Orthopaedic Management Of Cerebral Palsy Health And Social Care Essay

Orthopaedic Management Of Cerebral Palsy Health And Social Care Essay The condition of cerebral palsy refers to a varied group of permanent disorders of movement and posture caused by injury to the immature brain in utero, at birth or in the first years of life. These lesions are static not progressive and can be caused by a wide variety of factors such as intrauterine infections, trauma, neonatal stroke and genes, often in combination. Reflecting the varied aetiology and sites of injury cerebral palsy is often accompanied by neurological disturbances in cognition, behaviour, sensation and epilepsy. Most significantly from the orthopaedic perspective is that it leads to a progressive musculoskeletal pathology and abnormalities of muscle strength, tone and joint movement. These tend to be hidden at birth and are only revealed during the rapid growth of childhood as spasticity leads to abnormal posturing and thus secondary contractures and impaired torsional bone remodelling. Eventually this process leads to problems such as scoliosis, hip dislocation an d the development of fixed contractures.1 It is here that orthopaedic surgery can intervene by correcting fixed deformities leading to improved function and appearance. Cerebral palsy is the most common cause of referral to elective paediatric orthopaedic units.2 This essay will discuss the various surgical techniques that can be employed to tackle the musculoskeletal problems caused by cerebral palsy. Classification Cerebral palsy is classified based on the type of movement disorder present. The spastic form is the predominant type and can be divided into the subcategories of hemiplegic, diplegic or quadriplegic depending on topography. Appropriate management varies between these forms based on the level of functional outcome that can be expected; the most significant factor being whether the child is ambulant or not. It was the advent of gait analysis in the 1990s that revolutionised treatment of ambulatory cerebral palsy. Prior to this surgical intervention to improve gait was a matter of opinion, and often led to unexpected new problems which were even more intractable. The systematic empirical approach of gait analysis, however, enabled both more targeted and precise interventions and also critical evaluation of the outcomes of surgery.3 http://www.cpl.org.au/images/default-source/research/cp-body-map-graphics.jpg?sfvrsn=2 [Image 1: Distribution of symptoms in subtypes of cerebral palsy. Source: Cerebral Palsy League4] Modern gait analysis takes place in a specialised laboratory and includes a standardised physical exam, video recording, kinematic and kinetic measurements, electromyography, pedobarography and estimation of the energy consumption of walking.5 Age Generally speaking surgery for ambulant CP is not attempted until after the age of 7 by which time a mature gait pattern has developed. Between this age and the onset of the growth spurt in adolescence bone surgery is sometimes required in order to stabilise the bony levers of progression in the leg. These include femoral or tibial derotation osteotomies, intertrochanteric derotation of the femur and stabilisation of the subtalar complex.6 It is between the ages of 8 and the main adolescent growth spurt (12-13 in girls, 13-14 in boys) that soft tissue surgery is undertaken, the ideal timing remaining contentious.7 Increasing maturity and awareness allow for more complex surgeries that require strict compliance with rehabilitation programmes to succeed. Yet this must be balanced against the effects of the rapid growth of bone and muscle that may exacerbate and complicate deformity. Surgery for spastic diplegia Despite advances in the usage of botulinum toxin A, intrathecal baclofen and selective dorsal rhizotomy to reduce spasticity most children with cerebral palsy still develop progressive musculoskeletal deformities as they grow. These include fixed joint contractures and bony deformities collectively referred to as lever arm disease and which can only be treated effectively surgically.8 In the past a child with spastic CP typically presented with toe-walking and was managed by lengthening of the tendo Achillis. Although this procedure successfully levelled the foot it often led to a crouch gait as contractures of the knee and hip developed progressively in late childhood. Nowadays there is a strong consensus that the best approach is to gait correction is to address all deformities simultaneously in what is known as single-event multi-level surgery.9 Correcting fixed contractures is achieved by either fractional lengthening or muscle-tendon recession. Established procedures include tenotomy (lengthening) of the psoas muscle at the pelvic brim, rectus femoris transfer to semitendinosus or sartorius and fractional lengthening of the medial hamstrings. To correct bony torsional abnormalities necessitates