Пламя. 2017. № 071

Contemporary recognition theory has developed powerful tools for understanding a variety of social problems through the lens of misrecognition. It has, however, paid somewhat less attention to how to conceive of appropriate responses to misrecognition, usually making the tacit assumption that the proper societal response is adequate or proper affirmative recognition. In this paper I argue that, although affirmative recognition is one potential response to misrecognition, it is not the only such response. In particular, I would like to make the case for derecognition in some cases: derecognition, in particular, through the systematic deinstitutionalization or uncoupling of various reinforcing components of social institutions, components whose tight combination in one social institution has led to the misrecognition in the first place. I make the case through the example of recent United States debates over marriage, especially but not only with respect to gay marriage. I argue that the proper response to the misrecognition of sexual minorities embodied in exclusively heterosexual marriage codes is not affirmative recognition of lesbian and gay marriages, but rather the systematic derecognition of legal marriage as currently understood. I also argue that the systematic misrecognition of women that occurs under the contemporary institution of marriage would likewise best be addressed through legal uncoupling of heterogeneous social components embodied in the contemporary social institution of marriage

ToCUEST: a task-oriented client-centered training module to improve upper extremity skilled performance in cervical spinal cord-injured persons

Objectives: Given (a) the importance of upper extremity skill performance in persons with cervical spinal cord injury (C-SCI), (b) the limited number of studies on arm hand functioning in C-SCI and (c) the discrepancy between the importance of client centeredness and the lack of a theoretical framework and practical guidelines on how to apply client centeredness into practice, the aim of the present study is to (1) develop a training concept in which rehabilitation of the upper extremity focuses on patient's needs and wishes and (2) to put this concept into practice for tetraplegic persons. Methods: The training concept contains two main components. The client-centered component includes both extracting individual goals and defining and objectifying these goals. The task-oriented component incorporates a task analysis and the composition of an individual training program. Results: A task-oriented client-centered training aimed at improving upper extremity skilled performance in tetraplegic persons is described step by step. The Canadian Occupational Performance Measure is used to identify patient's specific needs. The Goal Attainment Scale is applied to define and objectify individual goals. A task analysis is essential to map limiting and facilitating factors of the person, the task and the environment and to identify which aspects should be trained. An individual task-oriented training program is composed, based on principles of motor learning and training physiology and the use of assistive devices. Each step is explained and illustrated using a case example. Spinal Cord (2011) 49, 1042-1048; doi:10.1038/sc.2011.52; published online 31 May 201

Motor training programs of arm and hand in patients with MS according to different levels of the ICF: a systematic review

<p>Abstract</p> <p>Background</p> <p>The upper extremity plays an important role in daily functioning of patients with Multiple Sclerosis (MS) and strongly influences their quality of life. However, an explicit overview of arm-hand training programs is lacking. The present review aims to investigate the training components and the outcome of motor training programs for arm and hand in MS.</p> <p>Methods</p> <p>A computerized systematic literature search in 5 databases (PubMed, CINAHL, EMBASE, PEDro and Cochrane) was performed using the following Mesh terms: Multiple Sclerosis, Rehabilitation, Physical Education and Training, Exercise, Patient-Centered Care, Upper Extremity, Activities of Daily Living, Motor Skills, Motor Activity, Intervention Studies and Clinical Trial. The methodological quality of the selected articles was scored with the Van Tulder Checklist. A descriptive analyses was performed using the PICO principle, including scoring of training components with the calculation of Hedges’g effect sizes.</p> <p>Results</p> <p>Eleven studies were eligible (mean Van Tulder-score = 10.82(SD2.96)). Most studies reported a specific improvement in arm hand performance at the ICF level that was trained at. The mean number of training components was 5.5(SD2.8) and a significant correlation (r = 0.67; p < 0.05) between the number of training components and effect sizes was found. The components ‘client-centered’ and ‘functional movement’ were most frequently used, whereas ‘distribution based practice’, ‘feedback’ and ‘random practice’ were never used. The component ‘exercise progression’ was only used in studies with single ICF body function training, with the exception of 1 study with activity level training. Studies including the component ‘client-centred’ demonstrated moderate to high effect sizes.</p> <p>Conclusion</p> <p>Motor training programs (both at the ICF body function and activity level) have shown to improve arm and hand performance in MS in which the value of the training specificity was emphasized. To optimize upper extremity training in MS the component ‘client-centred’ and ‘exercise progression’ may be important. Furthermore, given the importance attributed to the components ‘distribution based practice’, ‘feedback’ and ‘random practice’ in previous research in stroke patients, the use of these components in arm hand training should be explored in future research.</p