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148 Cards in this Set
- Front
- Back
Range of motion with respect to physiologic barrier is limited by
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the muscle's ability to shorten on its own
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range of motion with respect to anatomic barrier is limited by
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physical barriers such as ligament and bone
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anatomic barrier is the limit of this type of motion
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passive
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neutral point
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point where tissue tension is balanced, usually roughly half way between pyhsiologic barriers, unless there is a restriction such that the neutral point becomes halfway between the restrictive barrier and physiologic barrier
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alpha motor neuron
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transmitts motor impulses to muscle tissue resulting in contraction of a group of muscle fibers
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gamma motor neuron
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transmit motor impulses to small intrafusal muscle fibers in the spindle to maintain tension in the spindle at different muscle lengths
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muscle spindle apparatus
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sends information about absolute length and rate of length change in muscle
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golgi tendon sends information to nervous system about
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tension or rate of change in tension
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load reflex
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muscle spindles mediate response to load placed on muscle
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nuclear bag fibers
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innervated by group 1a and group II
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nuclear chain fibers
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innervated by group 1a only
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Ia fibers known as
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annulospiral endings
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type II fibers known as
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flower spray endings
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both fiber types react to
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rate of length change
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Ia fibers react more to
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absolute length change
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stretching of muscle spindle (muscle getting longer) does this
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increases rate of firing
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golgi tendon does this to muscle contraction if tension gets too high
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it inhibits further alpha contraction to protect muscle from damage
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physician who formulated muscle energy technique
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Fred Mitchel Sr. DO
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isometric contraction
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static contraction where constant muscle length is maintained, Dr. applies equal force to patient
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isotonic contraction
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concentric contraction where muscle length is reduced because force applied by physicican is less than by patient
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isolytic contraction
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eccentric contraction where muscle length increases, physician applies a greater force than the patient
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muscle energy takes advantage of this reflex
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golgi tendon reflex
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6 steps of muscle energy technique (different from 8 essential steps he mentions 2 slides later)
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diagnose, engage dysfunctional barrier and hold, patient contracts against holding force for 3-5s, pt relaxes for 2 seconds, new barrier is engaged, sequence is repeated asappropriate (~3-5x)
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role of golgi tendon reflex in ME
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golgi tendon reflex is activted by the resisted contraction
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neuromuscloskeletal apparatus role in ME
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allows muscle to relax and be relatively inhibited by golgi tendon, such that it can be passively lengthened by physicial without recripicol activation of stretch receptors
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muscle energy 8 essential steps
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accurate structural diagnosis ; engage restrictive barrier in 3 planes ; unyielding counterforce in form of isometric resistance ; appropriate pt muscle effort ; complete relaxation after muscle effort ; repositioning to new restrictive barrier in all 3 planes ; repeat 3-6 ; retest region after
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mistakes made during ME
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physician doesn’t monitor accurately, pt contracts too forcefully, muscle contraction too short, pt doesn’t totally relax, examiner doesn’t reevaluate
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articulatory techniques
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direct, passive and do not involve a thrust
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thrusting techniques
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direct, passive and involve a thrust
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5 essentials for thrust techniques
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relax soft tissue ; engage restrictive barrier ; maintain lockout ; don’t use excessive force ; localize treatment
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Contraindications to HVLA
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fractures ,neurologic symptom worsening during evaluation ; severe RA; cancer; osteoporosis; hypermobility or instability; medicolegal situations
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Developed FPR
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Stanley Schiowitz DO
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FPR is what type of technique
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passive, indirect
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positioning in FPR is similar to