rotational osteotomies. For femoral anteversion and concomitant hip internal rotation, femoral derotation osteotomy has proven to produce very effective and durable results.10 In order to correct a valgus foot deformity there are two options; a lengthening osteotomy of the os calcis or more commonly an extra-articular subtalar joint fusion utilizing an autogenous graft of bone from the iliac crest combined with a screw fixation .11 Spastic hemiplegia The most common joint deformities in the upper limb include internal rotation of the shoulder, elbow flexion, forearm pronation, wrist flexion and ulnar deviation, and swan-neck and thumb-in-palm deformities in the digits .12 Muscular injection with BTX-A can be useful in managing stiffness and increasing range of movement but is not effective at improving function.13 As with gait correction deformities in the upper limb are treated in a one-stage multilevel operation combining muscle releases and tendon transfers. The most common procedures are biceps aponeurosis and pronator teres release for pronation of the forearm, tendon transfers to extensor carpi radialis longus or brevis for ulnar deviation/wrist flexion (with first web z-plasty) and first dorsal interosseous and adductor muscle release with tendon transfer for thumb-in-palm.12 Patterns of gait in spastic hemiplegia have been classified comprehensively by Winters et al. and can be used to plan surgical management. In groups I and II the primary abnormality is drop foot due to equinus contracture which can be treated by lengthening of the gastrocsoleus muscle and appropriate orthosis. The situation is more complex, however in groups III and IV which require multilevel surgical intervention and gait analysis due to the involvement of proximal muscles leading to jump knee gait and in the case of group IV fixed hip flexion on top of equinovarus. These can be managed in the same way as soft tissue deformities in spastic diplegia by fractional lengthening or muscle-tendon recession.14 [Image 2: Saggital gait patterns in hemiplegia: classification and management. For each group: contractures shown in orange text, orthoses in green, surgical correction in red. Adapted from Winter et al.14] Tendon transfers to correct muscle imbalances are also employed in hemiplegia. This is most useful for equinovarus deformity, which is treated with split tendon transfer of the tibialis posterior (useful in the younger patient with more flexible deformity) or anterior combined with lengthening of the gastrocsoleus and tibialis posterior (better for older children with stiffer deformity).15, 16 Another possible problem in hemiplegia is limb shortening, presenting most commonly in the tibia and ranging from 1-3 cm. If necessary operative correction can be achieved by epiphysiodesis at the end of growth plates proximal to the knee at the appropriate age.7 Spastic Quadriplegia Surgical management of a child with spastic quadriplegia is particularly challenging owing to the presence of multiple co-morbidities such as epilepsy, osteopenia, respiratory disease and nutritional deficiencies. As such it requires the close co-operation of a multi-disciplinary team to manage possible complications as well as follow-up in terms of pain and intensive care. A variety of tests are important to help assess suitability for surgery. Lung function tests are used to evaluate the likely necessity of protracted assisted ventilation after the operation. Testing serum total protein and albumin levels is used to spot malnutrition associated with poor wound healing and infection. Detection of osteomalcia due to anti-epileptic medication is important and must be treated, and improving general nutritional state through supplementation is often desirable. Finally, identification of the degree of osteoporosis due to disuse is relevant in assessing the stability of any surgical fixat ion desired.7 Hip Management Hip displacement is rarest in spastic hemiplegia at 1%, uncommon in spastic hemiplegia at 5%, but much more common in spastic quadriplegia with an estimated incidence of 35-55%.17 If left untreated it may lead kyphotic sitting posture and pelvic obliquity increasing the risk of spinal deformity as well as chronic hip pain and increased difficulties in activities of daily living. In hemiplegia and diplegia the gait is so severely impacted that subluxation is identified early due to rapid orthopaedic referral. In quadriplegia, however, due to the higher visibility of issues such as seizures and feeding difficulties and the fact hip displacement is hidden in the early stages, it often can go undetected. Thus systematic radiographic screening is vital to detect it early with one study recommending commencing at 30 months and following up every 6 months thereafter.18 When abnormality is detected it is best to intervene early to try to prevent dislocation. The favoured soft tissue surgical approach is adductor and psoas