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If changing the font size is not possible, then enlarge each page on a copy machine, by changing from 8. The Office for Students with Disabilities is always trying to reach out to students with disabilities and inform them of the services available. You can help in that mission by adding the following sentence to each syllabus produced for your class. Students who qualify will have an assistive listening device signed out to them while they are students at Chipola. However, students who are hard of hearing may not know that assistive listening devices are available. If you become aware that a student cannot hear what is being said, inform the student that assistance is available through the Office for Students with Disabilities. Alternative Print Any publication that describes services, programs or activities. Upon request, for persons with print-related disabilities, this publication is available in alternate formats. If you have a document such as the College Catalog that you would like to offer in one particular format, the following is an example of what the statement would look like: 2. Upon request, the college catalog is available on computer disk to persons with print oriented disabilities. When selecting one type of format over another, you need to be aware that the person requesting the alternate format should be given primary consideration as to the format of the publication. Obviously, a computer disk would not be any good to someone who does not have a computer. Generally speaking, the first should be large-print copy and the second should be worked out between both parties. The program producing the publication is responsible for the costs associated with any alternate format publication. You are not required to stockpile any document; however, it is wise to be prepared and ready to act when and if a request is made. If you have the text on computer, select an 18-point font and print a copy, or enlarge the document on a photo copy machine. Telecommunication Device for the Deaf Any time you list a telephone number within a letter, booklet, pamphlet, resource guide, program announcement, application, notice, advertisement, letterhead and in any other circumstance where you provide a number to be reached, you should be sensitive to the fact that there are individuals who may not be able to call the phone number listed due to one of many disabilities (deaf, hard of hearing, speech impaired). Categories of Disabilities In order to provide services to students with disabilities, Chipola asks for voluntary self identification of students with a specific disability.

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The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy. E-6 Framework A: Spasticity Spasticity is characterized by hyperreflexia and resistance to muscle lengthening (Table E 10 2). Potential morbidities associated with spasticity include contractures, decubitous ulcers, scoliosis, gait problems, nutrition problems, pain, fractures, and functional impairments. Reasons to treat spasticity include reducing pain and muscle spasms, facilitating brace use, improving posture, minimizing contractures and deformity, facilitating mobility and dexterity, and improving patient ease of 7 care or self-care and hygiene. Although spasticity is a major focus in clinical practice there are a limited number of clinical trials to support current practices. The treatment strategies include stretching, daily range-of-motion exercises, weight bearing (standing), serial casting, bracing and orthotic devices, oral medications, intrathecal medication, specific nerve or motor blocks, dorsal 6,8 rhizotomy, and orthopedic surgeries. The goal of these interventions is to increase function, 10 decrease disability, and facilitate mobility. These treatment strategies can generally be divided into pharmacologic, surgical, and rehabilitative strategies. Additionally, many of the most clinically important treatment strategies have little available evidence. This localized approach is in contrast to the role of other pharmacologic therapies for generalized spasticity. Anti-spastic or spasmolytic agents, include medications that act on the central nervous system on synaptic neurotransmission or receptors like benzodiazepines. There is insufficient evidence to support the efficacy of most of the oral anti-spasticity medications. Compared to oral administration, intrathecal baclofen can 12 provide a lower incidence of cerebral side effects and a greater reduction in tone. The initial E-7 implantation of the pump device and catheters requires a surgical procedure. These surgeries include tendon lengthening, tendon transfer, bony osteotomy, and joint fusion. There is variability in the indications and combinations of therapies recommended. Rehabilitative Treatment Strategies Rehabilitative treatment strategies include occupational therapy and physical therapy. There are variations in the outcomes measured in this area: structure versus function versus activity limitation. Prevention and Surveillance Close surveillance for deformity to soft tissue or bony structures is recommended for patients with spasticity. European Consensus of 2009 recommends re-classification of a child during every appointment, especially if the child is under 4 57 years old. Reliance on clinical classification by describing the anatomical distribution of spasticity results in some variation in diagnosis. Instead of basing surgical interventions on age, they should be based on severity of spasticity, effect of spasticity, and patient 1 size.

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At its core, Complex, or mixed, Sleep Apnea is a type of sleep apnea with mixed causes. Damage to the head, neck (cervical spine), nerve paths between the brain and the chest area, etc. Dose can be increased to 10 mg once Time to effect may be delayed if taken with or soon after a meal per night if the 5 mg dose is not effective. Particularly in obese women, the increased risk of exposure-related adverse effects should be considered before increasing the dose [see Clinical Pharmacology (12. Discontinue or decrease the dose in patients who drive if daytime somnolence develops. Immediately evaluate patients with suicidal ideation or any new behavioral sign or symptom. In primarily depressed patients treated with sedative-hypnotics, worsening of depression, and suicidal thoughts and actions (including completed suicides) have been reported. Suicidal tendencies may be present in such patients and protective measures may be required. Intentional overdose is more common in this group of patients; therefore, the lowest number of tablets that is feasible should be prescribed for the patient at any one time. The emergence of any new behavioral sign or symptom of concern requires careful and immediate evaluation. These events can occur in hypnotic-naive as well as in hypnotic-experienced persons. Such symptoms can include periods of leg weakness lasting from seconds to a few minutes, can occur both at night and during the day, and may not be associated with an identified triggering event. The failure of insomnia to remit after 7 to 10 days of treatment may indicate the presence of a primary psychiatric and/or medical illness that should be evaluated. Table 2 shows the percentage of patients with adverse reactions during the first three months of treatment, based on the pooled data from 3-month controlled efficacy trials (Study 1 and Study 2). At doses of 15 or 20 mg, the incidence of somnolence was higher in females (8%) than in males (3%). Of the adverse reactions reported in Table 2, the following occurred in women at an incidence of at least twice that in men: headache, abnormal dreams, dry mouth, cough, and upper respiratory tract infection. The adverse reaction profile in elderly patients was generally consistent with non-elderly patients. The adverse reactions reported during long-term treatment up to 1 year were generally consistent with those observed during the first 3 months of treatment. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. Suvorexant decreased maternal weights at doses 150 mg/kg/day and fetal weights at doses 325 mg/kg/day.

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