Therapy

The glenohumeral joint, otherwise known as the shoulder joint, is made up of the head of the humerus, clavicle, and the scapula. In the shoulder joint, stability has been sacrificed to provide the most freely moving joint of the body. The shoulder is a ball-and-socket joint. The large hemispherical head of the humerus fits in the small, shallow glenoid cavity of the scapula, like a golf ball sitting on a tee.

There are multiple reasons why individuals may need to have a shoulder replacement. Some of those reasons may be osteoporosis, rheumatoid arthritis, avascular necrosis, or even a fracture if severe enough. Functional results after TSA vary, depending largely on the underlying cause.2 The most common cause is usually due to a rotator cuff tear or normal wear and tear leading to arthritis. This often leads to difficulty doing everyday tasks that involve reaching overhead, or sometimes behind the back, hence why people need to have shoulder replacements. Shoulder replacements aren’t as common as hip or knee replacements; however, they are just as effective in relieving joint pain most of the time.

There are three different types of shoulder replacement procedures; a total shoulder arthroplasty, partial shoulder arthroplasty, and a reverse shoulder arthroplasty. A total shoulder arthroplasty procedure consists of replacing the whole shoulder joint, whereas the partial shoulder surgery just consists of replacing the head of the humerus. A reverse total shoulder arthroplasty is not as common as the other two types of shoulder replacements, but is necessary for those in an instance that the rotator cuff muscles are severely damaged, don’t function as needed, or result from a severe fracture. During a reverse total shoulder replacement the artificial hardware the surgeon puts in place makes the head of the humerus the socket and they place a ball into the shoulder joint space. With the procedure being done this way, the ball-and-socket joint is now reversed from how it normally is. For an individual who has had a reverse total shoulder arthroplasty, their outcome isn’t the same as someone who has a normal total shoulder arthroplasty procedure. Due to how a reverse total shoulder replacement is performed, those who have this procedure done aren’t expected to regain full range of motion (ROM).

Typical physical therapy treatment for any type of shoulder replacement consists of strengthening and restoring range of motion, and sometimes the use of manual therapy or modalities to help manage pain. Just like any joint replacement surgery, early mobilization is a key intervention to restore range of motion because joint motion is a necessary component of most functional tasks.3

This patient is an 82-year-old female who I will refer to as Jane. Due to pain in the right shoulder, and deteriorating rotator cuff muscles, Jane ended up having a reverse total shoulder arthroplasty. Her past medical history includes a heart condition and a previous eye surgery. Jane also has reported that she has arthritis, scoliosis, and stenosis all in her back. She has no allergies, and her current medications were reviewed with the referring doctor. Also, Jane’s grandson lives with her as he does all the cooking and any other tasks that she’s unable to do, which is very discouraging to her.

Jane presents to therapy for her initial evaluation on January 20, 2020 with a diagnosis of stiffness in both of her shoulders, as well as the right wrist and elbow, effusion of the right hand, muscle weakness (generalized), and pain in the left shoulder. She had a reverse total shoulder arthroplasty on her right shoulder on December 5, 2019. Her doctor referred her to physical therapy when she had a check up and noticed her hand was swollen. Jane hasn’t had any pain in her right shoulder since the surgery; however, her left shoulder is causing her pain as she states that it needs replaced as well. The worst the pain in her left shoulder has been she rated as an 8/10, and the best it has ever been is a 2/10.

Jane also complains of feeling very weak and has trouble putting it in certain positions. She reports independence with dressing and bathing; however, with her being right hand dominant she claims that it takes a long time to do so. Due to weakness and lack of motion, Jane can’t eat with her right hand anymore, drive, or even sign a check. The doctor has instructed her not to lift anything heavier than a gallon of milk. Before coming to therapy, Jane started working on some exercises at home that she remembered she was given at the hospital following her surgery. These exercises included pendulums, shoulder flexion by sliding her hand up the wall, and using her thera-putty. Jane’s goals are to restore her strength and range of motion so that she may become more independent and achieve maximum functional mobility.

Range of Motion: Jane’s upper extremities were tested actively with the following objective findings for the left shoulder: flexion was 108˚, and abduction was 85˚. The following were the objective findings for the right shoulder: flexion was 108˚, and abduction was 98˚.

Strength: Grip strength was measured using a hand-held dynamometer. Jane’s grip strength on the right side was 20 pounds, and the left was 40 pounds.

Goals: Jane’s plan of care includes duration of 8 weeks at 2 times per week, for a total of 16 visits. She is a moderate complexity case due to 1-2 personal factors and/or comorbidities that impact the plan of care. Jane’s rehab potential is fair, and she has given verbal informed consent to proceed with treatment.

Chapter 4: Case Study: When radiation therapy kills. The concepts of ethics are illustrated in this chapter. Ethics is a concern of humans who have freedom of choice. Responsibility, accountability and liability are issues that are raised by radiation technology. In this case we see that the carelessness or laziness of the medical technician, the lack of training in the handling of the equipment (software), also of the maintenance of the updates of the software can cause the life a person.

These errors cause by humans or machines can be prevented: if software had some type of safeguards that control the amount of radiation that they can deliver, if the technician or machine operators were more aware of the message errors, that appear on the screen, and if the hospitals had given the proper training to their staff. Technicians, hospital and the software manufacturer all need to collaborated with each other to create a common set of safety procedures, software features in order to prevent this to happen, all of them are responsible.

Each of them had the capacity to prevent this type of things to happen and they all decide to blame each other for their own mistakes. The use of a central reporting agency could reduce the numbers of radiation therapy errors in the future because this enables the state to identify trends and exposures that may create safety concerns.

