So now we're gonna look at a
couple of presentations where
the respiratory-circulatory model approach
could help treat pediatric patients.
So when we are looking at the Respiratory
Circulatory model, our goal is
to try to increase and improve
lymphatic and circulatory flow.
So we're gonna do this by first
addressing any diaphragm restrictions
like the thoracic inlet, abdominal
diaphragm, pelvic diaphragm.
We wanna try to improve the overall
motion of the thoracic cage
where breathing is the main pump
for lymphatics and circulation.
And to promote fluid motion
through these pumps.
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.
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.
So kids frequently present with
otitis media or ear infection.
So otitis media is the
infection of the middle ear.
It's much more common in children because in
children, the eustachian tube is more horizontal.
As children grow, their face becomes longer
and the eustachian tube becomes more vertical
and thus drain more
naturally with gravity.
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.
So this is of upmost importance in
children because recurrent infections,
recurrent ear infections could
lead to long term sequelae.
So, chronic infections could lead to
increased pressure pain and build up.
Sometimes they may need to have to go in there
and put ear tubes to allow for drainage.
And long term, you worry
about possible hearing loss
So OMM could be utilized
to treat otitis media.
There's a technique called
the Galbreath's technique,
which helps to improve drainage
of the eustachian tube.
We have to look at different cranial dysfunctions,
especially looking at the temporal bone
because that's what houses
the eustachian tube itself.
You wanna look at cervical, thoracic especially the
thoracic inlet to help promote lymphatic drainage.
There's been different studies that
have been performed looking at children
with acute otitis media and
also chronic otitis media.
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.
Here, we're gonna talk a little bit more
about the Galbreath technique itself.
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.
And so when you depress and
move your jaw anteriorly,
that helps to open
the eustachian tube.
And so for babies and children, this is something
that's more difficult for them to do spontaneously.
So, you could possibly do this technique
to help open the eustachian tube.
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.
And this will help to improve lymphatic
drainage from the eustachian tube.
Asthma is another frequent
Asthma is usually due to bronchial
spasms - there's air trapping
due to possible overactivity of the vagus
nerve and also secondary to inflammation.
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.
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.
So when children have asthmatic
attacks, what happens is
they start using their accessory muscles
for inspiration a little bit more.
That usually tends to where a little
bit more on their accessory muscles
and those muscles start to spasm.
There's excessive work of breathing
because of that obstructive lung disease.
And so what happens is they'll work much harder
to try to exhale and they get air trapping
And so their lungs
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.
And that becomes a problem because
the diaphragm really is responsible
for about 60% of the change
in thoracic pressures.
So, if we have a hyperinflated airway, the rib
cage is not moving, the diaphragm is stuck.
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.
Here is that image, you could see that with
inspiration, the diaphragm will descend and flatten.
And with exhalation, the diaphragm will
dome and restore it's natural shape.
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.
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.
So what do we want
to do with OMM?
With OMM, what we want to try to do is
improve venous and lymphatic flow.
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.
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.
We want to make sure that we focus
our treatment on treating any
somatic dysfunctions that might
be affecting the thoracic cage.
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.
So we want to try to treat the
spine, the ribs, the muscles
attaching to the rib cage to
allow for optimal expansion.
We also want to
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.
And then again, looking at the
accessory muscles of respiration,
when we struggle to breathe, we're
gonna overuse those muscles.
We want to try to reduce the spasms
at those accessory muscles
including the sternocleidomastoid and the
intercostals and the pectoralis muscles.
So all these different secondary muscles of inspiration
are ones that we need to look out and address.
We have to look at the abdominal diaphragm.
Like we said before, the abdominal
diaphragm becomes flattened in asthma.
So gentle doming of the diaphragm could help to
restore it's natural shape and then it's function.
Patients with asthma typically do not
feel comfortable lying on their back.
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.
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.
Or try to do a thoracic outlet
release in a seated position.
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.
There've been prior research studies
looking at the safety and efficacy
of OMM in improving pulmonary
function in asthma.