Effect Of Maitland Mobilisation Health And Social Care Essay

Effect Of Maitland Mobilisation Health And Social Care Essay Patient is a 35 years old golf coach. Patient had a history of going over his ankle on both sides. General health status of the patient is good. Patients activity ranges from a round of18holes of golf and driving range for 60mins a day. Patients activity includes more walking. The main problem of the patient is pain and stiffness in right ankle. Patient had a history of slowly developed pain and stiffness over the last 4months during his full time coaching job. The aggravating factors of his problem were powerful driving range shots for 30mins and walking for 40mins. The easing factors of his problem are rest and heat for 40mins. In the 24hours pattern of pain, patient has stiffness on rising and which gets easier with gentle activity. On palpation there is puffiness to anterior and lateral aspect of right ankle. On examination the resisted dorsiflexion is weak and painful. There is a decreased range of motion of active plantar flexion. In passive plantar flexion pain is produced after resistance. The resisted plantar flexion is weak and painful. Active range of motion of inversion is reduced and painful. During passive inversion pain is felt after resistance. Resisted inversion is weak and painful. Resisted eversion is weak. In accessory movement of talocrural joint, postero-anterior glide is stiff and the pain is produced at the end of range. In the distal tibio-fibular joint, longitudinal cephalad glide is painful before resistance and during postero-anterior glide the patient feels easier. The muscles are weak on both sides of ankle. The right ankle is weaker compared to left ankle. Anterior talo-fibular ligament and calcaneo-fibular ligaments show bilateral laxity. On palpation there is puffiness around the lateral malleolus. Heel raise of the patient is poor, which is 5 on right and 10 on right side. SEVERITY, IRRITABILITY, AND THE NATURE OF PAIN According to Petty (2006) severity and intensity of pain are related together. Severity can be determined by the ability of the patient to maintain the position or movement. Severity is a main factor to determine whether the patient may be able to tolerate overpressure and perform movements up to the first point of pain. According to Hartley (1994) the perception of pain differs from person to person depending on the individuals emotional status and his previous pain experiences. The intensity of pain depends on the number of nociceptors in the site of injury and the surrounding tissues. Intensity of pain can be more in the areas of high innervation than the area of poor innervations. According to Hengeveld Banks (2003) the intensity of pain is subjective and it varies from person to person. In this case the intensity of pain of the patient is 4/10 of visual analogue scale. The patient can play a round of18holes of golf a day and practices on the driving range for 60mins a day. He also walks for a long distance. In spite of pain the patient was able to perform his activity. So the patients severity of pain may be low to moderate. Hengeveld Banks (2003) says that irritability depends on activity causing the pain, the intensity of the activity and the time taken for the pain to subside after the activity is stopped by the patient. According to Petty (2006) irritability can be determined by the time taken for pain symptoms to ease. The symptom is said to be irritable, when the symptom persist after the activity producing pain is stopped. If the symptoms are irritable the patient will not be able to tolerate movements for longer durations. The symptoms may even get worse with activity. So the testing movements should be done with caution. In this case the aggravating factors are powerful driving rage shots for 30mins and walking for 90mins. Similarly the easing factors are rest and heat for 40mins. So the irritability of patient may be moderate to high. However according to Hartley (1995) aching pain is related to the structures like deep ligament, deep muscles, tendon sheath, chronic bursa, compact fascia. Further Magee (2008) argues that, when pain is caused by an activity and eases with rest indicates that there is a mechanical problem which is related to movements. Occasional pain may indicate that there is a mechanical involvement and it is related to movement and mechanical stress. In this case the pain is intermittent and deep in nature. The patient has pain after activity and the pain resolves with rest. So the pain may be mechanical, intermittent and deep in nature MANUAL THERAPY TREATMENT In this case, the main problem of the patient is stiffness rather than pain, in the right ankle. Maitlands grade4 mobilisation with postero-anterior glide of talus on ankle mortise can be given to improve range of motion of plantar flexion. The glide can be given in grade 4, because it is stable and controlled compared to grade3 (Hengeveid Banks, 2003). Here the ankle mortise is a concave surface and the dome of talus is convex. When ankle mortise is fixed and talus is moved, plantar flexion occurs by concave-convex rule. (http://www.pt.ntu.edu.tw/hmchai/Kinesiology/KINmotion/JointStructionAndFunciton.htm, Date accessed: 13/12/2009) However before treatment the important factors that should be taken into account are patients objective marker of pain, loss of range of motion and movements causing pain and these factors should be evaluated after treatment sessions. In Maitlands technique, there is no standard duration for the treatment, but the