If I were to design electronic software for a linear acceleration, I will certainly put some type of safeguards that control the amount of radiation that they can deliver, by this way trying to prevent the overdose of radiation. Polytechnic University of Puerto Rico Graduate Program in Management Chapter 4: Case Study: When radiation therapy kills. Jayline Benitez Hernandez #46654 MGM 6560 – Management of Information Systems September 1, 2011

Gestalt therapy is a therapeutic approach in psychology that helped foster the humanistic theories of the 1950s and 1960s and that was, in turn, influenced by them. In Gestalt philosophy, the patient is seen as having better insight into himself or herself than the therapist does. Thus, the therapist guides the person on a self-directed path to awareness and refrains from interpreting the patient’s behaviors. Awareness comprises recognition of one’s responsibility for choices, self-knowledge, and ability to solve problems.

Its originators, Frederick S. (Fritz) Perls (1893–1970) and Laura Perls (born Lore Posner, 1905–1990), were born in Germany and studied psychology there. They fled Germany during the Nazi regime, moving to South Africa and then to New York City. They were both initially influenced by Sigmund Freud’s psychoanalytic approaches and by Wilhelm Reich’s Orgonomic psychotherapy. Their later ideas on Gestalt therapy broke with the psychoanalytic tradition, moving toward existentialism and, ultimately, humanism.

In New York City the Perls founded the Gestalt Therapy Institute in 1952. Their novel technique in therapy was to face the patient, in contrast to the typical Freudian technique of sitting behind a reclining person. The face-to-face positioning permitted the therapist to direct the patient’s attention to movements, gestures, and postures so the patient could strive to gain a fuller awareness of his or her immediate behaviors and environment.

Another well-known approach introduced in Gestalt therapy is the so-called “empty chair technique,” in which a person sits across from and talks to an empty chair, envisioning a significant person (or object) associated with psychological tensions. By using these techniques, the Perls believed, the patient would be able to gain insight into how thoughts and behaviors are used to deflect attention from important psychological issues and would learn to recognize the presence of issues from the past that affect current behavior.

The aim was for the patient to experience feelings, not to gain insight into the reasons for them, as psychoanalysts favored. In the evolution of their therapy, Laura and Fritz Perls differed in some of their approaches. Laura emphasized more direct, physical contact and movement than Fritz did, and the contact favored by Fritz Perls was more symbolic than physical. Gestalt therapy took its name from the school of academic psychology called Gestalt psychology. Perls asserted that Gestalt psychology had influenced the development of his ideas, but the Gestaltists laimed that there was no connection between the two. Later scholars suggested a common substrate linking the academic Gestalt psychology of Max Wertheimer (1880–1943), Wolfgang Kohler (1887–1967), and Kurt Koffka (1886–1941) and the Gestalt therapy of the Perls and their collaborators Ralph Hefferline (1910–1974) and Paul Goodman (1911–1972). This commonality involved appreciation of the whole rather than a reductionistic approach to understanding psychological phenomena and behavior. Gestalt therapy took form in the 1950s and 1960s, when humanism first flourished.

The optimistic theory promulgated by the Perls was quite compatible with the ideas of other humanistically oriented psychologists such as Carl Rogers (1902–1987). Its influence has waned since the 1980s, although current therapies have been influenced by the humanistic and optimistic outlook of the theory and by some of the interactive techniques developed by the Perls and their followers. Gestalt theory, a major school of psychology during the first half of the twentieth century, was an influential counterpoint to the other mostly atomistic psychological systems of the time: structuralism, functionalism, and behaviorism.

While its controversies with these other systems during the “age of schools” in psychology have receded into history, its major tenets once again became salient toward the end of the twentieth century in such fields as social psychology, cognition, personality psychology, and visual neuroscience. Gestalt psychology proposed a radical revision of the atomistic view that had prevailed for centuries in Western science and social science. Natural wholes, according to the Gestalt view, are not simply the sum total of their constituent parts.

Rather, characteristics of the whole determine the nature of its parts, prescribing the place, role, and function of each part in the unified whole. The Gestalt principle of Pragnanz, furthermore, asserts that the organization of any whole will be as “good” (i. e. , balanced, simple, integrated) as the prevailing conditions allow. This insistence on holistic processes applies equally to all integrated wholes, from physical systems such as electrical fields, magnetic fields, and soap films to psychological systems such as cognitive processes, the organization of perception, personality, and social phenomena.

The Gestalt movement is generally viewed (Ash 1995; King and Wertheimer 2005) as having been launched by a series of experiments by Max Wertheimer (1880–1943) on apparent movement published in 1912, although clear indications of a Gestalt perspective were already evident in two earlier publications of Wertheimer on musical structures (1910) and on aboriginal thinking about numerical issues (1912).

Two of Wertheimer’s colleagues who served as observers in these experiments, Wolfgang Kohler (1887–1967) and Kurt Koffka (1886–1941), became his collaborators during the next decades in promulgating the new Gestalt approach (Kohler 1929; Koffka 1935). A typical experiment in Wertheimer’s series involved, for example, exposure of a short vertical line in the visual field, followed after a brief interval by exposure of a second similar vertical line a short distance away from where the first one had been exposed.

If the time and distance relations are appropriate, observers see a single line moving from one location to the other. The experience is indistinguishable from watching an actual short vertical line move from one location to the other; in both cases, the perception of motion is immediate and compelling. The prevailing alternate theoretical orientations, maintaining that percepts always correspond with their correlated physical stimuli, could not explain the perceived motion when the actual stimuli are two stationary lines successively exposed.

The whole, the experience of motion as a Gestalt, cannot be derived from a combination of the “component sensations” of the two stationary stimuli. The Gestalt school became prominent in European and American psychology. Its principles of perceptual organization have been summarized in almost every introductory psychology textbook; Wertheimer’s book Productive Thinking. (1945) challenged the computer models of the late twentieth century to try to account for the ubiquitous cognitive processes of insight and understanding.

