The electrical discharge of neurons associated with seizure activity stimulates a marked rise in cerebral metabolic activity. Estimates from animal experiments indicate that energy utilization during seizures increases by more than 200", while tissue adenosine triphosphate (ATP) levels remain at more than 95" of control, even during prolonged status epilepticus. The brain generally withstands the metabolic challenge of seizures quite well because enhanced cerebral blood flow delivers additional oxygen and glucose. Mild to moderate degrees of hypoxemia that commonly accompany seizures are usually harmless. However, severe seizures and status epilepticus can sometimes produce an imbalance between metabolic demands and cerebral perfusion, especially if severe hypotension or hypoglycemia is present. A marked increase in glutamate release, which occurs during a prolonged seizure, is likely to result in the activation of all types of glutamate receptors. Although kainic acid produces seizures in the immature brain, it produces little cytotoxicity.
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Recent advancements in molecular genetics have expanded our understanding of the etiology of many neurological diseases and neurodevelopmental abnormalities. Having a comprehensive understanding of genetics is essential in treating patients with metabolic epilepsies. Genetic counseling has been defined as a process of helping people understand and adapt to the medical, psychological, and familial implications of genetic contributions to disease. Some of the components of a genetic counseling interaction include interpretation of family and medical histories to assess the chance of disease occurrence or recurrence; education about inheritance, testing, management, prevention, resources, and research; and counseling to promote informed choices and adaptation to the risk or condition. The genetic counselor may also educate patients and their families about the underlying genetics of their epilepsy and the relevance of a genetic cause of epilepsy for family members, including recurrence risk, reproductive options and the possible teratogenic effect of antiepileptic drugs.Source:
This chapter presents a brief review of the enzymes, transporters, and cofactor producers of the urea cycle. Seizures have long been associated with urea cycle disorders (UCDs), thought to be caused by high levels of ammonia. Furthermore, the brain damage obtained during metabolic crisis has been thought to damage critical structures, leading to epilepsy after the conclusion of the crisis. The first and most critical step of successful treatment of UCDs is recognition. Neurologic monitoring is an essential part of the emergency management of UCDs. The neurological abnormalities observed in patients with urea cycle defects are vast. Controlling ammonia levels by dialysis and complementary medication are needed. EEG monitoring should be initiated early, as this may be very useful for clinical management and indication of untreated metabolic crises. Furthermore, aggressive treatment of clinical and subclinical seizure activity may be helpful in optimizing outcomes for these patients.Source:
Clinical neurophysiology (CNP) is a time-honored medical specialty that continues to make great strides, bolstered by rapid advances in neuroscience, biomedical engineering, and computer technology. It encompasses a wide range of methods and techniques for recording, presenting, and analyzing neurophysiologic signals in order to diagnose sensory, motor, autonomic, and central nervous system disorders. Testing performed in CNP or procedures used in current neurological practice include a variety of modality-specific and mixed-modality tests. Modality-specific CNP tests are performed to assess specific functional modalities using biomedical instruments that measure changes in neurophysiologic signals that occur spontaneously or with activation. Mixed-modality CNP tests utilize two or more test modalities to assess complex states (e.g., sleep, coma), to track multiple physiologic parameters, or to obtain more accurate results. CNP tests are classified based on functional anatomy or neural pathway tested. This chapter discusses artifact recognition and presents sources of artifacts in clinical neurophysiologic testing.
This chapter promotes a better understanding of women’s experience of abuse. It articulates strategies used in victim advocacy, and addresses the experiences and needs of female victims of intimate partner violence. The chapter examines common practices used and issues faced by victim advocates–who are often trained social workers–who work with women who have been victimized by a male intimate partner. It also highlights firsthand experiences of a victim advocate for female victims of intimate partner violence. Many women continue to be victims of intimate partner violence, and the work of victim advocates who serve these women is challenging. Advocates must be able to assess the needs of victims, refer them to appropriate services, protect their rights, empower them, and help them navigate the criminal and civil justice systems. These responsibilities require advocates to possess various personal and professional skills and to collaborate with many different professionals.
Student learning in college and university settings has changed over the years as more and more emphasis has been placed on learning competencies and learning outcomes. The student learning agenda, sometimes called a learning contract, is the universal tool that all social work students use to integrate the competencies within their field placement. A learning agenda’s main purpose is to provide a framework for student identification of needed learning, and for the evaluation of the demonstrable competencies and behaviors shown by the student at the field site. The learning agenda is a tool to identify what learning experiences the agency has to offer and what skills and abilities the student brings. The CSWE requires field instructors who have degrees from accredited social work programs for at least part of field instruction and supervision because of the unique perspective and educational model of social work education.
According to the Council on Social Work Education (CSWE), the field practicum is the signature pedagogy of the student’s social work education. Students are evaluated on their performance in the field practicum. This chapter focuses on the use of field evaluation measures to characterize the student’s readiness for social work practice, and focuses on the literature review, the purpose of evaluation, the timeline for the practicum and the tasks that students perform at the field agency which serves as evidence of the student’s mastery on the content of the field placement. Studies have named the merits of the fieldwork experience in social work education. Reflective practice is an important skill for any social worker. At all points of all levels of social work practicum experiences, field instructors should ask themselves and their students whether the learning that is happening is appropriate for the specific stage of professional development.
Field education is an integral aspect of every social work student’s training. Whether a student is obtaining a bachelor’s degree in social work (BSW) in the hope of pursuing a career in generalist practice or working toward a master’s degree in social work (MSW) to prepare for advanced or independent work, learning skills and practice techniques in community settings is essential. The work that is performed by students in the field is supervised by social workers in many different organizational and practice settings. The relationship between the field instructor and the social work student provides fertile ground for socialization as a member of a profession and the acquisition of practice skills. Whether we are working in health care, child protection, mental health services, corrections, education, gerontology, or another area of social work practice, we have much important knowledge to share with a student.
Serving as a field instructor is usually a delightful and rewarding experience. Most of our students are bright, motivated, and eager to develop into skilled professionals. However, there are times when a practicum student may be ill-suited to the internship. Field supervision is both a process and a relationship. Several frameworks have been discussed in the social work literature about the nature of the field instructor-student relationship. These include the developmental model, attachment-based approaches to supervision, and the relational approach. Program faculty can also work with you to help in the process of integrating classroom knowledge and theory with interventions in the practicum setting. Some areas where students may particularly struggle are the following: emotional self-care, professionalism, setting appropriate professional boundaries, integrating classroom knowledge with fieldwork, professional writing skills, accepting constructive feedback, and asking for help.
Nearly all social work professionals remember their field instructors. Field instructors clearly play a critical role in social work education. This chapter is for those field instructors who would like to broaden their repertoire of tools for helping students become more adept at integrating theory, models, and skills in a coherent manner. It briefly reviews the literature, then identifies barriers, and makes recommendations about strategies for theory and practice integration. The literature suggests that students have appreciated the systematic integration of theory and practice by field instructors. The literature about how to foster integration in field education has a different focus when comparing academic field faculty and agency-based field instructors. For more experienced field instructors, the literature recommended training centered on topics such as enhancing students’ critical thinking, group work, and communication skills, as well as conflict resolution skills.