Ethical dilemmas Free Essays

Unique This paper investigates the lawful and physiological just as an instructors best measures to take incase of a crisis identifying with a mishandled lady who has an infant that could endure if the lady is additionally presented to the mischief she has been experiencing. Presentation Moral issues are balanced by struggle of moral codes and a patient’s intrigue. As per Hill, Glaser and Harden, a moral issue is a consequence of ‘no suitable strategy, since each game-plan clashes with a set code of morals all which uncover the leaders to dubious dangers (18-19). We will compose a custom article test on Moral quandaries or on the other hand any comparative subject just for you Request Now All things considered, the clinician or advisor needs to survey the best strategy, help and proposals to determine a case without uncovering both himself and the patient to dangers. For this situation, Jean is looked by a moral issue where she needs to gauge her choices without crushing her remedial relationship with Mary and her work. Jean needs to survey her expert codes, the conceivable legitimate ramifications and the client’s needs before leaving on discovering resolve. In spite of the fact that Mary is currently invested in the directing, it’s not satisfactory that she is so dedicated to the treatment, also, Mary is potentially too genuinely weakened that, she is confounded about positive determination. Mary’s from the beginning doesn’t need her concern to be uncovered, and furthermore, she is apprehensive her choices may result to additionally composition of her life, jeopardize her son and therefore open her to dangers. She has trusted in Jean and Jean has, through expert morals, to look for an appropriate philosophy of capturing Mary’s issue. As indicated by Hill, Glaser and Harden, moral thought which covers instinctive and intellectual degrees of thinking and conâ ­crete models for moral dynamic, and remarks supposedly arises as Mary wouldn't like to be realized that she is going to advising exercises most unquestionably by her significant other. Issues of in regards to the data and circumstance of the casualty secret is clashing with a lot of systems which would help resolve Mary’s case. As such some moral contemplations in favor of Jean are important in order to discover an answer and to all the more properly help Mary and the kid. Moral contemplations Jean has a commitment to defend regard for people. This means regarding the self-rule and self-assurance of the person in question. The setting of privacy emerges as the preeminent issue Jean is confronting. Mary is looking for review in any case; she is as yet unbending about projections which she needs to look in case of complete partition with her significant other. Most precisely, she is monetarily incapable henceforth would prefer to endure further maltreatment than starve in the roads. From this point of view, Jean is confronting a significant moral predicament since she needs to assess the requirement for helping this lady while simultaneously; she stays quiet about her concern. This is an aftereffect of Mary’s uneasiness about the damaging social, physical, mental and legitimate results of disâ ­closing her experience. Her circumstance is described by unsteadiness, weakness, dread, reliance and loss of self-rule. Jean has an obligation to ensure the individuals who need independence, including giving security from mischief or misuse. Any lawful activity focused on Mary’s spouse will positively summon a stalemate which will additionally influence Mary. Mary has trusted in Jean and Jean’s obligation is to gauge and survey the choices most appropriate to help Mary moving forward without any more encroaching her physiological prosperity. Be that as it may, Jean has an increasingly significant job in her ability; she is presently depended with the government assistance of Mary and the kid in question (Nama Schwartz 2002). She has a job which incorporates limiting dangers and guaranteeing that benefits which Mary will get exceed dangers and outcomes which would hurt Mary and her kid. The youngster is another issue which Jean needs to morally consider. The kid has endured is as yet presented to both physical and physiological risks. Jean has an obligation to guarantee that, the youngster is secured and that she equally conveys the advantages of kid insurance without encroaching Mary’s physiological prosperity (Brasseur 2001).On this kid issue, research has demonstrated that both maternal melancholy and social misfortune lead to bargained social, subjective, and passionate results for newborn children (Murray Cooper, 1997), as such Jean has a colossal duty to help the kid too. Peruse likewise Ethical Dilemma â€Å"Glengarry Glen Ross†Ã¢ by David Mamet Notwithstanding; Jean needs to gauge the obligation serious on the off chance that she helps the person in question. Her choices and inclusion in actualizing the best and succinct choices may result to extraordinary legitimate repercussions on her side (WHO 2007). As indicated by Nama and Schwartz, as a social laborer, Jean may end up going past her manager code of morals (6). Secrecy The setting of secrecy comes up when Mary admits her horrendous life and the touchy issue of the boy’s provocation. Jean has been advantaged by Mary as a friend paying little heed to her situation as a social laborer. Furthermore, Mary has affirmed that the kid is in incredible hazard if the dad keeps on being close to him. The requirement for trusting is to edge closer to reality with regards to both Mary’s and the baby’s condition and if the dad had in any capacity attacked or even explicitly ambushed the infant. This depends on the way that Mary needs the issue of the infant and the dad left well enough alone. Jean has an obligation to caution the patient of the looming risks of returning to her significant other and the resulting inevitabilities on the infant (143). The spouse may be progressively brutal and as he is utilized to, beat her and misuse the kid. Jean should, survey and archive Mary’s issues and advise the obligated specialists. Along these lines, the standards of the act of educated assent won’t put Jean at a danger of arraignments since if ‘the clients’ wellbeing is endangered, Mary gambled with her assent completely mindful of the suggestions as prompted by Jean (Bednar et al., 1991). As per Hill, Glaser and Harden, ‘the insurance of Mary overshadows Mary consenting to treatment in this crisis circumstance (143). Tending to the issues From the beginning, Jean should record Mary’s case and educate the facilitator regarding the hindering issue. Along these lines she will have the option to introduce trustworthy proof about Mary’s case to any referral or during guiding. Archiving Mary’s case is the underlying advance to address the issue. This, she ought to do in a way that wont hazard the secrecy of the people in question. She should make accessible the essential consideration Mary and the youngster need. This she ought to do at the most punctual comfort even before Mary tells away any further issues she is confronting. Jean has just surveyed the prompt results of previous treatment and since Mary’s conduct reacâ ­tion to the current circumstance is possibly destructive to herself and the infant. In the event that help isn't offered promptly, she needs to make whatever strides are important to guarantee no damage comes to Mary and the infant (Bednar et al). In that capacity, Jean needs to secure the privacy to guarantee the child and the moms are protected just as herself (WHO, 2001). Jean should think about that the victim’s physical wellbeing is the most significant advance; as such she ought not permit Mary to leave the office at all until a purpose is found. Likewise, she should ensure the secrecy of the casualty remains organized. Each settle she uses ought to be planned for diminishing any conceivable caused to Mary. The infant ought to be given all important kid insurance comforts and remained careful. This ought to be organized to turn away Mary’s nonsensicalness from taking extraordinary passionate cost for the infant. These activities will protect both the mother and infant. Discussion There is a pressing requirement for Jean to talk with applicable specialists about the issue of the spouse. This depends on an instinctive and the basic evaluative degrees of good thinking as contended by Kitchener (1984). This will assist Jean with having a foundation and a foreword on what Mary needs in treatment and on the off chance that, she Jean, is competent or can't, founded on a psychological assessment of the certainty part of the case, keep on advising Mary. This will expeditiously prompt talking with another advisor to support Mary. Jean needs to account if the psychological and judicious reprieves are useful for both the subjects and herself, and if, in her point of view, would they befit her (Hill, Glaser and Harden, 12). Through conference Jean can have the option to recognize a superior treatment. She and the associate can rethink the information Jean has gathered about the patient and concocted a progressively conclusive purpose. The new purpose may influence Mary and break the morals of secrecy, however they are compelling and would result to helping Mary unequivocally. Not to respect the client’s decision without convincing reasons would comprise a paternalistic reaction from the Jean (Hill, Glaser and Harden, 25). The contemplations here should target ensuring more advantages and less damage came to Mary thoughtfully paying little heed to her recognition. Jean will proceed to assess and counsel about the case to discover progressively fitting purposes in head. To talk with somebody and record the interview if all else fails is an obligatory practice which Jean ought not disregard. Discussion is obligatory since the circumstance includes physical damage to both Mary and the infant and dangers and circumâ ­stances in which misuse is helpless (Hill, Glaser and Harden, 25). Obligation Jean Is currently bound in head as the watchman to Mary. She needs to catch up the case and ensure that Mary’s treatment con

THE EXTENDED FAMILY A SOURCE OF STRENGTH AND HOPE essays

THE EXTENDED FAMILY A SOURCE OF STRENGTH AND HOPE expositions THE EXTENDED FAMILY: A SOURCE OF STRENGTH AND HOPE In his books Grapes of Wrath and Of Mice and Men, John Steinbeck caught the truth of the battles that struck humanity in various structures and in different levels as he had seen during his lifetime. Steinbeck watched predominantly Californians and vagrants who had experienced destitution and pain brought to them by the Depression and the Dust Bowl, the residue storm that carried dry season to the Great Plains during 1932 to 1939. He started to compose books to identify with and support the numerous oppressed individuals whom he had viewed. Steinbeck recommended a technique for solace and help to the individuals who were distant from everyone else and enduring; he talked about the criticalness that a more distant family has in giving its constituents the solidarity to adapt to their financial uncertainties and social issues. Because of the Dust Bowl and the Depression that hit the United States in the thirties, numerous Oklahomans encountered an abrupt deserting from their landowners. Since most Oklahomans were ranchers, many were left jobless once they were commenced their property. For endurance, this monetary fiasco brought about two distinct instances of responses: that of Muley Graves and that of the Joads. Steinbeck presented a character, Muley Graves, who turned into a bum since he was excessively connected to the land to leave and too free to even consider abiding with his family that had left, venturing out to California. Too difficult to even consider budging, Muley just glared, If they distract me, Ill return... I aint a goin...An I aint a-going while at the same time remanding behind by the land that not, at this point was under his family control or domain, eating wild creatures to endure. Be that as it may, an alternate attitude of the ranchers was appeared through the Joads. At the point when their property was removed, for endurance, Joads didn't stop for a second to leave their territory without a moment's delay: their homes were left empty on th... <!

3 Christmas Gifts from The Minimalists

3 Christmas Gifts from The Minimalists Merry Christmas, and happy holidays! Whichever holiday you celebrate (or even if you don’t celebrate at all), we have three gifts for you: 3 Gifts from The Minimalists Free Book. Last week we published the second edition of Minimalism: Live a Meaningful Life. And now, as our gift to you, you can read it for free: download the free PDF here. If youd prefer the paperback, audiobook, or a different ebook version, you can still purchase those here. New Podcast. Surprise! The Minimalists Podcast will officially launch in January 2016, but you can download our special first episode today on iTunes, or you can stream it on Soundcloud. And be sure subscribe to the podcast on iTunes, or wherever you get your podcasts, if youd like to hear future episodes. Online Meetups. Were also answering questions live on our weekly video broadcast: join us on Periscope every Tuesday at 7 PM EST until the end of January 2016, or post your questions on social media using our hashtag #AskTheMinimalists. If you missed yesterdays video, you can watch it up to 24 hours after the broadcast. (You can also meet like-minded folks in our free Local Meetup Groups at Minimalist.org. What a great way to start 2016!) 3 Gifts for The Minimalists If you find value in our work and would like to give us a gift, please consider any of the following (all of which we find meaningful): Review. If you enjoy the new edition of Minimalism: Live a Meaningful Life, would you be willing to review it on Amazon? Doing so will help us improve the books overall rating. Rate. If you like our new podcast, would you be willing to rate it on iTunes? Your review will help our message reach new sets of ears. Contribute. The old saying is true: ’tis better to give than to receive. So we’d be remiss if we didn’t discuss the gift of giving. A few months ago Ryan donated his birthday to help build a family-style orphanage in Honduras. Good newsâ€"were halfway to our goal! Perhaps youd be willing to help us get all the way there: if you have any extra holiday cash, would you consider donating a few bucks to help build a home for this group of orphans? Subscribe to The Minimalists via email.

