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The increased research interest into the nature of clinical reasoning has been attributed to the increasing accountability of clinicians in the current health care climate managing diabetes 445 discount glucotrol xl 10 mg mastercard, and independent decision-making is a key characteristic of autonomous practice (Edwards et al. Assessment represents a process of gathering information for a number of potential purposes (Wade 1992). Accurate assessment is fundamental to , and inextricably linked with, the clinical reasoning process. Conversely, the nature of the clinical reasoning process will influence the way in which the assessment is performed with respect to its content and progression. Clinical reasoning is central throughout the whole process of assessment, intervention and evaluation. This would include analysis of posture, balance and voluntary movement, and the components that underpin them, along with appropriate and meaningful functional tasks for that person. It should focus on intervention to enable it to be goal orientated and specific to that person. It is closely integrated with intervention and is ongoing and progressive to capture not only current abilities or problems but also the changing potential and emerging recovery. Assessment is holistic, and therefore it is crucial that working cooperatively with other members of the multidisciplinary team underpins the therapeutic process. The clinical reasoning process is only completed when the therapist follows a process of reflection to evaluate the outcomes (Jensen et al. This chapter will not present a general description of the content of a neurological assessment as there are many examples of this that can be found in other texts (Freeman 2002; Kersten 2004). Instead, it will seek to illustrate the specific ways in which clinical reasoning takes place within the Bobath Concept and how this influences the way in which assessment is approached. Models of clinical reasoning and the Bobath Concept There are many potential influences on the decision-making process within clinical practice, and a number of models that underpin clinical reasoning have been identified and can be applied to the Bobath Concept. These models seek to explain the nature of clinical decision-making and provide a very useful means of reflecting upon current reasoning processes in order to further refine them. The literature highlights the potential interplay between differing paradigms of inquiry and knowledge within the overall clinical reasoning process. Diagnostic reasoning is identified as being rooted in a positivist paradigm and involves the assessment and measurement of specific clinical signs such as weakness, restriction in range of movement and reduction in postural control (Edwards et al. Included under the umbrella of diagnostic reasoning are specific models such as hypothetico-deductive reasoning and pattern recognition reasoning (Higgs & Jones 2008). Hypothetico-deductive reasoning involves the clinician gathering multiple items of data and using these to generate hypotheses about a cause-and-effect relationship. These initial hypotheses direct further evaluation leading to refinement of a hypothesis which is ultimately tested by the application of some form of clinical intervention (Doody & McAteer 2002; Hayes Fleming & Mattingly 2008). The outcome may be assessed either formatively or quantitatively, and depending upon the result of the intervention there may be a 45 Bobath Concept: Theory and Clinical Practice in Neurological Rehabilitation requirement to re-evaluate the hypothesis or consider the effectiveness of the treatment intervention. Pattern recognition reasoning is generally more evident amongst expert clinicians and involves the recognition of certain previously encountered clinical presentations (Doody & McAteer 2002; Jensen et al. It not only allows for a faster reasoning process but also represents a greater risk of reasoning error if domainspecific knowledge is inadequate.
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According to functional classification joints may be immovable (synartherosis) diabetes symptoms ulcers and staph infection order glucotrol xl 10 mg mastercard, slightly movable (amphiartherosis) and freely movable (diarthrosis). According to structure joints can be classified in to , fibrous, cartilaginous & synovial. The main function of the skeletal system is: a) Protection b) Storage of minerals c) Support d) Producing motion e) All of the above 2. The two type of ridged connective tissue found in the human skeleton are: a) Spongy & compact bone b) Bone & cartilage c) Periosteum & endosteum d) Metaphysis & Diaphysis e) Cancellous & bone plate 3. The major bone at the posterior aspect of the base of the skull is: a) Sphenoid b) Occiputal c) Temporal d) Lacrimal e) Zygomatic 105 Human Anatomy and Physiology 4. Describe the structure of a muscle Describe the connective tissue components of skeletal muscles Briefly describe how muscles contract List the substances needed in muscle contraction and describe the function of each Differentiate between isotonic and isometric contractions Define the following terms: origin, insertion, synergist, antagonist, and prime mover Define the different bases employed in naming skeletal muscles Identify the principal skeletal muscle in different regions of the body by name, action, and innervations. The muscular system, however, refers to the skeletal muscle system: the skeletal muscle tissue and connective tissues that makeup individual muscle organs, such as the biceps brachii muscle. Cardiac muscle tissue is located in the heart and is therefore considered part of the cardiovascular system. Smooth muscle tissue of the intestines is part of the digestive system, whereas smooth muscle tissue of the urinary bladder is part of the urinary system and so on. We will see how skeletal system 108 Human Anatomy and Physiology produce movement and we will describe the principal skeletal muscles of the human body; their action and innervation. Functions of muscle tissue Through sustained contraction or alternating contraction and relaxation, muscle tissue has three key functions: producing motion, providing stabilization, and generating heat. Motion: Motion is obvious in movements such as walking and running, and in localized movements, such as grasping a pencil or nodding the head. Stabilizing body positions and regulating the volume of cavities in the body: Besides producing movements, skeletal muscle contractions maintain the body in stable positions, such as standing or sitting. Postural muscles display sustained contractions when a person is awake, for example, partially contracted neck muscles hold the head upright. In addition, the volumes of the body cavities are regulated through the contractions of skeletal muscles. For example muscles of respiration regulate the volume of the thoracic cavity during the process of breathing. These movements rely on the integrated functioning of bones, 109 Human Anatomy and Physiology Much of the heat released by muscle is used to maintain normal body temperature. Physiologic Characteristics of muscle tissue Muscle tissue has four principal characteristics that enable it to carry out its functions and thus contribute to homeostasis. Excitability (irritability), a property of both muscle and nerve cells (neurons), is the ability to respond to certain stimuli by producing electrical signal called action potentials (impulses).
