Jon P. Wietholter, PharmD, BCPS

• Clinical Associate Professor, Department of Clinical Pharmacy, West Virginia University School of Pharmacy
• Internal Medicine Clinical Pharmacist, Ruby Memorial Hospital, West Virginia Medicine, Morgantown, West Virginia

https://directory.hsc.wvu.edu/Profile/33364

Physical examination shows a 1-cm spasms in your sleep buy discount lioresal online, visible anal mass located below the dentate line spasms vulva order lioresal cheap online. If the mass if found to be malignant spasms when i pee discount 10 mg lioresal otc, it is most appropriate to evaluate which of the following lymph nodes for possible metastasis A 59-year-old man is brought to the emergency department because of a 4-day history of nausea gastric spasms purchase lioresal 25 mg mastercard, vomiting spasms cure purchase genuine lioresal online, and diarrhea muscle relaxant names order lioresal master card. Physical examination shows delayed capillary refill of the lips and nail beds and cool extremities. Single-Item Questions A single patient-centered vignette is associated with one question followed by four or more response options. A portion of the questions involves interpretation of graphic or pictorial materials. This is the traditional, most frequently used multiple-choice question format on the examination. Example Item A 32-year-old woman with type 1 diabetes mellitus has had progressive renal failure over the past 2 years. Her hemoglobin concentration is 9 g/dL, hematocrit is 28%, and 3 mean corpuscular volume is 94 m. Each question is associated with the initial patient vignette but is testing a different point. You must click Proceed to Next Item to view the next item in the set; once you click on this button, you will not be able to add or change an answer to the displayed (previous) item. Please note that reviewing the sample questions as they appear on pages 7-41 is not a substitute for practicing with the test software. You should become familiar with all item formats that will be used in the actual examination. Although the sample questions exemplify content on the examination, they may not reflect the content coverage on individual examinations. The questions will be presented one at a time in a format designed for easy on-screen reading, including use of exhibit buttons for the Normal Laboratory Values Table (included here on pages 56) and some pictorials. Photographs, charts, and x-rays in this booklet are not of the same quality as the pictorials used in the actual examination. In addition, you will be able to adjust the brightness and contrast of pictorials on the computer screen. To take the following sample test questions as they would be timed in the actual examination, you should allow a maximum of one hour for each 46-item block, for a total of three hours. In the actual examination, answers will be selected on the screen; no answer form will be provided. He had normal She has had mild intermittent vaginal bleeding, development at birth. He chews his fingers and sometimes associated with lower abdominal lips, which has resulted in tissue loss. Serum and urine uric acid cramping pain in the right lower abdomen for concentrations are increased. She has not had a menstrual period for following abnormalities is the most likely cause 3 months; previously, menses occurred at regular of these findings Abdominal examination shows mild tenderness to palpation in the right lower (A) Adenine phosphoribosyltransferase quadrant. Bimanual pelvic examination shows a deficiency tender walnut-sized mass in the right (B) Hypoxanthine-guanine parametrium. She says that she has felt systemic lupus erythematosus is brought to the well except for occasional episodes of physician for a routine follow-up examination. She was treated for a renal calculus 10 exception of occasional mild frontal headaches, years ago and was told she had a "lazy fatigue, and arthralgias; the results of regular gallbladder. Passive motion of the elbows, Cl 107 mEq/L 2+ wrists, and knees produces mild discomfort. A 3-year-old boy is brought to the physician because of fever, headache, and sores on his back and left shoulder for 1 day. Physical examination shows vesicles over the back and left shoulder as in the photograph shown. A 4-year-old girl has the sudden onset of (E) Immunosuppression abdominal pain and vomiting. Physical examination shows localized tenderness over the lumbar spine (A) Appendicitis after movement. Serum (D) Necrotizing enterocolitis calcium and phosphorus concentrations and (E) Strangulated hernia serum alkaline phosphatase activity are within the reference ranges. A 12-year-old girl with sickle cell disease has drug is most likely due to which of the following pain in her right arm. Which of the following is the most (A) Decreased insulin-like growth factor-1 likely causal organism Hospital discharge of a 75-year-old man is delayed due to unavailability of a bed in a nursing home. During a 3-day period, his pulse increases from 82/min to 125/min, and blood pressure decreases from 124/72 mm Hg to 100/55 mm Hg. A placebo-controlled clinical trial is conducted hypertrophy has the recent onset of increased to assess whether a new antihypertensive drug is difficulty urinating. A total of after he started taking a nasal decongestant orally 5000 patients with essential hypertension are for cold symptoms. Which of the following types enrolled and randomly assigned to one of two of receptors is most likely to be involved in these groups: 2500 patients receive the new drug and adverse effects A 15-year-old girl is brought to the physician statistically significant findings because of a 3-week history of excessive thirst (E) There is an increased likelihood of a and voiding excessive amounts of urine. She Type I error shows no signs of kidney damage, and she is not taking any medications. Gram stain of the exudate shows Under both conditions, she continues to produce numerous neutrophils, many that contain large volumes of dilute urine. He has most likely due to a relative lack of which of the had three similar episodes of urethritis over the following proteins from the apical membranes of past 2 years. Neurologic examination 6 weeks later shows an extensor plantar reflex on the right. When she is asked to protrude her tongue, it deviates to the