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In countries of the Eastern Mediterranean Region allergy map beconase aq 200MDI low price, among people aged 25–65 years allergy shots timeline purchase generic beconase aq canada, the prevalence of smoking ranges from 16% to 35% allergy medicine ragweed order beconase aq 200MDI visa, overweight/obesity from 40% to 70% and dyslipidaemia from 20% to 45% allergy symptoms sinus headache best order for beconase aq. In most countries of the Region, more than two out of three adults have one or more of the major risk factors for cardiovascular disease. Primary (essential or idiopathic) hypertension is systemic hypertension of unknown cause that results from dysregulation of normal homeostatic control mechanisms of blood pressure in the absence of detectable known secondary causes. Secondary Renal Coarctation of the aorta • Renal parenchymal Pregnancy-induced hypertension – acute glomerulonephritis Neurological disorders – chronic nephritis • Increased intracranial pressure – polycystic disease – brain tumours – diabetic nephropathy – encephalitis – hydronephrosis – respiratory acidosis • Renovascular • Sleep apnoea – renal artery stenosis • Quadriplegia – intrarenal vasculitis • Familial dysautonomia • Renin-producing tumours • Acute prophyria • Renoprival • Guillain-Barre syndrome • Primary sodium retention (Liddle • Lead poisoning syndrome, Gordon syndrome) Acute stress, including surgery Endocrine • Psychogenic hyperventilation • Acromegaly • Hypoglycaemia • Hypothyroidism • Burns • Hyperthyroidism • Pancreatitis • Hypercalcaemia • Alcohol withdrawal (hyperparathyroidism) • Alcohol and drug abuse • Adrenal • Sickle cell crisis i. Cortical • After resuscitation – Cushing syndrome • Postoperative – primary aldosteronism Increased intravascular volume – congenital adrenal hyperplasia – apparent mineralocorticoid excess (liquorice) ii. Medullary – phaeochromocytoma • Extra-adrenal chromaffin tumours • Carcinoid • Exogenous hormones: estrogen, glucocorticoids, mineralocorticoids, sympathomimetics, tyramine- containing food, monoamine oxidase inhibitors Systolic hypertension 1. Increased cardiac output Aortic valvular insufficiency Pagets disease of bone Arteriovenous fistula, patent ductus arteriosus Beri-beri Thyrotoxicosis Hyperkinetic circulation 2. Iatrogenic hypertension Diagnosis of hypertension Background Uncomplicated hypertension is usually asymptomatic and many of the symptoms often attributed to hypertension such as headache, tinnitus, dizziness and fainting are probably psychogenic in origin. They may reflect hyperventilation, induced by anxiety over the diagnosis of a lifelong disease that threatens well-being and survival. However recent data indicate that, surprisingly, a persons general sense of well-being often improves during initiation of medical treatment of hypertension. These new data suggest that hypertension may not be as asymptomatic as was previously assumed. Even if not totally asymptomatic, hypertension can go unrecognized for years because overt symptoms and signs generally coincide with the onset of target organ damage. Therefore, proper technique of blood pressure measurement is the cornerstone of hypertension detection. Blood pressure measurement Condition of the patient Posture • Sitting pressures are usually adequate for routine measurement of blood pressure. Patients should sit quietly with back supported for 5 minutes, with arm bared and supported at the level of the heart. Distended abdominal viscera cause blood pressure elevation presumably because of anxiety, sympathetic stimulation and pain. Diagnosis of hypertension 19 Equipment Cuff size the bladder size (six sizes are available) should encircle at least 80% of the arm circumference and cover two thirds of the arm length; if not, place the bladder over the brachial artery. Manometer Mercury, anaeroid or electronic devices used in measurement of blood pressure should be calibrated frequently and routinely against standards (typically every 6 months) to assure accuracy. Ensure that the equipment used is in working order: clean, calibrated, filled with non-leaking tubing and has a properly sized cuff. Technique and precautions Number of readings • On each occasion, take at least two readings separated by as much time as is practical. If readings vary by more than 5 mmHg, take additional readings until two or more are close. Although it is traditional to average blood pressure measurements at a given visit, recent guidelines state recording individual blood pressure measurements with the lowest reading in any position (including standing) to be considered as the “blood pressure taken at that visit. Performance • Inflate the bladder quickly to a pressure of 20 mmHg above systolic as recognized by disappearance of the radial pulse. Important diagnostic information will be missed if the “auscultatory gap is not detected. At least one Korotkoff sound should be heard at each 2 mmHg gradation