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which has been assigned to baroreceptor domain) output was too low for precise sible, however, to resolve all assignment
function.45 The signal amplitudes shown quantitative measurement. However, the ambiguities through the use of spectral
in Figure 3 indicate that these three signals Fourier transform (frequency-domain) filtering and expansion routines.
comprise the principal components of the record of subject 12 included all of the fea- Considering all flexion or extension
slow-wave oscillations observed in the tures observed for the other 11 subjects. events recorded for the 11 subjects with
original flowmetry time-domain record. Recorded frequencies for maxima and high-quality data, and their correspond-
This is illustrated in Figure 4 (bottom), minima were distributed uniformly ing flowmetry maxima or minima, the
which is an inverse Fourier transform among the 11 test records (n 613; two groups are the same. By the paired t-
spectrum of the data of Figure 3 after mean, 56; range, 39 to 77). There were test there was no statistical difference
high-frequency filtering. This filtering pro- 166 flexion events and 162 extensions between the time values recorded for pal-
cess removed those components of the (n 328) associated equally between pated flexion or extension events and the
original record that were above 0.5 maxima (n 164) and minima (n corresponding flowmetry maxima or min-
cycles/sec (30 cycles/min). 164), with no correlation between the ima (N 328; mean difference between
Minor signals also are observed in the occurrence of a maximum or minimum pairs, flowmetry time-palpation time,
power spectra that have not been as- and the palpation of a flexion or extension 0.078; SD, 1.361; 2-tailed sig., 0.303).
signed. Of particular note is a signal at event (Pearsons R value, 0.085; approx. As may be anticipated from Figures
0.39 cycles/sec (23.4 cycles/min). Oscil- sig., 0.123). 1 and 2, both groups of time values were
lations in this frequency range have been Laser-Doppler flowmetry compared with highly correlated (N 328 data pairs;
attributed to lymphatic vasomotion.46-52 palpation. The time at which a maxi- correlation, 1.000; sig., 0.000). The sta-
Some of the minor signals undoubtedly mum or minimum occurred in the tistical comparison was repeated after
represent harmonics of the major signals; flowmetry record was compared with the introducing a 150-millisecond reaction
others may represent fundamental phys- time recorded for the nearest flexion or time delay for the technician into the flex-
iologic functions. Each, however, will extension event. For almost all flexion ion/extension record. This computation
contribute added complexity to the time- or extension events, association of the caused a slight convergence of the two
domain record. event with the nearest maximum or min- means with a change in sign of the mean
imum presented no difficulty (Figure 2). difference (mean difference between pairs,
Combined record: quantification of For 2% of events, signal assignment was 0.072; SD, 1.361; 2-tailed sig., 0.336).
time-domain data problematic because the flexion/exten- The computed statistical power34 was
Descriptive statistics. Twelve subjects par- sion event mark fell either approximate- 0.527 (alpha, 0.336; difference, 0.0724;
ticipated in the study. Of these, 11 pro- ly midway between maxima or minima or sigma, 1.3614; N 328). The addition
vided high-quality data for analysis. For because the signal-to-noise ratio at that of a second 150-millisecond reaction time
subject 12, the signal-to-noise ratio point was insufficient for precise maxi- delay for the examiner (300 millisecond
observed in the laser-Doppler (time- mum or minimum location. It was pos- total introduced delay), however, caused
Table 1
Descriptive Statistics (11 Subjects) for the Relative Blood Velocity Oscillation
Determined by Laser-Doppler Flowmetry
Subject No. of Mean cycle Standard Standard 95% Confidence Minimum Maximum
No. cycles period deviation error interval (mean)
(sec/cycle)
Lower Upper
bound bound
the two means to diverge significantly way analysis of variance (P .05). Of the changes that also occurred in all records.
(mean difference between pairs, 0.222; 55 possible combinations of study subject To document the periodic frequency
SD, 1.361; 2-tailed sig., 0.003). pairs, 38 (69%) differed significantly. changes and to assess their magnitudes
Mean frequency variance among sub- Frequency variability. As mentioned pre- within and among individual subject re-
jects. The mean oscillatory frequencies viously, examination of either the flow- cords, two contiguous groups of approx-
determined by both laser-Doppler flow- metry or the palpation records of all sub- imately 10 complete cycles each, the short-
metry and palpation (these are equiva- jects revealed the presence of both higher- est group and the longest group, were
lent) differed among subjects even though frequency and lower-frequency segments selected from each subject record. All
the experimental circumstances (supine, that alternated in a periodic manner, sug- selected sequences were separated within
awake, and at rest) were essentially iden- gesting the presence of a frequency-mod- each subject record by at least 2 minutes.
