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Lectures 18-23

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.
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Question
Answer
What is the function of the cervical spine?   show
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show women; this may be b/c the cervical vertebrae of women are not as robust  
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show 20-40  
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show 30-59  
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show False; neck pain is second to lower back pain  
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What fraction of ppl have an episode of neck pain during their lifetime?   show
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show smoking, middle age, female gender, mental stress, dental/facial problems, obesity, other MSK pains, prolonged work with the hand above shoulder level  
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What are some co-morbid conditions associated with neck pain?   show
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show 7  
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show lordosis  
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show they are bifid  
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What is the fxn of the uncinate process on the cervical vertebrae from C3-C7?   show
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show the vertebral artery runs through the foramen  
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What are the three distinct biomechanical areas of the cervical spine?   show
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What is the occipital-atlantal segment?   show
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What is the atlantal-axial segment?   show
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show They stabilize the spine and control the effects of gravity. They also integrate cervical spine movement with thoracic, rib, and upper extremity motions.  
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Cervical muscles are divided into what two major groups?   show
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What motions are enabled when the cervical muscles act bilaterally?   show
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show sidebending and rotation  
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show 8  
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show ABOVE the corresponding cervical vertebrae (for example: C1 nerve root exits above the C1 vertebrae)  
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Where does the nerve root of C8 exit?   show
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Where do the rest of the nerve roots exit?   show
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Where is the most common herniation in the cervical spine?   show
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show flexion and extension  
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show 50%  
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show NO  
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show in the OPPOSITE direction  
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What is the primary motion of the atlantal-axial joint?   show
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show 50%  
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show they open  
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What happens to the facets during extension of the cervical spine?   show
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In the cervical spine (excluding the OA joint), when sidebending occurs, what direction will rotation occur?   show
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When might you observe dorsokyphosis?   show
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Sluggish movement of the cervical spine may be indicative of...   show
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show acute muscle spasm  
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show active  
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show Passive range of motion should be equal to or greater than active range of motion.  
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show loss of rotation (rotation to either side should be near 90 degrees with a smooth end feel)  
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show perform a neuro exam of the upper extremities and consider doing an x-ray to evaluate for osteoarthritis, cervical radiculopathy, and severe cervical strain.  
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show diminished ability to sidebend (should be greater than or equal to 45 degrees)  
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What is the most commonly irritated neck muscle?   show
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show trauma and/or cervical strain (think reactive whiplash, fibromyalgia, poor posture, etc.)  
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show radiculopathy, but it is not a sensitive test  
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How do you perform the Spurling maneuver?   show
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show C5  
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wrist extensors nerve   show
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show C7  
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finger flexors nerve   show
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interossei m nerve   show
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biceps reflex nerve   show
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show C6  
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triceps reflex nerve   show
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What does the Wallenberg test asses?   show
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How do you perform the Wallenberg test?   show
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show nystagmus, dizziness, lightheadedness, visual disturbance  
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What is contraindicated by a positive Wallenberg test?   show
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show paracervical tenderness, abnormal upper extremity exam, loss of full ROM (especially rotation), positive Spurlings, and relief when vertical traction is applied  
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show You would treat the muscle tension and/or tender points with soft tissue, counterstrain, or MFR  
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What tests should you perform before treating cervical somatic dysfunction?   show
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When should you obtain an x-ray before treatment?   show
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What is the most common cause of cervical strain and sprain?   show
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show muscular injury  
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show ligamentous stretch injury  
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show posterior muscle strain, interspinous ligament sprain, anterior vertebral body compression or fracture, disc herniation, and spinal stenosis  
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show anterior muscle strain, anterior ligament sprain, brachial plexopathy, and fracture of the dens (atlanto-axial subluxation)  
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What is at risk when there is a contusion caused by a shearing injury?   show
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show the anterior longitudinal ligament, the facet capsule, and the anulus fibrosis of the disc  
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show the articular pillar, the subchondral plate, evulsion of the endplate, and the articular surface  
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show neurological symptoms are more probably; this is b/c the cranial nerves may be subjected to stretch  
