Facilitated Oscillatory Release Zachary J. Comeaux, DO, FAAO

Abstract again with his students, including Dr. paper presents the manner of applica- Finding a practical approach to the Robert Fulford. Each has been an in- tion, as well as an exploration of pos- osteopathic mandate to diagnose and spiration to me. sible physiologic mechanisms for effi- treat the patient as body, mind, and Robert Fulford, DO, a student of cacy of facilitated oscillatory release as spirit has always been a challenge. Sutherland, explored progressively a form of osteopathic treatment. Robert Fulford, DO spent a lifetime more integrative definitions of dys- As in Dr. Still’s time, the populace developing a protocol for an inte- function and approaches to treatment. is challenging the medical commu- grated approach to somatic dysfunc- In his quest for synthesis he chose to nity to integrate concepts from the tion, the residuum of trauma, includ- explore the interrelationship of peri- basic sciences which have not yet ing the percussion vibrator and odic motion and its relationship to found their way into the conventional manual bioelectric assessment. The matter. He began with attention to medical model. The current pressure author builds on this legacy introduc- cranial rhythmic motion and respira- to develop “energy medicine”, and ing a treatment strategy, facilitated tory rhythms, but discovered and used explorations of the physiology of con- oscillatory release, using manually other aspects of the patient’s energy sciousness, the physics models rep- applied oscillations or vibrations to state to work toward improvement of resenting the progeny of relativity and treat dysfunction. A review of scien- symptoms. In applying principles of quantum mechanics, and probability tific and traditional osteopathic litera- motion to his clinical practice, he be- models of mathematics, including ture provides a justification for con- gan to explore, use and teach the use chaos models, all cry to make a con- sidering the biomechanical, neuro- of vibratory motion to release restric- tribution. The concepts of matter/en- muscular and bioelectric characteris- tion of motion using a percussion vi- ergy are the legacy of a quest to un- 15 tics of the body as complementary brator as well as other means. derstand creation which is revisited aspects of one coordinative system in In the early 1990s, after he en- in every generation. The ancient which rhythmic function is key. trusted me with the care of his wife, I Greeks used the language of Matter This paper represents the author’s watched him continually search for and Form; in Still’s day it was phrased scholarly requirement for a com- ways to refine his effectiveness as Vitalism vs. Materialism. Still’s pleted application process for AAO through understanding the implica- insight was that understanding of the Fellowship. Further detail on prin- tions of his way of treatment on his patient occurred by recognizing the ciples of application of FOR will fol- patients. In the process of his explo- integration of these aspects, not in- low in a later issue of The AAOJ. ration, he developed the percussion troducing a new reductionism. Any vibration approach to resolving so- “energy” approach to medicine needs matic dysfunction. He insisted how- to recognize the osteopathic concept Introduction ever, that the machine was not essen- of the interrelationship of structure The challenge of osteopathic clini- tial and that he could accomplish cor- and function. Fulford, as Still and oth- cal practice is to use our hands, on rection with other means. ers before him, was trying to work demand, without complete under- In the course of working with him, toward this reconciliation of empha- standing, to restore ease and comfort. I began to apply manual oscillation sis to more fully recognize the nature We detect patterns of dysfunction by to dysfunctional tissues. As I explored of the patient. I hope in some small palpation and observation, aided by the implications, applications and rel- way to encourage those working in intuition, and perhaps inspiration. evant literature, I identified the this tradition. This was the way with Dr. Still, his method for charting purposes as FOR, students including Dr. Sutherland and for facilitated oscillatory release. This 24/The AAO Journal Summer 2002 Vibrational Medicine an electromagnetic significance to habitus and subtle motion were re- in the Osteopathic somatic dysfunction and osteopathic flective of Intelligent Action ex- treatment. He referred to the works pressed as motion in a wave form. So, Context of Harold Saxton Burr, PhD,5,6 Rob- Dr. Fulford spoke of his work as in Dr. Still, the founder of Osteopa- ert Becker MD,2 and Valerie Hunt, the field of energy or vibratory mo- thy, based his methods of treatment PhD25 who use electromagnetic field tion. Tissue response to vibrational on the philosophy of Creationism and theory as an explanation of the inte- motion, oscillation, was part of analy- Natural Law. The truth had to be dis- grative nature of the human being and sis of indigenous and pathologic mo- covered. Early analogies were based the hitherto non-empiric explanation tion as were articular range of mo- on mechanical principles as this was of Life. Fulford accessed and used the tion or respiration. We discussed his the advancing front of technology in work with refined quartz crystals, by reading, reflections and preliminary his day. Though biased to think of all Marcel Vogel, PhD, a senior IBM re- research in measurement of electro- human process as mechanical, he search scientist, in trying to scientifi- magnetic fields in himself and his conceded that medical study included cally justify an electromagnetic patients and attempts to use esoteric physiology, histology, chemistry and conceptualization of his work. The or intercultural explanations to con- surgery as branches of anatomy. common thread of the work of these ceptualize these effects, due to the Function, as well as structure, was five has been to demonstrate a clini- lack of a clear neurophysiological open to investigation and correction.51 cal connection between the physics paradigm to explain his clinical ob- Although mechanical diagnosis and of electromagnetic field theory and servations and effects. correction was the pattern of practice human physiology in health and dis- As I worked under his influence, most often mimicked by students, ease although correlations with gen- it became clearer to me that rhythmic Still insisted on the importance of the erally accepted neurophysiology, the motion, CRI or otherwise, was part central nervous system as an organiz- dominant paradigm, have yet to be of a natural state of relaxation and ing principle of motion and the im- clarified. This paper is part of that well being. It had been used socially, portance of “nerve force”. Addition- effort. as in dance in many cultures to in- ally, both Arthur Hildreth and Charles duce altered consciousness or spiri- Hazzard, early graduates of the Facilitated Oscillatory tual awareness, as well as to quiet American School of Osteopathy, Release babies naturally and comfort the sick. noted Dr. Still’s touch often directed In the healing arts, oscillation has to soften spastic muscle through in- been used minimally. The percussion hibition, reflecting neuromuscular Origins vibrator used such a force. How did involvement.37 They reference From 1992 until his death in 1997, it work? Charles Edouard Brown Sequard, a Dr. Fulford would visit my medical As I would palpate and find focal nineteenth century neurologist/endo- practice while visiting his wife in a sites of muscle spasm associated with crinologist, on the concept of neural nursing home nearby. We would talk somatic dysfunction, I would use