Expert associations-based treatment system for reducing tissue damage from reperfusion injury
10786424 ยท 2020-09-29
Assignee
Inventors
Cpc classification
G16H20/30
PHYSICS
A61H99/00
HUMAN NECESSITIES
International classification
G16H20/30
PHYSICS
Abstract
An expert system facilitates non-surgical manual semi-occlusion method for treating Reperfusion Injury (RI). This technique involves a four phase framework: (1) palpating a soft tissue structure or segment of the body in order to bring blood flow to the areacalled the Touch; (2) placing a contact point at the nearest proximal vascular branch that supplies the specific target structure and creating manual tension at a vector running 90 to the elongate axis of the artery to act as a manual tourniquetcalled the Activation; (3) maintaining the vector of tension until a pulse is felt under the contact point and then waiting for the pulse to adequately diminishherein called the Pulse; and (4) applying a stretch on the nerve that supplies the Structure or Segment, both locally and centrally, in order to occlude the blood supply to the nerve for 30 secondscalled the Neurovascular Stretch.
Claims
1. A system for use in guiding practitioners in prevention and treatment of patients afflicted by musculoskeletal soft tissue injuries from reperfusion injury, comprising: a database that contains images of taxonomically classified hand placement for treatment of reperfusion injury at one or more Structures of interest in a human body; descriptive information associated with the hand placement as shown in the images as part of a framework of data demonstrating how to activate treatment by creating a semi-occlusive manual tourniquet at an artery that supplies blood to the one or more Structures of interest; stretch a portion of the human body to occlude blood flow to a nerve segment of the human body by elongation of the nerve segment proximate the one or more Structures of interest; and a system of expert rules that facilitate selection of the taxonomically classified images and the descriptive information; a processor equipped with program logic for a query engine utilizing user input to access the system of expert rules as an aid used in reporting to select and organize of the images and the descriptive information as a report that demonstrates a modality of treating reperfusion injury at a particular Structure of interest; and a graphical user interface configured to present the report for use in performing the modality of treatment.
2. The system of claim 1, wherein the framework data further demonstrates how to touch the one or more Structures of interest to there attract blood flow; and ascertain effectiveness of the semi-occlusive manual tourniquet by determining a shift in volume and/or rate of a pulse at the hand placement.
3. The system of claim 1, wherein the images of the report show the stretch component of the treatment being performed sequentially after activation of the treatment.
4. The system of claim 1, wherein the images of the report show the stretch component of the treatment being simultaneously in a combined approach that conducts the stretch at the same time as activation of the treatment.
5. The system of claim 4, wherein the images show the stretch occurring centrally to further elongate the nerve by motion that is not occurring proximate the hand placement.
6. The system of claim 1, wherein the images show the stretch occurring locally to stretch the nerve locally by movement of the nerve as elongated by movement of the body under the hand placement.
7. The system of claim 1 wherein the images are taxonomically classified by use of a three element code corresponding to Systems as divisions of the human body, Segments as divisions of a particular System, and Structures forming the Structures of interest in the human body.
8. The system of claim 1 wherein the descriptive information origins, insertions, blood supply and innervation in order to facilitate proper hand placement.
9. The system of claim 1, wherein the hand placement is a single activation utilizing one hand for activation.
10. The system of claim 1, wherein the hand placement is a double activation utilizing two hands for activation.
11. The system of claim 1 wherein the hand placement is for a modality of treating a groin pull.
12. The system of claim 1 wherein the hand placement is for a modality of treating pectoral strain.
13. The system of claim 1 wherein the hand placement is for a modality of treating a lower back pain.
14. The system of claim 1 wherein the hand placement is for a modality of treating neck pain.
15. The system of claim 1 wherein the hand placement is for a modality of treating asacral sprain.
16. The system of claim 1 wherein the images include a combination of hand placements shown on medical illustrations and photographs demonstrating the modality in application.
17. The system of claim 1 where the program logic is user-selectively configurable for operation in a state selected from the group consisting of treating patients and training practitioners.
18. The system of claim 1 wherein the program logic includes a module for subscription access management.
19. The system of claim 1 wherein the program logic includes a module for patient monitoring across multiple therapy sessions to provide patient monitoring data.
20. The system of claim 1 wherein the system of expert rules accesses the patient monitoring data to assist selection of a treatment modality in a follow-on treatment session.
21. The system of claim 1, wherein the particular Structure of interest includes at least one Structure selected from the group consisting of: Abductor Digiti Minimi (Layer 1), Abductor Hallucis (Layer 1), Adductor Brevis, Adductor Hallucis (Layer 3), Adductor Longus, Adductor Magnus, Anterior Cruciate Ligament, Articularis Genu, Biceps Femoris(Long Head), Biceps Femoris (Long Head), Biceps Femoris(Short Head), Dorsal Interossei, Extensor Digitorum Brevis & Extensor Hallucis Brevis, Extensor Digitorum Longus, Extensor Hallucis Longus, Flexor Digiti Minimi & Opponens Digiti Minimi (Layer 3), Flexor Digitorum Brevis (Layer 1), Flexor Digitorum Longus, Flexor Hallucis Brevis (Layer3), Flexor Hallucis Longus, Flexor Retinaculum, Gastrocnemius & Achilles Tendon, Gluteus Maximus, Gluteus Medius, Gluteus Minimus, Gracilis, Iliacus, Iliotibial Band, Inferior Extensor Retinaculum, Inferior Gemelli, Interosseus Membrane of Leg, Joint Capsules, Lateral Collateral Ligament of Ankle, Lateral Collateral Ligament of Knee, Lateral Meniscus, Lumbricals (Layer 2), Medial Collateral Ligament of Knee, Medial Collateral Ligaments of Ankle (Deltoid Ligament), Medial Meniscus, Obturator Externus, Obturator Internus Distal (Insertion)m Patellar Ligament, Pectineus, Peroneus Brevis, Peroneus Longus, Peroneus Tertius, Piriformis, Plantar Calcaneonavicular Ligament (Spring Ligament), Plantar Fascia, Plantar Interossei (Layer 4), Plantaris, Plica, Popliteus, Posterior Cruciate Ligament, Psoas Major, Psoas Minor, Quadratus Femoris, Quadratus Plantae (Layer 2), Rectus Femoris, Sartorius, Semimembranosus, Semimembranosus, Semitendinosus, Semitendinosus, Soleus & Achilles Tendon, Superior Extensor Retinaculum, Superior Gemelli, Tensor Fascia Lata, Tibialis Anterior, Tibialis Posterior, Transverse Intermuscular Septum, Vastus Intermedius, Vastus Lateralis, and Vastus Medialis.
22. The system of claim 1, wherein the particular Structure of interest includes at least one Structure selected from the group consisting of: Common Extensor Tendon: Extensor Carpi Ulnaris, Abductor Pollicis Longus, Acromioclavicular Ligaments, Adductor Pollicis, Anconeus, Annular Ligament, Biceps Brachii, Bicipital Aponeurosis, Brachialis, Brachioradialis, Common Extensor Tendon: Extensor Carpi Radialis Brevis, Common Extensor Tendon: Extensor Carpi Ulnaris, Common Extensor Tendon: Extensor Digiti Minimi, Common Extensor Tendon: Extensor Digitorum Communis, Coracoacromial Ligaments, Coracobrachialis, Deltoid (Anterior and Middle Fibers), Deltoid (Posterior Fibers), Dorsal and Palmar Interossei, Dorsal Ligaments (Radioulnar, Radiocarpal, Intercarpal), Extensor Carpi Radialis Longus, Extensor Indicis, Extensor Pollicis Brevis, Extensor Pollicis Longus, Extensor Retinaculum, Extensor Tendons with Expansions, Flexor Carpi Radialis, Flexor Carpi Ulnaris, Flexor Digitorum Profundus, Flexor Digitorum Superficialis (2 heads), Flexor Pollicis Longus, Flexor Retinaculum/Transverse Carpal Ligament, Glenohumeral Joint Capsule, Hypothenar Muscles, Infraspinatus, Interosseus Membrane, Joint Capsules, Lateral Intermuscular Septum, Latissimus Dorsi Insertion (Distal 3rd), Lumbricals (Digits 2 & 3). Lumbricals (Digits 3 & 4), Medial Intermuscular Septum, Palmar Fascia, Palmar Ligaments (Radioulnar, Radiocarpal, Intercarpal), Palmaris Brevis, Palmaris Longus, Pectoralis Major, Pronator Quadratus, Pronator Teres, Quadrate Ligament, Radial Collateral Ligament of Elbow, Radial Collateral Ligament of Wrist, Serratus Anterior (Scapular Insertion), Subscapularis, Supinator and Arcade of Frohse, Supraspinatus, Teres Major, Teres Minor, Thenar Muscles, Triangular Fibrocartilage Disc, Triceps Brachii, Tunnel of Guyon, and Ulnar Collateral Ligament (UCL) Of Wrist.
23. The system of claim 1, wherein the particular Structure of interest includes at least one Structure selected from the group consisting of: Diaphragm, Erector Spinae (Iliocostalis, Longissimus, Spinalis), External Intercostals, Heart, Internal Intercostals, Interspinales (Cervical, Thoracic, Lumbar), Intertransversarii (Cervical, Thoracic, Lumbar), Latissimus Dorsi Origin, Levator Scapula, Levatores Costorum, Lung, Mamillary Tissue, Middle and Lower Fiber Trapezius, Multifidi (Cervical, Thoracic, Lumbar), Quadratus Lumborum, Rhomboids, Rotatores (Cervical, Thoracic, Lumbar), Semispinalis (Cervical, Thoracic, Lumbar), Serratus Anterior (Costal Origin), Serratus Posterior Inferior, Serratus Posterior Superior, Splenius (Capitus, Cervicis), Subclavius, Suboccipital: Obliquus Capitis Inferior, Suboccipital: Obliquus Capitis Superior, Suboccipital: Rectus Capitls Posterior Major, Suboccipital: Rectus Capitis Posterior Minor, Supraspinous/Nuchal Ligament, Supraspinous Ligament (Thoracic, Lumbar), Thoracolumbar Fascia, and Upper Fiber Trapezius.
