DOCSLIB.ORG

Management of Stroke Rehabilitation

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Management of Stroke Rehabilitation VA/DoD CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF STROKE REHABILITATION Department of Veterans Affairs Department of Defense And The American Heart Association/ American Stroke Association Prepared by: THE MANAGEMENT OF STROKE REHABILITATION Working Group With support from: The Office of Quality and Performance, VA, Washington, DC & Quality Management Division, United States Army MEDCOM QUALIFYING STATEMENTS The Department of Veterans Affairs (VA) and The Department of Defense (DoD) guidelines are based on the best information available at the time of publication. They are designed to provide information and assist in decision-making. They are not intended to define a standard of care and should not be construed as one. Also, they should not be interpreted as prescribing an exclusive course of management. Variations in practice will inevitably and appropriately occur when providers take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice. Every healthcare professional making use of these guidelines is responsible for evaluating the appropriateness of applying them in any particular clinical situation. Version 2.0 2010 TABLE OF CONTENTS INTRODUCTION ................................................................................................................................................ 2 Guideline Update Working Group Participants ......................................................................................... 7 Key Points ...................................................................................................................................................... 8 Outcome Measures ........................................................................................................................................ 8 THE PROVISION OF REHABILITATION CARE Algorithm .................................................................................................................................................... 12 Annotations .................................................................................................................................................. 15 Rehabilitation Interventions ....................................................................................................................... 69 APPENDICES Appendix A: Guideline Development Process ........................................................................................... 112 Appendix B: Standard Instruments for Post-Stroke Assessment .............................................................. 121 Appendix C: Acronym List ......................................................................................................................... 127 Appendix D: Participant List...................................................................................................................... 129 Appendix E: Bibliography .......................................................................................................................... 131 Version 2.0 VA/DoD Clinical Practice Guideline for the October, 2010 Management of Stroke Rehabilitation INTRODUCTION This update of the Clinical Practice Guideline for the Management of Stroke Rehabilitation was developed under the auspices of the Veterans Health Administration (VHA) and the Department of Defense (DoD) pursuant to directives from the Department of Veterans Affairs (VA). VHA and DoD define clinical practice guidelines as: “Recommendations for the performance or exclusion of specific procedures or services derived through a rigorous methodological approach that includes: • Determination of appropriate criteria such as effectiveness, efficacy, population benefit, or patient satisfaction; and Literature review to determine the strength of the evidence in relation to these criteria.” This VA/DoD Stroke Rehabilitation guideline update builds on the 1996 VA Stroke/Lower Extremity Amputee Algorithms Guide and the 2003 VA/DoD Guideline for the Management of Stroke Rehabilitation in the Primary Care Setting. The 2003 version of this guideline focused on stroke rehabilitation, utilizing a team model of intervention and interactions with patients and families (caregivers & support systems). Algorithms: This guideline has been developed using an algorithmic approach to guide the clinician in determining care and the sequencing of interventions on a patient specific basis. The clinical algorithm incorporates the information presented in the guideline in a format that maximally facilitates clinical decision-making. The use of the algorithmic format was chosen because such a format improves data collection, facilitates diagnostic and therapeutic decision-making, and changes in patterns of resource use. However, this should not prevent providers from using their own clinical expertise in the care of an individual patient. Guideline recommendations are intended to support clinical decision-making and should never replace sound clinical judgment. The VA developed an algorithm for the Stroke/Lower Extremity Amputee Algorithms Guide (1996) and the results of implementation of this guideline demonstrated the utility of the algorithm, as well as the feasibility of implementing a standard algorithm of rehabilitation care in a large healthcare system (Bates & Stineman, 2000). The algorithm of the 2003 version of the guideline was modified to emphasize