text:
Historical Overview and Update on Subluxation Theories
SOURCE: Journal of Chiropractic Humanities 2010 (Dec); 17 (1): 22–32
By Howard Vernon, DC, PhD
Manual therapy has, arguably, best been described by a Polish medical manipulation practitioner, Arkuszewski, [1] as "a mechanical therapy with reflex effects." The phrase mechanical therapy can be further characterized by noting that it is performed in the musculoskeletal (MSK) system. The phrase reflex effects can be further qualified, at the very least, to indicate that these are "health-beneficial." Therefore, a revised version would read as follows:
"a manually-performed mechanical therapy to the MSK system with health-beneficial reflex effects."
This formulation also provides a basis for describing the primary disorder posited by chiropractic theory: subluxation. Recognizing that, for chiropractic, the subluxation has always been viewed as the "thing for which adjustment (manual therapy) is done," a first-pass definition of subluxation, a la Arkuszewski, would be:
"a mechanical problem in the musculoskeletal system with health-deleterious reflex effects."
Since the founding of chiropractic and the other manual therapy professions, 2 fundamental issues have vexed us:
- What kind and location of mechanical problem in the MSK system qualifies as a subluxation (or any of the other terms used as synonyms within and outside of chiropractic)?
- What kind of health-deleterious effects are specifically associated with subluxation?
The author recognizes that numerous others have attempted to review the subluxation concept, including recent excellent reviews by Gatterman, [2] Peters, [3] and Ebrall. [4] These previously published discussions are not reviewed here. What follows is a nonsystematic overview of selected developments in the profession that have addressed these 2 questions.
An easier version to read is in the LINKS Subluxation Section
The archetypical and founding event in the history of the chiropractic profession is Daniel David Palmer's first treatment of Harvey Lillard. From Palmer's original work, [5] he describes his thinking leading up to this event as:
"Displacement of any part of the skeletal frame may press against nerves, which are the channels of communication, intensifying or decreasing their carrying capacity, creating either too much or not enough functionating [sic], as aberration known as disease."
"Pressure on nerves causes irritation and tension with deranged functions as a result. Why not release the pressure? Why not a just cause instead of treating the effects? Why not?"
"I claimed to be the first person to adjust a vertebra by hand, using the spinous and transverse processes as levers. I developed the art known as adjusting.…"
"The basic principle, and the principles of chiropractic which have been developed from it, are not new. They are as old as the vertebrae.… I am not the first person to replace a subluxated vertebra, for this art has been practiced for thousands of years."
Palmer relates that he came upon this theory and applied it first to a man with deafness. Keating [6] records this version of events:
"Harvey Lillard gave him the cue which opened a new field for research. Mr. Lillard was restored to hearing by two adjustments, a dorsal vertebrae was replaced in its normal position."
Here is Harvey Lillard's rendition of these events according to Palmer's newsletter:
"I was deaf for 17 years and I expected to always remain so, for I had doctored a great deal without any benefit. I had long ago made up my mind to not take any more ear treatments, for it did me no good. Last January Dr. Palmer told me that my deafness came from an injury in my spine. This was new to me; but it is a fact that my back was injured at the time I went deaf. Dr. Palmer treated me on the spine; in two treatments I could hear quite well. That was 8 months ago. My hearing remains good." Harvey Lillard, 320 W Eleventh St, Davenport, Iowa. [6]
Although Palmer articulated several versions of his theory, the archetypal elements of Palmer's theory follow a logical pattern, as follows:
- Subluxation, which is a misalignment of one of the vertebrae, causes
- pressure on nerves exiting around the vertebrae, causing
- disease.
- Removal of subluxation (by manually adjusting it to its correct position) causes
- release of nerve pressure, causing
- the restoration of health.
Figure 1 is a schematic depiction presenting this foundational chiropractic model. It also depicts the author's view of the evolution of this model through the 20th century. An important early advancement was the transformation of the understanding of the activity of the nervous system from a vitalistic interpretation, as the "flow of Innate Intelligence," to a mechanistic or physiologically-based understanding of function in the nervous system.
It appears that this understanding was not fully mature, as it focused only on the efferent neural activity that could be compromised by nerve compression, that is, neural conduction and efferent innervation of end organs. This produced a formulation whereby nerve compression was understood to result in an interference or derangement of nerve function, as understood in purely physiologic terms, which then resulted in end-organ dysfunction or disease.
One manifestation of this approach was the development of the Meric system by BJ Palmer and James C Wishart [7] that organized this "physiologic view" of neural regulation according to the spinal segmental level of the peripheral nerves and their end-organ territories of innervation. This development allowed many chiropractors to leave their vitalistic heritage behind to its rightful place in the history of ideas and move into a solidly, if not fully, mature physiologic/pathophysiologic model (Figure 1).
Fig 1. Historical evolution of the "subluxation model."
Another important advancement came with a change in the conception of the type of mechanical derangement that could constitute a subluxation. As noted above, for Palmer and the early chiropractors, this was 'misalignment' of the vertebra. By the 1920s, several chiropractic thinkers [8–11] had begun to shift their focus from static misalignment to some kind of "disturbance of function."
However, this required a fundamental change in thinking from a primary and very limited focus on "bone" (vertebra) to a more expanded focus on "joint" (spinal motion segment). This shift was critical in the evolution of a scientific model for chiropractors. It changed our practice, by emphasizing different technical procedures for the assessment of joint function, well beyond the limits of determining static misalignment of a bone.
As well, it prepared the way for the other major changes described below by grounding the theory of subluxation at the level of the joint, not the level of a single bone, and the pressure it could exert on nerves.
This led the way to the next important shifts that characterize the major theoretical advancement of the late 1940s to the 1960s: maturation of the understanding of effects on and contribution of the nervous system (ie, "reflexes") related to the subluxation. This work is associated with Dr Irwin Korr et al [12–19] and was echoed in chiropractic by many, including, but not limited to, Dr AE Homewood [20] in the late 1950s as well as his students, Drs R Gitelman [21, 22] and A Grice [23] from the Canadian Memorial Chiropractic College and Dr S Haldeman [24] from the Palmer College of Chiropractic.
This next step in the evolution of chiropractic thinking involved a shift from a focus solely on nerve compression to include the emerging understanding of the neural or reflex mechanisms that result directly from injury to the deep tissues of the vertebral motion segment. This shift incorporated the understanding of the effects of pain and inflammation from, for example, the facet joints of the spinal segments, on spinal cord mechanisms of sensory-motor integration and autonomic outflow.
For Korr, this was termed the facilitated segment and led to his theory of "central excitatory state (CES)". [14–20] The notion of "spinal irritability" had been developed as early as 100 years prior and had been part of the work of Head [25] and others in the early 20th century. [26–29] The work of Korr, Denslow, Wright, [12–19] and others revived this idea; and it was then applied in osteopathic and chiropractic thinking. Since that time, this model has come to be known as central sensitization (see below); and it has received enormous attention from pain researchers around the world.
A corollary to this development was the shift from a focus, especially in early chiropractic, which was solely on "efferent" or "downstream" neural mechanisms (those affected by compression), to a more comprehensive understanding of sensory-motor interactions within the central nervous system. In early chiropractic thinking, the "Big Idea" was to consider the action of "Innate Intelligence," as it flowed through the nervous system, as working from "above-down, inside-out."
In this theory, blockage of a nerve by a misaligned vertebra resulted only in a blockage of the outward flow of health-giving "innate." Once the shift of thinking beyond static misalignment of a vertebra to dynamic behavior of a spinal motion segment (joint) occurred, chiropractors could begin thinking about the sensory implications of their "lesion." Along with the shift away from spinal nerve compression mentioned above, this shift laid the groundwork for a much more sophisticated, fully scientifically grounded neural theory of "subluxation."
Korr summarized these developments in his famous categorization of "impulse-" and "non–impulse-based" mechanisms of the spinal lesion. It is actually better to consider these as "nerve compression–based" and "non–nerve compression–based" mechanisms. It will be instructive to fill in some of the voluminous work that has ensued on these themes since that time. This follows immediately after the next section. Fig 2 summarizes some of the notable historical developments in the neurosciences of manipulation.
Fig 2. Historical review of developments to subluxation theory
Contemporaneous with this work on the "neural side" of the subluxation story was the work on the mechanical side undertaken by such notables as Drs Fred Illi, [30] Joe Janse, [31] Henri Gillet and his colleague Liekens, [ 32, 33] as well as their North American students, Drs L John Faye, [34] Ron Gitelman, [22] and Adrian Grice. [23] Notable developments in these mechanical approaches to the "subluxation" were:
- the development of motion palpation (although there is a history of interest in this going back to the 1930s with the work of Grecco and others).
- the development of concepts such as "joint play," "end-feel," etc (the work of Mennel [35] is also important in this regard).
