RU2297820C2 - Method for treating cerebrovascular disease cases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves applying manual cranial therapy. Manual cranial testing procedure is preliminarily administered for detecting dysfunctions. Then, preparatory treatment stage is applied to soft head tissues and collar region. Myofascial release and suboccipital release are performed. At least two dysfunctions are eliminated during each manual cranial therapy session. Each session begins and ends with manual cranial testing. To eliminate the revealed dysfunctions with the view on the detected pathological biomechanical changes, sagittal suture relaxation is applied by laterally stretching parietal bones, coronal suture relaxation is applied in region of its restricted mobility caused by holding frontal and parietal bones and tapping occipital bone from the opposite side, waiting for 2 min until relaxation sensation appears. Occipital bone condyles are decompressed by stretching them first cranially and then laterally. Sphenobasillary synchondrosis lateroflection is carried out by rotating the base bone and occipital bone about their torsion and lateroflection axes to reach prestress condition. This state is to be retained until the restriction is removed. Sphenobasillary synchondrosis torsion on the left side is carried out by cranially moving the greater wing of base bone and lateral angle of occipital bone. Temporoparietal bone relaxation is carried out by applying temporal bone external rotation and stretching temporoparietal suture aside. Temporal bone is decompressed on dysfunction side by fixing frontal bone on the opposite side and stretching auricle during extension phase in dorsolateral direction along axis passing through temporal bone pyramid. The traction movements are repeated on both sides in bilaterial dysfunction cases. Then, temporal bone is rotated about the axis passing through external acoustic meatus, zygomatic process is moved in caudolateral direction, mastoid process in dorsomedial direction. Beginning from the third session, the fourth ventricle compression procedure is carried out in addition by medially compressing lateral angles of occipital bone squama, by synchronously rotating temporal bones acting upon mastoid processes, with rotation movement frequency and amplitude being gradually increased. Occipital pump is carried out by means of lateral mastoid processes traction with automobilization carried out at inhalation phase with pressure applied to parietal bone region concurrently with back bending, and pressure applied to middle point of frontonasal suture with feet sole bending on exhaling. Flexion is increased by moving the greater wing of the base bone downwards, backwards and aside, moving occipital bone downwards and forward, moving temporal bone laterally during flexion phase. Extension is increased by moving the greater wing of the base bone upwards, forward, inward, moving occipital bone upwards and backwards, and laterally moving temporal bone. Condyle decompression is carried out during extension phase. Greater occipital opening is laterally and caudally drawn apart during flexion phase. The treatment is administered daily or every other day.

EFFECT: enhanced effectiveness of treatment; prevented secondary ischemic attacks and disease relapses.

Description

The invention relates to medicine, namely to neurology and manual medicine, and can be used in the complex treatment of cerebrovascular disease.

In Russia, there has been a steady increase in the incidence of vascular diseases of the brain, the most common of which are discirculatory encephalopathy, cerebral infarction, transient ischemic attack, transient cerebrovascular accident.

A known method of treating discirculatory atherosclerotic encephalopathy, including electromagnetic stimulation of the motor zones of the cerebral cortex, cervical and lumbar thickening of the spinal cord, audiovisual stimulation, immunological studies and, according to its results, additional stimulation of the thymus gland. Patent No. 2186588, M.cl. 7 A 61 N 2/00, BIMP 22, 08/10/2002.

Immunological research is very expensive and time-consuming and difficult to use in everyday practice.

They do not normalize arterial and venous blood supply to the brain, which is very important for this pathology.

A known method of treating the initial manifestations of cerebrovascular accidents and discirculatory encephalopathy by introducing cerebrolysate using electrophoresis. Patent No. 2200033, M. Cl. 7 A 61 N 1/30, BIMP No. 7, 03/10/2003, p.335.

The use of endonasal electrophoresis is limited due to the presence of concomitant pathology (hypertension, coronary heart disease), in which electrophoresis is contraindicated.

A known method of treating cerebrovascular disease, including a standard complex of drugs (antiplatelet agents, anticoagulants, drugs that improve cerebral blood flow and metabolism (I.V. Damulin. Post-stroke motor disorders, J. Neurology / rheumatology, Media Medica, M., Volume 5, No. 2, 2003, p. 64-70).

However, often the generally accepted medication methods for treating patients with cerebrovascular disease are not effective enough.

The presence of the blood-brain barrier limits the flow of drugs to the brain tissue and the creation of a sufficient therapeutic dose in the area of brain ischemia to achieve the effect of drug treatment in patients with cerebrovascular disease.

The presence of concomitant pathology in patients with cerebrovascular disease, such as coronary heart disease, hypertension, atherosclerosis, chronic renal failure, chronic pancreatitis, chronic cholecystitis, and other diseases does not allow prescribing a number of medications, as well as sufficient therapeutic doses of the medications used, the required amount medications. Often, when prescribing the necessary medications, taking into account the concomitant pathology, doctors are forced to prescribe more than five medications, resulting in polypharmacy.

The presence of allergic reactions to medications in patients, as well as cross-allergic reactions, sharply limit the arsenal of drugs used.

The method of drug treatment does not affect the ratio of the interaction of blood vessels and membranes of the brain.

Drug therapy is effective in the early stages, in the first hours (three hours) after the occurrence of cerebrovascular accident, then in a day its effectiveness decreases sharply. Patients, with rare exceptions, are admitted to the hospital 24-72 hours after the occurrence of acute cerebrovascular accident, when irreversible pathological processes of the brain have already occurred.

The objective of the invention is to increase the effectiveness of the treatment of cerebrovascular disease in acute, early recovery, late recovery, residual periods of cerebral infarction, with discirculatory encephalopathy, transient ischemic attacks, transient cerebrovascular disorders, to prevent repeated ischemic attacks, relapses.

This improves the arterial and venous blood flow in the ischemic zone of the brain substance, improves collateral blood flow, normalizes cerebrospinal fluid changes, improves the neurodynamic processes of the brain, reduces exhaustion of nerve elements, improves memory, attention.

The method is as follows.