Altruism - Definition in the Study of Sociology

Definition: Altruism is the tendency to see the needs of others as more important than one’s own and to therefore be willing to sacrifice for others. In one of his major books (Suicide) Emile Durkheim saw altruism as the basis for patterns of suicide in some societies in which people might identify so strongly with a group or community that they would readily sacrifice themselves to protect its interests or to uphold its traditions.

Analysis Of The Book Portrait Of The Artist - 978 Words

Ovid’s Metamorphoses, having no set plot may at first confuse some readers, though it starts with creation, it moves on the practices involving Gods and mortals and the changes they incur. The stories seem to follow each other in time, but there are flashback’s that show Ovid is not concerned with the nebulas of time, instead he is showing the transformation’s the characters go through. Passage of time is not Ovid’s point, but as he put in the mouth of Pythagoras, the only constant in the universe is change. Ovid’s character’s changes are usually immediate, Athena changed Talos to a partridge, Daphne was transformed into a laurel tree, and Echo, well was turned into an echo. There is often a discontinuity of time, we know Echo wasted away, but how long that took is not important the theme is, the often lack of the restraints of time is what makes mythology so easy to relate for any era. James Joyce in his novel, Portrait of the Artist as A Young Man, ties his story with the semblances of mythology from the story of Daedalus and Icarus, fusing the ideas that discovery, sacrifice and rebellion is a process needed to be an artist. Though Daedalus and Icarus are from a mythical time and Stephen is living in a specific time during Dublin’s history, all characters are faced with the struggles of existence, self-discovery, and learning how to deal with one’s own need for artistic freedom and the disadvantages such gifts may pose. The path that each undergo, either byShow MoreRelatedThe Arnolfini Wedding Portrait: Interpretations856 Words   |  4 PagesJan van Eyck’s work, The Arnolfini Portrait, is a famous piece of Flemish portraiture with a lively history of interpretation (Hall xviii). 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Effects of Globalisation on Brazil Free Essays

Discuss the impact of globalisation on Brazil: Orientation: Globalisation refers to the integration between different countries and economies and the increased impact of international influences on all aspects of life and economic activity. Brazil is one of the fastest growing economies and superpower of South America. In the recent decade Globalisation has allowed Brazil’s economy to sustain stable economic growth, this was proven when Brazil experienced a very mild recession during the Global Financial Crisis of 2008. We will write a custom essay sample on Effects of Globalisation on Brazil or any similar topic only for you Order Now Due to the high levels of economic growth as well as increases in GNI per Capita Brazil’s government has also been able to implement successful macroeconomic policies that have allowed for consistent economic development. Though Brazil has benefited greatly from Globalisation they also have experienced many problems including the currency crises in the 1980-90’s which caused the country to undergo a complete economic restructure. Brazil also faces problems with environmental deconstruction that due to globalisation that are yet to be solved. Globalisation impact on Brazil Economically: Brazil’s failure to embrace Globalisation in the 1960’s 1970’s and 1980’s caused Brazil to be unable to fund its foreign debt and ultimately experience a currency crisis in the early 1980’s. Through the 1960’s and 1970’s successive governments sought to create a large industrial base and minimise Brazil’s dependency on imported manufactured goods. Brazil relied on foreign debt borrowing to fund this industrialisation movement but rather than increasing its economic integration the purpose of this industrialisation was for Brazil to become less heavily dependent on imports and more self sufficient; reducing reliance on the global economy and going against principals of globalisation in becoming more integrated. Due to large amount of foreign debt and Brazil’s inability to service this debt due to small amounts of export revenue Brazil’s debt servicing ratio reached 102% and, unable to service the debt Brazil’s currency depleted. For Brazil this outcome was among the most undesirable impacts of globalisation as it caused extreme volatility in Brazil’s exchange rate. From 1980 due to Brazil’s inability to repay debt, the Brazilian economy experience many exchange rate crises due to concerns that Brazil could not meet the debt repayments; this caused extreme inflation of over 1000%. Inflation was due to the rising cost of imports for Brazil as currency value fell sharply. In order to prevent/reduce the occurrence of extreme currency fluctuation and extreme inflation Brazil adopted the ‘Real Plan’ strategy in which a new currency known as the ‘real would be pegged 1 to 1 against the US dollar to control inflation. However this had to be abandoned as the currency had to once again be floated as investors pulled out of Brazil in the wake of the East Asian financial crisis which spread to other developing nations. Brazil now continues to floats the currency relies on strong values of exports, keeping foreign debt low and consistent economic growth in order to reduce fluctuating currency. Brazil has also established a currency reserve to buy back currency and increase its price if financial speculation causes to fall to low. After embracing globalisation, Economically Brazil has greatly benefited from Globalisation as foreign direct investment (DFI) flows have allowed Brazil to become competitive in the world market. Brazil receives the highest level of FDI inflows in Latin American and the 5th highest in the world; this has led to sustained economic growth and greater economic stability. Investment by transnational corporations has helped Brazil develop telecommunications, chemical, pharmaceutical, automotive and mechanical industries. After FDI inflows falling to only 345million in 1986 due to lack of confidence in Brazil’s ability to repay foreign debt, Brazil’s economic situation has been consistently improving as the government strategies for industrialisation were restructured with a movement more to funding industrialisation through FDI rather than borrowing from Foreign markets. In 1996 FDI inflows had increased to 11 Billion and in 2011 FDI inflows stood at their peak of 66 Billion US dollars. Through FDI inflows employment was created as transnational corporations such as L’Oreal and FIAT group began expanding into the Brazilian market. Lowered unemployment combined with reductions in income in-equality among the people of the Brazil provided sought after government revenue. This government revenue allowed for the Brazilian government to fund national activities in the areas of transportation, industry and trade as well as energy and mining which all helped in the growth of Brazils manufacturing industry. Growth of the manufacturing industry is now the largest contributor to Brazil’s exports comprising of 45%. The manufacturing industry and other large industries that contribute to Brazils exports have allowed for Brazil to increase GDP levels from 385Million in 1980 to 2. 4 Trillion in 2010. Due to the efficiency of industries and economic growth, globalisation also allowed for sustained economic stability to also be achieved. This was made evident during the 2008-09 Global Financial crises where due to the integration of financial markets across the world many markets entered large recessions and therefore loss of confidence for investment Brazil only experienced a mild recession of -0. 6% growth in 2009. From this recession however growth soared to 7% the following year as market confidence was immediately restored with FDI inflows bouncing back from the reduced amount of $26 Billion to $49 Billion the following year, almost doubling. It is clear that in Brazil’s ability to embrace FDI inflows and investment by transnational corporations have allowed Brazil to form and specialise in competitive industries such as the manufacturing industry. These industries then have the ability to sell the produced product to a world demand that has been created through improvements in technology and the breaking down of trade barriers, which are all effects of globalisation. Globalisation effect on Brazil Socially: Globalisation has also significantly affected Brazil socially. Investment into the country as well as demand for Brazil’s exported goods and services have allowed Brazil to substantially reduce income inequality and achieve economic development. As globalisation lifts economic growth rates in the Brazilian economy, it also raises the income levels of society and provides the government with greater amounts of revenue. After the Brazilian government received higher revenue due to increases in the country’s GDP, the government’s aim was to increase the quality of life among the people of Brazil, reducing poverty, increasing education level and increasing health and life expectancy. Programs such as the Fome Zero (zero hunger) program was widely regarded as one of the most successful government funded programs. It provided 11. 4 Million of Brazil’s poorest family’s sufficient income to be able to sustain basic needs in life. The policy was one of many that aimed or the government to reduce inequality by margining income distribution payments. Brazil has also achieved a substantial degree of progress in the economic development due to economic growth of the country through principles of globalisation. Through improvements in the government’s health care system as well as reduction in the cost of medicine as Brazilian companies begin producing pharmaceutical products of their own Brazil rank on the HDO increased from 0. 68 in 1980 to 0. 699 in 2010, mainly reflecting improvements in health care and income levels. Conversely, Brazil is still neglecting the significant problems that globalisation has cause to the natural environment. As Brazil is still as a majority a low income country it is desperate to obtain as much foreign investment as possible in order to earn higher export revenue; because of this is engages in some economic behaviour that harms the environment. For Brazil this environment destruction occurs in the form of large scale deforestation that Brazil undertakes mainly for paper and wood chips but as well as government income received through selling rainforest/forest land. Not only does this practice allow for foreign investors to have rights to Brazils agricultural land but is also causes for many species of plants and animals to become extinct and many rainforest plants hold value due to undiscovered possible medicinal purposes. Due to the large scale deforestation that Brazil undertakes, Brazil is now the 4th largest emitter of carbon emissions in the world. The High carbon emissions add to the most serious environmental problem of the 21st century which is climate change. In order to reduce this environmental destruction Brazil committed in 2009 to reduce deforestation by 80% by 2020. Conclusion: It can be concluded that Brazil has become a large beneficiary of globalisation. Brazil is attracting more foreign investment, expanding its own businesses offshore, enjoying strong sustained growth in exports, in particular in the resources sector, and government policies have been effective in making sure that the macroeconomic successes of recent years are resulting in improvements in living standards for the people of Brazil. How to cite Effects of Globalisation on Brazil, Papers

