Forward Head Posture Fix

Forward Head Posture Fix

This ebook guide teaches you the muscles that you need to work to make sure that you have excellent posture all day long, and that you will have the benefits that go along with good posture. You will be able to get rid of many headaches, brain fog, and aching neck muscles by using this workout. There is no need to look old! Stooping is the sign of old age Even if you are an older person you too can work out this muscle group to give you the powerful posture of a much younger person! This bad posture that we are correcting is called texting neck. It comes when you look down at something (like a book or your phone) too often, which puts a huge strain on your neck. You will learn how to fix this problem and help your neck to be in better shape today. Your neck is supposed to remain vertical; we can help put it back where it goes to make sure that you stay healthy for years to come. Continue reading...

Forward Head Posture Fix Summary

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Author: Mike Westerdal
Official Website: www.forwardheadposturefix.com

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Highly Recommended

I usually find books written on this category hard to understand and full of jargon. But the author was capable of presenting advanced techniques in an extremely easy to understand language.

My opinion on this e-book is, if you do not have this e-book in your collection, your collection is incomplete. I have no regrets for purchasing this.

Management Of The Sternocleidomastoid Muscle

Including the posterior triangle of the neck in the field of dissection requires a combined approach, both posterior and anterior to the sternocleidomastoid muscle (Fig. 4-15). In the upper half of the neck the dissection is performed anterior to the sternocleidomastoid muscle, whereas in the lower half of the neck the supraclavicular fossa is approached posterior to the sternocleidomastoid muscle. To better understand this, imagine the surgical field divided horizontally in two halves by a line passing through Erb's point, the place where the superficial branches of the cervical plexus appear at the posterior border of the sternocleidomastoid muscle. This creates an upper and a lower part of the neck. The upper half of this division includes the submental and submandibular nodes (area I), the upper part of the posterior triangle of the neck (upper part of area V), and part of the lymphatic chain of the internal jugular vein (area II and part of area III). The dissection of the upper...

Incision Of The Fascia Over The Sternocleidomastoid Muscle

To facilitate the complete dissection of the fascia surrounding the sternocleidomastoid muscle the initial incision must be made as close to the posterior border of the muscle as possible (Fig. 5-7). The reason for this is that the fascia is more easily dissected off the sternocleidomastoid muscle in a forward direction. Making the incision close to the posterior border of the muscle leaves no remaining fascia to be dissected posteriorly and facilitates the complete isolation of the muscle from its surrounding fascia.

Dissection Of The Sternocleidomastoid Muscle

Prior to approaching the fascia of the sternocleidomastoid muscle, the external jugular vein must be ligated and divided. Usually, three sections of the external jugular vein are required in functional and selective neck dissection (Fig. 4-9) (1) at the tail of the parotid gland, where the Figure 4-8 Boundaries of a complete functional neck dissection on the right side of the neck. ML, midline BM, inferior border of the mandible C, clavicle TM, trapezius muscle ga, great auricular nerve SC, sternocleidomastoid muscle sm, strap muscles pm, platysma muscle ej, external jugular vein aj, anterior jugular vein SG, submandibular gland. Figure 4-8 Boundaries of a complete functional neck dissection on the right side of the neck. ML, midline BM, inferior border of the mandible C, clavicle TM, trapezius muscle ga, great auricular nerve SC, sternocleidomastoid muscle sm, strap muscles pm, platysma muscle ej, external jugular vein aj, anterior jugular vein SG, submandibular gland. Figure 4-9...

Dermatomyositis Polymyositis

Inflammatory myositis in both DM and PM can prominently involve musculature in the head and neck area. About one-half of patients experience weakness of the neck flexors ocular and facial muscles are virtually never involved. Weakness of the striated oropharyngeal muscles can result in dysphonia and difficulty swallowing. Dysphagia can also result from esophageal dysmotility or cricoarytenoid sphincter muscle hypertrophy leading to obstruction (26).