Medical treatment is carried out. Additionally, manual cranial therapy is carried out, including cranial manual testing to detect dysfunctions, a preparatory stage of exposure to soft tissues of the head, collar region, performing myofascial release and suboccipital release, and control cranial manual testing. At each session of manual cranial therapy, no more than two dysfunctions are eliminated taking into account the detected pathobiomechanical changes. To eliminate the identified dysfunctions perform:

- relaxation of the sagittal suture by traction of the parietal bones in the lateral direction,

- relaxation of the coronary suture in the area of limiting its mobility by holding the frontal and parietal bones and performing a rapping of the occipital bone from the opposite side and waiting for two minutes until the sensation of relaxation,

- decompression of the condyles of the occipital bone by traction in the cranial, then in the lateral direction,

- lateroflexion of sphenobasillar synchondrosis by rotation of the main and occipital bones around the axes of the torsion and lateroflexion to the state of prestressing and holding in this state, until the restriction is removed,

- the torus of sphenobasilar synchondrosis on the left by the movement of the large wing of the main bone and the lateral angle of the occipital bone cranially,

- relaxation of the temporal-parietal sutures by external rotation of the temporal bone and stretching the temporal-parietal suture to the sides,

- decompression of the temporal bone from the side of the dysfunction is performed by fixing the frontal bone on the opposite side and traction behind the auricle in the extensional phase in the dorso-lateral direction, along the axis passing through the pyramid of the temporal bone, repeat the traction movement on both sides with bilateral dysfunction, then rotate the temporal bone around the axis passing through the external auditory meatus, the zygomatic process in the caudal-lateral direction, the mastoid process in the dorsal-medial direction,

- from the third session, we additionally perform “compression of the fourth ventricle” using medial compression of the lateral angles of the scales of the occipital bone, synchronous rotation of the temporal bones for the mastoid processes, with a gradual increase in the frequency and amplitude of rotational movements,

- "occipital pump" - lateral traction of the mastoid processes,

- self-mobilization, in the phase of inspiration - pressure in the parietal bone with simultaneous back flexion of the feet, on exhalation - pressure at the midpoint of the fronto-nasal suture, with plantar flexion of the feet,

- enhance flexion by moving the large wing of the main bone down, posteriorly and to the side, the occipital bone - down forward, the temporal bone - laterally during the flexion phase,

- enhance the extension by moving the large wing of the main bone - up, forward, inside, occipital bone up, back, temporal bone - laterally, during the extensional phase,

- condylar decompression during the flexion phase, pushing the large occipital foramen laterally and caudally.

The novelty of the method lies in the fact that by direct exposure to the soft tissues of the head, collar region, we improve collateral blood flow, increase venous outflow, which allows for more effective cranial manual therapy, and to prepare cerebral vessels for changing the operating mode.

We carry out the correction of pathobiomechanical changes that occur in patients with cerebrovascular disease, due to the presence of increased intracranial pressure, both acute and chronic.

Using only direct correction methods allows you to affect the dura mater, sinuses, veins, improve venous blood flow, respectively, arterial blood flow, reduce microcirculation disorders of the brain, brain membranes, skull bones.

The use of universal methods of automobilization allows you to affect the dura mater and normalize cerebrospinal fluid processes.

By direct action on the soft tissues of the head, collar area, we improve collateral blood flow, increase venous outflow.

Considering the presence of increased exhaustion of nerve elements in patients, cranial manual therapy allows in this category of patients to activate the preserved nerve elements of the ischemic zones of the brain, as well as reduce the exhaustion of nervous processes and normalize the vegetative processes of the brain.

Impaired blood circulation in the brain affects collateral blood flow, causing changes in aponeurosis, its stiffness, decreased elastic properties, elasticity, which also changes the bones of the skull. Circulatory disorders in the soft tissues of the skull, membranes of the brain, bones of the skull, reduces their elastic properties.

On the brain surface of the bones of the skull are the sulcus of the cerebral sinuses. Violations of the venous outflow creates stasis, stagnation of venous blood in the sinuses, impaired pulsation of the walls of the veins, which directly affects the membrane of the brain, skull bones. The obstruction of the venous outflow also impedes arterial blood flow, exacerbating the violation of microcirculation in the membranes of the brain, bones of the skull. All this reduces the elasticity, elasticity of the bones of the skull.

These pathobiomechanical changes are a source of pathological impulse, causing a violation of cerebral metabolism, hemoliquorodynamics.

Cerebral infarction is accompanied by cerebral edema. In addition, in the acute period, uneven cerebral edema causes a displacement of brain matter from one intracranial space to another, which changes the ratio of skull bones.

Dyscirculatory encephalopathy, the consequences of acute cerebrovascular accident are accompanied by both cerebral edema during decompensation and a chronic increase in intracranial pressure.

Multiple cerebral infarctions are accompanied by chronic non-obstructive hydrocephalus due to degenerative or destructive damage to the brain, accompanied by a secondary increase in ventricular size (edited by M. Samuels, Neurology, Moscow, Practice 1997), which in turn affects the change in ratios of the meninges , duplicates, bones of the skull, their functional state.

The method of cranial manual therapy is based on the fact that the development of pathobiomechanical changes in the skull in patients with cerebrovascular disease is due to the peculiarity of the anatomical structure of the skull. The dura mater of the brain is a thick fibrous layer that forms a capsule for the brain, at the same time is the periosteum of the bones of the cranial vault.

The arachnoid membrane of the brain, thin, devoid of blood vessels, the membrane is retained relative to the dura mater. Between them is a narrow subdural space. The arachnoid meninges are retained due to the surface tension, and attached to the pia mater by means of connective tissue cords.

Between the arachnoid and soft membranes, there is a subarachnoid space penetrated by connective tissue trabeculae and filled with cerebrospinal fluid.

The presence of increased intracranial pressure (the effect of an excessive amount of cerebrospinal fluid, impaired cerebrospinal fluid dynamics) affects not only the substance of the brain, but also causes a violation of microcirculation, ischemia of the soft tissues of the skull, bones of the skull, meninges, leading to a violation of their elastic properties, elasticity on local more or less extensive areas, depending on circulatory disorders.

The dura mater forms sinuses (venous channels with non-collapsing walls between the leaves of the dura mater of the brain). Sinuses collect blood from the brain, its membranes and divert it into the internal jugular vein.

Diploetic veins located in the diploe of the bones of the cranial vault connect the sinuses of the dura mater with the superficial veins of the head.

Emissive veins connect the dura mater sinuses, diploetic veins and superficial veins of the head. The above-mentioned structural features of the vascular system cause circulatory disorders of both the brain and collateral blood flow in cerebrovascular disease, which affects the membrane of the brain and skull bones. All this reduces the elasticity, elasticity of the bones of the skull and sutures.

