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South African Journal of Occupational Therapy
On-line version ISSN 2310-3833
Print version ISSN 0038-2337
S. Afr. j. occup. ther. vol.44 n.1 Pretoria Jan. 2014
A proposal for an undergraduate stroke rehabilitation curriculum appropriate for South African occupational therapy
Juliana FreemeI; Daleen CasteleijnII
IBSc OT (Wits), MSc. OT (Wits); Lecturer, Department of Occupational Therapy, School of Therapeutic Sciences, University of the Witwatersrand
IIB Occ Ther (UP), B Occ Ther (Hons) (Medunsa), PG Dip Vocational Rehabilitation (UP), Dip Higher Education and Training Practices (UP), M Occ Ther (UP), PhD (UP); Associate Professor, Department of Occupational Therapy School of Therapeutic Sciences, University of the Witwatersrand
The incidence of stroke will likely increase in the next few decades as the expected health of sub-Saharan Africans is predicted to deteriorate as a result of increasing infectious and poverty-related diseases. In addition, studies have shown that the risk factors for vascular disease as well as the increasing age of the population will add to this problem. Effective curriculum planning regarding stroke rehabilitation in tertiary educational institutions training occupational therapy students should be a pertinent topic in South Africa. This paper explores the opinions of clinicians and experts in the field of neurology about the occupational therapy stroke rehabilitation curricula. It also aims to clarify and evaluate opinions regarding occupational therapy stroke rehabilitation curricula, by raising awareness of the issues pertaining to the current educational curricula. Two combined methods were used which included a curriculum audit and a panel discussion. Specific information was extracted from the audit regarding the requirements for training in stroke rehabilitation, revising the number of stroke rehabilitation theories taught, the use of updated and uniform terminology across all universities, and lastly the need to teach and use standardised assessments to measure effectiveness of stroke rehabilitation techniques. Several common topics arose from the panel discussion, including the need for a suitable stroke rehabilitation theory, the difficulties in supervising students due to outdated and conflicting use of stroke rehabilitation terminology, and the importance of focussing the curricula on the needs of the South African community.
Keywords: Stroke rehabilitation, curriculum, occupational therapy training, South Africa
Stroke has been identified as an important cause of death and disability worldwide. Recently the impact of this condition on lower income countries has drawn significant attention1. The incidence of stroke is said to increase in the next few decades as the expected health of sub-Saharan Africans is predicted to deteriorate as a result of increasing infectious and poverty-related diseases1. Morbidity will likely increase due to demographic transition which leads to an increase in factors that are associated with an escalation in risk of stroke, such as unhealthy lifestyles, increased stress, lack of proper nutrition, and the loss of family and close community support. These factors are characteristic of more rural areas1. Stroke is also associated with HIV infection2, as 10% to 20% of HIV infected patients show neurological symptoms as their first manifestation, up to 40% of patients with AIDS develop clinical neurological dysfunction and up to 75% to 90% of autopsies indicate neurological involvement in persons with advanced AIDS. Sub-Saharan Africa faces an enormous burden of infectious diseases including HIV/AIDS, and therefore this directly impacts the increase in number of stroke patients who would need rehabilitation1.
Due to the disabling effects of stroke, occupational therapists are required to treat this population of patients by facilitating and improving motor control and hand function in the hemiplegic upper limb, maximising the patient's ability to perform occupational performance tasks, helping the patient manage cognitive, perceptual and behavioural changes due to the stroke, and preparing the patient for return to home and work environments3. Occupational therapists aim to facilitate task performance by improving relevant body functions and performance skills or through teaching compensatory techniques to overcome the loss of functional skills4. The burden of care of stroke survivors is also placed on caregivers and family members. Therefore, decreasing the burden of care as well as improving the quality of life of stroke survivors and their caregiv-ers is an essential role to be fulfilled by occupational therapists4.
Occupational therapists' patient load will be affected by the increased incidence of stroke in South Africa, and it is important that they are adequately trained to manage stroke patients effectively. It is important to explore whether the current occupational therapy stroke rehabilitation curricula are adequately preparing occupational therapists practising in this field to meet the demands of practice in this country.
Aligning the curriculum with clinical practice needs
The primary objective of universities offering occupational therapy training programmes is to generate competent, autonomous, and knowledgeable occupational therapists. This is achieved by providing professional education that teaches fundamental theoretical and clinical skills through academic and practical study5. The World Federation of Occupational Therapists (WFOT) minimum requirements for obtaining an occupational therapy degree reflect what is required of an occupational therapy graduate in terms of assessing and evaluating patients with physical dysfunction6. These minimum standards for education and entry-level competencies for occupational therapy require that entry level occupational therapists should be competently trained in all conditions based on the local health needs of a community7. As stroke is one of South Africa's most significant causes of illness and disability8, it requires the appropriate attention in an occupational therapy training programme, as most of an occupational therapist's workload in a general practice with physically dysfunctional patients is comprised of the management of stroke patients9,10.
The guidelines provided by McCluskey11 are broad enough to give curriculum developers flexibility in terms of the content and emphasis of a stroke rehabilitation course. In South Africa, the stroke rehabilitation curricula are not standardised across the training centres offering occupational therapy programmes. These variations in curricula, programme design and educational references in the different universities could result in discrepancies in terminology, skills and techniques in stroke rehabilitation.
With the current wide range of therapy interventions that exist, curriculum developers and researchers could consult occupational therapists in the field regarding methods they find effective and appropriate in clinical practice, and they could consider these opinions in curriculum development12. The curriculum design and content of university courses would usually also consider, amongst other factors, the work required of an entry-level occupational therapist9. Decisions regarding the development of suitable stroke rehabilitation curricula may therefore be shaped by academic as well as experienced occupational therapists practising in this area. A disparity between occupational therapy education and practice has been found, and one way to close the gap is to align curriculum content to clinical practice12 by better collaboration between academics and clinicians.
Academics are often perceived to only value evidence and theory, and clinicians argue that they need to react to difficult and complex situations immediately and spontaneously, and skills and techniques they were taught might not always be applicable in reality12. In the opinion of the author, the ideal curriculum should therefore consider what the latest research has developed in terms of skills and knowledge, but it should also be sensitive to, and incorporate, the needs and available resources of the occupational therapists and patients. Most importantly, the curriculum should consider the health needs of the community, as also reinforced in the WFOT minimum requirements for training.
In other countries such as the USA, the challenge of aligning the content of a curriculum with the requirements of clinical practice has been continuing since a study in 1979. A study has found discrepancies between the treatment activities therapists had been taught during their academic courses and activities they were using in clinical practice9, but no literature is currently available regarding the situation in South Africa. One reason for the disparity between training and practice may be that many of the techniques and skills that students are taught are developed and researched in countries other than South Africa. The available research on stroke rehabilitation has been completed in developed countries such as the United Kingdom (Neurodevelopmental therapy13) and Australia (Motor relearning theory14) and Norway15, making it difficult to translate to local interventions. This could be due to the differences in resources, patient profiles, comorbid disease profiles and available time for rehabilitation. Occupational therapists in South Africa should be careful not to accept what is prescribed by research in western countries without proper interrogation of the applicability and appropriateness in the South African context16.
The average South African stroke patient may present differently from the average British or Australian patient, as the majority of South Africans still face challenges such as extreme poverty, lack of basic resources (e.g. running water and electricity) and the effect of HIV/AIDS on stroke presentation and prognosis8. Addressing functional activities such as collecting water from a distant source is a different challenge to a stroke patient in England learning how to drive again. Patients are often unable to attend out-patient therapy due to the lack of public transport for disabled persons, and due to the low socio-economic situation of disabled persons, private transport is most often not an option in the South African context. Vast distances may further complicate their ability to reach the nearest rehabilitation centres17. Co-morbid conditions associated with poor nutrition, poor sanitation and overcrowding also affect the recovery rate of stroke patients, which then require more intensive therapy. This is not always possible due to the restriction of access to therapy and the therapists' heavy patient-load8,16,17. Stroke rehabilitation is therefore a complex process, and requires a high level of experience and problem solving skills to influence the patients' ability to function as independently as possible.
An appropriate starting point for developing or revising a curriculum should be with the priorities of the stroke rehabilitation practices and the problems clinicians find most important to address. Training should then align with the health needs and available resources of the patient population.
In a previous study carried out in Australia regarding collaborative curriculum development in neurology, occupational therapy clinicians elaborated on the components they felt stroke rehabilitation training should include11. They specifically highlighted the importance of teaching thorough assessment skills in stroke rehabilitation, choosing appropriate stroke rehabilitation theories to include in the curriculum and building confidence in occupational therapy students by giving sufficient opportunities for practising the management of stroke patients during their training11.
Assessment in stroke rehabilitation
It has also been felt that there is a need to use standardised assessments to ensure rehabilitation goals are related to activity and participation18. These goals must be specific, measurable and attainable, realistic, and relevant to the individual person3. From previous reviews, it is clear how important standardised assessments are to show effectiveness of techniques and the value of occupational therapy3,18. There should therefore be exposure to appropriate and relevant standardised assessments during the training of occupational therapy students. Educators should scrutinise assessment tools based on the areas in which occupational therapists will practise, the resources available and the population being assessed18. As universities aim to train competent occupational therapists, part of their competence should be to assess stroke patients thoroughly. This will be credible within the multi-disciplinary team, within the occupational therapy profession and, most importantly, in the best interest of the patient11.
