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Abstract | Method | Status | Syndrome | Dossier | Evidences | Mechanics | Pathomechanics | Etiopathogenesis | Therapy | Discussion | Conclusion

Evidence of vagally mediated relationship between tongue weakness and posture asymmetry: lineaments and etiology of the postural disorder, a case study. Paolo Platania (2008)

THREAT CONDITION

THREAT ONSET

EMERGENCY STRATEGY

STRATEGY IMPLEMENTATION

IMPLEMENTATION DRAWBACKS (evidences and symptoms of postural disorder)

Abstract

INTRODUCTION: Posture science enhancement pays for the present settlement of medical scientific society, this study proposes a different approach and explains the evidences yielded. CASE REPORT: an adult white male lamenting chronic unilateral motor disorder has been submitted to a long and thorough evaluation process by means of a method designed to fully exploit patient’s collaboration and underwent intermediate non invasive therapeutic attempts for differential diagnosis exclusion; final analysis highlights Tongue Motor Insufficiency (TMI), owed to nerve entrapment, as pathogenetic factor of the claimed symptoms as well as of a wider symptomatic picture hereby baptized platania’s syndrome. DISCUSSION: According to the observations, platania’s syndrome is the result of a permanent unilateral muscular spasm aimed at Cranio-Cervical Extension (CCE) and promoted by three actions: 1) main promoter is respiration, triggering Upper Airway Patency Maintenance Reflex (UAPMR) due to unilateral airflow augmented resistance, 2) Head Flexion Insufficiency (HFI) induced by extrinsic tongue muscles weakness and 3) Mandible Retrusion (MR), induced by teeth conflicts, further increasing airflow resistance due to tongue backward motion. Common pathogenesis of all three actions is TMI and the neurogenic etiology is Hypoglossal Rootlets Emergence Entrapment (HREE) under vertebral artery slightly deviated left branch. The complex mechanics, pathomechanics and etiopathogenesis are discussed along with their evidences and further validated by an accurate protocol. CONCLUSION: the theorized cause-effect relationship between “HREE / TMI / UAPMR-HFI-MR / CCE / head and neck posture / body posture / postural syndrome” along with it’s etiopathogenetic factor, not only explains platania’s syndrome, but, since observation and existing literature confirm this conditions to be as diffuse as overlooked, suggests a broad appliance to this theory.

Method

The case is exposed according to the following model: 

• Abstract: brief description; 
• Method: resources, tools and process;
• Completion status: case workflow description, current completion status and activity in process; 
• Platania's syndrome: relationship model of the pathology development; 
• Dossier: case elements collection; 
• Evidences: case relevant findings; 
• Mechanics: case findings relationship analysis and strategy identification; 
• Pathomechanics: link between mechanics and pathology; 
• Etiopathogenesis: diagnostic process; 
• Therapy: therapeutic process; 
• Discussion: comprehensive explanation; 
• Conclusion: final conclusions; 

METHOD: resources
The case has been carried out by the author being at the same time:
Profile	Skill
Patient	Having the pathological behaviour
Control subject	Having the physiological behaviour
Scientific personnel	Gathering all the specific knowledge and having developed the method

METHOD: tools
Tools	Purpose
Self evaluation	To Get full knowledge of his own postural
Information recording	To thoroughly record each valuable information and relationship for retrospective use
Information integration	For relationship analysis and pathology origin seek after
Literature search	Aimed to advance/verify hypothesis
Laboratory investigations	To validate the contingent hypothesis
Therapeutic attempts	For exclusion of differential diagnosis