In general, the economic system indicates the system of producing and selling goods within the society. It differs according to the owner of the production factors and regarding the methods which are used to manage the economic activity of the company

She is co-habiting with her fiance© of here months whom she plans to wed later In the year, although no date has yet been finalized. This client self referred to ‘Care In Crisis’ as she had heard about the organization through a friend and felt she ‘needed to talk. ‘ During the initial assessment she disclosed that her mother had passed away as a result of cancer in March of this year, hence her reason in coming for counseling is to help deal with the bereavement issues surrounding this. Since loosing her mother she has felt very low and misses her terribly as they were very close.

Furthermore, Jane also feels that t is starting to take its toll on other relationships in her life as she finds herself snapping at people. She also stated that she has low self esteem and has barely any confidence In herself. Her goals in coming for counseling are to be able to accept her mother’s death as well as building her self esteem and confidence. Firstly I feel that some Cognitive Behavioral Therapy approaches may work well in overcoming Cane’s needs. “Psychoacoustics and normalizing Interventions are frequently used In ACT and CB. Bach & Hayes (2002) I can see that they are relational interventions because they involve teaching people new relations. I believe it would be beneficial to psycho educate her on the ‘seven stages of grief. ‘ My alma In doing so would be to help Jane make sense of the emotions she is going through and to help her understand that they are perfectly normal, in other words ‘normalizing. ‘ As well as using some CB approaches I would choose to remain faithful to the Integrative model which at the heart lies the person centered approach. One of the key concepts within this approach is self actualization.

This is the belief that as humans we will pursue what Is best for us as Introduced by Mason In 1943 and his famous hierarchy of needs. ‘ He himself refers to self actualization as; “The desire for self fulfillment, namely the tendency for him [the individual] to become actualities in what he Is potentially. This tendency might be phrased as the desire to become more and more what one is, to become everything that one is capable of becoming. ” Mason (1943) Research does support the notion of self actualities tendency (Sheldon & Elliot 1999) and I can also recognize it in myself.

In actual fact, recognition of my self actualities tendency has helped me understand some of my self destructive behaviors, which ere introduced in my younger self. I’m hoping that this will also be the case with Jane. I consider this client to be very self aware which will aid her in self actualities myself as the therapist needs to ensure that I am offering Rogers’ core conditions of; empathy, congruence and unconditional positive regard, in doing so I will be assisting her on her Journey. I will aim to be real and genuine and by doing so I hope my client will experience something of my ‘real self. Furthermore I will try my most best to see things from their frame of reference without being influenced by my own feelings and experiences. In the first counseling session I contracted with Jane and explained the limitations with confidentiality such as disclosing anything which breaks the law or child protection issues. I also stated that I was a member of the BACK. By doing the above I feel that I was demonstrating safe work and professional practice. I used active listening skills as well as non verbal communication in the form of small nods to show that I was tentatively engaging with my client’s story.

The head nod is the most common gesture in listening “Small ones to show continued attention, larger and repeated ones to indicate agreement. Argyle (1992) I felt it important to show to my client that I was engaged with her telling her story as she mentioned in the initial session that she has never been able to open up to anyone before since her mum has passed. The majority of the first session was spent just staying with my client and giving her the space she needed to talk out loud about what sort of a person her mother had been and the lead up to her death.

As a counselor I used skills such as active listening, restating and paraphrasing to demonstrate this, as I felt these were the appropriate skills needed in order to meet he client’s needs. It is safe to say that in this session I was safely following Cane’s lead without prescribing any particular interventions. In session two my client reported a little change since our last session saying she had felt heard’ and that it was a ‘release’ as she had been keeping everything to herself.

By following my empathic hunch it opened up a lot of unfinished business regarding my client wanting to share and tell her mother things but had not had the chance to. Therefore this prompted my decision to suggest the CB approach of writing a letter to her deceased mother n her own time and if she wished she had the opportunity of sharing it in the session. This is something Jane was very keen on doing and would maybe even consider doing it that week if she got the chance. I can see that the letter writing process is therefore collaborative and would enable her to work at her own pace while also facilitating client empowerment.

This would be important in helping to build her self-esteem and confidence which are areas she is lacking in. In session three my client reported that she had written the letter to her mother and was eager to read it out. In the letter my client acknowledged many of her repressed feelings and by writing the letter she was maybe able to process them in a way she could not have in the therapy session. Zimmerman & Shepherd have stated; “We use therapeutic letters to help the patient to identify difficult feelings, processing them in another way than in a therapy session, with the chance of the patients to be finally free from these feelings.

The letter writing can allow a physical way for the problem to be externalities, named and then confronted. ” Zimmerman & Shepherd (1993) In the letter she also touched on the feelings she was experiencing now months after ere mother’s passing. At this point I normalized them for her by telling her there is feelings we may experience after loosing a loved one. I felt it in Cane’s best interest, which is in keeping with the ethical principle of beneficence to psycho-educate her on the ‘Seven stages of grief by giving her a sheet which had been given to me by my supervisor.

This would help her make sense of how she is feeling and it would also provide hope for her as one of the later stages is acceptance. In the forth session Jane talked about her goals, both short and long term. She acknowledged that whilst t was her mother at first who pushed her towards loosing weight for various health reasons, she now wanted to pursue her own goal of trying to loose some weight for her wedding day so that she could fit into her dream dress. I got a strong sense that the ‘configurations of self were being peeled back and the ‘real self was coming through, which Rogers theorized.

By doing so she was closer to self actualization. In session five we explored Cane’s lack of confidence and self esteem. It was evident that she had a low self concept of her physical appearance and dress sense. Although she ad received a compliment earlier in the week from a friend about how well she looked she perceived that the comment was made merely out of sympathy. As the therapist I got my client to explore this and by doing so we were able to get to the core of this view. It turned out that as a child she overheard her aunt telling her uncle that she had only told Jane her dress was lovely out of pity.