24. The system of claim 1, wherein the particular Structure of interest includes at least one Structure selected from the group consisting of: Anterior Auricular, Anterior Scalene, Aryepiglottic, Brain, Buccinator, Ciliary Muscle, Coronalis, Corrugator Supercilii, Cricothyroid, Depressor Anguli Oris, Depressor Labii Inferioris, Digastric, Dilator Muscle, Epicranius, Frontolacrimalis, Frontomaxilaris, Frontonasalis, Frontozygomatica, Genioglossus, Geniohyoid, Hyoglossus, Inferior Longitudinal, Inferior Pharyngeal Constrictor, Lacrimomaxillaris Suture, Lambdoid Suture, Lateral Cricoarytenoid, Lateral Pterygoid, Levator Anguli Oris, Levator Labii Superiores Aleque Nasi, Levator Labii Superioris, Levator Palpebrae Superioris, Levator Veli Palati, Masseter, Medial Pterygoid, Mentalis, Middle Pharyngeal Constrictor, Middle Scalene, Musculus Uvulae, Mylohyoid, Nasalis, Nasomaxillaris Suture, Oblique Arytenoid, Occipitimastoid Suture, Omohyoid, Orbicularis Oculi, Orbicularis Oris, Palatoglossus, Palatoglossus, Palatopharyngeus, Parathyroid, Parietomastoid Suture, Parotid Gland, Platysma, porus acusticus externus, Posterior Auricular, Posterior Cricoarytenoid, Posterior Scalene, Procerus, Risorius, Salpingopharyngeus, Sphenofrontalis Suture, Sphenosquamosa Suture, Sphenozygomatic Suture, Sphincter Pupillae, Squamomastoid Suture, Squamous Suture, Stapedius, Sternocleidomastoid, Sternohyoid, Sternothyroid, Styloglossus, Stylohyoid, Stylopharyngeus, Superior Auricular, Superior Longitudinal, Superior Pharyngeal Constrictor, Superior Tarsal, Temporalis, Temporozygomatic Suture, Tensor Tympani, Tensor Veli Palati, Thyroarytenoid, Thyroepiglottic, Thyrohyoid, Thyroid, Transverse, Transverse Arytenoid, Vertical, Vocalis, Zygomaticomaxillaris Suture, Zygomaticus Major, and Zygomaticus Minor.
25. The system of claim 1, wherein the particular Structure of interest includes at least one Structure selected from the group consisting of: Abdominals: External Obliques, Abdominals: Internal Obliques, Abdominals: Rectus Abdominus, Abdominals: Transversus Abdominus, Anterior Sacral Ligaments, Appendix, Ascending Colon, Bladder, Bulbospongiosis External, Cecum, Coccygeal Ligament, Cremaster, Deep Transverse Perineal, Descending Colon, Duodenum, Esophagus, External Urethral Sphinter, Gall Bladder, Iliocecal Valve, Iliococcygeus (Levator Ani), Iliolumbar Ligament, Illium, Inguinal Ligament, Ischiocavernosis External, Ischiococcygeus, Jejunum, Kidneys, Levator Ani External, Liver, Mesentery, Mons Pubis, Obturator Internus (Proximal Origin), Omentum, Ovaries, Pancreas, Posterior Sacral Ligaments, Prostate, Proximal Hamstrings Origin, Pubococcygeus (Levator Ani), Puborectalis (Levator Ani), Pyrimidalis, Rectum, Sacrospinous Ligament, Sacrotuberous Ligament, Sigmoid Colon, Sphinter Urethrae, Spleen, Stomach, Superficial Transverse Perineal, Transverse Colon, Transverse Perineal External, Uereters, Urethrovaginalis, and Uterus.
26. A method of treating a human body, the method including steps of consulting a report created by the system of claim 1 for guidance and, as guided by the report: touching the particular Structure of interest in the human body to there attract blood flow; activating treatment by creating a semi-occlusive manual tourniquet at an artery that supplies blood to the particular Structure of interest; ascertaining effectiveness of the semi-occlusive manual tourniquet by determining a shift in volume and/or rate of a pulse at the hand placement; and stretching a portion of the human body to occlude blood flow to a nerve segment of the human body by elongation of the nerve segment proximate the particular Structure of interest.
27. The method of claim 26, wherein the Structure of interest includes at least one Structure selected from the group consisting of: Abductor Digiti Minimi (Layer 1), Abductor Hallucis (Layer 1), Adductor Brevis, Adductor Hallucis (Layer 3), Adductor Longus, Adductor Magnus, Anterior Cruciate Ligament, Articularis Genu, Biceps Femoris(Long Head), Biceps Femoris (Long Head), Biceps Femoris(Short Head), Dorsal Interossei, Extensor Digitorum Brevis & Extensor Hallucis Brevis, Extensor Digitorum Longus, Extensor Hallucis Longus, Flexor Digiti Minimi & Opponens Digiti Minimi (Layer 3), Flexor Digitorum Brevis (Layer 1), Flexor Digitorum Longus, Flexor Hallucis Brevis (Layer3), Flexor Hallucis Longus, Flexor Retinaculum, Gastrocnemius & Achilles Tendon, Gluteus Maximus, Gluteus Medius, Gluteus Minimus, Gracilis, Iliacus, Iliotibial Band, Inferior Extensor Retinaculum, Inferior Gemelli, Interosseus Membrane of Leg, Joint Capsules, Lateral Collateral Ligament of Ankle, Lateral Collateral Ligament of Knee, Lateral Meniscus, Lumbricals (Layer 2), Medial Collateral Ligament of Knee, Medial Collateral Ligaments of Ankle (Deltoid Ligament), Medial Meniscus, Obturator Externus, Obturator Internus Distal (Insertion)m Patellar Ligament, Pectineus, Peroneus Brevis, Peroneus Longus, Peroneus Tertius, Piriformis, Plantar Calcaneonavicular Ligament (Spring Ligament), Plantar Fascia, Plantar Interossei (Layer 4), Plantaris, Plica, Popliteus, Posterior Cruciate Ligament, Psoas Major, Psoas Minor, Quadratus Femoris, Quadratus Plantae (Layer 2), Rectus Femoris, Sartorius, Semimembranosus, Semimembranosus, Semitendinosus, Semitendinosus, Soleus & Achilles Tendon, Superior Extensor Retinaculum, Superior Gemelli, Tensor Fascia Lata, Tibialis Anterior, Tibialis Posterior, Transverse Intermuscular Septum, Vastus Intermedius, Vastus Lateralis, and Vastus Medialis.
28. The method of claim 26, wherein the Structure of interest includes at least one Structure selected from the group consisting of: Common Extensor Tendon: Extensor Carpi Ulnaris, Abductor Pollicis Longus, Acromioclavicular Ligaments, Adductor Pollicis, Anconeus, Annular Ligament, Biceps Brachii, Bicipital Aponeurosis, Brachialis, Brachioradialis, Common Extensor Tendon: Extensor Carpi Radialis Brevis, Common Extensor Tendon: Extensor Carpi Ulnaris, Common Extensor Tendon: Extensor Digiti Minimi, Common Extensor Tendon: Extensor Digitorum Communis, Coracoacromial Ligaments, Coracobrachialis, Deltoid (Anterior and Middle Fibers), Deltoid (Posterior Fibers), Dorsal and Palmar Interossei, Dorsal Ligaments (Radioulnar, Radiocarpal, Intercarpal), Extensor Carpi Radialis Longus, Extensor Indicis, Extensor Pollicis Brevis, Extensor Pollicis Longus, Extensor Retinaculum, Extensor Tendons with Expansions, Flexor Carpi Radialis, Flexor Carpi Ulnaris, Flexor Digitorum Profundus, Flexor Digitorum Superficialis (2 heads), Flexor Pollicis Longus, Flexor Retinaculum/Transverse Carpal Ligament, Glenohumeral Joint Capsule, Hypothenar Muscles, Infraspinatus, Interosseus Membrane, Joint Capsules, Lateral Intermuscular Septum, Latissimus Dorsi Insertion (Distal 3rd), Lumbricals (Digits 2 & 3). Lumbricals (Digits 3 & 4), Medial Intermuscular Septum, Palmar Fascia, Palmar Ligaments (Radioulnar, Radiocarpal, Intercarpal), Palmaris Brevis, Palmaris Longus, Pectoralis Major, Pronator Quadratus, Pronator Teres, Quadrate Ligament, Radial Collateral Ligament of Elbow, Radial Collateral Ligament of Wrist, Serratus Anterior (Scapular Insertion), Subscapularis, Supinator and Arcade of Frohse, Supraspinatus, Teres Major, Teres Minor, Thenar Muscles, Triangular Fibrocartilage Disc, Triceps Brachii, Tunnel of Guyon, and Ulnar Collateral Ligament (UCL) Of Wrist.