METHOD: process
Activity	Description
Self evaluation activity	Monitoring all motor/static actions during the whole day. Activities monitored: ordinary: gait, car driving,static upright, laying supine and prone position, swallowing, masticating, sitting…..; athletic: cycling, cross, country ski, alpine ski, swim, jog, gym… Monitoring approach: focusing on all asymmetries between pathologic left side and physiologic right side, goal is to catalogue all muscles involved in the unbalance and work out the unbalance strategy extending observation of motor/static tasks involving contextual variables, goal is to monitor environmental dependence; focusing on therapeutic attempt outcome to validate possible cause/effect relationship; strong commitment in the analysis of regression events because these events greatly help in expanding knowledge of the own postural unbalance and almost always deliver new evidences, goal is to catalogue all that changes in the motor control during these short events.
Recording activity	Tracing the following daily details in digital format daily postural unbalance index: the index represents the amount of control allowed by the postural unbalance, meant to trace the occasional and temporary regression events it consists of 5 levels of motor control (Ere01); daily diary of gait analysis, cycling analysis and general motor analysis documenting the initial theory and all further enhancements after every new finding, the final result is a thorough postural disorder description; daily physiology diary: weight, fat mass; alimentary calories intake and athletic and basal caloric waste; daily health diary: illness events, medicines; daily athletic practice diary: specialty, training duration, training effort, valuable times recording, heartbeat (bpm) during training, power (watt) during training.
Retrospective analysis activity	Data analysis aimed at the following: statistically relevant relationships research among traced information (resources are office automation, reporting and graphic software products); pathology onset individuation by means of retrospective information such as: patient’s and parents photographs (congenital/inherited pathology); old memories and recollections ascribable to the postural pathology.
Literature research activity	Carried out either with “punctual” approach (to deepen the current hypothesis) and with a “inspiration” approach (to advance new hypothesis), resources are: books: see bibliography section; journals: freely available bibliographic abstracts and full texts available from indexed journals over the internet; others: news groups and forums, health care professionals web sites and email for dedicated contacts.
Diagnostic activity	Aimed to confirm/exclude theories of the moment, carried out by: health care professionals clinical evaluation; laboratory imaging services.
Therapeutic attempts activity	Therapeutic attempts carried out in the absence of etiological diagnosis; the initial “random therapeutic activity” to provide accidental and hopefully resolutive outcome has been superseded by a more “aimed therapeutic activity”. Therapeutic approach: therapies directly aimed at the postural symptoms; therapies directly aimed at other symptoms supposed to indirectly affect the postural problem.

Completion status

The research activity started in the year 2000 and the case is still in progress, the completion status specification is compliant to the naming convention in section Posture:

EVIDENCES

MECHANICS

PATHOMECHANICS

ETIOPATHOGENESIS

THERAPY

Pathological process

Etiological process

Collection of every evidence arising from whatever observation method

Postural strategy identification by analysing the evidences

Research of the relationship between the mechanics goal and the evidence that may activate it

Diagnostic process to identify the cause of the pathologic evidence

Procedure to treat the pathology in order to restore health

Informations and documentation collection involved in all the diagnostic and therapeutic process

Management process

DOSSIER

Management process:

DOSSIER (anamnesis, lamented symptoms….)

in progress (Ddo11, Ddo12)

Pathological process:

EVIDENCES (clinical, self evaluated, symptomatic..)	completed
MECHANICS (postural strategy identification)	completed

Etiological process:

PATHOMECHANICS (first primary pathology identification)	completed
PATHOMECHANICS (second primary pathology identification)	completed
ETIOPATHOGENESIS (first primary etiological diagnosis)	in progress (Ddo10)
ETIOPATHOGENESIS (second primary etiological diagnosis)	completed
THERAPY (first primary pathology correction)	to be undertaken
THERAPY (second primary pathology correction)	first attempt failed (Eot05), wait

Platania’s syndrome

The current hypothesis theorizes a syndrome whose features are discussed and motivated all along the case study, the syndrome has been baptized “Platania’s syndrome” and it’s complex relational model is hereby described.
The syndrome development model covers only neurogenic consequences of Hypoglossal Nerve Neuropathy (HNN) but please note that there is evidence of Hypoglossal Rootlets Emergence Entrapment (HREE) inducing Vertebral Artery (VA) vessel sufferance and vascular insufficiency (conflict with Hypoglossal nerve), despite the potential high harmfulness of these findings they are not directly relatable to posture, as such, beyond the scope of the present analysis.

