craniosacral therapy in the treatment of concussion · 2018-04-10 · (dynavision, voms, vision,...
TRANSCRIPT
Upledger Institute
CranioSacral Therapy in the
Treatment of ConcussionSally Fryer Dietz, PT, DPT, CST-D
Melinda Roland, M.A., P.T., L.Ac., O.M.D., Dipl-Ac, CST-D
The
Craniosacral
System
Influences
Nervous System
Musculoskeletal System
Circulatory System
Lymphatic System
Endocrine System
Respiratory System
Digestive System
A
Concussion
Affects
Nervous System
Musculoskeletal
Circulatory System
Lymphatic System
Endocrine System
Respiratory system
Digestive System
John E. Upledger, DO, OMM(1932-2012)
Coast Guard Medic in the 1950’s
Surgical discovery of Craniosacral
system (CSS)
1975-1983 Professor of
Biomechanics, Clinical research
team MSU to document CSS
1985 Established UII in
Palm Beach Gardens, Florida
(Upledger Institute International)
Upledger Institute
Believed the human body had
a greater capability to self-heal
Found the power of gentle,
intentioned touch to be
extremely effective in the
healing process.
Developed techniques to
address sutural and
membraneous restrictions
CST enhances recovery by:
1. Relieves symptoms: Parasympathetic nervous system.
Decrease need for meds.
2. Facilitates recovery: Rest, relaxation, decreased inflammation
3. Integrates corrections within connective tissue matrix and nervous
system: Addresses strain patterns
4.More productive rehab sessions with less stress on the body:
Patient feels better when they leave…more likely to come back.
Hypothesis:
Increased CSF
flow allows for
improved circulation
in the brain,
flushing of toxins
& decrease in
inflammation.
Promotes healing.
Anatomy of the
CranioSacral System
Meningeal
membranes
Cranium to coccyx
Dural Tube
CSF
Bony structures
(cranium to coccyx)
Cerebral Spinal Fluid
(CSF)
The meninges
The Fascia
Upledger Institute
Cerebrospinal FluidProduced in ventricles (Choroid plexus) Resorption in dural sinuses ( arachnoid villa and gran bodies )
Derivative of blood
Shock absorber
Cushions & protects
Nourishes & bathes the brain & spinal cord, removing waste from the CNS (chelating agent)
Glial Cell Attachments
Meninges of Brain
Upledger Institute
eninge
Meninges at the Spinal Cord
Cord
Dural Tube
• an extension of the intracranial membrane system
• a sealed membrane that encloses the spinal cord
• exits the spinal cord at every vertebra, travels a short distance along the course of the spinal nerve, then blends with the fascia of the body
• The dural extension is called the dural sleeve
Upledger Institute
CranioSacral Movement
Subtle but palpable movement
Narrowing & widening of the skull
Each cranial bone has its own axis of movement
Sutural restrictions can be osseous or membranous
6-12 cycles per minute
CranioSacral Rhythm
The Art & Practice of CranioSacral Therapy
• 5 grams = the weight of a nickel
• Light touch gets under body’s defense mechanism = change without harm
• Gentle, non-invasive manual therapy
• Allows for the detection and correction of imbalances within the CNS
• Corrects restrictions in CSS and body’s structural and physiological systems
• Mobilizes restrictions within cranium, sacrum, dural system and body
Upledger Institute
Jugular Foramen
Jugular Foramen
Carotid CanalCarotid Canal
Occipital Base & Jugular Foramen
Upledger Institute
Upledger Institute
Dure mater reflection. 1. Crista galli, 2. Falx cerebri, 3. Sinus sagittalis inferior,
4. Tentorial incisure, 5. Sinus rectus, 6. Confluence of sinuses, 7. Tentorium
cerebelli, 8. Sinus petrosus superior, 9.Sinus Sphenoparietalis, 10. Diaphragma
sellae, 11. Arteria carotis interna, 12. Nervus opticus, 13. Foramen magnum.
Dural membrane
Upledger Institute
• In order for tissue to survive and maintain equilibrium, each tissue and• its associated connections must be free in its environment.
• The tissue must have substantial mobility, extensibility and elasticity.
• When a tissue loses equilibrium, what affect does this have on the
• activity within the brain?
• Symptoms can be local or distant
from its origin.
• Symptoms are not exclusive
to physical structures.
Concept
Over 125,000 practitioners trained through
the Upledger Institute.
50 countries where the curriculum is taught
Dr. John E. Upledger Foundation
and
The Ricky Williams Foundation
Concussion Pilot ProgramR
E
S
E
A
R
C
H
Upledger Institute
"Serving Those That Serve-
A New Treatment Intervention
for Concussion Recovery".
