By Q. Navaras. Fort Valley State University. 2018.

For example order 2mg zanaflex with amex quad spasms after squats, an interactive diary for­ mat used by one client group might be modified for another zanaflex 2mg muscle relaxant allergy. Even reading leaflets where you feel the information is inadequate, incorrect or poorly presented is of use to you in your planning. Consult the users Users are not just the clients but also the clinicians and administrative staff who would be using the material. A facilitator using a set agenda of topics and questions runs groups of up to ten people. Clinical audits might also yield some information about complaints or plaudits regarding the giving of information. Consult with co-agencies Talk with associated agencies about the materials they produce and their perspective on the topic you wish to write about. Look at guidelines on best practice Check clinical guidelines, quality standards and care pathways. Review the research Search databases and liaise with medical schools or universities for infor­ mation on current research findings. Seek an expert opinion Find out from the experts about what should be in your leaflet. This involves a panel of experts who are asked to make suggestions about the ideal content. However, rather than discussing it as a group, the experts are asked to comment anonymously. The information is compiled into a list by a person external to the panel, who marks any items that have not received unanimous support. The list is returned to the ex­ perts who are asked to comment (again anonymously) on the items not agreed. The process is repeated until there is a core list of items that everyone agrees upon. Use a storyboard A storyboard is a way of planning the sequence of your information. Using a simple grid, the planned content is plotted out like a story using simple bullet points or summaries. This gives you a clearer idea of the order and provides an overview that is difficult to get in any other way. Your instinct may be to follow the medical model and start with a description of the disease, causes, treatment and so on. However, this might not be the way in which the client experiences his or her illness. Explain terminology It may be necessary to use certain terms and expressions. Always make sure you give an explanation, and if necessary provide examples. In the follow­ ing extract, the term ‘urethra’ is explained in simple language. The prostate is a small gland, which lies at the neck of the bladder in men and surrounds the urethra – the tube that carries urine from the bladder to the penis …’ (World Cancer Research Fund 2000) Once you have explained a label, continue to use it rather than introducing any alternatives. Be aware of ambiguous word meanings In English some of the words we use alter in meaning depending on the context in which they are used. Look at the examples below: ° Registrar = ° In the registry office – a keeper of names for births, deaths and marriages. Make sure that your reader will understand the intended meaning of your vocabulary. Check the emotional loading of words Certain words will have a higher emotional loading for clients. For exam­ ple, the words ‘cancer’ and ‘treatment’ in a recall letter after breast screen­ INFORMATION LEAFLETS FOR CLIENTS 99 ing were found to make women worry (Austoker and Ong 1994). Rewording the message may reduce stress and anxiety – so using ‘most re­ called women are found to have normal breasts’ was more reassuring than ‘most recalled women are found not to have cancer’ (Ong, Austoker and Brouwer 1996). Write words in full Avoid using abbreviations or acronyms even if these are explained in your text. They tend to confuse readers who are less familiar with these types of expressions. Phrasing the message The type and length of sentences will affect the amount of information the reader understands and remembers.