The concept of “suture dysfunction” means the consolidation of sutures arising due to disturbed microcirculation, increased intracranial pressure due to micro displacement of the bones of the skull relative to each other. The appearance of joint sealing is confirmed by the method of holographic interferometry (Bolshakova OP, Kazak V.L., Ilyinskaya T.A. Study of the process of skull deformation by holographic interferometry. - ARKh.anat., 1982, No. 9 - p. 18- 24). The main method of research and correction of cranial suture dysfunction is palpation. Suture dysfunction in cranial manual therapy is determined by the degree of spring resistance of the bones of the skull in the region of a particular suture and is manifested by a decrease in the elasticity of resistance.

In all cases of cranial manual exposure, it should be borne in mind that the skull is not an unconditionally rigid structure, but retains the ability to elastic deformations in the area of cranial sutures, which is confirmed by the work of domestic and foreign pathomorphologists and histologists. (Betz V.A., Rava A.K. To research methods in anatomy (Cranial sutures) - Kiev: Univ. Tipogr., 1879 - p. 78. Zvyagin V.I. Study of the thickness of the layers of the bones of the cranial vault in the area of sutures in men and women. - Vopr.antropol., 1975, issue 49 - pp. 108-115. Ibatullin I.A., Zaitseva R.L., Chudnovsky N.A. et al. Structure and histotopography of the meniscoid structures of the atlanto-occipital and atlanto-axial joints. Archive of Anatomy, Histology of Embryology. - 1987. TCS. "1 - p.30-38, EA Masharsky. Spring role of temporal lines and scaly sutures of the cerebral part of the skull. - Issues of Anthropology, 1969, issue 32 p. 128-186 , Mikhailov VP The first experience in the treatment of headaches with manual craniotherapy. Manual therapy in arthrovertebroneurology. Abstract, March 13-16, 1990, Novokuznetsk, 1990, p.214-216, Nikolaev G.A. Loshchilov V.I., Gazaryan A.S., Babaev E.P. Own stresses in the cranial bone tissue.In the book Biomechanics, Riga, 1975, issue 2, pp. 376-381, Moss ML Experimental alteration of sutural area morphology. Anat. Rec., 1957, v. 10, No. 1 - p. 9-12).

Rotation of the temporal bones of the skull does not imply angular displacements of the temporal bones, but restoration of the elastic-elastic properties of the joints of the temporal bones (in the presence of rigidity of these joints) using manual action in the direction of rotation. Traction of the mastoid processes does not imply linear displacements of the mastoid processes, but restoration of the elastic-elastic properties of the occipital mastoid sutures by means of manual action in the direction of traction of the mastoid processes. (Greenman P Manuelle Therapie am Brustkorb. - Manuelle Medizin. 1979, b17-s17).

The method is as follows.

The patient is given a course of cranial manual therapy of daily or every other day procedures after the patient undergoes standard drug therapy. The patient undergoes cranial manual testing: the patient lies on his back, the doctor sits at the head end, using the frontooccipital grip (with index fingers over the large wings of the main bone, middle above the junction of the temporal, parietal, sphenoid, frontal bones, their tips on the zygomatic process the temporal bone, with the fourth finger anterior to the junction of the temporal, parietal, occipital bones, the little finger on the lateral angle of the occipital bone, with thumbs opposite each other on the cranial arch), conducts an examination, assesses heteroactive reactions, palpation, the study of motor stereotypes, active and passive displacements of the bones and connective tissue elements of the skull, palpation of the craniosacral rhythm frequency (amplitude, symmetry, quality), study of the sutures of the skull.

Based on the data of cranial manual testing, structural disorders that are present in a patient with cerebrovascular disease are determined. In most cases, cranial manual testing reveals the following changes:

Sagittal suture dysfunction. Coronary suture dysfunction. Temporoparietal dysfunction. Compression of the temporal bones is more often on the left, sometimes on both sides. Lateral tension of sphenobasilar synchondrosis on the left. Limitation of the flexion and extension phases.

Much less commonly: Vertical tension of sphenobasilar synchondrosis. Lack of skull movements (“dumb” skull).

Given the cranial manual testing data, revealed pathobiomechanical changes in the skull, the patient’s vegetative reaction, manual cranial therapy is used in the acute, early recovery, late recovery, residual periods of cerebral infarction, in patients with dyscirculatory encephalopathy (atherosclerotic, hypertensive, complex genesis, venous manifestations of cerebral circulatory failure, transient ischemic attacks, transient cerebral impairment blood circulation.

Manual cranial therapy begins with the preparatory stage, the impact on the soft tissues of the head, collar region, in order to improve venous, lymphatic outflow, reduce vegetative reactions, adapt venous, arterial blood flow.

First, light stroking is performed from the frontal to the occipital region with a transition to the neck and shoulder area on both sides for 1-2 minutes. Then, light rubbing movements with the fingertips of a progressive nature from the frontal, through the temporoparietal region, to the occipital, cervical region, to the shoulders for 1-2 minutes. Repeat stroking for 1 minute.

We carry out soft rubbing movements with the fingertips in opposite directions from the right frontal to the left temporal-occipital region and from the left frontal region to the right temporal-occipital region for 1-2 minutes, then stroking for 1 minute.

In order to activate neurocortical mechanisms, relieve muscle tone, improve lymphatic drainage, we use myofascial release, remove the tension of the upper and horizontal projections of the trapezius muscle by palpating the area of muscle tension, determine the point of onset of action, the area of tissue tension, gradually press on the tissue, penetrating gently and gently deep into , we carry out traction to the barrier (sensations of tissue resistance, avoiding pain), then we twist the tissue to relax, we reach wow after 10-60 seconds.

We perform a suboccipital release. The patient is lying on his back, the doctor is at the head of the bed. The doctor holds the patient’s head with the second, third, fourth, fifth fingers of both hands, located caudal to the outcrop line and penetrating to the bone, the patient’s head is held in the palms of the hands. The doctor performs easy traction at the places of attachment of the muscles to the back of the head, stretching them laterally to the barrier (tissue resistance). Having reached the release from one side, the doctor carries out a tissue torsion, displacing the tissue in opposite directions. Reception is performed exclusively on soft tissues.

We perform light stroking from the mastoid processes along the posterior-lateral surfaces of the neck. Control cranial manual testing is carried out. Taking into account the detected pathobiomechanical changes, the following methods of cranial manual therapy are carried out: at the first stage, the sagittal suture is counter-palpated with the pads of the thumbs in opposite directions, coronary, temporal-parietal sutures, and translational-return movements. We relax the sagittal suture, the hands are located on the cranial vault: the forefinger on the front-lower corners of the parietal bones, the middle on the parietal bone under the base of the temporo-zygomatic processes, the ring fingers above the parietal-mastoid corners, the thumbs are located cross over the sagittal suture, touching the suture with opposite side, opposite each other, the sagittal suture is opened, spreading the thumbs in the lateral direction.