It is said that; “Experiences are accurately perceived as meeting the needs of the core self or being consistent with the self concept and reinforcing it. ” Acreage (2010) It is therefore fair to say that Jane could not accept the compliment from her friend s being genuine as she was being true to her self concept. I offered the concept of looking for evidence borrowed from Cognitive theory in order to challenge her self concept. It appeared that there was no other evidence to support her views that compliments were only given to her out of pity, apart from the incident with her aunt.

When we looked into this further her aunt said this around the time her parents were not getting on which prompted the possibility that her aunt may have been saying it to comfort her in a difficult time. The client came up with this conclusion resell and I remained faithful to my integrative model which at the foundation has a profound respect for the client and their ability to construct their own views. Adapted from ‘The Theory and Practice of Counseling the ability to function and process experiences can result in being either low functioning or high functioning.

I considered Jane to meet the criteria for low functioning which means; “Low functioning people are out of touch with their valuing processes. In these areas their self concept is based on conditions of worth which cause them to ignore/deny or distort the experience. Nelson Jones (1992) Through challenging and looking for evidence I was aiming for Jane to become higher functioning. At the end of this session I talked to my client about the possibility of audio recording our next session if she agreed to it.

I felt it was in her best interest to give some notice rather than asking her on the day of recording so that it did not come as a shock or disorientate her. Fortunately Jane agreed for our next session to be taped. It was the sixth session with this client that was recorded. I made sure to training purposes so that she did not think it was some sort of test on her. At this point I was demonstrating safe work as I wanted to provide a non threatening environment for her. At present I attend a supervisor who is based a few miles outside of the town I undertake my placement with.

Firstly, her geographical location is convenient because when I am at placement I can call and see my supervisor when I am finished. This is beneficial as I find things tend to be much fresher in my mind if I see her on the day I have had clients. In additional her name was on the approved list issued by the college, this meant she was BACK approved to supervise therefore I to satisfaction from this knowing she worked ethically and had experience of supervision with students. Moreover because she was approved by the college meant she was familiar with the course requirements and as a result could effectively support my learning.

Prior to choosing a supervisor I had some requirements including at least ten years experience of counseling and I wanted someone who worked from an integrative perspective, my supervisor met both of these. On first meeting my supervisor I feel that there was a connection so I instantly felt comfortable. Before commencing supervision I had the view that they would be like a joss, however now that I have been several times this view has been diminished and I consider my supervisor as someone to consult with.

I get a strong sense of being facilitated and supported by my supervisor. For example while working with this client I had limited experience of working with bereavement so my supervisor gave me a book which would support my counseling, in addition I was facilitated by being given a sheet on the ‘seven stages of grief which I could give to my client. At first with Jane I was working from a person centered approach because I felt unfamiliar tit bereavement and felt this was a safe angle for me to work from.

With the support and guidance I received at supervision I was able to change my approach with this client by being more integrative. I was able to bring in some Cognitive interventions which I do not feel I could have done confidentially on my own without the aid of my supervision sessions. My supervisor is quite directive in the sense that if I do something effective in the sessions she will acknowledge my style of practice and vice versa if I do something that may not have worked so well she will then encourage me to challenge this and look at alternatives.

As a result of this my confidence has grown and I feel a little more competent in my role as a counselor to the point that I would trust my intuition with regards making appropriate decisions with my client work. By continuous supervision I hope to learn and grow as a counselor as well as developing new techniques and interventions and as a result improve the value I provide to my clients. Since working with Jane I feel that I have grown personally as I have increased awareness around death and bereavement.

It is inevitable that I will loose a loved one at some point throughout my life. By hearing all about Cane’s grief of loosing her mother I feel I will be more prepared if I am faced with the death of someone close to me. My own mother has battled with health problems for the most part of her life and has been under close supervision of the medical profession especially in recent months. Having worked with this client has brought me in sync with reality and now I can see that there is a chance I may loose my own mother soon.

My work with Jane has prepared me a little if this does happen come with it. Furthermore working with Jane has taught me to appreciate the people I m close to in my life and I have learnt to cherish every moment with them as they could very easily be taken away. As a mother myself to a three year old boy, I feel I have made more time for him knowing how precious he is to me. Professionally I have also developed at a result of working with Jane.

In order to meet her needs I took part in a one day course held at my placement organization which was based on bereavement. From this I learnt the various techniques and skills required when working with this client. Not only did this course help me when working with Jane but t will also help me when counseling clients with similar situation. Also a fellow peer in my placement shared a poem about loss with me. I was very appreciative of this and felt it may be of benefit to my client as she is artistic and creative.

I shared it with Jane in one of the sessions and she informed me that she got great comfort from it. The following week she told me that had put it on her fridge so that every time she opens the door she can read it. I can safely say that support from my peers has helped with my client work and as a result helped me to develop professionally. In he first counseling session with Jane we engaged in contracting. A contract can be defined as “A mutual agreement negotiated between the client and the counselor prior to commencing counseling. Provence (2008) I made sure it articulated my responsibilities towards the client and also the client’s responsibilities in the counseling relationship. I made sure to inform Jane about the strict confidentiality policy that counselors abide by and told her about the exceptions to this such as breaking child protection or the law as it would not be ethical for me to withhold this information. In addition to this if the client disclosed that she was of risk to herself I could not keep this to myself as this would not be in keeping with the Backs ethical principle of non-maleficent.

By informing her of this I was hoping to provide a safe environment for her to share her story but at the same time letting her know the boundaries. I was also letting her know that I was obeying the ethical principle of fidelity. The importance of the contract became apparent in session four, in which my client disclosed that her mother had been one of the only women she had ever really gotten along with and that in general she did not get on tit women. This prompted my decision of using the skill of immediacy to establish what our relationship was like for the client with me being a woman.