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Much can be done to improve function in these patients with tendon transfer surgery and functional electrical stimulation order 2mg zanaflex with visa muscle relaxant topical cream. Patients should be at least 12 months post-injury and have been neurologically stable for 6 months prior to surgical intervention purchase zanaflex 2 mg with mastercard spasms post stroke. To restore: Fixed hand contractures are also a contraindication as they will • Active elbow extension compromise the quality of result. Soft, mobile hands with a full • Wrist extension passive range of motion in the joints are ideal. In the absence of sensation, vision replaces sensation: the • Improved ability to perform acts of daily living patient can only concentrate on one hand at a time. Restoration of elbow extension enables the patient to reach overhead and also facilitates wheelchair skills, for pressure relief and transfers. The posterior third of the deltoid muscle is usually used and its tendon is connected to the triceps tendon at the elbow. Wrist extension is a vital prerequisite to hand (palmar) grasp and lateral pinch (key grip). In C5 or high C6 patients, lateral pinch or key grip, as described by Moberg, is possible during wrist extension by tenodesing the flexor pollicis longus to the lower end of the radius and stabilising the interphalangeal joint. Wrist extension is achieved by transferring brachioradialis into carpi extensor Figure 14. With the wrist extended the thumb will oppose the radial side of the index finger. In lower C6 lesions or better, functional hand grasp may be restored with a passive flexor tenodesis. Active wrist extension is achieved, by transferring the brachioradialis into the insertion of extensor carpi radialis brevis. Relative factors in selection: Further surgical procedures include implantation of the • Adequate sensation in hand NeuroControl Freehand system (see below), which is an upper • Minimal or no spasticity limb neuroprosthesis suitable for C5 and upper C6 spinal cord • Minimal or no contractures injured patients, and procedures to achieve an intrinsic balance and improve hand function in lower cervical injuries. Functional electrical stimulation Following spinal cord injury, lower motor neurone pathways may remain intact and have the potential to be electrically stimulated. Functional electrical stimulation (FES) of paralysed muscles to restore function is becoming more commonly used, although only a few systems are commercially available, such as the NeuroControl Freehand system, the Handmaster, and the 71 ABC of Spinal Cord Injury ODFS. Eight electrodes are attached to specific muscles to Attempts to replace or improve missing functions, using the body’s achieve hand opening, lateral pinch, and hand grasp. The own muscles, through: implant is controlled by moving the opposite shoulder, which is • External devices connected by a lever to a “joystick” located on the central chest. Functional grasp patterns improve the user ability to perform specific activities of daily living. The forearm and wrist are held in a neutral position by the splint, on the inner surface of which are saline-soaked electrodes. These are placed over finger and thumb extensors and a thumb abductor, using pre-set patterns of stimulation to open and close the hand. Handmaster available from NESS (Neuromuscular Electrical Stimulation Systems Ltd), 19 Ha-Haroshet Street, PO Box 2500, Ra’anana 43654, Israel. ODFS available from Department of Medical Physics and Biomedical Engineering, Salisbury District Hospital, Salisbury, Wiltshire SP2 8BJ, UK Tel: 01722 429065. Self-adhesive electrodes are placed over the common peroneal nerve as it passes over the head of the fibula. Stimulation is timed to the gait cycle using a pressure switch placed in the shoe. Trials of the ODFS have shown that walking can be less effort, faster, and safer. The benefits of FES include an increase in muscle bulk and blood flow in the legs. This may be at the expense of spasms becoming stronger as muscular strength increases, but the majority of people find that their spasms are more predictable and less frequent, especially in the period immediately after FES. Re-training muscles calls for a long-term commitment, and places great demands on the patient’s time. Ambulation remains a distant goal for people with complete injuries, although cycling on recumbent tricycles is feasible. Systems in incomplete injuries can significantly improve walking speed and performance. Ageing with spinal cord injury The spinal cord injury population is ageing, partly because survival rates following injury have improved, and partly Figure 14.

