Tuesday, August 6, 2019
Media Portrayal of Women in Sports Essay Example for Free
Media Portrayal of Women in Sports Essay The mass media and all its components have always played an essential role in shaping the way society views and thinks about certain issues and events. The type influence, which television shows, radio shows and other mediums of mass media have on their audiences, go widely unchecked by the professionals involved in that field and by society in general. The effects could be damaging and entirely maladaptive and yet only a few organizations and individuals take on the role of serving as the counterchecking department of the products of this industry. One of the many fields into which mass media have dipped their fingers into is the field of sports. What little attention is given to the effects of mass media on society is focused on children’s shows, violence-related topics and religion-based issues. The field of sports has been relatively untouched by those who monitor the mass media. The public has mainly stood by and accepted the information and manner of presentation that mass media has taken with regards to sports. This type of attitude has proven to be increasingly damaging to women in particular. Sports has become a highly gender-based field. Despite efforts to assimilate women into the various games and competitions, it has become increasingly evident, despite the lack of monitoring organizations, that mass media has not gone beyond the days of bias towards women in sports. There are still many issues that need to be addressed in terms of how television, radio, magazines, newspapers, and other such media have come to portray women professionals in the field of sports. How does mass media affect the way their audiences perceive women athletes and other female sports professionals? What steps can be taken to correct wrong practices in this field? This paper aims to answer these questions as well as to specifically understand the way mass media has shown females involved in various sports activities and whether there truly is reason for these women to be concerned. Television Coverage of Women in Sports            Of all the instruments of mass media available today, the television set is perhaps the most successful and most popular. It has invaded the living spaces of almost all homes worldwide and is able to communicate to its audience in much more modalities than that offered by other instruments of mass media. It also allows for coverage of events at the exact moment the said event occurs.            Research regarding how women have been portrayed through the medium of television has been much more numerous as opposed to research on portrayal via other mediums. The literature regarding this research has shown that women in sports have been greatly marginalized and stereotyped. The following section will delve deeper into this aspect of mass media coverage in sports.            The most encompassing research done on television coverage of women in sports may be that of Higgs Weiller (1994). They conducted a research to assess gender bias in the television coverage of the 1992 Olympic games. The two researchers found much to disappoint the many women athletes involved in the said games as well as all other women who were just as concerned about women’s rights, equality of the sexes, and politically correct representation of males and females in different fields.            Commentators of the different events in the Olympic games were noted to most commonly use terms such as â€Å"girl†â€Å"babe†and â€Å"sweetheart†to refer to the women competitors whereas none of the male competitors were referred to as â€Å"boy†even when the contestant was obviously of a very young age. Also, strength and weakness descriptions and allusions were clearly gender-biased. Men in swimming were lauded for their strokes whereas female swimmers would receive comments such as â€Å"a powerhouse of a stroke from a 16-year old girl†. There were clearly ways by which the commentators were able to inject their own prejudiced views of the genders of the competitors.            There were also findings pointing to the fact that events wherein males competed were aired for longer times than those where females competed. Time differentials were noted for each event and there was a noted significant difference for each. This was applicable for such sports as basketball, volleyball, and the likes. Although individual events such as gymnastics were prone to have more airtime dedicated to women athletes, these were highly edited and sometimes even spliced together.            Each broadcast was also done with use of narratives. This was to draw the audience deeper into the mood of the game. However, researchers found that games with men contestants were broadcast with narratives of competition and strength. Women contestants, on the other hand, were often accompanied by emotional narratives pertaining to the athletes aspirations and the achievement of these with their success in the particular event they were entered in. If emotional narratives were not used by the television broadcasters, none at all were provided. It was either emotional or not at all.            It is therefore, a well-known fact that ambivalence in reporting of women’s sports on television exists. There is a denial of power for women in this particular type of mass media. Although women athletes are equally as capable and equally as competent as their male counterparts, this is not credited by professionals reporting their games. Where women have been noted for their involvement in sports, negative allegations and prejudiced reporting have served to undermine the efforts of these athletes. Radio Coverage of Women in Sports            Radio coverage of women in sports has also been one of the more devastating instruments of undermining women’s efforts and women participation in various sports activities. The radio set, however, is less of a weapon of the mass media at present than the television set. The radio set does not cater to the visual modality of its audiences and as such may prove less of a weapon. However, it is also advantageous because reporting of the sporting event can occur at the same time that the actual event occurs. This means that up-to-the-minute, live coverage is possible.            However, airing time on the radio set is significantly less for sports events than that on television sets. The large percentage of non-recognition that goes on in television broadcasting of women participation in sports is thus multiplied by great factors on the radio set. Only limited numbers of sports are chosen to be reported and reviewed over the radio and most, if not all, of these are male-dominated sports. Sporting events that are not action-packed, that do not provide the reporter with a message full of strength, adrenaline, and passion are not marketable on the radio waves. And because of the trend and well-established fad of reporting male events and male athletes with narratives involving competition, strength, and passion, these are the events that radio broadcasters and radio networks focus on. Women-dominated sports and women athletes prove to be less of a popular choice of broadcasting for professionals in the radio industry as these gives them, to their perception, with a softer story that is not full of the characteristics they look for in reportable stories and which audiences will not much favor or listen to. Thus the perception that male athletes and male-dominated sporting events will have more popularity than their counterparts. Publication Coverage of Women in Sports            Another instrument used in mass media are magazines and other similar published sources. These cater only to the audiences visual modalities and are not able to give audio feedback. Also, publications such as newspapers and magazines are only able to give a reporting of the event after a period of time has elapsed. It cannot be given during the time the actual event occurs. A processing time for writers, photographers, layout artists, editors, publishers and other personnel involved in the production process is required. Thus newspapers come one day after the events have occurred and magazines are released at particular time intervals within the year – monthly, quarterly, annually, and the like.            A study by Hardin et al (2005) showed that women were often portrayed as sexually different even in sports magazines. Sexually different in sports can mean the portrayal of women as dissimilar. This can be shown through the presentation of sport type in the said magazine or given publication. This could be shown in a manner such that women, who participate in sporting events wherein women are not usually included as competitors, are either excluded or represented as masculine.            However, it has been seen that certain sporting magazines have been very generous to the female component of sporting activities. However, this balance is only present in magazines that have been produce through the efforts of staff that were consciously aware of the disparity in gender reporting of sports events. These magazines are, more commonly, actively fighting for women’s equality in this field. As such, they are few and not representative in the publishing industry.            