By Z. Yasmin. Emerson College. 2018.

Some authors argue that participation in alternative therapies represents an over- all disenchantment with biomedicine (Furnham and Kirkcaldy 1996) benicar 10mg with visa blood pressure patch. These contrasting views have been conceptualized as the push/pull debate by Furnham and Smith (1988), among others (Vincent and Furnham 1996; Kelner and Wellman 1997; Sharma 1990). The question becomes: Are people pushed away from allopathic medicine and, as a consequence, pushed towards alternative therapies, or are they pulled towards alternative health care and, consequently, pulled away from allopathic medicine? However, the explanations for why people turn to alternative health care subsumed within the push/pull debate are problematic for a number of reasons, not the least of which is that what are commonly reported in the literature as motivating factors in people’s use of these therapies did not figure prominently amongst the people who participated in this research. In general, the people who spoke with me did not turn to alternative therapies for ideological reasons; they were neither seeking a holistic approach to health and health care, nor seeking control over matters of Why People Turn to Alternative Therapies | 43 health and healing. Nor does dissatisfaction with allopathic medicine alone sufficiently explain why these people first engaged in alternative approaches to health and healing. Rather, in participating in alternative therapies, they were actively seeking relief from problems for which they found little or no redress in other quarters. However, the people who took part in this research rarely identified ideological issues as reasons for their decisions to first seek out alternatives. While these informants made reference throughout their interviews to a variety of ideological components of the alternative model of health and healing they espouse, including a belief in the value of a holistic approach to health care or therapies that allow them to take control of health and healing, these beliefs were almost never voiced in conjunction with the accounts they gave of why they first turned to alternative therapies. Furthermore, while dissatisfaction with allopathic medicine was mentioned by informants as concomitant with their initial participation in alternative forms of health care, it proves problematic to attempt to explain an individual’s use of these therapies solely through a dissatisfaction with allopathic medicine. Control That alternative therapies allow individuals a greater degree of control over their health and health care is often specified as a motivating factor in people’s participation in these therapies (Furnham and Beard 1995). For example, in talking about her encounters with her naturopath, Grace said, “She encouraged me to take control. For instance, Trudy was one of the two who indicated that her interest in holism predated her initial foray into alternative approaches to health and healing: I had a bladder infection and I knew that there was more to it. I realised that there was a lot more to it in terms of the whole psychology. I could understand that my body was responding to my own thinking and I was responding to my environment with my thinking. I came from a family of alcoholics, so I was also looking for my healing, so I got involved with the Wellness Centre. Again, it was only through their experiences with these therapies, and in interaction with alternative practitioners, that the vast majority of these informants came to espouse alternative ideologies, including a belief in holism. For example, it was long after he first participated in alternative therapies that Greg began learning about alternative ideology from his practitioners: “They [practitioners] try and I listen and it’s kind of, well it’s [their] show and I’m not going to tell [them] how to conduct the symphony. However, these informants did identify dissatisfaction with allopathic medicine as something concomitant with their decisions to turn to alternative health care.

