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Craniosacral therapy: A systematic review of the clinical evidence
Abstract
AimCraniosacral therapy (CST) is a popular treatment for a wide range of conditions. This systematic review evaluates the evidence of effectiveness for CST for any human condition. Method
An electronic search for relevant studies was conducted across three databases; this was complemented by extensive hand-searching of departmental files and bibliographies. Articles were included if they reported RCTs of CST for any human condition. Data were extracted according to predefined criteria and trial quality was determined using the Jadad score. ResultsSix studies were included. Except for one, all were associated with a high risk of bias. Low quality studies suggested positive effects, while the high-quality trial failed to demonstrate effectiveness. Conclusion
The notion that CST is associated with more than non-specific effects is not based on evidence from rigorousRCTs.
... The clinical effectiveness of CST has been tested in numerous clinical trials and summarized in several previous systematic reviews and meta-analyses. Three systematic reviews concluded that there was insufficient evidence to support the application of CST in patients with headache disorders, low back pain, lateral epicondylitis, fibromyalgia, visual alterations, asthma, attention deficit hyperactive disorders, infantile colic, preterm infants, and cerebral palsy mainly because the studies included were seriously flawed [1,15,18]. However, these systematic reviews also included studies not related to the clinical effectiveness of CST. ...
... Craniosacral therapy (CST) is defined as an intervention based on a gentle touch that allegedly releases restrictions in any tissues influencing the craniosacral system [1]. It has been considered as complementary and alternative medicine by the World Health Organization (WHO) and has been included in the Benchmarks for Osteopathic Education of the WHO [2]. ...
... Several previous systematic reviews have investigated the effects of CST in different populations [1,15,18,19,[57][58][59][60]. Most of them concluded that there was insufficient evidence to support CST in any condition. ...
Objectives:
The aim of this study was to evaluate the clinical effectiveness of craniosacral therapy (CST) in the management of any conditions.
Methods:
Two independent reviewers searched the PubMed, Physiotherapy Evidence Database, Cochrane Library, Web of Science, and Osteopathic Medicine Digital Library databases in August 2023, and extracted data from randomized controlled trials (RCT) evaluating the clinical effectiveness of CST. The PEDro scale and Cochrane Risk of Bias 2 tool were used to assess the potential risk of bias in the included studies. The certainty of the evidence of each outcome variable was determined using GRADEpro. Quantitative synthesis was carried out with RevMan 5.4 software using random effect models.
Data synthesis:
Fifteen RCTs were included in the qualitative and seven in the quantitative synthesis. For musculoskeletal disorders, the qualitative and quantitative synthesis suggested that CST produces no statistically significant or clinically relevant changes in pain and/or disability/impact in patients with headache disorders, neck pain, low back pain, pelvic girdle pain, or fibromyalgia. For non-musculoskeletal disorders, the qualitative and quantitative synthesis showed that CST was not effective for managing infant colic, preterm infants, cerebral palsy, or visual function deficits.
Conclusions:
The qualitative and quantitative synthesis of the evidence suggest that CST produces no benefits in any of the musculoskeletal or non-musculoskeletal conditions assessed. Two RCTs suggested statistically significant benefits of CST in children. However, both studies are seriously flawed, and their findings are thus likely to be false positive.
... . Sutherlands Hypothese, die auch heute noch die Grundlage der Curricula fast aller osteopathischer Schulen darstellt [17,37], konnte in keiner der bisher veröffentlichten Studien bestätigt werden [6]. Die Untersucher waren nicht in der Lage, bei denselben Patienten die gleiche PRM-Frequenz zu messen [6,7,9]. ...
... . Sutherlands Hypothese, die auch heute noch die Grundlage der Curricula fast aller osteopathischer Schulen darstellt [17,37], konnte in keiner der bisher veröffentlichten Studien bestätigt werden [6]. Die Untersucher waren nicht in der Lage, bei denselben Patienten die gleiche PRM-Frequenz zu messen [6,7,9]. Es zeigte sich kein überzeugender klinischer Effekt [6,7,9,13]. ...
... Die Untersucher waren nicht in der Lage, bei denselben Patienten die gleiche PRM-Frequenz zu messen [6,7,9]. Es zeigte sich kein überzeugender klinischer Effekt [6,7,9,13]. Negative Wirkungen, sogar Todesfälle wurden beschrieben [35]. ...
Background
According to Sutherland’s original model of cranial osteopathy, intrinsic rhythmic movements of the human brain cause rhythmic fluctuations of cerebrospinal fluid and specific rhythmic changes in dural membranes, cranial bones and the sacrum (i.e. primary respiratory mechanism, PRM). The model is based on the assumption that these rhythmic fluctuations are palpable and can be modified to improve the patient’s health; however, the studies published to date do not suggest the existence of a PRM. A convincing interexaminer reliability has not yet been shown, and there is no scientifically convincing evidence for a clinical effect going beyond a placebo effect.
Methods
In this context, a tonus test of the deep suboccipital muscles is presented, which can be used as a monitor for the localization, therapy setting and therapy control of osteopathic lesions in the area of the soft tissues of the neck and skull. The test is plausible according to the present state of knowledge, is easy to learn and apply and could open up new perspectives in the diagnosis and treatment of somatic dysfunctions in the craniocervical region.
... Clinically, this study can prompt future research into specific treatment protocols targeting autonomic somatic dysfunctions. Criticisms of CST include debate on the reliability of palpating the craniosacral rhythm as well as the lack of quality randomized-controlled studies on this technique [7,8]. HRV data was measured with two metrics, high-frequency (HF) and low-frequency (LF) power [9]. ...
... Restriction within the craniosacral system can affect its components: the brain, spinal cord, and protective membranes [13]. Since the initial theory proposal, studies have investigated the validity and effectiveness of CST [7,8]. The theory behind CST postulates that gentle pressure manipulations can stimulate parasympathetic tone and promote ANS balance [3]. ...
Craniosacral treatment (CST) is an osteopathic technique grounded in the assumption that there is an intrinsic, fine movement of the cerebrospinal fluid. This rhythmic movement can be utilized for diagnostic and therapeutic purposes by palpation and manipulation of the skull, spine, and associated connective tissues. Therapeutic benefit is likely due to action on the autonomic nervous system (ANS), specifically through the vagus nerve. Current literature on the neurophysiological effects of CST is limited, which has contributed to controversy regarding its effectiveness. Heart rate variability (HRV) as a measure of cardiovascular stress and autonomic system activity is thus proposed as a tool to evaluate the neurophysiologic effects of CST. HRV can be analyzed in two different bands, high-frequency (HF) and low-frequency (LF) power associated with a parasympathetic and sympathetic response. In this meta-analysis, we provide a brief introduction to CST, analyze three primary studies, and summarize the therapeutic benefits and pitfalls of this alternative treatment on the ANS. A significant negative HF standardized mean difference after CST was observed; standardized mean difference = -0.46; 95% CI (-0.79,-0.14). No significant effect on LF power was observed. We conclude that CST does provide a moderate short-term increase in parasympathetic activity. These findings suggest that CST may be used to treat patients with an overactive sympathetic state. Further studies should be conducted for comparison against a control group to eliminate the possibility of a placebo effect and to elucidate long-term effects.
... Almost 10% of the participants reported current use of facilitated communication, despite extensive data against its effectiveness (Bligh & Kupperman, 1993;Cabay, 1994;Eberlin, McConnachie, Ibel, & Volpe, 1993;Tostanoski, Lang, Raulston, Carnett, & Davis, 2014). Additional treatments which persisted despite lack of evidence-base included craniosacral/myofascial (Ernst, 2012;Hartman, 2006), auditory and sensory integration (Baranek, 2002;Dawson & Watling, 2000) and supplement use (Salman, 2002). ...
... Additionally, the use of multiple simultaneous therapies poses a methodological challenge, as the effects of evidence-based treatments may be masked or misattributed to non-evidence-based treatments. For example, caregivers often seek evidence-based treatments targeting speech, language, motor skills, communication and challenging behaviour (e.g., speech and language therapy; Kumin, 2012;Rondal & Buckley, 2003; physical therapy; and applied behaviour analysis; Bauer, Jones, & Feeley, 2014;Feeley & Jones, 2006;Neil & Jones, 2016), coupled with treatments that are not evidence-based (e.g., facilitated communication, sensory/auditory integration, and craniosacral/myofascial; Ernst, 2012). Confounding effects across treatments may account for positive caregiver ratings across treatments regardless of empirical support, as caregivers may misattribute treatment gains to non-evidence-based treatments. ...
Down syndrome is associated with a range of developmental strengths and challenges. The treatment use of individuals with Down syndrome along with associated factors have not yet been determined. In a pilot study to address this issue, we elected to conduct an online survey rather than a classical representative population survey to generate relevant information quickly. An online survey was completed by 162 primary caregivers of children and youth with Down syndrome. Caregivers reported the types of treatments children were currently receiving and had received in the past, along with the overall satisfaction with treatments. Associations with other child variables (e.g., age, gender, and race) and family characteristics were also examined. Findings indicate that children were currently receiving a mean of 6.1 (SD = 3.5) different types of therapy treatments; the most common treatments was speech–language therapy currently received by 73%. Only 2.4% of children were currently receiving applied behaviour analytic treatment, an empirically supported therapy. Caregivers reported using a number of treatments without empirical support including facilitated communication, holding therapy, and auditory/sensory integration. Caregivers tended to agree that each treatment was efficacious and contributed to their child’s growth. Treatments that were associated with strong agreement included medication (69.8%), care from family and friends (62.8%), assistive technology (58.3%), and floortime (55.6%). Future research should focus on understanding the process of treatment selection by caregivers of children with Down syndrome and develop accessible guidelines on empirically supported therapies.
