By M. Kalan. Concordia College, Saint Paul Minnesota. 2017.
Rosie has full custody of her 8-year-old son 60mg cardizem free shipping, and Rusty has his 9-year-old daughter from a previous marriage for six months at a time. This couple immediately de- scribed a fighting cycle of Rosie attacking, Rusty defending, and then withdrawing. Rusty had once kicked a dent in the car, and each reported screaming at the other. After these fights, the couple did not speak for up to three days, and Rusty would sleep in the guest bedroom. Typi- cally, after three days, they reported getting so exhausted that one of them would give up, and the other would be receptive. The arguments, however, were never resolved, and this vicious cycle quickly came around again, get- ting "worse each time. They had attended previous counseling from 179 180 THEORETICAL PERSPECTIVES ON WORKING WITH COUPLES their pastor, who then referred them for professional therapy. Segments of their therapy will be used to illustrate the clinical application of emotion- ally focused therapy (EFT) and how it fits in the current field of couples therapy. THE CHANGING FIELD OF COUPLES THERAPY The field of couple and family therapy is signaling its readiness to move into a less-radical postmodernism and develop in an integrative direction (Johnson, 2003b; Johnson & Lebow, 2000; Linares, 2001). Linares describes how the stage is set for a shift into an ultramodern family therapy, one that expands the systemic field and leads to both new achievements and new adherents. Johnson describes how a revolution is occurring in the field and how couple therapy is coming of age. She lists common integrative elements of contemporary approaches (Johnson & Denton, 2002). Scholars stress that contemporary approaches must move beyond a bag of tricks mentality (Lid- dle et al. Absent from these observa- tions are the messianic tendencies that in the past have been part of the couple and family therapy field (Johnson, 2001). In contrast to the next new way of thinking mentality, these authors describe a field desiring to use knowledge from expanding areas of psychology and break bread with other treatment approaches and disciplines historically viewed as existing outside of MFT circles.
Clinical Approach to the Older Patient 153 Evaluating the Patient patient is dressed appropriately to the outside tempera- ture cardizem 120 mg fast delivery. Accordingly, examining rooms should be kept be- Much of what has been written on evaluation of the older tween 70°F and 80°F. Brighter lighting is required for patient is simply attention to the details of careful clini- adequate perception of the physician’s facial expression cal assessment. Contemporary emphasis on efﬁciency and gestures by the older patient, whose lenses admit less and effectiveness of clinical care requires thoughtfulness than half the light they did in youth, due to cross-linking about any extension of the already lengthy evaluation of lens proteins. Brief screening questions background noise more distracting and interferes with rather than elaborate instruments are appropriate for the patient’s hearing. Even in a quiet setting, the high- ﬁrst encounters52; more detailed assessment should be tone loss of presbycusis makes consonants most difﬁcult 35 to discriminate; speaking in a lower-than-usual pitch will reserved for patients with demonstrated deﬁcits. Even at its most parsimonious, the initial evaluation of older help the patient hear, and facing the patient directly will patients with multiple disorders and treatments will gen- improve communication by allowing lip reading. The erally be prolonged, as compared with time needed for patient’s eyeglasses, dentures (to enhance the patient’s younger persons. Dividing the new patient assessment speech), and hearing aid (with a functional battery) into two sessions can spare both patient and physician an should always be brought to and used at the physician exhausting and inefﬁcient 2-h encounter. Chairs with a higher-than-standard seat or a personnel can collect much information by questionnaire mechanical lift to assist in arising are useful for frail older before the visit, from previous records, and from patient persons with quadriceps weakness, and a broad-based and family before the physician’s contact. It is essential step stool with handrail can make mounting and dis- that good care, fully informed by current geriatrics mounting the examining table safe. Drapes for the knowledge, be delivered within a reasonable time alloca- patient should not exceed ankle length so as not to be a tion consistent with contemporary patterns of primary risk for tripping and falling. One hour for a new visit and 30 min for a follow-up are an absolute maximum in most environments. The Acute Hospital or Nursing Home Completing a home visit may also provide valuable The patient room is commonly the site of evaluation for insight into a patient’s environment and daily functional the nursing home resident or hospitalized older adult. How mobility may affect function in a particular Little is different in evaluating older persons in the hos- environment, real insight into nutrition, medication use pital; the patient is usually conﬁned to bed, so that safety and compliance, and social interactions and support can and comfort are dictated by the hospital amenities. In one well- other considerations relevant in the ambulatory setting designed trial, in-home comprehensive geriatric assess- apply.