of the mercury column. At the conclusion of blood pressure measurement, there should be no lasting indentation in the area where the stethoscope was placed. Too great pressure with the stethoscope overestimates the systolic blood pressure and underestimates the diastolic blood pressure. Home (self) blood pressure measurements Home readings of blood pressure tend to be better correlated with both the extent of target organ damage and the risk of future mortality than are readings taken in the physicians office. They are also helpful in evaluating symptoms of hypotension particularly if they are intermittent and infrequent [11,12]. Many machines are now available for the purpose that are convenient, inexpensive and relatively accurate. Home readings are on average 12/7 mmHg less than office measurements, even in normotensive subjects. However, many factors that contribute to blood pressure variability including circadian variation, food and alcohol ingestion, exercise and stress are more difficult to control in the home environment. Technique and precautions When giving instruction about self-measurement of blood pressure at home, the following points should be made [10]. Office values of 140/90 mmHg correspond to 24-hour average values of approximately 125/80 mmHg. Clinical decisions may be based on day, night, or 24- hour mean values, but 24-hour values are preferable. The following situations are ones in which a better knowledge of what is happening to a patients blood pressure over 24 hours can lead to different therapeutic decisions [10]. Evaluation of newly diagnosed hypertensive patients without target organ damage In these patients, therapeutic decisions will depend mainly on how blood pressure is evaluated. Isolated office hypertension the condition refers to persistently elevated office blood pressure readings (140/90 mmHg at several visits) while 24-hour ambulatory blood pressure values are normal (<120/80 mmHg. Diagnosis can also be based on home blood pressure mean values <135/85 mmHg, after several days recording. Isolated office hypertension is encountered in about 10% of the general population and accounts for a non-negligible population of individuals in whom hypertension is diagnosed. Several, but not all, studies have reported this condition to be associated with target organ damage and metabolic abnormalities, which suggests that it may not be an entirely innocent phenomenon. Lifestyle changes and a close follow-up should be implemented in all patients with isolated office hypertension. Drug treatment is instituted when there is evidence of target organ damage or high cardiovascular risk profile. This refers to individuals with normal office blood pressure (<140/90 mmHg) but elevated ambulatory blood pressure values (isolated ambulatory hypertension. These individuals display a greater than normal prevalence of target organ damage. Refractory hypertension this may be the result of a genuinely resistant hypertension, non-compliance or an exaggerated white-coat hypertension. The best clue to this exaggerated white-coat effect is a persistently elevated office pressure in the absence of target organ damage. A clue to this may be 22 Clinical guidelines for the management of hypertension that although the average blood pressure level and heart rate fall during the night, their variability increases. Intermittent symptoms possibly related to blood pressure Episodes of light-headedness, particularly in patients who are on antihypertensive medication, may be a manifestation of transient hypotension. Episodic hypertension Episodic symptoms accompanied by transient elevation in blood pressure may occur in a variety of conditions, including phaeochromocytoma and panic attacks. There are huge swings of blood pressure during the day depending to a large extent on changes of posture and physical activity, and relatively stable but high pressure at night when the patient is supine. Autonomic neuropathy is common in type 1 diabetes and has been attributed to interruption of both vagal and sympathetic control of the circulation. The former is manifested by a relatively fixed heart rate and the latter by orthostatic hypotension. In common with patients with idiopathic orthostatic hypotension, blood pressure remains high at night. Most normotensive patients and perhaps 80% of hypertensives have at least 10% drop in blood pressure during sleep compared with daytime average. There is about a 3-fold increased risk of cardiovascular events among those with non-dipping blood pressure or pulse patterns. Technique and precautions [13] When measuring 24-hour blood pressure, care should be taken to follow certain procedures. There is evidence that subjects in whom nocturnal hypotension is blunted and thus exhibit a relatively high night-time blood pressure may have an unfavourable prognosis. The blood pressure thresholds for definition of hypertension with office, 24-hour ambulatory and home measurements are given in Table 4.


