a study of the rhythmic motions of the living cranium - iahe · tactile illusions of rhythmic...

A study of the rhythmic motions of the Cranium

living craniumVIOLA M. FRYMANN, D.O., FAAOLa Jolla, California

The hypothesis of inherent motilityof the cranium has been supportedby palpation of the living head.The hypothesis that a rhythmsynchronous with the arterial pulseand another associated with thoracicrespiration might be detected is inaccord with known physiologicphenomena. The report of a thirdpalpable rhythm, slowerthan either pulse or respiration,required more study. Thisarticle records a series of experimentsconducted with instrumentationsuitable for studying minuteexpansile-contractile motions ofthe live cranium. The recordingsshow that there is a cranial motilityslower than and distinguishablefrom the motility of the vascular pulseand thoracic respiration, and thatsuch motion can be recordedinstrumentally. Studies of rhythmiccellular function and movementof cerebrospinal fluid have been reportedelsewhere. More investigation isneeded to establish the relations amongthe various physiologic phenomenadescribed. Additionally, theclinical significance of the rhythmicmotion of the cranium needsdocumentation.

It has been 70 years since Sutherland con-ceived the idea that the cranial bones are bev-eled for articular mobility to accommodate themotion of a respiratory mechanism.' Hismeticulous study of the cranial bones re-vealed that each bone is beveled reciprocally,with corrugations running transversely, diag-onal friction gears, balls and sockets, pintles,pulleys, fulcrums, hinges, and other mechan-ical arrangements that made provision formovement. Palpation of the living head lentsupport to the hypothesis, first advanced in1939, 2 that there is inherent motility of thecranium. It was a plausible contention and inaccord with known physiologic phenomena,that a rhythm synchronous with the arterialpulse might be detected, but his report of athird palpable rhythm, slower than eitherpulse or respiration, needed further study.Does such a motion really occur? Can it bemechanically recorded? If it exists, what is itsrelation to known physiologic functions?

This paper is intended to present the re-sults of exploration of these three questions.With regard to the first question, as to theexistence of such a rhythmic motion, slowerthan and different from the thoracic respira-tory rhythm, within the living cranium, thosetrained in skillful palpation of the human bodyhave claimed for nearly 30 years that suchinherent motility is detectable. The validityof the palpatory findings of persons withtrained hands is, however, subject to questionby those who lack such palpatory skill. Thedoubt is due primarily to the plausible hy-pothesis that the sense of touch will experiencesystematic tactile illusions when subjected tosmall cyclic motions.

It can be shown mathematically that if thepressure-sensing nerve ends are acted on bythe sum of two oscillatory pressures of dif-ferent frequency, and if the effective signal

Journal AOA/vol. 70. May 1971 928/83

Motions of the cranium

developed by the nerves is a nonlinear func-tion of the total pressure, then the signal willcontain two pseudo-oscillations of which thefrequencies are the sum and the difference ofthose actually present. Further, if the neuralnetworks are developed by attention and prac-tice to filter out all but the lowest frequency,the sense of touch will experience the illusionthat a repetitive motion is clearly felt at afrequency which is the difference between thetwo frequencies actually present. In palpation,the fingertips are subjected to four cyclicmotions of different frequency, one eachfrom the pulse and the respiratory cycles ofthe operator and of the subject. It may becontended with some force of argument thatthe apparent sensation of a slow cranialrhythm represents only a "beat" frequencybetween, say, the two pulse cycles.

It should be noted in this regard that theear is known to be subject to this same error.When two piano strings vibrate at slightly dif-ferent rates, a beat note is distinctly heard atthe difference frequency, although the note isnot physically present. Furthermore, a varietyof tactile illusions are known to exist. Per-haps the most common one is generated whenan object is touched with the tips of crossedfingers, so that an impression of two objectsinstead of one is received.

Because exceptions of this sort can be takenas evidence perceived by palpation alone, itwas essential to devise an instrument programto demonstrate whether the tactile observa-tions of cranial motility are, in fact, valid.

An intensive search of scientific literaturefailed to reveal any investigation of the motil-ity of the living cranium. The anatomic studiesof Pritchard, Scott, and Girgis 3 substantiatedSutherland's theory that cranial sutures aredesigned to permit motion and in fact ex-tended this concept to several species of

animals, but the physiologic concept thus pro-pounded had not yet been challenged experi-mentally.