... The reviews by Jäkel & von Hauenschild suffer either from non-systematic analysis of results [9] or unsuitable methods for the analysis of bias [10]. Finally, Ernst [11] uses more suitable methods for the determination of quality and an analysis of bias, and suggests eligibility criteria for studies that are in line with those conventionally used to assess efficacy. ...
... Taken together, our critical appraisal of the studies included in our review lead us to conclude that there is no evidence at present for the specific efficacy of techniques or therapeutic strategies used in cranial osteopathy. Our results are consistent with those of previous reviews on the same topic [6,[9][10][11] and underline the need to improve methodological standards of research dealing with manual therapies in general, and osteopathy in particular. ...
Context:
In 2010, the World Health Organization released benchmarks for training in osteopathy in which they considered cranial osteopathy as an important osteopathic skill. However, the evidence supporting the reliability of diagnosis and the efficacy of treatment in this field appears scientifically weak and inconsistent.
Objectives:
To identify and critically evaluate the scientific literature dealing with the reliability of diagnosis and the clinical efficacy of techniques and therapeutic strategies used in cranial osteopathy.
Methods:
Relevant keywords were used to search the electronic databases MEDLINE, PEDro, OSTMED.DR, Cochrane Library, and in Google Scholar, Journal of American Osteopathy Association and International Journal of Osteopathic Medicine websites. Searches were conducted up to end June 2016 with no date restriction as to when the studies were completed. As a complementary approach we explored the bibliography of included articles and consulted available previous reviews dealing with this topic.
Study selection:
Regarding diagnostic processes in cranial osteopathy, we analyzed studies that compared the results obtained by at least two examiners or by the same examiner on at least two occasions. For efficacy studies, only randomized-controlled-trials or crossover-studies were eligible. We excluded articles that were not in English or French, and for which the full-text version was not openly available. We also excluded studies with unsuitable study design, in which there was no clear indication of the use of techniques or therapeutic strategies concerning the cranial field, looked at combined treatments, used a non-human examiner and subjects or used healthy subjects for efficacy studies. There was no restriction regarding the type of disease.
Search results:
In our electronic search we found 1280 references concerning reliability of diagnosis studies plus four references via our complementary strategy. Based on the title 18 articles were selected for analysis. Nine were retained after applying our exclusion criteria. Regarding efficacy, we extracted 556 references from the databases plus 14 references through our complementary strategy. Based on the title 46 articles were selected. Thirty two articles were not retained on the grounds of our exclusion criteria.
Data extraction and analysis:
Risk of bias in reliability studies was assessed using a modified version of the quality appraisal tool for studies of diagnostic reliability. The methodological quality of the efficacy studies was assessed using the Cochrane risk of bias tool. Two screeners conducted these analyses.
Results:
For reliability studies, our analysis leads us to conclude that the diagnostic procedures used in cranial osteopathy are unreliable in many ways. For efficacy studies, the Cochrane risk of bias tool we used shows that 2 studies had a high risk of bias, 9 were rated as having major doubt regarding risk of bias and 3 had a low risk of bias. In the 3 studies with a low risk of bias alternative interpretations of the results, such as a non-specific effect of treatment, were not considered.
Conclusion:
Our results demonstrate, consistently with those of previous reviews, that methodologically strong evidence on the reliability of diagnostic procedures and the efficacy of techniques and therapeutic strategies in cranial osteopathy is almost non-existent.
... (Green ym. 1999, Ernst 2012, Guillaud ym. 2016.) ...
Osteopatia on tuki- ja liikuntaelinvaivojen hoitoon erikoistunut terveydenhuollon ala. Manuaaliterapialla on osteopatiassa merkittävä rooli. Biodynaaminen osteopatia ja biodynaaminen kraniosakraaliterapia ovat viime vuosina Suomessa jalansijaa saaneita hoitomuotoja. Tämän systemaattisen kirjallisuuskatsauksen tavoitteena oli selvittää biodynaamisen hoidon vaikuttavuutta tutkimusnäytön perusteella. Artikkeleita haettiin neljästä terveystieteellisestä tietokannasta (Pubmed, PEDro, Cochrane Database, EBSCO) hakusanoilla ”biodyn* + osteopa*” ja ”biodyn* + craniosa*”. Katsaukseen hyväksyttiin kaikki sairauksien ja kiputilojen hoitoa ihmisillä selvittäneet tutkimukset, jotka raportoivat vertaisarvioidussa lehdessä alkuperäisdataa kliinisestä, tapaus- tai tapausverrokkitutkimuksesta biodynaamisen hoidon jälkeen. Haun tuloksena saatiin duplikaattien poiston jälkeen 19 alkuperäisartikkelia. Niistä yksikään ei käsitellyt sairauksien tai kiputilojen hoitoa biodynaamisella osteopatialla tai kraniosakraaliterapialla. Tällä hetkellä minkäänlaista tieteellistä näyttöä biodynaamisen osteopatian tai biodynaamisen kraniosakraaliterapian vaikuttavuudesta ei ole. Abstract A systematic review of biodynamic osteopathy and biodynamic craniosacral therapy: clinical efficacy Osteopathy is a healthcare profession which specializes in the treatment of musculoskeletal disorders. Manual therapy has a big emphasis in the osteopathic care. Biodynamic osteopathy and biodynamic craniosacral therapy have recently begun getting foothold in Finland among osteopaths. The aim of this systematic review was to evaluate the effectiveness of the biodynamic treatment based on the evidence. Search was performed by using four different databases (Pubmed, PEDro, Cochrane Database, EBSCO) with the keywords ”biodyn* + osteopa*” and ”biodyn* + craniosa*”. All articles which showed original data on the biodynamic treatment of humans in a peer-reviewed journal about a clinical trial, case study or case-control study were approved. The search brought 19 articles after removal of duplicates. None of these included data on the treatment of diseases or pain syndromes in the biodynamical osteopathy or craniosacral therapy. As of now, there is not any scientific evidence showing efficacy of biodynamic osteopathy or biodynamic craniosacral therapy. Keywords: osteopathy, manual therapy, biodynamic osteopathy, biodynamic craniosacral therapy, systematic review
... In clinical application, CST has been shown to have positive effect for a number of chronic syndromes that parallel PCS subtypes, but the body of data is limited to observational designs and low to moderate quality of randomized controlled methods. 51,52 The credibility of a sham control protocol for future study of CST was reported. 53 A recent study of former pro-football players with PCS showed statistically greater improvements in range of motion, pain, sleep, and cognitive function after a series of combined manual therapies. ...
This case report illustrates the treatment outcomes of a collegiate athlete presenting with an 18-month history of post-concussion syndrome who received a series of mixed manual therapies in isolation of other therapy. Persistent symptoms were self-reported as debilitating, contributing to self-removal from participation in school, work, and leisure activities. Patient and parent interviews captured the history of multiple concussions and other sports-related injuries. Neurological screening and activities of daily living were baseline measured. Post-Concussion Symptom Checklist and Headache Impact Test-6™ were utilized to track symptom severity. Treatments applied included craniosacral therapy, manual lymphatic drainage, and glymphatic techniques. Eleven treatment sessions were administered over 3 months. Results indicated restoration of oxygen saturation, normalized pupil reactivity, and satisfactory sleep. Post-concussion syndrome symptom severity was reduced by 87% as reflected by accumulative Post-Concussion Symptom Checklist scores. Relief from chronic headaches was achieved, reflected by Headache Impact Test-6 scores. Restoration of mood and quality of life were reported. A 6-month follow-up revealed symptoms remained abated with full re-engagement of daily activities. The author hypothesized that post-concussion syndrome symptoms were related to compression of craniosacral system structures and lymphatic fluid stagnation that contributed to head pressure pain, severe sleep deprivation, and multiple neurological and psychological symptoms. Positive outcomes over a relatively short period of time without adverse effects suggest these therapies may offer viable options for the treatment of post-concussion syndrome.
... Краниосакральные техники начали применять в остеопатии с 1970-х годов. Их описывают как мягкий подход, который уменьшает боль и устраняет дисфункции за счет высвобождения ограничения в тканях, окружающих центральную нервную систему [43,44]. Повышение абсолютной мощности α-ритма на электроэнцефалограмме (ЭЭГ), улучшение сна, снижение тревожности были показаны во многих исследованиях как эффект этих техник (компрессия четвертого желудочка) [45,46]. ...
... Thus, we performed the first meta- analysis of CST trials that revealed no statistical heterogeneity except for one follow-up analysis; although it contained some clinical heterogeneity regarding the length of the CST interventions and the pain diagnoses of the patients. A further important issue for research and clinical practice are safety analyses that are not part of many previous reviews of CST [22,24,46]. ...
Objectives:
To systematically assess the evidence of Craniosacral Therapy (CST) for the treatment of chronic pain.
Methods:
PubMed, Central, Scopus, PsycInfo and Cinahl were searched up to August 2018. Randomized controlled trials (RCTs) assessing the effects of CST in chronic pain patients were eligible. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for pain intensity and functional disability (primary outcomes) using Hedges' correction for small samples. Secondary outcomes included physical/mental quality of life, global improvement, and safety. Risk of bias was assessed using the Cochrane tool.
Results:
Ten RCTs of 681 patients with neck and back pain, migraine, headache, fibromyalgia, epicondylitis, and pelvic girdle pain were included. CST showed greater post intervention effects on: pain intensity (SMD = -0.32, 95%CI = [- 0.61,-0.02]) and disability (SMD = -0.58, 95%CI = [- 0.92,-0.24]) compared to treatment as usual; on pain intensity (SMD = -0.63, 95%CI = [- 0.90,-0.37]) and disability (SMD = -0.54, 95%CI = [- 0.81,-0.28]) compared to manual/non-manual sham; and on pain intensity (SMD = -0.53, 95%CI = [- 0.89,-0.16]) and disability (SMD = -0.58, 95%CI = [- 0.95,-0.21]) compared to active manual treatments. At six months, CST showed greater effects on pain intensity (SMD = -0.59, 95%CI = [- 0.99,-0.19]) and disability (SMD = -0.53, 95%CI = [- 0.87,-0.19]) versus sham. Secondary outcomes were all significantly more improved in CST patients than in other groups, except for six-month mental quality of life versus sham. Sensitivity analyses revealed robust effects of CST against most risk of bias domains. Five of the 10 RCTs reported safety data. No serious adverse events occurred. Minor adverse events were equally distributed between the groups.