duration of the treatment should not be more than 2minutes. The duration of the treatment can be altered based on the severity, irritability and nature of the symptoms of the patient. Since the irritability of the patient is moderate to high, the initial treatment can be given for the duration of 30 seconds, with one or two repetitions to avoid exacerbation of the symptoms. After observing the objective marker, duration of the treatment can be progressed to 1 to 2mins and the repetitions can be progressed gradually. The patient can be positioned in prone lying with knee in 90 degree flexion. The starting position of the therapist can be standing by the side of patients righ t knee to have close contact with the treatment area. To give proper support to the shin, the left knee is placed on the couch. The therapist can perform the postero-anterior glide by holding the posterior surface of the calcaneus in his right hand with his thumb, fingers fanning around the calcaneus and his left hand held in supination, with his heel placed against the tibial anterior surface and the therapists fingers are proximally pointed. These positions can be followed to stabilise the part. The force can be applied by movement of the forearms opposing each other. The movement of the therapists forearms produce postero-anterior glide (Hengeveld Banks, 2003). Even though, there are literatures supporting the effectiveness of joint mobilisations, there is not enough controlled studies to prove that joint mobilisation can restore the normal range of motion and functions of hypomobile joint effectively (Farrel, J.P Jenson, G.A. 1992) EFFECT OF MAITLAND MOBILISATION Maitlands technique, are based on restoring arthrokinematic movements. Generally arthrokinematic motion of the joint can be restricted by the ligaments, capsules of the joint and periarticular fascia. The elastic properties of these connective tissues are based on the arrangement of the collagen bundles. In ligaments and tendons, the collagen bundles are arranged parallel to each other with elastic bundles in between them. When the connective tissue structures are unloaded, the collagen bundles show a crimp formation in their structure. This crimp results in production of slag in the connective tissue structure. During the phase of loading, slag is stretched first, followed by the stretching of main bundles. In contrast the fascia and aponeurosis have multilayer collagen bundles but have less crimping and slack compared to ligaments. Initially when the load is applied, structures with less slack are first subjected to stress, followed by the other bundles. The bundles of the fascia w hich have least slag will first resist the tensile stress. If the stress is increased then the ligaments which have more slag will resist the tensile load. After further deformation, the other bundles will act to resist the stress. To obtain elongation of the connective tissue on the whole, all the bundles should be subjected to required stress. This principle can be explained with the help of stress strain curve. In this graph, x-axis represents the stress and y-axis represents the corresponding strain produced by the load. The curve shows a slope, which indicates the connective tissue resistance to a load. The collagen bundles which are still slag, represent the toe region. The curve also represents the physiological loading range, which is then followed by the stage of microscopic failure. If the stress still increases the curve will proceed to the stage of macroscopic failure and may even result in the rupture of the connective tissue. Based on this concept Maitlands grade 4 technique aims to produce permanent elongation (plastic deformation) of the tissue by inducing low level of micro-failure in the connective tissues, there by increases the range of motion (Therkeld, 1992). There is no enough evidence to prove that Maitlands mobilisation can be done in full weight bearing and functional position. Its reliability is based on the clinicians treatment experience and patients reaction to the treatment (Farrel, J.P Jenson, G.A. 1992) SECONDARY TREATMENT The other problems of the patient are poor heel raising due to the weakness in the muscles of ankle joint and pain. In this case Maitlands grade1 mobilisation can be given to reduce pain by pain gate mechanism. As the patient is a golf coach, he needs good heel rising and strong ankle muscles for good performance in the game and to prevent further injury to ankle joint. Strengthening exercises to the muscles of plantarflexion, dorsiflexion, inversion and eversion can be taught to the patient to correct the muscular imbalance of the patient. Then the heel raising should be encouraged gradually and can be progressed if there is no pain. Balance training with the help of wobble board can be taught to the patient. The final phase of treatment is functional training. The patient can be trained to gradually increase the intensity and the duration of drive shots in the game. Walking can be encouraged in a stable surface. CONCLUSION Additional to manual therapy the effective means of rehabilitation of sports injuries should consist of soft tissue massage, electrotherapeutic modalities, proprioceptive neuromuscular facilitation, strengthening exercises, co-ordination training, endurance, flexibility, improving stability and educating the patient about the injury mechanism and methods of prevention (Farrel, J.P Jenson, G.A. 1992). Sports therapist should mainly concentrate on prevention of the injury rather treating when the injury has occurred.