Relaxing the coronal suture between the parietal and frontal bones, use the "technique of expansion of sutures." The index and middle fingers are located on the area where there is a limitation of the mobility of the seam, and put the fingers near the seam, opposite each other, from opposite sides, in parallel. The index finger of the other hand is positioned at the point most opposite to the seam restriction area, forming a long diagonal between it and the seam restriction site. An intermittent double tapping is carried out and we wait for two minutes until a feeling of relaxation.

We again carry out control manual testing using the frontooccipital grip in order to determine the effectiveness of the performed manipulation.

Carrying out the correction of pathobiomechanical changes, at the initial stage we carry out decompression of the condyles of the occipital bone.

The patient lies on his back, the doctor sits at the head of the patient, the nape of the patient lies on the palms of the doctor, the terminal phalanges of the fingers are bent at an angle of 90 degrees and apply light pressure to the suboccipital region until the soft tissues feel relaxed, while the fingertips of the doctor rest against the atlas arc.

At the next stage, the doctor performs a light traction behind the condyles of the occipital bone in the cranial, then in the lateral direction. This technique removes the tension of the soft tissues of the suboccipital region and releases the condyles of the occipital bone.

To eliminate lateral flexion of sphenobasilar synchondrosis, a “combined capture” (fronto-occipital capture) is used. The patient lies on his back, the doctor sits at the head, the index fingers are located above the large wings of the main bone, the middle fingers are above the junction of the temporal, parietal, sphenoid and frontal bones, and their tips are on the zygomatic process of the temporal bone. The fourth finger is somewhat anterior to the junction of the temporal, parietal, and occipital bones. The little finger behind the junction of the temporal, parietal, occipital bones, thumbs are located opposite each other on the cranial vault. With lateral displacement of sphenobasilar synchondrosis to the left. The left index finger moves the large wing of the main bone in the forward direction. The left little finger and ring finger move the occipital bone in the same direction. The right index finger moves the large wing backward. The right little finger and ring fingers move the occipital bone in the same direction. Rotary movements of the main and occipital bones are caused around the vertical axis, passing around the axes of the torsion and lateroflexion, to the state of prestressing and holding in this state, until the restriction is removed. With torzii of sphenobasilar synchondrosis on the left, the left index finger moves the great wing of the main bone cranially. The left little finger moves the lateral angle of the occipital bone also cranially.

Each subsequent session begins with stroking and light grinding, myofascial release in order to improve venous, arterial blood flow, and adaptation of cerebral vessels to subsequent exposure. We carry out palpation of the sutures of the skull, complete manual cranial testing in order to determine the degree of stability of the dysfunctions, its connection with other dysfunctions, clarify the plan of action, eliminate dysfunctions in this session of cranial manual therapy. With each subsequent session, we gradually eliminate the remaining dysfunctions. We relax the temporoparietal sutures. The patient is lying on his back, the doctor is at the head. The thumb on the opposite side of the hand dysfunction is located on the parietal bone, near the suture. The same side of the dysfunction is the thumb on the scales of the temporal bone near the suture. The index and middle fingers of the same hand are located above the mastoid process.

During the extensional phase, the index and middle fingers of the right hand press on the mastoid process slowly and posteriorly, causing an external rotation of the temporal bone.

Thumbs stretch the temporoparietal suture to the sides.

Decompression of the temporal bone is as follows.

The patient is lying on his back, the doctor is at the head of the bed. The index finger is located in the external auditory canal, we hold the auricle with the thumbs, the cushion of the third finger is located at the junction of the temporal, parietal, sphenoid, frontal bones, tenars in the occipital bone.

We catch the craniosacral rhythm and in the extensional phase we traction the auricle along the axis passing through the pyramid of the temporal bone in the dorso-lateral direction. We repeat the movement of traction behind the auricle in the extensional phase with bilateral dysfunction on both sides simultaneously, until the compression is removed. With unilateral dysfunction, we additionally fix the frontal bone on the opposite side of the ongoing relaxation.

Then we conduct one-sided rotation of the temporal bone around the axis passing through the external auditory canal.

The left hand grasps the occipital scales like a cup and during the flexion phase causes a slight flexion of the occipital bone.

This is accompanied by the opening of the suture (right) due to the very easy rotation of the nape to the left around the vertical axis.

Right hand:

The thumb and forefinger encircle the zygomatic process of the temporal bone: large at the apex, the index under it and gently press caudally and laterally.

The middle finger is located in the external auditory meatus - the center of the rotational movement.

The ring finger and little finger encircle the mastoid process in front and behind and move it in the dorsal-medial direction.

From the third session of manual therapy, methods are used that stimulate neurodynamic processes that correct cerebrospinal fluid dynamics.

Apply "compression of the fourth ventricle":

The brushes are crossed, forming a container for the scales of the occipital bone. Tenars of both hands are located medially from the lateral angles of the occipital scales.

Tenars press medially and slightly cranially; in the extensional phase, compression; in the flexion phase, retention. Repetition to a halt (craniosacral rhythm, achievement of a “fixed point”, equilibrium position, if membrane activity can be felt, it must be waited and returned to the previous rhythm). With severe rigidity of the skull, compression is combined with breathing. When you inhale, compression increases, when you exhale, it stops. Compression gradually increases to relaxation.

For physiological stimulation of the neurodynamic processes of the brain, synchronous rotation of the temporal bones is also used. The patient lies on his back, the doctor’s hands are on the back, his fingers are bound and cover the occipital scales. The doctor places the first fingers parallel to the front edge of the mastoid processes. With the pads of the thumbs, the doctor shifts the tips of the mastoid processes in the dorsomedial direction during the inspiration phase, increasing the external rotation of the temporal bones.

Then, in the exhalation phase, the area of the temporal bones is dorsomedially displaced by the area of the tenars to enhance internal rotation, gradually increasing the amplitude and frequency of movement.

To establish the balance of the connective tissue elements of the skull, especially at the level of the occipital and temporal bones, I use the “occipital pump” technique.

The patient lies on his back, the doctor is at the head of the bed, the palms of the doctor are folded in a cup shape and hold the nape of the patient so that the pads of the second and third fingers are located behind the mastoid processes in the biceps muscles and carry out external traction during the exhalation phase for several respiratory cycles until relaxation is felt . For the purpose of decompression and impact on the dura mater, we carry out a universal method of automobilization.

The patient is lying on his back, the doctor is at the head of the bed.

At the inhalation phase, the patient simultaneously performs complete back flexion with the feet; the doctor performs soft pressure with tenars in the lower parietal line on both sides simultaneously.