In 1962, therefore, I invited a skilled elec-tronics engineer, F.G. Steele, a designer ofcomputers, to design an electronic recordinginstrument suitable for investigating minuteexpansile-contractile motions of the livecranium. This report has been prepared withhis assistance, because an understanding ofthe interrelation between the laws of electron-ics, the laws of mechanics, and the laws ofnerve function is necessary for comprehensionof the principles involved in the instrumentdesign and the interpretation of results.

Mechanical recordingInvolved in the instrumental problem is thefact that touch is nonlinear. The nervous sys-tem will transmit to the brain signals whicherroneously include sinusoids having the fre-quencies of the sums and differences of theactual cyclic motions present.

Tactile illusions of rhythmic motions in thehead, or, in fact, in any part of a subject,might arise in the following way:

The experimenter's fingertips are placedlightly on the subject's head, with both headand hands supported in such a way that norelative motions take place. Both the scalp andthe fingers will experience slight expansionsand contractions due to the two pulse surges.If it may be assumed that the fingers act aslinear elastic constraints, a pressure propor-tional to the sum of the pulse amplitudes willbe generated at the contact surfaces.

The next assumption is that the pressure-sensing neurons have a nonlinear response,that is, that a graph of the effective neuron-sensing rate with variations in applied pres-sure will yield a curved rather than a straightline. One would assume, a priori, that human

921,/81

pressure sensors would show a logarithmicrather than linear response in order to coverthe wide ranges encountered.

Under these conditions, it can be shownmathematically that the neurons will not onlysense the two cyclic pulses but will developsignals containing two other rhythmic signalswith repetitive frequencies which do not existexternally—one at the sum and the other atthe difference between the two pulse fre-quencies.

The automatic recording of small trans-latory motions—between, say, 0.01 and 0.0001inch in excursion—has become a common oc-currence. A number of sensing devices whichcan respond to displacements as small as thosewhich now appear meaningful in cranial studyare available. Thus the sensitivity of the pick-off is a serious but not dominant concern. Op-tical techniques are available, if required,which can detect movements of less than0.000001 inch, and the MOssbauer effect can,in theory, be utilized to detect motions as slowas the rate of growth of a fingernail.

All of the primary design considerations inthis application were related to the means ofmounting pick-offs to register the motionssought while excluding those which were notdesired. The latter arise from at least threesources:

(1) The large motions of the thorax duringbreathing can produce a variety of small mo-tions of the head.

(2) Involuntary movements of the subject,such as swallowing, sniffing, clenching theteeth, or accommodating fatigue, introduceboth transient disturbances and null shifts.

(3) The pulse introduces a cyclic scalp mo-tion with an amplitude on the order of themotion sought.

In addition, variations in the tonus of themuscles of the head and neck must be regarded

with suspicion.There are two fundamental methods of

mounting the pick-offs; one is to place themdirectly on the subject and the other is to at-tach both pick-offs and subject to a common,rigid frame. The padded table is the obviousunit.

Each method of mounting has inherent ad-vantages and difficulties.

Pick-offs mounted directly on the head andsupported by it will be relatively unaffected bymotions of the entire head, since they go withit. It is best to apply them with the subjectseated. Disturbances from breathing shouldbe at a minimum, but chronic difficulties fromlarge pulse signals are probable. Head-mount-ed systems will offer difficulty in localizingmotion, in sensing the head without "loading"it, in shifting pick-offs to arbitrary positions,and in controlling the pressure of the probes.

With instruments supported externally tothe subject, the reverse situation tends to oc-cur. Difficulty with undesired head motions isinherent. It is highly desirable to apply theinstruments with the subject supine. Pulsesignals are minimized by this application, butbreathing signals offer a major difficulty. Pick-offs may be shifted freely in position, arelocalized in their measurements, and may beapplied with controlled pressure.

It was decided to begin work with a sys-tem that would duplicate as closely as feasiblethe standard conditions under which palpa-tion, diagnosis, and treatment normally areperformed. External mounting therefore wasselected. An important additional considera-tion was that it was better to be bothered bythe breathing than by the pulse, since breath-ing can be interrupted at will.

