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Blog http://www.stavian.co.uk/ 2016-02-01T14:26:00Z Models of Disability and Active Rehabilitation Stavian http://www.stavian.co.uk/blog/4590999445/Models-of-Disability-and-Active-Rehabilitation/10502858 <content:encoded>
"We learn, when we respect the dignity of the people that they cannot be denied the elementary right to participate fully in the solutions to their own problems. Self-respect arises only out of people who play an active role in solving their own crises and who are not helpless, passive, puppet-like recipients of private or public services. To give people help, while denying them a significant part in the action, contributes nothing to the development of the individual. In the deepest sense, it is not giving but taking – taking their dignity. Denial of the opportunity for participation is the denial of human dignity and democracy. It will not work."

Rules for Radicals - Saul D Alinsky (1971)

Considering Models of Disability

Models of disability are frameworks designed to provide a basis upon which society can devise strategies for understanding and meeting the needs of disabled people. There are a number of different models which people subscribe to:

The moral or religious model. Disability tends to be viewed as a punishment inflicted upon an individual or family by an external and usually supernatural force. This may be due to misdemeanours committed by the disabled person, someone in the family or a community group.

The medical model. Disability is seen to result from an individual person's physical or mental limitations, and is largely unconnected to their social or geographical environments. It is sometimes referred to as the Biological-Inferiority or Functional-Limitation Model. The medical model places the source of the problem within the person, and as such solutions are found by focusing on the individual.

The expert professional model. This has tended to provide what can be seen as the 'traditional response' to disability issues and has developed from the Medical Model. Within this framework, professionals follow a process of identifying the impairment and the person's limitations. Professionals then take the necessary action to improve the position of the disabled person – 'fixing' them. This is probably the cause of a system in which the service provider is authoritarian and over-active, prescribing and acting for an individual who is expected to be passive in the process.

The tragedy / charity model. Disabled people are depicted as victims of circumstance and objects of pity. This and the Medical Model are probably those most used by non-disabled people to define and explain disability. It has been broadly used by charities for fund-raising. For example the televised appeals often have disabled children depicted alongside young "victims" of famine, poverty, abuse and other circumstances.

The economic model. This defines disability as a person's inability to participate in work. It also assesses the degree to which impairment affects an individual's productivity and the economic consequences for society. It is used primarily by policy makers to assess distribution of benefits to those who are unable to participate fully in work.

The social model. This says that disability is caused by the way society is organised, rather than by a person's impairment or difference. It looks at ways of removing barriers that restrict life choices for disabled people. When barriers are removed, disabled people can be independent and equal in society, with choice and control over their own lives.

The Social Adapted Model. This is a new model, which builds on the social model of disability, by incorporating elements of the medical model. It accepts that impairments (biological, functional, cognitive or otherwise) are significant factors in defining the overall phenomenon of disability, but demands that the more disabling problems are created by social and environmental barriers. While not all problems of impairment can currently be corrected, if it is recognised that our environment are discriminatory a great deal can be done to improve people's lifestyles. The social adapted model argues that the inability of some disabled people to adapt to the demands of society may sometimes be a contributory factor to their condition. However, it still maintains that disability stems primarily from a social and environmental failure to account for the needs of disabled citizens.

The real advantage of the social and social adapted models is that they do not concentrate on people's limitations, but focus on capabilities and potential.

The World Health Organisation (WHO 2006) uses a model of progression to describe disability. When this is combined with the idea that disability stems primarily from a social and environmental failure to account for the needs of disabled citizens, it provides a framework for providing people with brain injury the tools they need to maintain independence and self-determination.

This model is useful because it focuses support on what should be provided for people with disabilities. It takes the focus away from the impairment, i.e. what is physically or psychologically damaged, as this is often not repairable. When people assume that it is the impairment that causes the disability; this is wrong. It is the choices that we make as a society that cause certain groups of people to be disabled. If society chooses to organise things differently people can be enabled even though their impairment has not changed.

Without glasses or contact lenses very many people (in excess of 2 Million in the UK) would experience a reduced quality of life. They would not be able to join in many activities, and may even become a danger to themselves and others in certain circumstances, i.e. driving a car. However, because society provides an opticians in every high street and a simple system for obtaining prescription glasses / contact lenses, people with visual impairments don't suffer any exclusion. They are provided with the "tools" they require to live their life independently despite their impairment.

As a further illustration – imagine what a kitchen would look like if it was designed for someone using a wheelchair. High level cupboards and shelves would not be useful, but a suspended gantry running the length of the kitchen, to hang utensils and equipment off, could be. If it could be easily used by the person in the wheelchair, it would be at around 1.6m from the ground – approximately chin height for any person not in a wheelchair. Who would be disabled in this environment? Similarly, should we expect a person with no sight to put light fittings in their house.............?

If we work to order lifestyles and environments differently, the same can be true for people with brain injury despite the complexity of their impairments. If we can find the right "tools" we can minimise disability by helping people to live as customary and self-determined a life as they are capable of. Frequently this involves helping people do the simple things in life when the simple things have become difficult. Therefore people with brain injury would receive support to live the lives that they want to, getting involved in society, with other people and making informed choices about what they do.

Impairments Associated with Brain Injury

There are a number of impairments that commonly result from head / brain injuries. The number and the type of impairments depend upon the scope of the damage that occurs to the brain. Some people experience impairments that are spread over different areas of the brain, while other people have impairments that are limited to specific areas of the brain. The severity of the damage that occurs also varies widely. These impairments fall within five general groups:

1. Cognitive Impairments – problems with remembering, unintentionally saying the same things repeatedly, difficulty understanding written information, difficulty learning new things, difficulty concentrating, difficulty making decisions, difficulty communicating thoughts and feelings, problems understanding spoken instructions, difficulty in starting / planning / doing things in the right order, difficulty 'finding' words in conversation, being easily disorientated by slight changes in routine, problems with 'multi-tasking', unintentionally repeating the same activities, being mentally rigid and having a very literal understanding of things, misplacing or having difficulty finding things, difficulties with adding / subtracting simple numbers, difficulty solving problems, being easily distracted.

2. Neurological Impairments – epilepsy, altered sensations (numbness, tingling, burning), loss of motor function (paraplegia / hemiparesis), uncontrolled shaking (ataxia), alteration in taste / smell, sensitivity to noise / temperature changes / light, speech difficulties (dysarthria / dysphonia), visual problems, balance / coordination problems, swallowing difficulties.

3. Physiological Impairments – ringing in ears (tinnitus), heart pounding / racing, easily startled / hyper-vigilance, weakness / loss of strength, easily fatigued, feeling tense, feeling restless / having problems sitting still, appetite changes, decreased tolerance to alcohol / drugs, having trouble falling asleep, nightmares, restless / disturbed sleep, headaches, sexual dysfunction, sleepwalking, sensitivity to light.

4. Psychological Impairments – feelings of depression / ineptitude / worthlessness / shame / guilt / fear / dread / anxiety / self-pity / chronic frustration / irritation / anger, an impaired sense of self, feeling everything is too much effort, fearing a loss of control over life, feeling that others do not understand, being unsure about things that the person once knew well, worrying thoughts that will not go away, feeling low / discouraged, making up explanations for things, becoming withdrawn and isolated, having episodes of panic and terror.

5. Behavioural / Personality Impairments – problems with insight, difficulty controlling emotions, excessively talkative, being oversensitive, lacking interests or emotion, sexually indiscrete, impulsivity, being over-familiar / egocentric / irresponsible / aggressive / grandiose / boastful / childish / paranoid / suspicious / passive / submissive / self-indulgent, a lack of tact and diplomacy, having to keep checking / re-checking things, confabulation (fabricated memories or 'lying' but without the intention to deceive), the inability to learn and benefit from experience.

In active rehabilitation the aim is to focus on what 'tools' the person requires to live their lives meaningfully despite their impairments. With these tools, the aim is to support the individual to develop and maintain:

Individuality and Self-Determination – is about people with a brain injury leading their life in their own way. Living the life that they are capable of living. It is about people participating in decisions about themselves whenever it is possible to do so. People need to make informed choices about what they do and how they do it. They need support to continue to develop and express preferences. Owing to the importance of language in humans it is essential that people are able to communicate in the most appropriate way and via the most appropriate means. People with brain injury need to continue to develop and maintain their own personal identity. This is about their individuality in terms of appearance, interests, lifestyles, hopes, dreams and ambitions.

Competence and Productivity - is about people with brain injury being 'busy' in a wide range of meaningful activities. This should include social, domestic, leisure, recreational, vocational and educational pastimes. People need to do as much as possible for themselves across the full range of lifestyle skills, tasks and activities. People with brain injury need to be as independent as possible by minimising any dependency on other people do things for them.

Social Inclusion – is about people with brain injury getting out and about on a frequent basis. It is about them having the opportunities to participate in a range of normal community activities that are meaningful to them. This should include social, domestic, leisure, recreational, vocational and educational pursuits. People need to do as much as possible for themselves across a full range of community orientated activities.

