Advances in Soft Tissue Therapy:Soft Tissue Release of the Cranial

BasePresented by:

Hiltons Law (John Hilton, English Surgeon 1804-1878)

The nerve supplying a joint supplies also the muscle which moves the joint and the skin covering the articular insertions of these muscles. (Dorland Medical Dictionary)

Righting Reflex

The ability to assume optimal position when there has been a departure from it. (Dorland’s Medical Dictionary)

Law of Balance and Symmetry

This concept has been around for so long that it is never referenced. The idea comes from mathematics, and things in nature are symmetrical. An example would be a leaf. The general belief is that if you were to bisect a leaf, hold half of it up to a mirror, it would be the same as the original

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leaf. Another would be how the root structure of a tree is typically about the same size as the branches of the tree.

In humans, symmetry has been linked to fitness and attractiveness. Studies have been done showing that we tend to be more attracted to persons who appear symmetrical. (Langlois, J. H. and Roggman, I. A., Attractive faces are only average, Psychological Science 1 (1990) 115-121). By creating greater symmetry, we are increasing attractiveness. One common theory is that symmetry implies fitness, and that we are genetically programmed to be attracted to more fit persons. (Barber, Nigel. "The Evolutionary Psychology of Physical Attractiveness: Sexual Selection and Human Morphology." Ethology and Sociobiology 16(5): 395-424 1995.) Our observation is that healthier people tend to be more symmetrical (or conversely, that asymmetrical persons tend to be less healthy) from a postural perspective, lending credence to these studies.

Notes

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Brainstem

medullaoblongata

pons

reticularformation

olfactoryoptic

oculomotortrochlear

abducent

trigeminal

facialnervus intermedius

acoustic

glossopharyngealvagusaccessory

hypoglossal

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Medulla Oblongata-makes up the lower portion of the brainstem, and is about 3cm in length. The region between the anterior median sulcus and the anterolateral sulcus is occupied by an elevation on either side called as the pyramid of the medulla oblongata. This elevation is caused by the corticospinal tract. In the lower part of the medulla some of these fibers cross each other thus obliterating the anterior median fissure. This is known as the dessucation of the pyramids. Some other fibers that originate from the anterior median fissure above the decussation of the pyramids and run laterally across the surface of the pons are known as the external arcuate fibers. The region between the anterolateral and posterolateral sulci in the upper part of the medulla is marked by a swelling known as the Olivary body. It is caused by a large mass of gray matter known as the inferior olivary nucleus. The lower part of the medulla, immediately lateral to the fasciculus cuneatus, is marked by another longitudinal elevation known as the tuberculum cinereum. It is caused by an underlying collection of gray matter known as the spinal nucleus of the trigeminal nerve. The gray matter of this nucleus is covered by a layer of nerve fibers that form the spinal tract of the trigeminal nerve. The base of the medulla is defined by the commissural fibers, crossing over from the ipsilateral side in the spinal cord to the contralateral side in the brain stem; below this is the spinal cord.

Functions controls autonomic functions: respiration, blood pressure, heart rate, swallowing,

vomiting and defecation.

relays nerve signals between the brain and spinal cord

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Pons-is the portion of the brainstem located just superior to the medulla oblongata. The "knob-like" process (Basal pons) is 2 centimeters long and located on the anterior (front) of the brainstem. It is formed of nerves that travel from one side (left or right) to the other. Most other fibres in the brainstem travel up and down.

Function

relays sensory information between the cerebellum and cerebrum.

aids in relaying other messages in the brain.

controls arousal.

regulates respiration.

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Midbrain (or mesencephalon) is the most anterior portion of the brainstem. It is located between the forebrain and brainstem.

Function:

Controls Responses to Sight

Eye Movement

Pupil Dilation

Body Movement

Hearing

Reticular formation—a part of the brain that is involved in actions such as awaking/sleeping cycle, and lying down. It is essential for governing some of the basic functions of higher organisms, and is one of the oldest portions of the brain.

It is a poorly-differentiated area of the brainstem, centered roughly in the pons. It is the core of the brainstem running through the mid-brain, pons and medulla. The ascending reticular activating system connects to areas in the thalamus, hypothalamus, and cortex, while the descending reticular activating system connects to the cerebellum and sensory nerves.

