Cranial Rhythmic Impulse Related To The Traube-Hering-Mayer Oscillation
Cranial Rhythmic Impulse Related To The Traube-Hering-Mayer Oscillation
Cranial Rhythmic Impulse Related To The Traube-Hering-Mayer Oscillation
n 1865, Traube1 reported the measurement of a fluctuation in pulse pressure with the frequency of respiration
that persisted after respiration had been
arrested. These findings were corroborated by Hering 2 in 1869. Independently, Mayer3 identified similar oscillations
with a slower rate in 1876. These phe-
Methods
Subjects
Twelve healthy subjects over 18 years of
age (6 males; 6 females, none pregnant)
were recruited from the faculty and students of the Chicago College of Osteopathic Medicine (Midwestern University, Downers Grove, Ill). All signed
IRB-approved informed consent forms.
ject. Following this, each subject lay quietly on the examination table for approximately 5 minutes prior to the onset of
data acquisition. It was essential that the
probe and leads were free of tension so
that earlobe blood flow was not compromised. Laser-Doppler flowmetry provided measurement of the relative velocities of blood (hemoglobin) while simultaneously, the examiner, at the head of the
table, palpated the CRI using light touch
with the hands in a biparietal-hold position. Both examiner and subject were
blinded to activities at the computer screen
and keyboard.
A 2-minute-long equilibration-period
record was recorded. Following the equilibration period, the examiner would,
using a subdued voice, enunciate f at
the instant a cranial flexion event began,
and a second investigator, operating the
computer console in the examination
room, would depress a key entering the
first event mark into the digitized flowmetry record. Thereafter, serial extension
(e) and flexion (f) events were
marked into the record. This method of
recording could introduce a 150-millisecond reaction-time delay into the CRI
record, 300 milliseconds if the reaction
times of both the examiner and the
recording investigator are considered.32
Continuous, unbroken records of approximately 5 minutes duration were recorded for each subject.
Laser-Doppler flowmetry
The perfusion monitor (Transonic Systems Inc, Ithaca, NY) determines the
Doppler velocity change of the erythrocyte
(hemoglobin) in circulating blood, and
that information is digitized for subsequent data reduction. The device uses an
optic fiber probe that rests on the skin
surface, which causes no discomfort to the
subject. The probe (type R) has two optic
fibers: one sends laser light into the tissue,
the other transfers the light reflected from
those tissues to a photo detector for subsequent electronic processing (WinDaq
Data Acquisition and Playback Software,
also from Transonic Systems).
Results
Combined laser-Doppler
flowmetry and CRI records:
qualitative overview
Figure 1 presents two different subject
records that display all of the features
observed in the 12 records of this study.
The oscillating waveforms are records of
the flowmetry relative blood velocity
changes detected at the earlobe (recorded
as an output voltage); the vertical event
marks denote the flexion and extension
events detected through palpation (entered
by technician). In the 7-minute period
presented in Figure 1, the high-frequency
oscillations of the Doppler record, such as
those arising from the heartbeat, are compressed and appear as spectral noise so
that the low-frequency oscillations may be
observed easily. The earliest event mark
(extreme left mark) of each recorded segment denotes a flexion event. Thereafter,
the event marks denote alternate extension
and flexion throughout the sequence.
In Figure 2 (top), a portion of subject
2s record is expanded along the time
axis to reveal the fine structure of the cardiac cycle and the relationship of this
cycle to the THM oscillation. Three THM
cycles are displayed. The amplitudes of the
THM waves are nearly double those of
cardiac cycle waves. The THM cycle corresponds to large relative changes in blood
velocity and, therefore, is of a magnitude
that ought to be readily palpable through
osteopathic techniques, particularly if
these blood velocity changes are proportional to blood volume changes (compare with Burch and colleagues35).