Examples of standardised measures for assessment of areas of occupation in stroke rehabilitation include the Functional independence measure (FIM)19, Barthel index20 and the Assessment of Motor and Process Skills (AMPS)21. Several standardised assessments for evaluating perceptual functions after stroke are available, and a commonly used one is the Rivermead Perceptual Assessment Battery (RPAB)22. Some of the common visual perceptual disorders seen in stroke patients are agnosia, figure-ground, depth perception and body scheme disorders, and unilateral neglect23,24. These disorders affect the ability of the patient to move normally in order to perform tasks in all areas of occupation. Assessments available for measurement of cognitive, memory and executive functioning abilities are the Mini Mental State Examination (MMSE)25, the Cognitive Assessment of Minnesota (CAM)26, the Rivermead Behavioural Memory Assessment (RBMA)27 and the AMPS3. Several standardised assessments are available to measure the neuromusculoskeletal and movement related functions. The most commonly used assessment to test for an increase in muscle tone is the Modified Ashworth scale3. Manual muscle testing, grip and pinch strengths can be measured using the Oxford scale and a dy-namometer3. Assessments commonly used to evaluate the return of movement in the limbs and hand is the Fugl-Meyer Assessment of Motor Recovery after stroke3,28 and the Motor Assessment Scale29. There is no single upper limb assessment method that is universally accepted3 therefore results of assessments recording the patient's ability to move must be correlated with the patient's ability to perform functional activities.
Stroke rehabilitation theories
Another factor that has been highlighted is the need to teach appropriate stroke rehabilitation theories, which focusses on motor retraining, particularly of the upper limb11. The occupational therapy clinicians in the McClusky11 study identified Proprioceptive Neuromuscular Facilitation (PNF) theory, the Neurodevelopmental theory (NDT), and the Motor Relearning Theory (MRT) as suitable theories to be included in a curriculum11. Although, previous studies have not included the MRT in the curricula, this study from Australia supported its inclusion11. However, the study also showed that occupational therapy clinicians are of the opinion that a curriculum should not teach several theories, but rather focus on a smaller number of theories. The saying "Jack of all trades, but master of none" may become true. If occupational therapists are trained in multiple stroke rehabilitation theories; they may run the risk of knowing a little of everything, but due to the time constraints in a full curriculum, there may not be enough time to adequately comprehend each theory11. Novice occupational therapists practicing in this field may also feel overwhelmed by the large number of theories that inform practice.
The NDT theory is a popular approach used by occupational therapists worldwide, as well as all the members of the neurological rehabilitation multidisciplinary teaml3,30,3l,32. The original NDT theory developed by Bobath and Bobath in the 1940s included the use of manual techniques to eliminate spasticity and dysfunctional movement patterns and to retrain normal patterns of coordination in the affected trunk, arm, and leg. The Bobaths have presented their methods and theories in two well-known books published in l974 and in l99033,34. NDT is based on current neurophysiology, muscle, and motor learning to promote specificity and individuality in assessment and treatment35. The main goal for treatment is normal functioning, to minimise impairments and to prevent disabilities. The therapist uses principles of movement science to address quality of movement, and this includes direct handling, including facilitation and inhibition, to optimise function36. There is however limited research indicating the effectiveness of this theory in the rehabilitation of stroke patients31,37, and it has not been shown to be superior to other methods of intervention30,38.
The MRT by Carr and Shepherd suggests that active practice of context specific motor tasks with appropriate feedback would promote motor learning and motor recovery. The MRT is based on the dynamic systems theory of motor control, the neuroplasticity of the CNS, and the maladaptive biomechanical changes that occur after CNS injuryl4,39. Principles of motor learning guide the therapist in structuring the therapeutic environment to maximise the patient's recovery of motor function39. The emphasis is on training for control of the muscles and preserving the integrity of the musculoskeletal system, as well as on promoting the learning of relevant actions and enabling active participation by the patientl4.
The Brunnström theory is another theory well known in South Africa. This theory encourages treatment that progresses developmentally from evocation of reflex responses to willed control of voluntary movement, to automatic, functional movements40. Emphasis is placed on the importance of voluntary willed movements, and a patient will be more successful with familiar movements with a goal, and repetition of the correct movement is essential for motor learning. There are limited studies available to support the effectiveness of this theory, and some of the basic research of this theory seems to be outdated.
The Rood theory is also a theory used in stroke rehabilitation by occupational therapists. This theory uses facilitation techniques to facilitate muscle activation, and this includes tactile, thermal, proprioceptive and special senses. A therapist trained in the Rood theory will use facilitation techniques to elicit muscle activity, and inhibitory techniques are used for the treatment of hypertonicity41. Some of the techniques address the neural component of hypertonicity (spasticity), and the visco-elastic components (hypertonicity and secondary impairments). These facilitation and inhibition techniques must be used in conjunction with goal directed action for the purpose of developing movement related abilities4l. Again, there is very little evidence to support the effectiveness of this method of intervention.
It is crucial that occupational therapy stroke rehabilitation curricula are continuously reviewed to ensure that occupational therapists qualify with basic and essential knowledge and skills to manage stroke patients in South Africa, understanding the complexities of the condition, but also understanding the complexities of the South African population and its health needs. Occupational therapists should also not follow theories blindly after their training, but should continually evaluate their patients' progress through reliable and valid assessments to ensure that their intervention is effective.
Course requirements for training confident occupational therapists
As the field of neurology is complex, it is a difficult area of practice in which occupational therapists have to build confidence. This factor was identified by the occupational therapy clinicians in the Australian study as essential in assessment and treatment of patients with neurological dysfunction11. In order to gain confidence, students should build a sound theoretical base by ensuring that they read, understand and discuss current literature in neurology11. It is also essential that students gain knowledge and confidence through supervised practice of skills. Students need actual hands-on experience of handling patients with neurological dysfunctionll and it is crucial that students are supervised by occupational therapists with sound foundational knowledge, good assessment and treatment skills, and excellent justification for their use of specific theories. Supervisors with sound evidence based practice knowledge and skills and who are role models in their practice of stroke rehabilitation theories should be selected to be involved in student training.
The methodology will be presented in two parts. The first part relates to the curriculum audit and the second part to the panel discussion. The audit was done as part of a M.Sc. (Occupational Therapy) study. The recommendations from this study led to the researcher seeking to further discuss the issues regarding the training of occupational therapists in the field of stroke rehabilitation. A panel discussion was held at the occupational therapy association of South Africa's (OTASA) conference held in Kwa-Zulu Natal in July 2012 to elaborate on the topic.
Methodology of survey
A cross-sectional descriptive survey was used to audit the stroke rehabilitation curricula of the occupational therapy training centres in South Africa. Lecturers responsible for the teaching of stroke rehabilitation at all eight occupational therapy training centres were invited to participate in the study. This was done by providing the necessary information regarding the content of the curricula at the centres. The study sample consisted of seven of the eight occupational therapy training centres in South Africa that gave permission to participate in the study (the universities of the Witwatersrand, the Free State, Pretoria, the Western Cape, Stellenbosch, Kwa-Zulu Natal and Cape Town). One lecturer from each centre submitted the information for the audit.
The research measuring instrument used to obtain information for the curriculum audit was an electronic, self-administered form. Curricular structures were different at each university; therefore the researcher asked specific questions and requested documentation in order to make a comparison between the courses. The curriculum audit form was purpose-designed for the study, based on a questionnaire used in studies done in the UK, Australia, New Zealand, Canada, and South Africa5. A pilot study was done with the curriculum audit form and adaptations were made according to the recommendations that arose from the pilot study. The audit consisted of two sections where the researcher requested information regarding the content of the curricula in the first part, and specific closed-ended questions were presented in the second part.
The curriculum content specifically focussed on the structure and the objectives set for the course.
The information requested in the second part included:
- The specific requirements regarding the number of patients with neurological dysfunction, and the estimated number of patients with neurological dysfunction the students would assess and treat during the four year course.
- The stroke rehabilitation theories taught to the students during the four year course.
- The stroke rehabilitation assessments (standardised and non-standardised) taught to the students during the four year course.
The researcher collected all the information electronically from the respective lecturers.
Descriptive analysis was done to ascertain the content of the different courses. The data were processed and presented in tables and figures.
Methodology of panel discussion
Participants for the panel discussion were invited prior to the OTASA conference in July 2012. The researcher invited all registered attendees of the conference to participate as panelists in the panel discussion. The invitation was sent through the conference organisers. Four panelists were selected by the researcher to participate. The panelists were selected if they were occupational therapists practising in the field of stroke rehabilitation and the researcher ensured that they were from diverse backgrounds. The panel included two lecturers from different training centres, one newly qualified occupational therapist and an occupational therapist experienced in the field of stroke rehabilitation. Each panelist was asked to prepare a five minute presentation on (i) perceived current assets to enable effective practice and training in stroke rehabilitation (ii) perceived current frustrations and barriers preventing effective practice and training in stroke rehabilitation (iii) perceived problems with the current curricula (iv) perceived strengths of the current curricula, and (v) suggestions for the future of stroke rehabilitation training in South Africa. The audience was able to ask questions and give their comments to the panel. The panelists and audience members gave informed consent to participate and to be audio recorded. The panel discussion was recorded and transcribed by the researcher. The main points from the panel discussion were summarised, and organised based on the answers from the curriculum audit, i.e. the requirements of the courses, the stroke rehabilitation theories taught and the assessments taught.
The results from the curriculum audit and the main points from the panel discussion are presented under the following headings: The stroke rehabilitation curricula content, the specific requirements, the stroke rehabilitation theories and the assessments taught.
The stroke rehabilitation curricula content
The typical route for qualifying as an occupational therapist in South Africa is through a four year degree at any one of the eight training centres. The training centres have differently structured programmes. The students will have some exposure to patients in the first three years, but the final year of the course consists mainly of clinical fieldwork practice under the supervision of qualified occupational therapists. Students only have exposure to stroke patients when they are in a setting for the treatment of patients with physical dysfunction, or a community setting where they would manage patients with a variety of physical and psychiatric conditions.