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Sympathetic activities are marked by the “flight or fight emergency response; parasympathetic activities are marked by lowered blood pressure allergy medicine 906 cheap beconase aq online mastercard, pupil contraction and slowing of the heart allergy symptoms of gluten buy generic beconase aq 200MDI on line. Axon: the nerve fiber that carries an impulse from the nerve cell to a target allergy treatment mouth drops discount beconase aq on line, and also carries materials from the nerve terminals (e allergy shots asthma cheap beconase aq 200MDI otc. When an axon is cut, proteins required for its regeneration are made available by the nerve cell body. In the spinal cord, a damaged axon is often prepared to regrow, and often has available a supply of material to do so. Scientists believe it is the toxic environment surrounding the axon, and not the genetic programming of the axon itself, that prevents regeneration. Biofeedback: a process that provides sight or sound information about functions of the body, including blood pressure and muscle tension. Bladder outlet obstruction: any type of blockage that restricts urine from flowing freely from the bladder. Botulinum Toxin: better known as Botox, a neurotoxin used clinically to treat crossed eyes, wrinkles, and other muscle related issues, including overactive bladder and spasticity in people with paralysis. Bowel program: the establishment of a “habit pattern or a specific time to empty the bowel so that regularity can be achieved. Brown-Sequard Syndrome: a partial spinal cord injury resulting in hemiplegia, affecting only one side of the body. Bladder stones are easily removed; kidney stones may require lithotripsy (shock wave shattering) or surgery. Carpal tunnel syndrome: painful disorder in the hand caused by inflammation of the median nerve in the wrist bone; commonly caused by repetitive motion, including pushing a wheelchair. Splints might help; surgery is sometimes indicated to relieve pressure on the nerve. Catheter: a rubber or plastic tube for withdrawing or introducing fluids into a cavity of the body, usually the bladder. Cauda equina: the collection of spinal roots descending from the lower part of the spinal cord (conus medullaris, T11 to L2), occupying the vertebral canal below the spinal cord. For diagnostic purposes, a lumbar puncture (spinal tap) is used to draw the fluid. Clinical Trial: a human research program usually involving both experimental and control subjects to examine the safety and effectiveness of a therapy. Clonus: a deep tendon reflex characterized by rhythmic contractions of a muscle when attempting to hold it in a stretched state. Colostomy: surgical procedure to allow elimination of feces from a stoma that is formed by connecting part of the large intestine to the wall of the abdomen. People with paralysis sometimes get colostomies because of bowel care issues or skin care hygiene. Paralysis Resource Guide | 356 Complete Lesion: injury with no motor or sensory function below the zone of cord destruction, at the site of primary trauma. By immobilizing the “good limb a patient is forced to use the affected limb, leading in some cases to improved function. This is made possible by using a section of the stomach or intestine to create an internal pouch. Contracture: a body joint which has become stiffened to the point it can no longer be moved through its normal range. After the spinal cord terminates, the lumbar and sacral spinal nerves continue as a “freely moving bundle of nerves within the vertebral canal and are called the cauda equina (literally, horse tail. Crede maneuver: Pushing into the lower abdomen directly over the bladder to squeeze out urine. Cutaneous ileovesicostomy: A surgical procedure in which a piece of the intestine (ileum) is attached to form a tube from the bladder to an opening in the skin (called a stoma) on the lower abdomen. Cyst (post traumatic cystic myelopathy): a collection of fluid within the spinal cord; may increase pressure and lead to increased neurological deterio- ration, loss of sensation, pain, dysreflexia. Cystometric examination: an exam measuring pressure of forces to empty or resisting to empty the bladder. Cystoscopy: An examination of the urethra and bladder using a small, circular instrument called a cystoscope. Some intact but non-working nerve fibers might be coaxed into remyelinating, perhaps restoring function. The total length of dendrites within the human brain exceeds several hundred thousand miles. Depression: a mental health disorder characterized by low mood, low self esteem and loss of interest or pleasure in activities that were typically enjoy- able. Causes of