Another condition that cuts across the four causal categories is pressure ulcers (decubitus ulcers) discount 20mg benicar overnight delivery blood pressure 8660, which occur where bony structures press into sur- rounding tissues of people who are immobilized, seated, or bedridden for long periods. Pressure ulcers can become profoundly debilitating and life-threaten- ing, particularly among institutionalized persons with severely impaired mo- bility. But among people living in the community, less than 4 percent of those with major mobility problems report pressure ulcers, as do 0. For people with amputations above the knee, the prosthesis must include not only a foot-ankle complex but also a knee joint, allowing persons to sit, climb stairs, walk up and down inclines. Complicated biomechanics make this prosthesis more difficult and expensive to devise, and it requires more training to use than below-the-knee prostheses. Sophisticated prostheses can substan- tially restore mobility, even permitting performance in rigorous competitive sports among athletes with high amputations. The NHIS-D asked about sensory and other physical functions (Table 3) but did not indicate whether mobility difficulty caused or resulted from prob- lems. These data on use of cigarettes, snuff, and chewing tobacco come from the 1994 Healthy People 2000 supplemental questionnaire administered along with the 1994 NHIS-D. Exact percentages are 28 for minor, 30 for moderate, and 29 for persons with major mobility difficulties. Be- fore broad-spectrum antibiotics became available, urinary tract infections killed many people with spinal cord injuries, who generally must use catheters or other instrumentation to evacuate their bladders. Today, these infections re- main the leading reason for medical services, with more than half of people with spinal cord injuries developing urinary tract infections each year (Berkowitz et al. I write this revision just over a year after the 11 September 2001 terror- ist attacks on the United States. What future airport security will entail is still evolving, as it becomes a federal responsibility. I resumed traveling by air about a month after the attacks and found that little had actually changed for 300 / Notes to Pages 54–55 me when passing through airport security, although the request to remove my shoes is physically difficult and seems perhaps excessive. Anecdotal reports suggest that airlines’ performance was mixed when it came to accommodating passengers using wheelchairs even before 11 September. Williams, decided 8 January 2002, a unanimous court ruled against Ella Williams, who had argued that her carpal tunnel syn- drome prevented her from performing her job at a Toyota manufacturing plant. Williams was not “disabled” because she could still perform routine tasks at home, such as brushing her teeth and gar- dening—in other words, that her condition did not limit “major life activities” (thus implicitly viewing employment as outside “major life activities,” the standard used by the ADA to describe disabling conditions). Another impor- tant case was Board of Trustees of the University of Alabama et al. In this case, two employees of Alabama sued the state for money damages under Title I of the ADA.

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The final common (efferent) pathway for these responses is the facial nerve nucleus and facial (VII) nerve discount benicar 20 mg overnight delivery arteria lingual, the afferent limbs being the trigeminal (V), optic (II), and auditory (VIII) nerves respectively. Electrophysiological study of the blink reflex may demonstrate peripheral or central lesions of the trigeminal (V) nerve or facial (VII) nerve (afferent and efferent pathways, respectively). It has been reported that in the evaluation of sensory neuronopathy the finding of an abnormal blink reflex favors a nonparaneoplastic etiology, since the blink reflex is normal in paraneoplastic sensory neuronopathies. Journal of Clinical Neuro-ophthalmology 1992; 12: 47-56 Cross References Balint’s syndrome; Blinking; Corneal reflex; Glabellar tap reflex Body Part as Object In this phenomenon, apraxic patients use a body part when asked to pan- tomime certain actions, such as using the palm when asked to demon- strate the use of a hair brush or comb, or fingers when asked to demonstrate use of scissors or a toothbrush. Ideomotor apraxia in patients with Alzheimer’s disease: why do they use their body parts as objects? Neuro- psychiatry Neuropsychology and Behavioral Neurology 2001; 14: 45-52 Cross References Apraxia “Bon-Bon Sign” Involuntary pushing of the tongue against the inside of the cheek, the “bon-bon sign,” is said to be typical of the stereotypic orolingual move- ments of tardive dyskinesia, along with chewing and smacking of the mouth and lips, and rolling of the tongue in the mouth. These signs may help to distinguish tardive dyskinesia from chorea, although periodic pro- trusion of the tongue (flycatcher, trombone tongue) is common to both. Cross References Chorea, Choreoathetosis; Trombone tongue Bouche de Tapir Patients with facioscapulohumeral (FSH) dystrophy have a peculiar and characteristic facies, with puckering of the lips when attempting to whistle. The pouting quality of the mouth, unlike that seen with other types of bilateral (neurogenic) facial weakness, has been likened to the face of the tapir (Tapirus sp. Cross References Facial paresis Bovine Cough A bovine cough lacks the explosive character of a normal voluntary cough. It may result from injury to the distal part of the vagus nerve, particularly the recurrent laryngeal branches which innervate all the muscles of the larynx (with the exception of cricothyroid) with result- ant vocal cord paresis. Because of its longer intrathoracic course, the left recurrent laryngeal nerve is more often involved. A bovine cough may be heard in patients with tumors of the upper lobes of the lung (Pancoast tumor) due to recurrent laryngeal nerve palsy. Bovine cough may also result from any cause of bulbar weakness, such as motor neu- rone disease, Guillain-Barré syndrome, and bulbar myopathies. New England Journal of Medicine 1997; 337: 1370-1376 Cross References Bulbar palsy; Diplophonia; Signe de rideau Bradykinesia Bradykinesia is a slowness in the initiation and performance of voluntary movements, one of the typical signs of parkinsonian - 58 - Broca’s Aphasia B syndromes, in which situation it is often accompanied by difficulty in the initiation of movement (akinesia, hypokinesia) and reduced ampli- tude of movement (hypometria) which may increase with rapid repet- itive movements (fatigue). It may be overcome by reflexive movements or in moments of intense emotion (kinesis paradoxica). Bradykinesia in parkinsonian syndromes reflects dopamine depletion in the basal ganglia. It may be improved by levodopa and dopaminergic agonists, less so by anticholinergic agents. Slowness of voluntary movement may also be seen with psy- chomotor retardation, frontal lobe lesions producing abulia, and in the condition of obsessive slowness. Cross References Abulia; Akinesia; Fatigue; Hypokinesia; Hypometria; Kinesis paradoxica; Parkinsonism; Psychomotor retardation Bradylalia Bradylalia is slowness of speech, typically seen in the frontal-subcorti- cal types of cognitive impairment, with or without extrapyramidal fea- tures, or in depression.

