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By P. Hengley. Juniata College. 2018.
I saw it as assisting with my physical condition order vasotec 5 mg with amex arrhythmia ultrasound, so I could enjoy the park thoroughly with the rest of my family. So the people who are renting out the wheelchairs saw a woman walking toward them with a slight limp: why would she need this? Because, if I didn’t use it, by a quarter into the trip, I wouldn’t be limping anymore. So, it’s wonderful for people who can’t go the distance, quite literally. The threat of needing a wheelchair terrifies persons newly confronting chronic disease. In one, the woman posed coquettishly in a bathing suit with a “Miss Michigan” sash emblazoned across her chest. In the other, she sat dejectedly in a wheelchair, appearing broken and helpless. The author explained that she was paralyzed, unable to care for herself... Not surprisingly, on hearing my diagnosis, my first question to the physician was, “Will I end up in a wheelchair? So we must look beyond specific physical limitations to the whole person. How ironic it is that wheelchairs symbolize dependence and lost control since they build on that most enabling of early technologies, the wheel. In fact, wheels and chairs probably developed contemporaneously, albeit separately, some- where in the eastern Mediterranean region around 4000 B. Chairs certainly improved personal comfort, but wheels literally transformed human beings’ sense of space in the world. Although canes, crutches, and walkers also symbolize dependence, they carry less stigma than wheelchairs, perhaps because their users remain up- right. The distinction is not based on practical functionality: wheelchairs can be fast, safe, and flexible. As Nancy Mairs said of her power wheelchair, “Certainly I am not mobility impaired; in fact, in my Quickie P100 with two twelve-volt batteries, I can shop till you drop at any mall you desig- nate, I promise” (1996, 39). James Charlton, who uses a lightweight man- ual wheelchair, wonders why people struggle to remain erect: When I see old people using “walkers” I am always struck by the generation and development gaps in how people with disabilities live. Someday people will be liberated enough to discard such ridicu- lously antiquated aids. The idea that slowly hobbling around is bet- ter than briskly moving about in an electric wheelchair would be shocking if I did not see it practiced every day. In- stead of using metaphors of confinement, they “are more likely to say that someone uses a wheelchair. The latter phrase not only indicates the active nature of the user and the positive way that wheelchairs increase mobility and activity but recognizes that people get in and out of wheelchairs for different activities” (Linton 1998, 27). Today’s wheelchair users go many places, independently and with confidence, because they control equipment Wheeled Mobility / 201 designed specifically for their needs. New technologies allow people to do for themselves rather than rely on others. Occasionally, generally for the convenience of others, they needed to be moved. As Herman Kamenetz, a physiatrist, recounted in his history of wheelchairs, in ancient times people with limited mobility rode on litters or palanquins, carried by slaves, servants, or family mem- bers. By the 1700s some chairs had devices for self-propulsion, including pulleys, cranks, springs, and large wheels. The most common wheeled chair was the Bath chair, named after the English spa. Bath chairs typically had two large wheels in the rear and a smaller wheel in front. While an atten- dant pushed the chair from behind, its occupant steered using a handle connected to the front wheel, offering everything “which the safety of in- valids requires” (Kamenetz 1969, 20). Wheelchairs first appeared in America to transport wounded soldiers during the Civil War.