Not shown here diabetes symptoms gastroparesis discount glucotrol xl 10 mg buy online, but this reflection onto the pelvic viscera creates low points in both males and females. In the male peritoneal cavity, the reflection of peritoneum between the rectum and bladder forms the rectovesical pouch. In the female peritoneal cavity, the reflection of peritoneum between the rectum and posterior wall of the vagina and uterus forms the rectouterine pouch. From this posterior view, the relationship between the greater and lesser sciatic foramina can be appreciated. The arteries and nerves that exit the pelvis through the greater sciatic foramen are the sciatic nerve, the superior gluteal artery and nerve, and the inferior gluteal artery and nerve. Recall that the piriformis muscle passes through the greater sciatic foramen and that the obturator internus muscle passes through the lesser sciatic foramen to attach to the femur. Differences between the male and female pelvis relate to pregnancy, child birth, and muscular support. The female pelvis is wider to support the fetus during pregnancy and the anterior portion of the pubis bone is shallower with a more obtuse pubic arch angle. Also the female pelvic inlet is more oval (to allow for passage of the fetus during childbirth). The perineum is the area that is located inferior to the pelvic floor and is contained inferiorly by the skin. It is important to remember that in this area, structures that are superior in the perineum are considered deep and structures that are inferior in the perineum are considered superficial. The perineum is a diamond-shaped area: pubic symphysis anteriorly, the tip of the coccyx posteriorly, and the ischial tuberosities laterally, with a line between the ischial tuberosities separating the perineum into the anal triangle and the urogenital triangle. Within the anal triangle the levator ani muscle can be seen forming the superior boundary of the perineum (the pelvic floor). The external anal sphincter muscle lines the anal canal and aids in controlling the anus. The ischiorectal fossa is a fat-containing area between the ischial tuberosities and levator ani muscle that allows for distension during defecation. The ischiorectal fossa of the anal triangle communicates with the urogenital triangle. The urogenital triangle is bound posteriorly by the superficial transverse perineal muscles. Specifically, the pudendal canal is located within the fascia of the obturator internus muscle. It transmits the internal pudendal artery, the pudendal nerve, and the perineal nerve (a branch of the pudendal nerve) after re-entering the pelvis through the lesser sciatic foramen. The muscles that can be found in the perineum are split between the anal and urogenital triangles and located just deep to the skin and fascia.
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Lisk, 21 years: These changes, including an increase in sympathetic discharge, can temporally compensate for the heart failure. Supine was actively created and the left knee was positioned out of hyperextension whilst the foot was more specifically assessed. Congenital pulmonary stenosis born with a narrowing of the opening between the pulmonary artery and the right ventricle. The intervertebral symphysis is a wide symphysis located between the bodies of adjacent vertebrae of the vertebral column.
Owen, 65 years: They are experience dependent and are therefore learned responses modified by feedback (Mouchnino et al. In the discussion of individual agents that follows, reference should also be made to Table 19-2 for the electrophysiologic actions of representative antiarrhythmic drugs. Note the irregular pattern of collagen (orange) and elastic (purple/black) fibers throughout the tissue. Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishers have made every effort to ensure that such references are in accordance with the state of knowledge at the time of production of the book.
Ernesto, 33 years: Bone-marrow suppression is a well-recognized complication of immunosuppressive drugs such as azathioprine, methotrexate, leflunomide, sulfasalazine, cyclophosphamide and mycophenolate mofetil, which are used to treat rheumatoid arthritis, psoriatic arthritis and lupus. They leave the blood vessels and proceed by ameboid or ameba-like motion to the area of infection. Ideation of the goal of walking and creation of the initial postural set are essential for the initiation of the first step. Synarthroses are immobile or nearly immobile joints with adjacent bones strongly linked together.