Functions

Regulates respiration rate, heart rate and gastrointestinal activity.

Plays an important role in sleep and consciousness.

Modulates pain.

Controls alertness, fatigue, and motivation to perform various activities.

Some researchers have speculated that the reticular formation controls approximately 25 specific behaviors, including sleeping, walking, eating, urination, defecation, and sexual activity.

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Reticular activating system (or ARAS, for Ascending Reticular Activating System) is the name given to the part of the brain (the reticular formation and its connections) believed to be the center of arousal and motivation in animals (including humans).

Functions

Maintains state of consciousness.

It is involved with the circadian rhythm.

Controls respiration, cardiac rhythms, and plays a role in maintaining consciousness.

Notes

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Six DimensionalPostural Evaluation

Posture Pattern Force CreatedTilting Lateral Compression

Rotation Torque

Flexion Anterior Compression

Extension Posterior Compression

Projection Anterior Shearing

Obliquity Lateral Shearing

Remember:You can’t hit a target you can’t

see. A proper assessment is half of

the healing.

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Lovett Reactor

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Temporal Bones1. Make sure the head is not tilted. 2. Keeping fingers parallel to the table, insert them into external auditory

meatus (ear holes) on either side. 3. Document on the chart with a short line segment.

Note: If one finger is higher than the other, this means that that temporal bone is superior to the other.

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What Does This Mean?The cranial measurements we will review in this class are only the basic cranial measurements. Cranial measurements in the supine position are important not only for seeing the fixations and hidden sources of proprioception but also because they are used when correcting the cranium. This is due to the influence of the postural muscles (i.e. erector spinae) on the position of the cranium while standing

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Temporal Bones1. Make sure the head is not rotated.2. Place the index finger in the external auditory meatus.3. Press anteriorly until bone is met.4. Document on the cranial chart with a long line segment.

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What Does This Mean?In the supine position, the pull of the SCM, longissimus capitus, and splenius capitus should be removed. However, the muscles of the TMJ may remain hypertonic, causing a distortion. Also note that Lovett’s Reactor may still dictate a relationship between the ilium bones and the temporal bones. A distorted measurement in the supine position will often indicate a craniofacial imbalance.

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Dura Mater and Dural Sheath Mobilization

DURA MATER (doo r m ter) [TA] Pachymeninx (as distinguished from leptomeninx, the combined pia mater and arachnoid); a tough, fibrous membrane forming the outer covering of the central nervous system. Syn: pachymeninx TA , dura TA [L. hard mother, mistransl. of Ar. umm al-j f yah, tough protector or covering]

DURAL SHEATH an extension of the dura mater that ensheathes the roots of spinal nerves or, more particularly, the vagina externa nervi optici. (Stedman’s)

Why Do We Treat?

The Dural membrane surrounds the brain and spinal cord to protect the contents and to sustain a barrier to antigens, yet transport nutrients to the central nervous system. The dura mater and the dural sheaths may adhere to the vertebral or neural foramena, or the dural sheaths may adhere to the neurons as they exit. As a result, they may cause stimulation of the nerves and resulting muscle tension patterns associated with these entrapment. Performing this technique will often result in an overall relaxation response, and may be used in conjunction with other modalities to facilitate the therapist’s work. Uneven traction of the dura mater may lead to fascial distortion that encroaches upon the pituitary and pineal glands leading to hormonal dysfunction.

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Copyright© 2008 by Neurosomatic Educators Inc.17

Treatment1. The patient is supine with the

therapist seated at the head of the table.

2. With the heal of the hands pressed together, press the patients cranium directly inferior. This will shorten the dura mater as well as muscles all along the spinal column. Be certain that the neck does not go into flexion or extension with the pressure as this buckling will limit the effectiveness of the technique.

3. Traction the cranium superiorly by hooking the fingers under the nuchal line of the occiput and pulling in a superior direction. Keep the fingertips at a right angle to the occiput as this will provide the most leverage. Be certain not to use the mandible as this can compress the TMJ causing an excitation of the trigeminal nerve.

