By X. Brontobb. University of Central Florida.
My daughter’s comment made me realise that it was not only I who was aware of my son’s disabilities generic amitriptyline 75mg line anxiety girl meme, but my daughter also, and she was thinking of his future at a time when my partner and I were ‘taking a day at a time’. The inspiration drawn from that comment helped formulate a plan of research into the needs of siblings, and subse- quently this book. The book is structured to inform the practitioners (whether they are from the health, welfare or educational sectors), of the needs of siblings. I trust too, that the views expressed, based as they are on the experience of others and with some insights drawn from personal experience, will resonate with families in situations similar to my own. Outline of chapters Throughout the text quotations from families will be used to clarify points and issues raised, and detailed case examples will show how siblings react 9 10 / BROTHERS AND SISTERS OF CHILDREN WITH DISABILITIES to the experience of living with a disabled brother or sister, creating ‘disability by association’. Chapter 1 provides an introduction and a theoretical framework for analysis linking to the key concepts: inclusion, neglect, transitions and adjustments, children’s rights and finding a role for the practitioner. Models of disability are discussed to illustrate some of the differences found between professions. Chapter 2 introduces, in Part 1, a theoretically informed research typology (Table 2. The impact of disability on the family and siblings introduces some of the difference between parental perceptions and sibling expectations. Chapter 4 looks at change, adjustments and resilience. The chapter illustrates how siblings’ experience changes as they get older, at home and at school, and explores how the everyday restrictions and experiences create difficulties with making friends at school and in social group encounters. Chapter 5 is concerned with children as young carers: what it means, how it makes life too restrictive. Chapter 6 examines different family experiences linked to a range of disability, and considers how family support may be provided. Chapter 7 evaluates the use of a siblings support group and explains how such a group may meet the sibling’s need for attention and also allow time for themselves. Chapter 8 is about support services, the need for personal empowerment and establishing a role for professionals. Chapter 9 draws the various themes which inform the earlier chapters together and clarifies the role for professional practice. Chapter 10 adds a postscript, concerning disability by association, reflecting on some incidental and personal experiences gained shortly after concluding the research on which the book is based. Chapter 1 Theory and Practice In this chapter I will introduce a theoretical structure that will help to explain the need for working with siblings of children with disabilities. This builds on the idea that disability within one family member affects the whole family to such an extent that the family may feel isolated from others, or different because of the impact of disability. The impact of disability, as I will demonstrate, often has an initially debilitating and, often, continuing consequence for the whole family; I refer to this as ‘disability by association’. The incidence of disability within families is reported by the Joseph Rowntree Foundation to exceed 300,000 children in England and Wales (http://www. It is estimated that within an average health authority of 500,000 people, 250 families are likely to have more than one child with disabilities. According to Atkinson and Crawford (1995), some 80 per cent of children with disabilities have non-disabled siblings. The research I carried out indicated that siblings who experience disabilities within their families are to varying degrees disabled by their social experience at school and with their peers. The sense of difference which disability imparts is partly explained by Wolfensberger (1998, p. For example, the image of Captain Hook, the pirate from J. Barrie’s Peter 11 12 / BROTHERS AND SISTERS OF CHILDREN WITH DISABILITIES Pan, puts a disabled person in a wicked role; the image of Richard III in Shakespeare’s play conveys badness associated with an individual whose twisted humped back was in reality a deformity invented by the Tudors to discredit his name. Not all disabled people will experience such an extreme sense of difference, but an element of ‘bad’ and ‘disabled’ may well be part of a stereotypical view of others: disability becomes, conse- quently, an undesirable social construct.
In 75% of the cases order amitriptyline 10mg amex anxiety of influence, in fact, the ﬁrst manifestation of myasthenia gravis is ptosis. History It is important to determine how and when the ptosis developed. Identify any associated altered vision and whether the patient believes the vision has been altered by the drooping eyelid. Ask about all other medical dis- orders and medications. Determine whether the patient has a history of hypertension, peripheral vascular disease, or any other risk factors for stroke, or a history of myasthenia gravis. Ask about the history of any recent trauma to the head or eye region. Closely inspect the lids, noting the degree of ptosis and location of the lid margin to other eye structures, such as the iris or pupil. Measure the palpebral ﬁssure, comparing one eye with the other. While inspecting the lids and determining the degree of asymmetry, ensure that there is not merely an illusion of ptosis, caused by a contralateral retraction of the opposite lid as seen in conditions causing exophthalmos. Palpate the lids for masses or swelling; observe for redness and discoloration. Assess cranial nerve III and muscle function by testing extraocular movements. Perform a general assessment of the face and cranial nerves. Assess the pupils for symmetry, shape, and reaction to light. HORNER’S SYNDROME Horner’s syndrome is caused by decreased sympathetic innervation to the structures of the eye. Horner’s syndrome can be caused by a variety of lesions, including trauma, tumors, and ischemia. The symptoms vary, but usually include unilateral ptosis, reduced sweating of the face, and miosis. The ptosis is typically incomplete and, although there is no true enophthalmos, the eye appears to have receded. The pupil reaction to light and accommodation remain intact. A complete history and physical exam should be performed to identify likely etiologies. Based on ﬁndings, referral and/or imaging studies should be ordered. MECHANICAL PTOSIS Lacrimal gland tumor is an example of a mechanical cause of ptosis, adding bulk to the upper lid. The degree of ptosis will depend on the size of the tumor. There is often pain associated with a lacrimal gland tumor, as well as with many of the inﬂammatory causes, such as from a chalazion or hordeolum. When inﬂammation is involved, the abnormal lid may be reddened and tender. If lacrimal gland tumor is involved, there may be some degree of exophthalmos and deviation of the eye, depending on tumor size. Aging Senile involutional ptosis is a very common cause of ptosis, particularly in patients with advanced age. The lids and other accessory structures will have a thin, inelastic appearance. No masses, inﬂammation, or systemic signs will be evident. MYASTHENIA GRAVIS Myasthenia gravis causes skeletal muscle weakness owing to a dysfunction of the acetyl- choline receptors; this dysfunction results in reduced muscle innervation. Ptosis is the most common initial sign of myasthenia gravis, which often occurs at an earlier age in women than in men. In myasthenia gravis, patients often have intermittent diplopia, in addition to the pto- sis. The patient may attempt to compensate by raising the opposite lid.
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