text: Intensive Motor Skills Training Program Combining Group and Individual Sessions for Children With Cerebral PalsyStørvold, Gunfrid Vinje PT, MSc; Jahnsen, Reidun PT, PhDPediatric Physical Therapy: July 2010 - Volume 22 - Issue 2 - p 150-159 doi: 10.1097/PEP.0b013e3181dbe379 Research Report Free Abstract In Brief Author InformationAuthors Article OutlineOutline Article MetricsMetrics Purpose: To describe and evaluate a local program of intensive goal-directed motor skills training for a small number of children with cerebral palsy. Methods: Multiple single-subject (ABA) design over a period of 18 weeks consisting of A1: 6 weeks of assessment and goal setting; B: 6 weeks of intensive goal-directed functional training combining group and individual sessions; and A2: 6 weeks of follow-up. Six children, 3 to 11 years old, Gross Motor Function Classification System levels I, II, and IV participated in this study. Outcome measures were Gross Motor Function Measure-66, functional hand grips, pediatric evaluation of disability inventory, fine motor speed, Assisting Hand Assessment, and Goal Attainment Scale. Results: On completion of the described program, 29 of 35 individual goals were reached. Gross Motor Function Measure-66, functional hand grips, and self-care and mobility scores of Pediatric Evaluation of Disability Inventory showed significant gains. Conclusions: An intensive program combining group and individual sessions resulted in a high rate of goal attainment and positive changes in relevant outcome measures even if the children had different age, goal areas, and functional levels. An intensive program combining group and individual sessions resulted in a high rate of goal attainment and positive changes in relevant outcome measures for children of different ages, goal areas, and functional levels. Nord-Trondelag Habilitation Department, Levanger, Norway (Ms Størvold); and Section for Child Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway (Dr Jahnsen). Correspondence: Gunfrid Vinje Størvold, PT, MSc, Habiliteringstjenesten for barn i Nord-Trondelag, Levanger Hospital, Nord-Trondelag Health Trust, 7600 Levanger, Norway (email@example.com) Grant Support: This work was supported by the Nord-Trondelag Health Trust. Abstract INTRODUCTION METHODS Participants Design Outcome Measures Intervention Data analysis RESULTS DISCUSSION Limitations CONCLUSIONS REFERENCES Back to Top | Article Outline INTRODUCTION Cerebral palsy (CP) is a group of complex developmental disorders caused by nonprogressive disturbances in the immature brain,1 occurring in approximately 2 to 2.6 of every 1000 live births in industrialized countries.2,3 Although brain damage is permanent, motor function continues to develop in these children over time. The recently published reference curves for the Gross Motor Function Measure (GMFM) have provided normative percentiles for gross motor change over time for children with CP and also show the great variability of change in children's percentiles.4 The great variability of change in gross motor development, the heterogeneity of the interventions under study, and methodological limitations have made it difficult to demonstrate the effectiveness of therapy for children with CP.3,5,6 However, specific factors associated with physiotherapy have been shown to have a positive effect. This includes increased exposure to therapy,7–14 setting specific treatment goals,7,9,15,16 and functional training.7,15,16 In goal-directed functional therapy, the goal is to enable a child to accomplish an identified task.16 Therefore, service providers try to provide frequent opportunities to practice activities toward predefined goals in many situations and many occasions throughout the day.7 Some of the parents in our local, rural area wanted their children to benefit from group training despite the fact that the children were of different ages and had different functional levels and different goal areas. In planning an intervention for such a group of children, we had to involve children and parents in defining goals that were specific, achievable, and meaningful for the child. In creating group sessions with functional therapy, the challenge was to create meaningful and motivational joint activities with the goals in mind, ensuring that the children's individual goals were addressed specifically and frequently. The purpose of this study was to describe the change in motor function for each of a small number of children after the intervention and whether the improvements in individual goal attainment were reflected in relevant standardized instruments. Furthermore, our goal was to describe an example of an intervention program, combining group and individual sessions, for a small number of children with CP who were of different ages and had different functional levels, and a broad range of goal areas. Back to Top | Article Outline METHODS Participants All the children with CP in a local rural area in Norway, Gross Motor Function Classification System (GMFCS) levels I through IV, younger than 12 years, without severe intellectual disabilities, who had identified a goal area suitable for intensive training, were invited to participate in the study. Seven children were eligible and 1 child withdrew from the study 2 weeks into the training period due to the death of an immediate family member. Therefore, 6 children at GMFCS levels I through IV, 3 to 11 years old (mean age, 6.3 years) participated in the study. The program was run twice. Child 6 did not participate the first time. Results are reported from the children's first participation period in the program. The children's functional level was classified using the GMFCS,17 the Zancolli classification of deformities in the spastic hand,18 and the House classification of thumb deformities.19 The GMFCS levels were already determined at the habilitation center before this study by clinical judgment supported by plotting GMFM-66 scores on motor growth curves. The Zancolli and House classifications