Various Methods of Palpating the Cranial Rhythm Impulsefiles.academyofosteopathy.org/AAOJ/10SepAAOJ.pdfrecommends that osteopathic physicians use osteopathic manipulative treatment

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Various Methods of Palpating the Cranial Rhythm Impulse Pgs 9-20

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The AAO Journal Volume20,Issue3,September2010Page2

The American Academy of Osteopathy® is your voice . . .... in teaching, advocating, and researching the science, art and philosophy of osteopathic medicine, emphasizing the integration of osteopathic principles, practices and manipulative treatment in patient care.

• FreesubscriptiontothenewAAOonlinemembernewsletter.• AccesstotheactivememberssectionoftheAAOwebsite

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Forjust$5.01aweek(lessthanalargespecialtycoffeeatyourfavoritecoffeeshop)orjust71centsaday(lessthanabottleofwater),youcanbecomeamemberofthespecialtyprofessionalorganizationdedicatedtothecoreprinciplesofyourprofession!

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PAIN ALTERNATIVES, INC

Seeking a physician to join dynamic expanding multi-practitioner Osteopathic practice. Osteo-pathic manipulative office based care and inpatient consultative services are the cornerstones of this practice which treats newborns through geriatrics.

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Physicians need to have completed or board certi-fied in Neuromusculoskeletal Medicine.

For further information or to send a CV please contact:Kelley Beloff, MSW, CMM

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Volume20,Issue3,September2010 The AAO Journal Page3

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Indianapolis,IN46268P:(317)879-1881F:(317)879-0563

www.academyofosteopathy.org

American Academy of Osteopathy®

RichardA.Feely,DO,FAAO........................................ PresidentMichaelA.Seffinger,DO.....................................President-ElectDianaL.Finley,CMP.................................... Executive Director

Editorial Advisory BoardRaymondJ.Hruby,DO,MS,FAAOMurrayR.Berkowitz,DO,MPHDeniseK.Burns,DO,FAAOEileenL.DiGiovanna,DO,FAAOEricJ.Dolgin,DOClaireM.Galin,DOWilliamJ.Garrity,DOStephenI.Goldman,DO,FAAOStefanL.J.Hagopian,DO,FAAOHollisH.King,DO,PhD,FAAOJohnMcPartland,DOStephenF.Paulus,DO,MSPaulR.Rennie,DO,FAAOMarkE.Rosen,DOWalterWitryol,MD

The AAO JournalRaymondJ.Hruby,DO,MS,FAAO.................... ScientifcEditorMurrayR.Berkowitz,DO,MPH.........................AssociateEditorDianaFinley,CMP........................................... SupervisingEditor

The AAO Journal is the official publication of the AmericanAcademy ofOsteopathy®. Issues are published inMarch, June,September,andDecembereachyear.

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The AAO Journalisnotresponsibleforstatementsmadebyanycontributor.Althoughalladvertisingisexpectedtoconformtoethicalmedicalstandards,acceptancedoesnotimplyendorsementbythisjournal.OpinionsexpressedinThe AAO JournalarethoseofauthorsorspeakersanddonotnecessarilyreflectviewpointsoftheeditorsorofficialpolicyoftheAmericanAcademyofOsteopathy®ortheinstitutionswithwhichtheauthorsareaffiliated,unlessspecified.

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in this issue:Contributors............................................................................................ 4AAOCalendarofEvents...................................................................... 22CMECertificationofHomeStudyForms............................................ 29DigOn:ACaseStudy........................................................................... 30 Allison B. Kolkhorst, OMS-IV and Daniel J. Kary, DO, FAAO

editorialAdmittingInternationalOsteopathicPhysiciansandOsteopathstoOsteopathicGraduateMedicalEducationPrograms.......................... 6 Murray R. Berkowitz, DO, MA, MS, MPH

regular FeaturesViewfromthePyramids .......................................................................16 Raymond J. Hruby, DO, MS, FAAOFromtheArchives................................................................................. 32ComponentCalendarofEvents............................................................ 33

original contributionsVariousMethodsofCRIPalpationofBodyParts,theirDiagnosticValuesandInterpretationoftheFindings ............................................... 9 Krishnahari S. Pribadi, MD, ABPN Diplomate AttitudesandConfidenceLevelsofFourth-YearOsteopathicMedicalStudentstowardsOsteopathicManipulativeMedicine......................... 23 Thomas A. Quinn, DO; Mark Best, MD, MBA, MPH; Lisa D. Ball, OMS-II; Veronica J. Ruston, OMS-I;andThomas J. Fotopoulos, DO.


ContributorsKrishnahari S. Pribadi, MD, ABPN Diplomate,pres-entsuswithvarious methods of CRI palpation of body parts, their diagnostic values and interpretation of the findings.Thisarticlerepresentssomeoftheirongo-ingresearchintopalpationofthecranialrhythmicimpulse,includinginvestigationsintosomeareasthatsomereaderswillrecognizeasbeingcontroversialattimes.

Daniel J. Kary, DO, FAAO and Allison B. Kolkhorst, OMS IV,presentacaseentitled, A Patient with Recent Onset of Dysarthria and Ataxia.Thisarticledescribesapatientwithratherstrikingneurologicalsignsandsymptomswhichrespondedremarkablywelltotheap-plicationofosteopathicmanipulativetreatment.

Thomas Quinn, DO; Mark Best, MD, MBA, MPH Lisa D. Ball, OMS-II; Veronica J. Ruston, OMS-I and Thomas J. Fotopoulos, DOhavewrittenAttitudesandConfidence

Regular Features

From the Archives:

WiththisissuewepresentthefinalexcerptfromabookbyGeorge M. McCole, DO,entitledAn Analy-sis of the Osteopathic Lesion.Thisissue’sexcerptisfromChapterXLIX,“FacetSeparation(continued)”,inwhichtheauthorcontinueshisdiscussionof“jointpopping”anditsrole(ornon-role)inthealleviationofsomaticdysfunction.Inthissection,hepresentspatientcommentsaboutjoint“popping”,anddiscusseswhenandhowtousethe“popping”technique.

Leonardo da VinciPublic Domain

Now available at the AAO Bookstore!

Osteopathic Management of the Female Patient.

A Pocket Reference Guide.JP Maganito, DO; Anita Showalter, DO; and

Melicien Tettambel, DO, FAAO

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(Select “AAO Store” from the left -hand menu.)

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Leonardo da VinciPublic Domain

LevelsofFourth-YearOsteopathicMedicalStudentsto-wardsOsteopathicManipulativeMedicine.Theseauthorshavegatheredinterestinginformationonthistopicbywayofstudentsurveys.TheyprovideideasandrecommendationsastohowtheosteopathicprofessioncanworktoensurethecontinuedandincreaseduseofOMMbyourgraduatingstudentsastheyenterclinicalpractice.


View From the Pyramids

Recently,wehavelearnedthattheAmericanOsteo-pathicAssociation’s(AOA)recommendationsfortheuseofosteopathicmanipulativetreatment(OMT)isnowincludedinthedatabaseoftheNationalGuidelineClearinghouse.Youcanseethisinformationontheirwebsiteathttp://www.guideline.gov/content.aspx?id=15271&search=low+back+pain.Thereyoucanreadasummaryanddescriptionoftheguidelines,andthereisalinkthatwillallowyoutodownloadtheentiremeta-analysisoftheevidenceuponwhichtheseguidelinesarebased.ThismarksthefirsttimethatguidelinesspecificallyaddressingtheuseofOMTforaconditionareincludedinthisdatabase.

Asmentioned,anextensivemeta-analysiswasdone,leadingtotheformationoftheguidelinesandrecommen-dations.Theexecutivesummaryofthedocumentationreadsasfollows:“TheAmericanOsteopathicAssociationrecommendsthatosteopathicphysiciansuseosteopathicmanipulativetreatment(OMT)inthecareofpatientswithlowbackpain.Evidencefromsystematicreviewsandmeta-analysesofrandomizedclinicaltrials(EvidenceLevel1a)supportsthisrecommendation.”Incaseyouareunaware,Level1aisthehighestlevelofevidencethatcanbeusedtosupporttheuseofanykindofinterventioninmedicaltreatment.

Alongwithotherinformationpresentedintheseguidelines,thereisalsoanalgorithmforuseinclassify-ing,evaluatingandtreatinglowbackpainwithOMT.ThealgorithmisadaptedfrominformationgiveninChapter4,“Themanipulativeprescription,”In:Somatic Dysfunction in Osteopathic Family Medicine.Nelson,KE,Glonek,T,eds.,Baltimore,MD:Lippincott,Williams&Wilkins;2007;27-32.

Whataretheimplicationsofthis?TheevidenceisstrongthatOMTiseffectiveasatreatmentformechani-callowbackpain.TheAOAhascreatedguidelinesfortheuseofOMTinthetreatmentofmechanicallowbackpain.Theguidelinesarenowinanationallyrecognizeddatabase.Isthisonlyaguideline,ordoesthismeanthatthisnowbecomesthestandardofpractice?Whataretheimplica-tions,clinical,moral,ethical,medicolegal,andotherwise,

fortheDOwhodoesnotfollowthisguideline?Expertswillbewatchingthis,likeallguidelines,verycarefully.Thedocumentationstates:“TheAOAbelievespatientswithlowbackpainshouldbetreatedwithOMTgiventhehighlevelofevidencethatsupportsitsefficacy.Changesincarewhenthisguidelineisimplementedwillbedeterminedbyphysi-cianandpatientsurveys,billingandcodingpracticepat-ternsamongstosteopathicphysicians,datagatheredfromosteopathicphysiciansviatheAOA’sClinicalAssessmentProgram,andotherregistrydatagatheringtoolscurrentlybeingdevelopedbyresearchers.”Timewilltell.Thisisground-breakingnewsandshouldbeofcriticalinteresttoallDOs.

New Treatment Guidelines for Low Back Pain: Big Change or Big Noise?Raymond J. Hruby


“TheMissionoftheAmericanAcademyofOste-opathyistoteach,advocate,andresearchthescience,artandphilosophyofosteopathicmedicine,emphasizing the integration of osteopathic principles, practices and ma-nipulative treatment in patient care.”

Iintendtodevotethisissue’seditorialtoconsider-ationofadmittingbothinternationalosteopathicphysi-ciansandnon-physicianosteopathsintoUnitedStatesOsteopathicGraduateMedicalEducation(OGME)pro-grams.Asmanyofyouareaware,therehavebeenrecentconcernswithrespecttotheterms“osteopathicmedicine”and“osteopathy”.Thesewillbedealtwithbyourre-spectedcolleaguesservingourprofessionasmembersoftheEducationCouncilonOsteopathicPrinciples(ECOP)oftheAmericanAssociationofCollegesofOsteopathicMedicine(AACOM).Withoutgettingintotheconcernsabouttheseterms,relatedtothesetermscomethetermsregardingthepractitionersofosteopathicmedicineandosteopathy,thatis,“osteopathicphysician”and“osteo-path”.Forthepurposesofthiseditorial,letusagreeonmyuseof“osteopathicphysician”asbeing“apersonwithfullunlimitedpracticerights”1andmyuseof“osteopath”asbeinganon-physician.Justtobeclear,whileIdescribemyselfasbothanosteopathicphysicianandanosteopath(Ievenhaveashingletothiseffectonthewallofmytreat-mentroom)whousesosteopathicmedicineandosteopathyinterchangeablytodescribemyprofessionalpractice,forthiseditorialIamanosteopathicphysician.

IthinkwecanagreethattheAcademy’sroleandleadershipinrepresentingtheAOAinourinternationalef-fortstoexpandOsteopathyhasresultedinsomeextremelyfinework.WehavebeenwellrepresentedatmeetingsoftheWorldOsteopathicHealthOrganization(WOHO),InternationalFederationofManualMedicine(FIMM),andOsteopathicInternationalAlliance(OIA),tonameonlyseveral.Wehavemetinternationalcolleagueswhoarebothosteopathicphysiciansandosteopaths.Theseinter-nationalcolleaguesdonotenjoythesameopportunitiesforadvancedosteopathiceducationandtrainingthatweU.S.DOshave.Thatmanyofourcolleaguesdonottake

advantageoftheseopportunitiestotraininosteopathicinstitutionsfollowingawardoftheirDOdegreeisasub-jectfordiscussionatanothertime;however,theirchoicesand/ordecisionsresultinunfilledopeningsinourOGMEprogramsnationwide.InanefforttofulfillourAcademy’smission,IbelieveweshouldadvocatethattheseOGMEvacanciesshouldbefilledbyourinternationalcolleagues.

ThereareproblemswiththeideaoffillingOGMEresidencyvacancieswithinternationalgraduates.Theseproblemsarebothphilosophicalandpractical.IbelievethatfillingOGMEvacancieswithinternationalosteopathicphysiciansismoreplausible;however,boththephilosoph-icalandpracticalproblemsremain.First,howdoweassesstheinternationalgraduates’knowledgeandcompetencies?Intheallopathiccommunity,thereexiststheEducationalCommissionforForeignMedicalGraduates(ECFMG)thatperformsthisimportantfunction.AmajorpartofthisprocessistheapplicantsuccessfullypassingStep1,Step2CK(ClinicalKnowledge–thatis,thewritten),andStep2CS(ClinicalSkills–similartotheCOMPEXLevelII-PE)oftheUnitedStatesMedicalLicensingExamina-tion(USMLE).Inthismanner,thereisamethodtobeabletocompareU.S.andCanadianM.D.graduateswiththeIMGs–InternationalMedicalGraduates–includingthe“offshore”schoolsintheCaribbean.ThisisrequiredofallopathicandIMGapplicantstoallopathic(ACGME)programs.PleasenotethatmanyoftheACGMEprogramsdo,infact,acceptCOMLEXforadmissionofD.O.stoACGMEprograms–IwenttooneatJohnsHopkinsandhavenevertakenanypartoftheUSMLE!Thereisnoosteopathicequivalent.WewouldneedtohaveanEduca-tionalCommissionforOsteopathicGraduates(ECFOP),atleastinfunction.Atonelevel,thiswould“simply”requirethattheinternationalosteopathicgraduate(IOMG)suc-cessfullycompletetheCOMLEXLevelI,LevelII-CE,andLevelII-PE.Atanotherlevel,thiswouldnecessitatetheinfrastructuretoperformthelogisticalandadministra-tivefunctionsrequired.

WhiletheU.S.isexperiencingandwillseeaworsen-ingphysicianshortage,Ialsoknowtherearegreatshort-

Admitting International Osteopathic Physicians and Osteopaths to Osteopathic Graduate Medical Education ProgramsMurray R. BerkowitzAssociate Editor


agesofphysiciansinmanynationsoverseas,especiallyinthedevelopingnations,andIhaveaphilosophicalproblemwithpotentiallydivertingphysicianworkforcefromthoseareasofgreatneedtocomehere.Also,aswehaveseenwiththeallopathicIMGs,therewouldbethepotentialthatinternationalosteopathicphysicianswouldcomeheretoattendOGMEandthenwishtostayintheU.S.,whentheirveryincreasededucationandtrainingissoneededtoincreaseosteopathicandgeneralmedicalcareintheirna-tivelands.Iamphilosophicallyopposedtothemremainingwhentheoverseasneedisgreat,andIamalsophilosophi-callyopposedto“forcing”peopletodothings(thatis,leave).Alas,Idonothaveanyproposedsolutiontotheseseeminglydiametricallyopposedpositions.

