Efficacy Of Dynamic Splinting Health And Social Care Essay

The process has proven to both dependable and lasting. A successful entire articulatio genus replacing allows patient to restart about all activities of day-to-day populating with minimum trouble. In most instances patients no longer necessitate external AIDSs or chronic medicines. Finally entire articulatio genus replacing helps patients to keep their overall ego regard. Entire articulatio genus replacing is indicated when there is unremitting terrible hurting in the articulatio genus with or without malformation. The pain/ malformation may be due to osteoarthritis, Rheumatoid arthritis and assorted non specific arthritis. It relieves hurting, provides mobility and right malformation. Entire articulatio genus replacing is a surgical process in which injured or damaged parts of the articulatio genus articulation are replaced with unreal parts. The process is performed by seperating the musculuss and ligaments around the articulatio genus to expose the articulatio genus capsule. The articulatio genus capsule is opened, exposed the interior of the joint. The terminal of the thighbone and tibial are removed. The unreal parts are cemented into topographic point. The articulatio genus will dwell of metal shell at the terminal of the thighbone, a metal and plastic trough on the shinbone and if needed a fictile button in the cap. In a manner this could be more suitably called a Knee resurfacing operation.The common pathology for entire knee replacing is knee flexure contracture.Definition:Flexure contracture is defined as the shortening of the connective tissue thereby stiffening the joint. It is due to fastening of the posterior capsule combined with the tightening of bi ceps femoris and indirect ligaments. Hence rehabilitation plan should be undertaken shortly after TKA to keep joint scope of gesture. In peculiar this survey examined the value of dynamic splinting in increasing scope of gesture and cut downing the flexure contracture. Dynamic splinting utilizes the biomechanical version of maintaining the articulation at end-range to accomplish a physiological alteration of molecular realignment to stretch the connective tissue. This protocol of low-load, prolonged-duration stretch with dynamic tenseness continually reduces the contracture.ANATOMY OF KNEE JOINT:The articulatio genus articulation is the largest and most complex articulation in the organic structure. It is synovial modified flexible joint articulation. It is formed by merger and median tibio- femoral and patella- femoral articulation.ARTICULAR Surfaces:It is comprised the Femoral condyles: distal terminal of thighbone Tibial condyles: proximal terminal of shinbone. Patellar facetes: posterior surface of kneecap.Femoral condyles:The articular surfaces of thighbone are block shaped. The femoral condyles are convex in both planes. They are extended interiorly by the block shaped patellar surfaces. The cervix of the block is represented anteriorly by the cardinal channel on the patellar surface and posteriorly by the intercondylar notch. 111Tibial condyle:The tibial surfaces are in return curved and comprises two curved and concave analogue troughs which are separated by a blunt distinction running antero- posteriorly distinction lodges the two intercondylar tubercles.Tibio-femoral articulations:The tibial condyles correspond to the femoral condyles while the inter condylar tibial tubercles come to within the femoral intercondylar notch, these surfaces constitute functionally the tibio-femoral articulation.Femero-patellar articulations:The aspects of kneecap correspond to the patellar surface of the thighbone while the perpendicular ridge of the kneecap fits into the cardinal channel of the thighbone.LIGAMENTS OF KNEE JOINT:Medial indirect ligament:It is flattened set rhomboidal in outine. It is attached above to the median epicondyle of thighbone, below to the median border and the bordering median surface of shinbone. Function: restrain valgus rotary motionLateral indirect ligament:Function: restrain varus rotary motion and resist internal rotary motion kneeanatAnterior cruciate ligament:It is attached below to the anterior portion of the intercondylar country of shinbone between the anterior terminals of sidelong and median semilunar gristles. Above it is attached to the posterior portion of the median surface of sidelong femoral condyle. Function: To defy anterior supplanting of the shinbone on the thighbone when the articulatio genus is flexed To defy varus or valgus rotary motion of the shinbone, particularly in the absence of the collateral ligaments Resists internal rotary motion of the shinbone.Posterior cruciate ligament:It is attached below to the posterior portion of intercondylar country of shinbone, buttocks to the fond regard of posterior terminal of median semilunar gristle. Above it is attached to the anterior portion of sidelong surface of the median condyle of thighbone. Function: To let femoral push back in flexure Resist posterior interlingual rendition of the tibia relation to the thighbone Controls external rotary motion of the shinbone with increasing articulatio genus flexure. Retention of the PCL in entire articulatio genus replacing has been shown biomechanically to supply normal kinematic push back of the thighbone on the shinbone. This besides is of import for bettering the lever arm of the quadriceps mechanism with flexure of the articulatio genus.MUSCLES OF KNEE JOINT:Quadricepss femoris Popliteus Semitendinosus Semimembranous Sartorius Bicepss femoris Gastrocnemius PlantarisBURSAE AROUND THE KNEE JOINT:Anteriorly:The suprapatellar Bursa The prepatellar Bursa Superficial intrapatellar Bursa Deep infrapatellar BursaLaterally:A Bursa between sidelong indirect ligament and biceps tendon A Bursa between sidelong indirect ligament and popliteus sinew Popliteus Bursa lies between the popliteus and sidelong condyle of thighbone.Medially:The tibial inter sinewy Bursa ( pes anserine Bursa ) A Bursa between median collateral ligament and semimembranous sinew A Bursa between semimembranous sinews and shinbone.Posteriorly:A Bursa between sidelong caput of gastrocnemius and capsule. Semimembranous Bursa ( brodies bursa )NERVE SUPPLY:Femoral nervus Sciatic nervus Obturator nervusBLOOD Supply:The arterial supply to knee joint, is from the subdivisions of Popliteal arteria Femoral arteria Tibial arteriaTIBIO-FEMORAL ARTHROKINEMATICS:Viewed in the sagittal plane, the thighbone ‘s jointing surface is convex while the shinbone ‘s in concave. We can foretell arthrokinematics based on the regulations of concave shape and convexness:During Knee ExtensionDuring Knee FlexionOpen ChainClosed ChainOpen ChainClosed ChainTibia Glides Anteriorly On Femur Femur Glides Posteriorly On Tibia Tibia Glides Posteriorly On Femur Femur Glides Anteriorly On Tibia from 20o articulatio genuss flexure to full extension from full articulatio genus extension to 20o flexure Tibia rotates externally Femur rotates internally on stable shinbone Tibia rotates internally Femur rotates externally on stable shinboneTHE â€Å" SCREW-HOME † Mechanism:Rotation between the shinbone and thighbone occurs automatically between full extension ( 0o ) and 20o of articulatio genus flexure. These figures illustrate the top of the right tibial tableland as we look down on it during knee gesture. top of tibial tableland top of tibial tableland top of tibial tableland During Knee Extension, the shinbone glides anteriorly on the thighbone. During the last 20 grades of articulatio genus extension, anterior tibial semivowel persists on the shinbone ‘s median condyle because its articular surface is longer in that dimension than the sidelong condyle ‘s. Prolonged anterior semivowel on the median side produces external tibial rotary motion, the â€Å" screw-home † mechanism.THE SCREW-HOME MECHANISM REVERSES DURING KNEE FLEXIONtop of tibial tableland top of tibial tableland top of tibial tableland When the articulatio genus begins to flex from a place of full extension, posterior tibial semivowel begins foremost on the longer median condyle. Between 0 deg. extension and 20 deg. of flexure, posterior semivowel on the median side produces comparative tibial internal rotary motion, a reversal of the screw-home mechanism.Entire KNEE REPLACEMENTEntire articulatio genus replacing is indicated when there is unremitting terrible hurting in the articulatio genus with or without malformation. The pain/ malformation may e due to osteoarthritis, Rheumatoid arthritis and assorted non specific arthritis. It relieves hurting, provides mobility and right malformation. Entire articulatio genus replacing is a surgical process in which injured or damaged parts of the articulatio genus articulation are replaced with unreal parts. The process is performed by seperating the musculuss and ligaments around the articulatio genus to expose the articulatio genus capsule. The articulatio genus capsule is opened, exposed the interior of the joint. The terminal of the thighbone and tibial are removed. The unreal parts are cemented into topographic point. The articulatio genus will dwell of metal shell at the terminal of the thighbone, a metal and plastic trough on the shinbone and if needed a fictile button in the cap. In a manner this could be more suitably called a Knee resurfacing operation. Tocopherol: New FolderNAGU PROJECTimAGESTotal-Knee-Replacement.jpg The entire articulatio genus replacing can be: Unicompartmental arthroplasty: The Articular surface of thighbone and shinbone, either the medial or sidelong compartment of the articulatio genus are replaced by an implant. Eg: osteoathritis. Bicomprtmental arthroplasty: In bicompartmental arthroplasty, the articular surface of shinbone and thighbone of both median and sidelong compartments of the articulatio genus articulations are replaced by an implant. The 3rd compartment i.e.. , the patellofemoral articulation is nevertheless left intact. Tricomprtmental arthroplasty: the articular surface of the lower thighbone, upper shinbone and kneecap are replaced by prosthetic device. Most normally performed arthroplsty. The prosthetic device consists of a tibial constituent, a metal femoral constituent and a high molecular weight polythene button for articular surface of the kneecap.TKA GOALSRestore mechanical alliance [ impersonal tibiofemoral alliance = 4A °-6A ° of anatomic valgus ] , Horizontal joint line, Soft tissue balance ( ligament ) , ( Patella tracking ( Q-angle )IndicationOteoarthritis Rheumatoid arthritis Hemophilic arthritis Traumatic arthritis Sero negative arthrides Crystal deposition disease Pigmented villonoular synovitis Avascular mortification Bone dysplasias Asymmetric arthritsCONTRA INDICATIONAbsolute contraindicationsHolocene or curren joint infection Sepsis or systematic infection Neuropathic arthropathy Painful solid articulatio genus mergerRelative contraindicationsSevere osteoporosis Debilated hapless wellness Non working extensor mechanism Painless, good working arthrodesis Significant peripheral vascular diseasesTKA ComplicationsDeath: 0.53 % Periprosthetic Infection: 0.71 % Pneumonic emboli: 0.41 % Patella break: Component Relaxation: Tibial tray wear: Peroneal Nerve Palsy: 0.3 % to 2 % Periprosthetic Femur Fracture: Periprosthetic Tibial Fracture: Wound Complications / Skin gangrene: rare Patellar Clunk Syndrome: rare Patellofemoral Instability: 0.5 % -29 % DVT: Instability: Popliteal artery hurt: 0.05 % Quadricepss Tendon Rupture: 0.1 % Patellar Tendon Rupture: & lt ; 2 % Stiffness: Fat Embolism MCL ruptureNeed AND SIGNIFICANCE OF STUDY:Need of the survey:To cut down flexure contracture To better scope of gesture To better functional activitySignificance of the survey:This survey is to measure the efficaciousness of dynamic splinting for articulatio genus flexure contracture following a entire articulatio genus arthroplasty.Statement of the job:To analyze the efficaciousness of dynamic splinting for articulatio genus flexure contracture following a entire articulatio genus arthroplasty. Therefore the survey is entitled as â€Å" efficaciousness of dynamic splinting for articulatio genus flexure contracture following a entire articulatio genus arthroplasty † .Aims:To cut down flexure contracture To better scope of gesture To analyse the consequence of dynamic articulatio genus splintNull hypothesis:The void hypothesis can be stated as follows