- the elucidation of complex segmental motions by end-motion radiographs leading to an understanding of reference ranges of segmental motion, "coupled motion," and axes of motion.
- the use of spinal-pelvic cineradiography.
- the use of weight scales and posturometers to assess full body posture.
- interest in gait mechanisms.
- an expanded biomechanical model that grounded single spinal subluxations within the larger context of the vertebral column and the locomotor system and considered the assessment and treatment of 'patterns of findings' (vs single separate findings) in these larger contexts. I call this model structural wholism.
Aside from this work representing a shift toward the dynamic, functional aspects of the spine, it also represented a shift away from single vertebral analysis (subluxation listings etc) to a more sophisticated analysis of, and interest in, the entire locomotor system. In fact, the definition of chiropractic developed at the Canadian Memorial Chiropractic College in the late 1960s was:
"A discipline of the scientific healing arts concerned with the pathogenesis, diagnostics, therapeutics, pain syndromes and neurological effects related to the statics and dynamics of the locomotor system, especially of the spine and pelvis." [36]
The emphasis on the phrase locomotor system is mine, showing how that term predominated in the thinking of that time. Notice that no mention of "subluxation" is found.
In a countermovement to this development, a new model called the vertebral subluxation complex was promulgated by Faye and Lantz. [34, 37] It is the author's opinion that this model may have created unwanted and unnecessary complexity in the numerous categories and aspects of tissue and physiologic functioning applied to the concept of subluxation, such as histopathology, myopathology, neuropathology, etc. All tissue sites or structures in the body—somatic, neural, and visceral—have these many dimensions or aspects (ie, all of these "ologies"). In the author's opinion, this model did not contribute to the scientific advancement, especially the scientific elucidation, of the subluxation concept.
In the author's opinion, another similar unfortunate development was the American Chiropractic Association paradigm statement on subluxation in 1996:
"Chiropractic … focuses particular attention on the subluxation. A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health." (from Gatterman [38])
This "definition" is too ambiguous and tentative, with its many "and/ors" and conditional assertions; and it has yet to be shown how this definition has contributed to the scientific development of the "subluxation concept."
In more recent times, a consensus appears to have been reached in the manual therapy academic literature around the nature of the mechanical problem in the spine amenable to manual therapy, namely, hypomobility associated with a disturbance of joint function, hence, the terms joint dysfunction or, for the spine, spinal or segmental dysfunction. The International Association for the Study of Pain Classification of Chronic Pain includes a definition of segmental dysfunction (in each of the spinal regions), as follows:
"(spinal) pain, ostensibly due to excessive strains sustained by the restraining elements of a single spinal motion segment.
… features (spinal) pain, with or without referred pain, that can be aggravated by selectively stressing the particular spinal segment.
Diagnostic criteria (all of the following should be satisfied):
- The affected segment must be specified.
- The patient's pain is aggravated by clinical tests that selectively stress the affected segment.
- Stressing adjacent segments does not reproduce the patient's pain.
Pathology: Unknown. Presumably involves excessive strain incurred during activities of daily living by structures such as the ligaments, joints or intervertebral disc of the affected segment." [39, p.111]
Recent and current concepts
The following recounts the development of ideas on the neurologic and mechanical issues relevant to subluxation from the 1960s onward and includes a short list of recent developments that are important to the development of the modern "subluxation model."
A. Neurologic mechanisms
A.i Nerve compression–based mechanisms
1. Chiropractors received considerable and protracted scorn for the idea of a "pinched nerve." Crelin's [40] effort to debunk chiropractic focused directly on this phenomenon by putatively showing that there was ample room in the intervertebral foramen (IVF) for the nerve to never undergo such compression. The phenomenon of nerve compression became very strongly associated with disk herniation after Mixter and Barr's 1934 article. The role of minor intervertebral joint derangement in compression on nerves and in referred back pain became greatly diminished in the "medical model."
2. However, the link between herniated disks and nerve compression did eventually loosen so that, by the 1970s, the phenomenon of lateral entrapment of the spinal nerve root had become well accepted. The work of Sharpless, [41] Sutherland, [42, 43] and Luttges and Gerren [44] on nerve root compression susceptibility and the work of Rydevik et al [45–53] "rehabilitated" the concept of the compressed nerve in spinal diagnosis.
Several chiropractic researchers investigated the effects of nerve root compression in the IVF by using animal models (see reviews by Vernon [54] and Henderson [55]). Disturbances of nerve conduction velocity and neural axoplasmic flow were demonstrated. However, these studies only provided an animal model of what might occur if "the subluxation really did result in compressed nerves." Actual compression of nerves by something that most would agree was a subluxation was not studied. The mechanical derangement of the subluxation is not easy to create in an animal model.
Most importantly, for our purposes of discussion in modern pain research circles, this type of research goes under the name of neuropathic pain. It is clear that compression/irritation of the peripheral nerves, either as nerve roots or as nerve trunks, results in profound changes in sensorimotor processing throughout the central nervous system, but especially in the spinal cord. This means that, all along, compression of nerves was not just an "inside-out" matter. There is a whole dimension of "outside-in" (centripetal) processes that involve highly complex and clinically important changes in central sensorimotor processing that then results in profound changes in sensory, motor, and autonomic functions.
In other words, we now know that nerve compression/neuropathic pain is a much more complex matter than was originally conceived by the early chiropractors; and if, as part of the modernization of our thinking on subluxation, we believe that a role for nerve compression should be preserved, we should do so only with great respect and full regard for the body of data now available on the matter.
3. Recent work has shown that facet inflammation can induce compressive radiculopathy by spread of inflammatory exudate anteriorly into the IVF. [56] Therefore, spinal joint dysfunction/inflammation can lead to direct nerve compression (ie, neuropathic pain) and not just "reflex" effects from pain (see below). Ironically, this work convincingly refutes Crelin's infamous report and finally provides confirmation of the oldest chiropractic theory: that relatively minor problems in the small joints of the spine can actually deleteriously compress or irritate the adjoining nerve!
A.ii Non–nerve compression–based mechanisms
4. Since the 1970s, a great deal has been learned about deep somatic pain mechanisms, that is, pain from deep somatic—muscle, joint, ligament—sources. This is an advance on the situation whereby the great preponderance of knowledge of pain mechanisms before that time came from studies of cutaneous sources only.
Deep pain mechanisms have been strongly associated with the development of central sensitization in the central pain transmission system: dorsal root ganglion cells, spinal cord dorsal horn, projection tracts to the brain, wide-ranging brain-based mechanisms in the medulla, midbrain, thalamus, and sensory cortex. As well, deep pain mechanisms are now known to evoke antinociceptive mechanisms local to the spinal cord as well as descending to the cord from midbrain nuclei.
5. Central sensitization involves such changes in dorsal horn neurons as lowered thresholds of excitation, prolonged after-discharges, spread of reactivity of dorsal horn neurons, increases in the peripheral receptive fields, and a host of molecular and cellular/synaptic changes that underlie these functional changes. All of these changes are thought to be responsible for the clinical phenomena of spread of pain from an initial source, referral of pain from the original source, the development of allodynia and other hypersensitivity states, the development of chronicity of pain by virtue of the persistence of these changes (long-term potentiation), and the development of recurrence by virtue of the creation of persisting neural engrams or "pain memories."
These changes are also now regarded as the mechanisms responsible for the efferent manifestations of the subluxation, as they were conceived in the theory of the "central excitatory state": reflex muscular hypertonicity, reflex autonomic changes (somatovisceral mechanisms), and the functional changes that result from these manifestations, such as reduced mobility of the joints, contractures of muscles, altered patterns of joint use and function, altered tissue health, etc.
The fact that so much more is now known about the mechanisms of central sensitization and the particular mechanisms of deep somatic pain is owed to the advancement of animal models of joint and muscular pain. [57, 58] However, the vast majority of these studies, and therefore the vast majority of the data about these phenomena, comes from studies of the hind limbs of small animal models. Subcutaneous pain mechanisms typically involve the tissues of the hind paw; muscular mechanisms have involved mainly the gastrocnemius and soleus muscles; joint mechanisms have mainly involved either polyarthritic models of all the tissues of the hind quarters or, in monoarthritic models, the knee and ankle joints. This led one of the leaders in the field of muscle pain mechanisms, Siegfied Mense, to title an article in 2003 as "What's different about muscle pain?" [59]
6. There has been a conspicuous absence of work on deep pain mechanisms from spinal (paraspinal) tissues. This leaves us with a critical question. Is what is now known about deep pain mechanism from the MSK tissues of the peripheral limbs automatically to be applied to deep pain arising from spinal tissues? Are there no important differences? If not, there is no compelling reason to hold on to theories that make the spine distinctive in any way; and there is no reason to develop animal models of spinal deep pain. So I now ask the question, "What's (or: Is there anything…) different about spinal muscular (and ligamentous) pain?"