left, and the muscle in the left side of the tongue shows considerable atrophy. Which of the following labeled areas in the transverse sections of the brain stem is most likely damaged A 22-year-old man develops delusions, flattening because of a 2-day history of mild nausea, of affect, catatonic behavior, hallucinations, and increased urinary urgency and frequency, and aphasia. Examination of biopsy (C) Aphasia and delusions specimens from the cervix and anterior wall of (D) Catatonia and delusions the vagina show well-differentiated keratinizing (E) Hallucinations and catatonia squamous cell carcinoma. After infection with measles virus, a 6-year-old boy produces antibodies to all eight viral (A) Inactivation of cellular p53 proteins. The next year he is again exposed to (B) Insertion of viral promotors adjacent to measles virus. Antibodies to which of the cellular growth factor genes following viral proteins are most likely to be (C) Specialized transduction protective A 25-year-old woman comes to the physician because of a 10-year history of frequent occurrences of fever blisters. Microscopic examination of culture of scrapings from three vesicles shows herpes simplex virus 1. A 35-year-old woman with a bicuspid aortic because of a 2-day history of fever and left flank valve comes to the physician because of a 1 pain. She has been treated for multiple episodes week history of a swollen, painful left knee. A grade 2/6 occasional lymphocytes and mononuclear cells systolic murmur is heard. Gross stain shows no organisms, and culture is examination of the mass after it has been negative. Which of the shows a predominance of epithelioid cells with following is the most likely cause of the joint partially clear and granular-to-foamy cytoplasm. Nuclei are eccentric, normochromic, symmetric, and without significant pleomorphism. Scattered (A) Autoimmune response triggered by a lymphocytes and plasma cells are intermixed. A 28-year-old man comes to the physician because of a 1-year history of pain with urination that has increased in severity during the past month. Endoscopy shows a bleeding 3 Imaging studies show bilateral hydroureter and cm ulcer in the antrum of the stomach. A biopsy specimen of the photomicrograph of Steiner silver-stained tissue bladder shows marked chronic inflammation (400x) from a biopsy of the gastric mucosa with fibrosis and scattered granulomas. Which of the following processes is most likely to be the following best explains the biopsy findings Which of the following sets of additional serum findings is most likely in this patient Calcium Inorganic Phosphorus 1,25-Dihydroxycholecalciferol Erythropoietin (A) ^ ^ ^ v (B) ^ ^ v v (C) ^ v v ^ (D) v ^ ^ v (E) v ^ v v (F) v v ^ ^ 24. A chest x-ray shows a right upper is reacted in a mixture containing lobe infiltrate. Which of the following performed, and the reaction product is detected should be added to the medication regimen to by gel electrophoresis. A 12-year-old girl is brought to the emergency department by her parents because of a 3-day 27. A 6-year-old boy from rural Mississippi is history of fever and a 12-hour history of brought to the physician by his mother because lethargy. Her parents say that she has been of a 6-month history of lethargy; he also has had sleeping most of the day and has been a 4-kg (9-lb) weight loss during this period. The numerous petechial hemorrhages and nuchal patient is at the 10th percentile for height and rigidity. Which of the following is the most most appropriate pharmacotherapy for this likely causal organism Warfarin is administered to a 56-year-old man following placement of a prosthetic cardiac valve. He has the recent onset of trimethoprim-sulfamethoxazole therapy is begun angina pectoris. In addition leukocyte count is 12,000/mm, and erythrocyte to monitoring prothrombin time, which of the mass is increased. Erythropoietin concentration following actions should the physician take to is decreased. A 40-year-old woman comes to the physician because of a 6-month history of increased facial 33. Her with serum prostate-specific antigen pulse is 80/min, and blood pressure is 130/82 concentrations greater than 5 ng/mL (N<4). Physical examination shows temporal hundred men undergo biopsy procedures; 90 are balding and coarse dark hair on the upper lip and found to have prostate cancer, and five are found chin. Her serum testosterone following is necessary to calculate the sensitivity concentration is increased. Which of the following best (B) Number of men with test results greater describes this mass A 47-year-old man comes to the physician because of a 1-week history of temperatures to 38. He also has a 1-year history of joint and muscle pain in his calves and a 1-month history of intermittent, diffuse abdominal pain. Breast and recurrence of the tumor despite aggressive pubic hair development began at the age of treatment. Menarche occurred at the age of prognosis with his parents and recommends 14 years. The parents ask how they should open and closed comedones over the cheeks and talk with their son about his prognosis and forehead. A 45-year-old man comes to the physician follow-up examination 1 week after he passed a because of right shoulder pain that began after he renal calculus. Examination of the the calculus showed calcium as the primary right upper extremity shows no obvious bone cation. A 24-hour collection of urine reproduced when the patient is asked to shows increased calcium excretion. Which of the externally rotate the shoulder against resistance; following is the most appropriate there is no weakness. A 2-year-old girl is brought to the emergency processing highly radioactive substances department because of pain in her right forearm accidentally receives a high, whole-body dose of after a fall 1 hour ago. She has a history of ionizing radiation estimated to be fractures of the left femur and right tibia. There autopsy, histologic examination of the skin is tenderness to palpation over the distal right shows scattered, individual epidermal cells with radius. A mutation in which of the following shrunken, markedly eosinophilic cytoplasm and genes is the most likely cause of the recurrent pyknotic, fragmented nuclei. A 55-year-old woman with small cell carcinoma of the lung is admitted to the hospital to undergo 39.

