Cranial

[Bookworm]

Where can I find research on cranial osteopathy? I have heard that there has been research on cranial and longitudinal studies on otitis media and children who receive cranial. However, where do I find these studies?
I have never seen these studies so I also don?t know how valid they are--how controlled and randomized they are.
Has there ever been a good study that compared children receiving cranial with those who did not and their outcomes later in life as far as learning disabilities and otitis media etc? I?ve heard that there was one, but I looked on OstMed and didn?t really find much regarding this.
Thanks for pointing me in the right direction

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[Pilot]

Mariam Mills at Oklahoma State University has been doing research on this topic. I don't know if the final results have been published, but I know that some of my classmates did summer work for her processing data. You might try a search with her name.

 

[DrMom]

Here's some information on Dr. Mills

Miriam Mills, M.D.

(Yep, she is an M.D.)

 

[DermpathDO]

Try looking for research from Viola Frymann DO or material from the Sutherland Foundation. Viola is the Cranial doc ensconced at Western ( if she is still alive) and I did some training with her back in the 80's. A very wonderful lady who pioneered using cranial therapy in the treatment of children, especially new borns and the ******ed. The Sutherland Foundation is the group that teaches cranial through the AAO as well as many other programs.
I am sure your Medical school library ( if it is Osteopathic ) has much material from these two sources.

 

[Bookworm]

thanks for the info

 

[osteodoc13]

Here is a bibliography of cranial research I posted for this purpose...enjoy!!!

http://home.earthlink.net/~bloveless/biblio.html

 

[stacyg]

Dr. Frymann is still alive and working at the Osteopathic Center For Children in San Diego.

 

[paramed2premed]

I come in peace! But I do wonder what you guys think of a few studies I found on MEDLINE.

INTRAEXAMINER AND INTEREXAMINER RELIABILITY FOR PALPATION OF THE CRANIAL RYTHMIC IMPULSE AT THE HEAD AND THE SACRUM: Moran RW, Gibbons P/ J Manipulative Physiol Ther 2001
"Conclusions: The results fail to support the construct validity of the 'core-link' hypothesis as it is traditionally held by proponents of CS therapy and osteopathy in the cranial field."

A SYSTEMATIC REVIEW OF CRANIOSACRAL THERAPY: BIOLOGICAL PLAUSIBILITY, ASSESSMENT RELIABLITY AND CLINICAL EFFECTIVENESS: Green C, Martin CW, Bassett K, Kazanjian A/ Complement Ther Med 1999
"This systematic review and critical appraisal found insufficient evidence to support CS therapy. Research methods that could conclusively evaluate effectiveness have not been applied to date."

CRANIOSACRAL RHYTHM: RELIABILITY AND RELATIONSHIPS WITH CARDIAC AND RESPIRATORY RATES: Hanten WP. Dawson DD, Iwata M, Seiden M, Whitten FG, Zink T/ J Orthop Sports Phys Ther 1998
"The rate of the CSR palpated by two examiners is not consistent."

SIMULTANEOUS PALPATION OF THE CRANIOSACRAL RATE AT THE HEAD AND FEET: INTRARATER AND INTERRATER RELIABILITY AND RATE COMPARISONS: Rogers JS, Witt PL, Gross MT, Hacke JD, Genova PA/ Phys Ther 1998
"Conclusion: The results did not support the theories that underlie craniosacral therapy or claims that craniosacral motion can be palpated reliably"

 

[minime]

Commom sense says that cranial doesn't work. Think about it. As for Viola Frymann she is featured on quackwatch.com. Look her up. She was put on probation in 99 (and in 96) for gross negligence. Apparently she treated a baby with a urinary tract infection with cranial and vitamin C! After several visits to Dr. Frymann, the baby was continually getting worse and Dr. Frymann only documented somatic dyfxn. The whole story and the court documents are linked there. (The baby's parents finally got smart and took the baby to a real doctor).
Dr. Frymann is no longer licensed to practice medicine, and is one of the reasons that D.O's have a bad name.

 

[paramed2premed]

Ooh, that doesn't sound good.

Quacks are quacks, though. It seems like Harvard Med has turned out their fair share (Hey, this doc went to Harvard! He must be on to something.), but their graduates manage to walk around with their heads held high.

One thing we should avoid in this discussion, however, is the appeal to "common sense." It is almost as useless as personal experience, or mechanism. Common sense lead many smart people to believe that HRT would lower the risk of heart disease for postmenopausal women. Except it doesn't. It took a big study to show that common sense was 180 degrees wrong.

Outcomes research is the only good way to show something works, randomized and controlled.

 

[minime]

I agree with you 100%. The only way to prove something is to do controlled and randomized research. The women's health initiative that you've cited is a great example of that.