Theissueofadmittingnon-physicianosteopathstoOGMEpresentstheadditionalproblemsassociatedwithadmittinganynon-physician(e.g.,nursepractitioner,PA,etc.)toaphysiciantrainingprogram.WhileIfeelthatanon-physicianwillnotpasstheseveralpartsofCOMLEXneededtoqualifyforcertificationbyanECFOG,Idonotfeelthatallowingthemtositfortherequiredexamsisanappropriateprecedent.

Idohopeforthedaywhentherewillbeonlyinterna-tionalschoolsofosteopathicmedicineandallinternationalosteopathsareosteopathicphysicians–asintendedbyourFounder,AndrewTaylorStill,MD,DO–andIfeelthatuntilthen,wehaveadutytohelpfurtheradvanceournobleosteopathicheritagebyprovidingincreasedosteopathiced-ucationandtrainingopportunities–bothhereandabroad.

Onanunrelatedtopic,inmyintroductoryeditorial

oneyearago,Istronglyencouragedthatyou“activelycon-tributetothisprocessoflife-longlearningbysubmittingoriginalresearch,casereportsorcaseseries,commentary,orletterstotheeditorsforpublication”.2IwasgratifiedtoseeuspublishaLettertotheEditorbyourcolleague,DickMacDonald,DO3intheJune2010issueoftheAAO Journal.Ihopethisisthebeginningofabeautifultrendofexchangingideassowecancontinuetomakeadvancesinboththeartandscienceofosteopathicmedicine.

Finally,InoticedthattheAOAconsideredtheissueofadmittingMDstoAOAOGMEattherecentHouseofDelegates(HOD)meetinginChicagoinJuly.4TheHODvotedtocontinuetostudythisissue.ItisinterestingtonotethatthisfollowedthepublicationintheMarch2010issuethatcontainedtheeditorial,“AdmittingAllopathicPhysicianstoOsteopathicGraduateMedicalEducationPrograms:theCaseforCompetency-BasedNMM/OMMTraininginOGME”.5IhopethatthisrepresentsanexampleofourJournalhavingamuchdesiredimpactbeyondourAcademyonourosteopathicprofession.

References1 Glossary of Osteopathic Terminology.Educational

CouncilofOsteopathicPrinciples.AmericanAssocia-tionofCollegesofOsteopathicMedicine.April2009,p34.

2 BerkowitzMR.Editorial.American Academy of Oste-opathy Journal.2009.19(3):7.

3 MacDonaldD.LettertotheEditor.American Academy of Osteopathy Journal.2010.20(2):2.

4 NicholsK.MD’sinOsteopathicGMEPrograms.AOAPresident’sBlog.August3,2010accessedatwww.do-online.orgonAugust6,2010.

5 BerkowitzMR.AdmittingAllopathicPhysicianstoOsteopathicGraduateMedicalEducationPrograms:theCaseforCompetency-BasedNMM/OMMTraininginOGME.American Academy of Osteopathy Journal. 2010.20(1):6.§

Touro University Nevada College of Osteopathic Medicine (TUNCOM) is seeking an osteopathic physician (D.O.) for a full-time faculty position in the Department of Osteopathic Manipulative Medicine. Responsibilities include teaching, patient care and program development. In addition, there are opportunities for conducting research.

Qualifications: Graduate of an AOA-approved osteopathic medical collegeSatisfactory completion of an AOA-approved internship Certified by the American Osteopathic Board of Special Proficiency in Osteopathic Manipulative Medicine or American Osteopathic Board of Neuromusculoskeletal Medicine. The applicant must also be licensable in the State of Nevada.

TUNCOM offers a competitive salary and benefits package. Touro University Nevada is an EEO.

In addition, Southern Nevada has year-round sunshine with excellent weather, close proximity to Zion, Bryce and Grand Canyon National Parks, world-class food and entertainment in Henderson and neighboring Las Vegas, and convenient access to an international airport.

Information regarding this position may be obtained by contacting: Paul R. Rennie, DO, FAAO Touro University Nevada College of Osteopathic MedicineDepartment of Osteopathic Manipulative Medicine874 American Pacific Drive, Henderson, NV 89014(702) [email protected]

Application Closing Date: Open until filled.

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OMM position advertising.pdf 1 10/27/2009 3:49:54 PM


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“Successful palpation of this cranial rhythmic impulse requires a tactile sense trained and developed beyond the usual re-quirements. Its diagnostic possibilities have never been fully explored, although an electronic device is being developed to do such recording. It is known that the rate is accelerated in fevers and decelerated in psychiatric conditions somewhat in pro-portion to their severity, varying as the clinical picture varies. In this respect, the cranial rhythmic impulse foretells psychic changes rather accurately and so may well be of considerable prognostic and diagnostic value.” –Magoun1 “We will eventually be able to identify specific cybernetic-holographic engrams responsible for specific physiological functions and specific diseases. This will allow our therapeutic interventions to be more specific, precise and effective. We should eventually be able to identify specific entry points within the body as part of specific cybernetic-holographic engrams which can give us direct access to the CSS.”–Pribadi.2

SummaryTheCranialRhythmImpulse(CRI)reflectsthehomeostaticstatusofaperson.AbnormalCRIusuallyindicatesthere

areproblemswithinthehomeostaticmechanismsofaperson.ThereareagentsandforcesthatcaninfluencetheCRIcharacteristics.Theuseofpalpation,with“feeling,thinking,seeingandknowingfingers”isthecornerstoneofthecranialdiagnosticmethodasdevelopedbySutherland.MonitoringtheCRIwhileapplyingthecranialmanipulativeproceduresisanimportantaspectofthepalpationoftheCRI.ThisarticlediscussesmanyothermethodsofpalpationoftheCRIdevel-opedbyvariouspractitionersofCranialOsteopathy.SegmentalRestrictionLocalizationPalpatoryMethodcanlocatearestrictionareathatinhibitsthecourseofCRInaturalflowcaudally.ArcingPalpatoryMethoddevelopedbyUpledgerisusedtolocaterestrictionlesionsand“energycysts”inthebody.Bio-energyPalpatoryMethodintroducedbyBeckerisapalpationmethodtosensethebioenergyfieldswithinbodyareasbeingdiagnosedandtreated.Craniosacral Acupunc-ture Palpatory Method©introducedbytheauthorisusedtolocateabnormalacupuncturepoints.Craniosacral Diagnostic Digital Method©developedbytheauthorisdesignedtodeterminethemeridianprofile,therebyassistingmedicaldiag-nosis.Craniosacral Nutritional Assessment Method©isamethodtodeterminenutritionalrequirementsbypalpatingthenutritionalpointsforCRI.Craniosacral Allergy Screening Test©developedbytheauthorcanscreenfoods,substances,drugsforallergyorintolerance.Craniosacral Therapeutic Sensitivity and Dose Determination©isamethodtodetermineindividualtherapeuticsensitivitytotherapeuticagentsandtheirdoses.Lastly,Craniosacral Tele-Diagnostic Method© suggestedbytheauthorcanbeusedtodiagnoseaswellastreatpatientsfromgreatdistances.

Key words:acupunctureprofile,Arcing Palpatory Method, Bio-energy Palpatory Method,BreathofLife,cranialrhythmicimpulse,CranialOsteopathy,craniodermalpoints,Craniosacral Acupuncture Palpatory Method©, Craniosacral Allergy Screening Test©, Craniosacral Diagnostic Digital Method©, craniosacral mechanism, Craniosacral Nutritional Assess-ment Method©, Craniosacral Tele-Diagnostic Method©, Craniosacral Therapeutic Sensitivity and Dose Determination©,energycysts,highestknownelement,LeakyGutSyndrome,liquidlight,meridianprofile,Riddler’s Nutritional Reflexes, Segmental Restriction Localization Palpatory Method,SurfaceScanningLaserDisplacementMeter,Upledger-Pribadi’ssign.

Various methods of CRI palpation of body parts, their diagnostic values and interpretation of the findingsKrishnahari S. Pribadi


Craniosacral Palpatory MethodTheuseofpalpation,with“feeling,thinking,see-

ingandknowingfingers”isthecornerstoneofthecranialdiagnosticmethodasdevelopedbySutherland.3Thisbasiccranialdiagnosticmethodreliesonthepalpationofthecraniosacralstructuresandposition,cranialmotionandtheinvoluntaryactivemotionofthecraniosacralmecha-nism.Craniallesions(andsacrallesions)aredeterminedbypalpatingthepositionsofspecificcranialandsacralbonesassociatedwiththecraniosacralmechanism.Estab-lishingspecificcranial(strainpattern)lesionsisrequiredtodeterminethecorrectmanipulativeactionsrequiredtocorrectthelesions,therebynormalizingthecraniosa-cralmechanismtoestablishthemechanicalhomeostaticbalanceaspartofthetreatmentprocess.MonitoringtheCRIwhileapplyingthecranialmanipulativeproceduresisanimportantvalueofthepalpationoftheCRI.ItiswellknownthatthequalityofCRIchangesasamanipulativeprocedureisbeingdone;startingwithanabnormalCRI(suchasnodetection,weak,irregular,asymmetrical,slow,rapid,abnormalwaves,etc.),deceleration,astand-still,accelerationandfinallymoreorlessnormalCRI.Indo-ingso,thephysiciancanadjusthistechniqueinordertodeliverthebestapproachtocreatechangeswithinthecra-niosacralmechanismwithoutintroducingundueforcethatmayevenexaggeratelesionsorpathology.Thus,themostimportantvalueofpalpationoftheCRIisthemonitoringaspectoftreatment.ThedictumisthatwhenonecansensethereturnoftheCRIatthepartsbeingtreatedfollowingastill-point,onecanbeassuredthattreatmentissuccessful.4

TheCRIreflectsthehomeostaticstatusofaperson.“Homeostatisisaconditionmaintainedwithinanarrowrangebycoordinatedphysiologicalprocesses,betheymechanical,fluid,chemical,electricalormagnetic.”1Thus,onemaybeablegetsomeideasaboutthehomeostaticstatusofanindividualbypalpatingtheCRIandanalyzingthecharacteristics(vitality,amplitude,frequency,sym-metry,formofwave,irregularity,demarcationofmotion)oftheCRIatthecraniumoranypartsofthebody.WhentheCRIiscompletelyabsent,anindividualcanbeeitherdeadorsickorundergoingastill-point.However,differentqualitiesoftheCRIatdifferentpartsofthebodycanexistsimultaneouslybecauseoflocalreasons,restrictionsoftheCRIwaves,neurologicalconditions,etc.AdeadmanwillnothaveCRIonallpartsofthebody.Asamatteroffact,theCRImaystillexisteventhoughonehasbeendeclaredtobebraindeadforafewminutes.TheabsenceofCRIisnotsynonymouswithdeath.HoweveradeadbodyceasestogeneratetheCRIinallpartsofthebody.AnabsenceoftheCRIatthecraniumusuallyindicatesthepresenceofseverespheno-basilarcompression.Whenthelesioniscorrected,theCRIwillresumeatvariousstrengths,frequenciesandshapes.AbnormalCRIusuallyindicates

thereareproblemswithinthehomeostaticmechanismsofaperson.ItcanbestatedpositivelythatabnormalCRIdetectedinanypartsofthebodyindicatesusuallymeansthatpersonisnotwell,eventhoughhehasnosymptomsorsignswhatsoever.AphysiciancandeterminewhetheroneissickornotbysimplypalpatingtheCRIattheheadoranypartsofthebody.Determiningsicknessandwell-nesscanbesimplydonebypalpatingtheCRIofaperson.AmalingerercanbeeasilyspottedbythepresenceofnormalCRI!Still-pointisaconditioninwhichtheCRIceasestobegeneratedtemporarilyduringtherapeuticprocessinducedbytreatmentprocedureswhichaffectthecraniosacralsystemsuchascranialmanipulation,somato-emotionalrelease,acupuncture,intensivepsychotherapy,relaxationmethods,aromatherapy,meditationandspiritualtranscendentalexperience.Attimes,still-pointoccursspontaneouslywhenoneengagesincontemplationorspiritualforcesinfluencethebio-energyfieldofaperson,willinglyorunwillingly.Possessivestateisnotrecognizedinmedicine.However,theauthorhasobservedthattheCRIisundetectablewhenpossessivestateorhypnoticstateistakingplaceandusuallyresumeswhenthepersonisliberatedfromthisstate.Thus,theCRIisnotmerelythereflectionofthecraniosacralmechanism,butisaphenom-enonthatinvolvesthewholeorganismanditsinteractionswiththeenvironmentandevencosmos!TheinterpretationofthequalityoftheCRIrequirestherecognitionofthecontextinwhichapersonisexperiencingandthoroughunderstandingofallinternalandexternalfactorswhichmayexertinfluencesuponthegenerationoftheCRI.

Segmental Restriction Localization Palpatory Method

ThismethodisdonebycomparingthefindingsoftheCRIpalpationappliedtobodyregionsandsegmentssuchasthehead,cervical,chest,abdomen,pelvic,upperarms,lowerarms,hands,thighs,lowerlegs,feet,anteriorandposteriorandleftandright.AdemarcationofdifferentialCRIcharacteristics(suchasamplitudeandfrequency)indicatesadiseaseprocessaffectingthenervoussystemintegritythatoccursatorslightlyabove,lateraltoorantero-posteriortothelineofdemarcation.ThisrestrictionareainhibitsorsuppressesthecourseofCRInaturalflowandtherebycausesdifferentialCRIqualities. Craniosacral Acupuncture Palpatory Method©

Inapaperpublishedin1998,theauthorproposedtheinterconnectionbetweentheprimaryrespiratorymecha-nismandtheacupuncturemeridiansystembasedontheCRIpalpatoryfindingsinlivinghumansubjectsthatthecranialrhythmicimpulsecouldbedetectedatacupunc-turepoints.TheauthoralsointroducedatermcalledtheUpledger-Pribadi’ssigntodescribeaclinicalphenomenon


inwhichthecranialrhythmicimpulseisabsentinpatho-logicalacupuncturepoints.Thus,determiningthequalityofandtheabsenceofpulsationatspecificacupuncturepointscouldassistinassessingthehealthstatusoftheindividual,particularlyconcerningthestatusofthemeridiansandthecorrespondinginternalorgans.Bypalpatingpulsationsatmajoracupuncturepoints,wecanthenreadilyestablishthespecificabnormalacupunctureprofilesofthepatientscorre-spondingtothespecificdiseasepatterns.7UsingtheSurfaceScanningLaserDisplacementMeter,theauthorhasprovenobjectivelythepresenceofsinusoidalwavepulsationatthetipoftherightmastoidbone(withamaximumdeflectionof0.8mm),thefrequencyofwhichiswellwithintherangeofcranialrhythmicimpulse.Furthermore,thisworkhasdemonstratedobjectivelythepresenceofpulsations(withamaximumdeflectionof0.07mmandfrequencyrangefrom4to11cpm)atseveralacupuncturepoints,thecharacter-

isticsofwhichappeartobeidentifiedwiththecharacter-isticsofthecranialrhythmicimpulse.8(Seegraphic1onnextpage).