a inhibition versus sensitization in and work together. Dr. Fulford would focused myofascial or ligamentous muscle spasm.43,24 The challenge for often have a new hold, a new way of articular release technique to the in- osteopaths of each subsequent era is working with a child in relation to his/ volved segment. However, since to be inclusive in our habits of inves- her mother, or speculate about a new much of our work was in the vibra- tigation regarding the nature of the philosophical consideration. He was tory arena, it seemed sensible occa- patient while remaining critical of an avid and broadly discursive reader sionally to use focused vibratory convention and wishful thinking. with a thirst for synthesis and a pen- force applied manually instead of Robert Fulford, DO, graduated chant for experimentation for the reaching for the vibrator which would from the University of Health Sci- good of the patient. disrupt the orderly progression of ences College of Osteopathic Medi- As indicated above, his theater of treatment. Over time there were more cine in Kansas City, MO in 1941. As operation went far beyond use of the occasions on which to supply such an a general practitioner during the WW- “percussion hammer”. All his meth- intervention. II years, he worked for greater effi- ods depended on the concomitant use When I reflected on the probable ciency against exhaustion. He was of diagnostic touch to discover re- methods of effectiveness, I realized impressed by the impact of cranial striction of subtle motion, intention that I could also utilize longer wave- osteopathy and studied it in detail. He including desire to heal, and subtle length and affect regional as well as 52 looked for further underlying mecha- force. He felt as Sutherland, the local articular fascial relationships nisms and relationships. He intuited forces involved as reflected in bodily ➻

Summer 2002 The AAO Journal/25 and facilitate ease of motion. Thus I at approximately 150-200 cycles per internal/external rotation of a lower moved to call this facilitated oscilla- minute and the barrier is reassessed. extremity with associated pelvic tory release, realizing some of the Force is directed in two ways depend- imbalance (direct regional) commonalities with facilitated posi- ing on applications intended. thoracic outlet restriction (direct tional release in gentle ease of clini- For direct focal application, such regional) cal application, as well effective as the atlanto—occipital area or the carpal tunnel restriction (direct quickness, though not necessarily in paraspinous spasm associated with a regional) mechanism. rib head and vertebral segment, ap- thoracic dysfunction involving As indicated above, oscillation had plication is directed by focused fin- paraspinous muscle spasm been mentioned as a modality in the ger force. The palpating finger that (direct or indirect focal) literature of physical medicine. As identifies tissue tension is gently upper cervical dysfunction, includ- one aspect of massage percussion pressed to place the associated soft ing atlanto-occipital reflected in cadence (rhythmic percussion) was tissue under additional tension. Seg- headache or occipital used by Seguin in France in 1838 for mental repositioning toward a barrier neuritis (focal direct or indirect) acute torticollis, or in the use of can be helpful. Oscillations are gen- medial parascapular tension (focal manual vibrations by the Swedish erated by reciprocating forearm mo- direct) physiotherapist, Kellner. The contem- tion with flexion at the wrist, such as porary Australian physiotherapist , G. would be done in a “limp” handshake. sternal angle / costoclavicular area D. Maitland discriminated manipula- The reciprocating momentum of the (focal direct) tion to be of two types: sustained forearm generates a force that is di- temporomandibular joint (focal stretch, and passive oscillatory move- rected by the focused contacting fin- indirect) ments . These would be directed with ger tip to effect change where needed. bicipital groove (focal indirect) finger tip pressure at 2-3 cycles per For regional application such as to tendinous insertions at the knee, second and may be maintained for 5 the lower extremity, pelvis, lum- including iliotibial tract (regional to 15 minutes for articular mobiliza- bosacral areas, the lower limb is used indirect) tion.32 Leon Chaitow, ND DO, re- as a lever to impart regional oscilla- base of the nasal bones with ethmoid, cently deceased British osteopath, tion. The operator’s placing the lon- falx implications (regional describes friction and vibration to gitudinal fascial planes under tension indirect) focal sites as part of massage with by leaning backwards helps direct the limited description of the type or rea- oscillatory force to target tissues. The FOR, in my practice, is most often son for effect.9 Susan Edwards, PT, oscillations may be applied in a used as an expedient adjunctive describes manipulation generally as rotationally neutral plane or with ro- method combined with myofascial or traction, glides and oscillation, with tation toward the rotational barrier. muscle energy techniques. The end the latter proposed to reduce pain, Gentle oscillation is accomplished range of treatment by these methods increase periarticular extensibility, by the reciprocal raising and lower- can be gently extended by several correct positional faults, and reduce ing of the operator’s arms, using the cycles of oscillatory enhancement spinal disc herniation.11 However, no mass to the extended upper arms and much as expiratory effort, or gentle systematic use of oscillation in osteo- shoulders as a “flywheel” to smoothly thrust might do. Yet it is gentle, quick, pathic manipulation is known to me. accommodate the changes in the mo- and readily accepted as relaxing by mentum during change of direction. the patient. Alternating the tech- Technique Rate, again, is in the 150-200 cycles niques, or layering the cumulative Facilitated oscillatory release per minute depending on tissue reso- release effects, makes for a more ex- (FOR) depends on recognizing a nance. Restrictive barriers are reas- tensive effect as is required in a fam- pathologic barrier to freedom of mo- sessed and treatment proceeds as ily practice. tion as part of a constellation of find- needed. ings defining somatic dysfunction. If The process may be used in indi- Additional Notes on Application active motion testing is used, subtle rect application anywhere during a Touch is firm enough to direct restriction as assessed in functional scanning exam in which one finds force and have an effect, yet gentle methods of Johnston is most helpful. segmental hyperemia or other sign of enough to be accepted by the patient FOR can be used both as a direct and focal somatic dysfunction as not intrusive. In some applications an indirect technique. Areas of routine application and a more diffuse contact, such as the In direct technique, the barrier is utility include: hypothenar eminence, can direct the engaged gently. Oscillation is applied force. Forces are best conceptualized 26/The AAO Journal Summer 2002 using a point of contact directing the point of contact will be induced to with the concept of discovering re- force, alternating muscle movement accept the introduced motion and to striction of motion and the concept on the operator’s part to generate the resume its normal mobile participa- of neural coordination beginning with force, a “fly wheel effect” of the tion in endogenous: rhythmic mo- Still’s statements about “nerve force” operator’s treating arms to generate tions. One indicator of this phenom- and restoring these to natural freedom the rhythmicity, and a flexion of the enon is ease of respiration. Attention of motion in order to promote