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Patient education should ability to discount 60caps ashwagandha with visa anxiety symptoms eye twitching resist injury and repair damaged tissue (Ameri occur at all points of care with the child and family order ashwagandha 60 caps without prescription anxiety uk. Review the National Heart order ashwagandha 60 caps online anxiety 5 things, which is reduced as a result of a combination of factors buy 60caps ashwagandha overnight delivery anxiety symptoms 10 year old. Hypoxia occurs secondary to ventilation?perfusion mis Although timing of diagnosis varies, the clinical diagnosis match in the areas of alveolar collapse. Increased pulmo is generally made at approximately 1 month of age in nary vascular resistance causes intrapulmonic shunting, infants who required mechanical ventilation for at least 1 thus also contributing to hypoxia. Hypercarbia is com week; have symptoms of persistent respiratory distress; are mon and is also caused by ventilation?perfusion mis dependent on supplemental oxygen; and have chest radio match, as well as by hypoventilation. Some retrospective studies of neo chomalacia are commonly found in this population and 714 Unit 3 n n Managing Health Challenges are postulated to be the cause of acute, severe cyanotic problems when they are school age. Developmental delays and results from increased caloric needs, caused by the result from long-term ventilatory support, poor nutritional increased work of breathing, and high resting oxygen status, inadequate sensory stimulation, neurologic sequelae, consumption. Growth failure and lung disease may also and decreased energy and respiratory reserves. An interdisciplinary team may assist in a comprehen that result from the fibrosis and chronic hypoxia. Report any abnormal findings to the team monary vasculature of these infants develops increased reac and implement appropriate interventions and referrals. Studies have shown that surfactant therapy medical therapies such as supplemental oxygen, diuretics, reduces the severity of respiratory distress syndrome and bronchodilators, anti-inflammatory agents, and various decreases the amount of time on mechanical ventilation. Pulmonary hypertension responds at least in part to oxygen, a potent Assessment pulmonary vasodilator. Tachypnea, dysp Tracheostomy is considered for those who require assisted nea, and wheezing are intermittently or chronically present ventilation for more than 3 months as a neonate or who secondary to airway obstruction and increased airway re have chronic hypercarbia and increased work of breathing. Infants who have been intubated for long periods may develop subglot the primary and most important aspect of therapy in tic stenosis, which results in inspiratory stridor. Maintaining more, hypoxemia and hypercapnia are chronic states that adequate tissue oxygenation is imperative to prevent severe contribute to the problem. Supplemental oxygen ther when crying or after a few moments without supplemental apy is prescribed to promote growth and neurodevelop oxygen. They may develop irregular sleep patterns as Pulse oximetry or transcutaneous oxygen monitors are a result of frequent medical treatments, medications, and used to continuously or intermittently display oxygen satu therapies. Oxygen saturation levels (SaO2) of 92% to 95%, a result of the continuous increase in abdominal pressure depending on severity of illness, are necessary to facilitate caused by high airway resistance and use of accessory respi an improved rate of weight gain and to control pulmonary ratory muscles. Feedings, peri the incidence of neurologic abnormalities and develop ods of increased activity, and periods of sleep are occasions mental delay in infants with bronchopulmonary dysplasia when desaturations are most likely. Even if there is no evident damage to the tracheostomies may use a tracheostomy mist collar (Fig. Cough is often ineffective in these children because of generalized debilitation and tracheo malacia. Nasopharyngeal or tracheal suctioning is needed frequently to maintain patent airways, especially during illnesses or respiratory tract infections. Chest physiother apy may also help improve secretion clearance and lessen atelectasis. Always collaborate with respiratory therapists and parents to schedule chest physiotherapy to occur 30 minutes before feedings and before rest periods if possi ble. Humidified