TheCraniosacralAcupuncturePalpatoryMethod© consistsoffirstsensingthebioenergyforceemanatingfromanacupuncturepointbyplacingthevolarsurfaceofthepalpatingfinger0.5–1cmabovetheacupuncturepoint.Animmediatepricklingsensation(asifbeingpen-etratedbyafineneedle)willbefeltasthebioenergyforcejumpsthegapbetweentheacupuncturepointandthepal-patingfingerandbombardsthesurfacewithchargedpar-ticles,theintensityofwhichvariesaccordingtothephasesoftheCRI.Oncethelocationofanacupuncturepointisidentified,thecontactpartofexaminingfingerisgentlyplacedontheacupuncturepointtoperceivetheCRIpulsa-tionatthepoint.Ofcourseifonerecognizestheanatomi-calpositionofaspecificacupuncturepoint,theexaminer

Chart 1Localization of segmental restriction(record the CRI palpatory findings: + presence, - absence) RIGHT: CRA-

NIUMCERVI-CAL

THORAX ABDO-MEN

PELVIS ARMS HANDS LEGS FEET

ANT POST

LEFT: CRA-

NIUMCERVI-CAL

THORAX ABDO-MEN

PELVIS ARMS HANDS LEGS FEET

ANT POST

Arcing Palpatory MethodUpledgerintroducedthearcingpalpatorymethodtoidentifyrestrictionlesionsand“energycysts”inthebody.

Injuryandrestrictiveareassetupinterferencewaveswhichsuperimposeuponthethenormalinherentbodymotion.Insteadofinternalandexternalrotation,interferencewavescreateconcentricglobalwavesemanatingfromthecenterofarestrictionlesioncausedbydiseaseorinjury.Byplacingbothhandsinturnsymmetricallytopalpatetheconcentricwaves,theexaminercanpinpointthecenterofrestrictionbyimaginingtheintersectionpointoftheradiiofthearcs(seepicture1)

Bio-energy Palpatory MethodBeckerdevelopedapalpatorymethodtosensebioenergyfieldswithinbodyphysiologicalfunctioningoftheareas

beingexaminedandtreated.Theexaminerplaceshishandsuponorunderapatientandestablishesafulcrumpointbytheelboworarmupontheexaminationtableorcrossedknees,orsomeportionofthepatient.Compressionisapplieddirectlydownwardatthisfulcrumpointwhilethehandcontactremainstobefirmbutgentle.Threephasesofmotionwillbesensedbytheexamininghandssuccessivelyuptoseveralminutesduration:1.patternofbioenergyforceswork-ingtheirwaytowardsthepointofbalance,2.afunctioningstill-point,and3.amorenormalpatternofmotion.Bysens-ingthesebioenergyfieldsand“memoryreactions”onecanassesstheseverity,acuity,chronicity,theageofthelesions,traumaandstressfactorsandthepotencyforhealing.6


justsimplyplacesthecontactsurfaceoftheexaminingfingerupontheacupuncturepoint.Therearethreelevelsofpressure:1.gentle:tosensethebioenergycomponent,2.medium(5-9grams):todetectabnormalchemicalprob-lems,3.deep(10-20grams):toidentifyabnormalstruc-turalproblems,whichcanbeappliedsuccessivelyateachacupuncturepointbeingexamined.Suspectedabnormalacupuncturepointscanbeselectedormajorimportantacupuncturepointscanbescreenedforsystemicprob-

lems.AnabnormalacupuncturepointisindicatedbythepresenceofapositiveUpledger-Pribadi’ssign(thatistheabsenceofCRIpulsationatthepoint).Todeterminewhetheranabnormalpoint(adeficiencystate)requirescharging,touchtheYangpointatthecenterofthedorsalsurfaceofthepatient’srighthandwithafreefingeroftheexaminer’shand.Ifthepointimmediatelypulsates,thenitrequirescharging.Ifitremainspulselessthen,itmostlikelyrequiresdischarging.Inthiscase,touchtheYinpointatthecenterpointofthedorsalareaofthepatient’s

lefthandwithafreefingeroftheexam-iner’shand,thepoint(anexcessivestate)willstartpulsating.Thispalpatorymethodcanbeusedtodeveloptheacupunctureprofileofthepatient,therebyassistinginestablishingmedicaldiagnosisaswellasspecifictreatmentprocedures(includingacupuncture). Craniosacral Diagnostic Digital Method©

Byseriallyandsimultaneouslypal-patingbodyorganareasandtheMUE-49’s(atthedorsalfaceofthethetipsoffingers)forCRIwiththefingersoftheauthor’sbothhands,respectively(oneattheorganandtheotherattheMUE49)theauthorwasabletoestablishthepres-enceofanewmeridiansystem,calledbytheauthorasthesynergicmeridiansystem.Theauthorcalledthispalpatorymethod,theservo-cyberneticpalpatorymethod.Thepatientandthephysicianformaservo-cyberneticcircle.Onehandpicksuptheoutputofthecraniosacralsystem(MUE-49)andtheotherhanddeliversthefeedbackdatatotheinputpartofthecyberneticsystem(acorrespondingorgan).WhenaspecificMUE-49andthecorrespondingorganarepalpatedsimul-taneously,theCRIatthecorrespondingorganandthespecificMUE-49ceasestemporarily.Whereas,ifthespecificMUE-49doesnothaveacorrespondingrelationshipwiththatparticularorgan,thenboththeorganandMUE-49continuetogenerateCRIpalpablebythefingersplacedonthem.Afunctionaltechniqueasopposedtoastructuraltechniqueusingtheservo-cyberneticprinciplehasbeenintroducedbyHoover.Bythistechnique,thephysicianintroducedelementsinthecircletoinitiatechangesinthehomeo-

Graphic 1

Pulsation at LI3

-2.2-2.18-2.16-2.14-2.12-2.1

-2.081 1515 3029 4543 6057 7571 9085

second

mm Series1

Pulssation at TB3

-0.68

-0.66

-0.64

-0.62

-0.6

-0.581 1179 2357 3535 4713 5891 7069 8247 9425

second

mm Series1

Pulsation at SI 3

-4.55

-4.5

-4.45

-4.4

-4.351 1128 2255 3382 4509 5636 6763 7890 9017

second

mm Series1

Cranial rhythmic pulsations at several acupuncture points as detected by the Surface Scanning Laser Displacement Meter.8


staticequilibrium.9However,theauthor’sservo-cyberneticpalpatorymethoddoesnotintroduceanyforcesorelement.ThepalpatingfingersofbothhandssimplysensetheCRIatbothendsofthecircuit.Frymannhasdescribedalsotheuseoftwohandstodiagnosethepotentialimprovementofaspinallesioncausingaparalyzedlimb.

“Itispossibletoestimatethepotentialforimprove-mentfurthermore,bysimultaneouslyplacingonehandonthespinalsegmentwhichsuppliestheprincipleinnervationtothatlimbareapresentlybeingstudiedbytheotherhand.Pauseafewminutesandconcentrateupontheactivitytransmittedtothetwohands”.

“If‘communication’isestablishedbetweenthetwohands,whichinrealitymeanscommunicationbetweenaspinalsegmentanditsperipheraldistributionthenitmaybeassumedthatthereisstillapotentialavenueforthevitalfluidtidewithin.”10

BypalpatorytracingtheCRIgeneratedbythechannelsofthisnewmeridiansystem,theauthorisabletomapoutthespecificchannelsandinterconnectionswithorgansandothermeridians.Allchannelsbeginningatthedorsalhandsandfeetintersectatthenavel(Co-8ortheQizhong,thepointthatwarmstheYang).WhereasallchannelsbeginningattheventralsurfacesofhandsandfeetintersectattheG4,ortheMingmenpoint(theKidneyYinSourcePoint).Fromthesepointsthechannelsenterspecificorgansandconnectwithotherorganmeridiansinternally(see picture 2).

Basedonthesefindings,theauthordevelopedadiag-nosticCRIpalpationmethodtodeterminetheacupunc-turemeridianprofilecalledthe“Craniosacral Diagnostic Digital Method©”whichcanbeusedtoscreenthehealthstatusofbodyorgansandgeneralhealth.Theauthoralsointroducestheterm:“craniodermalpoints”toindicatepointsontheskinsurfacethatgeneratetheCRIandhavespecificconnectionswithinternalorgans,structuresand

processes.Acupuncturepointsarecraniodermalpoints.However,therearemanyothercraniodermalpointswhichhavenotbeenconsideredtobeacupuncturepointswhichqualifytherequirementstobecalledcraniodermalpoints.Picture 3,foundonnextpageshowsthesynergicmeridiansystem,theMUE-49’s,theYinpoint,theYangpoint,theTrippleBurner(theendocrinepoint),thesmallintestine

Chart 2:ACUPUNCTURE PROFILE:(Insert an X sign at the appropriate box indicating a positive Upledger-Pribadi’s sign, and a letter D for discharging or C for charging).

Gentlepressure(bioenergiccomponent)GV20 MHN13 GV26 Co4 Co17 Co12 Co6 GV4 GV9 GB20 TB1 LU9HT7 PC5 LI4 LI11 St36 SP6 Ki3 Li3

Mediumpressure(chemicalcomponent):GV20 MHN13 GV26 CO24 C017 CO10 CO6 GV4 GV9 GB20 TB1 LU9HT7 PC5 LI4 LI11 St36 SP6 Ki3 Li3

Deeppressure(physical-structuralcomponent):GV20 MHN13 GV26 CO24 C017 CO10 CO6 GV4 GV9 GB20 TB1 LU9HT7 PC5 LI4 LI11 St36 SP6 Ki3 Li3

Picture 2.

DorsalSynergicMeridianSystemVentralSynergicMeridianSystemCopyright©2009,byKrishnahariS.Pribadi


pointandsomecraniodermalpointslocatedattheinter-phalanxspaces.Basically,the“CraniosacralDiagnosticDigitalMethod©”,isdonebyseriallytouchingallMUE-49swiththevolarsurfaceoftheexaminer’sthumbwhileplacingthelateralsurfaceoftheexaminer’sindexfingeratthevolarsurfaceofthepatient’slastdigitsandpalpatingothercraniodermalpointslocatedonthedorsalandvolarsidesofbothhandstodeterminetheabsenceorpresenceoftheUpledger-Pribadi’ssignatthepoints.PositiveUpledg-er-Pribadi’ssignsindicateabnormalcraniodermalpoints,organmeridiansandspecificcorrespondingorgans.Therearesixyinorgans(heart,spleen,liver,kidney,lungs,tripleburner-endocrine),andsixyangorgans(stomach,bladder,circulation,greatintestine,gallbladderandsmallintestine).Theyinorgansarerepresentedbythecraniodermalpointsonthelefthand.Theyangorgansarerepresentedbythecraniodermalpointsontherighthand.Thecraniodermalpointslocatedatthelastdorsalintermetacarpalspacesoftheleftandrighthandshavebeenidentifiedtobeassoci-atedwithspecificphysiologicalsystems.ThemethodusesthreelevelsofpalpationtechniquetodetecttheCRIatthecraniodermalpoints.Thefirstlevelutilizesnopressureatall;otherthantouchingthepointslightlytodetecttheCRI.Thislevelreflectsthebioenergicstatusofthemeridiansandcorrespondingorgans.Thenextlevelrequiresslightpressurenotmorethenfivegrams.Thislevelisusedtodiagnosethechemicalstatusoftheorgans.Toestablishmedicalcondition,thesecondlevelpressureshouldbesuf-ficient.Thethirdlevelusesmorepressurethan5gram(ap-proximately10-20gram).Thisleveldeterminesthephysi-calstructuralconditionofanorgan.ApositiveUpledger-Pribadi’ssignisshownwhentheCRIisnotdetectedwhenthecraniodermalpointispalpatedusingeachspecificpres-

surelevel.Thephysiciancanusethefollowingchartstorecordthefindingsbywriting+or–attherespectiveboxes.

Theauthorhasidentifiedseveralcraniodermalpointsatthepalmarsurfaceofthehand.Theyusuallyreflectspecificpathologialprocesses,circulatoryandmetabol-icprocessesandhormonesaswellasphysiologicalbodychemicals.Themajorspecificpathologicalprocessescanbeclassifiedasfol-low:aging,infection,neoplasma,hormonalimbalance,toxin,allergy,reducedcellularoxygenization,andabnormalmetabolism,eachofthemisrepresentedbyaspecificcraniodermalpoint.Picture 4 on page 16 showsthesemajorspecific

pathologycraniodermalpoints.Therearealsocraniodermalpointsassociatedwithspecificdiseaseentitiescalledbytheauthorasthe“SpecificDiseaseCraniodermalPoints”(see picture 5 on page 16).Eachpointisassociatedwithaspecificdiseaseentity.PositiveUpledger-Pribadi’ssignselicitedbythethreelevelsofpalpatorypressureindicateabnormalitiesatthebioenergetic,chemicalorstructurallevel,respectivelyorthecombinationofthem.

Becauseoftheinterconnectionbetweentheprimaryrespiratorymechanismandtheacupuncturemeridiansys-tem,abnormalcraniosacralmechanismcancauseabnor-malqualitiesofCRIatacupuncturepoints.SphenobasilarcompressioncancauseundetectableCRIatacupuncturepoints.Othercraniallesionsmaycauseweakacupuncturepulsations.Therefore,itisimperativetocorrectabnormalcraniosacralstrainpatternsfirstbeforeproceedingwiththeproceduresoftheCraniosacralDiagnosticDigitalMethod©.Likewise,anystructuralrestrictionsthatinhibittheflowoftheCRIwavestothehandscandistortthefindingsandneedtobecorrectedaswell.Spinalnerveentrappmentorpolyneuropathyofthebrachialplexusanditstributariesmayalsoyielddistortedfindings.Ontheotherhand,bysimplypalpatingtheMUE-49’s,andspecificcraniodermalpoints,thephysiciancandeterminethepresenceorabsencepathologiesatthecranisacralmechanism,medullaspinalis,brachialplexusanditstributaries,occipito-atlantaljoint,andcervicalspine,etc.WhenacompleteabsenceofCRIpulsationoccursatallMUE-49’sdespitenormalcranio-sacralmechanismandtheunrestrictedflowofCRIwavestohands,mostofthetime,wecanassumethattherearechemicalorbacterialtoxinsinthebodythatsuppresstheCRIpulsationsatallMUE-49’s.Inthatcase,theauthorusesadetoxifyingherbalformulaoraherbalremedy

Picture 3: Dorsal Synergic Meridian System, Organ Acupuncture Points, and Craniodermal Points. Copyright© 2009, by Krishnahari S. Pribadi


Chart3:ACUPUNCTUREMERIDIANPROFILE:MUE-49’S CD-

YinCDYang

5thLH

4thLH

3rdLH

2ndLH

1stLH

3rdMT-CARPLH

1stRH

2ndRH

3rdRH

4thRH

5thRH

3rdMTCARPRH

Meridians PressureLevels(PL)

YIN YANG H SP Li K L TRIPBR

ST B PC LI GB SI

BioEnergy(BE) Chemical(CH) Structural(ST)

Chart4:PHYSIOLOGICALSYSTEM&ORGANPROFILE:

PL MC3-4/5L MC3-3/4L MC3-2/3L MC3-1/2L(L.Hegu)

MC3-1/2R(R.Hegu)

MC3-2/3R MC3-3/4R MC3-4/5R

Endocrine Cardio-vascular

Musculo-skeletal

BodyDefenseAgainstInfection

Derma-tology

Blood&BoneMarrow

Teeth MucosalMembranes

BE CH ST

PL MC2-4/5L

MC2-3/4L MC2-2/3L

MC2-1/2L MC2-1/2R MC2-2/3R

MC2-3/4R MC2-4/5R

Heart Thymus Liver Kidney VenousSystem

Colon Gallbladder

Cranio-SacralSystem

BE CH ST

PL MC1-4/5L MC1-3/4L MC1-2/3L MC1-2/3R MC1-3/4R MC1-4/5R SalivaryGland Vestibular

SystemAuditorySystem

Retina Lens Cornea

BE CH ST


suchasAndrographispaniculataorYellowdock(Rumexcrispus)orhisownherbaldetoxifyingformulaasafilterbyplacingabottleofherbaltinctureorcapsuledpowdersorevenahomeopathicpreparationofthemonthebodyofthepatient.Foranunexplainablereason,theCRIpulsationsatMUE-49’swillresumewiththeexceptionsofthosethathaveabnormalnon-toxicconditionsofthecorrespondingmeridiansandorgans.Thisprovesthatthereisabio-energeticmechanismtakingplaceandoperatingwithinthecraniosacralandacupuncturemeridiansystemandisalsothebasisoftheCraniosacralDiagnosticDigitalMethod©.Confirmationofthefindingsusingthismethodofexamina-tioncanbedonebyfurthermedicalphysicalexamination,laboratorystudiesandotherdiagnostictestsasdeemednecessary.