Alcohol addiction drinks on the same occasion on at least often involves a similar pattern as opioid addiction muscle relaxant clonazepam buy lioresal australia, often 1 day in the past 30 days spasms jaw generic lioresal 25 mg otc. As with opioids muscle relaxant methocarbamol addiction order lioresal with mastercard, addiction to alcohol is characterized by intense craving that is often driven by negative emotional states spasms mid back buy 25 mg lioresal with mastercard, positive emotional states muscle relaxant vitamins minerals purchase 25 mg lioresal with mastercard, and stimuli that have been associated with drinking spasms right side under ribs order lioresal in india, as well as a severe emotional and physical withdrawal syndrome. Many people with severe alcohol use disorder engage in patterns of binge drinking followed by withdrawal for extended periods of time. Extreme patterns of use may evolve into an opioid-like use pattern in which alcohol must be available at all times to avoid the negative consequences of withdrawal. Stimulants Stimulants increase the amount of dopamine in the reward circuit (causing the euphoric high) either by directly stimulating the release of dopamine or by temporarily inhibiting the removal of dopamine from synapses, the gaps between neurons. These drugs also boost dopamine levels in brain regions responsible for attention and focus on tasks (which is why stimulants like methylphenidate [Ritalin ] or dextroamphetamine [Adderall ] are often prescribed for people with attention defcit hyperactivity disorder). Stimulants also cause the release of norepinephrine, a neurotransmitter that affects autonomic functions like heart rate, causing a user to feel energized. Addiction to stimulants, such as cocaine and amphetamines (including methamphetamine), typically follows a pattern that emphasizes the binge/intoxication stage. A person will take the stimulant repeatedly during a concentrated period of time lasting for hours or days (these episodes are called binges). The binge is often followed by a crash, characterized by negative emotions, fatigue, and inactivity. Intense craving then follows, which is driven by environmental cues associated with the availability of the substance, as well as by a persons internal state, such as their emotions or mood. Marijuana (Cannabis) Like other drugs, marijuana (also called cannabis) leads to increased dopamine in the basal ganglia, producing the pleasurable high. It also interacts with a wide variety of other systems and circuits in the brain that contain receptors for the bodys natural cannabinoid neurotransmitters. Effects can be different from user to user, but often include distortions in motor coordination and time perception. Over time, individuals begin to use the substance throughout the day and show chronic intoxication during waking hours. Withdrawal is characterized by negative emotions, irritability, and sleep disturbances. Synthetic cathinones, more commonly known as bath salts, target the release of dopamine in a similar manner as the stimulant drugs described above. To a lesser extent, they also activate the serotonin neurotransmitter system, which can affect perception. Synthetic cannabinoids, sometimes referred to as K2, Spice, or herbal incense, somewhat mimic the effects of marijuana but are often much more powerful. Fentanyl is a synthetic opioid medication that is used for severe pain management and is considerably more potent than heroin. Prescription fentanyl, as well as illicitly manufactured fentanyl and related synthetic opioids, are often mixed with heroin but are also increasingly used alone or sold on the street as counterfeit pills made to look like prescription opioids or sedatives. Factors that Increase Risk for Substance Use, Misuse, and Addiction Not all people use substances, and even among those who use them, not all are equally likely to become addicted. Many factors infuence the development of substance use disorders, including developmental, environmental, social, and genetic factors, as well as co-occurring mental disorders. Other factors protect people from developing a substance use disorder or addiction. The relative infuence of these risk and protective factors varies across individuals and the lifespan. Early Life Experiences 1the experiences a person has early in childhood and in adolescence can set the stage for future substance use and, sometimes, escalation to a substance use disorder or addiction. See Chapter 1 Introduction and Early life stressors can include physical, emotional, and sexual Overview and Chapter 3 Prevention Programs and Policies. Research suggests that the stress caused by these risk factors may act on the same45 46 stress circuits in the brain as addictive substances, which may explain why they increase addiction risk. In addition, the brain undergoes signifcant changes during this life stage, making it particularly vulnerable to substance exposure. For example, a brain imaging study of adolescents revealed that the volume of the frontal cortex was smaller in youth who transitioned from no or minimal drinking to heavy drinking over the course of adolescence than it was in youth who did not drink during adolescence. Genetic and Molecular Factors Genetic factors are thought to account for 40 to 70 percent of individual differences in risk for addiction. Some of these variants have been associated with the metabolism of alcohol and nicotine, while others involve receptors and other proteins associated with key neurotransmitters and molecules involved in all parts of the addiction cycle. Genes involved in strengthening the connections between neurons and in forming54 drug memories have also been associated with addiction risk. Additional research on the mechanisms underlying gene by environment interactions is expected to provide insight into how substance use disorders develop and how they can be prevented and treated. Use of Multiple Substances and Co-occurring Mental Health Conditions Many individuals with a substance use disorder also have a mental disorder,57,58 and some have multiple substance use disorders. One reason for the overlap may be that having a mental disorder increases vulnerability to substance use disorders because certain substances may, at least temporarily, be able to reduce mental disorder symptoms and thus are particularly negatively reinforcing in these individuals. Second, substance use disorders may increase vulnerability for mental disorders,62-64 meaning that the use of certain substances might trigger a mental disorder that otherwise would have not occurred. As these possibilities are not mutually exclusive, the relationship between substance use disorders and mental disorders may result from a combination of these processes. Regardless of which one might infuence the development of the other, mental and substance use disorders have overlapping symptoms, making diagnosis and treatment planning particularly difcult. For example, people who use methamphetamine for a long time may experience paranoia, hallucinations, and delusions that may be mistaken for symptoms of schizophrenia. And, the psychological symptoms that accompany withdrawal, such as depression and anxiety, may be mistaken as simply part of withdrawal instead of an underlying mood disorder that requires independent treatment in its own right. Given the prevalence of co-occurring substance use and mental disorders, it is critical to continue to advance research on the genetic, neurobiological, and environmental factors that contribute to co-occurring disorders and to develop interventions to prevent and treat them. Biological Factors Contributing to Population-based Differences in Substance Misuse and Substance Use Disorders Differences Based on Sex Some groups of people are also more vulnerable to substance misuse and substance use disorders. For example, men tend to drink more than women and they are at higher risk for alcohol use disorder, although the gender differences in alcohol use are declining. They also report worse negative affects during withdrawal and have higher levels of the stress hormone cortisol. Female rats, in general, learn to self-administer drugs and alcohol more