health wrist to soften the change of direc- to CRI or all other criteria for ease of and ease. tion each cycle. Duration of dose is a motion are used to reassess as con- Patient comfort is an ingredient to matter of experience but rarely do I centric indicators. Dr. Fulford and treatment. It is both a goal and a fa- use the techniques for more than 20 others describe the root phenomenon cilitating condition. Almost univer- seconds per site, often 3-5 seconds. of this concentric expression as the sally people recognize intuitively the Sometimes, however, I will treat a re- Breath of Life. Sutherland described healing power of vibration and often gion with a sequence of brief focal it as the Tide. associate the effect with the device, treatments depending on the anatomic I would suggest that each is a form not the process. Patient comfort is and physiologic organization of a of endogenous rhythmic motion, de- enhanced by the quality of the problem as with other methods. Clini- scribed differently from a different physician’s touch and what he or she cal experience is a useful guide. perspective. My suggestion is that communicates about their disposition Patient and practitioner need to be FOR and percussive vibration induce and intent presented by touch. Appre- comfortably balanced and relaxed. If entrainment of these natural rhythms ciation as a treater of the nature and relaxation is a final goal, trust must if restricted. As described below, this extent of natural respiratory motions be negotiated with the patient through includes manual transduction of elec- of the patient enhances effectiveness. tactile communication. If this cannot trical stream potentials altering the The method is rapid and depends be achieved, do not proceed; patient effect of a central spinal pattern gen- more on change of physician inten- must be ready to accept treatment. erator on the propriospinal/proprio- tion and concentration than on a Otherwise, another method or another ceptive tonality of muscles coordi- change in hand position. Therefore, day may be chosen for treatment. nated by patterns of oscillatory activ- it fits readily into routines using eclec- As with the percussion vibrator, ity in neuromuscular networks. Ex- tic or combined approaches to tech- technique is guided by resonant feed- planation is to follow. nique especially blending elements of back from the tissues and continued cranial, myofascial, muscle energy. effort is adjusted to enhance harmonic Comments on utility and validity. It gives us more impetus and response of the patient. As in any The method is easy and device stimulus, as we will pursue below, to method, palpatory sense guides the free. It provides the novice with a integrate the mechanical, neuromus- treatment; tension and release are uni- means of applying oscillatory and cular and bioelectric aspects of health versal in dysfunction and osteopathic perhaps bioelectric intervention to and disease; it raises further questions manipulative treatment and appli- smooth dysfunctional tissue. It is de- as to the nature of function and dys- cable here. Periodic motion, as in a vice independent, an advantage over function, and Osteopathic diagnosis standing wave, involves concepts the percussion vibrator due to issues and treatment. such as movement around nodes on of logistics, available AC power and the wave. As the fulcrum concept is portability. Can this still develop the Contraindications used in many aspects of myofascial efficacy of the percussion vibrator There are instances when FOR, or work, FOR is a biodynamic model (PV) as taught by Fulford? Fulford PV, technique is counter productive, which carries the idea of fulcrum to was not attached to the machine. He yet I have not experienced it causing the nodes of a standing wave, the recognized the vibrator as a magnifi- harm. Clearly it is not indicated when points around which the other parts cation of the intention and energy of there is suspicion of acute fracture, of the connected fascial system os- the operator. He would use magnets or over the site of suspected nerve cillate. Here, in focused technique, or crystals to likewise magnify the in- impingement. I have found FOR and the nodes (points that move mini- tention. He even used his finger, prop- PV technique to be counter produc- mally) are the wrist, and the applied erly “charged” as a crystalline treat- tive in cases of paraplegia involving finger tip. The arm and hand are the ment device. He read my material and relative decortication after stroke, or periodically displaced portions of the thought it of value. FOR reflects an encephalitis. I would proceed with wave motion. In this way, the rela- easily learnable path to his venue of caution if there were suspicion of tively immovable (dysfunctional) tis- vibratory osteopathic treatment. deep vein thrombosis with the pos- sue in the patient just distal to the Both FOR and PV are compatible ➻ Summer 2002 The AAO Journal/27 sible dislodgments of clot. experience of clinical effectiveness of A. Chila, et. al. The associated in- osteopathic vibratory methods, spend volvement of the H- reflex of the ten- Discussion: time reviewing issues of scientific don is also considered.23 Explanation and Verification plausibility, then demonstrating com- Frank Willard, PhD has pursued In his Sutherland Memorial Lec- patible scientific research. In so do- relentlessly the explanation of the ture to the AAO, Robert Kappler, DO ing, I hope to continue to deepen our persistence of pain and spasm in so- revisits the osteopathic task of assess- understanding of the nature of har- matic dysfunction by focusing on ing the whole patient, defends the monic well being, somatic dysfunc- neuronal intercommunication and has wisdom of pursuing our osteopathic tion, and osteopathic treatment. suggested a number of specific mod- clinical observations (here referring els. He suggests that the efficacy of to the validity of the cranial concept) Neuromuscular (Biomechanical) osteopathic manipulative treatment while scientific explanation is forth- Explanations depends on breaking this facilitated coming. He makes an admonition to Clearly, if we think of non-osseous internal communication loop within the our use of the scientific method. “We tissue as conglomerate “soft tissue”, CNS of the cord, involving somatic and 62 are obsessed in our western civiliza- a direct alteration of its state may be visceral autonomic afferents. tion with the scientific method, which accomplished by adding a force Richard Van Buskirk, DO, PhD re- is frequently misinterpreted to mean which causes the tissue to reorganize formulates the research and literature, that if we know nothing about some- into a different shape. Although use- and proposes that the experience of thing, it must be false . . . Properly ful, there is a quest to understand the pain and the nociceptive pathways as- applied, the scientific method tells us intricacies of somatic organization sociated with it determine reflex re- that if evidence to support data is not beyond this model. striction of motion, or dysfunction. He present the only conclusion possible Still, as recalled by Arthur uses this as a way to explain referred is that there is insufficient informa- Hildreth, DO, often restored physi- pain and the clinical discrepancy be- tion to make a judgement.”27 Encour- ologic normalcy by simply applying tween physical findings and experience aging continued cranial clinical prac- pressure to an area to “inhibit” the of pain through central processing of tice and concurrent research he closed hyperactivity of irritated nerves.22 He neural signals beginning in nociceptive 56 with, “The unique osteopathic phi- considered regional “nerve force” unmyelinated fibers. losophy developed by Still and