tenotomies.19 If dislocation has already been established more drastic intervention is required with a single-stage open reduction of the hip, combined with a varus shortening derotation osteotomy of the proximal femur, which relieves pressure from the rim of the acetabulum stimulating growth and balancing the soft tissues by re-tensioning the hip abductors and relaxing the adductors, and a pelvic osteotomy to improve the shape and coverage of the acetabulum.20 Although this procedure offers the best long-term prognosis in terms of stability, further dislocations are not infrequent.21 Scoliosis Scoliosis in cerebral palsy can be non-structural secondary to femoral and pelvic muscular spasticity or structural secondary to contractures of the intrinsic spinal muscles. In non-ambulant patients it often extends to the sacrum and is associated with poor sitting posture, pelvic obliquity and hip dislocation. Prevention of these is thus vital to reducing the risk of distortion of the spine. Surgically the established management of severe scoliosis is instrumented posterior fusion along the length of the spine to the pelvis.6 Conclusion As surgical techniques for correcting deformities have proliferated and been refined in recent decades so the orthopaedic management of cerebral palsy has progressed from art to science. We are now in the pleasing position of having a tried and tested toolbox of procedures to deploy in the common musculoskeletal pathologies induced by diplegia, hemiplegia or quadriplegia. Yet a tool is only useful if it is used in the right place and so it is arguably the standardised assessment provided by gait analysis as well as improved understanding of the development of gait that has made the most difference by allowing clinicians to target interventions precisely temporally and anatomically to ensure the best outcomes. Although validated evaluations exist for the upper arm they have yet to reach the same level of reliability and universality as gait analysis, a desirable goal for future research. It is also important to remember that orthopaedic interventions can only ever ameliorate rather than solve the lifelong disabilities caused by cerebral palsy. For this reason it is vital that management first and foremost takes into account the desired outcomes of patients and carers including concerns such as cosmesis and independence. Likewise it is important to emphasise functional outcomes rather than abstract measures of deformity as these are in the end more important to patients.

Online information system Essay

1. INTRODUCTION 1.1 BACKGROUND OF THE STUDY Future university’s training unit deliver training services to both novice and professionals in different areas of information technology core courses, arts and design, programming languages as well as basic studies manually. Interested individuals enroll in any of the available courses only by going to the university’s training unit. Also there is no means of advertising these services which is vital to those in search of it, somehow there is need for the training center to have a fully functional system that serve the same purpose online 24/7. 1.2 SITE OF THE PROJECT Future University 1.3 NATURE OF THE PROJECT Web based application 1.4 SIGNIFICANCE OF THE STUDY The significance of the study is that it will help in designing a system that will provide services online to subscribers of training programs. The training unit can also make use of the outcome of this study for the purpose of providing effective and convenient services to its subscribers. When completed the system will provide the following benefits: 1.It will provide user convenience since it can be accessed from anywhere around the globe through the internet. 2.It will serve as a means for the trainers to handle large number of trainees from different locations around the world at a time. 3.The proposed system will provide an advertisement functionality for the global reach of the training unit. 4.The online services will also provide easy access to information. 2. PROJECT DESCRIPTION 2.1 PROBLEM STATEMENT 2.1.1General problem There is no online system by which the training unit can advertise its training services in order to gain recognition worldwide. And the records of  information is done manually. 2.1.2 Specific problem 1.Registration of trainees is done manual therefore requiring large amount of paper work. 2.Bulk amount of papers occupy most of the office space and cost a lot of money. 3.The training unit has no means of creating awareness apart from the university’s medium. 4.There is no proper scheduling of courses and this may cause trainees’ dissatisfaction. 2.2 PROJECT OBJECTIVES 2.2.1 General Objectives To develop a web application that will deliver the same services in more efficient and effective way. 2.2.2 Specific Objectives 1.To include a database system within the application to store retrieve, manipulate, secure and save data. 2.To add interactive graphics to support awareness creation on the web as e-advertisement. 