rapidly, escalate their drug taking more quickly, show greater symptoms of withdrawal, and are more likely to resume drug seeking in response to drugs, drug-related cues, or stressors. The one exception is that female rats show less withdrawal symptoms related to alcohol use. Differences Based on Race and Ethnicity Research on the neurobiological factors contributing to differential rates of substance use and substance use disorders in particular racial and ethnic groups is much more limited. Although these effects may protect some individuals of East Asian descent from alcohol use disorder, those who drink despite the effects are at increased risk for esophageal76 and head and neck cancers. Another study found that even low levels of alcohol consumption by Japanese77 Americans may result in adverse effects on the brain, a fnding that may be related to the differences in alcohol metabolism described above. Additional research will help to clarify the interactions between race,78 ethnicity, and the neuroadaptations that underlie substance misuse and addiction. This work may inform the development of more precise preventive and treatment interventions. Recommendations for Research Decades of research demonstrate that chronic substance misuse leads to profound disruptions of brain circuits involved in the experience of pleasure or reward, habit formation, stress, and decision-making. This work has paved the way for the development of a variety of therapies that effectively help people reduce or abstain from alcohol and drug misuse and regain control over their lives. In spite of this progress, our understanding of how substance use affects the brain and behavior is far from complete. Effects of Substance Use on Brain Circuits and Functions Continued research is necessary to more thoroughly explain how substance use affects the brain at the molecular, cellular, and circuit levels. Such research has the potential to identify common neurobiological mechanisms underlying substance use disorders, as well as other related mental disorders. A better understanding of the neurobiological mechanisms underlying substance use disorders could also help to inform behavioral interventions. As with other diseases, individuals vary in the development and progression of substance use disorders. Not only are some people more likely to use and misuse substances than are others and to progress from initial use to addiction differently, individuals also differ in their vulnerability to relapse and in how they respond to treatments. For example, some people with substance use disorders are particularly vulnerable to stress-induced relapse, but others may be more likely to resume substance use after being exposed to drug-related cues. Developing a thorough understanding of how neurobiological differences account for variation among individuals and groups will guide the development of more effective, personalized prevention and treatment interventions. Additionally, determining how neurobiological factors contribute to differences in substance misuse and addiction between women and men and among racial and ethnic groups is critical. Continued advances in neuroscience research will further enhance our understanding of substance use disorders and accelerate the development of new interventions. Data gathered through the National Institutes of Healths Adolescent Brain Cognitive Development study, the largest long-term study of cognitive and brain development in children across the United States, is expected to yield unprecedented information about how substance use affects adolescent brain development. Technologies that can alter the activity of dysfunctional circuits are being explored as possible treatments. Moreover, continued advances in genomics, along with President Obamas Precision Medicine Initiative, a national effort to better understand how individual variability in genes, environment, and lifestyle contribute to disease, are expected to bring us closer to developing individually-tailored preventive and treatment interventions for substance-related conditions. Neurobiological Effects of Recovery Little is known about the factors that facilitate or inhibit long-term recovery from substance use disorders or how the brain changes over the course of recovery. Developing a better understanding of the recovery process, and the neurobiological mechanisms that enable people to maintain changes in their substance use behavior and promote resilience to relapse, will inform the development of additional effective treatment and recovery support interventions. Therefore, an investigation of the neurobiological processes that underlie recovery and contribute to improvements in social, educational, and professional functioning is necessary. Prospective, longitudinal studies are in which data on a particular group of people are gathered repeatedly over a needed to investigate whether pre-existing neurobiological period of years or even decades. Studies that follow groups of adolescents over time to learn about the developing human brain should be conducted. These studies should investigate how pre-existing neurobiological factors contribute to substance use, misuse, and addiction, and how adolescent substance use affects brain function and behavior. Neurobiological Effects of Polysubstance Use and Emerging Drug Products Patterns of alcohol and drug use change over time. New drugs or drug combinations, delivery systems, and routes of administration emerge, and with them new questions for public health. Concerns also are emerging about how new products about which little is known, such as synthetic cannabinoids and synthetic cathinones, affect the brain. Additional research is needed to better understand how such products as well as emerging addictive substances affect brain function and behavior, and contribute to addiction. Phasic vs sustained fear in rats and humans: Role of the extended amygdala in fear vs anxiety. How adaptation of the brain to alcohol leads to dependence: A pharmacological perspective. The attribution of incentive salience to a stimulus that signals an intravenous injection of cocaine. Cocaine cues and dopamine in dorsal striatum: Mechanism of craving in cocaine addiction. Increased occupancy of dopamine receptors in human striatum during cue-elicited cocaine craving. Stimulant-induced dopamine increases are markedly blunted in active cocaine abusers. Parallel and interactive learning processes within the basal ganglia: Relevance for the understanding of addiction. Decreased striatal dopaminergic responsiveness in detoxifed cocaine-dependent subjects. Decreased dopamine D2 receptor availability is associated with reduced frontal metabolism in cocaine abusers. Glucocorticoid receptor antagonism decreases alcohol seeking in alcohol dependent individuals. Dysfunction of the prefrontal cortex in addiction: Neuroimaging fndings and clinical implications. Dysfunctional amygdala activation and connectivity with the prefrontal cortex in current cocaine users. Drug addiction and its underlying neurobiological basis: Neuroimaging evidence for the involvement of the frontal cortex. Profound decreases in dopamine release in striatum in detoxifed alcoholics: Possible orbitofrontal involvement. Association of frontal and posterior cortical gray matter volume with time to alcohol relapse: A prospective study. Fear conditioning, synaptic plasticity and the amygdala: Implications for posttraumatic stress disorder. Marijuana craving questionnaire: Development and initial validation of a self-report instrument. Cannabis craving in response to laboratory-induced social stress among racially diverse cannabis users:the impact of social anxiety disorder. Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use:the adverse childhood experiences study. Childhood maltreatment and psychopathology: A case for ecophenotypic variants as clinically and neurobiologically distinct subtypes. Genetic and environmental contributions to alcohol abuse and dependence in a population-based sample of male twins. Human cell adhesion molecules: Annotated functional subtypes and overrepresentation of addictionassociated genes. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions.