I'm a D.O. student. I've sat through the cranial lectures and labs, and they were unsuccessful in their attempts to brainwash me. You see, every modality in Osteopathic manipulation has "research" attached to it. Most, if not all of these attempts at research would be laughed at by any true scientific thinker. Have you seen the ridiculous pictures of these calipers that supposedly measure the cranial rhythm in nanometers? What you've probably heard about are the small, small studies that try to prove interexaminer reliabilty in assessing the CRI, what you haven't heard about are the studies that showed there was none.

Can you imagine what medicine would be like if everything that we learned was based on anecdotal evidence. We'd be prescribing epsom salts baths for cancer and prophylactic fleet enemas. Let's take the quackery out of osteopathic medicine.

 

[Dr Sum Day]

wwww.osteohome.com has some interesting stuff plus cases!

 

[paramed2premed]

So, Minime, what is it like to be a DO student and have stuff espoused in class that you believe is, at best, unsupported by literature? I am really appalled that CST has a place in the curriculum, giving it the imprimatur of medical knowledge.

Osteopathic schools appeal to me on many levels. I believe in their emphasis on hummane and personal medicine, and their role of the patient as chiefly responsible for the healing. I started this thread because I was concerned about the degree to which my education will include topics such as craniosacral therapy. Did this concern any of you current students before you applied? How do you handle the potential conflicts with your professors?

 

[Stillfocused]

You are right "Cranio-sacral Therapy" or CST is not medicine nor is it practiced by osteopathic physicians!

Cranio-sacral Therapy is the bastrad child of Osteopathy in the Cranial Field. It was "discovered" by John Upledger DO who kicked out of the AAO and lost his Fellow designation. It is a dumbed down, sloppy method that is practiced by physical therapists, social workers and European DOs.

In fact 3 out of the 4 studies that paramed2premed cited were from physical therapy journals. Is it any shock that PTs with one weekends worth of training were unable to reliably palpate the CRI???

The only inter-rater reliabilty study of CRI palpation concerning DOs and DO students was by Norton et. which showed that experienced practioners had a >.70 IRR correlation while inexperienced practioners blew. This is despite the fact that they study really small and used a "Biodynamic" (not a classic Sutherland) hand position. The IRR for other qualitative diagnostic methods like psychiatric diagnosis are not as high as .70.

Moreover, almost all of the "research" on OMM sucks.

However, it is getting better. Although, finding funding for non drug related studies is difficult. Remember, that until recently osteopathy existed far outside the world of conventional medicine and goverment research grants.

And, there are reams of interesting, suggestive studies that support OCF and its principles; see the links already provided.

Moreover, there are more than 125 years worth of strong clinical evidence suggesting that osteopathy, including OCF, is a safe and effective medical-surgical modality. It is stupid to dismiss a treatment method that seems to work well for so many reasonable, intelligent people because we do not have the numbers yet. That is simply putting the cart before the horse.

The most important recent work has come from Nelson et al. at CCOM that was published last year in the JAOA. It is pretty cool stuff.

And, once you have experienced palpating the CRI you will know that it is as real as the ground beneath your feet.

 

[minime]

My dad read in Prevention magazine that eating a bunch of cherries will keep you from getting cancer. If you believe in that or cranial then you have earned the title "QUACK"!!

 

[bones]

Originally posted by minime
My dad read in Prevention magazine that eating a bunch of cherries will keep you from getting cancer. If you believe in that or cranial then you have earned the title "QUACK"!!

How very scientific of you, minime, to dismiss something out of hand by appeal to this "common sense" notion again. While I haven't seen the evidence to support some of the claims made for cranial osteopathy in adults, cranial MOTION TESTING seems very reliable for dx from my experience in lab. probably no more difficult than thoracic segments, and similar reliability. the "cranial rhythm" that some classes start with is very hard to feel, and some probably imagine they are feeling it and aren't.

Clinically speaking I've seen some great things come out of cranial for babies. It doesn't take double blind studies to notice that a baby with a square head/uneven sutures and a hx of severe cholic- that looks normal and seems happy after a treatment or 2 may have noticed some benefit. Of course they don't have fused segments to wrestle with... beats surgical reconstruction anyway.

Unfortunately, I get the sense that most DO's just don't know how to do research. There is big NIH moola out there for those that want to jump on it though. You see very few good studies by DO's period, for OMM or otherwise- something I hope will change one day.

so hows that? a common sense appeal by a guy who wants you to avoid common sense appeals. just keep it all in perspective... common sense appeals are great for inclusion- finding things that are worth studying, etc... (though dangerous when accepted as truth). They are piss poor for exclusion, however, which is why quackwatch doesn't work. He uses just as hollow arguments to dismiss alternative medical treatments as most of the proponents use to promote them. You risk throwing out valuable modalities this way, just as you risk the lives of those you treat if you rely solely on unproven but seemingly effective techniques without backing them up with something more solid.

cheers,
bones

 

[paramed2premed]

Another perspective -

Allopathic medicine has a long tradition of manual diagnosis. Physicians palpate the abdomen, examine the chest for tactile fremitus, assess limb mobility, check various reflexes.

