2.3.3.11

Bioengineering Support of the Cranial Osteopathy Treatment.

Yu. Moskal enko, T. Kravchenko, V. Semerni a, A. Cherv otok, K. S harapov.Institute of evolutionary Physiology and Biochemistry Russian Academy of Sciences.

Sankt- Petersburg Center of Osteopathy.M.Thorez prospect M, Sankt-Petersburg 1942?3, Russia.

Abstract: Effectivity of the osteopathic treat-ment, directed to correction of dynamicsofliquid media inside the craniospinal cavity'de-pends on data, whieh is demotrate realresults of treatment. Electricalimpedansography of the human head withapplication of electrodes on frontal andmastoidal regions is one of accep-tablemethods, because impedance fluctua-tions,initiated by periodical cardiovascular systemactivity, directly reflect changes in dis'tribution between volumes of blood and cereb-rospinal fluid inside closed cranial cavity.Acceptance of impedansography, ås a '6feed-back", has been examined by observations on28 patients indicated for osteopathie treatment.

INTRODUCTION

Success of a number of kinds of treatments, which arecomposed as a series of periodically applied proceduresduring , sometimes, up to several month, becomes clearonly after comparatively long time from beginning of thetreatment. In such conditions optimization of theeffectivity' of the treatment is not simple problem.Therefore it is important to find for these cases someinstrumental methods, which could play a role of"operative feedback" between patient conditions andphysician.

A typical example of such type of treatment may becranial osteopathy, directed to minimization ofneurological deficit due to changes in structure ofcerebrospinal pathways of CSF movements. Techniques ofcranial osteopathy are based on manual correction of thedynamic of liquid media (cerebrospinal and extracellularliquids) inside the craniospinal cavity by extracranialactions. Usually, the first definite results of the treatmentare possible to obsen'e after several treatment proceduresand evaluation of the effectivity of any changes in theprocedure of the treatment takes sufficient time.

It is possible to get objective rapid results of theeffectivity of cranial osteopathic treatment techniques,using electrical impedance(ElM) measurements of humanhead. Changes in periodical fluctuations of highfrequency(40-60kHz) EIM between electrodes placed onhuman head, initiated by heart and vascular activity,objectively reflect redistribution between liquid media(arterial and venous blood, cerebrospinal-SCF andextracellular fluids-Ecfl inside the cranial cavity[1,2].Application of modern computer technique permitsclearly evaluate these changes[3].

Aim of the present communication is to demonsrtatesome possibilities of application of high frequency

electn cerl i m pedance peri odacal fl uctuations recordi ngs w i th

adequate computation, as a bioengineering support ofcranial osteopathic treatment (COT).

MATERIAL AND METHOD

Examination of acceptance of EIM recordings withconsequent computer analysis has been realized byobservation of 28 patients with moderate neurologicaldeficit as a result of perynatal deformation of in skull andvertebral bones or perynatal injury of the centralnerveous system. Two pairs of plated ( about I cm indiameter) silver electrodes were fixed by rubber strap onfrontal tubers and mastoidal(F-M) skull regions to theright and the left hemispheres. Special electroconductinggel was placed between skin and electrode surface. Fordetermination of interferences, which are represented byextracranial tissues electrical conductivity, additionally toF-M recordings, fluctuations of EIM were taken from theleft and the right frontal(F-F) electrodes. Using F-Fposition of electrodes mainly extracranial(ExC) tissuecomponent was recorded. Comparison of F-F recordingswith data received from F-M electrode position permits toevaluate the role of ExC influences to F-M recordings, andcalculate real intracranial( t nC) component by subtractionF-F pulse fluctuations from F-M ones. Due to heart ratevariations, standardization of time scale is necessary.

Periodical changes of EIM in ranges of 0.2 - 10 Hz,were recorded by routne rheoplethismographic instrumentRc2-02(Russian) together with ECG on PC "MacintoshIIsi", using "MacLab-4" analog-digital system. Forrecording and analysis of received data the next softwareScart 8.2.3, Cricket Graph I.32, Canvas 3.0 have beenused. Recordings of EIM just before and just after singleosteopathic treatment technique have been made. For more

clear evaluation of the changesof the SCF-dynamic,functional test - Stuckey maneuver(3Oc pressing ofstomach by 3 kg weight) has been used. The nextelements of osteopathic treatment procedures wereexamined: passive compression of 4-th ventncle(4-VPC),venous sinuses technique(VsT) and correction ofpathologic skull pattern(PSkP). Duration of the testedelement of the treatment procedure was the same as duringreal treatment in combination with other elements: 5 -10min. Recordings were taken immediately before and just

after of the procedure. For additional evaluation of thechanges, responses of EIM fluctuations to Stuckeymaneuver 2 min before and 2 min after the procedure weretaken.

