15.1: Case Study: Muscles and Movement - Biology

Case Study: Needing to Relax

The dog in Figure (PageIndex{3}) is expressing his interest in something—perhaps a piece of food—by using the neck muscles to tilt its head in an adorable fashion. Humans also sometimes tilt their heads to express interest. But imagine how disturbing and painful it would be if your neck tilted involuntarily, without you being able to control it! Forty-three-year-old Nasir, unfortunately, knows just how debilitating this can be. Nasir uses they, them, and their pronouns.

Nasir has a rare condition called cervical dystonia, which is also called spasmodic torticollis. In this condition, the muscles in the neck contract involuntarily, often causing the person’s head to twist to one side. The illustration in Figure (PageIndex{2}) shows one type of abnormal head positioning that can be caused by cervical dystonia. The muscles may contract in a sustained fashion, holding the head and neck in one position, or they may spasm repeatedly, causing jerky movements of the head and neck.

Cervical dystonia is painful and can significantly interfere with individuals' ability to carry out their usual daily activities. In Nasir’s case, they can no longer drive a car, because their uncontrollable head and neck movements and abnormal head positioning prevent them from navigating the road safely. Nasir also has severe neck and shoulder pain much of the time.

Although it can be caused by an injury, there is no known cause of cervical dystonia—and there is also no cure. Fortunately for Nasir and other cervical dystonia sufferers, though, there is a treatment that can significantly reduce symptoms in many people. You may be surprised to learn that this treatment is the same substance that, when injected into the face, is used for cosmetic purposes to reduce wrinkles!

The substance is botulinum toxin, one preparation of which may be familiar to you by its brand name: Botox. It is a neurotoxin produced by the bacterium Clostridium botulinum, and can cause a life-threatening illness called botulism. However, when injected in very small amounts by a skilled medical professional, botulinum toxins have some safe and effective uses. In addition to cervical dystonia, botulinum toxins can be used to treat other disorders involving the muscular system, such as strabismus (misalignment of the eyes), eye twitches, excessive muscle contraction due to neurological conditions like cerebral palsy; and even overactive bladder.

Botulinum toxin has its effect on the muscular system by inhibiting muscle contractions. When used to treat wrinkles, it relaxes the muscles of the face, lessening the appearance of wrinkles. When used to treat cervical dystonia and other disorders involving excessive muscle contraction, it reduces abnormal contractions.

In this chapter, you will learn about the muscles of the body, how they contract to produce movements and carry out their functions, and some disorders that affect the muscular system. At the end of the chapter, you will find out if botulinum toxin helped relieve Nasir’s cervical dystonia, and how this toxin works to inhibit muscle contraction.

Chapter Overview: Muscular System

In this chapter, you will learn about the muscular system, which carries out both voluntary body movements and involuntary contractions of internal organs and structures. Specifically, you will learn about:

  • The different types of muscle tissue—skeletal, cardiac, and smooth muscle—and their different characteristics and functions
  • How muscle cells are specialized to contract and cause voluntary and involuntary movements
  • The ways in which muscle contraction is controlled
  • How skeletal muscles can grow or shrink, causing changes in strength
  • The structure and organization of skeletal muscles (including the different types of muscle fibers) and how actin and myosin filaments move across each other, according to the sliding filament theory, to cause muscle contraction
  • How cardiac muscle tissue in the heart contracts to pump blood through the body
  • Smooth muscle tissue that makes up internal organs and structures, such as the digestive system, blood vessels, and uterus
  • The physical and mental health benefits of aerobic and anaerobic exercise, such as running and weight lifting
  • How individuals vary in their response to exercise
  • Disorders of the muscular system, including musculoskeletal disorders (such as strains and carpal tunnel syndrome) and neuromuscular disorders (such as muscular dystrophy, myasthenia gravis, and Parkinson’s disease)

As you read the chapter, think about the following questions:

  1. How is the contraction of skeletal muscles controlled?
  2. Botulinum toxin works on the cellular and molecular levels to inhibit muscle contraction. Based on what you learn about how muscle contraction works, can you think of some ways it could potentially be inhibited?
  3. What is one disorder involving a lack of sufficient muscle contraction? Why does it occur?

Case study -1

Chad is an avid golfer. He wishes to improve his golf game and is very motivated to get started on a training program. Chad has exercised regularly for the past 8 years and is in good physical health. Most of his exercise has been aerobic in nature with only a small amount of resistance training.

1. Using the information above, calculate the client’s BMI

2. Calculate the client’s BMR.

3. Calculate the client’s target heart rate at 60% and 80% using the Karvonen formula.


Using the information above, address questions 4-6.

4. Discuss fitness tests or methods of evaluation that should be used to assess the client, providing rationale for your recommendations. Be sure to address the specific conditions presented by your client.

5. Provide a detailed, comprehensive, 12-week periodized training program, including specific sets, repetitions and exercises, utilizing an integrated approach. You do not need to use all the provided rows. Instructions
Any commentary regarding specific instructions or rational for your recommendation can be included in Question 4

Make sure to save all questions on this page before working on the training program.