Interpersonal Relationships – is about people developing and / or maintaining the depth and range of connections and feelings that exist between other people. This involves people with brain injury developing and / or maintaining meaningful contact and having dealings with a range other people. These relationships are invariably both formal and informal and range from acquaintances to friendships to families to children to intimate relationships. In certain circumstances people need support to develop these relationships and in other circumstances to sustain those already present.

Civic Rights – is about people with brain injury having and enjoying the same civil, human and legal rights as other people as they often experience inequalities in all these areas. This means that people with brain injury need to be supported to live in circumstances that enable them to maintain optimum levels of privacy, dignity, status and respect. This is achieved by living in the least controlled or least limiting manner and by being able to take reasonable risks and live life to the full via 'normal' lifecycles, 'normal' housing and 'normal' economic standards.

Issues of Stigma:

People with 'disabilities' are not only disabled or handicapped as a result of how society responds to their impairment, they also face stigma associated with what has been called their 'spoiled identity'. This means that it not just the particular features or marks that identify someone's membership of stigmatised group. It is also the way that people think, feel and act in response to coming across the stigmatising feature.

Stigma affects our "thinking" and as a result we develop stereotypes. Stereotypes are the negative beliefs that can be widely held about a particular group of people, e.g. "people with mental disorders are all dangerous".

Stigma also affects our "feelings". We develop prejudices when we agree with one group of people who hold stereotypes about another particular group of people. Prejudices are the negative attitudes or emotions that develop when we 'buy into' a stereotype. E.g. "I agree that people with mental disorders are all dangerous and so I am afraid of them".

Finally, stigma affects the way we "act", which leads to discrimination. Discrimination is about the unfair treatment of the people who have been stereotyped and prejudiced against, E.g. "People with mental disorders are dangerous and I am afraid of them – they should be kept out of the way of the rest of us".

Public stigma refers to the stigma that occurs when the general public supports certain stereotypes and discriminates against a particular group. Self stigma is the loss of self esteem that is experienced by people as they suffer the public stereotypes of their group (I am stigmatised because I have a disability). Courtesy stigma is the negative impact that can be experienced by individuals because they are family, friends or acquaintances with a publicly stereotyped group (I am stigmatised because my partner has a disability).

There is significant evidence that people with brain injury can experience discrimination in many aspects of their lives.

Unfulfilled Lives - Many people do not take part in community activities or participate in wider social networks with non-disabled people. Few have friends except for those paid to be with them, their family and other people with similar disabilities. They experience difficulties in being included within the local community and wider society.

Unemployment - Disabled people have the lowest employment rate in society with many people having less than a 10% chance of being in some type of employment. While paid employment may not be a realistic option for everyone, there is little acknowledgement that real jobs and real wages are a major aspiration for many people and are an immensely important part of most people's lives.

Limited Choice and Control - Despite being able to make choices and express views and preferences, people with brain injury often have little if any involvement in decision making and frequently not central to planning their lives.

Poor Support for Families and Carers - Families and carers do not receive enough good quality information to support their family member. They do not receive assessments of their own needs and receive a poor range of support services. They are rarely treated as valued partners by local agencies despite providing primary support to their disabled family member.

A Simple Case Example:

"Bob was a widower who enjoyed pottering about in his bungalow, walking the dog and following customary routines such as fetching his newspaper and a pint of milk from the shop every day. Since his stroke, his life has changed. He has a left-sided weakness and needs assistance with many aspects of his life. His family kindly paid for a very expensive residential care home. It is like a hotel. He has his paper brought to him every day and a choice of food from the menu. Unfortunately there are strict rules and he has to fit in with the routines. If the weather is good he may be wheeled outside for an hour or so, but the staff are very careful about not exposing him to too much sun. His family take him out on a Sunday and sometimes he will go to the park, although he understands that they have busy lives.

Harry also lived alone when he had his stroke. He is supported by people who enable him to continue living in his own bungalow and to live his life as far as possible the way he wants to. He gets up at his usual time (not at a time that accommodates the staff shifts). He is assisted to go to the shop every day to collect his pint of milk and newspaper (even though this now takes over an hour and can be quite exhausting). He goes to the park most days and throws a stick for his dog or enjoys watching his personal assistant struggling to get his dog to obey commands."

As was illustrated earlier, there are a great many potential impairments that can result from a brain injury. However, if we work to order people's lifestyles and environments differently, they can live more capable lives. If we can find the right "tools" we can minimise disability by helping people to live as customary and self-determined a life as they are capable of. Frequently this involves helping people do the simple things in life when the simple things have become difficult. Therefore people with brain injury can live the lives that they want to, get involved in society, with other people and make informed choices about what they do, if we can provide capable support. The question then is – how can we support each person to live as independent and meaningful life as is possible despite their impairments?

 </content:encoded> 2016-02-01T14:26:00Z 2016-02-01T14:26:00Z A Practical Guide to Improving Sleep Disturbance Stavian http://www.stavian.co.uk/blog/4590999445/A-Practical-Guide-to-Improving-Sleep-Disturbance/10493410 <content:encoded>
"Your life is a reflection of how you sleep, and how you sleep is a reflection of your life."

Pelayo

Introduction:

Having a good night's sleep is not only invigorating and satisfying; it is the foundation for having healthy and productive days. Some people experience difficulties sleeping on a recurring basis while others only experience occasional problems. For anyone experiencing sleep disturbance, identifying and correcting poor sleeping habits can help to improve their wellbeing and quality of life.

Recent research has not only suggested that poor sleep habits can make people tired, irritable and causes decreased concentration, but it also weakens the immune system and can cause depression. While scientists are not exactly sure why people need sleep, studies suggest that it essential for survival. Some experts believe that sleep gives that brain time to repair cell damage and restore energy levels. In children and young adults sleep coincides with the release of growth hormones. REM sleep stimulates the brain regions used for learning which is why children have much more REM sleep than adults.

Sleep Disturbance and Acquired Brain Injury

Many people who have brain injuries suffer from sleep disturbances. A review of sleep disorder studies and surveys suggest that sleep disorders are three times more common in people with ABI than in the general population and that nearly 60% of people with ABI experience long-term difficulties with sleep. Women were more likely to be affected than men. Sleep problems are more likely to develop as the person ages.

Sleep disturbances have been found in people with all severities of brain injuries from mild to severe. Sleep is a complex process that involves many parts of the brain. For this reason, and depending on the location and extent of injury, many different kinds of sleep disturbances can occur after brain injury.

• Insomnia: Difficulty with falling asleep or staying asleep; or sleep that does not make you feel rested. Insomnia can worsen other problems resulting from brain injury, including behavioral and cognitive (thinking) difficulties. Insomnia makes it harder to learn new things. Insomnia is typically worse directly after injury and often improves as time passes.

• Excessive Daytime Sleepiness: Extreme drowsiness.

• Delayed Sleep Phase Syndrome: Mixed-up sleep patterns.

• Narcolepsy: Falling asleep suddenly and uncontrollably during the day.

• Restless Leg Syndrome (RLS): Urge to move the legs because they feel uncomfortable, especially at night or when lying down.

• Bruxism: Grinding or clenching teeth.

• Sleep Apnea: Brief pauses in breathing during sleep, resulting in reduced oxygen flow to the brain and causing loud snoring and frequent awakening.

• Periodic limb movement disorder (PLMD): Involuntary movement of legs and arms during sleep.

• Sleepwalking: Walking or performing other activities while sleeping and not being aware of it.

What causes these sleep problems in brain injury?

Physical and chemical changes - The internal clock in the brain controls when people sleep and wake every day. If injured, the brain may not be able to tell the body to fall asleep or wake up. There are chemicals in our body that help us to sleep. An injury can change the way that these chemicals affect the body. If brain mechanisms for starting and stopping sleep are injured, a condition called post-traumatic hypersomnia may result in which a person sleeps many hours more than normal.

Changes in breathing control - Sometimes the brain's ability to control breathing during sleep becomes altered after an ABI, resulting in periods of apnea (when breathing actually stops for long enough for blood oxygen levels to drop). This is called sleep apnea. Other factors may affect the chance of having sleep apnea such as family history or being overweight.

Medications - Medications taken after a brain injury may cause problems going to sleep or staying asleep, or can make people sleepy during the day and unable to participate in activities. Prescription drugs for treating asthma and depression may cause insomnia. Also, stimulants that are meant to treat daytime sleepiness can cause insomnia if taken too close to bedtime. These problems can often be avoided by adjusting the timing of the medication or by substituting a different drug of course, in consultation with your physician. Many other medications can cause sedation (sleepiness), as well. Most over-the-counter sleep aid medications contain an antihistamine (commonly diphenhydramine) and are not recommended for people with ABI because they may cause disturbances in memory and new learning. Retention of urine, dry mouth, nighttime falls and constipation are also possible side effects of this class of medications.

Daytime sleeping (napping) and physical inactivity - Napping during the day is likely to disturb sleep at night. Inactivity or lack of exercise can also worsen sleep.

