Working with shunts.

+ How do you work with people with shunts? – September 08

Hi John,

Your newsletter’s archive is fantastic.  Very easy to use
(much better than mine). Thanks.
My question today is about treating people with a shunt
in the head. Do you(or anyone else) has experience with that?
Is there a risk of having the shunt come out of place
(and causing big problems to the person) when working
on the person? I was wondering because of the movements of
the bones and membranes in the head (things coming back
in place).
Any comments will be much appreciated.
Odile. Brisbane.

>>>MY COMMENTS:

Hello Odile,
I’m glad you find the newsletter archive useful.
I’m hoping the ‘search’ function makes it easier for
people to find what they are looking for across the
whole site.

I have treated quite a few people with shunts.
I’ll just explain what they are for any of the other
readers who don’t know.

A shunt is tube that is fitted surgically to relieve
cerebrospinal fluid pressure. There is a one way valve
in the shunt that stops the cerebrospinal fluid coming
back up the tube.  They are usually fitted in people
who have prolonged or extreme hydrocephalus.

The types of shunts I have treated have fallen into
two categories.  Cranio shunts and spinal shunts.
Spinal shunts go from the drural tube and drain into
the stomach. Cranial shunts drain from the cranium into
the heart.

From my experience they are pretty robust arrangements
and I have never got the feeling that they would dislodge
with treatment. The main thing I have felt when treating
people with shunts is how the fluid dynamics of their
cerebrospinal fluid is screwed up. Their cranio sacral
rhythm is usually confused.

Most of my work has been firstly dealing with the
underlying cause of the hydrocephalus and then helping
the person’s system come to terms with the foreignness
of the shunt.

This is similar to any kind of work where there is a
foreign object in a person’s body be it a pin or a screw
or a pacemaker.

***FOLLOW ON COMMENT FROM MALCOLM HIORT***

Hi John,
Re Odile’s email/your reply:
My experience of clients with shunts is that their
cranial rhythms are compromised.
Specifically, I notice that maximal expansion/flexion
is never reached.
The end-point of movement has a ‘rebound’ quality
to it, without the ‘tapering’ effect normally palpated.
I have felt this characteristic diminished amplitude
throughout the body.

Another consequence of a shunt is that inducing a
still point cannot be achieved, at least in my
experience.
It seems that when CSF back-pressure begins to
build within the ventricles, it is vented by the
shunt.
Again, this is a bodywide occurrence, no matter
where the technique is applied.

I would be interested to get any feedback on my
remarks at info@craniofascial.com
www.craniosacralart.com was interesting.

cheers John, keep up the good work.

Malcolm Hiort, Director,
Australian Craniofascial Therapy School

>>>MY COMMENTS:

Thanks for that Malcolm.
Shunts certainly compromise the fluid dynamics of the system.

***FOLLOW ON COMMENT FROM AL PELOWSKI***

There’s a good description and pics of shunts in
the Netter Collection of Medical Illustrations,
V.1, the Nervous System, Part II -Neurologic and
Neuromuscular Disorders.

In there you’ll see that shunts can be set to
drain into the peritoneal space rather than the jugular v.

Peritoneal drainage is often preferred in babes
and kids because the longer tube allows for growth.

But, either way, shunting tubes have to penetrate
several layers of membrane, muscle and fascia.
This can, and often does lead to chronic infections
and irritation.

Another problem is the silting up of the valve and
the thin cannula–CSF is loaded with salts (electolytes)
that can crystallise out of solution in the margins
of turbulent flows and eddies in the apparatus.

Shunting therefore can require frequent reinsertions
+ drugs (e.g. antibiotics and steroids)

Some of the risk factors are covered in
Toru Fukuhara et al, “Risk factors for Failure of
Endoscopic Third Ventriculostomy for Obstructive
Hydrocephalus,” in the journal Neurosurgery, V.46,
No. 5, May 2000, where you will also find
some 40 references.

It might also be useful to see*
*CRANIOSYNOSTOSIS SYNDROMES by **J. Cary Moorhead,
MD, in Grand Round Archives June 24, 1993.

I’ve worked cranially with maybe a dozen babies
and kids with shunts.
It’s vital to know the history of it and to be
aware that tubal irritation and immune suppression
will distort and disempower the child’s responses.
There are loads of cautions in this work, but no
firm contraindications I can think of.
Other practitioners seeing cases of craniosynostosis?
Please get in touch.

I believe it’s a mushrooming problem worldwide.

>>>MY COMMENTS:

Thanks for that Al.

For those of you that don’t know, Craniosynostosis,
is a condition where some or all of the sutures in the
skull of an infant or child become fused.

I have treated a few children with it in Australia.
The cranium felt like it was made of marble.
Hardly any movement.  In all cases it felt like
a blueprint problem to me.  It felt like the
developmental process of the system was accelerated.
It felt like the sutures had met each other with such
force that they fused in a solid way that no adult would.

In all the children I saw, the condition had got to
the point where they needed surgery to separate the
sutures. My sense was that if I had seen them earlier
we could have avoided the surgery.

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