The researcher found differences in the requirements of assessment and treatment of stroke patients at the training centres, due to the different structures of the occupational therapy courses. Some training centres teach clinical skills in occupational therapy applied to physical dysfunction, psychiatric dysfunction and applied to paediatrics in one course, and theoretical foundations in another. At other training centres, physical dysfunction, psychiatry, and paediatrics are taught theoretically and practically in different courses. Comparison of the stroke rehabilitation courses is therefore difficult due to these differences in the curricular structures.
Modes of teaching were unique to each setting and curricular structure. These methods ranged from problem based learning, traditional teaching, case based teaching, and a hybridisation of different methods. Training centres were similar in their structure of clinical fieldwork. Occupational therapy students were exposed to clinical fieldwork practice with patients in all junior years, and they have an opportunity to manage stroke patients in a variety of settings in the final year of study.
Specific requirements in stroke rehabilitation courses
None of the training centres indicated that there are stipulated requirements regarding the number of stroke patients assessed and treated during the four year course. The lecturers noted that the number of stroke patients managed during the four year course depends on where the student is placed during clinical fieldwork. All the centres reported that the students have the opportunity to practise assessment and/or treatment skills with at least one stroke patient during the four years of training. Thus, an occupational therapist may graduate after assessing and/or treating only one stroke patient and still meet the minimum requirements for training in occupational therapy.
A concern raised in the panel discussion was the insufficient amount of time in the curriculum to teach and practise stroke rehabilitation clinical skills. While some training centres are equipped with state-of-the-art clinical skills laboratories for students to use independently and in their study time, the current frustration is that students do not seem to utilise this facility optimally. The students still require some instructions and guidance due to the complexity of stroke rehabilitation.
Results from the panel discussion indicated that there does not seem to be a shortage of appropriate patients for students to practise their skills, and there are sufficient placements for students to do clinical fieldwork. There are also sufficient opportunities for students to be exposed to stroke patients, but students sometimes lack correct guidance from supervisors or are exposed to supervisors who practise differently due to diverse training.
Panelists discussed the difficulty of separating undergraduate skills and requirements from postgraduate requirements, as stroke rehabilitation is complex. The audience also emphasised the difficulties of expecting unrealistic knowledge, skill and experience from newly-qualified occupational therapists. A high level of skill is often expected after only minimal contact with stroke patients in training. The complexity of stroke rehabilitation was noted, reminding occupational therapists and lecturers of the high level of skills and knowledge that are required to manage stroke patients effectively; which only comes with postgraduate training and several years of experience.
Stroke rehabilitation theories taught at an undergraduate level
As can be seen in Table I the NDT theory is taught at all the centers in the sample (n = 7). Only three centers are providing training to the students in the MRT and Brunnström theory. Only two centres are including the Rood theory in their training.
During the panel discussion it was noted that the NDT theory is seen as the most superior theory to use in South African stroke rehabilitation. This was also raised by the audience as a concern in terms of the status attached to NDT training and the expectation that all occupational therapists working in stroke rehabilitation should be trained in NDT in order to be competent. A point was raised that there was insufficient evidence to show that this theory is the most effective theory to use in the South African context.
Assessments taught at an undergraduate level Non-standardised assessments
All the training centres in the sample taught assessment of the commonly affected body functions: balance, muscle tone, postural control, coordination and range of motion as part of the undergraduate training (see Figure I). Commonly affected body functions such as cardiac and muscular endurance are only taught at four centers (57.1%), and selective control of movement is taught at only three centres (42.9%). At five centres muscle strength assessment is taught, although it was not determined if this is taught in relation to neurological conditions specifically, or in general (i.e. as part of the musculoskeletal conditions).
There was also a discussion by panelists and the audience around curricula being outdated in terms of terminology. There seems to be an outdated focus on treatment of certain body functions and performance skills such as spasticity, and the lack of teaching of skills in muscle strengthening and alleviating secondary impairments caused by stroke. The view of the panelists was that students become frustrated when they are supervised by clinicians from different universities, as some clinicians avoid muscle strengthening, while others believe firmly in normalising muscle tone.
Standardised assessments
A wide range of options were given in the survey, and the participants had to select the standardised assessments taught at their training centres (see Figure 2). The Rivermead Perceptual Assessment Battery (RPAB)22 is taught at three centres (42.9%) and the Canadian Occupational Performance Measure (COPM)42 and the Chessington Occupational Therapy Neurological Assessment Battery (COTNAB)43 are taught at two centres (28.57%). The Arm Motor Ability Test (AMAT)44, Motor Assessment Scale (MAS)29 and the Assessment of Motor and Process Skills (AMPS)21 are not taught at any of the centres.
The stroke rehabilitation curricula content
The diverse structures of the occupational therapy courses across the universities in South Africa will limit university departments' ability to standardise the stroke rehabilitation curricula. A solution would be for university lecturers and curriculum developers to join with experienced occupational therapists working in the field of stroke rehabilitation to align the curriculum with the situation in the clinical field, so that the stroke rehabilitation course is appropriate for an entry level occupational therapist. It is suggested that curriculum developers at the training centres should review the exact core competencies or basic skills required of entry-level occupational therapists in the field of neurological rehabilitation. A reduction in the amount of information given in a course could allow for more time to practise essential clinical skills. Further research is required regarding this topic, and a method of data collection to extract more in-depth information should be developed.
Course requirements for stroke rehabilitation
The survey and panel discussion highlighted that there are no set requirements regarding the assessment and treatment of stroke patients, particularly the number of patients seen during the four year undergraduate training course. The lack of set basic requirements is of concern as a novice's confidence in treating patients can only be developed through sufficient opportunities to practise. A study in the United Kingdom regarding graduates' perceptions of their preparation for clinical roles indicated that they felt ill-prepared for more specific evaluation procedures and that they needed more practical knowledge in their curricula5. It is recommended that training centres collaborate to revise the minimum requirements of training by agreeing on the minimum number of stroke patients a student should assess and treat during their clinical fieldwork experiences. As seen from the panel discussion, there is a great concern that students only being exposed to one stroke patient are unlikely to be competent in this field. The requirements for qualification should also state clearly that students should practise skills in both assessment and treatment. The Australian study stated that occupational therapists will only qualify with the necessary skills and confidence when the curriculum structure has allowed for sufficient practice opportunities with stroke patients11.
A recommendation made by the panelists was that educators could optimise students' learning experiences with teaching tools in addition to formal clinical placement opportunities to interact with and manage stroke patients. These tools could include videos, practical skills laboratories and patient simulations. Students could also have access to a variety of learning material available through electronic-learning, through lecturers and clinical supervisors developing electronic audiovisual resources to enrich the students' experiences.
Clinical skills laboratories are an ideal solution to the problem of limited time doing clinical fieldwork to ensure students are competent in stroke rehabilitation. A suggestion was made that the student could be given outcomes and measurable evaluations to test whether their skills are sufficient; quizzes and computerised skills tests could be used to indicate to them whether they had become competent. These self-evaluations would encourage more effective use of their self-study time.
Stroke rehabilitation theories taught at an undergraduate level
One study suggested that training in the NDT theory, MRT and PNF should be given11, and another in the United States of America found that the occupational therapists and physiotherapists were most commonly trained in the NDT, Brunnström and PNF theories31. Therefore, the findings from the current study are congruent with that of other countries, as the NDT theory is also taught most frequently at the training centres in South Africa.
The NDT theory has historically been the most popular stroke rehabilitation theory amongst occupational therapists and phys-iotherapists13,30,31,35,45,46. Often the decision to use NDT is based on initial education and previous experience, and not necessarily on evidence based research findings30. Clear research stating that any one of the stroke rehabilitation theories is superior to the others is yet to emerge13.
The confusion regarding which theory to use in practice might however be overstated. Recent studies showed that any stroke rehabilitation theory an occupational therapist uses will be effective45. Therefore, the theories selected for inclusion in the curricula should rather be based on the latest research on neuro-plasticity and the recovery of the central nervous system after a neurological lesion. It is recommended that the use of evidence based practice principles be first considered before deciding on the content of stroke rehabilitation curricula11. However, the most important consideration is whether the theory allows for intervention with clients in the South African context. As mentioned in the panel discussion, the majority of stroke patients live in rural communities, and occupational therapists can usually not undertake intensive rehabilitation on a one-on-one basis. The theory therefore needs to be flexible and allow for home programmes, group therapy and independent practice by patients and families, and should not require intensive intervention from the occupational therapist. Intervention has to be based on improvement of occupational performance and community reintegration, and not just the underlying dysfunctional components such as weakness, spasticity and secondary impairments. Panelists also discussed the need to focus more on the treatment of chronic stroke patients and the population requiring rehabilitation in the rural areas of South Africa. The intensity and individual attention required by the NDT theory may therefore not fit well with the needs of the majority of stroke patients.
Another concern raised in the discussion was that occupational therapists might be realising the shortcomings of certain stroke rehabilitation theories, and therefore supplementing them with other theories, and thereby hybridising several very different theories. The danger of hybridisation is that occupational therapists become unsure of what techniques they are using and are unable to explain their actions. This is confusing for students who are learning the use of theories as interpreted by their role models.
It was mentioned in the panel discussion that the answer might lie in teaching one effective stroke rehabilitation theory rather than several theories that do not have sufficient evidence for effectiveness in our unique context. Which theory this is to be has yet to be decided.