Pain - Many people who have suffered brain injuries also experience pain in other parts of the body. This discomfort may disturb sleep. Medications taken to relieve pain may also affect sleep.

Depression - Depression is much more common in persons with traumatic brain injury than in the general population. Sleep problems such as difficulty falling asleep and early morning waking are common symptoms of depression.

Alcohol - While alcohol may help bring on sleep, drinking alcohol before bedtime is likely to interfere with normal sleep rather than improve it.

Caffeine and Nicotine - Nicotine from tobacco may cause sleep disturbances and is often overlooked. Caffeine can disturb sleep when consumed in the afternoon or evening.

Stages of Sleep:

Normal sleep consists of five stages that occur in cycles through the night and each cycle last for between and 90 and 110 minutes. The five stage cycle is as follows:

Stage 1 - Light Sleep - we drift in and out of sleep and can be easily woken. There are slow eye movements and muscle activity

Stage 2 - Light Sleep - The slow eye movements stop and brain waves slow. This accounts for about half of people's total sleep time

Stage 3 - Deep Sleep - There are no eye movements or muscle activity and it is difficult to wake someone.

Stage 4 - Deep Sleep - people can be woken more easily but they are groggy and disorientated if woken.

Stage 5 - REM Sleep - Breathing becomes rapid, irregular and shallow.Eyes jerk rapidly and limbs become partially paralysed. Dreaming occurs and REM accounts for about 20% of sleep adult time.

What Causes Sleep Disturbance?

For many people the underlying cause of sleep disturbance tends to be poor diet and poor sleeping habits. The leading cause of sleep disturbance is the use of 'stimulants' before bedtime such as:

• Caffeine – found in coffee, tea, Colas and many other foods, drinks and medicines. Importantly, around half of the caffeine consumed at 7.00pm still remains in the body at 11pm which causes sleep disturbance.

• Alcohol - while alcohol may initially induce sleep, once the effects wear off sleep is then disturbed.

• Nicotine – in cigarettes and cigars

• Eating spicy foods or big 'heavy' meals before bedtime can cause sleep disturbance. Equally not eating enough can cause 'hunger pangs' during the night which can wake people. Finally, while regular exercise is very healthy, exercising within three hours of bedtime can make people more alert and can delay falling asleep.

What are the Key Principles for Good Sleep?

Having the right amount of sleep – every person needs to have the right amount of sleep and most people need between 7 and 8 hours every night. Sleep is deeper and better for people if it is in one continuous block of time.

Keep a regular schedule – it is very important to keep a regular bedtime and wake time for as much of the time as is possible. If possible this should be every day. It is best to get up at the same time each morning even if people have experienced a bad night's sleep. Big fluctuations between 'workdays' and 'days off' often causes further sleep disturbance.

Sleep at night – work out the time that you need to wake at, and then count back the number of hours you need and add 30 minutes. For example, if people need to wake by 7.00am, and need 7½ hours sleep per night – counting 7½ hours back from 7am and adding another ½ hour will mean they need to go to bed at 11.00pm. Avoid sleeping during the day – if people do 'nap' then it should be no longer than 15 minutes and ensure it is before 4.00pm.

Limit alcohol – many people drink alcohol to help them to get to sleep. However, while the alcohol may help people fall asleep, it actually has the opposite effect during the night and tends to wake people up. In addition, with continued drinking, the 'sleep-inducing' of alcohol stops working.

Limit caffeine – too much caffeine and particularly later in the day tends to keep people awake during the night. It is recommended that people try and limit drinking caffeine after midday. For the same reasons it is recommended that people avoid eating lots of chocolate too.

Limit nicotine in the evenings and avoid it during the night – many people argue that smoking relaxes them. However, it is actually a stimulant and like caffeine will make it harder for people to fall asleep and will also shorten the length of time people sleep through the night.

Exercise at the right time – regular exercise is definitely very good for people and can actually help good sleep. However, exercise too close to bedtime can leave people invigorated and over-stimulated making it harder to fall asleep. Try and avoid exercise within three to four hours of bedtime.

Make the bedroom comfortable and 'sleep–inducing' – make sure that people have a comfortable bed and a bedroom that encourages sleep. Block out unnecessary sunlight, make sure the mattress and pillows are comfortable and consider ear plugs if noise is an issue.

'Sort out' a bed time routine – going to bed is not the right time to think about paying bills, thinking about life's stresses and problems or being competitive. It is best to make a list of how problems can be resolved earlier in the evening or equally engage in competitive activities a couple of hours before bedtime. Try and perform relaxing activities in the hour before going to bed.

Keep the bed for sleeping and sex only – spending time in bed doing other things weakens the association between bed and sleep – avoid stimulating, frustrating or anxiety provoking activities. Therefore avoid doing these other activities that are not sleep related in bed – i.e. watching TV, studying, playing on games consoles, etc.

Go to sleep when you are sleepy, otherwise get out of bed – it should only take 15 to 20 minutes to fall asleep. If people are lying in bed longer than this it is helpful to get up and re-engage in a relaxing activity such as reading a book or listening to relaxing music until feeling sleepy again; then return to bed and try again.

Sleep is essential for the learning process – according to the latest research sleep helps people to secure their memories and helps in some types of learning. For example, students who study hard all week but 'party hard' at the weekends, often lose a lot of what they have learned. Sleep deprivation on critical nights after learning can result in people forgetting a third or more of what they had previously learned.

 </content:encoded> 2016-01-28T11:35:00Z 2016-01-28T11:35:00Z Fatigue and Acquired Brain Injury (ABI) Stavian http://www.stavian.co.uk/blog/4590999445/Fatigue-and-Acquired-Brain-Injury-(ABI)/10475830 <content:encoded>
"Winston was gelatinous with fatigue"

Orwell

Fatigue is one of the most common complaints associated with brain injury. It tends to be most severe immediately following a brain injury and can improve with time. For some people fatigue can persist long after the other symptoms have disappeared.

As many as 98% of people with a brain injury may have some kind of fatigue including mental fatigue. Fatigue is a huge feeling of exhaustion. People can be weary or listless. It can affect their ability to do both physical and mental work. It can sap people's energy so much that it prevents them from taking care of themselves, going back to work and doing things they used to enjoy doing.

Physical Fatigue can come from muscle weakness. It can come from having to work harder to do things that were easy before the head injury. This includes things like dressing, working around the house and even walking. Physical fatigue gets worse as the day goes on but the next morning, after a good night's sleep, it should be less. Often this kind of fatigue gets better over time.

Psychological Fatigue is the fatigue that comes with depression and other psychological conditions. This kind of fatigue gets worse with stress. Often, sleep does not help at all. Psychological fatigue is often worse when people wake up in the morning. To "cure" psychological fatigue it is essential to find its cause.

Mental or Cognitive Fatigue is a special kind of fatigue that can happen after an ABI. Somebody with mental fatigue might say, "Sometimes, I just can't concentrate any more. I just can't think." This may happen because the ABI forces the person to concentrate harder to do tasks that were easier before the injury. Just like hard physical work tires people out, so does mental effort.

Fatigue may affect many aspects of people's rehabilitation. As such, the success of any rehabilitation programme may largely depend on how well people learn to manage their fatigue, because:

• Fatigue decreases concentration, memory, and reduces the ability to cope with social interaction.

• Fatigue also increases irritability, distractibility, depression and anxiety.

• If the brain is processing information more slowly it takes more energy to do things.

• Tasks that require a lot of thinking and concentration often drain 'brain energy' faster, leaving people feeling tired.

• Fatigue is often aggravated when sleep is poor. After a brain injury, people frequently experience sleep disturbance.

Managing fatigue can be an important starting point for many people's recovery. To manage fatigue, there needs to be recognition that people do not have the same physical and mental stamina that they had before the accident.

Fatigue is frequently connected to thinking and concentration tasks - people may find it is their brain that is tired rather than their body. This may be due to:

• Problems with coordination, balance and movement meaning that actions take extra effort and concentration.

• The brain having to work harder because of concentration and memory problems.

• Poor or interrupted sleep.

• Boredom and feeling low / depression.

• Tinnitus – persistent 'ringing' in the ears that is very tiring for the brain.

What can people do to help reduce fatigue in brain injury?

• Try to restore a good sleep pattern - have good bedtime routines and aiming for 8 to 10 hours sleep each night.

• Take regular rest breaks each day to 'recharge' before 'the batteries go flat'. Once exhaustion sets in, it may take days to restore energy levels.

• Try to balance high demand thinking tasks with some low energy activities. Don't expect to be able to concentrate hard for hours initially –build up to it slowly.

• Learn the early warning signs of fatigue and rest accordingly.

• Engage in regular physical activity (as appropriate for any physical condition)

• Build relaxation time into each day.

Rest and relaxation exercises can also help to reduce any stress related headaches. Fatigue often increases conditions such as headaches and dizziness. People may experience daily headaches particularly in the early stages of recovery. The headaches may be caused by the initial bruising and swelling of the brain or they may be associated with a neck injury. Stress caused by worry, fatigue, and concentrating for too long may also produce headaches. Some people find that their headaches are worse when they are fatigued and the combined affect can be exceptionally debilitating.

