of http://www.neuropaediatrie.com/aerzte/Stellungnahme/KRANIOSAKRAL.htm :
Craniosacral
Statement by the Society for Pediatric Neurology.
Commission treatments for developmental disorders and cerebral movement disorders: D. Karch, G. Gross-Selbeck, H.-G. Schlack, A. Ritz, D. Rating
Introduction
The Craniosacral is increasingly in recent years more frequently used in the treatment of developmental disorders in childhood and adolescence by physiotherapists, occupational therapists and speech therapists. The therapy is indicated for alleged motor and language development disorders, behavioral problems, learning disabilities, autism. However, in chronic pain, rheumatoid arthritis, scoliosis, vision and hearing disorders or mental disorders and is recommended. The Craniosacral is often framed in a longer-term treatment with conventional treatments, but are not that a special regulation.
The Craniosacral belongs to the realm of manual medicine and in the U.S. mainly promoted by doctors of osteopathy or osteopathic medicine at the Institute of the State University research in Michigan. Conceptually, it moves between traditional allopathic medicine and osteopathic medicine, which relies mainly on psycho-physiological self-regulation processes, such as Green in the preface of the textbook for Craniosacral (Upledger and Vredevoogd, 1996) performs. This opinion of the Society for Pediatric Neurology relates essentially to this textbook, and cited scientific publications.
Theoretical ideas
The "Kraniosakralsystem" is an independent physiological system considered, which is composed of: the Meningealmembranen, bone structures in which the Meningealmembranen are attached, the fibrous structures which are closely linked to the Meningealmembranen, the cerebrospinal fluid and for the production, absorption and storage of the liquor serving structures. The system would be in close liaison with all other body systems, especially the nervous and musculoskeletal system, the systems would interact.
The Kraniosakralsystem is characterized by continuous rhythmic movement ability, the frequency usually amounts to 6-12 cycles per minute. This rhythm is changing in diseases very and lie as much in comatose patients because of brain lesions at 2-4x per minute, or due to ingestion of drugs at 12x per minute. He was abnormally high in hyperkinetic children, or acute febrile conditions. Changes of the amplitudes would allow to draw conclusions about the vitality level of the patient. The other hand, remained stable at Kraniosakralrhythmus emotional arousal during physical exertion or at rest, in contrast to cardiac and respiratory rhythm. The Kraniosakralrhythmus leave at the entire body to detect especially in the area of the sacrum, palpation. Here there is a gentle rocking motion about a transverse axis, located about 25 mm before the second Sakrumsegment. A movement Sakrumspitze of the expansion phase corresponds to anterior and posterior movement of the extension phase. But also the entire body turn during the expansion phase and are wider to the outside or inside during the expansion phase and then narrower.
The origin of the Kraniosakralrhythmus had still not been known. Upledger and Vredevoogd (1996) posit a "pressure balance model": If one were to assume that the Liquorproduktion twice as fast as we successes the absorption, arises an upper pressure limit that care by an unknown mechanism to ensure that the Liquorproduktion be stopped, and a lower pressure limit at the start production again. The changing and dismantling of the pressure will indeed limited by the bony and connective tissue of the skull, but this limit is flexible, be deemed as the most anatomists. The collagen and elastic fibers of the sutures were crossed by vascular and nerve plexus, so that could be activated in certain hydraulic pressure in the skull inside a stretch reflex that is responsible for stop or start the Liquorproduktion. Researchers at the University of Michigan are trying to prove not only that neurophysiological control loop, but also about the fact that neuro-physiological regulation mechanisms in the cranial venous (Sine) admit that the flow of cerebrospinal fluid would control reflex.
non-physiological movements would occur as a result of restriction by connective tissue or fascia in the musculoskeletal system (eg, adhesions, inflammation or abnormal neuro-reflexes), but even with a constant overload of the sympathetic nervous system as a result of everyday stress when the body was no longer able to to reduce the stress stimuli. Against these restrictions or barriers to the work Kraniosakralsystem, which would change the quality and amplitude of craniosacral motion. Rigid barriers would arise by bony problems, elastic, by contrast, abnormal Membrane voltages. "The response of the whole body based on the Kraniosakralsystem on the concept of fascial continuity throughout the body. The movements of the body are probably related to the impact of fluctuations in the cerebrospinal fluid on the nervous system, which in turn affects the tone of the body tissue." (Upledger and Vredevoogd 1996, p.31)
techniques and objectives
The focus of the examination technique to evaluate the craniosacral rhythm is the palpation. It takes place with both hands, the proprioceptive perception had to be specially trained. Then one could feel, for example, that the head of 6-12x per minute will narrow and wide, with the occiput will broadly in the expansion phase and the base of the skull move anteriorly and to rotate about a transverse axis about 5 inches from the inion and in the expansion phase become smaller and curved turn back in the opposite direction. Also on palpation of the temporal bone or parietal you feel their movement, which runs symmetrically and in the same rhythm. Importance of the synchronous motion between the occiput and sacrum (above) to collect. The investigation techniques vary depending on the body part or organ system.