Assessments taught at an undergraduate level
Non-standardised assessments
Due to the differences in non-standardised assessments taught at the different training centres, as well as emerging evidence of the most effective treatment of body functions that should be addressed in intervention with stroke patients, it is recommended that the curricula be revised. The revision should be based on the latest research in stroke rehabilitation. This includes a reduced focus on the treatment of spasticity. Reducing spasticity during intervention with stroke patients has been proven ineffective in automatically improving performance, and there is little correlation between a reduction in spasticity and an improvement in function. Although the presence of spasticity is acknowledged, the emphasis in therapy has been questioned47,48. The reduction of spasticity is traditionally treated using the NDT33,34 and Rood theories13,49. The results from this study show that all training centres teach the assessment of muscle tone. However, it is important to note the research findings regarding the effect of abnormal muscle tone on a person's function after stroke and that abnormalities in muscle tone alone do not cause dysfunction14,39,47.
The treatment of negative impairments, as described in lit-erature50, is becoming more important in reducing disability after stroke, therefore muscle strengthening and improvement of endurance should be a priority in treatment39,47, and skills in assessing these components should also be a priority. The results from this study show that not all centres consider muscle testing as part of the assessments taught in stroke rehabilitation. The improvement of muscle strength and reduction of secondary impairments have been shown to be correlated with an improvement in function of stroke patients14,47, and may be seen as essential in a stroke rehabilitation curriculum.
As discussed in the panel, students are experiencing frustrations due to the different terminology used by clinicians, and the different focuses in stroke rehabilitation. Revision of the content of the curricula should also clear up confusion regarding terminology and the most important factors affecting abnormal movement after central nervous system injury. Supervisors should ensure that they are updated regarding the latest information in stroke rehabilitation, and training centres should host regular workshops to ensure that clinicians understand what students are taught.
Standardised assessments
The findings from the current study show that very few standardised assessments are included in the undergraduate curricula. If occupational therapists are not taught to use standardised assessments effectively during their undergraduate training, their subsequent ability to use these assessments as part of their intervention protocols could be negatively affected. Assessments should not be based on observations and subjective opinion only. However, previous surveys showed that general observations were used most frequently, and occupational therapists have been widely criticised for their lack of use of standardised assessments3,18,23. A principle should be followed in the occupational therapy profession that a sound assessment or re-assessment cannot be based on observations only, but should be supplemented and substantiated by standardised assessments39. Through the increased use of standardised assessments, occupational therapists will be able to provide evidence for their intervention techniques. In order to research the effectiveness of the NDT theory specifically in the South African context, standardised assessments should be used instead of subjective opinions and observations only.
Stroke is a disabling condition which affects stroke survivors and their families' ability to function in everyday tasks. Stroke rehabilitation is an important field in which students should receive adequate training and experience in order to manage stroke patients effectively and competently, as research predicts an increase in stroke incidence in sub-Saharan countries. In order to ensure that training at an undergraduate level is sufficient to ensure that newly qualified occupational therapists can manage stroke patients effectively, several changes would have to be made to the current stroke rehabilitation curricula in South Africa. Firstly, requirements of the number of stroke patients students assess and treat during the four years of training should be revised and formally set. Secondly, the most suitable stroke rehabilitation theory for the South African setting should be selected, and the number of theories taught should be limited to ensure competence and understanding of all concepts related to that theory. Thirdly, the terminology and focus on underlying dysfunctional components after stroke should be based on the latest evidence in stroke rehabilitation, and all training centres should use the same terminology to make supervision less frustrating and confusing across the different universities. And lastly, the use of standardised assessments should be introduced at an undergraduate level, to ensure that occupational therapists are evaluating their effectiveness and ensuring that their practice is evidence based. This will also allow for sound evidence to be presented regarding the most suitable stroke rehabilitation theory for South Africa.
Special thanks and acknowledgements
The author would like to thank the following persons and acknowledge their contribution to the article by assisting with the panel discussion: Fiona Millan, Amshuda Sonday (University of Cape Town), Anupa Singh and Jodie de Bruyn (University of Pretoria).
1. Connor MD, Walker R, Modi G, Warlow CP Burden of stroke in black populations in sub-Saharan Africa. Lancet Neurology. 2007 March; 6: 269 - 278. [ Links ]
2. Mochan A, Modi M, Modi G. Stroke in black South African HIV-positive patients: A prospective analysis. Stroke. 2003;(34): 10 - 15. [ Links ]
3. Rowland TJ, Cooke DM, Gustafsson LA. Role of occupational therapy after stroke. Annals of Indian Academy of Neurology. 2008;(ll): S99 - SI07. [ Links ]
4. Steultjens EMJ, Dekker J, Bouter LM, Van de Nes JCM, Cup EHC, Van den Ende CHM. Occupational therapy for stroke patients, a systematic review. Stroke. 2003 March; 34: 676 - 686. [ Links ]
5. Brown GT, Brown A, Roever C. Paediatric occupational therapy university programme curricula in the United Kingdom. British Journal of Occupational Therapy. 2005 October; 68(10): 457 - 466. [ Links ]
6. Dubouloz C, Egan M, Vallerand J, Von Zweck C. Occupational Therapists' perceptions of evidence-based practice. American Journal of Occupational Therapy. 1999 September/October; 53(5): 445 - 453. [ Links ]
7. World Federation of Occupational Therpists. WFOT. [Online].; 2008 [cited 2013 June 7. Available from: HYPERLINK "http://www.wfot.org" http://www.wfot.org. [ Links ]
8. Fritz V Stroke in South Africa. International Journal of Stroke. 2006 February; l: 47 - 48. [ Links ]
9. Nelson CE, Cash SH, Bauer DF. Adult physical dysfunction content in professional curricula. The American Journal of Occupational Therapy. 1990 December; 44(12): 1079 - 1087. [ Links ]
10. Ballinger C, Ashburn A, Low J, Roderick P. Unpacking the black box of therapy - A pilot study to describe occupational therapy and physiotherapy interventions for people with stroke. Clinical Rehabilitation. 1999 January 13; 13: 301 - 309. [ Links ]
11. McCluskey A. Collaborative curriculum development: Clinicians' views on neurology content of a new occupational therapy course. Australian Journal of Occupational Therapy. 2000; 47: I - 10. [ Links ]
12. Prince Wittman P. The disparity between educational preparation and the expectations of practice. The American Journal of Occupational Therapy. 1990 December; 44(12): 1130 - 1131. [ Links ]
13. Lennon S, Baxter D, Ashburn A. Physiotherapy based on the Bobath concept in stroke rehabilitation: A survey within the UK. Disability and Rehabilitation. 2001; 23(6): 254 - 262. [ Links ]
14. Carr JH, Shepherd RB. Neurological rehabilitation. Optimizing motor performance. Edinburgh: Elsevier Limited; 1998. [ Links ]
15. Langhammer B. Bobath or motor relearning programme? A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomized controlled study. Clinical Rehabilitation. 2000; 14: 361 - 369. [ Links ]
16. Joubert R. Evidence-based practice: a critique based on occupational therapy within the SA context. South African Journal of Occupational Therapy. 2005 September; 35(2): 8 - 12. [ Links ]
17. Crouch R. The impact of poverty on the service delivery of occupational therapy in Africa. In Crouch R, Alers V editors. Occupational Therapy: An African Perspective. Johannesburg: Sarah Shorten publishers; 2010. 98 - 108. [ Links ]
18. Unsworth C. Measuring the outcome of occupational therapy: Tools and resources. Australian Occupational Therapy Journal. 2000; 47: 147 - 158. [ Links ]
19. Granger CV Guide for the uniform data set for medical rehabilitation (Adult FIM), Buffalo: State University of New York; 1993. [ Links ]
20. Mahoney FI, Barthel DW. Functional evaluation: The Barthel Index. MD State Medical Journal. 1965; 14: 61 - 65. [ Links ]
21. Fisher AG. Assessment of motor and process skills. 2nd ed. Fort Collins: Three star press; l997. [ Links ]
22. Whiting S. RPAB - Rivermead perceptual assessment battery. Windsor: NFER-Nelson; 1985. [ Links ]
23. Woodson AM. Stroke. In Radomski MV, Trombly Latham CA, editors. Occupational Therapy for Physical Dysfunction. 6th ed. Philadelpia: Wolters Kluwer / Lippincott Williams Wilkins; 2008: 1001 - 1041. [ Links ]
24. Gillen G. Cerebrovascular accident/Stroke. In McHugh Pendleton H, Schultz-Krohn W, editors. Pedretti's Occupational therapy practice skills for physical dysfunction. 6th ed. Missouri: Mosby Inc.; 2006: 802 - 837. [ Links ]
25. Folstein MF Folstein SE, McHugh PR. Mini-Mental state: A practical method for grading cognitive state of patients for the clinician. Journal of Psychiatric Resources. 1975; 12: 189-198. [ Links ]
26. Rustad RA. Cognitive assessment of Minnesota. Texas: Harcourt Assessment; l993. [ Links ]
27. Wilson B, Cockburn J, Baddeley A, Hiorns R. The development and validation of a test battery for detecting and monitoring everyday memory problems. Journal of Clinical Experiences in Neuropsychology. I989;(ll): 855-870. [ Links ]