Thankfully, there is a small but growing body of work on mechanisms of deep pain from paraspinal sources that is beginning to address this need. Chiropractic research in this area has been reviewed by Vernon54 and Henderson.55 A full list of chiropractic neurophysiological research is available from the Colloquium planners and is appended to this article. In addition, the works of Solomonow et al, [60–62] Indahl et al, [63] Tachihara et al, [56] and Taguchi et al [64, 65] must be recognized. All of these studies are elucidating the mechanisms of deep somatic pain of axial (spinal) tissues and helping to address the question of whether there are any unique features of such pain, especially those that might underlie the distinctive clinical phenomenology of spinal pain. The early results provide encouragement for the notion that there may be distinctive features of spinal pain mechanisms and that these might explain the distinctive features of spinal pain complaints in our patients.
B. Mechanical mechanisms
With respect to subluxation models, the recent work on spinal loading and spinal motor control patterns deserves mention. Notable models include the following:
- spinal buckling [66, 67]
- neutral zone [68–71]
- ligamentomuscular reflexes [60–62, 72–75]
- multisegmental motor control patterns
With respect to integrating the concept of "subluxation" with more sophisticated motor control theories, an adage adapted from Korr (personal communication) is instructive:
Under normal, healthy conditions, spinal segments function in a multi-segmental pattern; no segment acts alone. Under conditions of pain and injury, segments can "act alone." Therefore, we cannot expect to restore function by having injured segments move; they must be moved to accomplish this.
The notion of segments "acting alone" means that focal pain initiates
1. ligamentomuscular reflexes altering local segmental motor control, as well as
2. somatosympathetic reflexes altering local vaso- and sudomotor control (as well as distant end-organ function?).
Fig 3 depicts a comprehensive model of spinal dysfunction. Note that this is not a clinical model in the style of the vertebral subluxation complex; rather, it is a predictive model that, although based upon current knowledge, identifies areas of important future laboratory and clinical work.
Fig 3. Comprehensive model of spinal dysfunction
C. Current challenges to subluxation
In this final section, some of the very current challenges to the subluxation model are reviewed.
For almost all of its history, chiropractic has posited that neurologic or reflex effects do result from subluxation and that it is these effects that underscore the importance of subluxation in the health of the patient. It is this proposal—or this side of the "Arkuszewski-like" formulation with which we began this article—that received the greatest amount of criticism from opponents of the profession. Throughout this time, the mechanical side of our original formula was not overly criticized, although the concept of "misalignment" has lost most of its favor.
Recent developments in manipulative sciences have created a unique challenge to the very concept of a "specific mechanical problem" toward which manipulation is directed.
1. Studies on the reliability of palpation of segmental motion have reported mixed results. [76] This has led some to discard this procedure in their analysis of spinal pain. This has led others to go further and become skeptical that a "segmental mechanical problem with a disturbance of motion" actually exists.
2. A small number of studies on the validity of palpation for segmental motion or for segmental findings have reported questionable results. These studies have taken the form of randomized clinical trials of a single session of manual therapy—manipulation, [77] mobilization, [78] and manual traction [79]—in which one group receives a single palpation-specific procedure and the other group receives the same procedure at sites distant from the target segment. The immediate clinical outcomes of these studies show no significant difference between groups, calling into question the need to identify a specific segment at all. The combination of 1 and 2 led some to suggest that the whole idea of a mechanical lesion is invalid and should be discarded.
3. Recently, classification-based approaches to treatment of spinal disorders based on apparently validated prediction rules (predicting positive outcome of treatment from symptom profiles) have been developed. [80–82] Some of these either exclude or downplay the results of palpatory examination for spinal hypomobility. [80–82] On the other hand, some of them do the opposite and strongly emphasize the findings of "motion palpation" for "spinal fixation." [83] Clinicians are now able to choose among these predictive models, with one option being to discard, or at least greatly downplay, the role of a mechanical lesion.
4. A few recent studies on healthy subjects appear to indicate that cavitations occurring during spinal manipulations are not localized to the segment putatively identified as the "lesion" and as the "target" of the maneuver. [84] This has been interpreted by some to mean that, even if a "specific mechanical lesion" does exist and even if it can be reliably identified in clinical assessment, such an exercise may be fruitless if the treatment cannot match this level of specificity.
The older challenge faced by the chiropractic profession was largely to the second half of our initial formulation of subluxation: "the health-deleterious effects." Our critics have persistently questioned the premise that chiropractic subluxations caused anything more important than local, benign pain. The entire historical chiropractic project of attaching health-significant effects to subluxation (such as the Association of Chiropractic College's statement including the phrase that compromise neural integrity and may influence organ system function and general health) was challenged by these critics.
The newer challenge is now to the first part of our statement: "A subluxation is a mechanical problem in the musculoskeletal system.…" Recent research appears to challenge this premise as well; and some, within and outside of the profession, have adopted a completely skeptical view of the entire "subluxation project." "If it doesn't exist in the first place," they say, "how can it have any effects? If we can't find it, why look for it and why include it in our clinical decision-making? If we can't localize our treatment to one segment, why be concerned to do so?"
These challenges to the "subluxation concept" are in their early days and, in many instances, are based on only one or a few studies. In several instances, these studies have involved healthy subjects or those with relatively mild symptom severity. In several studies, the manual therapy intervention might be regarded as nonspecific and, therefore, would not qualify as an "adjustment." On the other hand, critiques could be made of the quality of many of the studies that formed the basis for what might be called the "standard model" in chiropractic and the other manual therapy professions, including those which extend back several decades. Indeed, some of the modern challenges, especially in the area of manual diagnostic procedures, appear to derive precisely from the poorer quality of prior studies. The only way forward is to strengthen our efforts to investigate the "subluxation concept" with high-quality scientific studies including animal models and human clinical studies.
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The great archangel Michael is probably the most well known of all the angels, as he appears in numerous scripture within Christianity, Judaism, and Islam. It is said that he commands the armies of God, and is responsible for vanquishing foes both in heaven and on earth. Michael is referred to directly by name first in the Book of Daniel, where it is said that he is a great prince among angels, a title that he shares only with his angelic brother Lucifer. In this scripture he comes to the archangel Gabriel's aid as he's confronted by Dobiel the angel of Persia. Throughout this same scripture, Michael is also declared as a fierce protectorate of Israel, and that he serves Daniel's people. Outside of the Book of Daniel, Michael is also directly referenced by name in the Book of Jude, as well as in the Book of Revelation. In the later book, it is foretold that Michael will battle the Antichrist, an indirect reference to his coming final battle with Lucifer or Satan.
According to Judeo Christian teachings, the great archangel Michael is thought to have been referenced indirectly as far back as the book of Genesis. It it taught that it was Michael who stood guard at the gate of Eden, making sure that the tree of life was kept safe. It is also taught that Michael was the angel who facilitated the publishing of the Decalogue for the Jewish people, who blocked the way forward for Balaam, and who vanquished the army of Sennacherib. Christian scripture also refers to Michael directly by name, such as in the Book of Jude, it states that Michael has a confrontation with Satan over the body of Moses. Michael is also mentioned in the Book of Revelation, where it states that there was a great war in heaven, and that the archangel Michael with a legion of his followers fought the great dragon. This is a reference to Michael defeating his brother Lucifer, and then casting him and his followers out of heaven for all of time.
As stated repeatedly within Jewish rabbinic teachings, the archangel Michael has served and continues to serve as the protectorate and guardian of the promised land of Israel. On numerous occasions within Old Testament scripture, Michael had to battle with the angelic princes of other nations, such as his conflict with the angel Samael, an evil accuser of Israel. It is also taught that Michael was the angel that saved Abraham from the burning furnace that he was thrown into by Nimrod. In a likely more well known story, Michael was credited as the angel that stopped Isaac's father from sacrificing him. There are numerous other Old Testament scripture that include Michael interacting directly with both Jacob and Moses. In more contemporary Jewish teaching such as Kabbalistic traditions, the archangel Michael is regarded as the protector of not just the state of Israel, but of all the Jewish people, regardless of where they reside.
The Islamic faith recognizes four separate archangels, Michael, Gabriel, Azrael, and Isfrafel. Within Islamic traditions and literature, the archangel Michael is referred to by name as Mikha'il or Mikal. Islamic teachings state that Michael dwells within the seventh heaven, and has wings of beautiful emerald green. He is mentioned just one time in the holy Qur'an in Sura Chapter 2 verse 98. In this scripture Michael is described as an angel of good, who brings peace and prosperity to all of mankind. In this same set of scripture, it is also reaffirmed that it was Michael and two other archangels who visited Abraham, the same teachings held by Christians and Orthodox Jews. Within Islam Michael is closely linked with the great archangel Gabriel, with both appearing together while carrying out numerous duties for God himself, such as comforting Adam and Eve after they are both banished from the Garden of Eden for all of time.