Discussion:
In patients with chronic pain, this meta-analysis suggests significant and robust effects of CST on pain and function lasting up to six months. More RCTs strictly following CONSORT are needed to further corroborate the effects and safety of CST on chronic pain.
Protocol registration at prospero:
CRD42018111975.
... CST was developed in the 1970s and it is described as a gentle approach that releases tension deep in the body to relieve pain and dysfunction and improve whole-body 6 Evidence-Based Complementary and Alternative Medicine health and performance. These techniques are able to release restrictions in the soft tissues that surround the central nervous system by using gentle touch [21,22]. The systematic review showed that there are only a few studies suggesting the effectiveness of the CV4 therapy. ...
Compression of the fourth ventricle (CV4) is a well-known osteopathic procedure, utilized by osteopaths, osteopathic physicians, craniosacral therapists, physical therapists, and manual therapists as part of their healthcare practice based on some evidence suggesting impact on nervous system functions. The main objective of the study was to identify randomized controlled trials (RCTs) assessing the clinical benefits of CV4 and to show the evidence supporting clinical prescriptions, guides, and advice in treating. A computerized search of the PubMed, CINAHL Complete, Scopus, Web of Science, and ScienceDirect databases was performed. Two filters were used (article type: RCTs; species: humans). The methodological quality of the trials was assessed using the Downs and Black quality checklist for healthcare intervention studies. Only six studies met the inclusion criteria, of which four were RCTs and two were observational studies. The Downs and Black score ranged from 17 to 24 points out of a maximum of 27 points. The present review revealed the paucity of CV4 research in patients with different clinical problems, as five out of six included studies investigated healthy adults. According to the results of the included studies, CV4 may be beneficial for patients with different functional problems.
... The author agrees that a high risk of bias exists in most reported low quality studies about CST. One systematic review of a small body of clinical evidence concurred with this position [35]. Nonetheless, specific effects of outcomes such as this case is noteworthy despite the fact that the best methodologies for researching CST have yet to be used. ...
Objective: Present single case study of a 26 year old female with congenital agenesis of cerebellum and other congenital malformations who achieved fecal continence and measurable mobility improvements following a prolonged series of craniosacral therapy.
Design: Retrospective review of data based on several interviews with the patient’s mother, her primary caregiver and review of the medical record.
Setting: Community based private therapy clinic in the upper Midwest. Interventions: Craniosacral Therapy and minimal use of other therapies.
Results: Craniosacral Therapy over the course of 4 years contributed to unexpected attainment of fecal continence as well as other areas of functional improvements. The patient was 22 years of age at the time this therapy series began and had life-long neurogenic bowel and bladder dysfunction. Gains were indirectly achieved. Treatment had been initiated to address chronic pain from an older spinal surgery and sessions continued long term for health and wellness. Mobility improvements beyond pre-surgery status and fecal continence were a surprise to all parties involved.
Conclusion: Clinical significance of these outcomes stimulates curiosity as to the actual type of stimulation CST actually provides to the central nervous system and its effect upon neuroplasticity.
... 11,15,16 The effectiveness of craniosacral treatment on health outcomes has been shown for a number of chronic pain syndromes, but it is limited to observational designs and randomized controlled trials with low to moderate methodological quality. [17][18][19] Efficacy studies and studies on musculoskeletal pain have not been conducted to date, 20 although neck and back pain were the most frequent symptoms for which CST was requested. 21 Therefore, this study aimed at investigating the efficacy of CST in chronic nonspecific neck pain in comparison with a manual sham control intervention. ...
Objectives: With growing evidence for the effectiveness of craniosacral therapy (CST) for pain management, the efficacy of CST remains unclear. This study therefore aimed at investigating CST in comparison with sham treatment in chronic nonspecific neck pain patients.
Materials and Methods: A total of 54 blinded patients were randomized into either 8 weekly units of CST or light-touch sham treatment. Outcomes were assessed before and after treatment (week 8) and again 3 months later (week 20). The primary outcome was the pain intensity on a visual analog scale at week 8; secondary outcomes included pain on movement, pressure pain sensitivity, functional disability, health-related quality of life, well-being, anxiety, depression, stress perception, pain acceptance, body awareness, patients’ global impression of improvement, and safety.
Results: In comparison with sham, CST patients reported significant and clinically relevant effects on pain intensity at week 8 (�21mm group difference; 95% confidence interval, �32.6 to �9.4; P=0.001; d=1.02) and at week 20 (�16.8mm group difference; 95% confidence interval, �27.5 to �6.1; P=0.003; d=0.88). Minimal clinically important differences in pain intensity at week 20 were reported by 78% within the CST group, whereas 48% even had substantial clinical benefit. Significant between-group differences at week 20 were also found for pain on movement, functional disability, physical quality of life, anxiety and patients’ global improvement. Pressure pain sensitivity and body awareness were significantly improved only at week 8. No serious adverse events were reported.
Discussion: CST was both specifically effective and safe in reducing neck pain intensity and may improve functional disability and the quality of life up to 3 months after intervention.
Key Words: craniosacral therapy, manual therapies, neck pain, sham treatment, randomized controlled trial
... No hay evidencias que muestren la eficacia de la osteopatía o la terapia cráneo-sacral para la intervención en dislexia o en la mejora de la lectura. Se han realizado varias revisiones sistemáticas sobre la eficacia de estas técnicas en diversos problemas, y ninguna de ellas menciona que la investigación respalde sus beneficios en el tratamiento de problemas de lectura (Green, Martin, Bassett y Kazankian, 1999;Jäkel y von Hauenschild, 2011;Ernst, 2012;Posadzki, Lee y Ernst, 2013). ...
Revisión sobre la eficacia de intervenciones para el tratamiento de la dislexia, incluyendo las que popularmente se denominan como "tratamientos alternativos".
... 11,15,16 The effectiveness of craniosacral treatment on health outcomes has been shown for a number of chronic pain syndromes, but it is limited to observational designs and randomized controlled trials with low to moderate methodological quality. [17][18][19] Efficacy studies and studies on musculoskeletal pain have not been conducted to date, 20 although neck and back pain were the most frequent symptoms for which CST was requested. 21 Therefore, this study aimed at investigating the efficacy of CST in chronic nonspecific neck pain in comparison with a manual sham control intervention. ...
... 23 Almost simultaneously another systematic review was published that met the scientific quality criteria of the Database of Abstracts of Reviews of Effects (DARE), 24 which concluded, 'The notion that craniosacral therapy (a synonym for OCF) is associated with more than non-specific effects is not based on evidence from rigorous RCTs'. 25 In the osteopathic literature, Hamm (2011) suggests throwing a life-saver to OCF practitioners before they become marginalised stating, 'It seems eminently sensible to try and determine the scientific basis for OCF, not just to pacify the scientific, medical and osteopathic community, but to prevent OCF practitioners becoming marginalised'. 26 On the contrary, given the supposed findings of the GVP there appears no reason to suggest OCF practitioners run any risk of becoming 'marginalised'. ...
The Osteopathic International Alliance (OIA) released a report in 2013 entitled, 'Osteopathy and osteopathic medicine. A global view of practice, patients, education and the contribution to healthcare delivery'. The report was widely circulated by the statutory regulator in New Zealand. It is said to be a representative document by the OIA. Two osteopathic professional streams were identified - Osteopathic physicians (and surgeons) and osteopaths. Other than by ancestry, it is apparent that these two streams are not comparable. The claim of shared 'core practice' between the streams is not upheld by the data, which also indicates a dichotomy between a claim of evidence-based practice and the nature of practice itself. The response rate to unpublished surveys does not appear to support the notion that the OIA report is representative of global osteopathic practice. The data within the OIA Report identifies the most frequently utilised form of Osteopathic Manipulative Treatment (OMT) as Osteopathy in the Cranial Field (OCF).These issues are explored further by comparing the bibliographies of a systematic review of cranial osteopathy conducted 12 years ago with a current snap-shot summary (2013) published by the UK National Council for Osteopathic Research. OCF appears to be an unfalsifiable practice that has become professionally institutionalised. Far from being marginalised this practice now holds a central position, one inconsistent with a claim of ethical, evidence-based best practice, and one seemingly endorsed by statutory regulators. From these perspectives then, the report appears closer to an echo chamber of belief than an accurate reflection of contemporary osteopathic practice.
... Am [13]. ...
Currently, treatment of the cranium is a rapidly growing domain within medicine. The aim of this systematic literature review was to give an overview of studies concerning the effect of passive techniques on the cranium.
37 studies were identified related to orthodontic splint thera- py, craniosacral or manual therapy as passive interventions. The most commonly described clinical pattern was craniomandibu- lar dysfunction.
Only very little evidence could be identified concerning the ef- fect of all therapy approaches on, amongst others, headache and psychogenic problems.
In summary, current scientific findings do not allow a definite statement on the effectiveness of the investigated measures. ( German Article)
... Am [13]. ...
Currently, treatment of the cranium is a rapidly growing domain related to assessment and neuromusculoskeletal treatment. The aim of this systematic literature review was to give an overview of studies concerning the effect of passive techniques on the cranium.
37 studies were identified related to orthodontic splint therapy, craniosacral or manual therapy as passive interventions. The most commonly described clinical pattern was craniomandibular
dysfunction.
