Friday, March 13, 2009

Why Don’t We Fight?

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Why Don’t We Fight?

An Answer to the Behavioral Health Planning Council LC10

By Rogi

"The only thing we have to fear is fear, itself."

-- F. Roosevelt

At a past  meeting, a question was posed: “Why don’t we fight?” We do fight; that’s why we’re here. We are fighting the exploitation, abuse, stereotyping and neglect of people with behavioral health issues.

It angers us that people whom Jesus might have called, “the least of these,” are so poorly treated and stigmatized in our culture. We are advocating on behalf of citizens with behavioral health issues, and advising the State of New Mexico with our recommendations for how their challenges and needs may be met.

Anger is a great motivator for change. It is a primal emotion and very dangerous, if not released in a disciplined and constructive manner. Anger is triggered by fear. We are afraid that, if someone doesn’t do something, behavioral health issues will never be healed and might, quite possibly, be worsened. We felt somebody ought to do something, and we thought it could be us.

Many behavioral health challenges stem directly from fear.

As Dr. Martin Luther King, Jr. said, “Normal fear protects us; abnormal fear paralyses us. Normal fear motivates us to improve our individual and collective welfare; abnormal fear constantly poisons and distorts our inner lives. Our problem is not to be rid of fear but, rather to harness and master it.”

By that definition, our whole culture suffers from behavioral health issues, as it is toxic with abnormal fears.


Substance abuse begins as an attempt to self-medicate fear and anger. It then progresses into a physiological and neurological addiction. Most people don’t begin abusing substances with a goal of slow suicide by addiction; they’re usually trying to numb themselves to powerful emotions. Fear and anger are usually the strongest of these.

People with organic, psychiatric disorders are continually plagued by fear and anger, as are the developmentally disabled and those with other neurological disorders, such as trauma. They’re afraid someone will find out they have “mental disability” and either: shun, ridicule, persecute, exile or torment them for a condition they never chose. Our culture fears them, although most are harmless, no matter how unconventional their behaviors, appearance or thoughts might seem.

People with behavioral health issues are probably the least able to productively deal with fear. Altered mental states make rational thought difficult, at best. Impulse control isn’t even an option, for some. Many who could constructively control impulses and channel anger into positive action have been so dismissed and ostracized from our communities that they’ve never been taught they have the option. They just don’t know any better.

Those of us who struggle with behavioral health issues, and who love, care and work for them, don’t need any more exposure to irrational fear and anger. Our lives are riddled with them. For some of us, it’s all we can do to shelter ourselves and our loved ones from fear and anger. We need peace. We need hope. We need constructive outlets. We need to seek out the root causes and conditions from which fear and anger spring and heal ourselves and our community.

We can’t heal rage, terror and violence by using the same tactics. .We have got to restrain our impulses to act out irrationally when we feel fear or anger. It’s healthier for the mental equilibrium of ourselves, our loved ones, our clients and our society.

As Gandhi said, “"An eye for an eye makes the whole world blind."

Hey, South Africa!




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Rogi

Accessible Internet


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Accessibility and Learning Theories
By Martyn Cooper.
"...The paper seeks to review the interrelation between accessibility and
learning theory as it relates to eLearning. Here I give some key points from
the paper for comment if you wish..."
http://tinyurl.com/coo3vk

IMS AccessForAll Meta-data Specification
By Inovation Adoption Learning (ISM) Consortium.
"The AccessForAll Meta-data specification is intended to make it possible to
identify resources that match a user's stated preferences or needs. These
preferences or needs would be declared using the IMS Learner Information
Package Accessibility for LIP specification. The needs and preferences
addressed include the need or preference for alternative presentations of
resources, alternative methods of controlling resources, alternative
equivalents to the resources themselves and enhancements or supports required
by the user. The specification provides a common language for identifying and
describing the primary or default resource and equivalent alternatives for that
resource..."
http://www.imsglobal.org/accessibility/

Captioning Video with 'World Caption'
By University of Wisconsin.
"World Caption is a program for adding captions to a QuickTime compatible
video, using a transcript of that video. While World Caption cannot be used to
generate a transcript, it makes the process of synchronizing a transcript to
video simple, and allows quick and easy generation of captions."
http://kb.wisc.edu/helpdesk/page.php?id=6525

No Fuss Accessibility
By Antonio DaSilva.
"This article describes how you can quickly and easily create documents with
enhanced accessibility options for vision-impaired users using Microsoft Word
and Adobe Acrobat..."
http://www.writersua.com/articles/accessibility/index.html