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counterstrain ; indirect positioning in still technique
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physiolgic mechanism for FPR
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by applying compressing force and moving into position of freedom, the muscle spindle is unloaded and will decrease its rate of firing, lowering the rate of firing in the alpha neurons and allowing the muscle to lengthen
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technique styles for FPR
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myofacial and articular
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3 basic steps for FPR
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flatten AP curve, add a facilitaing force, move into freedom
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why flatten the AP curve
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when you put a spinal segment in neutral it opens the facets and the articulation moves freely
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advantages to FPR
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easy, fast, you can repeat if nesissary
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contraindications to FPR
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joint instability, HNP, foramenal stenosis, severe sprain, vertebrobasilar instability, certain congenital anomalies
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6 steps of FPR
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relaxed position, flatten AP curve, apply facilitating force, place vertebra into position of freedom, hold 3-5 s, release and recheck
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developed Still Technique
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AT Still DO
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first published Still Technique
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Richard Van Buskirik DO
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Still Technique steps
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place pt into dysfunction (freedom), apply compression/traction, guide dysfunctional segment into barrier, collect $200
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indication for still technique
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any somatic dysfunction
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contraindications to still technique
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severe structural loss of intersegmental motion, foramenal stenosis, joint instability, severe strain/sprain
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differences between FPR/Still
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in still you don’t flatten AP curve, apply compression after moving into dysfunction, and you guide into barrier after that
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Cranial Lecture 1
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Cranial Lecture 1
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cranial osteopathy was established by
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William Garner Sutherland DO
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how many bones in adult skull
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29 bones
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cranial group of bones
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occiput, sphenoid, ethmoid, frontal, temporal (2), and parietal (2)
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facial group of bones
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vomer, mandible, maxillae (2), palatines (2), zygomatics (2), lacrimals (2), nasals (2), inferior conchae (2)
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coronal suture
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joins frontal and parietal bones
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bregma
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junction of coronal suture and saggital suture
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lamboid suture
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joins parietal bones with occiput
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lambda
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junction of saggital suture and lamboid suture
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saggital suture
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seperates parietal bones, runs from bregma to lambda
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pterion
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junction of frontal, parietal, temporal, and sphenoid
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asterion
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junction of parietal, temporal, occiput
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1st prinicple of cranial motion
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inherit mobility of brain and spinal cord
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2nd principle of cranial motion
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fluctuation of CSF
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3rd principle of cranial motion
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mobility of intracranial and intraspinal membranes
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4th principle of cranial motion
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articular mobility of cranial bones
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5th principle of cranial motion
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involuntary mobility of sacrum between the illia
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inherant motility of CNS due to
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coordinated contraction of oligodendroglia
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Flow of CSF
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lateral ventricles, foramen of monro, 3rd ventricle, cerebral aqueduct, 4th ventricle, Lateral formaen of lushika (2) or medial foramen of magendie into subarachnoid space
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seperates the cerebral hemispheres
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falx cerebri
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sepreates the cerebellar hemispheres
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falx cerebelli
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sepreates the cerebrum from the cerebellum
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tentorium cerebelli
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common origin of dural membranes
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straight sinus
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dural attachment points
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foramen magnum, C2, C3, and S2
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sutherland fulcrum
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another name for straight sinus?