Simba Chips

Simba Packaging: Simba is re-launching the iconic potato chipbrand with a new look and feel to drive additional interest in the snack aisle. The re-launch is focused on refreshing the range of fun and flavourful potato chips to address consumer needs whileboosting brand exposure in retail outlets. A South African icon for 56 years, Simba is committed to further investing in its brand by continuously updating its image to appeal to shoppers and consumers alike and provide easier on shelf navigation and presence.This contemporary new design includes a bigger and more prominent Simba The Lion, capitalising on the loved and easily identifiable icon. At the top center of the packet, is a modified brand logo re-introducing the famous crown that makes it The Unmistakable King of Snacks. The changes made to the packaging are significant, yet the product range retains the key elements that have made Simba a recognisable South African brand for so many years. Additionally the large 125g packet will come in a thicker film to enhance the look and feel on shelf.Part of the research conducted by Simba included elements to ensure that the fundamentals of the new design are assembled centrally on the pack, making it easier for the consumer to track all the important product information at a glance. ‘At Simba we are extremely proud of this fresh look, which marks an exciting new chapter for the brand. The new packaging will help to revitalise the brand and contribute to continued growth. We are confident that this updated look will appeal to all customers while keeping the brand firmly in touch with Simba’s rich heritage’ says Rita Fernandes, Senior Brand Manager for Simba.The brand re-launch will be supported by a full marketing campaign including a television and radio commercial, sampling activity, PR and in store branding. The campaign will communicate the changes to customers and ensure that while their favourite Simba product may have had a makeover, i t’s still the same Simba taste experience inside the pack. The refreshed look of the range is not the only big news from Simba. The party bag size (200g) will also be launched concurrently with the packaging re-launch, giving consumers a format for the socialising and party occasion.

Discussion of Literature Set in Dystopian Societies Essay

This paper takes a look at three renowned dystopian authors; George Orwell, Anthony Burgess and Aldous Huxley and compares the dystopian societies that are described in their respective novels 1984, A Clockwork Orange and Brave New World. The ways in which the rights and freedoms of the citizens in each of their novels are suppressed and controlled is described with particular reference to the use of propaganda, language, sexual relationships and violence. The paper will progress to consider the ways in which the protagonists attempt to rebel from their situation and overcome cruel and unfair laws in order to escape the society. In discussing the ability of characters to overcome the unjust constraints of their society, it is worthwhile considering in some detail what a dystopian society is and how it is manifested. The concept of dystopia is inextricably related to the idea of Utopia, a theory that was developed originally by Plato in Republic and further explored by St Thomas More in Utopia. Whereas Utopia is envisaged as a perfect society where subjects live peacefully side-by-side, dystopia is the antithesis of this; â€Å"dystopia was invented to denote a bad place. Utopia expresses desire, dystopia fear† (Aldridge, 53). Quite often a dystopian society is one that is believed to have formed as a direct result of unsavory actions that were taken in order to achieve a utopian society; the methods used to solve problems and assert control lead to undesirable outcomes. In literature a dystopian society often has a number of distinct characteristics. One of which is the manipulation of one group of people by another. A Clockwork Orange, 1984 and Brave New World (BNW) are all examples of novels that depict such a society. In all three novels a minority group of people have acquired the power to control the citizens and they utilize this to command and dictate every element of their subject’s lives. Psychological oppression is in evidence in all three novels and the characters are limited in their thoughts and expressions. In both 1984 and A Clockwork Orange, the dystopian society is represented by violent and disturbing images. Fear and hate is utilized as a means of controlling the population and, as described by O’Brien in 1984, a strong correlation is formed between mental and physical being, â€Å"We control matter because we control the mind. Reality is inside the skull† (Orwell, 331). The prime emotion that is encouraged in the population is that of fear and the threat of brutality and torture the protagonists face entail that they are able to suspend even their own thoughts in order to evade punishment. Winston