More things people can do?

If it is felt that fatigue is being caused by depression, anxiety, or other psychological conditions, it is advisable to see someone who specialises in this area. If the fatigue is physical or mental:

1. Get more sleep and rest. Check for insomnia or sleep apnoea as these can sometimes occur in ABI.

2. Try to change the daily schedule - do things that require more physical or mental effort earlier in the day rather than later when tired.

3. Schedule time for rest during the day.

4. Take regular exercise. Begin with just a little, and gradually increase to improve physical endurance and mental alertness. There is evidence that people with ABI who exercise experience fewer symptoms and better cognitive function. They tend to report that their health is better, they feel less depressed, more mobile and more productive.

5. Eating a healthy balanced diet may also help.

6. The key is to find a good balance between staying mentally and physically stimulated whilst avoiding becoming overtired and fatigued.

 </content:encoded> 2016-01-21T13:02:00Z 2016-01-21T13:02:00Z An Introduction to Cluster B Personality Disorders Stavian http://www.stavian.co.uk/blog/4590999445/An-Introduction-to-Cluster-B-Personality-Disorders/10454759 <content:encoded>
"Personality has power to uplift, power to depress, power to curse, and power to bless."

 -Harris

Definition of a personality disorder:

• A personality disorder can be described as a cluster of deeply ingrained and enduring behaviour patterns manifesting themselves as inflexible responses to a broad range of personal and social situations.

• The effects of personality disorders are enduring if not permanent, and have a major impact on most or all aspects of the individual's life. They are thought to be caused by a combination of the individual's genetic make-up, their childhood experiences and learned behaviour.

Cluster B Personality Disorders (anti-social, borderline, histrionic, narcissistic) - are the most common personality disorders and have TEN core personality features that serve as the foundation for each of the specific personality disorders in that cluster.

Feature 1 - Being Self-Centred

We often hear the phrase "It's all about me".............

When making decisions, most of us weigh the needs and concerns of others as well as our own.

A person with a personality disorder weighs only their own needs and concerns. They may use money intended for others (i.e. their family or friends) for their own purpose. They may intimidate vulnerable others for money or manipulate situations to eliminate others from having or sharing what they want for themselves.

In most situations, if we are engaged by a person with personality disorder, the contact is for their purpose, not ours.

Feature 2 - Accepting No Responsibility

Individuals with a personality disorder almost never accept personal responsibility for their behaviour.

They invariably blame others, use excuses, claim misunderstandings, and then depict themselves as either righteous or the victim in the situation.

Those that are physically abusive actually blame the victims of their abuse for the assault. Victims may often hear "This is your fault! Why did you make me so angry?"

Feature 3 - Self-Justification

Individuals with a personality disorder don't tend to think, reason, feel, or behave normally. However, they typically are able to justify all of their behaviours.

Their justification often comes from their view that they have been victims of society or others and are therefore justified in their manipulative, controlling, criminal or abusive behaviours. For example, a common justification in criminals is to blame the victim for the crime.

Many of us find it impossible to reason with a person who has a personality disorder, because we find their justifications impossible to rationalise.

Feature 4 - A Sense of Entitlement

Individuals with a Personality Disorder have a tremendous sense of entitlement, a sense that they deserve respect, money, fame, power, authority, attention, possessions, etc.

In addition people often feel they are entitled to be the centre of attention and when that doesn't happen, they are entitled to create a scene or uproar to gain that attention.

Entitlement also creates a justification to punish others. As such, if other people violate one of their rules or demands, they feel entitled to punish them in some way.

Feature 5 - Shallow Emotions

Many of us can be amazed and astonished that a person with a personality disorder can quickly detach from a partnership or friendship, move on, and exhibit very little in the way of remorse or distress. The person can then very quickly find another partner or friend following a breakup. These same individuals can also quickly detach from or abandon their parents, family and children and not contact them for years.

Their ability to behave in this manner is related to what

is termed "shallow emotions".

Feature 6 - Situational Morality

A person with a personality disorder often takes pride in being able to "do what I gotta do" to have their demands or needs met. They have few personal or social boundaries and in the most severe cases, do not even feel bound by the laws of the land and quickly engage in criminal activity if needed.

The motto tends to be "the end justifies the means" – therefore, many people may have no hesitation in harming themselves or others to meet their own needs. They may well cut themselves, overdose, threaten suicide, or otherwise injure themselves with the goal of retaining a relationship using guilt and obligation.

Behaviours seen as manipulative are often 'tools of the trade' (lying, dishonesty, conning behaviour, intimidation, scheming, and acting) - "social chameleons" -evaluating a potential victim or partner, alter their presentation to be the most effective.

Feature 7 - Narcissism

People with Cluster B personality disorders often have two lives - their "real life" and the imaginary life they present to others that is full of excuses, half-truths, deceptions, cons, lies, fantasies, and stories prepared for a specific purpose.

Frequently there is an ineffective life - reports of tremendous talent and potential but very little in the way of social or occupational success.

There tends to be a life of excuses and deceptions often accompanied by financial irresponsibility, chronic unemployment, legal difficulties, and unstable living situations in the community.

Their behaviour often emotionally exhausts those around them. No matter what "real life" situation occurs, there will be a justification and excuse for it.

Feature 8 - Social Disruption

There is frequently no calm, peaceful, and stable relationship with someone who has a Cluster B personality disorder.

Their need to be the centre of attention and in control of those around them can ensure a near-constant state of drama, turmoil, discord, and distress.

An individual with a personality disorder often creates drama and turmoil in almost every social situation. Holidays, family meetings, outings in the community, travel, and even shopping can be turned into a social nightmare.

Feature 9 - Naturally Manipulative

To obtain our daily personal, social, and emotional needs, most of us have a variety of strategies to use including taking personal action, politely asking someone, making deals, being honest, etc. We can also use manipulation as one of many social skills - buying someone a gift to cheer them up, making comments and giving hints that something is desired, etc.

However in personality disorder manipulation is the preferred method of obtaining wants and needs. These manipulations - when combined with shallow emotions, entitlement, and being self-centred - can be extreme. To obtain their goals, people may resort to physical threats, harassment, intimidation, and assault. Alternatively, they may create dramatic situations, threaten (engage in) self-harm, or create social embarrassment.

Feature 10 - The Talk / Behaviour Gap

Generally, as people, we engage in talk / conversations / promises that match our behaviour most of the time. The more frequently talk matches behaviour, the more trust we are able to place in people.

Due to shallow emotions and situational morality the gap between talk and behaviour can be very wide. There is a tendency to promise much with little or no intention of fulfilling that promise, or of assuring others of a friendship while spreading nasty rumours or untruths.

The Key Features of Successful Support Plans:

• Support that is tailored to the individual's needs

• Explicit goals that are clearly formulated

• Realistic goals that are achievable

• Prioritised goals

• Having a long-term time-frame

• Attempting to reach shared expectations with the individual

• Ensuring a consistent approach

• Ensuring a tolerant approach

The Importance of Consistency

Supporting people with personality disorders can be very draining to deal with and it helps to spread the burden, leaving no single individual feeling responsible for everything.

......................... and so consistency is the key

Many people experience inconsistency in their upbringing and have not received the stability and validation of their thoughts and feelings that have enabled them to be able to form appropriate relationships and to deal with stress and problems constructively. Furthermore there is often limited and inconsistent care from services, which tends to mimic their own internal turmoil.

The evidence shows that regardless of any setting, professional background or role - offering consistent support and taking every opportunity to assist the individual in learning from experience, and developing strategies can lead to successful outcomes.

In Summary

• Try not to pre-judge the individual on the basis of their diagnosis.

• Show them that you are trustworthy and dependable.

• Treat them equitably; don't promise things you can't deliver.

• Avoid colluding with any strong ideas, particularly about other staff members.

• In terms of verbal communication adopt a strategy of providing reassurance, repeating information and finishing with more reassurance.

• Maintain clear boundaries.

• Observe for signs of vulnerability and exploitation.

• People with BPD can have very low self-esteem, and it can help them enormously if you emphasise the positive parts of their personality while pointing out their specific behaviours that are problematic.

• Be patient.

• Take account of your own psychological safety and be prepared to deal with your own feelings of professional powerlessness.

 </content:encoded> 2016-01-12T17:49:00Z 2016-01-12T17:49:00Z The Adolescent Brain Stavian http://www.stavian.co.uk/blog/4590999445/The-Adolescent-Brain/10326563 <content:encoded>
"Any person could, if so inclined, be the sculptor of their own brain" - Cajal

People across the ages have recognised that teenagers act differently to young children and they also act differently to adults. There continues to be certain teenage behaviours that adults can find mystifying, such as poor decision-making, recklessness, and emotional outbursts. It has always been known that hormones play a large role in this 'unique' behaviour of adolescents, but more recently an understanding has developed that hormones are only one piece of a bigger picture. It used to be assumed that because the brain of an adolescent was the same physical size as the brain of an adult, that it must be fully-formed. It was also assumed that if there were any structural changes at all in the teen brain, they were subtle ones. What is now known is that the adolescent brain is far from fully developed. On the contrary, the adolescent brain undergoes dramatic transformations in early childhood and then between the ages of about 10 and the mid-twenties.