Diana Baumrind free essay sample

Baumrind is a clinical and developmental psychologist that specializes in parenting styles. Baumrind was born on August 23, 1927 in a small Jewish community in New York City; she was the first of two daughters born to Hyman and Mollie Blumberg. Baumrind earned a B. A. in philosophy at Hunter College in 1948. She later received her M. A. and Ph. D. in Psychology at the University of California, Berkley; she studied developmental, clinical, and social psychology. Her doctoral dissertation was entitled â€Å"Some personality and situational determinants of behavior in a discussion group† Baumrind completed a clinical residency at the Cowell Memorial Hospital/Kaiser Permanente and was a fellow under the NIMH grant investigating therapeutic change, extending her research to families and therapy groups. By 1960 Baumrind was a clinical and developmental psychologist at the Institute of Human Development at the University of California, Berkeley. She is well known for her research on parenting styles and for her critique of deception in psychological research. She has been awarded multiple national grants over a 40-year career devoted to family socialization and parenting research. Baumrind is the author of 58 articles in journals or as book chapters, as well as three books and monographs. She has also served as an editor and consultant to numerous professional journals and has been an esteemed member of multiple national psychology organizations (Berkley University). Diana Baumrind had many different influences that directed her studies in psychology, including personal influences, historical influences, as well as influences from other psychologist. One personal influence on Baumrind’s research is the fact that she was divorced and a single mother of three daughters. She chose a research career that was supported by multiple large grants because of the flexible hours help her to balance caring for her daughters, political activism, and scholarship. Also having raising three children alone could cause one to evaluate different parenting styles in the search of trying to do what is best for the children (Kemp, 1997). The historical factor that influenced Baumrind’s research is that when she started graduate school in 1948 there was huge turmoil of the loyalty oath controversy of 1948-1949 that led to the legal battle of Tolman vs. Underhill. This historical even may had some effect on the focus of Baumrind’s research because Tolman was a senior professor at the University of California and his refusal to sign the oath resulted in a uproar at the time that could have effected many of the students that attended the university but mainly Baumrind because Tolman was in the psychology department. Another influence on Baumrind’s research was Stanley Milgram’s 1963 study of obedience to authority. Milgram’s study had a great effect on Baumrind; she was highly critical of Milgram’s study. Baumrind challenged Milgram on whether he had properly protected the welfare of the participants. She used direct quotes from Milgram’s original report to illustrate the lack of regard she said was shown to the participants. In particular she noted the detached manner in which Milgram described the emotional turmoil experienced by the volunteers (Baumrind, 1964). In Baumrind’s view, and in the view of numerous others, the levels of anxiety experienced by participants were enough to warrant halting the experiment. Milgram related his study to the behavior of people who worked in Nazi death camps and suggested that his study illuminated the way that ordinary people living ordinary lives are capable of playing a part in destructive and cruel acts. Baumrind dismissed this justification for the study and suggested there are few, if any, parallels between the behavior in the study and the behavior in the death camps. (Baumrind, 1964). Baumrind went on to publish an influential commentary on research ethics. Baumrind has continued to address ethical issues in research on humans through consultation with the American Psychological Association and published work. As we can see Milgram’s study greatly influenced Baumrind and she was sure to use ethical measures when performing her own research on humans. Baumrind was also greatly influenced by many teachers and professors, many who were closet Marxist who reinforced her social consciousness and strengthened her philosophical grounding in dialectical materialism. John Somerville, Bernard Frank Riess, and Otto Klineberg influenced Baumrind. Their research on selective migration and racial stereotypes challenged American racism and eugenics programs greatly influenced her, Klinebergian cross-cultural sensitivity permeates Baumrind’s writing on ethical theory and moral development. These three people influence her my allowing her to engage and intellectual conversation about philosophy and ethical topics that resulted in Baumrind conducting her own studies and becoming a political activist (Baumrind, 1998). Research from other psychologist also influenced Baumrind. Baumrind was influenced by the research of Theodore Adorno, Else Frenkel-Brunswik, Daniel Levinson and Nevit Sanford on anti-Semitism and the authoritarian personality. The teaching of Egon Brunswik who impressed upon her the importance of idiographic research also influenced her. The conformity research of Krech and Crutchfield also influenced her (Kurtines, 1992). Each of these different influences can be seen through different research projects and works of Diana Baumrind. Baumrind utilized something she learned from each of her influences to become the amazing psychologist she is today. Baumrind’s work on parenting styles is probably her most famous and important research. Back in the early 1960s, Baumrind conducted her famous childcare research. In her stuffy she and her research team followed more than 100 middle class children of preschool-age Baumrind’s primary research methods were interviews and observation. The aim of her child parent behavior study was to formulate and evaluate the effect of most typical Western parenting styles. The three parenting styles studied were the authoritarian parenting style, the permissive parenting style, and the authoritative parenting style. Her findings were ground breaking and the time and have since been subject to both academic acclaim and criticism. In her study Baumrind used two aspects of parenting to evaluate and from her data the 3 parenting styles were defined in relation to those two elements. The two elements that she evaluated were parental responsiveness vs. parental unresponsiveness and parental demandingness vs. parenting undemandingness. Baumrind describes responsiveness as â€Å"the extent to which parents intentionally foster individuality, self-regulation, and self-assertion by being attuned, supportive, and acquiescent to children’s special needs and demands† (Baumrind, 1991). This is basically how much the parent’s responds to their child’s needs and if they meet their child’s needs. Baumrind described demandingness, as â€Å"the claims parents make on children to become integrated into the family whole, by their maturity demands, supervision, disciplinary efforts and willingness to confront the child who disobeys† (Baumrind, 1991). Demandingness could also be described as the parents control over the child. It is the level of behavior control the parents exercise on their kids based on their expectations of â€Å"mature† behavior. The authors investigated the effects of preschool patterns of parental authority on adolescent competence and emotional health and differentiated between confrontive and coercive power-assertive practices, which accounted in part for differential long-term effects of the preschool patterns (Baumrind, 2010). The objective of the exercise of parental authority is to maintain order in the family and to help with the responsibility of the parents to lead their child from a dependent infant to a independent, self-determining, self-regulated adult. The aim of the study was to investigate how preschool patterns of parental authority contribute to adolescents’ competence and emotional health (Baumrind, 2010). For this experiment the participants were 87 families initially studied when children were preschool students, with outcomes assessed during early adolescence. Families were drawn from Baumrind’s Family Socialization and Developmental Competence longitudinal program of research. Baumrind used observational and interview data to test hypotheses relating to preschool power-assertive practices and patterns of parental authority to children’s attributes as adolescents (Baumrind, 2010). The researchers used variable-centered analyses to investigate the differential effects of 5 oercive power-assertive practices that they hypothesized were authoritarian-distinctive and detrimental and 2 confrontive practices, behavioral control and normative spanking, that they hypothesized were neither authoritarian-distinctive nor detrimental (Baumrind, 2010). Diana Baumrind came up with three parenting styles authoritarian, permissive, and authoritative. In the authoritarian parenting style, children are expected to follow the strict rules established by the parents. Failure to follow the rules set by the parents usually results in some sort of p unishment. Authoritarian parents fail to explain the reasoning behind the rules set for the children. If asked to explain, the parents might reply, â€Å"Because I said so. † These parents have high demands, but are not responsive to their children. According to Baumrind, these parents are obedience and status-oriented and expect their orders to be obeyed without explanation (Baumrind, 1991). Praise and reward are potentially dangerous with this style because of the idea that they may lead to children becoming â€Å"too full of themselves† and consequently developing too much autonomy and straying off the â€Å"good† path. This parenting style has a great effect on the child. Children of authoritarian parents quickly learn to adjust to the parents’ expectations. They tend to willingly obey authorities they have accepted that they must follow the rules. These children are not used to making independent choices, taking full responsibility for themselves and they do not experiment with new ways of doing things or alternative ways of thinking. Research suggests that these children are not as socially â€Å"skilled† as children from different parenting styles. These children may also find it difficult to handle frustration and they are more likely to suffer from low self-esteem, anxiety and depression (Baumrind, 1996). In the authoritative parenting style, the parents establish rules that their children are expected to follow but the parents will explain why the rules are necessary. The parent encourages verbal give and takes and questions from the child. When the child fails to meet the expectations these parents are more nurturing and forgiving rather than punishing. Baumrind suggests that these parents â€Å"monitor and impact clear standards for their children’s conduct. They are assertive, but not intrusive and restrictive. Their disciplinary methods are supportive, rather than punitive. They want their children to be assertive as well as socially responsible and self-regulated as well as cooperative† (Bower, 1989). This parenting style enforces the parent’s perspective as an adult but also recognizes the child’s individual interest and special ways. This parent affirms the child’s present qualities but also sets standards for future conduct (Baumrind, 1967). Research suggest that because of the use of positive reinforcement along with logical and fair rules set in a caring manner the child will learn that behaving and following the rules is good and they will receive positive attention. This will help the child to develop social skills and emotional regulation. It is suggested that children from authoritative parents do well in school, are self confident and goal orientated (Baumrind, 1967). In the permissive style of parenting the parents are referred to as indulgent, having very few demands to make of their children. These parents do not discipline their children because they have low expectations of maturity and self-control. Baumrind suggests that permissive parents â€Å"are more responsive then they are demanding. They are nontraditional and lenient, do not require mature behavior, allow considerable self-regulation, and avoid confrontation (Baumrind, 1991). Permissive parents are generally nurturing and communicative with their children, often taking on the status of a friend more than that of a parent. This parent attempt to behave in an acceptant manner towards the child’s impulses, desires, and actions. The parent is not seen as an active agent responsible for shaping the child’s future behavior. Research suggests that the complete lack of limits, absence of authority figures and no consistent routines may lead to a sense of insecurity in the child. Because of the belief that the world is open to explore without limits the children of permissive parents are found to be more impulsive and involved in â€Å"problematic† behavior such as drug and alcohol use. These children may end up with high social skills, high self esteem and low levels of depression (Baumrind, 1966). Maccoby and Martin later added the neglectful or uninvolved parenting style. This parenting style is both low on responsiveness and low on demandingness and very little communication (Maccoby, 1992). These parents fulfill the child’s basic needs but they are usually detached and emotionally separated from their child’s life. In extreme cases, these parents may even reject or neglect the needs of their children. The children of neglectful or uninvolved parents have very low self-esteem. No attention makes them feel unimportant. They are less socially competent and they usually perform poorly in all domains (Maccoby, 1992). Baumrind’s results showed that adolescents whose parents were classified as directive, democratic, or authoritative when the adolescents were preschool students were competent and well adjusted relative to adolescents whose parents were classified as authoritarian, permissive, or disengaged. Adolescents from authoritarian families were notably incompetent and maladjusted. Variable centered analyses indicated verbal hostility and psychological control were the most detrimental of the authoritarian-distinctive coercive power-assertive practices (Baumrind, 1991). Severe physical punishment and arbitrary discipline were also authoritarian-distinctive and detrimental. Normal punishment and confrontive discipline were neither. Confrontive discipline and maturity demands contributed to authoritative parenting’s effectiveness, whereas normative physical punishment was neutral in its effects. The findings extend the consistently negative outcomes of authoritarian parenting and positive outcomes of authoritative parenting (Baumrind, 1991). Baumrind has also studied the effect of corporal punishment on children. She concluded that the mild spanking, in the context of authoritative parenting style, is unlikely to have a significant detrimental effect, if the one is careful to control other variables. Baumrind believes that mild corporal punishment per se does not increase the likelihood of bad outcomes. (Baumrind, 1996). Many of the issues Baumrind researched and the conclusion she made are very controversial. Due to her controversial topics Diana Baumrind research had influenced many other psychologist to look into parenting styles, not only to criticize her work but also to support it. Baumrind’s research had major influences on other psychologist and the field of psychology as a whole. Baumrind’s research that led to her development of parenting styles resulted in many other psychologist conducting research to further develop her research now we know how each parenting style effects children and how certain parenting styles can be utilized for aggression, academic achievement, attachment, etc. Two psychologist who were influenced by Baumrind are Maccoby and Martin. Baumrind had such a huge effect on these two that the furthered her theory by adding a fourth parenting style. The neglectful/uninvolved parenting style where the parents had very little demandingness, communication, and responsiveness. This was good discovery for the field of psychology because it allows families that didn’t fit into the other three categories to be placed (Maccoby, 1992). With these four parenting styles psychologist were able to come up with other hypothesis about the parenting styles and other influences in combination with parenting styles such as location, culture, background, etc. Psychologist such as Turiel furthered Baumrind research on the use and miss use of cultural construct. Turiel went even further by relating this to oppression and morality (Turiel, 1998). Rodriguez also furthered Baumrind studies by researching protective parents in first generation Latinos. Not only did Rodriguez look at it in a cultural since, parenting style was also made more specific to a protective parent. This study was great for the field of psychology because it allow us to see how parenting style varied in a Latino community specifically and it was all influenced by Baumrind previous work (Rodriguez, 2009). Bowlby another psychologist influenced by Baumrind used her studies on parenting style to study attachment. Bowlby believed that attachment characterized the human personality through out their like. The representations or working models that the child has a relationship are from his or her care giving experience. Hazan and Shaffer went on to explore Bowlby ideas of attachment but in a romantic relationship. They concluded that romantic love is a property of the attachment behavioral system as well as the motivational systems that given rise to care giving and sexuality. Although Baumrind did not have a direct influence on their research, she had an indirect influence (Shaffer, 2005). Baumrind research has led to many psychological discoveries that are now used to treat patients and to help parents with their style of parenting. In conclusion Diana Baumrind development as a psychologist in addition to her research and finding had lead to many benefits in the field of psychology. Diana Baumrind has identified 3 different ways of parenting and she studied out each style of parenting may effect the child. Her research influenced others to do research concerning parenting styles, which lead to the discovery of the fourth parenting style. Out of the four parenting styles, authoritarian, permissive, authoritative, and neglectful Baumrind decided that the authoritative was the best form of parent and had the chance of resulting in the most stable and self-regulated child. Baumrind’s findings also influenced other psychologist to research these four parenting styles under specific culture backgrounds. Diana Baumrind has had a major effect on psychology her parenting style are used to help diagnose and treat patients as well as give parenting advice for parents who have their child’s best interest at heart. Diana Baumrind is very important to psychology.