28. Gladstone DJ, Danells CJ, Black S. The Fugl-Meyer assessment of motor recovery after stroke: A critical review of its measurement properties. Neurorehabilitation and Neural Repair. 2002; 16: 232 - 240. [ Links ]
29. Carr JH, Shepherd RB, Nordholm L, Lynne D. Investigation of a new motor assessment scale for stroke patients. Physical Therapy. 1985 February; 65(2): 175 - 180. [ Links ]
30. Walker MF, Drummond AER, Gatt J, Sackley CM. Occupational therapy for stroke patients: A survey of current practice. British Journal of Occupational Therapy. 2000; 63(8): 367 - 372. [ Links ]
31. Natarajan P Oelschlager A, Agah A, Pohl PS, Ahmad SO, Lui W. Current clinical practices in stroke rehabilitation: Regional pilot survey. Journal of Rehabilitation Research and Development. 2008; 45(6): 841 - 849. [ Links ]
32. Langhammer B. Bobath or motor relearning programme? A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomized controlled study. Clinical Rehabilitation. 2000; 14: 361 - 369. [ Links ]
33. Bobath B. Adult hemiplegia. 2nd ed. Oxford: Butterworth-Heinemann Ltd.; 1974. [ Links ]
34. Bobath B. Adult hemiplegia. 3rd ed. Oxford: Butterworth-Heinemann Ltd.; 1990. [ Links ]
35. Raine S. Defining the Bobath concept using the Delphi technique. Physiotherapy Research International. 2006; 11(1): 4 - 13. [ Links ]
36. Neuro-developmental treatment association. Neuro-developmental treatment association. [Online].; 2010 [cited 2010 August 25]. Available from: HYPERLINK "http://www.ndta.org/" http://www.ndta.org. [ Links ]
37. Paci M. Physiotherapy based on the Bobath concepts for adults with post stroke hemiplegia: A review of effectiveness studies. Journal of Rehabilitation medicine. 2003; 35(1): 2 - 7. [ Links ]
38. Luke C, Dodd KJ, Brock K. Outcomes of the Bobath concept on upper limb recovery following stroke. Clinical Rehabilitation. 2004; 18(8): 888 - 898. [ Links ]
39. Shapero Sabari J. Optimizing motor skill using task related training. In Radomski MV Trombly Latham CA, editors. Occupational Therapy for Physical Dysfunction. 6th ed. Philadelphia: Wolters Kluwer / Lippincott Williams Wilkins; 2008. 618 - 7I3. [ Links ]\
40. Trombly Latham CA. Optimizing motor behaviour using the Brunnstrom movement therapy approach. In Radomski MV, Trombly Latham CA, editors. Occupational Therapy for Physical Dysfunction. 6th ed. Philadelphia: Wolters Kluwer / Lippincott Williams Wilkins; 2008. 667 - 689. [ Links ]
41. Longenecker Rust K. Managing deficit of first-level motor control capacities using Rood and Proprioceptive neuromuscular facilitation techniques. In Radomski MV, Trombly Latham CA, editors. Occupational Therapy for Physical Dysfunction. 6th ed. Philadelphia: Wolters Kluwer / Lippincott Williams Wilkins; 2008. p. 690 - 727. [ Links ]
42. Carswell A, McColl M, Baptiste S, Law M, Polatajko H, Pollock N. The Canadian occupational performance measure: A research and clinical literature review. Canadian Journal of Occupational Therapy. 2004;(7l): 210-222. [ Links ]
43. Tyerman R Tyerman AHP Hadfied C. Chessington occupational therapy neurological assessment battery. Nottingham: Nottingham Rehab; 1986. [ Links ]
44. Kopp B, Kunkel A, Flor H, Platz T, Rose U, Mauritz KH. The arm motor ability test: Reliability, validity and sensitivity to change of an instrument for assessing disabilitites in activities of daily living. Archives of Physical Medical Rehabilitation. I997;(78): 615 - 620. [ Links ]
45. Kwakkel G, Kollen BJ, Wagenaar RC. Therapy impact on functional recovery in stroke rehabilitation: A critical review of the literature. Physiotherapy. 1999; 85(7): 377 - 391. [ Links ]
46. Lennon S, Ashburn A. The Bobath concept in stroke rehabilitation: A focus group study of the experienced physiotherapist's perspective. Disability and Rehabilitation. 2000; 22(15): 665 - 674. [ Links ]
47. Ada L, Canning C. Changing the way we view the contribution of motor impairments to the physical disability after stroke. In Refshauge K, Ada L, Ellis E, editors. Science-based Rehabilitation -Theories into practice. 1st ed. Edinburgh: Butterworth Heinemann; 2005. 87 - 106. [ Links ]
48. McCluskey A, Lannin N, Schurr K. Optimising motor performance following brain impairment. In Curtin M, Molineux M, Supyk-Mellson J, editors. Occupational Therapy and Physical Dysfunction: Enabling Occupation. 6th ed. Edinburgh: Churchill Livingstone Elsevier; 2010. [ Links ]
49. Rood MS. The use of sensory receptors to activate, facilitate and inhibit motor response, autonomic and somatic, in developmental sequence. In Sattely C. Approaches to the treatment of patients with neuromuscular dysfunction. Dubuque: W.C. Brown; 1962: 26 - 37. [ Links ]
50. Carr JH, Shepherd RB. Stroke rehabilitation: Guidelines for exercise and training to optimise motor skill. London: Butterworth-Heinemann; 2003. [ Links ]
Juliana Freeme


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The Elk River Watershed (shown in the image below) was heavily logged by Maxxam-owned Pacific Lumber Company and continues to suffer from those past logging practices. The condition of the river which is still plagued by flooding and heavy sedimentation prompted a meeting involving residents of the Elk River Watershed and other stakeholders. Held in Eureka on Sat., Nov, 16, 2013 and hosted by the Humboldt County Board of Supervisors, the meeting, dubbed the Elk River Forum, was an attempt to look for solutions to this on-going problem. The audio from the forum can be heard using the players below.
Use the player directly below to hear coverage of the Elk River Forum in a piece submitted by Kelly Lincoln and aired by KMUD News anchor Eileen Russell on the Local News, Mon., Nov. 18, 2013.
The map of the Elk River Watershed shown below, was designed by the
Redwood Community Action Agency Natural Resources Services, and appears on their website.
Additional Resources:
Audio from the forum and the audio descriptions were provided by Kelly Lincoln and can be heard using the players below.
HC Supervisor Rex Bohn defines the goal of the meeting as "working collaboratively to address some of the impacts to the Elk River Watershed."
Jerry Martien of Friends of the Elk River, describes the issue and the motivations of Friends of the Elk River.
Craig Benson of Redwood Community Action Agency's Natural Resources Division is the day's moderator. He introduces the topic, the panelists, the speakers and the goals for the meeting. The major point of interest is the sediment and the TMDL (total maximum daily load) released by the NCRWQCB (North Coast Regional Water Quality Control Board) in the summer of 2013.
The first speaker of the day was Adonna White who coordinated writing the Total Maximum Daily Load (TMDL) for the NCRWQCB. In the vernacular of the Regional Water Quality Control Board, when a stream has been determined to be "impacted" by a pollutant, then a measurement of the pollutant is taken and studies are done to determine how much of the pollutant can be allowed and still allow the stream to be moderately healthy. That measurement is called the TMDL. This audio is broken up into Parts 1 and 2 below.
Jack Lewis provided consultant services to the NCRWQCB in its statistical analysis phase. He explains what method he used and the results he obtained which backed the agency's analysis.
Humboldt Baykeepers gives an overview of the role of the Elk River in providing sediment to the bay. There is a lot that is unknown about the health of the Humboldt Bay.
The forum moderator shows a slide of sediment build up over time.
Jim Robbins, CalFire Forestry Supervisor, explains the rules of forestry, how they are implemented, and that the level of sediment reduction being proposed by the TMDL far surpasses ordinary timber harvest plan control mechanisms for sediment control.
Darren Mierau of CalTrout explains Caltrout's role in the feasibility study. They have been named the lead agency and are seeking the best possible site to locate the practice trial of physically removing sediment from the channel.
A Registered Professional Forester explains his perspective on the totality of the situation. He puts land-use conflicts into perspective with the statistic of how many board feet annually are not cut due to conflict with urban encroachment on the timberlands.
Update - Wed., Dec. 18, 2013: Ray Fidler, wanted by the Humboldt County Sheriff's Office for suspicion of auto theft and assault with a deadly weapon (see the original post on this story below), was located in Fortuna by Fortuna Police Department officers and arrested on multiple charges. According to a press release from the Fortuna Police Dept., the arrest included recovery of two stolen vehicles and, "...hand guns, ski masks, gloves and other items consistent with committing thefts." Two other suspects were arrested along with Fidler: Blake Nicole Treadwell (age 25) and Anna Crowl (age 42). The FPD press release appears below.
FPD press release, dated Wed., Dec. 18, 2013:
Fortuna, CA - On December 17th 2013 at about 9:52 am, Officers with the Fortuna Police Department located Daniel Ray Fidler (age 40) in the 600 block of 15th Street. Fidler was known to officers and was wanted by the Humboldt County Sherriff's Office for suspicion of auto theft and assault with a deadly weapon. Fidler attempted to flee on foot and was apprehended by officers. Daniel Ray Fidler (age 40) was taken into custody and he was transported to the Humboldt County Correctional Facility where he was booked on the following charges.
• 496(a) Penal Code, Possession of Stolen Property
• 29800(a)(1) Penal Code, Felon in possession of Firearm
• 30305(a)(1) Penal Code, Felon in possession of Ammunition
• 148(a)(1) Penal Code, Resisting Arrest
• 1203.2(a) 4 Penal Code, Violation of Probation
• Also 836/245 Penal Code, Assault with Deadly Weapon and an outstanding Arrest from Humboldt County Sherriff's Office for Auto Theft
In the course of the investigation two stolen vehicles were recovered, two handguns were seized and we believe further serious crimes were prevented. In addition to the seized handguns officers located, ski masks, gloves and other items consistent with committing thefts.
Two additional arrests were made along with Daniel Ray Fidler (age 40). Officers arrested Blake Nicole Treadwell (age 25) and she was transported to the Humboldt County Correctional Facility where she was booked on the following charges.