Laser-Doppler detection produces
Figure 2. Expanded laser-Doppler flowmeter relative blood velocity record of subject 2. TopFlowmeter trace, revealing fine structure of the cardiac cycle. The double-headed arrow indicates the wavelength of one Traube-Hering-Mayer cycle. BottomTraube-Hering-Mayer wave form component only of the top trace. The
bottom waveform was created from the top waveform by filtering (removing) the highfrequency cardiac component, leaving only the low-frequency baro and respiratory
components. Inverse Fourier transformation of this filtered data generates the bottom trace. Both traces are in register with respect to time, and the event markers indicate the positions of the palpatory findings.
JAOA Vol 101 No 3 March 2001 165
Figure 4. Inverse Fourier transform time-domain spectra from subject 2; top spectrum, all frequency domain data used in the
inverse computation; bottom spectrum, only the frequency component lying below 0.5 cycles/sec (30 cycles/min) used. The
bottom spectrum is the THM oscillation. The insert box shows that portion of the Fourier transform spectrum used to compute the inverse THM spectrum (see Figure 3).
Table 1
Descriptive Statistics (11 Subjects) for the Relative Blood Velocity Oscillation
Determined by Laser-Doppler Flowmetry
Subject
No.
1
2
3
5
6
7
8
9
10
11
12
Total
No. of
cycles
Mean cycle
period
(sec/cycle)
Standard
deviation
Standard
error
95% Confidence
interval (mean)
Lower
bound
Upper
bound
Minimum
Maximum
57
55
45
55
46
45
66
53
37
75
57
10.20
8.59
10.87
9.97
9.94
13.47
7.59
12.03
11.75
9.63
11.67
1.89
0.93
2.19
2.22
2.05
1.38
1.04
1.74
2.05
1.84
2.46
0.25
0.12
0.32
0.29
0.30
0.20
0.12
0.23
0.33
0.21
0.32
9.69
8.34
10.21
9.37
9.32
13.06
7.33
11.55
11.06
9.21
11.01
10.70
8.85
11.53
10.57
10.55
13.89
7.85
12.51
12.43
10.06
12.32
4.80
6.36
7.20
5.08
7.70
11.52
5.60
7.04
8.00
6.24
5.12
14.88
12.00
14.40
16.00
16.80
16.64
10.18
17.80
16.20
13.44
17.92
591
10.35
2.42
0.099
10.15
10.54
4.80
17.92
Table 2
Multiple Comparisons of the Traube-Hering-Mayer Component of the Relative Blood Velocity
Oscillation Laser-Doppler Record (sec/cycle; One-way Analysis of Variance, Range Test: Bonferroni)
(I)
Subject
No.
(J)
Subject
No.
Mean
difference
(I-J)
Standard
error
2
3
5
6
7
8
9
10
11
12
1.60*
-0.67
0.22
0.26
-3.27*
2.60*
-1.83*
-1.55*
0.56
-1.47*
0.349
0.368
0.349
0.366
0.368
0.334
0.352
0.390
0.324
0.346
3
5
6
7
8
9
10
11
12
-2.27*
-1.37*
-1.34*
-4.88*
1.00
-3.44*
-3.15*
-1.03
-3.07*
5
6
7
8
9
10
11
12
6
7
8
9
10
11
12
Significance
Upper
bound
0.000
1.000
1.000
1.000
0.000
0.000
0.000
0.004
1.000
0.001
0.44
-1.89
-0.93
-0.95
-4.50
1.49
-3.01
-2.85
-0.51
-2.62
2.76
0.55
1.39
1.48
-2.05
3.71
-0.66
-0.25
1.64
-0.32
0.371
0.352
0.369
0.371
0.337
0.355
0.392
0.328
0.349
0.000
0.006
0.016
0.000
0.168
0.000
0.000
0.088
0.000
-3.51
-2.54
-2.57
-6.11
-0.12
-4.62
-4.46
-2.13
-4.23
-1.03
-0.20
-0.11
-3.64
2.12
-2.25
-1.84
0.053
-1.91
0.89
0.93
-2.60*
3.27*
-1.16
-0.88
1.23*
-0.80
0.371
0.387
0.389
0.357
0.374
0.410
0.348
0.368
0.858
0.895
0.000
0.000
0.105
1.000
0.023
1.000
-0.33
-0.35
-3.90
2.08
-2.41
-2.24
0.076
-2.02
2.13
2.22
-1.30
4.46
0.081
0.48
2.39
0.42
0.032
-3.50*
2.37*
-2.06*
-1.78*
0.33
-1.70*
0.369
0.371
0.337
0.355
0.392
0.328
0.349
1.000
0.000
0.000
0.000
0.000
1.000
0.000
-1.19
-4.74
1.25
-3.25
-3.08
-0.76
-2.86
1.26
-2.26
3.50
-0.88
-0.47
1.42
-0.53
Table 2 (continued)
Multiple Comparisons of the Traube-Hering-Mayer Component of the Relative Blood Velocity
Oscillation Laser-Doppler Record (sec/cycle; One-way Analysis of Variance, Range Test: Bonferroni)
(I)
Subject
No.
