Small Arms Survey - Small Arms Survey 2. The Small Arms Survey 2. Guns and the City offers new and updated information on small arms production, stockpiles, transfers, and measures, including a special focus on transfer controls. This edition also features chapters on lessons learned from the tracing of ammunition, the relationship between gun prices and conflict, and the role of small arms in South Sudan. List of modern Russian small arms and light weapons. Anti- tank. PG- 7. If you ask my wife she’ll say my personality lends to me being a headfirst, all or nothing type of guy. When I started getting into the precision rifle market, I was overwhelmed by the different options available to me. Small Arms and Light Weapons (SA/LW) Guns are generally classified according to use, size, and tradition. This varies among the military services. The basic distinction is between small arms and artillery. Modern Firearms world: pistols and revolvers, submachine guns, rifles, automatic assault rifles, sniper rifles, the civilian rifles, shotguns, machine guns, antitank guns, grenade launchers, ammunition, weapons and traumatic.
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Su Doku Solver. Su Doku problems were introduced to the UK in The Times. November 2. 00. 4. Since then they have somewhat risen in popularity. It works for (almost*) all problems we've seen so far. If so, we've solved that square, so fill it in and remove all. Repeat this until you get no more changes. See if we can find a square that can only have one possible value. This. lets us fill in some more and then we repeat with stage 1 again. Find. the square with the least number of possibles and pick one of them. This gets. tricky because we now have to remember all we fill in from now on so we can. Having guessed one square, repeat stages 1. If not, delete all the guesses and pick. Repeat until we solve it. Manulal M Inasu points out that the first problem (the one with two solutions). GUESSEDMAX in our program from 1. Professor Nigel Topham. I wrote the Excel solver when the Times first started publishing its Su Doku problems in November 2. Having solved it, though, I completely lost interest in the subject, and still have. It takes at the most a second or two to find a solution. Completing the program to work without guessing would be a nice theoretical. Sudoku Extreme 25X25 Easy level. 16x16 Easy 16x16 Medium 16x16 Hard Extreme 25x25 Medium Extreme 25x25 Hard. C Program to Reverse A String C Program: Building an Expression Evaluator C Program: Check for Armstrong Numbers C Program: Check whether a string is a Palindrome or not. Categories: (2), - (1).NET (3), Accessibility (3), ACME (43), Adjunctions (1), ADSB (4), AI (43), Algebra (29), Algorithm (2), Algorithm. C Program source code to solve, via series expansion, the functions exp(x),sin(x),cos(x),tan(x). Crossword Giant Crossword puzzle solver. Solves crosswords by clues or by pattern matching. Cross references clues to answers as well as to past puzzles. Tonight, I was thinking about, how to make a sudoku solver, using excel and visual basic. 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How innocent it looks now, the controversial Jaime- Cersei scene, with its single demure assault of a grieving woman by her brother beside the poisoned corpse of their incestuously- begotten son. The next episode gifted us with a whole flotilla of angry cocks as – in another departure from George R. R. Martin’s source books – the Night Watch assaulted en masse the already serially abused daughter- wives of Craster. It made for grim viewing. Watch the scene for long enough and the Cersei- Jaime- corpse caper takes on the fond, sepia edges of an Edwardian picnic. Ah, for the rapes of yesteryear. If you’re one of the large and increasingly vocal number of people who are disturbed by the treatment of sex and violence on “Game of Thrones”, then this scene probably provoked a familiar feeling of angry exhaustion. This reaction can be difficult to manage, because the sadness and weariness means you don’t have much energy left for the anger. And – especially as a person who doesn’t generally have a problem with sex and violence – you don’t know where to direct the anger. Martin, the author of the novels on which the show is based? Or should it be at the show’s co- creators, David Benioff and D. Maybe the problem lies with the directors of offending episodes, such as Alex Graves, who gave us the Jaime- Cersei rape scene? Or does the buck stop ultimately with HBO, who commissions this series, and puts it out into the world? On this last point, here we have Michael Lombardo, president for programming at HBO, responding to the recent controversy in an email to The New York Times, and defending the show, arguing “the choices our creative teams make are based on the motivations and sensibilities that they believe define their characters. We fully support the vision and artistry of Dan and David’s exceptional work and we feel