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Preface

Posture

Posturology

The case study

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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: Ddo07 and discussed in detail in cycling analysis discussion, and in the self evaluation section and discussed in gait analysis discussion. 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

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