Choosing an instrumental system that par-alleled palpation seemed the shortest waytoward evolving it.

Journal AOA/vol. 70, May 1971 930/85


As mentioned, the chief disadvantage oftable mounting of pick-offs is their sensitivityto motions of the whole head. To counteractthis in principle, the frame must use twomatched pick-offs which come in contact withthe head on opposite sides. Their signals arecombined to subtract when displacements arein the same direction and to add when dis-placements are in opposite directions. Thus,any shifting of the head cancels out signals,while expansions or contractions produce adoubled signal.

If people were complete blockheads—thatis, if the two sides of the skull were parallel—this compensation would be complete. Un-fortunately and inconveniently, at most pointsof interest the sides of the head slant some-what in two directions—toward the foreheadand toward the vault. Breathing, by raisingand lowering the thorax, tends to rock thethe head slightly about its effective point ofsupport, and this in turn causes the head tomove the pick-offs farther apart or closer to-gether by a wedging action.

Thus, the cancellation of directly coupledbreathing motions is achieved only partially.To keep the remainder small, much attentionmust be given to the design of the neck rest.It can be seen that the undesirable feature ofthe neck rest is its resiliency—which is, un-fortunately, the basis for all normal pad andpillow action. The typical cushion is springy.When placed beneath the neck, it is pusheddown not only by the weight of the neck itselfbut by a certain part of the weight of theupper part of the shoulders. As the shouldersare raised by the respiratory motion of thethorax, they lighten the load of the lower partof the neck; the cushion rises up slightly, androcking of the head ensues.

After much tinkering with shaped woodenblocks and other paraphernalia, the problem

was solved with a small sandbag. This provedto be a major inspiration, since sand, by ac-commodating readily to all shapes, is thorough-ly comfortable, yet is completely devoid ofresiliency. Immobilization of the head was in-creased later by the use of a Flexicast pillow.This is a rubber case filled with a powderedplastic that behaves in the presence of air aswould any other finely divided solid, accom-modating itself to the shape of the head to givecomfortable nonelastic support, as does thesandbag. When the air is pumped out of therubber bag, however, the plastic grains locktogether in a shape virtually as rigid and hardas concrete. No comfort is lost because theshape still exactly conforms to the head, whichis now immobilized in its "cast." Between thecompensating pick-offs and the nonresilienthead and neck support, external physicalcoupling of the chest motion into the headpick-offs can be reduced to a tolerable min-imum.

Effective contact between pick-offs andskull presents the second serious problem. Atone time there was some talk of putting smallscrews in a subject's skull and using theprojecting screw heads for measuring points.Members of the dental profession suggestedthe use of small L-shaped metal slips of a typewhich has been used in dentistry for record-ing motion of the maxillae. One arm of theL is slipped under the soft tissue in contactwith the bone and allowed to become fixed inits position by fibrosis. The other arm is at-tached to measuring and recording instru-ments when needed. A similar application wasconceived for recording motion in other cranialbones. It was suggested that the metal slipscould be inserted and allowed to become sealedin position and would be available for usewhen needed. Unfortunately, the line of volun-teers waiting outside the door was not as long

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as had been hoped, so this method wasabandoned.

In general, the scalp presents an interven-ing layer of damping material which not onlyattenuates the already small motions beneathit but is itself a source of spurious signals. Itis desirable to have probes which reduce scalpeffects to a minimum and standardize what-ever remains. This implies that probes mustbe applied with specified pressure.

The probes of the pick-offs finally chosenare freely suspended—that is, without fric-tional contact—by pairs of high qualitysprings. Their tips are rounded approximatelyinto a small parabola of revolution 0.25 inchin diameter. In present use, they are moved inby setscrews until the subject reports thatfirm pressure has been established. After afew minutes they must be tightened again.The scalp tissue slowly deforms beneath theprobe tip in plastic flow, forming a temporarydent. The remaining tissue between the probecenter and skull presumably consists of a cellmass from which the intercellular fluid hasbeen largely expelled, with the capillariessqueezed off.