Week (x-y) Strength Training Aerobics
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week 4-9 View/Modify Chart Entry View/Modify Chart Entry Clear Row
week 9-12 View/Modify Chart Entry View/Modify Chart Entry Clear Row
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6. Discuss nutritional strategies and supplement recommendations with a rationale for your choices.

this is how i need it to be written specifically like this

3) Case Studies
• Question 4: With regard to your fourth question, discuss the required professional responsibilities as a trainer, including but not limited to a medical clearance, discussing your fees and defining your client’s goals. Please refer to Unit 12 in your textbook.
• You also u also need to provide enough references to specific fitness assessment tests for flexibility, strength, muscular endurance and/or cardiovascular endurance in the fourth question. Please review Unit 13 in your textbook.
• Question 5: With regard to the fifth question, you need to provide a more in-depth explanation or validation behind your program recommendations, including the frequency, intensity, time and type of cardiovascular, resistance, and flexibility training in case studies 1 and 2. Please refer to Units 14, 15 and 16 to address these requirements, and include this information at the end of question 4.
• Question 6: With regard to your sixth question, you need to provide a more comprehensive nutritional strategy for each client specific to their particular dietary needs. We would like for you to go beyond simply discussing the 1-2-3 and/or zig zag approach, and include information and recommendation based on the clients’ BMR/DCR as well as their required daily protein, carbohydrate and fat requirements. Please review Units 18-20 in your text book.
• In addition, for these case studies make sure you provide a definitive connection between your initial evaluation, the assessments you chose, the actual exercise program design, the nutrition strategy, and how each aspect will most effectively assist them in achieving their goal(s). If you have not done so already, please review the Sample Case Study Answer provided to you in your Practice Examination. In addition it may help if you review pages 361-452 in your text which is Unit 12 to Unit 20.

the book is in the official text for issa’s certified fitness trainer course edition 8.6.6

and plese answer all questions

this is an example to go by

Sample Case Study – 1. Jocko Johnson
Age Gender Height Weight Body Fat %
30 Male 73 inches 200 18
Jocko was an athlete in high school playing a variety of sports including football, track (100- 400 meter events) and baseball. He has come to you because he has recently had his 30 th birthday and wants to get back in shape. While he is in decent shape already, Jocko wishes to get in excellent shape with an eye on perhaps competing in a local bodybuilding show in the future.

Sample Case Study Answer:
While Jocko may appear to be a dream client on the surface, I realize that his athletic background and mid- life crisis that brought him here will probably lead to more than a little impatience on his part. At my initial consultation I would explain to him that I would need at least a three- month commitment from him to ensure his getting started on the right foot. In my experience most clients need about this long to really get in the swing of things and start seeing some results. At this time I would establish my fees, get him signed up and give him a health history questionnaire to fill out for our next meeting.

After this I would set up our first appointment. I would plan on having enough time in the first session to have him complete a release of liability form and go over his health history questionnaire. If he had any red flags or other concerns we would hold off on training until I had spoken to his doctor and he had gotten a doctors release. Otherwise we would get started on the enclosed program. Before starting I would do circumference, bodyweight and bodyfat percentage measurements so we can track his progress.

I would follow the enclosed program for a few reasons. First, the first mesocycle is a low volume, low intensity one that is designed mainly to increase tendon and ligament strength and allow him to get back in the groove of working out without asking too much of him and discouraging him. After a foundation has been set I would want to increase the intensity and volume levels resulting in a routine geared towards muscle growth. Next I would work on limit strength by introducing a mesocycle that had very high intensity levels and moderate volume. We would then reassess his goals and see where to go from there.

My nutritional strategy for this client would consist of 5 high calorie days and 2 low calorie days. I would suggest he follow a 1-2-3 or 1-2-4 macronutrient ratio depending on his metabolism and mesocycle. The higher intensity mesocycles would warrant more carbs and the lower intensity ones would not need as much fuel. I would suggest he get around 160 grams of protein a day and get his fat from “healthy” fats such as olive oil and hemp seed oil. The easiest way to estimate his daily caloric requirements is to have him keep a food log for a few days and see where he is at now. It will be much easier to make adjustments to his diet if I have a reference point.

Sample Essay Questions
Short answer question:
What are the prime movers, synergists and stabilizers involved in the bench press?
Short answer answer:

The prime movers for the bench press are the pectoralis major and minor (pecs for short). The synergists are any muscles actively involved with the motion. While there are numerous muscles involved the main ones are the anterior deltoid and the triceps. Stabilizers are any muscles that contract isometrically to stabilize joints in order to perform the movement. Two of the main stabilizers involved in the bench press are the abdominals and the hamstrings.

Actually go through the steps involved in launching your new business. Obtain your DBA, your business checking account and obtain liability insurance. Create all necessary forms including policies, rates, consent form, health history questionnaire, your portfolio and anything else that seems appropriate. Design your logo as well. Don’t hurry this, as it will define your business for a long time to come! Include copies of all of the above with your answer and include a description of any difficulties you may have encountered as you went through this process.
Long essay answer:

I have to be honest right off the bat here. I did actually obtain many of the things asked for in this question. My finances did not allow me to pay the $300 or so dollars it would cost to get my business off the ground and I am not sure that starting my own business right off the bat is my first plan of attack. I did go through all the steps asked for, though, not only to answer this question but so that I would be better prepared when the time actually comes to start my own business.

First things first I checked into the “Doing Business As” license, or DBA. I called the County Clerk’s office to inquire about where and how to obtain one. It was explained to me that I needed to go to the Hall of Records and fill out the appropriate paperwork and pay my $27 processing fee and then the name of my business would officially be mine.

Next on the agenda was a business license. A business name is no good if I cannot legally operate it. I was referred to City Hall for this one and informed that to obtain a business license for Santa Barbara, it would cost $100 and would have to be renewed annually. Again, a trip and some paperwork, along with my fee, were all that were needed.

Next I checked on a business checking account. After placing a few phone calls and visiting a few local banks I was able to find a bank that met all of the recommendations in The Complete Guide to Fiscal Fitness. Liability insurance was very easy to find out about with the brochure in our package that recommended a company. I called and was told that after I was certified my acceptance was all but assured.

Enclosed are the forms that I created on my friend’s computer for my business. I had another friend of mine who is an art design major at a local college help me design my logo. After all this preparation I feel very confident about starting my business when the time comes.