It should be acknowledged, however, that such magazines were launched and that these were successful in their goals. Perhaps this will provide the much needed gender-equality into the field of sports and mass media. Although these types of magazines form the minority in published mass media, they offer hope and raise out a cry of challenge to their colleagues, a cry for gender-equality and female liberation from the marginalization and disempowerment occurring in their field. Conclusion            The large discrepancies in sports portrayals of women athletes has been seen to be significant in all mediums of mass media specifically that of the television set, the radio set, and published sources. Women have been marginalized, stereotyped, and stripped of power through the way these mass media instruments have been used to represent their participation in sports activities.            However, no matter how anyone looks at it, this type of portrayal is unwarranted and unnecessary. Women have just as much talent, skill and capability as their male counterparts. The efforts they exert in order to actively and competently engage in their given sporting event is equally similar to that which males exert. The strain and stress they undergo during training and during the actual competition are just as nerve-wracking and exhausting as that which male athletes experience. In all respects, female athletes should be considered and hailed as equal to male athletes.            However, this has not been the case. Mass media, whether through television, radio, or magazines, has proven to be unforgiving and thoughtless in bringing justice to the efforts of women athletes. There is a great need for change and renewal in the way mass media portrays females.            One of the best first steps towards a better and more fair portrayal of women in sports is by actively disseminating information about the marginalization and disempowerment that is occurring. Most audiences and most reporters are perhaps so tied down to the hegemony of sports and mass media that they are no longer aware when stereotypical remarks are made on air. Knowledge of the fact that sports is for both females and males and that both sexes are equally capable of succeeding in this field must be spread. Without awareness, there is no chance for gender issues to be resolved in this field.            It would, perhaps, also be constructive for organizations and bodies to be set up that would monitor the violations to women’s rights that occur during broadcasting of sporting events. This would help to check the prejudiced actions and comments of those involved in the mass media industry. This would also make other individuals aware that what is currently going on is not acceptable and that there is a growing need for better treatment and appreciation of women athletes.            There is still much improvement that can be done to the way mass media portray women. Mass media has come to influence the way society thinks in that women themselves have congregated around socially acceptable sports. Only the few who are not afraid of being dubbed masculine are able to compete in the sports where the male sex has dominated. There should be adequate measures taken to ensure that future biased and stereotyped thoughts will no longer exist. Women portrayal in sports still has hope to become much more fair and with this hope comes the assurance thaw women participation in sports will also become less prejudiced and stereotyped. Reference Higgs, C., Weiller, K. (1994). Gender bias and the 1992 summer Olympic games: an analysis of television coverage. Journal of Sport and Social Issues, 18,  234-246 Hardin, M., Lynn, S., Walsdorf, K. (2005). Challenge and conformity on â€Å"contested terrain†: images of women in four women’s sport/fitness magazines. Sex Roles, 53(1), 105-117
Monday, August 5, 2019
Van Genneps Stages of a Rite of Passage
Van Genneps Stages of a Rite of Passage Van Genneps stages and understanding a rite of passage in relationship to one or more rituals Wittgenstein (1987, p.14, Chapter I. Introduction) set a large challenge for anthropology that has yet to be taken up. After reading the Golden Bough, he argues that Fraser made a crucial mistake by trying to deduce what things mean. He accused Fraser of not understanding that practices signify nothing but themselves, and that the extent of anthropology could be to delimit and work out the practical structure of such tasks. For the past fifty years or so, anthropology has largely ignored Wittgensteins remarks and has built an anthropology that privileges the observer. It privileges the observer because it is only the observer who can read into phenomenon their underlying socio-cultural meaning. It is precisely this sort of reifying reductionism that we find in Van Genneps (1909) theory of the rite of passage. Rites of passage present an irresistible and difficult focus for the ethnographer: they are constellations of compacted meanings removed from the process of everyday life. In the authors own experience, they are also some of the most frustrating things to analyse. Presented with so many unusual phenomenon, the ethnographer asks, what does this mask mean only for your informant to respond with a shrug. This difficulty of compacted meaning may partly explain why ethnographers are so quick to ignore the phenomenon involved in a rite of passage in favour of reading it as a structural process. This difficulty may also explain why, fully one hundred years after it was published, Van Genneps Rites of Passage theory remains unchallenged in the anthropological world. That said, Van Gennep’s overall structures has remained remarkably adept at matching up to all the rituals people apply to it. However, there should not be taken as a mark of its success. It one is to recall that the success of Evans-Pritchards structural-functionalism (Kuper: 1988, pp. 190-210, Chapter 10 Descent Theory: A Phoenix from the Ashes), was more based on the tastes and cultural paradigms of anthropologists than it was on its correspondence to any ethnographic reality. This essay will argue that Van Genneps stages of rites of passage do indeed cohere to many rituals, however, like Turners schemes (1995), these stages do little to explain to us the significance of ritual. In order to do so, this essay will argue, it is necessary to turn to how the phenomenologically experienced reality of ritual constitutes the social reality of a ritual. To make this argument this essay will focus on three rites of passage: French marriage ritual in Auvergne (Reed-Dahany: 1996), Yak a healing rituals in Zaire (Devisch: 1998, 1996) and refugee experience in Tanzania (Malikki: 1995). The last example proves the most difficult for Van Genneps theory: because though it corresponds to his stages, nothing about the experience of refugees would correspond to the socially rigid categories Van Gennep claims are central to rites of passage. From this example, this essay will argue to understand rites of passage we need to consider more fully the relationship of time-out-of-time in culture. For until we confront the question of what allows a certain unit of time to be taken out of the experience of the everyday, we will be no closer to understanding how rites of passage deal with other senses of time-out-of-time. Van Gennep (1909, Chapter I The Classification of Rites) attempts to demonstrate a there is a universal structure underlying all rites of passage. While there might be physiological, factors involved (e.g. coming to puberty) the mechanisms that determined the rites of passage are always social, and these social constructions display a cross-cultural similarity. Rituals and ceremonies in Van Gennep’s scheme serve the function of guaranteeing ones path through liminal transitory categories as one passes through the stages of separation, transition and reincorporation that he claims are present in all stages of rites of passage. What we can note about this model already is that the ritual serves the purpose of a unit of causation in a socially determinist model of society: there is a societal need that ritual fulfils. Because of this functional model, we are none the wiser as to how a society determines the exact elements of a ritual, or how people experience the ritual. Van Genneps approach is based on a socially functional model: though he is far more inclined to admit the power of the individual in the social form sui generis than is Durkheim (Zumwalt: 1982:304). That said, he still claims (Van Gennep, 1909, p. 72, Chapter Six Initiation Rites) that in mutilation: the mutilated individual is removed from the mass of common humanity by a rite of separation which automatically incorporates him into the defined group. His emphasis here is on the social end process: as if it could somehow be separated from the phenomenological experience of the pain. Thus, the process of scarification that marks many initiation rituals is merely placed as part of the logic of social cohesion: following such a pattern, it is hard to explain the beating and terror that often accompanies initiation rituals. Indeed, it ignores the central challenge Merleau-Ponty (1962, p.115, Part I The Body, Chapter III The Spatiality of Ones own Body and Motility) posed when he asked: H ow can we understand someone else without sacrificing him to our logic or it to him? The domain of phenomenology is closely linked to that of ritual. Jackson (1996, p.3, Chapter I Introduction) characterises phenomenology as a project designed to understand being-in-the-world. This attempt to understand how inter-subjective experience is constituted is a possible answer to the question Merleau-Ponty poses above how does one understand the other. Characteristically, phenomenology attempts to answer this project by not privileging one domain of experience or knowledge, as