Alt-erations
By Markku (Mark) Hakkinen.
"The section on the alt attribute in the current HTML5 working draft that
begins with 'What an img element represents depends on the src attribute and
the alt attribute' really seems to miss the point. This is the semantic Web
era, correct? Isn't the conditional logic of the current draft really trying
to affix a meaning or purpose to an image in all the wrong ways? Ambiguity is
not the way..."
http://www.talkinginterfaces.org/2009/03/06/alt-erations/

Connection
By William Loughborough.
"...Are people who provide materials for the Web, but ignore the 'everyone'
part ('after all, I'm not writing this for blind people') bigots, or just
uninformed, but well-meaning?..."
http://william-loughborough.blogspot.com/2009/03/connection.html

Does Your Grandfather Surf the Web?
By William Loughborough.
"...Dismissing old folks as pitiful fools is a poor plan for the continued
growth towards universal connection."
http://www.boobam.org/webgeezermild.htm

Web Accessibility as a Political Movement
By David Baron.
"...I think the attitude that evil Web authors need to be forced to care about
accessibility leads to technically worse solutions that require more work for
authors and leave the Web less accessible to disabled users as a result..."
http://dbaron.org/log/20090311-accessibility

Web Accessibility as a Political Movement IRC Discussion
By Karl Dubost and others.
"hmmm not sure I 100% agree with david..."
http://krijnhoetmer.nl/irc-logs/html-wg/20090312#l-67

Is Web Accessibility a Human Rights Issue?
By Wendy Chisholm.
"It's important for us to recognize each other's concerns. On the one hand we
have technologists who want to create things to help make the world better?help
people communicate more richly and quickly, to create technologies for
self-expression and commerce. Rock on. We want you to innovate because you're
changing the world. On the other hand we have people who want to use the
technologies and to participate in society. When the technologists say, 'Don't
make me think about accessibility, I want to be innovative.' The response from
people with disabilities can be hostile because the message from the
technologists is, 'I do not value you enough to include you in my innovation.'"
http://sp1ral.com/2009/03/is-web-accessibility-a-human-rights-issue/


The Electronic Curb-Cut Effect
By Steve Jacobs.
"Unusual things happen when products are designed to be accessible by people
with disabilities..."
http://www.icdri.org/technology/ecceff

Understanding the Effects of Cognitive Disorders: Parts 1 -3
By Kyle Lamson.
"On the baseline, cognitive disorders are about the brain and problems
understanding things. So there is no easy fix like slapping an alt attribute in
code, increasing color contrast and we will not understand something whether
written or read in a screenreader, using flexible widths where the content
paragraphs are to long can even cause more trouble for us even though free
flexing sizes are considered accessible..."
http://tinyurl.com/ba6xg7
http://tinyurl.com/bkrpt2
http://tinyurl.com/amevlg

Effective Health Care


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Effective Health Care Home
U.S. Department of Health & Human Services |
The White House |
USA.gov:
The U.S. Government's Official Web Portal
Agency for Healthcare Research and Quality
540 Gaither Road Rockville, MD
20850 Telephone: (301) 427-1364
<http://effectivehealthcare.ahrq.gov/>

One of the greatest challenges in making health care decisions is finding
reliable and practical data that can inform these decisions. The Effective
Health Care Program is dedicated to facilitating decision making by
providing findings from high-quality research in formats for different
audiences.

population with
rheumatoid arthritis
New Final Research Report available

Press Releases
<http://effectivehealthcare.ahrq.gov/news.cfm?newstype=pr

Glossary Terms
<http://effectivehealthcare.ahrq.gov/
tools.cfm?tooltype=glossary&report=full
>
A shorter URL for the above link:
<http://tinyurl.com/clw89x>

Internet Accessiblity


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How People with Disabilities Use the Web
Working-Group Internal Draft, 5 May 2005

This Version:
<http://www.w3.org/WAI/EO/Drafts/PWD-Use-Web/20050505>
Latest Version:
<http://www.w3.org/WAI/EO/Drafts/PWD-Use-Web/>
Previous Version:
http://www.w3.org/WAI/EO/Drafts/PWD-Use-Web/2004070
Abstract

This document provides an introduction to use of the Web by people with
disabilities. It illustrates some of their requirements when using Web
sites and Web-based applications, and provides supporting information for
the guidelines and technical work of the World Wide Web Consortium's (W3C)
Web Accessibility Initiative (WAI).