New information regarding the adolescent brain provides insight for those of us who have been puzzled by this unique stage of life. By understanding the changes that are taking place in the brains of adolescents, we may be better able to guide people through this often difficult span of years. Gaining knowledge of exactly what may be 'going on' can lead to an understanding of the critical period that is created by the dramatic changes that take place in an adolescent's brain. During this time, the brain needs to experience specific types of input, to ensure that it develops most efficiently and effectively. As parents, educators, clinicians or carers we cannot leave this to chance. So, how is the brain of an adolescent different than the brain of a young child, or an adult?

Throughout childhood, there is a thickening of "grey matter" in the brain. This thickening is caused by growth spurts of the connections between brain cells (neurons). This occurs to ensure that the brain is prepared to survive in any environment and through any circumstance that it encounters. At about the age of 10 in girls and 11 in boys, this 'spurt' gives way to a systematic 'pruning' of these connections. The connections that are used remain intact and strengthen, whilst connections that are not used are 'pruned', essentially discarding pathways that are deemed unnecessary. The phrase 'use it or lose it' seems particularly applicable to the adolescent brain! Therefore, utilizing certain neural pathways through life experiences results in a strengthening of some connections, and the removal of others. The aim is a final product that is highly efficient and effective, which has been perfectly 'shaped' by its environment and its experiences.

Beginning before birth and continuing into the mid-twenties, a process called myelination occurs where brain cells (neurons) are coated with a fatty, waxy substance (myelin). Once coated, these myelinated cells become more efficient in the way they carry messages throughout the brain. The myelin provides insulation for each neuron and enables messages to travel much more quickly than in cells that have not been myelinated. It is only when all of the neurons in the brain are equipped with their myelin sheath, that it becomes efficient and effective in its functioning. Some neurons are fully-myelinated at birth, i.e. those that control the ability of an infant to suck. Other neurons become myelinated in early life, and provide ever-increasing efficiency for infants as they fine-tune their vision, hearing, language, emotions, and physical capabilities. The last areas of the brain to receive their full coating of myelin are the frontal lobes. When fully developed, it is the frontal lobes that allow us to plan for the future, accurately assess risk, control our impulses, reason, set goals and priorities, make sound judgments, plan and organize multiple tasks, and exhibit emotional control. In adolescents such tasks are often associated with difficulties. The late myelination pattern in adolescents provides valuable information regarding the types of experiences needed in order to maximize this critical wiring phase of brain development.

Though the adolescent brain's frontal lobes are still under construction, the emotional centre is fully-functional. This group of structures, known as the limbic system, develops from infancy and in adolescence is almost complete. Like the rest of the brain, the emotional centre's development is dependent upon a combination of genes and environmental stimuli. Because the frontal lobes are not fully developed until the mid-twenties, adolescents rely upon their fully-functional emotional centres more heavily than most adults. Most adults are able to mediate their brain's emotional centre which allows more complex thinking and reasoning via fully-functional frontal lobes. The adult brain is able to overrule the more primitive area of the brain and utilize the more fully evolved and complex frontal lobes as they move through their daily lives. Adolescents often find this difficult, reacting emotionally to experiences and events, rather than rationally and thoughtfully. The adolescent brain is an emotional engine with no brakes.

The ability to hold information in working memory develops with age in the prefrontal lobes located directly behind the forehead. Children with a developmental age of 5 can typically hold approximately 2 pieces of information at any one time. From the developmental age of 15 and throughout the rest of our lives, people typically have the ability to work with around 7 pieces of information at any time. The capacity of working memory does not typically grow as we age. However, by learning to group and chunk bits of information, we are then able to hold larger and larger amounts at any one time. It has been said that the difference between a novice and an expert in any field is their ability to chunk information. This is the process of combining multiple bits of information to form larger coherent chunks each of which carries meaning.

Recent research shows that teens and adults use different regions of the brain in responding to certain tasks and in their ability to read and understand emotions in the faces of others. Adolescents can misread facial expressions often seeing sadness, anger and confusion instead of fear. There is a progressive shift of activity, with maturation, from the amygdala to the frontal lobes when interpreting the emotional states of others.

So, what are the implications?

It is probably wise to exercise caution and carefully interpret the current information about adolescent brain development. It is still early in the process of analysing and understanding what it may mean. However, current understanding seems to add new dimensions to issues facing young people and those supporting them. If choices about using drugs / alcohol and engaging in or avoiding challenging learning tasks do have long-term and irreversible consequences for the development of the adolescent brain, then discouraging harmful choices and encouraging healthy ones is all the more necessary. Current evidence may provide an explanation for why adolescents often fail to heed adults' warnings about such choices. They may simply not be able to understand and take on board arguments that seem logical to adults. It is also possible that teenagers are misperceiving or misunderstanding the emotions of adults, leading to miscommunication both in terms of what the young person thinks the adult is feeling and in terms of their subsequent response. Perhaps most importantly, young people need to be actively empowered with opportunities to develop their brains through meaningful activities in which they choose to participate.

 </content:encoded> 2015-11-16T14:54:00Z 2015-11-16T14:54:00Z A Whistle-stop Tour - The Brain, Brain Function, Brain Dysfunction (in head / brain injury) Stavian http://www.stavian.co.uk/blog/4590999445/A-Whistle-stop-Tour---The-Brain-Brain-Function-Brain-Dysfunction-(in-head-brain-injury)/10326408 <content:encoded>
"Biology gives us a brain. Life turns it into a mind" - Eugenides

Rather obviously the brain is the center of the nervous system. It's located in the head, protected by the skull and sited closely to the body's primary sensory apparatus – vision, hearing, balance, taste and smell. The average weight is 1.5kg and sized between 1130 and 1260 cubic centimeters. It contains between 15 and 33 billion neurons, depending upon a person's age and gender, with each neuron being linked with anything up to 10,000 synaptic connections. Therefore each cubic millimeter contains roughly 1 billion synapses.

Neurons communicate with each other via interconnecting fibres (axoms) which carry pulses to specific recipient cells in other parts of the brain or the body. It is estimated that there are between 149,000 and 176,000 km of axoms in the human brain. Although the brain only accounts for around 2% body weight, it receives 15% of cardiac output, 20% of total body oxygen and 25% of total body glucose utilization.

Human brains have the same general structure as the brains of other mammals, but they are over three times larger than that of any mammal of equivalent body size. Most of this expansion comes from the cerebral cortex - a layer of neural tissue that covers the surface of the forebrain. Especially expanded are the frontal lobes which are involved in executive functions such as:

 Self-control

 Planning

 Reasoning

 Abstract thought

The area of the brain for vision is also greatly enlarged in the human brain.

The brain is protected by – 1. The thick bones of the skull; 2. Suspension in cerebrospinal fluid; 3. Isolation from the bloodstream by the blood / brain barrier. Despite this, the complex and delicate nature of the brain makes it susceptible to many types of damage and disease.

We like to think of the brain as each person's own personal and private 3lb universe. It is the means by which we experience ourselves and our environment. The brain can be thought of as an information processor. Our experience of ourselves, and our environment is dependent on the brain's ability to receive, process, store, retrieve and transmit information………

1 The brain can store information for more than a century

2 The brain uses a range of sensors that sample vibration, electromagnetic radiation, chemicals and pressure. It then prioritises in seconds what is of interest or concern.

3 The brain co-ordinates all of the 640 muscles in our bodies

4 The brain looks after the essentials of energy generation, and survival with little thought, freeing our minds to socialise, ponder the meaning of our existence and to learn from our experiences.

5 It enables us to worry……and to fear….and question the truth of "I think therefore I am"…….

Even though the brain represents a small proportion of the total body, it is such an essential organ that it uses a large percentage of all the energy generated by the body working 24 hours a day. From birth it has taken us about twenty two years of development and maturation to achieve optimal brain functioning as an adult. During this times the 100 billion cells that make up the brain have specialised and organised themselves to process enormous amounts of information in a split second. Comparatively the brain has the processing capacity of about 120 million typical 'Pentium 4' computers.

The ability to think, see, smell, feel, remember, and behave appropriately is dependent on the brain correctly processing information. Importantly then, even minor brain damage can result in permanent impairments in function. Such impairments can often interfere with normal everyday activities even if the person appears perfectly competent.

Equally importantly, the brain is the organ of the mind. It contains the very essence of who we are, what we think of ourselves and how we interact with the world. No two people are the same and therefore, no two brain injuries are the same.