none of them can encompass the totality of the lived experience. Instead, it is an investigation into (Ricoeur, 1979, p.127, Chapter IV The Structure of Experience) the structures of experience which proceed connected expression in language. This is what Merleau-Ponty would call the preobjective. This understanding of the importance of structures that escape linguistic formalisation has also been part of the emphasis of the study of ritual in anthropology. In Levi-Strauss (1965, pp.167-186, Chapter Nine The Sorcerer and His Magic) classic examination of north American healing sorcerers he emphasises how the experience of the healing takes place between the triad of patient, sorcerer, and social body. He also emphasises the importance in this relationship of the sensory experience of the sorcerer. However, despite this emphasis, he is undertaking his analysis from a recorded text, and his emphasis is on the structural coherency sorcery provides rather than its embodied experience. He writes (ibid: 181): In a universe which it [the social body] strives to understand but whose dynamics it cannot fully control, normal thought continually seeks the meaning of things which refuse to reveal their significance. So-called pathological thought, on the other hand, overflows with emotion al interpretations and overtones, in order to supplement an otherwise deficient reality. The sensory experience of the ritual as understood by Levi-Strauss is constituted as a means-end relationship to get to the desired goal, the assertion of the cosmological unity of the social body. Here we can see the same pattern of assumptions about bodily meaning we noted earlier in Van Gennep. This emphasis, a legacy of Durkheim, characteristically means that repetition, often the element of ritual that constitutes its definition, is overlooked as window-dressing to the mythical meat of the ceremony which is that which can be vocalised (and thus objectified). This legacy can also be found in the two anthropologists whose writing about myth has defined the field, Van Gennep and Turner (1986, 1995). In Van Gennep, central to his notion of ritual as a rite of passage is a sacred-profane dualism, which is also kept in Turners scheme, though he also includes the notion of the marginal or liminal. In this distinction we can see that both theorists only deal with the relationship between the sacred and profane in terms of social structure and fail to deal with these elements interpenetrate in everyday lived reality. In a sense, their distinction is similar to that made by Mauss (1993, p. 12, Chapter I The Exchange of Gifts and the Obligation to Reciprocate) when understanding the gift. Mauss claims that the person for whom the sacrifice is performed enters the domain of the sacred and then rejoins the profane world, which is separate from the sacred, though conditioned by it. For Turners early work, and for Van Gennep, ritual is the heightened activity in which the sacred-profane worlds are mediated between. What is advantageous about these approaches is that they identify ritual as the situation or drama par excellence, as an organisation of practice constructed and defined by participants and it is a practice in which the participants confront the existential conditions of their existence. However, there are problems with Turner and Van Gennep’s approaches which parallel that of Levi-Strauss. In both cases, the emphasis is on the formal unity of the social world. Kapferer (1997, pp.55-61, Chapter II: Gods of Protection, Demons of Destruction: Sorcery and Modernity. The Transmutation of Suniyama: Difference and Repetition) illustrates some of these problems when analysing the Sri Lankan suniyama, or exorcisms. While he agrees with Turner that the suniyama constitute their own space-time, he also makes clear the extent to which they borrow from everyday life. Rather than seeing resolution and unity in the suniyama, he notes that the reactualisation of the ordinary world amid the virtuality of the rite is a moment of intense anxiety. In the events of the chedana vidiya, the tension, he argues, is not just about the destructive forces of the demon but also about the re-emergence of the victim in the ordered world. One can see in the suniyama that the lived world is not reducible to categories, despite the attempts at structuration. It is an excellent example of what Jackson (1989, p.5, Chapter I Paths Towards a Clearing) calls mans rage for order, and simultaneously usurpation of that order coupled with an awareness that the order is always exceeded by the lived world. Kapferer refuses to push dualistic or triadic models onto the Sri Lankan suniyama, and argue for it being a continuous process orientated at the restitution of social action. One of the ways this uncertainty the rage for order and its ambiguity or infirmity is manifested is in sensory experience. It is here that the Durkheimean project is unable to provide a satisfactory analytical framework and where phenomenology can provide some edifying lines of inquiry. None of these lines of inquiry are pursued by Reed-Dahany (1996), who illustrates the extent to which Van Gennep can be utilized, and also the extent to which Van Genneps scheme founders in its constructionist model, in her analysis of marriage practice in Auvergne. She notes that (ibid: 750) in the early morning after a wedding, a group of unmarried youths burst into the room to which the bride and groom have retired for the night and present them with a chamber pot containing champagne and chocolate. The youth and the newly wed couple then consume the chocolate and champagne together. The participants describe is as something which appears disgusting, and yet actually tastes really good. Reed-Dahany utilises Bourdieus work on taste to show how this reversal of the established bourgeois order simultaneously parodies marriage and bourgeois taste. Like the examples we see in Turners work, the sacred ritual of marriage here is associated with the inversion of established meanings only for these meanings to be ever more forcefully reinserted after the period of liminal disaggregation. We can see how such a ritual fits Van Genneps scheme very well: the couple are segregated from society (both from each other before marriage, and then from society the honeymoon afterwards) before being reaggregated. Thus, Reed-Dahany has no problem in understanding the ritual of la rà ´tie as a ritual of reincorporation in the sense Turner had meant it. Through the partaking of food with the unwed they are allowed to re-enter society, the wet-substance consumed standing in for fecundity. Indeed, as Reed-Dahany notes (ibid: 752) Van Gennep himself had commented on these rituals in his work on folk customs in rural France and had pursued much the same conclusion. Yet what Reed-Dahany notes is that the focus for the people involved in the ritual are the scatological reference implicit in the ritual: these elements of parody of bourgeois society that take place at the level of bodily praxis are left unexplained by Van Genneps scheme, in which any set of symbols is replaceable with anot her as long as they have the same social purpose. This is why Van Gennep has great problems explaining rites of passage that are not formal. Yet, it is not the case that rites of passage and other temporal markers must be institutionalised. As Malikki (1995, p. 241, Chapter Six Cosmological Order of Nations) notes: historical consciousness is lodged within precarious accidental processes that are situated and implicated in the lived events and local processes of the everyday. In her work, Malikki looks at the creation of a mythico-history among Hutu refugees who fled the mass killing of 1972 in Burundi for Tanzania fifteen years ago. She contrasts two groups; the first, living in an urban environment, deploy their ethnicity and history only rarely, situationally and relationally, and attempt not to stick out. In contrast, at the refugee camp, the inhabitants were continually engaged in recreating their homeland. Malikki (ibid: p.3, Introduction An Ethnography of Displacement in the National order of Things) notes: The camp refugees saw themselves as a nation in exile, and defined exile, in turn, as a moral trajectory of trials and tribulations that would ultimately empower them to reclaim, or recreate anew, the homeland in Burundi. One of the noticeable elements in this construction of a mythico-history is the way in which it internalised exterior categories, and then subverted them. For instance, Malikki draws attention to the way in the powerful discourse of inter-nationalism, refugees are in an ambiguous space, particularly polluting, between national boundaries. Malikki uses the work of Van Gennep and Turner to understand how the Hutu refugees in the camp had turned this liminal space into a trial of separation, which would empower them to return. The narratives that people told Malikki were incredibly standardised, they functioned, as Malikki notes, as moral lessons, that represented (ibid: p. 54, Chapter Two The Mythico History) a subversive recasting and reinterpretation of [events] it in fundamentally moral ways. In Malikkis work, we can see that rites of passage can be lodged in accidental processes and contingent historical events. Even here, they seem to fit the categories of Van Genneps classificati on. However, one notes that nothing about these classifications explains the way these patterns were then sedimented into a rite of passage that structured and organised practice. She notes that one of the key moments in this history is when the refugees