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Stridor
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Presentation: short history of sore throat, inspiratory stridor, muffled voice, drooling, and sepsis. Classical tripod position: using the arms to support the shoulders and maximise accessory muscle use.
Examination of Knee Joint in a Child
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
Patellar tracking (passive and active). The patient is seated comfortably with legs hanging down and arms behind extended to assume a tripod position. This relaxes the hamstrings by tilting the pelvis posteriorly. The examiner extends the knee from 90° of flexion to complete extension. Normally, the patella tracks in a relatively straight line or it moves slightly medial at the beginning of extension and then back slightly lateral upon terminal extension of the knee to assume the original position. Excessive gliding indicates tightness of the superficial retinacular fibers, and excessive tilting indicates pathology of the deep retinacular fibers. When the patient actively extends the knee, carefully observe the knee between 30° flexion to full extension. An abrupt lateral deviation/lateral J sign upon terminal extension indicates vastus medialis obliquus dysfunction.
Management of Conditions and Symptoms
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
A critical role for clinicians is patient education related to exacerbations of shortness of breath, and what the individual and family can do to help manage symptoms. A handheld, desktop, or small floor fan directed towards the face can reduce dyspnea or air hunger. Elevation of the head of the bed can help reduce breathlessness while attempting to sleep. Reduction of salt in the diet can help reduce fluid retention that can exacerbate breathlessness. Reducing the exposure to environmental allergens such as seasonal pollens, and limiting time out of doors in the presence of high air pollutants, can be beneficial. Good hand hygiene precautions should be utilized to reduce the risk of respiratory infection. Smoking cessation is a key component for individuals with tobacco use disorder (see Chapter 16). Relaxation techniques, and pacing for energy conservation, can be helpful (see Chapter 6 regarding Integrative Medicine). Pursed lip breathing and diaphragmatic breathing can also encourage optimal oxygen utilization and depth of respiration. Leaning forward onto something in sitting (e.g. palms/forearms on thighs or a tray table), also known as the orthopneic or tripod position, and/or leaning forward on something in standing (e.g. countertop or walker), can also reduce symptoms of breathlessness (see Figure 17.1). Tracking symptoms on a Borg scale can be helpful to keep a record of exacerbations, and/or triggers for exacerbations, associated with breathlessness.27
Assessing the fidelity of the independently getting up off the floor (IGO) technique as part of the ReTrain pilot feasibility randomised controlled trial for stroke survivors
Published in Disability and Rehabilitation, 2022
Laura Hollands, Raff Calitri, Krystal Warmoth, Anthony Shepherd, Rhoda Allison, Sarah Dean
IGO is a five-stage technique designed to help stroke survivors rise from sitting on the floor to standing without use of aids, using positions designed to compensate for hemiparesis and associated balance issues. For the purposes of the video analysis, we defined hemiparesis as observable one-sided weakness of either the upper or lower limb, or both. The full sequences of movements are detailed in the ARNI manual [16]; in the ReTrain manual, the stages were condensed into five steps as summarised below:Beginning from a seated position with hips abducted, the foot of the stronger leg is placed to groin.The stronger hand is placed behind trunk on the floor; pivoting on the stronger knee, the stronger hip is quickly raised from the floor.The weaker leg is swung around to the front of the body and placed upright with foot flat on the floor. The stroke survivor is now in a “tripod” position, consisting of a single arm, an upright leg, and a kneeling leg.With the stronger hand placed on the floor, the stronger knee is quickly raised and pivoted outwards, planting the stronger foot on the floor. Both feet are now flat on the floor, with the torso being supported by the stronger hand.Come to stand by shifting weight backwards off hands, using bodyweight to bring the torso slowly upright.