29. The method of claim 26, wherein the Structure of interest includes at least one Structure selected from the group consisting of: Diaphragm, Erector Spinae (Iliocostalis, Longissimus, Spinalis), External Intercostals, Heart, Internal Intercostals, Interspinales (Cervical, Thoracic, Lumbar), Intertransversarii (Cervical, Thoracic, Lumbar), Latissimus Dorsi Origin, Levator Scapula, Levatores Costorum, Lung, Mamillary Tissue, Middle and Lower Fiber Trapezius, Multifidi (Cervical, Thoracic, Lumbar), Quadratus Lumborum, Rhomboids, Rotatores (Cervical, Thoracic, Lumbar), Semispinalis (Cervical, Thoracic, Lumbar), Serratus Anterior (Costal Origin), Serratus Posterior Inferior, Serratus Posterior Superior, Splenius (Capitus, Cervicis), Subclavius, Suboccipital: Obliquus Capitis Inferior, Suboccipital: Obliquus Capitis Superior, Suboccipital: Rectus Capitls Posterior Major, Suboccipital: Rectus Capitis Posterior Minor, Supraspinous/Nuchal Ligament, Supraspinous Ligament (Thoracic, Lumbar), Thoracolumbar Fascia, and Upper Fiber Trapezius.
30. The method of claim 26, wherein the Structure of interest includes at least one Structure selected from the group consisting of: Anterior Auricular, Anterior Scalene, Aryepiglottic, Brain, Buccinator, Ciliary Muscle, Coronalis, Corrugator Supercilii, Cricothyroid, Depressor Anguli Oris, Depressor Labii Inferioris, Digastric, Dilator Muscle, Epicranius, Frontolacrimalis, Frontomaxilaris, Frontonasalis, Frontozygomatica, Genioglossus, Geniohyoid, Hyoglossus, Inferior Longitudinal, Inferior Pharyngeal Constrictor, Lacrimomaxillaris Suture, Lambdoid Suture, Lateral Cricoarytenoid, Lateral Pterygoid, Levator Anguli Oris, Levator Labii Superiores Aleque Nasi, Levator Labii Superioris, Levator Palpebrae Superioris, Levator Veli Palati, Masseter, Medial Pterygoid, Mentalis, Middle Pharyngeal Constrictor, Middle Scalene, Musculus Uvulae, Mylohyoid, Nasalis, Nasomaxillaris Suture, Oblique Arytenoid, Occipitimastoid Suture, Omohyoid, Orbicularis Oculi, Orbicularis Oris, Palatoglossus, Palatoglossus, Palatopharyngeus, Parathyroid, Parietomastoid Suture, Parotid Gland, Platysma, porus acusticus externus, Posterior Auricular, Posterior Cricoarytenoid, Posterior Scalene, Procerus, Risorius, Salpingopharyngeus, Sphenofrontalis Suture, Sphenosquamosa Suture, Sphenozygomatic Suture, Sphincter Pupillae, Squamomastoid Suture, Squamous Suture, Stapedius, Sternocleidomastoid, Sternohyoid, Sternothyroid, Styloglossus, Stylohyoid, Stylopharyngeus, Superior Auricular, Superior Longitudinal, Superior Pharyngeal Constrictor, Superior Tarsal, Temporalis, Temporozygomatic Suture, Tensor Tympani, Tensor Veli Palati, Thyroarytenoid, Thyroepiglottic, Thyrohyoid, Thyroid, Transverse, Transverse Arytenoid, Vertical, Vocalis, Zygomaticomaxillaris Suture, Zygomaticus Major, and Zygomaticus Minor.
31. The method of claim 26, wherein the Structure of interest includes at least one Structure selected from the group consisting of: Abdominals: External Obliques, Abdominals: Internal Obliques, Abdominals: Rectus Abdominus, Abdominals: Transversus Abdominus, Anterior Sacral Ligaments, Appendix, Ascending Colon, Bladder, Bulbospongiosis External, Cecum, Coccygeal Ligament, Cremaster, Deep Transverse Perineal, Descending Colon, Duodenum, Esophagus, External Urethral Sphinter, Gall Bladder, Iliocecal Valve, Iliococcygeus (Levator Ani), Iliolumbar Ligament, Illium, Inguinal Ligament, Ischiocavernosis External, Ischiococcygeus, Jejunum, Kidneys, Levator Ani External, Liver, Mesentery, Mons Pubis, Obturator Internus (Proximal Origin), Omentum, Ovaries, Pancreas, Posterior Sacral Ligaments, Prostate, Proximal Hamstrings Origin, Pubococcygeus (Levator Ani), Puborectalis (Levator Ani), Pyrimidalis, Rectum, Sacrospinous Ligament, Sacrotuberous Ligament, Sigmoid Colon, Sphinter Urethrae, Spleen, Stomach, Superficial Transverse Perineal, Transverse Colon, Transverse Perineal External, Uereters, Urethrovaginalis, and Uterus.
32. A method of preventing or treating reperfusion injury in a human body including steps of: consulting a system that organizes images of taxonomically classified hand placement for treatment of reperfusion injury at one or more Structures of interest in a human body; descriptive information associated with the hand placement as shown in the images as part of a framework of data demonstrating how to activate treatment by creating a semi-occlusive manual tourniquet at an artery that supplies blood to the one or more Structures of interest; stretch a portion of the human body to occlude blood flow to a nerve segment of the human body by elongation of the nerve segment proximate the one or more Structures of interest; and rules that facilitate selection of the taxonomically classified images and the descriptive information; the one or more Structures of interest being parts of the human body that are proximate a site which is susceptible to reperfusion injury, the one or more Structures of interest being selected from the group consisting of muscles, tendons, ligaments, fascia, skin, fibrous tissues, connective tissue, fat, synovial membranes, nerves, blood vessels, glands, ducts, organs, and combinations thereof; touching the one or more Structures of interest to attract blood flow; activating occlusive treatment by creating a semi-occlusive manual tourniquet at an artery that supplies blood to one or more Structures of interest in a body, ascertaining effectiveness of the semi-occlusive manual tourniquet by determining a shift in volume and/or rate of a pulse at the hand placement; and stretching a portion of the human body to occlude blood flow to a nerve segment of the human body by elongation of the nerve segment proximate to the Structure of interest.
33. The method of claim 32, wherein the Structure of interest includes at least one Structure selected from the group consisting of: Abductor Digiti Minimi (Layer 1), Abductor Hallucis (Layer 1), Adductor Brevis, Adductor Hallucis (Layer 3), Adductor Longus, Adductor Magnus, Anterior Cruciate Ligament, Articularis Genu, Biceps Femoris(Long Head), Biceps Femoris (Long Head), Biceps Femoris(Short Head), Dorsal Interossei, Extensor Digitorum Brevis & Extensor Hallucis Brevis, Extensor Digitorum Longus, Extensor Hallucis Longus, Flexor Digiti Minimi & Opponens Digiti Minimi (Layer 3), Flexor Digitorum Brevis (Layer 1), Flexor Digitorum Longus, Flexor Hallucis Brevis (Layer3), Flexor Hallucis Longus, Flexor Retinaculum, Gastrocnemius & Achilles Tendon, Gluteus Maximus, Gluteus Medius, Gluteus Minimus, Gracilis, Iliacus, Iliotibial Band, Inferior Extensor Retinaculum, Inferior Gemelli, Interosseus Membrane of Leg, Joint Capsules, Lateral Collateral Ligament of Ankle, Lateral Collateral Ligament of Knee, Lateral Meniscus, Lumbricals (Layer 2), Medial Collateral Ligament of Knee, Medial Collateral Ligaments of Ankle (Deltoid Ligament), Medial Meniscus, Obturator Externus, Obturator Internus Distal (Insertion)m Patellar Ligament, Pectineus, Peroneus Brevis, Peroneus Longus, Peroneus Tertius, Piriformis, Plantar Calcaneonavicular Ligament (Spring Ligament), Plantar Fascia, Plantar Interossei (Layer 4), Plantaris, Plica, Popliteus, Posterior Cruciate Ligament, Psoas Major, Psoas Minor, Quadratus Femoris, Quadratus Plantae (Layer 2), Rectus Femoris, Sartorius, Semimembranosus, Semimembranosus, Semitendinosus, Semitendinosus, Soleus & Achilles Tendon, Superior Extensor Retinaculum, Superior Gemelli, Tensor Fascia Lata, Tibialis Anterior, Tibialis Posterior, Transverse Intermuscular Septum, Vastus Intermedius, Vastus Lateralis, and Vastus Medialis.
34. The method of claim 32, wherein the Structure of interest includes at least one Structure selected from the group consisting of: Common Extensor Tendon: Extensor Carpi Ulnaris, Abductor Pollicis Longus, Acromioclavicular Ligaments, Adductor Pollicis, Anconeus, Annular Ligament, Biceps Brachii, Bicipital Aponeurosis, Brachialis, Brachioradialis, Common Extensor Tendon: Extensor Carpi Radialis Brevis, Common Extensor Tendon: Extensor Carpi Ulnaris, Common Extensor Tendon: Extensor Digiti Minimi, Common Extensor Tendon: Extensor Digitorum Communis, Coracoacromial Ligaments, Coracobrachialis, Deltoid (Anterior and Middle Fibers), Deltoid (Posterior Fibers), Dorsal and Palmar Interossei, Dorsal Ligaments (Radioulnar, Radiocarpal, Intercarpal), Extensor Carpi Radialis Longus, Extensor Indicis, Extensor Pollicis Brevis, Extensor Pollicis Longus, Extensor Retinaculum, Extensor Tendons with Expansions, Flexor Carpi Radialis, Flexor Carpi Ulnaris, Flexor Digitorum Profundus, Flexor Digitorum Superficialis (2 heads), Flexor Pollicis Longus, Flexor Retinaculum/Transverse Carpal Ligament, Glenohumeral Joint Capsule, Hypothenar Muscles, Infraspinatus, Interosseus Membrane, Joint Capsules, Lateral Intermuscular Septum, Latissimus Dorsi Insertion (Distal 3rd), Lumbricals (Digits 2 & 3). Lumbricals (Digits 3 & 4), Medial Intermuscular Septum, Palmar Fascia, Palmar Ligaments (Radioulnar, Radiocarpal, Intercarpal), Palmaris Brevis, Palmaris Longus, Pectoralis Major, Pronator Quadratus, Pronator Teres, Quadrate Ligament, Radial Collateral Ligament of Elbow, Radial Collateral Ligament of Wrist, Serratus Anterior (Scapular Insertion), Subscapularis, Supinator and Arcade of Frohse, Supraspinatus, Teres Major, Teres Minor, Thenar Muscles, Triangular Fibrocartilage Disc, Triceps Brachii, Tunnel of Guyon, and Ulnar Collateral Ligament (UCL) Of Wrist.