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If they want more answers quality zanaflex 2 mg spasms lower right abdomen, I’ll recommend people who’ve got better answers discount 2mg zanaflex visa muscle relaxant comparison, who’ve got the answers. This type of account is one in which these informants reinterpret aspects of their biographies in order to show a clear, linear progression towards the use of alternative forms of health care. While they are aware that others may label their use of these therapies as deviant behaviour, they are able to see it, and themselves, as normal within the context of their reinterpreted biographies. In other words, alternative therapy use is something toward which they had always been moving. To illustrate, when discussing their use of alternative Using Alternative Therapies: A Deviant Identity | 105 health care, almost half of the people I spoke with cited their parents’ use of home remedies as foreshadowing their current use of alternative therapies. For instance, Marie told me, “Home remedies, the natural way of doing things. My mother was a smoker and if you had earaches as a kid she used to blow smoke in my ear. She would make bread poultices if you had splinters and mustard plasters when you had colds. Betty also had a story to tell about her mother’s home remedies: My mum always tried to make nutritious meals. We had our vitamins, which I believe in now within common sense, but I have in my cupboard my vitamins. Past occupational experiences were another aspect of personal biography that some informants reinterpreted to mesh with their current participation in alternative therapies. For instance, Lucy and Marie had both worked in the health care system in the past. In their accounts of their use of alternative health care, they reinterpreted these experiences to coincide with their current use of alternative therapies. Marie reinterpreted her duties as a podiatrist’s assistant as a precursor to her present-day engage- ment in training to become a reflexologist: I had worked for a podiatrist when I first got out of high school and part of his treatment was that after he finished with the patient, his digging and cutting and scraping and gouging, the last thing was that I went in for five minutes and I massaged their feet so that they left on a really positive note and I always knew the importance of that. Similarly, in her account, Lucy reinterpreted her experiences working in a hospital as seminal events that inevitably led her to become a user of alternative therapies. In her words, “Well, I had always realized that the medical field can only basically deal with disease. I’ve worked in a 106 | Using Alternative Therapies: A Qualitative Analysis number of hospitals so I was well aware of that. In other words, we engage in “biographical work where old objects must be reconstituted or given new meaning” (Corbin and Strauss 1987:264). That the importance of these past experiences is something that is assigned through retrospective reinterpretation is exemplified in Natalie’s words below. While she believes that her past experiences at work are connected to her present-day use of alternative approaches to healing, her account belies the fact that she has reinterpreted her past occupational experience to explain her current use of alternative therapies. She put it this way: I used to say as I was nursing, ‘There’s gotta be better ways than what the doctor’s ordering here, pushing pills. Even after I gave up nursing and worked in a hospital as a ward clerk, I could see prostate after prostate after prostate coming out and I’m thinking, ‘This has got to be wrong but they’re continuing and they’re still doing it,’ and I think ‘No, there’s got to be another way. Yet when I later asked them what family health care was like when they were children, they began telling me anecdotes about their parents’ use of home remedies. In telling these stories, they connected their parents’ use of home remedies with their own current use of alternative therapies. That these accounts entailed retrospective reinterpretation is evidenced by the fact that the use of home remedies was something these informants’ parents no doubt viewed as conventional rather than alternative, if only because at that time in history Canadian Medicare did not exist. Consequently, most Canadians employed home remedies as a form of self- care before resorting to paying for a physician (Heeney 1995). We used to pay doctors for visits when I was very young until I was in my teens, until we had medical coverage. For example, in looking back and recasting her biography, Nora speculated about a connection between her mother’s use of home remedies and her current participation in alternative health care: I guess I always knew that there were ways to effect better health probably from way, way back in the dark ages when I was a little kid and my mother used to do home remedies.

