Comp 7

Question 1

For ME for rib 1 exhalation pump handle dysfunction, what is the position of the patient?

Answer 1

Supine with hand on side of dysfunctional rib on forehand and palm up

Question 2

For ME for rib 1 exhalation pump handle dysfunction, where is the student and the hands?

Answer 2

Standing at edge of table on dysfunctional rib side
Contact superior aspect of affected rib angle with one hand
Place other hand on top of patient’s hand on forehead

Question 3

What does the student do during inhalation for ME for rib 1 exhalation pump handle dysfunction?

Answer 3

Pull inferior on affected rib, encouraging engagement into inhalation barrier of rib
While simultaneously applying a posterior pressure to patient’s hand that is on forehead

Question 4

What does the patient do when holding his breath and force is being applied to rib angle for ME for rib 1 exhalation pump handle exhalation dysfunction? What muscle is activating to correct the dysfunction?

Answer 4

Patient raises his head off table into student’s hand for 3-5 seconds (isometric contraction)
Then relax and breathe (post-isometric relaxation)
Anterior scalene muscle is activating to correct dysfunction

Question 5

Describe how to diagnose rib 1 bucket handle exhalation somatic dysfunction

Answer 5

Patient supine
Student at head of table
Student places thumbs on angle of rib 1 and index fingers posterior to clavicle and over lateral aspect of rib 1 on midaxillary line
Student monitors through inhalation/exhalation
Note dysfunctional rib lagging behind upon inhalation compared to other side

Question 6

Describe position of patient for ME for rib 1 exhalation bucket handle dysfunction?

Answer 6

Patient supine with head and neck rotated 30 degrees away from affectd side
Patient has hand on side of dysfunctional rib on forehead and palm up

Question 7

Describe position of student and hands for ME for rib 1 bucket handle exhalation dysfunction?

Answer 7

Student at edge of table on dysfunctional rib side
Contacts superior aspect of affected rib angle with one hand
Places other hand on top of patient’s hand on forehead

Question 8

What does the student do during patient inhalation for ME for rib 1 exhalation bucket handle dysfunction?

Answer 8

Student pulls inferior on affected rib, encouraging engagement into the inhalation barrier of rib
While simultaneously applying posterior pressure to patient’s hand that is on forehead

Question 9

What does the patient do when holding his breath and force is being applied to rib angle during ME for rib 1 bucket handle exhalation somatic dysfunction? What muscle is activating to correct dysfunction?

Answer 9

Patient raises his head off table into student’s hand for 3-5 seconds (isometric contraction)
Then relax and breathe (post-isometric relaxation)
Middle scalene muscle

Question 10

Describe how to diagnose rib 2-10 exhalation pump handle somatic dysfunction

Answer 10

Patient supine
Student at head of table
Fingers or medial aspects of hands parasternally for ribs 2-6 then over costochondral junctions of ribs 7-10.
Monitor through inhalation/exhalation
Dysfunctional rib lags behind upon inhalation copmared to other side
For a group dysfunction, treatment will be focused to superior rib of group

Question 11

Where is the patient for ME for ribs 2-10 exhalation pump handle somatic dysfunction?

Answer 11

Patient supine

With hand on side of dysfunctional rib on forehead palm up

Question 12

Describe how to diagnose a rib 1 pump handle exhalation somatic dysfunction

Answer 12

Patient supine
Student at head of table
Place thumbs on angle of rib 1
Place index fingers posterior to clavicle and over anterior aspect of rib 1
Monitor through inhalation and exhalation
Dysfunctional rib lagging behind upon inhalation compared to other side

Question 13

Where is the student and hads for ME for ribs 2-10 exhalation pump handle somatic dysfunction?

Answer 13

Student standing at edge of table on dysfunctional rib side
Contact superior aspect of affected rib angle with one hand
Other hand on top of pt’s hand on forehead

Question 14

What does the student do during pt inhalation for ME for ribs 2-10 pump handle somatic dysfunction?

Answer 14

Pull inferior on affected rib
Encourage engagement into inhalation barrier of rib
While simultaneously applying a posterior pressure to pt’s hand that is on forehead

Question 15

During ME for ribs 2-10 exhalation pump handle somatic, what does the patient do while holding breath and force is applied to rib angle? What muscles are activating the force?