(J)
Subject
No.
Mean
difference
(I-J)
Standard
error
7
8
9
10
11
12
-3.53*
2.34*
-2.09*
-1.81*
0.30
-1.73*
0.387
0.354
0.372
0.408
0.346
0.366
8
9
10
11
12
5.88*
1.44*
1.72*
3.84*
1.80*
9
10
11
12
Significance
Upper
bound
0.000
0.000
0.000
0.001
1.000
0.000
-4.82
1.16
-3.33
-3.17
-0.84
-2.95
-2.24
3.52
-0.85
-0.45
1.45
-0.51
0.357
0.374
0.410
0.348
0.368
0.000
0.007
0.002
0.000
0.000
4.69
0.19
0.36
2.68
0.57
7.07
2.68
3.09
5.00
3.03
-4.44*
-4.15*
-2.04*
-4.07*
0.340
0.379
0.311
0.334
0.000
0.000
0.000
0.000
-5.58
-5.42
-3.07
-5.19
-3.30
-2.89
-1.00
-2.96
10
11
12
0.28
2.40*
0.36
0.395
0.331
0.352
1.000
0.000
1.000
-1.03
1.29
-0.80
1.60
3.50
1.53
10
11
12
2.11*
0.079
0.371
0.390
0.000
1.000
0.88
-1.21
3.35
1.37
11
12
-2.03*
0.324
0.000
-3.11
-0.95
each subject record were compared by ttest for equality of means. Two examples, one from a higher-frequency (subject
8) and one from a lower-frequency (subject 11), are presented in Table 3. The
mean differences between higher- and
lower-frequency sets within each subject
record are statistically significant (P
.01), with the high-frequency (subject 8)
exhibiting a frequency difference of 1.51
cycles/min and the low-frequency (subject
11) exhibiting a difference of 1.73 cycles/min.
Comments
The statistical comparisons demonstrate
that the CRI is concomitant with lowfrequency fluctuations in blood velocity as
measured with the Transonic Systems
BLF 21 Perfusion Monitor laser-Doppler
flowmeter. Moreover, the observed concomitance is sustained at all points in the
record even though blood-velocity-change
frequency may vary, with periodicity, as
much as 20% (Table 3). These findings
imply that the PRM/CRI and the THM
oscillation are simultaneous, if not the
same phenomenon. This opens new possible explanations for the basic theoretical concepts of the physiologic mechanism of the PRM/CRI and cranial
therapy. Comparison of the PRM/CRI
with current understanding of the physiologic mechanism of the THM oscillation
is, therefore, warranted.
Primary respiratory mechanism. The
PRM is described as the driving force
associated with the activity of cellular
metabolism.17,19,21,24 The THM oscillations are intimately involved in the regulation of peripheral blood flow and, consequently, tissue perfusion. 4,8,10,16
Circulatory and body core temperature
homeostasis are considered to be a result
of the THM oscillation.8 A hypothetical
explanation for the PRM can be devised
by employing our understanding of the
THM oscillation.
The THM oscillation affects all tissues of the body through its impact on the
entire circulatory system. Blood pumped
from the heart, the rhythm of which fluctuates under the influence of the THM
oscillation,11,12 arrives in all of the capillary beds in the body via arteries and
170 JAOA Vol 101 No 3 March 2001
Table 3
Comparisons of Shorter and Longer Oscillations
Within Individual Subject Records (t-test for Equality of Means)
Subject
No.