there is no important difference in articulatio genus flexure contracture after the application of dynamic knee splint.Alternate hypothesis:The hypothesis can be stated as follows there is important difference in articulatio genus flexure contracture after the application of dynamic knee splint.2. REVIEW OF LITERATURE:1. TOTAL KNEE ARTHROPLASTY:Simon H Palmer, MD, Consultant Surgeon: Sep 21, 2010 Osteoarthritis devastation of the articulatio genus is the most common ground for entire knee replacing. Jayant joshi, prakash kotwal says that entire knee replacing alleviations pain, provides mobility & A ; corrects malformation.2. FLEXION Contracture:J. Ilyas ; A.H. Deakin ; C. Brege ; and F. Picard Flexion contracture is a common malformation encountered in patients necessitating entire articulatio genus arthroplasty ( TKA ) . Department of orthopedicss, aureate jubilee national infirmary, clydebank, Glasgow, g81 4hx, United Kingdom. One hundred and four uninterrupted TKA were completed by a individual adviser utilizing the OrthoPilot ( BBraun, Aesculap ) pilotage system and Columbus implants. Seventy-four articulatio genuss had preoperative flexure contracture ( including impersonal articulatio genuss ) while 30 were in hyperextension. Ouellet D, Moffet H. Arthritis Rheum October 2002 Large motion shortages are present, particularly in single-limb support pre-op and 2 months following TKA. Huei-Ming Chai, PHD. November 24, 2008 sum articulatio genus arthroplasty bounds scope of gesture3. DYNAMIC SPLINT:Dennis cubic decimeter armstrong, m.d. Buck Willis, Ph.D. evaluates the efficaciousness of dynamic knee extension splinting for articulatio genus flexure contracture following TKA. FingerA E, WillisA FB Health Physical Education, Recreation, Texas State University, Cases Journal 2008, Physical therapy entirely did non to the full cut down the contracture and dynamic splinting was so prescribed for day-to-day low-load, prolonged-duration stretch. Finger E, Willis B 29Dec2008: Dynasplint offers extension Systems to help in rehabilitation and recovery from flexure contracture. Clinical surveies have demonstrated greatest mean decrease in rehabilitation clip and cost with the usage of Dynasplint Systems in concurrence with physical therapy. Willis FB Biomechanics.2008 Jan ; 15 After surgery, a patient is frequently left with sawed-off connective tissue and may hold a hard clip walking usually once more. Wearing a dynamic articulatio genus splint will lengthen and reconstruct the tissue to reconstruct scope of gesture. McClure P, Blackburn L, Dusold C Ideally, have oning your Dynasplint for 6-8 uninterrupted hours yields the best consequences as it allows a safe, long enduring remodeling of the soft tissue. Cliffordr.Wheeless, Iii, Md.December3, 2008. The intent of this study is to reexamine the usage of external fixator for the gradual rectification of terrible articulatio genus flexure contractures that bound patient map. James f. Mooney three, mendelevium, l. Andrew koman Posted: 05/01/2001 Average preoperative flexure contracture was 80.5A ° . Each patient achieved full extension. There was one return, despite brace, which was managed with replacing of the fixator and soft tissue processs4. CONVENTIONAL PHYSICAL THERAPY FOR KNEE ARTHRITIS:Jan.K.Richardson, Pt, Phd, Ocs Said that arthritis is a degenerative disease of the gristle and castanetss that consequences in hurting and stiffness in affected articulation. There is no remedy for arthritis, but physical therapy can do life easier and less painful. Brigham And Women ‘s Hospital Department of Rehabilitation Services Physical Therapy.ROM along with proper soft tissue balance is required to guarantee proper biomechanics in the articulatio genus articulation. Aggressive post-operative PT has been shown to be effectual in bettering patient results and shortening length of stay Balint G And Sz Ebenyl.B Showed that curative exercisings decreases hurting, increases musculus weariness and scope of gesture every bit good as improve endurance and aerophilic capacity. Weight decrease is proven in corpulent patients with OA of articulatio genus. Curative heat and cold, galvanism, stylostixis are widely used. Dr. Margriet new wave baar reported that important good effects from exercising therapy including betterments in ego reported hurting, disablement, walking ability and overall sense of good being. Dorr LD.A J Arthroplasty June 2002 CPM helps accomplish articulatio genus scope of gesture quicker in first post-op hebdomads but at concluding followups, no difference in concluding scope of gesture Byrne, et al.A Clin Biomech October 2002 Deficits in articulatio genus strength balanced by increased hip extensor work ; rehab should optimise bilateral hip and articulatio genus map after TKA McManus et al 2006, Jorge et al 2006 the higher frequences ( 90-130Hz ) to excite the hurting gate mechanisms & A ; thereby dissemble the hurting symptoms. Ozcan et Al, 2004 Low frequence nervus stimulation is physiologically effectual ( as with TENS and NMES ) and this is the key to IFT intercession. Adedoyin, R. A. , et Al. ( 2002 ) .IFT acts chiefly on the excitable ( nervus ) tissues, the strongest effects are likely to be those which are a direct consequence of such stimulation ( i.e. hurting alleviation and musculus stimulation ) . National Taiwan University Hospital, November 2008 PNF stretching techniques has been used often for patients with entire articulatio genus arthroplasty in clinical pattern to increase scope of gesture efficaciously and decreased articulatio genus hurting during exercising. Huei-Ming Chai, PHD November 24, 2008 PNF stretching technique is a curative technique utilizing the PNF construct to the related muslces either to increase neuro-inhibition mechanism for let go ofing musculus cramp and stretching musculus length, or to increase neuro-excitation mechanism for heightening musculus strength Harold B. James H. Beaty, MD Range-of-motion exercisings, musculus strengthening, pace preparation, and direction in executing activities of day-to-day life are of import.5. GONIOMETRIC MEASURENT FOR ROM:Carlos Lavernia, MD, Range of gesture appraisal through direct observation without a goniometer provides inaccurate findings. Mark D. Rossi, PhD, PT, CSCS The Journal of Arthroplasty Vol. 23 No. 6 Suppl. 1 2008 Measured tonss utilizing a goniometer provided an improved grade of truth, but consequences appear to be dependent on the clinician executing the measuring. Richard l. Gajdosik Associate Professor Physical healers may accept most knee goniometric measurings as clinically valid, and the grounds indicates that most of these measurings are dependable.6. KNEE SOCIETY SCORE:Gil Scuderi, MD-Chair ; Jim Benjamin, MD ; Jess Lonner, MD ; Bob Bourne, MD and Norm Scott, MD, 2007, The Knee Society evaluation system ( KSS ) was foremost published in CORR in 1989 and has become the standard clinical rating system for describing consequences for patients undergoing Entire Knee Replacement. John N. Insall, MD, Lawrence D. Dorr, Scott, MD Rationale of the Knee Society clinical evaluation system. Clin Orthop Relat Res. 1989 Nov: The Knee Society has proposed this new evaluation system to be simple but more fastidious and more nonsubjective. MD, Richard D. Scott, MD, and W. Norman It is hoped the articulatio genus society evaluation system will go universally recognized and will be adopted by all writers, even if they wish to describe consequences utilizing a customary marking method every bit good.3. MATERIALS AND METHODOLOGY:Materials:Evaluation tool:Goniometry Knee society markOutcome step:Scope of gesture Knee mark Function markMaterial used:Dynamic articulatio genus splintMethodology:( A ) Study design:30 topics with flexure contracture following one-sided TKA assigned in two groups.GROUP A:15 topics: Dynamic Splint Along With Conventional Physiotherapy.GROUP B:15 topics: Conventional Physiotherapy.( B ) Study scene:This survey was carried out in the section of physical medical specialty and rehabilitation, Sri Ramakrishna infirmary, Coimbatore.( C ) Study continuance:This survey was carried out for a period of 6 months.( D ) Sampling:Random sampling.INCLUSION CRITERIA:Age: 45 to 70 old ages. Both sex Flexure contracture: 20 – 12 deg ( post operatively ) Unilateral TKA Reduced flexibleness in AROM of articulatio genus extension Pain that is worsened by flexing over while legs are consecutive Impaired pace form Ability to understand informed consent and experiment dutiesExclusion Standards:Fractures Bilateral TKA TKA & lt ; 2 months Knee sepsis Osteomyelitis or any orthopaedic infection Extensor mechanism disfunction Psoriasis Knee articulation neuropathy Previous Stroke or Brain InjurySTATISTICS Tool:The information collected was analyzed utilizing independent t-test. The trial was carried out between two groups. Independent't ‘ trial was used to compare the effectivity of intervention between the groups. T = S = X1 = Difference between pretest and posttest values of Group I X2 = Difference between pretest and posttest values of Group II = Mean difference of Group I = Mean difference of Group II n1 = No. of samples in Group I n2 = No. of samples in Group II S = Combined criterion divergenceTreatment:Dynamic articulatio genus Extension splint:The Rebound Effecthypertext transfer protocol: //www.dynasplint.com/uploads/user-uploads/rebound2.gif53 % Average Reduction in Time and Cost Associated with ROM Rehabilitationâ€Å" High-force, short-duration stretching favours recoverable, elastic tissue distortion, whereas low-force, long-duration stretching enhances lasting fictile distortion. In the clinical scene, high force application has a greater hazard of doing hurting and perchance ruptures of tissue. Dynasplint Systems improve scope of gesture by making lasting, non-traumatic tissue elongation and remodeling, therefore virtually extinguishing the scope of gesture recoil consequence frequently observed in the clinical scene. RangerKnee2Features & A ; BenefitsLLPS ( Low-Load, Prolonged-Duration Stretch ) engineering has been proven to successfully handle joint stiffness and limited scope of gesture. Early application can cut down clip and cost associated with scope of gesture rehabilitation Simple, adjustable and consistent bilateral tensioning System Available for rent or purchase Biomechanically right Comfortable to have on Each Dynasplint System is recycled to cut down waste and assist the environment A Dynasplint Systems adviser will suit your patients and oversee their intervention to guarantee the best possible consequences Over a one-fourth of a million patients have been successfully treated with Dynasplint Systems Handily labeled and easy to utilizePatient Wearing ProtocolPlease reexamine the tenseness your Dynasplint adviser set for you ab initio. In the beginning, the splint should be worn for 2-4 hours. Do non increase the tenseness until you can digest nightlong wear. Time is the most of import factor and your first end should be 6-8 hours of hurting free wear. After accomplishing this clip end, when you take the splint off if you have less than 1 hr of post-wear stiffness, bend tenseness up by one on both sides. However if you are unable to have on the splint for a drawn-out period of clip, diminish the tenseness by a half to one full bend. During the procedure of recovering your scope of gesture, if you have any inquiry or concerns reach your Dynasplint adviser. hypertext transfer protocol: //www.wheelessonline.com/images/i1/imk11.jpgConventional Treatment:MODALITIES FOR PAIN CONTROL, EDEMA REDUCTION:Moist Heat Functional electrical stimulation Transdermal electrical stimulation Ice therapy Interferential therapy Voltaic StimulationJoint Mobilization:Flexion limitationPosition: patient seated Posterior semivowel of shinbone on femur-grade 3 Oscillation with 30 2nd clasp, Repeated 5 times with patellar mobilisation of inferior semivowels ( 5 mins )Extension limitationPosition: patient prone with kneecap off of tabular array Anterior semivowel of shinbone on femur- class 3 oscillation and inactive clasp ( 10 secs in 3 repeats ) with patellar mobilisation superior semivowels ( 5 mins )EXERCISE Plan:Closed and unfastened kinetic concatenation strengthening exercisings Proprioceptive/balance exercisings aiming the bole and lower appendage muscular structure Partial organic structure weighted knee bends Gait preparation