Craniosacral Nutritional Assessment Method©

TheconceptthattherearespecificpointsontheskinsurfacethatreflectspecificnutritionalconditionsandrequirementsofthebodyhasbeendevelopedbyRiddler.Hecalledthesenutritionalpoints:“Riddler’sNutritionalReflexes”whichcanbeassessedbykinesiologicmuscletestingtechnique.Thismuscletestingtechniqueallowsidentificationofspecificnutritionaldeficienciesandexcess-es.11Theauthormodifiedthistechniquebyreplacingthe

muscletestingwithpal-pationoftheCRIofthethesenutritionalreflexes.WhentheCRIisabsence(apositiveUpledger-Pribadi’ssign),itcanbeassumedthatabnormalnutritionalconditionsexist.Todeterminenutritionaldeficienciessimplytouchtheliverareaofthepatientwiththeexaminer’sotherhandsimultaneously:theCRIwillremaintobeundetectable.Nutritionalexcessesaredeterminedbythesamemethod.Inthiscase,theCRIatthespecificnutritionalreflexeswillstartpro-ducingabriefrapidCRIpulsation.Thefollowingpicture 6showsthesenutritionalreflexes.Somenutritionalpointsareaddedbytheauthor(vitminB12,intrinsincfactorpoints).Specific

doserequirementsofnutritionalsubstances(vitamins,sup-plements,minerals)canbedonebymonitoringthespecificnutritionalpointwhiletheexaminerverballystates(loudlyorintheheart)severaldose-incrementsgraduallyupwardordownwardoftherequirednutrition(eitherinunitormgsuchas250mg,500mgand1000mgCalciumperdayforCalciumnutritionalpoint)untilasuddenrapidpulsationoftheCRIatthenutritionalpointisdetected.ThedoseofthenutritionisestablishedattheexactdosethatinducesarapidpulsationoftheCRI.Thissoundsmagicalbutitdoesworkverywell.Itappearstoworkbasedontheservo-cyberneticmechanismestablishedbetweenthepatientandtheexamin-er.Theinputbeingprovidedintheformofverbalcommu-nicationoftheexaminerregardingthedoseistransmittedtothepatient’sbrainandthecorrespondingorganorbodyfunctioning,whichisprocessedbytheBodyIntelligencewhiletheoutputistheCRIatthenutritionalpoint.Furtherresearchneedstobedoneinthiscontroversialarea. Craniosacral Allergy Screening Test©

TheCRIhasbeencalledasignificantdetectorasitreflectsthebodyhomesostaticregulatorystate.Ittellsthatthereissomethinggoingoninthebody.Theauthordiscoveredthatwhenthebodyrejectsaspecificsubstancebecauseof

Picture 4. Specific pathology craniodermal points at the palmar surface.

Explanation of abbreviations: LIP (lipid metabolism), AGING/DEG (degeneration). INF (Infection), NEO (neoplastic process), TOX (toxic accumulation), ALL (allergic diathesis), OXY (tissue oxygenization state), CH (carbohydrate metabolism), PROT (protein metabolism). Positive Upledger-Pribadi’s sign indicates specific abnormal condition of the specific pathological process corresponding with the point. Copyright© 2009. by Krishnahari S. Pribadi.


allergyorintoleranceandthissubstanceisplacedonthebodyskinortouchedbythepatient,theCRIattheallergycraniodermalpoint(L-10orYuji)willsuddenlyceasetemporarily.Thispointcanbefoundatthemidpointonthethethenarsurfaceofthe1stmetacarpus,atthe“bor-der”separatingthelightcoloredskinofthepalmfromthedarkercoloredskinofthebackofthehand.12Foods,naturalsubstances,herbsorchemicaldrugsgeneratebio-energicfieldswhichinteractwiththebodybio-energyfieldswhenplaceduponthebodysurface.Whenadis-synchronystateoccursbetweenthetwobioenergyfields,theCRItemporar-ilyceasestobedetected.Basedonthisfinding,theauthordevelopedamethodtodetectallergyorintolerancetosubstancescalledtheCraniosacralAllergyScreeningTest©.Thisnon-invasivemethodconsistsofplacingsubstances(foodsorchemicals,drugsornaturalproducts)seriallyeitherintheoriginalformorhomeopathicdilutiononthebodyofthepatient,andatthesametimemonitoringtheCRIattheYijupoint.AsuddencessationoftheCRIindi-catesthepresenceofallergyorintolerancetothesubstance.Theauthorhasdevelopedakitconsistingofmorethan100homeopathicdilutionofsubstancestobeusedforthistest.Thisscreeningmethodcanbesubstantiatedobjectivelybytheallergicskinpricklingtestorserologytest(RAST)forsuspectedallergens.Thisscreeningmethodisusefulindesigningnutritionaldietforallergicconditions,LeakyGutSyndrome,foodintolerance,AutismSpectrumDisorders,

evenGout,diabetesmel-litus,andotherdiseasesrequiringspecificdiets.Forexample,highpurinefoodswhentouchedbyahyperuricpatientwillcausetemporarycompletecessationoftheCRIattheYujiandtherespec-tiveuricacidCDpoint.Likewiseadiabeticpa-tientwillshowcessationoftheCRIatthepointandthepancreasCDpointwhenpresentedbysugarcontainingfoods.Apatientcanbeeducatedtousethistestonhimselftoscreenoutunwantedandundesirablefoods.Thisscreeningmethodcanbeclinicallyusefulinscreeningoutdrugs(suchasantibiotics)whichpotentiallymaycauseallergybeforeprescrib-ingorgivingthem.Onceaphysicianbecomes

familiarwiththespecificfoodsorallergens(byvisuallyviewingandtouchingthesubstances),itseemsengramsofthesespecificsubstancesareregisteredinthememorycomponentofthecraniosacralsystem.Bysimplyvisual-izingthesespecificsubstances,thephysicianaccessestheseengramsinhisCSSmemory.Thisproceduremayreplacetheprocedureofhavingthepatientcontactthespecificagentssuccessivelywhenthesesubstancesarenotavail-able.Thepatientcanalsobeaskedtoimagineandvisual-izespecificagentsbeingtested.Again,thissoundsratherunscientific,buttheauthorhasfoundthistobeaccurate.Furtherresearchinthisareaneedstobedone. Diagnosis of Leaky Gut Syndrome

LeakyGutSyndrome(LGS)isaconditioninwhichthepermeabilityoftheintestinalmucosaincreasesresultingintheentranceoftoxins,haptenes,allergens,bigmoleculessuchascasein,gluten,undigestedmaterials,toxinstothecirculatorysystemandbodyorgansaswellasthebrain.Thissyndromeisassociatedwithautism,ADHD,ADD,allergies,auto-immunediseasessuchaslupus,vitiligo,idiopathicthrombocytopenia,Crohn’sdisease,Syogren’sdisease,scleroderma,multiplesclerosis,rheumatoidar-thritisdiabetes,alopecia,evenasthma,etc.Viral,bacterialoryeast(candida)infectioncantriggerLGS.Someagents

Picture 5.Several Craniodermal Specific Disease Points at the palmar surface. Each point is associated with a specific disease entity. Positive Upledger-Pribadi’s sign indicates the presence of the disease entity if sup-ported by other objective diagnostic medical tests. Copyright© 2009, by Krishnahari S. Pribadi.


Picture 6.RIDDLER’SNUTRITIONALREFLEXES11

No 29 & 30 added by the author.


suchantibiotics,NSAID’s,corticosteroids,cytotoxicagents,evenantihistamines,chemicalfoodadditivesmayinduceLGS.

Alaboratoriumtestingprocedurecalledthelactu-lose/manitoltestbygivinglactulose(notabsorbedbytheintestine)andmannitol(absorbedbytheintestine)tothesubjectfollowedbymeasurementofthesugarsintheurinecandeterminethepresenceofLGS.Lactulose/man-nitolexcretionratiobelow0.03isconsiderednormal.AbimanualCRIpalpatorymethodbysimultaneouslyplacingonehandontheliverandtheotherhandonthestomach,smallintestines(theareainthemiddlebetweenthenavelandthexyphoidprocess)andleftcolonareassuccessivelycandetectthepresenceorabsenceofLGS.IfthebimanualpalpationdetectsCRIpulsationsatbothends,then,LGSisnotpresent.IfLGSexists,theCRIpulsationsatbothendswillbeweakornotfeltatall.

Craniosacral Therapeutic Sensitivity and Dose Determination©

Weareenteringanothercontroversialissuewhichrequiresfurtherresearchtovalidatetheauthor’sfindings.Thebodyhasitsowninnateintelligenceandcandeterminetherapeuticsensitivityanddosesoftherapeuticagentssuchaschemicaldrugs,herbalremedies,homeopathicremedies,vitaminsandsupplements.BytheapplicationofthethinkingfingerstodetecttheCRIataspecificcranio-dermalpointoradiseasearea,wecandetectthesensitivityandappropriatedoseofatherapeuticagent.Todeterminesensitivityofatherapeuticagent,firstpalpatethespecificcraniodermalpointappropriatetothetherapeuticagent(infectionpointforantibiotic,allergypointforanti-aller-gy,neo-plasticpointforanti-neoplastic,seizurepointforantiepileptic,schizophrenicpointforantipsychoticmedi-cation,etc.)oraspecificMUE-49oraphysiologicalororgancraniodermalpointatthedorsalorventralsurfaceofthehandassociatedwiththediseaselocationorabodydiseaseareaoraspecificdiseasesentity.Whendiseased,thesepointsorareasusuallydonothavepalpableCRIpul-sations.Then,havethepatienttouchorplacethespecifictherapeuticagentbeingtestedonthepatient’sbody.ThesuddenreappearanceoftheCRIattherespectivepointindicatessensitivitytotheagent.Todeterminethecorrectdose,first,placethespecifictherapeuticagentbeingtested(suchasachemicaldrug,aherbalformula,ahomeopathicpreparationorasupplement)withinthevisualfieldoftheexaminer(butnottouchingthepatient’sbody)suchasonabedortable.ThenpalpatetheappropriatecraniodermalpointorthediseasedareaforCRI.Lookatthetherapeuticagentandstartverbally(loudlyorsilently)statinggradualdoseincrementsintelligentlyupwardordownward(inunitormgspecifictothetherapeuticagentaccordingtotheusualpharmacologicalorherbalorhomeopathicornutri-

tionaldosestandardandthefrequencyofadministeringperday)whilepalpatingthespecificcranio-dermalpointorthediseasedareaappropriatetothespecifictherapeuticagentbeingtested.ThedosethatinitiatesrapidpulsationoftheCRIisthecorrectdoseforthepatient.Forexampletodeterminethedoseofathyroidagent(suchasT3orkelp)tosupportthehypo-functioningthyroid,placeabottleoratabletoracapsuleoftheagentinthevisualfieldwhilepalpatingthethyroidareaortheTBchannel(rep-resentingendocrine),thenstartverballystatingtheincre-mentdoses,andstopatthedosethatgeneratesimmediaterapidpulsationoftheCRI.

Craniosacral Tele-Diagnostic Method©

Thisisacontroversialandrevolutionaryapplicationofthecranialconcept.Let’sexaminethefollowingstatementbySutherland:

“Doyouknowanythingaboutsheetlightning?Youseeitsmanifestationallthroughthecloud,butitdoesnottouchthecloud.Iwantyoutoseetheinvisible“liq-uidlight,”ortheBreathofLifeassheerlightningandatransmutation,thesheetlightningallthroughthenerves,nottouchingthe“coppertube.”ThetransmutationiswhatDr.Stillpointedtointheearlydaysas“nerveforce.”Hewastryingtoputacrossthisunderstandingusingtheexampleoftheelectricalforce,ortheelectrical“juice,”thatrunsalongthewire.Thatsignalthatrunsalonghastohaveatracttorunon.Itisapush-buttonmechanism,anattunementwithinthehumanbody.Tunedtowhat?Tothathighestknownelement,“theBreathofLife”,notthebreathofair.Quotinganothertext:“inthecreationofman,theBreathofLifewasbreathedintothenasalsofaformofclay,andmanbecamealivingsoul.”13

Itdoessuggestthatthecranialrhythmicforceisdivineinnatureandiscapableofpenetratingsolidsubstancesandtravelingatagreatdistancejustlikelightwaves.

Now,ifadoctortuneshimselfasareceiverintothecranialmechanismandallthecranialrhythmicwavesemanatingfromthebody,organsandacupuncturepoints(orcraniodermalpoints)ofaperson/hispatientknownalreadytohimpersonallyorhisrepresentations(suchashispicture,voice,signatureorevenhisname),thisintel-ligent“liquidlight”ofthatpersontravelingatagreatdistancecanenterthedoctor’sbodyandchangetemporar-ilyhiscraniosacralmechanism,meridianprofile,specificacupuncturepulsations,hisnutritionalpoints,etc.Then,bysimplyapplyingallthevariousmethodsofcranialpalpa-tionasdescribedaboveonthedoctor’sbodyhimself,thenthedoctorcandiagnosethecraniallesions,meridianpro-file,nutritionalprofile,pathologicalprofile,allergyprofileandevendeterminethemedicaldiagnosesofthatparticu-larpatientandhismedicalandtherapeuticneedsatagreatdistance!Theauthorhasappliedthismethodtomanyof


hispatientstodiagnoseandmonitortheirmedicalcondi-tionsfromagreatdistancewiththeaccuracynear100%.Furtherresearchinthisfieldisrequiredtosubstantiateandprovethevalidityofthismethod.Ifthismethodisproventobescientificallyvalid,thenitmaybecomeanotherdiagnosticarmamentofTele-Medicineandbepracticedbydoctorswhousethecranialconceptintheirpractices.Thismethodcanalsobeusedtotreatpatientsatgreatdistances.Thedoctorcanprescribepharmaceuticaldrugs(basedonphysicalcomplaints,medicalhistory,physicalmedicaldi-agnosessupportedbythisdiagnosticmethod),herbalrem-edies,homeopathicremediesandalltreatmentmethodsandagentsthatcaninfluencethecranio-sacralsystem.Asthe“BreathofLife”ofapatientcaninfluencethedoctorduringthetele-diagnosticprocess,soalsothe“BreathofLife”ofthedoctorcanpotentiallyinfluencehispatientatagreatdistancetocorrectcraniallesions,performcranialmanipu-lationandevenapplybioenergytreatmentandmodifythemeridianprofileandcorrectabnormalacupuncturepoints.Itsoundsmagical.ButletscontemplateonthisfollowingstatementbySutherland:

“Osteopathyisasciencewithpossibilitiesasgreatasthemagnitudeoftheheavens.Itisasciencedealingwiththenaturalforcesofthebody.Weworkasosteopathswiththetraditionalprincipleinmindthatthetendencyinthepatient’sbodyisalwaystowardsthenormal.Hereismuchtodiscoverinthescienceofosteopathybyworkingwiththeforceswithinthatmanifestthehealingprocesses.Theseforceswithinthepatientaregreaterthananyblindforcethatcansafelybebroughttobearfromwithout.”14

TherearemanyusesofthepalpationoftheCRIandthepotentialappearstobeunlimited.Thereadersarefreetotrytheabovemethodstofurthersubstantiatetheau-thor’sfindingsandevencomparetheresultswithobjectivediagnosticmeasurementsandtosupportandevenselectfurtherappropriateclinicaldiagnosticexaminations,labora-toryexaminationsandmedicaltestsasdeemednecessary.Manyoftheideasandconceptsandfindingshereappeartobemindbogglingandconventionallyunscientific,buttheyarebasedonstudiesofrealcasesusingthepalpationoftheCRIinnormalandabnormalconditions.ItissuggestedthattheuseofanobjectiveCRIdetectorinstrumentsuchastheSurfaceScanningLaserDisplacementMetercanobjec-tivelydetermineifthespecificpalpatorymethods,theirvaluesandtheirinterpretationasdescribedinthisarticleareindeedvalidandcorrect.