arrive across the border in Tanzania, and are able to meet other refugees from Burundi (there appeared to be little widespread national connections before then ibid: p.103, Chapter Two The Mythico History). Thus, collective effervescence of consciousness, which, as the narrative describes, allowed people to understand the final secret of the Tutsis, was not just experienced verbally. The supplanting of the social order with chaos (though an ordered chaos) was accompanied by very physical processes. The fear of pursuit, the bodily feeling of cramp and hunger, the sight of corpses on the road: all these were processes that the refugees took great pains to describe to Malikki. The refugees referred to this moment as one of revelation, and this memory, which must have in part formed the social bond that allowed for the creation of the mythico-history, was a silent history of bodily feeling and gesture as much as i t was one verbalised. If we develop Malikkis understanding of the similarity between rites of passage and the refugee experience slightly, there is a parallel between the symbolic death and rebirth in the liminal stage of separation in a rite of passage, normally accompanied by ritual action that provides the unity of a shared painful experience, and the collective pain of that crossing into Tanzania in 1972. These phenomenological bodily experienced realities are not marginal to a group feeling of cohesion: rather than social aspects of the rite of passage stem from these silent memories of bodily experience. We will now turn to an analysis of the rites of passage in the Yaka healing cults of Zaire. In contrast to the social world of the Yaka, which is patrilineal, femaleness, uterine filiation and mediatory roles are cyclical and occupy a concentric life-cycle (Devisch: 1996, p.96, The Cosmology of Life Transmission). It is within this contrast that the healing rituals takes place. The healing rituals a re not a collection or commiseration, rather, they are bodily and sensuous, they (ibid: 95) aim at emancipating the initiates destiny clearing and enhancing the lines of force in the wider weave of family. It is not just in the matrilineage that healing occurs however, for (Devisch: 1998, p.127, Chapter Six Treating the affect by remodelling the body in a Yaka Healing Cult) it is in the interplay of physical links and individualising relationships a person weaves through his mothers lineage with the uterine sources of life and the primary and fusional object that the Yaka cultures in Kinshasa and south-west Congo localise the origin of serious illness, infirmity and madness. The ritual allows for the rebirth of the individual, and occurs at the margins (physical and cultural) of the society. This re-sourcing of the body is very fundamentally sensory. For instance, in the period of seclusion a young Mbwoolu become body doubles, and become an inscribed body envelope that serves as his interface with the social body. It is important to note there that the Yaka identity is structured as an envelope and knot. Harmful things like thievery of sorcery are associated with this knot being tied too tightly or loosely, inversion of normal bodily functions, such as flatulence or ejaculation outside of coitus can be understood as the knot being tied too tightly or gently. The person in this sense is constructed inter-subjectively, spreading outwards in a myriad of exchanges and well formed knots. The transference to the Mbwoolu involves an enacted cosmology where the objects and the initiate are covered with a red paste. Devisch notes that the notion of the person in these ceremonies is to be found to be located at the skin level, through a myriad of exchanges. At an early stage in the ritual, the initiates and the Mbwoolu figurines are floated in water, and this is the beginning of a process that continues throughout the ritual, as the initiates skin is turned inside out. In this process, the illness is displaced onto the Mbwoolu, and his insides become a receptacle for the power of the healing ritual. The figurines become a social skin to be idealised, socialised and protected. The importance of sensory experience in the ritual is also in the moment where the master shaman bites off the head of a chicken and sprays the initiates with its blood. Devisch (ibid: 146) also talks about the importance of the fusional absorption in the rhythm and music, then (ibid) [the] tactile olfactory and auditory contacts envelop, and are finally interwoven into an increasingly elaborate utterance, by the mirrored gaze. By this Devisch is alluding to the process by which the initiate converts the primary fusional object into phenomena of identification by incorporation. In this process of incorporating the figurine into themselves, all the senses are in use. What is noteworthy and excellent in Devischs work is that while he does occasionally lapse into statements about trance-inducing music, she is clear to emphasise that sensual phenomenon are not part of a means-end relationship to induce the required result, nor are they somehow secondary to the meaning of the ritual. Rath er, he emphasises that the sensory experience is in many respects, the ritual that the experience of being covered in red clay and submerged in water and having your skin reversed cannot be separated from the transference of your illness to the statues. What Mauss (1993, p.2, Chapter I The Exchange of Gifts and the Obligation to Reciprocate) was right to emphasise when he claimed sacrifice was a total social fact was that questions of sacrifice are questions of Being first and foremost. They occupy a place were the social world is made and remade. In Devisch, what is understood to constitute the central aspects of the Yaka healing cult are sensory experience. This is very different to the understanding laid out by Van Gennep and Turner. For while Devisch makes clear that in the Yaka healing cult one is separated from society pending ones reincorporation, he does not allow the socially functional explanation to obscure what the ceremony might mean. One can see the difference if we contrast Turners work to Devischs. For Turner, the performative and sensory aspects of healing function at its normative pole, the pole at which ritual healing is a resolution of social and emotional conflict. The power of dominant symbols, for Turner, derived from their capacity to condense structural or moral norms the eidetic pole and fuse them with physiological and sensory phenomena and processes – the oretic pole. In Turner, the oretic pole, where emotional and bodily praxis is centred, is a given. For Devisch, this given in Turners work is a critical problem, for it prevents his understanding that the basis of creativity in ritual (1993, p.37, 1.6 Body and Weave: A Semantic-Praxilogical Approach) is to be sought not in liminality but in the body seen as a surface upon which the group and the life-world is inscribed. We have seen in three rituals how Van Genneps classification superficially fits the pattern of behaviour. However, like in the work of Victor Turner, we have seen that Van Gennep cannot explain the detail of rites of passage using his system of classification. In his system, the details of a ceremony become marginal, whereas for the practioners they are central. To explain such details we need to pursue a phenomenologically informed anthropology such as that which Devisch practices. For if a rites of passage is a primarily embodied experience, then the body cannot simply be a receptacle for social value rather, one would argue, it can also be a generative movement, both of meaning and of experience Bibliography Devisch, R. 1998: Treating the affect by remodelling the body in a Yaka healing cult. In Strathern Lambek, Bodies and Persons. Oxford: Oxford University Press. Devisch, R. The Cosmology of Life Transmission. pp.94-115. In, Jackson, M. (ed) 1996: Things as they are: New Directions in Phenomenological Anthropology. Indiana: Indiana University Press. Devisch, R. 1993: Weaving the Threads of Life: The Khita Gyn-Eco-Logical Healing cult among the Yaka. Chicago: University of Chicago Press. Jackson, M. 1989: Paths Towards a Clearing. Indiana: Indiana University Press. Jackson, M. (ed) 1996: Things as they are: New Directions in Phenomenological Anthropology. Indiana: Indiana University Press. Kuper, A. 1988. The Invention of primitive society: transformations of an illusion. London: Routledge Kapferer, B. 1997: The Feast of the Sorcerer: Practices of Consciousness and Power Chicago: University of Chicago Press. Levi-Strauss, C. 1965. Structural Anthropology 1. London: Penguin. Malikki, L. 1995: Purity and Exile: Violence, memory and National Cosmology among Hutu Refugees in Tanzania. London: University College Press. Mauss, M. 1993: The Gift: The Form and Reason for exchange in Archaic Societies. London: Routledge. Merleau-Ponty, M. 1962 Phenomenology of perception. London : Routledge Reed-Dahany, D. 1996: Champagne and Chocolate: Taste and Inversion in a French wedding ritual. American Anthropologist. Vol. 98, No. 4, pp. 750-761. Ricoeur, P. 1979: Interpretation Theory: Discourse and the Surplus of Meaning. Texas: Christian University Press. Turner, V.W. 1995: The Ritual Process: Structure and anti-structure. London: Aldine. Turner, V.W. 1986. The drums of affliction. Oxford: Clarendon Press. Van Gennep, A. 1909: The Rites of Passage. London: Routledge. Wittgenstein, L. 1987: Remarks on Frazers Golden Bough. London: Brynmill Press. Zumwalt, R. 1982: Arnold Van Gennep: The Hermit of Bourd-la-Reine. American Anthropologist. Vol 84, No 2, pp. 299-313.