4. Each traction should result in more movement as the muscles continue to relax.

5. An additional therapist may facilitate this movement by compressing and tractioning at the feet simultaneous to the compression and traction of the cranium.

Copyright© 2008 by Neurosomatic Educators Inc.18

Atlanto-occipital/Atlanto-axialJoint Decompression

1. Patient is lying supine with therapist seated at the head of the patient.

2. Grasp and cradle the occiput with the non-dominant hand. Grasping the hair may increase the leverage in tractioning these two joints.

3. Place the index, middle, and ring finger at the superior aspect of the spinous process of C2.

4. Traction the occiput while stabilizing C2. This will facilitate a release of the ellipsoidal articulations of these three structures.

5. Repeat 3-5 times.

Copyright© 2008 by Neurosomatic Educators Inc.19

Atlanto-occipital/Atlanto-axialLateral Mobilization

1. With the patient in a supine position the therapist will palace one hand on either side of the patient’s cranium.

2. Move the patients head laterally to the right making sure not to tilt the head by keeping the patient’s lip line horizontal.

3. Move the head to the right until the head will move no further or the left shoulder begins to move superior.

4. Move the head laterally to the left until the right shoulder moves superior.

5. Repeat lateral movements 7-8 times.

6. Note any restrictions in movement to either side.

Copyright© 2008 by Neurosomatic Educators Inc.20

Copyright© 2008 by Neurosomatic Educators Inc.21

Anterior/Posterior Mobilization

1. Move the patient so that the shoulders are at the top edge of the table and cradle the head until the patient can relax into the therapist’s hands.

2. Place the edge of one hand just inferior to the occiput and one hand on the frontal bone.

3. Move the patients head as far anterior as possible without flexing or extending the head.

4. Use the hand on the frontal bone for leverage, move the head as far posterior as possible broadening the hand under the occiput again being sure not to let the head go into flexion or extension.

5. Repeat anterior and posterior movements 7-8 times.

6. Note any restrictions in movement.

Note: Anchoring the elbow of the supporting hand into the therapist’s thigh may be necessary to prevent muscular fatigue in the therapist.

Copyright© 2008 by Neurosomatic Educators Inc.22

Circumduction1. Move the patient so that the

shoulders are at the top edge of the table and cradle the head until the patient can relax into the therapist’s hands.

2. Place one hand on either side of the cranium.

3. Being sure to keep the lip line horizontal, take the cranium through increasingly larger circular movements in either a clockwise or counterclockwise direction.

4. If the patient has an area of pain move away from that area first.

5. Move slower through any area the feels restricted.

6. Repeat circular movements in the opposite direction.

List of ReferencesBrainstemCrowe, HS, Kleinman, T “Upper Cervical Influence on the Reticular System.” 1991.

Biedermann H. "Kinematic Imbalances due to Suboccipital strain in newborns. " Medicine Springer-Verlag1992, 151-156.

Quattrochi JJ, McBride PT, Yates AJ, Brainstem immaturity in sudden infant death syndrome: a quantitativerapid Golgi study of dendritic spines in 95 infants., Brain Res 325: 1-2, 39-48, Jan 28, 1985.

Pauli RM, Scott CI, Wassman ER Jr, Gilbert EF, Leavitt LA, Ver Hoeve J, Hall JG, Partington MW, Jones KL,Sommer A, et al, Apnea and sudden unexpected death in infants with achondroplasia. , J Pediatr 104: 3, 342-8,Mar, 1984

Pamphlett R, Murray N, Vulnerability of the infant brain stem to ischemia: a possible cause of sudden infantdeath syndrome. , J Child Neurol 11:3,181-4, May, 1996.

Atkinson JB, Evans OB, Ellison RS, Netsky MG, Ischemia of the brain stem as a cause of sudden infant deathsyndrome., Arch Pathol Lab Med 108: 4, 341-2, Apr, 1984.

Takashima S, Armstrong D, Becker L, Bryan C, Cerebral hypoperfusion in the sudden infant death syndrome?Brainstem gliosis andvasculature., Ann Neurol 4: 3, 257-62, Sep, 1978.

Kinney HC, Filiano JJ, Brainstem research in sudden infant death syndrome., Pediatrician 15: 4, 240-50, , 1988.

