Lectures 18-23
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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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