Making the Diagnosis Leonard’s notebook accurately described a fairly typical case of “frozen shoulder discount vasotec 10mg amex arrhythmia facts,” sometimes known as adhesive capsulitis, which is characterized by stiffness, limited range of motion and pain. The ligaments and tissue around the shoulder capsule or joint become inflamed and stiff. Usually this occurs after surgery or a fracture of the arm when the limb is immobilized. Leonard’s history didn’t seem to have any of the things that normally cause frozen shoulder. But his notebook repeatedly made mention of this problem occurring after he moved from the suburbs to Manhattan. He even joked about possibly being “allergic” to the city as a cause of his problem. Rosenbaum asked him to return to his journal, act like a medical detec- tive, and specifically list what in his life had changed since he moved to the city, using what he now knew about the causes of frozen shoulder—surgery, immobilization, or a physical trauma or injury. Leonard realized that the change from suburb to city was mainly in the form of exercise. Rosenbaum that both shoulders were being affected so Leonard had to be doing something with both arms. He asked Leonard to do an experiment using the treadmill: to run and describe exactly what he did with both arms while he ran. He reminded Leonard not to make any assumptions and to keep an open mind. Leonard did what he was told and immediately realized he was lean- ing both his arms on the support bars of the treadmill while running. By using his shoulders to support his weight, Leonard was probably causing progressive microtrauma to both shoulder joints. As the pain from the trauma intensified, Leonard began guarding against the pain by not using them. First he was immobilizing them as he Are Your Ways of Staying Healthy Making You Sick? Then he was immobilizing them further by refusing to use them because of the pain, giving himself a double whammy. Conclusion Attempting to stay healthy through diet and exercise is certainly recom- mended. However, as with Maria, Jennifer, and Leonard, exercise and diet- ing can be hazardous to your health if not done properly and with supervision. And don’t forget to analyze your own so-called healthy habits when searching for clues to your mystery malady. Ask yourself these questions: • Have you begun any new routine or regimen in an attempt to get or stay healthy? Neck, back, and joint pain affects a whopping 60 to 85 percent of the population at any given time. Musculoskeletal and joint pain often starts without warning and for no obvi- ous or easily explainable reason. In other cases, it becomes recurrent and we don’t know why we are hurting or how to fix it. Most of the time, with this kind of pain, people just assume they have injured themselves, and the injury was the precipitating cause of their pain. In this chapter, we share several interesting cases of seemingly unex- plainable muscle or joint pain. Once these frustrated patients used the Eight Steps, they finally found the correct diagnosis and obtained relief from their pain. Being an active young man and having injured various parts of his body at one time or another, he knew the drill. When he got home, he iced the most painful area of his back, laid down, and later applied moist heat.
Each stereotype affixes blame or innocence and suggests whether people have control over their conditions and fu- tures generic vasotec 5 mg overnight delivery hypertension dizziness. People “crippled” from birth or young adulthood by diseases or health conditions are the classic victims, without control over their fates. Tiny Tim, created by Charles Dickens for his 1843 story A Christmas Carol, ex- emplifies this stereotype. Tiny Tim was the son of Bob Cratchit, the hapless clerk working for Ebenezer Scrooge of “bah, humbug” fame. Cratchit asked her husband how little Tim had be- haved at church: “ ‘As good as gold,’ said Bob, ‘and better.... As Scrooge metamorphosed, guided by his ghosts, the unhappy fate of Tiny Tim haunted and exhorted him to a better life. This imagery of unfortunate innocents, struggling to walk, remains po- tent today, especially among fund-raisers and sloganeers, such as “Jerry’s kids” for muscular dystrophy. Stories of persons struck down in youth through no fault of their own evoke powerful, sympathetic responses. Franklin Delano Roosevelt, who contracted polio at age thirty-nine, was virtually never seen publicly in his wheelchair. Yet he became the om- niscient, de facto “poster child” of his National Foundation for Infantile Paralysis. Brainstorming about how to raise money from a nation just emerging from economic depression, the radio and vaudeville entertainer Eddie Cantor suggested that people send 10 cent contributions directly to Roosevelt at the White House: “Call it the March of Dimes” (Gallagher 1994, 150). Cantor and the Lone Ranger broadcast Roosevelt’s appeal, and within days, envelopes containing dimes overwhelmed the postal service. The polio vaccine became possible because Roo- sevelt’s foundation raised millions of research dollars (Gallagher 1994). These mass solicitations nevertheless solidify one stereotype of walking 16 W ho Has Mobility Difficulties problems—blameless people, courageously confronting adversity and strug- gling to walk, crutches in hand. Despite their exertions, they seemingly have little control over their futures, waiting for the charity-supported research to suddenly sprout a cure. In an America that celebrates independence and self- determination, this stereotype implicitly marginalizes people. Equally troubling, however, is holding people accountable for their physical impairments in defiance of their disease—a slippery slope be- tween hope and despair. For twenty years, she had periodically experienced episodic, unnerving sensory symptoms but never knew why. A physician friend had privately diag- nosed MS, but he had not told Joni or her husband. Now all of a sudden, Joni began having serious trouble walking, and the physician revealed his diagnosis. Her husband and his male friends, including Sam, rallied around and mapped out an exercise program “to improve her function. Over- whelmed by this onslaught motivated by true affection and concern, Joni felt powerless to make them understand that her legs now felt as if they were encased in concrete, that fatigue drained every scrap of strength. Sam told me later that the husband and his friends had abandoned their physical fitness regime, but I heard doubt in Sam’s voice. The second stereotyped cause, catastrophic accidents, is sometimes shadowed by hinted conjectures about fault—was the person somehow to blame? One “innocent” subgroup is injured either by seemingly random violence, such as being struck by a car, or by mishaps occurring during so- cially acceptable activities, such as bicycling, skiing, or contact sports. In contrast, a more suspect subgroup involves people injured by their own recklessness, such as driving while drunk. Persons claiming injuries at work and seeking disability compensation, “workers’ comp,” are particularly problematic (chapter 9). Soldiers return- ing from war, however, are a special class of people injured “at work.
