Left Sided Spastic Hemiplegia | Case Study

Left Sided Spastic Hemiplegia | Case Study Intervention Analysis Background Jane Walters is a five year old girl and has a diagnosis of left sided spastic hemiplegia, a form of Cerebral Palsy. Jane has two older sisters who attend horse riding lessons at their local stables. Jane has recently expressed an interest in joining them to her parents. However her parents are worried that because of her diagnosis she will not be able to keep up with her siblings. Jane is very aware of her condition, and has recently lost confidence, asking her parents why she is different from other children her age. Diagnosis Cerebral Palsy (CP) refers to non-progressive conditions characterised by impaired voluntary movement or posture, and resulting from prenatal developmental malformations or postnatal CNS damage (Reed, 2013, pp. 38-47). According to the National Institute of Neurological Disorders and Stroke (2008), it is highly likely that a child with CP will have other medical disorders such as; cognitive impairments, seizures, delayed growth and development. Spastic syndromes such as Jane’s occur in more than 70 percent of CP cases. Spastic hemiplegia is a type of CP that typically affects the body down one side. The spasticity creates a state of resistance against any range of motion; this resistance ultimately increases with increasing speed of that movement (Reed, 2013, pp. 38-47). Children like Jane with spastic hemiplegia will generally walk later than other children and will tend to walk on their tiptoes because often they will suffer from high heel tendons. Often the arm and leg on the child’s affected side are shorter and thinner (National Institute of Neurological Disorders and Stroke 2008). Impact of Right Hemisphere Brain Damage- Jane has left sided spastic hemiplegia, indicating that damage to the brain has occurred in the right hemisphere. The primary cause of CP is damage to white matter of the brain this is often caused by abnormal brain development. This can be caused by a bleed on the brain, or by a lack of oxygen to the brain, generally caused by a difficult birth (NINDS 2008). It was important to consider additional complications related to right sided brain damage to ensure an awareness of Jane’s level of functional ability be it; physically, cognitively or behaviourally. Those that may relate to Jane’s case are listed below in table one. Table one: How damage to the Right Hemisphere can affect function and the occupation of horse riding. Jane’s diagnosis would mean that she would need input from a Multi-Disciplinary Team (MDT). Given her age this would come from a community paediatric teams (CPT). The team will work closely with the children’s’ team in social services and primary care. The team will provide a range of assessments and interventions to young people and their families. In Jane’s MDT team there will be a range of different members such as: Physiotherapists, Paediatricians, Occupational Therapists, Social Workers, Speech and Language Therapists and Educational Psychologists (NHS 2012). According to the Disability Act Jane is entitled to an independent assessment of her individual needs. The act is designed to promote the participation of people with disabilities in society by supporting the provision of disability specific services (NCSE 2011). A standardised interview was used, this was to allow the OT staff to observe how Jane and her family interact with each other making it easier to; obtain information, identify strengths needs and goals as well as generate an intervention plan and enable goal scaling Due to Jane’s condition she would have already been known to social services and the MDT, as she had already received physiotherapy to aid with muscle stiffness and improve core strength. Therefore upon the OT department accepting Jane’s referral, an initial assessment was carried out in her home environment with mother and father present (An and Palisano 2013). Collaboration between professional ataff and Jane’s family is a vital component in family-centred services, this is considered best practice in early intervention and paediatric rehabilitation (An and Palisano 2013). Collaboration between the two parties is essential for setting meaningful and achievable goals for a child. Planning and implementing interventions must be able to fit within the context of family life. (An and Palisano 2013) The following strengths and weaknesses were identified during the initial assessment. Table two: Jane’s strengths and limitations During the initial assessment Jane’s mother expressed concerns about her core strength and whether this would affect Jane’s ability to ride. In order to address these concerns a Sitting Assessment for Children with Neuromotor Dysfunction (SACND) assessment was completed this is a clinical instrument to assess static and dynamic postural control in sitting in children with neuromotor dysfunction’ (Reid 1995) This standardised assessment was used to ascertain how Jane’s CP affects her ability to sit comfortably and concentrate. This skill will be essential if Jane wants to be able to sit upon a horse comfortably and be able to concentrate for the entire session. The SACND measures quality of independent sitting ability across four areas: proximal stability, postural tone, postural alignment, and balance (Knox 2002). The assessment revealed that Jane has weak upper trunk control