Only very little evidence could be identified concerning the effect of all therapy approaches on, amongst others, headache and psychogenic problems.
In summary, current scientific findings do not allow a definite statement on the effectiveness of the investigated measures.
... In a review performed by Jaekel and von Hauenschild [10] , positive clinical outcomes were reported for pain reduction and improvement in general well-being of patients in randomized clinical trials; as the quality of other trials was low, the authors stated that currently available evidence was insufficient to draw definite conclusions on the general efficacy of this treatment modality. A review by Ernst [11] was less optimistic, and concluded that "the notion that CST is associated with more than non-specific effects is not based on evidence from rigorous randomized clinical trials". ...
... In a review performed by Jaekel and von Hauenschild [10] , positive clinical outcomes were reported for pain reduction and improvement in general well-being of patients in randomized clinical trials; as the quality of other trials was low, the authors stated that currently available evidence was insufficient to draw definite conclusions on the general efficacy of this treatment modality. A review by Ernst [11] was less optimistic, and concluded that "the notion that CST is associated with more than non-specific effects is not based on evidence from rigorous randomized clinical trials". ...
Background:
Subjective discomforts in a preclinical range are often due to imbalanced autonomic nervous system activity, which is a focus of craniosacral therapy.
Objective:
The aim of this work was to determine any changes in heart rate variability (HRV) in a study on craniosacral therapy.
Design, setting, participants and interventions:
This is a quasi-experimental (controlled) study with cross-over design. In a private practice, measurements were performed on 31 patients with subjective discomforts before and after a control and an intervention period. HRV was determined using a device that requires a measuring time of 140 s and electrode contact only with the fingertips. Main
Primary outcome measures:
HRV change under the influence of a defined one-time intervention (test intervention) with craniosacral therapy versus control (defined rest period).
Results:
Standard deviation of all RR-intervals (ms) and total power of RR-interval variability in the frequency range (ms(2)) were together interpreted as an indicator of test subjects' autonomic nervous activity and as a measure of their ability to cope with demands on their health. Neither of these parameters increased during the control period (P>0.05), whereas during the test intervention period there was an increase in both (P<0.05, P<0.01). Nevertheless, interactions between treatment and the increase were statistically not significant (P>0.05). No changes were observed in the low frequency/high frequency ratio (sympathetic-vagal balance) in the course of the control or the test intervention period (P>0.05).
Conclusion:
Craniosacral treatment had a favourable effect on autonomic nervous activity. This in itself is an interesting result, but further research will be needed to distinguish specific effects of craniosacral therapy technique from less specific therapist-client interaction effects.
... 11,15,16 The effectiveness of craniosacral treatment on health outcomes has been shown for a number of chronic pain syndromes, but it is limited to observational designs and randomized controlled trials with low to moderate methodological quality. [17][18][19] Efficacy studies and studies on musculoskeletal pain have not been conducted to date, 20 although neck and back pain were the most frequent symptoms for which CST was requested. 21 Therefore, this study aimed at investigating the efficacy of CST in chronic nonspecific neck pain in comparison with a manual sham control intervention. ...
The list of inventors of bizarre alternative therapies and diagnostic methods is long—too long for me to mention them all in this book. In this chapter, I will very briefly discuss several of the men who were, for this or that reason, not honoured with a dedicated chapter in the previous section.
Objectives
To analyze the effectiveness of craniosacral therapy in improving pain and disability among patients with headache disorders.
Design
Systematic review and meta-analysis.
Data sources
PubMed, Physiotherapy Evidence Database, Scopus, Cochrane Library, Web of Science, and Osteopathic Medicine Digital Library databases were searched in March 2023.
Review methods
Two independent reviewers searched the databases and extracted data from randomized controlled trials comparing craniosacral therapy with control or sham interventions. The same reviewers assessed the methodological quality and the risk of bias using the PEDro scale and the Cochrane Collaboration tool, respectively. Grading of recommendations, assessment, development, and evaluations was used to rate the certainty of the evidence. Meta-analyses were conducted using random effects models using RevMan 5.4 software.
Results
The searches retrieved 735 studies, and four studies were finally included. The craniosacral therapy provided statistically significant but clinically unimportant change on pain intensity (Mean difference = –1.10; 95% CI: –1.85, –0.35; I2: 44%), and no change on disability or headache effect (Standardized Mean Difference = –0.34; 95% CI –0.70, 0.01; I2: 26%). The certainty of the evidence was downgraded to very low.
Conclusion
Very low certainty of evidence suggests that craniosacral therapy produces clinically unimportant effects on pain intensity, whereas no significant effects were observed in disability or headache effect.
Numerous alternative treatments are physical by nature. They often require a hands-on approach of an alternative practitioner. In this chapter, I discuss treatments that fall into this category.
Objective
The purpose of this study was to investigate the utilization of CranioSacral Therapy (CST) in patients with Post-Concussion Syndrome (PCS) and capture patient-reported perceptions of clinical outcomes of lived treatment experiences.
Design
Two-part, longitudinal study conducted through a chart review of target group, followed by a Patient-reported Treatment Outcome Survey (PTOS).
Participants
A convenience sample of 212 patients with a historical incidence of head trauma not requiring hospitalization was obtained through medical records department dating back ten years. Inclusion criteria for further chart review (n=67) was determined by identifying patients with a confirmed concussion directly correlated with presenting symptoms and for which CST was specifically sought as a treatment option. Demographics and patient-determined treatment duration data were analyzed by comparison groups extensively suggested in existing literature: Recovery time since injury as either Post-acute concussion (<6 months) or Post-Concussion Syndrome (PCS) (≥ 6 months); Athletes (A) or Non-athletes (NA); and traditional gender. Final PTOS group criteria was determined by eliminating confounding issues reporting (n=47): (A, n=24 and NA, n=23)
Results
Quantitative data was analyzed via Numerical Analysis, and qualitative data was analyzed via Inductive Content Analysis. Symptoms reported in all charts as well as in the PTOS were consistent with identified PCS subtypes. Utilization of CST revealed that most patients determined the treatment effect upon concussion symptoms within 1-3 sessions. Nearly twice as many sessions were attended in the PCS than post-acute groups. Referral sources, studied for a perspective on local concussion after-care discharge planning, ranged from professional to personal recommendation or self-discovery. A majority of patients met goals of reducing post-acute or PCS as reasons cited by self-determined change-in-status or discharge from service. Patients were asked to indicate on the PTOS which pre- and post-treatment symptoms were helped or not helped by this particular intervention.
Conclusions
Patient-reported changes of PCS symptoms is critical when evaluating treatment options. CST is an experiential treatment that addresses subjective levels of dysfunction, thus it is the patient deciding the value of an intervention. A sizable portion of patients in all groups reported a positive effect upon their symptoms by CST. Patients indicated personal meaning to CST through their utilization of multiple sessions. A high percentage indicated the likelihood of referring others with PCS for CST. Of the 212 patient charts first studied, the 145 not meeting inclusion criteria suggest some chronic conditions may present as long-term effects of older head injuries. CST is a low-risk, conservative treatment option for PCS sub-types worthy of further clinical study.
Akupressur ist die Stimulation spezifischer Punkte, auf der Körperoberfläche durch Druck zu therapeutischen Zwecken. Der erforderliche Druck kann manuell oder mit einer Reihe von Instrumenten ausgeübt werden.
This chapter introduces several complementary approaches for children. These approaches include therapeutic garments, therapeutic taping, yoga, Pilates, myofascial release, Conductive Education, patterning, Feldenkrais, Vojta, medical marijuana, and craniosacral therapy, and the latest evidence for use and impact for use are presented for each intervention strategy. Care should be taken when recommending certain therapies as the evidence may not support their effectiveness for children with cerebral palsy (CP). On the other hand, many of the complementary intervention approaches have proven to be useful in improving a child’s ability to participate. Complementary therapies should be introduced to families as potential reasonable additions to traditional therapies and may replace the traditional therapy protocol in some cases. Rich and meaningful discussions among the medical providers, child, and the child’s caregivers should occur when considering complementary therapies.
Acupressure is the stimulation of specific points, called acupoints, on the body surface by pressure for therapeutic purposes. The required pressure can be applied manually of by a range of devices. Acupressure is based on the same tradition and assumptions as acupuncture. Like acupuncture, it is often promoted as a panacea, a ‘cure all’.
Aim: To investigate the importance of the latest results of scientific work in the suboccipital region regarding the principle of structure-function-relationship of Osteopathy. Also to investigate the meaning of these results for applying manual and osteopathic techniques to the structures of the suboccipital region and to incorporate these results to the daily clinical work.
Studydesign: A narrative review, to investigate the latest outcome of scientific work, related to the suboccipital region and its structures and functions.
Methods: Search for defined keywords in the field of the suboccipital region unseing the onlinelibaries Pubmed, Google-Scholar and the Osteopathic Medical Digital Repository (Ostemed) and narrative description of the results.
Results: The existance of the myodural bridge has been proven in various structures and it has functions, regarding the stabilisation of the cervical dura, its influence on cerebospinal fluid circulation and ist meaning for the pathophysiology of various headache and circulation-dissorders supports the biomechanical (n = 36), circulatory (n = 9) and neurological (n = 17) models of the structure-function-relationship. Also the anatomical connection of the first spinal nerve and the hypoglossal nerve and their common branches to the atlanto-occipital joint fits in to these concepts. It also seems that the manual interventions in the suboccipital region are able to modulate nociceptive input, mobilize restricted structures and influence the static of the craniocervical junction.
Conclusion: The results are supporting the biomechanical, circulatory and neurological models of the structure-function-relationship. There is only poor research regarding the biopsychosocial or bioenergetic model. It seems that manual and ostepathic techniques are able to treat the dysfunctions of the described structures and the results may support craniosacral concepts just like the neurodynamic and sacro-occipital concepts of physiotherapists or chiropractors.