Sample Workouts
Strength training: Weeks 1- 3

Exercise Reps Sets
Squat/ Leg Press 10-15 1-3
Incline Bench Press 10-15 1-3
Leg Curl 10-15 1-3
T- Bar Row 10-15 1-3
Standing Calf Raises 10-15 1-3
DB Shoulder Press 10-15 1-3
Crunches 20 1-3
Seated DB Curl 10-15 1-3
Back Extensions 15 1-3
Cable Pushdowns 10-15 1-3
Exercises to be performed in a circuit fashion. Workout to be performed on Monday, Wednesday and Friday.

Weeks 4- 9
For this mesocycle we will use the following split:

Monday Wednesday Friday
Quads Pecs Back
Hamstrings Biceps Triceps
Calves Abs/ Low back Shoulders

Exercise Reps Sets
Squat 8- 10 4
Stiff Leg Deadlift 8- 10 4
Leg Extension a1 12 2
Leg Curls a2 12 2
Seated Calf Raises 6 2
Standing Calf Raises 12 2
Note: a1 and a2 designate two exercises that are to be done in a superset fashion. Do one set of the a1 exercises and while you are resting perform one set of the a2 exercise. Repeat until you have completed all prescribed sets for those exercises before moving on to the next exercise(s).

Exercise Reps Sets
Incline Bench Press 8- 10 4
Pec Deck 12 2
Preacher Curl 10- 12 2
Russian Twist 8 3
Back Extensions 10 3

Exercise Sets Reps
Pull- up 8- 10 4
Cable Rows 8- 10 3
Lying Tri Extensions 8- 10 3
DB Shoulder Press 8- 10 2
Lateral Raises 8- 10 2

Weeks 10- 12
For this stage we will use the following split:

Monday Wednesday Friday
Quads Pecs Biceps
Hamstrings Back Triceps
Calves Abs/ Lower Back Shoulders
Note: Allow at least one days rest between weight training days.

Exercise Reps Sets
Dead Lift 3- 5 6
Stiff Leg Deadlift 5 4
Seated Calf Raises 8 5

Exercise Reps Sets
Bench Press a1 3- 5 6
Pull- up a2 3- 5 6
Russian Twist 8 3
Back Extension 8 3

Exercise Reps Sets
Barbell Curl a1 5 5
Close Grip Bench a2 5 5
Military Press 5 5

Weeks 1-3
Tuesday/Thursday – 20- 45 minute run
Saturday – 30 seconds jog/ 30 seconds sprint- 5 minutes total

Weeks 4- 9
Tuesday – 30 seconds jog/ 30 seconds sprint- start 5 minutes and add 1 minute each week
Thursday – 30- 45 minute run
Saturday – 30 seconds jog/ 30 seconds sprint- start 5 minutes and add 1 minute every other week

Weeks 10- 12
Thursday – 30 minute run
Saturday – 30 seconds jog/ 30 seconds sprint- start 10 minutes and add 1 minute each week

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Human movement is dependent on the amount of range of motion (ROM) available in synovial joints. In general, ROM may be limited by 2 anatomical entities: joints and muscles. Joint restraints include joint geometry and congruency as well as the capsuloligamentous structures that surround the joint. Muscle provides both passive and active tension: passive muscle tension is dependent on structural properties of the muscle and surrounding fascia, while dynamic muscle contraction provides active tension ( Figure 1 ). Structurally, muscle has viscoelastic properties that provide passive tension. Active tension results from the neuroreflexive properties of muscle, specifically peripheral motor neuron innervation (alpha motor neuron) and reflexive activation (gamma motor neuron).

Factors contributing to muscle tension.

Obviously, there are many factors and reasons for reduced joint ROM only one of which is muscular tightness. Muscle “tightness” results from an increase in tension from active or passive mechanisms. Passively, muscles can become shortened through postural adaptation or scarring actively, muscles can become shorter due to spasm or contraction. Regardless of the cause, tightness limits range of motion and may create a muscle imbalance.

Clinicians must choose the appropriate intervention or technique to improve muscle tension based on the cause of the tightness. Stretching generally focuses on increasing the length of a musculotendinous unit, in essence increasing the distance between a muscle's origin and insertion. In terms of stretching, muscle tension is usually inversely related to length: decreased muscular tension is related to increased muscle length, while increased muscular tension is related to decreased muscle length. Inevitably, stretching of muscle applies tension to other structures such as the joint capsule and fascia, which are made up of different tissue than muscle with different biomechanical properties.

Three muscle stretching techniques are frequently described in the literature: Static, Dynamic, and Pre-Contraction stretches ( Figure 2 ). The traditional and most common type is static stretching, where a specific position is held with the muscle on tension to a point of a stretching sensation and repeated. This can be performed passively by a partner, or actively by the subject ( Figure 3 ).

Techniques of Muscle Stretching. HR=Hold relax CR=Contract relax CRAC= Contract relax, agonist contract PIR= Post-isometric relaxation PFS=Post-facilitation stretching, MET= Medical exercise therapy.

Static stretching of the posterior shoulder (Used with permission of the Hygenic Corporation).

There are 2 types of dynamic stretching: active and ballistic stretching. Active stretching generally involves moving a limb through its full range of motion to the end ranges and repeating several times. Ballistic stretching includes rapid, alternating movements or 𠆋ouncing’ at end-range of motion however, because of increased risk for injury, ballistic stretching is no longer recommended. 1

Pre-contraction stretching involves a contraction of the muscle being stretched or its antagonist before stretching. The most common type of pre-contraction stretching is proprioceptive neuromuscular facilitation (PNF) stretching. There are several different types of PNF stretching ( Table 1 ) including 𠇌ontract relax” (C-R), “hold relax” (H-R), and 𠇌ontract-relax agonist contract” (CRAC) these are generally performed by having the patient or client contract the muscle being used during the technique at 75 to 100% of maximal contraction, holding for 10 seconds, and then relaxing. Resistance can be provided by a partner or with an elastic band or strap ( Figure 4 ).