this work speaks for itself.”To which we might reply: yes, the work speaks for itself, but it also speaks for you, HBO. You’re a network, a conduit. You are what you choose to present. And this statement offers a blanket endorsement while also spectacularly passing the buck. Then there’s this from Neil Marshall, who directed the second season episode “Blackwater” of “Game of Thrones”, and has described the . The producer’s reasoning? A lot of the anger so far has understandably been directed at the show’s writers and directors. And it’s true that they’re the ones on the ground, making the creative choices. Below is a list of boxing terminology commonly used in the boxing world. If you have any questions about this boxing terminology send an email to [email protected]. Bleeder: A boxer who is known to have a propensity for. The Attractive Bent-Gender trope as used in popular culture. Whenever a male is turned into a female (or sometimes just when he dresses as one), he/she will Filling time, Internet with Ananova is best. Ananova is an everlasting fog of information. In form of news, articles, reports, books, pictures, videos, audios & information exists on website, Editor “Manish K.” says. Song: Bent - As You Fall (Kyau & Albert Remix) Picture: My current Wallpaper = But HBO influences these choices. Drastic departures from agreed- upon limits must be theirs to check, if they want to. But not only does the ickiness of “Game of Thrones” only increase over time, but in the wake of the recent controversy – about something as serious as rape, no less – they’ve come out with their explicit support. Et tu, HBO? So why does this matter, HBO? It’s not the thing to say it now, but “Sex and the City” was a benchmark. It set so many new rules for television and changed the scene so completely that it’s hard to see now, looking back at it, what was so revolutionary. Before the last few seasons (and then the egregious movies) tipped it over into sentimentality, product placement, and the sexual status quo, “Sex and the City” put a lot of good stuff in place for television in terms of whip- smart satire, comedy, cine- worthy production values, and depictions of sex (especially women having sex) that brimmed with wit and realism and a refreshing lack of prudery. The tits had a purpose. And if Sex and the City was your mask of comedy, then The Sopranos was your Mask of Tragedy. Culture and philosophy of Ivy Style by a master of the genre. And boy, did you give it to us. Everything that tragedy was, everything that film and literature was, you showed us that TV could deliver too. Tony Soprano: the flawed, neurotic, basic, brilliant, ruthless, sentimental bully- boy, the exemplar and antithesis of the American Dream. Sure, there were plenty of boobs in “The Sopranos”, genuine and otherwise. There was plenty of sexposition. You could rarely get through an episode without the rote titillations of Bada Bing. Al Czervik: What're we, waiting for these guys? Hey Whitey, where's your hat? Judge Smails: Do you mind, sir. I'm trying to tee off. Al Czervik: I'll bet you a hundred bucks you slice it into the woods. Judge Smails: Gambling.But that seemed to be the point of the tits: they were meant to be rote, they were part of a wider exploration of a culture built around power and coercion, especially coercion through gender. The arses were a panorama. They revealed something. Ditto . A show that could have gone crazy with the titties, but was sparing with the titties. The titties came out when there were Ukrainians being trafficked for sex, or when a police informant (and bona fide Interesting Character) who happened to be a bar dancer, or when characters were in a brothel for a narratively compelling reason. Occasional nakedness was a meaningful detail. Other shows followed. A mixed bag, but all of them shows where explicitness and violence were for the most part approached in grownup ways, for grownup reasons. They were blessing the medium. And that’s why, with “Game of Thrones”, there was a lot that your faithful audience was willing to overlook at the start. They took it on trust. The endless sexposition. The tittering frathouse atmosphere of so many bared boobies. In a world of casual misogyny it seemed, initially, like a knowing nod. Even the most infamous case of sexposition – the girl- on- girl sex scene in that constant brothel as Littlefinger narrates his history, pausing now and then to give the prostitutes instruction on what to do next, and how to do it – could be explained in sympathetic terms. Littlefinger, and by extension “Game of Thrones”, was using the clich. It was about connivance through performance, see? It was metaphor, not tits! But we’re in the fourth season now, and it’s getting tiring. Has “Game of Thrones” jumped the shark? Or has it jumped so high into its own frathouse flatulent ether that even that famous shark is lost from view, a sort of distant pin- glint in the water? The logical answer is of course, no. The