OCF Compression of the 4th Ventricle CV4

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OCF-Compression of the 4th Ventricle (CV4)

• OMM 3
• December 1, 2005
• Sharon Gustowski, DO, MPH
• Assistant Professor, OMM Dept. TUNV-COM

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Objectives

• The student will accurately demonstrate on a
  written and practical exam the indications for
  and goals of performing a CV4 technique.
• The student will accurately demonstrate on a
  written and practical exam the CV4 procedure.

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• If you do not know what else to do compress the
  4th ventricle. No one is too sick to have this
  done. - W. G. Sutherland

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Cv4- What is it?

• The CV4 is a mechanical compression of the 4th
  ventricle of the brain
• Think of the occiput as being like a flexible
  saucer
• As you bring the occiput into extension, the
  lateral angles approximate slightly, putting
  tension on the tentorium. The cerebellum is
  rolled downward on the roof of the pons and
  medulla while the brachium pontis lifts the pons
  and medulla up, compressing the 4th ventricle.
• Magoun

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CV4- Effects

• The CV4 is a way to affect the flow of the CSF,
  the autonomic nervous system, the structures at
  the floor of the 4th ventricle
• CV4 technique can alter sleep latency and
  directly measured muscle sympathetic nerve
  activity
• Cutler MJ, Holland BS, Stupski BA, Gamber RG,
  Smith ML. Cranial Manipulation Can Alter Sleep
  Latency and Sympathetic Nerve Activity in
  Humans A Pilot Study. Journal of Alternative
  Complementary Medicine Feb2005, Vol. 11 Issue
  1, p103-108

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When not to use the CV4 (Contraindications)

• Acute cerebral hemorrhage
• Acute head injuries
• Known or suspected cranial bone fractures
• Elevated intracranial pressure

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CV4 and Labor Delivery

• May affect the induction of labor
• Through stimulation of the pituitary-hypothalamic
  axis
• pitocin
• Be prudent with your use of this technique on
  women who are in the 2nd or 3rd trimester of
  pregnancy

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CV4 Technique

• May be performed through the posterior angles of
  the parietal bones, mastoid processes of the
  temporals or both the temporal and occiput as a
  unit
• May be performed from the sacrum
• We are teaching the technique through the
  supraocciput

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CV 4 Technique

• Patient is supine
• Doctor cups one hand inside the other or laces
  fingers such that the thenar eminences are about
  2 inches apart.
• Patient lifts head and the thenar eminences are
  placed on the supraocciput
• Do Not Cross the Occipitomastoid Suture!!!

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Procedure

• Tune into the PRM with the proper hand placement
• Follow the occiput into extension
• Slightly pull your thumbs superior (towards you)
• Continue holding this position until the PRM has
  stopped
• This is called a still point
• You will know if this occurs- trust your hands!
• Once the PRM starts again, gently allow the
  occiput to move into flexion and extension
• Slowly remove your hands and place the patients
  head on the table
• Recommend to the patient to remain still on the
  table for a few moments

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Finishing Touches

• Instruct the patient to get up slowly and sit
  upright for a few moments.
• It is common for patients to report an
  orthostatic response and to feel lightheaded
• Dizziness, if any, should subside within a minute
  or so.
• If not, then you must reassess the patient to be
  sure that the temporal bones are balanced.
• Lightheadedness may last for up to 1 hour
• Patients are usually safe to drive and perform
  activities, however, they may feel that their
  senses are slowed.
• Warn them of this, and have them wait in your
  office until they feel more comfortable.