Comparison of Stroke Rehabilitation Guidelines
Comparison of Stroke Rehabilitation Guidelines Stroke is considered to be the third cause of death and disability for millions of people in developed countries (1). Stroke is the clinical manifestation of a wide range of pathologies, with different etiologies and prognoses, and many risk factors. Stroke is defined as a syndrome characterized by rapidly developing clinical symptoms and/or signs of focal loss of cerebral function, in which symptoms last more than 24 hours or lead to death, with no apparent cause other than that it is a vascular origin. Stroke victims who survive the first attack may have persisting impairments such as cognitive impairments, upper and lower limb impairments and speech disabilities. The United Kingdoms prevalence of stroke in the population is estimated to be 47 per 10000 making stroke the most common cause of adult physical disability (1; 2; 3). In the United State the Veterans Health Administration (VHA) estimated that 15000 veterans are in hospitals with a diagnosis of stroke every year (4). Stroke rehabilitation is a main factor in helping stroke survivors to regain their functional ability when medical and surgical interventions are limited (5). Physical therapy plays a major role in stroke rehabilitation. Physical therapists choose the duration and type of therapy given and provide education for stroke patients. Stroke rehabilitation aims at giving the patients the ability to regain maximum and full potential in functional activities and restoration of motor control (6; 7; 8; 5). Three main factors in rehabilitation contribute to the speed and quality of recovery. These factors are: treatment session duration and frequency, type of treatment approach used for rehabilitation, and providing education about the condition for patients during and after therapy (2; 3; 7; 8; 9). Physical therapy rehabilitation for stroke patients is designed to impact the disabilities and impairments associated with post stroke conditions. Rehabilitation is mainly aimed at limiting any deterioration of impairments and maximizing the functional level for patients suffering from stroke. To be able to deliver this, physical therapists should follow a certain set of guidelines which will insure better outcomes and avoid unnecessary practices that could prolong and delay optimum gain of function (6; 7). It is unclear whether physical therapists in Kuwait follow any specific guidelines in stroke rehabilitation. Therefore, it would be plausible to learn more about current local rehabilitation procedures. This may help in the further development of local rehabilitation procedures and practice guidelines, optimization of treatment and rehabilitation management, improvement in stroke patients health and quality of life, and minimization of conflicted rehabilitation practices that prolong therapy which in turn affect and burden the health system with increased number of patients (6; 8; 10; 11). We hypothesize that physical therapist in Kuwait rehabilitation do not follow stroke rehabilitation guidelines and science based practices in stroke rehabilitation. Therefore the aims of this study are to: Explore if stroke rehabilitation in Kuwait follow general guidelines of stroke rehabilitation regarding frequency of treatment sessions and duration of each session. Investigate if physical therapists specializing in the field of neuroscience in Kuwait follow general guidelines of stroke rehabilitation regarding their treatment approaches. Identify if education is being provided for stroke patients about their condition during and after rehabilitation. Literature Review: Stroke is defined as a syndrome in which clinical symptoms and/or signs of cerebral function loss develop rapidly, and last for more than 24 hours or result in death. Stroke can be classified according to the cause, which is either ischemic or hemorrhagic. Ischemic strokes account for 85% of all strokes, while 15% account for hemorrhagic strokes. Over 10% of patients who had a first stroke will have a second one within a year, and the risk of recurrence within 5 years is 15-42% (1). There are a wide range of conditions that lead to stroke, such as hypertension and diabetes. Each year, 5.45 million deaths are attributed to stroke, and over 9 million survive. Survivors often experience a wide range of persisting impairments. Common impairments include Physical disability, cognitive impairment, Lower limb impairments, and speech difficulties (1). Rehabilitation is an important part after survival from a stroke. Rehabilitation was defined in the New Zealand guideline for management of stroke as a problem-solving and educational process aimed at reducing the disability and handicap experienced by someone as a result of disease, always within the limitations imposed by both available resources and the underlying disease (12). Its of utmost importance that the stroke patient understands, and receives education concerning his/her condition and what limitations may persist, even after rehabilitation (12). Reker D. M. et al, researched whether adherence to post stroke guidelines was associated with greater patient satisfaction. They used a prospective inception cohort study design for new stroke admissions, including post-acute care, and they made follow-up interviews at 6 months after the stroke injury. Two hundred and eighty eight patients were included in the study, from eleven Veterans Affairs medical centers (VAMCs). The main outcome measures used in this study were: 1) compliance with the Agency for Healthcare Research and Quality (AHRQ), 2) patient satisfaction with care provided, and 3) stroke-specific instruments. Results have shown that, for every 10% percent increase in guidelines compliance, the average value of patient satisfaction increases by 1.5 points for the mean overall satisfaction score, which ranges from 4 to 39, and includes items for hospital satisfaction, home satisfaction, and overall satisfaction. The study concluded that compliance to AHRQ guidelines is sign ificantly associated with patient satisfaction (7). Several comparisons between Stroke Rehabilitation Protocols/ guidelines have been performed. This is beneficial in establishing the best treatment, with regards to dosing, intensity, duration, as well as efficiency and efficacy of interventions. A study by McNaughton H, et al examined the practice and outcomes of stroke rehabilitation between New Zealand and the United States facilities. This study used a Prospective observational cohort design and included 1161 participants from six United States (U.S.) Rehabilitation facilities and 130 participants from one New Zealand rehabilitation facility, all above the age of 18 years. In this study, New Zealand patients were older than the United States patients. However, the severity of initial stroke was higher for the U.S. patients. Despite that fact, patients in the U.S. were discharged earlier. They also had more intensive therapy, represented in higher durations spent with physical therapy and occupational therapy professionals. Also, U .S therapists tended to spend less time on assessment and non-functional activities, while focusing more on active management of patients. Results showed that, U.S. participants had better outcomes represented by changes in Functional Independence Measure FIM scores and fewer discharges to institutional care (13.2% vs. 21.5%). This study illustrates that duration and intensity of therapy can be adjusted to gain a better outcome. Also, it is important to know which activities are being done in the treatment session, and find out if they contribute to a better outcome of rehabilitation (10). Horn et al. investigated the effect of specific rehabilitation therapies in stroke rehabilitation on outcomes, taking into account the differences between patients. In this study, they wanted to examine the associations between patient characteristics, rehabilitation therapies, neurotropic medication, nutritional support, and time of starting therapy with functional outcomes and discharge destination for stroke inpatients. Discharge total, motor, and cognitive FIM (functional independence measure) scores and discharge destinations were registered for 830 patients with moderate or severe strokes from five U.S. inpatient rehabilitation facilities. Results showed that earlier initiation of rehabilitation, time spent in higher-level rehabilitation activities, such as upper-extremity control, gait and problem solving, usage of newer psychiatric medications, and gastric feeding, were all associated with better outcomes. The study also illustrated that a variety of Physical Therapy, Occupat ional Therapy, and Speech Language Pathology activities were correlated with higher or lower FIM scores. On one hand, more minutes spent per day on PT gait activities, OT upper-extremity control activities and home management, and SLP problem solving activities were associated significantly with higher FIM scores. On the other hand, more minutes spent per day on PT bed mobility and sitting, OT bed mobility, and SLP auditory comprehension and orientation were consistently associated with lower FIM scores (11). One study described Physical Therapy intervention for stroke patients in inpatient facilities within the U.S. (13). Six rehabilitation facilities in the U.S. included 972 subjects with stroke injury. Variables studied were time spent in therapy, and content and activities that were used in rehabilitation. The mean duration of stay in the inpatient facilities was 18.7 days, and received PT was on an average of 13.6 days. Patient spent 57.15 minutes on average for Physical therapy treatment every day. Activities of gait, transferring, and pre-functional activities, which include strengthening exercises, balance training, and motor learning, were the most performed interventions. Also, therapists included activities that incorporated different functions into one functional activity. This study implicated that a focus of physical therapist when providing treatment is optimizing functional activities, as they were the most frequent activities performed. However, activities to remediate im pairments and to compensate for lost functions were also included in the treatment sessions (13). Brocklehurst et al. investigated the use of physical therapy, occupational therapy, and speech therapy for patients suffering from stroke, as they mentioned that