1. CRANIAL Jonathan Phillips, DO

2. Vault Hold Patient:Supine Patient:Supine Dr: Seated & Resting forearms on table Dr: Seated & Resting forearms on table Index finger:Greater wing of sphenoid Index finger:Greater wing of sphenoid 2 nd finger:Temporal 2 nd finger:Temporal 3 rd finger:Mastoid of Temporal 3 rd finger:Mastoid of Temporal 4 th finger:Occiput 4 th finger:Occiput Follow the CRI & evaluate rate, amplitude & symmetry Follow the CRI & evaluate rate, amplitude & symmetry

3. VAULT HOLD

4. Frontal-Occipital Hold Patient:Supine Patient:Supine Dr: Rest forearms on table Dr: Rest forearms on table One hand contacts frontal bone One hand contacts frontal bone Thumb on one greater wing of sphenoid Thumb on one greater wing of sphenoid Middle finger on one greater wing of sphenoid Middle finger on one greater wing of sphenoid One hand allows occiput to rest in it, avoiding any pressure on the occipitomastoid suture One hand allows occiput to rest in it, avoiding any pressure on the occipitomastoid suture Follow the CRI & evaluate for rate, amplitude and symmetry Follow the CRI & evaluate for rate, amplitude and symmetry

5. FRONTO-OCCIPITAL HOLD

6. Sacral Assessment Patient:Supine Patient:Supine Dr:Seated @ side of table Dr:Seated @ side of table Base of hand @ apex of sacrum Fingers @ base of sacrum Craniosacral flexion: Sacral base moves posterior Craniosacral flexion: Sacral base moves posterior Craniosacral extension: Sacral base moves anteriorly Craniosacral extension: Sacral base moves anteriorly

7. Functional/Nonpathological Strain Patterns PREDOMINANTLY FLEXION PREDOMINANTLY FLEXION More flexion than extension during a cycle More flexion than extension during a cycle “Ernie” “Ernie” PREDOMINANTLY EXTENSION More extension than flexion during a cycle “Bert”

8. Augmentation of the Cranial Rhythmic Impulse Use either vault or fronto-occipital hold Use either vault or fronto-occipital hold Have patient take deep inspirations to augment the motion Have patient take deep inspirations to augment the motion If in flexion, follow into flexion If in flexion, follow into flexion

9. Inhibition of the Cranial Rhythmic Impulse Use either vault or fronto-occipital hold Use either vault or fronto-occipital hold Gently follow hands into a more extension phase (if in flexion) Gently follow hands into a more extension phase (if in flexion)

10. FUNCTIONAL STRAIN PATTERNS: TORSIONS Axis: A/P Axis: A/P Motion: Sphenoid & occiput rotate in occiput directions Motion: Sphenoid & occiput rotate in occiput directions Nomenclature: Named by the side of higher wing of greater sphenoid Nomenclature: Named by the side of higher wing of greater sphenoid Palpation: vault hold Palpation: vault hold One hand rotates more posteriorly One hand rotates more posteriorly Index finger: Moves superiorly Index finger: Moves superiorly Little finger: Moves inferiorly Little finger: Moves inferiorly Etiologies: Normal, Trauma, Postural strains Etiologies: Normal, Trauma, Postural strains

11. TORSIONS: Cont. RIGHT TORSION R-GWS:Superior R-GWS:Superior R-O:Inferior R-O:Inferior L-GWS:Inferior L-GWS:Inferior L-O:Superior L-O:Superior *GWS = Greater wing of sphenoid *GWS = Greater wing of sphenoid *O = Occiput *O = Occiput LEFT TORSION R-GWS:Inferior R-O:Superior L-GWS:Superior L-O:Inferior

12. TORSIONS

13. FUNCTIONAL PATTERNS: SIDEBENDING ROTATION Axes: (3) Axes: (3) Two parallel vertical axes Two parallel vertical axes One A/P axis One A/P axis Motion: Motion: Sidebending: Sphenoid & occiput rotate in opposite directions about the parallel vertical axes Sidebending: Sphenoid & occiput rotate in opposite directions about the parallel vertical axes Rotation: Sphenoid & occiput rotate the same direction about the A/P axis Rotation: Sphenoid & occiput rotate the same direction about the A/P axis Nomenclature: Named by the side of the convexity Nomenclature: Named by the side of the convexity Etiologies: Normal, Trauma, Postural strain Etiologies: Normal, Trauma, Postural strain

14. SIDEBENDING ROTATION CONT. Palpation: Palpation: Fingers approximate on side of concavity Fingers approximate on side of concavity Fingers spread on side of convexity (the side it’s named for) Fingers spread on side of convexity (the side it’s named for) Ex. Left sidebending rotation: left hand spreads wider & moves inferiorly Ex. Left sidebending rotation: left hand spreads wider & moves inferiorly

15. SIDEBENDING ROTATION Cont. RIGHT SIDEBENDING ROTATION R-GWS:Ant/Inf R-GWS:Ant/Inf R-O:Post/Inf R-O:Post/Inf L-GWS:Post/Sup L-GWS:Post/Sup L-O:Ant/Sup L-O:Ant/Sup LEFT SIDEBENDING ROTATION R-GWS:Post/Sup R-O:Ant/Sup L-GWS:Ant/Inf L-O:Post/Inf