tical for all (Table 1). Pair-wise compar- ulated component.53 Moreover, these fre- Frequencies for each cycle (in cycles/min)
isons of computed means (Table 2) also quency changes were not related in any were computed from the time data, and
were tested for significance by the one- obvious way to analogous amplitude pairs of short and long segments within
Relationship between the PRM/CRI and brain is displaced from the ventricles and Entrainment and manipulation of the
pulmonary respiration. Pulmonary res- intracranial subarachnoid space. PRM/CRI. Manipulative treatment
piration has always been recognized as During systole, the CSF moves medi- directed at affecting the PRM/CRI is
closely associated with, yet independent ally from the lateral ventricles of the cere- often used to modulate the rate (fre-
of, the PRM/CRI. The respiratory coop- bral cortex into the third ventricle and quency), amplitude, and direction of the
eration of the patient is often employed in a craniocaudad direction from the third wave.19(p339) Respiratory cooperation of
in association with cranial treatment.17,59 ventricle into the fourth ventricle and in the patient can be used in association
Cranial manipulation has been said to the subarachnoid space surrounding the with cranial treatment.17,59 Spontaneous
affect respiration,61 and spontaneous deep spinal cord. During diastole, with the deep sighing respiration has been report-
sighing respiration has been reported return of the caudal displacement of the ed coincidental with the therapeutic end
coincidental with the therapeutic end brain, CSF motion reverses direction. The point.23
point.23 As shown by the Fourier analy- fourth ventricle acts as a mixing cham- Entrainment of frequency occurs
sis (Figures 3 and 4), the component parts ber to allow for CSF oscillation. The when two nonlinear oscillatory systems
of the total THM oscillation, that is, system must demonstrate capacitance. are coupled and operating at close but
Mayer (0.01 to 0.09 cycles/sec), Traube- The spinal dural sac acts as the required different frequencies.8,16,36,45 The cou-
Hering (0.09 to 0.17 cycles/sec), and res- capacitor. pling causes the two oscillators to lock
piration (0.2 to 0.3 cycles/sec), are dis- Oscillations of cortical metabolism into a common frequency. The THM
tinctly separate.4,9,10,53,62 The components (9.58 cycles/min in an awake, nonanes- oscillation has been entrained using rhyth-
at 0.01 to 0.09 cycles/sec and 0.09 to thetized cat) with associated fluctuations mic alteration of body position,45 expo-
0.17 cycles/sec, however, are closely in blood volume have been demonstrat- sure to fluctuating temperature,16 and
linked to, and may be modulated by, the ed by reflectance spectrophotometry of respiratory activity.4,38,39,45 Entrainment
pulmonary respiration component at 0.2 the cortical cytochrome oxidase redox of THM has been accomplished using
to 0.3 cycles/ sec.39,40 state. The data65 suggest that the cyclic baroreceptors and vasomotor reflexes;
Fluctuation of the cerebrospinal fluid increases in cortical oxidative metabolism the lower limit of the entrainment band-
and motion of the central nervous system. represent the primary oscillatory process, width is 0.0841 (SD, 0.0030) cycles/sec,
The PRM/CRI is described as consisting followed by reflex hemodynamic changes and the upper limit is 0.1176 (SD,
of five distinct component parts.17,19,21-24 that affect intracranial blood volume. 0.0013) cycles/sec.49 Entrainment of the
Of these, the fluctuation of the cere- Volume oscillations representing pre- THM by the respiratory rate specifical-
brospinal fluid (CSF) and the inherent sumed THM waves have been measured ly occurs over a similar frequency range
mobility of the central nervous system in the brains of conscious healthy humans of 5 breaths/min (0.083 cycles/sec) to 7
(CNS) are of particular interest in the using ultrasound.66 breaths/min (0.12 cycles/sec).40 Although
context of the THM oscillation. Motion As the intracranial blood volume in- cranial manipulation involves more com-
of the brain63 and motion of the CSF in creases, CSF is displaced from the interi- plexity of intervention than merely mod-
synchrony with the cardiac cycle has or of the brain case into the extracranial ulating the PRM/CRI, the concept of
been demonstrated using magnetic reso- subarachnoid space, increasing the amount oscillatory entrainment offers an inter-
nance velocity imaging.63,64 For a brief of CSF in the spinal dural sac capacitor. As esting explanation for this one aspect of
period during systole, there is a net inflow intracranial blood volume decreases, the treatment, as has been proposed by Mac-
of blood into the brain, causing it to tension of the spinal dural sac facilitates the Partland and Mein.31a
expand in volume. This causes the central return of CSF into the skull. Because of this
portion of the brain and the brainstem to synchronicity with and relation to THM Conclusion
be displaced caudally. An amount of CSF oscillation, the CSF could be described as The results of this study indicate that the
approximating the volume change of the ebbing and flowing. PRM/CRI and the THM oscillation occur
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