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show True  
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Victims of whiplash have a worse prognosis if...   show
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show 56%  
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What percent of whiplash patients have recovered at 24 months?   show
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Persistent restricted motion predicts...   show
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show pain and disability at 2 years  
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Patient guarding with active ROM is a red flag for...   show
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Why is ROM at 3 months important?   show
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How long after a whiplash injury should you wait to use direct techniques?   show
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show indirect techniques, sympathetic normalization, and lymphatic drainage  
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If there is still pain after two weeks, you can add...   show
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If there is still pain after 2 months, what can you do?   show
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What is somatic dysfunction?   show
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show the neurogenic hypothesis  
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show TRUE  
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The key to diagnosis of somatic dysfunction is...   show
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What component of physiology are we concerned with when using counterstrain?   show
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afferent nerves   show
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show carry info from the CNS to functional motor end organs  
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show sensing of motion and position of the body in space  
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show sight, hearing, the vestibular system, golgi tendon organs, and muscle spindle afferents  
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Nociception is carried out via...   show
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alpha motor nerves   show
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gamma motor nerves   show
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show stretch, rate of stretch, and relative/absolute position in space  
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show trauma/sudden strain causes proprioceptive dysregulation; spindle afferents send inaccurate info to the muscle which maintains spasm at rest; lack of coordination of agonist/antagonist; dysfunctional hypertonia causes tenderness  
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show alpha/gamma resetting  
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What is the competing model to the counterstrain model?   show
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show postural imbalance - strain - NEURAL IMBALANCE - muscle spasm - tenderness - pain  
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nociceptive hypothesis order of events:   show
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What are we trying to fix in the counterstrain/gamma gain hypothesis?   show
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show pain b/c this is the cause  
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show William G. Sutherland  
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show 1. motility of the brain and spinal cord 2. fluctuation of CSF 3. mobility of the intracranial and intraspinal membranes 4. mobility of cranial bones 5. involuntary mobility of the sacrum between the ilium  
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Cranial rhythm corresponds to...   show
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show cranial rhythmic impulse (CRI)  
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show the sphenobasilar synchondrosis  
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How does the SBS move in extension?   show
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How does the SBS move in flexion?   show
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show 10-14 cycles/minute (Note: rate is determined from flexion to flexion...NOT flexion to extension)  
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show flexion to extension  
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show CRI rate, amplitude, and symmetry  
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What is a normal CRI amplitude?   show
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show TRUE  
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The CRI can be palpated over the entire body as...   show
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coronal suture   show
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show articulation b/w the parietal bones  
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show articulation b/w the occipital and parietal bones  
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show articulation b/w the parietal and temporal bones  
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pterion   show
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show articulatory spot where the temporal, parietal, and occipital bones all meet  
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occipitomastoid suture   show
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bregma   show
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show where the lambdoidal and sagittal sutures touch  
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show headaches, sinus congestion, URI, CN entrapments, TMJ dysfxn/facial pain, cervical pain, mood disorders, otitis media, tinnitus, vertigo, colic, torticollis, feeding disorders, and plagiocephaly  
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Contraindications for cranial manipulative therapy   show
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What is the cranial base?   show
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show a union of two bones formed by hyaline cartilage or fibrocartilage (allows for slight movement)  
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show FALSE...ALL cranial base strain patterns are named in relation to what the SBS is doing.  
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show there are 2 parallel TRANSVERSE axes; during flexion the sphenoid and occiput rotate in opposite directions around the axes so that the SBS moves superiorly  
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What axes are involved in extension?   show
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What are the physiologic cranial base strain patterns?   show
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What are the non-physiologic cranial base strain patterns?   show
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Which strain patterns (physiologic or non-physiologic) are usually caused by trauma to the head?   show
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SBS torsion   show
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show it is named for the greater wing of the sphenoid that is superior  
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SBS sidebending rotation   show
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show for the side of convexity  
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show shearing forces at the SBS (such as a helmet to helmet hit at the top of the head)  
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Describe the movement associated with a vertical strain:   show
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show named for relative position of the sphenoid base to the occipital base. b/c we are monitoring the greater wing of the sphenoid, naming is opposite to what is felt. if you feel the sphenoid move superiorly, it is an inferior vertical strain.  