Some of these tests have been found to be reproducible and predictive. Others have been found to be inaccurate or have poor interexaminer reliability. That is why we now use the myriad imaging technologies available. Many of these physical signs are now only valuable as medical trivia to remember for boards.

The main point is that allopathic physicians, despite their loyalty to their beloved eponymic signs, are constantly assessing the utility of these "manual diagnoses." If a physical finding is found to, in reality, have a poor sensitivity or specificity, it is regarded as a bad test.

And, once you have experienced palpating the CRI you will know that it is as real as the ground beneath your feet.

Medicine cannot resort to common sense, the appeal to personal experience, appeal to authority, ad hominem attacks, or improper analogies. We need evidence for what we do.

If we assume the actual existence of a CRI, then we should be able to do two things. First, we should be able to document, through some sort of imaging or studies, the existence of a physical phenomenon that corresponds to the CRI, e.g. an oscillation in ICP unrelated to HT or RR. Second, we should be able to demonstrate an acceptable interexaminer reliablity (is 0.7 acceptable? I am not so hot with stats.)

Until then, let us avoid justifying CST on a scientific basis. Hey, if it feels good, do it. Just don't say that it is medicine.

 

[Stillfocused]

If you track down the references that have already been posted, you will find studies that address some of the concerns that you have in regards to ICP, RR and HR and cranial suture mobility. Yet these oscillations are not utterly separated form the Primary Respiratory Mechanism - Remember the principle of body unity.

Nelson et al have been able to demonstrate, in a preliminary manner, an established, direct, measurable physical phenomenon that strongly correlates with the PRM. Furthermore, they are at work on inter-rater reliability studies linking the PRM to THM and possibly a study using THM to teach students CRI palpation. Their early evidence suggests that highly experienced examiners are better able to correlate their perceived palpation of the CRI with THM. See the following:

For a good overview see:
The Primary Respiratory Mechanism
Kenneth Nelson DO, FAAO, FACOFP
AAO Journal Winter 2002 Pages 24-33
It is available here:
http://www.academyofosteopathy.org/journals.htm

On Medline see:

Cranial rhythmic impulse related to the Traube-Hering-Mayer oscillation: comparing laser-Doppler flowmetry and palpation.

Nelson KE, Sergueef N, Lipinski CM, Chapman AR, Glonek T.

Department of Osteopathic Manipulative Medicine, Chicago College of Osteopathic Medicine of Midwestern University, USA.

The primary respiratory mechanism (PRM) as manifested by the cranial rhythmic impulse (CRI), a fundamental concept to cranial osteopathy, and the Traube-Hering-Mayer (THM) oscillation bear a striking resemblance to one another. Because of this, the authors developed a protocol to simultaneously measure both phenomena. Statistical comparisons demonstrated that the CRI is palpably concomitant with the low-frequency fluctuations of the THM oscillation as measured with the Transonic Systems BLF 21 Perfusion Monitor laser-Doppler flowmeter. This opens new potential explanations for the basic theoretical concepts of the physiologic mechanism of the PRM/CRI and cranial therapy. Comparison of the PRM/CRI with current understanding of the physiology of the THM oscillation is therefore warranted. Additionally, the recognition that these phenomena can be simultaneously monitored and recorded creates a new opportunity for further research into what is distinctive about the science and practice of osteopathic medicine.

 

[Stillfocused]

Medicine cannot resort to common sense, the appeal to personal experience, appeal to authority, ad hominem attacks, or improper analogies. We need evidence for what we do.

I guess it depends on what you mean by ?evidence.?

If by evidence you only mean the ?gold standard? of double blind placebo controlled outcome studies then we must stop practicing surgery and psychotherapy immediately. Because it is technically and ethically impossible, to conduct such research. The direct comparison of drugs:surgery is an ?improper analogy.?

Manual medicine, as a branch of ?bloodless surgery?, faces a similar problem. The standards of evidence for drug testing simply do not apply.

Moreover, there are 100s if not 1000s of drugs that are pushed every day for which there is very little accepted evidence about their mechanism action ? see Wellbutrin as an example.

And, it is possible to argue that much of the current fetishization of ?Evidence Based Medicine? is due to pressures to maximize profit and minimize risk created by drug companies and the insurance industry not on a solid epistemology of medicine.