Treatment serves the aim of abnormal restrictions and barriers to the movement adopted to eliminate and has played an "autonomous flexibility" to restore. "Somatic dysfunction" or "osteopathic lesions" were palpable in the paravertebral areas as altered tissue structures, there are also pressure sensitivity and visceral dysfunction would.
barriers would be detected by moving samples, it is the movement initiated by the therapist of the tissue and evaluated in the further course. This could be abnormal restrictions of movement are detected, especially in the connective tissue and the fascia. The removal of restrictions is abnormal by indirect or by direct techniques. The indirect technique there is to promote the movement to free, unrestricted movement direction to the extent deemed possible. In this position, the structure is held by the therapist, it would be possible to the mobility of capital structure, stand-alone way back to a neutral position. This procedure is repeated for several craniosacral motion rhythms. This relaxed the tissue ("Release"). By the direct technique will attempt to resolve an abnormal barrier in that the limited structure or membrane was supported in its movement. All procedures are performed smoothly and without great effort in very different parts of the body, very often stood but occiput and sacrum at the center of the treatment. In the course of treatment will aim at the rhythm of the craniosacral motion can be modified or stopped. If the rest point (point still ") is reached, step on a total relaxation, somatic disorders were relieved and pain is alleviated. These phases are brought about several times.
As "CV-4 technique the treatment is called the occiput, where the adjustment to the intracranial pressure conditions is usually very good and vice versa as a result of external influence by the movement of the occipital bone of the intracranial pressure could be increased. A compression of the 4th Ventricle was adopted. Thus, the intracranial fluid movement and the exchange of cerebrospinal fluid is encouraged. The osteopathic treatment at occiput influences include the diaphragm activity and the autonomic breathing control. They also lower the tone of the sympathetic nervous system, which has a very positive effect on "stress patients" (Upledger and Vredevoogd 1996, p.54).
It is assumed that a continuity of fascial structures in the musculoskeletal system is so that abnormal changes and therapeutic measures along this system could be passed almost without hindrance. In this longitudinal system of fascial continuity links are involved ("Transverse diaphragms restrictive), the areas of significant pressures and therefore predilection for dysfunction of the craniosacral system are. Therefore, that the loosening of restrictions as to transverse the diaphragm, the diaphragm of the pelvis or upper thorax an important role.
Other goals of treatment are mentioned include: dysfunction in the craniosacral Durasystem, at the base of the skull, bone and bone joints of the skull, mouth and face and the temporomandibular joint. In these areas some special investigation techniques used for the detection of functional disorders in the textbook of Craniosacral (Upledger and Vredevoogd, 1996) described in detail together with the treatment techniques. Although this could be derived specific "lesions", but the clinical symptoms, which is caused by "lesions" or dysfunction, is addressed only very vague. In Torsionsstörungen (limited flexion or extension of Kraniosakralbewegung) should lead to headache and pain in the "nervous system, skeletal muscle, recurrent sinus infections or even malfunction of the endocrine system. For specific disorders sphenobasilar also existed personality changes (angry outbursts, antisocial behavior) in compression of the skull base, the most severe symptoms (depressive states, autism) were. In a "wedging" of the os sacrum (for example, fall injuries) between the ilia and disorders of the autonomic nervous system were observed. Breakdowns in the condyles of the Os would occiput lead to serious clinical symptoms were due to in part to faulty development of the bony nerve canals or impairment of the atlanto-occipital joints (eg, speech and swallowing difficulties, taste disturbances, heart rhythm disturbances). Find that the temporal bones symptoms existed in the area of hearing, Balance, motor control of eye (strabismus) and reading disorders. It could also be assumed that general disorders or disturbances outside of the nervous system, skeletal muscle "to the craniosacral rhythm take secondary influence, and thereby cause the above-mentioned disorders.
to the child's age, the following symptoms due to dysfunction of the craniosacral system can cause: severe anxiety and excessive crying in infants, hyperkinetic behavior, concentration problems and anxiety and learning problems (eg dyslexia) at school age, as well as spastic cerebral palsy and autism!
studies on the investigation techniques
Some publications deal with the frequency of measurable disturbances of Kraniosakralrhythmus for certain diseases or the reliability of applied research techniques. Thus Upledger et al. (1977) the reliability of the examination technique to determine the craniosacral rhythm at 25 preschool children tested. 4 doctors, all trained at the School of Osteopathy in Michigan studied independently with the same 19 techniques either every 25 or 11 children, 8 and 6 children. Evaluated, only the findings that were related to the restriction of each movement, and the degree of correspondence was sometimes very high, it was on average 71%. The authors therefore conclude that the existence of an imperceptible movement craniosacral system is proved substantially.