That this is true is borne out by the factthat pulse signals become negligible so thattightened settings tend to give reduced pulsesignals. It appears also that initially tightsettings become progessively lighter with theplastic deformation of the scalp tissue. Hence,after equilibrium is reached, light contact willbe sufficient. The technique of progressivetightening has not caused discomfort exceptin a few subjects in whom heavy final pres-sures were investigated.

Although many years may pass before thefinal word is said about tip size, shape, ma-terial, and pressure, it appears that probesused in about this fashion will give satisfac-tory results and yet be painless and easy to

apply. Since some of the best results wereobtained from women subjects with luxurianthair, it has been possible to stop specializingin studies of bald men.

The pick-offs used are matched differentialtransformers of high sensitivity.

The oscillograph is especially designed torecord signals from this type of device on oneof its two pens. The two transformer outputsare wired in opposing series to achieve thecancellation of undesired displacements andthe doubling of desired ones. The differentialtransformer was chosen in preference to otherdevices because by type it is perhaps the mostreliable, repeatable, and trouble-free of stan-dard sensors and gives reputable results.

Report of studyThe work may be divided roughly into fourperiods, as follows:

First period

In the early part of the study, a unit was as-sembled of a plywood frame, a borrowed oscil-lograph, and a standard pair of surplus trans-formers with springs added. The results,although generally negative, justified the quicksetup. Enough was learned to warrant pro-ceeding immediately to a relatively finishedunit. The most significant discovery at thispoint was that the cranial motions are muchsmaller than anticipated, in the range of from0.0005 to 0.001 inch.

Second periodDuring the second period, the apparatus nowin use was machined (Figs. 1-4), assembled,and put into operation. For pick-offs, the mostsensitive differential transformers commer-cially available at the time of ordering wereused. The period was long, and there werea number of minor but obscure difficulties,


Fig. 1. Apparatus viewed from the front, showingFlexicast pillow shaped to the head.

Fig. 3. Lateral view with subject in situ.


Fig. 2. Close-up of apparatus, showing pick-offs andcarrying yoke.

Fig. 4. Apparatus viewed from above with subject insitu.

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Fig. 5c. After a second tightening of the pick-offs, rhythmic motion during sustained inhalation is of greateramplitude and slower than the respiratory rhythm preceding and following it. The patient developed severeheadache following the test, in which the pressure was increased to the point of discomfort.

Fig. 5a (left). Recording of May 30, 1963, with the pen moving at 1 mm./sec. From right to left, the cyclesynchronous with thoracic respiration is seen before and after a sustained inhalation during which no sig-nificant motion other than that of the pulse was recorded. Fig. 51) (right). After tightening of the pick-offs,distinct rhythmic motion was recorded during a sustained inhalation.

only humorous on hindsight, which blockedsuccessful recording. There had, however, beenone significant recording, on May 30, 1963,which sustained the effort through this de-pressing period (Figs. 5a, 5b, and 5c). At thistime, the first unmistakable recording of a•cranial rhythmic impulse independent of anddifferent from pulse or respiration was made.

The subject suffered from a severe headachedue to tightness of the large pick-offs, but ithad been established that such motion did exist

and could be recorded. Minor modificationswere made in the apparatus to make it lesstraumatic to the subject. In all subsequent ex-periments, pick-offs of 0.25 inch were used.

Figure 6 is a recording made of a man withexcellent respiratory control and shows reduc-tion in amplitude of the wave and some varia-tion in frequency during a period of inter-rupted respiration. Results are better when asubject is able to interrupt respiration at themidpoint between inhalation and exhalation,


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Fig. 6. Recording of another subject, with pen moving at 5 mm./ sec., showing reduction in amplitude of thewave and variation in frequency during interrupted respiration.

but few subjects have the necessary control todo this and tend to inhale vigorously whenasked to stop breathing.

Third periodIn 1964 recordings of the cranial rhythmic im-pulse and simultaneous pneumographic record-ings of thoracic respiration were made on thesame record. Now significant recordings werebeing obtained. After that the frequency ofrecordings which showed the Sutherland cyclesteadily increased. At this time it probably ispossible to get such records from most subjectsor to obtain recordings from the same sub-ject on most occasions.