depression may include psychological, psychosocial, hereditary and biological factors. Patients are often treated with antidepressant medica- tions as well as psychotherapy. Dermatome: map of the body that shows typical function for various levels of spinal cord injury. Detrusor sphincter dyssynergia: A loss of coordination between the urinary sphincter and the bladder. Diaphragmatic pacing: also known as phrenic nerve pacing; the rhythmic application of electrical impulses to the diaphragm, resulting in respiration for patients who would otherwise require a mechanical ventilator. Dorsal root: the collection of nerves entering the dorsal section (on the back) of a spinal cord segment. Double blind studies: neither the participating trial subject nor the investiga- tors, institutional staff or sponsoring company are aware of the treatment each subject has received during the trial. Less effective for pain arising from midthoracic and cervical areas; better suited for lower thoracic, upper lumbar pain in legs. Electro-ejaculation: a means of producing sperm from men with erectile dysfunction. Epidural stimulation: the application of a continuous electrical current—at varying frequencies and intensities—to specific locations on the lower part of the spinal cord. It involves implanting a device or stimulator over the dura of the lumbar section of the spinal cord. Epidural stimulation is being used to activate the nerve circuits in the spinal cord to provide signals that would normally come from the brain. If the testicle also becomes infected, the condition is called epididymo-orchitis. Ergometer: exercise machine, equipped with an apparatus for measuring the work performed during exercise. Foley: a catheter that remains inserted in the bladder, continuously draining to a storage bag. Other uses include correction of scoliosis, bladder control, electro-ejaculation, phrenic nerve stimulation, stimulation of cough. Genes are units of hereditary material located on a chromosome which, as a blueprint, determine a specific charac- teristic of an organism. Gizmo: condom catheter external device for collecting urine in males without bladder control. Astrocytes and oligodendrocytes are central nervous system glial cells; in the peripheral nervous system, the main glial cells are called Schwann cells. Glial cells are not involved in impulses (they are not “excitable), but play a very significant role in maintaining the proper environment for neural growth and survival. Treatment prescribes range-of-motion exercises and weight-bearing activity, can involve surgical removal if severe loss of function occurs. Hydronephrosis: a kidney distended with urine to the point that its function is impaired. Hypothermia: a technique to cool the spinal cord after injury; may reduce metabolic and oxygen requirements of the injured tissue; may reduce edema (swelling), which may reduce secondary nerve fiber damage. Important issue in emergency treatment and also for those with limited pulmonary function. Paralysis Resource Guide | 360 Immune response: the bodys defense function that produces antibodies to foreign antigens.

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The tumor is suspected to mus and optic chiasm tend to be large allergy symptoms like flu cheap beconase aq 200MDI with visa, soft allergy testing uk boots discount 200MDI beconase aq fast delivery, cyst- arise from reactive astrocytes (2 allergy shots eustachian tube dysfunction purchase beconase aq online pills. When the tumor arises within the There is considerable variability in the contri- optic nerve allergy shots for cats cost discount beconase aq online visa, it inltrates and engulfs the nerve to bution of each pattern to the overall histologic produce fusiform enlargement of that structure, appearance of pilocytic astrocytomas. Some tu- with peripheral extension into the surrounding mors have a predominance of the glial compo- leptomeninges. Brainstem pilocytic astrocytomas nent, whereas others show more of the piloid tis- are usually peripheral and are attached to the sue. The few reported cases have strate sufcient characteristic histologic features occurred in the chiasmatic-hypothalamic region that a denitive diagnosis can be rendered with in children less than 2 years of age; these tumors condence. However, the variety of histologic were associated with a higher rate of recurrence patterns among pilocytic astrocytomas and the and cerebrospinal uid dissemination (2,39. Occasional hy- be of tanycytic origin, leading some authorities to perchromasia and pleomorphism, especially when describe it as a “tanycytoma. In rare cases, some tu- Slow growth is the rule for most pilocytic as- mors, especially those arising