Cranial Osteopathy

The compression of the forth ventricle (CV-4) is a procedure that purports to affect the cranial rhythmic impulse, a phenomenon that has been shown to be concomitant with the low-frequency Traube-Hering (TH) oscillation in blood flow velocity. This study examines the affect of the CV-4 upon blood flow velocity. Fourier-transform spectra extracted from laser-Doppler flowmetry of each of three component parts of the experimental CV-4 procedure (Control, Treatment, Response). The component spectra are compared statistically in each of three low-frequency and four high-frequency spectral parameters derived therefrom. Also included in the analysis are the mean frequency of the dominant flowmetry (TH) wave, and the mean duration of the CV-4 procedure. Human subjects (informed consent obtained) were paired with 28 individual physicians for the performance of the CV-4 procedure. Flowmetry records (Transonic® Laser-Doppler, BLF21, Ithaca, NY) were obtained tracking the course of the procedure, 20 of which were useable for inter-group comparisons. Segments of Fourier-transformed flowmetry records were subtracted, one from the other, and the difference spectra compared statistically using the One-Way ANOVA (SPSS Inc., Chicago, IL). The mean frequency of the TH waveform visible in the blood flowmetry record was 7.10 ± 2.07 cpm. The mean CV-4 procedure length was 4.43 ± 2.22 minutes. The CV-4 procedure was shown to specifically affect the low-frequency oscillations in blood flow velocity. Following its application, the amplitude of the TH wave increased [0.10 Hz frequency relative area units: control minus treatment (0.08010 units) compared with control minus response (-0.03358 units), P = 0.011]. It is concluded that cranial manipulation effects the autonomic nervous system because the TH waves have been demonstrated to be mediated through autonomic activity (Akselrod et al., 1985). Since palpation alone does not greatly effect blood flow velocity oscillations, there is a quantifiable difference between palpation alone and cranial treatment utilizing the CV-4 procedure. It can be said that the practitioners of cranial manipulation who participated in this study affected their subjects in a quantifiable manner with the CV-4 procedure.

A correlation between the Traube-Hering-Mayer (THM) oscillation in blood flow velocity, as measured using laser-Doppler flowmetry, and the cranial rhythmic impulse (CRI) has been established [J Amer Osteopath Assoc 2001;101(3):163-173]. Reported herein is the effect of cranial manipulation upon the THM. Methods  Healthy adult subjects of both sexes participated (N=23, 13 sham controls, 10 cranial treatment). A laser-Doppler flowmetry probe was placed upon the left earlobe of each subject, whereupon a baseline blood flow velocity record of five minutes was obtained. Cranial manipulation, consisting of equilibration of the global cranial motion pattern and the cranio-cervical junction, was then applied for a period of 10-20 min; the sham treatment was palpation only. Immediately following these procedures, a 5 min post-treatment laser-Doppler recording was acquired. Results  For each cranial treatment subject (N=10), the 4 major component parts of the blood flow velocity record, the thermal (Mayer) signal, the baro (Traube-Hering) signal, the respiratory signal, and the cardiac signal, were analyzed, and the pre- and post-treatment data were compared. After cranial treatment, the thermal signal power decreased (47.79-38.49 dB, P < 0.001) and the baro signal increased (47.40-51.30 dB, P < 0.021), while the respiratory (29.72-30.02 dB, P < 0.747) and cardiac (41.11-40.70 dB, P < 0.788) signals did not change. Conclusion Cranial manipulation affects the blood flow velocity oscillation in its low-frequency THM components. Because it has been shown that these low-frequency oscillations are mediated through parasympathetic and sympathetic activity, it is concluded that cranial manipulation affects the autonomic nervous system.