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recripricol tension membrane
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inelastic dura are being moved by CSF flow and have fixed attachments to cranial bones, therefore the dura acts as a rope that causes cranial bones to move in response to these fluctuations
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how is it that cranial bones are able to move
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they arent….but to get this question right on the test we would say the cranial sutures are joints that allow motion
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rocking motion of the sacrum occurs about what axis
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a transverse axis that runs through the superior transverse axis of sacrum at S2
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2 phases of CRI
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flexion and extension
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cranial rhythmic impulse
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palpable wave of CSF
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CRI is distinct from
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pulmonary respirations and pulse
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articulation between sphenoid bone and occiput
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sphenobasillar syncondrosis (sBS)
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defines flexion and extension phases
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angle of SBS
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rotation of sphenoid in flexion
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anterior
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basoocciput moves this way in flexion
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anterosuperiorly
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foramen magnum moves this way in flexion
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superiorly
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transverse diameter in flexion
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increases
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AP diameter in flexion
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decreases
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sacral base in flexion
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drawn posteriorly
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in flexion midline structures do this
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flex
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midline cranial bones
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occiput, sphenoid,ethmoid
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midline facial bones
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vomer
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midline vertebral structures
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vertebrae, sacrum
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paired structures do this in flexion
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externally rotate
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extension motion
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reverse of flexion
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head diameter in extension
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increased longitudinal diameter
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forehead in extension
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vertical
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eyes in extension
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receeded
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paired bones in extension
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internally rotated
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ears in extension
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close to head
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BEEF
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bert (the one with the tall head) extended ; Ernie Flexed
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typical cranial cycle (per minute)
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8-12 cycles per minute
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1 cycle is
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one flexion, one extension with pauses in between
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F/E phases should be
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smooth and forceful
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amplitude of F/E should be
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equal
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still point
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pause in CRI, thereputic and within typical motion
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midline bones should follow
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flexion/extension
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paired bones should follow
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internal/external rotaion
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sacrum follows
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occiput
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temporals follow
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occiput
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facial bones follow
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sphenoid
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keystone of all cranial movement
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SBS
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sacral counternutation occurs in
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flexion, means base of sacrum moves posterior
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sacral nutation occurs in
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extension, means base of sacrum nods anteriorly
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index finger in vault hold
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posterior to orbit
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middle and ring fingers in vault hold
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opposite sides of ear
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5th finger in vault hold
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behind mastoid process
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hands in vault hold are
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shaped over cranium
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thumbs in vault hold
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off cranium or touching very lightly
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SBS decompression can help relieve symptoms in these patients
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concussion patients
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Physiologic strains (3)
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flexion extension, torsion, sidebending &rotation
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Non physiologic strains (3)
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vertical, lateral, compression
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strains are named for
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the way they like to go
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in flexion the SBS deviates
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cephlad
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in extension the SBS deviates
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caudad
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in a torsion strain what is the axis of movement
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an AP axis through the SBS
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in a torsion strain the sphenoid and occiput rotate about the AP axis in __________ directions
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opposite
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torsion strain is named based on what
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whatever greater wing is superior
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motion in S&R strains occurs in ____ axes
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AP axis ; 2 vertical axes (one through sphenoid and one through foramen magnum)
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S&R strains are named for the side of
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convexity
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rotation in S&R strain occurs about what axis
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A to P axis
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sidebending in S&R strain occurs about what axis
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occiput and sphenoid sidebend about two vertical axes
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vertical strain pattern
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vertical deviation of sphenoid relative to occiput
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superior strain
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cephlad deviation of base of sphenoid relative to base of occiput
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inferior strain
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caudad deviation of base of sphenoid relative to base of occiput
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motion in vertical strain pattern occurs on what axes
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2 transverse axes
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lateral strain pattern
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lateral deviation of sphenoid relative to occiput
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lateral strain named for
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direction of base of sphenoid
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lateral strain motion occurs among what axes
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2 vertical axes
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lateral strain can be likened to a
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parallelogram head
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compression strain
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bowling ball strain, SBS pushed together
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amplitude of F/E in compression strain
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diminished
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indications of cranial tx (4)
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all systemic dysfunctions, birth, trauma to PRM, dentistry
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complications of cranial tx
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dizziness, headache, tinnitus, alternations of autonomic functions
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absolute contraindications of cranial (4)
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acute intracranial bleed, increased ICP, skull fracture, acute CVA
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relative contraindications of cranial (4)
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known siezure history or dystonia, traumatic brain injury, coagulopathies, space occupying lesion of cranium
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purpose of vault hold
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to adress strains at SBS
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purpose of V spread
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to separate restricted or impacted sutures
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purpose of lift technique
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frontal and parietal lifts are commonly used to aid in balance of membranous tension
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purpose of CV4 bulb decompression
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increase amplitude of CRI
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in CV4 bulb decompression you resist this and encourage this
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resist extension and encourage flexion
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