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C Sutures, jointsandligaments 57 1 2 2 3 3 4 14 4 6 15 17 10 5 5 6 15 7 8 A Skull of newborn, C Ligaments of vertebral column 9 inferior view and ribs, lateral view 10 11 58. Ligament extend lar facet of the atlas and the superior articular ing from a rib to the next higher transverse 2 facetoftheaxis. Cruciateligamentconsistingofthetwo tween the superior costotransverse ligament following ligamentous bands (6, 7) located be andtheneckoftherib. Part of the cruciform ligament of 11 theatlaspassingbehindthedensandextending 22 Radiate sternocostal ligaments. It passes from the axis to the branous covering of the anterior surface of the anterior margin of the foramen magnum and is sternumformedbythefibersoftheradiatester continuouswiththedura-periosteallayerofthe nocostalligaments. Ar Fiber tracts extending downward from the 7th 15 ticularconnectionsoftheskeletonofthethorax. Articular unions that connect the headsoftheribswiththevertebralbodiesandin 26 Internal intercostal membrane. Continuation of the internal 18 intercostalmusclesnearthevertebralendofthe 12 Radiate ligament of head of rib. Ligament radiating predomi 19 nantlyfromtheanteriorsideoftheheadofaribto 26a Sternocostal synchondrosis of the first rib. Ligament between the neck of a rib and 25 the transverse process of the corresponding vertebra. Fibrocar of fibrous tissue and fibrocartilage positioned tilaginousinterarticulardisc. Two-part band connecting the coracoid 4 capsule on all sides, it divides the joint into two processandtheclavicle. C portion of the coracoclavicular ligament taking 4 Lateral (temporomandibular) ligament. G 12 dibular foramen to the spine of the sphenoid bonelateraltotheforamenspinosum. Ligamentpassingfromtheanteriorsurface of the styloid process to the angle of the 26 Costoclavicular ligament. Articulationes ment running between the styloid process and membrisuperiorisliberi. Strong band extending from the Thickened portion of the capsule passing from 20 coracoid process to the acromion. Weak fibrous band passing from the root of the spine of the scapula to the posterior margin of the glenoid 24 cavity. D Sutures, jointsandligaments 61 1 3 2 5 7 1 4 3 10 8 4 9 9 5 11 6 A Temporomandibular joint, C Temporomandibular joint, 7 lateral viewl sagittal section 8 B Temporomandibular34. Ligament extending from the flexor circumferenceoftheradiusandtheradialnotch sideoftheheadoftheulnarchieflytothecapitate 5 oftheulna.

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However, when an injury occurs, the procoagulants are activated and a clot is formed. Basically, the clotting process consists of the following essential steps ure 9-2): 1. The injured tissues release thromboplastin, a substance that triggers the clotting mechanism. Thromboplastin reacts with certain protein factors and calcium ions to form prothrombin activator, which in turn reacts with calcium ions to convert the prothrombin to thrombin. Fibrin forms a network of threads that entraps red blood cells and platelets to form clot. Thromboplastin Ca++ Prothrombin Thrombin Fibrinogen Fibrin threads + Blood cells and plasm a Clot Blood Typing and Transfusions Blood Groups If for some reason the amount of blood in the body is severely reduced, through haemorrhage or disease, the body cells suffer from lack of oxygen and food. The obvious measure to take in such an emergency is to inject blood from another person into the veins of the patient, a procedure called transfusion. These reactions are determined largely by certain proteins, called antigens, on the surface membrane of the red blood cells. There are many types of these proteins but only two groups are particularly likely to cause a transfusion reaction, the so-called A and B antigens and the Rh factor. Blood serum containing antibodies that can agglutinate and destroy red cells that have A antigens on the surface is called anti-A serum; blood serum containing antibodies that can destroy red cells with B antigen on the surface is called anti-B serum. However, because of other factors that may be present in the blood, determination of blood type must be accompanied by additional tests (cross matching) for compatibility before a transfusion is given. The Rh factor Rh factor is another red cell antigen that determines the blood group. Those individuals who possess this antigen in their red cell surface are said to be Rh positive. If Rh positive blood is given to an Rh negative person, he or she may become sensitized to the protein in the Rh positive blood.