Prediciting the probability for falls in community dwelling older adults using the Timed Up & go Test spasms of the bladder buy lioresal 10mg mastercard. Clinical relevance using timed walk tests and the timed up and go testing in persons with Multiple Sclerosis muscle relaxant patch order lioresal 10 mg on-line. The timed up & go test: its reliability and association with lowerlimb impairments and locomotor capacities in people with chronic stroke spasms near kidney buy discount lioresal 25mg online. TestRetest Reliability and Minimal Detectable Change Scores for the Timed Up & Go Test muscle relaxant 5658 order lioresal mastercard, the SixMinute Walk Test infantile spasms 9 months generic 10 mg lioresal amex, and Gait Speed in People with Alzheimer Disease spasms lung purchase 10mg lioresal. Reliability and concurrent validity of the Expanded Timed UpandGo test in older people with impaired mobility. Reliability of gait performance tests in men and women with hemiparesis after stroke. Prognostic validity of the Timed UpandGo test, a modified GetUpandGo test, staffs global judgment and fall history in evaluating fall risk in residential care facilities. Reliability of Measurements Obtained With the Timed Up & Go Test in People With Parkinson Disease. The timed Up & Go: a test of basic functional mobility for frail elderly person. Testretest reliability and minimal detectable change on balance and ambulation tests, the 36Item ShortForm Health Survery, and the Unified Parkinsons Rating Scale in people with parkinsonism. Scores with high total indicate lower confidence with selffiefficacy or fear of falling. Reliability (testretest, Intrarater: intrarater, interrater) N/A Interrater: N/A Testretest: In study with 74 patients r=0. Discriminative validity: Sensitivity/Specificity/Predictive Values/Likelihood Ratios: In a study with 53 subjects: Senstivity59%; specificity82%. Attachments: Score Sheets: X Uploaded on website Available but copyrighted Unavailable. Fear of falling and fallrelated efficacy in relationship to functioning among communityliving elders. Covergent and Predictive Validity of Three Scales Related to Falls in the elderly. Screening for balance and mobility impairment in elderly individuals living in residential care facilities. Fear of Falling and associated activity curtailment among middle aged and older adults with multiple sclerosis. Level of client participation Participants must be able to follow instructions and able to Tinetti Performance Oriented Mobility Assessment Multiple Sclerosis Outcome Measures Taskforce required (is proxy ambulate short distances with assistive device. Reliability and validity of the Tinetti Mobility Test for individuals with Parkinson disease. Interrater and intrarater reliability of the Tinetti Balance Test for Individuals with Amyotrophic Lateral Sclerosis. A randomized controlled trial of functional neuromuscular stimulation in chronic stroke subjects. Interrater reliability of the Tinetti Balance Scores in novice and experienced physical therapy clinicians. Tinetti Performance Oriented Mobility Assessment Multiple Sclerosis Outcome Measures Taskforce 10. Sensitivity of a clinical scale of balance and gait in frail nursing home residents. Testretest reliability and concurrent validity of the Tinetti Performanceoriented Mobility Assessment in patients undergoing inpatient physical therapy after stroke. Validity and reliability of quantitative gait analysis in geriatric patients with and without dementia. Psychometric comparisons of the timed up and go, oneleg stand, functional reach, and Tinetti balance measures in communitydwelling older people. Discrepancies between balance confidence and physical performance among communitydwelling Korean elders: a populationbased study. The effect of spasticity, sense and walking aids in falls of people after chronic stroke. Tinetti Performance Oriented Mobility Assessment Multiple Sclerosis Outcome Measures Taskforce Instrument name: Trunk Control Test Reviewer: Susan E. Reliability (testretest, Intrarater: intrarater, interrater) Interrater: Good interrater reliability (Spearmans Rho= 0. Validity (concurrent, Concurrent validity: criterionrelated, Good correlation of the Trunk Control Test and Rivermead Motor predictive) Assessment Rho=0. Equipment required Bed or mat table, stopwatch, stepstool Time to complete 1 5 minutes or less How is the instrument 4 item test (minimum score 0 to maximum score 100), obtained scored Walking after stroke: What does treadmill training with body weight support add to overground gait training in patients early after stroke Psychometric and practical attributes of the trunk control test in stroke patients. The Trunk Impairment Scale: a new tool to measure motor impairment of the trunk after stroke. Discriminant ability of the Trunk Impairment Scale: A comparison between stroke patients and healthy individuals. Visual Analog ScaleFatigue Multiple Sclerosis Outcome Measures Taskforce 6) 18 individual 0100 mm lines. The minimally important difference for the fatigue visual analog scale in patients with rheumatoid arthritis followed in an academic clinical practice. Fatigue assessments in rheumatoid arthritis: comparative performance of visual analog scales and longer fatigue questionnaires in 7760 patients. A comparison of two methods of measuring fatigue in patients on chronic haemodialysis: visual analogue vs Likert scale. A doubleblind, randomized, crossover trial of pemoline in fatigue associated with multiple sclerosis. Substantial discounts on bulk quantities of Jossey-Bass books are available to corporations, professional associations, and other organizations. For details and discount information, contact the special sales department at Jossey-Bass Inc. Lecture Strategies 12 Preparing to Teach the Large Lecture Course 99 13 Delivering a Lecture 111 14 Explaining Clearly 120 15 Personalizing the Large Lecture Class 125 16 Supplements and Alternatives to Lecturing: Encouraging Student Participation 131 17 Maintaining Instructional Quality with Limited Resources 140 ix Contents V. Instructional Media and Technology 35 Chalkboards 315 36 Hipcharts 3/9 37 Transparencies and Overhead Projectors 321 38 Slides 326 39 Films and Videotapes 331 40 Computers and Multimedia 334 X. Finishing Up 47the Last Days of Class 393 48 Student Rating Forms 397 49 Writing Letters of Recommendation 407 Index 413 xi Preface In the continuing debate over how to improve the quality of undergraduate education, two questions are of central importance: What should be taught The aim of the book is to encourage faculty to become more aware of how they teach and how they might teach more effectively, and to provide them with the tools for doing so. New faculty members who are teaching for the first time will find reassuring suggestions on how to design and offer a new course, how to write and grade an exam, and how to attend to the range of responsibilities involved in teaching and managing a large lecture course. Experienced faculty members who are faced with thorny teaching problems or are concerned about burning out or getting stale will find descriptions of various ways to revitalize their courses. Graduate student instructors