those interventions formed the basis of stroke rehabilitation. The study included 135 stroke patients from five general and one geriatric hospital, in South Manchester. Of the 135 subjects, 107 received PT, 35 received OT, and 19 received speech therapy. Results were obtained after measuring the rate of change in function over a one year period. Patients, who had more severe disabilities, and the worst prognosis, were more likely to get physical therapy treatment. Factors that determine type and specificity of physical therapy to stroke rehabilitation were also examined. Some of the factors were extent of disability, and disability-associated morbidities, such as fecal incontinence, spasticity, sensory loss and dysphasia. Even though the most disabled received the most physical therapy treatment, they showed the least improv ement in function even after six months of therapy. This study also concluded that patients, whose progress was poorest, received more physical therapy (5). Hsiu-Chen Huang et al. investigated the impact of timing and dose of rehabilitation delivery on the functional recovery of patients suffering from stroke. In this study, a retrospective review of medical charts was done for 76 patients who were admitted to a regional hospital for a first-ever stroke. Patients had multidisciplinary rehabilitation programs, including PT, OT, and a continuous rehabilitation for at least three months. The main outcome measure for this study was the Barthel index, taken at initial assessment, one month, three months, six months and one year after stroke. Results of this study showed that there is a dose-dependent effect of rehabilitation on functional outcome improvements of stroke patients. Also, earlier delivery of rehabilitation is associated with lasting effects on functional recovery up to one year post-stroke (14). It is unclear whether physical therapists follow evidence based practice many countries of the world including Kuwait. There is no doubt the era of evidence based practice is upon us for many reasons including better treatment outcomes, patient satisfaction, reimbursement amongst others. In one survey study, conducted by Iles and Davidson, examination of physical therapists current practice in Australia was undertaken. This study found that there are several barriers in the way of evidence-based practice. Those barriers included time to stay up to date, access to journals, access to summaries of evidence that are easy to understand, and lack of personal skills in looking for and evaluating research evidence (15). Salbach et al. examined the determinants of research use in clinical decision making among physical therapists treating post-stroke patients. Two hundred and sixty three physical therapists from the state of Ontario, Canada, responded to a survey questionnaire, containing items for evaluating practitioner and organizational characteristics and perception of research believed to be influencing evidence-based practice. The survey also contained the frequency of using research evidence in clinical decision making in a typical month. Results showed that, only a small percentage of therapists (13.33%) reported using research in clinical decision making six times a month or more. However, most therapists (52.9%) reported using research 2-5 times a month, while 33.8% used research 0-1 time per month. In this study, research use was associated with the academic preparation in the principles of Evidence-Based Practice (EBP), research participation, service as a clinical instructor, being self -effective in implementing EBP, attitude towards research, perceived organizational support of research use, and access to bibliographic databases at work. This study concluded that a third of therapists rarely apply research evidence in clinical decision making. Suggested interventions to promote research use included education in the principles of EBP, EBP self-efficacy, having a positive attitude towards research, and involvement in research (8). A study by Ogiwara, made a comparison between the bases of treatment between Japanese physical therapists, and Swedish therapists. They investigated the reasons why the Japanese choose certain approaches of treatment when handling stroke patients, and then compared the results with those of Swedish therapists. Swedish therapists attributed their choice of treatment to hands-on experience and participation in practical courses, in which various techniques are taught. Bobaths approach was the only method that was commonly continued to be used after graduation in both countries. Results have illustrated that Swedish therapists were more interested in new methods of treatment (91%), whereas only 77% of Japanese therapists had an interest. Implication of their results might mean that Japanese therapists are interested in their treatment approach, and also show that introducing new approaches of treatments takes a longer time in comparison to Sweden. Additionally, Swedish therapists tend t o make a combination of treatment approaches, while Japanese physical therapists tend to follow only one particular approach. Several reasons were speculated for addressing the differences in treatment protocols, some of which were: 1) diversity of cultures, 2) diversity of health the care system, 3) availability of equipment and space needed to follow a certain new approach, 4) belief of efficacy of a certain approach and 5) the language barrier imposed on Japanese therapist, and availability of translated literature. This study showed that there are several barriers and differences encountered when the need of application of new approaches is desired (9). Wachters-Kaufmann et al. conducted a study regarding the conferring of information for stroke patients and caregivers. Their study investigated how information was provided to patients and caregivers and how they actually preferred to be informed. The actual and desired information correspond in terms of content, frequency, and method of presentations well as the actual and desired information. The study was done in the North of the Netherlands and the stroke unit of University hospital Groningen. The General practitioners (GP) distributed a guide from a community-based study of cognitive disorders and quality of life (CognitiVA) after a stroke. The guide was given three months after the stroke. For the final measurement of the study, which was 12 months later, the patients and caregivers participated in a telephone survey, which asked about three things: 1) professional stroke-care providers, 2) other sources of information, 3) the guide. Fifty one patients and 38 caregivers were co ntacted, of which 18 patients and 11 caregivers declined to be interviewed for various reasons. The results showed that the GPs, neurologist, and physical therapists were both the actual and desired information providers. As for the content, the actual content was the guide, whereas the desired was mostly medical information concerning the course of the disease, its cause, consequences, and treatment. Regarding the frequency, the actual and desired was within 24 hours of the stroke, and one day to two weeks later, and after two weeks. As for the method of presentation of information, the patients and caregivers mostly desired only verbal (73% patients, 89% caregivers) (16). Methods: This comparative design research project will compare the stroke rehabilitation program implemented in Kuwait with the established guidelines for stroke rehabilitation in the United States of America. The rehabilitation program stroke patients are receiving in Kuwaits Ministry of Health hospitals, specifically, Al-Jahra, Mubarak, Farwanya, Physical Medicine and Rehabilitation, and Al-Sabah hospitals will be investigated. Subjects of the study will be physical therapists practicing in the stroke rehabilitation field. We will provide physical therapists experienced in stroke rehabilitation with self-administered questionnaires, which will be collected after one week. We will also examine patient records over a three week period. To access the records, we will get permission from the head of the physical therapy department of each hospital as well as each hospitals director. Institutional Review Board (IRB) approval will be obtained prior to any data collection. Approval from the Minist ry of Healths IRB will be obtained as well as approval from Kuwait University. Data will then be compared with the established American Stroke Guidelines. All data gathered during the study will be kept under lock and key. Any identifiable information obtained from patient files and records will only be accessible to the primary investigator. No identifiable information will be used for publication purposes. Confidentiality will be insured throughout the study duration. Subjects: The subjects of this study will be physical therapists working in Kuwaits Ministry of Health hospitals neurology department and with experience in out-patient stroke rehabilitation. Tools: To investigate the frequency and duration of treatment, we will look into the records, which are the patients files. There is also a section in the questionnaire that will ask about the frequency and duration of sessions. As for finding out the treatment approach patients are receiving, a self-administered questionnaire will be distributed at selected MOH hospitals, specifically at Al-Jahra, Mubarak, Farwanya, Physical Medicine and Rehabilitation, and Al-Sabah hospitals. Therapists will be given the questionnaire to fill out. In order to evaluate the type of education given to patients, educational guides, or pamphlets, about the patients condition available at the hospital and distributed to patients will be looked at. The questionnaire will also ask about different patient education techniques used by the participants. For comparison of data, we will compare the data we obtain with the American Stroke Association guidelines. Questionnaire: The questionnaire will consist of several questions used in the Ogiwara (9) questionnaire as well as others pertinent to our study population. The questionnaire will consist of four parts: demographic information questions concerning the therapists professional history and experience Questions concerning the rehabilitation program: treatment approach, and frequency and duration of sessions. questions concerning the types of education techniques Each questionnaire will have a cover letter explaining