| Dural Connection Internet Edition Volume 1, Number 3 This is the third of a series of abstracts of published articles relating to Sacro Occipital Technique and Cranial Manipulation. Please use these for educating insurance companies, the judiciary, the legislature, the colleges and the interested public. These two research abstracts are from the New York College of Osteopathic Medicine, Departments of Biomechanics and Bioengineering, Physiology and Neuroscience, Old Westbury, New York, 11568. They were published in the Journal of the American Osteopathic Association , August 1995, Vol. 95 (8), p. 497. Research Presentations: 1. Zanakis, M.F., Lewandoski, M/A., Marmoura, M., Kircher, K.T., Banlhashem, M., Dowling, D.J., (016) Cranial mobility in man: Objective measurements in normal subjects. This study objectively measured human cranial mobility using a 3Dkinematic motion analysis system. The system allows accurate determination of 3D motion using infrared reflective markers, and filters out any unwanted movement (from heartbeat, respiration and muscular activity). With the subject in the supine position, acupuncture needles are anchored into the parietal and frontal bones, as well as the bregma with attached infrared reflective markers. The marker movement relative to the bregma indicates cranial bone motion at 10µ resolution. Skull motion is then isolated and presented as position versus time, and is called the"cranial kinetogram" (CKG). The CKG allows for an objective and reliably method of quantifying cranial motion in human subjects. The CKG does not require a subjective interpretation nor physician involvement, both of which could bias results and interpretation. 2. Zanakis, M.F., Marmoura, M., Banlhashem, M., Kircher, K.T., Lewandoski, M.A., Ferris-Phillips, M.T., (017) Subjective and objective evaluations of the cranial rhythmic impulse in man. In this study the 3D kinematic motion analysis system (Macreflex)was used simultaneously along with physician (subjective) observers to evaluate cranial mobility in 22 normal healthy subjects. Acupuncture needles are anchored into the parietal and frontal bones, as well as the bregma. Infrared markers are attached to the needles so that the system can detect motion caused by separation of the markers. Cranial bone patternsof movement are isolated and presented as movement relative to the bregma over time in an "XY" matrix. With the subject in the supine position, recording by the CKG system was performed while a physician observer determined the cranial rhythmic impulse using the "vault hold". The physician depressed a foot switch (which was logged by the computer) at the time he/she perceived maximal flexion. All subjects had 3 tests performed, each 30 seconds in duration. In total, 3 physician/observers demonstrated 95% correlation with the kinematically acquired motion. Also subjectively reported qualities such as symmetries correlated well with the objective findings. The researchers concluded that the physician/observer was capable of detecting actual motion of the cranial bones (as determined kinematically) with high accuracy. The next six abstracts are from posture presentations given at the New York College of Osteopathic Medicine, Departments of Biomechanics and Bioengineering, Physiology and Neuroscience, Old Westbury, New York, 11568. The abstracts were presented at the Fortieth Annual American Osteopathic Association Research Conference, 1996: Part 2, and published in the Journal of the American Osteopathic Association, September 1996, Vol. 96 (9), pp. 551-2. Poster Presentations: 1. Lewandoski, M. A., Drasby, E., Morgan, M., Zanakis, M.F., Kinematic system demonstrates cranial bone movement about the cranial sutures. This study explored a hypothesis concerning cranial bone mobility, the investigators attempted to determine that cranial bone mobility is based on the hinge properties of the cranial sutures and not the malleableproperties of living bone. Verification of this hypothesis used a technique to quantify cranial bone motion (JAOA, 1995, 95(8): 016, 017, p 497) which evaluated the dynamics of each examined cranial bone with infrared markers attached to acupuncture needles that were anchored into specific locations onthe cranial bone. The results of the study indicated that parietal bone movement is not due to the malleability of the bone, but due to movement about the cranial sutures alone. 2. Zanakis, M.F., DiMeo, J., Madonna, S., Morgan, M., Drasby, E., Objective measurement of the CRI with manipulation and palpation of the sacrum. The aim of the study was to correlate movement of the sacrum during motion of the cranial bones. The technique for measuring cranial mobility used a 3D kinematic system (JAOA, 1995, 95(8): 016, 017, p.497) , and provided a graphic representation of bone movement relative to the bregma. Eighteen normal adults (ages 18-42), in the supine position, had infrared surface markers adhered to the skin over each parietal bone, frontal boneand bregma. Cranial motion was determined in 3 tests, each 45 seconds long: (1) during a quiet period, (2) during simultaneous palpation of the sacrum, and (3) after bilateral compression of the ilia (at ASIS). During test (2), the physician signaled perception of maximal flexion of the sacrum bya foot switch. It was found that the mean CRI rate throughout the experiment was8.0 cycles per minute. Accuracy in palpating the CRI from the sacrum was greater than 92% compared to kinematic findings, with decisional delay times similar to those when palpating the cranium. The findings demonstrated objectively that flexion and extension cycles in the cranium can be palpated in the sacrum. 