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hilarious! best Regular Show reference I've seen.
Ahahah this is soooo cool :) love this interpretation !
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Images: Crew chiefs provide breathing room [Image 6 of 7]
Photo by Senior Airman Kayla Newman
U.S. Air Force Senior Airman Matthew Martin, 455th Expeditionary Aircraft Maintenance Squadron C-130J Super Hercules crew chief, services a C-130J with liquid oxygen at Bagram Air Field, Afghanistan, Feb. 21, 2014. LOX is oxygen in the form of liquid until it is converted into gas, which allows pilots, aircrew members and everyone on board the aircraft the ability to breathe while in the air. (U.S. Air Force photo by Senior Airman Kayla Newman/Released)
This work, Crew chiefs provide breathing room [Image 1 of 7], by SrA Kayla Newman, identified by DVIDS, is free of known copyright restrictions under U.S. copyright law.
Date Taken:02.21.2014
Date Posted:02.24.2014 07:13
Photo ID:1172851
Size:4.48 MB
Location:BAGRAM AIR FIELD, AF
Gallery Images
Associated News
Crew chiefs provide breathing room


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VANCOUVER — Diana Lee remembers back to 2011 and the FIBA World Under-19 women's basketball championships, where she and her former high school teammate Kris Young, had been re-united as members of the Canadian national team. "We went to Chile … Continue reading
scott Palmer RSS
Difference Makers 2013: Handsworth Royals girls basketball
HANDSWORTH ROYALS NORTH VANCOUVER — The words of Handsworth Royals' senior girls coach Scott Palmer seemed to indicate that the North Vancouver school won a pretty big basketball game last week. "Tonight, I was a very proud coach," Palmer said. … Continue reading
Ramblers, Pipers quite a pair: Orum, Elliott lead their girls teams to marquee AAA banners
Interesting night in senior girls Triple A basketball, where the whispers always seem to suggest that not enough new happens. Well, how about a new Fraser Valley champion, and a new Lower Mainland champion? And how about a Richmond school … Continue reading
Four weeks of play reinforce the fact that a parity party taking place in B.C. girls 3A basketball
PORT COQUITLAM — The first four weeks of the B.C. senior girls Triple A basketball season has done nothing but point out the fact that it's a wide-open race to the 2013 title this March at the Langley Events Centre.… Continue reading
Dixon treys, Homer's drives enough to carry Handsworth past Argyle in all-North Van clash for Telus title
VANCOUVER — It was yet another opportunity for the North Shore neighbourhood battle to continue. In the end, it was the three-point shooting of point guard Abby Dixon that made the difference, Dixon draining back-to-back triples over the late stages … Continue reading
TELUS CLASSIC FINAL 4: All-North Van girls final, WRCA vs. No. 1 Kits in boys battle royale
The finals have been set for the 13th annual Telus Basketball Classic tonight at UBC's War Memorial Gymnasium. On the boys side, the No. 1 Kitsilano Blue Demons will clash with the No. 3 White Rock Christian Academy Warriors, while … Continue reading
For Dixon and Homer, it's a case of opposites connecting in Handsworth Royals' back court
VANCOUVER — Fire and ice. If you ask Handsworth Royals senior girls basketball coach Scott Palmer to talk about the chemical elements that makes up his starting back court, he can't think of a better way to describe the contrasting … Continue reading
Her grit now second nature, Handsworth's Patterson soldiers on to B.C.'s then SFU
NORTH VANCOUVER — When Handsworth Royals senior girls basketball coach Scott Palmer finally decided to leave the gym following a 90-minute team practice on Tuesday evening, he did so with the understanding that the one player still left would take … Continue reading


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Dave MorganNew Member
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Deep Loud Noise Recently Appeared On My Focus - Help!!
Dave Morgan posted a topic in Ford Focus ClubNEW TO FORUM - PLEASE HELP ME OUT!! I have a slight car problem. Since Friday I have experienced a really loud intermittent noise on dual carriageway/motorway when I reach about 50mph. Lasts for about a mile or so then just goes. I have tried staying at the same speed to eliminate anything speed oriented and noise just disappears down the road?!?! Slight drop in acceleration while noise apparent otherwise driving fine. Still drives ok elsewhere, anyone any ideas??? If something easy to fix I'll do it if not garage time!! need to book for MOT those week anyway!
Dave Morgan started following Deep Loud Noise Recently Appeared On My Focus - Help!!
Welcome to the Ford forums Dave Morgan :)


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More New and Used
from Private Sellers
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How to Differentiate Instruction in Mixed Ability Classrooms
ISBN13:by Tomlinson, Carol Ann
Questions About This Book?
Why should I rent this book?
Renting is easy, fast, and cheap! Renting from eCampus.com can save you hundreds of dollars compared to the cost of new or used books each semester. At the end of the semester, simply ship the book back to us with a free UPS shipping label! No need to worry about selling it back.
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Returning books is as easy as possible. As your rental due date approaches, we will email you several courtesy reminders. When you are ready to return, you can print a free UPS shipping label from our website at any time. Then, just return the book to your UPS driver or any staffed UPS location. You can even use the same box we shipped it in!
What version or edition is this?
This is the 2nd edition with a publication date of 4/27/2004.
What is included with this book?
- The New copy of this book will include any supplemental materials advertised. Please check the title of the book to determine if it should include any CDs, lab manuals, study guides, etc.
- The Used copy of this book is not guaranteed to include any supplemental materials. Typically, only the book itself is included.
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For education courses in Educational Psychology, Advanced Educational Psychology,Differentiated Instruction, Inclusion/Mainstreaming, Mild/Moderate Disabilities Methods, or General Methods (K-12).This brief Merrill/ASCD text provides guidance, principles, and strategiesfor teachers who are interested in creating learning environments that address the diversity typical of mixed-ability classrooms. The text will help educators understand what differentiated instruction is, why it is appropriate for all learners, how to begin to plan for it, and how to become comfortable enough with student differences to make school comfortable for each learner in the classroom.
Author Biography
Carol Ann Tomlinson is Associate Professor of Educational Leadership, Foundations and Policy at Curry School of Education, University of Virginia.
Table of Contents
|What Differentiated Instruction Is--And Isn't
|The Rationale for Differentiated Instruction in Mixed-Ability Classrooms
|The Role of the Teacher in a Differentiated Classroom
|The Learning Environment in a Differentiated Classroom
|A Look Inside Some Differentiated Classrooms
|Strategies for Managing a Differentiated Classroom
|Preparing Students and Parents for a Differentiated Classroom
|The How To's of Planning Lessons Differentiated by Readiness
|The How To's of Planning Lessons Differentiated by Interest
|The How To's of Planning Lessons Differentiated by Learning Profile
|Differentiating Content
|Differentiating Process
|Differentiating Products
|Grading ina Differentiated Classroom A Final Thought
|A Few Instructional and Management Strategies for Differentiated, Mixed-Ability Classrooms
|Further Reading
|About the Author
|Table of Contents provided by Publisher. All Rights Reserved.


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Milton man dies in single vehicle crash on Cedar Creek Road
A Milton man was killed in an early morning crash on Cedar Creek Road today.
A preliminary investigation indicates that Andrew Rottmann, 28, was traveling south at a high rate of speed on Cedar Creek Road at 2:25 a.m. Sunday, April 27, in a 1999 Volkswagen Jetta.
In the area of Isaacs Road, the vehicle exited the western edge of the road as Rottmann attempted to negotiate a slight left curve. The vehicle reentered the roadway and crossed into the northbound lanes. Rottmann, attempting to regain control, overcorrected, and the vehicle began to rotate clockwise while leaving the right side of the roadway.
The passenger side of the vehicle struck a utility pole, causing the vehicle to abruptly change direction and rotate counterclockwise. It came to rest on the shoulder of the southbound lane.
Rottmann was pronounced dead at the scene. He was properly restrained at the time of the crash. Cedar Creek Road was closed for approximately three hours as Troopers investigated and cleared the crash.


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Meditation on Morality
Do we understand what morality encompasses? Do we say one thing, but act the opposite way?
Morality, to me, means living a life that causes no one harm.
Morality is keeping personal commitments when faced with challenges, or when it would be easy to cheat, because no one would find out.
The problem with cheating on morality is that our actions form our personality. When we live good and moral lives, we are building a personality and way of thinking that will spontaneously choose for the highest good.
When we live without morals we can't expect to enjoy harmony or peace in our lives, and by our actions we may drag others down by exposure to our negative way of living.
Here is a meditation to help fortify our will to choose to live a moral life.
Sit in a quiet spot or in your meditation space. Keep your meditation journal and pen at your side. Begin even and regular breathing such as 2 counts to breathe in, and 2 counts to breathe out. Keep up this rhythmic pattern during your meditation without actually saying the counts. Breath is the tie between the body and mind. When we are stressed, even breathing is calming.
