patient reported significant subjective pain relief as well. Temporomandibular pain was again reported during the fifth, sixth and seventh post-treatment visits due to exacerbations caused by daily activities. There was no pain reported from the beginning of the eighth post-treatment visit to the end of the study. CONCLUSION: The findings of this study show this specific manipulation of the TMJ may be appropriate for the conservative treatment of adhered anteriorly dislocated disc.

Influence of variation in jaw posture on sternocleidomastoid and trapezius electromyographic activity, Zuniga C, Miralles R, Mena B, Montt R, Moran D, Santander H, Moya H.

Cranio. 1995 Jul;13(3):157-62.

Abstract: This study was conducted in order to determine the influence of variation in the occlusal contacts on electromyographic (EMG) cervical activity in 20 patients with myogenic cranio-cervical-mandibular dysfunction. EMG recordings during maximal voluntary clenching were performed by placing surface electrodes on the left sternocleidomastoid and upper trapezius muscles in the following conditions: intercuspal position; edge to edge left laterotrusive contacts (ipsilateral); edge to edge right laterotrusive contacts (contralateral); edge to edge protrusive contacts; and retrusive occlusal contacts. A significant higher EMG activity was recorded in both muscles during maximal voluntary clenching in retrusive occlusal contact position, whereas no significant differences in EMG activity were observed between intercuspal position, ipsilateral, contralateral and protrusive contact positions. The EMG pattern observed suggests that a more frequent intensity and duration of tooth clenching in retrusive occlusal contact position could result in more clinical symptomatology in these cervical muscles in patients with myogenic cranio-cervical-mandibular dysfunction.

Temporomandibular disorder associated with sacroiliac sprain, Gregory TM.

J Manipulative Physiol Ther. 1993 May;16(4):256-65.

Abstract: A case of the external derangement-type temporomandibular disorder (TMD), temporarily relieved following chiropractic sacro-occipital technique (SOT) treatment, including SOT category II blocking to reduce sacroiliac sprain, is presented. Symptom exacerbation midway through the course of treatment followed additional dental work; symptom remission followed additional SOT treatment. Freedom from symptoms is maintained with a 3-wk treatment interval. There appears to be a cause-effect relationship between external derangement-type TMD and sacroiliac sprain. Concurrent, coordinated chiropractic and dental treatments may improve the success rate of TMD resolution.

Birth Induced TMJ Dysfunction: The Most Common Cause of Breastfeeding Difficulties, Arcadi V,

Proceedings Of The National Conference On Chiropractic. 1993 Oct: 18-22.

Abstract: In a clinical setting, 1,000 newborns were observed and treated (ages hour to 21 days), for failure and/or difficulty with breast-feeding. In 800 or 80%, birth induced Temporomandibular Joint Dysfunction was found to be the cause. In all cases, the babies were treated with chiropractic cranial and spinal adjustments, with excellent results in 99% of the cases. This paper discusses the basic clinical findings, related newborn discomforts, and associated symptomatology involving other symptoms.

Alteration of vertical dimension and its effect on head and neck posture, Urbanowicz M.

Cranio. 1991 Apr;9(2):174-9.

Abstract: Previous research has shown a relationship between head posture and rest position of the mandible. Should this relationship really be an interrelationship? Does a

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change in mandibular posture alone also alter head and neck posture? The purpose of this article is to demonstrate how a change in mandibular posture, specifically an increase in vertical dimension, contributes to craniovertical extension leading to suboccipital compression and upsetting the postural balance between the head and neck. A model of physiologic equilibrium is presented for the craniomandibular articulation.

Postural differences between asymptomatic men and women and craniofacial pain patients,Braun BL.

Arch Phys Med Rehabil. 1991 Aug;72(9):653-6.

Abstract: A forward head position and rounded shoulders have been implicated in the development or perpetuation of craniomandibular disorders. Since women seek treatment for these problems more frequently than men, postural differences may account for the increased incidence of symptoms in women. The purposes of this study were (1) to compare the sagittal head and shoulder posture of asymptomatic men and women and (2) to compare the posture of asymptomatic and symptomatic women to determine differences in sagittal plane posture. Subjects were 20 asymptomatic men and women volunteers and nine consecutive women patients presenting for evaluation and treatment of craniomandibular pain. The subjects were compared using a valid, reliable, computer-assisted slide digitizing system called the Postural Analysis Digitizing System (PADS). Asymptomatic men and women did not differ in the postural characteristics associated with craniomandibular disorders. Sagittal posture does not appear to be a gender-related factor in these disorders. Symptomatic women, however, do display these postural characteristics to a greater extent than asymptomatic women. Evaluation and treatment of postural dysfunction should be included in the management of these patients.

Nerve entrapment in the lateral pterygoid muscle, Loughner BA, Larkin LH, Mahan PE.