Scope of gesture exercisings Heel slide ( supine & A ; sitting ) Stretching ( prone/supine ) to increase articulatio genus extension ROMGAIT Training:Forward Walking Hedging Backward or Retro-WalkingFunctional Training:Standing Transportation Activities Raising Transporting Pushing or Pulling Squating or Crouching Return-to-Work UndertakingsENDURANCE Training:Upper organic structure exercising. Ambulation activities One-leg cycling, utilizing non-operative leg with opposition to gesture.BALANCE/PROPRIOCEPTION Training:Tandem Walking Lateral Stepping over/around objects Weight-Shifting Activities Closed Kinetic Chain Activities5. DATA ANALYSIS AND INTERPRETATION:KNEE EXTENSION ROM: Group IPre trial( Two months after TKA )Post trial( conventional PT with SPLINT )DifferenceX116 0 16 16 1 15 16 2 14 16 2 14 16 4 12 14 0 14 14 0 14 14 1 13 14 1 13 14 2 12 12 0 12 12 0 12 12 1 11 12 1 11 12 1 11Mean=12.93PRE TEST AND POST KNEE EXTENSION ROM: Group IKNEE EXTENSION ROM: GROUP IIPre trial( Two months after TKA )Post trial( conventional PT without splint )DifferenceX218 7 11 18 6 12 18 6 12 18 6 12 18 4 14 16 7 9 16 7 9 16 4 12 16 4 12 16 4 12 14 3 11 14 4 10 14 4 12 14 2 12 14 2 12Mean=11.46t=2.82s.dev=1.42grades of freedom = 28The chance of this consequence, presuming the void hypothesis, is 0.009PRE TEST AND POST KNEE EXTENSION ROM: GROUP IIKNEE SCORE AND FUNCTION SCORE:S.No.ParametersGroupsMeanS.D.Value‘t ‘ Value1. Knee Tonss Group A 18 4.47 3.06 Group B 13 2. Function Mark Group A 35.6 4.98 3.01 Group B 30.1MEAN DIFFERENCE BETWEENKNEE SCORE AND FUNCTION SCOREDEMOGRAPHIC DATATHE AGE OF THE SAMPLES BETWEEN 45 -70 YEARS IN EACH GROUPAge ( old ages )No. of SamplesEntireGroup AGroup B45-50 4 3 7 50-55 5 4 9 55-60 2 5 7 60-65 2 2 4 65-70 2 1 3Entire NUMBER OF MALES AND FEMALES IN EACH GROUPSexual activityNo. of SamplesEntireGroup AGroup BMale 8 10 18 Females 7 5 12Entire NUMBER OF RIGHT AND LEFT SIDE INVOLVEMENT IN EACH GROUPSide of engagementNo. of SamplesEntireGroup AGroup BRight 11 8 19 Left 4 7 115. DiscussionEntire articulatio genus arthroplasty ( TKA ) is considered the intervention of pick for patients with intractable hurting and significant functional disablements who have non had acceptable alleviation and functional betterment after conservative intervention. Knee flexure contracture is a common pathology following TKA impacting up to 61 % of these patients. The intent of the survey is to find the effectivity of dynamic splinting in handling patients with flexion contracture following Unilateral TKA. Literature reexamine provinces that there is important difference between dynamic splinting and conventional physical therapy direction in cut downing flexure contracture following Unilateral TKA. A sum of 30 patients with one-sided TKA were selected under inclusive standards and were indiscriminately allocated into an experimental group and control group as Group A and group B severally. In each group 15 Persons were allotted In Group A, dynamic splint along with conventional physical therapy was given and in Group B, Conventional physical therapy entirely was given. Both Groups were treated for a period of 6 months and the pre trial and station trial values are taken on the 1st ( 2 months after TKA ) and at the terminal of 6th months. In between Follow up appraisals were done at regular interval of every two hebdomads to judge the forecast. Statistical analysis performed between the Group A and Group B and the consequences showed the undermentioned result. The scope of gesture and functional betterment among the patients following the intercession was evaluated by Goniometry and knee society mark severally.ParameterGroupsMeanâ€Å" T † Valueâ€Å" Phosphorus † ValueScope of gestureA 12.9 2.82 0.009 Bacillus 11.5Knee markA 18 3.06 0.005 Bacillus 13Function markA 35.6 3.01 0.005 Bacillus 30.1 With goniometric measuring the scope of gesture showed a important betterment of about12.9 and 11.5 for Group A and Group B severally. â€Å" T † value for the independent T trial calculated between the Group is 2.82 which is important at the degree of 0.009 degree at 28 grades of freedom. With knee society mark measurement the articulatio genus mark showed a important betterment of about18 and 13 for Group A and Group B severally. â€Å" T † value for the independent T trial calculated between the Group is 3.06 which is important at the degree of 0.005 degree at 28 grades of freedom. With knee society mark measurement the map mark showed a important betterment of about35.6 and 30.1 for Group A and Group B severally. â€Å" T † value for the independent T trial calculated between the Group is 3.01 which is important at the degree of 0.005 degree at 28 grades of freedom.6. DecisionFrom statistical analysis it is clear that there was a average decrease in flexure contracture of about 12.9 of Group A when compared to 11.5 with that of Group B. The calculated't ‘ value was 2.82 which is greater than the table value at 28 grades of freedom With knee society score it was apparent that the Group A ( articulatio genus mark and map mark ) showed a important average betterment of about 18 and 35.6 when compared to 13 and 30.1 with Group B ( knee mark and map mark ) severally. The calculated't ‘ value was 3.06 which is greater than the table value at 28 grades of freedom. Hence it is cleared that dynamic splinting reduces flexure contracture from 20-12deg ( two month after TKA ) to 5-0 deg ( after the application of dynamic splint ) So the statistical analysis infers us to reject void hypothesis and at that place by accepting the alternate hypothesis i.e. there is important difference in articulatio genus flexure contracture after the application of dynamic knee splint. Hence it is suggested that supplying a dynamic splint is effectual in cut downing flexure contracture and bettering functional position in intervention of articulatio genus flexure contracture following one-sided TKA.LIMITATION OF STUDYSample size is smaller. It is a clip edge survey. The survey was carried on with few nonsubjective parametric quantities in entering the efficaciousness of intervention. The survey concentrated merely on one-sided TKASuggestionThe survey could hold been done with long term follow up and more figure of patients, to analyse the result. The survey could hold employed some more parametric quantities to measure the clinical result more accurately and exactly Further surveies can be done, to analyse the effects of dynamic splint in bilateral TKA. Further surveies can be done, to compare the effects of dynamic splint in one-sided and bilateral TKA.Bibliography1. David J. Magee, Orthopedic Physical Assessment, Second edition, W.B. Saunders company London 1992. 2. Kothari C.R ; Research methodological analysis methods and techniques, wiswaprakasan. 3. Robert Dontelli ; orthopedic P.T 4. Bent And Brotzmen ; Orthopaedic Rehabilitation. 5. Carolyn Kisner & A ; Lynn Allen Colby ; Therapeutic Exercises Foundation & A ; Techniques, New Delhi, Jaypee Brothers 1996, Third edition. 6. Carrie M.Hall, Therapeutic Exercise traveling towards map, Walters kluwer company. 7. Jayant Joshi, Essentials of orthopaedicss & A ; applied physical therapy, New Delhi B.I. Churchill Livingstone pvt Ltd 1993. 8. T.S. Ranganathan, A Text book of Human Anatomy, New Delhi, S Chand & A ; company, 1990 Fourth Edition 9. B.D Chaurasia, Human Anatomy Third edition, CBS Publishers New Delhi. 10. Carolyn M. Hicks & A ; Research for Physiotherapist, Project design analysis, Second add-on, Churchill populating rock, New York, Tokyo. 11. Cynthia C. Norkin Pamela K. Levangies joint construction & A ; Function, Third edition. 12. Graies anatomy: erectile dysfunction 13, 1899 13. J.Maheshwari, MS ortho: essestial orthopedicss. 14. Jagmohan singh: text book of electrotherapy 3rd edition 2005 15. Ann Thomson et Al: tidy ‘s physical therapy, London, butterworth, heinman, 191 12th edition 16. Patricia A. Downie, hard currency text edition of orthopedicss & A ; Rheumatology for physical therapist, jaypee brothers, 1993: 1st edition. 17. Mayilvahanan Natarajan: text book of orthopedicss & A ; tramatology 4th edition. 18. Susan B.O.sullaivan, physical rehabilitation appraisal & A ; intervention, 4th edition jaypee brothers, new Delhi 2001 19. Joan M. Walker, Antonie helewa, physical therapy in arthritis, A division of hartcourt brace & A ; company.APPENDICIESAppendix: 1Basic rating chartPOST OPERATIVE ASSESSMENT FOR TOTAL KNEE REPLACEMENTSubjective AppraisalName: Age: Sexual activity: M/F Occupation: Address: Date of Admission: Referred by: Date of surgery: Side operated: Right / Left Height ; Weight: IP/OP figure: Chief ailments:Critical marksTemperature ( Beat/Min ) Pulse rate ( F ) Respiratory Rate ( mm/Hg ) : Blood Pressure ( Breaths/min )Pain appraisalSide of hurting Site of hurting Type of hurting Nature of hurting Duration of hurting Intensity Worsening factors Reliving factors Rating of hurting by ocular / parallel graduated tableNo hurtingSlight hurtingModerate hurtingSevere hurting0 1 2 3 4 5 6 7 8 9 10Medical HistoryI ) Past Medical History – Any old disease or hurt two ) Present Medical History Onset Duration Intensity Worsening factors Activities of day-to-day life three ) Personal History – Smoker or intoxicant four ) History of occupation V ) Surgical history Name of sawbonesOn PalpationInflammatory marks: Warmth and Tenderness Crackle Muscles spasm Oedema: Piting / Non PitingOn ExaminationMusculo skeletalJoint ROMJointMotionActivePassivePain freePain fullPain freePain fullHip Flexure Extension Abduction Adduction External rotary motion Internal rotary motion Knee Flexure Extension Medical rotary motion Lateral rotary motion Ankle Dorsiflexion Plantarflexion Inversion Eversion Muscle power Muscle blowing – quadriceps Deep sinew Reflexes Deformites Limb length measuringsGait AssessmentType of pace Measure length Stride length Base breadth Cadance External contraptions ( Splints or orthosis ) Type of walking AIDSsRespiratory AssessmentType of respiration ( Thoraco Abdomen, Abdomino – thoracic ) Pattern of respiration ( Asymmetry or Symmetry ) Depth of respiration ( shallow or deep ) Accessory musculuss of respiration Chest enlargement aˆ? Axilla aˆ? Nipple aˆ? XiphisternumFunctional AppraisalProblem listManagementShort term directionPurposesLong-run direction Short term managemMeanssLong-run directionAPPENDIX 2:DYNASPLINT SYSTEM, RANGE OF MOTION AND COMMON DIAGNOSESFOR ORTHOPAEDICAL CONDITIONS:1. Knee extension dynasplint system ( ked )ROM=65 ° flexure to 25 ° hyperextension2. Knee flexure dynasplint system ( kfd ) :ROM=50 ° flexure to 140 ° flexure Common DIAGNOSES: ( extension & A ; flexure ) Entire articulatio genus replacings, Tibial tableland breaks, Tendon and ligament fixs ( ACL, PCL ) , Open decrease internal arrested development ( ORIF ) , Burns, Meniscectomy, Tendon releasesFOR NEUROLOGICAL CONDITIONS:1. Knee extension neurological dynasplint system ( ken ) :ROM=130 ° flexure to 40 ° flexure2. Double-jointed articulatio genus extension dynasplint system ( ked-dj ) :ROM=130 ° flexure to 50 ° hyperextensionCommon DIAGNOSES:Head injury and spinal cord hurts, Cerebral paralysis ( CP ) , intellectual vascular accident ( CVA ) , and other neurological conditions.FOR AMPUTEE:1. Knee amputee extension dynasplint system ( bka-ed ) :ROM=65 ° flexure to 25 ° hyperextensionCommon DIAGNOSES:Distal limb remotionAppendix: 3:GONIOMETRY OF THE KNEEGestureRecommended Testing PositionStabilizationCenterProximal ArmDistal ArmStartEndFlexureSupine, articulatio genus in ext. Initially hip in 00 ext, abd, add, but as articulatio genus flexes, hip besides flexes Stabilize thighbone to forestall rotary motion, abduction & A ; adduction Over sidelong epicondyle of thighbone Lateral midplane of thighbone, citing greater trochanter Lateral midplane of calf bone, mention sidelong malleolus & A ; fibular caput hypertext transfer protocol: //at.uwa.edu/gon/KnExt.jpg hypertext transfer protocol: //at.uwa.edu/gon/KnFlex.jpgExtensionSupine, articulatio genus in ext. Hip in 00 ext, abd, attention deficit disorder. Stabilize thighbone to forestall rotary motion, abduction & A ; adduction Over sidelong epicondyle of thighbone Lateral midplane of thighbone, citing greater trochanter Lateral midplane of calf bone, mention sidelong malleolus & A ; fibular caput hypertext transfer protocol: //at.uwa.edu/gon/KnExt.jpg hypertext transfer protocol: //at.uwa.edu/gon/KnExt.jpg