Take a few moments to think lovingly about someone or a pet dear to you; this brings up a positive frame of mind.
Reflect on this affirmation: I choose to live a moral life because it gives me peace of mind and a happy, harmonious life.
Repeat this affirmation at least 5 times. Sit quietly for a few minutes thinking about what you need to do to live a moral life. Write your plans in your journal.
To finish your meditation, breathe in deeply and slowly release the breath. Now stretch out and continue with your day, in a moral way.
I invite you to join me in a daily group cyber meditation for personal and planetary peace. Click the article here to read about it.
Meditation Lessons for Teens and Adults
More than 70 offerings, from guided meditation techniques to on-the-go stress relief and relationship meditations interspersed with verse, and a section of special occasion prayers. 114 pages. PDF Ebook | EPUB | Paperback | Mac Users | B&N NOOK eBook
Meditation for All Kids
Sitting, walking, dance and group circle meditations, along with positive affirmations, verses and benefits of meditation for kids of all ages and abilities in a 100 page book with illustrations. PDF Ebook | EPUB | Paperback | Mac Users | B&N NOOK eBook
Sign up below or in the right-hand column for our meditation site newsletter. It only requires your email address and is never given out or sold to anyone. If at any time you wish to stop receiving it, each newsletter contains a link to unsubscribe. Each person must sign up themselves. We can't sign up for you. It is an easy way to keep abreast of new articles on the meditation site. Make meditation part of your daily routine and let the Bellaonline meditation articles help you select just what kind of meditation is right for you, whether you are a child, teen, or adult, a beginner, or advanced practitioner.
Article by Susan Helene Kramer
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Have Legal Questions? Ask a Lawyer Now.
"You can exclude up to $250,000 of the gain on the sale of your main home if all of the following are true.
To claim the exclusion, you must meet the ownership and use tests. This means that during the 5-year period ending on the date of the sale, you must have:
You meet the ownership test. = Owned the home for at least 2 years.
You meet the use test. = Lived in the home as your main home for at least 2 years
During the 2-year period ending on the date of the sale, you did not exclude gain from the sale of another home.
If you and another person owned the home jointly but file separate returns, each of you can exclude up to $250,000 of gain from the sale of your interest in the home if each of you meets the three conditions just listed.
You may be able to exclude up to $500,000 of the gain on the sale of your main home if you are married and file a joint return and meet the requirements listed in the discussion of the special rules for joint returns, later, under Married Persons. "
cited from the IRS.
Dr. Pfeiffer
DISCLAIMER: Answers from Experts on JustAnswer are not substitutes for the advice of an attorney. JustAnswer is a public forum and questions and responses are not private or confidential or protected by the attorney-client privilege. The Expert above is not your attorney, and the response above is not legal advice. You should not read this response to propose specific action or address specific circumstances, but only to give you a sense of general principles of law that might affect the situation you describe. Application of these general principles to particular circumstances must be done by a lawyer who has spoken with you in confidence, learned all relevant information, and explored various options. Before acting on these general principles, you should hire a lawyer licensed to practice law in the jurisdiction to which your question pertains.
The responses above are from individual Experts, not JustAnswer. The site and services are provided "as is". To view the verified credential of an Expert, click on the "Verified" symbol in the Expert's profile. This site is not for emergency questions which should be directed immediately by telephone or in-person to qualified professionals. Please carefully read the Terms of Service (last updated February 8, 2012).


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Multi-tasking is not everyone's forte. Yet at workplaces we are left with no other choice but to juggle between multiple activities. Experts say it is important to set realistic goals to multitask. ET talks to experts for a few tips:
Be efficient in juggling
SMART (Specific, Measurable, Attainable, Relevant and Timebound) goals can help in multi-tasking. "A SMART plan helps you to remain focused and to be efficient in juggling. It allows you to evaluate when and how much attention is needed to complete a task and whether two tasks are compatible," says Ruchi Sinha, assistant professor of business, organisational behavior at ISB.


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Bugs, bones weekend set for Ponca State Park
PONCA, Neb. (AP) - Ponca State Park officials will guide the public on insects and fossils. The park's annual Bugs and Bones Weekend will be held June 15-16. The event will include fossil digs, educational hikes, crafts and hayrack rides. On June 15, an archery shoot for those 8 and older will be held. The cost is $1 for six arrows. Participants may also observe a retired paleontologist chip away at a Gillicus fossil throughout the weekend. The ancient fish fossil was discovered within the park by a child during a guided fossil dig. On June 16, a Father's Day Fish Fry will be held. The cost is $10 for adults and $5 for ages 12 and under. Reservations are requested and can be made by contacting the park office at 402-755-2284.
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Wisconsin Act 207 Eases Farm-Raised Fish Import Requirement! Changes already in effect for fish farms across Wisconsin. Click here for more information.
From getting started as a fish farmer to bringing your finished product to market, the Department of Agriculture, Trade and Consumer Protection has resources to assist the Wisconsin's aquaculturists with each step of the process.
Fish farms in Wisconsin need to be registered with the Department of Agriculture, Trade and Consumer Protection, and registration must be renewed annually. If you have a private fishing pond on your property, you must register it as a fish farm with the Wisconsin Department of Agriculture, Trade and Consumer Protection. If you plan to fish from your pond, a benefit of registering your pond is that you can stock your pond with fish whenever you want, without a stocking permit from the Department of Natural Resources.
Processing Fish for Food
If you process fish or seafood as human food, your processing facility must be licensed as well as comply with minimum construction and sanitary standards.
Importing Fish
Importing fish or fish eggs into Wisconsin may require proof of health and other documentation.
Using Pesticides
Rotenone is a common ingredient in aquatic-use pesticides. Find out how to be trained and certified to use it and other aquatic-use pesticides.


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Ford Owners Club - Ford Forums Messages
Club Announcements
Ford Fair 2016: Tickets and stand passes are now available to purchase. More info here.
Review your Ford: Help others when it comes to buying a car like yours and review your Ford now
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Marc Finney liked a post in a topic: Pattern On Sony Stereo
Marc Finney started following Pattern On Sony Stereo
Pattern On Sony Stereo
Marc Finney posted a topic in General Ford Related DiscussionsI purchased a Sony Stereo for my 2006 Focus to replace the standard ford unit. When it arrived I noticed it had a sort of water droplet effect on all the buttons. I was told it was from a 2007 Focus ST and I am wondering if anyone else has seen this before. I've been looking at cars (ST's and Titanium's) and images online and never seen this pattern there all just plain silver. The unit itself works perfectly i'm just curious to know if anyone has seen this wired pattern before. Thanks, Marc :)
Welcome to the Ford forums Marc Finney :)
If you get stuck on how to post a question on the forums or trying to message a member then check out our video guides to help you get started!


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State Fair Community College participates in the Academic Quality Improvement Program (AQIP), a quality-based, continuous improvement model of accreditation through the Higher Learning Commission (HLC), a Commission of the North Central Association of Colleges and Schools (NCA).
Participation in AQIP allows SFCC to shape the direction of institutional accreditation, to gauge the success of its integration of AQIP into strategic planning implementation, and to demonstrate it meets accreditation standards and expectations.
SFCC is an active participant in AQIP and appreciates the potential benefits that come from recasting accreditation activities so that they better support the institution's program for continuous improvement. SFCC, from the beginning, has intentionally integrated AQIP into its strategic planning process. A combination of action projects, SFCC's AQIP Systems Portfolio, the Strategic Plan, and the SFCC Report Card provide evidence of SFCC's commitment to continuous quality improvement.
The Systems Portfolio effectively supplies SFCC with a credible, ready-to-use accountability report for its constituencies interested in institutional performance. SFCC looks forward to its continuing partnership with AQIP and to the opportunity to continue looking at its systems and processes in new and revealing ways.
SFCC AQIP Systems Portfolio 2012 Systems Appraisal 2013
SFCC AQIP Systems Portfolio 2008
If you have knowledge of unit work that needs to be added and/or updated in the Systems Portfolio, please contact Becky Rose at 660-596-7271 or firstname.lastname@example.com.
© Copyright 2014 State Fair Community College
3201 W. 16th St · Sedalia, Missouri · 65301-2199
Toll-free: (877) 311-7322 · Map/DirectionsEqual Opportunity/Accommodations A tobacco-free campus


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Get Online Today!Thursday, July 21st, 2011
The current generation of engagement ring buyers look to the internet with a true sense of trust. When they are looking to purchase anything in fact, they will make a point of reading a handful of articles before daring to venture into the 'real' world.
This does not mean the retail experience is irrelevant. It does however mean that the retail experience has changed dramatically. Before the internet, shoppers would go to their local store for both education and to ultimately purchase. They would be lead to the store because of word of mouth or because they had past by the store many times and had finally decided to walk in. Shoppers these days will go online to research. Once they are satisfied with the knowledge they have acquired and read a few reviews on some local retail stores, they will then take the plunge and visit a store or two.