INTRODUCTION: The term Cerebrovascular accident (CVA) describes all of the clinical consequences emerging from a cerebral vessels lesion, whether there is one or more affected. The patient can experiment a diversity of problems in those functions: motricity, sensory, cognitive, communication or urinary. He could feel emotional unease and experience diverse symptoms like fatigue. Data from 2015 indicated that CVA was the second cause of mortality in the world. The trends of the absolute numbers regarding the incidence and the prevalence of CVA are going to potentially increase during the next thirty years in the world, Canada and Quebec.
Thanks to numerous researches a health continuum and rehabilitation program have been created on a medical level. Osteopathy does not belong to the continuum in the three countries from which came the participants: Canada, England and France. Even if the continuum allows for patient's management care, new researches are still broadening the field of knowledge, notably on how the brain works, neuroplasticity, recovery mechanisms and rehabilitation methods. Those researches allowed to challenge the myth of the immutable brain bringing out the knowledge on neuroplasticity and the myth of the six months delay on post CVA recovery.
METHODS: This study subscribes in the constructive paradigm in qualitative research. The design is a focussed ethnography. The chosen sampling method was non probabilistic and the sampling type was done by networking. Population was constituted of two groups: patients and osteopaths. Six patients and seven osteopaths (6 DO and 1 IO) were recruited. Osteopaths-participants came from three different countries as to where they were trained and where they practiced. The patients-participants were all Canadians. Semi-directed interviews permitted to collect data which was analyzed according to the analysis method by writing. Numerous strategies were put in place to reach a certain methodology rigour: verification of the collecting data tools, triangulation, peer debriefing, saturation, additional training of the researcher and logbook.
RESULTS: Results were articulated in four axes: protagonists (patient and osteopath) and their exchanges (uni-directional exchanges like advices and bi- directional like the protagonist’s synergy) ; approaches, clinical principles, specificity and utility of osteopathy ; the therapeutic component (and especially the results) osteopathic intervention and the factors influencing this intervention.
DISCUSSION AND CONCLUSION: Data originating from the participants was a lot richer than data coming from the collected literature. This present study carries strength like the strategy used to reach a certain methodology rigour, bilingualism, country diversity in training and practice (3 countries) for the osteopath-participants and additional training undertook by the researcher. Weaknesses are in relation with the data collecting tool, the origin of the patients-participants (only Canada) and a
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bias of social desirability which was controlled. Given the state of current knowledge and this study results, it seems appropriate to perform new qualitative and quantitative studies on the osteopathic intervention in a CVA context.
To conclude, the osteopathic intervention in a CVA context is complex. It articulates around the patient and the osteopath. Various elements like personal experience, attitudes, beliefs, patient and osteopath perceptions are all important factors influencing the osteopathic intervention and its results.
Keywords : Cerebrovascular accident, osteopathic intervention, personal experience, patients, osteopaths, brain, neuroplasticity, qualitative study, focussed ethnography.

Deformational Plagiocephaly (DP) is a common clinical presentation. There is no consensus as to the aetiology of DP, there is no risk factor that is uniformly considered as dominant. The consensus about the pathogenetic factors that are important in the onset of DP is more robust. Most cases are presented with no skull deformity at birth and most problems seem to appear at the age of two months. This implies that postnatal factors have an influence on the onset of DP. Prolonged back-laying position in combination with a restriction in motion of the upper neck area are generally considered as important factors in the onset of DP. The restriction in motion can be caused by muscular and neurological reasons. The purpose of this article is to present an aetiology model as to the neurological aspects that may be causing plagiocephaly and how osteopathy may potentially influence the amelioration of plagiocephaly. Sensitization of the upper neck and brainstem may be caused by intrauterine positioning, traumatic birth processes or prolonged pressure on specific areas of the skull. This sensitization will increase sensitivity of touch-, pressure-and pain-fibers, muscle tone, impair muscle function and enhance postural and birth survival reflexes. The postural reflexes, in combination with impaired muscle function and the prolonged supine positioning of the infant, play a crucial role in the progress of some types of Deformational Plagiocephaly (DP). These neurological considerations should be analyzed and treated by osteopaths and allied professions when faced with DP.