16. SIDEBENDING ROTATION

20. Vertical Strains Superior Superior Etiologies: Etiologies: Blow on top of the head posterior to the plane of the SBS Blow on top of the head posterior to the plane of the SBS Blow from below anterior to the plane of the SBS Blow from below anterior to the plane of the SBS Palpation: Palpation: Both hands move inferiorly Both hands move inferiorly Inferior Etiologies: Blow on top of the head anterior to the plane of the SBS Blow from below posterior to the plane of the SBS Palpation: Both hands move superiorly

21. Vertical Strains Axes: Two parallel transverse axes Axes: Two parallel transverse axes Motion: Sphenoid & Occiput rotate in same direction (due to shearing force) Motion: Sphenoid & Occiput rotate in same direction (due to shearing force) One bone in flexion, the other in extension One bone in flexion, the other in extension Nomenclature: Named according to direction the sphenoid is moving Nomenclature: Named according to direction the sphenoid is moving Etiology:Trauma Etiology:Trauma

22. VERTICAL STRAINS SUPERIOR SUPERIOR R-GWS:Inferior R-GWS:Inferior R-O:Superior R-O:Superior L-GWS:Inferior L-GWS:Inferior L-O:Superior L-O:Superior INFERIOR R-GWS:Superior R-O:Inferior L-GWS:Superior L-O:Inferior

23. VERTICAL STRAINS

24. SUPERIOR & INFERIOR SHEARS

25. Lateral Strains Axis: Two parallel vertical axes Axis: Two parallel vertical axes One through sphenoid One through sphenoid One through foramen magnum One through foramen magnum Motion: Sphenoid & occiput rotate in same direction Motion: Sphenoid & occiput rotate in same direction Nomenclature: Named by direction of the base of sphenoid Nomenclature: Named by direction of the base of sphenoid Etiology:Trauma Etiology:Trauma

26. Lateral Strain Palpation: “Parallelogram Head” Palpation: “Parallelogram Head” Forefingers shift one direction & little fingers shift to opposite side. Forefingers shift one direction & little fingers shift to opposite side. Ex. Left lateral Strain: Ex. Left lateral Strain: Forefingers shift right Forefingers shift right Little fingers shift left Little fingers shift left

27. LATERAL STRAINS CONT. RIGHT LATERAL STRAIN R-GWS:Ant/Med R-GWS:Ant/Med R-O:Ant/Lat R-O:Ant/Lat L-GWS:Post/Lat L-GWS:Post/Lat L-O:Post/Med L-O:Post/Med LEFT LATERAL STRAIN R-GWS:Post/Lat R-OPost/Med L-GWS:Ant/Med L-O;Ant/Lat

28. LATERAL STRAIN

30. SBS Compression Sphenoid & Occiput: Little or no motion Sphenoid & Occiput: Little or no motion Etiologies:Trauma, Severe depression Etiologies:Trauma, Severe depression

31. Competency Exam Competency Exam

32. Question 1 Which finger position is wrong in the vault hold? Which finger position is wrong in the vault hold? A. Index finger- greater wing of the sphenoid A. Index finger- greater wing of the sphenoid B. 2 nd finger- parietal bone B. 2 nd finger- parietal bone C. 3 rd finger mastoid of temperal C. 3 rd finger mastoid of temperal D. 4 th Occuput D. 4 th Occuput

33. Question 1 Which finger position is wrong in the vault hold? Which finger position is wrong in the vault hold? A. Index finger- greater wing of the sphenoid A. Index finger- greater wing of the sphenoid B. 2 nd finger- parietal bone B. 2 nd finger- parietal bone C. 3 rd finger mastoid of temperal C. 3 rd finger mastoid of temperal D. 4 th Occuput D. 4 th Occuput

34. Question 2 Which does not CRI evaluate ? Which does not CRI evaluate ? A. Rate A. Rate B. Amplitude B. Amplitude C. Symmetry C. Symmetry D. Rhythm D. Rhythm

35. Question 2 Which does not CRI evaluate ? Which does not CRI evaluate ? A. Rate A. Rate B. Amplitude B. Amplitude C. Symmetry C. Symmetry D. Rhythm D. Rhythm

36. Question 3 Which is the correct matching with craniosacral flexion? Which is the correct matching with craniosacral flexion? A. Sacral bone moves posterior A. Sacral bone moves posterior B. Sacral base moves anterior B. Sacral base moves anterior C. Sacral base moves caudal C. Sacral base moves caudal D. Sacral base moves Dorsal D. Sacral base moves Dorsal

37. Question 3 Which is the correct matching with craniosacral flexion? Which is the correct matching with craniosacral flexion? A. Sacral bone moves posterior A. Sacral bone moves posterior B. Sacral base moves anterior B. Sacral base moves anterior C. Sacral base moves caudal C. Sacral base moves caudal D. Sacral base moves Dorsal D. Sacral base moves Dorsal