I am surprised to see that many retail stores still do not have websites. Or, their web presence is not adequate. This means many stores are missing out on sales before a potential customer has even stepped into their store. Marketing is changing. Retailers need a visually pleasing and well thought out website with agressive online marketing such as facebook.
Northam Diamonds has many tools to help your store quickly and effectively reach these new savey buyers. Please contact us at 1.800.941.4367 for more information.


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Review: I Like it HereUser Review - Lachlan - Goodreads
Being a kind of ex-pat in Portugal myself who "likes it here", I read this brief novel from the 50s. The Portugal Amis evokes is the period of Salazar's despotic rule, but much of it is still very ... Read full review
Review: I Like it HereUser Review - Anthony Peter - Goodreads
I read this as it was my book group's choice. Liked it as a quick read, though some of Amis' genial ranting became tedious to me. I was taken aback by the response of some book group's members: they ... Read full review
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abroad Afilhado Alec anyway Barbara Bennie Hyman bloody Bowen asked Bowen felt Bowen thought Bowen tried British Buckmaster Buckmaster's Cascais chap chauffeur couple course dear drink Emilia English Estoril eyes face feel Finland flea foreign Frank Sinatra Garnet getting Gimme gimme girl going Gomes Graham Greene grinning hand happened Harry Bannion heard Hiscock hope Isabella Bannion kind KINGSLEY AMIS knew Knowles laughing lavatory Lisbon Llansamlet London looked Lopes lunch Lydney madeira Marchant mean mind minutes motor-bike murdered your wife nasty nasty boy never nice Oates Oates's Oh yes Parry perhaps Portugal Portuguese pretty remember Rosie Rough Magic round Salazar Sandra seemed senhor ship sitting smile sort Sousa and Bachixa Strether stuff suppose sure Swansea talking tell there's thing tion told trying turned veranda Welsh Welsh Nationalist wife wondered writer


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Why does python use modules, instead of just including the module functions in the main language. It would be very useful and pretty easy, especially for the main ones such as random, re, and os. If Python preaches simplicity and minimalist, why do you have to write in extra lines of code?
1) Zen of Python #19: "Namespaces are one honking great idea -- let's do more of those!"
Named modules are good because they eliminate any chance of a collision between functions with the same name. If everything was a builtin, then
Ditto the builtin
This is the same reason the syntax
2) Who decides what's a builtin and what's a module?
Most of the programs that you personally write involve
After a while your list of builtins gets to be bigger than Ben Hur.
Memory and speed efficiency
Objects that have been created (and everything is an object in Python) occupy the memory allocated to the Python interpreter process. When you import a module, its code is executed, resulting in the creation of many objects (functions, classes, data, etc.), most of which must persist in memory to be useful. By separating functionality into logically distinct modules, we allow programs to devote their memory only to objects providing the functionality they need.
If everything were built-in, you would have a huge chunk of memory devoted to all the classes, functions, and other objects of the entire standard library, less than 1% of which would actually be useful to the average program. Furthermore, you would waste time executing all the code that creates all these objects, every time the interpreter starts.


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Unmoderated, Remote Usability Testing: Good or Evil?
Published: January 18, 2010
Conducting traditional synchronous, or moderated, usability testing requires a moderator to communicate with test participants and observe them during a study—either in person or remotely. Unmoderated, automated, or asynchronous usability testing, as the name implies, occurs remotely, without a moderator. The use of a usability testing tool that automatically gathers the participants' feedback and records their behavior makes this possible. Such tools typically let participants view a Web site they are testing in a browser, with test tasks and related questions in a separate panel on the screen.
Recently, there has been a surge in the number of tools that are available for conducting unmoderated, remote usability testing—and this surge is changing the usability industry. Whether we want to or not, it forces us to take a closer look at the benefits and drawbacks of unmoderated testing and decide whether we should incorporate it into our usability toolbox.
To clarify, there are a lot of tools out there that label themselves as usability testing tools, but don't actually offer the capability of doing usability testing with users through task elicitation. Some of these tools are nothing more than survey tools, Web analytics tools with new and improved visuals—such as CrazyEgg and clickdensity—or Web analytics tools that turn analytics data into videos of actual user sessions—such as Userfly, ClickTale, TeaLeaf, and Clixpy. All of these tools provide a wealth of data about your Web site's users. However, such tools are not the focus of this article. Instead, this article focuses on unmoderated usability testing tools that actually simulate traditional usability testing by asking participants to complete a series of tasks using your user interface and answering questions about their experience.
What You Can Learn
Unmoderated usability testing lets you do test sessions with hundreds of people simultaneously, in their natural environment, which, in turn, provides quantitative and even some qualitative data. The exact metrics and feedback you can collect vary, depending on the tool you use. (I'll provide a list of unmoderated usability testing tools later.) Most unmoderated testing tools can gather the following quantitative data:
- task-completion rate
- time on task
- time on page
- clickstream paths
- satisfaction ratings or opinion rankings
- Web analytics data—such as browser, operating system, and screen resolution
Most of these tools can also capture qualitative feedback as users complete their tasks—such as users' suggestions and comments. This is where the true value of unmoderated usability testing can come into play.
Some unmoderated testing tools can recruit users for tests by intercepting them on your live Web site. This lets you collect invaluable data on participants' true intent and motivation for visiting your Web site.
How Actionable Is the Data?
How actionable your data is depends heavily on the types of tasks you ask participants to perform. If you have participants perform scavenger-hunt tasks—asking them to find specific content on a Web site—you may miss out on important feedback. Just because someone was able to find the information you requested doesn't mean they understood it. To elicit more valuable information, you should try to make finding tasks more meaningful by having participants answer a question about the information they were asked to find. For example: Using the Web site, please find out which Smartphones are available on Verizon Wireless. Where can you purchase these phones locally?
The self-reported feedback and comments you get in response to open-ended questions can be the most valuable data you collect during an unmoderated test. Sometimes users' direct quotations can be just as impactful as videos, especially when you start to see a consensus building among different participants.
Take satisfaction ratings and opinions with a grain of salt. Pay closer attention to what users actually do—not what they say they do. Participants can have a terrible experience using a user interface and still give it a high satisfaction rating. For this reason, I suggest asking participants open-ended questions about their experience rather than having them rate it.
Also, you must keep in mind that Web analytics alone cannot paint the full picture. Just because it took someone longer to complete a task doesn't mean it was harder to complete. They could just have been more interested in the content. Without asking participants, you don't really know for sure. You must be careful not to make hasty assumptions that are based on just the quantitative data you've collected.
Conducting Unmoderated Usability Tests
Creating and administering an unmoderated usability study is similar to the process of creating and administering an online survey, but with the additional steps of a traditional usability study, as follows:
- Define the study. Decide what tasks you are going to ask participants to perform, the order of the tasks, and what follow-up questions you want to ask them about their experience. Unfortunately, since you are not observing the tests, you can't ask probing or follow-up questions on the fly, depending on what participants do. However, some unmoderated usability testing tools let you structure tests to ask probing questions after users' perform specific interactions with a user interface.
- Recruit participants. You can choose to do the recruiting yourself or hire a recruiter. As I mentioned earlier, some unmoderated testing tools offer you the options of either intercepting users on your live Web site or recruiting them from the tool developers' own panels of participants—which are pools of test participants they've recruited in advance. You should be careful when choosing participants from such panels as your representative users. Who participates in your test is just as important for an unmoderated usability test as it is for a moderated test. Your team will base important design decisions on the data you obtain, so participants should be real or prospective users of a product.
- Launch your test and send email invitations. Typically, an unmoderated test should be only 15–30 minutes in duration—comprising approximately 3–5 tasks—because the dropout rate tends to increase if a test takes longer.
- Analyze your results. Most unmoderated testing tools offer live, real-time reporting during tests.
Benefits and Drawbacks
Before choosing to conduct unmoderated usability tests, it's best to take a look at their benefits and drawbacks in comparison to traditional moderated testing.
Benefits of unmoderated usability testing include the following:
- You can test hundreds of people simultaneously—while keeping them in their own natural environment.
- You can test multiple Web sites simultaneously—for example, competitor Web sites, different brands, or Web sites for different countries.
- You can test at a reduced cost—depending on the tool you use. There are definitely unmoderated usability testing tools that have ridiculously high prices, but some recent tools are very affordable, which can make unmoderated usability testing a less expensive option. (See my list of unmoderated usability testing tools.) Also, the participant honorariums for unmoderated tests are typically a lot lower.
- Doing unmoderated usability testing is a great way of planting the seed of UCD methodologies and introducing usability testing into a company, using limited resources and budget—assuming you can use one of the less expensive testing tools.