The primary respiratory mechanism (PRM) as manifest by the cranial rhythmic impulse (CRI), concepts fundamental to cranial osteopathy, and the Traube-Hering-Mayer (THM) oscillation bear a striking resemblance to one another. For this reason the CRI and the PRM are considered in the context of current knowledge of the physiology of the THM and associated biochemistry. It is concluded that the Traube-Hering, baroreflex, oscillation is the Sutherland wave, or “fast tide” of the CRI, and the Mayer, thermal reflex, oscillation is the “slow tide” of the CRI described by Becker. It is further concluded that, the PRM can be explained in the context of the THM. Using the THM to understand the PRM offers a holistic model. It unites the central nervous system with every cell in the body through the sympathetic and parasympathetic branches of the autonomic nervous system and the cardiovascular system. Additionally, the recognition of a body of scientifically validated material will assist future research into the basic science and clinical applications of cranial osteopathy.

Background: Osteopathy is present in a large number of hospitals in Italy, firstly in pediatric departments. It is mainly deals with musculo-skeletal imbalances, but osteopathy states to have a role in improving general health. Few studies about safety and efficacy of osteopathic manipulative treatment (OMT) in Obstetrics have been produced.

Sacrifice-the process of making sacred through meaningful surrender-is the core topic of my doctoral research in psychology and psychodrama is at the heart of my research methodology. It was during psychodrama foundation training at the Corban Estate in Auckland, New Zealand with Max Clayton in 2010, that creative sacrifice and its relationship with spontaneity began to take root in me as a Muse that would power seven years of doctoral research and practice.

I remember this event in my training vividly: Max was being a skilful rascal in helping two participants negotiate a conflict. It became clear to me as an observer that one participant had a significant block to spontaneity that was preventing the conflict from resolving. The other participant had a high level of spontaneity and seemed to have a compassionate knowing that there was something in the way of their colleague surrendering to the necessities and meanings of the moment. As the tension built, my attention became focused on the backdrop of the scene, the church altar raised up on a dais behind the two participants. In my imagination, I saw the defensive participant lay down reverently on the altar, surrendering to let the other participant eviscerate their defensive anatomy, housed in their abdomen, and then offer it up to Deity as a service to the entire group. The person on the altar rose and danced blissfully. Their defence was surrendered as a painful sacrificial offering.

I didn't mention this awesome and terrible vision to anybody in the group, but I knew that I had heard the Muse and the impact was deep. I moved back to the United States shortly after my foundation training and began my doctoral journey, delighting in the fact that my graduate studies afforded experiential group work and role training that deepened and diversified my understanding of spontaneity theatre. The seeds of my doctoral hypothesis were planted: that spontaneity had something to do with the capacity of a person to engage in conscious sacrifice. This article highlights the main learnings that support this hypothesis while championing the efficacy of psychodramatic inquiry.

There is a lot of controversy about osteopathy in the cranial region. Various terms are used in the literature. Explanatory mechanisms and effectiveness are also under discussion. The aim of this article is to describe through literature review the historical base of this confusing situation, provide a clear and generally acceptable definition of the terms used, provide a scientific explanation for primary respiration and propose future research in this field. W.G. Sutherland, considered as founder of osteopathy in the cranial field, had two different periods in his scientific life. The first was dominated by mechanical view on the cranium * 16-11-2021 09:45 Osteopathy in the Cranial Field from a Systems Theory Perspective https://www.heraldopenaccess.us/openaccess/osteopathy-in-the-cranial-field-from-a-systems-theory-perspective?fbclid=IwAR06Gqv2MKCzEsH… 2/20 which scientifically can be supported by the "five Model" concept. However, this "five model" concept gives no scientific base for terms such as "primary respiration", "Breath of Life" and others that were described by Sutherland is the later period of his life and nowadays used in Biodynamic model of Osteopathy in the Cranial Field (BOCF). Although there is a great controversy about the Biodynamic aspect of osteopathy in the cranial field, today it is considered as an important part of the profession, and furthermore osteopathy is not osteopathy without it. In this article a scientific approach which has his origin in systems biology and chaos theory, is presented. A proposition is made for scientific substantiation of "Primary respiration" and related concepts, including suggestions for future research. For research and support, the field of mathematics, artificial intelligence, chaos theory and complex systems thinking can be of fundamental and essential value.