• 25400(a)(2) Penal Code, Possession of Concealed Firearms
• 11377(a) Health and Safety, Possession of 11.2 grams of Methamphetamine
• 11379 Health and Safety, Transportation of Methamphetamine
Officers arrested Anna Crowl (age 42) and she was transported to the Humboldt County Correctional Facility where she was booked for an outstanding arrest warrant for Burglary.
The original post on this appears below.
According to a Humboldt County Sheriff's Office Press release, a man identified as Danny Ray Fidler (shown in the photo) is wanted for allegedly using a suspected stolen vehicle to ram another man's truck - also striking another parked car and a tree - as he was attempting to flee the area.
Fidler is described as a White male adult, 40 years old, brown hair, hazel eyes, 5'8" tall, 130 lbs., and has several tattoos on both arms. He is wanted for assault with a deadly weapon, felony vandalism, possession of stolen property, violation of probation and a previous felony warrant in another case. Anyone with information about Fidler is asked to call the Sheriff's Office at 707-445-7251 or the Sheriff's Office Crime Tip line at 707-268-2539. See the complete HCSO press release below for more information.
HCSO Press Release-Fri., Dec., 13, 2013:
On 12-7-2013, approximately 9:00 a.m. the Humboldt County Sheriff's Office was notified of the theft of a vehicle from a garage on Akerman Lane, Carlotta. The victim told the investigating deputy he exited his home at 6:30 a.m. on 12-07-13 and noticed his garage door was open and his forest green 2011 Jeep Wrangler, California Plate 6PZA957 was missing. The victim also saw his truck which had been parked in front of his residence had been ransacked, and his garage door opener was missing. The victim had parked his Jeep in his garage the evening before and closed the garage door.
On 12-12-2013, at approximately 12:00 p.m., the Humboldt County Sheriff's Office was notified of an assault with a vehicle which just occurred in the 5400 block of Highway 36, Carlotta. A deputy and California Highway Patrol officer responded to the scene. When the investigating deputy met with the 36 year old male victim and witnesses, he learned the Jeep that was stolen on 12-7-2013, was the vehicle involved. The victim told the deputy he was working on a private driveway that leads to several residences in the 5400 block of Highway 36. The victim was aware of the stolen 2011 Jeep Wrangler, because it belonged to a friend. The victim saw the Wrangler drive past the location where he was working. He called his friend and confirmed the license plate and that it was still stolen. The victim saw the Jeep park in the driveway of a nearby residence. The victim had a co-worker call 911 to report finding the stolen Jeep, while the victim drove his Ford 350 truck to where the Jeep parked and attempted to block it in until law enforcement could arrive.
When the victim started to block the Jeep in, the driver of the Jeep put it in reverse and rammed the victim's truck to escape. The Jeep rammed the victim's truck, and also struck an unoccupied parked 2008 Nissan Altima and a tree before fleeing the area.
The victim was uninjured; however, his truck and the Altima sustained several thousand dollars in damage. Deputies located witnesses who also saw the intentional ramming.
Deputies learned during their investigation, the person driving the stolen Jeep was identified as Danny Ray Fidler, 40 years old. Fidler has an outstanding felony warrant for his arrest for violation of Post Community Release Supervision. He is also on felony probation for stealing a vehicle, fleeing a police officer and transportation of a controlled substance.
A be-on-the-lookout for the Jeep and Fiddler was issued to area wide law enforcement. Besides the arrest warrant, Fidler is wanted for assault with a deadly weapon, felony vandalism, possession of stolen property and violation of probation.
Danny Ray Fidler is described as follows: White male adult, 40 years old, brown hair, hazel eyes, 5'8" tall, 130 lbs. He has several tattoos on both arms.
Anyone with information for the Sheriffs Office regarding this case or related criminal activity is encouraged to call the Sheriffs Office at 707-445-7251 or the Sheriffs Office Crime Tip line at 707-268-2539.
Community members rallied after hearing about the possible closure of the Obstetrics Unit at Redwood Memorial Hospital (RMH) in Fortuna. About 200 members of the public attended an afternoon public meeting on the issue held last Thursday, Dec. 5, 2013. The objective of the meeting was to explain the situation and get feedback from the public to help inform the St. Joseph Health/Humboldt County Board of Trustees as they consider several options, including consolidating the Redwood Memorial and St. Joseph obstetrics programs.
According to Redwood Memorial Foundation President John Egan, coverage issues and lack of recruitment, not lack of money, were the reasons for considering eliminating the obstetrics program at Redwood Memorial. Use the player below to hear more on this story, aired by Terri Klemetson on the KMUD Local News Friday, Dec.6.
Use the players below to hear audio from the public meeting. KMUD thanks Precision Intermedia and the McLean Foundation for providing us with the audio recordings.
RMH Public Meeting part 1: Introductions and Comments
RMH Public Meeting part 2: Health System Presentation
RMH Public Meeting part 3: Comments
Medicare's annual open enrollment period has begun and will run through Dec. 7, 2013. According to a press release from David Sayen, Medicare Regional Administrator, if you want to change your Medicare Advantage or Medicare Part D (prescription drug) plan, now is the time to do it. Any changes in coverage will then begin as of Jan. 1, 2014.
Click here for more information and comparisons of benefits. Call 1-800-MEDICARE (1-800-633-4227) for around-the-clock assistance to find out more about your coverage options. For more information see the complete press release below.
Medicare Press release:
Medicare's annual open enrollment period has begun, and I want to encourage everyone with Medicare to review their current health and prescription drug coverage. Open enrollment runs through Dec. 7, 2013. If you want to change your Medicare Advantage or Medicare Part D (prescription drug) plan, this is the time of year to do it. Any new coverage you select will kick in on Jan. 1, 2014.
If you have Original Medicare and you're satisfied with it, you don't need to do anything during open enrollment. Also, Medicare's open enrollment has nothing to do with the Affordable Care Act's new Health Insurance Marketplace. If you have Medicare, you don't need to worry about Marketplace plans.
The Centers for Medicare & Medicaid Services, or CMS, announced recently that the average Medicare Advantage premium for 2014 is projected to be $32.60. CMS estimated that the average basic Part D drug premium in 2014 would be $31 per month, holding steady for four years in a row.
Since the Affordable Care Act was passed, average Medicare Advantage premiums are down by 9.8 percent. The deductible for standard Part D drug plans in 2014 will be $310, a $15 decline. Meanwhile, the quality of Medicare Advantage and Part D drug plans continues to improve, with more than one-third of Medicare Advantage plans receiving four or more stars (out of a possible five stars) in 2014 -- a 28 percent increase over last year. Medicare Advantage and Part D drug plans with five stars are allowed to enroll beneficiaries at any time during the year.
Medicare plans' coverage options and costs can change each year, and Medicare beneficiaries should evaluate their current coverage and choices and select the plan that best meets their needs. If you think your current coverage will meet your needs for 2014, you don't need to change anything.
For more information on Medicare open enrollment and to compare benefits and prices of 2014 Medicare Advantage and Part D drug plans, please visit: www.cms.gov/Center/Special-Topic/Open-Enrollment-Center.html.
A variety of resources are available to help people with Medicare, their families, and caregivers compare current coverage with new plan offerings for 2014. You can:
- Visit www.medicare.gov to see plan coverage and costs available in your area, and enroll in a new plan if you decide to make a change. Open enrollment information is available in Spanish.
- Call 1-800-MEDICARE (1-800-633-4227) for around-the-clock assistance to find out more about your coverage options. TTY users should call 1-877-486-2048. Counseling is available in a wide variety of languages.
- Review the 2014 Medicare & You handbook. This handbook has been mailed to the homes of people with Medicare and it's also online at: www.medicare.gov/pubs/pdf/10050.pdf.
- Get one-on-one counseling assistance from your local State Health Insurance Assistance Program (SHIP). Local SHIP contact information can be found:
- At www.medicare.gov/contacts/organization-search-criteria.aspx or;
- On the back of the 2014 Medicare & You handbook or;
- By calling Medicare (contact information above).
People with Medicare who have limited income and resources may qualify for Extra Help paying for their Part D drug plans. There's no cost or obligation to apply for Extra Help, also called the low-income subsidy. Medicare beneficiaries, family members, or caregivers can apply online at www.socialsecurity.gov/prescriptionhelp or call Social Security at 1-800-772-1213 (TTY users should call 1-800-325-0778) to find out more.
Please watch out for scammers during Medicare open enrollment season. Don't give personal information to anyone who shows up at your home uninvited or makes an unsolicited phone call to sell you Medicare-related products or services. If you believe you're a victim of fraud or identity theft, please contact 1-800-MEDICARE. More information is available at www.stopmedicarefraud.gov.
The State Water Resources Control Board's Division of Water Rights today (Nov. 26, 2013) issued a Cease and Desist Order to the Benbow Water Company, in Benbow Calif., requiring the company to stop water sales outside the district's area of service, according to a press release from the State Water Board. The release cited possible negative impacts on fish and wildlife as a rationale for the order which was reportedly triggered by a public complaint.
The Cease and Desist Order, requires the Benbow Water Co. to immediately stop the bulk sale and delivery of water outside the authorized place of use, including some local community-sponsored events. However, the order allows the water company to choose to continue to provide bulk water sales outside its authorized place of use, when the water is needed for emergency domestic water supply. More details appear in the press release below.
Hear more on this story in a news piece aired on the KMUD Local News on Wed. Nov. 27, 2013 by News Director Terri Klemetson.
