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 William Garner Sutherland – came up with cranial rhythmic impulse (aka primary

respiratory mechanism)
o Respiratory does not refer to the lungs, diaphragm, etc
o Respiratory refers to cellular respiration- mechanism by which cells survive-
expel trash, take stuff in, and make nutrients (in other words, movement of fluid
back and forth)
 Sutherland noted that there was movement that seemed to occur (inhale and exhale, ebb
and flow) independent of breath, independent of cardiac rate
 29 bones in the adult skull
o Should be able to list all of them
o Be able to ID on picture – aka GTQ
 Cranial group- be most familiar with these
o Occiput
o Sphenoid
o Ethmoid
o Frontal
o Temporal
o Parietals
 Facial group not as important
o Vomer
o Mandible
o Maxillae
o Palatines
o Zygomatics
o Lacrimals
o Nasals
o Inferior conchae
 Frontal bone and mandible function as paired bones – GTQ
o What is the paired bone with the frontal? Mandible
 Should know all the sutures and be able to find them
 Five principles
o Inherent MOTILITY of the brain and spinal cord (different from mobility!!)
 Motility is inherent motion of the cell types, as the cells essentially inhale
and exhale (draw in nutrients and expel them)
o Fluctuation of the CSF
 Pressure increases and decreases as it ebbs and flows
 Pressure fluctuations is independent of cranial heart rate and respiration
o MOBILITY of the intracranial and intraspinal membranes
 Membranes on which bones sit can be tugged and pulled on
 Connection between dura through the foramen magnum, sits and tugs on
the sacrum
o Articular MOBILITY of the cranial bones
 Always been taught bones of the skull are fused
o Involuntary MOBILITY of the sacrum between the ilia
 Piriformis attaches to the inferolateral anterior aspect of the sacrum,
reaches out and grabs greater trochanter
 Pubococcygeus muscle
 Inherent motion of the CNS
o Coordinated contraction of oligodendroglia
o Neural cells actually contract
 Fluctuation of the CSF
o Flow of CSF: lateral ventricles  foramen of Monroe  3rd ventricle  cerebral
aqueduct  4th ventricle (through medial aperture of Magendie and lateral
aperture of Luscka)  subarachnoid cisterns
o Know where CSF is created and where it is absorbed
 Mobility of the dural membranes
o Fals cerebri
o Falx cerebelli
o Tentorium cerebelli
o Know these 3 have the title of SICKLE SHAPED AGENCIES
o Distribute the forces that are put on the brain
o If you pull on any of these membranes, will put tension on the skull
 Know the common origin of the 3 dural membranes
o STRAIGHT SINUS aka SUTHERLAND FULCRUM
 Dural attachments
o Foramen magnum
o C2, C3
o S2
 Mobility of the dural membrane
 Articular mobility of the cranial bones
o Sutures accommodate the CRI as the skill ossifies
 The sutures are joints
o Joints allow motion
o Shape for the suture reflects its motion
 Ex. Infant skull deforms coming out the birth canal. Osteopathic tenet?
o Structure and function are reciprocally interrelated
 Limit of quantification (LOQ) for Merkel’s disc
o 10 nm
o Ie have to push 10 nm (or 10 nm deformation) to feel Merkel disc
o Impulse travels through atoms in waves
o We can sense movement without seeing movement
 Involuntary mobility of the sacrum between the ilia
o Movement occurs through superior transverse axis of S2
o There are 3 transverse axes that go through S2