This study has been accepted for publication in the journal “Medical Acupuncture”
Authors: Wetzler, Gail, PT, DPT, EDO, BI-DFryer Dietz, Sally, PT, DPT, CST-D
Roland, Melinda, M.A., P.T., L.Ac., O.M.D., Dipl-Ac, CST-D Ahern, Dee, PT, BI-D
"Medical Acupuncture" is connected to Harvard University
and relates to all variables of complimentary medicine.
Purpose of Study
To demonstrate that advanced manual therapies administered by certified, licensed manual
therapists would help to alleviate the symptoms of post concussion syndrome.
Five day intensive manual therapy program at the
Upledger Institute in Palm Beach Gardens Florida.
Designed for football players who had a predisposition
to CTE (Chronic Traumatic Encephalopathy) &
other sports related injuries
All had been suffering from their injuries for years!
Upledger Institute
Year 1 Pilot (2015): Five Participants
Year 2 (2016) - Seven participants
Year 3 (2017) - Pending
The players all received treatment twice a day
for five days with therapists certified in
Upledger CranioSacral Therapy.
All were examined & diagnosed
by a medical doctor trained in sports medicine
Diagnoses:
Post concussive syndrome &
other sports related injuries.
Upledger Institute
Performed by
Independent
physicians &
therapists.
Pre & Post TestingUsed “Gold Standard” evaluation tools
First Day (day 1)
Last Day (day 5)
4 weeks later
3 months post RX
Physical Medical Exam
(physical, orthopedic exam, strength, range of motion, rhomberg test,)
Neurocognitive testing
(imPACT Test)
Psychological Testing
(Beck Depression Inventory, SF 36 Quality of Life)
Pain Assessments
(HIT 6 Headache Intensity Test, Numeric Pain Intensity Scale)
Vestibular & Balance Tests
(Dizziness Handicap Inventory, Dynamic Gait Index, TUG – timed up and
go test)
Specialty Tests year 2+
(Dynavision, VOMS, Vision, Interactive Metronome)
:
AnxietyDepression
Sleep problemsFatigue
Cervical/head pain
Difficulty withMemory, Learning, Reading, Decision making
Symptoms
balance, dizziness,
digestive or elimination problems
Minor Complaints
Major Complaints
Upledger Institute
The Results
CERVICAL
RANGE OF MOTION
Normal Cervical Flexion from neutral:
40-60 degrees
CERVICOGENIC PAIN
Pain Scale
1-10
10 worst
1 no pain
Upledger Institute
Numeric Pain Scale:
Total Body 1-10
HEADACHE IMPACT TEST (HIT)
Score Range 36-78
Higher scores =
greater impact on life
78
36
DIZZINESS HANDICAP
INVENTORY (DHI)
Scores:
16-34 Points (mild handicap)
36-52 Points (moderate handicap)
54+ Points (severe handicap)
Upledger Institute
DYNAMIC GAIT INDEX
Total Score = 24
Interpretation
< 19/24 = predictive of falls in the
elderly,
> 22/24 = safe ambulators
Total Score Levels of Depression
0-10 = These ups and downs are considered normal
11-16 = Mild mood disturbance
17-20 = Borderline clinical depression
21-30 = Moderate depression
31-40 = Severe depression
over 40 = Extreme depression
21 QUESTIONS
LOWEST SCORE 0
HIGHEST SCORE 63
Dynamic SF-36
Quality of Life Scale
Designed to assesses
health improvement &
treatment
effectiveness.
HIGH SCORE IS
MORE FAVORABLE
Upledger Institute
HOURS OF
SLEEP
Self Report
imPACT COGNITIVE
EFFICIENCY TEST
Thank you!
Upledger Institute
ADDITIONAL RESEARCH
A growing list of case studies & research articles can be found at
www.UPLEDGER.COM
For more information on CranioSacral Therapy visit the Upledger booth
Research Articles:
•Alsalaheen B, Mucha A, Morris L, Whitney S and et al. (2010), Vestibular rehaabilitation for dizziness and balance disorders after concussion. Journal of Neurological Physical Therapy; 34 (2): 87-93
•Amen, D, Raji C, Willeumier K, Taylor D, Tarzwell R, Newberg A, Henderson T, Functional Neuroimaging Distinguishes Posttraumatic Stress Disorder from Traumatic Brain Injury in Focused and Large Community Datasets, PLoS One, July 2015
• Arnadottir, T.S., Sigurdardottir, Arun K, Is craniosacral therapy effective for migraine? Tested with HIT-6 Questionnaire. Complementary Therapies in Clinical Practice, 2013. 19: 11-14.
•Bulat, M. Klarica M., Recent insights into a new hydrodynamics of the cerebrospinal fluid. Brain Res Rev 2011, 65:99-112.