College Expectation Essay

I felt scared about moving to college, university or away from home for the first time. From a small community in the province to a city with a population of less than 2 million, everything changed. I came to college and had no idea what to expect. When I entered the school I have chosen, it seemed like I was in a new world with people I do not know. I walked around the campus and felt like I was this lost little freshman. FEU was not my 1st choice actually. I just had no choice. But my â€Å"tito† said, â€Å"it is not which school that matters, it is in you if you will study hard enough to reach your goals in life. † He was right, so I need to love the school I am destined to study at. College life is completely different from high school. I expected it to be harder. Well, my expectation was right. Everything is harder. My first semester here at college, I can say was a wake-up call. I had to learn to be very independent. I have never known what it was like to be that independent before. I have learned that I am capable of a lot of things that I never thought I was back then. My expectations for attending college: To get a good education that will help me to get my dream job. To learn to be independent and to live on my own. To meet new people. To be able to take care of myself.

Collegative properties Essay

A detailed explanation, one paragraph or more in your own words, of the colligative property being discussed and why that property changes the way that it does when the amount of solute is increased. A detailed description, at least one paragraph, of a real-world application of the colligative property, including an explanation of how this application of the colligative property is important or useful to those affected. The real-world example must be one that was not mentioned in the lesson. An introduction and conclusion that is appropriate for the audience and for the content of the article. At least three resources (web sites, articles, etc.) that you used to write the article. Colligative properties can be confusing, but all you really need to remember is that the more solute in a solution the lower the boiling point. The more solute in a solution, the higher the boiling point. A colligative property of a solution or solvent varies depending on the amount of solute particles in it, though it doesn’t matter the kind of solute. The more solute the more colligative property of the solvent. Also, its boiling point changes. The more solute, the higher the boiling point. Less solute causes a lower boiling point. Antifreeze lowers the freezing point of an H2o based solution.Antifreeze is commonly used for airplane wings, cooling systems, and defrosting things. Antifreeze can be used to achieve high boiling points and also lower boiling points. Antifreeze keeps things from boiling and freezing all at once. It keeps things around atmospheric temperature. The amount of solute decreases the boiling point. The pressure keeps the atmospheric temperature lower than the pressure with the solute. Antifreeze used in heating and cooling systems is a solution of water and ethylene glycol has a lower freezing point than pure water or pure ethylene glycol. Antifreeze is a good example of the colligative property, except its special because it keeps from boiling or freezing. Read more: http://www.chemistryexplained.com/Ce-Co/Colligative-Properties.html#ixzz2gOJ05F9U http://en.wikipedia.org/wiki/Antifreeze#Measuring_the_freeze_point http://library.thinkquest.org/C006669/data/Chem/colligative/antifreeze.html http://www.chemistryexplained.com/Ce-Co/Colligative-Properties.html

The family experiencing leukemia and a financial crisis Assignment

The family experiencing leukemia and a financial crisis - Assignment Example Furthermore, she is increasingly under stress of having to balance her role at work and acting as a caregiver for Peter in the hospital (Friedman, Bowden, & Jones, 2002). In addition, Maria is in a psychological and emotional dilemma on how to deal with her 8 year old daughter. Maria’s work and caregiver attention to Peter do not let her have enough time for dealing with her daughter’s emotional stress. Katy, the 8 year old child, is facing an emotional difficulty in coping with her brother’s diagnosis. Accordingly, she is affected by the lack of parental attention and thus acts out in anger both at school and at home. Furthermore, her disability in coping is exhibited by her reluctance to visit her brother in hospital (Pedia, 2012). Foremost, as a solution for Maria’s emotional coping stress, a referral to a support group is necessary. Consequently, she will be able to receive professional emotional support and coping mechanisms pertaining to the stressors resulting from caregiver role and taking care of her sick son (Friedman, Bowden, & Jones, 2002). In addition, Maria equally needs to seek social support from her church. This can be through church members who rotationally volunteer to assist her in household chores such as grocery or taking care of Katy whenever she is at work or at the hospital with Peter. In essence, Maria should be advised to seek the professional help from social workers that can assist her with a homemaker. The main purpose is to obtain a homemaker that can assist her with household chores while she is at work and consequently lower her caregiver stressors. Moreover, Maria needs to be furnished with a list of animal shelters that assist families in financial need by providing free food for their pets (Pedia, 2012). Both parents of Katy need to be advised by family psychiatrist on the need to devote some parental attention time for Katy. Furthermore, in providing parental attention to Katy they need to reassure

Summary Essay Example | Topics and Well Written Essays - 250 words - 100

Summary - Essay Example As a point of departure, the purpose of this research is to test for both first and second level intermedia agenda-setting interrelationships among news media. The content analysis methodology is used in this article. Hypothetical analysis on the public response and interrelationship between salience issues of in the Obama Campaign ads and the salience of issues in Obama in 30 seconds ads were created (Ragas & Kiousis, November 01, 2010). Several other hypotheses that relate salience of issues in MoveOn.org ads wit salience of issues in Obama campaigns ads were also created. In the essence, the methodology is hypothetical. This implies the hypothesis is tested based on the primary data used in this article. Random sampling was used to select the subsamples of the ads. For instance, second trainer examined 20% of the subsample of ads. On the same regard, the primary data collected and the samples selected were analyzed by the use of Spearman’s rho correlation. The statistical tests were used to compare the agendas that regarded the issues and the attributed salience (Ragas & Kiousis, November 01, 2010). The study remains one of the first analyses to analyze the communication efforts of web-based political activist group during the initial stages of an election contest in a close range. In addition, the study associates the efforts to the schedules of activists and a candidate’s campaign. It can be concluded that, the article consists of the original research findings because primary data is used in the hypothetical analysis (Ragas & Kiousis, November 01,

Annotated Bibliography Example | Topics and Well Written Essays - 1000 words - 1

Annotated Bibliography Example Teams become effective and productive, whenever working on a similar task, since such groups can leverage off one another’s strong point and compensate weaknesses of other colleagues. Project team leadership explains individual roles. Leadership gets dispersed among the members of the team. Team leader leads members to lead themselves. Leaders can generate thought patterns, which are motivating and positive. Project team leadership embraces personal goal setting through self evaluation and observation. Goals can be attained through enhancing illuminating roles among team members. The book, Field Guide to Project Management has the importance of measuring and monitoring individual and team performance (Cleland, 2004, p. 398). Project team leadership should develop motivation using extrinsic and intrinsic rewards. Developing skills among team members requires team training and coaching. Global project management entails a framework which tackles the combined challenges in the virtual and distributed projects internationally. Global project management includes leading by exception. The book, Field Guide to Project Management, find many leaders or managers in different time zones, and locations to have detrimental meetings to initiate activities. It is recommendable to plan a vast project management tool for tracking that gives accurate information, right metrics, and maintains the status of the work efforts of everyone appraised. Create team synergies through strategic gatherings (Cleland, 2004, p. 12). A social on line application can be made to allow the team members recognize one another. Respect the numerous cultures, activities and holidays the team members take part in without allowing work boundaries sorting the home. Virtual project team gives a virtual growth of assets. Virtual project team requires core elements. Leadership provided should be robust and

Yakuza criminal organization Essay Example | Topics and Well Written Essays - 2000 words