Short or
long cycles
Mean
(sec/cycle)
Standard
deviation
Mean
difference
Significance
(2-tailed)
Short
Long
9
9
6.49
8.00
0.63
0.93
1.51
0.001
11
Short
Long
11
10
8.88
10.61
0.72
1.68
1.73
0.006
Conclusion
The results of this study indicate that the
PRM/CRI and the THM oscillation occur
JAOA Vol 101 No 3 March 2001 171
Acknowledgments
The authors thank James & Associates, Inc.,
of Barrington, Illinois, for use of the BLF 21
Transonic Laser-Doppler Flowmeter, and
Edgar F. Allin, MD, Professor in Anatomy at
the Chicago College of Osteopathic Medicine
of Midwestern University, for his wit, wisdom, and willingness to always champion the
null hypothesis.
References
1. Traube L. Uber periodische Tatigkeitsanderungen des Vasomotorischen und Hemmungs-Nervenzentrums. Cbl Med Wiss 1865;56:881-885.
2. Hering E. Uber Athembewegungen des Gefasssystems. Sitzungb d k Akad d W math naturw
1869;60:829-856.
24. Lay E. Cranial field. In: Ward RC, ed. Foundations for Osteopathic Medicine. Baltimore, Md:
Williams & Wilkins; 1997:901-913.
50. Olszewski WL, Engeset A. Intrinsic contractility of prenodal lymph vessels and lymph flow in
human leg. Am J Physiol 1980;239:H775-H783.
51. Mislin H. The lymphangion. In: Foldi M, CasleySmith JR, eds. Lymphangiology. Stutgart, NY:
F.K. Schatauer-Verlag, 1983;165-175.
52. Johnston MG, Kanalec A, Gordon JL. Effects
of arachidonic acid and its cyclo-oxygenase and
lipoxygenase products on lymphatic vessel contractility in vitro. Prostaglandins 1983;25:85-98.
53. Kobayashi M, Musha T. 1/f Fluctuation of heartbeat period. IEEE Trans Biomed Eng 1982;BME29:456-457.
39. Barman SM, Gebber GL. Basis for synchronization of sympathetic and phrenic nerve discharges. Am J Physiol 1976;231:1601-1607.
40. Ahmed AK, Harness JB, Mearns AJ. Respiratory control of heart rate. Eur J Appl Physiol
1982;50:95-104.
41. Bachoo M, Polosa C. Properties of the inspiration-related activity of sympathetic preganglionic neurones of the cervical trunk in the cat. J Physiol (London) 1987;385:545-564.
42. Burton AC, Taylor RM. A study of the adjustment of peripheral vascular tone to the requirements of the regulation of body temperature. Am
J Physiol 1940;129:565-577.
43. Bornmyr S, Svensson H, Lilja B, Sundkvist G.
Skin temperature changes and changes in skin
blood flow monitored with laser Doppler flowmetry
and imaging: a methodological study in normal
humans. Clin Physiol 1997;17:71-81.
44. Lewis T. Studies of the relationship between
respiration and blood-pressure. Part II. Facts bearing on the relationship of different factors in the
production of respiratory curves of blood-pressure.
J Physiol (London) 1908;37:233-255.
57. Burton AC, Taylor RM. A study of the adjustment of peripheral vascular tone to the regulation
of body temperature. Am J Physiol 1940;129:565577.
58. Retzlaff EW, Michael DK, Roppel RM. Cranial bone mobility. JAOA 1975;74:869-873.
59. Becker RE. Life in Motion. Portland, Ore: Rudra
Press; 1997.
60. Chess GF, Tam RMK, Calaresu FR. Influence
of cardiac neural inputs on rhythmic variations of
heart period in the cat. Am J Physiol 1975;228:775780.
61. Younozai R, Fryman VM, Nardell BE, Pryor MJ,
Senicki M. Effects of temporal manipulation on
respiration. JAOA 1981;80:751.