the purpose of the study, and a consent form. Data Analysis The data will be analyzed using SPSS (Statistical Package for Social Sciences) (v. 17.0) to describe means, standard deviations, frequencies, and percentages. Once the data is analyzed, we will compare the data we collected with the general guidelines and treatment approaches in the literature. Expected Outcomes and Recommendations Our expectation for this study is that physical therapists in the state of Kuwait will not be following the American stroke rehabilitation guidelines. Due to cultural differences between the two countries, establishing new guidelines for the stroke rehabilitation in Kuwait might be necessary, addressing the nature of referral to physical therapy in Kuwait, and making recommendations for increasing treatment duration if needed. Also, it should be mentioned what type of special equipment might be used in the process of rehabilitation. References: Rudd A, Olfe C.W. (2002, Feb). Aetiology and pathology of stroke. Vol. 9, pg 32-36. Hafsteinsdottir T.B, Vergunst M, Lindeman E, Schuurmans M. (2010, 29 July). Educational needs of patients with a stroke and their caregivers: A systematic review of the literature. www.elsevier.com/locate/pateducou Hoffman T, McKenna K, Herd C, Wearing S. Written stroke materials for stroke patients and their careers: perspectives and practices of health professionals. Top Stroke Rehabil 2007;14(1):88-97 Duncan P, Zorowitz R, Bates B, Choi J, Glasberg J, Graham G, Katz R, Lamberty K, Reker D. Management of Adult Stroke Rehabilitation Care: A Clinical Practice Guideline. (Stroke. 2005; 36:e100-e143.) Brocklehurst J.C, Andrews K, Richards B, Laycock P. J. (1978, 20 MAY). How much physical therapy for patients with stroke? Vol. 1, 1307- 1310. British Medical journal. Kollen, B, Kwakkel G, Lindeman E. (2006, 11 July). Functional Recovery after Stroke: A Review of Current Developments in Stroke Rehabilitation Research. Vol.1, No.1, 75-80. Reker D.M, Duncan P. W, Horner R.D, Hoenig H, Samsa G.P, Hamilton B, Dudley T.K.(2002, June) Post acute Stroke Guideline Compliance Is Associated With Greater Patient Satisfaction. Arch Phys Med Rehabil Vol. 83, pg 750-756. Salbach N, Guilcher S, Jaglal S, Davis A. (2010) Determinants of research use in clinical decision making among physical therapists providing services post-stroke: a cross-sectional study. http://www.implementationscience.com/content/5/1/77 Ogiwara S. (1997) Physical therapy in stroke rehabilitation: A comparison of bases for treatment between Japan and Sweden.vol.9 Pg. 63-69, Journal of physical therapy sciences. McNaughton H, DeJong G, Smout J, Melvin L, Brandstater M. (2005, Dec) A Comparison of Stroke Rehabilitation Practice and Outcomes between New Zealand and United States Facilities. Vol. 86, suppl.2, Arch Phys Med Rehabil. Horn D, DeJong G. Smout J, Gassaway J, James R, Conroy B. (2005, Dec) Stroke Rehabilitation Patients, Practice, and Outcomes: Is Earlier and More Aggressive Therapy Better? Vol. 86, pg. 101-114, suppl. 2, Arch Phys Med Rehabil. Life after stroke: New Zealand guideline for management of stroke (November 2003). Jette D.U, Latham N.K, Smout R.J, Gassaway J, Slavin M.D, Horn S.D (2005, March) Physical Therapy Interventions for Patients with Stroke in Inpatient Rehabilitation Facilities. Vol. 85, num. 3, pg. 238-248, physical therapy. Huang H, Chung K, Lai D, Sung S. The Impact of Timing and Dose of Rehabilitation Delivery on Functional Recovery of Stroke Patients (J Chin Med Assoc: May 2009 , Vol 72, No 5) Iles R, Davidson M. Evidence based practice: a survey of physiotherapists current practice. Physical therapy. Res. Int. 11(2) 93-103 (2006) Watchers-Kaufmann C, Schuling J, The H, Jong B. Actual and desired information provision after a stroke. Patient Education and Counseling 56 (2005) 211-217 Appendices Appendix 1 American Stroke Association Guidelines: E. Patient and Family/Caregiver Education Background The patient and family/caregivers should be given information and provided with an opportunity to learn about the causes and consequences of stroke, potential complications, and the goals, process, and prognosis of rehabilitation. Recommendations Recommend that patient and family/caregiver education be provided in an interactive and written format. Recommend that clinicians consider identifying a specific team member to be responsible for providing information to the patient and family/caregiver about the nature of the stroke, stroke management rehabilitation and outcome expectations, and their roles in the rehabilitation process. Recognize that the family conference is a useful means of information dissemination. Recommend that patient and family education be documented in the patients medical record to prevent the occurrence of duplicate or conflicting information from different disciplines. N. Educate Patient/Family, Reach Shared Decision about Rehabilitation Program, and Determine Treatment Plan Objective ensure the understanding of common goals among staff, family, and caregivers in the stroke rehabilitation process and, therefore, optimize the patients functional recovery and community reintegration. Recommendations Recommend that the clinical team and family/caregiver reach a shared decision about the rehabilitation program.    The clinical team should propose the preferred environment for rehabilitation and treatments on the basis of expectations for recovery.    Describe to the patient and family the treatment options, including the rehabilitation and recovery process, prognosis, estimated length of stay, frequency of therapy, and discharge criteria.    The patient, family, caregiver, and rehabilitation team should determine the optimal environment for rehabilitation and preferred treatment. Recommend that the rehabilitation program be guided by specific goals developed in consensus with the patient, family, and rehabilitation team. Recommend that the patients family/caregiver participate in the rehabilitation sessions and be trained to assist patient with functional activities, when needed. Recommend that patient and caregiver education be provided in an interactive and written format. Provide the patient and family with an information packet that may include printed material on subjects such as the resumption of driving, patient rights/responsibilities, support group information, and audiovisual programs on stroke. Recommend that the detailed treatment plan be documented in the patients record to provide integrated rehabilitation care. Intensity of Therapy The heterogeneity of the studies in all aspects-patients, designs, treatments, comparisons, outcome measures, and results-combined with the borderline results in many of the trials limits the specificity and strength of any conclusions that can be drawn from them. Overall, the trials support the general concept that rehabilitation can improve functional outcomes, particularly in patients with lesser degrees of impairment. Weak evidence exists for a dose-response relationship between the intensity of the rehabilitation intervention and the functional outcomes. However, the lack of definition of lower thresholds, below which the intervention is useless, and upper thresholds, above which the marginal improvement is minimal, for any treatment, makes it impossible to generate specific guidelines. Partridge et al did not find any differences in functional and psychological scores at 6 weeks in 104 patients randomized between a standard of 30 and 60 minutes of physical therapy. Kwakkel et al randomized 101 middle-cerebral-artery stroke patients with arm and leg impairment to additional arm training emphasis, leg training emphasis, or arm and leg immobilization, each treatment lasting 30 minutes, 5 days a week, for 20 weeks. At 20 weeks the leg training group scored better for ADLs, walking, and dexterity than the control group, whereas the arm training group scored better only for dexterity. The clinical trials provide weak evidence for a dose response relationship of intensity to functional outcomes.
Sunday, August 4, 2019
To Kill A Mockingbird Essay: Use of Symbolism :: Kill Mockingbird essays
Use of Symbolism in To Kill A Mockingbird "I'd rather you shoot at tin cans in the backyard, but I know you'll go after birds. Shoot all the bluejays you want , if you can hit 'em, but remember it's a sin to kill a mockingbird." This is what Atticus Finch tells his children after they are given air-rifles for Christmas. Uniquely, the title of the classic novel by Harper Lee, To Kill A Mockingbird, was taken from this passage. At first glance, one may wonder why Harper Lee decided to name her book after what seems to be a rather insignificant excerpt. After careful study, however, one begins to see that this is just another example of symbolism in the novel. Harper Lee uses symbolism rather extensively throughout this story, and much of it refers to the problems of racism in the South during the early twentieth century. Harper Lee's effective use of racial symbolism can be seen by studying various examples from the book. This includes the actions of the children, the racist whites, and the actions of Atticus Finch. The actions of the children in this novel certainly do have their share of symbolism. For instance, the building of a snowman by Jem and Scout one winter is very symbolic. There was not enough snow to make a snowman entirely out of snow, so Jem made a foundation out of dirt, and then covered it with what snow they had. One could interpret this in two different ways. First of all, the creation of the snowman by Jem can be seen as being symbolic of Jem trying to cover up the black man and showing that he is the same as the white man, that all human beings are virtually the same. Approval of these views is shown by Atticus when he tells Jem, "I didn't know how you were going to do it, but from now on I'll never worry about what'll become of you, son, you'll always have an idea." The fire that night that engulfed Miss Maudie Atkinson's house can be seen as the prejudice of Maycomb County, as the fire melted the snow from the snowman, and left nothing but a clump of mud. The fire depicts the prejudice people of the county saying that blacks and whites are, certainly, not the same. Another way of looking at the symbolism of the snowman would be to say that Jem's combination of mud and snow signifies miscegenation, marriage or sexual relations between persons of different races.
Saturday, August 3, 2019
Cause and Effect Essay - The True Cause of School Shootings
Most of us learned when we were very young that we should not judge by appearances. But, in the aftermath of massacres in schools everywhere, a sane person has to take seriously what the material world shows - and pass judgment. After all, a lack of judgment and subsequent action may lead to further youth violence. This event has been thoroughly dissected by a whole herd of politicians and pundits over a period of some months. But they have, unfortunately, failed to reach the heart of the matter. For the heart of the matter is theological, a category that does not often appear in American public discourse. Instead, we hear talk about psychology, community, exclusion - the narrow, modern litany of cause and effect. David Mandel, a psychologist who has studied the Goth subculture - one of the causes being invoked - wrote last year, "It is not sinister, but tongue in cheek." And he continued: "People who are really into it use it to construct meaning in their lives. . . . They really find beauty in the dark things much the way others find beauty in bright, happy things" (Mandel...
Friday, August 2, 2019
Community Management of Toyota Owner Club
Background Technology takes part in the development of human being, especially information and technology. It creates globalization in almost every sector of economy, politics, education, and culture in almost every country. Technology makes information almost borderless and simplifies the customer source of information but on the other hand makes the market analysis grow more sophisticated and also creates the need of improvement in knowledge to understand the marketing model to cope with the dynamic improvement of technology.Marketing as knowledge to describe â€Å"what-who-when-where-why-and how†to the market works describe in 3 main issue which is ; 1. Product management 2. Customer management 3. Brand management That is all learnt by marketeers so corporates could generate the demand of production continually time after time and surviving in the market. The problem nowadays is when the company’s marketing slowly has less effect on customer due to a lack of trust o r the obsolete company methods used in today’s shifting market, companies needs to be more ease and open to new, necessary information so it could be disseminated to their customers.Social media and information portal, easily accessed by those who need current information and recommendations, is more preferrable to the consumer. A research said that 90% of customers are sure about recommendations his/her friend gave them and 70% of customers are sure about opinions on the internet. graph 1 Degree of Trust for company advertisement (April 2009, the Nielsen Company) Somehow it is a phenomenon that less of consumers are convinced of company’s advertisements and shifted to another form of â€Å"advertisement†which is what we call recommendation by acquintances.It is an oopportunity for companies to take advantage of a community or group of loyal customers as an information pipeline to attract customers and prospected customers. It is what we know as word of mouth, which the dissemination of information is not massive but specified and spread in high speed thus making it unstoppable. To companies, above the line (ATL) advertising should not only be the main focus and main budget spent to market their product information and create the willingness to buy, companies also should convince the potential customer by developing the methods of effective below the line (BTL) advertising effective-efficient.Community involvement in this BTL aactivity is one of the activations in horizontal marketing. How to do that is develop a company that has marketing orientation from a precious concept (main issue of marketing explained above) into new concept of horizontal marketing which contains; 1. Co Creation 2. Communitization 3. Character building The point in communitization is explaining the relationship between the company and the consumers with a community between them. Godin Seth in his book â€Å"Tribal†concludes that successful companies have t he support from the community.It explains that consumers intend to be more connected with other costumers rather than with the company. Here is great oopportunity if companies understand what its consumers want and take the appropriate action by accomodating consumers in a community or enter the existing community and give the company's influence there. A company needs to help consumers connect to their community so the influence has more power to persuade the following marketing effort. Fourier and Lee explain that consumers themselves would choose where they belong on the following type of connection : 1.Pools : here is where consumers are real brand fans and event hough they did not interact directly with other consumers in a community they would still be â€Å"brand evangelists†and strengthen brand power. 2. Webs : the consumer has one-on-one interraction, it is typically consumers who connect with each other on social media. They spread information and influence in one- on-one interaction but usually also affects other group members. 3. Hubs : A hub connection needs a leader, the trend setter and figure who brings another consumer (follower) into the network and these consumers will move around the leader and create a loyalty of brand.We might agree that a community is developed not to serve the business but to serve their members which attracts loyal consumers. But this indirect relationship does not mean the company has no intention, the company needs to maintain in effective-efficient way so marketing effort will not be a waste but instead succeed slowly but sure, the company builds the building blocks of a consumer’s trust and loyalty, and the community has significant role in it. 1. 2Problem Formulation For the background has been explained before, authors have researched the question to be developed as mentioned below : 1.What sre Toyota Owner Club’s strengths, weaknesses, opportunities, and threats in its current position ? 2. How Toyota explains the frame work and milestones in this community management process ? 1. 3Research Objectives This research is done pursuing the explanation of problem found and set objectives as shown below : 1. Identifying Toyota Owner Club has strength, weaknesses, oopportunity, and threat 2. Giving suggestion of current community management process has frame work and milestone 1. 4Research scope Author has scope in this research are ; 1.Research conducted while doing industrial training in PT Toyota-Astra Motors (Head Office, Jalan Yos Sudarso – Sunter II Jakarta 14330) in Marketing Division- Marketing Communication Departement, Event Section. 2. Information provided is infromation from author has observation, discussion, and primary and secondary data from industrial training period. 3. This research is not for profit and conducted as author has suggestion to the management, event section of PT Toyota-Astra Motors. 1. 5Internship Objectives This internship itself were conduct more than doing research are also to achieve these objectives ;
Thursday, August 1, 2019
Shadow Divers
Shadow Divers By: Kurson, Robert Shadow Divers by Robert Kurson is a true story of a few ordinary men risking everything to solve a World War II mystery, which even governments had not been able to budge. One is introduced to Bill Nagle at the start of the book. He is given a location of the mystery object from a fisherman. Nagle is the caption to the Seeker and had a feeling that this dive will be a life changer. So he meets with John Chatterton, the only man that he can trust on a dive like this one. Chatterton has been diving for almost his whole life and is known as one of the best divers in the world in 1991.Nagle and Chatterton proposed a plan to take six top divers to the site and see what was down there. On the first dive Chatterton finds out that the object is a submarine and in a later dive finds that the submarine is a German U-boat. They know this because of a peace of china Chatterton found with an eagle and the swastika, the symbol of Hitler’s Third Reich on it. Chatterton also found a knife with the name Horenburg hand carved into the handle. The problem is that they do not know what U-boat they just found. All records show that no German U-boat was sunk in that area.To solve the mystery Chatterton has to bring Richie Kohler on board because Nagle is dying from liver poisoning. Kohler is also one of the best divers, yet Chatterton and Kohler do not get along very well. Kohler tried to steal one of Chatterton’s dive sites a long time ago, when the two first met. Over time Chatterton and Kohler become best friends and spend six years of their lives trying to solve the mystery of the German U-boat. Within the six years they found tons of artifacts that do not get them any closer to finding the name of the U-boat.The only major clue was the name Horenburg, yet there was only one Horenburg and he died in a U-boat 2,000 miles away on another U-boat. After, Chatterton and Kohler had leaped over many hurdles and had lost almost everything t hey had in their lives, Chatterton came up with a plan to resolve their mystery, yet it could kill him in the process. He would go into the submarine and take off his oxygen tank to fit through a tiny hole. On the other side he would look for an old oxygen tank that will have the name of the U-boat on it.Then, push it through the small hole to Kohler and Chatterton while doing all of that with only five minutes of air. Risking his life he goes through with his plan and after it all he and Kohler get their name, U-boat 869. Word: Hurdle /noun /? h? rdl – Difficulty, something that impedes progress or achievement Word: resolved /adjective /ri? zalvd – Settled, find an answer Explanation: The words are important because Chatterton and Kohler feel that it is up to them to resolve the mystery of the submarine for the fallen soldiers and had to go through many hurdles to get there.
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