3. Zanakis, M.F., Marmora, M., Morgan, M., Lewandoski, M.A., Application of the CV4 technique during objective measurement of the CRI. Compression of the 4th Ventricle (CV4) is theorized to have impact on the movement of the cranial bones. CV4 is performed with thenar contact to the supraocciput, just medial to the lateral angles. Steady manual compression is maintained as the patient holds their breath in prolonged exhalation, three or four times, until a warmth and softening of the supraocciput is palpated. This study attempted to objectively measure cranial mobility before, during and after CV4 to correlate with subjective physician findings. The technique incorporated a 3D kinematic system for measuring cranial mobility (JAOA, 1995, 95(8): 016, 017, p. 497). The system has capabilities of detecting small motions from the cranial bones, providing a graphic representation of bone movement relative to the bregma. Normal adults (N=19, ages 18-42) in the supine position had infrared surface markers adhered to the skin over each parietal bone, frontal boneand bregma. Each subject was analyzed for 30 seconds ("pre-period"). After a 4 minute rest, a physician performed the CV4 maneuver. When a "still point" was reached (the "warmth and softening"), kinematic data was acquiredfor another 30 seconds ("CV4-period") . While still in the "vault hold" the subject relaxed for 4 more minutes, and data was acquired for another 30 seconds ("post-period"). During the first and last 30 second data acquisition periods, the observer palpated and reported maximum flexion of each CRI cycle using a foot switch. The results showed that mean CRI rate (7.1 cycles per minute) didnot change significantly in the three periods. While parietal bone amplitudes varied greatly among subjects, 11 showed marked increases in amplitude in the "post-periods" compared to "pre-periods", and only slightly increased amplitudes in the "CV4 period". Also, the quality of the parietalbone movement generally changed from "ratchet" or baseline shift" to "smooth". Palpation of maximal flexion was 91% accurate compared to kinematic findings. The investigators determined that the results allowed for more critical evaluation of the CV4 maneuver in order to better understand cranial mobility. 4. Zanakis, M.F., Zhao, H., Schatzer, M., Zaza, W., Morgan, R., Dyer, D., Abboud, A., Studies of the cranial rhythmic impulse in man using a tilt table. In this study cranial mobility was objectively assessed in normalhealthy adults using a method of 3D kinematic motion analysis (JAOA, 1995, 95(8): 016, 017, p. 497). The 3D kinematic method is reported to be capable of detecting small motions from the cranial bones, and can constructa "cranial kinetogram" (CKG), or a graph of bone movement relative to the bregma. Fifteen adults, ages 19-35, were fitted with infrared surface markers adhered to the skin of each parietal bone frontal bone and bregma. Each subject was analyzed in the sitting position, then on a table angled at 45 degrees (head up), and then supine. Ten minutes elapsed between the three positions before data acquisition. At each position, CKG's were acquired both while the subject remained still and with an observer palpating the craniumusing the "vault hold". The test with palpation occurred 5 minutes after the first test, and each test was 30 seconds long. Results showed that the mean CRI was 7.9 cycles per minute, and did not change appreciably at any position or with simultaneous palpation. Simultaneous observer palpation generally resulted in an increasein the amplitudes of all bones. The researchers hoped that the findings might lead to a more complete understanding of the physiological properties of the CRI. 5. Zanakis, M.F., Zaza, W., Zhao, H., Morgan, R., Schatzer, M., Objective measurement of the cranial rhythmic impulse in children. This study also used the 3D kinematic system (JAOA, 1995, 95(8): 016, 017, p. 497) as a method of detecting small movements, which provided a "cranial kinetogram" (CKG), or a graph of bone motion relative to the bregma. Objective quantification of cranial mobility was assessed in normal healthy children using the 3D kinematic system method. Ten children, ages 5-10, were placed in the supine position and infrared surface markers were adhered to the skin on each parietal bone, frontal bone, and bregma. CKG's were reported on two tests, each 30 seconds long. In one test the subject remained still, while in the other test, simultaneous palpation was performed by an observer using a cranial "vault hold". The results indicated that all the children tested exhibited a marked CRI compared to normal adults. The CKG's also revealed that the typesof rhythms were comprised of the "smooth", "ratchet", and "baseline shift" types observed in adults. Asymmetries were found in 7 children. The "observer effect" (increasing amplitude during palpation) was present, yet not as pronounced as in adults. The researchers concluded that the CRI of children is approximately the same rate found in adults, but movement amplitudes are much greater. Also, the quality of the rhythms are approximately similar to adults, while asymmetries are more prevalent. 6. Zanakis, M.F., Morgan, M., Storch, I., Bele, M., Carpentieri, A., Germano, J., O'Shaughnessy, P., Detailed study of cranial bone motion in man. This study evaluated human cranial mobility using a technique (JAOA, 1995, 95(8): 016, 017, p. 497) developed to provide a graphic representation of bone movement relative to the bregma. Infrared markers were placed on the cranium to allow a 3D kinematic system method to analyze individual bone motion. Previous studies focused on the motion of cranial bones using a single marker per bone. However in this study, multiple markers provided a more comprehensive understanding of each bones' motion. This study compared the motion of each cranial bone, with multiple markers, in normalhealthy adults. Subjects (ages 22-36) rested in a reclining chair angled at approximately 50 degrees. Two surface markers were adhered to the skin over each parietal, frontal and occipital bone. One was also placed at the lambda andat the bregma, which served as precise reference points for the other marker placement. Cranial bone motion was determined for 60 seconds withthe subject at rest. It was found that mean CRI rate throughout each experiment was comparable to the earlier studies, with considerable variation among subjects. Motion of the frontal and occipital bones demonstrated less amplitude that the parietal bones. The researchers concluded that the motion of the cranial bones is not a simple "hinge" operation, but a complex motion involving more than one axis of movement. |