Answer 15

Pt raises hand on forehead toward ceiling and into student’s hand for 3-5 seconds (isometric contraction)
Then relax and breathe (post-isometric relaxation)
Pectoralis and serratus anterior muscles

Question 16

Describe diagnosis of rib 2-10 bucket handle exhalation somatic dysfunction

Answer 16

Patient supine
Doc at head of table
Doc fingers on ribs in midaxillary line
Monitor through inhalation/exhalation
Dysfunctional rib lags during inhalation
Treatment will be focused to superior rib of group

Question 17

For ME for ribs 2-10 exhalation bucket handle somatic dysfunction, describe pt placement

Answer 17

Pt supine with hand on side of dysfunctional rib placed on forehead, palm up

Question 18

For ME for ribs 2-10 exhalation bucket handle somatic dysfunction, where is the students and hands?

Answer 18

Student at edge of table on dysfunctional side
Contact superior aspect of affected rib angle
Other hand on top of pt’s hand that is on forehead

Question 19

During inhalation for ME for ribs 2-10 exhalation bucket handle somatic dysfunction, what does the student do?

Answer 19

Pull inferior on affected rib
Encourage engagement into inhalation barrier
While simultaneously applying a posterior pressure to pt’s hand on forehead

Question 20

When pt holds breath during ribs 2-10 exhalation bucket handle somatic dysfunction, what does the pt do? What is the activating muscle?

Answer 20

Raise hand toward ceiling and laterally at 45 degree angle and into student’s hand (isometric contraction)
Relax and breathe (post-isometric relaxation
Lateral part of serratus anterior muscle

Question 21

Describe diagnosis for ribs 11-12 exhalation caliper somatic dysfunction

Answer 21

Pt prone
Student at side of table
Place fingers on body of ribs 11-12
Monitor through inhalation/exhalation
Dysfunctional rib lags behind inhalation compared to other side
Group dysfunction will be treated by focusing on superior rib

Question 22

What is the position of the pt for ME for ribs 11-12 exhalation caliper dysfunction? Student position?

Answer 22

Pt prone
Student standing at side opposite dysfunctional rib
While monitoring dysfunctional rib, student moves pt’s lower extremities to induce side-bending of spine away from rib
Student moves pt’s involved side arm above head in abduction
With caudad hand, student grasps ASIS on side of dysfunction and pulls posterior to induce spinal rotation toward side of dysfunction
Cephalad hand will be placed on posterior aspect of involved rib just proximal to rib angle

Question 23

What do the student and pt do when pt holds breath during ME for ribs 11-12 exhalation caliper dysfunction? What muscles provide activating force?

Answer 23

Student applies lateral distraction force on affected rib
Pt pulls ipsilateral hip toward table
Lateral part of latissimus dorsi and quadratus lumborum

Question 24

Describe student and pt positions for ME for rib 1 inhalation pump handle somatic dysfunction?

Answer 24

Pt supine
Student at head of table and contacts superior/anterior aspect of dysfunctional rib with thumb (between 2 heads of SCM)
Student flexes head and neck to engage exhalation barrier

Question 25

What does the student do during exhalation and inhalation for ME for rib 1 inhalation pump handle? Activating muscle?

Answer 25

During exhalation, apply force to anterior aspect of rib to follow dysfunctional rib inferiorly into its exhalation position During inhalation, resist rib motion SCM

Question 26

Describe student and pt position for ME for rib 1 inhalation bucket handle?

Answer 26

Pt placed in supine Student at head of table and contacts lateral aspect of dysfunctional rib with thumb (lateral to SCM) Student flexes head and neck and sidebends toward dysfunctional rib to engage exhalation barrier

Question 27

WHat does student do during exhalation and inhalation for ME For rib 1 inhalation bucket handle?

Answer 27

During exhalation, student applies force to lateral aspect of rib to follow dysfunctional rib motion inferiorly into exhalation position During inhalation, resist rib motion SCM

Question 28

Describe student and pt position for ribs 2-10 inhalation pump handle?

Answer 28

Pt supine Student at head of table with knee on table and under patient at level of dysfunctional rib to flex trunk to encourage rib into exhalation barrier Contact affected rib parasternally/costochondral junction as well as superior aspect of dysfunctional rib

Question 29

what does the student do during exhalation and inhalation for ME for ribs 2-10 inhalation pump handle? Activating muscles?

