By I. Dennis. Metropolitan State University.

Compression between bone and a hard surface cuts off blood flow to soft tissues order imuran 50mg free shipping muscle relaxant gel uk, which can die in as short as one to two hours (Lewis 1996 imuran 50mg on line spasms before falling asleep, 263). Pressure ulcers result, sometimes taking months and surgery to heal, and contributing to feelings of hopelessness and de- pression. The most common wheelchair injury, however, involves falls, either from tipping over or from falling out of the wheelchair (Currie, Hardwick, and Marburger 1998; Gaal et al. Using standard wheelchairs, most people tip or fall forward, but scooters (especially three-wheeled models) can tip to the side. People can also tip backward, especially during accelera- tion of rear-wheel drive power wheelchairs. Jenny Morris had taken her daughter to the park: “I was on a three-wheel scooter, with Rosa on my knee, when suddenly the scooter overbalanced on the steep gradient and we were in a heap on the grass.... I had felt such panic at this sudden reminder of my physical vulnerability” (1996b, 168). The federal Technology-Related Assistance for Indi- Wheeled Mobility / 221 viduals with Disabilities Act of 1988 (P. Through the National Institute on Disability and Rehabilitation Research (NIDRR) in the Department of Education, the Tech Act allocates over $39 million annually to state programs to help peo- ple identify and understand assistive technologies (Brandt and Pope 1997, 151). Although Tech Act projects generally do not provide assistive devices directly, some do give practical guidance and legal advice on navigating in- surance hurdles (Appendix 2 lists these sites). Penney on sale, while her Medicaid-funded scooter sat unused in her apartment. Gerald Bernadine searched the Inter- net, finding his scooter and a lift device for his car. One man bought his scooter secondhand, through newspaper want advertisements; another inherited several wheel- chairs from dead friends. Tina DiNatale seeks an ultralightweight manual wheelchair but cannot find one at local medical supply stores. Wheelchairs are serious equipment with important physical, mechani- cal, practical, and emotional ramifications. Although diverse technologies exist, “there are no menus of assistive devices, and consumers simply are not aware of their options” (Olkin 1999, 277). The Internet offers dozens of sites about wheelchair technologies, although questions remain about the completeness and veracity of information. While primary care physicians sometimes discuss ambulation aids with their patients, few physicians I in- terviewed discuss wheelchairs or know much about them. The best way to select a wheelchair is to work with experienced profes- sionals, potentially including a physiatrist, occupational and physical ther- apists, social worker, equipment manufacturer, vocational rehabilitation counselor, and even health insurer (Warren 1990; Currie, Hardwick, and Marburger 1998; Karp 1998, 1999). After people receive equipment, they must be trained to use it, espe- cially on how to avoid falls and other injuries. Gary McNamara, a physical therapist, considers wide-ranging practical implications when suggesting wheelchair technologies. If they have a manual chair now, are they dependent on an- other person propelling because, for whatever reason, they can’t propel themselves? But someone’s got to dismantle it, to carry it downstairs, and to put it back to- gether. Unfortunately, a lot of the homes and housing projects in Boston 222 W heeled Mobility are not accessible. Usually a wheelchair gives them a little more maneuverability through narrower places, but the scooter lets you go longer distances. Then you have that whole problem of having two pieces of equip- ment and insurance will only pay for one. When I bought my first scooter over a dozen years ago, I had a gold-plated indemnity insurance policy, now virtually extinct, from Blue Cross–Blue Shield. The benefits package clearly included wheelchairs, but Blue Cross rejected my claim, arguing that a scooter-type electric wheelchair is a “recreational vehicle” analogous to a “golf cart”—a convenience item. Two neurologist friends intervened with letters and telephone calls, but Blue Cross stood firm. The insurer did offer to pay for a four-wheeled power wheelchair (then about $4,500), but not a scooter-type wheelchair (roughly $2,300), never mind that the scooter better suited my mobility needs. This request has been de- nied because the information did not support the medical necessity of the equipment. If you do not agree with this decision, you may request a re- view in writing within six months of the date indicated in this letter.