On exhalation, the patient conducts a movement of the plantar flexion, the doctor with his index finger performs a soft effect in the midpoint of the frontal-nasal suture.

Repeat three times. You may feel dizzy.

On the fourth day, the correction of the flexion phase is carried out using a collective capture.

Index finger on the lateral surface of the main bone. The large wing moves down, back and to the side. The little finger behind the junction of the temporal, parietal, occipital bones is shifted down forward. The base of the middle and ring fingers moves laterally.

When the extension phase is limited, the fingers are located with a collective grip, the movements are carried out in the directions opposite to those experienced in the flexion phase. The large wing of the main bone moves up, anteriorly, inwards. The little finger moves up, back. The base of the middle and ring fingers is lateral.

Movements are made with a gradual increase in amplitude.

We use the “fourth ventricle compression” method.

Also, in cranial manual therapy, condylar decompression (expansion of the large occipital foramen) is performed to affect the occipital bone and the dura mater of the spinal cord.

The index and middle fingers of both hands are located as close as possible to the posterolateral edge of the large occipital foramen. During the flexion phase, the fingers of both hands separate and move posteriorly, laterally and caudally, making a slight traction of tissue.

After each manipulation, stroking along the temporoparietal sutures is performed with a transition to the mastoid processes, the posterior surface of the neck. Sessions are held daily or every other day.

Example No. 1. Patient G., 46 years old.

He suffers from hypertension for more than five years; he has not regularly received antihypertensive therapy.

In April, weakness appeared in the arm and leg on the left, was treated on an outpatient basis.

A week later, weakness in the extremities intensified to plegia, was hospitalized in the hospital, nerve compartment, with a diagnosis of CVB, cerebral infarction in the pool of the right midbrain artery, left-sided hemiparesis of the 3rd degree of clinical manifestations.

Concomitant diagnosis: Hypertension 3 tbsp., A high degree of risk.

He was admitted to the department five months after the onset of the disease. Complaints: weakness in the leg and arm on the left, awkwardness when moving the arm and leg on the left, increased blood pressure, staggering when walking. Objectively: HELL 170/100 mm Hg, pulse 76 beats per minute. General condition is satisfactory.

Somatic status without features. Hemiparetic gait, Wernicke-Mann posture, convergence weakened, finer nasolabial fold on the left, tongue deviating to the left. The tone of the pyramidal type in the left hand is increased to the second degree, in the left leg to the first degree.

Tendon reflexes are enlivened on the left. Hemigipesthesia left-sided. The range of motion in the left hand in the shoulder joint is up to 80 degrees, incomplete extension in the elbow joint (90 degrees), can not straighten the brush on the left. The strength in the left hand is 2 points, in the left leg 3 points.

Pathological signs on the left are called - the Babinsky symptom, the Rossolimo symptom is upper and lower.

In the Romberg position, he falls more to the left, he carries out a finger-bearing, heel test with a rough fall, more to the left.

Examination: MRI of the brain. Conclusion: Diffuse atrophy of the brain with secondary communicating hydrocephalus. Ischemic stroke in the MCA pool, early chronic stage.

Fundus: hypertensive angiopathy.

Duplex scanning of extracranial vessels: a plaque in the ICA on the right with a size of 7.3 by 2.8 mm. ICA stenosis is 50-60%.

Memory curve: memorization unstable, depleted.

Cranial manual testing revealed: sagittal suture dysfunction, coronary suture dysfunction, temporal-parietal suture dysfunction, left-sided lateroflexion of sphenobasilar synchondrosis, temporal bone compression on the left, limitation of the flexion and extensional phases.

A course of cranial manual therapy. Each session began with a preparatory stage: stroking the scalp to the shoulders, light rubbing, myofascial release in the area of the trapezius muscles more to the left, suboccipital release.

The first session: cranial manual testing was carried out, sagittal suture dysfunction, coronary suture dysfunction, left-sided lateroflexion of sphenobasilar synchondrosis, temporal bone compression on the left, limitation of the flexion and extension phases were revealed.

Preparatory stage: stroking from the frontal to the occipital region with the transition to the neck and shoulder area on both sides for 1 minute. Rubbing with a fingertip of a progressive nature from the frontal, through the temporal-parietal region, to the occipital, along the cervical region, to the shoulders for 1-2 minutes. Repeat stroking for 1 minute. Then, grinding movements were carried out in opposite directions from the right frontal to the left temporal-occipital region and from the left frontal to the right temporal-occipital region for 1-2 minutes.

Myofascial release was made, in the area of the horizontal portion of the trapezius muscle, the point of tissue tension (the beginning of the impact) was determined by palpation, gradually pressing on the tissue, gently and gently penetrating into the depth, traction to the barrier (sensation of tissue resistance) was carried out, then the tissue was twisted until it relaxed.

A suboccipital release was performed, carrying out a light tarcation at the points of attachment of the muscles to the back of the head, stretching them laterally to tissue resistance, then performing tissue torzion, displacing them in opposite directions.

Light stroking from the mastoid processes along the posterior-lateral surfaces of the neck was performed for 1 minute.

Then they performed palpation, relaxation of the sagittal and coronal sutures.

The sagittal suture was relaxed by diluting the parietal bones during the flexion phase.

The relaxation of the coronal suture was carried out by the technique of expansion of the suture. Then, stroking along the temporoparietal sutures was performed with a transition to the mastoid processes, the posterior surface of the neck.

At the end of the session, control cranial manual testing was performed, dysfunctions of the sagittal and coronary sutures were eliminated, dysfunction of the temporal-parietal sutures, lateral flexion of sphenobasilar synchondrosis on the left, compression of the temporal bone on the left, limitation of the flexion and extensional phases.

The second session: they began with cranial manual testing, revealed dysfunction of the temporoparietal sutures, lateroflexion of sphenobasilar synchondrosis on the left, compression of the temporal bone on the left, limitation of the flexion and extension phases.

The preparatory stage began with stroking from the frontal to the occipital region with a transition to the neck and shoulder area on both sides for 1-2 minutes. Rubbed with fingertips of a progressive nature from the frontal, through the temporal-parietal region, to the occipital, along the cervical region, to the shoulders for 1-2 minutes. Stroking was repeated for 1 minute. Then, grinding movements were carried out in opposite directions from the right frontal to the left temporal-occipital region and from the left frontal to the right temporal-occipital region for 1-2 minutes.