Table 1.

Contract Relax (CR)Contraction of the muscle through its spiral-diagonal PNF pattern, followed by stretch
Hold Relax (HR)Contraction of the muscle through the rotational component of the PNF pattern, followed by stretch
Contract-Relax Agonist Contract (CRAC)Contraction of the muscle through its spiral-diagonal PNF pattern, followed by contraction of opposite muscle to stretch target muscle

Contract-Relax stretching with stretching strap (Used with permission of the Hygenic Corporation).

Other types of pre-contraction stretching include “post-isometric relaxation” (PIR). This type of technique uses a much smaller amount of muscle contraction (25%) followed by a stretch. Post-facilitation stretch (PFS) is a technique developed by Dr. Vladimir Janda that involves a maximal contraction of the muscle at mid-range ( Figure 5 ) with a rapid movement to maximal length followed by a 15-second static stretch. 2

Post-Facilitation Stretching of hamstrings (Used with permission of the Hygenic Corporation).

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Case Studies Musculoskeletal Key

  • Chapter 10 Case Studies Introduction Case 1
  • Compromised Gait and Function Secondary to Muscle Weakness Case 3
  • Fatigue Secondary to Muscle Weakness Case 4
  • Muscle Weakness Following Nerve Injury Case 5
  • Muscle Weakness Following Hip Surgery Case 6
  • Muscle Weakness Following Childbirth Introduction This chapter serves as a brief summary of the muscle

Overheated: A Case Study on Skeletal Muscle Physiology

  • Overheated: A Case Study on Skeletal Muscle Physiology “Time to scrub in,” says Dr
  • The appendectomy you are about to observe is your second surgical case in surgical technician school
  • The patient, David Sims, is an 18-year-old male who was healthy until two days ago when he began having severe abdominal pain, fever, and vomiting

Hamstring Injury-A Case Study Trigenics DA: 13 PA: 31 MOZ Rank: 46

  • David Gryfe B.Sc., DC, DAc, FCCSS (c), RTP February 2003
  • David Gryfe graduated Magna Cum Laude (Clinic Honors) from CMCC in 1992
  • He then certified as Doctor of Acupuncture from the Open International University (Sri Lanka).

Case studies in a musculoskeletal out-patients setting

CHAPTER EIGHT Case studies in a musculoskeletal out-patients setting Adrian Schoo, Nick Taylor, Ken Niere, with a contribution fromJames Selfe Case study 1: Jaw Pain 217 Case study 2: Headache 218 Case study 3: Neck Pain – Case One 221 Case study 4: Neck Pain – Case Two 224 Case study 5: Thoracic Pain 226…

Muscle Physiology Case Study #1.doc DA: 18 PA: 49 MOZ Rank: 71

  • Muscle Physiology Case Studies - Case 1 Sarah, a twenty-one year old student at the University of Maryland had spent Thanksgiving day with relatives at her grandparent’s farm
  • During her drive back to campus on Friday morning her vision became blurry, and she was forced to pull over to the side of the road
  • As she sat in her car, her vision worsened.

Case Study 3 (Muscle) Flashcards Quizlet DA: 11 PA: 43 MOZ Rank: 59

  • Case Study 3 (Muscle) David's body temperature rises above normal during the surgery (hyperthermia)
  • How does skeletal muscle tissue contribute to body temperature? Skeletal muscle produces heat when it contracts, which is an essential function in maintaining normal core body temperature.

How I Gained 5 Pounds of Muscle in 9 Weeks Real-World DA: 15 PA: 19 MOZ Rank: 40

  • The goal should be maximal muscle growth and minimal fat gain
  • This first trial indicates that I gained 5 lbs
  • Of muscle and a little more than 2.5 lbs
  • Therefore, hopefully, I can continue this increase for another 9 weeks (10 lbs

Formthotics™ Case Study Calf Muscle Pain DA: 19 PA: 35 MOZ Rank: 61

  • Foot Science I Case Study - Calf Pain Page 4 Lower limb muscle balance A full lower limb muscle balance assessment is carried out to determine what factors are contributing to the patients pain
  • Doug found major weakness in Pete’s gluteal muscles

Case Study: Freddie Ljungberg's Calf Muscle Strain Injury DA: 18 PA: 50 MOZ Rank: 76

  • Freddie Ljungberg suffered a Calf muscle injury during Sweden's 2-0 Euro 2008 qualifier victory over Spain and was forced to miss several Premiership matches
  • Calf muscle injuries are common in sports such as football, basketball, and tennis, where there is a lot of running and jumping.

Suicidal Ideation and Muscle Twitches DA: 13 PA: 43 MOZ Rank: 65

  • A new case study in which the patient, a 40 yr-old mixed-race woman presents to her primary care physician with concerns about suicidal ideation
  • She has some other troubling symptoms as well including muscle twitches, fatigue, difficulty concentrating and memory lapses
  • “I just don’t feel like anything matters

Sternocleidomastoid syndrome: a case study

  • This article presents a case study of a patient diagnosed with dysfunction of the sternocleidomastoid (SCM) muscle, a condition which can result in head and face pain, nausea, dizziness, coryza, and lacrimation
  • In this particular case, the SCM muscle had developed tightness and weakness with presence of multiple trigger points within both heads.