and so will be issued a specially adapted chair which will enable her to sit more comfortably and for longer periods of time compared to standard chair. After both assessments were completed an intervention plan was made with input from Jane, her family and the occupational therapist. Jane identified her long term goal of horse riding and to achieve this long term goal, four short term aims were set to serve as recovery milestones (Duncan 2011). Table three: Jane’s long term aim and short term goals. Occupational therapists are not required to use a specific functional outcome assessment tool in the selection of their assessments. When a professional is selecting an assessment, they must rely on their clinical and professional judgment (Asher 2007). Therapists need to reflect on what it is that they intend to achieve with the assessment, and if this is managed the assessment can be classed as a success. One way of evaluating an assessment is to look at the performance of patients on an individual assessment task (Steultjens 2005). And will be able to question how well did the assessment relate to the goal setting and objectives for the patient (Duncan 2011). As part of the Model of Human Occupation horse riding will play a central part in Jane’s habituation. Not only will this establish a routine, it can be something that Jane can take pride in (Kielhofner and Forsyth 2011). Riding will help Jane build upon her self-confidence, having that natural trusting relationship with a horse that shows no judgment and does not understand that she is different (Horseback UK). The major concern that Jane’s mother presents is the worry that she will not be able to keep up with the physical requirements of riding and that this will dishearten Jane’s enthusiasm. This concern will be tackled in goal number four. Once Jane and her family have a better understanding of hemiplegic cerebral palsy, the OT can begin discussing, through the use of pictures how this may affect her. If Jane has a basic understanding of her condition it will be easier for her to set more realistic goals with the OT as she will have a greater awareness of what she is able to do and may struggle with. This will reduced the likelihood becoming distressed when trying to achieve goals her agreed goals, this will hopefully reduce mum’s concerns about the intervention plan. Jane feels her parents do not allow her to do as much as she would like to be able to do for fear of hurting herself or become too tired. The OT decided to make to make Jane aware of what fatigue is and may feel like. This would hopefully encourage Jane to let her mum or dad know when she is feeling tired. With this information Jane’s parents can keep a fatigue diary with Ellie. This will provide the OT with some information regarding when Jane feels most tired and how this impacts on her occupations. This can then be discussed with Jane’s parents and the RDA and suitable arrangements can be made regarding fatigue management as to when would be the most appreciate time for Jane to have her riding lesson when she has the most energy. Once a pattern of fatigue can be established the OT staff will develop strategies to manage Jane’s fatigue. For example Jane should engage in an activity that she finds relaxing such as reading, colouring or watching television. This can be done after more strenuous activity or in the morning if Jane is known to have a busy afternoon full of physical activities such as a riding lesson. If Jane is able to vary her day with relaxing and more strenuous activities, she will be able to conserve energy for the more strenuous activity of riding and therefore last the full hour lesson. This form of intervention uses the Compensatory Approach. The principle behind this approach is adapting to and compensating for a dysfunction rather than just treating the cause of the problem. Which in this is Jane’s cerebral palsy and her left sided weakness there is more of an emphasis on treating the symptoms (Feaver and Edmans 2006). Additionally, the Compensatory Approach may allow Jane to be able to regain a degree of her independence by compensating where the main cause cannot be treated. In Jane’s case this is managing and compensating on her weakness and fatigue, and therefore allowing her to conserve energy in order to complete a riding lesson (Addy 2006). The social approach recognises Jane as a social being who is easily influenced by the people around her. Therefore by using Jane’s whole family in her therapy and fatigue management, the professionals are integrating Jane’s social environment into her therapy (Polglase and Treseder 2012). Both interventions also reveal the perception of Jane by her social circle, thereby mitigating Jane’s fear about her social circle (Polglase and Treseder 2012). Jane has always said that Jane feels her parents do not allow her to do as much as she would like to be able to do for fear of hurting herself or become too tired. The treatment will require Jane to trust her parents and tell them when she is tired instead of retreating from her social circle (Martin 1998). In order to determine if Jane’s intervention has been a success we first evaluate it. Evaluation a professionals practice is one of the most important elements in occupational therapy; without it, the value of their intervention diminishes (Lawcett 2007). Evaluation is important as in theory it enables the OT and the client to