The main functions of the diaphragm are altered in the presence of respiratory diseases, due to a reduction in muscle mass and electrical coordination, and a nonphysiological adaptation of the intrinsic protein structure. Patients with COPD or OSAS, and people weaned from ventilation machines follow a rehabilitation path and physiotherapy to recover the diaphragm strength, combining manual and osteopathic therapy with specificic techniques which can be directly used on the rib muscle. The operator manually evaluates the mobility of the diaphragm before and after physiotherapy; the initial evaluation is useful to address the training, and the final one to evaluate the outcome.In literature a manual assessment of the less mobile areas of the diaphragm is currently missing, these information would be vital for the operators, in order to decide which muscle areas need to be treated. The scale proposed in the present article can be useful to address the treatment on specific affected areas and can improve informational exchange on the patient's specific needs between different professional persons. The article is the first step to present the scale as a hypothesis. Subsequently, we will make a second article to validate the scale with objective clinical tools.
The Eustachian tube (ET) plays an important role in the function of the middle ear, stimulating drainage and ventilation. The drainage of secretions from the middle ear is carried out by the mucociliary system of the tube (and the mucus membrane of the middle ear), the muscular system of the tube and the tension of the tubal lumen. The ET is normally closed by periluminal pressure which is greater than the outside pressure, while it is rhythmically opened by muscle activity to which it is directly or indirectly linked. There are six muscles recognised as having an active role in the functions of the tuba: tensor veli palatini; levator veli palatini; tensor tympani; salpingopharyngeus; lateral and medial pterygoids. Literature available on an osteopathic approach to treating the ET is lacking. The article reviews the literature on the osteopathic treatment of the Eustachian tube and proposes a new hypothesis of treatment for a non-pediatric population. This may lead to new scientific findings and improved results to the patient's overall health.
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