Solved: 6:12 Done Muscle Case Study 1-1.doc Overheated: A DA: 13 PA: 50 MOZ Rank: 74

  • Question: 6:12 Done Muscle Case Study 1-1.doc Overheated: A Case Study On Skeletal Muscle Physiology Time To Scrub In." Says Dr
  • The Appendectomy You Are About To Observe Is Your Second Surgical Case In Surgical Technician School
  • The Patient, David Sims, Is An 18-year-old Male Who Was Healthy Until Two Days Ago When He Began Having Severe Abdominal Pain,

The importance of the gluteus medius muscle – a case study

  • The importance of the gluteus medius muscle – a case study
  • A man in his late 40s came to see us for a pain in the left buttock, being referred to us by another acupuncturist
  • His pain began about 6 months earlier after a fall when cross-country skiing
  • He fell on his buttocks and had severe back pain that lasted

15.1: Case Study: Muscles and Movement

  • excessive muscle contraction due to neurological conditions like cerebral palsy and even overactive bladder
  • Botulinum toxin has its effect on the muscular system by inhibiting muscle contractions
  • When used to treat wrinkles, it relaxes the muscles of the face, lessening the appearance of wrinkles.

Muscle Type And Performance: A Case Study DA: 12 PA: 35 MOZ Rank: 61

  • Muscle Type And Performance: A Case Study
  • Essay Submission Assignment #1 1
  • Discuss the relationship between distribution of muscle fiber type and performance
  • How might exercise training modify or change a person’s fiber-type distribution? Muscle fibers can be categorized into two main properties, twitch and

Muscular System Case Study: Muscle Fatigue The DA: 13 PA: 50 MOZ Rank: 78

  • Transcribed image text: Muscular System Case Study: Muscle Fatigue The following graph shows muscle force exerted (y-axis) versus time (x-axis) for a simple test: the test subject was asked to grip a force meter as hard as possible for 60 seconds
  • 300 1 200- 100 There Use this graph to answer the following thought questions: 1
  • The initial force was 200 N, but it pretty quickly drops to about

Impact of presymptomatic COVID-19 on vascular and skeletal

  • This case study details the presymptomatic impact of COVID-19 on vascular and skeletal muscle function in a young woman [24 yr, 173.5 cm, 89 kg, body mass index (BMI): 29.6 kg·m-2]
  • Vascular and skeletal muscle function were assessed as part of a separate study with the first and second visits separated by 2 wk.

Duchenne Muscular Dystrophy: Misko, a case study DA: 16 PA: 50 MOZ Rank: 83

  • Duchenne Muscular Dystrophy: Misko, a case study
  • A few months following Misko’s birth in January 2007, a blood test revealed that his liver enzymes were elevated but his parents did not consider it extremely serious
  • “For us it was something we had to investigate in order to eliminate it.

Muscle fatigue evaluation with EMG and Acceleration data

  • Monitoring muscle fatigue can increase the usability of rehabilitative and restorative devices as it helps avoiding premature tiring and injury of patients whose resistance is already compromised
  • In this study, we collected EMG and accelerometer data from one healthy subject during a 30-minute walk on treadmill to determine the variations of

Unilateral absence of the sternothyroid muscle: a case report DA: 14 PA: 50 MOZ Rank: 83

  • Case Report eISSN 1308-4038 International Journal of Anatomical Variations (2016) 9: 55–56 Unilateral absence of the sternothyroid muscle: a case report Introduction The infrahyoid (strap) muscles act on the thyroid cartilage of the larynx and the hyoid bone to function in speech, swallowing and mastication

Case Study Cognitive Drill Therapy and Jacobson DA: 9 PA: 36 MOZ Rank: 65

Case Study Cognitive Drill Therapy and Jacobson Progressive Muscle Relaxation in the Treatment of Obsessive Compulsive Disorder (OCD): A Case Study Preeti Bajpai1, Neeraj Kumar Mishra1, Sweta2 1M.Phil Clinical Psychology, Department of Clinical Psychology, Nai Subah Institute, Varanasi, UP, India.

Case Study: Persistent Shoulder Pain

  • Case Study: Explanation: A 56-year-old man presents to the office with left shoulder pain that has persisted for several months
  • He notices the left shoulder is not as strong as the right shoulder

New study shows how muscle memory works -- you never DA: 18 PA: 43 MOZ Rank: 83

New study shows how muscle memory works you never really lose it However, according to a new review, this isn’t the case — and muscles are able to “bank” muscle growth potential.

Slipping rib syndrome is difficult to diagnose because the symptoms resemble other conditions. First take a medical history and ask about symptoms, including when they started and if anything makes them worse.One test that can aid in the diagnosis is the hooking maneuver:

  • The hooking maneuver that helps diagnose slipping rib syndrome. To perform this test hooks your fingers under the rib margins and then move them upward and back - If this test is positive and causes the same discomfort, usually no need to do any additional tests such as an X-ray or MRI scan [1] .

5. Conclusion

This review identified some possible mechanisms of cupping therapy based on certain theories that explain its diverse effects. No single theory could explain its full spectrum of effects. The beneficial effects of cupping therapy need to be substantiated by large randomized clinical trials, systematic reviews and meta-analyses in future. Basic scientific innovative research is also needed to verify the discussed theories about cupping along with inventing new theories. Prevailing theories on cupping therapy mechanism of action that are related to Traditional Chinese Medicine, Unani Medicine or other traditional healing practices need to be addressed in a new innovative study.

Extended V-Y Latissimus Myocutaneous Flap: An Option For Reconstruction Of Large Defect Following Mastectomy For Locally Advanced Breast Cancer

L Ndiaye, A Sankale, A Ndiaye, M Foba. Extended V-Y Latissimus Myocutaneous Flap: An Option For Reconstruction Of Large Defect Following Mastectomy For Locally Advanced Breast Cancer. The Internet Journal of Plastic Surgery. 2020 Volume 15 Number 1.


Management of breast cancer remains challenging in underdeveloped countries such as Senegal. Diagnostic is often made late with locally advanced breast cancer. This causes difficulties with covering large defects after mastectomy. Through two observations we report the feasibility of covering large thoracic defects by an extended V-Y latissimus dorsi myocutaneous flap.