Keywords: Suboccipital area, suboccipital muscles, craniocervical junction, atlanto-axial joint, atlanto-occipital joint, myodural bridge, craniosacral osteopathy
Braucht es einen Paradigmenwechsel in der osteopathischen Diagnostik und Therapie im kraniozervikalen Bereich?
Von besonderem Interesse für die Osteopathie im kranialen Bereich ist
die Studie von Kiviniemi et al. aus dem Jahr 2016. Mittels ultraschneller Magnetresonanztomographie gelang es dieser Arbeitsgruppe, unterschiedliche physiologische Mechanismen darzustellen, welche die Pulsation des Liquors beeinflussen. Neben den aus früheren Arbeiten bekannten respiratorischen und kardiovaskulären Einflüssen konnten auch Pulsationen
im niederfrequenten Bereich und im extrem niederfrequenten
Bereich nachgewiesen werden. Ein Einfluss von
elektrophysiologischer und neurovaskulärer
Aktivität (Sympathikus, Parasympathikus) auf diese Wellenform
wurde diskutiert.
Die kardiale Information wurde als „postprocessing“ aus der im hochauflösenden MRT gefundenen Summationsbewegung unter elektrokardiographischer Triggerung gewonnen, wobei Artefakte mittels spezieller Sof ware eliminiert wurden. Analog wurden
respiratorische Daten mit einem Monitor des Atemrhythmus abgeglichen.
Die nachgewiesenen niederfrequenten Pulsationen sind ebenfalls als
Teilkomponente dieser Summationsbewegung anzusehen.
Liem folgert aus diesen Ergebnissen:
„Solche Studien können helfen, viele spekulative Ansätze bezüglich der Palpation von Körperrhythmen mit der Nähe zu Metaphysik und Glaubensannahmen zu relativieren und sie in physiologischen
Diskussionen zu verorten. Die sehr langsamen Wellen könnten
möglicherweise der Palpationserfahrung von Beckers ‚longtide‘ entsprechen.“
Diese Schlussfolgerung ist aus zwei Gründen nicht plausibel:
• Es ist palpatorisch nicht möglich, aus einer Summationsbewegung einzelne Komponenten zu isolieren.
• Die Kraft , die von den beschriebenen Pulsationen ausgeht, ist viel zu gering, um überhaupt extrakraniell wahrgenommen zu werden.
So konnten Downey et al. bei Kaninchen mit off enen Suturen eine eben tastbare Distraktion der Suturen erst bei einer applizierten
Kraft von mehr als 500 mg feststellen. Derartige Druckänderungen intrakranialsind kaum vorstellbar, auch werden derartige Drucke bei der
osteopathischen Behandlung im Kranium niemals erreicht [4].
Die eigentliche klinische Relevanz der Studie von Kiviniemi et al. für die
kraniale Osteopathie hat uns Liem aber vorenthalten: Die Existenz eines von Atmung und Puls unabhängigen kranialen Rhythmus (primärer respiratorischer Mechanismus, PRM) konnte nämlich durch modernste bildgebende Verfahren erneut nicht nachgewiesen
werden. Neuere Studien mit räumlich und zeitlich hochaufl ösendem MRT finden übereinstimmend rhythmische Bewegungen des Liquors und des Gehirns, aber ausschließlich im Zusammenhang mit respiratorischen und kardiovaskulären Einflüssen].
Der PRM ist also wohl nicht mehr als ein Artefakt, ein metaphysisches Konzept, wobei oberfl ächliche physiologische rhythmische Prozesse bei Untersuchern und Probanden in Kombination mit Imaginationen des Untersuchers die subjektiven Ergebnisse der Palpation beeinfl
ussen. Denkbar ist, dass ein Summationseff ekt von multiplen oberfl
ächlichen Oszillationen im Patienten und im Th erapeuten Sutherland, Magoun, Becker und viele andere an die Existenz eines PRM glauben ließ. Dies würde auch erklären, warum bei unterschiedlichen Untersuchern niemals vergleichbare Rhythmen festgestellt werden
konnten. Kaum vorstellbar ist, dass die Palpation einer derartigen Überlagerungswelle einen Bezug zur Symptomatik des Patienten haben kann, und es ist auch nicht klar, ob und ggf. auf welche Weise dieser Rhythmus zu beeinflussen wäre und wie ein Patient von dieser Beeinflussung profitieren könnte [8].
Hartman forderte bereits im Jahr 2006: „… the ‚cranial‘ arts should be dropped from all academic curricula; insurance companies should stop paying for them; and patients should invest their time, money, and health in treatments grounded in the extraordinarily successful, science-based biomedical model of the modern era.“
Die Dominanz dieser sich hartnäckig haltenden Lehrmeinung eines real
existierenden PRM trotz des Eingeständnisses einer großen rrtumswahrscheinlichkeit führte bislang dazu, dass wichtigen osteopathischen Fragestellungen nur unzureichend nachgegangen wurde:
• Gibt es intrakraniell überhaupt eine somatische Dysfunktion oder eine osteopathische Läsion und wie könnte man sie ggf. defi nieren?
• Wenn es sie gibt: Ist sie unserer physischen Palpation zugänglich und
wenn ja, wie?
• Ist dann eine zielgerichtete und kontrollierte osteopathische Th erapie
im kraniozervikalen Bereich möglich?
L'approche ostéopathique de la tête a été fondée, dès son origine, sur un modèle biomécanique qui se re-trouve aujourd'hui largement controversé. La nécessité de concilier la pratique ostéopathique avec les preuves disponibles, ainsi que l'esprit critique que nous attendons de la part de nos étudiants, ne sont plus compatibles avec l'ostéopathie crânienne telle qu'elle a été conçue par Sutherland. Ces dernières décennies ont vu émerger un nouveau domaine de recherche s'intéressant à la méca-nique des tissus vivants. Les ostéopathes pourraient y trouver des éléments utiles à l'élaboration d'un modèle de diagnostic et de traitement de la tête qui serait davantage en adéquation avec l'état actuel des connaissances. La biomécanique ne se limite pas à la cinématique du corps humain. Elle inclut l'étude des propriétés mécanique des tissus vivants et la manière dont ils se déforment sous l'action de sollicitations extérieures. Ces études ont notamment permis de mieux comprendre le rôle et le développement des su-tures crâniennes ainsi que la répartition des contraintes et des déformations sur le crâne. Bien qu'ils figurent parmi les éléments plus rigides du corps, les os subissent des déformations, tant dans les scènes de la vie quotidienne qu'au cours d'événements traumatiques. Comme pour tout autre * Titre de l'article original : Osteopathic decapitation : why do we consider the head differently from the rest of the body? New perspectives for an evidence-informed osteopathic approach to the head (International Journal of Osteo-pathic Medicine, 2014, 17, 256-262) http://dx. Texte traduit par les auteurs et disponible sur Le Site de l'Ostéopathie https://osteopathie-france.fr/osteopathes/articles-memoires-theses/3024-l-osteopathie-decapitee matériau, contraintes et déformations naissent au sein du tissu osseux sous l'effet des sollicitations exté-rieures qui s'y exercent, et les os du crâne ne constituent pas une exception. Dans cet article nous passons en revue les propriétés mécaniques des os et des sutures du crâne et mettons en évidence le rôle primordial que jouent les muscles dans les déformations du crâne. L'action des muscles qui se contractent est désormais reconnue comme l'une des principales causes de sollicitation du tissu osseux : en dehors des événements traumatiques, un nombre conséquent de publications sur le comportement mécanique des os et sutures du crâne confirme le rôle prépondérant que jouent les muscles dans les déformations de la tête.
Objectives:
The objectives of this preliminary study were to explore: the use of CranioSacral Therapy for persons with Autism Spectrum Disorder, the demographics of participants, and the retrospective interpretation of reported changes related to the intervention. Participants included therapists, parents, and clients.
Methods:
Recruitment of participants was conducted through electronic social and professional networks. Online questionnaire surveys were provided. Demographic questions were posed to understand both the extent of clinical use and the rationales for such treatment, and surveys were unique to each subject groups. All participants were given a 20-item functional behavior checklist as a means to measure their perception of change attributed to this intervention. Open-ended comments were also encouraged to explore perspectives from their experiential treatments. The Qualitative data collected was analyzed via Inductive Content Analysis. The data was stored on excel and analyzed manually and independently by all 3 authors.
Results:
A total of 405 people responded to the recruitments and of the participants who completed surveys, 264 were therapists and 124 parents. Only a small sampling of clients responded. The demographics of professionals using CST for ASD, their level of CST training, and their qualifications to work with ASD were reflected. Demographics and referral sources of parents, and other details of their experiences, were surveyed. Perceived changes to the use of CST were explored through analysis of responses to both the Likert scale as well as the open comments.
Conclusions:
This preliminary study introduces the concept of CranioSacral Therapy as a treatment option for symptoms associated with ASD. Its clinical use has been available for three decades but few empirical studies exist. The results of the survey suggest that CST is already being professionally recommended as a treatment. This study found that there were positive responses observed by all 3 targeted groups leading to the authors concluding that there is worthy cause to further investigate how CST benefits Autism Spectrum Disorders (ASD).
Over the past two decades there has been a growing acceptance of 'integrative oncology', also known as complementary and alternative medicine (CAM), in cancer care and research at academic medical centres and medical schools. Proponents of integrative oncology argue that it is based in science and provides the 'best of both worlds' by combining science-based treatments and 'holistic' medicine. However, a close examination of the methodologies indicates that, from a standpoint of basic science, the vast majority of 'integrative' treatments are supported by little, if any, scientific evidence. What are the consequences of this integration? Is there any harm? Are there any potential benefits?