Press Release from PIO Office, State Water Resources Control Board:
To prevent possible negative impacts to fish and wildlife, the State Water Resources Control Board's Division of Water Rights today issued a Cease and Desist Order to the Benbow Water Co. in Humboldt County to halt water sales outside the district's area of service. Under the order, the Benbow Water Co. must stop selling bulk water for use outside the area of service defined in the water district's permit, and take actions to correct permit violations involving service to 20 homes outside of the service area. Violations were discovered as a result of a public complaint.
The water district has a State Water Board permit to draw water from the East Branch of the South Fork of the Eel River, and it also claims a riparian right to water from the river. The water right permit defines the uses for the water, the amount that may be diverted and the area in which the water may be used. Water diversions under riparian rights do not need a permit, but the water must be used on land contiguous to the water body. The continued sale of bulk water outside the area of service of the Benbow Water Co. poses a threat to public trust resources and fisheries, according to the California Department of Fish and Wildlife. The South Fork of the Eel River is a designated Wild and Scenic River, and supports Coho Salmon, Chinook Salmon and Steelhead Trout, all listed as threatened species. The unauthorized diversion of water reduces the amount of water available for fisheries and other riparian habitat.
Under the Cease and Desist Order, Benbow Water Co. must immediately stop the bulk sale and delivery of water outside the authorized place of use, including some local community-sponsored events, until the State Water Board considers a petition for change in the water right permit; and stop all other sale of bulk water outside the place or season of use within 30 days. The Order allows Benbow Water Co. to choose to continue to provide bulk water sales outside its authorized place of use, however, when the water is needed for emergency domestic water supply.
The water company is ordered to keep accurate records of bulk water sales within the area of service, detailing the name of the water hauler, the volume of water sold, the date, purchaser, purpose and place of use. Separate records of bulk water sales for emergency domestic water use must be kept. Within 60 days, Benbow Water Co. must file a petition for change in place of use to include areas now receiving water diverted under the Benbow permit, and keep monthly records of the water served to areas outside the authorized places of use.
Benbow Water Co. must demonstrate a valid basis of right to deliver water to the 20 homes outside the authorized service area or file an appropriative water right to cover the diversion and use of water; and immediately discontinue adding new residential or commercial water service connections to parcels outside of the authorized place of use or without a riparian claim of right. If Benbow Water Co. fails to comply with the order, it could be subject to civil liability fees of up to $1,000 for each day of violation, or referral to the Attorney General for further enforcement action.
To learn more about the State Water Board's protection of public trust resources,visit: http://www.swrcb.ca.gov/waterrights/water_issues/programs/public_trust_resources/
The Community Journalism Project (CJP) took shape in 2009 under the direction of Terri Klemetson who is now News Director at KMUD. Initial goals of the CJP included getting more voices on the Local News, and more multi-media collaboration within the KMUD listening community. Participation in the program does not require prior knowledge of journalism or radio broadcasting. The CJP training component covers the basics of broadcast journalism, including: ethics, interviewing techniques, recording equipment basics, writing for radio, story composition and editing.
Terrri Klemetson describes her vision in this way, "I wanted listeners to understand journalism ethics, and I wanted to create a space for open dialogue about why and how the KMUD Newsroom picked stories to air. It was a great forum for open discussion, critique and skill sharing. I also firmly believe that KMUD is more than a radio station - our newsroom needs to adapt to the changing media world and the expansion of social media as a news source and communication tool."
A spin-off from the CJP was the Emergency Response Team (ERT), which evolved in 2010 to enhance the coverage of emergency events such as earthquakes, major slides, fires, and floods. ERT members come from those who have already gone through the Community Journalist training and then receive additional emergency preparedness training and participate in practice sessions.
Another round of Community Journalist training classes has been scheduled between now and the end of the year. All classes are free (donations welcome) and are held at the KMUD studios at: 1144 Redway Dr, Redway, Calif. For more information call the KMUD Office at (707) 923-2513 or the KMUD News Room (707) 923-2605.
The current 2013 class schedule appears below:
- Nov. 24 – (Everyone invited!) - 1:00-3:00. This class will teach audio editing, using both Audacity and Sound Studio. Both Monique Rowan and Terri Klemetson will be teaching. Newsroom reporters, producers, and anchors will be attending to share audio editing tips.
- Dec. 1 – (Everyone invited!) - 1:00-3:00. This class will include information about investigative reporting, Public Records Act (PRA) , and Freedom of Information Act (FOIA).
- Dec. 15 – (Everyone invited!) - 1:00-3:00. Emergency Response Team class will cover winter disaster preparedness.
- Jan. 5 – (Everyone invited!) - 1:00-3:00. This class will focus on audio editing.
- Jan. 19 – (Everyone invited!) - 1:00-3:00. This class will present information on investigative reporting.
According to a press release from the Calif. Attorney General Kamala D. Harris, ten non-approved private health insurance websites have been shut down. Harris stated, "These websites fraudulently imitated 'Covered California' (the state's official insurance marketplace for the Patient Protection and Affordable Care Act) in order to lure consumers away from plans that provide the benefits of the Affordable Care Act." Harris added, "My office will continue to investigate and shut down these kinds of sites. I urge Californians to avoid healthcare scams by visiting coveredca.com."
The complete press release appears below including a list of the deactivated sites and tips on how not to get caught up in health coverage scams.
Press Release:
SAN FRANCISCO -- Attorney General Kamala D. Harris today announced the removal of ten private health insurance websites that misled Californians by imitating Covered California, the state's official insurance marketplace for the Patient Protection and Affordable Care Act (ACA). Attorney General Harris also released tips to help consumers avoid insurance scams.
"These websites fraudulently imitated Covered California in order to lure consumers away from plans that provide the benefits of the Affordable Care Act," Attorney General Harris said. "My office will continue to investigate and shut down these kinds of sites. I urge Californians to avoid healthcare scams by visiting coveredca.com."
In September, the California Attorney General's office began an investigation into websites that imitate the state's Covered California website (www.coveredca.com). Multiple website operators were sent cease and desist letters informing them that their websites were in violation of state law and demanding the immediate removal of the website or transfer of the domain name to the state's official exchange.
These websites were operated by private health insurance brokers or companies that were not affiliated with Covered California. The websites have domain names similar to the state's official healthcare exchange and contain unauthorized references to the official exchange's trademarked logo and name. In several cases, websites used the phrases "Get Covered," "Covered California" and "California Health Benefit Advisers."
The California Affordable Care Act forbids individuals or entities from claiming to provide services on behalf of Covered California without securing a valid agreement with the State Exchange. (Gov. Code, § 100510.) State law also prohibits solicitations that falsely imply a governmental connection (Bus. & Prof. Code, § 17533.6), the use of a domain name that is confusingly similar to another entity (Bus. & Prof. Code, § 17525), making or disseminating untrue or misleading representations with the intent of selling goods or services (Bus. & Prof. Code, § 17500) and unfair competition through untrue or misleading advertising (Bus. & Prof. Code, § 17200).
To date, all website operators who have been contacted by the Attorney General's office have complied, and the following websites have been either deactivated or redirected to the official exchange website:
The California Health Benefit Exchange is charged with implementing the ACA and is the operator of California's online health insurance marketplace known as Covered California. California consumers who purchase health insurance policies through this marketplace receive protections guaranteed by the ACA that may not exist in policies outside of the exchange.
Health insurance plans sold outside the official exchange on the individual market before January 1, 2014 do not qualify for federal subsidies and do not have the guarantees provided by the ACA's consumer protection provisions. Major consumer protections include: no denials based on preexisting conditions; no rating differences based on factors other than age, geography, and family size; issuers may not impose any annual dollar limits for covered services; and all qualified plans must cover essential health benefits identified under the ACA.
The California Attorney General's Health, Education and Welfare Section, in conjunction with Covered California and the California Department of Insurance, will continue to monitor these and other potentially fraudulent sites.
To avoid scams related to California's health insurance marketplace, Attorney General Harris has released the following tips for consumers:
- California's only official health insurance marketplace is www.coveredca.com, which is where individuals, families and small businesses can get information, compare plans and enroll.
- Be wary if you receive a call from a representative claiming to be a government official asking for your personal information like Social Security number or Medicare card number. You should not provide personal or financial information over the phone and should instead contact Covered California directly.
- If you are approached by someone offering assistance from Covered California, verify that they are a Certified Enrollment Counselor by asking to see their required ID badge or by contacting Covered California directly.
- Never pay someone for assistance with healthcare enrollment. Free enrollment assistance is available by contacting Covered California directly.
- If you believe that you have been the victim of a scam, please report it by contacting Covered California directly or by filing a consumer complaint with the California Attorney General's office at: http://oag.ca.gov/contact/consumer-complaint-against-business-or-company
Assistance by phone is also available in the following languages:
Arabic: 800-826-6317
Armenian: 800-996-1009
Chinese: 800-300-1533
Farsi: 800-921-8879
Filipino: 800-983-8816
Hmong: 800-771-2156nie
Khmer: 800-906-8528
Korean: 800-738-9116
Lao: 800-357-7976
Russian: 800-778-7695
Spanish: 800-300-0213
Vietnamese: 800-652-9528
Update March 4, 2014 - Elan Firpo launched her election campaign for Humboldt County District Attorney last Thurs., Feb. 27, 2014 in Eureka. Firpo's platform includes strengthening the management of prosecutors, in the D.A.'s Office, and focusing on serious crimes in collaboration with law enforcement.
Hear more on Firpo's campaign launch in the report below submitted by Daniel Mintz and aired by Kerry Reynolds on the KMUD Local News Mon., March 3, 2014.