things that were always good about “Game of Thrones” are still good – and in fact the show has recently upped its game in terms of tighter episode focus on compelling storylines. And certain central performances, like Peter Dinklage’s, continue to deepen and delight. But what was rank in the show has only grown ranker. And you can only take in the whiff for so long before you start to wonder: is this an isolated problem with “Game of Thrones”, or does it signal something about HBO’s approach more generally? Article continues on next page. And the show that crystallises the shift most readily is “Rome“. So what did Rome do that marked the decline? The most obvious thing was the introduction a phenomenon now so common it’s become a tired TV convention: the fight- fuck. Take this scene in “Rome”, where Titus Pullo (which you might translate as Honourable Chicken) beats and fucks his slave. Now, you can justify this scene by saying that men in ancient Rome beat and fucked their slaves all the time. I’m sure, afterward, those same bleeding slaves murmured to their masters, through the post- coital happy miasma, . This is just historical reportage, dammit! It’s responsible reportage! Ditto, presumably, the roadside rapes, and the middle- of- the- tavern breast- washing- from- a- bowl that happens in at least one scene in “Rome”, incidental to the action, but somehow finding itself in the foreground of the shot. I’m sure archaeologists have uncovered many touching tableaux, etched lovingly into the dusty vellum, of ancient women washing their breasts with sudden urgency in the middle of taverns. Them streets were dusty. But, back to Honourable Chicken beating and fucking his slave. Or, to use the touching description from the video’s You. Tube uploader: “Titus Polo and his slave girl get hot”. The latent justification for the fight- fuck in this scene, the things that makes it all ok, is presumably that a) it’s the (oblivious) wife who’s ordered the slave to be beaten in the first place, silly girl cuckold! So it’s not really male sexual violence, it’s just a totally hot Punch- and- Judy show. Then b) the slave girl fights back. And really fights back. Also, she’s completely carnally into it. I bet all the slaves were into it. I bet that’s why they applied to be slaves. So: she fights back, and she’s a good fighter, she’s a strong woman dammit, and he’s . It’s Robin Thicke as wannabe- Tarantino. It plays at the edges of rapey fantasy. It’s the first step on the path to the idea that a man can begin raping a woman and it can then become consensual sex. And I single it out because it’s a telling precursor to HBO’s recent carnival of rape in “Game of Thrones”. It follows much of the same logic of power- struggle as sex play. It has in common with rape scenes like that Jaime- Cersei one the idea – articulated by Alex Graves, who directed the episode – that rape can “become consensual by the end”. In which case it’s useful to unpick the logic that unites the fuck- fight and that rape scene, and the fuck- fight and the rapist’s reasoning. It goes something like this: 1. Desire is a kind of animosity. The physical closeness that comes with violence resembles the physical closeness that comes with sex. So, the physical closeness of violence will stir similar feelings to the physical closeness that comes with sex. If you fight her for long enough, desire will occur. Resistance is foreplay. Consent is inevitable. Now, this is very fucked- up. It doesn’t tally with most people’s experience of violence or sex. It certainly doesn’t tally with the experience of people who are forced violently into sex. Violence shouldn’t be the leitmotif of attraction. In fact, most sexual relationships that have violence at their core look more like this (a clip from the days when HBO approached sexual violence with brutal realism). But even working with this . A rape might already be occurring. And when is that ever anything but deeply horrifying? Why aren’t we all horrified? Of course, HBO isn’t the only network guilty of the banal fantasy fuck- fight. Attractive Bent- Gender - TV Tropes. Whenever a male is turned into a female (or sometimes just when he dresses as one), he/she will almost always be extremely attractive, especially to members of his inner circle and close associates. This may result in awkwardness for all concerned. The sex- changed character will often examine her new form and find it to be very.. Only to promptly Squickherself out when she realizes what she's thinking. Attractive Bent- Gender operates in tandem with the First Law of Gender- Bending to leave the world more attractive than it had been before. Or at least no less attractive. A handsome man may become a beautiful woman.. In true Gender Bender or Easy Sex Change situations, one rarely encounters a handsome man who becomes an unattractive woman. Sometimes this is played straight, but (particularly when the crossdressing is Played for Laughs) it's often a case of Informed Attractiveness. In such scenarios, despite the . Sweet on Polly Oliver is a subtrope where a woman crossdressing is found attractive by straight guys. Frequently accompanies Old Friend, New Gender. See also Rule 6. 3, which basically exists because of this trope. When they actually are both genders, it becomes Everybody Wants the Hermaphrodite. It varies from person to person, however, as some of the changes involved with puberty involve reshaping the bones in the face; this results in the Lantern Jaw of Justice that can make it difficult for many men to pull this off. At the end of the ad, another cop studies him and remarks, . Note that he is already considered handsome as a male. This is justified by being quite bishonen, and the one time he wore male clothes the girls were all over him. They all look horrible, at least in part because their outfits are ridiculous. Needless to say, they are not pleased when they find out the truth, and insist that Doah pay them back by working as their manager. He just happens to look exactly like Princess Fatora. This causes another student to remark on one occasion that . Despite all of the school knowing of her situation, she still gets more Valentine's chocolates and love letters from the girls than all of the other boys. Tamimi and Momono (who dressed him up in his sleep in the first place) knew he would since he was fairly girlish and were still amazed at . When one of his classmates sees . He absolutely hates this part of his life, and resents his father for dragging him into the business. This causes problems with her male best friend who comically is conflicted about his undeniable attraction to her despite the fact he knew her as a boy until the gender switch. His disguise is so convincing that even the local pervert Fukuyama mistakes him for a pretty girl. This makes for one of the most humorous scenes in anime when Fukuyama finds out his true gender. Does a good enough job (with the aid of a voice- changer) that one of the captured crew, Bart, falls in love with him. The reveal in Vandread: Second Stage is well- done. Even after learning that she's a man, Bart still proclaims his love. It's not very disturbing for Bart to love a cross- dresser, as he lived all his life on a planet populated entirely of men. He was able to convince Naruto that he was a girl simply by removing his mask and changing his clothes, and it came as no small shock to Naruto when he discovered the ruse. He occasionally finds call to dress up as a woman, and is considered attractive by both genders. He also temporarily unsettles Faye when she bursts in on him in the shower, sees his breasts (and body), and thinks he's a woman. Then her eyes scroll down. Every season of Slayers has a crossdressing episode (and it's always episode 1. Gourry looks very attractive - men (and lesbians) hit on him, and in Slayers Try a sea monster mistakes him for a beautiful princess. His friends just stare at him for a few seconds, he just looks so damn hot. Though in this case, guys usually consider him attractive even out of the dress. She uses it as a opportunity to hang out with the guy she has a crush on as a friend. In this form, he is described as having long black hair, crimson lips, and shining black eyes fringed by long eyelashes. Towards the end of the series, he plays highly successful female roles in a movie and a play (and frets that he's going to have to make his living as an actress instead of as an actor). Because of that, he begins to exhibit feminine qualities (sometimes seemingly having longer hair), and all of his friends start finding themselves disturbingly attracted to him. Much to his embarrassment, several of his friends quickly develop crushes on this new . Made even funnier in that Yuki never actually claims to be a girl (he even tries to explain it, but is ignored), just dresses and acts like one. It doesn't help that he has a very feminine build including what seem to be breasts. He doesmake a pretty cute girl. When Riku dresses up as a maid for a school festival in Wandering Son he is noted to be attractive. Fumika crossdresses to attract the attention of a girl she likes, who likes feminine boys and is attracted to the transsexual protagonist, and likes to flaunt his cuteness around. You wouldn't think that a hairclip and skirt could turn an average looking boy into a cute girl. The effect is so striking the entire gang falls in love with him. Said friend later shows off a picture he took on his phone. Seiji responds by eating the phone. He goes to an all- male school, but practically everyone else thinks he's a girl in disguise, and has vowed to never reveal 'her' secret since they find the idea of a sweet Polly Oliver romantic. This is endlessly frustrating to Kanako, who's not only a lesbian but fears boys so much they make her break out in hives. She's intensely attracted to Mariya as a girl, and has to keep reminding herself he isn't one. Looking back later in the series, Cooro mentions that 'Husky was pretty as the Mermaid Princess.' When Nana knocks Husky out and puts him in a dress, someone (probably Cooro again, since Senri never talks), says that it's pretty. When Husky is bought by Lord Hashas and shows up at his mansion dressed like a black- haired pre- teen girl, he finds 'her' . Nana even believes he's a girl secretly crossdressing as a boy in the beginning. Shun Kusanagi and his little brother look like girls, which is disturbing/amusing/arousing to the general populace of the all- male Greenwood dorm. Various other male characters don drag at different points in the manga (mostly for cultural/sports festivals), and attract various admirers. This is not including the alternative- dimension Cherrywood where everyone male is female. The school's males are lovestruck with Moe. It's a no- brainer for Nuriko, while Hotohori is just so bishounen it's no problem for him, and Tomo merely wonders how much make- up needs changing. As for the others, some of them end up looking good, ranging from cute (Chiriko) to gorgeous (Nakago and Chichiri), others end up looking ridiculous (Tamahome and Tasuki), while Mitsukake, who's face was censored, ended up giving everyone a big scare. Madarame: I think we should stop talking about this. Ivankov from One Piece. When Ivankov is a man he is ugly, and barely even human- looking. When he is a woman she is beautiful. Because your painfully forced Designated Girl Fight wouldn't be complete without two attractive girls duking it out! Hell, his power is probably how he has his usual appearance of a vaguely bowling- pin shaped giant. His best friend falls for him, and one of his love interests starts out only being comfortable around him when he's in drag. He does make a real cute girl. Well, cute enough that he would get kidnapped by the handsome Viscount Druitt. And both genders LOVE HIM/HER!!! Doesn't help that his Gender Bender side is VERY beautiful. Strawberry Eggs really does make a convincing woman, even if it is just to get a job as a Gym Teacher. Justified in that she always was a girl (albeit an intersexed one) and even the guys wanted him before he Jumped The Gender Barrier. Parodied somewhat in Gintama. Gintoki and Katsura end up being forced to work in a crossdressing club after offending the leader of the crossdressers, Fierce God Mademoiselle Saigou. Due to the somewhat bishonen nature of the main characters, they look pretty good. The other crossdressers however are... Everyone other than Hijikata (Who turns into an overweight Gonk of a girl) and Kagura (Who inexplicably becomes a rugged old man) has good looks, especially Kondo, who doesn't look even remotely similar to how he did as a male. It really doesn't help his case that he is voiced by a woman in all dubs of the anime adaption. That the local bathhouse owners built him his own personal bathing area is a bad sign, too. Dressing up as a girl due to a Zany Scheme, . Mutsurini also sold out the . Both Akihisa and Mutsurini scored very well with the male crowd. Taro looks very nice in his maid costume. Taro looks quite beautiful in his Mahoromatic cosplay costume. What does come as a surprise is that so does his best friend Psy, after taming his wild shock of hair. En Shinohara is a male, man- hating. Wholesome Crossdresser. He's cute enough that the male student body actually doesn't believe he's male until his uniform blouse gets wet and transparent. However, this doesn't completely remove the problem, as at least one guy afterward is quoted as saying ! The 'girl' in question is actually a very male Francein disguise. They're androgynous though, so they look the same whatever they're wearing; though Mizuki looks a little overly masculine even when wearing female clothing. Then people are unsettled with reveals, much to Liesl's disapppointment. A while later, Liesl confesses to Jeudi that she miiiight be a little infatuated with her still, and lampeents that Jeudi's not a guy. Crossdressed Tadakuni was so hot that his friends wonder . He now finds it incredibly embarrassing. As his local theatre was swift to notice, Nezumi makes a really good- looking woman. Super- Effective Tickling Hentai - Read Super- Effective Tickling hentai manga online for free.
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Unfortunately, once intelligibility begins to decrease, speech performance often deteriorates so rapidly that there is little time to implement an appropriate augmentative and alternative communication (AAC) intervention; therefore, appropriate timing of referral for AAC assessment and intervention continues to be a most important clinical decision- making issue. AAC acceptance and use have increased considerably during the past decade. Many people use AAC until within a few weeks of their deaths. Introduction. Almost all people with amyotrophic lateral sclerosis (ALS) experience a motor speech disorder as the disease progresses. Mlm Database Quality and Accuracy :-We sale accurate and updated mlm leaders