oxygen is provided to the child using a therapy and be done at other times as needed. Watch infants for increased oxy or premature infants who are chronically ?air hungry gen demand, especially during acute illnesses, fever, are extremely irritable and may be difficult to console. Watch for signs of overstimulation in the neurologi cologic agents, monitoring their effectiveness, and identi cally immature child such as cyanosis, avoidance of eye fying possible adverse effects (Table 16?11). They work by relaxing the Shakiness or tremors Albuterol (inhaled) muscles around the airways. Diuretics Furosemide (Lasix) Diuretics cause an increased amount of Imbalances in potassium (hypokalemia/hy Spironolactone (Aldactone) water and salt to be excreted in the perkalemia) and calcium (hypocalcemia) Chlorothiazide (Diuril) urine. They also decrease the amount of Muscle cramps and irregular heart rhythm fluid in the lungs. These medicines impaired growth and decreased ability do not reverse or stop existing wheez to fight infections. They are used on a long-term basis to prevent wheezing and respiratory dis tress. Yet, these infants Calorie-dense formulas can be administered with minimal suffer from a myriad of conditions that impair their ability risk of aspiration, in a continuous infusion if necessary, to to feed: gastroesophageal reflux, often with aspiration; promote optimal growth. It can seem that amount of oral feedings can be increased (Nursing Inter the more that nurses and parents are concerned and anx ventions 16?2). This strategy temporarily relaxes the ious about nutrition and place pressure on the infant or intense focus on eating and can transform parental anxiety child to eat, the less the child eats. Family Education and Support Begin with an nutritional assessment that includes docu mentation of anthropometric (precise measurement of the Other nursing and social service interventions should body includes weight, height, and head circumference) and focus on providing education and support. If the child is to receive oxygen, arrangements caloric intake to meet individual needs. Concentrating for must be made for administering the oxygen (Community mula to provide more calories per ounce; medication to Care 16?4). Medication administration, feeding and control gastroesophageal reflux; and small, frequent feed nutrition, developmental interventions, chest physiother ings all are appropriate for mild to moderate growth failure. Head and neck posture can alter oral?motor 90 degrees of flexion, both upper extremities with patterns during sucking. Ideally, marked neck elbows flexed at 90 degrees, and swaddled across extension should be reduced to aid oral?motor the chest. The goal of improving head and neck or sweaty with swaddling of the entire body, then positioning may need to be approached slowly, fold a thin pillowcase or light towel in a long rec to minimize stress to the infant.

Introduction Asthma is a common yet complex airway disease discount ashwagandha 60 caps on-line anxiety quizzes, characterized mainly by chronic airway in? A complete analysis of the pathophysiology of the disease is beyond the scope of this paper cheap 60caps ashwagandha free shipping anxiety hot flashes, but a brief review of the main mechanisms involved in disease exacerbations is necessary to order ashwagandha 60caps fast delivery anxiety symptoms 3dp5dt better grasp the acid-base derangements often encountered in these patients cheap ashwagandha 60 caps line anxiety disorder. Although asthma is increasingly being recognized as a heterogeneous disease with many di? In acute asthma exacerbations, exposure to a precipitating factor leads to an exaggerated in? The consequent narrowing of airway diameter leads to increases in airway resistance and limitation of expiratory? Hyperinflation essentially leads to the generation of an inspiratory threshold, which is reflected by the presence of positive end-expiratory pressure must be overcome by the inspiratory muscles during each breath in order for inspiratory? This inspiratory threshold must be overcome by the inspiratory muscles during each Another deleterious factor is the disadvantageous positioning of respiratory muscle length-tensionbreath in order for inspiratory flow to begin. Another deleterious factor is the disadvantageous curves in these large lung volumes, necessitating the recruitment of accessory inspiratory and