It was reassuring to learn that I was not like most other women she had encountered as I was not Judgmental or bitchy. This proved to me that I was working in an ethical manner and respecting my client’s autonomy. When I first began keeping notes they were rather long and detailed, however now I have learnt to keep concise and factual notes. I recognize the importance of not noting opinions or Judgments in the notes n the off chance they may be called for in a court hearing.

Each client’s notes are kept in their own personal folder which is kept in a locked filing cabinet in a locked room and each client is identified with a seven digit code. This ensures maximum confidentiality which is in keeping with the ethical framework principle of fidelity. In an emergency for example if I died and client’s notes needed to be accessed the receptionist could identify the client by searching the code on the computer system. Respect that the client has the right to be self governing which is in keeping with the ethical principle of autonomy.

Massage is described as the systametic and scientific use of the soft tissue of the organic structure for the intent of obtaining and keeping wellness harmonizing to massage therapy: rules and pattern by Susan G. Salvo ( 2007 ) . Massage has been shown to cut down emphasis, enhance blood circulation, lessening hurting, promote slumber, cut down swelling, enhance relaxation and increase O capacity of the blood, ( Salvo, 2007 ) .

“ Because massage therapy is a inactive intervention that requires little, if any, physical demands on the single having the therapy and because it has shown to develope musculus tone for other kids ( Field,1998 ) massage therapy might heighten physical development for kids with Down Syndrome, ” ( Hernandez-Reif, et Al ; 2004 ) .

Massage has risen in popularity over the old ages particularly for those looking for alternate and complementary therapies to supplement their medical interventions and make a positive impact on their wellness. Massage has shown good to many people ( Salvo, 2007 ) .

Down Syndrome is a familial status and it can consequence one in every eight hundred to one 1000 babes per twelvemonth in the united provinces, while there are two babes born every twenty-four hours in the UK with Down Syndrome, ( Fiona Marshall, 2004 ) . Down syndrome is present in a kid when they are formed with three instead than two transcripts of chromosome 21, this gives the kid 47 alternatively of 46 chromosomes ( Marshall, 2004 ) . The symptoms vary from individual to individual and can run from mild to severe, but they can be easy recognised because of the visual aspect. “ The caput may be smaller than normal and abnormally shaped. For illustration, the caput may be round with a level country on the dorsum. The interior corner of the eyes may be rounded alternatively of pointed, ” ( Neil K. Kaneshiro, 2010 ) . People with Down Syndrome can endure from typical physical characteristics such as:

Reduced musculus tone

• A little olfactory organ and level seventh cranial nerve characteristics
• A little oral cavity and a big looking lingua
• Broad hands with a individual fold across the thenar
• Shorter than usual in tallness

( Marshall, 2004 ) .

Down syndrome is a familial upset impacting 1000000s of people worldwide ( National Institute of Child Health and Human Development, 1997 ) its cognitive defects characterise the status ( Nichols et al. , 2003 ; Seung & A ; Chapman, 2004 ) including motor and perceptual developmental jobs ( John et all. , 2004 ; Kearny & A ; Gentile, 2003 ) .

There is no specific intervention for Down Syndrome as it is a familial upset, nevertheless, due to this there is a opportunity the sick person may necessitate surgery for GI obstructions and certain bosom defects, ( Neil K. Kaneshiro, 2010 ) . Since there is no intervention for Down Syndrome much can be done to better quality of life and minimise development holds, ( Marshall, 2004 ) . Fiona Marshall ( 2004 ) , sites from Patricia Winders ‘ book, Gross Motor accomplishments in kids with Down Syndrome: A usher for parents and professionals ( 1997 ) , that the motor development can be affected by four factors: deficiency of musculus control, shirker ligaments taking increased flexibleness of the articulations, less musculus strength and short weaponries and legs. The NHS Direct ( 2010 ) , believe that an early intercession plan can supply support to babes and kids with Down Syndrome from the minute they are born until the age of five ; these plans provide health care, instruction and interventions for illustration address therapy and physical therapy.

Harmonizing to Marshall ( 2004 ) , early intercession can antagonize the inclination to hapless musculus tone and so be good for the kid to assist pattern new accomplishments such as sitting and walking. A physiotherapist uses physical methods to advance wellness and wellbeing utilizing use, “ A kid with Down ‘s syndrome will frequently hold physiotherapy from a immature age because it can assist them to better their scope of motion. Babies with Down ‘s syndrome may hold hapless musculus tone, so a physical therapist can assist them to larn to turn over over, sit up or walk, ” ( NHS Direct, 2010 ) . Due to the hapless musculus tone of people with Down Syndrome it is harder to execute undertakings which need a grade of physical co-ordination such as eating and dressing, the NHS ( 2010 ) determine that an occupational healer can assist by interrupting down the undertakings into little stairss to assist supply an easier manner to finish the undertaking, step-by-step.

Harmonizing to Marshall ( 2004 ) , early intercession and physical therapy needs to maintain the long-run motor accomplishments in head and non merely the short-run. Besides physical therapy may non rush up the rate of motor development but it could assist to forestall following unnatural compensatory motion forms, for illustration ; hapless position, walking with the pess broad apart or unnatural spine curvature.

Harmonizing to the National Down Syndrome Society { NDSS } ( 2011 ) , references that some of the alternate therapies are aimed at handling the whole organic structure non merely the disease of symptom. It besides states that

“ Most of these therapies have non made claims for people with Down syndrome that have been any different from the claims they have made for the general population. However, some therapies have claimed to better motor and cognitive maps every bit good as growing and overall activity specifically in individuals with Down syndrome. Some have claimed to alter some of the physical characteristics of Down syndrome to a more “ normalized ” visual aspect and to change by reversal rational disablement. ”

NDSS merely recommends interventions that have gone through scientific tests for people with Down Syndrome. Harmonizing to Susan Mumford ( 2009 ) , massage can assist the musculuss by exciting normal organic structure processes. Waste merchandises such as lactic acid are released from the musculus fibers, enabling them to travel more freely, this returns the musculus tone to an optimal degree. It besides helps to better circulation and conveyance foods to the musculuss and variety meats and have a good consequence on the bosom rate.

