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Posture, etiology of a syndrome

Paolo Platania
Posturology guidelines and
interdisciplinary case study

  
  
  
Posturology
  
The case study
  
The backstage
  
 
Abstract | Method | Status | Syndrome | Dossier | Evidences | Mechanics | Pathomechanics | Etiopathogenesis | Therapy | Discussion | Conclusion

Discussion

VALIDATION PROCESS

The Hypoglossal Rootlets Emergence Entrapment (HREE) etiological hypothesis requires a complex validation process subdivided into four stages.
The protocol is aimed at validating the first primary pathologic process only, the second primary process validation is subject of a dedicated protocol, which, at present, is to be designed.

Stage Goal Protocol Discussion
STAGE 1

Validation of the mechanics
The first stage of the validation protocol is aimed at describing the unilateral Cranio-Cervical Extension (CCE) spasm that constitutes Head Forwarding Postural Strategy (HFPS), the goal is to provide univocal and repeatable measures of:
  • Point 1) The map of muscles involved in the postural disorder,
  • Point 2) The exact extent of muscle unbalance ,
  • Point 3) Multidimensional model of the postural disorder.
The measures meant to describe the mechanics are supplied by:
  • Point 1,2 ) Electromyography custom sampling (Ddo11),
  • Point 3) Photo imaging (Ddo12), sabilometry, gait analysis, cycling analysis (Ddo07).
A simplified subset of this protocol has already been applied in: providing consistence to the mechanical hypothesis at STAGE 1

Validation in progress
STAGE 2

Validation of the pathomechanics
The second stage is aimed at demonstrating direct relationship between
a) pharyngeal airflow vagal afferences /
b) Head Forwarding Postural Strategy (HFPS),
the goal is to provide repeatable evidences of cause-effect relationship between:
  • Point 1) vagal reset procedure -> improvement of HFPS,
  • Point 2) airflow reduction -> improvement of HFPS,
  • Point 3) upper airway shape modification -> improvement HFPS,
  • Point 4) HFPS -> airway patency
Evidence of this hypothesis would be achieved with the following protocol:
  • Point 1, 2, 3) Differential STAGE 1 protocol: habitual vs. vagal reset (Ddo10),
  • Point 4) Differential MRI pharynx imaging: habitual vs. vagal reset
A simplified subset of this protocol has been applied in Ddo10 and discussed in detail in vagal reset procedure discussion, underscoring the evidences expected at STAGE 2 - Point 1.

Validation in progress
STAGE 3

Validation of the pathomechanics
The third stage is aimed at demonstrating direct relationship between
a) Tongue Motor Insufficiency (TMI) /
b) pharyngeal airflow asymmetric afferences /
c) Head Forwarding Postural Strategy (HFPS)

NOTE: TMI is validated at STAGE 1.
Evidence of this hypothesis would be achieved with the following protocol: Differential STAGE 1 protocol: habitual vs. electrostimulation of left side weak extrinsic tongue weakness. Validation in progress
STAGE 4

Validation of the etiopathogenesis
The fourth and last stage is aimed at demonstrating direct relationship between
a) Tongue Motor Insufficiency (TMI) /
b) Hypoglossal Nerve Neuropathy (HNN) /
c) Hypoglossal Rootlets Emergence Entrapment (HREE)

NOTE: TMI is validated at STAGE 1
Evidence of this hypothesis would be achieved with the following protocol:
  • MRI to display the suspected space occupying lesion (Ddo09),
  • Nerve Conduction Studies (NCS) of left hypoglossal nerve,
  • Exclusion of other lesions aside from the suspected vertebral artery space conflict (Ddo08)
  • Differential STAGE 1 protocol: habitual vs. follow up after appliance of the most suitable approach to relieve the XII CN / vertebral artery conflict
A subset of this protocol has been applied in Ddo09 and Ddo08 supporting the evidences expected at STAGE 4

Validation in progress



Discussion text...

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Posture, etiology of a syndrome - 2008 Paolo Platania