expiratorypositioning of respiratory muscle length-tension curves in these large lung volumes, necessitating the muscles, further contributing to respiratory muscle fatigue [recruitment of accessory inspiratory and expiratory muscles, further contributing to respiratory1]. The aforementioned pathophysiological mechanisms eventually lead the deteriorating patientmuscle fatigue [1]. The aforementioned pathophysiological mechanisms eventually lead the deteriorating patient towards ventilatory failure. Nonetheless, acute respiratory failure is a far more common event in towards ventilatory failure. Nonetheless, acute respiratory failure is a far more common event in acute asthma. Indeed, hypoxemia is widely prevalent, with PaO2 levels of less than 60 mmHg acute asthma. Indeed, hypoxemia is widely prevalent, with PaO2 levels of less than 60 mmHg even even in non-severe asthma [2] having being reported in several studies [3]. The pathophysiological disorders in asthma result in various acid-base disturbances; these areThe pathophysiological disorders in asthma result in various acid-base disturbances; these are summarized in Figuresummarized in Figure 1 and are briefly discussed below. Respiratory Alkalosis Acute asthmatic crisis is usually accompanied by hyperventilation and hypocapnia with respiratory2. Respiratory Alkalosis alkalosis [3,Acute asthmatic crisis is usually accompanied by hyperventilation and hypocapnia with5]. However, it seems that mild, asymptomatic asthma is also associated with hypocapnia. Studies that have demonstrated hypocapnia in asymptomatic asthmatics, as well as during asthmaticrespiratory alkalosis [3,5]. However, it seems that mild, asymptomatic asthma is also associated with attacks, are presented in Tablehypocapnia. Studies that have demonstrated hypocapnia in asymptomatic asthmatics, as well as1. It was suggested that hypocapnia is probably associated with the airway obstruction observed in asthmatics, thus having an important role in the pathophysiology of asthma. The Buteyko breathing technique, an innovative treatment approach for asthma, named after Professor Konstantin Buteyko, has been widely applied [12]. In a recent trial, breathing training programs improved disease-related quality of life in adult asthmatic patients [13]. Respiratory Acidosis Respiratory acidosis is a very common acid base disturbance in acute severe asthma and is widely considered to be an ominous? In asthmatic patients, hypercapnia and respiratory acidosis occur in clinical exacerbations characterized by severe airway obstruction [14]. This study reported 177 events in 139 asthmatic children, both symptomatic and asymptomatic. Respiratory acidosis or mixed acidosis was present in severely dyspneic patients [18]. It has also been reported that the absence of pulsus paradoxus makes the presence of hypercapnia unlikely, although it is noted that clinical signs and symptoms during acute severe asthma often are not correlated with the severity of the functional impairment [19]. Hypercapnia in asthma, in addition to the severity of the disease, is also associated with the therapeutic administration of oxygen. Another study evaluated the acid-base status in 22 patients with acute severe asthma [36]. However, in an earlier animal study it was found that, during compensation for hypocapnia, the reduction in renal proton excretion was associated with increased Na+ excretion and not with Cl? Furthermore, in another study, chronic hypocapnia was found to suppress renal acid secretion while J. Insofar as chronic hypocapnia in these patients is accompanied by hyperchloremia, the role of Cl? Nevertheless, one of the patients with the more severe metabolic acidosis, diagnosed with the base excess criterion (? Thus, the physiologic 3 2 3 compensation for an uncomplicated acid-base disturbance has been viewed as a serious metabolic acidosis superimposed on the chronic respiratory disorder. Overall, caution is needed in assessing the metabolic component of these acid-base disorders by utilizing the base excess values; diagnostic errors and therapeutic ill-practices may occur when they are not considered alongside the required clinical information. Criticism on the subject has long been made by Schwartz and Relman [48], which even took the form of a ?transatlantic debate with arguments from both sides [49]. Hyperchloremia induced by intravenous administration of crystalloid solutions with high Cl?