In order to understand the high prevalence of musculoskeletal disorders of the hand among vineyard workers, we conducted a study to evaluate biomechanical strains on the hand-wrist system during grapevine pruning.
Surface electromyography (sEMG) activity of the right flexor digitorum muscle and wrist posture were analysed in six healthy vineyard workers using the same hand-powered pruning shears during grapevine pruning.
The biomechanical strains on the hand-wrist system were high during grapevine pruning. Mean sEMG activity during pruning was high [23.5% (standard error of the mean (SEM): 0.4) in the maximal voluntary handgrip contraction (MVC)], as was the mean cutting frequency per minute (38; range=24-48). Approximately 14% of cuts were performed with the wrist in extreme flexion/extension (F/E) (>60% of the maximum range). Numerous cuts required moderate (20%-40% of the maximum range) or extreme (>50% of the maximum range) ulnar deviation (17% and 12% of cuts, respectively). Approximately 18% of cuts required both high muscular activity (sEMG >15% MVC) and extreme ulnar/radial (U/R) deviation of the wrist (>50% of the maximum range).
Pruning imposes high biomechanical strains on the hand-wrist system in view of the repetitiveness of the task. The magnitude of physical exposure during pruning explains the high prevalence of hand disorders among vineyard workers. The use of ergonomic pruning shears is advised to lower force exertion and to reduce the frequency of awkward wrist postures during pruning.
Cranial osteopathic manipulative medicine (OMM) involves the manipulation of the primary respiratory mechanism to improve structure and function in children and adults.
To identify and critically evaluate the literature regarding the clinical efficacy of cranial OMM.
The clinical keywords "cranial manipulation" OR "osteopathy in the cranial field" OR "cranial osteopathy" OR "craniosacral technique" were searched in the following electronic databases: EMBASE, MEDLINE In-Process & Other Non-Indexed Citations, The Cochrane Central Register of Controlled Trials, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and AMED (Alternative Medicine). Searches were conducted in April 2011 with no date restriction for when the studies were completed.
Randomized controlled trials and observational studies that measured the effectiveness of cranial OMM on humans were included in the study. Exclusion criteria included non-English language articles, studies not relevant to cranial OMM, animal studies, and studies in which there was no clear indication of the use of cranial OMM. Studies that described the use of cranial OMM with other treatment modalities and that did not perform subgroup analysis were also excluded. The present study did not have criteria regarding type of disease.
Outcome measures on pain, sleep, quality of life, motor function, and autonomic nervous system function were extracted. The methodological quality of the trials was assessed using the Downs and Black checklist.
Of the 8 studies that met the inclusion criteria, 7 were randomized controlled trials and 1 was an observational study. A range of cranial OMM techniques used for the management of a variety of conditions were identified in the included studies. Positive clinical outcomes were reported for pain reduction, change in autonomic nervous system function, and improvement of sleeping patterns. Methodological Downs and Black quality scores ranged from 14 to 23 points out of a maximum of 27 points (overall median score, 16).
The currently available evidence on the clinical efficacy of cranial OMM is heterogeneous and insufficient to draw definitive conclusions. Because of the moderate methodological quality of the studies and scarcity of available data, further research into this area is needed.
Developing valid control groups that generate similar perceptions and expectations to experimental complementary and alternative (CAM) treatments can be challenging. The perceived credibility of treatment and outcome expectancy often contributes to positive clinical responses to CAM therapies, thereby confounding efficacy data. As part of a clinical feasibility study, credibility and expectancy data were obtained from subjects suffering from migraine who received either CranioSacral therapy (CST) or an attention-control, sham, and low-strength magnet (LSSM) intervention.
The objective of this study was to evaluate whether the LSSM intervention generated similar levels of subject credibility and expectancy compared to CST.
This was a two-arm randomized controlled trial.
Sixty-five (65) adults with moderate to severe migraine were the subjects of this study.
After an 8-week baseline, subjects were randomized to eight weekly treatments of either CST (n=36) or LSSM (n=29). The latter involved the use of a magnet-treatment protocol using inactive and low-strength static magnets designed to mimic the CST protocol in terms of setting, visit timing, body positioning, and therapist-subject interaction.
A four-item, self-administered credibility/expectancy questionnaire, based on a validated instrument, was completed after the first visit.
Using a 0-9 rating scale, the mean score for perceived logicality of treatment was significantly less for LSSM (5.03, standard deviation [SD] 2.34) compared to CST (6.64, SD 2.19). Subject confidence that migraine would improve was greater for CST (5.94, SD 2.01) than for LSSM (4.9, SD 2.21), a difference that was not statistically significant. Significantly more subjects receiving CST (6.08, SD 2.27) would confidently recommend treatment to a friend than those receiving LSSM (4.69, SD 2.49).
Although LSSM did not achieve a comparable level of credibility and expectancy to the CST, several design and implementation factors may have contributed to the disparity. Based on analysis of these factors, the design and implementation of a future study may be improved.
To estimate the effect of cranial osteopathy on the general health and wellbeing, including physical functioning, of children with cerebral palsy.
Pragmatic randomised controlled trial.
142 children from Greater London and the South West of England, aged 5-12 years with cerebral palsy.
Participants were randomised to six sessions of cranial osteopathy with a registered osteopath or a waiting list with partial attention control (parents invited to participate in two semistructured interviews).
Blind assessment of motor function by physiotherapists using the Gross Motor Function Measure-66 (GMFM-66) and quality of life using the Child Health Questionnaire (CHQ) PF50 at 6 months.
Parents' assessment of global health and sleep at 6 months, pain and sleep diaries at 10 weeks and 6 months, CHQ PF50 at 10 weeks and quality of life of main carer (Short Form 36) at 10 weeks and 6 months.
Compared with children in the control group, children in the osteopathy group demonstrated no statistically significant differences in GMFM-66 (mean difference 4.9, 95% CI -4.4 to 14.1), CHQ Physical Summary Score (mean difference 2.2, 95% CI -3.5 to 8.0) or CHQ Psychological Summary Score (mean difference 3.4, 95% CI -0.8 to 7.7). There were no significant differences between groups with respect to pain; sleep (either 'time asleep' or 'time to sleep'); or main carer's quality of life. Compared with children in the control group, carers of children receiving cranial osteopathy were nearly twice as likely to report that their child's global health had 'improved' at 6 months rather than 'decreased' or 'remained the same' (38% vs 18%; odds ratio 2.8, 95% CI 1.1 to 6.9).
This trial found no statistically significant evidence that cranial osteopathy leads to sustained improvement in motor function, pain, sleep or quality of life in children aged 5-12 years with cerebral palsy nor in quality of life of their carers.
Fibromyalgia is a prevalent musculoskeletal disorder associated with widespread mechanical tenderness, fatigue, non-refreshing sleep, depressed mood and pervasive dysfunction of the autonomic nervous system: tachycardia, postural intolerance, Raynaud's phenomenon and diarrhoea.
To determine the effects of craniosacral therapy on sensitive tender points and heart rate variability in patients with fibromyalgia.
A randomized controlled trial.
Ninety-two patients with fibromyalgia were randomly assigned to an intervention group or placebo group.
Patients received treatments for 20 weeks. The intervention group underwent a craniosacral therapy protocol and the placebo group received sham treatment with disconnected magnetotherapy equipment.
Pain intensity levels were determined by evaluating tender points, and heart rate variability was recorded by 24-hour Holter monitoring.
After 20 weeks of treatment, the intervention group showed significant reduction in pain at 13 of the 18 tender points (P < 0.05). Significant differences in temporal standard deviation of RR segments, root mean square deviation of temporal standard deviation of RR segments and clinical global impression of improvement versus baseline values were observed in the intervention group but not in the placebo group. At two months and one year post therapy, the intervention group showed significant differences versus baseline in tender points at left occiput, left-side lower cervical, left epicondyle and left greater trochanter and significant differences in temporal standard deviation of RR segments, root mean square deviation of temporal standard deviation of RR segments and clinical global impression of improvement.
Craniosacral therapy improved medium-term pain symptoms in patients with fibromyalgia.
The effects of osteopathy in the cranial field on visual function-particularly on changes in the visual field and on the binocular alignment of the eyes-have been poorly characterized in the literature. The authors examined whether osteopathy in the cranial field resulted in an immediate, measurable change in visual function among a sample of adults with cranial asymmetry.
Randomized controlled double-blinded pilot clinical trial.
Adult volunteers between ages 18 and 35 years who were free of strabismus or active ocular or systemic disease were recruited. Inclusion criteria were refractive error ranging between six diopters of myopia and five diopters of hyperopia, regular astigmatism of any amount, and cranial somatic dysfunction.
All subjects were randomly assigned to the treatment or control group. The treatment group received a single intervention of osteopathy in the cranial field to correct cranial dysfunction. The control group received light pressure of a few ounces of force applied to the cranium without osteopathic manipulative treatment.
Preintervention and postintervention optometric examinations consisted of distant visual acuity testing, Donder push-up (ie, accommodative system) testing, local stereoacuity testing, pupillary size measurements, and vergence system (ie, cover test with prism neutralization, near point of convergence) testing. Global stereoacuity testing and retinoscopy were performed only in preintervention to determine whether subjects met inclusion criteria. Analysis of variance (ANOVA) was performed for all ocular measures.
Twenty-nine subjects completed the trial-15 in the treatment group and 14 in the control group. A hierarchical ANOVA revealed statistically significant effects within the treatment group and within the control group (P <.05) in distance visual acuity of the right eye (OD) and left eye (OS), local stereoacuity, pupillary size measured under dim illumination OD and OS, and near point of convergence break and recovery. For the treatment group vs the control group, a statistically significant effect was observed in pupillary size measured under bright illumination OS (P <.05).
The present study suggests that osteopathy in the cranial field may result in beneficial effects on visual function in adults with cranial asymmetry. However, this finding requires additional investigation with a larger sample size and longer intervention and follow-up periods. (ClinicalTrials.gov number NCT00510562).