Oral Surg Oral Med Oral Pathol. 1990 Mar;69(3):299-306.

Abstract: The posterior trunk of the mandibular division of the trigeminal nerve normally descends deep to the lateral pterygoid muscle. In three of 52 dissections the three main branches of the posterior trunk (lingual, inferior alveolar, and auriculotemporal nerves) were observed to pass through the medial fibers of the lower belly of the lateral pterygoid muscle. The mylohyoid and anterior deep temporal nerves also were observed to pass through the lateral pterygoid muscle in other specimens. These nerve entrapments in the infratemporal fossa provide new information concerning the anatomic and clinical relationships between the mandibular nerve and the lateral pterygoid muscle. These findings support the hypothesis that a spastic condition of the lateral pterygoid muscle may be causally related to compression of an entrapped nerve that lead to numbness, pain, or both in the respective areas of nerve distribution.

[The relation between the condition of the stomatognathic system and the condition of whole body. I-1. Concerning the effects of a change of occlusion on upright posture especially on the locus of the body's gravity center], Miyata T, Satoh T, Shimada A, Umetsu N, Takeda T, Ishigami K, Ohki K.[Article in Japanese]

Nihon Hotetsu Shika Gakkai Zasshi. 1988 Dec;32(6):1233-40.

The Lateral Pterygoid Muscle: Its Significance in Craniomandibular Dysfunction, Sarkin JM

Dig Chiro Econ, Jan/Feb 1987;29(4)120-22.

Abstract: The lateral (external) pterygoid is a muscle of mastication that is extremely

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important in cranio-mandibular dysfunction. When the lateral pterygoid is shortened and hypertonic, it can produce internal derangement of the temporomandibular joint (TMJ) joint noises, limited and deviated mouth opening, referred myofascial trigger point pain to the TMJ and maxilla, and the cranial primary respiratory dysfunction. Through careful consultation and examination, the problematic lateral pterygoid can be uncovered and subsequently treated and managed. Resolution of lateral pterygoid dysfunction is crucial in establishing optimal craniomandibular function.

Craniopathy and dentistry, Denton DG

Basal Facts 1986;8(4):181-202

Abstract: At this particular time, many health professions are trying to work together, using all avenues at their disposal, for the establishment of normal health. Dentists have long been leaders in many areas of scientific research in the health field: acupuncture, nutrition, hypnosis, biofeedback, etc. In fact, general dentistry has always been in the forefront of the health field, but all too often dentists consider themselves merely technicians rather than doctors. Concurrent with the revolution of dentistry, craniopathic physicians have proven that temporal mandibular motion, proper equilibration of the dental arches and tooth placement, are absolutely necessary for proper function.

Relations between occlusal interference and jaw muscle activities in response to changes in head position, Funakoshi, M., Fujita, N., Takenana, S.

J Dent Res, 1976;35:684-690

Abstract: The jaw muscles responded to changes in the head position. Electromyographic responses to head positions were classified as either of two types--balanced and unbalanced. The balanced type of electromyographic responses of participants with normal occlusion changed to the unbalanced type after being set with an overlay to make a premature contact artificially, and returned to the balanced type after removal of the overlay. The unbalanced type of electromyographic response of participants with occlusal interference turned to the balanced type after occlusal adjustment.Comment: In AK examination and treatment, the complexity of the TMJ apparatus is appreciated. The TMJ is part of a complex system including the bones of the skull and cervical spine, the mandible and hyoid bone, the related muscle attachments and other soft tissues, and neurologic and vascular components. This complex is often referred to as the stomatognathic system. The use of AK methods, especially challenge and therapy localization, greatly assists the practitioner in finding concealed or hidden TMJ problems.

Neuromuscular control of mandibular movements, Perry, C.

J Prosthet Dent, 1973;30:714-720

Muscular changes associated with temporomandibular joint dysfunction, Perry, H.T., Jr.

J.A.D.A., 1957;54:644-653

Table 1: Cranial Manipulative TherapyCharacteristics of reports on clinical research and outcomes of cranial manipulative therapy

Cuthbert S. Motion Sickness Disorder: A Review, Treatment Strategy, and Case Series Report

J Chiro Med Spring 2006

Cuthbert S. The Applied Kinesiology Research and Literature Compendium

The International Journal of Applied Kinesiology and Kinesiologic Medicine Spring 2006;21:6-63

Lancaster DG, Crow WT. Osteopathic Manipulative Treatment of a 26-Year-Old Woman With Bell's Palsy

J Am Osteopath Assoc May 2006; 106(5):285-89.

Cuthbert S., Blum C Symptomatic Arnold-Chiari malformation and J Manipulative Physiol Ther. 2005 May;28(4):e1-6.