Twelve sample recordings are presentedhere. It must be remembered that a typical re-cording may average 50 feet in length, butonly a few inches can be presented in the cut.Not all of the sections have been chosen as thebest ones to exhibit the cranial rhythm, al-though these are now common. Some of them,however, illustrate surprising results, whichappear to suggest unexplored vistas.

In the early part of the study it was difficultto determine the optimum pressure of thepick-offs on the head. This was a problem alsowith the pneumograph around the chest. Itherefore served as the subject so that I mightcorrelate my own subjective observations withthe objective recording. When the pick-offswere first positioned on the head, I was con-scious of a throbbing arterial pulsation. Aftera brief period it gradually subsided. When thepick-offs were tightened, I was aware of thetransmitted respiratory motion, that is, of amotion of the head related to thoracic motion.Additional tightening made me gradually con-scious of the rhythmic, cyclic increase and de-crease of pressure from within the head

against the pick-offs. This would wax andwane, depending on the direction of motioninside the head. If the motion was predom-inantly lateral and medial, I was aware of thepick-offs. When the motion was in an antero-posterior direction, pressure on the pick-offswas reduced. Correlation of these observa-tions with the recordings proved that periodsof low-amplitude recordings coincided withanteroposterior motion within the head. Whenthoracic respiration was interrupted at aneasy midpoint in the cycle, the cranial motionwas easily palpable from within against thepick-offs. If, however, a forceful inhalationwas held, the increased intracranial pressureinduced thereby seemed to reduce the amp-litude of movement. The degree of tension ofthe pneumograph around the thorax was im-portant, because it affected the cranial motion.When it was applied tightly enough to presentresistance to thoracic expansion, there wasimmediately an increase in the diaphragmaticand abdominal excursion on the one hand andin the transmitted respiratory motion of thehead on the other. It became apparent thatthe chest band must be tight enough to movewith the chest wall, but loose enough not torestrict its excursion, if the cranial impulsewas to remain uninfluenced by it.

Figures 7a, 7b, and 7c show three sections ofthe same recording, with the cranial tracingabove and the pneumogram below. The pneu-mogram shows two respiratory cycles beforethe interruption of respiration, with slow,shallow exhalation continuing throughout. Al-though there was no slow cycle of motion inthe cranial recording during the interruptionof breathing, the respiratory cycle started afull cycle earlier in the head than in the lungs.It is not probable that this reflected a strong

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Fig. 7a (top). Three sections of recording from same subject, with oscillograph set at 5 mm./sec. The cranialtracing appears at the top and the pneumogram below. From right to left the pneumogram shows two respir-atory cycles, before interruption of respiration, with continuing slow, shallow exhalation throughout.Fig. 7b (middle). Later section shows cranial rhythm lagging behind chest movement and peak of motionduring interrupted respiration which is neither respiratory nor arterial.Fig. 7c (bottom). Still later section shows tracings out of phase.


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Fig. 8. Cranial recording during two periods when breath was interrupted at middle of respiratory cycleafter deep inhalation. Cranial cycles of approximately 5 seconds can be seen.

involuntary muscular effort to breathe whichwas blocked in the mouth and throat, since thepneumograph is directly sensitive to suchmuscular actions and would clearly reveal anaborted breathing attempt. Instead it showsslow exhalation continuing until inhalationoccurred.

In the second section the cranial rhythmlagged behind the chest movement, and therewas a peak of motion, which was neitherrespiratory nor arterial, in the period of in-terrupted respiration.

In the third section the two tracings wereout of phase.

Figure 8 shows a cranial recording of twoperiods when the breath was interrupted atthe middle of the respiratory cycle. A deep in-halation preceded each period.

Subjects selected for these experimentswere known to have mobile cranial mech-anisms, for the purpose of the study was toascertain the activity within a healthy head.However, an exception was made to this rulewhen a patient with hypertrophic frontalispresented herself (Figs. 9a and 9b).

Figure 10 shows three sections from the re-cording of a remarkably mobile cranial mech-anism. There were many interesting varia-tions in character of the excursions, phaserelations to respiration, superimposed rapidoscillations, and slow waves, and the correla-tion with chest movements was highly erratic.Later, the amplitude of the cranial rhythmwas greater than that of the respiratory cycle.This made it much easier to distinguish than ithad been before, although it was still distortedby the mixing. The superimposed pulse signalwas unusually large.