early decision-making regarding discharge to home/community. The key decisions in early stages of the assessment and management of a patient recovering from stroke include assessment of rehabilitation needs and the appropriateness of providing these interventions in both community and outpatient rehabilitation settings. The interventions module on this 2010 update has been reorganized, and the recommendations are formulated to address possible impairment regardless of care setting. Target Population: This guideline applies to adult patients (18 years or older) with post-stroke functional disability who may require rehabilitation in the VHA or DoD health care system. Audiences: The guideline is relevant to all healthcare professionals providing or directing treatment services to patients recovering from a stroke, in any healthcare setting (primary care, specialty care, and long-term care) and in community programs. Introduction Page - 2 Version 2.0 VA/DoD Clinical Practice Guideline for the October, 2010 Management of Stroke Rehabilitation Stroke Rehabilitation: Stroke is a leading cause of disability in the United States. (AHA, 1999) Forty percent of stroke patients are left with moderate functional impairment and 15% to 30% with severe disability. Effective rehabilitation interventions initiated early after stroke can enhance the recovery process and minimize functional disability. Improved functional outcomes for patients also contribute to patient satisfaction and can reduce potentially costly long-term care expenditures. Substantial evidence indicates that patients do better with a well-organized, multidisciplinary approach to post-acute stroke care. The highest priorities of early stroke rehabilitation are to prevent recurrence of stroke, manage comorbidities and prevent complications. In addition to facilitating mobilization and resumption of self care activities, ensuring proper management of general health functions and providing emotional support to the patient and family are important. Following the "acute" phase of stroke care, the focus of care turns to recovery of physical and cognitive deficits, as well as compensation for residual impairment. There is a growing body of evidence that indicates patients do better with a well-organized, multidisciplinary approach to post-acute stroke care (Cifu & Stewart, 1999; Evans et al., 1995; Stroke Unit Trialists’ Collaboration, 2002). For this Guideline update, the VA/DoD Stroke Rehabilitation Working Group only focused on the rehabilitation phase of the post-acute care. Secondary Prevention of Stroke will not be addressed in this update. Providers may refer to the revised AHA/ASA Guideline for Prevention of Stroke in Patients with Ischemic Stroke or Transient Ischemic Attack (http://stroke.ahajournals.org/cgi/content/full/37/2/577).. Duncan, Horrner and colleagues (2002) found that greater adherence to post-acute stroke rehabilitation guidelines was associated with improved patient outcomes and concluded that “compliance with guidelines may be viewed as a quality of care indicator with which to evaluate new organizational and funding changes involving post-acute stroke rehabilitation." Stroke in VA population: The Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) estimates that 15,000 veterans are hospitalized for stroke-related diagnoses each year (VA HSR&D, 1997). In 2006, the number of new stroke patients at the VA was 5766 with an additional 5920 being identified in 2007. Although a significant percentage of these patients (87.60% & 83.89% respectively) received an initial assessment, the percentage who received comprehensive rehabilitation (22.30% &22.50%) was quite low. There are only 45 rehabilitation bed units (RBU) in the VA today. Many veterans, who are admitted to a VA Medical Center after suffering a stroke, will find themselves in a facility that does not offer comprehensive, integrated, coordinated care. In a VA rehabilitation field survey published in December 2000, over half of the respondents reported that the “rehabilitative care of stroke
Load more

Recommended publications
  • The Origin of the Peculiarities of the Vietnamese Alphabet André-Georges Haudricourt
    The origin of the peculiarities of the Vietnamese alphabet André-Georges Haudricourt To cite this version: André-Georges Haudricourt. The origin of the peculiarities of the Vietnamese alphabet. Mon-Khmer Studies, 2010, 39, pp.89-104. halshs-00918824v2 HAL Id: halshs-00918824 https://halshs.archives-ouvertes.fr/halshs-00918824v2 Submitted on 17 Dec 2013 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Published in Mon-Khmer Studies 39. 89–104 (2010). The origin of the peculiarities of the Vietnamese alphabet by André-Georges Haudricourt Translated by Alexis Michaud, LACITO-CNRS, France Originally published as: L’origine des particularités de l’alphabet vietnamien, Dân Việt Nam 3:61-68, 1949. Translator’s foreword André-Georges Haudricourt’s contribution to Southeast Asian studies is internationally acknowledged, witness the Haudricourt Festschrift (Suriya, Thomas and Suwilai 1985). However, many of Haudricourt’s works are not yet available to the English-reading public. A volume of the most important papers by André-Georges Haudricourt, translated by an international team of specialists, is currently in preparation. Its aim is to share with the English- speaking academic community Haudricourt’s seminal publications, many of which address issues in Southeast Asian languages, linguistics and social anthropology.