Outcome studies are really important, but good clinicians make sound medical decisions that are also based on their experience, morals beliefs, an understanding of a patient?s worldview and on their own hard won intuition. As an experienced clinician you trust your intuition constantly; it is silly to pretend that you don?t.

The practice of medicine is a science and an art.

I hope you have the chance to experience of the potency of Osteopathy in the Cranial Field before you dismiss it out of hand.

And, at its heart osteopathy is a holistic, even explicitly vitalist philosophy of medicine. It always has been a radical attempt to reform. If this makes you unbearably uncomfortable, maybe it is not your straightest path.

Best wishes.

 

[paramed2premed]

Stillfocused-

I am applying to UNECOM in 1 month. I would only be too pleased to continue this conversation with you as a fellow student.

Your response contains much that I agree with about the context in which medical decisions are made. Your descripition of OCF as "explicitly vitalistic" was insightful, as it does strike at the heart of what I find disturbing about explanations of OCF (though, if it does work, not the actual practice). We have much in common, however.

If I knew my "straightest path" I would jump on it. I do believe, though, that it will involve osteopathy.

Thank you for your thoughts

 

[osteodoc13]

Wow...it's great to see that the same discussions are still going on here at SDN.

Stillfocused: I see you are still posting. Thanks for posting the info on Nelson's work on CRI and THM. I was reading through the posts thinking the same thing.

As far as those who disagree with OCF, I think the discussion has to be centered on the effects of OCF, not on the existence of the CRI. There has been enough clinical and basic science research to show that there is a cyclical motion of the cranial bones which is palpable to a trained, experienced clinician. This does not include first year medical students, most MDs, and CST practicioners who take a weekend course from Upledger.

If someone wants to debate the effects of cranial manipulation on the body, then I would agree that the majority of the "research" consists of case studies and anecdotal evidence. There was a poster, however, at AAO Convocation this year in Ottowa which showed that cranial manipulation could have a measurable effect on the THM ossicillation. This effect was not evident during palpation alone. As the THM is mediated by the ANS, this is indirect evidence that OCF can alter the ANS tone in the body. Stay tuned to CCOM for more info!!!

 

[Stillfocused]

Hi Brian,

It is good to see you here also. How was your internship year?

CCOM is not the only school doing THM/CRI research. Rumor has it that WU/COMP has also gotten ahold of a laser doppler. Apparently, it is a 2nd generation machine that is equipped with 2 probes instead of only one. This should allow for more dynamic measurement, like simultaneous measurement the THM of the patient and the operator.

If you are still close to Pamona, maybe you could check the thing out and then tell us what you think.

 

[Stillfocused]

In terms of OMT and ANS control, here are a couple of preliminary studies that look at the osteopathic regulation of physiology that were published by the Meridian Institute(http://www.meridianinstitute.com). It is clinical research arm of the Association for Research & Enlightenment (the Edgar Cayce people).

They are little bit out there but they do have a fairly good understanding of traditional osteopathic theory and practice and the studies were originally published in relatively legitimate places.

This book chapter was published in Physical Medicine and Rehabilitation: State of the Art Reviews, Vol. 14, No. 1, February, 2000.
Physiological Regulation Through Manual Therapy
ERIC A. MEIN, MD et al.
http://www.meridianinstitute.com/ceu/ceu13phy.html

Osteopathic Regulation of Physiology
Fall 2001 The AAO Journal
Volume 11, Number 3, pages 34-38
http://www.meridianinstitute.com/ceu/ceu23aao.html

This is a somewhat tangential (but fascinating) article based on traditional osteopathic principles of ANS regulation and current research.

The Abdominal Brain and Enteric Nervous System
The Journal of Alternative and Complementary Medicine, Vol. 5, No. 6, 1999
http://www.meridianinstitute.com/ceu/ceu12abd.html

Also, the Meridian Institute also hosts ?Early American Manual Therapy,? a free web based library of some of the classics of traditional osteopathic literature including Still?s ?Autobiography? and selections from J.M. Littlejohn. But, it also includes some real garbage- caveat emptor.http://www.meridianinstitute.com/eamt/files/contents.htm

Enjoy!

 

[osteodoc13]

Hey Stillfocused:

Actually I still have 2 months of internship to go, but it's been a great experience. I'm at Chino Valley Medical Center which is right near COMP. I'll have to look into that doppler.

I was wondering if you could help me. I recently read an article on conceptual models and treatment models as they relate to OMM. The problem is I can't remember where I read the article. I have searched my AAO journals, but it isn't there. The best I can think is I might have read it in a Cranial Academy newsletter. Have you seen the article I'm speaking of?

Thanks in advance