23 junio, 2024

Cephalocaudal: concept, anatomy, assessment, warming

The term cephalocaudal It refers to an anatomical orientation that goes from the head to the feet. In the medical field, its use is not limited to an anatomical fact, since it also has clinical utility during the orderly evaluation of a patient, in radiology for tomographic cuts or in the echosonographic assessment of the fetus.

It is a word composed of two elements: «cephalus» or «cephalus» from the Greek kephalos, which means head; and «caudal» from Latin cauda, which is equivalent to tail. It is a perfect example of the Greco-Latin roots of medical terminology, used since the technical beginnings of medicine.

Fetal maturation (not only in humans) occurs from the organs of the head towards the base of the medulla. Development proceeds in a cephalocaudal direction, indicating that the upper parts of the body grow before the lower parts; for this reason, the embryos are always shown as specimens with large heads and small trunk and limbs.

Some pathophysiological events also have a cephalocaudal behavior. Certain diseases have clinical manifestations that begin in the head and work their way down to the feet. Even in physical and sports practice, some experts on the subject use pre-competitive movements in cephalocaudal order.

Anatomy

The origins of the term cephalocaudal go back to the first classical anatomists before Christ. Already in the vitruvian man, one of the most recognized works of Leonardo da Vinci, the indications of the anatomical plans are raised. The location of the human figure in two overlapping situations is clear in the idea of ​​positioning.

In the anatomical position, one of the basic axes is the vertical, also known as the craniocaudal axis. The direction of the named axis is, as seems evident, cephalocaudal. It is complemented by two others called horizontal or latero-lateral, and anteroposterior or ventro-dorsal.

The union of the vertical axis with the anteroposterior axis generates the lateral or sagittal planes. This divides the body into two zones: left and right.

The union of the vertical axis with the horizontal axis produces the frontal or coronal planes, dividing the body and two sections: anterior and posterior.

Assessment

The anatomical foundations are not the only ones obtained from cephalocaudal dynamics. The clinical and imaging evaluation also has certain cephalocaudal bases.

clinical assessment

Most authors on semiology recommend the cephalocaudal order for physical examination. This strategy is not whimsical, it even has hygienic purposes.

The upper parts of the body tend to be neater than the lower parts; for this reason, among other reasons, it is suggested to start from the top down.

The cephalocaudal physical examination is carried out following the four classical methods in the usual order: inspection, palpation, percussion, and auscultation.

An attempt should be made to fully cover each region explored in a descending way, avoiding going back, since mistakes can be made or key steps can be forgotten.

There are many medical specialties that use the cephalocaudal order to carry out their clinical assessment. We must also include dentistry and maxillofacial surgery in this group, which carry out their limited exploration in this way as well.

radiological evaluation

The vast majority of complex imaging studies are ordered according to a descending scheme of cephalocaudal sections. This applies to computerized axial tomography and nuclear magnetic resonance in any of its different modalities.

Other radiological studies respect this standard. Mammograms are read from top to bottom, as are bone scans, whole body X-rays, contrast studies (when contrast is given orally), and upper GI endoscopies for obvious reasons.

Obstetric ultrasound uses the cephalocaudal axis as a common marker of intrauterine fetal growth. This measurement helps to calculate the gestational age of the embryo and is useful from week 6 of pregnancy.

Despite some current controversy due to issues of imprecision, it continues to be a frequent finding in the results of obstetric echosonography.

Pathological evaluation

Some diseases have a behavior of cephalocaudal involvement. It may seem like a far-fetched topic, but it is a really valuable finding when making a differential diagnosis.

They are usually degenerative neurological diseases, although some space-occupying lesions, infections and traumas can behave in the same way.

Spongiform encephalopathies have this feature, in addition to psychiatric disorders. Rapidly growing spinal cord tumors cause violent and dramatic descending neurological deterioration, as well as some cases of infectious meningitis and encephalitis.

One of the most frequent diseases that generate cephalocaudal symptoms are herniated discs. The protrusion of the intervertebral disc causes unilateral or bilateral neurological symptoms that are usually descending, beginning with the neck and can reach the lower limbs.

Cephalocaudal warming

As previously commented, the term cephalocaudal does not apply only to the medical universe; in sports and physical education it is also useful.

Pre-competitive movements or warm-up can be done in cephalocaudal order, and this scheme is the most used in sports practice.

The organization of the cephalocaudal heating establishes that the motor response is carried out from the head to the feet; that is, in descending order. It is then understood that the movements of the head are controlled first to end in the lower limbs.

A common mistake is to define proximal-distal training as contrary to cephalocaudal training, when in fact they can complement each other.

The proximal-distal concept refers to heating that begins at the midline of the body and progressively moves away. In the upper limbs it begins at the shoulders and ends at the wrists or fingers.

Rationale for heating

Like all pre-competitive training, the idea is to prepare the body for a greater physical effort. Warming up has effects on the circulatory, respiratory, muscular, neurological and psychological fields. The most frequently used order is:

Anteroposterior and lateral movements of the neck. Circulatory movements or turns should be avoided.
The upper limbs are trained from the proximal (shoulders) to the distal (wrist and fingers). In this case, circulatory movements are tolerated, thanks to the laxity of the local joints.
The stretches continue in the hip, lower back and abdomen.
Already in the lower limbs it starts in the hips and continues with the thighs, knees, calves and feet, including ankles and fingers.

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