This illustrates occur when alveoli become damaged or lost generic 60 caps ashwagandha otc anxiety symptoms worse in morning, with a re how limited our knowledge of this important com duction in the elastic supporting structure of the lung cheap ashwagandha 60 caps without prescription anxiety symptoms 8 weeks, plaint really is in this group of patients safe 60caps ashwagandha anxiety quizlet. We urgently since the airways are no longer tethered by the radial need a validated cough questionnaire that can be ap traction forces of the surrounding alveolar attachments plied to cheap ashwagandha 60caps otc anxiety symptoms 97 suf? Attempts to do this have been made chospasm, mucus hypersecretion and loss of elastic [38], and studies of objectively recorded overnight lung recoil. Substance P 0 may also be an important mechanism for augmentation and persistence of the cough re? Repro lial damage and slowing of ciliary beat frequency duced with permission from [37]. These latest epidemiological data support the a control population of somewhat younger subjects concept that the development of cough and sputum in a (Fig. It is also possible that the underlying cause of troublesome cough as in most other investigations. First, the basis for the in pared with controls without respiratory disease [49]. Apart from possible positive correlation between the amount of submucos mucus stimulation of cough, chronic smoking may al glands and both the amount of mucus in the airway increase airway sensitivity to capsaicin [43], and cough lumen and the daily sputum volume was reported. Increased mucus production could overwhelm the the differentiation of epithelial cells into goblet normal mucociliary clearance mechanisms and lead cells is another aspect underlying mucus hypersecre to the pooling of secretions and activation of the cough tion and this is determined by the expression of mucin re? Alternatively the direct ciliotoxic effects of to genes that encode the mucin glycoproteins in epithelial bacco smoke coupled with delayed or ineffective ep cells. Mucin genes can be up-regulated by exposure of ithelial healing following infective injury could impair epithelial cells to environmental factors including in the capacity of this system to clear more normal fections and pollutants, and to neutrophil elastase, amounts of mucus produced physiologically in the air while acrolein, a component of cigarette smoke, in ways. How treatment is not used as a marker of response because ever, in asymptomatic smokers, normal values of such change may be small or within the error of the mucus transport velocity were found in central measurement, yet still be associated with signi? This was reversed by b-agonist Such symptomatic improvement can be obtained by the therapy. Nicotine replacement children and in sputum samples from patients with therapy with either gum, skin patches or inhaler is ben chronic bronchitis [56]. Mucus hypersecretion may also be induced by tients following smoking cessation, with an improve in? On the basis of this informa mucus secretion, together with epithelial damage and tion, one would assume that the cough re? Although a small bronchodilator response is sary, such as those targeted against neutrophils or usually observed, they may relieve symptoms of effort macrophage activation. Inhaled corticosteroids should be considered agonists for regular use are more conveniently used in patients who do not experience bene? The combination of inhaled the many different mechanisms underlying cough in steroids and inhaled tiotropium will be of interest. There are two approaches, which There are data suggesting that patients who receive are to suppress the amount of airway secretions and to short-acting anticholinergic drugs have a lower cough reduce the enhanced cough re? The currently avail Corticosteroids able anticholinergics do not affect mucus secretion. Several trials of inhaled cor inhibitory effect on goblet cells or on the expression ticosteroid therapy have shown that these agents do not of mucins in the airways [76?78]. Steroids do not slow the decline in lung function, although they do pro inhibit the neutrophilic in? There has been a trend in the past to use mucolytic 5 Prescott E, Lange P, Vestbo J. Effect of exacerbation on quality acetylcysteine has been shown to have some bene? It is not recommended that centrally acting antitussives Am Rev Respir Dis 1992; 145: 1321?7. Obstruc pressive effect on breathing (although in severe breath tive lung disease and low lung function in adults in the lessness opiates are sometimes used), and also because United States: data from the National Health and Nutri of the risk of retaining secretions and of infections. A 30-year perspective on alpha 1-antitrypsin tone achieved by bronchodilators may be a reason why de? Am J Respir Cell from suppression of the effects of tachykinin on air Mol Biol 1999; 20: 287?91. References 14 Pilette C, Godding V, Kiss R, Delos M, Verbeken E, Decaestecker C etal. Alternative projections of mortal secretory component in small airways correlates with ity and disability by cause 1990?2020: Global Burden of air? Global strategy for the diagnosis, management, and Rev Respir Dis 1977; 116: 73?125. Am J Pathol 20 Saetta M, Turato G, Baraldo S, Zanin A, Braccioni F, 1972; 67: 265?75. J Lab Clin Capsaicin responsiveness and cough in asthma and Med 1986; 108: 294?300. Eur Resp 26 Saetta M, Baraldo S, Corbino L, Turato G, Braccioni F, J 1994; 7: 1246?53. Ann 27 Saetta M, Di Stefano A, Maestrelli P, Ferraresso A, Drigo Intern Med 1987; 106: 196?204. Chronic tobacco smoke exposure increases peripheral airways of smokers with chronic obstructive cough to capsaicin in awake guinea pigs. Oxidative stress causes mucin synthesis via structive pulmonary disease morbidity. Copenhagen City transactivation of epidermal growth factor receptor: role Heart Study Group. Morphometric analysis of intraluminal bronchial epithelium in habitual smokers of marijuana, mucus in airways in chronic obstructive pulmonary dis cocaine, and/or tobacco.