A retrospective study was carried out at the Department of Plastic Surgery of Dantec on patients with locally advanced breast cancer with predicted problems of wound closure after mastectomy. We used the extended V-Y latissimus dorsi myocutaneous flap.

These were two patients aged 45 and 57 years with both a T4dN1M0 breast cancer. Their breast cancer had resisted to chemotherapy. Mastectomies and lymph nodes removal were followed by immediate coverage with an extended latissimus dorsi V-Y flap. One patient had delayed wound healing due to lymphorrhea. Complete wound healing was achieved within 21 and 35 days. One patient died 2 years after surgery and the second is still alive after 18 months of follow up.

The extended V-Y latissimus dorsi myocutaneous flap is a good and safe option in covering defects left by extended mastectomy. Its morbidity is low and does not delay adjuvant chemotherapy and or radiotherapy.


The prevalence of breast cancer (BC) is increasing in low- to middle-income countries such as those in West Africa. In Senegal, as in most countries of the subregions, breast cancer continues to be diagnosed at a late stage. Seventy-six percent of breast cancer is diagnosed at the T4 stage [1]. This poses the problem of management of breast cancer in Senegal with limiting factors located at all stages of the care process which remains long, difficult and expensive for the majority of patients [2]. In advanced, ulcerated and infected breast cancers, covering defects left by the extended mastectomy is particularly problematic. The extended V-Y latissimus dorsi myocutaneous flap described by Micali and Carramaschi [3] provides a suitable method of wound closure without a significant donor site morbidity. The aim of this article is to confirm the usefulness of the flap&rsquos design and its safety through these two cases of advanced breast cancer.

Case 1

A 57-year-old patient was admitted at the Cancer Department for a left breast tumor evolving for more than 2 years. Clinical examination showed an ulcerated and inflammatory tumor of the whole breast with fixed axillary lymph nodes (Fig 1). The biopsy reveals an invasive ductal carcinoma classified as a T4dN1M0 breast cancer.

Figure 1a

A first line chemotherapy with a CMF protocol (Methotrexate - 5FU- Cyclophosphamide) and a second line based on taxanes did not show response. A mastectomy of cleanness was then planned. The procedure began in the supine position for the time of the mastectomy and axillary lymph nodes removal. A 25 cm defect in its major axis was left. The patient was then placed in the left lateral position and the flap was harvested according to the classic extended V-Y latissimus dorsi flap design. The muscle tendon was sectioned on his 4/5 to facilitate anterior translation. The defect and the donor site were closed primarily. Complete wound healing was achieved in 15 days. The patient survived for two years.

Figure 1b

Figure 1c

Figure 1d

Figure 1e

Case 2

A 45-year-old patient was admitted at the Cancer department for a right breast tumor evolving for 1 year. She had in her pass a conservative treatment for a left breast cancer. Clinical examination showed an ulcerated and infected tumor in the external quadrant of the right breast with fixed axillary lymph nodes (Fig 2). Clinical and paraclinical examination showed a breast cancer classified T4d. Pre-operative chemotherapy had not given a significant response.

Figure 2a

Figure 2b

The mastectomy and axillary lymph node removal left a defect of 23 cm in its major axis. An extended V-Y latissimus dorsi flap was performed to cover the defect and donor site primarily. A continuous lymphorrhea occurred and caused delayed wound healing in the anterior part of the flap. Complete wound healing was obtained 35 days later. Chemotherapy and radiotherapy were then given. After 25 months follow up the patient is still alive, and no recurrence is detected.

Figure 2c

Figure 2d

Figure 2e

Figure 2f


Breast cancer is a real management challenge in developing countries.

It is the second most common cancer in women after that of the cervix with an ever-increasing incidence and mortality [4]. According to the GLOBOCAN 2018 study [5], the incidence of BC reached 1,758 cases per year in Senegal compared with 869 in 2012. However, these statistics seem to be largely underestimated for several reasons, including poor reporting processes, lack of cancer registries, lack of diagnostic facilities, and low accessibility to screening and oncology care in rural areas. Almost 76% of cancers continue to be diagnosed at the T4 stage [1]. In this specific cases, surgical management is advocated as it provides local control and satisfactory wound care [6,7]. Although disease-free survival can be expected in only a minority of patients, local control rates can be adequate and patients have a better quality of remaining life [6,8].

The main problem posed by these enlarged mastectomies is the coverage of the defect which is not accessible to the usual technique of latissimus dorsi flap. The fear of leaving a large defect causing pain, discomfort and delay adjuvant therapy did not facilitate our oncologist surgeons to make decision of operating these patients before. Surgical abstention was previously the main option, but this was very badly experienced by the patients who lost hope. Skin graft had been also used to cover the mastectomy wound but according to authors [8,9,10] wide excision of tumor and skin grafting do not provide robust wound cover that allows for postoperative chemotherapy and radiotherapy.

The extended V-Y latissimus dorsi myocutaneous flap was described by Micali and Carramaschi [3]. The usefulness of the extended V-Y latissimus dorsi flap design is its ability to close a large defect without the expense of a donor wound [11]. The thoraco-dorsal pedicle is already dissected during the mastectomy and facilitates flap harvesting and reduces the time of the procedure. In both cases where this flap was performed, we achieved complete defect and donor site primarily covering. Wound healing was obtained in good timing that not delay adjuvant therapy. The other important fact is that, complete tumor removal had increased the comfort of life with better social integration and better adherence to treatment due to the hope raised.


Locally advanced breast cancer continues to be seen in developing countries. Their surgery posed the problem of covering large mastectomy defects. The extended V-Y latissimus dorsi flap is a safe procedure with low morbidity that allows wound closure in enlarged mastectomy.