ETIOPATHOGENESIS

PATHOMECHANICS

MECHANICS

EVIDENCES

THREAT CONDITION

THREAT ONSET

EMERGENCY STRATEGY

STRATEGY IMPLEMENTATION

IMPLEMENTATION DRAWBACKS (evidences and symptoms of postural disorder)

Etiological process (first primary)

Pathological process

HYPOGLOSSAL NERVE NEUROPATHY (HNN)

TONGUE MOTOR INSUFFICIENCY (TMI)

UPPER AIRWAY PATENCY MAINTENANCE REFLEX (UAPMR)

Hypoglossal Rootlets Emergence Entrapment (HREE)

Pharingeal airflow augmented resistance

Cranio-Cervical Extension (CCE) - unilateral

Head flexion torque decrease

HEAD FORWARDING POSTURAL STRATEGY (HFPS)

EVIDENCES

Vertebral Artery (VA) vascular insufficiency (unconcerned by this study)

Swallowing and mastication disorder

HEAD FLEXION INSUFFICIENCY (HFI)

Muscle spasm - unilateral

Clinical

Maxillary arch develpment disorder

Cranio-Cervical Extension (CCE) - unilateral

Symptoms and degenerations

Self evaluation

Etiological process (second primary)

Regression events

MAXILLARY ARCH INSUFFICIENCY

DENTAL CONFLICT

UNCLEAR MEDIATION (vagal, trigeminal, proprioception)

MANDIBLE RETRUDING POSTURAL STRATEGY (MRPS)

Orthodontic treatment

Maxillary emiarch unexpanded - unilateral

Mandible retrusion

Cranio-Cervical Extension (CCE) - bilateral

Muscle spasm - bilateral

Teeth crowding

Mastication disorder

Dossier

Platania’s syndrome case elements collection grouped by classes:

• Anamnesis: personal, familiar… and historical informations;
• Lamented symptoms: patient’s complaints;
• Resolution attempts: diagnostic and/or therapeutic intervention aimed at problem resolution
• Documentation: diagnostic lab exams or other evaluation report.

DOSSIER: anamnesis
#	Type	Informations
Dan01	Patient	Paolo Platania, born in 1968, white, male
Dan02	Personal, familiar and historical	omitted… reserved information
Dan03	Surgical treatments	omitted… reserved information;
Dan04	Habits	omitted… reserved information.

DOSSIER: lamented symptoms
#	Feature	Description
Dls01	Initially lamented (all referring to the left side), all chronic, idiopathic and not disabling, clue of presence since age 18 but suspected to be arisen much earlier	Predisposition to slip in descent gait or in slippery surface gait; Uneasiness in slope gait; Athletic performance limitations; Sometimes it all improves for a few days
Dls02	Onset during current therapy	Constant back pain, lumbar and dorsal spine; Acute episodic back pain and motor impairment due to L3/L4 temporary exacerbation; Acute episodic sacroiliac joint pain.