permits himself to think only of those subjects and issues that he has permission to think of, whereas Alex specifically avoids thoughts of violence in order to eliminate the chance he will become violently ill as a result of the side effects of the Ludivico he experienced at the government’s hands. In both cases the protagonists are no longer able to freely express themselves, their fear psychologically controls them and their entire mental thought processes altered as a direct result of this. Whilst A Brave New World, also describes a society where people’s thought processes and actions are controlled, this control is achieved in a very different way; through drugs and sex. Immediately form birth, the citizens are physically, chemically and psychologically encouraged to be happy and content. Where, in 1984 and A Clockwork Orange, the characters are punished for rebelling against the constraints of the society in which they are placed, in A Brave New World the people are provided with rewards for following the doctrines of their leaders. In this novel the subjects are conditioned from an early age to accept the values of the ten world leaders and they are indoctrinated to a value system that is based on superficial pleasures. The leaders thus control their society by limiting their aspirations and desires; the people accept simple things and are thus unlikely to rebel against their leaders. In all three novels, the ways in which the dystopian society is controlled is physically and visually represented by the use of propaganda. In 1984 the government literature, videos and advertisements are aimed at enforcing the state of fear that they have created. Reality is purposely altered in order to inspire feelings in the nation, feelings that can ultimately be used by the government to assert control and prevent rebellion. Clearly the propaganda utilized in 1984 is very effective and stirs strong emotions in Winston and the people in his social group and he describes the effects as they watch a film and experience, â€Å"a desire to kill, to smash faces in with a sledgehammer seemed to flow through the whole group of people,† (Orwell, 16). In A Clockwork Orange propaganda is also of immense significance and is utilized to control the feelings and emotions of the subjects. In this novel, two main forms of propaganda exist. The Ludivico Technique represents an outright propaganda, where the subject takes drugs and observes negative images in order to form associations with such images. In Alex’s case watching the repetition of violent images causes him to feel physical pain at the thought of violence and thus the propaganda serves to stem his aggression. Mass media is also utilized, as in 1984, and subliminal messages are utilized to encourage the populace to obey the state. Propaganda is observed in the posters in Alex’s home and the effectiveness of this is evidenced by impact that the images have upon him both prior to, and post, his Ludivico treatment at the state’s hands. Prior to his experience he seems unable to associate with the graffiti ridden images in the poster and he cannot recognize the significance of the visuals. However, after his treatment the poster appears clean and renewed and is able to fully recognize their message. A Brave New World also features the use of propaganda as a means of controlling the emotions and free will of the citizens. Fordisms are used to assert the supremacy of their leader and the inhabitants of society are fed subliminal messages as they sleep. They have no free will and thus become dehumanized. A further means by which the dystopian society engendered and controlled within the three novels in through the encouragement, or discouragement, of social interaction. In 1984 the subjects of society are sexually repressed and sex is permitted for procreation purposes only, â€Å"to beget children for the service of the Party† (Orwell, 69). Sex is no longer associated as being pleasurable and natural but instead becomes an unemotional procedure. In A Clockwork Orange Alex is unable to accommodate thoughts of sexual pleasure as his treatment entails that he now associates this with violence and thus experiences pain at the thought of partaking in a sexual act. His inability to behave as a normal man transpose him into the â€Å"clockwork orange† (Burgess, 96), he is a machine incapable of experiencing and fulfilling his natural urges. In both 1984 and A Clockwork Orange the mechanical, unemotional feelings attributed to sex and lust serve to dehumanize the characters and thus prevent them from feelings and emotions that could place the rule of the governments at risk. In Brave New World the government openly encourages sex as it is recognized as a means by which sexual desire can conquer and eliminate all other emotions. In this novel babies are artificially created in laboratories and sex therefore serves the purpose of pleasure alone. Family units cannot be formed as babies are