Author Information

L Ndiaye
Department of Plastic and Reconstructive Surgery Aristide Le DANTEC Hospital
[email protected]

AA Sankale
Department of Plastic and Reconstructive Surgery Aristide Le DANTEC Hospital

Aï Ndiaye
Department of Plastic and Reconstructive Surgery Aristide Le DANTEC Hospital

ML Foba
Department of Plastic and Reconstructive Surgery Aristide Le DANTEC Hospital

Summary of Article 15 of the Constitution of India

Article 15 of the Constitution provides that no citizen shall be subjected to discrimination in matters of rights, privileges and immunities pertaining to him. This Article lays down:

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(1) The State shall not discriminate against any citizen on grounds only of religion, race, caste, sex, place of birth or any of them,

(2) No citizen shall on grounds only of religion, race, caste, sex, place of birth or any of them, be subjected to any disability, liability, restriction or condition with regard to:

(a) Access to shops, public restaurants, hotels and places of public entertainment, or

(b) The use of wells, tanks, bathing Ghats, roads and places of public resort maintained wholly or partly out of State funds or dedicated to the use of the general public.

(3) Nothing in this Article shall prevent the State from making any special provision for women and children.

(4) Nothing in this Article or in clause (2) of Article 29 shall prevent the State from making any special provision for the advancement of any socially and educationally backward classes of citizens or for the Scheduled Castes and Scheduled Tribes.

The guarantee under Article 15 is available to citizens only and not to every person whether citizen or non-citizen as applicable under Article 14 of the Constitution.

Article 15 directs that the State shall not discriminate against any citizen on grounds only of religion, race, caste, sex, and place of birth or any of them. Any law discriminating on one or more on these grounds would be void. The word, “only” has been purposely used In the Article.

Discrimination based on one or more of these grounds and also on other grounds or grounds will not be affected by Article 15 (1). It means that if one or more of the specified grounds is combined with a ground not mentioned In Article 15 (1) the laws will be outside the prohibition contained in Article 15 (1). Article 15 (1) prohibits discrimination on the ground of birth and not that of residence. A State can, therefore, grant concessions to its residents in matters of fees in an educational institution.

In D.P. Joshi v. State of Madhya Bharat, AIR 1955 S.C. 334, a rule of medical colleges provided that all students who are bona fide residents of Madhya Bharat, no capitation fee should be charged but for non-resident students, capitation fee should be retained.

The validity of this rule was challenged on the ground that it contravened Articles 14 and 15 (1) of the Constitution. It was held that the rule was not open to attack as infringing Article 15 (1). The ground for exemption from payment of capitation fee is bona fide residence in the State.

Residence and place of birth are two distinct conceptions with different connotations both in law and fact. Article 15 (1) prohibits discrimination on the ground of place of birth but not on the ground of residence.

Similarly, the requirement of a test in the regional languages for State employment does not contravene Article 15, as a test in the regional language for State employment does not contravene Article 15, as the test is compulsory for all persons seeking employment. It has been held so in P. Raghunandha Rao v. State of Orissa AIR 1955 Orissa 1131.

In Air India v. Nargesh Miija, AIR 1981 S.C. 1829, the Supreme Court struck down Regulations 46 and 47 of the Air India and Indian Airlines. Regulation 46 provided that an air-hostess shall retire from the service of the corporation upon attaining the age of 35 years or on marriage, if it takes place within 4 years or on first pregnancy whichever is earlier.

Under Regulation 47, Managing Director had discretion to extend the age of retirement by one year at the time up to the age of 45 years, if the air-hostess is found medically fit. The court held that termination of service on the basis of pregnancy is unfair and clearly violates Article 14. The power of managing director for the extension of age of retirement is also unconstitutional.

Article 15 (2) applies to States as well as private actions while Article 15(1) refers to the obligation of the States only.

Clauses (3) and (4) of Article 15 embodies exception to the general rule enunciated above. They empower the State to make special provisions for women and children and for the advancement of any socially and educationally backward classes of citizens for the Scheduled Castes and Scheduled Tribes.

In M.R. Balaji v. State of Mysore, AIR 1963 S.C. 649, the government reserved seats in the Medical and Engineering colleges in the State as follows:

Backward classes 28% more backward classes 22% Scheduled Castes and Tribes 18%. The court held that the sub-classification made by the order between backward classes, was not justified under Article 15 (4). Caste is not the sole criteria for determining backwardness. Reservation up to 68% is a fraud on the Constitution. Article 15 (4) only enables the State to make special provision and not exclusive provision for the backward classes.

In State of Madhya Pradesh v. Nivedita Jain, AIR 1981 S.C. 2045, the Supreme Court upheld the validity of an executive order of the Government of Madhya Pradesh completely relaxing the condition of qualifying marks for the candidates of Scheduled Castes and Scheduled Tribes in Pre-Medical Tests.

The court observed that in the absence of any law to the contrary, it is open to the government to impose such conditions which would make the reservation effective for the advancement of candidates of such classes.

The court held that the executive order completely relaxing the minimum qualifying marks was not volatile of the Regulation and Article 15 (4) of the Constitution.

In Mandal Commission case, the Supreme Court by a majority of 6-3 has held that the sub-classification of backward classes into more backward castes and backward castes for the purposes of Article 16(4) can be made. But as a result of sub-classification the reservation cannot exceed more than 50%. The distinction should be on the basis of degrees of social backwardness.