14 April Fools Day Pranks for College

14 April Fools Day Pranks for College Not all of us have the time or the patience to completely tinfoil someone’s dorm room, or sticky note their care. We don’t all have flash mobs of friends to do something nuts for April Fool’s Day. In this post we’ve got 14 gags that just about anyone should be able to pull off and there’s no real budget to speak of. Especially not if two or three people are in on them. Check it out! 1. Get like 80 Poppers And†¦ Here’s what you do: tape them to their dorm room door from this inside (no scaling any sky scrapers for this). With 100 of these things the sound will be pretty big; the mess will be lovely; you’ll scare the #$@ out of them! 2. The Best April Fool’s for Computer Nerds..EVER! After browsing the ten billion ideas Google has to offer, this is definitely one of the coolest. You’re basically going to put your head in a jar and then put it in their fridge. Or, you could go with their best friend’s, or significant other’s head. All you need is a computer. 3. Does Their Major Require Typing? Hey, if someone you want to play a prank on does a bunch of typing this is a really good one: rearrange the letters of their keyboard. It’s harmless, easy to do without breaking the keyboard and yeah. Even if they are the fastest and loudest typer in school, it will boggle their mind. You could order the letters to say something perhaps? 4. This is Hardcore This can get ugly fast so you need some finesse. If you’ve got a girlfriend/boyfriend, have a stranger they don’t know hand them a hand written â€Å"I’m breaking up with you and dropping out† letter. It helps if the gangs in on it, but again, while this will definitely get a reaction it might backfire†¦ 5. Nail Polish + Soap This is an oldy but goody. You just coat their soap with clear nail polish and in the morning when they try to shower it won’t lather and they’ll be like, â€Å"Whu?† 6. Fill the Halls with Fruit Not on the ground silly, but hanging from clear cords or strings. At least everyone will get their fruits in for the day. You could go with bananas, apples, pears, strawberries, grapes, or even go big with grapefruits. 7. Mouse + Jello These days a regular computer mouse doesn’t cost but a few bucks. So, go ahead and put their mouse in the middle of a jello mold of your choosing. It should be said that jello is both cheap and amazing. You can get pretty crafty with jello and just about everyone loves the stuff. 8. Go Pop Star Just pick a pop star they would love to have plastered all over their stuff and go to town. Bieber is always a favorite. But, let your imagination run wild. 9. Pregnancy This only works on guys that have no clue it’s April Fool’s Day. You know, those guys who only know basically New Years, Spring Break and Christmas. If they have a girlfriend, oh yeah this will get them good. If they don’t and you know someone they’ve been frisky with in the past that’s willing to play along†¦even better. 10. Flash Mob Anyone? Okay fine, no prank or gag list is complete without the theater company involved. 11. The Out of Reach Alarm Clock Simply put: legendary. Grab their alarm clock while they’re sleeping, set it to go off an hour earlier in a hidden place that will drive them nuts. If it can be taped to the ceiling out of reach – perfect! 12. The Ultimate Stink Bomb? Everybody loved a stink bomb. So why not bomb an entire dorm? Why not bomb an entire building? I mean you can get boxes of these things in multiples colors, head into the stairwell and go floor by floor (two people on both sides for ideal coverage). So awesome! And, if you’re major is covert operations you should be able to stealth-mode this and no one will even know you just pulled a prank that will make the college paper! 13. Dixie Cups for Miles This is especially cool for anyone that’s a fan of beer pong. You can get hundreds of these things for cheap (make sure to recycle them afterwards), fill them only a little bit with water or whatever works, and then chill. You could fill an entire dorm room hallway. You could fill their dorm room. It’s funny. 14. A Bed Full of Cornflakes! Cornflakes. Cheap, loud, crunchy, delicious with milk and processed sugar. Why not a bed, car, dorm room, or closet full of them? Okay all you aspiring students out there, how do you do it? Share your tips for pranks in comments!

Free Essays on Nicolas Poussin

Nicolas Poussin, Landscape with Saint John on Patmos (1690), Paul Cà ©zanne, Mount Saint Victoire (1904) – The painting by Cà ©zanne was done more some 300 years after the painting by Poussin. What stylistic characteristics used by the earlier painter to create the illusion of space are also used by Cà ©zanne. What has been changed? In his Landscape with Saint John on Patmos (1640), Nicholas Poussin used linear perspective to demonstrate his knowledge of geometry. He created an idealized landscape adjusting natural and man-made forms according to geometric principles. In the ruins in the foreground/background, a cube, a three dimensional rectangle, and a cylinder are represented in perfect perspectival form, each illustrating a different aspect of foreshortening. The pathway recedes into the distance giving an illusion of depth. Bibliography Similar to Poussin, Cà ©zanne’s Mont Sainte?Victoire (29–39) illustrates the three-dimensional quality of the landscape he sought to create by using color applied in geometric shapes. He wrote that he â€Å"wanted to make of Impressionism a lasting art like that of the museums† and that he â€Å"wanted to do Poussin over again according to nature.† He was particularly concerned with resolving the conflict between nature, which is three dimensional, and the canvas, which is two-dimensional. To this end he flattened planes and eliminated atmospheric perspective, creating recession by pure color alone, working with small patches or modules of color and locking together various areas of the canvas. In Cà ©zanne’s painting every thrust into depth is compensated by an equal return. Cà ©zanne has created a tension between the three?dimensional forms and two?dimensional quality of the canvas, and it is this tension that gives a vitality to his art, as well as the tension between abstract forms and the forms of nature. Although Cà ©zanne sought a geometric underpinning for his art, he never aban... Free Essays on Nicolas Poussin Free Essays on Nicolas Poussin Nicolas Poussin, Landscape with Saint John on Patmos (1690), Paul Cà ©zanne, Mount Saint Victoire (1904) – The painting by Cà ©zanne was done more some 300 years after the painting by Poussin. What stylistic characteristics used by the earlier painter to create the illusion of space are also used by Cà ©zanne. What has been changed? In his Landscape with Saint John on Patmos (1640), Nicholas Poussin used linear perspective to demonstrate his knowledge of geometry. He created an idealized landscape adjusting natural and man-made forms according to geometric principles. In the ruins in the foreground/background, a cube, a three dimensional rectangle, and a cylinder are represented in perfect perspectival form, each illustrating a different aspect of foreshortening. The pathway recedes into the distance giving an illusion of depth. Bibliography Similar to Poussin, Cà ©zanne’s Mont Sainte?Victoire (29–39) illustrates the three-dimensional quality of the landscape he sought to create by using color applied in geometric shapes. He wrote that he â€Å"wanted to make of Impressionism a lasting art like that of the museums† and that he â€Å"wanted to do Poussin over again according to nature.† He was particularly concerned with resolving the conflict between nature, which is three dimensional, and the canvas, which is two-dimensional. To this end he flattened planes and eliminated atmospheric perspective, creating recession by pure color alone, working with small patches or modules of color and locking together various areas of the canvas. In Cà ©zanne’s painting every thrust into depth is compensated by an equal return. Cà ©zanne has created a tension between the three?dimensional forms and two?dimensional quality of the canvas, and it is this tension that gives a vitality to his art, as well as the tension between abstract forms and the forms of nature. Although Cà ©zanne sought a geometric underpinning for his art, he never aban...

Todays workforce Essay Example | Topics and Well Written Essays - 250 words

Todays workforce - Essay Example In Lyusin, 2006: 55). It was interpreted as a complex construct consisting of three types of abilities; (1) the identification and expression of emotion as; (2) the regulation of emotions; and (3) the application of emotional information to thinking and action (Lyusin, 2006 pg. 55). Emotional intelligence is the skill of understanding the self and how he or she relates to people which is an important insight in motivating people. The second skill required to motivate people is social skill. Social skill on the other hand is the competency to adapt with the changing situation and environment that makes one effective in dealing the contexts of people (Shanley, 1971). The ability to adjust to different kind of people is necessary to effectively motivate people because not all employees came from the same cultural mold. Understanding their cultural background and able to adjust accordingly would spell a difference between success and failure of an effective manager and leader in a culturally diverse

Leprosy in the Middle Ages Essay Example | Topics and Well Written Essays - 1250 words

Leprosy in the Middle Ages - Essay Example If unchecked, it can result to loss of neural consciousness, blindness as well as local paralysis. Leprosy represented a major moral, social as well as health concern in the middle Ages. Few ailments have conjured the social reactions, which leprosy did in the middle Ages. Some primordial communities undertook exclusionary actions to isolate socially persons with the ailment. Other communities, whereas acknowledging the ailment, treated persons similar to normal citizens as well with compassion. This paper will discuss leprosy in the middle ages. Experts consent that Hansen’s disease was a familiar ailment in mediaeval Europe although opinions range as to its pervasiveness in the period. Writers have proposed that the ailment might have reached its peak in the 20th and 30th eras.4 They grounded this assumption upon the discovery that the total number of hospices started to care for persons with the ailment were many in the 20th and 30th centuries. For instance, in the middle o f 20th era, France had around two thousand leprosariums whereas Scotland and England had about two hundred and twenty to cater for around 1.5 m persons with leprosy. Nevertheless, some of these hospices never served persons with the ailment as well as the dread of the ailment might have resulted to over-exaggeration of its pervasiveness.3 Stereotypically, the medieval societies saw persons with the ailment as untrustworthy, unclean, wrathful, suspicious and hopeless. To the primordial citizen, Hansen’s disease meant a lengthy, disfiguring, as well as inevitable demise. Given the alleged fears of the ailment, primordial citizens evaded people with the ailment.5 Primordial citizens were apprehensive that they might contact Hansen’s disease from associating with persons with the illness and officials habitually made provisions within primordial law, for instance, prohibitions concerning ownership of property. For instance, primordial French communities regularly denied ow nership rights to persons with leprosy. Other communities approved laws to limit the personal free will of persons with leprosy, for instance, the 1276 inquests of London that stated that persons with Hansen’s disease could not reside within the city.6 Primordial communities established other restraints. For example, some individuals believed the Hansen’s disease could be contracted via the breath; therefore, persons with the ailment were only allowed to communicate only they were on down wind.1 Certain communities banned them from utilizing well-travelled roads, enter taverns, market, and even churches with no permission. Medieval communities also banned them from doing laundry within local streams, utilizing public drinking mugs, and touching babies. Restraints varied amid communities, for instance, certain Scottish communities hung or took them out of the village, whereas others allowed them to move around freely. Rendering to Kealey (1981), during 12th century Engl and, persons with the Hansen’s disease were not detested or removed from community, and leper bells and clappers were not used. One of the utmost dramatic social restraints upon persons with the Hansen’s disease was their isolation from mainstream community that was carried out for at least 8 centuries. Primordial citizens believed they might contract leprosy via association.1 Therefore, communities guaranteed that avoids were upheld amid those with and without the ailment. For