35. The method of claim 32, wherein the Structure of interest includes at least one Structure selected from the group consisting of: Diaphragm, Erector Spinae (Iliocostalis, Longissimus, Spinalis), External Intercostals, Heart, Internal Intercostals, Interspinales (Cervical, Thoracic, Lumbar), Intertransversarii (Cervical, Thoracic, Lumbar), Latissimus Dorsi Origin, Levator Scapula, Levatores Costorum, Lung, Mamillary Tissue, Middle and Lower Fiber Trapezius, Multifidi (Cervical, Thoracic, Lumbar), Quadratus Lumborum, Rhomboids, Rotatores (Cervical, Thoracic, Lumbar), Semispinalis (Cervical, Thoracic, Lumbar), Serratus Anterior (Costal Origin), Serratus Posterior Inferior, Serratus Posterior Superior, Splenius (Capitus, Cervicis), Subclavius, Suboccipital: Obliquus Capitis Inferior, Suboccipital: Obliquus Capitis Superior, Suboccipital: Rectus Capitls Posterior Major, Suboccipital: Rectus Capitis Posterior Minor, Supraspinous/Nuchal Ligament, Supraspinous Ligament (Thoracic, Lumbar), Thoracolumbar Fascia, and Upper Fiber Trapezius.
36. The method of claim 32, wherein the Structure of interest includes at least one Structure selected from the group consisting of: Anterior Auricular, Anterior Scalene, Aryepiglottic, Brain, Buccinator, Ciliary Muscle, Coronalis, Corrugator Supercilii, Cricothyroid, Depressor Anguli Oris, Depressor Labii Inferioris, Digastric, Dilator Muscle, Epicranius, Frontolacrimalis, Frontomaxilaris, Frontonasali s, Frontozygomatica, Genioglossus, Geniohyoid, Hyoglossus, Inferior Longitudinal, Inferior Pharyngeal Constrictor, Lacrimomaxillaris Suture, Lambdoid Suture, Lateral Cricoarytenoid, Lateral Pterygoid, Levator Anguli Oris, Levator Labii Superiores Aleque Nasi, Levator Labii Superioris, Levator Palpebrae Superioris, Levator Veli Palati, Masseter, Medial Pterygoid, Mentalis, Middle Pharyngeal Constrictor, Middle Scalene, Musculus Uvulae, Mylohyoid, Nasalis, Nasomaxillari s Suture, Oblique Arytenoid, Occipitimastoid Suture, Omohyoid, Orbicularis Oculi, Orbicularis Oris, Palatoglossus, Palatoglossus, Palatopharyngeus, Parathyroid, Parietomastoid Suture, Parotid Gland, Platysma, porus acusticus externus, Posterior Auricular, Posterior Cricoarytenoid, Posterior Scalene, Procerus, Risorius, Salpingopharyngeus, Sphenofrontalis Suture, Sphenosquamosa Suture, Sphenozygomatic Suture, Sphincter Pupillae, Squamomastoid Suture, Squamous Suture, Stapedius, Sternocleidomastoid, Sternohyoid, Sternothyroid, Styloglossus, Stylohyoid, Stylopharyngeus, Superior Auricular, Superior Longitudinal, Superior Pharyngeal Constrictor, Superior Tarsal, Temporalis, Temporozygomatic Suture, Tensor Tympani, Tensor Veli Palati, Thyroarytenoid, Thyroepiglottic, Thyrohyoid, Thyroid, Transverse, Transverse Arytenoid, Vertical, Vocalis, Zygomaticomaxillaris Suture, Zygomaticus Major, and Zygomaticus Minor.
37. The method of claim 32, wherein the Structure of interest includes at least one Structure selected from the group consisting of: Abdominals: External Obliques, Abdominals: Internal Obliques, Abdominals: Rectus Abdominus, Abdominals: Transversus Abdominus, Anterior Sacral Ligaments, Appendix, Ascending Colon, Bladder, Bulbospongiosis External, Cecum, Coccygeal Ligament, Cremaster, Deep Transverse Perineal, Descending Colon, Duodenum, Esophagus, External Urethral Sphinter, Gall Bladder, Iliocecal Valve, Iliococcygeus (Levator Ani), Iliolumbar Ligament, Illium, Inguinal Ligament, Ischiocavernosis External, Ischiococcygeus, Jejunum, Kidneys, Levator Ani External, Liver, Mesentery, Mons Pubis, Obturator Internus (Proximal Origin), Omentum, Ovaries, Pancreas, Posterior Sacral Ligaments, Prostate, Proximal Hamstrings Origin, Pubococcygeus (Levator Ani), Puborectalis (Levator Ani), Pyrimidalis, Rectum, Sacrospinous Ligament, Sacrotuberous Ligament, Sigmoid Colon, Sphinter Urethrae, Spleen, Stomach, Superficial Transverse Perineal, Transverse Colon, Transverse Perineal External, Uereters, Urethrovaginalis, and Uterus.
38. A computer readable form comprising: data including images of taxonomically classified hand placement for treatment of reperfusion injury at one or more Structures of interest in a human body; descriptive information associated with the hand placement as shown in the images as part of a framework of data demonstrating how to activate treatment by creating a semi-occlusive manual tourniquet at an artery that supplies blood to the one or more Structures of interest; stretch a portion of the human body to occlude blood flow to a nerve segment of the human body by elongation of the nerve segment proximate the one or more Structures of interest and rules that facilitate selection of the taxonomically classified images and the descriptive information; the one or more Structures of interest being parts of the human body that are proximate a site which is susceptible to reperfusion injury, and the one or more Structures of interest being selected from the group consisting of muscles, tendons, ligaments, fascia, skin, fibrous tissues, connective tissue, fat, synovial membranes, nerves, blood vessels, glands, ducts, organs, and combinations thereof.
39. The computer readable form of claim 38, wherein the Structure of interest includes at least one Structure selected from the group consisting of: Abductor Digiti Minimi (Layer 1), Abductor Hallucis (Layer 1), Adductor Brevis, Adductor Hallucis (Layer 3), Adductor Longus, Adductor Magnus, Anterior Cruciate Ligament, Articularis Genu, Biceps Femoris(Long Head), Biceps Femoris (Long Head), Biceps Femoris(Short Head), Dorsal Interossei, Extensor Digitorum Brevis & Extensor Hallucis Brevis, Extensor Digitorum Longus, Extensor Hallucis Longus, Flexor Digiti Minimi & Opponens Digiti Minimi (Layer 3), Flexor Digitorum Brevis (Layer 1), Flexor Digitorum Longus, Flexor Hallucis Brevis (Layer3), Flexor Hallucis Longus, Flexor Retinaculum, Gastrocnemius & Achilles Tendon, Gluteus Maximus, Gluteus Medius, Gluteus Minimus, Gracilis, Iliacus, Iliotibial Band, Inferior Extensor Retinaculum, Inferior Gemelli, Interosseus Membrane of Leg, Joint Capsules, Lateral Collateral Ligament of Ankle, Lateral Collateral Ligament of Knee, Lateral Meniscus, Lumbricals (Layer 2), Medial Collateral Ligament of Knee, Medial Collateral Ligaments of Ankle (Deltoid Ligament), Medial Meniscus, Obturator Externus, Obturator Internus Distal (Insertion)m Patellar Ligament, Pectineus, Peroneus Brevis, Peroneus Longus, Peroneus Tertius, Piriformis, Plantar Calcaneonavicular Ligament (Spring Ligament), Plantar Fascia, Plantar Interossei (Layer 4), Plantaris, Plica, Popliteus, Posterior Cruciate Ligament, Psoas Major, Psoas Minor, Quadratus Femoris, Quadratus Plantae (Layer 2), Rectus Femoris, Sartorius, Semimembranosus, Semimembranosus, Semitendinosus, Semitendinosus, Soleus & Achilles Tendon, Superior Extensor Retinaculum, Superior Gemelli, Tensor Fascia Lata, Tibialis Anterior, Tibialis Posterior, Transverse Intermuscular Septum, Vastus Intermedius, Vastus Lateralis, and Vastus Medialis.