A myofascial release was performed, in the region of the horizontal portion of the trapezius muscle, the next point of tissue tension (the onset of exposure) was determined by palpation, gradually pressing on the tissue, gently and gently penetrating deep into the barrier (sensation of tissue resistance), then the tissue was twisted until it relaxed .

Elimination of dysfunction of the temporoparietal sutures was carried out by stretching the seams to the sides. In the extensional phase, with the thumbs of the opposite hands located near the suture, simultaneously, with the index and middle fingers, pressing on the mastoid processes.

Then, light stroking from the mastoid processes along the posterolateral surfaces of the neck was performed for 1 minute. Carried out auto-mobilization, in the phase of inspiration - pressure in the area of the parietal bone with simultaneous back flexion of the feet, on exhalation - applying pressure at the midpoint of the fronto-nasal suture, simultaneously with plantar flexion of the feet, then stroking the temporal-parietal sutures with the transition to the mastoid processes , back of the neck.

At the end of the session, cranial manual testing was performed: sagittal suture dysfunction, coronary suture dysfunction, temporal-parietal suture dysfunction were eliminated, lateral flexion of sphenobasilar synchondrosis on the left, temporal bone compression on the left, limitation of the flexion and extension phases were preserved.

The third session: cranial manual testing revealed the preservation of lateroflexion of sphenobasilar synchondrosis on the left, compression of the temporal bone on the left, limitation of the flexion and extension phases.

The preparatory stage was carried out similarly to the previous sessions, it began with stroking from the frontal to the occipital region with the transition to the neck and shoulders on both sides for 1-2 minutes. Rubbing was carried out with fingertips of a progressive nature from the frontal, through the temporoparietal region, to the occipital, along the cervical region, to the shoulders for 1-2 minutes. Stroking was repeated for 1 minute. Then, grinding movements were carried out in opposite directions from the right frontal to the left temporal-occipital region and from the left frontal to the right temporal-occipital region for 1-2 minutes.

A myofascial release was performed, in the region of the horizontal portion of the trapezius muscle, the next tissue tension point (the beginning of exposure) was determined by palpation, gradually pressing on the tissue, gently and gently penetrated deep, traction to the barrier (sensation of tissue resistance) was performed, then the tissue was twisted until it was relaxed.

In the third session, lateroflexion on the left, sphenobasilar synchondrosis was eliminated using a combined grip, rotating the wing of the main bone in the forward direction with the left index finger, the left little finger and the ring finger in the same direction of the occipital bone. The right wing of the main bone was moved back with the right index finger, the occipital bone in the same direction with the right little finger and ring finger.

At the same session, the temporal bone was decompressed, fixing the frontal bone on the right side, pulling the auricle on the left along the axis of the temporal bone pyramid. At the end, stroking along the temporoparietal sutures was performed with a transition to the mastoid processes, the posterior surface of the neck.

At the end of the session, cranial manual tests were performed: sagittal suture dysfunction, coronary suture dysfunction, temporal-parietal suture dysfunction, lateral flexion of sphenobasilar synchondrosis on the left, temporal bone compression on the left, limitation of the flexion and extensional phases are preserved.

The fourth session: cranial manual testing revealed the preservation of the limitations of the flexion and extension phases.

The preparatory stage was carried out similarly to the previous sessions and began with stroking from the frontal to the occipital region with the transition to the neck and shoulder area on both sides for 1-2 minutes. Then we carry out rubbing with the fingertips of a progressive character from the frontal, through the temporoparietal region, to the occipital, along the cervical region, to the shoulders for 1-2 minutes. Stroking was repeated for 1 minute. Then, grinding movements were carried out in opposite directions from the right frontal to the left temporal-occipital region and from the left frontal to the right temporal-occipital region for 1-2 minutes.

Myofascial release was performed, in the region of the horizontal portion of the trapezius muscle, the next tissue tension point (the beginning of exposure) was determined by palpation, gradually pressing on the tissue, gently and gently penetrating deep into the barrier, traction to the barrier (sensation of tissue resistance) was performed, then the tissue was twisted until it relaxed. Then, a universal decompression technique, “fourth ventricular compression,” was performed using medial compression of the lateral angles of the scales of the occipital bone, synchronous rotation of the temporal bones for the mastoid processes, with a gradual increase in the frequency and amplitude of rotational movements.

The limitation of the flexion phase was eliminated by moving the large wing of the main bone down, posterior and to the side, the occipital bone - down, forward, the temporal bone - laterally during the flexion phase. Then, stroking along the temporoparietal sutures was performed with a transition to the mastoid processes, the posterior surface of the neck.

At the end of the session, cranial manual testing was carried out, and the limitation of the extensional phase was maintained.

Fifth session: cranial manual testing revealed persistence of the limitation of the extensional phase.

The preparatory stage was carried out similarly to the previous sessions and began with stroking from the frontal to the occipital region with the transition to the neck and shoulder area on both sides for 1-2 minutes. Rubbing was carried out with fingertips of a progressive nature from the frontal, through the temporoparietal region, to the occipital, along the cervical region, to the shoulders for 1-2 minutes. Stroking was repeated for 1 minute. Then, grinding movements were carried out in opposite directions from the right frontal to the left temporal-occipital region and from the left frontal to the right temporal-occipital region for 1-2 minutes.

A myofascial release was performed, in the region of the horizontal portion of the trapezius muscle, the next tissue tension point (the beginning of exposure) was determined by palpation, gradually pressing on the tissue, gently and gently penetrated deep, traction to the barrier (sensation of tissue resistance) was performed, then the tissue was twisted until it was relaxed.

The restriction of the extensional phase was eliminated by moving the large wing of the main bone up, forward, inside, occipital bone - down, forward, temporal bone - laterally during the extensional phase. At the end of the manipulation, stroking along the temporoparietal sutures was performed with a transition to the mastoid processes, the posterior surface of the neck.

Cranial manual testing was performed: no dysfunctions were detected.

After the second or third sessions, the patient decreased staggering, improved mood.

After five sessions of cranial manual therapy, the patient is objective: the strength in the left leg increased to 4 points, in the hand to 3 points, the range of movements in the left hand increased, he began to fully extend the arm in the elbow joint, began to fully extend the hand, the range of movements in the shoulder joint up to 170 degrees. The tone in the left arm decreased to the first degree, in the leg to normal. Conducts coordinating tests with less mimic. The gait became much more confident, less hemiparetic. The body position is more physiological, the flexion position of the left hand decreased.

According to dopplerography of extracranial vessels. In the ICA, a ring-shaped plaque measuring 7.3 by 2.4 mm, a stenosing vessel by 50-40%. Memorization has improved, there is no depletion, memorization is more stable.