References1. PribadiK.Thecybernetic-holographicmodeloftheCraniosac System.The Cranial Letter.Fall1991.Vol44.No4,p11. MagounHJ.Osteopathy in the cranial field.Idaho.TheCranial Academy,1976,p86.2. SutherlandAS.With Thinking Fingers.ApublicationofTheCra-

nialAcademy.1962.3. SteeleKM.ContemplationontheArtofOMTAfterThirtyYears

ofPractice.The Journal of American Academy of Osteopathy.Vol18.December2008.pp9-11.

4. UpledgerJEandVredevoogdJD. Craniosacral Therapy.EastlandPress,Seattle,WA.1987,pp249-250.

5. BeckerRE.Diagnostic Touch: Its Principles and Application. Cra-nialOsteopathy.RichardA.Feely,DO,FAAO,editor.TheCranialAcademy.1988.pp57-66.

6. PribadiK.Psychosynergisis,asynthesisofcranialosteopathy,acupunctureandhomeopathymedicineinPsychiatry.The Journal of American Academy of Osteopathy.Spring1998.pp29-35.

7. PribadiK.ThedetectionandrecordingofcranialrhythmicimpulseinacupuncturepointsusingSurfaceScanningLaserDisplacementMeterandit’ssignificance.The Journal of American Academy of Osteopathy.December2008.pp20-25.

8. HooverHV.Functionaltechnique.AAO yearbook.1969.pp112-115.

9. FrymannVM.Palpation.Cranial Osteopathy.RichardA.Feely,DO,FAAO,editor.TheCranialAcademy.1988.p46.

10. StokesGandMarksM.Dr.SheldonDeal’sChiropracticAssistantsandDoctors.BasicAKWorkshopManual.Touch for Health Foun-dation.FourthEdition.1983.p70.

11. O’ConnorJ.etal:Acupuncture,AComprehensiveText.EastlandPress.Seattle,WA.1987.p245.

12. SutherlandWG.Teachings in the Science of Osteopathy.EditedbyAnneL.Wales.Rudrapress.SutherlandCranialTeachingFounda-tion,Inc.1990.pp34-35.

13. Ibid.Backcover. Accepted for Publication: July 2010

Address Correspondence to:

Dr.KrishnahariS.Pribadi,MDJalanBorenoRaya8DepokTimur16418WestJava,IndonesiaE-mail:[email protected]


Prolotherapy Weekend

Course Outline: Thursday,Oct7:Thisisrequiredforthosephysicianswhohavenottakenapriorcourseinprolotherapy.Itwillincludeanintroductionto prolotherapy,woundhealing, degenerative postural cascade,codingandbilling.FridayandSaturday,Oct8-9:Participantswillbedividedintotwogroups,beginnersandadvanced.Thesetwogroupswillalternatebetweenlecturesandanatomyandinjectiontechniquewhiletheothergroupwillbeintheanatomylabperforminginjectionsundersupervisionandreviewingprosections.

Presenting:MarkS.Cantieri,DO,FAAO,ProgramChairGeorgeJ.Pasquarello,DO,FAAO

PrerequisitesFunctionalAnatomy;(1)LevelIcourseorequivalent

CMETheprogramanticipatesbeingapprovedfor20hoursofAOA

Category1-ACMEcreditpendingapprovalbytheAOACCME.

Program Time TableThursday,October7.............................5:00pm-10:00pmFriday,October8....................................8:00am-5:30pmSaturday,October9................................8:00am-5:30pm

Thursdayincludesa30minutebreak;Friday&Saturdayinclude(2)15minutebreaksanda(1)hourlunch)

Who May Attend PolicyThe primary educational objective forAAO is to provide

programs aimed to improve understanding of philosophy anddiagnostic/manipulativeskillsforAAOmembers,DOswhoarenotAAOmembers,individualswhoarelicensedfortheunlimitedscopeandpracticeofmedicine,andforthoseinprogramsleadingtosuchlicense.

Course Location:UniversityofNewEngland,BiddefordCampus11HillsBeachRoadBiddeford,ME04005(207)283-0171http://www.une.edu

Travel ArrangementsGlobally Yours TravelTinaCallahanat(800)274-5975

*Arentalcarisrecommendedsincethecampusislocatedabout15-20minutesfrommosthotelsandrestaurants.

Cancellation and Refund Policy.The American Academy of Osteopathy® reserves the right tocancel an educational program if insufficient physicians pre-register. Sufficient registrationsmust be received30days priorto theopeningof thecourse. Ifyouareconsidering registeringforacourse less than30daysprior to theopening,contact theAcademy office before making travel plans. In the event ofcoursecancellationby theAcademydue to lackof registration,all registration money will be refunded. Cancellation fromparticipantsreceivedinwritingupto30dayspriortothecourseopeningaresubjecttowithholdingofa20-percentadministrativefee or they may transfer 80-percent of their tuition to anothereducational program to be held within the next 12 months.Cancellations received in writing under 30 days prior to thecourseopeningcantransfer80-percentoftheircourseregistrationfeetoanothercoursetobeheldwithinthenext12months.AnyregistrantwhofailstoappearforanAAOprogramcantransferupto50-percentoftheirregistrationfeetoanotherAAOeducationalprogram tobeheldwithin thenext 12months if awritten andsignedexplanationisreceivedattheAAOofficewithin10daysof the scheduledcourse.Allothercancellationswill receivenorefundortransferofregistrationfees.

Registration Form Prolotherapy Weekend, October 7-9, 2010

Name:_____________________________________________NicknameforBadge:________________________________StreetAddress:________________________________________________________________________________________City:_____________________State:_____Zip:________OfficePhone:_________________Fax:________________E-Mail:____________________________________________By releasing your Fax/Email you have given the AAO permission to send marketing information regarding courses via fax or email.AOA#:__________College/YrGrad:________________❒Irequireavegetarianmeal(AAO makes every attempt to provide snacks/meals that will meet participant’s needs, but, we cannot guarantee to satisfy all requests.)

Registration Rates

$1,200(ifbookhasbeenpreviouslypurchased)$1,510toincludecoursesyllabus:

AAOacceptsCheck,Visa,Mastercard,orDiscover

Makecheckspayableto“AmericanAcademyofOsteopathy”

CreditCard#______________________________________Cardholder’sName_________________________________DateofExpiration_________________CVV#___________

IherebyauthorizetheAmericanAcademyofOsteopathy®tochargetheabovecreditcardforthefullcourseregistrationamount.

Signature_________________________________________

October 7-9, 2010 at UNECOM


AAO Calendar of EventsMark your calendar for these Academy meetings and educational courses

October 2010 7-9 ProlotherapyWeekendatUNECOMinBiddeford,ME 23 OptimizingOutcomes:ARoadmaptoFinancialSuccessinToday’sChangingReimbursementEnvironment inSanFrancisco,CA 24 OMTWithoutanOMTTableinSanFrancisco,CA 24 AAO BoardofTrusteesMeeting,SanFrancisco,CA 24-28 AOAOMEDinSanFrancisco,CA 25 AAOPostdoctoralStandardsandEvaluationCommitteeMeeting,AOAConvention,SanFrancisco,CA 25 AAOFellowshipCommittee,AOAConvention,SanFrancisco,CA 25 AAOLouisaBurnsOsteopathicResearchCommittee,AOAConvention,SanFrancisco,CA 26 AAOEducationCommittee,AOAConvention,SanFrancisco,CA 26 AAOStrategicPlanningand/orBoardofTrustees,AOAConvention,SanFrancisco,CA

November 2010

20-21 AOBNMMExams,WyndhamIndianapolisWestHotel,Indianapolis,IN

December 2010

10-12 TheCranialApproachofBerylArbuckle,DOatUMDNJSOMinStratford,NJ

January 2011

21-22 AAOEducationCommittee,WyndhamIndianapolisWestHotel,Indianapolis,Indiana

February 2011 9 AAOPostdoctoralStandardsandEvaluationCommittee,Teleconference

March 2011 15 AAOFellowshipCommittee,BroadmoorHotel,ColoradoSprings,CO 15 AAOEducationCommitteeMeeting,BroadmoorHotel,ColoradoSprings,CO 15 AAOPostdoctoralStandardsandEvaluationCommittee,BroadmoorHotel,ColoradoSprings,CO 15 AAOLouisaBurnsOsteopathicResearchCommittee,BroadmoorHotel,ColoradoSprings,CO 16 AAOBoardofGovernors,BroadmoorHotel,ColoradoSprings,CO 16 AAOInvestmentCommittee,BroadmoorHotel,ColoradoSprings,CO 16 AAOBoardofTrustees,BroadmoorHotel,ColoradoSprings,CO 17 AAOAnnualBusinessMeeting,BroadmoorHotel,ColoradoSprings,CO 19 AAOBoardofTrustees,BroadmoorHotel,ColoradoSprings,CO

June 2011 8 AAOPS&ECommittee,Teleconference

July 2011 9-10 AAOBoardofTrustees,Indianapolis,IN


Attitudes and Confidence Levels of Fourth-Year Osteopathic Medical Students towards Osteopathic Manipulative Medicine

Tom Quinn, Mark Best, Thomas J. Fotopoulos, Lisa D. Ball and Veronica J. Ruston

AbstractAsafollow-uptothestudyoftheinauguralclassof

LakeErieCollegeofOsteopathicMedicineatBradenton(LECOM-Bradenton)performedattheendoftheirsec-ondyearofmedicalschool,thisnewstudyaddressesthestudent’sconfidenceandattitudetowardstheuseofOsteo-pathicManipulativeMedicine(OMM)attheendoftheirfourthyear.ThefirststudywaspublishedintheDecember2007issueofJAAO.1InthisnewstudytheLECOM-Bra-dentoninauguralclasscompletedananonymoussurveyjustdaysbeforereceivingtheirDOdegrees.Thesurveyexam-inedtheirconfidencelevelinperformingOMMandtheirintentiontouseOMMintheirclinicalpractice.Almosthalf(45%)ofthestudentswereundecidediftheywouldorwouldnotuseOMM.Thestudents’experiencesduringtheirthirdandfourthyearclinicalrotationsdidnotseemtoimpacttheambivalencewhichparalleledthefindingsofthepriorstudy.

IntroductionOsteopathicmedicineremainsthefastestgrowing

healthcaresegmentintheUnitedStates.AsofDecember2008,thereare28collegesofosteopathicmedicine,withmoreproposedforthenearfuture,comparedtojust23osteopathiccollegesoperatingattheendof2006.Notablequestionshaveemergedregardingsacrificeofqualityforquantity,andifosteopathicstudentswillbecome“com-plete”osteopathicphysicians.

LECOM-BradentongraduateditsfirstclassinJune2008.WithitsexclusiveProblem-Based-Learning(PBL)pathwayLECOM-Bradentonrepresentsauniqueosteo-pathiceducationalexperiencepioneeredbytheinauguralclassof2008.Thestudentsreceivedathoroughintroduc-tiontoosteopathicprinciplesandpracticeduringtheirfirsttwoyearsatthecollege.However,sincethiswasthefirstclassofanewosteopathicmedicalschool,thestudentshadnoupperclassmentoguidethemintheirselectionoftheirthirdandfourth-yearclinicalrotations.Manyoftheclinicalrotationswerenewandtherewasnohistoryregardingtheiruseofosteopathicmanipulation.Thisstudywasdesigned

todeterminehowtheirclinicalyearsofmedicalschoolinfluencedtheirconfidencelevelsanddesiretouseosteo-pathicmanipulativetherapyintheirfuturepractices.

MethodAttheendoftheirfinalyearatLECOM-Bradenton,a

surveywasconductedoftheinauguralclass.Thissurveyassessedthesestudents’attitudestoward,andtheintentionsofusingOMMintheirclinicalpractices,andtheirlevelofconfidenceintreatingpatientsusingOMMtechniques.Separatequestionsthatweresimilartothoseintheinitialsurveyjusttwoyearspriorwereaskedofthestudents’con-fidencelevels,inHigh-Velocity-Low-Amplitude(HVLA)andnon-HVLAtechniques.One-hundred-thirty-fivestu-dents(100%)respondedtothesurvey.Thestudentswereinstructednottoputtheirnameoranyotheridentifyingmarksonthesurveytoassurethatwewouldreceivehonestanswersandbelesslikelytoresultinasociallydesirabilityresponsebias.

Eachstudentwasaskedtogiveonlytheprimaryreasonfortheiranswerbutsomegavemorethanonereason.Sincethestudywasanonymoustherewasnowayofidentifyingthestudenttofindwhichanswerwastheirprimaryreason,sobothreasonswereincluded.Thereforesomechartsshowmoreanswersthanstudents.

Survey resultsThefirstpartofthesurveytotheosteopathicmedical

studentsaskedhowmuchexposuretoOMMtheyhadduringtheirclinicalrotations.OnlyonestudentfelttheyhadtoomuchexposuretoOMM.Fifty-onestudents(38%)feltthattheyhadjusttherightamountofexposure.Eighty-threestudents(61%)feltthattheyhadtoolittleexposure.(seechart1)


Chart 1: The amount of exposure to OMM during clinical rotations.

Oftheeighty-threestudents(61%)whofelttheyhadtoolittleexposuretoOMMduringtheirclinicalrotations,fifty-eighthaddifficultyfindingOMMpractitioners.Twenty-eightstudentsansweredthatOMMpractitionerstakestudents,butdonotemphasizeorteachOMM.Onestudent’sreasonwasthatOMMpractitionersdonottakestudents.(seechart2)

Chart 2: Reasons for the 83 students with “too little” expo-sure to OMM during clinical rotations. Each student was asked to list the primary reason but some students listed more than one reason.

HVLAThestudentswereaskedtoratetheirlevelofconfidence

doingHVLAOMMasagraduatingOsteopathicMedicalStudent.Twenty-nine(22%)hadhighconfidence,sixty-four(47%)hadmoderateconfidence,andforty-two(31%)hadlowconfidence.(seechart3)

Chart 3: Graduating osteopathic medical students level of confidence in doing HVLA OMM.