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While voca- tional rehabilitation programs supposedly assess clients for assistive devices that could restore employment generic 20mg benicar heart attack kidz bop, SSDI and SSI recipients are not systemati- cally evaluated for technological fixes, such as power wheelchairs. Very few people receive special aids or technologies for vocational rehabilitation: 8 per- cent of persons with major mobility problems; and 2 percent of those with minor and moderate difficulties. He and his wife lived on her earnings, awaiting the verdict in his lawsuit. The precipitating incident was Harry’s fall out of bed: “I didn’t even realize I had fallen! My wife got the police to come down, as they always do, and put me back in bed. Halpern ended his long-term relationship with his oncologist because the volunteer could no longer drive him into Boston. While walking symbolizes independence within our personal microenvi- ronments, cars extend independence beyond distant horizons. Beyond its symbolic 120 / Outside Home—at Work and in Communities import, driving also has immediate practical utility. Increasing physical distances separating shops, work, home, friends, and family complicate daily life for people who do not drive. Harry Halpern couldn’t get his hair cut, and now he has changed his physician. Patients who forgo driving often lose independence, compromise their ability to work and provide for their dependents, and have dif- ficulty maintaining social contacts, continuing involvement in per- sonal interests, and participating in community activities. These losses have profound implications for many patients in terms of emotional and physical well-being, quality of life, and evaluation of self-worth. Crash rates for drivers 15 to 19 years old exceed those for persons 85 and older (2,000 versus 1,500 per 100 million miles). Physician organizations, such as the American Medical Association, have tried specifying legal and ethical obligations of physi- cians to report persons who should no longer drive, but these efforts have proved controversial. Physicians fear breaching patients’ confidentiality, and medical contraindications to driving (apart from severe dementia, like Alzheimer’s disease, and very low vision) are not clear-cut. Driving ability relating to progressive chronic conditions varies widely from person to person. One study of older persons found walking speed and distance had no effect on motor vehicle incidents, although limited neck ro- tation significantly heightened risks (Marottoli et al. Another study assessed driving abilities of people with arthritis and back problems (Jones, McCann, and Lasser 1991). Almost everybody could drive safely and com- fortably after making simple adaptations, such as moving from manual to automatic transmissions and using special seating cushions. Among people with major mobility difficulties, 48 percent say they never drive, compared to 32 percent with mild problems. Some interviewees had completely abandoned driving, although several older women had never learned. Now chauf- feured by their wives, several men asserted that they will someday reclaim the driver’s seat.

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