Архив событий

2015-04-28 00:00:00 Статья для конгресса на Тайване (на английском)


Slepchenko Iuliia (Russia)
doctor of osteopathy

Craniosacral mechanism or osteopathic evaluation
of the effectiveness of hippotherapy.


The theme of the research is the osteopathic craniosacral mechanism. With regard to the hippotherapy we consider it as a special transmission of therapeutic information. Hippotherapy is a neurophysiological therapy, where a walking horse serves as a therapeutic agent for simulating physical activity.
When the patient is on horseback, his posture responds to the movements of the horse by weak coordinated reactions, thanks to which the patient learns and trains to keep equilibrium and compensatory muscle contractions. Proprioceptive sensorimotor stimulation takes place, improves posture and facilitates finding and fixing the closest to normal motor responses the patient is capable of.

At the same time such motoric correction trains muscles, correcting the disproportions and regulating muscle tone, which also maximizes the amount of motor activity in the joints (Ingrid Strauss, 2000).
Osteopathy deals with mechanical and functional aspects of the human body. Studies have shown that osteopathy shows effective results through the influence on the craniosacral system of the body.

Strauss (2000) believes that hippotherapy breaks the vicious circle of problems arising due to the inability to walk straight, on the one hand, and improper coordination of the body, on the other hand, since the movements the patient cannot reproduce are simulated by the motor impulses coming from the horse. Motor impulses are transmitted along nerve pathways ascending from the periphery to the center, thereby "training" afferent transmission of nerve impulses in the central nervous system from conditionally correct movement patterns.

Hippotherapy solves many problems of patients with walking disturbances.
It also gives good results in the rehabilitation of patients with other disorders associated with the pathology of the nervous system, such as neurological speech disorder, post stroke state, and even multiple sclerosis. Practical experience shows that it is impossible to explain all cases of a positive therapeutic effect of hippotherapy from the standpoint of its biomechanical and structural mechanisms.
We suppose that osteopathic medicine can offer one more mechanism, that is, craniosacral, described by Sutherland (Magoon, 2010). Craniosacral system is the central concept of Osteopathic Medicine, discovered by V.G. Sutherland, who along with E.T. Still is considered to be the founder of osteopathy. The basic principles of his theory of craniosacral are the following:
- The mechanical view of the body and movement of the bones related to each other like a tooth gear. But this purely mechanical view of the body is complemented by a new interesting concept of PRM.
- PRM or "primary respiratory mechanism" ia a part of the craniosacral system and forms the main basic rhythm of the human body, animating its mechanics.
Sutherland described the 5 components of craniosacral mechanisms involved in the primary breathing:
- Cerebrospinal central nervous system, which runs the PRM motility,
- Cerebrospinal fluid, which responds by fluctuation to the primary inhalation and exhalation,
- Mutual membrane tension then transmits this fluctuation in all directions on the dura,
- Cranial bones respond by coordinated movement
- Sacrum moves between the ilium in sync with the occipital bone.
PRM rhythm is the main rhythm of the body and belongs to the slow rhythms.

The mechanisms of PRM were explained by the Russian scientists, in particular by Y.E. Moskalenko, who was the first to register slow waves in the 50es.

Magoon tied slow rhythms to PRM. He explained that they are scientific proof of the existence of PRM. Thus, the theoretical findings of Sutherland, that is, the presence of the craniosacral system, PRM and the mobility of the skull bones found scientific confirmation.
Osteopathy considers that the primary link in the chain of events that determine the VSD is cranial rhythmic impulse. CRI is the short but intense influx of cerebrospinal fluid in the cranial cavity of the spinal dural sac cavity, which causes an increase in intracranial pressure and thereby initiates the processes included in the concept of VSD.

The most realistic concept looks for a force starting the impulse directing the cerebrospinal fluid in caudal direction and so forming the CRI and initiating movement of the skull bones. Then, these forces would ensure the return of CSF in cephalic direction and create the conditions for a new cycle of VSD. In physiological terms, the force providing VSD can only be muscular strength. Recent studies suggest that the muscles of the lumbar spine –sacral junction drive the sacrum and due to the action of mutual tension membranes occipital bone and the entire skull is set in motion.

Similar assertion can be found in traditional Chinese medicine, believing that craniosacral chain begins in the coccyx-sacral junction and the initiator of movement is the pelvic diaphragm, in particular, Pubococcygeus muscle (Mantak Chia 1986).

We share this opinion, as opposed to Sutherland and Magoon, who believed that the source of strength of VSD is in the skull. We suppose that hippotherapy activates craniosacral mechanism of the patient, thus providing a comprehensive therapeutic effect on all tissues and systems. To confirm the hypothesis of involvement of the craniosacral mechanism in hippotherapy, we conducted a pilot study at the Institute of Human Physiology (Russia), under Professor Moskalenko.

We chose the control parameters, the change of which would allow to estimate the changes in the five components of the craniosacral mechanism.
- Linear velocity of cerebral blood flow (cm / s) was measured by transcranial Doppler.
- Mobility of liquor.
- Compliance of skull bones.
- Pulse index, changes in the volume of cerebral blood vessels and intracranial pressure were found through mathematical modeling.
- The reactivity of cerebral vessels was studied using Stange test (apnea), and hyperventilation.
For registration of cerebral blood flow velocity we used Doppler device "MultiDop" (DWL, Germany) and ADC «PowerLab-4" followed by the registration and processing of data on the computer using the «Chart-5" program.
Ultrasonic beam was focused on the M1 segment of the middle cerebral artery, which supplies about 80% of the volume of blood to the cerebral cortex.