in patients who un- trocytomas (41. However, some tumors, particu- derwent radiation therapy, may have frankly larly those of the optic nerve and chiasm, may malignant features (increased mitotic activity, show a propensity for periods of accelerated hypercellularity, endothelial proliferation, and growth (19. Growth of the tumor, especially necrosis with pseudopalisading) and also demon- those occurring in the cerebellum, may overrun strate aggressive biologic behavior (38. The growth dergo malignant transformation with an aggres- pattern of optic pathway glioma (including pilo- sive histologic appearance; such a tumor is called cytic astrocytoma) correlates with the presence or an anaplastic (malignant) pilocytic astrocytoma. This new vessel formation is particularly evi- and cerebral pilocytic astrocytomas have a well- dent within the cyst wall, and it is believed that demarcated appearance with a round or oval the uid within the cyst directly supports vascular shape smaller than 4 cm in size, cystlike features, proliferation (2) the presence of these glomeru- smooth margins, and occasional calcications loid vessels accompanied by extensive nuclear (Figs 2–4) (8,50,51. Most tumors (82% in one pleomorphism may mimic some of the features of series) are located near the ventricular system, high-grade astrocytomas (2,38. The increased and almost all (94%) enhance, typically intensely, vascularity of pilocytic astrocytoma may explain on postcontrast images obtained after intravenous why it may even be a target for metastatic disease, administration of contrast material (51. Findings from histologic anal- ysis conrmed pilocytic astro- cytoma with hemorrhage. Sig- nal intensity of the cyst is higher than that of cerebrospi- nal uid within the lateral ven- tricles, a nding indicative of hemorrhagic or proteinaceous content. As ex- regarded as the imaging study of choice for evalu- pected for a tumor of low biologic activity, the ation of pilocytic astrocytomas (24. Beliefs vary among neuro- with minimal to no cystlike component (17%) surgeons regarding whether to resect the cyst it- (Fig 8) (24. Some advo- onstrate the classic imaging manifestation of a cate complete resection, others biopsy, and still cystlike mass with an enhancing mural nodule. Removal of the cyst wall Although most cyst walls do not enhance, some has not been linked with improved survival (53. There is contradictory evidence in the litera- ferences in imaging manifestations of the two dis- ture regarding the most common location of pilo- eases may help establish the correct diagnosis cytic astrocytoma in the cerebellum. However, in another review of 168 cases, intraconal mass with characteristic kinking or 71% of the tumors were located in the vermis, buckling of the nerve secondary to the neoplasm whereas 29% occurred in the hemisphere (24. Location, enhancement, and the presence are typical, with variable enhancement following or absence of calcication seen at the time of ini- intravenous contrast material administration (21. The imaging ndings did not statisti- more than an academic curiosity, since the bril- cally correlate with the biologic behavior of the lary brainstem astrocytoma carries a dismal prog- tumors (58. Multiple cystlike masses and asso- available tissue for histologic analysis from this ciation with an area of gray matter heterotopia exquisitely sensitive region of the central nervous have been reported (59,60. Hemorrhage (Fig 3), system is generally limited, knowledge of the dif- either within the tumor or within the subarach- noid space, is a rare phenomenon (61–63. The small number of pilomyxoid astrocyto- minimally elevated, in contrast to signicant el- mas reported have occurred in the chiasmatic- evation noted in glioblastoma multiforme and hypothalamic region, with a tendency to have metastatic disease (61. Large cystic for an additional 2 years, and then annually after masses of the chiasm may be amenable to surgical 4 years from the time of treatment (68. A similar resection, thus allowing radiation therapy to be follow-up pattern is used to assess changes in pa- delayed (15. To avoid the deleterious effects of tients with pilocytic astrocytoma of the optic radiation therapy on the developing brain, che- pathway (16. Intraarterial delivery of indicated in patients with a single primary mass chemotherapy to treat recurrent disease has also and without corroborative symptoms (69. Other factors cytoma can also vary, depending on where it besides the native biologic behavior of the tumor arises. The increase in bral pilocytic astrocytomas is considered the 10-year survival rate (about 90% after 1970, com- treatment of choice and is generally regarded as pared with