Andrew Cook is a craniosacral practitioner working in Norwich, UK, with a background in engineering and computational fluid mechanics. Abstract Building on Sutherland's approach to sutures (" form follows function and function follows form ") applied to the thicknesses – and hence flexibility-of cranial bones, a new model of cranial motion has evolved. This places the sphenobasilar synchondrosis (SBS) as a primarily compressive-decompressive joint. SBS hinging is seen as an illusory artefact created as tissue rotations around a stable SBS. This article suggests that the apparent motion of the SBS instead takes place by a change in shape of the anterior body of the sphenoid, and that this motion is accommodated by the superior orbital fissure. This new model can be used to derive cranial bone motion patterns directly from the assumption that the cranium changes its lateral diameter, and elegantly explains the well-known " four interlinked gears " description of the occiput-sphenoid-vomer/ethmoid train. The model does not require sutures to be patent or membranous, since it applies equally well to ossified suture relics.

We report here a previously undescribed human Middle Pleistocene immature specimen, Cranium 14, recovered at the Sima de los Huesos (SH) site (Atapuerca, Spain), that constitutes the oldest evidence in human evolution of a very rare pathology in our own species, lambdoid single suture craniosynostosis (SSC). Both the ecto- and endo-cranial deformities observed in this specimen are severe. All of the evidence points out that this severity implies that the SSC occurred before birth, and that facial asymmetries, as well as motor/cognitive disorders, were likely to be associated with this condition. The analysis of the present etiological data of this specimen lead us to consider that Cranium 14 is a case of isolated SSC, probably of traumatic origin. The existence of this pathological individual among the SH sample represents also a fact to take into account when referring to sociobiological behavior in Middle Pleistocene humans.

Background: Clinical reasoning has been described as a process that draws heavily on the knowledge, skills and attributes that are particular to each health profession. However, the clinical reasoning processes of practitioners of different disciplines demonstrate many similarities, including hypothesis generation and reflective practice. The aim of this study was to understand clinical reasoning in osteopathy from the perspective of osteopathic clinical educators and the extent to which it was similar or different from clinical reasoning in other health professions.

This retrospective review study aims to contribute data regarding the normal range of the palpated cranial rhythmic impulse (CRI) rate from a population of 734 healthy subjects, each determined by a different examiner. Experience levels ranged from 1-25 years training/practice in cranial osteopathy. This study reports an overall CRI rate range (mean ± SD) of 6.88 ± 4.45 cpm for all subjects (valid N = 727). The examiner population was subdivided into three groups based upon the level of examiner experience. The rates obtained from each subgroup, from least experienced to most experienced, are as follows: Level 1 (one year of experience), 7.39 ± 4.70; Level 2 (two years of experience), 6.46 ± 4.10; Level 3 (three – twenty five years of experience), 4.78 ± 2.57. Both group mean values of the reported palpated CRI rates and their standard deviations showed an inverse relationship with the level of examiner experience, i.e., as experience increases, the mean CRI rate and its deviation decreases. In the light of the findings of this study, the currently accepted range of the palpated CRI, 8-14 cycles/minute, should be reconsidered to be as low as 2-7 cycles/minute.

Book Two presents new clinical models for both cartilaginous and muscular tissues, showing how they behave under stress and after trauma and what are the most effective treatment inputs.

The major presentations of osteoarthritis and spondylosis are re-examined, together with the latest research on disc prolapses. Completely new methods of working with tissue restriction and muscle resistance are presented, including a complete revamp of MET.

There is a chapter on trigger points and their role in overuse syndromes. In addition, the book introduces a completely new technique – Resonance Technique – that allows treatment of interacting joint systems.

Book Two also investigates the conundrums within cranial osteopathic philosophy, and presents a comprehensive new paradigm that re- integrates cranial treatment with the rest of the profession.