Ofthesixty-fourstudents(47%)whohadamoderatelevelofconfidenceindoingHVLAOMM:Forty-sevenstudentsdidnotpracticeOMMintheirclinicalrotationsveryoften,sevenstudentscontinuetobeconcernedthattheymayharmtheirpatient,fivefelttheydidnothavethemanualdexteritytobereallygoodatHVLA,andfourstudentsfeltthatOMMisnotahighpriority.Onestudentdidnotofferareason.(seechart4)

Chart 4: Reasons for the 64 students with “moderate” confidence in doing HVLA OMM. One student did not offer a reason.

Oftheforty-twostudents(31%)whohadalowlevelofconfidenceindoingHVLAOMM,thirty-twostudentssaiditwasbecausetheydidnotpracticeOMMintheirclinicalrotationsveryoften.ThismeansthatthemajorityofstudentsattributedtheirlowconfidencewithHVLAOMMtotheirlackofpractice.ItisemphasizedtostudentsthatthebestwaytogetgoodatOMMistopractice.ThesesurveyresultscanbehelpfulforfuturestudentstotakeresponsibilitytoseekoutopportunitiestopracticeOMMinthethirdandfourthyears.ElevenofthestudentswithlowconfidencefelttheydidnothavethemanualdexteritytobereallygoodatHVLA.EightstudentsfeltthatOMMisnotahighpriorityandsevenstudentscontinuetobeconcernedthattheymayharmtheirpatient.(seechart5)


Chart 5: Reasons for the 42 students with “low” confidence in doing HVLA OMM. Some students offered more than one reason.

Non-HVLAThestudentswereaskedtoratetheirlevelof

confidenceindoingnon-HVLAOMMasgraduatingOsteopathicMedicalStudents.Sixty-one(45%)hadhighconfidence,sixty-eight(50%)hadmoderateconfidence,andonlysix(5%)hadlowconfidence.(seechart6)

Chart 6: Graduating Osteopathic medical students level of confidence in doing non-HVLA OMM.

Onceagain,ofthesixty-eightstudents(50%)whohadamoderatelevelofconfidenceindoingnon-HVLAOMM,forty-nineansweredthattheydidnotpracticeOMMintheirclinicalrotationsveryoften.FourteenstudentsfeltthatOMMisnotahighpriority.Sevenstudentshadmoderateconfidencebecausetherearesomanytechniquesthattheyareconfusedandthreestudentscitedalackofmanualdexterity.(seechart7)

Chart 7: Reasons for the 68 students with “moderate” con-fidence in doing non-HVLA OMM. Some students offered more than one reason.

Ofthesixstudents(5%)whohadalowlevelofconfidenceindoingnon-HVLAOMM,fiveofthestudentsdidnotpracticeOMMintheirclinicalrotationsveryoften.ThreestudentsfeltthatOMMisnotahighpriority.Onlyonestudentansweredthattherearesomanytechniquesthattheyareconfusedandonestudentcitedalackofmanualdexterity.(seechart8)

Chart 8: Reasons for the 6 students with “low” confidence in doing non-HVLA OMM. Some students offered more than one reason.

Intention to use OMM in clinical practiceOftheone-hundred-thirty-fivegraduatingosteopathic

medicalstudentssurveyed,fortystudents(30%)planondoingOMMintheirpractice,sixty-onestudents(45%)mightdoOMM,andthirty-four(25%)donotintendtodoOMMintheirmedicalpractice.(seechart9)


Chart 9: Intention to use OMM in their medical practice.

Ofthesixty-onestudents(45%)thatmightdoOMMintheirmedicalpractice,twenty-fourofthemintendtogointoaspecialtythattraditionallydoesnotuseOMM,pathology,radiology,etc.2Twenty-twostudentssaidtheylacktheconfidenceorneedmorepracticeindoingOMMbeforetheywoulduseitintheirmedicalpractice.Eightstudentslackedtherolemodelsandmentors.SevenstudentsansweredthatOMMtakestoomuchtimeandtheycanmakemoremoneywithoutOMM.FourthinkOMMisgoodbutdoesnotsavelives.(seechart10)

Chart 10: Reasons for the 61 students who answered “maybe” for their intention to use OMM in their medical practice. Some students offered more than one reason.

Ofthethirty-fourstudents(25%)thatdonotintendtodoOMMintheirmedicalpractice,twenty-eightsaidthereasonwasthattheyintendtogointoaspecialtythatdoesnotuseOMM.ThisleftonlysixgraduatingosteopathicmedicalstudentsthatdonotintendtouseanyOMMintheirmedicalpracticeevenwhereitwouldbeindicated.FourofthesestudentssaidthattheylackedOMMrolemodelsormentors.TwostudentsdonotthinkOMMhasbeenscientificallyproven.OnlyonestudentansweredthatOMMtakestoomuchtimeandtheycanmakemoremoneywithoutOMM.Unlikethesurveyresultsobtainedfromthis

sameclasstwoyearsbefore,zerostudentsansweredthattheywerenotdoingOMMbecausetheywantedtobeanMDandwantedtheirpatientstothinktheyareanMD.(seechart11)

Chart 11: Reasons for the 34 students who answered “no” for their intention to use OMM in their medical practice. One student offered two reasons.

Analysis of the findingsThemajorityofthegraduatingosteopathicstudentshad

alowormoderatelevelofconfidenceinperformingbothnon-HVLAandespeciallyHVLAOMM.Whilemoststu-dentsfreelyadmittedthattheyhadn’tpracticedOMMdur-ingtheirrotations,additionalreasonsforthereducedlevelsofconfidenceincludedafearofharmingtheirpatient,feel-ingthathisorhermanualdexterityissubparforHVLA,andthatOMMsimplyisn’tahighpriorityforthem.ItisstressedtostudentsinthefirsttwoyearsthatOMMskillsmustbepracticed,buttheamountoftimeallocatedtothiswillvaryaccordingtothestudentdependinguponhisorherbackground.ThestudentshadaccesstotheOMMlabeverydayoftheweekwithavailableofficehoursforques-tionsorpracticewithaninstructoratleastthreedaysperweek.Anadditionalpartoftheconcernmaybethelackofsituationswhereastudentcanpracticeontheirrotations.

AnoverwhelmingnumberofstudentsfelttheyhadtoolittleexposuretoOMMduringtheirclinicalrotations.Overhalfthestudentsrevealedalackofexposureduringclinicals,duringwhichtimenoformalOMMclassesareattended,andincludedthisasthemainreasonfortheirlowormoderateconfidencelevels.StudentshadtheopportunitytodoclinicalrotationswithphysiciansthatuseOMMintheirpractice.However,theyreporteddifficultyinlocatingOMMpractitionersduringtheseyears,aswellasalackofemphasisonOMMtechniquesbyOMMpractitionersiftheywereabletoarrangearotationwithone.

AprimaryconcernfromtheprevioussurveywasthenumberofstudentsthatdidnotplanonusingOMMintheirpractice.Thestudentsinthissurveywerealsosplitbetween“yes”,“no”,and“maybe”intheirintentiontouseOMM


Exercise Prescription – Greenman’s MethodDVD Series

The American Academy of Osteopathy hosted Dr. Greenman’s final appearance at an Exercise Prescrip-tion course in January 2010. With the permission of course instructors, Brad Sandler, DO and Philip Greenman, DO, FAAO, the course was recorded and now is available in a 3-day, 10-disc DVD series which includes both lectures and OMT hands-on lab sessions. Don’t miss this opportunity to own this historic DVD series. Complete the order form today!!

Exercise Prescription – Greenman’s MethodDVD Series at $250.00

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CME QUIZThepurposeofthequizfoundbelowistoprovidea

convenientmeansofself-assessmentforyourreadingof thescientificcontent in“Attitudes and Confidence Levels of Fourth-Year Osteopathic Medical Students towards Osteopathic Manipulative Medicine” by TomQuinn,DO;MarkBest,MD,MBA,MPH;VeronicaJ.Rustin,OMS-II;LisaD.Ball,OMS-IIandThomasJ.Fotopoulos,DO.Answer each question listed. The correct answers

willbepublished in theDecember2010 issueof theAAOJ.To apply for Category 2-B CME credit, transfer

youranswerstotheAAOJCMEquizapplicationformanswersheetbelow.TheAAOwillrecordthefactthatyousubmittedtheformforCategory2-BCMEcreditandwillforwardyourtestresultstotheAOADivisionof CME for documentation. You must have a 70%accuracyinordertoreceiveCMEcredits.

intheirpractice.Forthemostpart,studentsnotaimingtoutilizeOMMareplanningonenteringspecialtiesthattypicallydonotuseOMMtechniques.Onceagain,thoseindicatingapossibleuseofOMMmostlystatedthattheylackedtheconfidenceandneededmorepractice.However,otherreasonsamongthesestudentsarealackofOMMrolemodelsandmentors,whichreflectssomeofthelowercon-fidencelevelsintheirOMMabilities.AlsoincludedisthefeelingthatOMMrequirestoomuchtimefortheamountofmoneytheadditionalskillswouldgenerate,andthatOMMdoesn’tsavelives.

ConclusionOneofthestrikingfeaturesofosteopathicmedicine

thatseparatesitfromitsallopathiccounterpartisitsuseofOMMasmedicaltreatment.OMM,however,requiresmuchpatienceandpracticetoacquirebothconfidenceandskill.Withtheprominentexplosionoftheosteopathicprofessioninthemedicalsector,OMMisbecomingamorecommonandacceptedtreatmentandservesasabridgebe-tweentraditionalandalternativemedicine.Tocontinuethistrend,OMMneedstobelearnedandimplementedbytheosteopathicphysicianswhoarejustenteringthescene.

WiththecurrentboomofosteopathiccollegesinthenationthereisashortageofqualityOMMrotationsites,aswellaspost-graduateprogramsthatincludequalityincorporationofosteopathicprinciples.Asaresultofthesesurveys,LECOM-BradentonnowmaintainsalistofosteopathicphysicianswhouseandteachOMMandthislistisfreelyavailabletothestudentsastheyscheduletheirclinicalrotations.AnyDOwhoincorporatesOMMintotheirclinicalpracticeandwishtomentorthirdandfourthyearosteopathicmedicalstudentsshouldcontacttheauthorofthisarticle.

Theeffectoftheirchosenpost-graduateprograms—whetherornottheyexperiencequalityincorporationofosteopathicprinciplesfromDOrole-models—seemstobetheremainingfactordeterminingifthestudentswillbemotivatedintobecoming“complete”osteopathicphysi-cians,andcontinuingthevisionofthefoundingfatherofosteopathy.

Thepresentclinicalrotationsdoseemtohaveasignifi-cantinfluenceupontheconfidence,motivation,andinten-tionofthirdandfourthyearmedicalstudentstouseOMMinpractice.Embodyingthefoundingvisionofmedicine,OMMisintegraltoanosteopathicstudentbecominga“complete”osteopathicphysician.

References1 QuinnT,FotopoulosT,BestM,“AttitudesandConfidenceLevels

ofSecond-YearOsteopathicMedicalStudentstowardsOsteopathicManipulativeMedicine”.The AAO Journal.Vol17,No.4.December2007.pp23-27

2. SpaethD,PheleyA,“UseofosteopathicmanipulativetreatmentbyOhiophysiciansinvariousspecialties,” Journal American Osteopathic Association.Vol.103.No.1.January2003.pp16-26.

Accepted for Publication:June2010

Address Correspondence to:

ThomasA.Quinn,DO,FAOCOPMClinicalAssociateProfessorofFamily/OccupationalMedicineLakeErieCollegeofOsteopathicMedicineBradenton5000LakewoodRanchBlvd.Bradenton,[email protected]

MarkBest,MD,MPH,MBAProfessorofPathologyLakeErieCollegeofOsteopathicMedicineBradenton5000LakewoodRanchBlvd.Bradenton,[email protected]

ThomasJ.Fotopoulos,DOClinicalAssociateProfessorofOMMLakeErieCollegeofOsteopathicMedicineBradenton5000LakewoodRanchBlvd.Bradenton,[email protected]


CME CErtifiCation of HoME Study forM

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READthefollowingarticlesforAOACMEcredits.

Name of Article: Attitudes and Confidence Levels of Fourth-Year Osteopathic Medical Students towards Osteopathic Manipulative Medicine

Author(s): ThomasA.Quinn,DO;MarkBest,MD,MPH,MBA;LisaD.Ball,OMS-II;VernonicaJ.Ruston,OMS-IandThomasJ.Fotopoulas,DO.

Publication: AAOJ,Volume20,No.3,Sept2010,pp.23-28

Complete the quiz below by circling the correct answer.Mailyourcompletedanswersheet to theAAO.TheAAOwill forwardyour completed test results to theAOA.Youmusthavea70-percentaccuracy inorder to receiveCMEcredits.

1.In a recent survey, approximately what percentage ofosteopathicstudentsexpressedambivalenceastowhethertheywoulduseOMTinpractice?

a) 5% b) 0% c) 50% d) 75% e) 100%

2.One of the major challenges facing the osteopathicprofessionis:

a) Buildingmoreosteopathichospitals b) Creatinganindependentliabilityinsurancecompany c) Havinglargerpractices d) Creatingenoughqualityclinicaltrainingprograms forDOgraduates e) Usingelectronicmedicalrecords

3.AmajorreasonstudentsdidnotfeelconfidentintheOMTskillsis:

a) Theydon’tunderstandwhatOMTis b) LackofpracticetimeoutsideofOMMclasses c) Toomanytechniquestolearn d) LackofgoodOMTtechniquemanuals e) Difficultexams

Mailthispagewithyourquizanswersto:AmericanAcademyofOsteopathy®

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Patient identification:JP,a61year-oldfemale.

Chief complaint:Slurredspeech,difficultywalking,dizziness,neck,back,andlegpain.

History of present illness:Shewashospitalizedaftertwoweeksofsymptoms.Routinelabs,carotiddopplerstudy,echocardio-gram,andMRIwerenegative.Dischargediagnosiswas:“slurredspeech,difficultywithcoordinationandgaitinstability,mostlikelymedicationinducedduetopropoxyphene.”Propoxyphenewasdiscontinued,butsymptomspersisted.Shewasreferredforosteopathicmedicalevaluationfourweekspostsymptomonset.Shereportedseveralfalls,butdeniedsyncope,visualfielddefi-cits,headinjuryorlossofconsciousness.

Allergies: Amoxicillin,lithium,skinsensitivitytometals.

Medications: Trifluoperazine20mg,trihexyphenidyl5mg,lisinopril10mg,sitagliptin100mg,glyburide/metformin5/500mg,aspirin325mg,ibuprofen800mg,gabapentin100mg,omeprazole20mg.

Medical history:Paranoidschizophrenia,TypeIIdiabetes,hyper-tension,hyperlipidemia,GERD,chronicbackandlegpain.

Surgical history:Appendectomy,hysterectomy,cataractsre-moved.

Social history:Smoker,livesalone,doesnotdrive,dependsupondisabilitybenefits.

Review of systems:Head:Chroniclefttemporalcephalalgia;Eyes:Diabeticretinopathy;Cardiopulmonary:Hypertension,hyperlipidemia;Endocrine:TypeIIdiabetes;GI:GERD;GU:G2,P2,hysterectomy;Musculoskeletal:Chronicleg,lowback,andneckpain;Neurologic:Recentonsetdysarthriaandataxia;Psychiatric:Paranoidschizophrenia.