Injury Risk in Elite Basketball Players

Injury Risk in Elite Basketball Players The elite basketball player is considered in this piece not only in terms of his potential for injury but also in terms of the potential of the physiotherapist and other sports professionals, to give advice, support and guidance so that he may practice his chosen sport as safely as is reasonably possible. We have looked at the nature, incidence and sites of injuries sustained. We have looked at the two most commonly injured sites (the knee and ankle) in specific detail. We have also discussed the relevant modalities of treatment that a physiotherapist can provide for their clients. There appears to be considerable controversy in the current literature, particularly in the field of pre-exercise stretching. As this is commonly accepted practice by participants, coaches, trainers and sports medicine professionals alike, we have reviewed the arguments both for and against in some detail. We have paid particular attention to its value in the prophylaxis of injury and the evidence to support it. The role of the physiotherapist in education and training of the elite athlete is also discussed. There are a number of sources quoted who regard it as a prime responsibility of the physiotherapist to give the athlete the information to allow them to train and participate as safely and effectively as possible. We have also considered the role of the physiotherapist in the prophylaxis of injury by looking at the various modalities of treatment and intervention that can be employed to make the field of play a safer place. In addition to the main-stream elite basketball player we have also looked at the role of the physiotherapist in the role of helping the disabled basketball player, some of whom have achieved elite status in their own right. They have their own specific problems and these are reviewed and discussed. Lastly we look at the specific gender differences in the sport. With many women finding that the sport is attractive, they participate at a top level of achievement. We look at the reasons why they have a different injury profile to men, both in terms of numbers of injuries but also in terms of the frequency of specific types of injury. The mechanisms of this difference is discussed together with the means whereby it can be addressed. Introduction Basketball is a world-wide sport practised by children in their backyard, adolescents in their playground, amateurs in their league games and elite athletes in their world-stage arenas. It is – by any standards – a fast game with inevitable physical contact, both intentional and accidental. Both these factors lead to the potential for injury. The explosive effort for the fast moves leads to particular pattern of muscle, ligament and tendon injury (see on) and the physical contact can lead to bruises, dislocations, fractures another injuries. It is a sport that is enjoyed by both sexes. Although it was originally conceived primarily as a male sport (for the YMCA)in an era when female participation in sport was a rarity, women now participate in it to elite levels and suffer injury to a similar extent to their male counterparts. The game itself has evolved dramatically since its humble beginnings when Dr James Naismith nailed two peach baskets at the ends of his gymnasium in 1891 (hence the name basketball) It was developed as a tool for fitness training by the YMCA. By 1927 The Harlem Globetrotters had been formed and by 1936 it was included as an Olympic sport. According to FIBA (Basketball governing body) over 400 million people play basketball on a world-wide basis Training for the fitness needed to play the sport can also lead touts own problems. One huge study by Ruhr M Kuala et al. (1994) (1) found that of all the injuries associated with basketball, 50% occurred during the matches and 50% occurred during training for the matches. This should be contrasted with the finding in study by Meeuwisse et al.(2) where injuries during the game were 3.7 times as likely to occur as in training. One could reasonably conclude that a large proportion of the injuries sustained in the â€Å"cut and thrust† of a full scale match are part of the risk package accepted in playing the game. The huge proportion of injuries sustained whilst training, however, should be largely preventable, as training should be ideally undertaken in carefully controlled circumstances. The physiotherapist, personal trainer and sports medicine specialist are ideally placed to advise and oversee poor practice in the training arena and to give advice and guidance to maximise training efficiency and to reduce the toll of injury. Any experienced sports care professional will tell you that the single most important factor in determining the likelihood of sustaining an injury is the occurrence of a previous injury (2). It therefore follows that prevention of any injury will help, not only in improving the immediate efficiency of the player, but will also confer protection against the possibility of recurring injury in any given site. Before we consider the mechanisms and prophylaxis of injuries in basketball, it would be prudent to consider the observed injuries from the sport, both in absolute number and site. The study by Meeuwisse(2003) (2) followed a cohort of 142 basketball players over a two year period and discovered that 44.7% of the players were injured in that time frame. As they recorded over 200 injuries in that time, it is clear that many players were injured more than once. The study by Ruhr M Kuala et al. (1994) (1) will be extensively quoted in this piece as it provides an enormous amount of meticulously collected data which has a high degree of confidence in its validity. It was based in Finland where the population has a particularly regimented system of bureaucratic personal information storage, especially with regard to injury and healthcare details. The entire population has to be registered with a nationally based health insurance, which records every accident and injury. This is of enormous value to studies such as this, as accurate statistics about entities such as specific sporting injuries can be derived comparatively easily. The study is also important in this specific regard as it encompasses an enormous cohort of basketball players analysing 39,541person years of basketball experience and 3,472 specific injuries. It’s worth considering the patterns of injury found in some detail as it has an impact on the deliberations in this piece. In terms of age distribution, it was found that injuries in thunder 15 yr. age group were comparatively rare and that the injury rate peaked in the 20 – 24 yr. age groups. Percentage of injuries by sites in basketball players (These results are slightly modified with some trivia removed) Injury Site % of total Lower limb Total 56.0 Thigh 2.5 Knee 15.8 Leg 2.0 Ankle 31.4 Foot 4.0 Other 0.4 Upper Limb total 19.3 Upper arm + Shoulder 2.6 Forearm and elbow 1.3 Palm + wrist Fingers 11.1 Other 0.4 Other Sites Total 24.7 Teeth 5.2 Eyes 3.0 Head + neck 7.4 Thorax + Abdomen 1.5 Back 5.4 Pelvis 0.9 Multiple sites 1.4 There are clearly a number of striking trends in these figures. The lower limbs sustaining the most injuries with 56% of the total. The ankle and knee taking the lion’s share of these. These results are clearly fairly predictable with the nature of the sport being one of sudden changes of acceleration and direction, many changes of direction(pivoting) involving turning forces impinging maximally on the knee and ankle. Both joints are intrinsically unstable for these modalities of movements. They are designed to be most effective in walking and running in a straight line. Although they can accommodate twisting movements, they are much less mechanically sound in these directions. The possibility of unanticipated, and therefore unraced, impacts is endemic in the sport and will increase the possibility of injury to these joins in particular. The upper limb has a substantial tally of injuries with the bulk being to the palm, wrist and fingers. Although it is not specified in this particular study, any experienced clinician would expect to see substantial proportion of hyperextensions and dislocations to the fingers and sprains and strains to the wrist (this is partially amplified in the next section). For a sport that involves considerable manipulative and throwing skills, it is, perhaps, surprising that the shoulder and upper arm account for only 2.6% of all the injuries. In contrast to the comments made about the knee and ankle, one can postulate that the shoulder, by virtue of its design to accommodate a much greater range and compass of movement, is less likely to be injured in the way that the knee and ankle are. Also, in the course of the normal game, it is subject to rather less overall mechanical force as both the knee and ankle have to assimilate peak loads of several times the body weight whereas the shoulder, unless involved in a fall, does not. Of the â€Å"Other Sites†, the neck and back are the commonest sites for injury. To a large extent, this again is a reflection of the explosive nature of the game with frequent changes of direction and velocity with high levels of acceleration. Having recognised the major sites of injury it is now prudent to discuss the main types of injury. Percentage injury by type in basketball players (These results are slightly modified with some trivia removed) Injury type + site % of total Sprains +strains 61.3 Knee 12.4 Ankle 29.5 Bruises + Wounds 22.2 Fractures 12.6 Fracture (other than dental) 7.6 Foot + ankle 18.5 Lower limb (other) 3.8 Fingers Palm + wrist 57.0 Upper limb (other) 4.2 Other (nondental) 16.6 Dental 4.9 Dislocations 1.7 Knee 0.5 Shoulder + elbow 0.3 Fingers 0.3 Others 2.2 Sprains and strains are the commonest type of injury in this sport with the ankle being the most frequently injured site in this respect. Considerable amounts of work and research have been done(2,3,4,5,6,7,8) to try to find mechanisms whereby ankle injuries can beat least reduced in both frequency and severity. This will be discussed in detail later. Knee strains and sprains are the next most frequent at12.4%. Similar amounts of work have been done to find ways of minimising knee injuries (9,10,11). The knee injury is notorious for producing long-term debilitating problems as not only is the acute injury painful and potentially debilitating in itself, but there is also the potential for Anterior Cruciate Ligament (ACL) damage and meniscal damage and wear as well. This may not be immediately apparent but may contribute to morbidity at a later date. This study (1) found that knee injuries were the most common cause of permanent disability In the longer term. During the time frame of this study, four basketball players sustained permanent injuries. In specific relation to knee and ankle injury, the Meiuwess study(2) found that the situation can be further amplified by the finding that the greatest number of injuries which resulted in seven or more sessions being lost in a season arose from the knee. Equally striking was the fact that the most common injury that involved less than seven sessions being lost, were injuries to the ankle. This underlines the comment made earlier that knee injuries tend to be potentially more serious than ankle injuries Bruises and wounds account for over 1/5th of the total types of injury and fractures account for just over 1/10th. In line with the comments made earlier about the frequency of hand, finger and wrist injury, it will come as no surprise therefore to see that the hand and wrist accounts for over half of the total of fractures. The foot and ankle account for 18.5% of total fractures. This is a reversal of the figures relating to site of injury. It would therefore appear that the hand gets injured less frequently that the foot, but when it does, it’s more likely to sustain the more serious (fracture) type of injury. Although the foot is more likely to be injured, it is more likely to suffer a strain or sprain rather than a fracture. In the study by Home et al.,(2004) (12) There was an unexpected, and slightly worrying, conclusion. They found that, in a study of fractures in sport, that (for men at least) basketball was the sport that put the participants at greatest risk of sustaining a fracture. The Knee and Basketball As we have already discussed, a knee injury is potentially more serious than just the implication of the immediate acute injury. For that reason, and for the fact that it is one of the two most commonly injured areas, we will look at the knee as a specific entity. We know that the single most important predictor for further injury is the past history of a preceding original injury. The knee is also significant insofar as the normal maxim of rest a joint until the inflammation has settled is rarely practical, as the knee is essential for locomotion and, as any experienced clinician knows, the vast majority of patients with resolving knee injuries will wait until the pain subsides to a tolerable level, and then start to walk on it. This effectively means that the joint is being stressed while resolving inflammation is present. Initially this may manifest itself as no more than a mildly aching knee, but it is likely that menisci, cruciate ligaments and articular surfaces are all being stressed in a â€Å"less than optimal† state. It is likely, on a first principles basis, that this type of mechanism may be, in part at least, responsible for the increased levels of arthritis and arthritis that is observed in lifelong athletes. (13,14) The paper by Meeuwisse (2) has been quoted several times in this piece. It is worth remembering that his team found that the knee waste joint which, if injured, gave rise to the longest periods of incapacity. It is therefore prudent to consider the mechanisms of injury, the treatment of those injuries and, possibly more importantly in the context of this piece, what can be done to minimise the incidence and impact of those injuries. We would commend an excellent paper by Bahr (2001) (3) on the subject. He discusses (amongst other things) the current thinking on knee injuries. He makes comment on the increasing incidence of cruciate ligament injuries. These injuries are seen with greatest frequency in athletes who participate in sports that involve â€Å"pivoting† – a movement which involves a fixed foot on the floor being used as a fulcrum topspin the body around – a movement which can put huge rotational stresses on the knee joint. As has been observed earlier in this piece, the knee is designed primarily to be efficient in dealing with movement in a sagittal plane. It is very poorly adapted to deal with rotational stresses. Bahr observes that the maximal incidence of cruciate ligament injury is in the 15-25 yr. old age group and in women three to five times more frequently than in men (see on) (14). He also refers to the post-injury, long-term complications of abnormal joint mechanics and the early onset of degenerative joint disease (15). Significantly he points to the fact that, although there has been an increasing trend recently (mainly because of improved operating techniques) to attempt to repair menisci and cruciate ligaments, this has not been accompanied by an apparent reduction in the rate of post-traumatic osteoarthritis. Similarly, arthroscopic repair of isolated meniscal damage has not been shown to reduce the incidence of arthritis. These factors all mitigate the argument that, although treatment is important, the identification of risk factors that predispose to injury is even more important. The Anterior Cruciate Ligament (ACL) is commonly injured in circumstances that many athletes would consider as normal or routine for their particular