3.To develop a module that will provide a convenient scheduling for the training. 2.3SCOPE AND LIMITATION 1.The proposed system will cover the issues of awareness by including advertisement functionality. 2. Subscribers of the training and the trainers supposed to have a forum for further discussions but unfortunately that will not be covered in this project. 3.This project will not cover the payment system. 2.4 Methodology Traditional waterfall model. 3. PROJECT MANAGEMENT 3.1 Resources Requirement for Development For the purpose of developing the system the following resources are required 3.1.1Hardware requirements The hardware needed for the development process is a computer system with the following specification HardwareDescription ProcessorCore i5 Random Access MemoryRAM 6GB Hard disk 750 GB 3.1.2 Software requirements SoftwareSpecification ServerII express Server Side Scripting LanguageAsp.net IDEVisual studio 2013 professional for web 3.2 Resources Requirement for Deployment 3.2.1 Hardware requirements The hardware needed for the deployment process is a computer system with the following specification

Social Media Negative Effects on Body Dissatisfaction - Free Essay Example

Sample details Pages: 6 Words: 1769 Downloads: 1 Date added: 2019/04/10 Category Society Essay Level High school Tags: Social Media Essay Did you like this example? Body Image is the way someone perceives and assumes how others perceive of them (DoSomething.org | Volunteer for Social Change). This image is often affected by family, friends, social pressure, and the media (DoSomething.org | Volunteer for Social Change). More and more studies are showing media may have the biggest impact on body dissatisfaction in young adults. Don’t waste time! Our writers will create an original "Social Media Negative Effects on Body Dissatisfaction" essay for you Create order Fifty-three percent of 13-year-old American girls are unhappy with their bodies. This number grows to 78% by the time they reach the age of 17. Over 50% of teen girls and 30% of teen boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives (Gallivan). Social media continues to have a negative effect on young adults and teenagers personal physical appearance. Social media has made a big impact on the world since it first became a thing in 1997, when a social media site known as Six Degrees was created (Hendricks). Web-based social networking is the group of online interchanges channels devoted to network-based information, communication, sharing information, and joint effort. Social media is mainly used to stay in touch with friends and family that you dont see every day. The psychological impacts of the broad communications depiction of the ideal body can make individuals resort to undesirable techniques for getting in shape to accomplish that athletic look that such many want. For example, people who think they are overweight dont eat, for the basic certainty that they need to shed pounds which can result to dietary problems like bulimia and anorexia. Bulimia is a nourishment issue caused by mental uncertainties and specialists prescribe that individuals who endure bulimia should see a therapist, and the manifestations incorporate enthusiastic exercise, taking intestinal medicines, and hurling, which can make ones body turn out to be short on electrolytes. Anorexia is a comparable condition in which one loses over the top measures of weight regularly by eating almost no and retching a little measure of nourishment that is really expended. Likewise men who think they are not solid take destructive substances, for example, steroids to develop their muscles, a risky demonstration that may jeopardize their wellbeing. Previously, the two people (predominately men) who were marginally overweight utilized a fat consuming medication known as Redux. It was intended for corpulent people, however the off-mark utilization of such medications ended up uncontrolled because of promoting systems by the makers. Numerous individuals, including specialists, who were marginally overweight utilized the medication and have encountered pneumonic hypertension, valvular coronary illness, and neurotoxicity. Different medications, for example, steroids, have been generally demonstrated to cause mind malignant growth, hindered development, and shrinkage of the testicles .Numerous understudy competitors utilize these execution enhancers trying to end up as solid as the men frequently depicted by media. This issue is available in female adolescents too. To a few young ladies, steroid use is practically identical to consume less calories pills and intestinal medicines. The maltreatment of these medications is mostly an aftereffect of wrong promoting and additionally the youngsters longing to look and execute and in addition the geniuses appeared in different types of media. Many young