    [Show full text]
  • ISO Basic Latin Alphabet
    ISO basic Latin alphabet The ISO basic Latin alphabet is a Latin-script alphabet and consists of two sets of 26 letters, codified in[1] various national and international standards and used widely in international communication. The two sets contain the following 26 letters each:[1][2] ISO basic Latin alphabet Uppercase Latin A B C D E F G H I J K L M N O P Q R S T U V W X Y Z alphabet Lowercase Latin a b c d e f g h i j k l m n o p q r s t u v w x y z alphabet Contents History Terminology Name for Unicode block that contains all letters Names for the two subsets Names for the letters Timeline for encoding standards Timeline for widely used computer codes supporting the alphabet Representation Usage Alphabets containing the same set of letters Column numbering See also References History By the 1960s it became apparent to thecomputer and telecommunications industries in the First World that a non-proprietary method of encoding characters was needed. The International Organization for Standardization (ISO) encapsulated the Latin script in their (ISO/IEC 646) 7-bit character-encoding standard. To achieve widespread acceptance, this encapsulation was based on popular usage. The standard was based on the already published American Standard Code for Information Interchange, better known as ASCII, which included in the character set the 26 × 2 letters of the English alphabet. Later standards issued by the ISO, for example ISO/IEC 8859 (8-bit character encoding) and ISO/IEC 10646 (Unicode Latin), have continued to define the 26 × 2 letters of the English alphabet as the basic Latin script with extensions to handle other letters in other languages.[1] Terminology Name for Unicode block that contains all letters The Unicode block that contains the alphabet is called "C0 Controls and Basic Latin".
    [Show full text]
  • (H+) Be the Ideal in KG Generated by H+
    THE ANNIHILATOR OF RADICAL POWERS IN THE MODULAR GROUP RING OF A £-GROUP E. T. HILL Abstract. We show that if N is the radical of the group ring and L is the exponent of JV, then the annihilator of N" is NL~W+1.As corollaries we show that the group ring has exactly one ideal of dimension one and if the group is cyclic, then the group ring has exactly one ideal of each dimension. This paper deals with the group ring of a group of prime power order over the field of integers modulo p, where p is the prime dividing the order of the group. This field is written as K and the group ring as KG. It is well known that KG is not semisimple; if N is the radical of KG and NL9£0 while A7L+1= 0, then L is said to be the exponent of N. We prove the following result: Theorem. Let G be a p-group and KG be the group ring of G over K = GF(p), the field with p elements. If L is the exponent of the radical, N, of KG, then the annihilator of Nw is NL~W+1. For 5 a nonempty subset of G, let S+= ^ei€Sgi', in particular, for H a normal subgroup of G, let (H+) be the ideal in KG generated by H+. For g and h in G, the following identities are used: (g- l)*-1 = 1 + g + g2+ ■ ■ • + g^; (g- l)" = g>- 1; (gh - 1) = (g - l)(h -l) + (g-l) + (k- 1); and (h - l)(g - 1) = ig - D(h -D + (gh - D(e -D + ic-D where c={h, g) =h~ig~1hg.
    [Show full text]
  • Proposal for Generation Panel for Latin Script Label Generation Ruleset for the Root Zone
    Generation Panel for Latin Script Label Generation Ruleset for the Root Zone Proposal for Generation Panel for Latin Script Label Generation Ruleset for the Root Zone Table of Contents 1. General Information 2 1.1 Use of Latin Script characters in domain names 3 1.2 Target Script for the Proposed Generation Panel 4 1.2.1 Diacritics 5 1.3 Countries with significant user communities using Latin script 6 2. Proposed Initial Composition of the Panel and Relationship with Past Work or Working Groups 7 3. Work Plan 13 3.1 Suggested Timeline with Significant Milestones 13 3.2 Sources for funding travel and logistics 16 3.3 Need for ICANN provided advisors 17 4. References 17 1 Generation Panel for Latin Script Label Generation Ruleset for the Root Zone 1. General Information The Latin script1 or Roman script is a major writing system of the world today, and the most widely used in terms of number of languages and number of speakers, with circa 70% of the world’s readers and writers making use of this script2 (Wikipedia). Historically, it is derived from the Greek alphabet, as is the Cyrillic script. The Greek alphabet is in turn derived from the Phoenician alphabet which dates to the mid-11th century BC and is itself based on older scripts. This explains why Latin, Cyrillic and Greek share some letters, which may become relevant to the ruleset in the form of cross-script variants. The Latin alphabet itself originated in Italy in the 7th Century BC. The original alphabet contained 21 upper case only letters: A, B, C, D, E, F, Z, H, I, K, L, M, N, O, P, Q, R, S, T, V and X.