Answer 29

During exhalation, student applies force to anterior aspect of rib to follow dysfunctional rib inferiorly into its exhalation position Resist rib motion during inhalation Intercostal muscles and descent of diaphragm

Question 30

Describe student and pt position for ME for ribs 2-10 inhalation bucket handle

Answer 30

Pt supine Student standing at head of table with knee on table under pt at level of dysfunctional rib to flex trunk to encourage rib into exhalation barrier Sidebend pt's rib toward affected rib until relief of tissue tension is felt Contact affected rib laterally (midaxillary line) as well as superior aspect of dysfunctional rib

Question 31

What does student do during exhalation and inhalation for ME for ribs 2-10 inhalation bucket handle? Activating muscles?

Answer 31

During exhalation, student applies force to lateral aspect of rib to follow dysfunctional rib inferiorly into exhalation barrier Resist during inhalation Intercostal m and descent of diaphragm

Question 32

Describe pt and student position for ME for ribs 11-12 inhalation caliper somatic dysfunction?

Answer 32

Pt prone Student standing at side of table, opposite side of dysfunctional rib While monitoring dysfunctional rib, pull pt's lower extremities to induce side-bending away from dysfunctional rib. Keep pt's arms at side With caudad hand, student grasps ASIS on side of dysfunction and pulls posterior to induce spinal rotation toward side of dysfunction Place cephalad hand on posterior aspect of involved rib just distal to rib angle

Question 33

During exhalation, what do student and pt do for ME for ribs 11-12 inhalation caliper? Activating muscles?

Answer 33

Lateral distraction force is applied on affected rib Pt pulls ipsilateral hip toward table Quadratus lumborum m

Question 34

Describe diagnosing posterior rib somatic dysfunction

Answer 34

pt prone or seated Student loads and springs on rib angles, noting for hard end feel Rib angle will be posterior in comparison to other side Tissue texture changes and pain

Question 35

Describe student and pt position for modified Kirksville HVLA for posterior rib head

Answer 35

Pt supine Student standing on contralateral side of dysfunction (opposite) Student has pt's arm on side of dysfunction reach toward opposite ASIS, while contralateral arm grasps opposite shoulder Student rolls pt toward self by grasping opposite shoulder, then places caudad thenar eminence on posterior rib angle to act as a fulcrum Student flexes upper extremity at shoulder closest to student, to place pt's elbow directly over posterior rib angle Cephalad hand and arm can be under pt's head to add slight tension Roll pt onto back and past midline to direct pressure to rib angle

Question 36

Describe the thrust for modified Kirksville HVLA for posterior rib head

Answer 36

Student will increase posterior pressure into thoracic cage | Then provide an anterior to posterior thrust (into table) to dysfunctional rib angle

Question 37

Describe pt and student position for chin pivot HVLA for ribs 1-4

Answer 37

Pt prone and cup chin with ipsilateral hand Student at head of table opposite side of dysfunctional rib Contact dysfunctional rib by placing thenar/hypothenar eminence at dysfunctional rib angle with one hand Move ipsilateral elbow cephalad until motion is palpated at dysfunctional to gap rib and transverse process Place other hand on same side of patient's head at dysfunctional rib and rotate head/neck toward side of dysfunction into restrictive barrier

Question 38

Describe the thrust for chin pivot HVLA for ribs 1-4

Answer 38

with exhalation, student increases force onto rib angle and simultaneously into rotation barrier with head and neck At end of exhalation, student applies thrust onto dysfunctional rib in an anterior/lateral direction Thrust is not onto patient's head/neck. Hand is only stabilizing head to maintain side bending/rotation barrier

Question 39

Describe diagnosis for elevated 1st rib

Answer 39

Pt supine Student at head of table Load and spring inferior onto 1st rib at midaxillary line noting for hard end feel

Question 40

Describe pt and student position for J-stroke HVLA for elevated 1st rib

Answer 40

Pt seated Student behind patient. Place foot opposite dysfunctional rib on table and have patient drape arm over knee and allow pt to lean into student's leg Student contacts dysfunctional rib with second MCP joint of hand on side of dysfunction rib in midaxillary line. Other hand on top of patient's head Side bend pt's head/neck toward dysfunctional rib

Question 41

Describe thrust for J-stroke HVLA for elevated rib 1

Answer 41

With exhalation, student provides inferior force onto first rib to engage restrictive barrier At end of exhalation, apply thrust inferiorly/medialy (in shape of J) on superior 1st rib Ipsilateral shoulder girdle is not held in cephalad position to be sure that pt relaxes for procedure