47

cranial nerve dysfunction: a case study of applied kinesiology cranial evaluation and treatment

Cutler,M.J. Holland, B.S. ; Stupski, B.A.; Gamber, R.G.; Smith, M.L.

Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans: a pilot study.   

Journal of Alternative and Complementary Medicine 2005;11(1):103-8.

Cuthbert S. Applied Kinesiology and Proprioception The International Journal of Applied Kinesiology and Kinesiologic Medicine Fall 2005;20:12-15

Pederick F. Cranial and Other Chiropractic Adjustments in the Conservative Treatment of Chronic Trigeminal Neuralgia: A Case Report

Chiro J Aust, 2005; 35:9-15.

Quezada D Chiropractic care of an infant with plagiocephaly

Journal of Clinical Chiropractic Pediatrics, 2004;6(1):342-8/

Vallone S. Chiropractic Evaluation and Treatment of Musculoskeletal Dysfunction in Infants Demonstrating Difficulty Breastfeeding

Journal of Clinical Chiropractic Pediatrics, 2004; 6(1):349-61.

Nelson, K.E.; Sergueef, N.; Glonek, T.

Cranial Manipulation Induces Sequential Changes in Blood Flow Velocity on Demand  

The American Academy of Osteopathy Journal 2004;14(3):15-7.

Fink M, Wahling K, Stiesch-Scholz M, Tschernitschek H.

The functional relationship between the craniomandibular system, cervical spine, and the sacroiliac joint: a preliminary investigation

Cranio. 2003 Jul;21(3):202-8.

Cuthbert S. Applied Kinesiology and Down Syndrome: a Study of Fifteen Cases

The International Journal of Applied Kinesiology and Kinesiologic Medicine, 2003;16:16-21

Sergueef, N.; Nelson, K.E.; Glonek, T.

Cranial manipulation induces sequential changes in blood-flow velocity, on demand  

Journal of the American Osteopathic Association 2003;103(8):380.

Blum CS The Compendium of SOT Peer Reviewed Published Literature 1984-2000 

Journal of Vertebral Subluxation Research Nov 2002; 4(4);123-124] 

Blum, C.L. Chiropractic Treatment of Mild Head Trauma: A Case History  

Proceedings of the 2002 International Conference on Spinal Manipulation. 2002 

Rivera-Martinez, S., Wells, M., Capobianco, J.

A retrospective study of cranial strain patterns in patients with idiopathic Parkinson’s disease

Journal of the American Osteopathic Association, August 2002;102(8):417-422

Cuthbert S. An applied Kinesiology evaluation of facial neuralgia: A case history of Bell’s palsy

The International Journal of Applied Kinesiology and Kinesiologic Medicine Summer 2001:42-45

Holtrop DP. Resolution of suckling intolerance in a 6-month-old chiropractic patient

J Manipulative Physiol Ther. 2000 Nov-Dec;23(9):615-8.

Funk, SL. Osteopathic Manipulative Treatment and Down Syndrome  

The American Academy of Osteopathy Journal 2000;10(2):36-7.

Hewitt EG. Chiropractic Care For Infants with Dysfunctional Nursing: A Case Series

Journal of Clinical Chiropractic Pediatrics. 1999 May ; 4(1): 241-4.

Blum CL. Cranial Therapeutic Treatment of Down’s Syndrome

Chiropractic Technique, May 1999; 11(2): 66-76.

Blum CL. Spinal/Cranial Manipulative Therapy and Tinnitus: A Case History

Chiropractic Technique, Nov 1998;10(4):163-8.

Connelly DM, Rasmussen SA

The effect of cranial adjusting on hypertension: a case report

Chiropractic Technique, Aug 1998;10(2):75-78

Van Loon M. Colic With Projectile Vomiting: A Case Study Journal Of Clinical Chiropractic Pediatrics. 1998 Aug; 3(1): 207-10.

Pederick FO A Kaminski-type evaluation of cranial adjusting Chiropractic Technique, Feb 1997;9(1): 1-15.

Chaitow L. Review of aspects of cranio-sacral theory. British Osteopathic Journal 1997:14-22Ulrich, RG. Osteopathic Manipulative Treatment of Bell's

Palsy  The American Academy of Osteopathy Journal 1997; 7(3):28-9.

Chinappi AS, Getzoff H. The Dental-Chiropractic Cotreatment of Journal of Manipulative and Physiological

48

Structural Disorders of the Jaw and Temporomandibular Joint Dysfunction

Therapeutics, Sep 1995; 18(7): 476-81.

Folweiler DS, Lynch OT. Nasal specific technique as part of a chiropractic approach to chronic sinusitis and sinus headaches

J Manipulative Physiol Ther. 1995 Jan;18(1):38-41.

Hu JW, Vernon H, Tatourian I.