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We believe that the skill of being able to make realistic evaluations of the quality of one’s work is an attribute that every graduate should have generic imuran 50 mg on line muscle relaxant histamine release. Yet 50mg imuran otc spasms between shoulder blades, in conventional courses, few opportunities are provided for self-assessment skills to be learnt and developed. The introduction of self-assessment practices into existing courses have been shown to be feasible and desirable. Whether marks generated in this way should count towards a final grade is an undecided issue. Work reported in the literature suggests that so long as the assessment scheme is well designed and students grade themselves on achievement (and not effort), they will generate marks which are reasonably consistent with staff marks. Thus, there is little doubt that self-assessment, used primarily to improve the students’ understanding of their own ability and performance, is worthwhile educationally 153 154 155 and encourages openness and honesty about the assess- ment. If you wish to embark on a trial scheme you must first set about the task of establishing criteria and standards. This can be done at a series of small group meetings attended by staff and students. Both must agree on the criteria to be applied to the students’ work, To help focus on this task you might have students reflect on questions such as: How would you distinguish good from inadequate work? Once criteria have been specified, students use them to judge their own performance. Marks are awarded with reference to each criterion and a statement justifying the mark should be included. An alternative is to contrast their own mark with one given to them by a peer. The teacher may also mark a randomsample to establish controls and to discourage cheating or self-delusion. We urge you to give this approach to assessment very serious consideration indeed. In our view, it is among the most educationally promising ideas in recent years, and we suggest you study the book by Boud listed at the end of this chapter. THE LEARNING PORTFOLIO All assessment methods require that students present evidence of their learning, yet in most cases (with theses and project work being notable exceptions) it is the teacher who controls the character of that evidence. Requiring students to respond to objective tests, write essays and participate in clinical examinations for example, does this. If we really believe in student-centred learning then we must work hard to ensure that our assessment practices reflect, encourage and rewardthis belief. In Chapter 1, we noted that assessment in student-centred learning needs to be more flexible with greater emphasis on student responsibility. The learning portfolio is one way of reinforcingstudent-centred learning. The portfolioclearly has validity as an assessment method in this situation, but its reliability for summative purposes has yet to be deter- 156 mined. This should not, however, discourage you from experimenting with learning portfolios with your students. A learning portfolio is a collection of evidence presented by students to demonstrate what learning has taken place. In the portfolio, the student assembles, presents, explains, and evaluates his or her learning in relation to the objectives of the course and his or her own purposes and goals. Used for many years in disciplines like the fine arts and architecture, portfolios are now being used more widely and are being strongly advocated as an approach to the revalidation (re-certification) of practising doctors in the UK. A learning portfolio might have several parts, such as: An introductory statement defining what the objectives are and what the student hopes to accomplish. A presentation of items of evidence to show what learning has taken place. An explanation of why items are chosen and pre- sented, evidence of the application of learning to some issue or real-life situation, and an evaluation of learning outcomes. A danger of using portfolios is that students might do too much, and some of their material might be less than relevant! So it is important to provide structure and to suggest sample items, the number of different items and their approximate size. Obviously, the items in a portfolio will reflect your particular discipline. Implementing learning portfolios as an assessment method requires careful preparation and planning on your part.

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SUMMARY X Most research projects will require the production of a research proposal which sets out clearly and succinctly your proposed project generic 50mg imuran fast delivery muscle relaxant gaba. X Before you write your proposal discount 50 mg imuran mastercard muscle relaxant methocarbamol addiction, check whether you need to produce it in a specific format. X The standard research proposal should include the fol- lowing: – title – background (including literature search) – aims and objectives – methodology/methods – timetable – budget and resources – dissemination. X Research proposals stand a better chance of being ac- cepted if you’re able to prove that you have the re- quired knowledge and/or experience to carry out the research effectively. X It is important to make sure that your proposed meth- ods will address the problem you have identified and that you are able to display an understanding of these methods. For each type you will need to think about how you are going to record the interview, what type of questions you need to ask, how you intend to establish rapport and how you can probe for more information. METHODS OF RECORDING If you’ve decided that interviewing is the most appropriate method for your research, you need to think about what sort of recording equipment you’re going to use. You should think about this early on in your research as you need to become familiar with its use through practice. Even if you decide not to use tape-recording equipment, and instead use pen and paper, you should practice taking notes in an interview situation, making sure that you can maintain eye contact and write at the same time. If, how- ever, you’re conducting a structured interview, you will probably develop a questionnaire with boxes to tick as your method of recording (see Chapter 9). This is perhaps the simplest form of recording, although you will have to be familiar with your questionnaire, to make sure you can do it quickly and efficiently. A battery indicator light is crucial – it enables you to check that the recording continues throughout the inter- view without drawing attention to the machine. A recorder which automatically turns at the end of the tape is useful as you can have twice as long uninterrupted interviewing. They can run out very quickly and this will have an influence on the quality of recording. X Is the room free from background noise, such as traf- fic, noisy central heating systems and drink machines? It is important to hear your own voice as well as that of the interviewee so that you know what answers have been given to which questions. T R M R elyonequi pment–i fi tfai lsyouh ave no vercome equi pmentfai lure bypracti ce T ape recorder anconcentrate onli steni ng tow h atth ey record ofi ntervi ew. A ble to mai ntai neye contact asyoush ould because i t’sbei ng recorded. H ave a complete record ofi ntervi ew for ould tak e a few notesasw ell–h elpsyou Some i ntervi ew eesmaybe nervousoftape- tow ri te dow ni mportanti ssuesand you analysi s i ncludi ng w h ati ssai d and recorders i nteracti onbetw eeni ntervi ew erand w i ll h ave some record i fequi pmentfai ls i ntervi ew ee. H ave plentyofuseful quotati onsforreport V i deo recorder P roducesth e mostcompreh ensi ve recordi ng T h e more equi pmentyouuse th e more ch ances fyouw anttouse vi deo equi pmenti ti s ofani ntervi ew. Note- tak i ng on’th ave to relyonrecordi ng equi pment annotmai ntai neye contactall th e ti me. I ntervi ew eesmayth i n th eyh ave someth i ng W i ll noth ave manyverbati mquotati onsfor i mportanttosayi fth eyseeyoutak i ng notes final report –w h i le youw ri te th eymayadd more i nformati on B ox- ti ck i ng Si mple to use. F orcesi ntervi ew eesto answ eri na certai nw ay th atyoucoverasmanytypesofansw eras E asyto compare i nformati onw i th th at possi ble. HOW TO CONDUCT INTERVIEWS / 67 X Does the recorder continue to run throughout the in- terview? Try not to draw attention to the machine, but check the battery indicator light every now and again. It is useful to take a pen and notepad with you to the in- terview, even if you intend to use a recorder. You might find it useful to jot down pertinent points to which you want to return later, or use it to remind yourself of what you haven’t yet asked. This could be be- cause the research is on a sensitive issue, or it might be that the interviewee has a fear of being recorded. Taking notes If you intend to take notes, buy yourself a shorthand no- tepad and develop a shorthand style which you’ll be able to understand later (see Chapter 10).