At this juncture it is important to revisit different areas of the brain and their relation to function. The brain is split into 2 halves (left and right hemispheres and each hemisphere is made up of four lobes (frontal, temporal, parietal and occipital lobes) which make up most of the brain – the cerebral cortex. The two hemispheres are joined in the middle and information crosses between them so that they don't act independently – the left hand actually does know what the right hand is doing! Much of the information relating to the left side of the body is processed in the right hemisphere and vice versa. The pathways along which information is transmitted have to cross over. In general terms, the right hemisphere controls the left side of the body and the left hemisphere controls the right. In most people the left hemisphere is the dominant hemisphere, which is why most people are right-handed. The dominant hemisphere also contains other important processes like language and memory.

The frontal lobes of the brain in humans are significantly larger than in other animals and their functioning is very complex. The frontal lobes are responsible for all our complex movements and actions. Behaviour is a combination of movements often pre-programmed and carefully co-ordinated with a clear purpose or goal. Parts of the frontal lobes are involved with judgement – or determining whether a particular action or behaviour should take place and weighing up the consequences and the pros and cons. All of which takes place in a split second. The frontal lobes are involved with many functions that we would consider to be the human mind:- empathy with others, planning and organising activities or determining the consequences of actions. This role of the frontal lobes is known as 'executive function'. The frontal lobes are also the seat of our personality, our identity and our sense of self. The brain continues to change into the early 20's, with the frontal lobes (notably responsible for reasoning and problem solving) developing last…… "We were young, we were foolish, we were arrogant, but we were right".

Immaturity of, or damage to, these structures may not result in problems or difficulties that are immediately obvious. Even when they are subjected to psychometric tests, many will still be intelligent and capable people. Unfortunately their ability to relate to their environment and their sense of self, may have nonetheless been fundamentally altered.

Left frontal lobe issues in head injury / brain injury:

- "A lack of behavioural spontaneity" - I struggle to generate my own cues and I'm only able to function in a familiar environment and with prompts…. This is not a lack of motivation though.

- "Stimulus-bound, leading to perseveration" – I do or say the same things over and over. I tend to risk take, rule break…. and be impulsive, inflexible and have disorganised behaviour.

- "Pseudo-depression" – I appear apathetic and indifferent with little emotion. I lack initiative but I do not complain of being unhappy.

Right frontal lobe issues in head injury / brain injury:

- "Pseudo-psychopathy" – I am immature and engage in childish behaviour. I am without tact or social judgement and often swear or use other inappropriate language.

In addition, people who have issues with the frontal parts of the brain involved with executive functions may also have problems with:

 Organising activities

 Setting realistic goals

 Motivation

 Making decisions and judgements

 Generating alternatives and options

 Impulsivity

 Insight

 Perseveration

 Social perception

 Abstract thinking

 Predicting outcome

Without appropriate support and what we refer to as 'capable environments', individuals frequently spiral downwards into a chaotic lifestyle. They make increasing demands on those around them, become frustrated, repeatedly failing at tasks and subsequently lose confidence. They become anxious, withdraw and self-isolate. They become suspicious. This leads to people becoming severely disabled and dependent despite on the surface appearing capable and intelligent. Psychiatrists may talk about an 'Organic Personality Disorder' or 'frontal lobe syndrome' where the expression of emotions, needs and impulses is particularly affected.

The limbic system is an area of the brain which is the seat of our appetites, drives and emotions. It is not a discrete structure or area of the brain, but is made up of a number of interconnected areas. It is closely associated with the hypothalamus and pituitary gland and as a consequence plays an important role in regulating hormones and maintaining the correct chemical balance in our bodies.

The limbic system acts very much like the "thermostat" of the brain. In limbic dysfunction the brain "over-heats" and this produces a recognised group of symptoms which include:

- Sudden depressed moods often with suicidal thoughts

- Sudden childish, silly or fatuous behaviour out of keeping with usual patterns and "over the top"

- Outbursts of rage and aggression. Typically the outburst is out of all proportion to the provocation. The individual presents with a fear of losing control and injuring someone, homicidal ideas, repeated acts of aggression (frequently worse when under the influence of alcohol), impulsivity, or dangerous use of a vehicle.

Symptoms of left temporal lobe problems in head injury / brain injury:

- "Problems with speech and language" - I have difficulties processing and understanding what is said.

- "Problems with sequential memory"– I can recall the gist of what is said but not the detail.

- "Problems with affect" – I can be over-emotional, hypochondriacal and depressed.

- "Problems with personality" – I can be egocentric, paranoid and aggressive.

Symptoms of right temporal lobe problems in head injury / brain injury:

- "Impaired long term memory" – I have problems with pictures, faces and places.

- "Impaired non-verbal communication" – I have problems interpreting body language, facial expression and tone of voice

- "Impaired social insight" – I tend to appear indifferent. I use inappropriate humour along with fatuous, inappropriate emotional reactions and impulsivity.

Symptoms of left parietal lobe problems in head injury / brain injury:

- "Impaired verbal short term memory" – I struggle to 'keep up' in conversations and therefore more is not merrier for me.

- "Agraphia" – I have an inability to write.

- "Dyscalculia" - I have an inability to do arithmetic.

Symptoms of right parietal lobe problems in head injury / brain injury:

- "Constructional apraxia" – I am very clumsy.

- "Disengagement" – I find it difficult to shift my attention from one stimulus to another.

- "Impaired visual short term memory" – I struggle to remember what I have just seen.

 </content:encoded> 2015-11-16T14:16:00Z 2015-11-16T14:16:00Z


text: When our angels call our attention to repeating number sequences, it is a sign of their power, love and devotion. Your reader will do most of the talking, but feel free to interact. An exchange of energy will keep the connection strong. You have nothing to fear. A good psychic "sees" you without judgment. They are there to help. "Belief in psychic ability and the misattribution hypothesis: A qualitative review". British Journal of Psychology. 97, 323-338. I've only had the Golden Thread Tarot deck for about a month and I can already tell that I'm going to use it a lot. Both for readings for myself and other people. Many psychics are skilled in using many different tools in order to best service your needs. On each of those flaps, write a number 0 through 10, and under each of those numbers — a fortune. Fortunes are entirely up to the creator; generally it's best to keep them gender-neutral but written in declarative statements about a person's future — "you will. …" Things like, "you'll meet the person of your dreams tomorrow," or "you will be wildly successful in business," but keep in mind not all fortunes need to be positive. Once there are eight different fortunes written under each of the numbered flaps, the game can begin. All the great religions originated in specific cultural contexts. As a result each of them uses different concepts for what we call 'spirituality'. These are all fairly standard, however some sites offer things like video chat as well. Moved by the Spirit, the Institute of Spirituality in Asia (ISA) is a concrete response and contribution to the challenges of Asian faiths, cultures and traditions to build a world where there is fullness of life. ISA commits to the search and research of lived spirituality that is dynamic, transformative and liberating that leads to inter-faith dialogue and collaborations. As a Carmelite Institute of Spirituality in Asia, it strives to work for wholeness of life through scholarly and dialogic academic researches, academic programs and courses inspired and guided by the venerable faiths and spiritualities, principles and values of the great peoples and religions of Asia. For some people, it may seem easier to connect with a fortune teller using a familiar chat room interface. The questions and answers between you and your psychic happen in real time, and the insight you receive can be very powerful. Readings have been known to make people laugh or cry. Often the energy will have a physical manifestation. You may feel a tickling on the top of your head (7th chakra) or slight pressure on your forehead (6th chakra). The Rune above is Berkano, signifying birth. I've been reading the Runes (Elder Futhark) for years, both for myself and friends. This is a new beginning: offering to read for the public. A. Phone Psychic's Tales of Life, Lust & Love" as a potential television series. Psychic Phone Readings. It is a NO NO to pester for readings. Psychic Members have a choice to take requests or feel drawn to read, therefore we can't set a specific limit on how many chat readings a member is offered. Ever wondered just how accurate those telephone psychics are? You've probably seen the TV commercials: a bunch of women chatting it up on a couch, boasting about their psychic abilities, urging viewers to call their own "personal psychic.

subset: commoncrawl


text:
Shirley M. Dickmann, 73
May 18, 1942 — Nov. 3,2015
Shirley M. Dickmann, of Grafton, passed away peacefully on Nov. 3, 2015, at the age of 73 years.
A private family memorial gathering was held at the Mueller Funeral Home in Grafton. Memorials of your choice are appreciated. Please visit www.muellerfuneralhome.com to view the Shirley M. Dickmann video tribute or to send online condolences to the Dickmann family.
Shirley was born on May 18, 1942, in Port Washington, the daughter of Herbert Kassens and Alice (nee Kannenburg) Kassens. She was united in marriage to Charles Dickmann on June 25, 1960, at St. John's Lakefield Lutheran Church in Grafton. Their marriage was blessed with two children, Debra and Chuck.
In her earlier years, Shirley enjoyed shooting pool as well as bowling in various bowling leagues. She enjoyed playing bingo as well, but her true love was spending time with her loving family.
Shirley is survived by her beloved husband, Charles Dickmann Sr.; children, Debra (Lance) Dreher and Chuck (Brenda) Dickmann Jr.; grandchildren, Lance (April) Dreher Jr., Nathan (Kaleigh Hibner) Dreher, Ryan Dreher, Alyssa Dreher, and Ashley Dickmann; great-grandchild, Asher Dreher; and sister, Beverly Davis. She is further survived by other relatives and friends. Shirley was preceded in death by her parents, one sister and three brothers.