RESUUTS

Direct effect of every tested technique of COT was

Medical & Biological Engineering & Computing Vol. 34, Supplement 1, Part 2, 19goThe 1st International Conference on Bioelectromagnetism, June 9-13, 1996, Tampere, Finland 185

clearly observed , first of all, as changes in amplitude ofEIM pulsations and deformation of their wave forms.Responses to Stuckey maneuver also are changed (Tab.1)after appl ied techniques.

Täble 1. Comparative changes in amplitude of pulsationafter application of some osteopathic techniques.x 96 to rest before procedure. ( MiSD)Amolitude of oulsationrest(Aft St- m. (Bef) St -m. (Aft.

VST(n=16) 77 -4+8.2 87 -4+6_7 91-l+9-5

4.V PC(n=14) I I Z-9t16. 91.6+13.O 03.7 +12.1

CPSKP(n=14) 73_2x14.2 88.7114.3 104 _1 +7 .8

A sufficiently high value of SD in the majority ofcases deserves special attention. This indicate that thesame technique may evoke different changes, which shouldbe depend on particular conditions of patient. VST andCPSkP techniques accomp:rnied by averaged decrease ofamplitude pulsation but 4-VPC technique evoke itsaveragedincrease.

Comparison of F-M and F-F recordings showed, thatalthough these tracings are similar, InC component maybe established by subtraction of F-F from F-M. Differencebetween F-F and F-M was the most emphasized duringStyckey maneuver and increased after COT(Fig.1)

Before treatmentF-MF-Fo.4

After trea'tmen't

Fig.l EIM pulsations, recorded from F-M and F-Fposition of electrodes, and calculated InC component,before and after 4-VPC technique in rest(A) and on 7sStuckey maneuver(B).

Data, presented on Fig I clearly show, that using F-Mposition of electrodes it is possible to receive real InC

chances of head electrical impedance. Fig I demonstratealso, that direct effect of the COT application is moreclearly developing if data received during Stuckeymaneuver are compared. The last conclusion is commonfor all examined elements of COT.

On about 807c recordings, together with pulsations, aslow fluctuatitrns of EIM with period 14.125*4.241 permin (n=18,MISD) are observed. After application ofCOT techniques slow EIM fluctuations also har,e changed.Their amplitude usually decreased or disappeared afterapplied techniques, but frequency may both increa^se anddecreane. Frequency changes are more expressed if appliedtechnique is influented to cerebrol'ascular controlcapabilities.

DISCUSSION.

hesented data clearly dcmonstrate, that recordings ofperiodic EIM fluctuations, initiatcd by the activit,v of thecardiovascular(pulsations) and cerebrol'ascular(slorvfluctuations) systems, reflect CSF movements inside theclosed cranial cavity and in cranial and spinal cavitics dueto close correlaticln bctween blclod and CSF volumesinside skull. Some extracranial component in EIMchanges also have taken place. Applications ol- COTtechniques sufficiently change CSF craniospinal dynamic,which is expressed in the change ol'amplitude and patternof pulsations, as well as parameters of slow lluvtuations.This is observed most clearly during application ol'Stuckcy maneuver. Although previously it wasreported[3], that during COT amplitudc of pulsationusually has been increased, such rcsult fclllorved aftcrapplication ol' the complex of techniques, but singletechnique as well as it has been demonstrated abrlve, mayhave opposite results.

CONCLUSION

Presented data permit to conclude that monitoring ()fEIM periodical fluctuations with F-M electrode pr-rsitionmay provide, as ef'fective "feedback", bioengineeringsupport for cranial osteopathy and other similar kinds oftreatments.

REFERENCES

[] Moskalenko Yu."Changes in Cerebral Blotxl Volumein normal conditions and under normal Conditions andGravitational stresses" Leningrad: Nauka ,1967Wasgington, NASA TT F49?, 1968.[2] Moskalenko Yu, Demchenko I, Wainstein G. et al."Biophysical aspects of Cerebral Ci rculation"Oxford: I 9tt0l3l Moskalenko Yu., Kravchenko T., Wainstein G.,Semernia V., Chervotok A. "lnl'ormative meaning ol'pulse impedance fluctuations" in Proceeding of IXInternational Conference on Electrical Bio-impedance.(E.Gersing and M.Schaefed,eds), (Gottingen) pp.tl7-90,Goltze Druck, 1995.t4l Magoun H."Osteopathy in the Cranial Field"Krrksville,MO: Journ. Printing Company, 1976.

Medical & Biological Engineering & computing Vot. 34, supptement 1, part 2, 1996The 1st lnternationalConference on Bioelectromagnetism, June g-tg, tggO, Tampere, Finland

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