Changes in neck electromyography associated with meningeal noxious stimulation

J Manipulative Physiol Ther. 1995 Nov-Dec;18(9):577-81.

Pick M. A Preliminary Single Case Magnetic Resonance Imaging Investigation into Maxillary Frontal-Parietal Manipulation and Its Short-Term Effect upon the Intercranial Structures of an Adult Human Brain

J Manipulative Physiol Ther. 1994;17(3)

Degenhardt BF, Kuchera ML.

The prevalence of cranial dysfunction in children with a history of otitis media from kindergarten to third grade.

Journal of the American Osteopathic Association 1994;94:754.

Manley P. Cranial osteopathy and the infantile craniopathies.

Journal of Naturopathic Medicine 1994;5(1):80-1.

Biedermann H. Kinematic imbalances due to suboccipital strain J Man Med, 1992;31:92-95Bilkey WJ Cranial suture manipulation in the treatment of

torticollisJ Man Med 1992;6:212-214.

Gitlin, R.; Wolf, D. Uterine Contractions Following Osteopathic Cranial Manipulation - A Pilot Study 

Journal of the American Osteopathic Association 1992;92(9):1183.

Braun BL. Postural differences between asymptomatic men and women and craniofacial pain patients

Arch Phys Med Rehabil. 1991 Aug;72(9):653-6.

Principato JJ. Upper airway obstruction and craniofacial morphology

Otolaryngol Head Neck Surg. 1991 Jun;104(6):881-90.

Blum C. Cranial therapeutic approach to cranial nerve entrapment Part II: Cranial nerve VII.

ACA J Chiropract 1990;27(7):108.

Carruthers R. An integrated approach to children with Downts Syndrome - a conference report.

British Osteopathic Journal 1990. IV. 18-21

The unanimous ruling of the Appellate Court in favor of W.M. Raemer, D.D.S.,

States that cranial therapy is an effective form of treatment for TMJ dysfunction. As such, it was ruled that dentists in Colorado are allowed to use cranial therapy for treatment in the scope of their practice.

The Colorado Board of Medical Examiners vs. W.M. Raemer, D.D.S. Court of Appeals, State of Colorado, Case No. 87CA1589, March 22, 1990

Blum C. Cranial therapeutic approach to cranial nerve entrapment Part I: Cranial nerves III, IV, and VI.

ACA J Chiropract 1988;22(7):63-67.

Blum C Spinal/cranial manipulative therapy and tinnitus: a case history

Chiropractic Technique 1988;10(4):163-167

Whineray G. An investigation into the efficacy of cranial manipulation for cephalgia.

Journal of the New Zealand Register of Osteopaths 1987;1(1):10-11.

Blum C. The effect of movement, stress and mechanoelectric activity within the cranial matrix

Int J Orthodontics 1987;25(1-2): 1-8

Coffin GS Asymmetry of the human head: clinical observations

Clin Pediatr. April 1986;25:230-232

Gillespie B. Dental Considerations of Craniosacral Mechanism

J. Craniomandibular Pract. December 1985;3:381-84.

Blum CL Biodynamics of the Cranium: A Survey The Journal of Craniomandibular Practice, Mar/May 1985: 3(2):164-71.

Carlsson GE. Long term effects of treatment of craniomandibular disorders

Craniomandibular Pract. Sept 1985;3(4):337-42

White WK, White JE, Baldt G.

The relation of the craniofacial bones to specific somatic dysfunctions: a clinical study of the

Journal of the American Osteopathic Association 1985;85:603-604.

49

effects of manipulationRetzlaff EW, Mitchell FL Jr, Hussar C, Walsh J.

The role of the Vth cranial nerve in the TMJ syndrome

Anat Rec 1983;205:161A

Upledger JE, Vredevoogd JD.

Examination of the cranial rhythm in long-standing coma and chronic neurologic cases

Craniosacral Therapy. Eastland Press, Seattle. 1983:275-281.

Retzlaff E et al Efficacy of cranial sacral manipulation: the physiological mechanism of the cranial sutures.

Journal of the Society of Osteopaths 1982-83;12:8-13.

DeBattersby R, Williams B.

Birth Injury: A Possible Contributory Factor in the Etiology of Primary Basilar Impression

J. Neurol. Neurosurg. & Psychiatry. 1982;45:879-83.

Younoszai R, Frymann VM, Bordell BE, et al.

Effects of temporal manipulation on respiration JAOA. July 1981;80:751-RES.

Mitchell FL Jr, Brooks HD, Bunnel WB.

You can help children with scoliosis Patient Care 1981;April 30.

Upledger J. et al Autistic children: preliminary physiologic, structural and craniosacral evaluations - research report.

Journal of the American Osteopathic Association 1979;79(2):123.