Background

The review of motion at the Spheno-Occipital Junction (SOJ) by Starkey (2015) makes substantial reference to Cook (2005), and this letter is a reply to the points raised. When describing cranial motion, anatomical complexity can obfuscate important general issues. Therefore, my intention here is to provide a pedagogical description of the motion of
the cranium as simply as possible from which more specific details may be inferred by the reader in as much detail as they see fit.

Methods

Critical analysis of palpatory experience and osseous anatomy.

Conclusion

The SOJ is seen to be incapable of significant motion in a normal adult skull – from the point of view of (i) the mechanical behaviour of deformable structures, (ii) anatomical structure, (iii) protection of the foramen lacerum, (iv) comparative anatomy, (v) redundancy, and (vi) accounting for the direction of motion of the frontal bone and vomer when compared to motion of the greater wings of the sphenoid.
With no motion at the SOJ, all of the palpated motion of the external cranium (and that described by Sutherland) can be accounted for through normal anatomy and biomechanics, with no need for any additional “unknown” mechanisms.

Osteopathy in the cranial field is an approach used by manual and physical therapists. However, there is minimal information in the literature about patient experiences of this treatment. The present study was undertaken to explore patients&#39; experiences of osteopathy in the cranial field. Patients completed the Patient Perception Measure-Osteopathy in the Cranial Field and identified sensations they experienced during treatment. Additional measures of anxiety, depression, Satisfaction With Life, and Meaningfulness of Daily Activity were completed. The Patient Perception Measure-Osteopathy in the Cranial Field was internally consistent (Cronbach&#39;s α = .85). The most frequently experienced sensations of osteopathy in the cranial field patients were &quot;relaxed,&quot; &quot;releasing,&quot; and &quot;unwinding.&quot; Satisfaction With Life and Meaningfulness of Daily Activity were positively associated with Patient Perception Measure-Osteopathy in the Cranial Field scores. Ne...

The work examines how antemortem cranial injury is diagnosed in the literature in order to determine whether nonlethal trauma is being over-diagnosed in archaeology. While the majority of publications cite criteria for perimortem cranial fractures, none have adopted a clear set of criteria for diagnosing antemortem depressed fractures. This study systematically reviewed the relevant bioarchaeological, forensic, and paleopathological literature and identified ten criteria commonly used in diagnosing healing, depressed cranial fractures (HDCF). Bioarchaeological studies (n = 146) describing trauma were evaluated for the criteria used to diagnose HDCF. Results indicate that studies recording HDCF rarely consider more than 2-3 criteria. The most commonly scored features, lesion shape (63%), size (63%) and location (91%), can only be considered consistent with HDCF. Features diagnostic of HDCF, retention of concentric or radiating fracture lines, were only mentioned in 1% and 7% of the studies respectively. Even more problematic were contradictions in how criteria were applied across studies. Unclear, ambiguous, inconsistent or absent diagnostic criteria for HDCL is potentially causing an
overestimation of nonlethal violence in the archaeological record.

Gastrointestinal tract dysfunction such as Irritable Bowel Syndrome (IBS) is one of the most common intestinal complaints that prompts an individual to consult a doctor. However, ambiguities in defining it and slow accumulation of evidence on the benefits of treatment have made this syndrome notoriously difficult to diagnose and treat. Our goal has been to prepare a text that provide an overview of IBS and the main concepts and practice of osteopathy and nutrition. The result is a book, which presents IBS management using OMT, dietary modifications, and nutritional supplements according to current evidence-based literature. We have also added some appendices on practical applications which might then serve as a simple treatment plan for a broad range of healthcare professionals including osteopaths, physiotherapists, manual therapists, sports science graduates, massage and bodywork therapists and nutritionists, to reduce the chronic pain and inflammation that are associated with IBS.