about 70% before 1970) has been at- curative when a gross total resection is attained tributed to improvements in neurosurgical tech- (4,6,22,24,54,68,70–72. For strictly avoided, given its risk of causing signi- patients with non–optic pathway pilocytic astro- cant morbidity in children younger than 5 years of cytomas, the most important factors for improved age and the absence of clinical proof that it pre- survival appear to be good neurologic status at the vents recurrence (71,72. Pilocytic astrocytomas arising in the optic is the key surgical objective, since the surrounding pathway or hypothalamus have the least favorable cyst occurs as a simple reactive change in most prognosis (75. However, neoplastic changes in the cyst conned to the optic pathway, the 17-year sur- wall, even in the absence of ndings at gross in- vival rate was 85%, compared with only 44% who spection or at imaging studies, have been docu- survived 19 years when the tumor extended into mented; these observations have led to consider- the hypothalamus (81. It is believed that many, if able debate among neurosurgeons regarding the not all, of the tumors in this latter group may rep- optimal surgical management of this structure resent the pilomyxoid subtype (82. Reoperation for recurrent disease is preferred, whereas radiation therapy or chemo- therapy is recommended for the treatment of multicentric or surgically inaccessible dissemina- tion (24,72. There are numerous reports of spontaneous regression of pilocytic astrocytomas arising in the optic pathway, diencephalon, and tectal region (75,87–92. Nu- merous theories have been proposed for this nd- ing and include postsurgical apoptosis (pro- grammed cell death), host immune reaction, thrombosis or infarction of tumor vessels, alter- ation of growth kinetics, removal of the offending carcinogen, genetic programming, and hormonal factors (89,94–98. Summary Contrast-enhanced sagittal T1-weighted the pilocytic astrocytoma has exceptionally slow image of the brain shows diffuse enhance- growth and a usually indolent biologic behavior ment (arrows) of the basilar cisternal that directly effects an extraordinarily promising spaces, with extension into the upper cervi- prognosis for patients with the disease. A cystlike mass (m) is seen ante- ized by its classic “cystic mass with enhancing rior to the brainstem. Recurrence imaging is essential in facilitating appropriate may be treated with a second surgical interven- therapeutic management. Although recurrence rates are low if gross total Acknowledgments: the authors gratefully acknowl- edge the contributions of case material from radiology resection has been attained, they are substantially residents worldwide to the Thompson Archives of the increased when only partial resection is achieved Department of Radiologic Pathology at the Armed (24. Most recurrences are noted within 4 years Forces Institute of Pathology, the assistance of Jessica of the initial surgery, although recurrent disease Holquin and Ingrid Jenkins in the preparation of the has been documented as late as 36 years after ini- images, and the assistance of Anika I. Survival rates among pa- tients with partial resection, compared with those References for patients with gross total resection, are not sta- 1. Surg Gy- Distant dissemination from pilocytic astrocy- necol Obstet 1931; 52:129–191. Pathology and genetics semination appears increased in three settings: of tumours of the nervous system. Treatment of juvenile pilocytic (b) for tumors that have been partially resected; astrocytoma. Ideguchi M, Nishizaki T, Harada K, Kwak T, 4 years of age at initial diagnosis (35,36,72. Pilocytic astrocytoma of the semination in reported cases tends to manifest velum interpositum. Juvenile pilocytic astro- dorsally exophytic brainstem gliomas: a distinct cytoma of the cerebrum in adults: a distinctive clinicopathological entity. Prognostic Tectal gliomas: natural history of an indolent le- signicance of type 1 neurobromatosis (von sion in pediatric patients. Intra- cephalic syndrome: clinical features and imaging cranial visual pathway gliomas in children with ndings. Amagasa M, Kojima H, Yuda F, Ohtomo S, tecture of optic nerve gliomas with and without Numagami Y, Sato S. Arch Ophthalmol 1980; 98: ing from an area of nodular heterotopia located in 505–511. Clin Neuro- Multiple cystic brain lesions in a patient with pilo- pathol 1999; 18:109–112. Persistence and cytic astrocytoma presenting as a spontaneous in- late malignant transformation of childhood cer- tracerebral haemorrhage in a child. De- thalamic pilocytic astrocytoma presenting with letions on the long arm of chromosome 17 in pilo- intratumoral and subarachnoid hemorrhage.