Fibromyalgia is considered as a combination of physical, psychological and social disabilities. The causes of pathologic mechanism underlying fibromyalgia are unknown, but fibromyalgia may lead to reduced quality of life. The objective of this study was to analyze the repercussions of craniosacral therapy on depression, anxiety and quality of life in fibromyalgia patients with painful symptoms. An experimental, double-blind longitudinal clinical trial design was undertaken. Eighty-four patients diagnosed with fibromyalgia were randomly assigned to an intervention group (craniosacral therapy) or placebo group (simulated treatment with disconnected ultrasound). The treatment period was 25 weeks. Anxiety, pain, sleep quality, depression and quality of life were determined at baseline and at 10 minutes, 6 months and 1-year post-treatment. State anxiety and trait anxiety, pain, quality of life and Pittsburgh sleep quality index were significantly higher in the intervention versus placebo group after the treatment period and at the 6-month follow-up. However, at the 1-year follow-up, the groups only differed in the Pittsburgh sleep quality index. Approaching fibromyalgia by means of craniosacral therapy contributes to improving anxiety and quality of life levels in these patients.
We hypothesize that stasis of the cerebrospinal fluid (CSF) occurs commonly and is detrimental to health. Physiologic factors affecting the normal circulation of CSF include cardiovascular, respiratory, and vasomotor influences. The CSF maintains the electrolytic environment of the central nervous system (CNS), influences systemic acid-base balance, serves as a medium for the supply of nutrients to neuronal and glial cells, functions as a lymphatic system for the CNS by removing the waste products of cellular metabolism, and transports hormones, neurotransmitters, releasing factors, and other neuropeptides throughout the CNS. Physiologic impedance or cessation of CSF flow may occur commonly in the absence of degenerative changes or pathology and may compromise the normal physiologic functions of the CSF. CSF appears to be particularly prone to stasis within the spinal canal. CSF stasis may be associated with adverse mechanical cord tension, vertebral subluxation syndrome, reduced cranial rhythmic impulse, and restricted respiratory function. Increased sympathetic tone, facilitated spinal segments, dural tension, and decreased CSF flow have been described as closely related aspects of an overall pattern of structural and energetic dysfunction in the axial skeleton and CNS. Therapies directed at affecting CSF flow include osteopathic care (especially cranial manipulation), craniosacral therapy, chiropractic adjustment of the spine and cranium, Network Care (formerly Network Chiropractic), massage therapy (including lymphatic drainage techniques), yoga, therapeutic breath-work, and cerebrospinal fluid technique. Further investigation into the nature and causation of CSF stasis, its potential effects upon human health, and effective therapies for its correction is warranted.
It has been suggested that the quality of clinical trials should be assessed by blinded raters to limit the risk of introducing bias into meta-analyses and systematic reviews, and into the peer-review process. There is very little evidence in the literature to substantiate this. This study describes the development of an instrument to assess the quality of reports of randomized clinical trials (RCTs) in pain research and its use to determine the effect of rater blinding on the assessments of quality. A multidisciplinary panel of six judges produced an initial version of the instrument. Fourteen raters from three different backgrounds assessed the quality of 36 research reports in pain research, selected from three different samples. Seven were allocated randomly to perform the assessments under blind conditions. The final version of the instrument included three items. These items were scored consistently by all the raters regardless of background and could discriminate between reports from the different samples. Blind assessments produced significantly lower and more consistent scores than open assessments. The implications of this finding for systematic reviews, meta-analytic research and the peer-review process are discussed.
A correlation has been established between the Traube-Hering-Mayer oscillation in blood-flow velocity, measured by laser-Doppler flowmetry, and the cranial rhythmic impulse.
To determine the effect of cranial manipulation on the Traube-Hering-Mayer oscillation.
Of 23 participants, 13 received a sham treatment and 10 received cranial manipulation.
Osteopathic Manipulative Medicine Department, Midwestern University, Downers Grove, Ill.
Healthy adult subjects of both sexes participated (N = 23).
A laser-Dopper flowmetry probe was placed on the left earlobe of each subject to obtain a 5-min baseline blood-flow velocity record. Cranial manipulation, consisting of equilibration of the global cranial motion pattern and the craniocervical junction, was then applied for 10 to 20 min; the sham treatment was palpation only.
Immediately following the procedures, a 5-min posttreatment laser-Doppler recording was acquired. For each cranial treatment subject, the 4 major components of the blood-flow velocity record, the thermal (Mayer) signal, the baro (Traube-Hering) signal, the respiratory signal, and the cardiac signal, were analyzed, and the pretreatment and posttreatment data were compared.
The 10 participants who received cranial treatment showed a thermal signal power decrease from 47.79 dB to 38.49 dB (P < .001) and the baro signal increased from 47.40dB to 51.30 dB (P < .021), while the respiratory and cardiac signals did not change significantly (P > .05 for both).
Cranial manipulation affects the blood-flow velocity oscillation in its low-frequency Traube-Hering-Mayer components. Because these low-frequency oscillations are mediated through parasympathetic and sympathetic activity, it is concluded that cranial manipulation affects the autonomic nervous system.
To determine if cranial manipulation is associated with altered sleep latency. Furthermore, we investigated the effects of cranial manipulation on muscle sympathetic nerve activity (MSNA) as a potential mechanism for altered sleep latency.
Randomized block design with repeated measures.
The Integrative Physiology and Manipulative Medicine Departments, University of North Texas Health Science Center, Fort Worth, TX.
Twenty (20) healthy volunteers (12 male, 8 female; age range, 22-35 years) participated in this investigation.
Subjects were exposed to 3 randomly ordered treatments: compression of the fourth ventricle (CV4), CV4 sham (simple touch), and control (no treatment).
Sleep latency was assessed during each of the treatments in 11 subjects, using the standard Multiple Sleep Latency Test protocol. Conversely, directly recorded efferent MSNA was measured during each of the treatments in the remaining 9 subjects, using standard microneurographic technique.
Sleep latency during the CV4 trial was decreased when compared to both the CV4 sham or control trials (p < 0.05). MSNA during the CV4-induced temporary halt of the cranial rhythmic impulse (stillpoint) was decreased when compared to prestillpoint MSNA (p < 0.01). During the CV4 sham and control trials MSNA was not different between CV4 time-matched measurements (p > 0.05). Moreover, the change in MSNA prestillpoint to stillpoint during the CV4 trial was different compared to the CV4 sham and control trials (p < 0.05). However, this change in MSNA was similar between the CV4 sham and control trials (p > 0.80).
The current study is the first to demonstrate that cranial manipulation, specifically the CV4 technique, can alter sleep latency and directly measured MSNA in healthy humans. These findings provide important insight into the possible physiologic effects of cranial manipulation. However, the mechanisms behind these changes remain unclear.
In this open, controlled, prospective study, 28 infants with colic were randomized to either cranial osteopathic manipulation or no treatment; all were seen once weekly for 4 weeks. Treatment was according to individual findings, and administered by the same practitioner. Parents recorded time spent crying, sleeping and being held/rocked on a 24-hour diary. A progressive, highly significant reduction between weeks 1 and 4 in crying (hours/24h) was detected (P<0.001) in treated infants; similarly, there was a significant improvement in time spent sleeping (P<0.002). By contrast, no significant differences were detected in these variables for the control group. Overall decline in crying was 63% and 23%, respectively, for treated and controls; improvement in sleeping was 11% and 2%. Treated infants also required less parental attention than the untreated group. In conclusion, this preliminary study suggests that cranial osteopathic treatment can benefit infants with colic; a larger, double-blind study is warranted.
Quasi-experimental design.
To determine if physical manipulation of the cranial vault sutures will result in changes of the intracranial pressure (ICP) along with movement at the coronal suture.
Craniosacral therapy is used to treat conditions ranging from headache pain to developmental disabilities. However, the biological premise for this technique has been theorized but not substantiated in the literature.
Thirteen adult New Zealand white rabbits (oryctolagus cuniculus) were anesthetized and microplates were attached on either side of the coronal suture. Epidural ICP measurements were made using a NeuroMonitor transducer. Distractive loads of 5, 10, 15, and 20 g (simulating a craniosacral frontal lift technique) were applied sequentially across the coronal suture. Baseline and distraction radiographs and ICP were obtained. One animal underwent additional distractive loads between 100 and 10,000 g. Plate separation was measured using a digital caliper from the radiographs. Two-way analysis of variance was used to assess significant differences in ICP and suture movement.
No significant differences were noted between baseline and distraction suture separation (F = 0.045; P>.05) and between baseline and distraction ICP (F = 0.279; P>.05) at any load. In the single animal that underwent additional distractive forces, movement across the coronal suture was not seen until the 500-g force, which produced 0.30 mm of separation but no corresponding ICP changes.
Low loads of force, similar to those used clinically when performing a craniosacral frontal lift technique, resulted in no significant changes in coronal suture movement or ICP in rabbits. These results suggest that a different biological basis for craniosacral therapy should be explored.
CAM therapies have become increasingly popular in pediatric populations. Yet, little is known about children's preferences for CAM. This study examined treatment preferences in chronic pediatric pain patients offered a choice of CAM therapies for their pain. Participants were 129 children (94 girls) (mean age = 14.5 years +/- 2.4; range = 8-18 years) presenting at a multidisciplinary, tertiary clinic specializing in pediatric chronic pain. Bivariate and multivariate analyses were used to examine the relationships between CAM treatment preferences and patient's sociodemographic and clinical characteristics, as well as their self-reported level of functioning. Over 60% of patients elected to try at least one CAM approach for pain. The most popular CAM therapies were biofeedback, yoga and hypnosis; the least popular were art therapy and energy healing, with craniosacral, acupuncture and massage being intermediate. Patients with a diagnosis of fibromyalgia (80%) were the most likely to try CAM versus those with other pain diagnoses. In multivariate analyses, pain duration emerged as a significant predictor of CAM preferences. For mind-based approaches (i.e. hypnosis, biofeedback and art therapy), pain duration and limitations in family activities were both significant predictors. When given a choice of CAM therapies, this sample of children with chronic pain, irrespective of pain diagnosis, preferred non-invasive approaches that enhanced relaxation and increased somatic control. Longer duration of pain and greater impairment in functioning, particularly during family activities increased the likelihood that such patients agreed to engage in CAM treatments, especially those that were categorized as mind-based modalities.