sport. Frequently the damage occurs without direct physical contact to the knee (9). This is strong evidence to support the â€Å"design fault† explanation of the aetiology. There is recent anecdotal data to suggest that improving the control of the knee may have an impact in reducing the incidence of these injuries. This views supported in a paper by Carafe (10) who looked at improving the proprioceptive and balance mechanisms in footballers over a three season period. They reported an 87% decrease in the incidence of injuries to the ACL. It may be significant that they studied semi-professional and amateur footballers who, presumably, did not train as efficiently of as skilfully as their professional footballer counterparts and therefore there was probably considerable room for improvement. Similarly constructed studies have shown similar pattern of improvement in young female football (11) and handball (16) players using a similar programme of training over a season. As has been pointed out earlier, such changes are more likely to be noticeable in females because of the higher incidence of ACL injury in the first place. Bahr points out that these studies were too small to allow a proper statistical evaluation of the reduction of injury to the ACL specifically, but there is sufficient evidence to conclude that the risk of serious knee injury can be significantly reduced by the introduction of structured training exercises that focus on improving the neuron-muscular control of the knee. Bahr makes the very salient point that balance (proprioceptive)training is not yet universally recognised by coaches and trainers as useful tool. As a result, he argues that it is the responsibility of doctors and physiotherapists to disseminate the knowledge that such training does reduce the incidence of serious short-term (and therefore long-term) knee injury. Anterior knee pain is a common, sometimes chronic presenting symptom in any sports related health professional’s clinic. There are many theories as to its aetiology and it is notoriously resistant to treatment. An unattributed paper (quoted by Minerva in the BMJ) (17)refers to Jumper’s knee where the pain is maximal near the attachment of the patella ligament. Ultrasound of the region can show an area of increased echogenicity in the inferior pole of the patella. Minerva quotes the study as observing that of 100 athletes seen in one clinic,18 had to give up their sport for over a year and about 1/3rd needed surgery in order to try to get resolution of the problem. In conclusion to this section we would refer the reader to the excellent paper by Adams WB (2004) (18) who reviews the current thinking on treatment options on both overuse syndromes and trauma tithe knee. The Ankle and Basketball As we have seen earlier, the ankle is the single most commonly injured site in the body during basketball comprising 31.4% of all the injuries observed (1) and ankle strains and sprains were the single commonest mechanism of injury observed with 1/3rd of all such injuries and 1/5th of all fractures. We will therefore also consider the ankles a special case. Bahr (3) quotes that in round figures 20% of sports related injuries involve the ankle. The vast majority of ankle injuries are simple sprains of the lateral and medial ankle ligaments. Proper functional care will allow the patient to return to work within a few days, or at worst a few weeks, with minimal squeal. Some sprains are found to cause prolonged disability in the form of chronic instability or persistent pain. Prophylaxis of injury is discussed elsewhere in this piece but it should be noted that taping and bracing are commonly employed techniques for protection, but their efficacy has only been demonstrated in sportsmen with a history of previous injury (5,6).There is little doubt that taping and bracing will reduce the incidence of sprains and result in less severe strains. â€Å"High-top† basketball boots have been introduced recently on the assumption that similar boots (18a) (viz. ski boots) reduce the incidence of ankle injury, but it has not yet produced any specific evidence that sprains and strains are reduced. Braces seen to be more effective than tape in preventing sprains of the ankle (7,8) Bracing has the advantage that it is more acceptable in terms of comfort for long-term use (6). Taping is commonly used but appears to be less effective than braces because it relies on adhesion to the skin to exert its protective influence. It can cause skin irritation and has to be reapplied on virtually every occasion where potential stress can occur. One of the major problems of doing research into ankle injuries is that qualitative and subjective measurements such as pain and immobility can be easily assessed, but the ankle joint is a very functionally complex structure and quantitative measurements of anything other than flexion/extension or rotation an very difficult. Its therefore heartening to read of a Dutch group who are developing a specially designed goniometer to use in researching the pathology of the ankle joint (19). This is only mentioned for the sake of completeness and we do not propose to go into any detail about the instrument. There is an excellent article by McKay on ankle injuries in basketball (20) but this is discussed at some length in the section on prophylaxis of injuries. Treatment of injuries The treatment of sports related injuries is a vast topic and specialism in itself. The sports medicine medical specialist and the physiotherapist sports specialist are technically knowledgeable people who have had to assimilate a vast quantity of information relative to their specialisation. It is therefore not proposed to present the topic in any great detail but to cover the elements of treatment of acute injuries and their subsequent treatment that are specifically important to the field of basketball. We will also present a brief literature review of some of the most recent papers in the field. In general terms, the old adage of ICE (immobilisation, compression and elevation) (20b) is a useful first-aid mnemonic which will help to minimise injury prior to assessment by a more specialist professional. In this article it is proposed to look primarily at the aspects of treatment which impinge on the areas covered in this piece and broad overviews. We shall restrict ourselves here to a brief literature review of some of the most important recent papers The area of dental trauma is highlighted in the analysis by Kujalaet al. (1994) (1) with 5.0% of all basketball injuries being dental. Airport by Randall (2005) (21) discusses the impact of dental injuries and suggests that sports field medical personnel should have at least basic training in the first-aid of dental injuries so that they can, at least, provide appropriate care until a dental specialist can be properly involved. A particularly controversial issue is raised by Dietzel and Hedlund(2005) (22) They review the current controversy about the use of analgesic and anti-inflammatory injections both in the acute phase of injury (to allow continued participation in a sporting event) or in the chronic recovery phase. This is a particularly well balanced article which evaluates both sides of the arguments for and against the use of injectable medications. Sanchez et al.(2005) (23) review the desperately important area of management of the potentially spine-injured athlete. This is an area which has had substantial changes in management techniques in the recent past. This paper is a particularly useful review of techniques of diagnosis and stabilisation of the injured athlete. Very significantly it highlights the role of pre-injury planning – so often overlooked – on the sports field. There are two recent papers which examine the thorny problem of concussion on the sports field (24,25). This has long posed a problem for the supervising healthcare specialist, both in terms of immediate diagnosis and subsequent action and treatment. The working â€Å"rule of thumb† has been that any player with definite signs of concussion(impaired consciousness or increased level of confusion) should be taken off the field and not returned to play for 48 hrs. In practice, this advice may be ignored by coaches who are anxious to keep their best players on the field and who may be ignorant of the potential side effects. McKean (24) and Johnston et al. (25) review the arguments in coherent manner and present the current thinking in a modern context. Injury types in relation to position played There are few studies that actually compare the rates and types of injury with actual position played on the court. Given the fact that Kuala, (1) reports that 50% of injuries are sustained in training rather than on the court, this may prove to be rather academic. The study by Meeuwisse (2003) (2), was one of the few that looked at this issue and regarded it as purely peripheral to the main mechanism of injury. However , they summed up the findings of the study in the phrase â€Å"Centres had the highest rate of injury, followed by guards, and then forwards. The relative risk of re-injury was significantly increased by previous injuries to the elbow, shoulder, knee, hand, lower spine or pelvis, and by concussions.† As part of their conclusions the research team commented that the predictive risk factors for injury were, in order of importance: previous injury, number of games played, the number of player contacts during a game, player position, and court location (this is a reference to the proximity to a hospital). In real terms, the players position is of much less importance in predicting injury than many other factors Clinical considerations The clinical implications of basketball injury must be viewed in the context of the benefits derived from playing any competitive sport– or indeed pursuing any degree of fitness. Virtually any sporting endeavour has a downside and indeed risks associated with it, but equally there are very considerable benefits to be gained as well. By concentrating (by necessity) on the risks of injury in basketball in this article we do not wish to ignore the balancing perspective of the health gains to also be derived. Clearly, one of the major benefits to be gained is the concurrent increase in cardiovascular fitness (13) This is in addition to the less easily quantifiable benefits of general fitness, social interaction, increase in self-confidence and satisfaction in participation which are common to most sporting endeavours. The study by Kuala et al. (1993) (13) looked at the incidence of degenerative joint conditions in elite athletes. It found that participation in sports generally could lead to premature osteoarthritis. Specifically it found that, in the elite international athletes studied there was a greater than predicted admission rate to hospital for treatments for osteoarthritis of the hip, knee and ankle. Very significantly, in the context of this article on physiotherapy, it concluded that proper treatment of injuries to these joints could significantly reduce the incidence of premature osteoarthritis in this group. It should be noted that this was a large control moderated study of over 2000 international athletes so the findings are clearly significant Disability and basketball It is important not to ignore the fact that basketball is played, not only by able-bodied sportsmen but also by those who have a concurrent disability as well. This group also presents a professional problem for the physiotherapist as. Not only are there the â€Å"normal â€Å"considerations for the able-bodied player that we have discussed in this piece, but also there may well be disability-specific considerations in the disabled player which will tax the physiotherapist every bit as much as those in their able-bodied counterparts. In consideration of this we would commend the reader to an excellent article by Chula (1994) (26) which discusses inconsiderable depth, the whole issue of sports specific medical considerations for people with a disability. The use of sports for the disabled as a therapeutic measure was championed by Sir Ludwig Guttmann, who was a specialist in spinal injuries. He pointed out not only the obvious physical benefits to be gained in improving functions of the body which the paraplegic ortetraplegic had not fully exploited in their pre-injury state togetherwith the obvious cardiovascular benefits that could be obtained, but healso pointed to the psychological benefits to be gained by socialisingand competing against others. The Disabled Person’s Employment Act (1944) was the first majorlegislative landmark in the effective rehabilitation of the disabledperson back into society and other legislation relating todiscrimination generally has helped the disabled person to achievelevels of attainment in sport that would have been unthinkable half acentury ago. The comments that have been made in this piece in relation toable-bodied people obviously apply, in general terms, to the disabledperson as well. Clearly it depends on the nature of the disability asto what specific measures need to be employed specifically, but thebasic principles are the same. Muscle groups need to be developed inorder to protect the joints that they work over. This is particularlyrelevant to the knee. Appropriate proprioceptive skills need to beenhanced if the risk of injury is to be kept to an acceptable minimum.More specific considerations that may involve the occupationaltherapist as well as the physiotherapist may include the prevention ofpressure problems from a wheelchair or calliper or the use ofrestraints in a patient who has sudden muscular spasms, so that theyare not thrown out of the wheelchair. The experienced physiotherapist will be well aware of the benefitsof sport in the disabled in improving strength, co-ordination andendurance. Basketball, in particular, is commonly employed in thewheelchair-bound patient, who has to learn transferable skills in orderto propel the wheel chair accurately as well as catch, intercept andpass the ball. Prophylaxis and pre-injury actions Earlier in this piece we briefly discussed a paper by Sanchez (23).and commended it for its tackling of the problem of anticipating an injury. This involved a significant amount of pre-planning andorganisation on the court and field of play. Such issues are of vitalimportance to the athletes although they may not either realise orappreciate it at the time. This type of forward thinking can lead to dramatic reductions in morbidity (or even in mortality) and should be the concern of each and every healthcare professional who is working in the field of acute sports injury. Prophylaxis can be considered not only as actual pre-planning thecourse of action needed if an injury is sustained (viz. are theresplints, bandages, sterile water and gloves etc. available?) but equally it can be considered as the correct training and preparation ofboth the players and the game officials, so that the game itself can beplayed in conditions of optimum safety. Although the first of these two considerations is clearly important, in the context of this piece, weshall consider the second element in detail. Prophylaxis of injury is a major concern. We have discussed thepredictive value of a pre-existing injury. It follows that, if thatinjury can be prevented, then the subject is statistically less likelyto suffer a further injury. Common sense is behind the definitive recommendation in the paperby Kuala et al., (1) where he states that, in an attempt to reduce the incidence of injuries in basketball, specific preventative measuresshould be employed to reduce the number of violent contacts betweenplayers. He cites improving the drafting of game rules so that violentinfringements of the rules can be mo