and teaching assistants can also benefit from the ideas described in Tools. Tools is truly a toolbox from which to select and adapt those ideas that match your teaching style and the needs of your students. Indeed, one of the premises of the book is that there are no pat answers, quick fixes, or sure-fire recipes for excellent teaching, only endless ways to improve your teaching skills. Origin of Tools for Teaching Every day, faculty in classrooms across the country acquire useful knowledge about teaching. This book is an attempt to catalogue those classroom-tested ideas and strategies in an easy-to-read format that lends itself to quick reference and skimming. I have made every effort to attribute each entry to a published source or to cite a reference that provides greater detail, although the source cited is not necessarily the originator of the technique. In some cases, though, the ideas form part of the general lore and common practices of faculty or reached me Preface without attribution or evolved from my own experiences in teaching and working with faculty. Therefore, I encourage those with the time and inclination to use the bibliographies at the end of each tool to delve more deeply into the background of a given area. Description and Organization of Tools for Teaching Tools is a practical source book designed to be used as a reference book; it is not meant to be read cover to cover in two or three sittings. Although all the principles and suggestions derive from classroom experience and educational research and theory, the various tools focus on what instructors can do rather than on the theoretical underpinnings for the suggestions. Those seeking discussions of theory and philosophy, essays on good teaching, personal reminiscences about classroom experiences, or case studies of typical teaching situations will want to look elsewhere. Personal descriptions of teaching experiences can be found in publications such asthe Teaching Professor and College Teaching or in discipline-specific periodicals related to college teach ing, such as Teaching of Psychology and Journal of College Science Teaching. Theories, models, and alternative outlooks on teaching have been proposed by Axelrod (1973) and Jackson (1986), among others. The book consists of forty-nine tools organized into twelve sections that represent, in roughly chronological sequence, the key teaching responsibilities and activities of college instructors. The topics range from specific tasks (writing a course syllabus) to broad social issues (dealing with diversity on campus). The format lends itself to easy and efficient identification of major points and to quick reading or browsing. Moreover, each tool can be read independently of the others, and the tools can be read in any order. As you will see, the groupings of tools within the sections are somewhat arbitrary. The table of contents, index, and cross-references within the tools should help you quickly locate the material you need. The following overview of the twelve sections may also help you decide where to delve. Section One, "Getting Under Way," addresses planning issues: how to design a new course or revise an existing one, how to create a syllabus, and how to handle the first day of class. Section Two, "Responding to a Diverse Student Body," explores issues that arise in teaching students with disabilities, stu dents from ethnic or cultural backgrounds different from your own, and older students returning to school after an extended absence. The final tool in this section looks at classes in which students have widely varying aca demic skills and abilities. The next three sections focus on instructional strategies for different class formats. Section Three, "Discussion Strategies," provides ideas on how to lead a productive discussion, frame challenging questions, and encourage student participation. Section Four, "Leaure Strategies," addresses all as pects of the leaure method, particularly the large lecture class: how to prepare, how to deliver effective lectures, and how to create a positive classroom environment in a large impersonal auditorium. This section also describes supplements and alternatives to lecturing, to more actively engage students and overcome the passivity of one-way communication. The theme of active involvement is continued in Section Five, "Collaborative and Expe riential Strategies. The section also addresses the thorny problem of motivating all students to do their best. For many faculty members, testing and grading are the most difficult aspects of teaching. Section Nine, "Instructional Media and Technology," explores low-tech media such as chalkboards, in addition to computers and multimedia presentations. Perhaps the most important section in the book is Section Ten, "Evaluation to Improve Teaching," for in order to become a more effective instructor, you need to know what works for your students and what does not. The section describes a variety of quick methods for getting immediate feedback from students, as well as the use of videotape, colleague observation, and self-assessment. Finally, Section Twelve, "Finishing Up," covers end-of-term activities: review sessions, student ratings, and letters of recommendation. Despite the size and scope of Tools, I was unable to address certain types of classroom situations (laboratory teaching, foreign language courses, fresh man seminars, individualized instruction, team teaching). Some topics are not the subject of an individual tool but are discussed in various tools. For example, "dealing with troublesome behavior in the classroom" is not a stand-alone tool, but relevant strategies appear in "Encouraging Student Participation in Discussion," "Preparing to Teach the Large Lecture Course," and "Diversity and Complexity in the Classroom: Considerations of Race, Ethnicity, and Gender. Furthermore, not all the suggestions are fully compatible; they represent a variety of innovative strategies, from which you can select those that best meet your needs. Refer to Took for Teaching over the course of the term as a resource for handling common teaching challenges (for example, encouraging students to talk during discussion periods). Do not feel obli gated to do everything immediately, but pick and choose from among the topics and try just a few things to start. If you feel generally comfortable about your teaching but are looking for ways to inject some excitement into your courses, browse through the book and select topics you would like to explore or experiment with. If you already have a sense of the areas you want to improve, read the tools that directly relate to those areas. By reviewing student rating forms from past classes, watching yourself on videotape, and asking a colleague or consultant to observe and comment on your teaching, you can begin to assess what you do well and what you could change. Other possibilities for assessment are described in "Self-Evaluation and the Teaching Dossier" in Section Ten. Once you have made your initial assessment, scan the table of contents and the index for the relevant topics. Regardless of how you use Tools for Teaching, whenever you find suggestions that you want to try, sketch out a plan.