40. The computer readable form of claim 38, wherein the Structure of interest includes at least one Structure selected from the group consisting of: Common Extensor Tendon: Extensor Carpi Ulnaris, Abductor Pollicis Longus, Acromioclavicular Ligaments, Adductor Pollicis, Anconeus, Annular Ligament, Biceps Brachii, Bicipital Aponeurosis, Brachialis, Brachioradialis, Common Extensor Tendon: Extensor Carpi Radialis Brevis, Common Extensor Tendon: Extensor Carpi Ulnaris, Common Extensor Tendon: Extensor Digiti Minimi, Common Extensor Tendon: Extensor Digitorum Communis, Coracoacromial Ligaments, Coracobrachialis, Deltoid (Anterior and Middle Fibers), Deltoid (Posterior Fibers), Dorsal and Palmar Interossei, Dorsal Ligaments (Radioulnar, Radiocarpal, Intercarpal), Extensor Carpi Radialis Longus, Extensor Indicis, Extensor Pollicis Brevis, Extensor Pollicis Longus, Extensor Retinaculum, Extensor Tendons with Expansions, Flexor Carpi Radialis, Flexor Carpi Ulnaris, Flexor Digitorum Profundus, Flexor Digitorum Superficialis (2 heads), Flexor Pollicis Longus, Flexor Retinaculum/Transverse Carpal Ligament, Glenohumeral Joint Capsule, Hypothenar Muscles, Infraspinatus, Interosseus Membrane, Joint Capsules, Lateral Intermuscular Septum, Latissimus Dorsi Insertion (Distal 3rd), Lumbricals (Digits 2 & 3). Lumbricals (Digits 3 & 4), Medial Intermuscular Septum, Palmar Fascia, Palmar Ligaments (Radioulnar, Radiocarpal, Intercarpal), Palmaris Brevis, Palmaris Longus, Pectoralis Major, Pronator Quadratus, Pronator Teres, Quadrate Ligament, Radial Collateral Ligament of Elbow, Radial Collateral Ligament of Wrist, Serratus Anterior (Scapular Insertion), Subscapularis, Supinator and Arcade of Frohse, Supraspinatus, Teres Major, Teres Minor, Thenar Muscles, Triangular Fibrocartilage Disc, Triceps Brachii, Tunnel of Guyon, and Ulnar Collateral Ligament (UCL) Of Wrist.
41. The method of claim 38, wherein the Structure of interest includes at least one Structure selected from the group consisting of: Diaphragm, Erector Spinae (Iliocostalis, Longissimus, Spinalis), External Intercostals, Heart, Internal Intercostals, Interspinales (Cervical, Thoracic, Lumbar), Intertransversarii (Cervical, Thoracic, Lumbar), Latissimus Dorsi Origin, Levator Scapula, Levatores Costorum, Lung, Mamillary Tissue, Middle and Lower Fiber Trapezius, Multifidi (Cervical, Thoracic, Lumbar), Quadratus Lumborum, Rhomboids, Rotatores (Cervical, Thoracic, Lumbar), Semispinalis (Cervical, Thoracic, Lumbar), Serratus Anterior (Costal Origin), Serratus Posterior Inferior, Serratus Posterior Superior, Splenius (Capitus, Cervicis), Subclavius, Suboccipital: Obliquus Capitis Inferior, Suboccipital: Obliquus Capitis Superior, Suboccipital: Rectus Capitls Posterior Major, Suboccipital: Rectus Capitis Posterior Minor, Supraspinous/Nuchal Ligament, Supraspinous Ligament (Thoracic, Lumbar), Thoracolumbar Fascia, and Upper Fiber Trapezius.
42. The computer readable form of claim 38, wherein the Structure of interest includes at least one Structure selected from the group consisting of: Anterior Auricular, Anterior Scalene, Aryepiglottic, Brain, Buccinator, Ciliary Muscle, Coronalis, Corrugator Supercilii, Cricothyroid, Depressor Anguli Oris, Depressor Labii Inferioris, Digastric, Dilator Muscle, Epicranius, Frontolacrimalis, Frontomaxilaris, Frontonasali s, Frontozygomatica, Genioglossus, Geniohyoid, Hyoglossus, Inferior Longitudinal, Inferior Pharyngeal Constrictor, Lacrimomaxillaris Suture, Lambdoid Suture, Lateral Cricoarytenoid, Lateral Pterygoid, Levator Anguli Oris, Levator Labii Superiores Aleque Nasi, Levator Labii Superioris, Levator Palpebrae Superioris, Levator Veli Palati, Masseter, Medial Pterygoid, Mentalis, Middle Pharyngeal Constrictor, Middle Scalene, Musculus Uvulae, Mylohyoid, Nasalis, Nasomaxillaris Suture, Oblique Arytenoid, Occipitimastoid Suture, Omohyoid, Orbicularis Oculi, Orbicularis Oris, Palatoglossus, Palatoglossus, Palatopharyngeus, Parathyroid, Parietomastoid Suture, Parotid Gland, Platysma, porus acusticus externus, Posterior Auricular, Posterior Cricoarytenoid, Posterior Scalene, Procerus, Risorius, Salpingopharyngeus, Sphenofrontalis Suture, Sphenosquamosa Suture, Sphenozygomatic Suture, Sphincter Pupillae, Squamomastoid Suture, Squamous Suture, Stapedius, Sternocleidomastoid, Sternohyoid, Sternothyroid, Styloglossus, Stylohyoid, Stylopharyngeus, Superior Auricular, Superior Longitudinal, Superior Pharyngeal Constrictor, Superior Tarsal, Temporalis, Temporozygomatic Suture, Tensor Tympani, Tensor Veli Palati, Thyroarytenoid, Thyroepiglottic, Thyrohyoid, Thyroid, Transverse, Transverse Arytenoid, Vertical, Vocalis, Zygomaticomaxillaris Suture, Zygomaticus Major, and Zygomaticus Minor.
43. The computer readable form of claim 38, wherein the Structure of interest includes at least one Structure selected from the group consisting of: Abdominals: External Obliques, Abdominal s: Internal Obliques, Abdominals: Rectus Abdominus, Abdominals: Transversus Abdominus, Anterior Sacral Ligaments, Appendix, Ascending Colon, Bladder, Bulbospongiosis External, Cecum, Coccygeal Ligament, Cremaster, Deep Transverse Perineal, Descending Colon, Duodenum, Esophagus, External Urethral Sphinter, Gall Bladder, Iliocecal Valve, Iliococcygeus (Levator Ani), Iliolumbar Ligament, Illium, Inguinal Ligament, Ischiocavernosis External, Ischiococcygeus, Jejunum, Kidneys, Levator Ani External, Liver, Mesentery, Mons Pubis, Obturator Internus (Proximal Origin), Omentum, Ovaries, Pancreas, Posterior Sacral Ligaments, Prostate, Proximal Hamstrings Origin, Pubococcygeus (Levator Ani), Puborectalis (Levator Ani), Pyrimidalis, Rectum, Sacrospinous Ligament, Sacrotuberous Ligament, Sigmoid Colon, Sphinter Urethrae, Spleen, Stomach, Superficial Transverse Perineal, Transverse Colon, Transverse Perineal External, Uereters, Urethrovaginalis, and Uterus.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
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DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
Introductory Principles of Ischemic Conditioning
(41) The present RI treatment system, is designed to provide non-surgical prevention (Pre-C), and treatment of acute (Per-C), sub-acute and chronic (Post-C) musculoskeletal injuries that have been damaged by reperfusion injury. This method of ischemic conditioning can eliminate or reduce symptoms of pain, swelling, numbness, aching, tingling, burning, weakness, atrophy, hypersensitivity, circulatory changes and restricted motion or any combinations thereof.
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(43) The application of the ischemic conditioning has both local and remote effects because the act of providing an occlusion has both an effect on the structures supplied by the artery being occluded and systemically throughout the body, i.e. remotely.
(44) The present system utilizes the TAPN framework to benefit less severe musculoskeletal soft tissue injury as, ischemia reperfusion cycles or I/R cycles may be found in surrounding healthy tissue which is damaged from primary musculoskeletal trauma through the loss of blood flow, thus mitigating the effects of RI as shown in
(45) The portions of the TAPN methodology pertaining to the direct ischemic conditioning technique occur during the A or Activation and the N or Neurovascular Stretch portion of the Touch/Activation/Pulse/Neurovascular Stretch framework. During the A portion, the semi-occlusive manual pressure is applied perpendicular to a blood vessel that is to be occluded. One occlusion technique is to create a pressure point by compressing the blood vessel with tension at 90 and slide the pressure point perpendicularly outward from the blood vessel until a substantial difference in pulse is achieved. This normal-gliding technique produces occlusive tension that may be visualized by the relationship Compression X Glide=Tension at 90. The A portion may precede the N portion, or there may be temporal overlap such that the A portion precedes the N portion with overlap at the end, or else there may be complete temporal overlap. The N portion may sometimes precede the A portion if patient tolerance improves, however, this is expected to be rarely performed.
(46) Using a pressure point that bisects the common vascular site of a specific Segment or Structure of the body along the indicated vector (3-Dimensional direction) is a preferred aspect of the occlusion technique. The amplitude of the tension can be subjectively determined using the following scale: level 1: light, level 2: mild, level 3: moderate, level 4: firm. The pulse taken at a point distal to the pressure point is termed the distal turbulent pulse. A determination that this pulse has diminished demarcates the end of the A phase or portion of the TAPN framework. By way of example, where the A phase precedes the N phase, a diminished pulse in the P phase may guide the practitioner to determine when the A phase finishes and when the N phase should begin.
(47) Once the distal turbulent pulse has diminished, a second ischemic event N occurs at the neurovascular supply to the nerve of the Segment or Structure of interest. This is the neurovascular stretch N, which is a neural stretch to approximately 15% of the usual anatomical length. This type of stretch is sufficient to choke off the blood supply to the nerve and create another ischemic event. If a 15% stretch cannot be accomplished in the local nerve, central or dural stretches in opposing limbs such as the contralateral limb and the head, may be implemented to enhance the effect of the stretch and, thus, the ischemia.