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Please note if making/ modifying equipment allergy shots while traveling purchase beconase aq without prescription, you may need to check with the relevant educational authority milk allergy symptoms 12 month old purchase beconase aq 200MDI without prescription, as there are safety requirements/ guidelines allergy treatment 3 antifungal purchase on line beconase aq. For example pollen allergy medicine in japan discount beconase aq online master card, in the game stuck in the mud, running can be replaced with skipping; students can take turns being disadvantaged in some way- such as wearing a blindfold; tying their legs together. Keep individualised scores/ times for children so that they are competing only against their personal best. Will they fnd it easier being in their walker, standing frame or their wheel chair Active Australia Schools Network Active Australia is the national initiative designed to encourage more Australians to become more physically active. Joining the Schools Network can offer support in areas such as professional development and resource material. Give it a go: including people with disabilities in sport and physical activity (Manual) produced by the Australian Sports Commission (2001) Tel: (02) 6214 1912 Ideas to promote inclusion in sports carnival. This handout from Cerebral Palsy Alliance is available from the students physiotherapist. Participation in Physical Education (1992) Kids First Publications, the Cerebral Palsy Association of Western Australia Available from the students physiotherapist Ten top tips for including students with differing abilities in physical education Handout produced by Ken Black (2002) Disability Sport Unit, Australian Sports Commission, Tel: (02) 6214 1415 Willing and Able is a project of the Australian Sports Commissions Disability Education Program. They run a series of workshops designed to help teachers to include students with disabilities in sport and physical activity. Sport & Physical Education 37 early school years fact pack 12 Ideas for Adapting Equipment the aim for students, including those with cerebral palsy is to participate in the class routines, play with other children and have a wide variety of educational learning experiences. Students all work towards becoming more independent and they need optimal opportunities to learn new skills. Sometimes it may be necessary to make some changes to equipment and plan how materials are presented so that students with cerebral palsy can participate in all parts of each lesson. At times the same equipment can be used but the student may need some help to get them set up ready to start, or some verbal or physical prompts to make sure they can keep going with the task. In each lesson, ensure the students are sitting or standing well, depending on the activity, with a good posture and balance. For some students with cerebral palsy setting up the lesson well with careful planning will enable them to complete the task successfully with reduced help. Ideas to consider: Writing: n Pencils and textas with a larger diameter are easier to hold. They are easier to hold because they open up the space between the thumb and index fngers allowing the student to use their fngertips more readily. A stabilising bar on the table that the student can hold or an adjustable height table could enable the student to put weight through their arms. Slope boards can also help left-handers to be able to see their work easier as a vertical surface can help to reorientate and straighten their wrist. These include: spring loaded loop scissors, mounted scissors and self-opening scissors. Using a ruler: Rulers can be adapted for students who have restricted use of their hands or for those who are unable to stabilise the ruler and draw a line. Some ideas for adapting rulers include: attaching door handles or knobs to make the ruler easier to hold and lining the base of the ruler with non slip matting or using magnets to hold the ruler in place as appropriate. They can be contacted on (02) 9808 2022 or Cerebral Palsy Alliance therapists can help you to make contact with this service. Ideas for Adapting Equipment 39 early school years fact pack 13 Using Technology Many students with cerebral palsy beneft from using technology equipment to assist with their learning and communication. Examples of technology equipment include using a communication aid or using a computer or note taker to help with their written work, as well as literacy and numeracy skills. Some students need their own computer or other alternatives to handwriting while others can access the classroom computer. Students with cerebral palsy may need to use a computer for the following reasons: n To help with poor handwriting skills n To develop the ability to present work effectively n To help develop organisational skills n To assist with literacy and numeracy skills n As a learning medium for attention and concentration diffculties If a student cannot access a standard mouse or keyboard, they may require an assessment by an occupational therapist to look at an alternative option. These options include using a switch or a different sized mouse or different keyboard options. Some examples are provided below: Bigkeys Kidstrack mouse Penny and Giles mouse There are also many software options available for students