Upledger J.(More than 10 other papers could be cited here by Upledger)

The Relationship of Craniosacral Examination Findings in Grade School Children with Developmental Problems

Journal of the American Osteopathic Association, June 1978; 77: 760/69 - 776/85.

Upledger J. Bioelectric and strain measurements during cranial manipulation.

Journal of the Society of Osteopaths 1978;5:24.

Upledger JE. The relationship between craniosacral examination findings and the problems of special education students.

Am Osteopath Assoc Res Conf, 1978.

Upledger JE The Reproducibility of Craniosacral Examination Findings: A Statistical Analysis

Journal of the American Osteopathic Association, Aug 1977; 76: 890/67 - 899/76.

Frymann VM. Learning Difficulties of Children Viewed in the Light of the Osteopathic Concept

Journal of the American Osteopathic Association, Sept 1976; 76: 46-61.

Frymann VM The trauma of birth Osteopath Ann 1976;4:22-31.Magoun, HI(20 other papers by Dr. Magoun could be listed here)

Trauma – A neglected cause of cephalgia JAOA. Jan 1975;74:400-10

Gelb H, Tarte J Two-year clinical dental evaluation of 200 cases of chronic headaches: The craniocervical –mandibular syndrome

J Am Dent Assoc. Dec 1975;91(6):1230-6

Peters JE, Romine JS, Dykman RA.

A special neurological examination of children with learning disabilities

Dev Med Child Neurol 1975:1563-78.

Lay EM. Osteopathic Management of Trigeminal Neuralgia

JAOA. January 1975;74:373-89.

Brookes, D Indications for cranial therapy in general osteopathic practice.

British Osteopathic Journal. 1973.6.2.25-8

Woods, R. Structural Normalization in Infants and Children with Particular Reference to Disturbances of the Central Nervous System

Journal of the American Osteopathic Association, May 1973; 72: 903-908.

Gelb H Review correlating the Medical-Dental Relationship in the Craniomandibular Syndrome

NY J. Dent. 1971;41(5):163-75.

Magoun H. Pertinent Approach to Pituitary Pathology D.O. Magazine. July 1971;11(11):133-141.

50

Magoun H. Entrapment neuropathy in the cranium. Journal of the American Osteopathic Association 1968;67(6):643-52.

Magoun H. Entrapment neuropathy of the central nervous system. Part II. Cranial nerves I-IV, VI-VIII, XII.

Journal of the American Osteopathic Association 1968;67(7);779-87.

Magoun H. Entrapment neuropathy of the central nervous system. Part III. Cranial nerves V, IX, X, XI.

Journal of the American Osteopathic Association 1968;67(8):889-99.

Frymann VM. Relation of Disturbances of Craniosacral Mechanisms to Symptomatology of the Newborn, Study of 1,250 Infants

Journal of the American Osteopathic Association, June 1966; 65: 1059-1075.

Frymann VM, Carney RE, Springall P.

Effect of osteopathic medical management on neurological development in children.

Journal of the American Osteopathic Association 1966;65:1059-1075

Woods JM, Woods RM Physical findings related to psychiatric disorders Journal of the American Osteopathic Association, Aug 1961;60

Arbuckle B. Subclinical Signs of Trauma JAOA. November 1958; 58:160-66.Arbuckle BE. The Value of Occupational and Osteopathic

Manipulative Therapy in the Rehabilitation of the Cerebral Palsy Victim

Journal of the American Osteopathic Association, 1955 Dec; 55(4).

Baily KG. Head Trauma in Children and its effect on Pituitary Gland

JAOA. November 1954; 54: 208-11.

Lippincoff R. Cranial thinking and Meniere's disease. Journal of the Osteopathic Cranial Association 1954;56-60

Arbuckle B. Effects of Uterine Forceps Upon the Fetus JAOA. May 1954; 53:499-508.

Santucci T. The management of the mentally retarded child. Journal of the American Osteopathic Association 1952;51(10):516-8.

Reid C. Cranial technic as related to eye, ear, nose and throat.

Journal of the American Osteopathic Association 1949;48(8):428-31.

Arbuckle B. Cranial Aspect of Emergencies in the Newborn JAOA. May 1948; 47:507-11.

Lippincott H Case of birth injury or cranial trauma. Academy of Applied Osteopathy Yearbook 1948;1:58.

Northup T. Osteopathic cranial technic and its influence on hypertension.

Academy of Applied Osteopathy Yearbook 1948:70-7.

Lippincott RC. Interesting cases of infantile paralysis AAO Yearbook 1947:109.Kimberly PE Two case records of cranial lesions Osteopathic Profession. March 1945;12(6):29-30Stevenson GM. Improvement of Traumatic Head Injuries under

Osteopathic CareJAOA. October 1943; 43:120.