The accuracy of the technique is proved by magnetic resonance angiography, which showed that the normal diameter of the middle cerebral artery at rest and during functional loads did not change (Bullitt E., 2010).

We used the methods of studying the reactivity of cerebral vessels, as the fact of low predictive value of the numerical values of cerebral blood flow at rest is well known.

We know about the highly informative indicators of cerebrovascular reactivity, so in the course of the study we determined the functional states of cerebral hemodynamics using stress tests.

Determination of cerebral vascular reactivity is based on the comparison of the values of blood flow at the base of the middle cerebral artery before and after the function test.

We calculated reactivity indexes reflecting the state of the system of regulation of cerebral blood flow by the results of changes in its linear velocity in the middle cerebral artery after the application of functional tests.

In order to objectively assess the reaction of vessels to the tests we evaluated changes in the state of the system of cerebral circulation, which are expressed in the changes of linear blood flow velocity in the spinal artery. For this purpose, the following functional tests were chosen:

Stange test - holding of breath at inspiration for 30 seconds. The test was proposed by the Russian doctor V.A. Stange in 1914 (Stange V.A. 1914; Kastrup, 1998). In this case, the accumulation of carbon dioxide in the circulating blood and oxygen depletion results in rapid (in 1-3 seconds) development of vasodilation (expansion) of cerebral vessels, which becomes significant after 15-20sec.
Hyperventilation functional test: 20-25 deep breaths with the most powerful exhalation. This increases the content of oxygen in the circulating blood and reduction of carbon dioxide content. As a result, the rise of vascular tone is observed .This test, the opposite of holding breath, also allows to judge the compensatory possibilities of the vascular system of the brain.
To assess the nature of liquorodynamic processes in the cranial cavity we suggested to use the following indicators: pulse compliance of the skull and mobility of cerebrospinal liquor in the cranial cavity. The definition of these indicators was based on the analysis of simultaneously recorded pulse fluctuations of reoentsefalogrammy (REG) at 100 kHz frequency at the front-mastoidal application of electrodes and transcranial Dopplerogram (TCD) at the base of the middle cerebral artery (Moskalenko, 2008).

We used the following methods of studying autoregulation of cerebral blood vessels.
Impact on the myogenic link of regulation of vascular tone by changing the cerebral perfusion pressure (the difference between the arterial and intracranial pressure) normally activates autoregulation mechanism which stabilizes the MC at a constant level.

We used the gentle method consisting in increasing intracranial pressure by 25-30 mm. Hg. Art., when venous blood is delayed in the chest lumbar vertebral canal for a short time by pressing the abdominal wall for 30 seconds at force of about 3.5-5 kg (diagnostic test described by the American neurosurgeon B. Stookey (Stookey B. et. al., 1924). In this case, CSF pressure increases and cerebral perfusion pressure is reduced by 25-30 mm. Hg. Art..
The experiment involved 12 patients, the young men of 19 in good physical form, wrestlers. They had not done horse riding before.

The subjects were examined according to the protocol outlined above, and then mounted a horse without saddle. The basics of proper posture were explained to riders. They were not supposed to do any exercises or movements. Their task was to maintain balance while the horse was rhythmically therapeutically walking for 30 minutes. After riding, re-examination was carried out within 10 minutes.

Results of the study:

- Liquorodynamic readings changed for 100% of the subjects.

- Biomechanical properties of the skull during the trial with apnea have changed in a positive way for 100% of the subjects.

- Compliance of the scull bones increased.

Thus, we conclude that the effectiveness of hippotherapy is based on its impact on the craniosacral mechanism. The results allowed to confirm the main factor of the craniosacral mechanism: the all-round impact in the process of hippotherapy. The all round effect is due to the intracranial hemoliquorodynamic function, consisting in providing circulatory and metabolic activity of the brain by the interaction of hemodynamic, liquorodynamic and biomechanical components.

The study proved that mechanical effect of hippotherapy on the pelvis causes cerebrospinal fluid flow changes in the brain that change the biomechanical properties of the skull increasing the mobility of his bones.

Speaking in terms of osteopathy, the osteopathic correction through this system eliminates blocks on the level of the skull sutures, removes distortions and stresses of dura mater, increases the vitality of the body, relieves blocks on the level of the pelvis, which do not allow the sanctum to move in common pattern with the occipital bone in the joint cranio-sacral rhythm. It affects the mechanics of the pelvic ring in the process of riding and not only removes the mechanical structural blocks, but influences the state of the entire dura mater (its attachment to S2), so to say, "unwinds from below", from the sacrum. It is also necessary to note the effect of the system on the connection between the structures, on the interaction between the temporal bones of the iliac and sacral pad.

Osteopathy also confirms that the process of hippotherapy is very complicated, requires qualified training of expert hippoterapist, and most importantly, requires a trained horse that has a perfectly balanced step and is capable of transmitting correct motor impulses, which form the basis of the mechanism of therapeutic effect of hippotherapy, if hippotherapy is applied as a method of effective treatment of the patient.

Magoun G.I., "Osteopathy in the cranial region", 2010.
Moskalenko Y., Kravchenko T. : Liquorodinamic Conception of the Primary Respiratory Mechanism. The AAO Journal. Official publication of the American Academy of Osteopathy, 2013
Ingrid Strauss «Neurophysiologishe Krankengymnastik auf dem Pferd »Hippokrates-Verl. Stuttgard
Mantak Chia «Iron Shirt. Chi Kung1» Copyright 1986. Inner Traditions International (USA)