Female copulatory behavior

Under these circumstances, the female's behavior is limited to responding to the male's mounts with lordosis, a concave dorsiflexion associated with raised hindquarters. This is achieved by extension of the hind legs. Simultaneously, the tail is turned sideward. The resulting body posture exposes the vaginal opening and makes it possible for the male to achieve intromission. In addition to lordosis, the female may respond to the male's approaches with short runs followed by a sudden stop, or she may even make short hops. These behaviors are identical to parts of the solicitation behavior described above. What is usually missing in small spaces is the initial approach to the male and the turning away from him at some distance. Nevertheless, the short runs and hops, called darting or hop-darting in the scientific literature, are frequently confounded with and used as synonyms for the entire sequence of solicitation. Another frequent behavior displayed by the female is...

Social Support in the Context of Behavioral Stress

Lepore and colleagues (1993) conducted a similar study using a speech task as the behavioral stressor. However, these researchers used slightly different support conditions. In addition to the alone condition, participants were randomly assigned to give a speech in the presence of a same-sex supportive or non-supportive confederate. Support behaviors included reassuring comments (Remember, it will all be over in a few minutes.) and compliments (You did fine.), in addition to non-verbal gestures such as smiles and an open-body posture. The non-supportive condition included neutral behaviors and actual interaction was minimal. Lepore et al found that participants who delivered a speech in the presence of a supportive partner had significantly less reactivity (as measured via systolic and diastolic blood pressure) than those who gave a speech in the presence of a non-supportive partner. The same was true when supported participants were compared with those

Dissecting Through Fascial Spaces

The Latin approach is based on the anatomical compartmentalization of the neck. The fascial system creates spaces and barriers separating the lymphatic tissue from the remaining neck structures. The lymphatic system of the neck is contained within a fascial envelope, which, under normal conditions, may be removed without taking out other neck structures such as the internal jugular vein, sternocleidomastoid muscle, or spinal accessory nerve. The surgical technique that made this possible was initially referred to as functional neck dissection because it allowed a more functional approach to the neck in head and neck cancer patients. However, as previously emphasized, the most important but less well known fact about functional neck dissection is that it represents a surgical concept with no implications regarding the extent of the surgery. Osvaldo Suarez never performed functional neck dissection as the comprehensive type of neck dissection that some have made of it. In fact, the...

Head and Neck Manifestations

Tuberculous Lymphadenitis (Scrofula). This represents the most common form of extrapulmonary TB (13), and in 80 to 90 of cases, it is the only site of infection. In HIVnegative patients, it is usually bilateral and posterior cervical in location, presenting as an erythematous, painless mass along the anterior border of the sternocleidomastoid, typically without systemic symptoms (11). The tuberculin skin test (TST) is positive in more than 75 of patients. In HIV-positive patients, multiple sites may be involved, often with mediastinal and intra-abdominal lymphadenopathy, pulmonary or other organ involvement, and systemic symptoms. The TST is often negative in these patients. Of the patients, 10

The Role Of Selective Neck Dissections In The Functional Approach

Modified Functional ND Fascial neck dissection, including the resection of one or more nonlymphatic structures usually preserved in conventional functional neck dissection (internal jugular vein, sternocleidomastoid muscle, spinal accessory nerve).* Modified Radical ND Neck dissection performed according to the surgical principles of the Crile operation, with preservation of one or more nonlymphatic structures usually removed in radical neck dissection (internal jugular vein, sternocleidomastoid muscle, spinal accessory nerve).*

Physical Characteristics

Hornbills have patches of bare skin around the eyes and throat and long eyelashes on their upper lids. To support their head and large bill, they have strong neck muscles and two neck vertebrae, bones in the spinal column, connected together. Hornbill plumage, feathers, is not very colorful, usually with areas of black, white, gray, or brown. The color and size of plumage and the shape of the casque identifies the age and sex. Hornbills vary in size and shape, from 11.8 to 47.3 inches (30 to 120 centimeters) long, and weigh between 3.5 ounces and 13.25 pounds (100 grams and 6 kilograms). Males are larger and heavier than females and have bills that are up to 30 percent longer.