Table 2. Cranial Manipulative Therapy Characteristics of studies demonstrating measurements of brain, spinal cord,

meningeal and CSF motility

Authors Investigation PublicationNelson KE,  Sergueef N.

Recording the Rate of the Cranial Rhythmic Impulse

J Am Osteopath Assoc, Jun 2006;106(6): 337-41.

Sergueef, N.; Nelson, KE.; Glonek, T.

Changes in the Traube-Herring Wave Following Cranial

The American Academy of Osteopathy Journal 2001;11(1):17.

51

ManipulationFarasyn, A.; Vanderschueren, F.

The Decrease of the Cranial Rhythmic Impulse During Maximal Physical Exertion: an Argument for the Hypothesis of Venomotion? 

Journal of Bodywork and Movement Therapies 2001;5(1):56-69.

Moskalenko YE, Kravchenko TI, Gaidar BV, Vainshtein GB, Semernia VN, Maiorova NF, Mitrofanov VF

The periodic mobility of the cranial bones in man

Fiziol Cheloveka, 1999 Jan-Feb;25(1):62-70.

Chu D, Levin DN, Alperin N.

Assessment of the biomechanical state of intracranial tissues by dynamic MRI of cerebrospinal fluid pulsations: A phantom study

Magn Reson Imaging 1998;16(9):1043-1048.

Boulton M, Armstrong D, Flessner M, Hay J, Szalai JP, Johnston M.

Raised intracranial pressure increases CSF drainage through arachnoid villi and extracranial lymphatics

Am J Physiol. 1998 Sep;275(3 Pt 2):R889-96.

Lockwood MD. Cycle-to-cycle variability attributed to the primary respiratory mechanism.

Journal of the American Osteopathic Association 1998;98(1):35-6 and 41-3.

Myers R. Measurement of small rhythmic motions around the human cranium in vivo

Australian J of Osteopathy 1998;9(2):6-13

Zanakis MF, Dimeo J, Madonna S, Morgan M, Drasby E.

Objective measurement of the CRI with manipulation and palpation of the sacrum

Journal of the American Osteopathic Association 1996;96(9):551.

Zanakis MF, Marmora M, Morgan M, Lewandoski MA

Application of the CV4 technique during objective measurement of the CRI

Journal of the American Osteopathic Association 1996;96(9):552.

Moskolenko YE, Kravchenko T, Chervotok A, Sharapov K.

Bioengineering support of the cranial osteopathy treatment

Med Biol Eng Comput. 1995;34:185-186

Maier SE, Hardy CJ, Jolesz FA.

Brain and cerebrospinal fluid motion: real-time quantification with M-mode MR imaging

Radiology, 1994 Nov;193(2):477-83

Urayama K. Origin of lumbar cerebrospinal fluid pulse wave

Spine, 1994 Feb 15;19(4):441-5.

52

Zanakis MF, Cebelenski RM, Dowling D, Lewandoski MA, Lauder CT, Kircher BA, Hallas BH.

The cranial kinetogram: objective quantification of cranial mobility in man.

Journal of the American Osteopathic Association 1994;94(9):761.

Feinberg DA. Modern concepts of brain motion and cerebrospinal fluid flow

Radiology 1992;185:630-632

Greitz D, Wirestam R, Franck A, Nordell B, Thomsen C, Stahlberg F.

Cerebrospinal fluid circulation and associated intracranial dynamics. A radiologic investigation using MR imaging and radionuclide cisternography

Neuroradiology,1992;34(5):370-80.

Enzmann DR, Pelc NJ.

Brain motion: measurement with phase-contrast MR imaging

Radiology. 1992 Dec;185(3):653-60.

Winston KR, Breeze RE.

Hydraulic regulation of brain parenchymal volume

Neurol Res. 1991 Dec;13(4):237-47.

Doursounian L, Alfonso JM, Iba-Zizen MT, Roger B, Cabanis EA, Meininger V, Pineau H.

Dynamics of the junction between the medulla and the cervical spinal cord: an in vivo study in the sagittal plane by magnetic resonance imaging

Surg Radiol Anat. 1989;11(4):313-22.

Flanagan, M. The Relationship Between CSF and Fluid Dynamics in the Neural Canal

J Manipulative Physiol Ther, Dec 1988;11(6):489-92

Feinberg DA, Mark AS.

Human brain motion and cerebrospinal fluid circulation demonstrated with MR velocity imaging

Radiology, 1987 Jun;163(3):793-9.

Podlas H, Allen KL, Bunt EA

Computed tomography studies of human brain movements

S Afr J Surg, 1984 Feb-Mar;22(1):57-63.

Cope MK, Dunlap SH

Calibration of a device for the measurement of the CRI

JAOA. Sept 1983;69-RES.

Britt RH, Rossi GT.

