Cranial osteopathy and Pediatric Craniopathy.
      Author: Paul Manley D.O. (ESO 1980), MAO

In one way this short paper describes mechanisms by which infants may suffer in the short and the long term from cranial abormalities, in another, it alludes to methods of diagnosis and manual treatment which can provide relief from such problems.

Enhanced Cranial Manipulation (ECM) is a 'nuts and bolts' approach to cranial problems and represents a unique collection of manipulative techniques as applied to the cranium. This is in contrast to the esoteric approach fostered by the ubiquitous practitioners of Cranio-sacral therapy etc..

The object of ECM is to optimize the elastance co-efficient of the cranium. This is acheived via manual de-compression techniques applied directly to the cranium. Stimulation of the venous drainage by increasing the circulation of the scalp is also a beneficial by-product of treatment.

The techniques are appropriate for cranial and autonomic symptoms only. They are not used for fixing a 'low-back pain' for example, other, more efficient, traditional techniques can deal with such problems. Nor is it used for 'past life regressions' or other similarly dubious practices such as 'functional tecnique. Cranial Osteopathy, when it began in the 1940's, was an area of exploration, a fascination with the notion that the cranium can influence our health and sense of being. Miraculous tales were told and tutors took up the flag of nebulousness with the fore-knowledge that their arguments would be relatively unassailable due to the complexity of the subject. Ubfuscation, ignorance and laziness on the part of the tutors and their followers has ultimately led to an emasculation of what was once a subject worthy of study.

There is much research out there, sufficient to convince even the hardest cynic and esoteric neophyte alike that the proposition that a cranium has an unfortunate tendency to rigidify, thereby producing symptoms of great importance is both feasible and applicable.

 

The following salient points must be considered:

1. The cerebral capsule (bone and membrane) changes in degrees of resilience due to the changes in ICP therein. The vault bones only grow in response to internal expansive pressures as the brain grows.

2. Intra-cranial pressure ( ICP ) varies in response to the following:

a. The rate of cerebro-spinal fluid ( CSF ) production.
b. The rate of CSF drainage.
c. The elasticity of the cerebral capsule.
d. The degree of responsiveness of the neurohumoral mechanisms which react with ICP fluctuations.

3. Increased ICP, even of short duration, can compromise cerebral circulation especially in the region of the brain stem activational and regulatory areas.

4. The "elastic coefficient" or elasticity of the cerebral capsule exerts a damping or shock absorbing action on ICP variations, thus providing a buffer between the CSF and the CNS.

5. The lower the elasticity of the cranium, the higher the ICP rises.

The shape of the anterior fontanelle (Figure 4 ), whilst still patent (un-ossified), can be very revealing with regard to the ICP. Normally the ICP is increased (from atmospheric pressure as baseline) when the infant is in the horizontal position and the fontanelle shows as convex, whereas in the vertical position the ICP is normally sub­atmospheric and the fontanelle will be concave. Thus, when the ICP is raised and the infant is in the vertical position the fontanelle will be convex, i.e. a bump.

There are a few exceptional circumstances when this principle does not apply and in such cases the fontanelle remains flat. This maneuver can be used to determine whether the ICP is in the normal range when used as a part of the usual diagnostic procedures.

1. ICP increases instantly with crying, laughing, abnormal respiratory patterns, abdominal straining, agitation, increase intrathoracic pressure, raised central venous pressure and pain.
2. The pressure of encircling bands and constrictions to the neck can produce ICP rise, the bands of nasal cannulae, phototherapy patches, tight collars, etc.

Because ICP rise alters the ratios of the monoamine axis (5HT, noradrenaline and dopamine) in the brain stem activational systems, general symptoms are many and vary greatly in both type and severity:

The most obvious are:

1. Sensorimotor and mental deprecation (i.e. listlessness, sleeplessness or lack of normal responsiveness, difficulty suckling, gripey and agitated).

2. Apneic (cessation of breathing) attacks and convulsions.

3. Neurological deterioration indicative of severe brain stem compression (such as inability to perform ocular tracking or lack of standard reflexes).

For those interested in ECM workshops: click here

 

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