    [Show full text]
  • Lexia Lessons Digraph Ch
    ® LEVEL 6 | Phonics Lexia Lessons Digraph ch Description This lesson is designed to reinforce letter-sound correspondence for the consonant digraph ch, where the two letters, c-h, represent one sound, /ch/. Knowledge of consonant digraphs will improve students’ ability to apply phonic word attack strategies for reading and spelling. TEACHER TIPS The following steps show a lesson in which students identify the sound /ch/ at the beginning of words and match the sound to the letters c-h. For students who have difficulty distinguishing the stop sound /ch/ from the continuant sound /sh/, place emphasis on the stop sound of /ch/ by repeating it while making an abrupt chopping motion with your arm: /ch/ /ch/ /ch/. PREPARATION/MATERIALS • For each student, a card or sticky note • A copy of the ch Keyword Image Card and with the digraph ch printed on it 9 pictures at the end of the lesson • Blank sticky notes Primary Standard: CCSS.ELA-Literacy.RF.1.3a - Know the spelling-sound - Know Standard: CCSS.ELA-Literacy.RF.1.3a Primary correspondences for common consonant digraphs. Warm-up Use a phonemic awareness activity to review how to isolate the initial sound /ch/. ListenasIsayawordintwoparts:/ch/op.Thefirstsoundis/ch/.Theendingsoundsareop.WhenI putthemtogether,Igetthewordchop.Whatisthefirstsoundinchop?(/ch/) Make a single chopping motion with one arm. Thesound/ch/isthesoundwehearatthebeginningofthewordchop.Let’sallsay/ch/together:/ ch//ch//ch/.I’mgoingtosayaword.Ifthewordbeginswith/ch/,chopwithyourhandlikethisand say/ch/.Iftheworddoesnotbeginwith/ch/,keepyourhanddownandmakenosound. Suggested words: chill, chest, time, jump, chain, treasure, gentle, chocolate. Direct Instruction Reading. ® Display the Keyword Image Card of the cheese with the ch on it.
    [Show full text]
  • Growth Hormone (GH) Receptor C.1319 G>T Polymorphism
    0031-3998/07/6206-0735 PEDIATRIC RESEARCH Vol. 62, No. 6, 2007 Copyright © 2007 International Pediatric Research Foundation, Inc. Printed in U.S.A. Growth Hormone (GH) Receptor C.1319 G>T Polymorphism, But Not Exon 3 Retention or Deletion Is Associated With Better First-Year Growth Response to GH Therapy in Patients With GH Deficiency LEI WAN, WEI-CHENG CHEN, YUHSIN TSAI, YU-TSUN KAO, YAO-YUAN HSIEH, CHENG-CHUN LEE, CHANG-HAI TSAI, CHIH-PING CHEN, AND FUU JEN TSAI Department of Medical Genetics and Medical Research [L.W., W.-C.C., C.-C.L., C.-H.T., F.J.T.], Graduate Institute of Chinese Medical Science [L.W., Y.T., F.J.T.], Department of Obstetrics and Gynecology [Y.-Y.H.], China Medical University Hospital, Taichung 404, Taiwan; Department of Biotechnology and Bioinformatics [L.W., C.-H.T., F.J.T.], Asia University, Taichung 413, Taiwan; Department of Obstetrics and Gynecology [C.-P.C.], Mackay Memorial Hospital, Taipei 104, Taiwan ABSTRACT: We investigated possible influences of single nucleo- activated kinase 2 (JAK2). These molecules serve in signal tide polymorphisms (SNPs) on first-year growth velocity in response transduction by phosphorylating signal transducers and acti- to growth hormone (GH) therapy in GH-deficient (GHD) children. vators of transcription-5 (1). Signal transducers and activators We recruited a total of 154 GHD prepubertal children who had of transcription (STATs) then induce the transcription of undergone GH therapy for 1 y. To exclude the possibility that the insulinlike growth factor (IGF)-I and IGF-II and modulation genotype/allele variants influenced the height of GHD patients, we of the expression of other genes.