(48) Both the A and the N phases of the technique are the ischemic phases and if they are done together, in a combined fashion, then the ischemic effect is augmented. The order of events of the framework is also a unique component of the system and has purpose. As indicated previously, the T phase brings blood flow to the Structure(s) of a Segment following guidance outlined by descriptive information that may be reported or otherwise ascertained by reporting from an electronic database. The database may be structured for reporting by taxonomical and/or symptomological identifiers for reporting to a practitioner who follows the report as a guide to implementing a modality of treatment for a specific structure of the body. Once the blood flow is directed to the area of interest during the T phase using the taxonomy as a guide, the blood flow is subsequently choked off during the A phase. The P phase is an indicator of when the A ends and the N begins. Finally, the N enhances the ischemic effect obtained by the A as it is the second ischemic event.
(49) The system utilizes a set of expert rules that facilitate a non-surgical semi-occlusive method which may be used to prevent (Pre-C) and treat (Per-C and Post-C) reperfusion injuries in musculoskeletal tissue.
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(51) In context of
(52) Overview of Treatment Process
(53) As the framework may be used clinically,
Working Example 1Groin Pull
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(55) The Pulse row 814 corresponds to Phase 613 of
(56) The Neurovascular Stretch row corresponds to Phase 619 of
(57) In implementation, as shown in
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(59) A legend 1006, accompanies the medical illustration which has been cited for use, 1007.
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(62) A Touch row 1404 provides useful information 1406 concerning the origins, insertions, blood supply and innervation for use as a reference tool in order to guide palpation of the correct structure and review anatomy according to Phase 601 (see
(63) A Pulse row 1420 corresponds to Phase 613 of
(64) A Neurovascular Stretch row 1424 corresponds to Phase 619 of
(65) A legend field 1428 accompanies the medical illustration which has been cited for use, 1007.
Working Example 2Pectoral Strain
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(67) The Pulse row 1516 corresponds to Phase 613 of
(68) The Neurovascular Stretch row 1516 corresponds to Phase 6D 619 of
(69) In implementation, as shown in
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Working Example 3Lower Back Pain
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(73) The Pulse row 2018 corresponds to Phase 613 of
(74) The Neurovascular Stretch row 2020 corresponds to Phase 619 of
(75) In implementation, as shown in
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Working Example 4Neck Pain
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(79) The Pulse row 2514 corresponds to Phase 613 of
(80) The Neurovascular Stretch row 2520 corresponds to Phase 619 of
(81) In implementation, as shown in
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Working Example 5Sacral Sprain
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(85) The Pulse row 3018 corresponds to Phase 613 of
(86) The Neurovascular Stretch row 3020 corresponds to Phase 619 of
(87) In implementation, as shown in
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(91) A database 3510 is connected to the central processing station 3504. The database has a variety of components, such as relational database tables 3512 which may be located at a central location or in a distributed database. A system of expert rules 3514 is established by a skilled practitioner to assist in the diagnosis and treatment of RI. A practitioner of this skillset may be, for example, a person with a doctorate in Physical Therapy or another expert in anatomy and manual therapy. Access to these rules permits reporting and presentation of images shown in Working Examples 1-5 to practitioners to facilitate educational training in the treatment of injuries as a result of RI, as well as the actual treatment of the injury itself.
(92) In one embodiment, software resident on the server 34502 or processing station 3504 may include a system reporting functionality (through use of GUI 3528) that guides practitioners who are implementing a treatment modality for a Structure of the human body. The reporting functionality may, for example, utilize an image of the human body with sequential click-downs that proceed through a system of taxonomy to arrive as a Structure in need of treatment. Once the Structure is selected, the reporting functionality may provide images and other data that guide the practitioner through the TAPN framework as shown in processes 600 (
(93) The images may include a table of local stretch images 3516, which may be images in the nature of
(94) The database 3510 also includes medical images 3520. These include images in the nature of
(95) The central processing station 3504 may be provided with program logic that is organized into functional blocks of logic 3526, which may be for example, subroutines or objects that interact with a user through graphical user interface 3528. A diagnostic query engine 3530 engages in a dialogue with a practitioner/user, such as users connected to the network hosts 3508, 3508A. The query may be any query that is useful in guiding practitioners to arrive at a reported TAPN box in the nature of what is shown in
(96) A patient monitoring segment 3534 tracks what treatments have been performed on each patient by taxonomy code, how well the treatment was tolerated, and whether the treatments caused any improvements or additional symptoms to occur. The occurrence of improvements or additional symptoms can be a significant factor in applying the system of expert rules. For example, in a patient who complains of both knee and spinal pain, compensation for the knee injury when striding may cause misalignments to occur in the hip, back and neck. Therefore, while all of these problems may be treated, treatment of the knee may be regarded as the primary goal with the other problems being secondary, and this may be confirmed by monitoring to assess whether the secondary problems diminish with improvement of the injury to the knee. Thus, the system of expert rules 3512 and the taxonomy selection and reporting engine 3532 may ascertain improvements or additional problems as a factor in determining the selection of treatments by taxonomic codes.
(97) The database 3510 is optionally a propriety database in the sense that a subscription or access management engine 3536 excludes unauthorized users. For example, users connected through the network hosts 3508, 3508A may pay a monthly or annual subscription access fee. This community of users may also be able to share data for TAPN frameworks of their own creation by uploading these to a user community database segment 3538, which may also contain user community notes regarding specific TAPN protocols, such as problems or benefits observed with these protocols, suggested improvements, and whether patients generally well-tolerate specific movements suggested by thee protocols.
(98) The system 3500 may be configured for real-time training or education 3538 through use of menu options presented through the GUI 3528. Thus, a user may place the system 3500 in a mode where patient data is only transiently retained for patient monitoring 3534 during the course of a training session where, for example, there may be a volunteer patient who has no actual injury but has been coached to complain of the symptoms that would be present in case of an actual injury. Alternatively, the menu system for the real-time training mode 3538 may be used to place the system 3500 in an interactive dialogue that demonstrates use of the system to a practitioner/user, for example, by interacting with the GUI 3528 to arrive at the TAPN boxes shown in
(99) There may be any number of network hosts 3508, 3508A. By way of example, each of network hosts 3508, 3508A may be for local networks allocated to a physical therapy practice located at a single brick-and-mortar address. For larger enterprises operating out of different addresses, the network hosts may be for wide area network or a virtual private network.
(100) Although
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(102) Program instructions and data for the operation of system 3500 may be stored on a computer readable form. A computer readable form may be, for example, a hard drive, DVD, CD-ROM, computer memory or memory stick.
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(104) With the artery so located 3706, one can place 3708 manual pressure adjacent to the artery. Here it is also preferred to note the name of the structure where the activation point resides. The activation point is then moved to bisect away from the longitudinal axis of the artery with a compression and a glide to create a manual tension across the artery. This is a test to ascertain HP1 for the Structure. A second determination 3710 is made by ascertaining a pulse to determine whether the proposed HP1 occludes blood supply to the Structure as intended. If so, another determination 3712 is made, for example, by consulting an anatomical diagram, whether there is a second palpable distal artery downstream from the Structure. If the determination 3712 is negative, then HP1 is a terminal branch to the Structure and no HP2 is required. If the determination 3712 is positive, then HP2 is determined on the test patient by locating 3716 a palpable distal downstream artery from the Structure. This manner of HP2 may be used as a redundant pulse palpitation point to compare to HP1.
(105) If the determination 3710 is negative, then one may locate 3718 another (second) proximal upstream artery to the Structure that may be occluded by hand placement other than at HP1. The longitudinal axis of this second artery is determined for purposes of establishing occlusion by compression plus glide. On the test patient, one may place 3720 manual pressure adjacent to the second artery. The name of the structure at the activation point is preferably recorded. One may then use compression plus glide to move the activation point HP2, bisecting away from the longitudinal axis of the artery to create a manual tension across the artery. This manner of HP2 is a double activation point because there are two points of occlusion for the same Structure. Pulses may be taken from the test patient to confirm that occlusion/activation has occurred.
