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Pediatric Considerations in OMM

by Sheldon C. Yao, DO

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    00:01 So now we're gonna look at a couple of presentations where the respiratory-circulatory model approach could help treat pediatric patients.

    00:09 So when we are looking at the Respiratory Circulatory model, our goal is to try to increase and improve lymphatic and circulatory flow.

    00:16 So we're gonna do this by first addressing any diaphragm restrictions like the thoracic inlet, abdominal diaphragm, pelvic diaphragm.

    00:23 We wanna try to improve the overall motion of the thoracic cage where breathing is the main pump for lymphatics and circulation.

    00:30 And to promote fluid motion through these pumps.

    00:34 In order to increase respiration and circulation, we wanna try to increase the amount of breathing and oxygen that gets to our tissues. We wanna try to improve lymph flow.

    00:45 And by improving lymph flow, we're going to improve immunity and then we're gonna use different treatments to help with reducing inflammation, swelling and infections.

    00:57 So kids frequently present with otitis media or ear infection.

    01:01 So otitis media is the infection of the middle ear.

    01:04 It's much more common in children because in children, the eustachian tube is more horizontal.

    01:11 As children grow, their face becomes longer and the eustachian tube becomes more vertical and thus drain more naturally with gravity.

    01:19 But as kids, the eustachian tube tends to be more horizontal, so there is increased risk of fluid building up, and if there is any sort of infection or blockages, it would cause acute infection in the ear.

    01:32 So this is of upmost importance in children because recurrent infections, recurrent ear infections could lead to long term sequelae.

    01:41 So, chronic infections could lead to increased pressure pain and build up.

    01:45 Sometimes they may need to have to go in there and put ear tubes to allow for drainage.

    01:49 And long term, you worry about possible hearing loss So OMM could be utilized to treat otitis media.

    01:57 There's a technique called the Galbreath's technique, which helps to improve drainage of the eustachian tube.

    02:03 We have to look at different cranial dysfunctions, especially looking at the temporal bone because that's what houses the eustachian tube itself.

    02:12 You wanna look at cervical, thoracic especially the thoracic inlet to help promote lymphatic drainage.

    02:18 There's been different studies that have been performed looking at children with acute otitis media and also chronic otitis media.

    02:24 And overall, they found that kids that received OMT had decreased need of antibiotic use, decreased episodes of acute otitis media, needed fewer surgical interventions and had improved hearing metrics.

    02:41 Here, we're gonna talk a little bit more about the Galbreath technique itself.

    02:46 So, when you have a lot of pressure in your ear and whether it be on an airplane or you're going up in high altitude, What is the first thing that you do? Most of us, we try to yawn and the reason why we try to yawn is because when we yawn, there are muscular attachments from the posterior pharynx to the opening of the eustachian tube.

    03:07 And so when you depress and move your jaw anteriorly, that helps to open the eustachian tube.

    03:13 And so for babies and children, this is something that's more difficult for them to do spontaneously.

    03:20 So, you could possibly do this technique to help open the eustachian tube.

    03:25 So to perform the technique, what you're going to do, is you're going to cradle the mandible underneath your hand and then you're gonna apply a gentle lift to try to open up the eustachian tube.

    03:36 And this will help to improve lymphatic drainage from the eustachian tube.

    03:41 Asthma is another frequent pediatric presentation.

    03:45 Asthma is usually due to bronchial spasms - there's air trapping due to possible overactivity of the vagus nerve and also secondary to inflammation.

    03:56 So usually there's a trigger, where there's increased inflammation of the airways, that inflammation causes the airway to swell and causes outflow obstruction.

    04:05 And so the inflammation is really what's key and is what needs to be taken care of in order to allow for resolution of asthmatic attacks.

    04:16 So when children have asthmatic attacks, what happens is they start using their accessory muscles for inspiration a little bit more.

    04:25 That usually tends to where a little bit more on their accessory muscles and those muscles start to spasm.

    04:32 There's excessive work of breathing because of that obstructive lung disease.

    04:38 And so what happens is they'll work much harder to try to exhale and they get air trapping And so their lungs get hyperinflated.

    04:47 That hyperinflation actually will cause the diaphragm to not work as well because the airways are hyperinflated, that doesn't allow the diaphragm to move with much excursion.

    05:00 And that becomes a problem because the diaphragm really is responsible for about 60% of the change in thoracic pressures.

    05:07 So, if we have a hyperinflated airway, the rib cage is not moving, the diaphragm is stuck.

    05:13 Ultimately, what happens in asthma and what you're afraid of is that the patient is no longer able to keep up with the work of breathing and ultimately will have to be intubated to prevent respiratory failure.

    05:29 Here is that image, you could see that with inspiration, the diaphragm will descend and flatten.

    05:36 And with exhalation, the diaphragm will dome and restore it's natural shape.

    05:41 And so in an asthmatic attack, what happens is the airway becomes hyperinflated and that diaphragm gets stuck in inhalated state and it does not restore and go to it's dome's natural shape.

    05:56 So when you have prolonged inflammation and chronic lymph congestion, what you have is increased risk of infection, increased mortality, increased healing time, increased fibrosis and scarring and also decreased effectiveness of the medications.

    06:15 So what do we want to do with OMM? With OMM, what we want to try to do is improve venous and lymphatic flow.

    06:22 We want to try clear that inflammation, we want to try to improve arterial supply to the lungs, ease the removal of bronchial secretions and phlegm, and decrease the overall workload of breathing.

    06:35 So how could we use OMM to treat patients with asthma or other pulmonary conditions? So OMT could be utilized to help improve respiratory excursion and decrease inflammation.

    06:46 We want to make sure that we focus our treatment on treating any somatic dysfunctions that might be affecting the thoracic cage.

    06:51 If someone's having trouble breathing, we want to try to decrease the amount of work they have to do by improving the thoracic compliance.

    06:59 So we want to try to treat the spine, the ribs, the muscles attaching to the rib cage to allow for optimal expansion.

    07:09 We also want to balance autonomics, looking at the cranial base for parasympathetic innervations to the lungs also looking at the upper ribs for possible viscerosomatics and that will also help to balance some of the secretions and the inflammation at the lungs.

    07:24 And then again, looking at the accessory muscles of respiration, when we struggle to breathe, we're gonna overuse those muscles.

    07:30 We want to try to reduce the spasms at those accessory muscles including the sternocleidomastoid and the intercostals and the pectoralis muscles.

    07:38 So all these different secondary muscles of inspiration are ones that we need to look out and address.

    07:45 We have to look at the abdominal diaphragm.

    07:47 Like we said before, the abdominal diaphragm becomes flattened in asthma.

    07:52 So gentle doming of the diaphragm could help to restore it's natural shape and then it's function.

    07:58 Patients with asthma typically do not feel comfortable lying on their back.

    08:03 And so, sometimes we may have to adjust our treatment so that we're going to be able to work, work with the patients in a seated position.

    08:11 So sometimes, we may have to do more of a seated re-bracing or do more inhibitory pressure on the spine with them on a seated position.

    08:19 Or try to do a thoracic outlet release in a seated position.

    08:22 As long as you understand the principles of the treatment and the anatomy that you're trying to affect, you could adapt the technique so that you're better able to help treat your patients.

    08:31 There've been prior research studies looking at the safety and efficacy of OMM in improving pulmonary function in asthma.


    About the Lecture

    The lecture Pediatric Considerations in OMM by Sheldon C. Yao, DO is from the course Osteopathic Treatment and Clinical Application by Specialty.


    Author of lecture Pediatric Considerations in OMM

     Sheldon C. Yao, DO

    Sheldon C. Yao, DO


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