with cerebral palsy who have specifc learning needs. Some software packages include using pictures and symbols as well as words to teach literacy skills. It may impact on the stability of the trunk, and the student may tend to lean to one side. The student may also have diffculties with eating, saliva control, speech or vision. As the student grows, muscle imbalance can become more noticeable, especially during growth spurts. Students may need to wear splints on their arms and legs or have Botox™ injections to reduce muscle tightness and help improve their walking or hand skills. Parts of the body affected by cerebral palsy Students with hemiplegia tend to: n Have muscle imbalances, which can impair voluntary movements, balance and coordination. Managing schoolwork… n Encourage a symmetrical sitting position at the desk or on the foor. This will also improve attention and fne motor control (see Seating Factsheet 9) n Place the students desk facing the teacher and near the front of the class to minimise distractions n Leave adequate space on desk top for affected arm n Stabilise paper and desk top activities with non-slip matting n Curriculum may need to be modifed to ensure success in tasks. A student may need to be given less work to complete in the same time as peers n Encourage students to use two hands together in class work. You may need to modify the activity, and plan for more support and time (Factsheet 11) n Because of balance diffculties, consider spacing between furniture in the classroom and be aware of trip hazards (e. This information-packed website features fact sheets and brochures about various aspects of cerebral palsy, a glossary of terms, recommended reading, an extensive links page and a full list of Cerebral Palsy Alliance services. This excellent site contains a wealth of information for people with cerebral palsy, their families, carers and disability providers. The research section contains fact sheets designed to inform professionals and the public about recent medical fndings, treatments and therapies related to developmental disabilities. The causes and types of cerebral palsy are discussed and the ways that teachers and therapists work together to achieve positive outcomes for students are shown. During the video students address some of the feelings they have to wheelchair users, while students in wheelchairs explain why they use a wheelchair and how it works. Classmates and friends of students with disabilities will beneft from building positive attitudes and friendly relationships. Independent Living Centre An information centre about equipment and products for daily living. Jillian Powell Questions and answers around different disabilities and ways students can help. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. OverviewOverview this guideline covers diagnosing, assessing and managing cerebral palsy in children and young people from birth up to their 25th birthday. It aims to make sure they get the care and treatment they need for the developmental and clinical comorbidities associated with cerebral palsy, so that they can be as active and independent as possible. Adapt the communication methods and information resources to take account of the needs and understanding of the child or young person and their parents or carers. For example, think about using 1 or more of the following: • oral explanations • written information and leafets • mobile technology, including apps • augmentative and alternative communication systems (see recommendations 1. Information that may be useful to discuss includes the following: • communication diffculties occur in around 1 in 2 children and young people with cerebral palsy • at least 1 in 10 need augmentative and alternative communication (signs, symbols and speech generating devices) • around 1 in 10 cannot use formal methods of augmentative and alternative communication because of cognitive and sensory impairments and communication diffculties • communication diffculties may occur with any functional level or motor subtype, but are more common in children and young people with dyskinetic or severe bilateral spastic cerebral palsy • communication diffculties do not necessarily correlate with learning disability (intellectual disability. These may include pictures, objects, symbols and signs, and speech generating devices. When choosing which medicine to use, take into account the preferences of the child or young person and their parents or carers, and the age range and indication covered by the marketing authorisations. Common types of pain in children and young people include: • non-specifc back pain • headache • non-specifc abdominal pain • dental pain • dysmenorrhea. These include: • communication diffculties • comorbidities, particularly epilepsy and pain • side effects and drug interactions of multiple medicines (polypharmacy) • adverse effects of medicines used for managing mental health problems on motor function • adverse effects of medicines used for managing motor function on mental health • specifc social care needs. Sensory diffculties may include: • primary sensory disorders in any of the sensory systems, such as processing of visual or auditory information (for example, diffculties with depth perception may affect the ability to walk on stairs) (see recommendations 1.

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