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Paul Manley - London and Maidenhead Back Pain and RSI Clinics:
Phone: 07925 616 753 for an appointment.
Enhanced Cranial Technique
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. Figure 1 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. The following points must be considered when forming an understanding of the cranium in relation to its contents: 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. 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. Infant development of the cranium: During
the passage of the infant through the birth canal, the head deforms,
causing overlap of the coronal, sagittal and
lambdoidal sutures. This overlapping usually disappears
during the first three days of life. It is most pronounced in
premature infants due to the wideness of the sutures but nonetheless
appears consistently in the normal neonate. Lambdoidal overlap and superior
sagittal sinus ( SSS ) compression
may be produced merely by laying the infant on its back, head
resting on its occipital bone. The pressure on the occipital
bone effectively blocks the SSS. The overlap is accentuated
when the infant is supine for prolonged periods. The compression
of the SSS produces slowing in the cerebral circulation time
and diverts drainage into the deep venous system. Due to the
thinness of these vein walls at this age, intracerebral hemorrhage
can occur and is one of the major causes of death in infants,
especially
preterm. The
practitioner should be capable of adequately differentiating between
potential contributary factors. Growth
responses to premature suture closure. Figure 3 Growth
responses to premature suture closure Figure
3: Legend Solid
line ____ normal A:
Normal Figure 3 illustrates
the various configurations most likely to occur. The synostotic
patterns can persist into adulthood and may result in gross
deformity or in sutural fixations. The incidence of mental
and/or motor deficit is high with this pathology. This is
due to the effect on the ICP either by hampering drainage
of CSF or by decreased elasticity failing to allow for optimal
ICP fluctuations. Palpation of Lambda (the junction of the
parietal and occipital bones) in order to ascertain the prescence
of overlap is very important. Ridging of the sagittal and
frontal sutures is generally present and palpable in premature
closure, even into adulthood. Changes
of anterior fontanelle in relation to atmospheric pressure
in the infant. 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. When assessing the
appropriateness of treatment, aggravating factors, and prognosis,
the following factors must be considered: 1. ICP
increases instantly with crying, laughing, abnormal respiratory
patterns, abdominal straining, agitation, increase intrathoracic
pressure, raised central venous pressure and pain. 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 signs and symptoms 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). Even
lesser degrees of ICP derangement can, over time, fundamentally
disrupt and cause delay to the sequences involved in the laying
down of the vital CNS developmental programs. This maturing and
myelinatiing process is the basis for maximal motor and cognitive
development in all infants. Indications of severe ICP compression
must be assessed by a pediatric neurologist before initiation of
any treatment. References: 1. Compression
of the superior sagittal sinus by neonatal calvarial moulding.
Radiology. 1974;(115): 6359 Do you have a question? Email me .....CLICK here
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