besides joint function and arterial Each of these three approaches Sutherland has been far too vital to patency in assessing dysfunction and propose the formation of a dysfunc- be fossilized into rigid orthodoxy. Our restoring health. Still correlatively tional reflex communication loop real challenge today is to continue this made use of frequent references to which causes somatic dysfunction. dynamic tradition with new contribu- nerve function as requiring nutrition One common aspect of all, much hy- tions that must validate and expand and generating nerve force. Charles pothesized in the literature, is the in- the osteopathic approach to patient Hazzard, DO references the experi- volvement of the gamma efferent care.” mental work of Brown-Sequard with regulation of muscle spindle length Percussion vibration treatment, as the concept of neural sensitization/in- relative to total muscle length. By introduced by Dr. Fulford, is a devel- hibition which suggests the later con- inference, the efficacy of osteopathic opment in this vein. It evolved from cept of competitive inhibition of manipulation is to interrupt this non- attention to subtle motion and nerve conduction.43 homeostatically adapted loop. To pulsatility as used in the cranial field. The work of Denslow, Korr, date, Howell’s work is the only one Facilitated oscillatory release is but Retzlaff and Jones,26 applying the which begins to approach this com- an extension of these concepts. As concept of neuromuscular interven- plex problem in the human model, with the CRI, scientific proof of the tion suggested by interruption of the and clearly there are limitations on mechanism needs to be elaborated afferent-efferent proprioceptive re- our ability to do invasive measure- progressively. As with cranial work, flex loop, has been suggested as an ment of the function of individual un- acceptance begins with observation explanation of the effectiveness of myelinated fibers in the human sub- of clinical efficacy and moves counterstrain and muscle energy ject who is in the interim our patient. through the area of scientific plausi- models of somatic dysfunction and Any one of these three models bility toward proof. Dr. Fulford’s treatment. Perhaps these same dy- could be used to explain the efficacy clinical success stands on its own namics may be applicable in the situ- of FOR. As in counterstrain, the os- record. This paper then is part of the ation of FOR. This train of thought cillatory intervention could induce a effort to move beyond, through the has been discussed exhaustively and relaxation state, resulting in length- has been investigated by J. Howell, ening of the muscle in a pleasantly 28/The AAO Journal Summer 2002 accepted condition of the patient, and Various experiments show that pha- subharmonic patterns progressing offer cyclically recurrent opportuni- sic stretch reflex and H reflex are sup- with increases in vibratory frequency. ties for gamma gain, resetting analo- pressed during muscle vibration.29,1 They deduce that the fall off of syn- gous to the time dependent isolated The TVR persists in the decerebrate chrony above 150 Hz is due to fa- opportunity of counterstrain.26 cat but is abolished with section of tigue. As discussed below, this may In Willard’s model, dysfunction is the spinal cord at the first cervical simply relate to the congruence or modulated by a degree of sympathetic segment.35 However, in the intact ani- dissonance of the oscillatory frequen- activation from interneuronal com- mal the TVR in the cat can be facili- cies to other rhythmic central neural munication with small unmyelinated tated by the lateral vestibular nucleus, processes. fibers. Vibratory motion, through a vestibulospinal tract, lateral medul- Although invasive cerebral stud- mechanism yet to be explained, may lary reticular formation and contralat- ies in humans are no longer permit- induce a reorganization of this facili- eral red nucleus. It can be inhibited ted, central effects on TVR can be tated communication loop resulting by stimulation of the contralateral deduced by the complex experiments in increased ease and return to func- motor cortex, internal capsule and of Garfinkle and Ivanenko16 which tional state.62 medial medullary reticular formation. demonstrated postural changes in- Key to Van Buskirk’s nociceptive Impulses ascend along the dorsal duced by turns of head position which model is the co-involvement of “noci- spinocerebellar tract and the dorso- could be simulated by vibration of the autonomic reflexes” involving the lateral fasciculus, and descending in muscles of the neck, intimating at sympathetic system. His model allows the vestibulospinal and pontine least the involvement of brain stem for significant central processing of the reticulospinal tracts. In nonhuman nuclei or cerebellum, or at least a re- nociceptive signals, as well as the co- primates the co-involvement of cere- gional pattern generator. involvement of the multi-organ, pan- bral premotor cortex is noted in re- personal implications of sympathetic sponse to vibratory stimulus evoking A New View of Neurophysiologic arousal. Vibratory force, a variant of the TVR.14 Coordinative Process endogenous periodic motion, which is In humans, the reflex can be dimin- These ways of modeling the found to be “pleasant” by most patients, ished by barbiturates and benzodiaz- mechanism of function/dysfunction may induce a cascade of centrally me- epines and is absent in the damage to build on a model of the neuromuscu- diated neurohumoral effect besides the spinal cord. It can be blocked by lar system that described structural parasympathetically mediated neural a gamma depressant, such as organizations around the unit of the effects. tolperasone HCL. 53 This latter study dedicated neural circuit. Motor con- The tonic vibratory reflex (TVR), showed a greater response of the TVR trol from the central nervous system named by Eklund and Hagbarth,12 an to mechanical vibration in patients to the periphery occurs by depolar- observed and discussed phenomenon with a tendency to clench the jaw. ization along neurons with interneu- from the classic neuromuscular Bite force was not increased in hy- ronal communication through dis- model, may be helpful in consider- pertonic individuals, suggesting the creet synapses. Peripheral integration ing cause and treatment of muscle difference was in threshold of excit- of movement occurs due to local in- spasm as it is encountered in somatic ability, not in increased muscle con- terconnections of afferent and effer- dysfunction or as dystonia, in the non traction. One may use this clench pat- ent neurons in the spinal cord. Modu- osteopathic literature. Just as tendon tern and the resultant muscle lation of (facilitation or inhibition) tap induces contraction, steady me- hypertonus as a model of somatic function occurs through interneuronal chanical vibration to a tendon elicits dysfunction. In another study,20 or redundant connections in the loop. an involuntary contracture of the baseline TVR of arm flexors was the The understanding of the complexity muscle, the tonic vibratory reflex, same in dystonic and normal subjects, of neural and neuromuscular adaptive TVR. Various consequences of vibra- but there was a misperception of and coordinative function is pursued tion have been observed and attrib- motion in the non-spasmodic arm if as the appreciation by finer dissection uted to this reflex. asked to match the hypertonic arm in of these structural connections. With muscle contraction of the the dystonic patients. The data sug- Another model of neural and neu- TVR, concomitant relaxation of the gest altered processing of propriocep- romuscular coordination, using the antagonists is induced. tive data at some level. temporal