women and men use social media for multiple purposes, including, but not limited to: keeping in touch with family and friends, making new friends, expressing themselves, distraction from their bad days, and many more. The researchers surveyed almost 1,500 teens and young people aged 14 to 24 from across the U.K. to score how each of the social media platforms they use impacts 14 specific factors related to their health and well-being (Welch). Facebook is an extremely well-known person to person communications site with more that eight hundred million clients. Facebook has made it more accessible for cyberbullies to thrive. They can harass and/or gang up on one person even easier than they could in a school environment (Barricella). Instagram is a long-range interpersonal communication app made for sharing photographs and recordings from a cell phone. Much like Facebook and Twitter, anyone who has an Instagram account has a profile and a news source to their friends and familys posts. Snapchat is an application for cell phones that enables supporters of send photographs to different endorsers. Be that as it is, Snapchat enables clients to set a 1-10 second lapse on the photographs. Snapchat was developed by Evan Spiegel and Bobby Murphy, two Stanford University students who were convinced that emoticons were not enough to transmit the emotion that a person might be wishing could be sent with a text message (Parker). Snapchat can be a fun and connecting with application when utilized suitably. It ought to be utilized precisely and with quite certain standard procedures or not utilized by any stretch of the imagination. Applications like Snapchat remind guardians that we should be cautious about our youngsters cell phone utilize and to screen their action to anticipate issues like sexting, cyberstalking, cyberbullying or different components of the clouded side of cell phone use by our kids. ASU graduate research associate Lydia Manikonda states, Instagram users are using the face filter to express themselves, and adding the filters leads to more views and comments (Myers). The use of the filters have become out of hand and are being way too much. If you were to scroll through Instagram or look at your friends stories on Snapchat and Facebook, more than a majority of those would have a filter on them. Is social media good? Tim Cook made his point clear when he stated: I may not have a kid, but I do have a nephew that I put boundaries on, said the Apple CEO when visiting a group of college students in London not too long ago. There are some things that I wont allow; I dont want them on a social network (Gibbs). Before, presentation to photographs or articles were essentially found in conventional media; in any case, the openness of the web today has brought about an unbounded exhibit on the web. The world we possess is coming to pass into an immersed place driven by symbolisms, which constrain [narrower] measures of magnificence than at any other time. One of the best impacts the web has on self-perception, is the making of internet-based life. Clients are always assaulted by warnings, posts, and photographs about the lives of others; sending messages about what we could, should, or would be on the off chance that we just obtained certain items, settled on specific decisions, or occupied with certain behaviors. Despite the capacity to make and control content via web-based networking media, the equivalent unattainable body standards we see in conventional media are additionally reflected in the online condition. Over-commitment with long range informal communication stages and pictures will in this way, likewise support a mental reception of improbable magnificence goals , [which] can prompt poor self-perception and low self-esteem. What can we do to change? Other than the negative and some positive effects on young adults; Facebook, Instagram, and Snapchat they have in common is the filters. Some of the filters have different effects such as heart eyes, dog face, and many more. Yet some of these filters seem to have a different effect than meant. As an endeavor to handle such issues, the UK propelled a national crusade called Be Genuine, after discoveries indicated 76% of auxiliary school understudies who found out about body trust in class felt progressively positive about themselves. The objective of this development was along these lines to enhance body certainty through instructive assets gave to schools, and inducing the media, organizations, and the eating regimen industry to support distinctive body shapes and sizes. Regardless of the negative results of mechanical progressions adjusting the impression of a persons self-perception and psychological wellness, the development of web-based life is yet helpful. Parallel to conventional media, it might be utilized as an apparatus to share and spread body inspiration. Informal communication destinations and applications at last