The use of games in educational circles has been practiced since at least the twentieth century. Use of paper-based educational games became popular in the 1960s and 1970s, but waned under the Back to Basics teaching movement. [4] (The Back to Basics teaching movement is a change in teaching style that started in the 1970s when students were scoring poorly on standardized tests and exploring too many electives. This movement wanted to focus students on reading, writing and arithmetic and intensify the curriculum. [5] ) Clark C. Abt is credited for coining the term "serious game" in the 1970s, defined as "games have an explicit and carefully thought-out educational purpose and are not intended to be played primarily for amusement." Abt also recognized that this "does not mean that serious games are not, or should not be, entertaining." [6]

The early 2000s saw a surge in different types of educational games, especially those designed for the younger learner. Many of these games were not computer-based but took on the model of other traditional gaming systems both in the console and hand-held formats. In 1999, LeapFrog Enterprises introduced the LeapPad, which combined an interactive book with a cartridge and allowed kids to play games and interact with a paper-based book. Based on the popularity of traditional hand-held gaming systems like Nintendo's Game Boy, they also introduced their hand-held gaming system called the Leapster in 2003. This system was cartridge-based and integrated arcade–style games with educational content. [7]

Also in the 2000s, educational games saw an expanse into sustainable development with titles such as Learning Sustainable Development in 2000 and Climate Challenge in 2006. [8]

Other directions for serious video games beyond education began to emerge in the early 2000s, with America's Army in 2002 as an early example. The game was a first-person shooter developed by the United States Army as a recruitment tool, and later used as an early training tool for new recruits. [9]

By 2010, serious games had evolved to incorporate actual economies [ citation needed ] like Second Life, in which users can create actual businesses that provide virtual commodities and services for Linden dollars, which are exchangeable for US currency. In 2015, Project Discovery was launched as a serious game. Project Discovery was launched as a vehicle by which geneticists and astronomers with the University of Geneva could access the cataloging efforts of the gaming public via a mini-game contained within the Eve Online massively multiplayer online role-playing game (MMORPG). Players acting as citizen scientists categorize and assess actual genetic samples or astronomical data. This data was then utilized and warehoused by researchers. Any data flagged as atypical was further investigated by scientists.

Health Edit

On the one hand, the health sector includes digital games for the professional area of doctor training, e.g. to train an operation or to impart specialist knowledge, and on the other hand they address the private end user who uses them, for example, as motivation tools for a healthier lifestyle, nutrition or for rehabilitation purposes. In addition, Serious Games can be used as a training measure for patients who acquire knowledge about their clinical pictures and possible therapy options. [ citation needed ] There is also an increasing use of serious games in health education programs. [10]

On 15 June 2020, the Food and Drug Administration approved the first video game treatment, a game for children aged 8–12 with certain types of ADHD called EndeavorRx. It can be downloaded with a prescription onto a mobile device, and is intended for use in tandem with other treatments. Patients play it for 30 minutes a day, 5 days a week, over a month-long treatment plan. [11]

Exercise therapy Edit

These include serious games that animate the player to sport and movement. For example, hand-eye coordination and upper body muscles can be trained using Wii Sports, regardless of age and physical disabilities, alone or with others. Even simple Jump-'n'-Run games can have an educational purpose, depending on the user. They are partly used in rehabilitation therapies to restore the user's finger mobility, reaction speed and eye-finger coordination. [12]

Politics, culture and advertising Edit

Persuasive games are developed for advertisers, policy makers, news organizations and cultural institutions. They are politically and socially motivated games that serve social communication. They cover areas such as politics, religion, environment, urban planning and tourism. The aim is to lead to create a demand for product due to a generated positive exposure to the product in the game or introduce new ways of thinking through experience.

Security Edit

Serious games in the field of security are aimed at disaster control, the defense sector and recruitment. Public, private and municipal institutions, such as fire brigades, police, Federal Agency for Technical Relief (Technisches Hilfswerk - Germany THW), DRK as well as crisis centres and NGOs benefit from them. Scenarios such as natural disasters, acts of terrorism, danger prevention and emergency care are simulated. Challenges such as acting under time and pressure to succeed can thus be realistically tested with fewer resources and costs. This area formed the second focal point. An example of serious games from this sector is the Emergency game series or the possibility to explore the response of communities in a game in disaster management. Psychological effect that exist in real life-threatening situation are not realistic in a serious game but the training in a serious game and exposure to the requirements and constraints in disaster management can prepare to a better response of the teams in a real disaster management case and lead to an improved risk mitigation strategies.

Military games Edit

Games like America's Army are training simulations that are used in the training and recruitment of soldiers. The games try to represent warfare as realistically as possible in order to familiarize users with the dangers, strategies, weapons, tactics and vehicles.

Recruitment games Edit

This type of serious games is intended to bring the user closer to tasks that would otherwise be less in the limelight. Companies try to present and profile themselves through such games in order to attract apprentices and applicants. Future tasks will be presented and carried out in a large context, for example "TechForce", in which various technical areas are combined into an end product with the aim of winning a race.

Product creation games Edit

The aim here is to give the user an understanding of a company's products. The user can test the products in a simulation under real conditions and convince himself of their functionality. Technical basics, handling and security risks can be taught to the user.

Adult education Edit

Real simulations and simulation games provide the user with the opportunity to gain experience. Actions generated from knowledge can be tested here according to the trial and error principle. Theoretical knowledge can either be acquired beforehand or imparted during the game, which can then be tested in a virtual practice. There is an educational policy interest in the professionalisation of such offers. With the research project NetEnquiry, the Federal Ministry of Education and Research supports a corresponding research project for education and training, implemented here with the focus on mobile learning. [13] In addition, there is an increasing incorporation of serious games within university curricula which students can use to consolidate learning or enhance knowledge. [14]

Youth education Edit

The user is given tasks and missions that they can only solve with the knowledge that they will gradually discover during the game. The theoretical aspects of the game are always taught in small quantities at the right time to be able to solve the next task and thus test the theoretical approaches in practice.

Art Games Edit

An art game uses the medium of computer games to create interactive and multimedia art. For the first time, the term was described scientifically in 2002 to emphasize games that attach more importance to art than to game mechanics. Mostly they convince by a special aesthetics and atmosphere and use the interactivity for creativity and the thought stimulation of the player. Art created by or through computer games is also called Art Game. [15] [16]

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