DOSSIER: resolution attempts
List of all the therapeutic attempt in chronological order, along with the continuous enhancement of the diagnostic hypothesis through the whole exclusion process.
#	Attempt	Status	Outcome
Diagnostic hypothesis		Mechanical hypothesis: unknown; Pathomechanical hypothesis: unknown; Etiological hypothesis: unknown
Dra01	Chiropractic 1	Completed	Diagnosis: hip torsion and thigh anterior/posterior muscle unbalance Therapy: manipulation on the neck, spine, hip, sacroiliac and other techniques Outcome: no
Diagnostic hypothesis		Mechanical hypothesis: left lower limb motor disorder; Pathomechanical hypothesis: generic muscle unbalance; Etiological hypothesis: neurological problem
Dra02	Neurology 1	Completed	Diagnosis: no Therapy: no
Dra03	Applied kinesiology 1	Completed	Diagnosis: no Therapy: yes Outcome: no
Dra04	Osteopath 1	Completed	Diagnosis: no Therapy: craniosacral therapy, manipulations Outcome: no
Dra05	Osteopath 2	Completed	Diagnosis: no Therapy: manipulations Outcome: no
Diagnostic hypothesis		Mechanical hypothesis: left lower limb motor disorder; Pathomechanical hypothesis: left psoas major (PM) weakness; Etiological hypothesis: radiculopaty, lower motor neuron disease;
Dra06	Neuraltherapy 1	Completed	Diagnosis: no Therapy: neuraltherapy on scars with emla procaine cream Outcome: no
Dra07	Chiropractic 2	Completed	Diagnosis: no Therapy: reactive food diet, neurolinfatic spots treatment, manipulations Outcome: no
Dra08	Applied kinesiology 2	Completed	Diagnosis: no Therapy: yes Outcome: no
Dra09	Podiatrist:	Completed	Diagnosis: no Therapy: no
Diagnostic hypothesis		Mechanical hypothesis: left lower limb motor disorder Pathomechanical hypothesis: left tibialis posterior (TP) weaknes; Etiological hypothesis: L5 radiculopaty, lower motor neuron disease;
Dra10	Neurology 2	Completed	Diagnosis: postural problem Therapy: no
Diagnostic hypothesis		Mechanical hypothesis: left lower limb motor disorder; Pathomechanical hypothesis: left TP weakness; Etiological hypothesis: soleus accessorius, neurological teeth…
Dra11	Self techniques	Completed	Alexander: self awareness improvement, helpful for self evaluation method, no postural benefit Feldenkrais: self awareness improvement, helpful for self evaluation method, no postural benefit
Dra12	Acupuncture	Completed	Diagnosis: chinese medicine diagosis… Therapy: yes Outcome: no
Dra13	Neuraltherapy 2	Completed	Diagnosis: no Therapy: neuraltherapy on suspect dermatomes with procainum compositum intradermal injections Outcome: isolated regression event occurrence, not repeatable, suspected lucky coincidence
Dra14	Shiatzu	Completed	Diagnosis: no Therapy: yes Outcome: no
Dra15	Neuraltherapy 3	Completed	Diagnosis: no Therapy: neuraltherapy on suspect “neurological teeth” with procaine local anaesthesia Outcome: no
Diagnostic hypothesis		Mechanical hypothesis: left lower limb motor disorder; Pathomechanical hypothesis: left TP weakness; Etiological hypothesis: mercury induced neuropathy;
Dra16	Dentist 1	Completed	Diagnosis: no Therapy: mercury amalgam removal therapy Outcome: suspect illness resistance improvement, nothing relevant to posture
Dra17	Plantar reflexology	Completed	Diagnosis: no Therapy: yes Outcome: no
Diagnostic hypothesis		Mechanical hypothesis: left lower limb motor disorder; Pathomechanical hypothesis: left TP weakness; Etiological hypothesis: stomatognatic disorder;