Upledger (1978) resulted in 203 primary school children by him for Kraniosakralbewegung by standardized tests and compared the results with the school success. Examined a total of 19 "Movement variables" are (on a scale of 1-3), were measured movement rash, bilaterality and restriction of movement caused by the doctor. The children were recruited from a regular school and a "Motor Coordination Clinic". The problems of the children were divided into 8 categories in advance, the report from the school or were taken from the history, according to the parents. 164 children were referred by the school as normal. Of these, 41 no other problems and 135 children have no problems from the categories 2-4 (behavioral disorders, motor disorders, learning disabilities) had, however, anamnestic abnormalities (category 5-8: seizures, head injury, pre-and perinatal risk factors or ear disorders). In the 39 non-normal children was usually more than one problem of the category 2-4. The comparison of these tests with the problems of the children showed a significant correlation between the mean values of all scales with the school assessment: normal / not-normal, and the existence of Behavioral problems, motor coordination disorder, learning difficulties and pre-and perinatal risk factors. It also showed that all tested investigative techniques or movement variables significantly correlated with the existing problems of the children had, had the highest correlation coefficient for "compression and decompression. The statistical calculations were carried out carefully and confirm that abnormal findings are significantly more common in school children with different problems in comparison with unproblematic children. The authors conclude that "the Kraniosakraluntersuchung as a reliable method for to see coverage of problem children in school is "without noticing that the statistical calculations on subjective rather than objectively verifiable findings are based.
outcomes
In the literature, no studies related to the evaluation of treatment results. In Textbook of Craniosacral (Upledger and Vredevoogd 1996) are reported experience and case reports or studies will be reported, but not in which journal they were published Here are some examples. On page 128 says that the correction "lateral strain" of the sphenobasilar " in a number of cases "to a staggering improvement of reading skills have done. On page 267 is of "immediate and dramatic relief of symptoms" in children's behavior and concentration problems in the treatment of the disorder reported the condyles of the occiput bone. The children were rarely more than 4 times must be treated to achieve a lasting success. A study for the treatment of hyperkinetic children was being prepared. On page 268, and 269 are "sensational" cases presented have which reached the Craniosacral an almost complete restoration of a 3-year-old boy and a 9-year-old girl with spastic hemiplegia, and an almost motionless tetraparetisches girls aged I learned 5 years after a few treatments and are crawling. It
and 108 children were treated with autism, which found themselves with little or no perceptible rhythmic movements of the Kraniosakralsystems and conducted various research findings at the conclusion were that would exist in autistic children heavy diaphragm restrictions (dural membrane). Even an etiological relationship is discussed. During the treatment, which must take place in several phases, would the behavior change in the typical way. First, improve the self-injurious behavior (possibly by reducing headaches), then many would Children's cooperative and showed a positive attitude toward therapy, and finally there is positive emotional and creative expression.
opinion
The Craniosacral is based on the assumption that a separate system of rhythmic movements in the CNS, whose existence was not proven and its possible origin is not even by the protagonists of this method explains uniform, but apparently due to changes in the cerebrospinal fluid pressure was. Another assumption is that bone synchondroses, coalitions, joints, fascia and muscles with the CNS a close-knit "nervous system, skeletal muscle" form and that mechanical changes particularly negative effect on the skull of this craniosacral system would (in the sense of abnormal barriers and restrictions). The third assumption is that, etc. are addressed by special, very gentle manual-medical interventions abnormal restrictions, blockades, jams could, especially by manual intervention on bone skull structures that are mechanically only minimally influenced. The treatment was necessary as would be caused by abnormal conditions somatic, psychosomatic and psychological symptoms. To date, although some case reports with clinical improvements described as blatantly informed but did no controlled studies on the treatment results.
There is no doubt that with careful palpation of the head, back, body and so on and tension, changes in Gewebskonsistenz be felt and so on. On this rests the diagnosis and treatment of manual medicine in general (Karch et al. 1998). The results of studies to monitor the investigation techniques of Craniosacral and the reliability of the findings are understandable in so far as the investigators are from the same school and have learned to interpret the palpatory findings in the same sense. Objective evidence of an alleged Kraniosakralrhythmus is not provided with it.
Passive and active mobilization with the aim of to alleviate abnormal limitation of motion of joints, and local and peripheral irritation of muscles, connective tissue and skin, are a means of manual therapy. Even and especially gentle massage techniques can lead to relaxation and mental relaxation techniques are helpful to many of the alleged subsequent symptoms of abnormal craniosacral rhythms (headache, restlessness and pain, impaired concentration, behavioral problems, changes in the autonomic nervous system, etc.) to alleviate.
are totally unacceptable the idea that by Kranialsakraltherapie "strangulation" of the os should be annulled or that the occiput "Kraniosakralrhythmus" immobilized may be, if its existence is based on the rhythm of Liquorproduktion and drain in the CNS should. In the preface of the book is highlighted with the Craniosacral the right analogy to an "energy therapy", that rationale no longer anatomical or neuro-psychological texts, and conducted their practices and assumptions to be compared with those of yoga. The detection of abnormal palpation findings in children with learning difficulties or autism, as well as in patients with different psychosomatic symptoms usually shows no causal relationship. There are many indications that can be detected in the non-specific tissue palpatory examination techniques, the caused secondary. Positive effects on the mental state of patients and the existing symptoms are the gentle manipulation and the entire treatment situation may be understandable, but certainly not specific. Therefore, the Craniosacral is ultimately to be regarded as a special type of body massage, which is in the broad sense of manual medicine associate. The use of the procedure for the treatment of specific developmental and learning disorders should be rejected.
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