form a stage for clients to stand up on issues, with numerous industry insiders using their online use to challenge for change. Past systems brands and influencers have tried incorporating, the advancement of a positive self-perception through mainstream hashtags and promoting efforts, and the development of gatherings that help self-esteem and the forbidding of body disgracing. Because of the analysis of online life driving dietary issues, stages, for example, Instagram, have restricted the utilization of thinspiration and thins related hashtags. Different arrangements incorporate change photographs, and the advancement of hashtags, for example, #SelfLove and #BodyPositivity. Change photographs are next to each other pictures showing a persons wellness or weight reduction advance. Although, it intends to fill in as motivation for individuals hoping to change themselves physically or live more advantageous lives, a few clients have used this system to exhibit the dimension of misdirection inside web-based life. In like manner, with an end goal to effectively help those experiencing dietary problems, Dietary problem Expectation propelled the Professional Recuperation Development. The task included facilitating of live Twitter visit urging sufferers to commend self-esteem and a positive self-perception, through recuperation topics. Different associations, for example, Task Recuperate, presented a battle called #WhatMakesMeBeautiful, with the point of celebrating diverse abilities, identities, and other non-appearance related characteristics that additionally make one delightful. This development was particularly effective among the dietary issue network; consequently, stressing the requirement for internet-based life developments that commend self-esteem and taking a gander at excellence through an alternate focal point. VIP culture is known as one of the primary impacts on self-perception for this age. Concentrates around there have been done with the lions share demonstrating that review media pictures influences members capacities to accurately evaluate the size and parts of their own bodies. We are exposed to photoshop so frequently when they were demonstrated a scope of photographs of celebrated VIPs the ladies with body disappointment reliably pick the photographs of the big name being photoshopped to look skinnier than the first. References Abramian, Alexandria. Forcefield. 25 July 2018. . Bain, Marc. Quartz. 23 May 2017. . Barricella, Nick. TurboFuture. 13 June 2012. . Desreumaux, Geoff. WeRSM We Are Social Media. 17 October 2018. . DoSomething.org | Volunteer for Social Change. n.d. 23 November 2018. . Facebook Newsroom. 2018. . Gallivan, Heather R. Park Nicollet Melrose Center. 18 May 2014. . Gibbs, Samuel. The Guardian. 19 January 2018. . Hendricks, Drew. Small Business Trends. 06 May 2013. . Hudson, Matthew. The Balance Small Business. 23 June 2018. . Instagram. 2018. . Maccabee, Emily. THe Odyssey Online. 28 August 2017. . Makwana, Bindal, et al. The Inquisitive Mind. Ed. Eiko Fried. n.d. . Meshioye, Anu. Dublin Bussines School. March 2016. . Moreau, Elise. Lifewire. 19 November 2018. . Myers, Jessica. The Arizona State Press. 18 April 2018. . Nations, Daniel. Lifewire. 20 November 2018. . Parker, Wayne. Verywell Family. 25 September 2018. . Puglia, Deanna R. Chapel Hill. 2017. . University, Fielding Graduate. Internet Safety | United States | Cyberwise. 11 July 2017. . Webwise.ie. 8 August 2018. . Welch, Ashley. CBS News . 23 May 2017. .

Human Resource Staff Plan for Burger Works Free Essay Example, 2500 words

It is evidently clear from the discussion that the role of various experts at the restaurant will be outlined and as such eliminate role duplication and ambiguity. The second part will cover assigning the identified roles to the specific experts at the restaurant. The manager will assign specific duties to each team for the undertaking. Procedures of coordination between the various departments will follow because the group will be working as a team. Modes of relation and association appear specified in the third step. The particular departments that entirely depend on others also appear in this section. Growth from one level to another will be sequential namely completion of one tier before stepping into the next. One team will complete work in some parts before another team jets in to commence its part. Therefore, provision of work timelines for specific teams remains crucial. Section 4 will cover very significant aspects as illustrated in the guideline. Time allocation in this pa rt will depend on the volume of work assigned to each team. Definitely, different teams will have different amounts of work. Summing the departmental timeline gives the approximate duration over which the human resources staff planning will take. We will write a custom essay sample on Human Resource Staff Plan for Burger Works or any topic specifically for you Only $17.96 $11.86/page