Filiano JJ, Kinney HC, Sudden infant death syndrome and brainstem research. , Pediatr Ann 24: 7, 379-83, Jul, ~i 1995. J

Takashima S, Becker LE, Relationship between abnormal respiratory control and perinatal brainstem and j cerebellar infarctions [see comments]', Pediatr Neurol 5: 4, 21 1-5, Jul-Aug, 1989.

Banks BD, Beck RW, Columbus M, Gold PM, Kinsinger FS, Lalonde MA, Sudden infant death syndrome: a

literature review with chiropractic implications., J Manipulative Physiol Ther 10: 5, 246-52, Oct, 1987.

Kinney HC, Burger PC, Harrell FE Jr, Hudson RP Jr, 'Reactive gliosis ' in the medulla oblongata of victims ofthe sudden infant death syndrome., Pediatrics 72: 2, 181-7, Aug, 1983.

O'Kusky JR, Kozuki DE, Norman MG, Sudden infant death syndrome: postnatal changes in the volumes of the pons, medulla and cervical spinal cord. , J Neuropamol Exp Neurol 54: 4, 570-80, Jul, 1 995. I J

Baba N, Quattrochi JJ, Reiner CB, Adrion W, McBride PT, Yates AJ, Possible role of the brain stem in sudden infant death syndrome. , JAMA 249: 20, 2789-9 1 , May 27, 1 983 .

Nodar RH, Lonsdale D, Orlowski JP, Abnormal brain stem potentials in infants with threatened sudden infant death syndrome., Otolaryngol Head Neck Surg 88: 5, 619-21, Sep-Oct, 1980.

Pettigrew AG, Rahilly PM, Brainstem auditory evoked responses in infants at risk of sudden infant death., Early Hum Devil: 2, 99-111, Jul, 1985.

Pamphlett R, Murray N, Vulnerability of the infant brain stem to ischemia: a possible cause of sudden infant death syndrome., J Child Neurol 11: 3, 181-4, May, 1996.

Rosenberg WS, Salame KS, Shumrick KV, Tew JM Jr, Compression of the upper cervical spinal cord causing symptoms ofbrainstem compromise. A case report., Spine 23: 13, 1497-500, Jul 1, 1998.

Schechtman VL, Harper RM, Kluge KA, Wilson AJ, Hoffman HJ, Southall DP, Cardiac and respiratory patterns in normal infants and victims of the sudden infant death syndrome., Sleep 11: 5, 413-24, Oct, 1988.

Takashima S, Mito T, Yamanouchi H, Developmental brain-stem pathology in sudden infant death syndrome., Acta Paediatr Jpn 36: 3, 317-20, Jun, 1994.

Summers CG, Parker JC Jr, The brain stem in sudden infant death syndrome. A postmortem survey., Am J Forensic Med Pathol 2: 2, 121-7, Jun, 1981.

Naeye, RL. "Brain-Stem and Adrenal Abnormalities in the Sudden Infant Death Syndrome." American Journal of Clinical Pathology 66(3):526-530, Sept. 1976.

Vertebral Artery

Pamphlett R, Raisanen J, Kum-Jew S, Vertebral artery compression resulting from head movement: a possible cause of the sudden infant death syndrome., Pediatrics 103: 2, 460-8, Feb, 1999.

Kuether TA, Nesbit GM, Clark WM, Barnwell SL, Rotational vertebral artery occlusion: a mechanism of vertebrobasilar insufficiency., Neurosurgery 41: 2, 427-32; discussion 432-3, Aug, 1997.

Seletz E. "Whiplash Injuries; Neurophysiological basis for pain and Methods used for rehabilitation. " JAMA 1958Nov;168.

Saternus KS, Adam G, [Sudden infant death. Postmortem flow measurements in the large vessels of the neck for the demonstration of posture-dependent cerebral hypoxemiaj, (Der plotzliche Kindstod. Postmortale Flussmessungen an den grossen Halsgefassen zum Nachweis der lageabhangigen zerebralen Hypoxamie.), Dtsch Med Wochenschr 110: 8, 297-303, Feb 22, 1985.