Table of Contents

1. Introduction
2. Scenarios of People with Disabilities Using the Web
3. Different Disabilities That Can Affect Web Accessibility
4. Assistive Technologies and Adaptive Strategies
5. Further Reading
6. Scenario References
7. General References
8. Acknowledgements

1. Introduction

The Web Accessibility Initiative (WAI) develops guidelines for
accessibility of Web sites, browsers, and authoring tools, in order to
make it easier for people with disabilities to use the Web. Given the
Web's increasingly important role in society, access to the Web is vital
for people with disabilities. Many of the accessibility solutions
described in WAI materials also benefit Web users who do not have
disabilities.

This document provides a general introduction to how people with different
kinds of disabilities use the Web. It provides background to help
understand how people with disabilities benefit from provisions described
in the Web Content Accessibility Guidelines 1.0, Authoring Tool
Accessibility Guidelines 1.0, and User Agent Accessibility Guidelines 1.0.
It is not a comprehensive or in-depth discussion of disabilities, nor of
the assistive technologies used by people with disabilities. Specifically,
this document describes:
* scenarios of people with disabilities using accessibility features
of Web sites and Web-based applications;
* general requirements for Web access by people with physical, visual,
hearing, and cognitive or neurological disabilities;
* some types of assistive technologies and adaptive strategies used by
some people with disabilities when accessing the Web.

This document contains many internal hypertext links between the sections
on scenarios, disability requirements, assistive technologies, and
scenario references. The scenario references and general references
sections also include links to external documents.

Assistive Devices For People With Motor Disabilities


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Assistive Devices For People With Motor Disabilities

Vijay Kumar
Department of Mechanical Engineering
222, Towne Building
220S, 33rd Street
Philadelphia, PA 19104-6315
e-mail: kumar at central.cis.upenn.edu

Tariq Rahman
Applied Science and Engineering Laboratories
Alfred I. duPont Institute and University of Delaware
1600 Rockland Road, P.O. Box 269
Wilmington, DE 19899
e-mail: rahman at asel.udel.edu

Venkat Krovi
Department of Mechanical Engineering
297, Towne Building
220S, 33rd Street
Philadelphia, PA 19104-6315
e-mail: venkat at grip.cis.upenn.edu

To appear in the Wiley Encyclopaedia of Electrical and Electronics
Engineering
Assistive Devices For People With Motor Disabilities -
Kumar, Rahman & Krovi, 1997

<http://www.cim.mcgill.ca/~venkat/PUBLICATIONS/Wiley.pdf>

There are many examples of assistive devices for people with manipulative
and locomotive disabilities. These devices enable disabled people perform
many activities of daily living thus improving their quality of life.
Disabled people are increasingly able to lead an independent life and play
a more productive role in society. In the case of disabled children, such
assistive devices have been shown to be critical to their cognitive,
physical and social development (1).

The earliest assistive devices were prothetic limbs, dating back to 500 B.
C. (2). The early wheelchairs, in contrast, found widespread use less than
300 years ago. These simple prothestic limbs and wheelchairs have since
evolved into more complex multi-degree-of-freedom mechanical and
elecromechanical devices. In particular, robotic technology has been used
to enhance the quality of life of people with disabilities, primarily by
enhancing a person's capability for independent living and vocational
productivity. An assistive robot (also called a rehabilitation robot), may
be viewed as being distinct from a prosthesis in that it may not attached
to the user, but may reside on a table top, or on the side of a
wheelchair, or on an independent mobile base. However, this distinction
may blur in the case of electro-mechanical aids that are worn by the user.

The goal of this article to review the state of the art in the technology
for assistive devices for people with disabilities, with a particular
focus on the technology that is loosely referred to as robotics. In the
process, we review research that has been done by us and by other groups
on assistive devices for manipulation and locomotion. We will be less
interested in examples of devices that simply perform the mechanical
function of a person's limb and instead focus on assistive aids that have
broader applications. Further therapeutic applications are beyond the
scope of this article. Similarly, orthoses that strengthen limbs and
spines, or prevent deformities are not considered here. Instead the main
goal is to provide the reader with an understanding of how the technology
and science that underlies robotics can be used to develop assistive
devices for people with manipulative and locomotive disabilities.