For example discount vasotec 5 mg amex blood pressure medication for sale, information about a teacher based on the results of just one student survey will not be as reliable as information derived from several surveys conducted over several years and from a representative range of classes taught. The reliability of an evaluation may also be enhanced if different, but valid methods, are used in combination. Now, armed with this background knowledge, how might you go about evaluating your teaching? Planning evaluation as part of your teaching Among the things you need to think about are the following: Determine what are your institution’s formal require- ments for evaluation. For example, is there a requirement that you should gather student feedback on a regular basis for curriculum development or for promotion or tenure? Make contact with the staff of your teaching unit who will at least be able to advise you if not provide direct evaluation services to you. As we have already suggested, evaluation is an important element of good teaching and so it is something you should be doing all the time. Matters you will need to consider in your plan are how and when you will evaluate your teaching, how you will evaluate student learning and what you will do with the information you gather. You must have some plan to use the information in ways to improve or develop learning and your teaching otherwise there is little point in doing it at all. One way of using information will be to incorporate it into an on-going record of your work known as a Teaching Portfolio. Another important way of using information is to ensure you give your students feedback on the outcomes of your evaluations and what it is planned to do with the results. Practical ways in which you can communicate this kind of information are through your personal or departmental Web page, or by posting information on the student notice board. The reliability of your evaluation of student learning will be enhanced by your judicious use of more than one valid measure of learning. The first, and major source of information about student learning, will be the results of your programme of student assessment - the examination results; assignments and projects; reports; clinical notes, and other products; and observations of student learning. In our experience a great deal of useful information from students is overlooked. For example, it is necessary to go beyond the scores and grades from tests, and to ask questions about learning, for example: What are common errors - and how can I address these in my teaching? In what areas have students shown particular strengths, weaknesses, interests and why might this be so? What misconceptions are evident in students’ work - and how can I address these in my teaching? What levels of intellectual achievement are revealed in students’ work: for example, do they simply appear to rote learn or is there evidence of analysis and critical thinking? This process of questioning and thinking about one’s teaching is a fertile way of developing an understanding of student learning so that you can modify teaching and provide additional assistance to students if this is indicated. A second way of evaluating learning is through well- designed and administered evaluations of teaching. There is a considerable body of research evidence that shows this to be a valid approach provided that the questions ask about factors related to learning and not something else! My ability to think critically/solve problems/perform clinical tasks/etc. Apart from formal questionnaire surveys, you will find that evaluation by brainstorming an issue with your students (such as ‘are the course objectives being achieved? The third way you can obtain information about the processes of learning is by using tools such as CATs (Classroom Assessment Techniques); two examples of which we have already mentioned in Chapter 2. Another CAT has been developed to help teachers evaluate student reaction to exams and tests and to improve these as effective learning and assessment devices. Called the Exam Evaluation, the procedure for using this evaluation tool is: Focus on a type of test you are going to use more than once. You might also consider asking students what questions they would like to be asked. Choose the questions and decide whether you will ask these at the end of a test or as part of a follow-up evaluation. Examples of questions are ‘Did you learn more from one type of test than another?
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