aspect rather than spatial Stimulus vibration rates of 100 to As with the cat model, variations distribution of signals as a means for 200 Hz at 1 to 2 mm amplitude were of vibratory frequency show varia- the central and peripheral nervous shown by Brown to cause optimal tions of muscle response. Martin and system to code data, has developed contractile response in the cat model.4 Park34 show EMG harmonic and ➻ Summer 2002 The AAO Journal/29 from the work of Donald Hebb.21,39 cells function. Hence the possibility of Abele, Loeb and others in the dem- Partly driven by the problem of ex- of synchronous recruitment or sync- onstration of relationships in sensory plaining plasticity (or adaptation) of fire chaining as a routine organiza- brain processes, alpha motor neuron central nervous system after injury, tional process analogous to recruit- pools, Ia afferent pools, gamma motor Hebb , in 1949, proposed that the co- ment of an expanded field of dedi- neurons, as well as afferent – efferent ordinative unit of brain function was cated circuits.58 correlations in the gross motor and not dedicated circuits but rather that This patterned way of cells influ- muscle spindle systems. Each popula- neurons coordinated as cell assem- encing one another creates an alter- tion has different frequency character- blies. A grouping of cells, not neces- native means for explaining a num- istics with short-term synchronization sarily in physical proximity, depolar- ber of observed functions of the ner- corresponding to close, shared presyn- ized in synchrony as the substrate of vous system. Plasticity, or adaptabil- aptic input. Long-term rhythmic syn- a cognitive process. The cells need ity of neural tissue, is required to ex- chronization represents participation in not be dedicated to that mental task, plain development, learning, memory more complex sync-fire chaining input efferent command or particular sen- and adaptation after injury, all of corresponding to interneuronal activ- sory modality. Cells could be re- which are known to occur. Partial re- ity. A special type of long period syn- cruited to be used in a variety of ac- turn of function is noted after natural chronization was observed to be present tivity patterns. The persistence of one or experimentally induced nerve in tremor disorders in humans.28 thought or activity required its inhi- damage or transection of nerves. Correlation may be direct, repre- bition of competitive thoughts and Devor and Basbaum10 explore the senting common input or facilitation; activities by obligating neurons in question of spontaneous reactivation it may be indirect, representing com- overlapping populations similar to the of denervated muscle but conclude petitive function or inhibition. And effect of latency periods in classical “The neural mechanisms underlying the end result interneuronal influence neuronal depolarization. Temporal functional respecification of dorsal is not only “amount of inhibition or binding of cells then constituted horn somatopy after nerve injury is excitation that is of importance but meaningful signal, rather than hard not known. Experiments . . . have also the pattern, and in particular the wired linkages to dedicated sites. failed to provide positive evidence of degree of synchrony of signal trans- Propagation consists of coordinated long distance sprouting of thigh af- mission, whose complexity and ca- dissemination of a signal through ferent terminals . . . or of the exten- pacity is immensely augmented by neural networks of cells depolarizing/ sion of dendritic arbors from the me- interneuronal systems.” (Windhorst repolarizing in a synchronous pattern. dial to the lateral part of the dorsal horn. p. 88.) In the central nervous system, Peripheral transmission occurs as this The alternative possibility, strengthen- the “Mental-cognitive states are in- wave of depolarization progressively ing of a preexisting synaptic channel is terpretations of current neural activ- expands as eligible cells depolarize. tenable to the extent that a pre-existing ity, carried out in reference to a tran- This pattern of dissemination is channel can be demonstrated,” but this sient coherency generating process termed sync-fire chain depolariza- solution “suffers from the apparent lack generated by that nervous system.”55 tion.63 This synchrony or temporal of an appropriate morphological sub- Likewise, peripheral action potentials organization of persistent firing of strate.” Others then have accepted that represent the temporal sum of inhibi- neurons to maintain muscle contrac- perhaps the substrate, in function and tory or activating oscillatory potentials tion, for example, is maintained by dysfunction, is temporal rather than reaching a population of muscle fibers. cyclically recurrent firing of the sync- morphological. Patterns of correlative function fire chain made possible by the With these questions raised, a showing temporally coupled activity strength and duration of the input ini- number of investigators have then demonstrate that coordination occurs tial signal. Cyclic persistence of the evaluated the possibility of temporal with diffuse modulations of inputs so signal occurs as resonance between patterns as key to meaningful signal as to imply the existence of a central cells, or oscillations detectable by in neural function. Windhorst reviews pattern generator or burst generators. EMG.55 the use of cross correlograms, as a Carter and Smith8 worked with the Additionally, the concept of short means of demonstrating the existence patterns of walking and paw shaking term modulation of synaptic signal, of synchronous firing on neurons. cyclic behaviors to be predictably now familiar in the limited field of Correlograms demonstrate the tem- rhythmically coordinated and postu- interneuronal influence, can be seen poral association of the depolariza- late the central process generator as as not an isolated phenomena but a tion of the neurons. One can show a sync-fire interneuronal network basic principle or pattern of organi- whether there is a direct or indirect coordinating the burst durations and zation or influence by which neuronal correlation pattern. He cites the work synchronized recruitment patterns of 30/The AAO Journal Summer 2002 muscles in adult spinal cats. The heart of their work was an springboard, or perhaps through oscil- Furthermore in the human model, experimental/clinical intervention latory hand pressure, could generate McAuley et al.,36 find corroboration wherein they observed the status of a stream potentials (described below) to of measurements of gross muscle vi- patient with partial spinal cord reset the central pattern generator bration, EMG recordings and move- transection and retrained the patient’s through entrainment, i.e. generating a ment (tremor) recordings, and find system by having him bounce on a rhythmic frequency near enough to the synchrony of the three phenomena springboard. Thereby they used ac- current one to “override” or capture it. during finger flexion in healthy hu- tively initiated oscillatory motion to The application of this to oscillatory or man subjects. reconstitute the native neuromuscu- other forms of passive hand-to-body These models of central and pe- lar oscillatory organization. contact in osteopathic manipulation ripheral plasticity or adaptability, ac- In the FOR model, as in percus- seems plausible. complished by reciprocally adaptive sion vibration work, we are taking Further work in research is needed responses to oscillatory firing pat- this one step further as therapeutic, to clarify the utility of the model in terns, have been suggested to account directed passive introduction of os- the elucidation of the nature of so- for adaptive changes after neural dam- cillatory