    [Show full text]
  • Organometallic CH Bond Activation
    C-H Bond Activation: An Introduction 1 Goldman and Goldberg Organometallic C-H Bond Activation: An Introduction Alan S. Goldman1 and Karen I. Goldberg2 1Department of Chemistry and Chemical Biology Rutgers, the State University of New Jersey New Brunswick, NJ 08903, USA 2Department of Chemistry, University of Washington, Seattle, WA 98195, USA Abstract An introduction to the field of activation and functionalization of C-H bonds by solution-phase transition- metal-based systems is presented, with an emphasis on the activation of aliphatic C-H bonds. The focus of this chapter is on stoichiometric and catalytic reactions that operate via organometallic mechanisms, i.e., those in which a bond is formed between the metal center and the carbon undergoing reaction The carbon-hydrogen bond is the un-functional group. Its unique position in organic chemistry is well illustrated by the standard representation of organic molecules: the presence of C-H bonds is indicated simply by the absence of any other bond. This “invisibility” of C-H bonds reflects both their ubiquitous nature and their lack of reactivity. With these characteristics in mind it is clear that if the ability to selectively functionalize C-H bonds were well developed, it could potentially constitute the most broadly applicable and powerful class of transformations in organic synthesis. Realization of such potential could revolutionize the synthesis of organic molecules ranging in complexity from methanol to the most elaborate natural or unnatural products. The following chapters in this volume offer a view of many of the current leading research efforts in this field, in particular those focused on the activation ACS Symposium Series 885, Activation and Functionalization of C-H Bonds, 2004, 1-43 C-H Bond Activation: An Introduction 2 Goldman and Goldberg of C-H bonds by “organometallic routes” (i.e., those involving the formation of a bond between carbon and a metal center).
    [Show full text]
  • Sound Production T 'Thick' D 'The' S 'Sh' Z 'Azure' Ts 'Ch' Dz 'J' N 'Thing
    Language & the Mind Sound LING240 Summer Session II 2005 Production Lecture 5 Sounds How you look to a phonetician How you look to a phonetician Nasal Cavity Palate Velum Oral Cavity Tongue Glottis (vocal folds) Lips, teeth etc. T ‘thick’ D ‘the’ S ‘sh’ Forget Spelling! Z ‘azure’ Sounds 䍫 Spelling tS ‘ch’ dZ ‘j’ N ‘thing’ / ‘ uh- oh’ 1 One Sound - Many Characters One Sound - Many Characters he e seas ea too oo threw ew believe ie amoeba oe to o lieu ieu Caesar ae key ey see ee machine i clue ue shoe oe people eo seize ei through ough Interantioanl Phonetic Alphabet: [i] IPA: [u] One Character - Many Sounds One Sound - Multiple Letters dame e shoot S dad Q either D character father a k deal call ç i Thomas t village I, ´ physics f many E rough f One Letter - 0, 1, 2 Sounds Differences across Languages mnemonic • English: judge, juvenile, Jesus [dZ] psychology resign • Spanish: jugar, Jesus [h] ghost • German: Jugend, jubeln, Jesus [j] island whole • French: Jean, j’accuse, jambon [Z] debt cute [kjuwt] 2 Major division: consonants vs vowels • Consonantal sounds: narrow or complete closure somewhere in the vocal tract. • Vowels: very little obstruction in the vocal tract. Can form the basis of syllables (also possible for some consonants). Describing Speech Sounds Where does the Air Flow? • Where/how is the air flowing? nasal/oral, stop, fricative, liquid etc. • Where is the air-flow blocked? labial, alveolar, palatal, velar etc. • What are the vocal folds doing? voiced vs. voiceless Block it at the velum Where does the air go? Your vocal tract again 3 N Block it at the velum Tongue against velum again Where does the air go? Now raise the velum Now raise the velum to block the air...
    [Show full text]
  • Five Centurie< of German Fraktur by Walden Font
    Five Centurie< of German Fraktur by Walden Font Johanne< Gutenberg 1455 German Fraktur represents one of the most interesting families of typefaces in the history of printing. Few types have had such a turbulent history, and even fewer have been alter- nately praised and despised throughout their history. Only recently has Fraktur been rediscovered for what it is: a beau- tiful way of putting words into written form. Walden Font is proud to pres- ent, for the first time, an edition of 18 classic Fraktur and German Script fonts from five centuries for use on your home computer. This booklet describes the history of each font and provides you with samples for its use. Also included are the standard typeset- ting instructions for Fraktur ligatures and the special characters of the Gutenberg Bibelschrift. We hope you find the Gutenberg Press to be an entertaining and educational publishing tool. We certainly welcome your comments and sug- gestions. You will find information on how to contact us at the end of this booklet. Verehrter Frakturfreund! Wir hoffen mit unserer "“Gutenberg Pre%e”" zur Wiederbelebung der Fraktur= schriften - ohne jedweden politis#en Nebengedanken - beizutragen. Leider verbieten un< die hohen Produktion<kosten eine Deutsche Version diese< Be= nu@erhandbüchlein< herau<zugeben, Sie werden aber den Deutschen Text auf den Programmdisketten finden. Bitte lesen Sie die “liesmich”" Datei für weitere Informationen. Wir freuen un< auch über Ihre Kommentare und Anregungen. Kontaktinformationen sind am Ende diese< Büchlein< angegeben. A brief history of Fraktur At the end of the 15th century, most Latin books in Germany were printed in a dark, barely legible gothic type style known asTextura .