Case Studies- Applying Theory to pattern:

The focal point of this is on whether massage therapy can assist with the betterment of musculus tone and motor development in kids with Down syndrome.

In 2004, Hernandez-Reif, Field, Largie, Mora, Bornstein and Waldman decided to mensurate the, if any betterment in the motor map and musculus tone of people who suffer from Down syndrome, with the early intercession of massage. Twenty-one kids with moderate to high working Down syndrome received early intercession where chosen at random to have two half hr therapies, either massage therapy or a reading session. This went on for a period of two months.

The kids ‘s operation degrees where assessed on both the first and last twenty-four hours utilizing the Developmental Programming for Infants and Young Children graduated table ( DPIYC ) and musculus tone was assessed utilizing a new preliminary graduated table ( ALT ) . During the initial first twenty-four hours the kids ‘s motor maps where measured by utilizing the following shaping characteristics, perceptual/fine motor, gross motor, self-care ( feeding etc ) social/emotional, linguistic communication and knowledge. This was used to demo any strengths and failings and to demo which developing accomplishments were emerging. The CPIYC was used in this trial for convenience and because the kids were already accustomed to it as they had been routinely administered by the professionals the kids already working with. A basal degree had been found and the survey could get down. The therapy Sessionss where for half an hr twice a hebdomad for the two months where a full structured massage therapy was given and the reading Sessionss were done on the same clip agenda and the reading Sessionss consisted of the healers merely keeping the kids as they read the books.

The consequences show that the ALT tonss reflected the original informations ; nevertheless, Mann-Whitney U-tests on certain musculuss show a tone alteration in the tonss uncovering that there was an betterment in musculus tone for the massage therapy group. For the DPIYC, measurings reflected outlooks and showed a greater addition for the massage therapy group on all right motor operation and gross motor working. They besides showed a small betterment in the group for linguistic communication development.

However, the alterations might non reflect what should be shown as the developments the kids have revealed in the trials might non really be from the massage Sessionss or the control reading session but could really be due to ripening over the two months. To mensurate which could be due to the intercession or to the ripening of the kids with Down syndrome hereafter research would be needed along with another control group entering how a massage session comprising of light stroking alternatively of a force per unit area would impact the same organic structure countries as the massage therapy group. This would besides decide any cultural issues which could originate from keep backing intercessions from some of the kids.

In malice of this harmonizing to Pardew and Bunes ( 2005 ) it is discussed that through research preformed, Field and co-workers in the Touch Research Institute ( TRI. N, D ) . Despite positive findings from other beginnings there is still a ground to be cautious with the usage of intercession of massage to babies as a method to advance mental, motor and /or social-emotional development in immature kids who have disablements. Up until now there have merely been three different reappraisals upon infant massage techniques ( i.e. Gallagher, 2003 ; Ottenbacher, Muller, Brandt, Heintzelman, Hojem & A ; Sharpe, 1987 ; Vickers, Ohlsson, Lucy & A ; Horsley, 2004 ) . Ottenbacher and co-workers conducted and analysis and admitted that the trial groups did better than the control groups nevertheless there was the recognition that there where design flaws with the surveies and where more likely to bring forth positive results for the survey group. The other two reappraisals found that although the surveies provided positive consequences the credibleness was compromised by methodological defects. While Gallagher ( 2003 ) finalised that the infant massage can non be recommended as grounds for the positive effects on cognitive, motor or social-emotional development in high kink babies.

Harmonizing to McWilliam ( 1999 ) Therapeutic, educational and medical are three countries of early intercession controversial interventions. Silver, ( 1995 ) considers discoursing intervention with kids with larning disablements controversial if:

“ ( a ) the attack was presented before any surveies were available or when pilot surveies had non been replicated, ( B ) the presented intervention went further than the information, or ( degree Celsius ) the intervention was used in an stray manner when a multimodal appraisal and intervention attack was needed. ”

Any curative patterns can be seen every bit controversial as they are described to necessitate a certain sum of clip per hebdomad, McWilliam ( 1999 ) . Whereas the more-is-better phenomenon is seen as a subject in the surveies about service use ( McWilliam, Tocci & A ; Harbin, 1995 ) and service integrating ( McWilliam, Young & A ; Harville, 1996 ) . This besides explains why in a therapy service the early intercession squad plans a therapy on the footing of a kid ‘s diagnosing alternatively of be aftering it to back up the ends of the survey ( McWilliam et al. , 1996 ) .

Validity and Recommendations:

The cogency of this trial might be discussed as there were so few patients involved in the test ; there were merely 21 patients who received merely two 0.5 hr therapies a hebdomad for eight hebdomads ( Hernandes-Reif, et Al, 2004 ) . It could hold been due to ripening effects that the consequences had shown that massage was effectual in the early intercession and to analyze this, another control group would hold to be involved to find if the consequences were right. This control group would dwell of kids with Down Syndrome who would non have early intercession services to find if the consequences were affected by ripening, nevertheless this would be seen as unethical to with keep the intercession for research intents. ( Hernandes-Reif, et Al. 2004 ) . Although a 2nd control group might hold been added with a assumed massage that merely received stroking to the same organic structure parts alternatively of using force per unit area, this would be a one manner of deciding the ethical issue and would besides be a control for attending and “ prove the effects of moderate poetries light force per unit area massage effects, ” ( Hernandes-Reif, et Al. 2004 ) .

Another restriction of this survey was that the DPIYC profiles a kid ‘s age scope ( in months ) and non the development age in months, due to this the cogency of the tonss is unknown. A recommendation for this is to utilize another step to change over the information into age tantamount tonss, for illustration the “ Peabody Development Motor Scales ( Folio and Fawell, 1983 ) for gross and all right motor appraisals, ” ( Hernandes-Reif, et Al. 2004 ) .