Injury Risk in Elite Basketball Players Injury Risk in Elite Basketball Players The elite basketball player is considered in this piece not only in terms of his potential for injury but also in terms of the potential of the physiotherapist and other sports professionals, to give advice, support and guidance so that he may practice his chosen sport as safely as is reasonably possible. We have looked at the nature, incidence and sites of injuries sustained. We have looked at the two most commonly injured sites (the knee and ankle) in specific detail. We have also discussed the relevant modalities of treatment that a physiotherapist can provide for their clients. There appears to be considerable controversy in the current literature, particularly in the field of pre-exercise stretching. As this is commonly accepted practice by participants, coaches, trainers and sports medicine professionals alike, we have reviewed the arguments both for and against in some detail. We have paid particular attention to its value in the prophylaxis of injury and the evidence to support it. The role of the physiotherapist in education and training of the elite athlete is also discussed. There are a number of sources quoted who regard it as a prime responsibility of the physiotherapist to give the athlete the information to allow them to train and participate as safely and effectively as possible. We have also considered the role of the physiotherapist in the prophylaxis of injury by looking at the various modalities of treatment and intervention that can be employed to make the field of play a safer place. In addition to the main-stream elite basketball player we have also looked at the role of the physiotherapist in the role of helping the disabled basketball player, some of whom have achieved elite status in their own right. They have their own specific problems and these are reviewed and discussed. Lastly we look at the specific gender differences in the sport. With many women finding that the sport is attractive, they participate at a top level of achievement. We look at the reasons why they have a different injury profile to men, both in terms of numbers of injuries but also in terms of the frequency of specific types of injury. The mechanisms of this difference is discussed together with the means whereby it can be addressed. Introduction Basketball is a world-wide sport practised by children in their backyard, adolescents in their playground, amateurs in their league games and elite athletes in their world-stage arenas. It is – by any standards – a fast game with inevitable physical contact, both intentional and accidental. Both these factors lead to the potential for injury. The explosive effort for the fast moves leads to particular pattern of muscle, ligament and tendon injury (see on) and the physical contact can lead to bruises, dislocations, fractures another injuries. It is a sport that is enjoyed by both sexes. Although it was originally conceived primarily as a male sport (for the YMCA)in an era when female participation in sport was a rarity, women now participate in it to elite levels and suffer injury to a similar extent to their male counterparts. The game itself has evolved dramatically since its humble beginnings when Dr James Naismith nailed two peach baskets at the ends of his gymnasium in 1891 (hence the name basketball) It was developed as a tool for fitness training by the YMCA. By 1927 The Harlem Globetrotters had been formed and by 1936 it was included as an Olympic sport. According to FIBA (Basketball governing body) over 400 million people play basketball on a world-wide basis Training for the fitness needed to play the sport can also lead touts own problems. One huge study by Ruhr M Kuala et al. (1994) (1) found that of all the injuries associated with basketball, 50% occurred during the matches and 50% occurred during training for the matches. This should be contrasted with the finding in study by Meeuwisse et al.(2) where injuries during the game were 3.7 times as likely to occur as in training. One could reasonably conclude that a large proportion of the injuries sustained in the â€Å"cut and thrust† of a full scale match are part of the risk package accepted in playing the game. The huge proportion of injuries sustained whilst training, however, should be largely preventable, as training should be ideally undertaken in carefully controlled circumstances. The physiotherapist, personal trainer and sports medicine specialist are ideally placed to advise and oversee poor practice in the training arena and to give advice and guidance to maximise training efficiency and to reduce the toll of injury. Any experienced sports care professional will tell you that the single most important factor in determining the likelihood of sustaining an injury is the occurrence of a previous injury (2). It therefore follows that prevention of any injury will help, not only in improving the immediate efficiency of the player, but will also confer protection against the possibility of recurring injury in any given site. Before we consider the mechanisms and prophylaxis of injuries in basketball, it would be prudent to consider the observed injuries from the sport, both in absolute number and site. The study by Meeuwisse(2003) (2) followed a cohort of 142 basketball players over a two year period and discovered that 44.7% of the players were injured in that time frame. As they recorded over 200 injuries in that time, it is clear that many players were injured more than once. The study by Ruhr M Kuala et al. (1994) (1) will be extensively quoted in this piece as it provides an enormous amount of meticulously collected data which has a high degree of confidence in its validity. It was based in Finland where the population has a particularly regimented system of bureaucratic personal information storage, especially with regard to injury and healthcare details. The entire population has to be registered with a nationally based health insurance, which records every accident and injury. This is of enormous value to studies such as this, as accurate statistics about entities such as specific sporting injuries can be derived comparatively easily. The study is also important in this specific regard as it encompasses an enormous cohort of basketball players analysing 39,541person years of basketball experience and 3,472 specific injuries. It’s worth considering the patterns of injury found in some detail as it has an impact on the deliberations in this piece. In terms of age distribution, it was found that injuries in thunder 15 yr. age group were comparatively rare and that the injury rate peaked in the 20 – 24 yr. age groups. Percentage of injuries by sites in basketball players (These results are slightly modified with some trivia removed) Injury Site % of total Lower limb Total 56.0 Thigh 2.5 Knee 15.8 Leg 2.0 Ankle 31.4 Foot 4.0 Other 0.4 Upper Limb total 19.3 Upper arm + Shoulder 2.6 Forearm and elbow 1.3 Palm + wrist Fingers 11.1 Other 0.4 Other Sites Total 24.7 Teeth 5.2 Eyes 3.0 Head + neck 7.4 Thorax + Abdomen 1.5 Back 5.4 Pelvis 0.9 Multiple sites 1.4 There are clearly a number of striking trends in these figures. The lower limbs sustaining the most injuries with 56% of the total. The ankle and knee taking the lion’s share of these. These results are clearly fairly predictable with the nature of the sport being one of sudden changes of acceleration and direction, many changes of direction(pivoting) involving turning forces impinging maximally on the knee and ankle. Both joints are intrinsically unstable for these modalities of movements. They are designed to be most effective in walking and running in a straight line. Although they can accommodate twisting movements, they are much less mechanically sound in these directions. The possibility of unanticipated, and therefore unraced, impacts is endemic in the sport and will increase the possibility of injury to these joins in particular. The upper limb has a substantial tally of injuries with the bulk being to the palm, wrist and fingers. Although it is not specified in this particular study, any experienced clinician would expect to see substantial proportion of hyperextensions and dislocations to the fingers and sprains and strains to the wrist (this is partially amplified in the next section). For a sport that involves considerable manipulative and throwing skills, it is, perhaps, surprising that the shoulder and upper arm account for only 2.6% of all the injuries. In contrast to the comments made about the knee and ankle, one can postulate that the shoulder, by virtue of its design to accommodate a much greater range and compass of movement, is less likely to be injured in the way that the knee and ankle are. Also, in the course of the normal game, it is subject to rather less overall mechanical force as both the knee and ankle have to assimilate peak loads of several times the body weight whereas the shoulder, unless involved in a fall, does not. Of the â€Å"Other Sites†, the neck and back are the commonest sites for injury. To a large extent, this again is a reflection of the explosive nature of the game with frequent changes of direction and velocity with high levels of acceleration. Having recognised the major sites of injury it is now prudent to discuss the main types of injury. Percentage injury by type in basketball players (These results are slightly modified with some trivia removed) Injury type + site % of total Sprains +strains 61.3 Knee 12.4 Ankle 29.5 Bruises + Wounds 22.2 Fractures 12.6 Fracture (other than dental) 7.6 Foot + ankle 18.5 Lower limb (other) 3.8 Fingers Palm + wrist 57.0 Upper limb (other) 4.2 Other (nondental) 16.6 Dental 4.9 Dislocations 1.7 Knee 0.5 Shoulder + elbow 0.3 Fingers 0.3 Others 2.2 Sprains and strains are the commonest type of injury in this sport with the ankle being the most frequently injured site in this respect. Considerable amounts of work and research have been done(2,3,4,5,6,7,8) to try to find mechanisms whereby ankle injuries can beat least reduced in both frequency and severity. This will be discussed in detail later. Knee strains and sprains are the next most frequent at12.4%. Similar amounts of work have been done to find ways of minimising knee injuries (9,10,11). The knee injury is notorious for producing long-term debilitating problems as not only is the acute injury painful and potentially debilitating in itself, but there is also the potential for Anterior Cruciate Ligament (ACL) damage and meniscal damage and wear as well. This may not be immediately apparent but may contribute to morbidity at a later date. This study (1) found that knee injuries were the most common cause of permanent disability In the longer term. During the time frame of this study, four basketball players sustained permanent injuries. In specific relation to knee and ankle injury, the Meiuwess study(2) found that the situation can be further amplified by the finding that the greatest number of injuries which resulted in seven or more sessions being lost in a season arose from the knee. Equally striking was the fact that the most common injury that involved less than seven sessions being lost, were injuries to the ankle. This underlines the comment made earlier that knee injuries tend to be potentially more serious than ankle injuries Bruises and wounds account for over 1/5th of the total types of injury and fractures account for just over 1/10th. In line with the comments made earlier about the frequency of hand, finger and wrist injury, it will come as no surprise therefore to see that the hand and wrist accounts for over half of the total of fractures. The foot and ankle account for 18.5% of total fractures. This is a reversal of the figures relating to site of injury. It would therefore appear that the hand gets injured less frequently that the foot, but when it does, it’s more likely to sustain the more serious (fracture) type of injury. Although the foot is more likely to be injured, it is more likely to suffer a strain or sprain rather than a fracture. In the study by Home et al.,(2004) (12) There was an unexpected, and slightly worrying, conclusion. They found that, in a study of fractures in sport, that (for men at least) basketball was the sport that put the participants at greatest risk of sustaining a fracture. The Knee and Basketball As we have already discussed, a knee injury is potentially more serious than just the implication of the immediate acute injury. For that reason, and for the fact that it is one of the two most commonly injured areas, we will look at the knee as a specific entity. We know that the single most important predictor for further injury is the past history of a preceding original injury. The knee is also significant insofar as the normal maxim of rest a joint until the inflammation has settled is rarely practical, as the knee is essential for locomotion and, as any experienced clinician knows, the vast majority of patients with resolving knee injuries will wait until the pain subsides to a tolerable level, and then start to walk on it. This effectively means that the joint is being stressed while resolving inflammation is present. Initially this may manifest itself as no more than a mildly aching knee, but it is likely that menisci, cruciate ligaments and articular surfaces are all being stressed in a â€Å"less than optimal† state. It is likely, on a first principles basis, that this type of mechanism may be, in part at least, responsible for the increased levels of arthritis and arthritis that is observed in lifelong athletes. (13,14) The paper by Meeuwisse (2) has been quoted several times in this piece. It is worth remembering that his team found that the knee waste joint which, if injured, gave rise to the longest periods of incapacity. It is therefore prudent to consider the mechanisms of injury, the treatment of those injuries and, possibly more importantly in the context of this piece, what can be done to minimise the incidence and impact of those injuries. We would commend an excellent paper by Bahr (2001) (3) on the subject. He discusses (amongst other things) the current thinking on knee injuries. He makes comment on the increasing incidence of cruciate ligament injuries. These injuries are seen with greatest frequency in athletes who participate in sports that involve â€Å"pivoting† – a movement which involves a fixed foot on the floor being used as a fulcrum topspin the body around – a movement which can put huge rotational stresses on the knee joint. As has been observed earlier in this piece, the knee is designed primarily to be efficient in dealing with movement in a sagittal plane. It is very poorly adapted to deal with rotational stresses. Bahr observes that the maximal incidence of cruciate ligament injury is in the 15-25 yr. old age group and in women three to five times more frequently than in men (see on) (14). He also refers to the post-injury, long-term complications of abnormal joint mechanics and the early onset of degenerative joint disease (15). Significantly he points to the fact that, although there has been an increasing trend recently (mainly because of improved operating techniques) to attempt to repair menisci and cruciate ligaments, this has not been accompanied by an apparent reduction in the rate of post-traumatic osteoarthritis. Similarly, arthroscopic repair of isolated meniscal damage has not been shown to reduce the incidence of arthritis. These factors all mitigate the argument that, although treatment is important, the identification of risk factors that predispose to injury is even more important. The Anterior Cruciate Ligament (ACL) is commonly injured in circumstances that many athletes would consider as normal or routine for their particular