At 85 degrees the individual become stuporous purchase ashwagandha 60 caps otc anxiety symptoms jaw pain, cardiac output drops 60caps ashwagandha fast delivery anxiety symptoms yahoo answers, cerebral blood flow is decreased g ashwagandha 60 caps with mastercard anxiety 38 weeks pregnant. If re-warming ashwagandha 60caps without a prescription anxiety symptoms heart rate, tepid, near body heat, water immersion of extremity, usually requires 10 to 30 minutes immersion. Many toxins cause the patients cells to release bradykinins, histamines, and serotonin c. May cause head trauma, cardiac damage, burns, extremity vasospasm, paresis or parethesias. Prevention is best, many patients take acteazolamide Page 297 of 385 Trauma Multi-System Trauma Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression to implement a comprehensive treatment/disposition plan for an acutely injured patient. Looking a trauma scene and attempting to determine what injuries might have resulted 2. Unbelted drivers and front seat passengers suffer multi-system trauma due to multiple collisions of the body and organs c. Typically a patient considered to have ?multi-trauma has more than one major system or organ involved a. Multi-trauma treatment will involve a team of physicians to treat the patient such as neurosurgeons, thoracic surgeons, and orthopedic surgeons 4. Consider use of tourniquets in emergent, hostile or multiple patient situations where bleeding is considerable 3. The definitive care for multi-system trauma is surgery which can not be done in the field b. Early notification of hospital resources is essential once rapidly leaving the scene f. Changes in vital signs or assessment findings while en route are critical to report and document 7. Newly licensed paramedics who have not seen many multi-system trauma patients need to stick with the basics of life saving techniques b. Do not develop ?tunnel vision by focusing on patients who complain of lots of pain and are screaming for your help while other quiet patients who may be hypoxic or bleeding internally can not call out for help because of decreases in level of consciousness c. Be suspicious at trauma scenes, sometimes an obvious injury is not the critical cause one the potential for harm. Blast waves when the victim is close to the blast cause disruption of major blood vessels, rupture of major organs, and lethal cardiac disturbances b. Multi-casualty care Page 301 of 385 Special Patient Population Obstetrics Paramedic Education Standard Integrates assessment findings with principles of pathophysiology and knowledge of psychosocial needs to formulate a field impression and implement a comprehensive treatment/disposition plan for patients with special needs. Bleeding Related to Pregnancy: pathophysiology, assessment, complications, management 1. Complications of Delivery: pathophysiology, assessment, complications, management A. Postpartum Complications: pathophysiology, assessment, complications, management 1. Post partum depression Page 306 of 385 Special Patient Population Neonatal Care Paramedic Education Standard Integrates assessment findings with principles of pathophysiology and knowledge of psychosocial needs to formulate a field impression and implement a comprehensive treatment/disposition plan for patients with special needs. Neonatal mortality risk can be determined via graphs based on birth weight and gestational age b. Resuscitation is required for about 80% of the 30,000 babies who weigh less than 1500 grams at birth 3. Complete airway obstruction a) Atelectasis b) right-to-left shunt across the foramen ovale ii. Incomplete airway obstruction a) Ball valve type obstruction b) developing pneumothorax c) chemical pneumonitis c. Transport consideration - transport to a facility with special services for low birth weight newborns g. Morbidity/ mortality - represent relative medical emergencies as they are usually a sign of an underlying abnormality c. Risk factors - prolonged and frequent multiple seizures may result in metabolic changes and cardiopulmonary difficulties 2. Degree of myelinization will affect manner of seizure presentation/observed clinical signs 3. Term newborns will produce beads of sweat on their brow but not over the rest of their body g. Pharmacological - administration of antipyretic agent is questionable in the prehospital setting d. Morbidity/ mortality - infants may die of cold exposure at temperatures adults find comfortable c. Pathophysiology - Increased surface-to-volume relation makes newborns extremely sensitive to environmental conditions, especially when wet after