    [Show full text]
  • First : Arabic Transliteration Alphabet
    E/CONF.105/137/CRP.137 13 July 2017 Original: English and Arabic Eleventh United Nations Conference on the Standardization of Geographical Names New York, 8-17 August 2017 Item 14 a) of the provisional agenda* Writing systems and pronunciation: Romanization Romanization System from Arabic letters to Latinized letters 2007 Submitted by the Arabic Division ** * E/CONF.105/1 ** Prepared by the Arabic Division Standard Arabic System for Transliteration of Geographical Names From Arabic Alphabet to Latin Alphabet (Arabic Romanization System) 2007 1 ARABIC TRANSLITERATION ALPHABET Arabic Romanization Romanization Arabic Character Character ٛ GH ؽٔيح ء > ف F ا } م Q ة B ى K د T ٍ L س TH ّ M ط J ٕ ػ N % ٛـ KH ؿ H ٝاُزبء أُوثٛٞخ ك٢ ٜٗب٣خ أٌُِخ W, Ū ٝ ك D ١ Y, Ī م DH a Short Opener ه R ā Long Opener ى Z S ً ā Maddah SH ُ ☺ Alif Maqsourah u Short Closer ٓ & ū Long Closer ٗ { ٛ i Short Breaker # ī Long Breaker ظ ! ّ ّلح Doubling the letter ع < - 1 - DESCRIPTION OF THE NEW ALPHABET How to describe the transliteration Alphabet: a. The new alphabet has neglected the following Latin letters: C, E, O, P, V, X in addition to the letter G unless it is coupled with the letter H to form a digraph GH .(اُـ٤ٖ Ghayn) b. This Alphabet contains: 1. Latin letters which have similar phonetic letters in Arabic : B,T,J,D,R,Z,S,Q,K,L,M,N,H,W,Y. ة، ،د، ط، ك، ه، ى، ً، م، ى، ٍ، ّ، ٕ، ٛـ، ٝ، ١ 2.
    [Show full text]
  • The Alphabets of the Bible: Latin and English John Carder
    274 The Testimony, July 2004 The alphabets of the Bible: Latin and English John Carder N A PREVIOUS article we looked at the trans- • The first major change is in the third letter, formation of the Hebrew aleph-bet into the originally the Hebrew gimal and then the IGreek alphabet (Apr. 2004, p. 130). In turn Greek gamma. The Etruscan language had no the Greek was used as a basis for writing down G sound, so they changed that place in the many other languages. Always the spoken lan- alphabet to a K sound. guage came first and writing later. We complete The Greek symbol was rotated slightly our look at the alphabets of the Bible by briefly by the Romans and then rounded, like the B considering Latin, then our English alphabet in and D symbols. It became the Latin letter C which we normally read the Bible. and, incidentally, created the confusion which still exists in English. Our C can have a hard From Greek to Latin ‘k’ sound, as in ‘cold’, or a soft sound, as in The Greek alphabet spread to the Romans from ‘city’. the Greek colonies on the coast of Italy, espe- • In the sixth place, either the Etruscans or the cially Naples and district. (Naples, ‘Napoli’ in Romans revived the old Greek symbol di- Italian, is from the Greek ‘Neapolis’, meaning gamma, which had been dropped as a letter ‘new city’). There is evidence that the Etruscans but retained as a numeral. They gave it an ‘f’ were also involved in an intermediate stage.
    [Show full text]
  • Background Paper 6.6 Ischaemic and Haemorrhagic Stroke
    Priority Medicines for Europe and the World "A Public Health Approach to Innovation" Update on 2004 Background Paper Written by Eduardo Sabaté and Sunil Wimalaratna Background Paper 6.6 Ischaemic and Haemorrhagic Stroke By Rachel Wittenauer and Lily Smith December 2012 Update on 2004 Background Paper, BP 6.6 Stroke Table of Contents Abbreviations ...................................................................................................................................................... 4 Summary ............................................................................................................................................................... 5 1. Introduction ................................................................................................................................................. 6 1.1 Definition and classification .............................................................................................................. 6 1.2 Ischaemic stroke .................................................................................................................................. 6 1.3 Haemorrhagic stroke .......................................................................................................................... 7 1.4 Investigation of a stroke ..................................................................................................................... 8 1.5 Assessment of acute stroke ...............................................................................................................
    [Show full text]