motion, at a harmonic fre- matic dysfunction and manipulative age and part of our ontogeny or growth quency, though the vibrator head or treatment. Such is our plan. process, hence the efficacy of patterned treatment finger as a transducer. It should also be noted again that movement therapies for children with others, including J.H. McAuley, ob- developmental delay. Later we will Endogenous Control of serve that endogenous tremor or oscil- consider their applicability to the defi- Oscillatory Motor Neuron latory movement in the range of 10, 20 nition of somatic dysfunction and rea- Firing; Clinical Implications in and 40 Hz during muscle contraction sons for treatment effectiveness of os- Function and Dysfunction of the finger demonstrates that oscilla- teopathic manipulation. As indicated above, the model of tory organization is part of normal Schalow and Blanc reviewed the a central pattern generator coordinat- motor function at the level of neuro- electromyographic literature and ing an oscillatory baseline firing pat- muscular coordination. Schalow dem- show that EMG assessment of muscle tern in motor neurons, linked in net- onstrated that the lack of correct syn- activity reveals that individual pos- works for the purpose of postural or chrony is part of neural damage and is tural and intentional muscle fiber con- propriospinal purposes (functional remediable by stimulation in a rhyth- traction are organized into synchro- motion), seems appropriate to their mic pattern. By extension, this way nized oscillatory firing patterns of clinical observations and measure- of viewing the neuromuscular system alpha 1 and alpha 2 motor units. In ments. Voluntary motion is caused by shows potential for elucidating nor- their own work they observe correla- an intensification of the rate of oscilla- mal motion and restriction of motion tion in symmetric and alternating pat- tory firing and involvement of progres- in the osteopathic model. The need is terns in contralateral limbs to affirm: sively more motor units previously de- to complement, the dedicated circuit “Coupled changes of oscillatory fir- scribed as recruitment. Coordination of model, including attention to relation- ing subnetworks to generate macro- oscillatory activity may be measured ships of type II and Ia afferents and scopic (integrative) network func- by noting either simultaneous or alter- alpha and gamma motor neuron tions are therefore a general organi- nating coupled patterns of oscillation. interconnectivity, and to think about zation form of the central nervous Phase changes between agonists, an- temporospatial coupling of these pro- system, and are not related to rhyth- tagonist or contralateral coagonists de- cesses and ways in which these may mic movements, like walking or run- termine functional coordinated patterns be resynchronized. ning only. It is proposed that synchro- of neuromuscular activity. Patterns of nization of spinal oscillators, phase normal versus dysfunctional patterns of Bioelectromagnetics changes in oscillation, changes from activity have begun to be elucidated. Clearly from the point of view of alternating to symmetric firing and Intervention, active rhythmic motion, modem bioengineering and electro backwards, and changes in the focus also involving rhythmic skin pressure, physiology there are myriad electro- of alternating oscillations are, among have been used as an active rehabilita- chemical/biomagnetic properties of others, physiologic coupling rules of tive process to entrain the endogenous the human body. Most of us are aware the human central nervous system to pathologic oscillatory pattern and in- of EEG, EKG, nerve conduction stud- generate, by ongoing coupling changes duce resumption of organized gross ies and MRI studies. Yet each of these of the oscillatory firing subnetworks, motor function. Mechanical contact, as clinical measures have a family of integrative functions such as rhythmic foot pressure when bouncing on a nonclinical measurement protocols to and non-rhythmic movement.”47 ➻ Summer 2002 The AAO Journal/31 which there has not been discovered through field theory in physics. due to subtle energies. This opens the or assigned a level of clinical appli- door to biochemical interactions in a cation. And so, for example, magne- Corroborative Current Work new arena. It is the arena of concern tocardiography or electrooculography in Bioelectromagnetics over magnetic fields and cancer or magnetic susceptibility plethys- To preface my review, since many among others. And yet these sensi- mography are not routinely per- of us have not a current knowledge tivities may be part of microelectric formed and most of us are not aware of the field of physics, let me make milieu of which we have been largely of their existence.33 some remarks to clarify what follows. naive. In other words, relevant forces Many medical interventions, in- Classical Newtonian physics, to that may generate biologically signifi- cluding pharmacology, depend on which many of us were introduced as cant events may be due to indigenous appreciation of electrical properties a complete understanding of the and exogenous subtle forces, includ- of phase barriers, such as cell mem- physical world, elaborates a view of ing periodic rhythms as the propri- brane where potentials are developed the world in which matter is discrete, ospinal oscillation of neural networks due to an ionic gradient caused by the and divisible into successively filter cited by Schalow above. semipermeability of the membrane. particles. For most of us, physical It is a coordinated reversal of these science education stopped at the bio- Endogenous Forces properties which generates the signal chemistry stage. Yet molecular bio- In this area of query, electromag- measures in an EKG or nerve con- chemistry, with all its sophistication, netic energy may affect all living tis- duction studies. including modem genetics, often ig- sues in ways previously unquestioned Electric phenomena are also ap- nores developments in the realm of and may redefine concepts such as preciated when the body is modeled physics beyond the Newtonian homeostasis. These would have con- as a volume source or volume con- model, which includes most of the sequences for our appreciation of ductor. An organ, when considered as work of the last century. The conse- what is transmitted in the vascular a whole may become electrically or- quences of the theory of relativity, for circulation, what is the constituency ganized to generate a dipolar field, one thing, mean that no longer is our and properties of connective tissue and the effects of this field can then understanding of molecular, atomic including the fascia. Kenneth Little, be disseminated electrically through or subatomic events dependent on the DO,30 and R. Taylor54 together discuss a wide bulk of tissue. And using this concept of kT or kinetic temperature the thermodynamic model, including model, a sensible EKG has been de- for the completion of a chemical re- energetic considerations, as it applies veloped using a coordinated array of action. These principles are still in- to homeostasis in the osteopathic con- peripheral leads comparing dipole deed true but concepts, such as are text. Let me begin this part of the dis- transmission in a pattern. introduced by quantum theory, sug- cussion by directing attention to the The body’s electromagnetic proper- gest that energetically induced effects electrical conductive property of fas- ties have also been modeled for sev- may promote the forward direction of cia most normally ignored by us. eral centuries including in Dr. Still’s a reaction without reaching kT. At Alan R. Becker, DO has called our time, to conduct unidirectional signals least the possibilities are