delivery a. Increased metabolic demand can cause metabolic acidosis, pulmonary hypertension and hypoxemia 4. Body releases counter-regulatory hormones including glucagon, epinephrine, cortisol and growth hormone d. Erythema, abrasions, ecchymosis and subcutaneous fat necrosis can occur with forceps delivery iii. Diffuse, sometimes ecchymotic, edematous swelling of the soft tissues of the scalp b. Psychological support/ communication strategies Page 325 of 385 Special Patient Population Pediatrics Paramedic Education Standard Integrates assessment findings with principles of pathophysiology and knowledge of psychosocial needs to formulate a field impression and implement a comprehensive treatment/disposition plan for patients with special needs. Properly placing an infant in ?sniffing position to open the airway may require a towel or roll under the shoulders d.

Does the greater trochanters cheap 60 caps ashwagandha with mastercard anxiety symptoms checklist pdf, sacrum order ashwagandha 60caps with amex anxiety keeping me awake, femoral and tibial condyles buy discount ashwagandha 60 caps online anxiety symptoms in 9 year old, child exhibit a strong asymmetric tonic neck refex that acts tibial tuberosities generic 60caps ashwagandha otc anxietyuncertainty management theory, fbular heads, and malleoli. Is abnormal muscle tone prominences must also be monitored in a child with intact in certain body segments a barrier to movement? Has the sensation but limited ability to reposition because of poor child been placed in devices at home that limit the oppor motor control, weakness, or severe spasticity. Once a determi nation has been made as to why a child has delayed motor skills and decreased mobility, realistic recommendations Cognitive, Sensorimotor, and Social/Emotional Skills for equipment can be ofered. Only when working with a Many physical therapists are not trained specifcally to assess child who is severely limited in his or her mobility, with cognition, some sensorimotor skills, or social/emotional de out reasonable short or long-term expectations of gaining velopment; as a result, these areas are often ignored. This is device-unaided mobility, would it be appropriate to opt im a serious omission with the pediatric patient, whose prog mediately for adaptive equipment for remediation of the nosis for function with adaptive equipment often depends problem(s). For development and stimulation are integral to the develop the child with visual or hearing impairments to learn to ment of motor skills as well as cognitive skills in the typi 26 manipulate his or her environment, methods for explora cally developing infant. If a child lacks example, other cognitive skills are key, including judgment, experience in exploring the environment owing to lack of problem-solving abilities, and the ability to understand 13,17 opportunity, the therapist must ofer as much freedom of cause and effect, direction, and spatial relationships. Limitations in cognition, perception, or social/emo may eventually play a role in each of these situations, tional skills may result in function that is lower than would adaptive equipment should not be the frst type of treat be predicted by physical fndings alone. Adaptive equipment should supplement and goals for a child, the physical therapist must know the whole complement function with the least amount of restriction child and must integrate information obtained from the of the child. When adaptive Functional Skills equipment or devices are used judiciously, the improvement Assessing functional skills requires integration of all avail in mobility should occur without increases in abnormal re able information, in an attempt to determine why a child fexes or patterns of movement in children with sensorimo behaves in a certain manner. The therapist should determine trol, strength, reflexes, sensation, perception, cognition, whether the family lives in an urban, suburban, or rural social/emotional skills, and function abilities is an integral community to assess the availability of and options for component of the assessment of the child. Issues such as the weight of mobility equipment, its versatility on various surfaces, and its ease of trans port are important considerations. The cost of equipment may have a After the child has been assessed, goals have been estab serious impact on the fnal decision regarding adaptive lished, and appropriate equipment has been identified, equipment for the child with a disability. When making a at least in theory, the therapist should evaluate the family, decision about buying adaptive