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Isabel Restrepo (nee Bastidas), age 75. Beloved wife of Fernando Restrepo. Cherished mother of Xavier Restrepo, Liza (Saul) Ayala, and Fernando (Crystal) Restrepo. Loving grandmother of Patricia, Aiyana, Ariyanda, Romello, Leo, and Nailah.... View Obituary & Service Information
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Idea: Just like any kind of acquisition deal, a residence customer's best choice is to depend on the similar sales and then deduct for the job that is required, based on actual estimates from licensed professionals. You might require to pay list price to acquire a residence that requires work if that changed rate lines up with the listed cost.
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I Buy Homes In Brunswick Tennessee
Short sale residences are marketed as is. You angle work out with the seller to repair them because the lender is eventually in control if there are troubles with the home. So if youre checking out brief sale homes, take mindful note of the condition of every one.
How To Sell A House As Is Brunswick Tennessee
Other articles that may be of interest to you:
- realtors that buy houses in Brunswick, TN
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- buy my house fast in Brunswick, TN


text:
Album: Blessed Be Your Name, Vol. 1
by Matt Redman
Verse 1:
When the music fades all is stripped away
And I simply come.
Longing just to bring something that's of worth
That would bless Your heart.
I'll bring you more than a song for a song in itself
Is not what you have required.
You search much deeper within through the way things appear
You're looking into my heart.
I'm coming back to the heart of worship and it's all about You.
It's all about You Jesus.
I'm sorry Lord for the thing I've made it
When it's all about You, It's all about You Jesus.
Verse 2:
King of endless worth. No one could express
How much You deserve.
Though I'm weak and poor, all I have is Yours.
Every single breath.
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text:
Click the link below for the order form for Senior Tribute Ads.
Senior tribute order form
Yearbook/Photography information for 2018-19 School Year
Yearbook Advisor: Ms. LaBarbara – email@example.com
School Pictures
Leonard's Photography Studio: http://new.leonards.com/
Students who want their senior photos in the yearbook must take their photos with Leonard's photography. Leonard's will be on campus June 20 & 21, July 30, (at Pine View Elementary) and September 20 at LOLHS. Appointment cards will be sent via mail (USPS). If students cannot make their time, or do not get something in the mail, they should call the studio to reschedule, or just come to the next scheduled photo day. If you cannot make these dates, you must go to the Tampa studio.
To confirm online or change appointment*:
Go to www.leonards.com > Seniors > login
No login? SCROLL DOWN School > Name > ID
If not in system, call 800-215-4852 for assistance
*Please note, summer appointments at the school locations get very busy. Plan ahead to be there for an hour and a half.
There is a $15 sitting fee that covers the cost of a photo session for one formal pose and one casual outfit pose to be included in the yearbook. (Checks should be made payable to: Leonard's)
Additional pricing includes photo sessions with more outfit changes that can be taken on the scheduled dates, or students can call for an appointment to go to Leonard's photography studio in Tampa.
- Photos taken on or before September 22 will have a choice of what pose they want included in the yearbook.
- Photos taken after September 23 will be included in the yearbook, but the photography studio will choose the poses used. Students who do not sit for the photos with Leonard's will NOT have their photos in the yearbook.
- LAST DAY for senior photos to be taken in order to make the yearbook is October 22, 2018.
- Picture day is September 7, 2018 (Order forms are passed out in English classes, and Open House night.)
- Picture make-up/retakes day is October 17, 2018
- Students will also receive a proof form to order photos online after picture day
*Students should make sure the spelling of their names is correct on their photo cards on picture day.
- Club Picture Day/Senior Panoramic will be on January 16, 2019
Yearbook Sales*
Walsworth Yearbook Company: https://yearbookforever.com
Yearbooks go on sale for the 2018-19 school year starting: 8/1/18
Either pay online directly through Walsworth* or use ACORN. Can also pay cash/check [payable to LOLHS] in room 522
*Walsworth has additional pricing for yearbook ad-ons; like engraving or covers
$65 until November 30
$75 December 1 – February 28
$85 March 1 – until sold out
Senior Tribute Ads – Complete application and turn in to Ms. LaBarbara Rm 522.
½ page 5 photos and 75 words – $100
Full page 10 photos and 150 words – $200
*Space is limited, on sale beginning of August until end of November, or until sold out
(Click the link at the top of the page for application)
*The Alligate yearbook is a student publication with a goal to encapsulate the school year's memories through photos and stories.


text:
Remember you found this company at Infoisinfo 922957421?
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text:
Dark Brown
- BEAUTIFUL & UNIQUE DESIGN. This essential oil diffuser with stylish wood grain finish matches any décor at your office or home perfectly, a lovely unit with fragrance (if you add several drops of oils into it) making your life beautiful and healthy.
14 SMOOTHING & COLORFUL LED LIGHT. There are 7 colors mood light to suit various environments. Each color has two further brightness modes(dim and brighter) to choose from, so totally you will get 14 colors to meet your different needs.
A PERFECT NIGHTLIGHT. This aroma diffuser has 15 lighting modes to create relaxing and romantic ambience. You can cycle it through 14 colors, set it to one fixed color or turn the light off. Put it in your child's room and use it as a night light for a restful night's sleep.
SAFETY PROTECTION. Three timer options: 1h/3h/Continuous. It holds 150ml/5oz of water and lasts about 5-8 hours, which will be auto-off when water runs out. No worrying about burning up. Made of BPA free material so there are no toxins.
MORE BENEFITS. This ultrasonic diffuser can offer therapeutic effects if you add some special water-soluble oils, alleviating the symptom of congested sinus, nasal passages etc. It also can help remove smoky smells, animal odors and provide a fresh air. The released negative ions enhance your mood for a happy life.
Shipping and Handling
This item is located in Canada.
There are no local pickups available.
All items will be shipped directly to you from our supplier within 1-3 business days after cleared payment. Most items are delivered within 3-6 business days after the item has been shipped, however, please allow 3-11 business days.
All items are in stock when they are listed. Inventory is tracked and updated regularly. However, if demand exceeds our supply, we will give the customer the following options: Full refund. Have the item back ordered and shipped when it becomes available. We will offer other items in similar style and quality. Your bid / purchase of the item implies you agree to this policy.
If you have a question about a product not otherwise answered in the item description, please contact us via eBay messages first and allow us the opportunity to help you and be sure we have what you're looking for.
Shipping to YT, NT, NU, NL, A0K, A0P, A0Q, A0R, and X0A-Y9Z may incur shipping charges or delivery restrictions. Please contact us before ordering
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We ship to most of Canada, However delivery restrictions may apply to Yukon, Nunavut and NW Territories.
PO BOX – we do ship to PO BOX, however some items may have delivery restrictions to PO boxes. if the item can not be delivered we will notify you by Ebay
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Some Remote or Rural addresses may experience a longer shipping time. And in some cases we may not be able to ship to your postal code due to restrictions from the delivery carrier. Please inquire about shipping availability and times if you live in remote or rural location.
Return Policy
All returns accepted
To qualify for the return, buyer should contact us within 14 days after receiving the item
Refund given as Money Back
Return shipping will be paid by the buyer
Your satisfaction is guaranteed! If for any reason you are unhappy with your item, just return it within 14 days for a full refund, minus shipping cost. Please contact us prior to initiating a return so that we can issue you a refund authorization.
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text:
Chelsea News: Tottenham striker WANTS Blues move, new deal for Bamford, midfielder's EXIT
STARSPORT brings you the latest news and transfer gossip from Premier League leaders Chelsea.
Patrick Bamford is set to be rewarded for his fine form on loan at Middlesbrough by being handed a new Chelsea deal, reports the Daily Mail.
The England under-21 star has fired Aitor Karanka's side to the brink of a return to the top flight.
And his permances at the Riverside Stadium have not gone unnoticed by Jose Mourinho.
The Mail also report that Tottenham striker Emmanuel Adebayor wants a switch to Stamford Bridge.
The Togo frontman is out of favour in north London, and reportedly is eyeing move across the capital.
Victor Moses' season is over after he picked up a hamstring injury in Stoke's draw at West Ham last weekend.
The Telegraph reports that the Nigeria international has returned to London for treatment for the injury.
Monaco are set to snap up midfield flop Gael Kakuta.
The Evening Standard suggest that the French youngster, who is currently on loan at Rayo Vallecano, is being lined up for a summer switch.