“ It is of import to observe, nevertheless, that none of the reappraisals indicated that infant massage was an uneffective intercession for immature kids but instead that to day of the month surveies have been conducted in a mode that adequately paperss efficaciousness. ” ( Pardew and Bunse, 2005 ) .

R. A. McWilliam ( 1999 ) in Controversial patterns: The demand for a re-acculturation of early intercession Fieldss ; believes that physical and occupational therapy have questionable research as there are no published true experimental surveies demoing the effectivity of one signifier of intervention over another as nil adequately separates the intervention from the control.

Decision:

The consequences show that massage therapy could assist in bettering the motor map and musculus tone of kids with Down Syndrome, nevertheless, with the restrictions and the recommendations added by those who created the tests and perceivers this could merely be a computing machine mistake, trial mistake, or even happenstance. To turn out that this would really work other factors would hold to be tested alongside the chief trial country as control groups to restrict any false consequences.

The psychological wounds of war present a situation where individuals are often mimes forgotten, unaddressed, and underrepresented-especially those who are suffering from the postgraduates stress syndrome, they are also struggling with the transition back to normal life and work. Literature Review: EST. Defined. Examining the impact of military trauma on a veteran’s life remains in an infant stage with respect to knowing all that must garnered (Stutter, 1995). Accountability, sustainability, and treatment are far from being complete.

Not only do diagnostic and treatment paradigms need to be made available to those veterans who suffer from PITS, but a support system must be identified and structured to as well. Family and friends have to learn that they must be proactive in their understanding and support of the military veteran who have been diagnosed with PITS disorder. Notwithstanding the fact that people who have been in military combat and suffer from PITS, there has been reported a direct relationship between the disorder and negative physical health as well such as non-specific EACH abnormalities and theoretically defects and infarction’s. Jackson’s, 2004). Although not extensively researched there are indications that PITS is related to some gastrointestinal and musculoskeletal dysfunctions as well. However, the psychological factors resulting from PITS has been researched more extensively and several treatments modalities have been used. These treatment methods include, but not limited to, cognitive-behavioral therapy, psychodrama therapy, group therapy, spectrographically therapy, as well as several experimental approaches utilizing seniority and Asian approaches. Dietrich, et al, 2000). Regardless of the treatment program employed to treat people with PITS all must concentrate of the protective factors surrounding the veteran, namely, the individual his or herself, the family, and friends or peers. As stated in Chapter 1 of Comers book entitled Fundamentals of Abnormal Psychology (2005), the road to better mental health for individuals suffering from any abnormal disorder rests with the community-based interventions and short-term therapy.

With respect to the PITS veteran what is at stake is to increase self-esteem, self-efficacy and those skills needed to cope with stress brought about by PITS via therapeutic intervention that is community related (support) and short-term goal oriented. The therapies generally used, according to Comer (Chapter 5) are usually multi-modal to include a combination of medication, psychotherapy, ND cognitive-behavioral intervention. As said earlier some Asian and sensory-motor therapies are used as well.

In order to accomplish this goal the individual must attempt to reestablish bonds of trust with family members, increase communication abilities, and begin to strengthen ties with peers and friends in pro-social activities and those involving the re-establishment trust and intimacy. Without a great deal of attention given to these protective features the risk factors for continued or strengthening of EST. is greatly increased. Those risk factors include, but are not limited to, continued excessive and realistic fears, social isolationism, family conflict, avoiding coping style, and interpersonal discord.

Whether or not an untreated stress disorder can and will lead to a more debilitating disorder such as schizophrenia (Chapter 12) has not been researched to the point wherein definite conclusions can be drawn. As such those individuals who have been diagnosed as PITS patients, but not treated, with respect to military combat service need to be re-evaluated to determine the possibility of having a much more serious disorder. As PITS is a relatively new diagnostic category for the

American Psychiatric Association, and for all those involved the diagnosis and treatment of the disorder, a great deal more investigative research must be conducted to determine its long-term effects on the individual, on society, and even on the country political and economic balance. What is the alarming fact that knowing EST. does indeed exist the research annals are void of cited programs used to prevent PITS in military, or any other high risk occupation. It is one thing to diagnose and treat a disorder, yet another to install preventative measures to deal with situations that can lead to PITS.

In edition, a literature review failed to locate any supportive materials as to how the government will deal with those returned military service people who will capitulate, involuntarily to PITS. What is desperately needed is a before and after military service program that focuses on strategies to assist military personnel to adjust to a new environment (I. E. Combat) as well as to re-adjust to a returning home environment. Such programs would have the crux of their efforts facilitative and proactive approaches that assist the person with a range of personal and relationship issues.

In addition for those military response re-locating to foreign bases should be involved in multicultural professional workshops and culturally sensitive caregivers should contact these workshops and preventative treatment programs. This is especially true for those people who are now serving in Iraq and other combat active regions. From involvement in Vietnam some 30 years ago our society has fallen short in supporting those who risk their lives for our nation’s well-being.

Attempting to shed light on a disorder that has political, psychological, and sociological components is not an easy task. Isolating each area is arduous hen attempting to look at only one Of the aforementioned variables with reference to PITS in veterans-male and female alike. There is even research to suggest that PITS is a very real veteran disorder, all efforts should ensure to treat not only those who have served their country but plan and implement strategic initiatives on a preventative basis.

For those individuals serving in Iraq the need for mental health support before entering the combat theater and while in combat is a move we cannot afford not to take. A war that has touted to be over in a few months has now dragged on for overall years and longer. As a result the cultural sensitivity initiatives before and after entering a foreign country must somehow be integrated into the war theater on a preemptive move. In other words, plan now or pay later.