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show a shearing force applied just anterior or posterior to the SBS (for example: a bat hitting someone on the side of the head)  
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Describe the movement associated with a lateral strain:   show
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show While in the vault hold, both index fingers would point in one direction while the pinkies point in the opposite direction  
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How is lateral strain named?   show
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What might cause SBS compression?   show
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How is SBS compression classically described?   show
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Describe the developmental difference b/w the cranial vault and the cranial base:   show
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What bones make up the cranial vault?   show
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Which of the bones composing the cranial vault are 'paired'?   show
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show the occiput and sphenoid (greater wings)  
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What are the midline bones and how do they move during CRI?   show
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How do the paired bones move during each CRI?   show
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show When the midline bones are in FLEXION, the paired bones are in EXTERNAL ROTATION. When the midline bones are in extension, the paired bones are in internal rotation.  
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Articulations of the occiput include...   show
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show the occiput, the temporal bones, the ethmoid, the palatine bones, the frontal bone, and the vomer  
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show trauma with forceps delivery, endocrine problems can result from sphenoid dysfuncion, and there may be problems with CN I-VI if there is sphenoid dysfunction  
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show parietals, ethmoid, sphenoid, lacrimals, nasals, zygomae, and maxillae  
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The frontal bone has an inferior attachment site for what important cranial structure?   show
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What brain region is housed in the frontal bone?   show
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show the frontal bone forms the roof of the orbit and the floor of the anterior cranial fossa  
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Indications for frontal lift (a cranial vault technique):   show
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show the middle meningeal artery  
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What brain structure is protected by the parietal bones?   show
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show the superior sagittal sinus  
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show sphenoid, temporal, occipital, and frontal  
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Indications for parietal lift (a cranial vault technique) include...   show
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articulations of the temporal bones:   show
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show mastoid process that connects the SCM, petrous portion that connects to the sphenoid, long protruding column that connects to the zygoma, fan-shaped squama that attaches to the parietals superiorly  
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Where is the axis of rotation for the temporal bones?   show
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What is contained within the petrous portion of the temporal bones?   show
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show hearing, balance, pain, and vagatonia  
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Why might strabismus improve with temporal balancing?   show
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Temporal balancing is good for children with...   show
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Important structures associated with the temporal bone include:   show
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Indications for temporal balancing through temporal decompression:   show
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show it overlies the anterior branch of the middle meningeal artery and is the thinnest region of the cranial vault; restrictions at the PRM can shut down the entire PRM  
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What is significant about the occipitomastoid suture?   show
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Hypertonus or contracture of the temporalis muscle, as in conditions of emotional stress, dental malocclusion, and/or temporomandibular joint dysfunction can restrict...   show
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show sutural tenderness or cranial bone restriction associated with headache, cranial nerve entrapment, or other problems  
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show through the general visceral afferent neurons of the autonomic nervous system  
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show ambiguity at the barrier  
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True or false: The intensity of the palpatory findings is often not a good indicator of the severity of the causative visceral pathology:   show
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show small (2-3 mm) firm nodular masses, palpable in soft tissue, that demonstrate sharp pinpoint nonradiating tenderness; Chapman's reflexes provide another method of recognizing viscerosomatic effects.  
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To diagnose viscerosomatic reflexes, it is recommended that special palpatroy attention be directed toward to costotransverse area in the thoracic spine. Viscerosomatic reflexes may be differentiated from primary somatic dyfxn by...   show
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show increased skin temp, red reflex, increased sweating, increased skin drag, cutaneous and subcutaneous tissue texture change, and active spasm of the deep paravertebral musculature (multifidi and rotatores)  
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What are some signs of chronic viscerosomatic reflex?   show
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show from the first thoracic segment through the mid lumbar region  
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show in association with the vagus with manifestations in the high cervical region; there may also be manifestation in the pelvic region  
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show the medical treatment specifically indicated for the underlying pathology responsible for the reflex  
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True or false: Manipulative treatment may be directed at the somatic dysfunction to decrease the facilitated state, even if it is of viscerosomatic reflex origin. This results in a beneficial effect upon the site of pathology.   show
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show inhibitory pressure procedures  
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show congested states (such as pneumonia) or hypoactive conditions (such as constipation)  
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Somatic dysfunction that resists manipulative treatment should cause concern about...   show
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How does OMT of viscerosomatic reflexes work?   show
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show massage of the point for 10-30 seconds  
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show T1-T4  
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cardiovascular   show
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show T2-T7  
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Stomach, liver, gallbladder   show
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Small intestines   show
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Ovaries/testicles   show
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Kidney, ureters, and bladder   show
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show T8-L2  
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show T10-T11  
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Prostate   show
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