Li YK, Zhang YK, Lu CM, Zhong SZ. "Changes and implications of blood flow velocity of the vertebral artery during rotation and extension of the head. " J Manipulative Physiol Ther Feb 1999;22 (2):91-95

Jargiello T, Pietura R, Rakowski P, Szczerbo-Trojanowska M, Szajner M, Janczarek M, Power Doppler imaging in the evaluation of extracranial vertebral artery compression in patients with vertebrobasilar insufficiency., Eur J Ultrasound 8: 3, 149-56, Dec, 1998.

-Hedera P, Bujdakova J, Traubner P, Blood flow velocities in basilar artery during rotation of the head., Acta Neurol Scand 88: 3, 229-33, Sep, 1993.

-Deeg KH, Alderath W, Bettendorf U, [Basilar artery insufficiency—a possible cause of sudden infant death? Results of a Doppler ultrasound study of 39 children with apparent life-threatening events (see comments)], (Basilarisinsuffizienz—eine mogliche Ursache desplotzlichen Kindstods? Ergebnisse einer dopplersonographischen Studie an 39 Kindern mit anscheinendlebensbedrohlichen Ereignissen.), Ultraschall Med 19: 6, 250-8, Dec, 1998.

Saternus KS, Hebold K, [Anomalies of the vertebral artery in sudden infant death], (Verlaufsanomalien der A. vertebralis beimplotzlichen Kindstod.), Beitr Gerichtl Med 44:, 563-7,, 1986.

Saternus KS, Hebold K, [Significance of birth trauma damage to the vertebral artery in sudden infant death], (Zum Stellenwert geburtstraumatischer Schadigungen der Arteria vertebralis beim plotzlichen Kindstod.), Beitr Gerichtl Med 44:, 569-71,, 1986.

Hebold K, Saternus KS, Schleicher A, [Morphometric studies of the vertebral artery in infants and small children], (Morphometrische Untersuchungen der A. vertebralis bei Sauglingen und Kleinkindern.), Z Rechtsmed 97: 1,41-8, ,1986.

-Dadsetan MR, Skerhut HE, Rotational vertebrobasilar insufficiency secondary to vertebral artery occlusion from fibrous band of the longus coli muscle., Neuroradiology 32: 6, 514-5,, 1990.

Johnson CP, How T, Scraggs M, West CR, Burns J, A biomechanical study of the human vertebral artery with implications for fatal arterial injury., Forensic Sci Int 109: 3, 169-82, Apr 10, 2000.

Dentate Ligament Cord Distortion Hypothesis

Grostic, JD. "Dentate Ligament-Cord Distortion Hypothesis. " Chiro Research Journal 1988; 1(1): 47-55

Abbot, K: "Foramen magnum and high cervical cord lesions simulating degenerative disease of the nervous system. " Ohio State Medical Journal 1950.

Emery, J: "Kinking of the medulla in children with acute oedema and hydrocephalus and its relationship to the dentate ligament." Journal of Neurol Neurosurg Psychitat, 1967.

Vagus Nerve

Howard RS, Thorpe J, Barker R, Revesz T, Hirsch N, Miller D, Williams AJ, Respiratory insufficiency due to high anterior cervical cord infarction., J Neurol Neurosurg Psychiatry 64: 3, 358-61, Mar, 1998.

Becker LE, Zhang W, Pereyra PM, Delayed maturation of the vagus nerve in sudden infant death syndrome., ActaNeuropathol(Beri) 86: 6, 617-22,, 1993.

Sachis PN, Armstrong DL, Becker LE, Bryan AC, The vagus nerve and sudden infant death syndrome: a mor-phometric study., J Pediatr 98: 2, 278-80, Feb, 1981.

Becker LE, Zhang W, Vagal nerve complex in normal development and sudden infant death syndrome., Can J Neurol Sci 23: 1, 24-33, Feb, 1996.

Bachman D, Prolonged apnea, vagal overactivity, and sudden infant death., Pediatrics 51: 4, 755-6, Apr, 1973.

Coryllos E, Vagal dysfunction and sudden infant death syndrome: one possible cause and its management., N Y State J Med 82: 5, 731-5, Apr, 1982.