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(107) Table 1 below provides a list of Structures that, among others, may be determined for treatment of RI and developed using logical processes 3700, 3800:
(108) TABLE-US-00001 TABLE 1 Structures for TAPN Treatment System No. System Structure 1 Lower Extremity Abductor Digiti Minimi (Layer 1) 1 Lower Extremity Abductor Hallucis (Layer 1) 1 Lower Extremity Adductor Brevis 1 Lower Extremity Adductor Hallucis (Layer 3) 1 Lower Extremity Adductor Longus 1 Lower Extremity Adductor Magnus 1 Lower Extremity Anterior Cruciate Ligament 1 Lower Extremity Articularis Genu 1 Lower Extremity Biceps Femoris(Long Head) 1 Lower Extremity Biceps Femoris(Long Head) 1 Lower Extremity Biceps Femoris(Short Head) 1 Lower Extremity Dorsal Interossei 1 Lower Extremity Extensor Digitorum Brevis & Extensor Hallucis Brevis 1 Lower Extremity Extensor Digitorum Longus 1 Lower Extremity Extensor Hallucis Longus 1 Lower Extremity Flexor Digiti Minimi & Opponens Digiti Minimi (Layer 3) 1 Lower Extremity Flexor Digitorum Brevis (Layer 1) 1 Lower Extremity Flexor Digitorum Longus 1 Lower Extremity Flexor Hallucis Brevis (Layer3) 1 Lower Extremity Flexor Hallucis Longus 1 Lower Extremity Flexor Retinaculum 1 Lower Extremity Gastrocnemius & Achilles Tendon 1 Lower Extremity Gluteus Maximus 1 Lower Extremity Gluteus Medius 1 Lower Extremity Gluteus Minimus 1 Lower Extremity Gracilis 1 Lower Extremity Iliacus 1 Lower Extremity Iliotibial Band 1 Lower Extremity Inferior Extensor Retinaculum 1 Lower Extremity Inferior Gemelli 1 Lower Extremity Interosseus Membrane of Leg 1 Lower Extremity Joint Capsules 1 Lower Extremity Lateral Collateral Ligament of Ankle 1 Lower Extremity Lateral Collateral Ligament of Knee 1 Lower Extremity Lateral Meniscus 1 Lower Extremity Lumbricals (Layer 2) 1 Lower Extremity Medial Collateral Ligament of Knee 1 Lower Extremity Medial Collateral Ligaments of Ankle (Deltoid Ligament) 1 Lower Extremity Medial Meniscus 1 Lower Extremity Obturator Externus 1 Lower Extremity Obturator Internus Distal 2/3 (Insertion) 1 Lower Extremity Patellar Ligament 1 Lower Extremity Pectineus 1 Lower Extremity Peroneus Brevis 1 Lower Extremity Peroneus Longus 1 Lower Extremity Peroneus Tertius 1 Lower Extremity Piriformis 1 Lower Extremity Plantar Calcaneonavicular Ligament (Spring Ligament) 1 Lower Extremity Plantar Fascia 1 Lower Extremity Plantar Interossei (Layer 4) 1 Lower Extremity Plantaris 1 Lower Extremity Plica 1 Lower Extremity Popliteus 1 Lower Extremity Posterior Cruciate Ligament 1 Lower Extremity Psoas Major 1 Lower Extremity Psoas Minor 1 Lower Extremity Quadratus Femoris 1 Lower Extremity Quadratus Plantae (Layer 2) 1 Lower Extremity Rectus Femoris 1 Lower Extremity Sartorius 1 Lower Extremity Semimembranosus 1 Lower Extremity Semimembranosus 1 Lower Extremity Semitendinosus 1 Lower Extremity Semitendinosus 1 Lower Extremity Soleus & Achilles Tendon 1 Lower Extremity Superior Extensor Retinaculum 1 Lower Extremity Superior Gemelli 1 Lower Extremity Tensor Fascia Lata 1 Lower Extremity Tibialis Anterior 1 Lower Extremity Tibialis Posterior 1 Lower Extremity Transverse Intermuscular Septum 1 Lower Extremity Vastus Intermedius 1 Lower Extremity Vastus Lateralis 1 Lower Extremity Vastus Medialis 2 Upper Extremity Abductor Pollicis Longus 2 Upper Extremity Acromioclavicular Ligaments 2 Upper Extremity Adductor Pollicis 2 Upper Extremity Anconeus 2 Upper Extremity Annular Ligament 2 Upper Extremity Biceps Brachii 2 Upper Extremity Bicipital Aponeurosis 2 Upper Extremity Brachialis 2 Upper Extremity Brachioradialis 2 Upper Extremity Common Extensor Tendon: Extensor Carpi Radialis Brevis 2 Upper Extremity Common Extensor Tendon: Extensor Carpi Ulnaris 2 Upper Extremity Common Extensor Tendon: Extensor Digiti Minimi 2 Upper Extremity Common Extensor Tendon: Extensor Digitorum Communis 2 Upper Extremity Coracoacromial Ligaments 2 Upper Extremity Coracobrachialis 2 Upper Extremity Deltoid (Anterior and Middle Fibers) 2 Upper Extremity Deltoid (Posterior Fibers) 2 Upper Extremity Dorsal and Palmar Interossei 2 Upper Extremity Dorsal Ligaments (Radioulnar, Radiocarpal, Intercarpal) 2 Upper Extremity Extensor Carpi Radialis Longus 2 Upper Extremity Extensor Indicis 2 Upper Extremity Extensor Pollicis Brevis 2 Upper Extremity Extensor Pollicis Longus 2 Upper Extremity Extensor Retinaculum 2 Upper Extremity Extensor Tendons with Expansions 2 Upper Extremity Flexor Carpi Radialis 2 Upper Extremity Flexor Carpi Ulnaris 2 Upper Extremity Flexor Digitorum Profundus 2 Upper Extremity Flexor Digitorum Superficialis (2 heads) 2 Upper Extremity Flexor Pollicis Longus 2 Upper Extremity Flexor Retinaculum/Transverse Carpal Ligament 2 Upper Extremity Glenohumeral Joint Capsule 2 Upper Extremity Hypothenar Muscles 2 Upper Extremity Infraspinatus 2 Upper Extremity Interosseus Membrane 2 Upper Extremity Joint Capsules 2 Upper Extremity Lateral Intermuscular Septum 2 Upper Extremity Latissimus Dorsi Insertion (Distal 3rd) 2 Upper Extremity Lumbricals (Digits 2 & 3) 2 Upper Extremity Lumbricals (Digits 3 & 4) 2 Upper Extremity Medial Intermuscular Septum 2 Upper Extremity Palmar Fascia 2 Upper Extremity Palmar Ligaments (Radioulnar, Radiocarpal, Intercarpal) 2 Upper Extremity Palmaris Brevis 2 Upper Extremity Palmaris Longus 2 Upper Extremity Pectoralis Major 2 Upper Extremity Pronator Quadratus 2 Upper Extremity Pronator Teres 2 Upper Extremity Quadrate Ligament 2 Upper Extremity Radial Collateral Ligament of Elbow 2 Upper Extremity Radial Collateral Ligament of Wrist 2 Upper Extremity Serratus Anterior (Scapular Insertion) 2 Upper Extremity Subscapularis 2 Upper Extremity Supinator and Arcade of Frohse 2 Upper Extremity Supraspinatus 2 Upper Extremity Teres Major 2 Upper Extremity Teres Minor 2 Upper Extremity Thenar Muscles 2 Upper Extremity Triangular Fibrocartilage Disc 2 Upper Extremity Triceps Brachii 2 Upper Extremity Tunnel of Guyon 2 Upper Extremity Ulnar Collateral Ligament (UCL) Of Wrist 3 Spine and Thorax Diaphragm 3 Spine and Thorax Erector Spinae (Iliocostalis, Longissimus, Spinalis) 3 Spine and Thorax External Intercostals 3 Spine and Thorax Heart 3 Spine and Thorax Internal Intercostals 3 Spine and Thorax Interspinales (Cervical, Thoracic, Lumbar) 3 Spine and Thorax Intertransversarii (Cervical, Thoracic, Lumbar) 3 Spine and Thorax Latissimus Dorsi Origin 3 Spine and Thorax Levator Scapula 3 Spine and Thorax Levatores Costorum 3 Spine and Thorax Lung 3 Spine and Thorax Mamillary Tissue 3 Spine and Thorax Middle and Lower Fiber Trapezius 3 Spine and Thorax Multifidi (Cervical, Thoracic, Lumbar) 3 Spine and Thorax Quadratus Lumborum 3 Spine and Thorax Rhomboids 3 Spine and Thorax Rotatores (Cervical, Thoracic, Lumbar) 3 Spine and Thorax Semispinalis (Cervical, Thoracic, Lumbar) 3 Spine and Thorax Serratus Anterior (Costal Origin) 3 Spine and Thorax Serratus Posterior Inferior 3 Spine and Thorax Serratus Posterior Superior 3 Spine and Thorax Splenius (Capitus, Cervicis) 3 Spine and Thorax Subclavius 3 Spine and Thorax Suboccipital: Obliquus Capitis Inferior 3 Spine and Thorax Suboccipital: Obliquus Capitis Superior 3 Spine and Thorax Suboccipital: Rectus CapitIs Posterior Major 3 Spine and Thorax Suboccipital: Rectus Capitis Posterior Minor 3 Spine and Thorax Supraspinous/Nuchal Ligament 3 Spine and Thorax Supraspinous Ligament (Thoracic, Lumbar) 3 Spine and Thorax Thoracolumbar Fascia 3 Spine and Thorax Upper Fiber Trapezius 4 Cranium, Face and Anterior Neck Anterior Auricular 4 Cranium, Face and Anterior Neck Anterior Scalene 4 Cranium, Face and Anterior Neck Aryepiglottic 4 Cranium, Face and Anterior Neck Brain 4 Cranium, Face and Anterior Neck Buccinator 4 Cranium, Face and Anterior Neck Ciliary Muscle 4 Cranium, Face and Anterior Neck Coronalis 4 Cranium, Face and Anterior Neck Corrugator Supercilii 4 Cranium, Face and Anterior Neck Cricothyroid 4 Cranium, Face and Anterior Neck Depressor Anguli Oris 4 Cranium, Face and Anterior Neck Depressor Labii Inferioris 4 Cranium, Face and Anterior Neck Digastric 4 Cranium, Face and Anterior Neck Dilator Muscle 4 Cranium, Face and Anterior Neck Epicranius 4 Cranium, Face and Anterior Neck Frontolacrimalis 4 Cranium, Face and Anterior Neck Frontomaxilaris 