Quantitative analysis of methods for reducing physiological brain pulsations

J Neurosci Methods. 1982 Sep;6(3):219-29.

Tettambel M et al Recording of the Journal of the American Osteopathic Association

53

cranial rhythmic impulse - research report.

1978;78(2):149.

Upledger J. Mechano-electrically recorded physiological patterns which relate to subjectively reported craniosacral mechanism phenomena - research report.

Journal of the American Osteopathic Association 1978;78(4):297.

Hamer J, Alberti E, Hoyer S, Wiedemann K.

Influence of systemic and cerebral vascular factors on the cerebrospinal fluid pulse waves

J Neurosurg 1977;46:36-45.

Frymann VM A study of the rhythmic motions of the living cranium

Journal of the American Osteopathic Association 1971;70:1-18

Steer JC, Horney FD.

Evidence for passage of cerebrospinal fluid among spinal nerves

Can Med Assoc J. 1968 Jan 13;98(2):71-4.

Wallace WK, Avant WS Jr, McKinney WM, Thurstone FL.

Ultrasonic techniques for measuring intracranial pulsations. Research and clinical studies

Neurology. 1966 Apr;16(4):380-2.

Deeming J A pilot study on periodicity and magnitude of cerebral spinal fluid pressure variations - research report.

Journal of the American Osteopathic Association, 1964;63(9):864-5.

Bering EA, Jr. Circulation of the cerebrospinal fluid. Demonstration of the choroid plexuses as the generator of the force for flow of fluid and ventricular enlargement

J Neurosurg. 1962 May;19:405-13.

Bering EA. Choroid plexus and arterial pulsation of cerebrospinal fluid: demonstration of the choroids plexuses as a cerebrospinal fluid pump

AMA Arch Neurol Psych 1955;73:165-172

Brierley JB The penetration of particulate matter from the cerebrospinal fluid into the spinal ganglia, peripheral nerves, and perivascular spaces of the central nervous system

J Neurol Neurosurg Psychiatry. 1950 Aug;13(3):203-15.

54

Table 3. Cranial Manipulative TherapyCharacteristics of studies measuring the mobility of the osseous-articular mechanism of the cranial

sacral system and suture structure and function

Cook, A. The mechanics of cranial motion—the sphenobasilar synchondrosis (SBS) revisited  

Journal of Bodywork and Movement Therapies 2005;9(3):177-188.

Sabini RC, Elkowitz DE.

Patency and Obliteration of the Cranial Sutures: Is There a Clinical Significance?

J Am Osteopath Assoc, Jan 2005;105(1):25.

Oleski, S, Smith G, Crow W

Radiographic Evidence of Cranial Bone Mobility

Cranio: The Journal of Craniomandibular Practice; Jan 2002;20(1):34-8

Miller RI, Clarren SK.

Long-term developmental outcomes in patients with deformational plagiocephaly

Pediatrics, 2000 Feb;105(2):E26.

Drangler, KE.; King, HH.

Interexaminer Reliability of Palpatory Diagnosis of the Cranium

J Am Osteo Assoc 1998;98(7):387.

Lewandoski MA, Drasby E, Morgan M, Zanakis M

Kinematic system demonstrates cranial bone movement about the cranial sutures

J Am Osteopath Assoc, 1996;96(9):551.

Zanakis MF, Morgan M, Storch I, et al.

Detailed study of cranial bone motion in man 

J Am Osteo Assoc. 1996;96(9):552.

Harring SW, Teng S, Huang X, Mucci RJ, Freeman J.

Patterns of bone strain in the zygomatic arch.

Anatomical Rec 1996;246:446-457.

Opperman LA, Passarelli RW, Morgan EP, Reintjes M, Ogle RC.

Cranial sutures require tissue interactions with dura mater to resist osseous obliteration in vitro

J Bone Miner Res, 1995 Dec;10(12):1978-87.

Madeline LA, Elster AD.

Suture closure in the human chondrocranium: CT assessment.

Radiology 1995;196:747-56

Upledger J. Research and observations support the existence of a craniosacral system.

Alternative Medicine Journal 1995;2(5):31-43.

Pick M. A Preliminary Single Case Magnetic Resonance Imaging

J Manipulative Physiol Ther. 1994;17(3)

55

Investigation into Maxillary Frontal-Parietal Manipulation and Its Short-Term Effect upon the Intercranial Structures of an Adult Human Brain

Miyasaka-Hiraga J, Tanne K, Nakamura S.

Finite element analysis for stresses in the craniofacial sutures produced by maxillary protraction forces applied at the upper canines

Br J Orthod. 1994 Nov;21(4):343-8.

Heisey, SR, Adams, T.

Role of cranial bone mobility in cranial compliance

Neurosurgery, 1993;33(5):869-876.

Fredrick DR, Mulliken JB, Robb RM.