Figures 11a and 11b show a remarkable de-gree of cranial mobility in an athletic octoge-narian. His astonishing breath-holding abilitymade him an ideal subject for the study, andhe had the added qualification of being com-pletely bald. The cranial and respiratoryrhythms were not synchronous.

Figure 12 is a recording made on the cra-nium of a 19-year-old youth. During a periodof holding the breath the cranial rhythmchanged from a pattern synchronous withthoracic respiration to the Sutherland cycle,which is slower than and separate fromthoracic respiration. His respiratory rate wasapproximately 15.5 cycles per minute and thecranial rate was 12.8 cycles per minute.

Fourth period

In 1965 the second channel of the oscillographwas used for a plethysmographic instead ofpneumographic study. The fourth phase ofthis research was directed toward determiningwhat relation might exist between volumetricchanges in the finger or the forearm and therhythmic cycles of the cranium. The ple-thysmograph registers changes in volume ofthe part it encloses. Changes are primarilyin blood volume, but movement of tissue fluidsmust not be overlooked as an importantthough minor contributor to the volumechange.

In Figure 13a and following figures the cra-nial record appears at the top and theplethysmographic record below. The record-ing in Figure 13a was made during easy, quietrespiration and shows a sharp decrease involume in the right forearm that almostcoincided with the contractile phase of the

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Fig. 9a. Recording of patient with hypertrophic osteitis frontalis. With cranial pick-offs on the parietal bonesthere is a pronounced lag between the cranial peaks in the upper tracing and the respiratory peaks in thelower. Forceful inhalation is accompanied with wide cranial deflection and two cycles of motion before ex-halation is recorded on the imeumogram.

Fig. 9b. Same patient as above. With pick-offs placed over the lateral angles of the frontal bone, the record-ing showed little significant motion. This was consistent with the results of palpation.

cranial rhythm.Figure 13b is a later recording of the same

subject during a period of interrupted respira-tion. During the three cranial cycles at thebeginning of the period there was a delay inthe decrease in limb volume in comparisonwith that during respiration.

Figure 13c is a record of the same subjectat a later date, with the plethysmograph on the

left middle finger. During both sustained in-halation and easy respiration the peak ofcranial expansion almost coincided with thetrough of low volume in the finger.

Figure 14 was recorded with the plethys-mograph on the forearm and again shows thepeak of cranial expansion coinciding with thetrough of low volume in the forearm.

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Fig. 10. Three sections from the same tape show interesting variations. Left, the correlation between cranialand chest movements is highly erratic. Center, amplitude of cranial rhythm has increased beyond that of therespiratory cycle. Right, a period of independent cranial rhythm during respiration.

observed during both respiration and its in-terruption. I venture to suggest that the cyclicchanges in volume in the extremity are closelyrelated to the cyclic changes in the head,whether the subject is breathing or not. Thisobservation provokes many questions whichdeserve further study and analysis.

The few examples presented here and manymore that have been recorded permit the as-sertion that there is a cranial motility which isslower than and distinguishable from themotility of the vascular pulse and thoracicrespiration. It has been demonstrated also thatthis motion can be mechanically recorded.Figure 9 demonstrates that the mechanical re-cording and the palpatory findings regardingthe range of mobility are compatible.

Relation of cranial motion to other physiologicphenomenaThis project has been a study of motion, theinherent motion within the organism. Themotility of cardiac muscle and the vascularsystem creates the familiar arterial pulsation.The motility of the diaphragm, intercostalmuscles, and lungs brings about the rhythmicmotion of respiration. The inherent motilityof the gastrointestinal system, known asperistalsis, is an essential factor in digestion,assimilation, and elimination. A peristaltictype of motion propels urine along the ureterand bile down the bile ducts. The motility ofthe germ cells is an essential factor in fertili-zation. Laborit4 has expressed the opinion

"that any excitable entity is endowed withautomatism." He cited the Wintreberg ex-periments on the automatism of embryonicmuscles, and stated: "This author, while in-vestigating the development of the cartil-aginous fish, noted rhythmic movements in themuscles of the embryo." Laborit furtherwrote:

The differentiation in structures and functions makesthis rhythmic periodicity in cell functioning less ap-parent in adult organisms, retaining this aspect onlyat the level of some privileged groups, such as thenodal tissue, or some nervous centers such as therespiratory centers.

