br Summary br Introduction br Respiratory rehabilitation pro

Summary
Introduction
Respiratory rehabilitation program Muscular training is the key factor of the respiratory rehabilitation program described in this paper. The exercises are grouped according to the body area of interest into local exercises (involving nose, lips, antigravity muscles of mastication), see Table 1, and general ones (physical therapy), Table 2. These exercises are taught with the cooperation of a speech therapist and they are performed by the patient in a work at home program. Muscular training must be performed for the whole ap-1 transcription factor of active expansion by the maxillary expander and for at least one month during the post-expansion retention period. The patient and their parents must really commit and cooperate to keep the therapy effective. The results achieved would allow to assess whether to continue the therapy for an additional variable period. With regards to the number of the exercises, we suggest to choose two kinds of general exercises and two kinds of local ones for each body area, alternating their prescription in the sessions. The patients are requested to carry out the whole series of the prescribed exercises (local exercises and general ones) twice a day at least; three times a day would be the ideal frequency. Whenever the child successfully completes the whole series he will note it on a chart marking the current date. This would make the child more aware and the operator will be able to monitor patient’s compliance with the therapy. In order to promote the restoration of physiological breathing it would be useful to add to the muscular training hygienic and behavior instructions as well as other therapeutic procedures such as rhinosinusal washes. We also suggest a postural re-education (Alexander technique) and, if necessary, a pharmacological treatment aimed to improve nasal obstruction. An otolaryngologist consultancy before the orthodontic-myofunctional therapy is advisable in order to prevent and treat nasal obstruction. The therapeutic program is described below, organized following a topographical criteria. It must be customized for each patient, considering their needs and level of collaboration.
Local rehabilitation of the nose
Local rehabilitation of the lips The myofunctional local therapy of our program is also aimed at improving lips function and tone, often found deficient in mouth breathing children [1,2]. For children showing hypotonia of both lips and not affected by hypertonia of the mental muscle a considerable improvement can be achieved by performing the following exercises. Each exercise is described by its name followed by the description of the exercise in the paragraph below. Perform the chosen exercises two-three times a day.
Local rehabilitation of the tongue The purpose of the tongue exercises is to maximize the mobility of the muscles styloglussus, genioglossus, hyoglossus, palatoglossal muscle superior longitudinal and transverse. The patient is requested to move the tongue tip in clockwise and counter clockwise directions within the vestibule of oral cavity for 20 times in each direction, three times a day, in the morning, afternoon and night, every weekday [60].
Exercises of the muscles velopharyngeal sphincter Exercises of the muscles velopharyngeal sphincter: executed to maximize the mobility (isothonic exercise) and to increase the tension (isometric excercise) of the muscles uvula, palatopharingeo, tensor and levator soft palate. The patient was oriented to emit a /ra/ syllable extending the /r/ consonant, with change of head position to facilitate the muscles mobility, that is, the patient could hold his head straight up or bend it down or up as he wished to facilitate the proper movement of the cited muscles, while producing the syllable. Three series of 10 repetitions were executed, three times a day, in the morning, afternoon and night every day of the week [49].
Exercises of the muscle suprahioideos and tongue