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Normative performance and suggestive cutoff scores for each subtest 2 are below infantile spasms youtube buy lioresal 10 mg without a prescription. This information would assist clinicians to target appropriate interventions based on client baseline characteristics muscle relaxant 563 cheap 10mg lioresal. Attachments: Score Sheets: Uploaded on website Available but copyrighted Unavailable Instructions: Uploaded on website Available but copyrighted Unavailable Reference list: Uploaded on website Second Reviewer Comments: Agree with the primary reviewers assessment Overall Taskforce Agreement with Recommendations: Practice Setting 4 3 2 1 Comments Acute X Inpatient Rehab X Home Health X Skilled Nursing X Outpatient X Overall Comments: Clinical utility is poor due to the time to complete spasms left abdomen discount lioresal 25mg overnight delivery, the use of customized equipment muscle relaxant tizanidine lioresal 10 mg line, and the need to buy standardized equipment set muscle relaxant lactation buy lioresal in india. Somatosensory recovery: A longitudinal study of the first 6 months after unilateral stroke spasms of the stomach purchase generic lioresal canada. An investigation of redundancy in the Rivermead Assessment of Somatosensory Performance. Sensory Loss in HospitalAdmitted People With Stroke: Characteristics, Associated Factors, and Relationship With Function. Interrater: In 23 patients with neurological conditions (stroke, head injury, statuspost neurosurgery), rho = 0. Attachments: Score Sheets: Uploaded on website x Available but copyrighted Unavailable Instructions: Uploaded on website x Available but copyrighted Unavailable Reference list: Uploaded on website Note: Although copyrighted, it is reported to be acceptable to reproduce provided the source is 1 acknowledged. The Rivermead Mobility Index: a further development of the Rivermead Motor Assessment. Comparison of psychometric properties of three mobility measures for patients with stroke. Psychometric properties of the Rivermead Mobility Index in Italian stroke rehabilitation inpatients. A testretest reliability study of the Barthel Index, the Rivermead Mobility Index, the Nottingham Extended Activities of Daily Living Scale and the Frenchay Activities Index in stroke patients. Assessing mobility in multiple sclerosis using the Rivermead Mobility Index and gait speed. Rasch analysis of the Rivermead Mobility Index: a study using mobility measures of firststroke inpatients. Pulsed high dose dexamethasone treatment in chronic inflammatory demyelinating polyneuropathy: a pilot study. A comparison of two physiotherapy treatment approaches to improve walking in multiple sclerosis: a pilot randomized controlled study. Physiotherapy outcome measures for rehabilitation of elderly people: Responsiveness to change of the Rivermead Mobility Index and Barthel Index. Ordinal measure scale based on observation of patient performance of gait, stance, sitting, speech, finger chase, nosefinger test, fast alternating hand movements, and heelshin slide. All studies referenced examined subjects with Spinal Cerebellar Ataxia or Friedreich Ataxia. Reliability (testretest, Intrarater: intrarater, interrater) (1) Cronbachs alpha =. Equipment required Stopwatch, 10 m walkway, examination table Time to complete Mean time 14. Level of client participation Patient must perform or attempt to perform all items of the test required (is proxy participation available Attachments: Score Sheets: X Uploaded on website Available but copyrighted Unavailable. Scale for the Assessment and Rating of Ataxia Multiple Sclerosis Outcome Measures Taskforce References: 1. Responsiveness of different rating instruments in spinocerebellar ataxia patients. Scale for the assessment and rating of ataxiadevelopment of a new clinical scale. Reliability and Validity of the Scale for the Assessment and Rating of Ataxia: A Study in 64 Ataxia Patients. The scale is based on findings of the standard neurologic examination with added subjective categories of sexual, bowel and 2 bladder dysfunction. Percent agreement was 6% when change was no difference and 76% when difference was 10 3 points. Attachments: Score Sheets: Uploaded on website Available but copyrighted Unavailable. References: Scripps Neurological Rating Scale Multiple Sclerosis Outcome Measures Taskforce 1. Responsiveness of the Scripps neurologic rating scale during a multiple sclerosis clinical trial. A doubleblind, randomized, controlled study of oral pirfenidone for treatment of seconday progressive multiple sclerosis. Scripps Neurological Rating Scale Multiple Sclerosis Outcome Measures Taskforce Instrument name: SemmesWeinstein Monofilaments Reviewer: Diane D. The most slender (smallest, most flexible) monofilament sensed at each location is 4, 5 recorded and given an ordinal score, using a defined scale. The values for each site are averaged to produce a composite sensory score, where a score of 0 represents normal somatosensation, and a score of 4 represents marked somatosensory loss. Normative Data: Instrument use Testing done at designated locations on the upper or lower extremity, frequently the finger tips or plantar surface. Level of client participation Client must state whether or not they detect the monofilament required (is proxy touching them. This test only reveals the force of the smallest detectable filament; some researchers advise against reporting the results using descriptors such as 6 diminished light touch, for instance. SemmesWeinstein monofilament testing for determining cutaneous light touch/deep pressure sensation. The repeatability of testing with SemmesWeinstein monofilaments J Hand Surg [Am]. How do strength, sensation, spasticity and joint individuation relate to the reaching deficits of people with chronic hemiparesis Sensorimotor impairments and reaching performance in subjects with poststroke hemiparesis during the first few months of recovery Phys Ther. Assessment of sensibility after nerve injury and repair: a systematic review of evidence for validity, reliability and responsiveness of tests. Fifty years of somatosensory research: from the SemmesWeinstein monofilaments to the Weinstein enhanced sensory test. The effect of textured insoles