Best and Taylor stated:

The vasomotor center exhibits inherent automaticity,since its continuous discharge goes on even after elimi-nation of all incoming nerve influences.

Ruch and Fulton 6 also described the tonicactivity of neurons of the vasomotor center.They also reported:

The rhythm of the impulse groups is often associatedwith the respiratory rhythm; at other times it is re-lated to the heart rate, although not infrequently itbears no relationship to any other observable cyclicphenomenon in the body (italics supplied).

At certain times they observed the wavesof rhythmic function to be much longer thanthose associated with respiration. Rhythmicvariations in activity of the vasomotor centerare manifest as periodic waxing and waningof the general arterial pressure. These wavesof changing pressure are usually designated as

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Fig. 111. Same subject as above. Slow cranial recordings during sustained inhalation.

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Fig. 13c. Simultaneous cranial and plethysmographic recordings of subject in Figs. 1,3a and 13b at a laterdate. The left hand was lying beside the body and the plethysmograph was on the left middle finger. Duringsustained inhalation (left) and easy respiration (right) the peak of cranial expansion occurs at almost thesame time as the trough of low volume in the finger. Long, slow cycles of from 50 to 60 seconds seen on theplethysmographic record apparently were not related to cranial changes.

Journal AOA/vol. 70, May 1971

942/97


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Traube-Hering waves, although this term,strictly speaking, should be applied only to thewaves "which Traube observed in animalswith the thorax open and the diaphragm par-alyzed. These waves, too, result from rhythmicvariations in the activity of the vasoconstrictorcenter. During sleep, certain much longerwavelike variations also occur."

The work of Sears' on spontaneously breath-ing anesthetized cats suggested that the res-piratory center in the medulla may have acomparable rhythmic activity, which influ-ences respiration by way of the spinal respir-atory motoneurons. By studying intracellularrecordings from respiratory motoneurons hemade the following observations:

The membrane potentials of different motoneuroneswere subjected to slow, rhythmic fluctuations having arespiratory periodicity .. . In the inspiratory moth-

neurone, the depolarizing phase of its slow potentialoccurred during inspiration.

On the other hand, he said:The expiratory motoneurone occurred during the ex-piratory pause ... Since the periodic firing of respira-tory motoneurones is causally dependent on theserhythmic slow potentials, it has been suggested thatthey be called central respiratory drive potentials, ab-breviated to CRDPs.

In one of his recordings there was an in-teresting transition from synchronous po-tential fluctuation with motoneuron activity toa change of phase between the two "and,finally, a phase of CRDPs alone, due to asteady increase in the average membrane po-tential and a decrease in the amplitudes ofsuccessive cycles of the CRDP." One is im-pressed by the similarity of this record to someof the cranial and pneumographic recordingsin the present study in which a change of

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phase occurred (Fig. 10). Sears concluded:

The phased inhibition is of considerable functionalsignificance since it provides one means by which thecentral nervous mechanism of respiration exerts a con-trol over the segmental proprioceptive reflexes ofrespiratory muscles.

This effect has not been elicited in spinalanimals.

The question to be considered next is wheth-er a relation exists between rhythmic cellularfunction as described by Traube, Ruch, Sears,and others, and rhythmic motion as recordedin the cranium.

Laborit4 stated:

Fessard showed that the initiation of rhythmic activitywas a frequent response of a nerve to electrical stimu-lation. Monnier and his school made an extensive in-vestigation of the rhythmic activity of the nerves andof the factors which dampened it. Laget showed thatthis dampening action was partly linked to the mem-brane potential, and that a drop of this potential re-duced the dampening and could lead to the developmentof spontaneous rhythmic activity.