Yakuza criminal organization - Essay Example The Yakuza is the name of the most famous criminal organization from Japan. However, the Yakuza is not a single homogeneous organization: it comprises several hundred of clans or gangs that operate in different cities. The Yakuza is involved - in some or other form - in many aspects of life in Japan and has certain interests in virtually every area of commercial activities. The Yakuza's sphere of influence is huge spreading from prostitution rackets to the government and top level businesses. At present, the Yakuza is considered to be one of the largest and most powerful criminal organizations in the world. Thus, the number of known yakuza members only in Japan is almost 85 thousand (Bruno 2007).The origins of Yakuza can be traced back to the Tokugawa shogunate. Tokugawa's unification of Japan in the beginning of the 17th century brought peace to the country, but also produced approximately half a million of samurai unemployed and with practically no employment opportunities. Althoug h many of these samurai turned merchants this option was acceptable and available to only few of them: the rest had not other choice but to search for other means to earn their living. Thievery and other illegal activities became an option for many samurai to support themselves (Seymour 1996).However, the precise origin of the organization is still debated: the diverse gangs that constitute the Yakuza have different origins. Furthermore, the versions of origin adopted by members of each gang often differ substantially from the actual origins traced through the historical records. Therefore, the most popular version is that the Yakuza developed from several different elements that characterized the Japanese society of Tokugawa period (Kaplan and Dubro 1986). Although the Yakuza claim that they originated from the Japanese versions of Robin Hood whose main function was to protect communities and restore social justice this standpoint is reasonably questioned by many. Thus, some resear chers trace origins of the Yakuza to the so-called kabukimono (crazy ones): the group of samurai who adopted unusual hair styles, dressed in a strange manner, spoke in highly specific slang, had long swords and harassed ordinary people: "Some feel that its members are descendents of the 17th-century kabuki-mono (crazy ones), outlandish samurai who reveled in outlandish clothing and hair styles, spoke in elaborate slang, and carried unusually long swords in their belts. The kabuki-mono were also known as hatamoto-yakko (servants of the shogun)" (Bruno 2007, p. 1). The adventures of kabukimono are still a popular theme in Japanese folklore literature. At the same time, the claims of some groups of the Yakuza to have their beginnings from the communal police or machi yakko (servants of the town) that protected the community are justified. These groups of police had different types of organization and consisted of various members of the community. Some groups also included several samurais: only samurai had the right to carry swords while the rest of population was officially prohibited to do so (Kaplan and Dubro 1986). The origins of the most well-known groups of the Yakuza, namely tekiya (peddlers) and bakuto (gamblers) have better traceability due to the specific initiation ceremony that involves rituals that directly relate to the initial spheres of interest of these groups. Tekiya began to create organizations to take over at least some administrative functions and duties relating to commerce and especially to protection of their business. Thus, during trade fairs and festivals each peddler paid certain amount to run his business safely under protection of their own security forces. These forces were eventually recognized by the Edo government, and their leaders called oyabuns (top chiefs) were granted the right to carry a sword like samurai and nobleman (Hill 2003). Bakuto (gamblers) also represented a low caste (even lower than tekiya) of the Japanese soci

Enterprise Car Rental Essay Example | Topics and Well Written Essays - 3000 words

Enterprise Car Rental - Essay Example According to the paper, the company built the largest car rental brand in North America. The brand is widely known for low rates that are exceptionally as well as outstanding customer service. The brand has effective product and service offering methodologies in relation to marketing. Regarding the company’s management it has successfully showed tremendous leadership that has enhanced its operations worldwide. Motivation among employees in the company has been achieved thus promoting entrepreneurial spirit among them thus enhancing and encouraging high productivity. Enterprise Car Rental has established a consumer oriented strategy in relation to marketing that is of great importance to success. The company though has been opposed by stiff competitions from its main competitors. Enterprise not only sells services, it also brings an experience that is real in the market industry. A market Development Strategy has been followed by the company rigorously since it has put great ef fort to an existing product(car-rentals) regarding the new market. Earning of profits that are high in the market that is untapped has been enhanced by the effective strategy. A rapid growth has been depicted in the Enterprise recently. The opportunities in relation to particular segments of market are now realized by competitors. Therefore, they are putting great effort to enormously build up their strengths in those realized branches. New entrants have posed a significant competition in the same segment of market. Therefore, Enterprise is gradually becoming saturated in its Market Development Strategy thus becoming obsolete. There will be no development room in the market soon because of the stiff competition that is slowly lowering demand from its consumers. For the Enterprise to regain its stability in the market context, they should switch over to a more advanced Market Penetration strategy to attempt.  

DIS7 Essay Example | Topics and Well Written Essays - 500 words

DIS7 - Essay Example However, the state and local pension experts oppose GASB’s requirements; since the inclusion of pension liability in the balance sheet will mean its being treated as a long-term financial obligation, like bonds and claims (GASB, 2010). This is detrimental to the accounting procedures, since the pension accounted for in the balance sheet is the amount payable and paid every year. The Statement No. 60 changed reporting requirements for joint ventures and related organizations by requiring that both parties in the joint venture or other such arrangements should report their portion of revenues received, as opposed to an earlier practice where the revenue of such ventures were reported jointly under single financial statements (GASB, 2010). The statement also requires such ventures to disclose their arrangements, including the assets, rights, guarantees, liabilities and commitments. The statement sought to improve the accounting practices by improving disclosures, while at the same time creating similarity and comparability between the financial statements of the non-governmental and governmental entities (GASB, 2010). However, the statement complicates the financial reporting for joint ventures and other such organizations, and should be improved through retaining the requirements for disclosure, but eliminating separate financial reporting requirement for the parties involved jointly. .LIFO should not be a valid inventory valuation method under IFRS, because it may not give the exact stock valuation. On the event of rising stock prices, LIFO results to the understatement of the value of closing stock. This, on the other hand, raises the valuation of the costs of goods sold; resulting to a reduction in the reported profits (Bloom & Cenker, 2009). Therefore, the consequences of US companies to using LIFO, if they move to IFRS, is that the profits earned will always be

Latin America Essay Example | Topics and Well Written Essays - 500 words - 3

Latin America - Essay Example Indigenous culture of the South Americans originates from the Incan empire. This empire was established in the year 1438 in the city of Andean for a period of 100 years. Communication was made easier in this region through the building of an expansive network of roads. The Incas built ports, signal towers and food storage facilities along this highway. This allowed the Incas to dominate the western part of the continent. Cultural landscape of South America changed immediately after the importation of African slaves. Most of the African slaves were brought to Brazil. This led to the integration of the African culture to that of indigenous Indian beliefs. Other historical cultures developed with both physical and cultural landscape (Keen & Haynes, 2012). Cowboy culture developed in pampas in the mid 18th century where they hunted herds’ of horses and cattle that roamed freely in the land (Un-Habitat, 2012). The rich history of South America is explored by contemporary cultures. Many organizations are trying to bring audience globally in order to spread social and political messages that will generate revenue from tourism and investment. The aim of these organizations is to ensure sustainable development in South America. Currently they are working on issues like environmental legislation, leadership training and cultural representation. Religious practices remain the stronghold of many South American cultures. Catholicism has dominated the entire continent while other spiritual beliefs dominate the secular activities. Carnival of Reo De Janeiro is an important secular practice that is celebrated 40 days before Easter. This is an important event in the catholic calendar and one of the largest revenue-generating events in Reo (Keen & Haynes, 2012). The Rio carnival is an important event in South America because it attracts many Brazilians and foreigners. During this time, the hotel