Dra18	Dentist 2	Completed	Diagnosis: postural disorder of stomatognatic pathomechanics Therapy: orthodontic + all wisdom teeth extraction + parodontal complications therapy Outcome: Successful: mandibular retraction, teeth crowding, deep byte, maxillar arch insufficiency, part of postural disorder, anterior tibial compartment syndrome, scapulohumeral instability; Unchanged: maxillar and mandibular arches asymmetry; Worsened: back pain and L4 radiculopathy motor symptoms onset; 2 months follow up from therapy completion: progressive restoration of initial pathology (due to immediate and fast left maxillary arch spontaneous collapse), consequent benefits regression and consequent complications subsidence. Complete discussion is available in orthodontic treatment section.
Diagnostic hypothesis		Mechanical hypothesis: current mechanical hypothesis (see Mechanics); Pathomechanical hypothesis: swallowing defects (first primary) and stomatognatic disorder (second primary); Etiological hypothesis: swallowing habit;
Dra19	Speech therapist	Interrupted	Goal: working on tongue functionality to somehow improving swallowing disorder and it’s stomatognatic impact Diagnosis: no Therapy: tongue exercises Outcome: no benefit; but…during tongue exercises, the patient recognizes tongue left side motor insufficiency and suspects it’s neurogenic origin, as therapist underrates the finding the treatment is interrupted due to suspected uselessly and therapist lack of professionalism;
Diagnostic hypothesis		Mechanical hypothesis: current mechanical hypothesis (see Mechanics); Pathomechanical hypothesis: current pathomechanical hypothesis (see Pathomechanics); Etiological hypothesis: current etiological hypothesis (see Etiopathogenesis);
Dra20	Neurology 3	Interrupted	Diagnosis: investigation terminated due to insufficient of collaboration of health care professionals
Dra21	Vascular surgery 1	Interrupted	Diagnosis: investigation terminated due to insufficient of collaboration of health care professionals Details are available in DOSSIER:documentation under (Ddo09)
Dra22	Auriculotherapy 1	Completed	Goal: acting on vagal and glossopharyngeal reflexive points to hopefully have a feedback in afferences sensitiveness Therapy: ear piercing appliance over vagal and glossopharyngeal reflexive points Outcome: cause-effect reaction but not repeatable: First appliance: sudden index 0 regression event, lasted for 1 week, after which, spontaneously restore index –2; Second appliance (after 1 week): no effect Thorough discussion is available in Ere02 section.
Dra100	Pranotherapy	Interrupted	Goal: testing the capability of this therapy to affect Vertebral Artery (VA) position Therapy: heands contact over the head and neck Outcome: none
Dra23	Atlantotec 1	Completed	Goal: use the atlas transeverse process to somehow move the Vertebral Artery (VA) away from it’s habitual position in order to relieve pressure on the XII cranial nerve Diagnosis: atlas has been found, by palpation, to be right-rotated Therapy: deep sub occipital massages, after which, appliance of vibrating pressure (by means of a vibrating device) to reposition the atlas Outcome: cause-effect reaction but not repeatable First appliance: sudden index +1 regression event, lasted for 1,5 days, after which, spontaneously restore index –2; Second appliance (after 2 weeks): no effect; Further discussion is available in vagal reset and Ere02 sections.