Disabled third group, works as a car mechanic.

Re-examination after nine months, no relapse.

Example No. 2. Patient N., 34

Received the day after the occurrence of diplopia in the horizontal plane, dizziness.

Diagnosis: CVB. Minor stroke according to the type of ischemic, stem localization, with oculomotor disturbances, vestibulo-atactic syndrome, grade 3 clinical manifestations.

Complaints of double vision on the horizontal plane, nausea, swaying when walking.

Objectively: blood pressure 180/100 mm Hg, pulse 80 beats per minute.

Somatic status without features. In neurological status: convergence is weakened, slight diverging strabismus, finely sweeping nystagmus in the horizontal plane, restriction of horizontal movement of the eyeballs to the right. There is no power paresis. Diffuse hypotension, tendon reflexes are equal, live. Ankle, finger test carried out with intention. In the Romberg position, dynamic and static ataxia. Cranial manual therapy was carried out from the fifth day, after drug (vascular, nootropic) therapy. In neurological status remained: finely spread nystagmus, diplopia.

Fundus: initial signs of hypertensive angiopathy.

MRI of cerebral vessels: pathological tortuosity of the extracranial part of the left internal carotid artery. No aneurysms detected.

Dopplerography of extracranial vessels: on the right, ICA in the initial segment is expanded to 6.0 mm.

There is no memory impairment.

When cranial manual testing revealed:

Dysfunction of sagittal, coronoid sutures, compression of the condyles of the occipital bone, compression of the temporal bones, bilateral, lateral tension of the sphenobasilar symphysis on the left.

A course of cranial manual therapy, consisting of four daily sessions.

Each session began with stroking the scalp, neck, shoulder girdles of light grinding, myofascial release on a horizontal portion of the trapezius muscles on both sides, suboccipital release.

In the first session: during cranial manual testing, the following dysfunctions were revealed: dysfunction of the sagittal, coronoid sutures, compression of the condyles of the occipital bone, compression of the temporal bones, bilateral, lateral tension of the sphenobasilar symphysis on the left.

We started with the preparatory stage, with stroking from the frontal to the occipital region, with the transition to the neck and shoulder area on both sides for 1-2 minutes. Then, rubbing with the fingertips of a progressive character was carried out from the frontal, through the temporoparietal region, to the occipital, along the cervical region, to the shoulder girdles for 1-2 minutes. Stroking was repeated for 1 minute. Then, grinding movements were carried out in opposite directions from the right frontal to the left temporal-occipital region and from the left frontal to the right temporal-occipital region for 1-2 minutes.

Myofascial release was performed, the next point of tissue tension (beginning of exposure) was determined by palpation in the horizontal portion of the trapezius muscle, gradually pressed onto the tissue, gently and gently penetrated deep, traction to the barrier (sensation of tissue resistance) was performed, then the tissue was twisted until it relaxed.

Suboccipital release was carried out, holding the patient’s head with the second, third, fourth, fifth fingers of both hands, located caudal to the outcrop line, and penetrated to the bone, the patient’s head was held in the palms of the hands. Light traction was performed at the points of attachment of the muscles to the back of the head, stretching them laterally to the barrier (tissue resistance). Reaching the release from one side, they carried out a tissue torsion, displaced the tissue in opposite directions. Reception was performed exclusively on soft tissues.

We started, with the goal of stimulating neurodynamic processes, with "compression of the fourth ventricle." Tenars were squeezed medially, slightly cranially into the extensional phase, into the flexion - retention phase, repeating until a fixed point was reached.

Then, the sagittal suture was relaxed by diluting the parietal bones during the flexion phase.

At the end of the manipulation, stroking along the temporoparietal sutures was performed with a transition to the mastoid processes, the posterior surface of the neck.

Cranial manual testing was performed, sagittal suture dysfunction was eliminated, coronary suture dysfunction, compression of the condyles of the occipital bone, compression of the temporal bones, bilateral, lateral tension of the sphenobasilar symphysis on the left.

Second session: during cranial manual testing, the following dysfunctions were revealed: coronary suture dysfunction, compression of the condyles of the occipital bone, bilateral compression of the temporal bones, lateral tension of the sphenobasilar symphysis on the left.

We started with the preparatory stage, with stroking from the frontal to the occipital region, with the transition to the neck and shoulder area on both sides for 1-2 minutes. Then, rubbing with the fingertips of a progressive character was carried out from the frontal, through the temporoparietal region, to the occipital, cervical region, to the shoulders for 1-2 minutes, repeating stroking for 1 minute. Then, grinding movements were carried out in opposite directions from the right frontal to the left temporal-occipital region and from the left frontal to the right temporal-occipital region for 1-2 minutes.

A myofascial release was performed, in the region of the horizontal portion of the trapezius muscle, the next tissue tension point (the beginning of the impact) was determined by palpation, gradually pressed onto the tissue, gently and gently pressed inward, traction to the barrier (sensation of tissue resistance) was carried out, then the tissue was twisted until it was relaxed. Suboccipital release was carried out, holding the patient’s head with the second, third, fourth, fifth fingers of both hands, located caudal to the outflow line and penetrated to the bone, the patient’s head was held on the palms of the hands.

Light traction was performed at the points of attachment of the muscles to the back of the head, stretching them laterally to the barrier (tissue resistance). Reaching the release from one side, they carried out a tissue torsion, displaced the tissue in opposite directions.

Reception was performed exclusively on soft tissues.

When the coronal suture was relaxed, the “technique of expansion of the sutures” was applied until the sensation of relaxation in the compression of the coronal suture was applied.

At the end of the manipulation, stroking along the temporoparietal sutures was carried out with a transition to the mastoid processes, the posterior surface of the neck.

During cranial manual testing, the following remaining dysfunctions were revealed: bilateral temporal bone compression, lateral tension of the sphenobasilar symphysis on the left.

Third session: during cranial manual testing, the following dysfunctions were revealed: again compression of the condyles of the occipital bone, compression of the temporal bones bilaterally.

We started with the preparatory stage, with stroking from the frontal to the occipital region with the transition to the neck and shoulder area on both sides for 1-2 minutes. Then, rubbing with the fingertips of a progressive character was carried out from the frontal, through the temporoparietal region, to the occipital, along the cervical region, to the shoulder girdles for 1-2 minutes. Stroking was repeated for 1 minute. Then, grinding movements were carried out in opposite directions from the right frontal to the left temporal-occipital region and from the left frontal to the right temporal-occipital region for 1-2 minutes.