A hypothesis is proposed which suggests biomechanical changes affect physiological mechanisms that may explain the therapeutic effects and tissue changes palpated by practitioners of osteopathy in the cranial field (OCF). It is suggested that the subtle application of manual compression between a practitioner's hands may cause a net negative charge in the collagen matrix resulting in a change of state from a gel to a sot. This is attributed to biochemical changes and the thixotropic properties of collagen. It is also hypothesized that ionic movement results in an electrochemical gradient which causes changes in the cellular/plasma membrane permeability. Altered cation (hydrogen and calcium ions) distribution, present in the extracellular fluid, results in 1) an electrochemical gradient which causes changes in the cellular/plasma membrane permeability and 2) the stimulation of a local vasomotive response. It is postulated that the stimulation of a local vasomotive response within the extracellular matrix (ECM) is perceived by the practitioner of OCF as feeling a change in the quality of the "primary respiratory mechanism" (PRM)(a) and the "cranial rhythmic impulse" (CRI).(b) Restoring a normal electrochemical/ionic gradient across the cellular/plasma membrane, equilibrium is reached and it is hypothesized that this is the point of balanced fluid interchange (BFI), a point practitioners of OCF refer to as a "still point". Other physiological mechanisms and their implications are discussed to 1) explain other palpatory findings felt during the therapeutic response and 2) to explain the reported changes in the quality of the PRM/CRI, made by OCF practitioners, after a still point(c) has been reached.
A mixed methodology was used to explore the effects of craniosacral still point technique (CSPT) in 9 older adults with dementia. Participants were monitored at baseline (3 weeks), intervention (6 weeks), and postintervention (3 weeks) using the modified Cohen-Mansfield Agitation Inventory (M-CMAI). CSPT was implemented daily for 6 weeks by a certified craniosacral therapist. Findings indicated a statistically significant reduction in M-CMAI total and subscale scores during the intervention period. This reduction continued during postintervention for subscale scores of physical nonaggression and verbal agitation. Staff and family interviews provided convergent validity to the quantitative findings. Participants were also more cooperative during caregiving activities and displayed meaningful interactions.
Tension-type headache (TTH) is a common reason for consulting a clinician. Manual therapies are being used in clinical settings to treat TTH with no documented research to validate their efficacy. This study investigated the effectiveness of CV-4 and resting position techniques on TTH sufferers. Sixty adults between the ages of 21 and 65 (x=36, SD=12) who were experiencing a TTH were randomly assigned to groups. Subjects in the first group received a 10-minute session wherein multiple still points were induced using the CV-4 craniosacral technique. Subjects in the second group were placed supine in a resting position with the head and neck positioned for ten minutes in the most comfortable points in the ranges of protraction-retraction and flexion-extension. Subjects in the third group received no treatment; they lay quietly for 10 minutes. Pain intensity and the affective component of pain were measured before and after the treatments using visual analog scales. To determine if significant differences existed between the groups, a one-way multivariate analysis of covariance (MANCOVA) was used, followed by univariate tests and post-hoc tests. The MANCOVA was significant (F=3.59; df=4,108; p
This study describes patients presenting for CranioSacral treatment, the conditions they present with, and the impact of treatment on both their symptoms and lives.
The records of 157 patients treated with Upledger CranioSacral Therapy (UCST) were reviewed. Seventy-three (73) patients had been treated by 10 different practitioners working independently and 84 patients were treated by a single practitioner working within the National Health Service.
Patients' ages ranged from neonates to 68 years. Seventy-four percent (74%) of patients reported a valuable improvement in their presenting problem. Sixty-seven percent (67%) also reported a valuable improvement in their general well-being and/or a second health problem. Outcome by diagnostic groups suggested that UCST is particularly effective for patients with headaches and migraine, neck and back pain, anxiety and depression, and unsettled babies. Seventy percent (70%) of patients on medication decreased or discontinued it, and patients' average general practitioner consultation rate fell by 60% in the 6 months following treatment.
The study suggests that further research into UCST as a treatment modality would be valuable for the abovementioned problems in particular.
The Dutch parliament has recently accepted a tax law in which certain groups of alternative therapists can be exempt from VAT. To be eligible for this VAT exemption, the disciplines to which the therapists belong have to meet certain training requirements. In this article it is contended, in agreement with the Royal College of Physicians in the UK, that statutory regulation is inappropriate for disciplines whose therapies are neither of proved benefit nor appropriately tested. It legitimizes harmful therapies. This is illustrated by two serious accidents, previously described in this journal, caused by a chiropractor and a craniosacral therapist.
To examine whether craniosacral therapy improves lower urinary tract symptoms of multiple sclerosis (MS) patients. A prospective cohort study. Out-patient clinic of multiple sclerosis center in a referral medical center. Hands on craniosacral therapy (CST). Change in lower urinary tract symptoms, post voiding residual volume and quality of life. Patients from our multiple sclerosis clinic were assessed before and after craniosacral therapy. Evaluation included neurological examination, disability status determination, ultrasonographic post voiding residual volume estimation and questionnaires regarding lower urinary tract symptoms and quality of life. Twenty eight patients met eligibility criteria and were included in this study. Comparison of post voiding residual volume, lower urinary tract symptoms and quality of life before and after craniosacral therapy revealed a significant improvement (0.001>p>0.0001). CST was found to be an effective means for treating lower urinary tract symptoms and improving quality of life in MS patients.
The objective of this research was to review critically the scientific basis of craniosacral therapy as a therapeutic intervention.
A systematic search for and critical appraisal of research on craniosacral therapy was conducted. Medline, Embase, Healthstar, Mantis, Allied and Alternative Medicine, Scisearch and Biosis were searched from their start date to February 1999.
A three-dimensional evaluative framework with related appraisal criteria: (A) craniosacral interventions and health outcomes; (B) validity of craniosacral assessment; and (C) pathophysiology of the craniosacral system.
The available research on craniosacral treatment effectiveness constitutes low-grade evidence conducted using inadequate research protocols. One study reported negative side effects in outpatients with traumatic brain injury. Low inter-rater reliability ratings were found.
This systematic review and critical appraisal found insufficient evidence to support craniosacral therapy. Research methods that could conclusively evaluate effectiveness have not been applied to date.
A range of health care practitioners use cranial techniques. Palpation of a cranial rhythmic impulse (CRI) is a fundamental clinical skill used in diagnosis and treatment with these techniques. There has been little research establishing the reliability of CRI rate palpation.
This study aimed to establish the intraexaminer and interexaminer reliability of CRI rate palpation and to investigate the "core-link" hypothesis of craniosacral interaction that is used to explain simultaneous motion at the cranium and sacrum.
Within-subjects, repeated-measures design.
Two registered osteopaths, both with postgraduate training in diagnosis and treatment, using cranial techniques, palpated 11 normal healthy subjects.
Examiners simultaneously palpated for the CRI at the head and the sacrum of each subject. Examiners indicated the "full flexion" phase of the CRI by activating silent foot switches that were interfaced with a computer. Subject arousal was monitored using heart rate. Examiners were blind to each other's results and could not communicate during data collection.
Reliability was estimated from calculation of intraclass correlation coefficients (2,1). Intrarater reliability for examiners at either the head or the sacrum was fair to good, significant intraclass correlation coefficients ranging from +0.52 to +0.73. Interexaminer reliability for simultaneous palpation at the head and the sacrum was poor to nonexistent, ICCs ranging from -0.09 to +0.31. There were significant differences between rates of CRI palpated simultaneously at the head and the sacrum.
The results fail to support the construct validity of the "core-link" hypothesis as it is traditionally held by proponents of craniosacral therapy and osteopathy in the cranial field.
A mixed methodology was used to explore the effects of craniosacral still point technique (CSPT) in 9 older adults with dementia. Participants were monitored at baseline (3 weeks), intervention (6 weeks), and postintervention (3 weeks) using the modified Cohen-Mansfield Agitation Inventory (M-CMAI). CSPT was implemented daily for 6 weeks by a certified craniosacral therapist. Findings indicated a statistically significant reduction in M-CMAI total and subscale scores during the intervention period. This reduction continued during postintervention for subscale scores of physical nonaggression and verbal agitation. Staff and family interviews provided convergent validity to the quantitative findings. Participants were also more cooperative during caregiving activities and displayed meaningful interactions.
Although very little scientific data exists on the efficacy and side effects of complementary and alternative medicines, their profile and availability is increasing. Use among Irish children is unknown.
To determine the nature and prevalence of complementary and alternative medicines (CAM) use in our paediatric population.
Parental questionnaires were distributed in 13 paediatric settings over a 4-month period.
There were 57% of parents reported using CAM for their child. Use was significantly higher in the 2-4 years age group (34/105, 32%, P = 0.005). The commonest medicinal CAMs used were vitamins (88%), fish oils (27%) and Echinacea (26%). The commonest non-medicinal CAMs used were homeopathy (16%) and craniosacral therapy (14%). Use varied between paediatric specialties, with the highest in neurological patients (23/25, 92%, P = 0.005). Only 13% of parents had informed their Paediatrician of their child's CAM use.
More than half of the children surveyed had used some form of CAM, usually without their Paediatrician's knowledge.