DOSSIER: documentation
#	Exam	Report
Ddo01	Lumbar spine RX	report omitted… reserved information
Ddo02	Left lower limb Electromyography (EMG)	no tibial nerve anomaly, report omitted… reserved information
Ddo03	Lumbar spine MRI	L3-L4 Hernia plus further degenerative processes, report omitted… reserved information
Ddo04	Gastroduodeno GDS	small hiatal hernia due to esophagus slip, report omitted… reserved information
Ddo05	Cranial RX	no anomaly, report omitted… reserved information
Ddo06	Dental panoramic RX	No anomaly except teeth crowding, report omitted… reserved information
Ddo07	Cycling ergonomic analysis	left lower limb motor disorder
Ddo07a	Custom designed oral splint implemented for differential diagnosis exclusion (Ptd03): by means of 2 asymmetric palatal sides, tongue is fit in a central position within palate, teeth are free to occlude, mastication and swallowing are preserved, phonation is normal, only tongue positioning is affected by this splint.	click to enlarge
Ddo08	Carotid artery Doppler	No tortuosity, normal vascular flow
Ddo09	MRI of intracranial and neck vessels; MRI of brain and brainstem	Clue of left Vertebral Artery (VA) overlying hypoglossal rootlets emergence, a neurovascular conflict lesion is further confirmed by left VA branch decreased blood flow (Full Arrow). This hypothesis is described in the Etiopathogenesis and thoroughly discussed and validated in STAGE 4 discussion section.
		Coronal view (Full Arrow = left VA branch, Arrow = right VA branch) click to enlarge high resolution (1.2 Mb), 1 of 2 high resolution (1.1 Mb), 2 of 2
		Top view (Full Arrow = left VA branch, Arrow = right VA branch) click to enlarge high resolution (1.3 Mb)
		Sagittal view (Full Arrow = left VA branch, Arrow = right VA branch) click to enlarge high resolution (1.1 Mb), 1 of 2 high resolution (1.1 Mb), 2 of 2
		Vessels view (Full Arrow = left VA branch, Arrow = right VA branch) click to enlarge high resolution (1.2 Mb), 1 of 2 high resolution (1.3 Mb), 2 of 2
Ddo10	Vagal reset procedure: local appliance of 30mg of lidocaine 2% in the pharynx	Cause-effect repeatable reaction provides clue of vagal afferences mediating head forwarding postural strategy (HFPS). Further discussion is available in vagal reset and Ere02 sections.
		First appliance: sudden index 0 regression event, lasted for 2 hours, after which, spontaneously restore index –2; Click to enlarge
		Second appliance (after 4 days): sudden index 0 regression event, lasted for 2 hours, after which, spontaneously restore index –2; Click to enlarge
	Other ways to induce the effect of vagal reset are: Holding breath (apnoea): no airflow to trigger receptor reaction Protruding tongue: improving symmetry of intraoral airway window, Tracheotomy: pharyngeal wall do not host airflow anymore,	Cause-effect repeatable reaction are provided by Holding breath: after few seconds of holding breath Head forwarding postural strategy (HFPS) subsides (index 0 / index 1 regression event), and is not restored until resuming respiration, Protruding tongue: index -1 / index 0 regression event is always reported when breathing with protruded tongue, measures are required to exclude suggestion Tracheotomy: option not yet attempted, hypothesis to be validated
Ddo11	Needle Electrode EMG: differential left-to-right electrical potential of all muscles involved in HFPS Description: needle electrode electromyogram of electric potential of the muscles involved in HFPS and of their contralateral, recorded in static upright and supine position, to be repeated in 2 consecutive days Requirements: patient with no ongoing regression event (only index -2 allowed) same electromygraph used for the whole sampling procedure Constants: to be recorded and replicated at every appliance musclesMap1: over the patient skin draw with a pen the sampling spots and report this map over paper to be able to subsequently overly paper on the patient and redraw the same spots, Detail: muscles to be recorded (left/right) weak left extrinsic tongue muscles: genioglossus (GG), hyoglossus (HG), styloglossus (SL); contracted left anterior muscles: anterior scalenus (AS), anterior intracostalis (AI), internal oblique (IO),tensor fascia lata (TFL), rectus femoris (RF), inhibited left posterior muscles: erector spinae (ES),posterior intercostalis (PI), inhibited gluteus maximus (GM),inhibited semimembranosus (SM), semitendinosus (ST), biceps femoris (BF), tibialis posterior (TP), flexor hallucis longus (FHL), flexor digitorum longus (FDL); contracted left superior muscles: upper trapezius (UT) (only scapulo-cervical fibers, NO occipiral fibers), pectoralis major (PMA), pectoralis minor (PMI), splenius capiti (SPC), semispinalis capitis (SEC); contracted left inferior muscles; soleus (S), tibialis anterior (TA)	To be undertaken Electromyogram dump: Day1:  ??