- There are fewer logistics to manage, with no need to set up testing schedules, set up and moderate individual test sessions, or worry about no-shows and getting last-minute replacements.
Drawbacks of unmoderated usability testing include the following:
- Nothing beats watching participants in real time and being able to ask probing questions about what they are doing as it's happening—and you'll miss out on this opportunity.
- Some participants may be interested only in earning the honorarium you've provided as an incentive. So, rather than taking the time to really perform each task and provide feedback, they'll just click through the tasks without much thought. Luckily, you can filter such participants out of your findings by looking at their time on task or open-ended feedback. Depending on the capabilities of your chosen testing tool, this task can either be time consuming or quite painless.
- You cannot conduct interview-based tasks. Participants who are passionate about the tasks they are performing interact with a user interface differently from those who are just doing what they are told.
- Web analytics can mislead you by giving a wrong impression of a user's experience. Also, what participants report on surveys can be very different in comparison to what they actually do. You can't rely solely on rankings and satisfaction ratings to create an accurate picture of what your users actually need and want. Therefore, you should always include qualitative research questions in your unmoderated studies and analyze the self-reported feedback. If necessary, follow up with participants after a study to discuss their feedback.
- It's possible for participants to think they've successfully completed a task when they haven't. To move on to the next task, participants must be able to decide whether they've completed their current task. For this reason, you need to develop straightforward tasks that have well-defined end states.
When Should You Conduct an Unmoderated Test?
Have you ever presented findings from a moderated usability test only to receive push back on the data, because only 5–10 people participated in your study? As usability professionals, we know when our data is actionable. (How many times do you need to see someone fail to complete a task before you know it's a problem?) But, sometimes, you need greater numbers to give stakeholders the warm-and-fuzzy feeling they need to make million-dollar design decisions.
Unmoderated usability testing can yield an enormous amount of data and feedback from participants, but you should not use it as a replacement for moderated usability testing. Unmoderated testing is best when you use it in conjunction with moderated testing. Use your large samples from unmoderated testing to help put big numbers behind some key findings from your initial moderated research.
Keep this in mind:
- Moderated testing is still much better suited for multifaceted products or complex tasks that don't have a structured sequence of steps.
- Unmoderated testing is most effective when you have very specific questions about how people use a user interface for relatively simple and straightforward tasks.
Overview of Some Unmoderated Testing Tools
Please note that this is not a complete list of all available unmoderated testing tools. New unmoderated testing tools are constantly appearing, so I urge you to use this list only as a starting point in your process of finding the best tool for your needs. Also, the pricing and feature list for each tool is current only as of this article's date of publication. Since pricing and feature sets can change, you should visit these companies' Web sites for the most current information about their offerings.
Keynote WebEffective
Self-service option: Yes
Software download required: Yes
Recruiting options: Intercept users, use their panel, or do it yourself
Pricing: $$$$
Self-service option: Yes
Software download required: Yes, but there is an optional version, without clickstream tracking, that doesn't require a download.
Recruiting options: Intercept users, use their panel, or do it yourself
Pricing: $$$$
This tool includes the ability to conduct card sorts and Chalkmark-like tests—see Chalkmark.
Self-service option: Yes
Software download required: No
Recruiting options: Use their panel or do it yourself
Pricing: $$$$
Self-service option: No
Software download required: Yes
Recruiting options: Intercept users, do it yourself, or they'll recruit for you
Pricing: $$$$
Note—No screenshots were available.
Morae Autopilot
This is an in-person, unmoderated testing tool. It does not provide the ability to conduct unmoderated, remote testing.
Self-service option: Yes
Software download required: Morae Recorder must be installed on the computer running the test.
Recruiting options: Do it yourself
Pricing: $$
Note—This pricing is for a one-time purchase of unlimited usage of Autopilot, and you are also buying the entire Morae package, which you can use for moderated, as well as unmoderated testing.
This low-cost option offers many of the same benefits and features as the higher-priced tools.
Self-service option: Yes
Software download required: No
Recruiting options: Do it yourself
Pricing: $
This tool also records on-screen interactions and audio.
Self-service option: Yes
Software download required: No
Recruiting options: Do it yourself
Pricing: $
This tool also records on-screen interactions and audio.
Self-service option: Yes
Software download required: No
Recruiting options: Panel, but do it yourself is a custom option.
Pricing: $
Self-service option: Yes
Software download required: No
Recruiting options: Panel only
Pricing: $
This tool uses task elicitation to collect opinions and feedback and also to find out where people first click—either a static image or a Web address, or URL—to complete a task.
Self-service option: Yes
Software download required: No
Recruiting options: Do it yourself
Pricing: $
This tool uses task elicitation to find out where people first click a static image to complete a task.
Self-service option: Yes
Software download required: No
Recruiting options: Do it yourself
Pricing: $
This tool uses task elicitation to find out what link people first click in an information architecture to find information.
Self-service option: Yes
Software download required: No
Recruiting options: Do it yourself
de la Nuez, Alfonso. "An Attainable Goal: Quantifying Usability and User Experience." (For subscribers only.) User Experience Magazine, Volume 7, Issue 3, 2008. Retrieved September 10, 2009.
—— and Kim Oslob. "What's the Real Value Behind Unmoderated Remote User Testing?" UserZoom Blog, September 9, 2009. Retrieved January 15, 2010.
Farnsworth, Carol. "Getting Your Money Back: The ROI of Remote Unmoderated User Research." (For subscribers only.) User Experience Magazine, Volume 7, Issue 3, 2008. Retrieved September 10, 2009.
Mach, Sabrina. "Is All Remote Usability Testing The Same?" FeraLabs Blog, February 24, 2009. Retrieved September 10, 2009.
Tulathimutte, Tony. "Read Chapter One of Remote Research!" Rosenfeld Media, January 26, 2009. Retrieved September 2, 2009.
Tullis, Tom. "Automated Usability Testing: A Case Study." (For subscribers only.) User Experience Magazine, Volume 7, Issue 3, 2008. Retrieved September 10, 2009.
Topic: Product Reviews | Usability
18 Comments
Thanks, Kyle, for sharing this. I used User Zoom for remote usability testing on a multi-phase project, in conjunction with moderated testing, and the final results were very good. In a couple of weeks, I will use User Zoom for an online survey.
You're welcome, Camilo! Thank you for sharing your experience with conducting moderated testing in conjunction with unmoderated testing using User Zoom. Good luck with your survey!
Nice, but since it's an article focused more on the technique and not so much a tool review, I have to say that it was a bit vague, to be honest, particularly when pricing is mentioned. I wish more attention had been paid to features and value instead.
URUT is actually a highly complex research method, and this must be taken into account. On one hand, Kyle talks about "ridiculously high prices" of some tools, when this judgment is completely dependant on the actual value the tool can provide. Just because new, low-cost tools have come out on the market in the past year or so, you can't just assume the ones that have been out there for years, solving highly complex research problems with sophisticated engineering work are "ridiculously expensive." Why is there this difference, one should wonder. Much the same has happened with other types of tools like online surveys or CRM systems, where no one labels SAP as "ridiculously expensive" because Salesforce.com offers a SaaS, low-cost version. SAP offers a lot more, therefore, it costs more. It's that simple.
Thanks Camilo for the note! ;)
Hi Alfonso,
As you stated, the focus of this article is not to be a tool review, hence the limited information given on each tool mentioned. The list is provided only to help give a starting point in the process of finding a tool. I prefer to let the reader separate the calves from the herd, so to speak.
I refrained from giving numbers for pricing since some of the tools mentioned have custom pricing, depending on the needs of the research study. I also didn't think it was appropriate for me to post the pricing, because some of these companies don't even post it on their own Web sites—including yours, UserZoom. You're absolutely right that my idea of high pricing might be different from someone else's, and whether someone thinks a tool or service is valuable is entirely subjective.
In my research, I have found that a couple of these lower-cost tools actually provide a lot of the same results for a fraction of the price. But, with the majoirty of these tools, I agree that you get what you pay for.
Best, Kyle
Hi Kyle, I understand what you mean.
The question is: Did your research include actually using the tools for a real study and gathering results—like a trial study? Or, by research, do you mean requesting information from each vendor and reading the Web site? If it's the second, I can understand why you came to the conclusion that "a couple of these lower-cost tools actually provide a lot of the same results for a fraction of the price," because the information on features provided by most of the vendors' Web sites does not clearly differentiate them. (We're working on this now, btw.)
So I guess my point is that expensive or cheap really depends on value and value should / can only be measured after you use or try out a product, right?
I don't mean to create too much controversy here, but I just think the reader should be fully informed. I appreciate the article being published in any case. ;)
Thanks, Kyle, for writing an article on URUT. There definitely is a huge trend toward gaining valuable metrics and quantitative data to validate findings. A few comments from a researcher perspective and from someone who has vast experience using this method.