Feminism and Homosexuality in Theater Essay Example for Free

Feminism and Homosexuality in Theater Essay Feminism in theater has a very close relationship with the depiction of homosexuality onstage. Playwrights and performance artists who advocate feminism have seen theater as a powerful tool to make the public understand their views. The work of artists such as Lillian Hellman, Holly Hughes, and Anna Deavere Smith shape the discussion of feminism and homosexuality in the theater. Lillian Hellman was a playwright who’s known for plays that discussed the psychological and social manifestations of evil. Her work was revolutionary because she created strong female characters at a time when men ruled American theater. On the subject of homosexuality, Hellman’s most relevant work was â€Å"The Children’s Hour† (Champion and Nelson 156). While â€Å"The Children’s Hour† sends a powerful message on the topic of homosexuality, Hellman herself wasn’t a homosexual and her work may have reflected her attitude toward the subject. Hellman described the play to a reporter as â€Å"not really a play about lesbianism, but a lie (Griffin and Thorsten 27). † According to Hellman, the bigger the lie, the better it gets. â€Å"The Children’s Hour,† which opened on Broadway on November 20, 1934, painted a grim but clear depiction of Hellman’s view. â€Å"The Children’s Hour† is about the lives of two young women who opened a school for girls. Eventually, their lives are gradually ruined when one of the students accuses them of lesbianism. The characters of Martha Dobie and Karen Wright were realistically rendered by Hellman, resulting in a Broadway hit that would have 691 performances. This was a milestone of an achievement since America at the time was very conservative and homosexuality was a taboo subject (Griffin and Thorsten 27). Homosexuality was so taboo a subject in the Western world that the play was banned in Chicago, Boston, and London. While the play earned critical success in France and New York, it wasn’t awarded the Pulitzer Prize for drama in 1935 because the subject matter was still thought to be too sensitive at the time. Critics from New York however, protested the refusal of conservative bodies in the theater industry by forming the Drama Critics’ Circle. The organization has since then presented its own awards for plays they thought were relevant to art and society (Griffin and Thorsten 27). Hellman’s guardedness toward the issue of homosexuality is reflected on the play’s morality, which though clearly controversial and shocking at the time, was nevertheless morally acceptable to the majority of audiences. One glaring example of this is the fact that in the play, the accusation that Martha Dobie and Karen Wright were engaged in a lesbian relationship was simply a lie. An archetypal malicious teenager named Mary Tilford who studied in the school for girls fabricated the story. In fact, Karen was engaged to Dr. Joe Cardin, whom she really loved. Martha may have really been a lesbian in the story, but fearing for her sexuality, she committed suicide after revealing her thoughts and feelings to Karen (Griffin and Thorsten 28). Despite her sensational plays often associated with left-wing politics and feminism, Hellman considered herself largely a â€Å"moral writer. † The issue of homosexuality was primarily just a tool in the story to illustrate Hellman’s view that good people sometimes bring about harm because of their unwillingness to challenge evil. Karen was clearly painted in the play as a heterosexual and Martha seemed to have paid for her crime (homosexuality) with her life. Aside from reaffirming the norms of American society at the time, the play also apparently satisfied the morality of the conservative audience (Griffin and Thorsten 28). â€Å"The Children’s Hour† may have shied away from directly defending homosexuality, but it nevertheless showed the gradual opening of society to the broader roles of women. Martha and Karen were women who earned their own money, thus sending a message that they were independent and had some sort of power to satisfy their desires. These female characters were different from another of Hellman’s characters named Regina in â€Å"The Little Foxes. † While Regina depended on others’ money and the things she got from her manipulation of men, Martha and Karen had the education and administrative skills which led to the success of the all girls’ school they founded. Joe, Karen’s partner, also symbolized the growing number of egalitarian men at the time. He was very supportive of his partner’s wish to continue her career after their marriage and he also respected her dedication to the school she co-founded. He even defended Karen and Martha to his aunt after Mary’s mother convinced other parents to take their children out of the school because of the lesbianism charge (Griffin and Thorsten 28). In effect, while the play was hesitant to probe the reality of homosexuality more deeply, it did affirm in the audience’s mind the expanding role and power of women in society. Hellman might have been too guarded about lesbianism, but performance artist Holly Hughes was definitely vocal about her views about homosexuality and homosexual relationships. Hughes was an openly homosexual performance artist and writer of various plays and books that center on the topic of homosexuality. Her work has both been debated and celebrated by artists and intellectuals. The National Endowment for the Arts (NEA) refused to fund Hughes’ work in the summer of 1990 because of its sensitive subject matter, which resulted in a fierce debate and controversy in the world of performance art. One of Hughes’ most controversial pieces is a play entitled â€Å"Well of Horniness. † Lynda Hart, Assistant Professor of English at the University of Pennsylvania, wrote that the â€Å"Well of Horniness† is both â€Å"transgressive and aggressive† because it dismantles the audience’s preconceived notions about lesbian homosexuality. The play is loosely based on a classic novel about lesbian homosexuality written by Radclyffe Hall. Hughes’ play became very successful and eventually inspired two sequels: â€Å"Part II: Victim Victoria† and â€Å"Part III: In the Realm of the Senseless (Hart and Phelan 60-61). † The play is mostly representational, with the plot repeatedly interrupted by mock commercials and commentaries (Hart and Phelan 60-61). The memorable characters of â€Å"Well of Horniness† include Georgette, Rod, and Vicki. Georgette is Rod’s sister and Vicki is Rod’s fiancee. Vicki and Georgette are members of a sorority called Tridelta Tribads. Georgette meets Rod and Vicki at a restaurant, and Georgette soon recognizes Vicki as someone she knows from her past sorority. Vicki instantly desires Georgette and stares at her longingly. While dining at the restaurant, Vicki drops her fork underneath the table. As she goes down to pick it up, she’s drawn instead to Georgette’s legs, which Hughes writes, were â€Å"two succulent rainbows leading to the same pot of gold (Hart and Phelan 61-62). † The aggressive affirmation of homosexual reality masked in comedy is performed in the play as Vicki continues to give Georgette cunnilingus while Rod delivers a monologue on honeymoon getaways. In productions of the play at East Village, Manhattan, this scene is performed explicitly with Georgette in a comedic manner to Vicki underneath the table. Vicki then gets up and says she’s feeling â€Å"a little too hot† and goes to the bathroom (Hart and Phelan 62). Rod tells Georgette that he senses â€Å"something fishy† but he can’t â€Å"put his finger† on it (Hart and Phelan 62). Georgette then replies, â€Å"I’m working on it. † The comedic conversation happens in the context of a play that is filled with references to fish, eager beavers, muff-divers, and other terms associated with lesbianism (Hart and Phelan 62). In contrast to â€Å"The Children’s Hour†, â€Å"Well of Horniness† certainly drives home its message on homosexuality in a more direct, striking manner. Hughes’ play doesn’t hide behind other issues or concerns such as the â€Å"lie† or â€Å"evil† in Hellman’s play, and instead hits audiences with the reality of homosexuality right away. It is this controversial nature of Hughes work that has made her notorious for conservative critics and even lesbians and other homosexuals who review her work. Hart though, thinks that Hughes’ play effectively challenges heterosexual hegemony. Its borderline messages and controversial nature opens up a â€Å"hopeful new space of visibility† for feminism and its supporters (Hart and Phelan 62). The popular scene from â€Å"Well of Horniness† is even more notable because it shatters lesbian stereotypes. Lesbians at the time were thought of as homosexuals who generally assumed male identities. Vicki though, was already engaged to Rod and yet still desired other women. Vicki’s performance of oral sex for Georgette in close proximity to her fiance destroys any notions the audiences might have regarding lesbianism and the sexuality of women. Since the play is representational, Rod’s character mainly stands for heterosexual hegemony, which explains why the character is named â€Å"Rod† to refer to male phallic symbol. Hughes shows that homosexual realities are happening throughout society despite the blind functioning of heterosexual institutions, such as marriage, as the play points out. Unlike Hellman, Hughes seems more concerned with homosexuality than feminism, although the empowerment of women might also be addressed by her aggressive plays. Through the clear depiction of women as freely desiring beings, Hughes is able to free women from societal stereotypes. â€Å"Women† isn’t a category of human beings who can only desire men. Instead, it’s a fuzzy category that mostly refers to female human beings who may desire any sex and express that desire in different ways. Overarching Hellman and Hughes’ work may be the amazing work of Anna Deavere Smith, performance artist, playwright, writer, and professor. Smith has received numerous awards and is widely known for her performances which have her assuming the identities of more than twenty people. Smith employs few props, such as chairs and tables to differentiate identities in her performances. All the identities she plays are real people who are interviewed beforehand about a social issue. The result of her lengthy monologues is a stunning commentary on the differences that fracture a community. One of Smith’s most popular acts is called â€Å"On the Road,† which she has been performing since 1982. In one of her performances, Smith interviewed twenty-five men and women from Princeton University on subjects such as the university’s eating clubs which are exclusive to men, assault against women, and the condition of black students among others. The fifty-minute dialogue that results from this research entertains and delights audiences at the same time. Smith usually invites her subjects to attend her performances and their reaction is usually positive. Many of them even laugh out loud when they recognize their own selves in the numerous identities performed. Some of them though, get unsettled when they see their views juxtaposed with others from the community (Hart and Phelan 35). This unsettling of the self may be one of the main goals of Smith in structuring her acts through such a unique manner. According to Smith, her goal is â€Å"to find American character in the ways that people speak (Cohen-Cruz 148). † She said that the spirit, imagination, and the challenges of the time can then be captured by inhabiting the words of the people in the community. Unlike other actors who try to project realistic characters on the stage, Smith’s emphasis is more on the filtering of the self through a single actor. She doesn’t assume that she has all the experiences of her subjects, but that she can learn many things from these experiences (Cohen-Cruz 148). Feminism has been one of the subjects of Smith’s performances for a very long time. In one Princeton performance entitled â€Å"Gender Bending,† Smith reminisced how women from Seven Sisters colleges had been imported to Princeton throughout history to provide weekend entertainment for members of fraternities. Feminist definitions of the body, the AIDS crisis, and modern literary representations of homosexuality are also discussed in the show. Smith tackled all these issues by impersonating the subjects she interviewed and playing them onstage (Hart and Phelan 37). In a way, Smith’s work is closer to reality than both Hellman and Hughes’ work because it merely projects the voice of real people onstage. What makes Smith’s performance more striking though than a simple video recording of interviews is that only one face speaks for all of the subjects. Through this technique, Smith is able to erase the immediate symbols of color, gender, and other characteristics of her subjects. Without the physical characteristics that differentiate one subject from another, audiences are forced to consider each subject’s view as a part of a unity that is the community. Stereotypes are then magnified as audiences realize that differences are oftentimes imaginary and unjust. Instead of masking the call for the empowerment of women through discussions about â€Å"evil† such as what Hellman did, or aggressively attacking the audience with controversial representations of lesbians such as what Hughes demonstrated, Smith is able to give voice to real women by simply putting their views side by side with others from the community. Smith puts real context in her performances, which makes the issue more immediate to viewers. Her acts send the message that gender discrimination is really happening right now and many people are unconsciously participating in it. They call for an immediate response to pressing social issues while entertaining audiences at the same time. For ordinary citizens, norms in society are always difficult to challenge, let alone break. Revolutionary works by Hellman, Hughes, and Smith are very valuable in that they help people to cross the bridge, so they can see the other side. While some audiences may dislike the oftentimes crude and vulgar images in their work, their act of watching alone is enough to gradually bend the norms of society. Norms always have to be challenged so that society’s morality and humanity doesn’t remain oppressively stagnant. Once taboo subjects are discussed, they cease to haunt the people concerned and become an issue for everyone. As modernity pushes people to think more about the effects of gender on society and the self, feminism and homosexuality will continue to be relevant topics in theater and other forms of art in the future. Hellman, Hughes, and Smith’s work will also continue to shape the discussions on these topics. These three brilliant writers represent different sides of the spectrum and their work should be read by anyone interested in exploring the relationship between feminism, homosexuality and theater arts. Works Cited Champion, Laurie and Emmanuel Sampath Nelson. American Women Writers, 1900-1945: a Bio-bibliographical Critical Sourcebook. Westport: Greenwood Publishing Group, 2000. Cohen-Cruz, Jan. Local Acts: Community-based Performance in the United States. New Brunswick: Rutgers University Press, 2005. Griffin, Alice and Geraldine Thorsten. Understanding Lillian Herman. Columbia: University of South Carolina Press, 1999. Hart, Lynda and Peggy Phelan. Acting Out: Feminist Performances. Ann Arbor: University of Michigan Press, 1999.

Investigation to find out whether changing Essay Example for Free

Investigation to find out whether changing Essay Air resistance is a force that acts upon any object falling through the air. It slows the rate of descent on an object with any surface area. Scientific research has found that by altering the objects surface area, the amount of air resistance either increases or decreases, changing the rate of descent. Newtons third law states that for every action there is an equal and opposite reaction. My helicopter will fall to the ground because of the gravitational pull of the Earth. In reflection to Newtons law, the opposite force in the case of my experiment will be air resistance. As gravity is pulling my helicopter to the ground, air resistance is pushing up onto my helicopter, slowing its rate of descent. The rate of gravity is always the same, as the gravitational pull from the Earth is the same, so the factor in this case, which affects the rate of descent, is air resistance. Newtons second law of motion states that the acceleration an object experiences multiplied by the mass of the object is equal to the net force acting on the object. Thus, if a given force acts on two objects of different mass, the object with the larger mass will have a lower acceleration. In the case of my experiment, the rate of descent on my helicopter, multiplied by the mass of my helicopter is equal to the total amount of forces acting on it. If the forces acting on my helicopter give a net force which is zero, then my helicopter will not accelerate, it will continue moving at a constant velocity. The forces on an object falling at terminal velocity are balanced. Terminal velocity occurs when the weight of an object is balanced by the drag. Drag depends on the speed of an object- the faster it moves the greater the drag. Therefore, if one of my helicopters is moving faster than another, then it will create more air resistance. Drag also depends on the shape of an object. A streamlined object will travel much faster than another object, and they have a lower terminal velocity. We call the force of gravity on something its weight. Weight (N) = mass (kg) x gravitational field strength (N/kg) The gravitational field strength on Earth is around 10N/kg. Astronauts on the moon tried an experiment suggested by Galileo. They dropped a feather and a hammer at the same time, and they landed together. Newton also tried this experiment, dropping a coin and a feather first in air, then in a vacuum. In the air the coin landed first, but in a vacuum, they landed at the same time. The feather and the coin have a similar surface area, so when they begin to fall they should have about the same amount of drag. As they fall the air resistance on the feather soon increases to balance its weight, causing it to travel at terminal velocity. The coin, on the other hand, is heavier, so it continues to accelerate, and probably hits the ground before reaching terminal velocity. The drag force (air resistance) is always in the opposite direction to the motion. The force of gravity is equal and opposite to the drag force. I predict that by altering the surface area of the wings on my helicopter, I will be able to change the rate of descent by increasing and decreasing the air resistance of the wings. I think that if I increase the surface area of the wings, the amount of air resistance will increase, and my helicopter will take longer to reach the floor. If I decrease the surface area, there will be less air resistance, so my helicopter will travel faster. I also think that whilst doing my experiment, I may find the terminal velocity of one of my helicopters. Method: Make a helicopter out of a piece of paper. Make the wings 11cm x 3cm each, and the base 10cm x 3cm, leaving a 1. 5cm gap from the edges of the wings, like the one shown here. Fold one wing forwards, and the other backwards along the dotted line. Measure a height of 2m from the floor. Make a mark on the wall so that you know where to drop your helicopters from. Stand so that the first helicopter is level with the mark on the wall, and get another person to stand on the floor with a stop clock. Let go of the helicopter and time how long it takes to hit the floor. Record your results in a table. Repeat with the same sized helicopter 3 times, and then cut 1cm off the length of the wings. Repeat the experiment until the wings are 1cm long. To keep my experiment fair- I will use the same helicopter throughout my experiment to ensure accurate results. I will also mark a point on the wall so that I can drop my helicopters from the same height every time. Results: Analysis: My results dont show a linear pattern, the average times go down in steps, but this may have been caused by experimental errors. More of my average times are above my line of best fit than on or below it. Evaluation: I think that my experiment was fairly successful, as from my results I can see that my prediction is usually correct- reducing the surface area of the wings decreases the time it takes to get to the floor, because of the reduce in air resistance. If I was to do this experiment again, I would make another helicopter in a different way, because I think that that my results may have been in a more linear fashion if the helicopter spun more in the air.