see if intervention is affective. However it is vital that the client is willing to be part of the evaluation process, because if they are not this could present an incorrect evaluation of effectiveness of treatment (Lawcett 2007). There are four main was a professional can evaluate their intervention process these are; Using up to date outcome measures. Using valid and reliable evidence based outcome measures. Evaluate from view point of the service user Evaluate throughout therapy process, at end of intervention (Lawcett 2007). The success of Jane’s intervention plans can be evaluated by the ‘Goal Attainment Scale’(GAS) (King’s College London [no date]). The GAS is a measurement technique which consist of individualising a person’s outcome indicators (Turner-Stokes 2009). In order to evaluate the intervention the professional must first construct a list of thorough and complete outcome measures, which will then be given a numerical value to determine the success of the intervention (Kiresuk and Sherman 1968; Purkiss et al. 2013). Jane’s goals were based on a realistic forecast of her progress (May-Benson 2012) Jane’s performance was scaled into five levels, these reflected her actual performance in comparison to her expected outcomes (Kiresuk et al. 1994). Table four: Example of GAS goals used from Jane’s second RDA lesson. A score like this was recorded for each weekly session over the course of a month and a total was tallied at the end, scoring the intervention with a numerical value. The professional knew it would be vital to give Jane and her control in her treatment in order to motivate an improvement (Turner-Stokes 2009), hence it was decided that the GAS goals would be discussed at the end of the session, showing a level of improvement (King et al. 1999) instead of recording it as s pass, fail assessment (Turner-Stokes 2009).

Why College Athletes Should Get Paid

The single most debated topic when it comes to compensating student-athletes concerns whether student athletes should be paid beyond the full cost of attending school. The pay for play doctrine, in which athletes would earn a portion of the revenue they help generate, is a highly controversial topic that has become more popular in recent years. The arguments in favor of pay for play originate from the fact that the players are the reason why the NCAA is able to make television contracts. These contracts include $11 billion over 14 years Just for the television rights to March Madness.Without the players of different sports and genders, the NCAA would not exist, let alone be able to sign huge contracts like that. Also, the report on â€Å"The Price of Poverty in Big Time College Sport† found statistics that show that these athletes deserve to be compensated. By using NFL and NBA collective bargaining agreements to estimate the fair market value of FBS football and basketball pl ayers, the study found that football players attending the University of Texas and basketball players at Duke have enormous fair market values. Football players at Texas have a fair market value of $513,922, while basketball players atDuke have a fair market value of $1 according to the study. I don't feel that these players need to be paid that much because that is more than minimum salaries in both professional leagues, but from a business standpoint it isn't ethical for these athletes to not be paid. Representative Bobby Rush of Illinois attended a congressional roundtable discussion on college sports in Washington, DC and described what the NCAA does as â€Å"a systemic, ongoing, prolonged abuse of thousands and thousands of innocent young men and women who are only trying to make a life for themselves and live the American dream.Athletes from the football got in trouble because their athletes received improper benefits would argue that pay for play would put an end to the blac k market for paying players. Many argue that these athletes are at school to get an education, but some come from families that could use the extra money for necessities. If these athletes were to get paid to play it could give them an incentive to not sell merchandise and to stay in school and get their degree.Also, Rob Gilmore who is an ESPN college football analyst states that at least 42 of the 119 division 1 football coaches earn more than $1 million per ear, but the athletes are the ones out on the field. So if it wasn't for the performance of the athletes, the coaches would not earn those salaries. When he played for the Ohio State Buckeyes, Terrell Pryor was a superstar of the game. Not only was he one of the best quarterbacks, but overall was one of the best players and that is why him selling memorabilia, was so widely publicized.Like I stated in my introduction, more and more players are selling memorabilia because of necessities that loved ones may need in time of their absence from home. In an article covered y ESPN Terrell Pryor was quoted saying, â€Å"The reason why I did it was to pay my mother's gas bill and some of her rent. I was telling the NCAA, ‘Please, anything that you can do. I gave my mother this so my sister wouldn't be cold, so my mother wouldn't be cold. ‘ They didn't have any sympathy for me. Pryor also told reporters that he sold his pants for $3,000 but friends of Pryor's said that he made off of autographs. The point is there is going to be stars of the college game that take advantage of their stardom and ones