on gait patterns of people with multiple sclerosis. Measurement of upperextremtiy function early after stroke: properties of the Action Research Arm Test. Relationships between sensorimotor impairments and reaching deficits in acute hemiparesis. Consists of 8 subscales that are often used separately as outcome measures of various aspects of healthrelatedquality of life. Bodily pain, general health, social function, physical role limitation, and emotional role limitation 5 also correlated (r =0. The marked floor and ceiling effects demonstrated in half of the dimensions, and across the range of disease severity, indicate a limited ability to discriminate between patients with multiple sclerosis at 2 a single point in time. Evidence shows that it underestimates the impact of multiple sclerosis on mental health. Clinical appropriateness: a key factor in outcome measure selection: the 36 item short form health survey in multiple sclerosis. Healthrelated quality of life and depression in an Italian sample of multiple sclerosis patients. Briggs examined 45 seconds on 4 the single leg stance to eliminate the ceiling effect. Instrument use Equipment required Stopwatch Time to complete How is the instrument Timed test recorded in seconds scored Static Standing Balance Test Multiple Sclerosis Outcome Measures Taskforce Yes x No Comments: Attachments: Score Sheets: Uploaded on website Available but copyrighted Unavailable Instructions: Uploaded on website Available but copyrighted Unavailable Reference list: Uploaded on website Second Reviewer Comments: Agree with rating and recommendations. Muehlbauer T, Roth R, et al: Intra and Intersession Reliability of Balance measures during OneLeg Stance in Young Adults. Phys Ther 64:10671070; 1984 Static Standing Balance Test Multiple Sclerosis Outcome Measures Taskforce Instrument name: Tardieu Scale for Assessing Spasticity Reviewer: Susan E. Tardieu Scale for Assessing Spasticity Multiple Sclerosis Outcome Measures Taskforce 7 (kappa= 0. Equipment required Hand held goniometer Time to complete Slightly longer than the Modified Ashworth Scale, around 1 minute or less per muscle or joint being measured. How is the instrument Grading is performed at the same time of day, in a constant scored The patient is sitting for are there subscales, etc) upper limbs and supine for lower limbs. V1 is used to measure the passive range of motion, V2 and V3 are used to rate spasticity. Level of client participation Maintain neutral sitting or supine posture while testing is being required (is proxy performed. Reliability of the Tardieu Scale for Assessing Spasticity in Children With Cerebral Palsy. Excellent testretest and interrater reliability for Tardieu Scale measurements with inertial sensors in elbow flexors of stroke patients. Reliability of the Modified Tardieu Scale and the Modified Ashworth Scale in adult patients with severe brain injury: a comparison study. Measures of muscle and joint performance in the lower limb of children with cerebral palsy. Intraobserver reliability of the modified Tardieu scale in the upper limb of children with hemiplegia. Feasibility, testretest reliability, and interrater reliability of the Modified Ashworth Scale and Modified Tardieu Scale in persons with profound intellectual and multiple disabilities. The Tardieu Scale differentiates contracture from spasticity whereas the Ashworth Scale is confounded by it. Evaluation of spasticity in children with cerebral palsy using Ashworth and Tardieu laboratory measures. The instructions may be for selffiselected walking speed or fastest safe walking speed. Time may be recorded manually with a stop watch or via more mechanized equipment such as photocells. Frequently, the course is set so that the 1 individual walks a total of 35 feet (14 meters): 5 feet (or 2 meters) prior to the beginning of the timed course and 5 feet (or 2 meters) after the end of the timed course, to minimize the acceleration/deceleration period within the recorded time. The time to (fast) walk 8 meters correlated strongly with the Hauser Ambulation Index at rho =. Ceiling/floor effects Ceiling effects (high number of seconds = slow gait velocity): the test is not useful for people unable to walk 25 feet. Normative Data: Normative data for healthy males, females in different decades between ages 20 and 70 have been published for the 25foot walk at comfortable (130146 cm/sec) and maximum (175253 14 cm/sec) speeds. Instrument use Equipment required Measured distance for a walking course and a stop watch or other timing device. Progression on the Multiple Sclerosis Functional Composite in multiple sclerosis: what is the optimal cutoff for the three components Clinical gait assessment in the neurologically impaired: reliability and meaningfulness. Clinical impact of 20% worsening on Timed 25foot Walk and 9hole Peg Test in multiple sclerosis. The six spot step test: a new measurement for walking ability in multiple sclerosis. Comfortable and maximum walking speed of adults aged 2079 years: reference values and determinants. Gait assessment for neurologically impaired patients: standards for outcome assessment. The subject stands up from a chair, walks 3m, then turns around walks back to the chair sits down. Subject is timed from the moment their pelvis lifts off of the chair and timing is stopped when the pelvis reaches the chair again. Assistive devices are allowed and must be documented, however physical assistance is not allowed. The Timed up and go test: Reliability and validity in persons with unilateral lower limb amputation. The Efects of HomeBased Resistance Exercise on Balance, Power, and Mobility in Adults with Multiple Sclerosis. For hundreds of years, college teaching was typified by a professor reading a lecture to an audience of note-taking students. Over the last thirty years, however, this model has given way to a new understanding of what constitutes effective college-level instruction. Good teachers also understand what makes certain topics or con cepts difficult for students, and they can explain those topics in plain, comprehensible terms. Their instruc tional methods emphasize cooperation, collaboration, and strategies that actively engage students in learning.

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