The Leisure Ability Model

The Leisure Ability Model Therapeutic Recreation seeks to promote the capacity and ability of groups and individuals to make self determined and responsible choices, in light of their needs to grow, to explore new perspectives and possibilities, and to realise their full potential. (reference) Within this assignment I am going to critically compare and evaluate the use of the following models in the Therapeutic Recreation Service: The Leisure Ability Model and the Health Promotion/ Health Protection Model. In doing so I will firstly describe the two models in detail and then critically compare and evaluate them both and their use in the therapeutic recreation service. The Leisure Ability Model: Every human being needs, wants, and deserves leisure. Leisure presents opportunities to experience mastery, learn new skills, meet new people, deepen existing relationships, and develop a clearer sense of self. Leisure provides the context in which people can learn, interact, express individualism, and self-actualize (Kelly, 1990). A large number of individuals are constrained from full and satisfying leisure experiences. It then follows that many individuals with disabilities and/or illnesses may experience more frequent, severe, or lasting barriers compared with their non-disabled counterparts, simply due to the presence of disability and/or illness. The Leisure Ability Models underlying basis stems from the concepts of: (a) learned helplessness vs. mastery or self-determination; (b) intrinsic motivation, internal locus of control, and causal attribution; (c) choice; and (d) flow. Learned Helplessness: Learned helplessness is the perception by an individual that events happening in his or her life are beyond his or her personal control, and therefore, the individual stops trying to effect changes or outcomes with his or her life (Seligman, 1975). They will eventually stop wanting to participate in activity or participate in any other way. They will learn that the rules are outside of their control and someone else is in charge of setting the rules. Their ability to take a risk will be diminished and they will learn to be helpless. Learned helplessness may present a psychological barrier to full leisure participation and it may, conversely, be unlearned with the provision of well-designed services. Intrinsic Motivation, Internal Locus of Control, and Causal Attribution: All individuals are intrinsically motivated toward behaviour in which they can experience competence and self-determination. As such, individuals seek experiences of incongruity or challenges in which they can master the situation, reduce the incongruity, and show competence. This process is continual and through skill acquisition and mastery, produces feelings of satisfaction, competence, and control. An internal locus of control implies that the individual has the orientation that he or she is responsible for the behaviour and outcomes he or she produces (Deci, 1975). Typically individuals with an internal locus of control take responsibility for their decisions and the consequences of their decisions, while an individual with an external locus of control will place responsibility, credit, and blame on other individuals. An internal locus of control is important for the individual to feel self-directed or responsible, be motivated to continue to seek challenges, and develop a sense of self-competence. http://dw.com.com/redir?tag=rbxira.2.a.10destUrl=http://www.cnet.com/b.gif Attribution implies that an individual believes that he or she can affect a particular outcome (Deci, 1975; Seligman, 1975). An important aspect of the sense of accomplishment, competence, and control is the individuals interpretation of personal contribution to the outcome. Without a sense of personal causation, the likelihood of the individual developing learned helplessness increases greatly. Choice: The Leisure Ability Model also relies heavily on the concept of choice, choice implies that the individual has sufficient skills, knowledge, and attitudes to be able to have options from which to choose, and the skills and desires to make appropriate choices. Lee and Mobily (1988) stated that therapeutic recreation services should build skills and provide participants with options for participation. Flow: When skill level is high and activity challenge is low, the individual is quite likely to be bored. When the skill level is low and the activity challenge is high, the individual is most likely to be anxious. When the skill level and activity challenge are identical or nearly identical, the individual is most able to achieve a state of concentration and energy expenditure that Csikszentmihalyi (1990) has labeled flow. Treatment Services During treatment services, the client generally has less control over the intent of the programs and is dependent on the professional judgment and guidance provided by the specialist. The client experiences less freedom of choice during treatment services than any other category of therapeutic recreation service. The role of the specialist providing treatment services is that of therapist. Within treatment services, the client has minimal control and the therapist has maximum control. The specialist typically designates the clients level and type of involvement, with considerably little input from the client. In order to successfully produce client outcomes, the specialist must be able to assess accurately the clients functional deficits; create, design, and implement specific interventions to improve these deficits; and evaluate the client outcomes achieved from treatment programs. http://dw.com.com/redir?tag=rbxira.2.a.10destUrl=http://www.cnet.com/b.gifThe ultimate outcome of treatment services is to eliminate, significantly improve, or teach the client to adapt to existing functional limitations that hamper efforts to engage fully in leisure pursuits. Often these functional deficits are to the degree that the client has difficulty learning, developing his or her full potential, interacting with others, or being independent. The aim of treatment services is to reduce these barriers so further learning and involvement by the client can take place. Leisure Education: Leisure education services focus on the client acquiring leisure-related attitudes, knowledge, and skills. Participating successfully in leisure requires a diverse range of skills and abilities, and many clients of therapeutic recreation services do not possess these, have not been able to use them in their leisure time, or need to re-learn them incorporating the effects of their illness and/ or disability. Leisure education services are provided to meet a wide range of client needs related to engaging in a variety of leisure activities and experiences. (Howe, 1989, p. 207). The overall outcome sought through leisure education services is a client who has enough knowledge and skills that an informed and independent choice can be made for his or her future leisure participation. Leisure education means increased freedom of choice, increased locus of control, increased intrinsic motivation, and increased independence for the client. Recreation Participation: http://dw.com.com/redir?tag=rbxira.2.a.10destUrl=http://www.cnet.com/b.gif Recreation participation programs are structured activities that allow the client to practice newly acquired skills, and/or experience enjoyment and self-expression. These programs are provided to allow the client greater freedom of choice within an organized delivery system and may, in fact, be part of the individuals leisure lifestyle. The clients role in recreation participation programs includes greater decision making and increased self-regulated behaviour. The client has increased freedom of choice and his or her motivation is largely intrinsic. In these programs, the specialist is generally no longer teaching or in charge per se. The client becomes largely responsible for his or her own experience and outcome, with the specialist moving to an organizer and/or supervisor role. As Stumbo and Peterson (1998) noted, recreation participation allows the client an opportunity to practice new skills, experience enjoyment, and achieve self-expression. From a clinical perspective, recreation participation does much more. For instance, recreation opportunities provide clients with respite from other, more arduous, therapy services. Leisure education programs may focus on: (a) self-awareness in relation to clients new status; (b) learning social skills such as assertiveness, coping, and friendship making; (c) re-learning or adapting pre-morbid leisure skills; and (d) locating leisure resources appropriate to new interests and that are accessible. Recreation participation programs may involve practicing a variety of new leisure and social skills in a safe, structured environment. In designing and implementing these programs, the specialist builds on opportunities for the individual to exercise control, mastery, intrinsic motivation, and choice. The ultimate outcome would be for each client to be able to adapt to and cope with individual disability to the extent that he or she will experience a satisfying and independent leisure lifestyle, and be able to master skills to achieve flow. Health Promotion/ Health Protection Model: The Health Protection/Health Promotion Model (Austin, 1996, 1997) stipulates that the purpose of therapeutic recreation is to assist persons to recover following threats to health, by helping them to restore themselves or regain stability. (health protection), and secondly, optimising their potentials in order that they may enjoy as high a quality of health as possible (health promotion). Within this model (Austin, 1997, p. 144) states that à ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒâ€¦Ã¢â‚¬Å"the mission of therapeutic recreation is to use activity, recreation, and leisure to help people to deal with problems that serve as barriers to health and to assist them to grow toward their highest levels of health and wellness The health promotion, health protection model is broken up into four broad concepts which are the humanistic perspective, high level wellness, stabilisation and actualisation and health. Humanistic Perspective: Those who embrace the humanistic perspective believe that each of us has the responsibility for his or her own health and the capacity for making self-directed and wise choices regarding our health. Since individuals are responsible for their own health, it is critical to empower individuals to become involved in decision-making to the fullest extent possible (Austin, 1997). High-Level Wellness: High-level wellness deals with helping persons to achieve as high a level of wellness as they are capable of achieving (Austin, 1997). Therapeutic Recreation professionals have concern for the full range of the illness-wellness continuum (Austin, 1997). http://dw.com.com/redir?tag=rbxira.2.a.10destUrl=http://www.cnet.com/b.gif Stabilization and Actualization Tendencies: The stabilizing tendency is concerned with maintaining the steady state of the individual. It is an adaptation mechanism that helps us keep stress in a manageable range. It protects us from biophysical and psychosocial harm. The stabilizing tendency is the motivational force behind health protection that focuses on efforts to move away from or avoid negatively valence states of illness and injury (Pender, 1996, p. 34). The actualization tendency drives us toward health promotion that focuses on efforts to approach or move toward a positively valence state of high-level health and well-being (Pender, 1996, p. 34). Health: King (1971) and Pender (1996) health encompasses both coping adaptively and growing and becoming. Healthy people can cope with lifes stressors. Those who enjoy optimal health have the opportunity to pursue the highest levels of personal growth and development. Under the Health Protection/Health Promotion Model, therapists* recognize that to help clients strive toward health promotion is the ultimate goal of therapeutic recreation. Further, therapists prize the right of each individual to pursue his or her highest state of well-being, or optimal health. TR practice is therefore based on a philosophy that encourages clients to attempt to achieve maximum health, rather than just recover from illness (Austin, 1997). The Component of Prescriptive Activities: When clients initially encounter illnesses or disorders, often they become self-absorbed. They have a tendency to withdraw from their usual life activities and to experience a loss of control over their lives (Flynn, 1980). Research (e.g., Langer Rodin, 1976; Seligman Maier, 1967) has shown that feelings of lack of control may bring about a sense of helplessness that can ultimately produce severe depression. At times such as this clients are encountering a significant threat to their health and are not prepared to enjoy and benefit from recreation or leisure. For these individuals, activity is a necessary prerequisite to health restoration. Activity is a means for them to begin to gain control over their situation and to overcome feelings of helplessness and depression that regularly accompany loss of control. At this point on the continuum, Therapeutic Recreation professionals provide direction and structure for prescribed activities. Once engaged in activity, clients can begin to perceive themselves as being able to successfully interact with their environments, to start to experience feelings of success and mastery, and to take steps toward regaining a sense of control. Clients come to realise that they are not passive victims but can take action to restore their health. They are then ready to partake in the recreation component of treatment. The Recreation Component: Recreation is activities that take place during leisure time (Kraus. 