Prescribing Therapy Services for Children with Motor Disabilities


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DISABILITIES: PHYSICAL DISABILITIES:
Pscribing Therapy Services for Children with Motor Disabilities

Prescribing Therapy Services for Children with Motor Disabilities
* Michaud LJ. Prescribing therapy services for children with motor
disabilities. Pediatrics 2004 Jun;113(6):1836-8. [23 references] PubMed
National Guideline Clearinghouse
<http://www.guideline.gov/summary/
summary.aspx?ss=15&doc_id=5325&nbr=3638
>
A shorter URL for the above link:
<http://tinyurl.com/cspqf8>

COMPLETE SUMMARY CONTENT

SCOPE
METHODOLOGY - including Rating Scheme and Cost Analysis
RECOMMENDATIONS
EVIDENCE SUPPORTING THE RECOMMENDATIONS
BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS
QUALIFYING STATEMENTS
IMPLEMENTATION OF THE GUIDELINE
INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES
IDENTIFYING INFORMATION AND AVAILABILITY
DISCLAIMER

SCOPE
DISEASE/CONDITION(S)

Motor disabilities, including those related to:

* Cerebral palsy
* Traumatic brain injury
* Myelomeningocele
* Spinal cord injury
* Neuromuscular disease
* Juvenile rheumatoid arthritis
* Arthrogryposis
* Limb deficiencies

GUIDELINE CATEGORY

Management
CLINICAL SPECIALTY

Family Practice
Pediatrics
Physical Medicine and Rehabilitation
Speech-Language Pathology
INTENDED USERS

Health Care Providers
Physician Assistants
Physicians
GUIDELINE OBJECTIVE(S)

To define the context in which rehabilitation therapies should be
prescribed, emphasizing the evaluation and enhancement of the childs
function and abilities and participation in age-appropriate life roles
TARGET POPULATION

Children with motor disabilities
INTERVENTIONS AND PRACTICES CONSIDERED

1. Accurate diagnosis /description of disability
2. Development of appropriate prescription for therapy programs
(physical, occupational, and speech-language)
3. Establishment of realistic functional goals (both short- and
long-term
4. Regular communication among parents and other caregivers,
therapists, educators, and prescribing physicians
5. Parent and caregiver education

MAJOR OUTCOMES CONSIDERED

Effectiveness of therapy for motor disability

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

The Pediatricians Role

The pediatricians responsibility in writing a prescription for therapy
includes providing an accurate diagnosis when possible. When the exact
cause of the disability is not apparent, the physician must provide an
accurate description of the medical condition and note whether the child
has a transient, static, or progressive impairment. In addition to the
primary motor disorder, all potential associated problems such as learning
disabilities, mental retardation, sensory impairment, speech disorders,
emotional difficulties, and seizure disorders must be identified, and a
care plan must be recommended. There are some children with special needs
whose medical conditions may be affected adversely by movement or other
specific therapeutic activities; therapists and caregivers should be
advised to take appropriate precautions with these children.

The physicians prescription for therapy should contain, in addition to the
childs diagnosis: age; precautions; type, frequency, and duration of
therapy; and designated goals. Goals for physical, occupational, and
speech-language therapy do not depend solely on the diagnosis or age of
the child, and they are most appropriate when they address the functional
capabilities of the individual child and are relevant to the childs
age-appropriate life roles (school, play, work). The pediatrician should
work with the family, child, therapists, school personnel, developmental
diagnostic or rehabilitation team, and other physicians to establish
realistic functional goals. The pediatrician can assist families in
identifying the short- and long-term goals of treatment, establishing
realistic expectations of therapy outcomes, and understanding that therapy
will usually help the child adapt to the condition but not change the
underlying neuromuscular problem. Pediatricians should be encouraged to
seek and use expert consultation as in any other area of medicine. Helpful
resources may include local and regional diagnostic and intervention
teams, early intervention and developmental evaluation programs,
developmental pediatricians, pediatric physiatrists, pediatric
neurologists, pediatric orthopedists, and orthotists.

Regular communication among parents and other caregivers, therapists,
educators, and prescribing physicians should be ongoing, with periodic
reevaluations to assess the achievement of identified goals, to direct
therapy toward new objectives, and to determine when therapy is no longer
warranted. Changes in the childs status (e.g., surgical intervention,
school-to-work transition warranting assistive technology intervention)
may indicate resumption of specific short-term, goal-directed services.

Summary

Successful therapy programs are individually tailored to meet the childs
functional needs and should be comprehensive, coordinated, and integrated
with educational and medical treatment plans, with consideration of the
needs of parents and siblings. This can be facilitated by primary care
pediatricians and tertiary care centers working cooperatively to provide
care coordination in the context of a medical home.