DEWEY’S VIEW OF SITUATIONS buy 60 mg cardizem with mastercard, PROBLEMS, MEANS AND ENDS111 THE STRENGTHS OF DEWEY’S THEORY, IN SUMMARY a. It is Possible to Reason About Value While denying the existence of external sources and criteria for the grounding of values involved in choosing our ends, Dewey nevertheless shows that such values are not arbitrary. They arise in the interaction of our embodied, biological natures with social and material environments. It is true that these natures and environments differ in great degree from one instance to the next, but Dewey shows that such differences have their limits. What individuals and groups have in common as revealed by reflection on and the investigation of human nature is vastly more considerable than individual biological differences, or cultural and environmental ones. Because of our shared psychobiological and social proclivities, we can share ideas about the range of reasonable response in problematic situations. With mindfulness toward these commonalities, there can be meaningful dialogue about value choices, and it is not true that "anything goes. Dialogue about value is thus very possible, while enforced, absolute agreement has no valid basis. Means and Ends are Mingled Dewey shows that means and ends are not things in themselves, but aspects of things in relation, and he shows this, as we have seen, in rich detail. It is enlightening to recognize that actions and objects have value in both their roles as means and as ends, processes and products mediating and giving immediate satisfaction. We can benefit by caring about means not only because of the ends toward which they are mainly directed, but also because we live there with them as ends themselves, and as means to many things other than the initially intended end. When means are judged in terms of all their consequences, including the accidental and unintended ones, the concept of "efficiency," whereby means are judged simply in terms of their contribution toward an intended end becomes highly suspect. In terms of that showcased end, the unrelated consequences are "side effects," "externalities," and sometimes "bonuses. But we still, by and large, fail to recognize the positive immediate values and positive unintended consequences of processes which are seen solely as means to a directed goal.
You will notice that the ranges (in newtonmetres cheap cardizem 60 mg line, Nm) for the flexion/extension and abduction/adduction moments are of the same order of magnitude. This is an excellent example of the potential danger in assuming that gait is purely a two dimensional activity, and therefore casts some doubt on concepts such as the support moment proposed by Winter (1987). We do not have force plate information for the second right foot contact (although we do have kinematic data up to 1. Medial Distal Internal and Normal adult male 50 Joint Dynamics Right 25 Hip Moment (N. Summary We have finally reached the furthest point up the movement chain the joint forces and moments in our efforts to determine the causes of the observed movements. This state of indeterminancy has been solved by some researchers using mathematical optimization tech- niques (Crowninshield & Brand, 1981; Davy & Audu, 1987), but their pre- dictions of individual muscle tensions have been only partially validated using electromyography. In chapter 4 you will learn some of the fundamentals of electromyography particularly their applications to human gait. We do not intend to suggest that EMG is the ultimate tool for understanding human gait, but we hope that you will find there are some definite uses for the technique in the field of locomotion studies. Much of the confusion surrounding EMG analysis stems from an inad- equate understanding of what is being measured and how the signal is pro- cessed, so we discuss some basic methodological issues first. These include basic electrochemistry regarding the operation of electrodes, selection of sam- pling frequencies, and signal processing methods. Next, we review the phasic activity of the major muscle groups involved in human gait. Finally, we study how these muscles interact with one another and reveal some basic patterns using a statistical approach.
If you have a tendency to retropulse (to walk backward) purchase cardizem 120mg with mastercard, then always keep one foot back when you stand still. When you walk, keep your body upright and as tall as possible: if your upper body is leaning forward (as is frequently the case with people who have Parkinson’s), you will fall more easily. A trick that dancers use to help them stand tall is to imagine that they are suspended from the ceiling (or the sky) by an elastic string attached to the top of the head; the elastic string exerts a gentle pull upward. Some people with Parkinson’s have a tendency to speed up as they move along, until they can no longer control their speed and balance. Some peo- ple with Parkinson’s like to use a walking stick, rather than a cane, because the stick helps them to stand up straighter. In stores, take advantage of the shopping cart: it frees you from having to carry items and using one steadies your walk. Some people with Par- kinson’s use walkers, but a walker that you have to lift and walk with is not suited to everyone because of the many different movements that it requires at one time. The walker should have brakes on the handles so that it won’t roll out of control. When you walk, you can free your hands by carrying your money, keys, medication, and identification in a fanny pack strapped around your waist; you don’t have to carry a handbag. Some people sew large pockets with Velcro closures onto their clothes and on the insides of their coats to hold their personal items. When you turn, make a U-turn (walk in the pattern of the letter U), instead of piv- oting in place. For some reason, people with Parkinson’s often "freeze" when they approach a doorway, a doorsill, a scatter rug, a step, or a curb, but others freeze when they are merely walking along or crossing a street. To break the freeze, you must use a little trick to get yourself moving again before you lose your balance and fall. Some people are able to break a freeze by imagining a line or a small object on the floor and stepping over it. To deal with rising from a fall, it may be a good idea to prac- tice getting down onto the floor and getting yourself up, once a day. If you can’t seem to get up, crawl over to the nearest stable object or railing and pull yourself up.