Dystocia in labor is still a clinical challenge. The "contracted pelvis" is the absence of pelvic mobility, which leads to fetal-pelvic disproportion, obstructed labor, and operative delivery. Maternal pelvis biomechanics studies by high technological techniques have shown that maternal shifting positions during pregnancy and labor can create more room in the pelvis for safe delivery. The external and internal pelvic diameters are related. The present study aims to evaluate the external obstetric pelvic diameters in shifting positions using a clinical technique suitable for daily practice in every clinical setting: the dynamic external pelvimetry test (DEP test). Seventy pregnant women were recruited, and the obstetric external pelvic diameters were measured, moving the position from kneeling standing to "hands-and-knees" to kneeling squat position. Results showed modification of the pelvic diameters in shifting position: the transverse and longitudinal diameters of Michaelis sacral area, the inter-tuberosities diameter, the bi-trochanters diameter, and the external conjugate widened; the bi-crestal iliac diameter, the bi-spinous iliac diameter, and the base of the Trillat's triangle decreased. The test showed good reproducibility and reliability. Linear correlations were found between diameters and between the range of motion of the diameters. The maternal pelvis is confirmed to modify the diameters changing its tridimensional shape. The pelvic inlet edge's inclination is inferred to be modified, facilitating the fetal descend. The pelvic outlet enlarged the transverse diameter, facilitating birth. The DEP test estimates the pelvic diameters' modification with postural changes, as magnetic resonance (MR) and computational biomechanics studies have demonstrated.

Objectives

To investigate the experiences of patients seeking osteopathy treatment in New Zealand; and to describe their perceptions of osteopathic treatment.

Design

Survey-based research design.

Setting

Private osteopathy practices.

Main outcome measures

Demographic survey and Patient Perception Measure-Osteopathy (PPM-O).

Results

Twelve osteopaths were recruited as practitioners. Responses from 107 patients were analysed.  Approximately 75% of patients reported receiving a ‘mostly cranial’ treatment approach.  The majority of patients (96.2%) indicated that osteopathic treatment helped their condition. The most frequently experienced sensation was ‘relaxed’.  A positive relationship was observed between the PPM-O and demographic variables.

Conclusions

This is the first study to report on New Zealand osteopathy patient’s experience of their treatment.  The sensations and emotions experienced are largely consistent with previous Australian research.  Predominantly positive perceptions of osteopathic treatment were reported.  The current study provides some evidence of the construct validity of the PPM-O in a New Zealand patient population.

The use of Lazer-Doppler flowmetry provides opportunitiy to study Cranial Osteopathy in the context of quantifiable aspects of human physiology. Six studies, spanning a period from 1998 to the present, are reviewed that support the following conclusions:
1) Palpation of the CRI tracks identifiable frequencies in bloodflow velocity.
2) Cranial palpation alone may be employed as sham treatment in future research into the clinical impact of cranial manipulation.
3) Cranial manipulation appears to exert effects upon baroreflex physiology.
4) Cranial manipulation affects the low-frequency, 0.10-0.20, Hz signal, and to a lesser extent the very-low-frequency, 0.003-0.05 Hz, signal in bloodflow velocity and does so in a manner consistent with the type of manipulative procedure being employed.
5) A frequency signal, 0.08 Hz (0.04-0.11 Hz) has been identified in the flowmetry record that is closely related to the 0.10-0.20 Hz signal. Both are demonstrated to be affected by cranial manipulation, in this case CV-4.
6) Although not everyone appears to be palpating at the same frequency, everyone tracks the 0.10-0.20 Hz signal, with the majority tracking at 0.04-0.11 Hz or 1 CRI cycle to 2 low-frequency bloodflow velocity waves.
7) A new normative range for the CRI of 2-7 cpm, as palpated by experienced examiners, has been identified.

Since individually determined cranial manipulation changed bloodflow velocity, it was decided to see if an affect could be obtained on demand, using palpation only, alternating with incitant bitemporal rocking. This alternating palpation and manipulation sequence was continued for a total of 35 minutes (maximum recording time for an uninterrupted laser-Doppler record). To eliminate the possibility that there might be an independent oscillation in bloodflow physiology, two different time sequences were decided on for the protocol. Five and 7 minute intervals, both divisible into 35, were chosen. The timing of the treatment/non-treatment sequence was established for each subject before the initiation of the protocol.