The Russian investigators Moskalenko andNaumenko8 conducted experiments to clarifythe question of the existence of cerebral pulsa-tion in the closed cranial cavity. Their defini-tion of cerebral pulsation was "periodicfluctuations in intracranial pressure." By elec-troplethysmography they demonstrated thatthere is a continual movement of fluid betweenthe subarachnoid spaces of the brain and thespinal cord. In their long-term experiments oncats the movement of cerebrospinal fluid wasrepresented in the form of displacementssynchronous with cardiac activity, respiration,and third-order waves. These authors definedthese third-order waves as Traube-Heringwaves. In the record they appeared as similarto but slower than the respiratory cycle.

CommentBy deduction or by direct observation it has

been concluded that the vasomotor center andthe respiratory center in the floor of thefourth ventricle possess a functional activitywhich at times manifests a rhythmic periodic-ity similar to but slower than that of respira-tion. Grosser experiments have shown thatmovement of cerebrospinal fluid occurs notonly synchronously with cardiac and respira-tory movement but with a rhythmic peri-odicity similar to but slower than respira-tion. Observation and recording of the minuterhythmic motions of the live cranium havedemonstrated that an expansile-contractile mo-tion occurs synchronously with heartbeat andrespiration and also with a rhythmic periodic-ity similar to but slower than respiration. Arelation between changing potential and rhyth-mic activity of a cell has been demonstrated.The perpetual outpouring of impulses from thebrain to maintain postural equilibrium, chem-ical homeostasis, and so on conceivably maymultiply the activity of individual cells into arhythmic pattern of the whole brain, smallenough to be invisible to the naked eye, butlarge enough to move the cerebrospinal fluid,which in turn moves the delicately articulatedcranial mechanism.

Further study is necessary to relate thevarious physiologic phenomena that have beendescribed. However, this rhythmic motion ofthe cranium, called the Sutherland cycle inhonor of the man who first discovered it, notonly is of didactic interest, but has vital clin-ical significance, as the work of Magoun,8Woods and Woods, 1° and many other ob-servers have demonstrated.

This is one more demonstration of the as-sertion of Dr. A. T. Still, as Truhlar1 ' quotedhim:

"As motion is the first and only evidence oflife, by this thought we are conducted to themachinery through which life works to ac-


Dr. Frymann. 8030 Girard Ave.,La Jolla, Calif. 92037.

complish the results as witnessed in 'mo-tion.' "

ConclusionsInherent motion does exist within the livingcranium. It can be instrumentally recorded,and its relation to other known physiologicfunctions may be deduced from its similarityto them. The point requires study, however.Its clinical significance also requires extensivedocumentation.

Appreciation is expressed to F.G. Steele of LaJolla,Calif., who designed the apparatus and offered muchimportant direction; to the Cranial Academy, whichprovided the equipment; and to Dr. I.M. Korr, Kirks-ville College of Osteopathy and Surgery, the physio-logic consultant.

1. Sutherland, A.S.: With thinking fingers. Journal PrintingCompany, Kirksville. Mo., 19622. Sutherland, W.G.: The cranial bowl. W.G. Sutherland, Man-kato, Minn., 19393. Pritchard, J.J., Scott, J.H., and Girgis, F.G.: The structureand development of cranial and facial sutures. J Anat 90:73-86,Jan 564. Laborit, H.: Stress and cellular function. J.B. Lippincott Co..Philadelphia, 1959

5. Best, C.H., and Taylor, N.B.: The physiological basis of med-ical practice. A text in applied physiology. Ed. 7. Williams &Wilkins Co., Baltimore, 19616. Ruch, T.C., and Fulton, J.F.: Medical physiology and bio-physics. Ed. 18. W.B. Saunders Co.. Philadelphia, 19607. Sears, T.A.: Investigations on respiratory motoneurones of thethoracic spinal cord. Progr Brain Res 12:259-72, 648. Moskalenko, Yu. Ye.: Cerebral pulsation in the closed cranialcavity. Izv Akad Nauk SSSR (Biol) 4:620-9, 619. Magoun, H.I.: Osteopathy in the cranial field. Ed. 2. JournalPrinting Company, Kirksville. Mo., 196610. Woods, J.M., and Woods, R.H.: A physical finding related topsychiatric disorders. JAOA 60:988-93, Aug 6111. Truhlar, R.S.: Dr. A. T. Still in the living. His concepts andprinciples of health and disease, R.E. Truhlar, Cleveland, 1950

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