plausible. attention to the possible piezoelectric though the conductive nerve fibers. One mechanism cited is the effect effect of these tissues in heeding There is no lack of observable phe- of electron spin. This concept of Still’s call to look to the fascia. Pi- nomena in the human body. The prob- paired electron spin resonance is the ezoelectric effects involve the gener- lems arise in trying to interpret pur- quantum equivalent of valence in ating of a charge or electrical poten- poseful organization of physiologic Newtonian chemistry. Chemical tial when tissue is placed under stress. and therapeutic significance. The in- bonding depends, to a large extent, This is a characteristic demonstrated terrelationship between structure and on the stability of radical paired elec- on dry tissue samples. In hydrated, as function is such that in the human trons. Should the electrical state of the in living tissue, these are called body one structure usually supports pair be altered, their spin resonance stream potentials.38 MacGinitie, et al., a variety of functions as each func- changes, and chemical reactions may demonstrate the presence of these tion depends on the coordination of be shifted in a forward direction to- currents in stressed bone in the dog multiple physical substrates. And it ward product. This can be accom- model, which correlated with new is in this context that this discussion plished at an energy level below the bone deposition associated with the needs to consider additional functions thermal coefficient cited above. In the stress. Bone deposition is directed by of the fascia, muscle, and interstitial biological arena, we are just begin- the force field generated by the po- milieu as interfacing with their elec- ning to consider these issues of physi- tential. These results correlate with tromagnetic properties, as clarified cal, including biochemical, change osteoblastic cell culture proliferation 32/The AAO Journal Summer 2002 testing in reaction to strain.42 Similar intracellular matrix as we normally tional set of normal and distressed effects have been found to occur with associate with the structural compo- musculature, as peripheral movement the exogenous pulsed electromag- nents, and therefore part of the un- is coordinated by the central nervous netic fields. MacGinitie goes on to derpinning of fascial relationships in system. cite the literature to demonstrate their somatic function and dysfunction. presence in cartilage and tendon. Multiple studies have been gener- Summary They decrease with the denaturation ated by the community defending Osteopathy has explored the natu- by hyaluronic acid. It is easily seen against the possible effects of the ral relationship of structure and func- that they represent a common char- magnetic fields generated by high tion in health and disease. Dr. Still acteristic in all connective tissue, and tension wire.3 These studies depend propounded the multivariate com- may be expected to be an organizing on the absence of fields strong enough plexity of our nature but insisted that factor in fascia. Clearly dysfunction to alter chemical stability within the his students have significant effects and OMT involve states of balance Newtonian chemical model. J. by their palpatory interaction with the of tissue forces. Walleczzek60 explores the bioapplica- patient. When a musculoskeletal expla- Endogenous electromagnetic bility within their context. Reviewing nation of effect seemed insufficient, he forces are also observed in one-celled the literature, she uses the popular rec- would include consideration of a neu- animals and embryos of a variety of ognition of free radical of calcium, oxy- ral or vascular explanation. His field species. Nucitelli,41 in elaborating the gen or nitrous oxide as driving, acting of observation was limited to palpation, presence of extracellular ionic cur- as messengers in cell signaling for dissection and late x-rays. rents in living tissue, measured in biosignificant reactions. She takes this More recent scholars in the osteo- vivo electric fields by using micro further in reviewing the relevance of pathic field, including Jones, Willard, electrodes. After citing the literature recombination of dissociated spin cor- Van Buskirk, Mitchell and Johnston of fields measured in interstitial area related pairs of electrons. Occasions have developed a common theme, of 25 species, ending with embryos of instability due to exogenous effects complementing the ligamentous ar- of chicks and amphibians, she notes are referred to as windows susceptible ticular components of motion and re- “These studies indicate that endog- to induced change. striction with neurophysiologic as- enous electric fields large enough to Research in the use of pulsed mag- pects. Current neurologic study influence (neural) crest-cell do indeed netic fields is inconclusive as to its makes this plausible. exist in the chick embryo at the proper use in directable, controllable use for William Garner Sutherland elabo- developmental stage.” In larger ani- therapeutic effect. However, multiple rated an approach to somatic dysfunc- mals such fields have been measured studies show that PEMF’s have physi- tion involving local palpation of dif- at the site of wound healing. At this ologic effects in wound healing and fuse patterns of subtle motion. His stage it cannot be concluded whether in resolution of edema and tissue elas- student, Robert Fulford, explored fur- or not these fields are cause or effect ticity.45 If there is even an unpredict- ther implications of these patterns of of the events studied but effects of able effect there are by deduction motion and other means of altering these fields could be part of the pat- electromagnetic properties of tissue them when restricted, including the terning of a central pattern generator yet to be appreciated in order to ac- percussion vibrator. as well as other biologic processes. cept such effects. He attempted to use electromag- If these subtle forces are capable netic field theory as a means of ex- of altering a developmental or heal- Relevance plaining his observation of dysfunc- ing cascade of biochemical events, When one recalls that energy is tions and treatment effects. While can they be considered a relevant described in waveform properties in- working under Dr. Fulford and wish- dynamic in homeostatic function or volving matter, that stress of connec- ing for a device free approach to us- inflammation as normally encoun- tive tissue induced an electric poten- ing vibratory motion, Facilitated Os- tered clinically? This is theoretically tial, oscillation or percussion would, cillatory Release, (FOR) evolved. relevant when we open ourselves to to some extent, be altering the endog- Gentle but directed oscillation of move beyond envisioning the body enous bioelectromagnetic interstitial connective tissue is applied through as parts to be passively and actively milieu with introduced force. It has manual contact with the patient at moved, or biochemical events depen- been demonstrated that in a number 150-200 cpm for short durations. The dent on development of kT to drive a of contexts, endogenous, electrical method is applicable to a variety of process forward. More germane is the fields are part of the inflammatory or ligamentous, articular restrictions or perspective that bioenergetic process healing process. Rhythmic bioener- palpable muscle spasm reflecting may be as significant an aspect of the getic potentials are part of the func- ➻ Summer 2002 The AAO Journal/33 neuromuscular hyperreactivity asso- 8. Carter M., Smith J. Soc Neurosci Abstr 23. Howell J. PhD, Cabell K., Chila A. DO, ciated with somatic dysfunction. 