without parents and thus the subjects do not form bonds and have become promiscuous. Although the use of sex as a control mechanism is different, like 1984 and A Clockwork Orange the intention is the same, to remove emotions from the subjects. A crucial characteristic of the regimes in place within the dystopian societies concerns language and communication. Language, as a means of communicating and forming relationships with others in society, is suppressed and with it is the extent of human interaction. The limit on language in all three books serves to limit free thought. In 1984 Newspeak is utilized as a means of brainwashing members of society and forcing them to think in a predetermined manner. In both Brave New World and 1984 the government’s intention to diminish the vocabulary reflects their plans to further diminish the thoughts of their public; without the words to communicate they are unable the commit thought crime, â€Å"In the end we shall make thought crime literally impossible (†¦) there will be no words in which to express it†. (Orwell, 200-201). In A Clockwork Orange Alex’s use of language acts as a means by which he can rebel from society. Nadsat allows him to communicate with the members of his gang and thus achieve the human interaction that the government attempts to suppress. In addition to this it serves as a means by which the unwelcome behaviors exhibited by Alex can be separated from the rest of the society, who, as with 1984, do not have a vocabulary capable of expressing such words. A further commonality between all three novels is that of rebellion, with the main characters in all three books actively rebelling against the system into which they have been indoctrinated. Winston, Alex and John all begin to question the merits of their society and, in all three cases they utilize a past reference as a means against which they can assess their current situation. For Winston this is his diary (which allows him to record the past and therefore have a term of reference), for Alex it is his meeting with Pete and for John it is Shakespeare’s Othello that acts as a significant prompt. Winston’s rebellion is manifested in three main ways. He commits the crime of keeping a diary, he partakes in a sexual affair and he joins a brotherhood. His actions reveal that he has realized the ills of the society and is trying to actively prevent himself from being fully indoctrinated. However, his efforts are not entirely successful. Through his capture and punishment in room 101 he is ultimately forced to love Big Brother and he rejoins the society as a fully integrated member. John too is not entirely successful in his rebellion against the repressive society in which he has been born. He attempts to rebel by refusing to partake in sexual contact, discourages the use of the drug soma and eventually causes a riot. The violence his actions engender causes a frenzied orgy which he himself takes part in. Such an orgy is a manifestation of the very society against which he is trying to rebel and he takes the only action that he feels remains, he kills himself. Finally, in the case of Alex, the effects of his treatment entail that he is forever changed and his attempts at violent behavior and rebellion are put to an immediate halt. However, unlike Winston, there are indications at the end of the novel that he is beginning to free himself and his ability to think and behave as an individual is being renewed. His reaction to the appearance of his friend Pete alert Alex to the changes he needs to make in his own life. However, his use of the Nadsat when speaking of his hope for the future, â€Å"Tomorrow is all like sweet flowers and the turning vonny earth and the stars and the old Luna up there† (Burgess 191), indicates that he is beginning to break from his control. Whilst rebellion against doctrine is present in all three of these novels, so is the reality that the rebellion has failed. In every case there is no real evidence that the dystopian society has been changed as a result of the protagonist’s actions and the characters appear to have been largely isolated in their ability to recognize the ill merits of the way in which they are being ruled. The efforts to overcome the cruel society are short-lived and the message portrayed is that members of a society cannot overturn their conditions alone; to truly escape the unfair laws citizens need to act as a collective whole. Works Referenced: Aldridge, Alan. Consumption (Key Concepts). University Park, PA: Polity, 2003. Burgess, Anthony. A Clockwork Orange. New York: W. W. Norton & Company, 1986. More, Thomas. Utopia (Penguin Classics). London: Penguin Classics, 2003. Orwell, George. Nineteen Eighty-Four. New York: Plume, 2003. Plato. Plato: The Republic (Cambridge Texts in the History of Political Thought). New York: Cambridge University Press, 2000.

The Single Payer Reimbursement System - 1608 Words

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