Physical examination: Alert,oriented,noapparentdistress,height64inches,weight128pounds,bloodpressure138/83;Eyes:Extra-ocularmovementsnormal,nonystagmus,icterus,orpapilledema;ENT:Oralmucosapinkandmoist,uvulamid-line;Neck:Supple,nolymphadenopathy,thyroidnotpalpable;Dermatologic:Negative;Abdomen:Soft,notenderness,rebound,organomegaly,orascites;GU:Nocostovertebralangletender-ness.Neurologic:Slurredspeechwithword-formationdifficulty,tongueprotrusionmidline.

Cardiopulmonary:Lungsclear,heartregularandnomurmurs.

Neuromuscular exam:Sheroseeasilyfromsittingtostanding,gaitwasataxic.Leftshoulderwasprotractedwithlimitedarmflexionandcoracoidprocesstenderness.Spheno-basilarsymphy-siswascompressedandC3sidebentright.Hyoidwasobliqueanddepressedontheleft.Inhalationribdysfunctionofrightfirstandsecondribwithserratusanteriortendernessinaxilla.Exhalationribdysfunctionwaspresentonribstwotosixonleftandseventotwelveonright.Leftiliaccrestwaselevated,withtendernessalongmedialaspectofcrest,atanteriorsuperiorspineandalongtheproximalthirdofilio-inguinalligament.Theleftpubicramuswasinferior,andL1-L5side-bentleft.Bothkneeshadgenuvalgustendencywithrightpatellatrackingmedially.Deeptendonreflexesandstrengthwerenormalinupperandlowerextremities.

Diagnosis

1. Somaticdysfunction:Head,neck,thorax,ribcage,upperextremity,lumbar,sacrum,pelvis,andlowerextremity.

2. Dysarthria,likelyassociatedwithhypoglossalnervedys-function.

3. Ataxia.4. Chroniclowback,neck,andkneepain.5. Paranoidschizophrenia6. Hypertension,hyperlipidemia,typeIIdiabetesmellitus

Course of treatment Initialvisit–Osteopathicmanipulativetreatmenttohead,

usingbalancedmembranoustension,withbalancedligamentoustechniquetoneckandknee,andcombinedmethod(myofascialreleaseandfunctionalmethod)toupperextremity,ribcage,lum-bar,sacrumandpelvis.Followingtreatment,speechwasclearwithoutword-formationdifficultyandgait,respiratoryexcur-sionsandleftarmflexionimproved.Moodwasbrighter.

Follow-uponeweeklater–Speechwasnormal,andbalanceandgaitmorestable.Shereported:“morebounceinherstep.”Theremainingright-sidedneckdiscomfortwastreatedwithfunctionalmethod.Hercasemanagerwaspresentandstatedthatgaitandspeechhadreturnedto“normal.”Anasneededfollow-upwasrecommended.

DiscussionThiscasedemonstratestheimportanceofrecognizingand

treatingcranialnervedysfunctioncausedbycervicalfascialstrain,whichiscommon.1Osteopathicmanipulativetreatment

Dig On

Case Report: Allison B. Kolkhorst and Daniel J Kary


tohead,neck,ribcage,thorax,lumbar,pelvisandsacralregionsreleasedtensionofpretrachealandprevertebralfascialuponthehyoidandcarotidsheath.This,inturn,reducedfascialdragonthedescendinghypoglossalnerve,whichallowedherspeechtoreturntonormal.

Dysarthricspeechhasbeenreportedinpatientswithcarotidaneurysms.2Theaneurysmputstensiononthehypoglossalnerveasitdescendsalongthelateralsurfaceofthecarotidsheath,causingslurredspeech.3,4Thecarotidsheathisacondensationoffasciallayersaroundthecarotids,internaljugularvein,andvagusnerve,composedprimarilyoftheprevertebralandmiddlecervi-calfascia.5,6Thesefasciaplayanimportantroleinthefunctionoftheneurovascularbundle.Releaseoffascialdragcanimprovecranialvenousdrainage.7Theselayers,aswellasthethick,fibrouspharyngobasilarfascia,originatefromthebasilarapophy-sis.8Thepharyngobasilarfasciarunsinferiorlyinatubeforma-tion,alongthemedialedgeofthecarotidsheath,and(asprever-tebralfascia)mergeswiththeanteriorlongitudinalligamentatT2toT3.9,10Throughtheseaswellasmyofascialconnectionsofthesternothyroid,sternohyoidandlonguscollimuscles,somaticdysfunctionwithinthethoracicregioncanleadtodysfunctionintheheadorcervicalregion,andvice-versa.

Thepharyngobasilarfasciaalsoattachesinacontinu-ouslinefromthetubercleofthebasiocciput,acrossthepetroustemporalbonetothemedialpterygoidplateofthesphenoid.11 Dysfunctionofthebasiocciput,temporal,ormedialpterygoidplateresultsintensionchangesofthisthick,inelasticmem-brane,12providingyetanotherpathwayfordysfunctionofthecarotidsheath.

Thehyoidishighlymobileandcentrallysuspendedbe-tweenmuscle,fascia,andthestylohyoidligaments.13Themiddlelayerofcervicalfasciaisfirmlyattachedtothebodyandgreaterhornsofthehyoid,andbecomescontinuouswiththeendo-thoracicfascia.Thislayerformstheexternalcarotidsheath.14 Dysfunctionofthemyofascialelementsthatattachtothehyoidorupperribcagemaycausestrainonthecarotidsheathandit’scontents.15Sympatheticafferentsfollowthecarotidarteriesintothecranium.16

Duetothecloseproximityofhypoglossalnervetoglos-sopharyngealandvaguswithintheretropharyngealandretrosty-loidspaceoftheneck,isolatedlesionsarerare.17Eagle(1937)describedasyndromecausedbyanelongatedstyloidprocess,whichaffectsthesenervesastheytraverseorfollowthecarotidsheath.Eaglesyndromemaypresentwithspeechdifficulties,clumsiness,andipsilateralcervicofacialpainandcentralnervoussystempathology.18

CranialnerveXII(hypoglossal)passesthroughtheduraastwoseparatebundlestowardthehypoglossalcanal.19,20CranialnerveIX(glossopharyngeal)travelsthroughthejugularfora-menseparatedfromX(vagus)andXI(accessory)byseparateduralsheaths.21,22Alteredtensionoftheduralsheathwrappingaroundtheglossopharyngealnerve,andonthehypoglossalnervebundlesmayleadtosymptomsofdysarthriaanddysphonia.

Cranialnervedysfunctionmaywarrantperipheralevalua-tion.Fascialdragcaninterferewithnormalfunctioning.23

Thispatient’sdysarthriaimprovedpromptlywithosteo-pathicmanipulativetreatment.Thoughchronicmentalillnessimpairedherabilitytocommunicatehersymptoms,listeningwithone’shandsprovidedcluestosolvetheproblem.Wejusthadtodigalittledeeper.Digon!

References1. SnyderG.EmbryologyandPhysiologyoftheFascia.Journalof

theOsteopathicCranialAssociation.1954.Meridian,Idaho.TheCranialAcademy.1988:5.

2. BrazisP,MasdeuJ,andBillerJ.LocalizationinClinicalNeurology,5thEdition.Philadelphia,PA.LippincottWilliamsWilkins.2007.p344.

3. Ibid.p344.4. SpalteholzW.HandAtlasofHumanAnatomy,7thEdition.

Philadelphia,PA.J.B.LippincottCompany.1907:734.5. StandringS.ed.Gray’sAnatomy.TheAnatomicalBasisof

ClinicalPractice,39thedition.NewYork,NY.ElselvierChurchillLivingstone,2005.p542.

6. PaolettiS.TheFasciae:Anatomy,Dysfunction,andTreatment,2ndEdition.Seattle,WA.EastlandPress,Inc.2006.p76.

7. HitchS.MalalignmentoftheSternumandFascialStrain.JournaloftheOsteopathicCranialAssociation.1954.Meridian,Idaho.TheCranialAcademy.1988.p28.

8. Paoletti,op.cit.p53-56.9. Hitch,op.cit.p2810. BeckerR.Glenard’sSyndromeandtheSutherlandFulcrum.

JournaloftheOsteopathicCranialAssociation.1954.Meridian,Idaho.TheCranialAcademy.1988.p32.

11. Standring,op.cit.p626.12. StrachanWF.Appliedanatomyofthepharynxwithcranial

applications.JournaloftheOsteopathicCranialAssociation.1949.Meridian,Ohio.TheCranialAcademy.1988.p38.

13. Ibid.p37.14. Ibid.p35-37.15. Paolettiop.cit.p60.16. Standringop.cit.p235.17. Brazisop.cit.p343.18. ChaungWC,ShortJH,McKinneyAM,etal.Reversibleleft

hemisphericischemiasecondarytocarotidcompressioninEagleSyndrome:SurgicalandCTangiographiccorrelation.AmericanJournalofNeuroradiology.2007.28:143.

19. Haines,D.FundamentalNeuroscienceforBasicandClinicalApplications,3rdEdition.Philadelphia,PA.ElsevierChurchillLivingstone.2006.p213.

20. Brazis,op.cit.p341.21 Standring,op.cit.p555-556.22 Spalteholz,op.cit.p728.23 Hitch,op.cit.p27.


From The Archives From: McCole, GM. An Analysis of the Osteopathic Lesion. Great Falls, Montana: Geo. M. McCole, Publisher. 1925. pp. 265-268.

CHAPTERL

FACETSEPARATION (Continued)

PSYCHOLOGYOFTHEPOP

InChapterXLVIIIissetforthouropinionastothesignificanceofthefacetseparationinspinaladjustment.InChapterXLIX,theopinionsofotherphysicianswerediscussed.Inthosetwochaptersthe ideasof thepatient, i.e., thepsychologyof facet separation,werenotconsidered.

Almostatthebeginningofanydiscussionoffacetseparation,thequestionofitspsychologyoccurs.Intheprecedingchaptersthediscussionwasconfinedtotechnicalvalues.

Inthischapterweshallconsiderwhatthepatientthinksandwhathesaystohisneighboraboutit.Afterwehavestudiedfacetseparationandthescientificphasesofitsuseandofitsabuse,theopinionofthepatientiscertainlyworthconsidering.

Thefirstdutyofaphysician is togive thepatient the treat-mentwhichiscorrectforhiscondition.Ontheotherhand,itisthephysician’sdutytounderstandwhatoffendsandwhatpleasesthepatientwhoretainshim.

Inthemajorityofcases,osteopathictreatmentoradjustmentmustbegivenwithouthurtingthepatient.Thereare,however,ex-ceptionswhenapatientiswillingtohaveavertebraadjustedevenifthereissomepainexperienced.Theadjustmentwhichcausespainis,however,theexception,certainlynottherule.Weoftenhearthefollowingthingssaid:

“Doctor, Idon’t like tohavemybones‘popped’.Ihadthattreatmentonce,andithurtmesoIamafraidofit.”

“Doctor,don’t‘pop’myneck.Ijustcan’tstandit.

“Doctor,Idon’tbelieve‘popping’doesmeanygood.Ihada lesion once inmy neckwhich a physician tried to relieve by`popping’butcouldnot,andIonlygotreliefafterIhadtreatmentwithoutthe‘pop’.”

Youwillpracticallyneverhaveanyobjectiontopoppingexceptoftheneck.

Ontheotherhandwehearsuchremarksasthese:

“WhenIwasinBlankville,Ihadatreatmentbutdidnotlikeitbecauseitwasnothingbutrubbingandkneading.WhenIgivemytimeandmoneyfortreatment,Iwantagooddeepspinaladjustmentthatwilldosomegood.”

“Doctor,Ihavealameback.WhileIwasaway,Ihadatreat-ment,butitdidmelittlegood.Iwishyouwouldgivemeagood

hardadjustment.Makethem‘pop’,Doctor.“

“Don’tpayanyattentiontomeifImakealittlefussaboutthis.Yougorightaheadandgivemeagooddeeptreatment.Italwaysdoesmealotofgoodtohavemyneck‘popped’”.

“Ihavetakentreatmentattimesformanyyears.Iusedtofindphysicianswhospentalotoftimerubbingandworkingthemusclesalloverthebodyandthearmsandlegs,sometimeseventhefingersandtoes.Idon’tfindthatanymore.Osteopathicphy-sicians,now-a-days,seemtowanttofindwhatiswrongandgivetreatmentforthat.”

Iamgoingtomakethisstatement;Ifnopatienthadeverhadajoint“popped”Idoubtwhetherthepracticeofosteopathywouldbeinexistencetoday.Isaythis,first,becauseIthoroughlybelievethatmanyofourfinestresultscouldneverhavebeenachievedwithoutitand,second,becausethe“pop”hasbeenourgreatpsychologicalasset.

Untoldthousandsoftimessomethinglikethishasbeensaid,“Iwenttoan,osteopathicphysicianandhefixedmyback.Why,itpoppedsoitcouldbeheardallovertheroom.Itwaswonder-ful”!

Thereasonspatientsobjecttofacetseparationarethat:

(1) itisgivenwhentheyarenotexpectingit;

(2) realattentionisnotgiventogettingthepatientthoroughlyrelaxed;

(3) itisgivensoforciblythatithurtsorleavesthepatientlame.Ifthephysicianwillgivethoroughattentiontodevelopinghistechnicsothathecangivedeep,forcible,yetgentlecor-rection,ifhewillpaystrictattentiontogetting-hispatientrelaxed,andaboveallifhewillnotsurprisethepatient,hewillhavelittletroublewithhispatient’sobjections.Whenapatientistreatedforthefirsttime,heshouldbe

toldthathisspineorthatacertainvertebraljointneedsaquick,deepadjustmentthatthedeepmusclesarecontracturedandtheligamentsstiffened;thatthesestructuresneedtobeloosenedandmadeflexiblesothatthenerveandbloodcirculationwillbefree.Ifthepatientismadetounderstandthisandtheadjustmentisgivengentlybuteffectively,thepsychologicaleffectwillbehelpful.

Immediatelyhavingadjustedthejointofapatientwhomyouthinkmaybealittlenervous,itiswelltoquiethisfearsimmedi-atelyandimplanttheideathatourtreatmentdoesnothurthim.Thatmakesithardforhimtosaytoanyoneoreventothinktohimselfthatyouadjustedhisneckandhurthim.

Itisnecessaryforthestudenttostudyeveryjointineverypatientcomingtohim.Hemustdecidewhatthatpatient,what


thatspine,andwhatthatjointneeds,andgiveasfaraspossiblethetreatmentindicated.Supposearigidupper-dorsalorcervi-calisfoundinwhichthejointsneeddeepadjustmentofthekindwhichisaccompaniedbythepop.Firstexplaintothepatientthatthejointisrigidandneedsdeepadjustment.Say,“Youdon’tobjecttohearingajoint‘pop,’doyou?”Tellhimthatifhethor-oughlyrelaxesanddoesnotholdhisbreath,theadjustmentwillnothurt.Thepatientnearlyalwayssayshewantswhatisneeded.Ifhestillseemsnervousaboutit,tellhimthatifithurtsorboth-ershimtoomuch,someothermethodwillbeused.

Ifthepatientstillobjects,thencertainquestionsmustbede-cided;theseverityofthelesion,thepsychologicalcomfortofthepatient,andcanIdomydutybythispatientbytreatinghimthewayhedesires?Usuallysomemethodcanbeselectedbywhichthejointcanbeadjustedandtowhichthepatientwillnotobject.

Thepsychologyoftheincidentalpopispracticallysettledifthephysicianunderstandshowtomaketheadjustment,whentomakeit,andifhemakesaplainstatementtothepatientastowhattreatmentisnecessary.

Itisusuallynecessarytogiveadjustmentaccompaniedbytheincidentalpop,butattimesitisnotnecessary.Attimesitisnotadvisableevenwhenthejointneedsitbutifthephysicianmaintainsathoroughunderstandingwiththepatientsothatherelaxes,andifthephysicianknowshowtogivetheadjustment,hismistakeswillbefew.

Knowledgeofwhatisneeded,confidenceinhimself,andanunderstandingwiththepatientatonceengendersconfidenceinthepatient.Patientshaveconfidenceinadoctorwhodisplaysquietconfidenceinhimself.Patientswanttobeguidedbyafirmhandandwill.

Toadjustthespinethepatientmustberelaxed.Thephysicianmustcarefullypalpatethetissues,knowjusthowmuchforcetouseinmakingtheadjustment,usethatmuchforceandstop.“Findit.Fixit.Andleaveitalone.“—A.T.Still.

Oneshouldnotbecriticalofapatientwhoobjectstoapop.Ifhehashadanexceedinglypainfulandcarelessadjustmentatthehandsofamanuntrainedinosteopathy,hewouldbefoolishnottoresentit.

Osteopathy Develops Through TechniqueMathematicsisanabsolutescienceintheory.Initsapplication

toindividualproblemsitisnostrongerthanthetechniqueofthepersonapplyingit.Thesameistrueofosteopathy.Thepracticalrealityofanyscienceisinitstechnique.

Everyphysician’stechniqueistheresultofhisownindividualdevelopment.Theonlytruecontributiontothesubject,therefore,isalongthelinesoftheconceptionofthelesionandtheprinciplesoftechnique.Therecanbenocompleteorexhaustivepresentationofmethods.

E.E.Tuckersaysthatinapplyingosteopathicprinciplestoindividualcasesthephysicianmustconsiderthefeelingsofthepatient. In thecaseof the fearfulpatient, that technique isbest

whichmakesthemostsuccessfulcompromisebetweenpleasingthepatientandpromptlycorrectingthelesion.

Component Society Calendar of Upcoming Events

September 24-26, 2010HVLA OMT Course - mobilization with impulse treatmentNorthwestAcademyofOsteopathyPortland,ORHours:26Category1AContact: 503/299-6776formoreinformation

October 15, 2010Neuroendocrineimmune II: Chronic PainSCTFUNECOM,Biddeford,MECourseDirector:HughEttlinger,DO,FAAOContact: SCTF JoyCunningham 509/469-1520 [email protected] Website:www.sctf.com

December 3-5, 201029th Annual Winter UpdateIndianaOsteopathicAssociationMarriottHotelIndianapolis,INContact: IOA MichaelClaphan,ExecutiveDirector 317/926-3009 www.inosteo.org

January 14-16, 2010Phase V - The Embryological Development of the FaceArizonaAcademyofOsteopathyHours:22Category1AContact: MarneeJealousLong 813/765-5005

January 15-17, 2011The Face: An Intermediate CourseSCTFTUCOM/NVCourseDirector:DouglasVick,DOContact: SCTF JoyCunningham 509/469-1520 [email protected] Website:www.sctf.com


OMT Without an OMT Table

October 24, 2010 in San Francisco, CA Course Description:Manyphysiciansworkinanoutpatientsettingwithhightablesorcartsonwhichtoexamineandtreatthepatient.Thispresentsachallenge:howcanthepatientbeeffectivelytreatedwithOMT?ThiscourseisdesignedtooffersolutionsfortreatingpatientsinanoutpatientsettingwithoutanOMTtable.Thecourseisdesignedforprimarycare,urgentcareandemergencymedicinephysicianswhowanttotreattheirpatientswithOMTbuthavebeenfrustratedbytheofficeequipment.Participantswilltreatonchairsandinadequateheighttables.OMTutilizinghighvelocity/lowamplitudefacilitatedpositionalrelease,Still,muscleenergy,andmyofascialreleasetechniqueswillbeincluded.Commonpatientcomplaintswillbeaddressed.

Learning Objectives:1. ToperformquickandefficientOMTforcommonoutpatient

complaints.2. Todemonstrateabilitytotreatutilizinginappropriateheight

tablesandcarts.3. Todemonstrateabilitytotreatutilizingchairs.

Prerequisites: Theparticipantshouldhaveabasicunderstandingoffunctionalanatomy.

CME: Theprogramanticipatesbeingapprovedfor8hoursofAOACategory1-ACMEcreditpendingapprovalbytheAOACCME.

Program Time Table:Sunday,October24,2010...............8:00am-5:00pm(lunchonyourown)

Course Location:MarriottSanFrancisco554thStreetSanFrancisco,CA

Program Chair: Ann L. Habenicht, DO, FAAODr.Habenichtisa1982graduateofMidwesternUniversityChicagoCollegeofOsteopathicMedicine.Sheisbothcertifiedinosteopathicmanipulativemedicineandosteopathicfamilypractice.SheisbothaFellowoftheAmericanAcademyofOsteopathyandtheAmericanCollegeofOsteopathicFamilyPractitioners.Dr.HabenichtcurrentlyservestheAAOasamemberoftheBoardofGovernors,amemberoftheUndergraduateAcademies,BylawsandEducationcommittees.Dr.HabenichtisapastpresidentoftheAAOandservedasachairoftheEducationCommitteeformanyyears.SheispresentlyaprofessorofosteopathicmanipulativemedicineatCCOM/MidwesternUniverisityandisinprivatepracticeinOakForestandUrgentCareinOrlandPark,IL.SheservesastheUAAOadvisorforCCOM.Dr.HabenichthasbeentheprogramchairpersonfortheFallOMTUpdateforthepast16years.

Please Note: TheAOAConventionwillrunfromOctober24-28,2010attheMosconeCenterinSanFrancisco,CA.

Hotel Information:Pleasevisithttp://www.omedconference.org/resources/pdfs/HotelInformationSheet.pdftoviewyourlodgingoptions.

Travel Arrangements:GloballyYoursTravelTinaCallahan-(800)274-5975

Registration FormOMT Without an OMT Table

October 24, 2010

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Phone:317/879-1881•Fax:317/879-0563Registeronlineatwww.academyofosteopathy.org


5. Manuscriptsmustbepublishedwiththecorrectname(s)oftheauthor(s).Nomanuscriptswillbepublishedanonymously,orunderpseudonymsorpennames.

6. Forhumanoranimalexperimentalinvestigations,includeproofthattheprojectwasapprovedbyanappropriateinstitutionalreviewboard,orwhennosuchboardisinplace,thatthemannerinwhichinformedconsentwasobtainedfromhumansubjects.

7. Describethebasicstudydesign;defineallstatisticalmethodsused;listmeasurementinstruments,methods,andtoolsusedforindependentanddependentvariables.

8. Inthe“MaterialsandMethods”section,identifyallinterventionsthatareusedwhichdonotcomplywithapprovedorstandardusage.

CD-ROM or DVDWeencourageandwelcomeaCDROM,orDVDcontainingthematerialsubmittedinhardcopyform.ThoughwepreferreceivingmaterialssavedinrichtextformatonaCD-ROMorviaEmail,materialssubmittedinpaperformatareacceptable.AbstractProvidea150-wordabstractthatsummarizesthemainpointsofthepaperanditsconclusions.Illustrations1. Besurethatillustrationssubmittedareclearlylabeled.2. Photosandillustrationsshouldbesubmittedasa5”x7”

glossyblackandwhiteprintwithhighcontrast.Onthebackofeachphoto,clearlyindicatethetopofthephoto.Ifphotosorillustrationsareelectronicallyscanned,theymustbescannedin300orhigherdpiandsavedin.jpgformat.

3. Includeacaptionforeachfigure.PermissionsObtainwrittenpermissionfromthepublisherandauthortousepreviouslypublishedillustrationsandsubmittheseletterswiththemanuscript.Youalsomustobtainwrittenpermissionfrompatientstousetheirphotosifthereisapossibilitythattheymightbeidentified.Inthecaseofchildren,permissionmustbeobtainedfromaparentorguardian.ReferencesReferencesarerequiredforallmaterialderivedfromtheworkofothers.Citeallreferencesinnumericalorderinthetext.Iftherearereferencesusedasgeneralsourcematerial,butfromwhichnospecificinformationwastaken,listtheminalphabeticalorderfollowingthenumberedjournals.Forjournals,includethenamesofallauthors,completetitleofthearticle,nameofthejournal,volumenumber,dateandinclusivepagenumbers.Forbooks,includethename(s)oftheeditor(s),nameandlocationofpublisherandyearofpublication.Givepagenumbersforexactquotations.Editorial ProcessingAllacceptedarticlesaresubjecttocopyediting.Authorsareresponsibleforallstatements,includingchangesmadebythemanuscripteditor.NomaterialmaybereprintedfromThe AAO Journal withoutthewrittenpermissionoftheeditorandtheauthor(s).

TheAmericanAcademyofOsteopathy®(AAO)Journalisapeer-reviewedpublicationfordisseminatinginformationonthescienceandartofosteopathicmanipulativemedicine.Itisdirectedtowardosteopathicphysicians,students,internsandresidents,andparticularlytowardthosephysicianswithaspecialinterestinosteopathicmanipulativetreatment.The AAO Journalwelcomescontributionsinthefollowingcategories:Original Contributions:Clinicalorappliedresearch,orbasicscienceresearchrelatedtoclinicalpractice.Case Reports:Unusualclinicalpresentations,newlyrecognizedsituationsorrarelyreportedfeatures.Clinical Practice:Articlesaboutpracticalapplicationsforgeneralpractitionersorspecialists.Special Communications: Itemsrelatedtotheartofpractice,suchaspoems,essaysandstories.Letters to the EditorCommentsonarticlespublishedinThe AAO Journal ornewinformationonclinicaltopics.Lettersmustbesignedbytheauthor(s).Noletterswillbepublishedanonymously,orunderpseudonymsorpennames.Book ReviewsReviewsofpublicationsrelatedtoosteopathicmanipulativemedicineandtomanipulativemedicineingeneral.NoteContributionsareacceptedfrommembersoftheAOA,facultymembersinosteopathicmedicalcolleges,osteopathicresidentsandinternsandstudentsofosteopathiccolleges.Contributionsbyothersareacceptedonanindividualbasis.

SubmissionSubmitallpapers(inwordformat)to:

AmericanAcademyofOsteopathy3500DePauwBlvd,Suite1080Indianapolis,IN46268Email:[email protected]

Editorial ReviewPaperssubmittedtoThe AAO JournalmaybesubmittedforreviewbytheEditorialBoard.Notificationofacceptanceorrejectionusuallyisgivenwithinthreemonthsafterreceiptofthepaper;publicationfollowsassoonaspossiblethereafter,dependinguponthebacklogofpapers.Somepapersmayberejectedbecauseofduplicationofsubjectmatterortheneedtoestablishprioritiesontheuseoflimitedspace.Requirements for manuscript submissionManuscript1. Typealltext,referencesandtabularmaterialusingupperand

lowercase,double-spacedwithone-inchmargins.Numberallpagesconsecutively.

2. Submitoriginalplustwocopies.Retainonecopyforyourfiles.

3. Checkthatallreferences,tablesandfiguresarecitedinthetextandinnumericalorder.

4. Includeacoverletterthatgivestheauthor’sfullnameandaddress,telephonenumber,institutionfromwhichworkinitiatedandacademictitleorposition.

Instructions to Authors


Optimizing Outcomes: A Roadmap to Financial Success in Today’s Changing Reimbursement Environment

October 23, 2010 in San Francisco, CA Program Chair:DouglasJ.Jorgensen,DO,CPCDr.Jorgensenisaboardcertified,osteopathicphysicianincentralMainepracticingpainmanagementandosteopathicmanipulativemedicine,certifiedinNMM/OMMandre-certifiedinFP/OMT.Inadditiontohispractice,heisacertifiedprofessionalcoderthroughtheAmericanAcademyofProfessionalCodersinSaltLakeCity,Utah.Asaconsultantandspeaker,helecturesnationallyonbillingandcodingissuesaswellasauthoringnumerouspeerreviewedarticles,twobooksandseveralacademicchaptersinvaryingtopicsfromosteopathicmedicine,painmanagementandmedicaleconomics.AgraduateofBowdoinCollegeinBrunswick,Maine,theUniversityofHealthSciencesCollegeofOsteopathicMedicineinKansasCity,MissouriandtheMaine-DartmouthFamilyPracticeResidencyinAugusta,Maine,heiscurrentlypresidentofthePayor-PayeeRelationsCommitteefortheMaineOsteopathicAssociation.HeistheimmediatepastpresidentoftheMaineOsteopathicAssociationandisonclinicalfacultyatDartmouthMedicalSchoolandtheUniversityofNewEngland.Dr.JorgensenisalifetimememberoftheAAOandservesontheAcademy’sBoardofGovernors.

Program Time Table:Saturday,October23,2010...............8:00am-5:30pm(lunchonyourown)

Course Location:MarriottSanFrancisco554thStreetSanFrancisco,CA

Please Note: TheAOAConventionwillrunfromOctober24-28,2010attheMosconeCenterinSanFrancisco,CA.Visitwww.omedconference.org/forregistrationandlodgingoptions.

Program Topics:

•ChangingReimbursementEnvironment

•TheBusinessofMedicine:BillingandCodingPart1

•Privateaudits

•OptimizingChronicDiseaseCare(Means,MoneyandProof)

•ProtectingyourpracticeviaComplianceAdherence

•HealthInformationTechnologyandYou

•PayforPerformance

•ICDandCPTUpdate

•EntityStructuring

•Areyouoptimizingorjustgettingbyinyourpractice?

•Whyvolumealonewillfailincontemporarymedicine

•TheBusinessofMedicine

•SavingtheUShealthcaresystemonepracticeatatime

•Preventivecarevs.sickcare

•Optimizepaymentbygettingpaidforyourfeeschedule

•Epidemiologyofyourpractice

•Advertingriskbycomparativeanalytics

•Identifyingpotentialoutliers

•OneonOneQ&A

ForacompleteschedulepleasecontactKelliBowersox,[email protected]

Registration FormOptimizing Outcomes: A Roadmap to Financial Success in

Today’s Changing Reimbursement EnvironmentOctober 23, 2010

Name:_______________________________________________

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StreetAddress:________________________________________

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City:____________________State:_______Zip:_________

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By releasing your Fax/Email you have given the AAO permission to send marketing information regarding courses via fax or email.

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Registration RatesOptimizing Outcomes: A Roadmap to Financial Success in

Today’s Changing Reimbursement EnvironmentRegistrationFee $225.00

AAOacceptsCheck,Visa,Mastercard,orDiscoverMakecheckspayableto“AmericanAcademyofOsteopathy”

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3500DePauwBlvd.,Suite1080Indianapolis,IN46268

Phone:317/879-1881•Fax:317/879-0563Registeronlineatwww.academyofosteopathy.org

Documents

Various Methods of Palpating the Cranial Rhythm Impulsefiles.academyofosteopathy.org/AAOJ/10SepAAOJ.pdfrecommends that osteopathic physicians use osteopathic manipulative treatment