Hands on Course

Course description: Identifying Invisible Influencers (3i)

This course will allow the participant to be able to understand the principles and identification of restrictions to function that are not easily identified by traditional clinical observations. The 3i Course (Identifying Invisible Influencers) will be valuable to the provider who is interested in supporting improved patient care by becoming familiar with restrictions that are neurological, fascial and metabolic  The 3i course is designed to help providers identify restrictions to patient responses that are metabolic, functional and neurologic in origin including:

• Oral myofunctional concerns with swallow and rest posture
• Retained primitive reflexes
• Fascial restrictions
• Cranial nerve dysfunction and imbalances
• Trigeminal reflex assessment
• Cranial strains
• Bite force imbalances
• Nutritional and metabolic deficiencies affecting sleep and growth

Invisible Influencers Course Agenda

Introduction to Concepts

   a. Neurology “Rules” as the primary determining factor of sleep physiology

   b. Hierarchy of needs – Cerebral perfusion

   c. Osteopathy as a concept and application

      i. Cranial vault mobility

      ii. Cranial vault symmetry and strains

   d. The Fascia Factor

Retained primitive reflexes: The Trump Card

   a. FPR

   b. Moro

   c. Overview of others and relevance to oral environment

Clinical applications of influences to the Locus Coeruleus

   a. Cranial base reflexes

   b. Bite response reflexes

Sleep physiology and architecture

   a. Importance of monitoring stage 3 sleep transitions, duration and QOL

   b. Remmers statement: AHI only determines reimbursement

   c. Looking beyond the airway choke point and into the signaling of sleep

Trigeminal Cardiac Reflex

   a. Etiology

   b. Diagnostics

   c. Treatment options

   d. Misdiagnosis and consequences

Cranial nerve stimming and toning

   a. Literature review

   b. Clinical applications

The mental dental connection

   a. Interpretation of pain through limbic pathways

   b. Depotentiation through Havening

The Me5 (mesencephalic nucleus of the trigeminal nerve)

   a. Pathway

   b. Implications in dentistry

   c. Primary vs permanent dentition

Fascia, Fascia, Fascia

  a. The role of the buccopharyngeal fascia

      i. Mandibular labial tendon

      ii. Buccinator aponeurosis

      iii. Airway corset

   b. Sublingual fascia

      i. Mills research

   c. Upper cervical fascia and influences on the dural membrane system

Fit2BTied – Tongue restriction analysis

   a. Visual vs functional assessment

   b. ROM and palpation

   c.  Tongue anatomy and physiology

   d.  Tongue/jaw dissociation and grading/fixing  

Airway assessment

   a. Tonsil (Friedman and Brosky)

   b. Nose

   c. Mallampati

   d. Tongue posture

Osteopathy in the Cranial Field

   a. Sutural homeostasis

   b. Symmetry

   c. Fluids and membranes

   d. Growth and developmental influences

   e.  Intracranial inflammation

      i. Symptoms 

      ii. Solutions

      iii. Williams research/Zamboni effect

Dysautonomia

   a. Connective tissue implications

   b. Autonomic nervous system implications

   c. Vascular considerations

   d. HRV as an effective screening tool for the complex patient

Clinical exam for neurological, fascial and structural restrictions

   a. Relating the SO to the AP

   b. Significance of palpation exam findings related to diagnosis and treatment

   c. If this, then that: Treatment sequencing

15. Indications for referral for structural co-treatment

16. Metabolic and nutritional considerations

   a. Vitamin (Prohormine) D, B, K, Ferritin and Mg

   b. Insulin resistance and sleep fragmentation

   c. Inflammatory markers

   d.  Dopamine pathways

   e.  Restless leg syndrome/periodic limb movements and their relevance to  sleep disordered breathing

   f.  The endocannibinoid system

   g. Discussion of research on the gut-biome sleep apnea connection as  published by Dr. Gozal

    h. Additional gut-brain connection information based on the emerging science

Dento-Cranial osteopathic releases

R&B Home care exercises

Clinical examination: Letting your fingers do the walking and the patient's fingers do the talking

   a. Palpation (finger and thumb, finger game)

   b. Cranial sutural release response assessment

.Wrapping it up and moving on

   a. Documentation

   b.Clinical implementation

   c..Communication with referring providers

   d.  How to build a treatment TEAM 

Now what?  How not to get overwhelmed by the unanswered questions