Konrat G, Halliday G, Sullivan C, Harper C, Preliminary evidence suggesting delayed development in the hypoglossal and vagal nuclei ofSIDS infants: a necropsy study., J Child Neurol 7:1, 44-9, Jan, 1992.

Misc.

Gutmann G. ''Blocked Atlanta] Nerve Syndrome in Infants and Small Children. " Manuelle Medizine, Springer-Verlag, 1987.

Koch LE, Biedermann H, Saternus KS, High cervical stress and apnoea., Forensic Sci Int 97: 1, 1 -9, Oct 12, 1998.

Winsor H. "Sympathetic segmental disturbances. The evidence of the association in dissected cadavers of visceral disease with vertebral deformities of the same sympathetic segments. " Med Times 49:1-7 1921.

Korobkin R, Guilleminault C, Neurologic abnormalities in near miss for sudden infant death syndrome infants., Pediatrics 64: 3, 369-74, Sep, 1979.

(Dure LS, Percy AK, Cheek WR, Laurent JP. Chiari type 1 malformation in children, J Pediatr 1989; 115-573-576)

Birth Trauma

Gottlieb MS, Neglected spinal cord, brain stem and musculoskeletal injuries stemming from birth trauma., J Manipulative Physiol Ther 16: 8, 537-43, Oct, 1993.

Towbin A, Latent spinal cord and brain stem injury in newborn infants., Dev Med Child Neurol 11:1, 54-68, Feb, 1969

Byers RK, Spinal-cord injuries during birth., Dev Med Child Neurol 17: 1, 103-10, Feb, 1975.

Harris LS, Adelson L, "Spinal injury" and sudden infant death. A second look., Am J Clin Pathol 52: 3, 289-95, Sep, 1969.

Towbin A, Spinal injury related to the syndrome of sudden death ("crib-death ") in infants., Am J Clin Pathol 49:4, 562-7, Apr, 1968.

Reid H, Birth injury to the cervical spine and spinal cord., Acta Neurochir Suppl (Wien) 32:, 87-90,, 1983.

Teng FY, Sayre JW, Vacuum extraction: does duration predict scalp injury?, Obstet Gynecol 89: 2, 281-5, Feb, 1997.

-Ross MG, Skull fracture caused by vacuum extraction, Obstet Gynecol 89: 2, 319, Feb, 1997.

-Menticoglou SM, Perlman M, Manning FA, High cervical spinal cord injury in neonates delivered with forceps: report of 15 cases, Obstet Gynecol 86: 4 Pt 1, 589-94, Oct, 1995.

, Papaefthymiou G, Oberbauer R, Pendl G, Craniocerebral birth trauma caused by vacuum extraction: a case of growing skull fracture as a perinatal complication., Childs Nerv Syst 12: 2, 117-20, Feb, 1996.

- Chan CC, Malathi I, Yeo GS, Is the vacuum extractor really the instrument of first choice?, Aust N Z J Obstet Gynaecol 39: 3, 305-9, Aug, 1999.

-Govaert P, Vanhaesebrouck P, de Praeter C, Traumatic neonatal intracranial bleeding and stroke [see comments], Arch Pis Child 67: 7 Spec No, 840-5, M, 1992.

Chiswick ML, James DK, Kielland's forceps: association with neonatal morbidity and mortality., Br Med J 1: 6155, 7-9, Jan 6, 1979.

SEMINAR EVALUATION SHEET

Course Title: Soft Tissue Release of the Cranial Base . Location: Orlando, FLDate: July 11, 2009 Instructor Name: Paul St. John

Please circle a number (1 being lowest, 5 being highest) that best describes your answer.

1. How would you rate this course? 1 2 3 4 52. Do you feel the material will improve your practice? 1 2 3 4 5

3. How would you rate the Instructor? 1 2 3 4 5 4. How would you rate the Instructors ability to deliver the material? 1 2 3 4 55. Do you feel the Instructor was knowledgeable and well prepared? 1 2 3 4 5

6. Did you find the course material to be consistent with your expectations? 1 2 3 4 57. Will you be taking any more seminars offered by this company? 1 2 3 4 5

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9. Tell us what you liked most about this seminar:

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