A myofascial release was performed, in the region of the horizontal portion of the trapezius muscle, the next tissue tension point (the beginning of exposure) was determined by palpation, gradually pressed onto the tissue, gently and gently penetrated into the depth, traction to the barrier (sensation of tissue resistance) was performed, then the tissue was twisted until it relaxed . Suboccipital release was carried out by holding the patient’s head with the second, third, fourth, fifth fingers of both hands, placing them more caudally than the outcrop line, and penetrated to the bone, the patient’s head was held in the palms of the hands.

Light traction was performed at the points of attachment of the muscles to the back of the head, stretching them laterally to the barrier (tissue resistance). Reaching the release from one side, they carried out a tissue torsion, displaced the tissue in opposite directions.

Reception was performed exclusively on soft tissues.

Then, the condyles of the occipital bone were decompressed by traction in the cranial, then lateral direction until relaxation.

Decompression of the temporal bones was performed by traction behind the auricles in the extensional phase in the dorso-lateral direction, along the axis passing through the pyramid of the temporal bone, from two sides.

At the end of the manipulation, stroking along the temporoparietal sutures was performed with a transition to the mastoid processes, the posterior surface of the neck.

During the control cranial manual testing, the following dysfunctions were revealed: lateral tension of the sphenobasilar symphysis on the left.

The fourth session: during cranial manual testing revealed the preservation of lateral tension sphenobasilar symphysis on the left.

We started with the preparatory stage, with stroking from the frontal to the occipital region with the transition to the neck and shoulder area on both sides for 1-2 minutes. Then, rubbing with the fingertips of a progressive character was carried out from the frontal, through the temporoparietal region, to the occipital, along the cervical region, to the shoulder girdles for 1-2 minutes. Stroking was repeated for 1 minute. Then, grinding movements were carried out in opposite directions from the right frontal to the left temporal-occipital region and from the left frontal to the right temporal-occipital region for 1-2 minutes.

Myofascial release was performed, the next point of tissue tension (beginning of exposure) was determined by palpation in the horizontal portion of the trapezius muscle, gradually pressed onto the tissue, gently and gently penetrated deep, traction to the barrier (sensation of tissue resistance) was performed, then the tissue was twisted until it relaxed. Suboccipital release was carried out, holding the patient’s head with the second, third, fourth, fifth fingers of both hands, located caudal to the outcrop line, and penetrated to the bone, the patient’s head was held in the palms of the hands. Light traction was performed at the points of attachment of the muscles to the back of the head, stretching them laterally to the barrier (tissue resistance). Reaching the release from one side, they carried out a tissue torsion, displaced the tissue in opposite directions. Reception was performed exclusively on soft tissues.

To eliminate lateral flexion of sphenobasilar synchondrosis, a fronto-occipital grip was used, causing rotator movements around a vertical axis passing through the body of the main bone and a large occipital foramen.

Then, a universal method of auto-mobilization was carried out by pressure on the area of the parietal bones on inspiration in a patient performing back flexion, and on exhalation, light pressure on the fronto-nasal suture in a patient performing plantar flexion. At the end of the manipulation, stroking along the temporoparietal sutures was performed with a transition to the mastoid processes, the posterior surface of the neck. During the control cranial manual testing, dysfunctions were not detected.

After four sessions of manual therapy, the patient completely regressed nystagmus, diplopia, restrictions on the movement of eyeballs, and coordinating disorders. HELL 130/80 mm Hg, pulse 76 beats per minute, hemodynamics is stable.

Dopplerography of extracranial vessels: expansion of the right ICA in diameter up to 6.8 mm.

The method was used in City Clinical Hospital No. 1, the department of rehabilitation treatment, where 75 patients were treated.

When using the proposed method, improvements in arterial and venous blood flow in the ischemic zone of the brain substance are achieved, collateral blood flow is improved, cerebrospinal fluid changes are normalized, which improves the neurodynamic processes of the brain, nerves are depleted, preserved nerve elements of the ischemic zones of the brain are activated, which allows to increase treatment .

Claims (1)

A method of treating cerebrovascular disease, including drug treatment, a preparatory stage of exposure and manual therapy, characterized in that each session begins and ends with manual cranial testing, the preparatory stage includes stroking from the frontal to the occipital region with a transition to the neck and shoulder area from two sides, then perform rubbing movements with the fingers of a progressive nature from the frontal, through the temporal-parietal region, to the occipital, along the cervical region, to the shoulder girdles, in oncoming boards from the right frontal to the left temporal-occipital region and from the left frontal to the right temporal-occipital region, perform myofascial and suboccipital release, relax the sagittal suture by traction of the parietal bones in the lateral direction, relax the coronal suture in the area of limiting its mobility by holding the frontal and parietal bones and tapping the occipital bone on the opposite side with the expectation for two minutes of a feeling of relaxation, decompression of the condyles occipitally bone by traction them in the cranial, then in the lateral directions, perform lateoflexion of sphenobasillar synchondrosis by rotating the main and occipital bones around the axes of the torsion and lateroflexion to the state of prestressing and holding in this state until the restriction is removed, perform the torzion of the sphenobasilar synchondrosis to the left by moving the large wing of the left the cranial bone and lateral angle of the occipital bone, relax the temporoparietal sutures by external rotation of the temporal bone and stretching the temporal of the parietal suture to the side, decompression of the temporal bone from the side of the dysfunction is performed by fixing the frontal bone on the opposite side and traction behind the auricle in the extensional phase in the dorso-lateral direction along the axis passing through the pyramid of the temporal bone, repeat traction on both sides with bilateral dysfunction perform rotation of the temporal bone around an axis passing through the external auditory meatus, the zygomatic process in the caudal-lateral direction, the mastoid process in the dorsal-medial direction, n and each session eliminates no more than two dysfunctions, from the third session they perform compression of the fourth ventricle using medial compression of the lateral angles of the scales of the occipital bone, synchronously rotate the temporal bones for the mastoid processes with a gradual increase in the frequency and amplitude of rotational movements, and receive the “occipital pump” by lateral traction of the mastoid processes, auto-mobilization at the inspiratory phase - pressure in the parietal bone with simultaneous dorsiflexion of the feet, while exhaling - crushed at the midpoint of the fronto-nasal suture with plantar flexion of the feet, they increase flexion by moving the large wing of the main bone down, back and to the side, the occipital bone down forward, the temporal bone laterally during the flexion phase, and increase the extension by moving the large wing of the main bones - up, forward, inside, occipital bone - up, back, temporal bone - laterally during the extensional phase, condylar decompression during the flexion phase, pushing the large occipital opening laterally and caudally, treatment is carried out daily or every other day.