sport. Frequently the damage occurs without direct physical contact to the knee (9). This is strong evidence to support the â€Å"design fault† explanation of the aetiology. There is recent anecdotal data to suggest that improving the control of the knee may have an impact in reducing the incidence of these injuries. This views supported in a paper by Carafe (10) who looked at improving the proprioceptive and balance mechanisms in footballers over a three season period. They reported an 87% decrease in the incidence of injuries to the ACL. It may be significant that they studied semi-professional and amateur footballers who, presumably, did not train as efficiently of as skilfully as their professional footballer counterparts and therefore there was probably considerable room for improvement. Similarly constructed studies have shown similar pattern of improvement in young female football (11) and handball (16) players using a similar programme of training over a season. As has been pointed out earlier, such changes are more likely to be noticeable in females because of the higher incidence of ACL injury in the first place. Bahr points out that these studies were too small to allow a proper statistical evaluation of the reduction of injury to the ACL specifically, but there is sufficient evidence to conclude that the risk of serious knee injury can be significantly reduced by the introduction of structured training exercises that focus on improving the neuron-muscular control of the knee. Bahr makes the very salient point that balance (proprioceptive)training is not yet universally recognised by coaches and trainers as useful tool. As a result, he argues that it is the responsibility of doctors and physiotherapists to disseminate the knowledge that such training does reduce the incidence of serious short-term (and therefore long-term) knee injury. Anterior knee pain is a common, sometimes chronic presenting symptom in any sports related health professional’s clinic. There are many theories as to its aetiology and it is notoriously resistant to treatment. An unattributed paper (quoted by Minerva in the BMJ) (17)refers to Jumper’s knee where the pain is maximal near the attachment of the patella ligament. Ultrasound of the region can show an area of increased echogenicity in the inferior pole of the patella. Minerva quotes the study as observing that of 100 athletes seen in one clinic,18 had to give up their sport for over a year and about 1/3rd needed surgery in order to try to get resolution of the problem. In conclusion to this section we would refer the reader to the excellent paper by Adams WB (2004) (18) who reviews the current thinking on treatment options on both overuse syndromes and trauma tithe knee. The Ankle and Basketball As we have seen earlier, the ankle is the single most commonly injured site in the body during basketball comprising 31.4% of all the injuries observed (1) and ankle strains and sprains were the single commonest mechanism of injury observed with 1/3rd of all such injuries and 1/5th of all fractures. We will therefore also consider the ankles a special case. Bahr (3) quotes that in round figures 20% of sports related injuries involve the ankle. The vast majority of ankle injuries are simple sprains of the lateral and medial ankle ligaments. Proper functional care will allow the patient to return to work within a few days, or at worst a few weeks, with minimal squeal. Some sprains are found to cause prolonged disability in the form of chronic instability or persistent pain. Prophylaxis of injury is discussed elsewhere in this piece but it should be noted that taping and bracing are commonly employed techniques for protection, but their efficacy has only been demonstrated in sportsmen with a history of previous injury (5,6).There is little doubt that taping and bracing will reduce the incidence of sprains and result in less severe strains. â€Å"High-top† basketball boots have been introduced recently on the assumption that similar boots (18a) (viz. ski boots) reduce the incidence of ankle injury, but it has not yet produced any specific evidence that sprains and strains are reduced. Braces seen to be more effective than tape in preventing sprains of the ankle (7,8) Bracing has the advantage that it is more acceptable in terms of comfort for long-term use (6). Taping is commonly used but appears to be less effective than braces because it relies on adhesion to the skin to exert its protective influence. It can cause skin irritation and has to be reapplied on virtually every occasion where potential stress can occur. One of the major problems of doing research into ankle injuries is that qualitative and subjective measurements such as pain and immobility can be easily assessed, but the ankle joint is a very functionally complex structure and quantitative measurements of anything other than flexion/extension or rotation an very difficult. Its therefore heartening to read of a Dutch group who are developing a specially designed goniometer to use in researching the pathology of the ankle joint (19). This is only mentioned for the sake of completeness and we do not propose to go into any detail about the instrument. There is an excellent article by McKay on ankle injuries in basketball (20) but this is discussed at some length in the section on prophylaxis of injuries. Treatment of injuries The treatment of sports related injuries is a vast topic and specialism in itself. The sports medicine medical specialist and the physiotherapist sports specialist are technically knowledgeable people who have had to assimilate a vast quantity of information relative to their specialisation. It is therefore not proposed to present the topic in any great detail but to cover the elements of treatment of acute injuries and their subsequent treatment that are specifically important to the field of basketball. We will also present a brief literature review of some of the most recent papers in the field. In general terms, the old adage of ICE (immobilisation, compression and elevation) (20b) is a useful first-aid mnemonic which will help to minimise injury prior to assessment by a more specialist professional. In this article it is proposed to look primarily at the aspects of treatment which impinge on the areas covered in this piece and broad overviews. We shall restrict ourselves here to a brief literature review of some of the most important recent papers The area of dental trauma is highlighted in the analysis by Kujalaet al. (1994) (1) with 5.0% of all basketball injuries being dental. Airport by Randall (2005) (21) discusses the impact of dental injuries and suggests that sports field medical personnel should have at least basic training in the first-aid of dental injuries so that they can, at least, provide appropriate care until a dental specialist can be properly involved. A particularly controversial issue is raised by Dietzel and Hedlund(2005) (22) They review the current controversy about the use of analgesic and anti-inflammatory injections both in the acute phase of injury (to allow continued participation in a sporting event) or in the chronic recovery phase. This is a particularly well balanced article which evaluates both sides of the arguments for and against the use of injectable medications. Sanchez et al.(2005) (23) review the desperately important area of management of the potentially spine-injured athlete. This is an area which has had substantial changes in management techniques in the recent past. This paper is a particularly useful review of techniques of diagnosis and stabilisation of the injured athlete. Very significantly it highlights the role of pre-injury planning – so often overlooked – on the sports field. There are two recent papers which examine the thorny problem of concussion on the sports field (24,25). This has long posed a problem for the supervising healthcare specialist, both in terms of immediate diagnosis and subsequent action and treatment. The working â€Å"rule of thumb† has been that any player with definite signs of concussion(impaired consciousness or increased level of confusion) should be taken off the field and not returned to play for 48 hrs. In practice, this advice may be ignored by coaches who are anxious to keep their best players on the field and who may be ignorant of the potential side effects. McKean (24) and Johnston et al. (25) review the arguments in coherent manner and present the current thinking in a modern context. Injury types in relation to position played There are few studies that actually compare the rates and types of injury with actual position played on the court. Given the fact that Kuala, (1) reports that 50% of injuries are sustained in training rather than on the court, this may prove to be rather academic. The study by Meeuwisse (2003) (2), was one of the few that looked at this issue and regarded it as purely peripheral to the main mechanism of injury. However , they summed up the findings of the study in the phrase â€Å"Centres had the highest rate of injury, followed by guards, and then forwards. The relative risk of re-injury was significantly increased by previous injuries to the elbow, shoulder, knee, hand, lower spine or pelvis, and by concussions.† As part of their conclusions the research team commented that the predictive risk factors for injury were, in order of importance: previous injury, number of games played, the number of player contacts during a game, player position, and court location (this is a reference to the proximity to a hospital). In real terms, the players position is of much less importance in predicting injury than many other factors Clinical considerations The clinical implications of basketball injury must be viewed in the context of the benefits derived from playing any competitive sport– or indeed pursuing any degree of fitness. Virtually any sporting endeavour has a downside and indeed risks associated with it, but equally there are very considerable benefits to be gained as well. By concentrating (by necessity) on the risks of injury in basketball in this article we do not wish to ignore the balancing perspective of the health gains to also be derived. Clearly, one of the major benefits to be gained is the concurrent increase in cardiovascular fitness (13) This is in addition to the less easily quantifiable benefits of general fitness, social interaction, increase in self-confidence and satisfaction in participation which are common to most sporting endeavours. The study by Kuala et al. (1993) (13) looked at the incidence of degenerative joint conditions in elite athletes. It found that participation in sports generally could lead to premature osteoarthritis. Specifically it found that, in the elite international athletes studied there was a greater than predicted admission rate to hospital for treatments for osteoarthritis of the hip, knee and ankle. Very significantly, in the context of this article on physiotherapy, it concluded that proper treatment of injuries to these joints could significantly reduce the incidence of premature osteoarthritis in this group. It should be noted that this was a large control moderated study of over 2000 international athletes so the findings are clearly significant Disability and basketball It is important not to ignore the fact that basketball is played, not only by able-bodied sportsmen but also by those who have a concurrent disability as well. This group also presents a professional problem for the physiotherapist as. Not only are there the â€Å"normal â€Å"considerations for the able-bodied player that we have discussed in this piece, but also there may well be disability-specific considerations in the disabled player which will tax the physiotherapist every bit as much as those in their able-bodied counterparts. In consideration of this we would commend the reader to an excellent article by Chula (1994) (26) which discusses inconsiderable depth, the whole issue of sports specific medical considerations for people with a disability. The use of sports for the disabled as a therapeutic measure was championed by Sir Ludwig Guttmann, who was a specialist in spinal injuries. He pointed out not only the obvious physical benefits to be gained in improving functions of the body which the paraplegic ortetraplegic had not fully exploited in their pre-injury state togetherwith the obvious cardiovascular benefits that could be obtained, but healso pointed to the psychological benefits to be gained by socialisingand competing against others. The Disabled Person’s Employment Act (1944) was the first majorlegislative landmark in the effective rehabilitation of the disabledperson back into society and other legislation relating todiscrimination generally has helped the disabled person to achievelevels of attainment in sport that would have been unthinkable half acentury ago. The comments that have been made in this piece in relation toable-bodied people obviously apply, in general terms, to the disabledperson as well. Clearly it depends on the nature of the disability asto what specific measures need to be employed specifically, but thebasic principles are the same. Muscle groups need to be developed inorder to protect the joints that they work over. This is particularlyrelevant to the knee. Appropriate proprioceptive skills need to beenhanced if the risk of injury is to be kept to an acceptable minimum.More specific considerations that may involve the occupationaltherapist as well as the physiotherapist may include the prevention ofpressure problems from a wheelchair or calliper or the use ofrestraints in a patient who has sudden muscular spasms, so that theyare not thrown out of the wheelchair. The experienced physiotherapist will be well aware of the benefitsof sport in the disabled in improving strength, co-ordination andendurance. Basketball, in particular, is commonly employed in thewheelchair-bound patient, who has to learn transferable skills in orderto propel the wheel chair accurately as well as catch, intercept andpass the ball. Prophylaxis and pre-injury actions Earlier in this piece we briefly discussed a paper by Sanchez (23).and commended it for its tackling of the problem of anticipating an injury. This involved a significant amount of pre-planning andorganisation on the court and field of play. Such issues are of vitalimportance to the athletes although they may not either realise orappreciate it at the time. This type of forward thinking can lead to dramatic reductions in morbidity (or even in mortality) and should be the concern of each and every healthcare professional who is working in the field of acute sports injury. Prophylaxis can be considered not only as actual pre-planning thecourse of action needed if an injury is sustained (viz. are theresplints, bandages, sterile water and gloves etc. available?) but equally it can be considered as the correct training and preparation ofboth the players and the game officials, so that the game itself can beplayed in conditions of optimum safety. Although the first of these two considerations is clearly important, in the context of this piece, weshall consider the second element in detail. Prophylaxis of injury is a major concern. We have discussed thepredictive value of a pre-existing injury. It follows that, if thatinjury can be prevented, then the subject is statistically less likelyto suffer a further injury. Common sense is behind the definitive recommendation in the paperby Kuala et al., (1) where he states that, in an attempt to reduce the incidence of injuries in basketball, specific preventative measuresshould be employed to reduce the number of violent contacts betweenplayers. He cites improving the drafting of game rules so that violentinfringements of the rules can be mo