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Anderson was an American– author of more than 60 articles that were pub- Canadian Exchange Traveling Fellow cheap zanaflex 2mg mastercard quad spasms after acl surgery, along with lished in medical journals and of more than 20 Dr order 2 mg zanaflex with mastercard muscle relaxants kidney failure. III, demonstrated tremendous energy and good reported on his pioneering work in a paper enti- nature. He became a leader early in his career and tled “Compression-Plate Fixation in Acute was the model of a true “southern gentleman. Not only did this MD, died at the age of 67 in Mobile, Alabama, change in technology have a dramatic effect on after a brief illness. Anderson was asked to review all three editions of the Manual of Inter- nal Fixation, by the AO Group, for The Journal of Bone and Joint Surgery; the reviews appeared in 1971, 1980 and 1992. Anderson became the first Profes- sor and Chairman of the Department of Orthope- dic Surgery at the University of South Alabama in Mobile. In 1989, he was named the Louise Lenoir Locke Distinguished Professor of Ortho- pedics. He served as President of the Board of Directors of the University of South Alabama Health Sciences Foundation from 1979 through 1982 and again in 1985, as Secretary–Treasurer of the Medical Staff of the University of South Alabama Medical Center in 1979, and as Presi- dent of the Professional Medical Staff of the University of South Alabama from 1980 through 1982. In 1986, he was appointed Interim Dean of the University of South Alabama College of Med- Nicolas ANDRY icine. He was named Vice President for Medical Affairs at that institution in 1987 and retained that 1658–1742 position until 1992. Anderson was named Emeritus Professor of The “Orthos Pais” or great seal of the American Orthopedic Surgery at the University of South Orthopedic Association and the emblem of the Alabama. In 1996, he returned from retirement to crooked tree being straightened by a splint, used serve as Interim Chairman of the Department of by the British in their Presidential Badge of Office Orthopedic Surgery in order to provide continu- for the American Presidents at the London ity to the residency program that he had founded meeting in 1953, are tributes to Nicolas Andry, and that he loved. He also belonged to the little recognition, either for his broad view or for 8 Who’s Who in Orthopedics his conception of the details necessary for the and others of his time to attempt artificial proper care of the crippled child. Thus, he credited Andry and his genera- surgeon who is distinguished for having tion with many of the devices for shaping the fea- “patented” some catheters and urethral bougies tures, the waist and much of the body, dyeing the and for a text on diseases of the ureter. Andry was nails and altering the eyebrows, the ears and the a historian (a characteristic of all sound innova- nose, the stock in trade of the “cosmetologists” tors), a writer and an official high in the councils ever since. Andry was most observant, Keith said, of the Andry said of the title of his L’orthopédie: defects in posture and gait, which lead to disabil- ity and deformity; although lacking information As to the Title, I have formed it of two Greek Words, about anatomy and physiology, he was most intel- viz. Orthos, which signifies streight [sic], free from ligent in his conclusions about measures required Deformity, and Pais, a Child. Keith did not mention it, but there I have compounded that of Orthopaedia, to express in are similarities between these observations and one Term the Design I propose, which is to teach the conclusions by Andry and those of the celebrated different Methods of preventing and correction the Deformities of Children. In his very useful Source Book of Ortho- follows: pedics, Bick spelled the name “André” and took the title from the English edition. However, Andry Asclepiades and Erasistratus have boldly condemned of course was presented correctly in every other all forms of exercise as not only of no advantage, but way in Bick’s text. Rest deserves its own share of praise; it Historical Survey is a restorer necessary in the course of a great many diseases. Andry’s preoccupation with muscular contraction as a cause of deformity influenced nearly all of Thus we see that the founder of orthopedics the French orthopedic specialists who followed recognized that rest, as well as action, had its own him. In fact, one might suppose that the great John particular therapeutic merit, but of the two, action 9 Hunter got some of his ideas, which he elaborated was that to which he attached the higher value. In this been the first to describe infra-orbital neuralgia way he undoubtedly influenced Venel, Delpech,7 (1756). I think, in crediting Venel with the establishment The great orthopedic biographer, Sir Arthur of the orthopedic specialty because he founded Keith, somewhat dismissed Andry and his the first institution for the treatment of deformi- Orthopaedia with the comment that Andry was ties (1780). However, he does say that “in la génération des vers dans le corps de l’homme M. Andry we meet the veritable founder of many (1700), showed extensive observation and much of our modern orthopedic practices. However, it is interesting that some directed our attention to the tendency of Andry of the descriptions and the illustrations are remi- 9 Who’s Who in Orthopedics niscent of Ambroise Paré’s section on “mon- J. He published a accepted both text and illustrations from other second edition of his work on animal parasites in authors for some of the “specimens,” which he 1702, which was an attempt to reply to the numer- had not seen himself. When this body was suppressed by Louis des vers dans le corps de l’homme, of which the XIV, Andry presented himself to the new Faculty English edition appeared in 1701.

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