1971). Client need to take part in intrinsically motivated recreation experiences that produce a sense of mastery and accomplishment within a supportive and nonthreatening atmosphere. Clients have fun as they learn new skills, new behaviors, new ways to interact with others, new philosophies and values, and new cognition about themselves. In short, they learn that they can be successful in their interactions with the world. Through recreation they are able to re-create themselves, thus combating threats to health and restoring stability. http://dw.com.com/redir?tag=rbxira.2.a.10destUrl=http://www.cnet.com/b.gif The Leisure Component: Whereas recreation allows people to restore themselves, leisure is growth promoting. Leisure is a means to self-actualisation because it allows people to have self-determined opportunities to expand themselves by successfully using their abilities to meet challenges. Feelings of accomplishment, confidence and pleasure result from such growth producing experiences. Thus leisure assumes an important role in assisting people to reach their potentials (Iso-Ahola, 1989). Core elements in leisure seem to be that it is freely chosen and intrinsically motivated. The Recreation and Leisure Components: Although recreation and leisure differ in that recreation is an adaptive device that allows us to restore ourselves and leisure is a phenomenon that allows growth, they share commonalities. Both recreation and leisure are free from constraint. Both involve intrinsic motivation and both provide an opportunity for people to experience a tremendous amount of control in their lives. Both permit us to suspend everyday rules and conventions in order to be ourselves and let our hair down. Both allow us to be human with all of our imperfections and frailties. It is the task of the therapeutic recreation professional to maintain an open, supportive, and nonthreatening atmosphere that encourages these positive attributes of recreation and leisure and which help to bring about therapeutic benefit (Austin, 1996). http://dw.com.com/redir?tag=rbxira.2.a.10destUrl=http://www.cnet.com/b.gif According to Bandura (1986), bolstered efficacy expectations allow clients to have confidence in themselves and in their abilities to succeed in the face of frustration. Thus, clients feel more and more able to be in control of their lives and to meet adversity as they move along the continuum toward higher levels of health. It is the role of the TR professional to help each client assume increasing levels of independence as he or she moves along the illness-wellness continuum. Of course, the client with the greatest dependence on the therapist will be the individual who is in the poorest health. At this point the stabilizing tendency is paramount while the client attempts to ward off the threat to health and to return to his or her usual stable state. At this time the therapist engages the client in prescriptive activities or recreation experiences in order to assist the client with health protection. During prescriptive activities the clients control is the smallest and the therapi sts is the largest. During recreation there is more of a mutual participation by the client and therapist. With the help of the therapist, the client learns to select, and participate in, recreation experiences that promote health improvement. Approximately midway across the continuum, the stabilising tendency reduces and the actualising tendency begins to arise. Leisure begins to emerge as the paramount paradigm. As the actualisation tendency increases, the client becomes less and less dependent on the therapist and more and more responsible for self-determination. The role of the therapist continues to diminish until the client is able to function without the helper. At this point the client can function relatively independently of the TR professional and there is no need for TR service delivery (Austin, 1997). Comparison of the use of the Leisure Ability Model to the Health Promotion/ Health Protection Model in Therapeutic Recreation Services: The role of the therapeutic recreation specialist, in order to reverse the consequences of learned helplessness, is to assist the individual in: (a) increasing the sense of personal causation and internal control, (b) increasing intrinsic motivation, (c) increasing the sense of personal choice and alternatives, and (d) achieving the state of optimal experience or flow. In theory, then, therapeutic recreation is provided to affect the total leisure behaviour (leisure lifestyle) of individuals with disabilities and/or illnesses through decreasing learned helplessness, and increasing personal control, intrinsic motivation, and personal choice. This outcome is accomplished through the specific provision of treatment, leisure education, and recreation participation services which teach specific skills, knowledges, and abilities, and take into consideration the matching of client skill and activity challenge. Another strength is the Models flexibility. One level of flexibility is with the three components of service. Each component of service is selected and programmed based on client need. That is, some clients will need treatment and leisure education services, without recreation participation. Other clients will need only leisure education and recreation participation services. Clearly, services are selected based on client need. In addition, programs conceptualized within each service component are selected based on client need. flexibility allow the specialist to custom design programs to fit the needs of every and any client group served by therapeutic recreation. The ultimate goal of leisure lifestyle remains the same for every client, but since it is based on the individual, how the lifestyle will be implemented by the individual and what it contains may differ. As such, the content of the Leisure Ability Model is not specific to any one population or client group, nor is it confined to any specific service or delivery setting. Some authors, including Kinney and Shank (1989), have reported this as a strength of the Model. According to the model, intervention may occur in a wide range of settings and addresses individuals with physical, mental, social, or emotional limitations (Peterson Gunn, p. 4). The intervention model is conceptually divided into three phases along a continuum of client functioning and restrictiveness. The three phases of therapeutic recreation intervention are arranged in a sequence, from greater therapist control to lesser therapist control, and from lesser client independence to greater client independence. This arrangement is purposeful and is meant to convey that the ultimate aim of the appropriate leisure lifestyle is that it be engaged in independently and freely. Summary The Health Protection/Health Promotion Model contains three major components (i.e., prescribed activities, recreation, and leisure) that range along an illness-wellness continuum. According to their needs, clients may enter anywhere along the continuum. The model emphasizes the active role of the client who becomes less and less reliant on the TR professional as he or she moves toward higher levels of health. Initially, direction and structure are provided through prescriptive activities to help activate the client. During recreation, the client and therapist join together in a mutual effort to restore normal functioning. During leisure, the client assumes primary responsibility for his or her own health and well-being. Evaluation of both models and there use in therapeutic recreation services: The overall intended outcome of therapeutic recreation services, as defined by the Leisure Ability Model, is a satisfying, independent, and freely chosen leisure lifestyle. In order to facilitate these perceptions, therapeutic recreation specialists must be able to design, implement, and evaluate a variety of activities that increase the persons individual competence and sense of control. In relation to leisure behaviour, Peterson (1989) felt that this includes improving functional abilities, improving leisure-related attitudes, skills, knowledge, and abilities, and voluntarily engaging in self-directed leisure behaviour. Thus, the three service areas of treatment, leisure education, and recreation participation are designed to teach specific skills to improve personal competence and a sense of accomplishment. Csikszentmihalyi (1990) summed up the importance of these perceptions: In the long run optimal experiences add up to a sense of mastery-or perhaps better, a sense of participation in determining the content of life-that comes as close to what is usually meant by happiness as anything else we can conceivably imagine (p. 4). The therapeutic recreation specialist must be able to adequately assess clients skill level (through client assessment) and activity requirements (through activity analysis) in order for the two to approximate one another. Given Decis (1975) theory of intrinsic motivation which includes the concept of incongruity, therapeutic recreation specialists may provide activities slightly above the skill level of clients in order to increase the sense of mastery. When this match between the activity requirements and client skill levels occurs, clients are most able to learn and experience a higher quality leisure. To facilitate this, therapeutic recreation specialists become responsible for comprehending and incorporating the: (a) theoretical bases (including but not limited to internal locus of control, intrinsic motivation, personal causation, freedom of choice, and flow); (b) typical client characteristics, including needs and deficits; (c) aspects of quality therapeutic recreation program delivery process (e.g., client assessment, activity analysis, outcome evaluation, etc.); and (d) therapeutic recreation content (treatment, leisure education, and recreation participation). These areas of understanding are important for the therapeutic recreation specialist to be able to design a series of coherent, organized programs that meet client needs and move the client further toward an independent and satisfactory leisure lifestyle. Again, the success of that lifestyle is dependent on the client gaining a sense of control and choice over leisure options, and having an orientation toward intrinsic motivation, an internal locus of control, and a personal sense of causality. The Leisure Ability Model provides specific content that can be addressed with clients in order to facilitate their development, maintenance, and expression of a successful leisure lifestyle. Each aspect of this content applies to the future success, independence, and well-being of clients in regard to their leisure. http://dw.com.com/redir?tag=rbxira.2.a.10destUrl=http://www.cnet.com/b.gif The client has reduced major functional limitations that prohibit or significantly limit leisure involvement (or at least has learned ways to overcome these barriers); understands and values the importance of leisure in the totality of life experiences; has adequate social skills for involvement with others; is able to choose between several leisure activity options on a daily basis, and make decisions for leisure participation; is able to locate and use leisure resources as necessary; and has increased perceptions of choice, motivation, freedom, responsibility, causality, and independence with regard to his or her leisure. These outcomes are targeted through the identification of client needs, the provision of programs to meet those needs, and the evaluation of outcomes during and after program delivery. A therapeutic recreation specialist designs, implements, and evaluates services aimed at these outcomes Austin (1989) objected to the Leisure Ability Model on the basis that is supporting a leisure behaviour orientation, instead of the therapy orientation. A number of authors have objected to the Leisure Ability Model, having observed that its all-encompassing approach is too broad and lacks the focus needed to direct a profession (Austin, p. 147). Austin advocated an alignment of therapeutic recreation with allied health and medical science disciplines, rather than leisure and recreation professionals The Model in Practice The Health Protection/Health Promotion Model may be applied in any setting (i.e., clinical or community) in which the goal of therapeutic recreation is holistic health and well-being. Thus, anyone who wishes to improve his or her level of health can become a TR client. TR professionals view all clients as having abilities and intact strengths, as well as possessing intrinsic worth and the potential for change. Through purposeful intervention using the TR process (i.e., assessment, planning, implementation, evaluation), therapeutic outcomes emphasize enhanced client functioning. Typical therapeutic outcomes include increasing personal awareness, improving social skills, enhancing leisure abilities, decreasing stress, improving physical functioning, and developing feelings of positive self-regard, self-efficacy and perceived control (Austin, 1996). Conclusion: In conclusion to this assignment on the critical comparison and evaluation of the use of the Leisure Ability Model and the Health Promotion/ Health Protection Model in the therapeutic recreation services I found that.. Reference Page: