Management of the hemiplegic shoulder complex.

Hemiplegia in the upper limb and shoulder complex is a common secondary impairment resulting from a cerebrovascular event; evidence-based intervention is required for effective treatment. Prior to addressing shoulder movement, biomechanical alignment of the pelvis and trunk must first be assessed. Extreme care must be taken when completing passive range of motion with the hemiplegic shoulder; motion should not exceed beyond 90° of shoulder flexion and abduction without scapular upward rotation and humeral head external rotation. It is recommended that the use of slings with upper limb hemiplegia be limited. A subluxation of the shoulder can be treated with surface neuromuscular electrical stimulation if the recommended protocol of 6 hours daily, 5 days a week, for 6 weeks is utilized. Taping/strapping for a subluxation has conflicting evidence for reducing the development of hemiplegic shoulder pain, and it does not improve upper limb function or range of motion.

Turn on, tune in, but don't drop out: The impact of neo-liberalism on magic mushroom users' (in)ability to imagine collectivist social worlds.

BACKGROUND: Between 2002 and 2005 fresh or unprepared psilocin-based 'magic' mushrooms were legal to possess and traffic in the UK, and commercial sales demonstrated a significant market for this hallucinogenic drug. During and after this time there has been relatively little analysis concerning how magic mushroom users accounted for their drug use, nor on the wider political and cultural discourses that might have shaped this sense making. METHOD: In this paper we present a critical analysis of contemporary discourses around magic mushroom use in the UK through a multi-level discourse analysis of focus group data from 20 magic mushroom users (13 male and 7 female, mean age 25 years), taken at a time when magic mushrooms were being legally sold in the UK. RESULTS: Locating participants' use of magic mushrooms within the context of a culture of intoxication, neo-liberalism and the legacy of 1960s psychedelic philosophy, we identify six interpretative repertoires in their talk, which were subsumed within two overarching discourses. The first discourse drew on neo-liberal rhetoric, constructing participants as rational risk managing subjects engaged in a form of calculated hedonism that was legitimated as an act of personal freedom and consumer choice. The second discourse, identified as 'post-psychedelic', both celebrated and problematised a collective, connected 'hippy' form of spirituality. CONCLUSION: The paper analyses the relationships between identity, consumption and citizenship by arguing that people's ability to imagine collectivist, spiritual or interconnected social worlds has been contained within neo-liberalism rhetoric.