Identification Of The Spinal Accessory Nerve

The main goal of this step of the operation is to locate the nerve at the entrance of the sternocleidomastoid muscle. The dissection of the entire course of the nerve between the sternocleidomastoid muscle and the internal jugular vein will be performed in a later step of the procedure. The spinal accessory nerve enters the sternocleidomastoid muscle approximately at the junction of the upper and middle third of the muscle. The transverse process of the atlas serves as a useful anatomical landmark (Fig. 4-16). Adequate exposure of the area requires posterior retraction of the sternocleidomastoid muscle. The small vessels that usually go along with the nerve are carefully cauterized and the nerve is examined for divisions that may appear before it enters the muscle. All nerve branches must be preserved to obtain the best shoulder function. Sometimes a branch from the second cervical nerve can be seen joining the spinal accessory nerve before its entrance into the sternocleidomastoid...

Dissection Of The Central Compartment

Figure 4-58 The neck after a right functional neck dissection for supraglottic cancer of the larynx. IJ, internal jugular vein CA, carotid artery SG, submandibular gland oh, omohyoid muscle sh, sternohyoid muscle ls, levator scapulae muscle as, anterior scalene muscle SC, sternocleidomastoid muscle. Figure 4-58 The neck after a right functional neck dissection for supraglottic cancer of the larynx. IJ, internal jugular vein CA, carotid artery SG, submandibular gland oh, omohyoid muscle sh, sternohyoid muscle ls, levator scapulae muscle as, anterior scalene muscle SC, sternocleidomastoid muscle. Figure. 4-59 Artist's view of the neck after right functional neck dissection. IJ, internal jugular vein fv, distal stump of the facial vein CA, carotid artery st, superior thyroid artery SG, submandibular gland PG, parotid gland TG, thyroid gland oh, omohyoid muscle sh, sternohyoid muscle dm, digastric muscle sp, splenius capitis muscle ls, levator scapulae muscle as, anterior scalene muscle...

Knife Dissection And The Functional Approach

The principle of fascial dissection is more easily achieved when the surgeon uses the knife through fascial planes. For some steps of the operation the scalpel is the best surgical tool whereas for others the scissor is preferred. Elevation of the skin flaps and dissection of the sternocleidomastoid muscle, submandibular fossa, deep cervical muscles, carotid sheath, and strap muscles are best performed using knife dissection. On the other hand, dissection of the area around the spinal accessory nerve, posterior triangle, and paratracheal space is more easily accomplished with the scissor. The main difference between these two groups is the type of tissue that is being dissected. Knife dissection requires firm tissue like muscle or vessels (Fig. 5-1), whereas fibrofatty tissue is more easily dissected with the scissors (Fig. 5-2).

Identification Of The Great Auricular Nerve

The great auricular nerve is used to identify the posterior border of the upper part of the surgical field (Fig. 5-5A). This branch of the cervical plexus rounds the posterior border of the sternocleidomastoid muscle from Erb's point and courses almost directly upward toward the ear lobule, where it supplies almost all the auricle, the skin over the parotid gland, and the skin over the mastoid process. Whenever possible, the great auricular nerve should be preserved to avoid numbness of the ear, which is especially disturbing in female patients (Fig. 5-5B).

The Spinal Accessory Maneuver

After the spinal accessory nerve has been completely isolated on its course from the sternocleidomastoid muscle to the internal jugular vein, the tissue lying posterior and superior to the nerve is dissected from the splenius capitis and levator scapulae muscles (Fig. 5-18A). Once dissected from the plane of the deep muscles, the tissue is passed underneath the nerve to be removed en bloc with the rest of the specimen (Fig. 5-18B). 2. After the spinal accessory maneuver has been completed, the dissection is continued anterior to the sternocleidomastoid muscle in a downward direction for a few more centimeters. Keeping the sternocleidomastoid muscle retracted posteriorly, a number 10 knife blade is used to cut the tissue located below the entrance of spinal accessory nerve, until the underlying levator scapulae muscle is noted (Figs. 5-19 and 5-20). This cut is taken inferiorly to the level of Erb's point, and helps in the dissection of the deep muscles that will be performed in a...

Cervical Complications

In the postoperative period, chylous fistula is recognized by the appearance of a milky fluid in the drains. This is usually evident within the first 5 days after surgery. The chylous origin of the fluid can be confirmed by measuring the content of triglycerides, usually over 100 mg dL. When chylous leak is suspected, dietary modifications can be prescribed. Low fat diet, either enteral or parenteral, is usually recommended because medium-chain triglycerides are absorbed directly into the portal venous circulation, avoiding the thoracic duct. Elevation of the head, repeated aspiration, and pressure dressing are also recommended. However, it is important to note that preservation of the sternocleidomastoid muscle in functional and selective neck dissection constitutes an important obstacle for successful compression. Insertion of a pressure packing impregnated with irritant solution, like Betadine, into the area of the thoracic duct has also been recommended as a nonsurgical method to...

Fascial Anatomy of the Neck

The superficial layer of the deep cervical fascia, also known as investing or anterior fascia, completely envelops the neck with the exception of the skin, platysma muscle, and superficial fascia (Fig. 2-1). It is attached to the occipital protuberance, mastoid process, capsule of the parotid gland, angle of the jaw, and body of the mandible to the symphysis, where it proceeds around the opposite side in a similar manner. It then goes posteriorly across the spinal process of the cervical vertebrae and the ligamentum nuchae. Anteriorly, it passes from the mandible to the hyoid bone and from here down to the sternum. Inferiorly, it attaches to the sternum, upper edge of the clavicle, acromion, and spine of the scapula. At the inferior border, in the midline, the superficial layer splits in two different layers just superior to the manubrium of the sternum. The space between these two layers is known as the suprasternal space of Burns. From posterior to anterior, the superficial layer...

Preserving The Branches Of The Cervical Plexus

As already mentioned, the cervical plexus has important connections to the spinal accessory nerve. A branch from the second cervical nerve typically joins the spinal accessory nerve before it enters the sternocleidomastoid muscle. Also, branches from the second, third, and fourth cervical nerves join the spinal accessory nerve (Fig. 5-22). Although the branches connecting the cervical plexus with the spinal accessory nerve are believed to be sensory, surgical evidence suggests that their preservation results in better shoulder function. On the other hand, the deep branches are largely motor, except for the contribution to the sternocleidomastoid and trapezius muscles, where controversy still remains. The deep branches include the ansa hypoglossi, or ansa cervicalis (Fig. 5-23), the phrenic nerve (Fig. 5-21), and the branches to the trapezius muscle (Fig. 5-22). Except for the ansa cervicalis, whose traject is different, the deep branches of the cervical plexus should be preserved by...

Inspiration and Expiration

An unforced, or quiet, inspiration results primarily from contraction of the dome-shaped diaphragm, which lowers and flattens when it contracts. This increases thoracic volume in a vertical direction. Inspiration is aided by contraction of the parasternal and external intercostals, which raise the ribs when they contract and increase thoracic volume laterally. Other thoracic muscles become involved in forced (deep) inspiration. The most important of these are the scalenes, followed by the pec-toralis minor, and in extreme cases the sternocleidomastoid muscles. Contraction of these muscles elevates the ribs in an an-teroposterior direction at the same time, the upper rib cage is stabilized so that the intercostals become more effective. The increase in thoracic volume produced by these muscle contractions decreases intrapulmonary (intra-alveolar) pressure, thereby causing air to flow into the lungs. Sternocleidomastoid Scalenes Sternocleidomastoid Scalenes such as the scalenes and...

Dissection Of The Submandibular Fossa

Figure 4-17 The fascia has been incised along the upper boundary of the surgical field and retracted inferiorly (right side). sf, superior skin flap ml, midline of the neck F, Fascia retracted inferiorly SC, sternocleidomastoid muscle SG, submandibular gland fv, facial vein. Figure 4-17 The fascia has been incised along the upper boundary of the surgical field and retracted inferiorly (right side). sf, superior skin flap ml, midline of the neck F, Fascia retracted inferiorly SC, sternocleidomastoid muscle SG, submandibular gland fv, facial vein. Figure 4-19 Surgical maneuver to preserve the marginal nerve on the right side of the neck. (A) The facial vein is identified immediately below the submandibular gland. (B) The vein is ligated and divided. (C) The distal ligature is left long and reflected superiorly. SG, submandibular gland fv, facial vein SC, sternocleidomastoid muscle dl, distal ligature reflected superiorly. Figure 4-19 Surgical maneuver to preserve the marginal nerve on...

Dissection Of The Posterior Triangle Of The Neck

Functional Neck Dissection Book

Figure 4-30 Spinal accessory maneuver on the right side of the neck. (A) The nerve is exposed between the sternocleidomastoid muscle and the internal jugular vein. (B) The fibrofatty tissue lying posterior and superior to the nerve is passed beneath the nerve. sa, spinal accessory nerve IJ, internal jugular vein SG, submandibular gland dm, digastric muscle SC, sternocleidomastoid muscle ls, levator scapulae muscle S1, specimen from the submandibular and upper jugular area S2, specimen from the upper spinal accessory and posterosuperior jugular area. Figure 4-30 Spinal accessory maneuver on the right side of the neck. (A) The nerve is exposed between the sternocleidomastoid muscle and the internal jugular vein. (B) The fibrofatty tissue lying posterior and superior to the nerve is passed beneath the nerve. sa, spinal accessory nerve IJ, internal jugular vein SG, submandibular gland dm, digastric muscle SC, sternocleidomastoid muscle ls, levator scapulae muscle S1, specimen from the...

Dissection Of The Spinal Accessory Nerve

Spinal Accessory Nerve Rats

The dissection of the spinal accessory nerve is one of the few steps of the operation that we usually perform using scissors instead of scalpel. To approach this area the sternocleidomastoid muscle is retracted posteriorly, and the posterior belly of the digastric muscle is pulled superiorly with a smooth blade retractor (Fig. 4-26). The wet surgical sponges previously left over the nerve at the level of its entrance in the sternocleidomastoid muscle are removed and the nerve is dissected toward the carotid sheath. At this level the nerve runs within the ''lymphatic container'' of the neck, thus forcing the surgeon to cut across the fibrofatty tissue instead of following fascial planes as for the rest of the operation. Consequently, the tissue overlying the nerve is divided and the nerve completely exposed from the sternocleidomastoid muscle to the internal jugular vein (Fig. 4-27). Figure 4-26 Surgical field prepared for the dissection of the spinal accessory area on the right side...

The Transverse Cervical Vessels

Nerve Dermatitis

Figure 5-18 Spinal accessory maneuver on the right side. (A). The fibrofatty tissue of the upper spinal accessory region has been dissected from the deep muscular floor. (B). The dissected tissue has been passed beneath the nerve to join the specimen coming from the submandibular area. sa, spinal accessory nerve ls, levator scapulae muscle IJ, internal jugular vein hn, hypoglossal nerve SC, sternocleidomastoid muscle SS, specimen from the upper spinal accessory region SJ, specimen from the upper jugular and submandibular area. Figure 5-18 Spinal accessory maneuver on the right side. (A). The fibrofatty tissue of the upper spinal accessory region has been dissected from the deep muscular floor. (B). The dissected tissue has been passed beneath the nerve to join the specimen coming from the submandibular area. sa, spinal accessory nerve ls, levator scapulae muscle IJ, internal jugular vein hn, hypoglossal nerve SC, sternocleidomastoid muscle SS, specimen from the upper spinal accessory...

Management Of The External Jugular Vein

Repair External Jugular Vein

The external jugular vein begins in the substance of the parotid gland. It is most often formed by the union of the retromandibular (posterior facial) and the posterior auricular veins. It runs vertically downward across the superficial surface of the sternocleidomastoid muscle to pierce the fascia of the posterior triangle of the neck just above the clavicle. The external jugular vein terminates in the subclavian or in the internal jugular vein after receiving several tributaries throughout its cervical course (Fig. 2-12). Figure 5-5 Identification and preservation of the great auricular nerve on the right side. (A) The great auricular nerve crosses the external face of the sternocleidomastoid muscle from Erb's point toward the ear lobule. (B) The fascia over the sternocleidomastoid muscle is incised anterior to the great auricular nerve in order to preserve innervation of the ear lobule. ga, great auricular nerve tc, transverse cervical branch of the cervical plexus SC,...

Dissection Of The Carotid Sheath

Carotid Artery Dissection

Figure 4-42 The whole specimen is now anterior to the sternocleidomastoid muscle. Note the anterior (a) and posterior (p) branch of the cervical plexus. The anterior branches must be sectioned (arrow) to continue the dissection toward the carotid sheath (right side). SC, sternocleidomastoid muscle US, upper part of the specimen (submandibular, upper jugular, and upper spinal accessory areas) LS, lower part of the specimen (supraclavicular fossa). Figure 4-42 The whole specimen is now anterior to the sternocleidomastoid muscle. Note the anterior (a) and posterior (p) branch of the cervical plexus. The anterior branches must be sectioned (arrow) to continue the dissection toward the carotid sheath (right side). SC, sternocleidomastoid muscle US, upper part of the specimen (submandibular, upper jugular, and upper spinal accessory areas) LS, lower part of the specimen (supraclavicular fossa). Figure 4-43 Lateral view of the deep branches of the cervical plexus that have been preserved on...

Dissection Of The Deep Cervical Muscles

Figure 4-41 Lateral view of the bridge of tissue between the upper and the lower parts of the specimen on a right functional neck dissection. br, bridge of tissue between the upper and lower parts of the specimen US, upper part of the specimen (submandibular, upper jugular, and upper spinal accessory regions) LS, lower part of the specimen (supraclavicular area) SC, sternocleidomastoid muscle retracted laterally IJ, internal jugular vein sa, spinal accessory nerve sn, supraclavicular branch of the cervical plexus. Figure 4-41 Lateral view of the bridge of tissue between the upper and the lower parts of the specimen on a right functional neck dissection. br, bridge of tissue between the upper and lower parts of the specimen US, upper part of the specimen (submandibular, upper jugular, and upper spinal accessory regions) LS, lower part of the specimen (supraclavicular area) SC, sternocleidomastoid muscle retracted laterally IJ, internal jugular vein sa, spinal accessory nerve sn,...

The Marginal Mandibular Branch Of The Facial Nerve

Marginal Mandibular Branch

Figure 5-7 Lateral view of the dissection of the sternocleidomastoid muscle on the right side. The fascia is incised over the posterior border of the muscle and dissected forward. The great auricular nerve has been preserved. Note the external jugular vein ligated at the posterior border of the sternocleidomastoid muscle and above the clavicle. SC, sternocleidomastoid muscle F, fascia dissected from the sternocleidomastoid muscle ga, great auricular nerve ej, external jugular vein. Figure 5-7 Lateral view of the dissection of the sternocleidomastoid muscle on the right side. The fascia is incised over the posterior border of the muscle and dissected forward. The great auricular nerve has been preserved. Note the external jugular vein ligated at the posterior border of the sternocleidomastoid muscle and above the clavicle. SC, sternocleidomastoid muscle F, fascia dissected from the sternocleidomastoid muscle ga, great auricular nerve ej, external jugular vein.

Crile and the Radical Neck Dissection

The grandfather of neck dissection in North America is George Crile, Sr., of the Cleveland Clinic. In 1906, Crile portrayed the field of head and neck surgery as being behind the times in terms of interest and progress. Many head and neck cases were regarded as hopeless. The belief, at that time, held that cancer of the upper aerodigestive system remained localized until regional metastases developed. Regional lymph nodes were regarded as vigorous barriers to distant dissemination. Crile cited an autopsy study of 4500 patients with head and neck cancer that was initiated by himself but carried out by Dr. Hitchings. The latter claimed that less than 1 of head and neck cancers, at death, had distant metastases. Crile believed that, if the neck lymphatics could be removed in a radical manner and ''en bloc,'' more cures could be accomplished. The oncological premises of Crile's time were strongly influenced by Halstead. The concept of the ''bloc'' that was in vogue for the treatment of...

Muscles Of The Thoracic Wall

The scalene muscles and the sternocleidomastoid muscle in the neck also contribute to respiration, especially during deep respiration (Figs. 4 and 5). The scalene muscles have their origin on the transverse processes of cervical vertebrae 4 to 6. The anterior and middle scalenes insert on the first rib and the posterior scalene on the second rib. As its name suggests, the ster-nocleidomastoid has its origin on the mastoid process of the skull and inserts on the medial aspect of the clavicle and the manubrium of the sternum. When contracting with the head and neck fixed, these muscles exert an upward pull on the thorax and assist in respiration.

Dietary Recalls

Regardless of whether 24-h dietary recalls are done in-person or over the telephone, the protocols work best when interviewer scripts are standardized on a computer screen with direct data entry into a software program. It is very important that the interviewer be well trained since tone of voice, body posture (when inperson), and reactions to participant descriptions of foods consumed can influence the quality of the data, including omissions or phantom food additions (Conway et al, 2004). Sometimes interviewers need to redirect the conversation back to the structured questions, should the respondent deviate off-topic, which can be a problem when assessing specific population subgroups, such as the elderly. As with food records, the use of portion size estimate aides, such as life-size food models, photographs, or dimensional aides including rulers and measuring cups, increases the ability to estimate portion size thereby improving the reliability of the recall data (Pietinen et al,...

Number

With careful scrutiny of Mr. von Osten, Pfungst noted that after a question was posed to Hans, Mr. von Osten lowered his head slightly and bent forward, maintaining this position until the correct number was tapped, at which time he jerked his head upwards. The three other people for whom Hans performed well showed similar behaviors. Pfungst performed experiments in which Mr. von Osten (and the others) provided these behavioral cues at appropriate times (consistent with the correct answer) and at inappropriate times (consistent with a wrong answer). Hans' performance showed that he was responding to these cues. Pfungst suggested that Hans was sensitive to subtle cues from Mr. von Osten, beginning to tap when Mr. von Osten bent his head and continuing to tap until he detected a shift in Mr. von Osten's body posture. Hans' numerical ability was not based on an understanding of number, but rather on his reading of unintentionally provided subtle behavioral cues from his human questioner....

Raising The Flaps

Figure 5-2 Fibrofatty tissue is best dissected with the scissors. Here an example of the dissection of the supraclavicular fossa on the right side. SC, sternocleidomastoid muscle retracted medially sn, supraclavicular nerve. Figure 5-2 Fibrofatty tissue is best dissected with the scissors. Here an example of the dissection of the supraclavicular fossa on the right side. SC, sternocleidomastoid muscle retracted medially sn, supraclavicular nerve. Figure 5-3 Regularly washing the field allows better visualization of the anatomical structures. SG, submandibular gland IJ, internal jugular vein ca, carotid artery lv, lingual veins sa, spinal accessory nerve hn, hypoglossal nerve SC, sternocleidomastoid muscle oh, omohyoid muscle sh, sternohyoid muscle sp, splenius capitis muscle ls, levator scapulae muscle ND, neck dissection specimen. Figure 5-3 Regularly washing the field allows better visualization of the anatomical structures. SG, submandibular gland IJ, internal jugular vein ca,...

The Thoracic Duct

The large lymphatic channels that terminate at the base of the neck are the thoracic duct on the left and the right lymphatic duct on the right. The right lymphatic duct is not a common source of problems during neck dissection. However, injuring the thoracic duct during the operation results in persistent chylous leak that may be extremely difficult to solve in patients with a functional approach. Preservation of the sternocleidomastoid muscle in these patients decreases the efficacy of the usual compressive maneuvers that are used to stop chylous leak. Thus, early recognition of lymphatic leakage during the operation is crucial in order to repair the injury before closure. Precise knowledge of the cervical course of the thoracic duct is fundamental to avoid postoperative problems. Figure 5-30 Repair of an injured thoracic duct requires the use of muscle, fascia, or adipose tissue to surround the fragile wall of this major lymph duct. td, thoracic duct IJ, internal jugular vein SC,...

Therapy Evaluation

Sitting and standing posture are observed with attention to trunk flexion, forward head, or uneven lower extremity weight-bearing. Postural deficits alter the body's center of gravity during movement. Postural deficits also create muscle imbalances due to overly tight and overly stretched muscles that can contribute additional impairment to the rigidity and weakness, usually accompanying PD.

Exercise

Postural instability is created by a pattern of weakness, muscular tightness, and standing alignment changes that diminish the patient's ability to control their center of gravity during transfers and gait. A common presentation is that of a stooped forward posture of the upper body with tight anterior chest wall musculature and a crouched lower body posture. A series of stretching exercises designed to diminish kyphosis of the thoracic spine and increase flexibility in the pectoralis major and minor muscles can lead to improved upper body posture and upper limb function. In the lower aspect of the body, strengthening of the lumbar paraspinal musculature and stretching of the hamstring and hip flexor muscles can be used to improve posture. It is important not only to stretch the key muscles in patients with poor posture, but to also strengthen the appropriate muscles to achieve good biomechanical alignment. To improve muscle length, therapists use several techniques, including heat...

Topographic Anatomy

Neck Spaces

From a topographic standpoint, the sternocleidomastoid muscle and the carotid sheath divide each side of the neck into two different spaces. Although pyramidal in shape, these spaces are known as the anterior and posterior triangles of the neck (Fig. 2-8). The posterolateral space has a cranial apex at the level of the mastoid and a base at the level of the clavicle. It does not have a definite anatomical boundary, because it merges into the axilla through the cervicoaxillary canal. The apex of the medial space is located at the bottom of the neck and its base lies at the level of the submandibular gland and tail of the parotid gland. These spaces contain the lymph nodes that drain most cervical structures. The anterior triangle is bounded by the anterior midline of the neck, the anterior border of the sternocleidomastoid muscle, and the inferior border of the mandible. The jugular notch constitutes the apex, and the base is formed by the inferior border of the mandible. The posterior...

Surgical Anatomy

Cervical Plexus

The external jugular vein begins near the angle of the mandible, within the parotid gland, by the union of the posterior division of the retromandibular vein (posterior facial vein) with the posterior auricular vein (Fig. 2-12). It then runs obliquely across the sternocleidomastoid muscle, in the superficial layer of the cervical fascia, accompanied by the great auricular nerve in its upper half. The vein pierces the deep fascial layer at the posterior border of the muscle, about 5 cm above the clavicle. It usually terminates in the subclavian vein, but it may also end in the internal jugular vein. It may be double or have a bifid termination. Sometimes the external jugular vein is very small and may even be absent. In these cases the anterior jugular vein, the internal jugular vein, or both, are usually enlarged. Tributaries and communicating branches to the external jugular vein include the posterior auricular, occipital, posterior external jugular, transverse cervical,...

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