that need the extra help to support their family when they leave for college. By paying these athletes a fair amount you could be doing them a well deserved Justice as well as doing away with a lot of the behind the scenes scandals. Not only is paying athletes the ethical thing to do, but when other people benefit from their pay it is possible for the law to be broke.One law that the NCAA violates when prof iting of the student-athletes is the right of publicity. The law is defined as â€Å"The right of publicity prevents the unauthorized commercial use of an individual's name, likeness, or other recognizable aspects of one's persona. It gives an individual the exclusive right to license the use f their identity for commercial promotion. † This also shows that the NCAA violates the law by not allowing the student-athletes to profit off their own personas. One example of how the NCAA violates the Right to Publicity is through Jersey sales.Up until recently they did this in two ways; one way was selling game worn Jerseys to retailors, the other which has been stopped was selling replica Jerseys on the NCAA online store. Under the common law of Right to Publicity the NCAA should not be able to sell used Jerseys to retailors without consent of the player and should also include some compensation for the sale. The player whose Jersey is being sold would not have as high of value if t he said player would have never played for an NCAA school.The NCAA uses the success of an athlete or program/school to make a profit on its Jersey sales. Contrary to the success of a team where it's not the name on the back you play for but it's the name on the front, Jersey sales are based more on the name of the player on the Jersey or of the player who wore it. This stays true even in professional sport, When Lebron James moved from the Cleveland Cavaliers to the Miami Heat he still stayed in the top 10 in Jersey sales. This shows that the of his own publicity that he makes money.The other way the NCAA made money from Jersey sales was from selling them on the online store. Even though the NCAA ended this in September it is still very relevant. This aspect of Jersey sales was brought into the spot light when Texas A&M Johnny Manziel football player was put into the spotlight when he was accused of selling merchandise and making a profit, an NCAA violation. When his status as an am ateur athlete, which would make him ineligible to compete in the NCAA, was in question; many former NCAA athletes came to the defense of Manziel.One former Duke Basketball player, Jay Bilas, accused the NCAA of being hypocrites when he went on their store and was able to search any players Jersey by name and buy it, even though the NCAA is not allowed to use players names in their sale of Jerseys. The NCAA suspended their direct merchandise sales in September due to the outrage over the issue. These two examples, selling used Jerseys and selling replica Jerseys, show that the NCAA was in violation of the Right to Publicly.The NCAA either needs to forego all merchandise sales tied directly to its athletes or they need to offer some compensation for any ales that the NCAA benefits from its athletes. Another way the NCAA violates the right to publicity is in the video games they create partnered with EA Sports. This is currently a hot topic and is being argued in courts. Former UCLA ba sketball player Ed O'Bannon filed a lawsuit against the NCAA for using his image in a video game. The NCAA and EA Sports currently make video games for football but in the past had made them for basketball and baseball.The video games do not use player names but they do use their numbers and accurately portray player's skill sets and body types. O'Bannon has gained tremendous support from former athletes saying that they deserve compensation because the NCAA and EA Sports both profited from the players likeness. So far EA Sports has settled for 40 million dollars, which will be distributed between 200,000-300,000 current and former NCAA athletes. The current lawsuit between O'Bannon and the NCAA is ongoing.Many people covering the lawsuit are calling the NCAA hypocritical because they do not allow student-athletes to profit off themselves but the NCAA has taken many steps to make money from the student-athletes, none of which is seen by the student-athletes. The fact that EA Sports settled in its case shows that they understand that the NCAA did something wrong. The fact that the NCAA will not admit to that and still withholds its student- athletes from making money off themselves while he NCAA continues to do so Just shows that the system needs to be adjusted to better help the student-athletes.The NCAA is an organization that should be looking out for the best interest of its student-athletes. For the most part the NCAA does this but when it comes to compensation the NCAA needs to adjust. The way the NCAA has treated its student- athletes would rival forms of theft. Between the sale of Jerseys and profiting of layers personas in video games, the student-athletes should have earned some compensation for being the driving factor behind the revenues made from these two activities.From the examples listed above the NCAA needs to revise its bylaws that deal with players and making money/being compensated. It is not legally and morally correct to be withholding mo ney from student-athletes who had a large part in generating the money.