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Hakomatic b 430 manual - Hakomatic E B 450 Manual cherryfire.org
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IT50C S IT50C1 S Contents Operating Instructions 50cm Free Standing Electric Cooker GB English, 1 GB WARNING,2 Introduction, 3 Safety Information, 4 Installation, 5
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component of hospice care, specifically bereavement programs in Alaska and looks at the following essential components of an effective bereavement program: assessment, bereavement services, budget and funding, data collection, and research.
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UP-895MD - Price: Please Call (07) 5573 1797 Black and White Video Graphic Printer, high quality 1280 dot density, 256 shades of gray, printing speed: STD mode: 3.9 seconds, SIDE mode, 6.9 seconds, multiple print formats: normal, small and 2x zoom in both normal STD and SIDE modes.
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17/02/2007 · Asoka PlugLink 9650 Today I went out and snagged the PlugLink 9650 , which let me split my DSL connection through my house's electrical outlets. While I can only have one item online at any one time, this now means that my Xbox 360 is an …
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The 2013 Ford Fusion Hybrid's badging on the front doors. Kevin Mio , The Gazette The 2013 Ford Fusion Hybrid's rear end is topped capped by a spoiler, which is part of an optional package.
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Australian Capital Territory: Deakin ACT, Wright ACT, Scullin ACT, Crace ACT, McKellar ACT, ACT Australia 2623
New South Wales: Guyra NSW, Strathaird NSW, Comboyne NSW, Forster NSW, Boro NSW, NSW Australia 2073
Northern Territory: Ngukurr NT, Birdum NT, Hermannsburg NT, Haasts Bluff NT, Yulara NT, Tortilla Flats NT, NT Australia 0898
Queensland: Ravenswood QLD, Wonga Beach QLD, Jondaryan QLD, Bentley Park QLD, QLD Australia 4059
South Australia: Bookpurnong SA, Sherwood SA, North Booborowie SA, Nepabunna SA, Padthaway SA, Willson River SA, SA Australia 5076
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Victoria: Kallista VIC, Miga Lake VIC, Dartmouth VIC, Minyip VIC, Orford VIC, VIC Australia 3001
Western Australia: Isseka WA, Leeman WA, Gindalbie WA, WA Australia 6038
British Columbia: Oliver BC, Fraser Lake BC, Kelowna BC, Nanaimo BC, New Westminster BC, BC Canada, V8W 3W7
Yukon: Carmacks YT, Watson Lake YT, Rock Creek YT, Ten Mile YT, Teslin YT, YT Canada, Y1A 1C9
Alberta: Halkirk AB, Athabasca AB, Big Valley AB, Rosalind AB, Rycroft AB, Lamont AB, AB Canada, T5K 7J8
Northwest Territories: Norman Wells NT, Ulukhaktok NT, Gameti NT, Fort Simpson NT, NT Canada, X1A 6L9
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Manitoba: Virden MB, Notre Dame de Lourdes MB, Hamiota MB, MB Canada, R3B 8P7
Quebec: Portneuf QC, Saint-Andre-du-Lac-Saint-Jean QC, Tring-Jonction QC, Maniwaki QC, Montreal West QC, QC Canada, H2Y 3W6
New Brunswick: Cap-Pele NB, Richibucto NB, Beresford NB, NB Canada, E3B 8H3
Nova Scotia: Mahone Bay NS, Lunenburg NS, Oxford NS, NS Canada, B3J 1S3
Prince Edward Island: Northport PE, Tignish PE, St. Peters Bay PE, PE Canada, C1A 2N7
Newfoundland and Labrador: Brent's Cove NL, St. Alban's NL, Rigolet NL, Branch NL, NL Canada, A1B 5J8
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Wales: Barry WAL, Neath WAL, Swansea WAL, Newport WAL, Neath WAL, WAL United Kingdom CF24 4D8


text:
|Selfreport on 2 questions:
A " How often did you feel that things were going your way
during the past week?"
B" How often did you feel depressed or very unhappy during the past week?"
Answer options:
0 not at all
1 once
2 several times
3 often
Summation: average scores on A and B
|Focus, A-BBr
|Affect: Balance (Brenner's index)
|Time frame, cw
|last week
|Mode, mq
|multiple questions
|Scale type, v
|verbal scale Range = 4
|Used in studies


text:
Daily Links For ThursdayLink
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Contributed by Max Chiriac, Julian Moffatt, and Wil Alambre over the course of January 17th…
Acapella cover Knew You Were Trouble - WALK OFF THE EARTH Feat. KRNFX
From the same guys who made Somebody That I Used to Know - Gotye cover
What No One Told You About Z-Index
Great writeup about some caveats CSS Z-Index spec have
A List Apart : A Pixel Identity Crisis
We were actually just talking about how we are going to move from basing everything on 1px. Good, quick read over at A List Apart on the hardware pixel, the one all of us have been using which refers to the smallest visible dot on your screen versus the reference pixel, which is defined as an optical reference pixel that can be used by software regardless of screen resolution.
If everyone gets on board with this it should be great. If it goes the way browsers went back in 1999, it will be a nightmare.
For Amusement Only
Laura June writes a great article on the life and death of the American arcade. Must reading for anyone who fondly remembers spending dozens of childhood hours and quarters.


text:
The Christmas Collection
AbeBooks Seller Since 14 August 2015Quantity Available: 1
Stock Image
AbeBooks Seller Since 14 August 2015Quantity Available: 1
About this Item
Bibliographic Details
Title: The Christmas Collection
Publisher: Hamlyn
Publication Date: 1998
Binding: Hardcover
Book Condition: Good
About this title
A recipe book exploring the Christmas sweetmeats from many different areas throughout the world, including northern Europe, the Mediterranean, Scandinavia, Russia, New Zealand and the USA. More than a hundred recipes are included, many illustrated with colour photographs.
"About this title" may belong to another edition of this title.
Store Description
Buy with confidence. Excellent customer service. 30 day return policy.
Books Express LLC
1465 Woodbury Ave
Portsmouth NH 03801
Default shipping is by USPS Media Mail and frequently USPS Priority Mail or UPS Ground is used. Books should arrive within 5-45 business days for expedited shipping, and 7-60 business days for standard shipping. Standard shipping can on occasion take up to 60 days for delivery.
Payment Methods
accepted by seller
Check Money Order PayPal Invoice Bank Draft Bank/Wire Transfer Direct Debit (Personally Authorized Payment)


text:
The MNN newsletter is delivered every Monday, Wednesday and Friday.
"We travel to the retreating ice margins, sample newly exposed plants preserved on these ancient landscapes and carbon date the plants to get a sense of when the ice last advanced over that location", Pendleton explained. Like the rest of the Arctic circle, the region is experiencing warming at a rate twice the global average - so much so that plants and moss that haven't been exposed since the last ice age are now starting to creep through the melting ice.
Researchers studying glacial retreat on Baffin Island in the Canadian Arctic have discovered landscapes and plant life that have not been seen for more than 40,000 years. In some regions, the current edge of the ice cap is up to a football field's length away from the previous edge from only a couple years ago. Where glaciers flow and grind down on the earth beneath them, ice caps are static.
"The high elevation landscapes that host these landscapes are striking in their own right, but knowing that the surface that you are walking on has been ice covered for millennia, and only now being exposed, is humbling", lead study author Simon Pendleton told MNN. "But by using what our data says about continuous cover for the last 40,000 years, and using the temperature records, we can speculate that they have been continuously ice-covered for the last 120,000 years".
Gmail's app is about to look totally different
It's also easier to switch between personal and work accounts, so you can access all of your emails without breaking a sweat. Google says it will be updating the rest of its G Suite mobile apps with a similar redesign later this year as well.
"Our last century of warmth is likely greater than any century in the last 120,000 years". The latter conserves lichens and moss in their original position in the ice for periods of time lasting thousands of years - a little like a cryogenic chamber.
Pendleton and others collected samples from around 30 ice caps and conducted radiocarbon dating to determine their age. Year to year, since Pendleton first came to the island in 2005, he has seen ice gradually retreating from the edge of the ice cap.
The modern-day retreat of glaciers and ice caps on Baffin Island are revealing plants preserved beneath them that can shed light on the last time the Arctic was as warm as it is now.
Pendleton said radiocarbon dating's effectiveness only goes back about 40,000 years; hence, his findings that ice coverage of the region under study goes back "at least" 40,000 years.
Isaac Success lead Watford into FA Cup fifth round
Watford boss Javi Gracia said: "In this moment we are in a good position in the league, but we are in January yet and there's a lot of games in both competitions".
According to the study, these results, combined with data from ice cores taken on Baffin Island and Greenland, suggest that the region is now experiencing its warmest century in 115,000 years.
"These trends are likely to continue and remove all ice from Baffin Island within the next few centuries", the study concluded, "even in the absence of additional summer warming".
As ice caps recede even further, scientists could expose even more ancient landscapes.
Huawei charges an attempt to 'strangle' Chinese business, Beijing says
Nonetheless the us charges raise pressure on Canada, which is already bearing the brunt of Beijing's wrath over Meng's arrest. Justice Department on Monday laid out its claims against Meng and stated it would proceed with an extradition request.


text: It doesn't' matter whether you are an expert cook or you are a beginner, choosing or buying the best seafood out there can be a very overwhelming process. You must understand that a wrong choice of seafood can turn your presentable meal into a disaster. It is essential that you take the time to find… Continue reading Looking for the Best Seafood Market and Restaurant?