10:631 Eland D DO. “Stretch receptor and H- reflcx response to manipulation treatment Classic neuromuscular reflexes, 9. Chaitow, L., ND, DO. Modem Neuromus- in Achilles Tendinitis” , Somatic Dysfunc- including stretch reflex, tonic vibra- cular Technique, Churchill Livingston. tion lab OUCOM, unpublished paper tory reflex or simple lagamma reset- New York, NY. 1996. 1997. ting may, explain the effectiveness. However, recent neural coordinative 10.Devor M., Bausbaum. A., and Seltzer, Z. 24. Hazzard, C., DO, Principles of Osteopa- Spinal somatotopic plasticity: possible thy. pp. 35-52. models involving temporal coordina- anatomic basis for somatotopically inap- tion of neurons complement the clas- propriate connections in Goldberger, E. 25. Hunt V. Infinite Mind. Science of Human sic spatial or dedicated circuit. Cy- Development and plasticity of the mam- Vibration of Consciousness. Malibu Press. clic firing of muscle fibers as mea- malian spinal cord. Springer Verlag. 1986. Malibu, CA. 1989. sured on EMG show patterns suggest- 11.Edwards S. MPH. Manipulation and Mo- 26. Jones L., DO. Jones Strain-Counterstrain. ing temporal, as well as spatial, asso- bilization. Mosby. Louis. 1993. Jones Strain-Counterstrain Inc. Boise, ID. ciations involving central pattern gen- 1995. p. 9ff. eration. Models of neural networks of 12.Eklund G., Hagbarth K., Normal variabil- cell assemblies frictioning in tempo- ity of tonic vibration reflexes in man. Exp. 27. Kappler R.E., DO. “Osteopathy in the Cra- Neurol. 16: 80-92. 1966. nial Field, Its History, Scientific Basis, and ral association to oscillatory, vibra- Current Status,” Sutherland Memorial tory motion support the clinical 13. Endo S., “Japan’s Ancient Trees Whisper Lecture. AAO Convocation 1978. re- model of somatic dysfunction/osteo- Their Secrets”, New Scientist. 18 May printed in The Osteopathic Physician. pathic manipulative treatment in gen- 1995. p. 9. 1979. p. 13-19. eral, FOR and PV approach included. 14. Fourment A., Chennevelle J. Responses 28. Kirkwood. Variation in the time course of Dysfunction and treatment are then of motor cortex cells to short chains of vi- the synchronization of the intercostal means of observing or rectifying a bration, Exp Brain Res 1996, Sep 111(2): muscles of the cat, J. Physiol, London. maladaptive pattern of central ner- 208-214. 350:225-251. vous system plasticity. 15. Fulford R. DO. Vibratory Energy, 1992. 29.Lance J., Gail P., Neilson P. Tonic and pha- AAO Convocation address and personal sic spinal cord mechanisms in man, J Bibliography communication. Neurol Neurosurg Psychiatry. 29: 535-44. 1. Arcangel C., Johnston R, Bishop B. The 1966. Achilles tendon reflex and the h response 16. 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AAO Convocation Didac- and 40 Hz during human finger muscle plete spinal cord lesion, oscillator forma- tic Presentation 3/96. contraction may reflect rhythmicities of tion training as a method of improving central neural firing, Exp Brain Res. 1997. motor activities.” Gen Physiol Biophys. 63.Windhorst U., How brain-like is the spi- 114:525-541. 1996. Aug 15 (suppl) 1 pp. 121-220. nal cord, Springer-Verlag Berlin Heidel- berg 1988, p. 11. 37. McConnell C.P., DO. The Basis of Tech- 49.Schillen T., Koonig P., Binding by tempo- nique. JAOA 1933, reprinted in The Se- ral structure in multiple feature domains 64.Windhorst U., The spinal cord and its lected Writings of C.P. McConnell DO. of an oscillatory network, Biol Cybern brain: representations and models. To what Editors, Jordan T., DO and Schuster R, 1994. 70 (5): 397-405. do forebrain mechanisms appear at DO. 1994. brainstem spinal cord levels, Prog 50.Spatz H., Hebb’s concept of synaptic plas- Neurobiol. 1996. Aug. 49(5): 381-414.❒ 38. McGinitie L., “Streaming and ticity and neuronal cell assemblies, Behav peizoelectric potentials in connective tis- Brain Res. 1996. Jun 78(l):3-7. Send all correspondence to: sue,” Electromagnetic Fields. Am Chem Zachary J. Comeaux DO, FAAO Soc, 1995, M. Blank, ed. 51.Still A.T. Philosophy of Osteopathy. Associate Professor/ Section of OPP Kirksville 1899, p. 16 ff. West Virginia School 39. Miguel A., Hebb’s Dream: the resurgence of cell assemblies, Neuron, vol. 19: 219- 52.Sutherland W. G., Contributions to of Osteopathic Medicine 221, 1997. Thought, ed. Adah Sutherland, Anne 400 N. Lee Street Wales. Sutherland Cranial Teaching Foun- Lewisburg, WV 24901 40. Mitchell F., DO. An Evaluation and treat- dation. 1967. p. 206 ff. zcomeaux4,wvsom.edu ment Manual of Osteopathic Muscle En- ergy Procedures. Mitchell, Moran, Pruzzo 53.Takata T., and Nakajima, T., Quantitative Associates. Valley Park, MO. 1979. evaluation of the tonic vibration reflex in the massiter muscle, J Oral maxillofax Registering for the 41. Nuccitelli R. Electromagnetic Fields. M. Surg. 1996, Nov: 54(11):1307-13. Blank ed p 109. “Endogenous Electric AOA Convention Fields in developing embryos”. 1995. p. 54.Taylor R.B. “Bioenergetics of Man”, AAO The AAO’s Education Committee has 5ff. Yearbook. 1958. pp 91-96. chosen the theme, “Economic Benefits of OMT in Osteopathic Medicine”. This 42. Neidlinger-Wilke C., “Cyclic Strain In- 55.Valera F. Resonant cell assemblies; a new program will encourage all DOs to bet- creases Proliferation of TGFB Release of approach to cognitive functional and neu- ter integrate OMT into their individual Human Osteoblasts”. European ronal synchrony. Biol Res. 28 81-95. 1985. Orthopaedi Research Society. Annual practices of osteopathic medicine and Conference Transaction , Munich. 7/95. 56.VanBuskirk R., DO. “Nociceptive reflex consider ancillary services that can distin- and Somatic Dysfunction, a model”. guish their practices from other physicians 43 Olmstead, J. Charles Edouard Brown- JAOA. v.90, no 9, 9/90, p 792 ff. in their communities. Speakers will also Seguard: Nineteenth Century. Neurologist demonstrate proven strategies to facilitate and Endocrinologist. Johns Hopkins. 57.Van Dijk J., Lammers G., Wintzen A., appropriate and legitimate reimbursement 1946. Molenar P. Repetitive CMAs: mechanisms for these unique services. of neural and synaptic genesis, Muscle In order for the AAO to earn a greater 44. Reise W., A History of Neurology, MD Nerve. 1996. Sep 19. 90:1127-33, Publications. NY. 1959. pp 131-136. share in Convention revenues which are coordinated by the AOA for its partici- 58. von der Malsburg C., How are nervous 45. Revel J., Grace K. “The effect of pulsed structures organized in Basar, E et al. Syn- pating affiliates, please consider register- electromagnetic fields in osteochondral ergies of the brain. Springer Berlin. ing as an AAO Member. It is possible to healing in the rat”. EONS (cf 23) p. 28. Heidelberg, NY. 238-249. SPLIT YOUR REGISTRATION be- tween TWO affiliates, thus each of them 46. Sakurai Y. Population coding of cell as- 59.Vogel M., PhD. misc. tapes and newslet- sharing evenly in the net proceeds. The semblies - what is in the brain. Neurosci ters from Psychic Research Inc., San Jose, Academy depends on these financial re- Res. Sept 1996. 26:(1) 1-16. CA sources to underwrite the expenses asso- ciated with sponsoring this educational 47. Samsonovich A., McNaughton B. Path 60.Walleczec J. “Magnetokinetic effects of program. propagation and cognitive mapping in a radical pairs: a paradigm for magnetic field continuous attractor neutral network interaction in biologic systems other than Please support the American Academy model, J Neurosci. 1997. Aug. 1: 17(15): thermal energy”. Electromagnetic Field. of Osteopathy with your registration as 5900-20. M. Blank, ed., p. 396. an AAO member for the 2002 AOA Con- vention in Las Vegas. 61.Whittle M., Ed. Biomechanic Measure- Sincerely, ment in Orthopedic Practice. Clarendon George J. Pasquarello, DO, FAAO Press. Oxford. 1985. 2002 Program Chairperson

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