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Eventing Horses Eventing comprises three tests over a period of three days: dres sage, stadium jumping, and cross-country. Only a horse capable of using the thrust and shock-absorbing capacity of his hindquarters and fore quarters correctly will be able to sufficiently reduce the strain on the tendons and muscles to cope with the demands of the three phases of competition. This discipline requires an extraordinarily high level of fitness and competence from both horse and rider. But even those horses that are fit to compete may show signs of tying up or colic, which could be influenced by weather condi tions or the stress of the competition itself. Proper conditioning is very important in building up the tendons, ligaments, and muscles to prevent sprains, strains, inflammations, and stress points. Endurance Horses Competitive trail riding and long-distance riding tests the endurance and stamina of both horse and rider. Endurance com petitions take place in an established time frame over distances ranging from 25 miles to 100 miles and over trails with varied ter rain, including steep hills and natural obstacles. During the ride, the physical condition of the horse is monitored at regular inter vals. At the end of the ride, the horse must show very close to the same physical statistics (pulse and respiration rate, hydration) as he did at the start of the ride. All breeds of horses compete in endurance, but serious com petitors prefer the Arabian horse and Arabian crosses. It is said that the shorter back, very dense bone, and natural ability of Arabians to go for long periods of time with little food or water are what make them a favorite choice for endurance riding. Problem Areas: Exhaustion, dehydration, electrolyte imbalance, tying up, inflammation, and muscle contractures are the principal problems. The recuperation routine (see chapter 6) is often used on endurance horses right after the race. Areas of Stress Specific to Each Discipline 311 Polo Ponies Polo is an exciting and spectacular game in which two opposing teams of four players on horseback use mallets to score goals with a ball. Polo ponies must be able to turn on a dime and do flying changes of lead, sliding stops, and neck rein. Small Thoroughbreds and Quarter Horse crosses are used, but the specially-bred Argentinean Thoroughbreds (Argentinean ponies) are preferred by the high goal and serious international players. Problem Areas: All ligaments and muscle groups of the leg are under constant stress. Also, as a result of the fast pace of the game, lactic acid builds up con siderably during this demanding activity; therefore the recupera tion routine (see chapter 6) is very helpful, especially after a game. Western Performance Horses Western performance competitions include action-packed sports such as reining, cutting, barrel racing, calf-roping, team penning, and steer-wrestling. Each discipline has its own unique and highly technical skills that have to be mastered by both horse and rider.

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Air way clearance therapies and modalities can increase the Relaxation Breathing rate and quantity of mucus movement from the lungs and Hyperinflation of the lungs during an asthmatic attack is thus improve lung function. For this chapter, the follow believed to be due to the hyperventilation in breathing ing clearance therapies will be described: positive expira which occurs during the attack. This type of breathing exercise is commonly prac ticed with alternative therapies such as yoga. The patients Positive Expiratory Therapy are instructed to relax their shoulders and take slow deep breaths through the nose or mouth. This muscular relax bronchitis, bronchiectasis), pneumonia, atelectasis, unpro ation also helps to reduce the hyperinflation that occurs ductive cough, and for postoperative patients. The relaxation technique has been shown to reduce expectoration of secretions, expansion of air distribution in respiratory rate, dyspnea scores, and anxiety associated the lungs, and improved gas exchange. Idiopathic pulmonary fibrosis; the inflammatory Asthma occurring in those over age 35 is considered hypothesis revisited. Acute asthma in adults: a re rial oxygen saturation, relief of airway obstruction, view. Acapella Device remove secretions and increase air flow to underaer ated portions of the lungs. The Acapella is a handheld has a mouthpiece connected to a plastic tube, and the device that should be used by patients who are oriented other end holds a metal ball in a plastic cone covered with and compliant and have a desire to positively affect their a cap. This creates the oscillatory effect tive exhalation, which produces an oscillatory effect that that vibrates the airway and allows air to get behind the vibrates the walls of the airway and aids in the removal of secretions, moving them to larger airways and thus mak secretions. Exhaled air is forced through an opening that is ing secretions easier to cough up. The oscillations also occasionally blocked by a pivoting cone and produces allow air to get into the small airways that may have col the vibratory effect. The oscillations only tory pressure in the airways that helps reduce the collapsi occur on exhalation. The frequency created by the oscil bility of the airway and assists in increasing air flow lations range from 6 to 20 Hz. The oscillation frequency range parallel to the ground, the frequency is 15 Hz; if the Flut from 0 to 30 Hz and can be adjusted by the dial found on ter valve is tilted slightly upward, the frequency increases the Acapella device; the resistance to the opening is also (. Instructions for using the Acapella device are pre efits of this device are the same as the Acapella and any sented in Table 13-5. The best angle can be found by plac 308 Therapeutic Exercise for Physical Therapy Assistants Figure 13-10 Patient utilizing the Acapella device.