Dream Deferred Essay

What happens to a dream deferred This quote from the famous poem by Langston Hughes, ? A Montage of a Dream Deferred,? represents the core of the play A Raisin in the Sun written by Lorraine Hansberry. When writing this Chicago set drama, Hansberry chose to use a line from Hughes? famous poem to create her title: A Raisin in the Sun. The entirety of the play is about an African American family living in the ghettos of Chicago. Mama, Walter, and Beneatha, three of the play? s main characters, all make their individual dreams known to the readers by stating them various times throughout the play (Kohorn 1). Hughes? poem ponders upon numerous questions that are surely on the readers mind as they venture through this particular play. Although Hughes offered many alternate answers to the question, ? What happens to a dream deferred,? as seen below, Hansberry supports the last view in this poem (Mauro 1): . . . The play depicts many different instances of dreams being ? deferred. In referring to Hughes poem, Walter? s dreams are not only deferred but they also ? sag like a heavy load (Hansberry 1). In addition to this, she also dreams of pursuing a medical education so she can become a doctor (Pink Monkey). These dreams are further destroyed when Mr. Once again, yet another dream has been ? deferred (Hansberry 1). ? The play answers Hughes? first question in his poem, ? What happens to a dream deferred,? by showing the characters reactions to their failing dreams. By now, the family has learned that the ? dream of a house is the most important dream because it unites the family (Kohorn 1). Ultimately, their dreams finally come into realization when they move into their new house. Dreams do not dry up as a raisin in the sun would. For him this would be ? he life? (Mauro 1). As Hughes? poem says, ? Maybe it just sags like a heavy load (Hansberry 1). At the beginning of the play, a determined Beneatha is studying at the local college and presents herself as an intellectual. In one particular case, he explodes on his sister, Beneatha by saying, ? Who the hell told you you had to become a doctor (Mauro 1) As Hughes states in his poem, a dream deferred may ? stink like rotten meat (Hansberry 1,? and to Walter it really does. She also wants the kids to receive a good, solid education.

Stylistic Analysis of James Joyces Eveline Essay example

Stylistic Analysis of James Joyces Eveline In the short story Eveline by James Joyce, the author challenges the morals of a young woman torn between desire and familial obligation. Joyce manipulates the theme of reflection as a tool for Eveline to make a life altering decision of staying in the comfortable atmosphere where she confined and controlled by her father and her boss, or to run off to the unknown with a man who loves her and offers her a life of security. This essay will analyze and explain the deixis, cohesion, process and participant type, discourse types and narrative structure in the text that enhance the emotion effect of the story. Joyce approaches this†¦show more content†¦Hill in paragraph six. Eveline throughout the story is a deeply feeble and compassionate woman. Sentences frequently project her as the powerless medium-t in material processes, and suggest that she is contemplating escape by watching the steady movement of others (Few people passed, she heard his footsteps clacking along†¦crunching†¦ 2) while reflecting (watching, tired 1) on what she might leave behind, making the sensor in most mental processes. The opening sentence alone constructs implications of Evelines destiny, ‘She sat at the window watching the evening invade the avenue.’ The square shape of a window alone, represent the shape of a cell and hence the notion of confinement. Her act of penetrating the view expresses ideas of possibility, hope and distance. While the image of Eveline gazing out a window epitomizes a degree of consciousness, the evening lexically relates to the decline of consciousness. While evening is invading the avenue, Eveline is witnessing her lif e of promise, represented as daylight, return to the grim comfort of passivity. The verbal tenses in this portion of the story remain consistent. They almost all contain past-tense verbs (She looked round, she had dusted, She had consented to). Five of the ten paragraphs begin with the personal