4 Cranium, Face and Anterior Neck Frontonasalis 4 Cranium, Face and Anterior Neck Frontozygomatica 4 Cranium, Face and Anterior Neck Genioglossus 4 Cranium, Face and Anterior Neck Geniohyoid 4 Cranium, Face and Anterior Neck Hyoglossus 4 Cranium, Face and Anterior Neck Inferior Longitudinal 4 Cranium, Face and Anterior Neck Inferior Pharyngeal Constrictor 4 Cranium, Face and Anterior Neck Lacrimomaxillaris Suture 4 Cranium, Face and Anterior Neck Lambdoid Suture 4 Cranium, Face and Anterior Neck Lateral Cricoarytenoid 4 Cranium, Face and Anterior Neck Lateral Pterygoid 4 Cranium, Face and Anterior Neck Levator Anguli Oris 4 Cranium, Face and Anterior Neck Levator Labii Superiores Aleque Nasi 4 Cranium, Face and Anterior Neck Levator Labii Superioris 4 Cranium, Face and Anterior Neck Levator Palpebrae Superioris 4 Cranium, Face and Anterior Neck Levator Veli Palati 4 Cranium, Face and Anterior Neck Masseter 4 Cranium, Face and Anterior Neck Medial Pterygoid 4 Cranium, Face and Anterior Neck Mentalis 4 Cranium, Face and Anterior Neck Middle Pharyngeal Constrictor 4 Cranium, Face and Anterior Neck Middle Scalene 4 Cranium, Face and Anterior Neck Musculus Uvulae 4 Cranium, Face and Anterior Neck Mylohyoid 4 Cranium, Face and Anterior Neck Nasalis 4 Cranium, Face and Anterior Neck Nasomaxillaris Suture 4 Cranium, Face and Anterior Neck Oblique Arytenoid 4 Cranium, Face and Anterior Neck Occipitimastoid Suture 4 Cranium, Face and Anterior Neck Omohyoid 4 Cranium, Face and Anterior Neck Orbicularis Oculi 4 Cranium, Face and Anterior Neck Orbicularis Oris 4 Cranium, Face and Anterior Neck Palatoglossus 4 Cranium, Face and Anterior Neck Palatoglossus 4 Cranium, Face and Anterior Neck Palatopharyngeus 4 Cranium, Face and Anterior Neck Parathyroid 4 Cranium, Face and Anterior Neck Parietomastoid Suture 4 Cranium, Face and Anterior Neck Parotid Gland 4 Cranium, Face and Anterior Neck Platysma 4 Cranium, Face and Anterior Neck porus acusticus externus 4 Cranium, Face and Anterior Neck Posterior Auricular 4 Cranium, Face and Anterior Neck Posterior Cricoarytenoid 4 Cranium, Face and Anterior Neck Posterior Scalene 4 Cranium, Face and Anterior Neck Procerus 4 Cranium, Face and Anterior Neck Risorius 4 Cranium, Face and Anterior Neck Salpingopharyngeus 4 Cranium, Face and Anterior Neck Sphenofrontalis Suture 4 Cranium, Face and Anterior Neck Sphenosquamosa Suture 4 Cranium, Face and Anterior Neck Sphenozygomatic Suture 4 Cranium, Face and Anterior Neck Sphincter Pupillae 4 Cranium, Face and Anterior Neck Squamomastoid Suture 4 Cranium, Face and Anterior Neck Squamous Suture 4 Cranium, Face and Anterior Neck Stapedius 4 Cranium, Face and Anterior Neck Sternocleidomastoid 4 Cranium, Face and Anterior Neck Sternohyoid 4 Cranium, Face and Anterior Neck Sternothyroid 4 Cranium, Face and Anterior Neck Styloglossus 4 Cranium, Face and Anterior Neck Stylohyoid 4 Cranium, Face and Anterior Neck Stylopharyngeus 4 Cranium, Face and Anterior Neck Superior Auricular 4 Cranium, Face and Anterior Neck Superior Longitudinal 4 Cranium, Face and Anterior Neck Superior Pharyngeal Constrictor 4 Cranium, Face and Anterior Neck Superior Tarsal 4 Cranium, Face and Anterior Neck Temporalis 4 Cranium, Face and Anterior Neck Temporozygomatic Suture 4 Cranium, Face and Anterior Neck Tensor Tympani 4 Cranium, Face and Anterior Neck Tensor Veli Palati 4 Cranium, Face and Anterior Neck Thyroarytenoid 4 Cranium, Face and Anterior Neck Thyroepiglottic 4 Cranium, Face and Anterior Neck Thyrohyoid 4 Cranium, Face and Anterior Neck Thyroid 4 Cranium, Face and Anterior Neck Transverse 4 Cranium, Face and Anterior Neck Transverse Arytenoid 4 Cranium, Face and Anterior Neck Vertical 4 Cranium, Face and Anterior Neck Vocalis 4 Cranium, Face and Anterior Neck Zygomaticomaxillaris Suture 4 Cranium, Face and Anterior Neck Zygomaticus Major 4 Cranium, Face and Anterior Neck Zygomaticus Minor 5 Pelvic, Abdominal and Visceral Abdominals: External Obliques 5 Pelvic, Abdominal and Visceral Abdominals: Internal Obliques 5 Pelvic, Abdominal and Visceral Abdominals: Rectus Abdominus 5 Pelvic, Abdominal and Visceral Abdominals: Transversus Abdominus 5 Pelvic, Abdominal and Visceral Anterior Sacral Ligaments 5 Pelvic, Abdominal and Visceral Appendix 5 Pelvic, Abdominal and Visceral Ascending Colon 5 Pelvic, Abdominal and Visceral Bladder 5 Pelvic, Abdominal and Visceral Bulbospongiosis External 5 Pelvic, Abdominal and Visceral Cecum 5 Pelvic, Abdominal and Visceral Coccygeal Ligament 5 Pelvic, Abdominal and Visceral Cremaster 5 Pelvic, Abdominal and Visceral Deep Transverse Perineal 5 Pelvic, Abdominal and Visceral Descending Colon 5 Pelvic, Abdominal and Visceral Duodenum 5 Pelvic, Abdominal and Visceral Esophagus 5 Pelvic, Abdominal and Visceral External Urethral Sphinter 5 Pelvic, Abdominal and Visceral Gall Bladder 5 Pelvic, Abdominal and Visceral Iliocecal Valve 5 Pelvic, Abdominal and Visceral Iliococcygeus (Levator Ani) 5 Pelvic, Abdominal and Visceral Iliolumbar Ligament 5 Pelvic, Abdominal and Visceral Illium 5 Pelvic, Abdominal and Visceral Inguinal Ligament 5 Pelvic, Abdominal and Visceral Ischiocavernosis External 5 Pelvic, Abdominal and Visceral Ischiococcygeus 5 Pelvic, Abdominal and Visceral Jejunum 5 Pelvic, Abdominal and Visceral Kidneys 5 Pelvic, Abdominal and Visceral Levator Ani External 5 Pelvic, Abdominal and Visceral Liver 5 Pelvic, Abdominal and Visceral Mesentery 5 Pelvic, Abdominal and Visceral Mons Pubis 5 Pelvic, Abdominal and Visceral Obturator Internus (Proximal Origin) 5 Pelvic, Abdominal and Visceral Omentum 5 Pelvic, Abdominal and Visceral Ovaries 5 Pelvic, Abdominal and Visceral Pancreas 5 Pelvic, Abdominal and Visceral Posterior Sacral Ligaments 5 Pelvic, Abdominal and Visceral Prostate 5 Pelvic, Abdominal and Visceral Proximal Hamstrings Origin 5 Pelvic, Abdominal and Visceral Pubococcygeus (Levator Ani) 5 Pelvic, Abdominal and Visceral Puborectalis (Levator Ani) 5 Pelvic, Abdominal and Visceral Pyrimidalis 5 Pelvic, Abdominal and Visceral Rectum 5 Pelvic, Abdominal and Visceral Sacrospinous Ligament 5 Pelvic, Abdominal and Visceral Sacrotuberous Ligament 5 Pelvic, Abdominal and Visceral Sigmoid Colon 5 Pelvic, Abdominal and Visceral Sphinter Urethrae 5 Pelvic, Abdominal and Visceral Spleen 5 Pelvic, Abdominal and Visceral Stomach 5 Pelvic, Abdominal and Visceral Superficial Transverse Perineal 5 Pelvic, Abdominal and Visceral Transverse Colon 5 Pelvic, Abdominal and Visceral Transverse Perineal External 5 Pelvic, Abdominal and Visceral Uereters 5 Pelvic, Abdominal and Visceral Urethrovaginalis 5 Pelvic, Abdominal and Visceral Uterus
(109)
(110) Then in the next stage 3914 of classification, each System is subdivided 3916 into Segments based upon major upstream arteries. The Segments that are identified in this manner are given an identifier as part of the system of taxonomy. In some cases there will be more than one major arteries that feed blood to a discrete Segment. In this instance 3918, the Segment may be divided into subclasses by use of an additional identifier, such as a numeric identifier followed by an alphanumeric component indicating a Segment having a plurality of arterial blood supplies. By way of example, Superior versus Inferior Gluteals have different arterial supplies.
(111) Once the Segments are located in the manner described above, the next phase 3920 includes subdividing 3922 each Segment into Structures. This subclassification may proceed by identifying discrete occlusale Structures on branches that are supplied by the common upstream artery for each Segment. Each Structure that is identified in this manner may be labeled with an identifier for use in the system of taxonomy. The Structures for each Segment may be ordered 3924 be based upon natural muscular attachment sites and fascial connections for the Structures.
(112)
(113) Those skilled in the art will appreciate that the embodiments shown and described may be subjected to insubstantial changes without departing from the true scope and spirit of what is claimed as the invention. The inventor, accordingly, states her intentions to rely upon the Doctrine of Equivalents as needed in protecting her rights to the invention.
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