directory only. We update when every we find new leads for buying. We have old and new both mlm data mix. What is Format of MLM Leaders Directory. Initial symptoms typically do not interfere with speech intelligibility and may be limited to a reduction in speaking rate, a change in phonatory (voice) quality, or imprecise articulation. At some point in the disease progression, 8. ALS are unable to meet their daily communication needs using natural speech. In time, most become unable to speak at all . For them, communication support involves a range of augmentative and alternative communication (AAC) strategies involving low- and high- technology (speech generating device) options . Clinical decision- making related to communication is quite complex as screening, referral, assessment, acquisition of technology, and training must occur in a timely manner, so when residual speech is no longer effective, AAC strategies are in place to support communication related to personal care, medical care, social interaction, community involvement, and perhaps employment. Although there is considerable research on the speech characteristics of people with ALS, it is the primary purpose of this paper to review the published research related to communication supports for people with ALS whose natural speech no longer meets their communication needs. Speech Characteristics ALS involves both upper and lower motor neurons; therefore, it results in mixed dysarthria of the flaccid- spastic type . In the early stages of ALS when dysarthria is mild, either spasticity or flaccidity is predominant. Garamchai.Com a complete listing of Mosques, masjid, muslim places of worship in North America and the US!! Call Centre Leads.com is in leads selling business since 2005. We provide best connectivity b2c and b2b mailing lists, email lists and telephone numbers data for USA, UK, AUSTRALIA and Canada. We provide 85% guaranteed connect. About, photos, skills and research. Creator of Kiran's Typing Tutor and Kiran's Kids Games. C# and Visual basic.NET tips and sources. April 08, 2016 Modi, Prabhu approve one lakh crore Amritsar- Delhi Bullet Train via Chandigarh : Tarun Chugh. India Catalog - Web Directory of Indian Companies and Businesses, Indian City Guide, Hotel, Health, IT and Real Estate Directories. Categories include Automobiles, Agriculture, Business Services, Construction. Get Email Marketing Service / Mass Mailing Service with all latest features at Unbeatable Low Pricing. We have email database of PAN India, NRI Email database. Our api based bulk email service provider or smtp bulk email. Art and Culture - Indian Dance and Music Schools in North-East of North America. As ALS progresses and dysarthria becomes severe, profound weakness resulting in reduced movement of the speech musculature and severely reduced phonation become increasingly common . Changes in speech patterns or speaking rate typically occur before a decrease in speech intelligibility . Initially, speaking rate gradually slows; however, speech intelligibility initially remains relatively high. In time, dysarthria becomes apparent to people with ALS and their listeners, and then speech intelligibility decreases such that communication effectiveness is reduced at first in adverse speaking situations, such as noisy crowds, and then in all situations. The results of a study by Ball et al. ALS speakers and their listeners reported a range of communication effectiveness depending upon the adversity of specific social situations. Speech Intervention. A recent review of ALS communication research . People with ALS, or those close to them, often request oral exercises to improve strength and mobility for speech and swallowing, as strengthening exercises seem intuitive to them as way to increase performance. However, such exercise programs should be discouraged, and those with ALS should be informed that the speaking that they do each day provides a sufficient amount of speech mechanism activity and exercise. Speech intervention should focus on learning to conserve energy for priority speaking tasks and to rest often to reduce fatigue instead of increasing effort and use with speech exercises. ALS speakers should learn to avoid adverse speaking/listening situations by muting the television, inviting people to speak with them in a quiet place rather than in a crowded room, and using voice amplification when speaking in noisy environments to reduce the effort required . As speech becomes difficult to understand, many ALS speakers supplement their speech by identifying the first letter of each word on an alphabet board (alphabet supplementation) or by identifying the topic on a communication board (topic supplementation). Although improvements of speech intelligibility have been documented for these supplementation procedures in a practice guideline article by Hanson et al. However, their speaking rate should be clinically monitored such that the referral for an AAC intervention is initiated