•Denton, GL, Brainlash, Maximize Your Recovery From Mild Brain Injury, Demos Medical Publishing, Inc. 1999
•Eisenberg, M. A., Meehan III, William P, Mannix, R, Duration and Course of Post Concussive Symptoms. Pediatrics, 2014 133 (6)
•Fryman V, A Study of the rhythmic motions of the living cranium, J AM Osteopathic Assoc, 1972,70:1-18
•Haller H, Lauche R, Cramer H, Rampp T, Saha FJ, Ostermann T, Dobos G, raniosacral Therapy for the Treatment of Chronic Neck Pain: A Randomized Sham-controlled Trial, Clin J of Pain, May 2016: 32(%) 441-9
•Hawker G, Samra M, Tetyana K, French M, Measures of Adult Pain, Measures of Pathology and Symptoms, Arthritis Care and Research, Nov. 2011, p 240-252
Upledger Institute
• Jakel, A., von Hauenschile, P., A systematic review to evaluate the clinical benefits of craniosacral therapy. Complementary Therapies in Medicine, 2012. 20(6): p. 456-65.
• Johanson CE, Duncan JA, Klinge PM, Brinker T, Stopa EG, Silverberg GD: Multiplicity of cerebrospinal fluid functions: New challenges in health and disease. Cerebrospinal Fluid Res 2008, 5:10
•Keffelgaard, I., Roe C., Soberg H and Bergland, Associations among self-reported balance problems, post concussion symptoms and performance based tests: a longitudinal follow-up study, 2012, Disability and Rehabilitation, 34(9): 788-794
•McCory P, Meeuwisse W, Johnston K, et al. Consensus statement on concussion in sport: 4th International Conference on concussion in Sport held in Jurich, November 2012 Br J Sports Med 2013 47: 250-258
•McPartland JM, Greenman PE, Cranial findings and iatrogenesis from craniosacral manipulation in patients with traumatic brain syndrome. J Am Osteopathic Assoc, 1995;95(3): 182-188
•Moskalenko YE, Fryman VM, Weinstein GB et al, Slow thythmic oscillations with the human cranium: phenomenology, origin and informational significance. Human Physiology: 2001; 27920: 171-178
•Moskalenko YE, Kravchenko TI, Gaidar BV, et al. Periodic mobility of cranial bones in human. Human Physiology 1999; 25(1): 51-58
•Small G, Kepe B, Siddarth P, Ercoli l, Merrill D, Donoghue N, Bookheimer S, Martinea J, Onalu B, Bailes J, Barrio J., PET Scanning of Brain Tau in Retired National Football League Players: Preliminary Findings, Am J Geriatr Psychiatry February 2013, 21:2
•Soble J, Silva M, Vanderploeg. R, Curtiss G, Belanger H, Donnell A, Scott S. Normative Data for the Neurobehavioral Symptom Inventory (NSI) and Post Concussion Symptom Profiles Among TBI, PTSD and Non-clinical Samples, The Clinical Neuropsychologist, 2014
•Wells, Adam et al, Reliability of the Dynavision D2 for Assessing Reation Time Performance. 2014. Institute of Exercise Physiology and Wellness, University of Central Florida, Orlando.
•Willer B, Leddy J, Time to Change from a Symptom-based Concussion Assessment to a Structured Physical Examination, Society for Academic Emergency Medicine, 2016, ISSN 1069-6563
Upledger Institute
Neural Visceral Relationships
•Aziz Q, Thompson DG, Ng V, Hamdy S, Saskar S, Brammer MJ, Bullmore E, Hobson A, Tracey I, Gregory A, Simmons A, Williams S, Cortical Processing of Human Somatic and Visceral Sensation, J Neuroscience, April 2000, 20(7):2657-2663
•Bansal V, Costantini T, Kroll I, et al, Traumatic Brain Injury and Intestinal Dysfunctions: Uncovering the Neuro-Enteric Axis, J Neurotrauma, 2009:26(8):1353-1359
•Coen s, Gregory L, Yaguez L, Amaro E, Brammer M, Williams S, Aziz Q, Reproducibility of human brain activity evoked by esophageal stimulation using fMRI, Am J Physiol Gastrointest Liver Physiol, March, 2007, 293:G188-G197
•Gaddam S, Buel T, Robertson C, Systemic Manifestation of Traumatic Brain Injury, Handbook Clinical Neurolog, 2015, 5:127:205-218
•Kharrazian, Datis, Traumatic Brain Injury and the Effect on the Brain Gut Axis, Alternative Therapies, Vol 21 Suppl 3, 2015
•Sarkar S, Hobson A, Furlong P, Central Neural Mechanisms Mediating Human Visceral Hypersensitivity, Am J Physiol Gastrointest Liver Physiol,
28:1:G1196-G1202, 2001