Ocular manifestations of deformational frontal plagiocephaly

J Pediatr Ophthalmol Strabismus. 1993 Mar-Apr;30(2):92-5.

Cohen MM. Sutural biology and the correlates of craniosynostosis

Am J Med Genet 1993;47:581-616.

Opperman LA, Sweeney TM, Redmon J, Persing JA, Ogle RC.

Tissue interactions with underlying dura mater inhibit osseous obliteration of developing cranial sutures

Developmental Dynamics 1993;1(98):312-322.

Kostopoulos, D., Keramidas, G.

Changes in Magnitude of Relative Elongation of the Falx Cerebri During the Application of External Forces on the Frontal Bone of an Embalmed Cadaver

Journal of Craniomandibular Practice, January 1992.

Adams T, Heisey RS, Smith MC, Briner BJ

Parietal bone mobility in the anesthetized cat

J Am Osteopath Assoc, 1992 May;92(5):599-600, 603-10, 615-22.

Patterson MM. Study demonstrates cranial bone mobility.

Journal of the American Osteopathic Association 1992;92(5):589.

Anton SC, Jaslow CR, Swartz SM.

Sutural complexity in artificially deformed human (Homo sapiens) crania

J Morphol. 1992 Dec;214(3):321-32.

Jaslow CR Mechanical properties of cranial sutures

J Biomech 1990;23(4):313-321.

Wagemans PA, van de Velde JP, Kuijpers-Jagtman AM.

Sutures and forces: a review

Am J Orthod Dentofacial Orthop. 1988 Aug;94(2):129-41.

Retzlaff E Cranial bones and their sutures in primates, including

Journal of the American Osteopathion Association 1987;87(10):699-700.

56

humans- research report.

Retzlaff EW, Mitchell FL Jr, Walsh J, Wendecker A.

The role of cranial ligaments in primates

Anat Rec 1985;211:159-60

Nanda R, Hickory W.

Zygomaticomaxillary suture adaptations incident to anteriorly-directed forces in rhesus monkeys

Angle Orthod. 1984 Jul;54(3):199-210.

Jones L, Retzlaff E, Mitchell FL Jr., Upledger J, Walsh J.

Significance of nerve fibers interconnecting cranial suture vasculature, the superior sagittal sinus, and the third ventricle.

Journal of the American Osteopathic Association 1982;82:113.

Cope M Calibration of a device for the measurement of the cranial rhythmic impulse - research report.

Journal of the American Osteopathic Association, 1983;8(3):1-69.

Libin B. Occlusal Changes Related to Cranial Bone Mobility

International Journal of Orthodontics, 20(1), March 1982

Harakal JH Dissection offers proof of Sutherland’s concept

JAOA. Oct 1982;82:87.

Heifitz, MD, Weiss M.

Detection of skull expansion with increased cranial pressure

J Neurosurg, 1981;55:811-812

Retzlaff EW, Mitchell FL Jr, Upledger J

Nerve fibers present within the parietal cranial bones of primates.

Journal of the American Osteopathic Association 1981;80:753-754.

Retzlaff EW, Mitchell FL Jr., Upledger J, Vredevoogd J, Walsh J.

Light and scanning microscopy of nerve fibers within the parietal bones of primates.

Anat Rec 1981;199:21.

Retzlaff E et al Neurovascular mechanisms in cranial sutures - research report.

Journal of the American Osteopathic Association 1980;80(3):218-9.

Retzlaff EW, Upledger J, Michell FL Jr, et al.

Aging of cranial sutures in humans

Anat Rec 1979;193:663

Retzlaff E et al Age-related changes in human cranial sutures - research report.

Journal of the American Osteopathic Association 1979;79(1):60-1.

Kokich VG, Shapiro PA, Moffett BC,

Craniofacial sutures. Aging in nonhuman primates

New York: Van Nostrand Reinhold: 356-368, 1979.

57

Retzlaff EW.Retzlaff E et al Nerve fibers and

endings in cranial sutures - research report.

Journal of the American Osteopathic Association 1978;77(6):474-5.

Kokich VG. Age changes in the human frontozygomatic suture from 20 to 95 years

Am J Orthod, 1976 Apr;69(4):411-30.

Popevec J et al.

Histological techniques for cranial bone studies - research report.

Journal of the American Osteopathic Association 1976;75(6):606-7.

Retzlaff EW, Michael DK, Roppel RM.(More than 10 other papers could be listed here by Retzlaff on this subject)

Cranial bone mobility. J Am Osteopath Assoc, 1975 May;74(9):869-73.

Michael DK A preliminary study of cranial bone movement in the squirrel monkey.

Journal of the American Osteopathic Association 1975;74:866-869.

Retzlaff EW, Jones L, Mitchell FL Jr., Upledger J.

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