Background and Objectives: The techniques directed to the cranial field in osteopathy are the most questioned due to the lack of scientific evidence. In osteopathic practice, manual palpation is essential and, therefore, measuring reliability is fundamental. The objective of this study is to assess the precision and objectification of an educational model in cranial osteopathy based on experience. Materials and Methods: A reliability study was conducted in a cadaver skull where a strain gauge was placed on the sphenobasilar synchondrosis (SBS) of the base of the skull. Three cranial osteopathic techniques (lateral compression, anteroposterior compression, and compression maneuver of the mastoids) were performed 25 times by osteopaths with different degrees of experience (5–10 years, 1–5 years, &lt;1 year). Measurements were computed for each of the three techniques of each group in comparison with the osteopath with &gt;15 years of experience. Data were analyzed to check for inter- ...

Here we present the paleopathological profiles of two young adult males, identified as brothers through ancient DNA analysis, who were buried together beneath the floor of an elite early Late Bronze Age I (ca. 1550–1450 BC) domestic structure at the urban center of Megiddo (modern Israel). Both individuals displayed uncommon morphological variants related to developmental conditions, and each exhibited extensive bone remodeling consistent with chronic infectious disease. Additionally, one brother had a healed fracture of the nose, as well as a large square piece of bone cut from the frontal bone (cranial trephination). We consider the potential etiologies for the appearance of the skeletal anomalies and lesions. Based on the bioarchaeological context, we propose that a shared epigenetic landscape predisposed the brothers to acquiring an infectious disease and their elite status privileged them enough to endure it. We then contextualize these potential illnesses and disorders with the trephination procedure. The infrequency of trephination in the region indicates that only selected individuals could access such a procedure, and the severity of the pathological lesions suggests the procedure was possibly intended as curative to deteriorating health. Ultimately, both brothers were buried with the same rites as others in their community, thus demonstrating their continued integration in society even after death.

The primary respiratory mechanism (PRM) as manifested by the cranial rhythmic impulse (CRI), a fundamental concept to cranial osteopathy, and the Traube-Hering-Meyer (THM) oscillation bear a striking resemblance to one another. Because of this, a protocol to concomitantly measure both phenomena was developed. Methods  Twelve subjects (age > 18y, 6 M, 6 F; consent IRB-approved) were simultaneously palpated for their CRI using light touch with the hands in a biparietal-hold position, while relative blood (hemoglobin) velocities were measured using non-invasive earlobe laser-Doppler. Examiner and subjects were blinded to the digital laser-Doppler record that also contained the flexion/extension event record from continuous, unbroken 5 min recordings. Results  Statistical comparisons demonstrated that the CRI is palpably synchronous with the low frequency fluctuations in blood flow of the THM oscillation as measured by laser-Doppler. Fourier transformation of the velocity data into the frequency domain revealed the low-frequency blood flow oscillation exclusive of the cardiac component to consist of three principal signals: pulmonary respiration (0.28/sec, 17/min), Traube-Hering (barorecption component) oscillation (0.10/sec, 6/min), Mayer (thermo component) oscillation (0.02/sec, 1.2/min). Conclusions  The synchronicity between the palpable CRI and the laser-Doppler velocity record of the THM oscillation opens potential explanations for the basic theoretic concepts of the physiology 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 the science of that which is distinctive in osteopathic medicine.

The rate of the cranial rhythmic impulse can be obtained by both palpation and instrumentation. However, the literature has reported higher rates obtained by instrumentation compared with palpation. The cranial rhythmic impulse has been demonstrated to be synchronous with the Traube-Hering oscillation, measured in blood flow velocity. The current study demonstrates that physicians tend to palpate the cranial rhythmic impulse and Traube-Hering oscillation in a 1:2 ratio. This finding provides an explanation for the difference between palpated and instrumentally recorded rates for the cranial rhythmic impulse.

A summary of research evaluating the relationship between low frequency oscillations demonstrable in bloodflow velocity and the cranial rhythmic impulse, the effect of specific manual therapy procedures and considerations of these findings in osteopathic medical education.