equipment, the therapist, home, and school environments. The home environment, often in conjunction with a social worker, must examine opportunities in the home, and parental expectations have insurance coverage, other third-party payment systems, been shown to infuence the development of a child, in funding agencies within the community, and potential 27?30 cluding motor development. Before equipment is ever ordered, it is development of a child with disabilities is also infuenced essential that the availability and source of funding is de by these factors. Compliance with the suggested use for the child using adaptive equipment must be compatible of adaptive equipment may ultimately be the main issue with the goals of the caregivers at home and school. Because adaptive equipment is often used not beneft from having the equipment or that the equip only in both home and school settings but in several other ment will be used by the family, there may be little justi settings as well, problems sometimes arise from conficting fcation for its purchase. These conficts over adaptive aids may arise tors, other cultural factors must be considered and re 31 in particular for the child who is institutionalized because spected. Increasingly, physical therapists and other the collaboration of several diferent caregivers on a rotating health care professionals fnd themselves working with staf is needed. It is imperative that physical therapists become not members about their expectations for the apparatus being only culturally sensitive but also culturally competent. This opportunity for family members to express Some cultural issues that need to be addressed when ob their opinions promotes a dialogue between family and taining equipment for children include the following: therapist, allowing the therapist to determine whether the. Length of time to receive equipment once it is ordered technology such as electricity or computers is not and lengthy repair time, both of which may leave child used in some cultures. These beliefs may affect the without needed equipment use of power wheelchairs, home-suctioning equip 8. Lack of timely onsite support for troubleshooting equip 36,37 ment, and some communications aids. General time constraints, including time to train staf, All of these questions obviously apply to obtaining equip time to learn how to use the equipment, time to obtain ment for any child. However, they are worth special men the equipment, and time troubleshooting tion in regard to a child whose culture difers considerably 10. Insufcient formal training and educational experiences from the dominant culture of the community. Teacher resistance to and/or rejection of adaptive tech ing recommendations of adaptive equipment. Device-specifc problems, including lack of portability, to determine whether the child is enrolled in a special slow operation, or space requirements for storage school for children with disabilities or mainstreamed into a 14. Storage of equipment so that it is difcult to access regular school and/or classroom. Sharing equipment among children so device is not read ers and staf are usually very open to suggestions and are ily available for a given child well equipped to handle any devices being considered. It is often these teachers who initiate the purchase or procure Suggestions for overcoming many of these barriers are also ment of the equipment and they are eager to learn and work reported by Copley and Ziviani. If the therapist is When the child is mainstreamed into a regular school, able to anticipate some of these potential issues, confict be teachers and staf may be reluctant to accept adaptive equip tween the family and the school staf may be avoided, and ment because of their limited experience with special ap the process will proceed more smoothly and more likely to paratus. This reluctance may be related to the health and the satisfaction of all involved. A thought A 2004 review of the literature by Copley and Ziviani de ful compromise is often necessary to meet the physical, scribed some of the foreseeable sticking points regarding the educational, emotional, and social needs of the child with use of assistive technology in school environments, includ a disability. Inadequate education of school staf about the equip use in the classroom to address physical impairments and ment, the needs of the child, or the specifc goals for disabilities include the following: using the equipment 5. Wedges for seating in chairs Does it fold or disassemble in some way that makes stor 7.

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