"Nothing beats watching participants in real time…." While it is true this method does not replace watching participants, we must understand its value. Researchers don't just use one method; we have many in our toolkit. The value is that it complements qualitative research and fills in where qualitative methods may lack. On the other end, you can say that nothing beats collecting quantitative metrics and participants walking through a site without being intimidated by being watched. I think what we have to look at is the value and how this method can get us in front of the stakeholders with more statistically significant data.
"Some participants may be interested only in earning the honorarium you've provided as an incentive…." This is true with even lab-based research. If it wasn't, we wouldn't have to offer incentives. However, with URUT, you can set up Quality Control filters to ensure participants are truly putting in an effort. In addition, you have more flexibility because of the numbers you are running. If you have a lab study and run only eight and two are bad participants, you need to run two more participants. With URUT, you can take out the outliers and bad data and still have statistically significant data.
"You cannot conduct interview-based tasks. Participants who are passionate about the tasks they are performing interact with a user interface differently from those who are just doing what they are told." You don't always have to give tasks with URUT. Rather, you can intercept customers as they come to a site and have them do natural tasks. At the end, you can ask them questions regarding their experience.
"Web analytics can mislead you by giving a wrong impression of a user's experience. Also, what participants report on surveys can be very different in comparison to what they actually do. You can't rely solely on rankings and satisfaction ratings to create an accurate picture of what your users actually need and want." This is not just Web analytics with surveys. With the right technology or tool, you can apply validation to your tasks to ensure accurate collection of Success and Error ratios. Validation can be in the form of questions they can answer correctly only if they did the task correctly, URNs by Web page, or by time. With this method, you combine the paths—analytics—with the survey data and the validation to create a complete picture of what happened. There is no misleading in the user's experience. In addition, you can ask open-ended questions to gain qualitative data, so you aren't locked into just ratings and multiple-choice questions.
In short, I have learned that there are many misconceptions in regard to URUT. I encourage researchers to explore and take the time to understand the value in using this method. It will not only complete your usability toolkit, but open the doors to gaining rich data that you couldn't otherwise collect in any other way.
Actually, I have been fortunate enough to use some of these tools for real client studies. However, I haven't used them all. Which is why I made a conscious effort not to evaluate the tools and to refrain from stating any personal opinions in the article.
When URUT tools first started coming out, I had a horrible opinion of them. Once I finally had the experience of using URUT with different tools and seeing the value of the method, I wanted to write this article so that other UX researchers gave it a fair shot before shooting it down as an option.
I'm in no way stating that any of these tools isn't valuable. I believe all the tools mentioned received both fair and equal coverage relative to the intent of the article.
First, I think readers need to understand that you also work for UserZoom.
"While it is true this method does not replace watching participants, we must understand its value. Researchers don't just use one method; we have many in our toolkit … it complements qualitative research and fills in where qualitative methods may lack." That is exactly why I highly suggested the benefit of using large samples from unmoderated testing to help put big numbers behind some key findings in initial moderated research.
"This is true with even lab-based research. If it wasn't, we wouldn't have to offer incentives." I agree that this is true no matter how the testing is performed. The point was that although real users may be participating only because of the honorarium, their feedback is much different from someone who would never use the product, since future changes would not impact them. In fact, I've done many tests over the years without even offering an honorarium. Often times, the incentive for real users of products is to have the opportunity to make the products they use better.
"However, with URUT, you can set up Quality Control filters to ensure participants are truly putting in an effort." While I agree that this is a valuable feature, the majority of URUT tools that I'm aware of don't have that ability. Broad statements about what you can do with URUT should only be made if you know that it can be done with all tools, not just some. When you do this, you are defending the tools, not the method.
"You don't always have to give tasks with URUT. Rather, you can intercept customers as they come to a site and have them do natural tasks." Again, the majority of URUT tools that I'm aware of don't have this feature. It's wonderful that some tools have these capabilities, and I wish more URUT tools did as well.
"This is not just Web analytics with surveys … There is no misleading in the user's experience … you can ask open-ended questions to gain qualitative data, so you aren't locked into just ratings and multiple-choice questions." I agree that open-ended questions are the best way to gain qualitative data, but if you present only the Web analytics, it can be misleading. That is how I stated this in the article.
~ Kyle
Thanks, Kyle. I believe it's great to be having this discussion.
I didn't mean to suggest that not all tools received fair and equal coverage. Again, I understood it was not a tool review type of article. My only point or concern is just with the adjective ridiculous. In this case, it was used when referring to pricing in a way that, in my humble opinion, may be misleading and requires further detailing.
Regarding Kim—or myself—working for UserZoom, I'd like to say that I wrote www.userzoom.com when I added these comments, but my name is linked somewhere else. I think that's what happened to Kim, and that's why she didn't mention that she works for UserZoom.
I'd be very happy to offer you a demo of our tool. I'm quite confident that, when you see it, you'll immediately understand what I'm talking about. I realize URUT is relatively new to many, but we didn't just come out to the market. We've been doing this for 8 years now.
If you are interested, get in touch.
For the sake of completeness, let me introduce UserFeel, which we published last week. UserFeel's remote usability testing differentiating factor is our large panel of multilingual users, so you can use it to test non-English sites as well.
To be fair, I would like to introduce your readers to Userlytics.com, providing a real-time, remote, unmoderated usability testing service that produces a high-quality video that consists of: full-screen recording of everything that transpires on the desktop, not just the browser, audio sound recording, and synchronized Web cam recording of the tester's face, mouse movements, and clickstream. And, in the near future, Userlytics.com will be adding moderated testing that will allow the moderator to create annotations during a task, chat and direct a tester during a task, as well as full video editing capability.
Dear Kyle, there has been a small glitch above. Webnographer does not require a software download. Participants simply click a link in an email invite or on an advertising banner. This takes them straight to the research where Webnographer records all their interactions on the Web site while carrying out a task. This is also combined with pre- and post-task questions.
It is very important that a remote testing tool does not require a download. In the many studies we have carried out for our clients using Webnographer, a large number of people have participated in the research during office hours and from their work desk. If a download were required, many of those people would be excluded from partaking, because most of them wouldn't have administrator rights to install software onto their work computer. Luckily Webnographer does not have that problem, because no download is required.
Where Webnographer clearly stands out from the other unmoderated tools is on the analysis side, going far beyond simple success rates. Webnographer provides intelligent analysis techniques built into the tool. It does not require any laborious Excel exports. All analysis happens in the Webnographer tool, including filtering of cohorts and satisficers, verifying success or failure, and much more.
We have started writing about our research experiences on our blog, where we also provide tips and tricks for conducting unmoderated usability tests. If you are interested, please visit.
Many thanks, Sabrina Mach
Thank you, UserFeel and Userlytics, for mentioning your tools, so people who read this article are aware of them.
Sabrina, thank you for pointing out the correction that Webnographer does not require a download. I was surprised when researching the tool last year that there weren't any screenshots or product tours available, and I'm even more surprised that there still aren't. Any chance you'll be posting more information about this tool anytime soon?
This is a very interesting article. I'd like to add another alternative to the mix, which has launched since this article was originally written: Kupima.
Broadly similar to the approach taken by usertesting and userlytics, Kupima offers video-based remote testing using either our own panel of manually approved users or choosing to use your own users—via a special hyperlink. The difference is that Kupima also offers quite a degree of control over the tasks and question types, which, for discrete answers, are automatically charted, and we will shortly be releasing functionality to create an instant report in PDF format, showing feedback summaries and key insights, plus charts.
I'd be thrilled to bits if anyone here would also consider Kupima as an option. It's feature-competitive, affordable, and has something the others don't have: lots of orange men. :)
You can also check out beeux.com. Have fun!
Thank you for this text, very informative. It is true that nothing is better than testing the users in reality. However, well-constructed automated tests come pretty close. I wanted to add to the mix another tool that wasn't around when the text was written, namely Automated Testing from Usability Tools. It is priced reasonably and includes a free credits pack for new users, which allows you to run a free automated test for 100 respondents. Cheers!
Fully informed? The reader fully informed?
If you are in any way associated with any of these companies—as could be deduced from Kyle's response—where is the full disclosure of this information?
Are you really associated with UserZoom. I can understand you have an incentive to lift up the higher-priced options. Now I begin to wonder why the first comment to this article promotes UserZoom.
I, for one, cannot afford an expensive product like that for my research, so I like that other options are mentioned as less expensive. I'm sorry, but we are not all Microsoft.
You should also check out Uxeria. (We also do a lot of testing, recruitment of respondents, and are really affordable.) Worth a look.
Thanks for an excellent article, Kyle. I was looking for a summary of what you presented at UPA 2012—the tutorial with you and Tom Tullis—and this was just what I was looking for. I enjoyed the tutorial very much and the article as well. Oh, and I do not represent any of the vendors mentioned in your article. :-)
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