Candidate Elan Firpo -click here for website
Update: Feb. 17, 2014 - So far four candidates, Allan Dollison, Elan Firpo, Maggie Fleming and Arnie Klein, have entered the 2014 race for Humboldt County District Attorney after last November's announcement, by sitting D.A., Paul Gallegos, indicating that he wouldn't run for another term. Gallegos was first elected to the office in 2002. During the last election cycle, he faced three challengers: Allison Jackson, Paul Hagen and Kathleen Bryson.
KMUD News Correspondent, Daniel Mintz, aired reports on the campaigns as they kicked off, and those audios, candidates photos and website links appear below, as does the original post made after Arnie Klein, the first candidate to enter the race, made his announcement.
Candidate Allan Dollison- click here for website
The submission below, from Daniel Mintz covering the Dollison campaign, aired on the KMUD Local News Jan. 21, 2014.
Candidate Maggie Fleming- click here for website
The news piece below was submitted by Daniel Mintz and aired on KMUD Local News Jan. 29, 2014
Candidate Arnie Klein - click here for website
See the original post below on the D.A race, including KMUD News audio on Arnie Klein candidacy
The 2014 race for Humboldt County District Attorney received some added interest last Wed, Nov 13 when Arnie Klein came out of retirement to announce his challenge to incumbent D.A. Paul Gallegos. Klein served as Humboldt County Deputy District Attorney from 2006 until he retired from that position in 2012. According to his election web page Klein, "...has served as deputy district attorney in four California counties and has built a legacy of championing social justice, whether for the indigent or the high profile. His convictions have gone beyond the confines of the courtroom and into the community where he has created educational programs that changed the way sexual assault victims are treated throughout the country."
Klein's experience, before joining the Humboldt County D.A.'s Office, ranges from working as a Deputy District Attorney in Los Angeles, as well as in Tulare County, to serving as senior trial lawyer in the Monterey County District Attorney's office.
Daniel Mintz attended Klein's candidacy announcement event and submitted the news piece below, which aired on the KMUD Local News Wed., Nov. 13, 2013.
Additional Resources:
- Arnie Klein's facebook Page
- Times Standard Article on Klein's retirement
- Recent North Coast Journal article on Klein
The photo below was taken by Daniel Mintz at Klein's annoucment event
Update: Nov. 18,2013 - Sixteen-year-old Katie Helberg, previously reported to the Humboldt County Sheriff's Office as a runaway juvenile at risk due to medical concerns, was found yesterday (Sun., Nov. 17) in good health, according to a press release from HCSO.
The original post on this story appears below.
According to a press release from the Humboldt County Sheriff's Office, Katie Helberg (shown in the photo), a 16 year old white female, was reported missing from her home in Eureka on the morning of Sat., Nov.9. Her family reported that she has health issues and requires medication.
Katie is further described as: approximately 5'4" tall, 130 pounds, with blue eyes and long blond straight hair. She wears braces on her teeth that have purple and green rubber bands on them. She was last seen wearing blue jeans, a black t-shirt with an "Alaska" logo on the front, and was wearing tennis shoes. Anyone with information about this missing person is asked to call: the Sheriff's Office at 707-445-7251 or Detective Greg Musson at 707-268-3643. The complete press release can be viewed below.
HCSO press release, dated Nov. 14, 2013::
On 11-10-2013, at approximately 8:45 p.m. the Humboldt County Sheriff's Office received a report of a missing 16 year old female, Katie Helberg. Katie's mother reported she last saw Katie at home in Eureka during the morning of 11-9-2013. Katie has health issues and needs medication. The Humboldt County Sheriff's Office would appreciate the public's help in locating her.
Katie Helberg is further described as follows: 16 years old, white female, approximately 5'4" tall, approximately 130 pounds, she has blue eyes and long blond straight hair. She wears braces on her teeth. The braces have purple and green rubber bands on them. She was last seen wearing blue jeans, a black t- shirt with "Alaska" logo on the front, and tennis shoes.
Anyone with information for the Sheriff's Office regarding this case or related criminal activity is encouraged to call the Sheriff's Office at 707-445-7251 or Detective Greg Musson at 707-268-3643.
Update - Fri., Nov. 15, 2013: According to a press release from the Humboldt County Sheriff's Office, at around 1:00 p.m. today Michael Gabriel's mother notified Hoopa Tribal Police that Michael had returned home. A Hoopa Tribal Police Officer met with Michael and his parents and found that Michael was in good health and had left his residence voluntarily.
The original post on this story appears below.
Thirteen year old Michael James Gabriel (shown in this photo provided by his parents) has been missing since Fri., November 8, 2013 and might be staying in the McKinleyville area, according to a press release from the Humboldt County Sheriff's Office. Michael was last seen leaving his home in Hoopa.
Michael is described as follows: Native American, 13 years old, 5' 3" tall, approximately 115 pounds, brown hair and brown eyes. If you have any information about this missing boy, please call: the Sheriff's Office at 707-445-7251 or the Sheriff's Office Crime Tip line at 707-268-2539. The press release appears below.
HCSO press release, dated Nov. 14, 2013:
On 11-13-2013, at approximately 10:40 a.m. the Humboldt County Sheriff's Office received a report of a missing 13 year old male. Family and school officials reported Michael James Gabriel 13 years old has been missing since November 8, 2013 and was last seen leaving home in Hoopa. He is possibly staying in the McKinleyville area. Due to his age he is considered a high risk missing juvenile. The Sheriff's Office would appreciate the public's help in locating Michael.
Michael James Gabriel is described as follows: Native American, 13 years old, 5' 3" tall, approximately 115 pounds, brown hair and brown eyes
Anyone with information for the Sheriff's Office regarding this case or related criminal activity is encouraged to call the Sheriff's Office at 707-445-7251 or the Sheriff's Office Crime Tip line at 707-268-2539.


text:
I was talking to Bombsaway a few days ago and he was saying that the old method of ciphering a file (pumping shit onto the end of the file) no longer works with CA. It just so happens I was bored at the time so I wrote this simple little cipher. Basically it just manipulates a few values within the PE structure and also rewrites some data into the .text section.
This, unlike the older ciphers, should work to fool Nexon's hash logic.
Using it is pretty straightforward:
- Download the .zip and extract it
- Run "Simple PE Cipher.exe"
- Press the browse button to locate your Dll
- Press "Run Cipher", if all goes as expected you should see a "Cipher Completed Successfully" message box appear.
- Inject the .dll. A backup of the original .dll is also created (with a .bak extension) in the same directory as the ciphered dll so you can revert at any time if something goes wrong.
Written in Win32 C++ for teh lulz.
If you have any issues with it, please feel free to PM me or post in the thread, I'll do my best to rectify the issues.
Virus Scan
No idea why this had those two scanners report a backdoor to be honest. Perhaps because I'm using some I/O API, dunno.
Anyways, enjoy, and report back with results.


text:
The AKG P120 is a 2/3-inch diaphragm true condenser microphone that offers solidly built quality, performance and value. The low-mass diaphragm delivers a clear sound with accurate sonic detail for vocals, speech and instrument recording in project studios and for home recording.
Key Features
- Rugged all-metal body and robust design withstands tough day-to-day use
- Switchable bass-cut filter eliminates rumble or footfall noise
- Switchable attenuation pad for high SPL applications up to 150 dB SPL
Audio frequency bandwidth: 20 to 20000 Hz
Equivalent noise level: 19 dB-A
Sensitivity: 24 mV/Pa
Signal to Noise: 75 dB-A
Preattenuation Pad: -20 dB
Bass cut filter: 300 - 6 dB/octave Hz
Electrical impedance: <= 200 Ohms
Recommended load impedance: >1000 Ohms
Polar Patterns : Cardioid
Voltage: 44 to 52 V
Current: <3 mA
Type: Male Balanced XLR
Contacts: 3-pin
Dimensions (LxD) mm
Net Weight: 455 g
Anthonys Music © 2020 Privacy Notice | Conditions of Use


text:
to Chiron:
may be in your pc settingsspoiler:the big egg thing doesn't works... but there is another way to go down the pit without falling and pull the lever, you must reach the 'behind shop' area and open the gold chest where inside you will find a couple of grapple arrows that are like rope arrows but they can be used also on stones surfaces. i tryed it now and i succesfull pulled the lever.
Good Luck !
to anyone else about some hints to solve mission 1 :
the bank:spoiler:look carefully on the upper windows on the sides zones of the bank, may be you will find a way to climb somewhere...
edited now: may be some of you just know that.. well.. where you found (up the ladder) a room wich has 4 levers inside.. the levers are useless but the heavy metal thing under them is useful to do something.. look carefull on the floor ouside the back, there is an 'X'... guess now what to do..
villa's area:
spoiler:in the way corridor where you go back outside to town there is a wall of bricks that can be removed, to do so you must use a torch.. .carry a torch in there and the bricks will be revealed... after that mission 1 ends... so before to pass to mission 2 go back to make some shopping..
the cabin key:
spoiler:if i understood well that should be the key that opens the door at the end of the corridor where the bricks are removable. Inside you will find something of interesting


text:
Basquiat: Rage to Riches
Season 32 Episode 8 | 1h 24m 16s
One of the most influential American artists of the 20th century, Jean-Michel Basquiat was a rock star of the early '80s New York art scene.
Aired: 09/14/18
Expires: 09/13/24Video has closed captioning.
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Major support for American Masters is provided by AARP. Additional funding is provided by Rosalind P. Walter, The Philip and Janice Levin Foundation, Judith and Burton Resnick, Ellen and James S. Marcus, Lillian Goldman Programming Endowment, The Blanche & Irving Laurie Foundation, Vital Projects Fund, Cheryl and Philip Milstein Family, The André and Elizabeth Kertész Foundation, Lenore Hecht Foundation, Michael & Helen Schaffer Foundation, and public television viewers.