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As I noted in the preface order 50 mg imuran with mastercard spasms verb, the uncertainty and physical consequences of MS consumed most of my psychic energy during my years at Harvard Medical School 50 mg imuran sale muscle relaxant with painkiller. And people’s reactions to the “me” they equated with MS were equally daunting. Though the medical school made necessary aca- demic accommodations (absolving me from staying up all night on clinical rotations, fearing that excessive fatigue could exacerbate MS), hints of trouble started immediately. During a critical clerkship, the chief resident peered around corners as I sat at nurses’ stations writing notes on patients. Later I learned that the clerkship director had requested his surveillance to confirm that yes, indeed, I was “working up” patients. An attending physi- cian had complained that I was lazy and not doing my job. Over the two years of clinical rotations, such episodes recurred count- less times. I didn’t fight back—I was bewildered and overwhelmed more than angry, and my immediate goal was slogging through. Why did the elite of this caring profession persist so doggedly in marginalizing and excluding me? Medical school is physically arduous: was my exclusion justified by some Darwin- ian imperative that only the physically “fittest” should become doctors? Even if it were, I was startled by the hospital leader’s pronouncement re- counted in the preface: “There are too many doctors in the country right now for us to worry about training handicapped physicians. One potential employer, an academic researcher, asserted, “Even if you work full-time, we couldn’t give you a full-time salary. Full-time here is eighty hours per week, and I’m sure you’d only work forty hours. I could hire you because I feel sorry for you; or I could not hire you because I don’t want to deal with your disease; or I could try pretending you’re not sick and look at your qualifications. Finally an influential friend from my Harvard School of Public Health days stepped in and pulled a few strings. With his generous recommenda- tion and assurances, Boston University hired me for a research job that, over the next six years, offered many opportunities. A few weeks after I started work, a senior physician did ask me to fetch him a cup of coffee. As does everybody, people with mobility problems need an income to live, if not a career to thrive. To participate fully in their communities, they also need to enter buildings; use public restrooms; board buses, trains, and air- planes; reach pay phones and checkout counters; wander through parks; stay at hotels; attend theaters, movies, and sporting events. All aspects of American communities—from public spaces to employment policies to transportation networks—were designed primarily for walking people. This context has changed somewhat over the last three decades, as sug- gested in chapter 4. Chapter 7 focuses on two topics, both reaching outside the home: having an income to live and getting around the community. If you wanted the kids to eat, be dressed right, you didn’t have much extra money to spend. They can buy stair lifts, customize mobility aids, hire drivers, and renovate homes, for example, whereas persons with little money cannot. Progressive mobility limitations threaten incomes and careers, risking both subsistence and self-esteem. Medicare refused reim- bursement for essential home modifications and his scooter—he inherited one when somebody died. The only bargain he sees is the local public wheelchair van service, the RIDE. Gracie Brown, an older woman, has a seventh-grade education and had been a housekeeper. She had the standard, no-frills, wooden cane with a crook handle, $10 to $15 at neighborhood drug stores. Serious illnesses of one family member, especially debilitating diseases, can decimate family savings. One study found that 31 percent of families lost most or all of their savings when a family member developed a life- threatening illness; families also moved to cheaper housing, delayed edu- cation, or postponed medical care for healthier family members (Covinsky et al.

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