in a timely manner. With sufficient education and preparation, people with ALS and their decision- makers are ready to examine their AAC options. However, speech deterioration can be so rapid that individuals can be left with limited communication options, if they are not prepared to act in a timely manner. Timely Referral for Communication Support. Often people with ALS, their family members, and, at times, their medical team, do not wish to consider an AAC decision until their deteriorating speech intelligibility limits their communication effectiveness. Unfortunately, once intelligibility begins to decrease, speech performance often deteriorates so rapidly that there is little time to implement an appropriate AAC intervention. Appropriate timing of referral for AAC assessment and intervention continues to be a most important clinical decision- making issue. These authors reported that speaking rate is a relatively good predictor of intelligibility deterioration for patients with spinal, bulbar, or mixed ALS. They recommend that ALS patients be referred for AAC assessment when their speaking rates reach 1. Speech Intelligibility Test (Sentence Subtest) . The mean speaking rate on this test for adults without disability is 1. This computerized test supports the efficient measurement of speaking rate in clinical settings, so speaking rate information can be shared with the patient and family immediately during clinical visits. This helps patients and their families monitor changes over time, prepare for an AAC evaluation, and it reinforces their understanding of rate and intelligibility. Using the Speech Intelligibility Test (Sentence Subtest), speaking rate can be accurately monitored over the telephone if a patient lives at a distance or is unable to travel due to illness weather, or support issues . It should be noted that speech intelligibility could not be objectively assessed over the telephone, as a clinical measure of understandability. Nordness et al. Each of these centers implemented the referral guideline of 1. Speech Intelligibility Test (Sentence Subtest). The authors reported that 8. AAC assessments. A higher percentage of females than males were identified as receiving late AAC assessments. AAC Acceptance. Ball et al. AAC acceptance and use have increased considerably during the past decade. Prior to 1. 99. 6, approximately 7. AAC technology was recommended accepted and used the technology . However, in a more recent report by Ball et al. No differences were reported for males and females. In the review by Ball et al. The results indicated agreement among these groups with a strong preference for AAC use for being over difficult to understand speech or a low- tech communication book. They reported very positive attitudes toward AAC technology. Those with greater AAC technology skills reported greater rewards associated with caregiving. They reported increased perception of social closeness to the individual with ALS and less difficulty in providing care. AAC Use. People with ALS use AAC technology for an extended period of time. More recent data from the Nebraska ALS Database have revealed that people with ALS use their AAC technology with an average of 2. ALS and 3. 1. 1 months for those with spinal ALS. Many people used AAC until within a few weeks of their deaths. Because 1. 5% of the participants in this study continued to use their AAC technology at the time the report was completed and were supported by invasive ventilation, the mean duration of use reported likely underestimated the length of use for this sample and for people with ALS in general . Many AAC devices now incorporate a variety of access options so that the technology can continue to meet the needs of the user despite a decline in physical capability. The sensitivity of dynamic touch screens can be adjusted to allow for lighter touch. The improved sensitivity of head- tracking technology has allowed many to use this access method with minimal head/neck movement control. Perhaps the most significant advancement in access technology has occurred with the widespread availability of eye- tracking systems to allow cursor control with eye movement to access high- technology AAC devices. As the disease progresses, many ALS patients require the use of eye- tracking for several reasons. First, eye- tracking is often the least fatiguing movement for AAC access. Others have reported that eye- tracking technology requires relatively little effort . In a follow- up investigation of 1. ALS, Ball et al. Ninety- three percent of the participants reported successful implementation of the technology. For 5. 3% of the participants, eye- tracking technology was selected because eye movement was the only viable access option available. The one individual who was not able to successfully use eye- tracking technology had difficulty with eyelid control, which has been noted as a potential issue in ALS . |
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