/??/2008, Day2:  ??/??/2008 Fill with electrodiagnostical values Weak left extrinsic tongue muscles: genioglossus (GG): left upright (Lu) ??, right upright (Ru) ??, left supine (Ls) ?? right supine (Rs) ??, mean left-to-right unbalance (MLRU) ?? hyoglossus (HG): Lu ??, Ru ??, Ls ?? Rs ??, MLRU ?? styloglossus (SL): Lu ??, Ru ??, Ls ?? Rs ??, MLRU ?? Contracted left anterior muscles: anterior scalenus (AS): Lu ??, Ru ??, Ls ?? Rs ??, MLRU ?? anterior intracostalis (AI): Lu ??, Ru ??, Ls ?? Rs ??, MLRU ?? internal oblique (IO): Lu ??, Ru ??, Ls ?? tensor fascia lata (TFL): Lu ??, Ru ??, Ls ?? Rs ??, MLRU ?? rectus femoris (RF): Lu ??, Ru ??, Ls ?? Rs ??, MLRU ?? hip adductor (HA): Lu ??, Ru ??, Ls ?? Rs ??, MLRU ?? Inhibited left posterior muscles: erector spinae (ES): Lu ??, Ru ??, Ls ?? Rs ??, MLRU ?? posterior intercostalis (PI): Lu ??, Ru ??, Ls ?? Rs ??, MLRU ?? inhibited gluteus maximus (GM): Lu ??, Ru ??, Ls ?? Rs ??, MLRU ?? semimembranosus (SM): Lu ??, Ru ??, Ls ?? Rs ??, MLRU ?? semitendinosus (ST): Lu ??, Ru ??, Ls ?? Rs ??, MLRU ?? biceps femoris (BF): Lu ??, Ru ??, Ls ?? Rs ??, MLRU ?? tibialis posterior (TP): Lu ??, Ru ??, Ls ?? Rs ??, MLRU ?? flexor hallucis longus (FHL): Lu ??, Ru ??, Ls ?? Rs ??, MLRU ?? flexor digitorum longus (FDL): Lu ??, Ru ??, Ls ?? Rs ??, MLRU ?? Contracted left superior muscles: upper trapezius (UT) (only scapulo-cervical fibers, NO occipiral fibers): Lu ??, Ru ??, Ls ?? Rs ??, MLRU ?? pectoralis major (PMA): Lu ??, Ru ??, Ls ?? Rs ??, MLRU ?? pectoralis minor (PMI): Lu ??, Ru ??, Ls ?? Rs ??, MLRU ?? splenius capiti (SPC): Lu ??, Ru ??, Ls ?? Rs ??, MLRU ?? semispinalis capitis (SEC): Lu ??, Ru ??, Ls ?? Rs ??, MLRU ?? Contracted left inferior muscles: soleus (S): Lu ??, Ru ??, Ls ?? Rs ??, MLRU ?? tibialis anterior (TA): Lu ??, Ru ??, Ls ?? Rs ??, MLRU ?? Overall contracted left to right unbalance: ?? Overall inhibited left to right unbalance: ??
Ddo12	Photograph Imaging: reproducible imaging of the postural disorder Description: 8 upright positions + 6 supine position, 2 snapshots x position, to be repeated in 2 consecutive days; total of 28 snapshots. Requirements: patient wearing only slip, short hair or, if not possible, wearing a cap for upright position snapshots: either stare and foot oriented toward body sagittal plane, for supine position snapshots: have the patient laying over solid surface (eg. Floor), for supine position snapshots: have the patient laying over a previously drawn axis. Constants: to be recorded and replicated at every appliance PatientInfo1: height, weight, eyes height, basal respiratory rate, basal heartbeat rate cameraPos1: height/direction/distance for upright position frontal snapshots, cameraPos2: height/direction/distance for upright position left profile snapshots, cameraPos3: height/direction/distance for upright position right profile snapshots, cameraPos4: height/direction/distance for upright position back snapshots, footDist1: distance between heels for upright position snapshots, footIncl1: foot axis inclination in the body sagittal plane for upright position snapshots, stareHeight1: stare marker height for upright position snapshots, stareDist1: stare marker distance from patient for upright position snapshots, cameraPos5: height/direction/distance for supine position profile snapshots, cameraPos6: height/direction/distance for supine position top/front snapshots, footDist2: distance between heels for supine position snapshots, Detail: 4 constrained upright position snapshots (front, left profile, right profile, back): cameraPos1-2-3-4, footDist1, footIncl1, stareHeighth1, stareDist1, footStareRelationship1 4 unconstrained upright position snapshots (front, left profile, right profile, back): cameraPos1-2-3-4, no positional constraint, the patient assumes the most comfortable position 3 constrained supine position snapshot (left profile, right profile, top/front): cameraPos5-6, footDist2, footHipShoulderHeadRelationship2, supineSurface1 3 unconstrained supine position snapshot (left profile, right profile, top/front): cameraPos5-6, no positional constraint, the patient assumes the most comfortable position.	To be undertaken Constants values: patientInfo1: 179cm, 92kg, ??cm, ??rpm, ??bpm cameraPos1: ??cm, horizontal, ??cm cameraPos2: ??cm, horizontal, ??cm cameraPos3: ??cm, horizontal, ??cm cameraPos4: ??cm, horizontal, ??cm footDist1: ??cm, footIncl1: ??° stareHeight1: ??cm, stareDist1: ??cm, cameraPos5: ??cm, horizontal, ??cm, cameraPos6: ??cm, ??°, ??cm, footDist2: ??cm Day1: ??/??/2008 To be filled with snapshots Day2: ??/??/2008 To be filled with snapshots

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Posture, etiology of a syndrome - ©2008 Paolo Platania