These EST. veterans also have to learn how to live back in society and handle work day to day. With only about half of veterans suffering from PITS seeking treatment (Tangential & Jaycee, n. D. ), transitioning back to everyday life can be difficult for returning soldiers in a variety of ways, including the workforce. There are a multitude of conditions that can arise from PITS that make rotational employment more difficult for a veteran suffering from PITS.

Researchers name some of the issues as memory loss, lack of concentration, stress (which can incorporate or be separate from panic attacks, flashbacks and emotional extremes), and inability to work well with supervisors or coworkers, and sensitivity to sounds and lights that can result in physical distress such as headaches (Babble 2012). All of these present challenges for employers, but can be managed as veterans look to adjust to a more traditional civilian life and work on managing their PITS symptoms with treatment.

Memory loss is one of the main effects associated with PITS. Perhaps one of the key problems with this as it relates to traditional employment is that PITS does not only impact long-term memory, but can have an effect on a patient’s day-to-day life. Researchers have found that memory loss’ “effects on daily functioning and treatment are of primary concern… And reduce the resources available to PITS patients when coping with life’s demands” (Samuelsson, 2011, p. 351 ). This can impact employees from the moment they are hired throughout the duration of their employment.

Veterans suffering from PITS may struggle with training, as numbering what they have just learned may prove difficult, and may also have trouble in meetings, remembering tasks and assignments, and how to use equipment they are unfamiliar with. There are suggestions for employers on how to make such complications easier on the workers, including budgeting for more training, writing minutes from or tape recording meetings, posting written directions for complicated equipment and providing the employee with a task list that can be checked off.

Much like memory loss, a lack of concentration can be extremely challenging for both an employer and the worker. A study out of Yale University found people who buffer from PITS tend to forget instructions even after hearing them multiple times, and typically are forgetful about where they have placed their possessions (Brenner, 2000). This can interfere with workplace tasks, especially in busy offices with potential distractions. To help combat the effects of lack of concentration for veterans with PITS, America’s Heroes at Work, a division of the U. S.

Department of Labor, suggests employers should aim to reduce as many possible distractions near the employee, by allowing sound machines or music, changing the lighting or creating a private workspace to keep the individual on task. While memory loss and lack of concentration are relatively similar in terms of their effects on veterans with PITS, there are several other symptoms that may be more difficult to help manage as an employer. Patients tend to suffer from stress as a result of p T SD, which can include flashbacks to the traumatic event or events that triggered the disorder.

Researchers argue that six major factors can help veterans overcome, or at the very least manage, stress associated with the effects of PITS: practicing altruism, having a positive outlook, maintaining an active coping lifestyle, getting exercise, seeking support from friends and Emily, and being flexible in responses to negative situations (Hoagland, Cooper, Southwest, & Charley, 2007). Veterans suffering from PITS-induced stress may struggle as unforeseen daily problems arise on the job and could have a difficult time as new responsibilities are added.

Stress could also play a role in absenteeism (Huge, Territorial, Castro, Messes & Engel, 2007) as veterans with PITS are not immune to experiencing triggers with their symptoms outside of their work environ meet that could have a secondary impact on work. Stress can also contribute to another common symptom of P T SD: recurring panic attacks. An employee may worry that these episodes will reflect negatively on them in the workplace; therefore, an employer would be best served by having a plan in place for handling this situation should it arise to help with the comfort of the veteran and other coworkers.

Additionally, a respectful and solid relationship between an employee and a supervisor is often critical for a productive workplace, which can sometimes be affected by a veteran suffering from PITS. Not only is the veteran likely not used to the traditional structure of a work environment as compared to the ranks of the military, but other symptoms of P T SD can trigger a negative action in a potentially frustrated employee.

For example, an employee suffering from PITS-induced memory loss who cannot perform a basic task that was explained to him or her earlier in the day may become overwhelmed or upset, and could lash out at or blame the supervisor, or having a generally negative reaction that could interfere with workplace morale and working relationships. Bosses are encouraged to make the transition easier on the worker by providing as much information in writing to serve as a reference as possible, and give positive reinforcement to the employee. Similarly, conflicts an arise between coworkers and veterans that may not occur between civilian employees.

It is critical to understand what is causing the tension: it is coming from stress, memory loss, lack Of concentration or another possible symptom of PITS? Coworkers should all receive some form of training on disable¶y’ awareness to help them make the best decisions in a potentially uncomfortable situation. Employers can also help diffuse tension before it begins by accommodating the veteran’s needs as best as possible, whether that be with a private workspace, allowing for music to be played during the day, or initiating techniques for managing stress. Finally, another key workplace concern for veterans with PITS is hypersensitivity.

This is defined as being anxious around large crowds and unknown areas, startling easily, and being sensitive to lights and sound. These symptoms can trigger physical reactions in soldiers, from headaches and migraines to more severe responses like panic attacks. In the workplace, this can present problems for a veteran because there is a certain lack of control over things like lighting and noises. An employer can provide alternative lighting for a worker who may be sensitive to bright office lights, and can also help with private accommodations when possible.

Coworkers should be sensitive to a veteran who may be prone to being startled when interrupted. Transitioning from life in a war zone to life in the civilian United States is likely difficult for all of the more-than two million men and women who have served overseas, but it can be made increasingly hard when adding PITS symptoms to the mix. With at least 20 percent of veterans reporting symptoms, it is paramount for employers to be aware of how to help manage a soldier’s medical concerns in the workplace. Veterans with this disorder will add unique issues to a work environment likely not seen as frequently in civilian employees.

Worries about transitioning well into an every-day job may even have the effect Of enhancing some PITS symptoms for certain veterans, depending on how they are affected by the disorder. Therefore, both veterans and employers should be responsible for having candid discussions regarding the patient’s experiences with the disorder, and how the work environment is likely to impact symptoms, in order to give both the company and the veteran the best chance to succeed as the soldier embarks on a new life as a civilian in the United States. The impacts of war have proven their significance to our service men and women.