were performed by an external tester (occupational therapist [OT]), based on videos of the functional hand grips testing. According to parent report, 1 child had general learning problems, 1 child had specific learning problems, and 1 child had attention problems. Three of the children had documented average intellectual function. All children communicated verbally. Table 1 summarizes the description of the children. TABLE 1 Back to Top | Article Outline Design We chose a multiple single-subject (ABA) design lasting 18 weeks. The first 6 weeks (phase A1) consisted of an assessment and goal-setting period with no treatment except for maintaining range of motion by parents or assistants on a daily basis if indicated, followed by 6 weeks of intensive goal-directed motor skills training (phase B), and finally a 6-week follow-up with no treatment (phase A2). Before the goal-setting period, the children received physical therapy or occupational therapy approximately once weekly, consisting of guidance to school staff regarding general aims according to their diagnoses and functional levels and maintaining range of motion if indicated. Standardized instruments were administered at T1, T2, T3, and T4 (Table 2). The detailed goals were set within days before the training started, and goal attainment was recorded daily during the training period, at T3 and at T4 (Table 2). TABLE 2 The protocol was approved by The Regional Committee for Medical Research Ethics, Central Norway, and the Norwegian Social Science Data Services. The parents signed informed consent forms on behalf of their children. Back to Top | Article Outline Outcome Measures Before recruitment, the parents or local therapists had identified a goal area for the child that they considered suitable for intensive training. After meeting with the local therapists and the parents of each child, standardized assessment instruments were administered. The assessment also included parent discussions and observation of the children in the relevant context of the goal area(s). Furthermore, we asked for a list of the children's interests and favorite leisure time activities to be used when designing the group activities. Based on the initial goal area(s) and assessments, 4 to 8 goals were negotiated with parents and local therapists. The goals were ideally set in terms of everyday activities. The children were not able to perform the goal activities without help at baseline (goal-setting time [T2]). Figure 1 summarizes the goals for each child. Fig. 1. Goal Attainment Scaling (GAS), an individualized criterion-referenced measure of change,20,21 was used to objectively measure each child's individualized functional change.20 GAS is responsive to change in individualized motor goals.21,22 Furthermore, it has been shown that it is possible to set relevant, achievable goals with clinically important levels of change using the GAS.22 We used GAS to specify 5 possible outcomes for each goal: baseline, less than expected, goal attainment, greater than expected, and much greater than expected (Figure 2). Both local therapists and specialists from the habilitation center participated in defining the Goal Attainment Scales. The scales were thereafter reviewed by another member of the staff, who was trained in setting goals, to ensure they had clearly demarcated steps. The GAS forms were put in a loose-leaf notebook that was kept during the intervention period. The process of setting goals, as described, lasted approximately 6 weeks for each child. Fig. 2. Goal attainment was recorded by the therapist who happened to be with the child when the child reached a new level of functioning. The best level of outcome recorded during the intensive period had to be demonstrated at T3 to be credited. Baseline level and levels at T3 and T4 were videotaped, and the videotapes were used by the recording therapist as support for the clinical judgment when goal attainment was recorded. Change in gross motor function over time was assessed using GMFM-66.23 The GMFM-66 is validated for evaluative purposes and has proven responsiveness to change.24 Test-retest reliability (intraclass correlation coefficient = 0.99) is also excellent.24 To assess how well the children performed hand grips frequently used in activities of daily living,25,26 a functional hand grips test, a nonstandardized instrument built on Sollermann's Grip Function Test, which shows good validity27 and is reliable and reproducible in adults,26,27 was used. This adult test has been adapted and is used for children.25 There are no reports of psychometric properties for the children's version. The grips chosen for this study were ball grip; vertical, horizontal, and extension grip; 5-finger pinch; key grip; and pulp pinch.26 For the children with hemiplegia, only the affected hand was assessed. For the child with quadriplegia, both hands were assessed. This test was not administered for the child with diplegia because there were no fine motor goals. The ordinal level raw scores on a scale from 0 to 425 were converted to the percentage of maximum score to present the results in the same graphs as the other results. Because all the children had goal areas of self-care and mobility, the Pediatric Evaluation of Disability Inventory (PEDI), a clinical assessment instrument of functional capabilities and performance in disabled children,28 was used through parent interviews. PEDI is a reliable instrument regarding internal consistency (α, 0.95–0.99) and inter- and intrainterviewer reliability for clinical samples (intraclass correlation coefficient: 0.84–1 versus 0.74–0.96).28 Construct validity is also well established.28 The scaled scores of the self-care and mobility domains are found to be responsive to change.29 A Norwegian translation of the PEDI including Norwegian score forms was used.30 The scaled scores of the Functional Skills (FS) and Caregiver Assistance (CA) scales were used. Fine motor speed was assessed using a stopwatch to record the time that the child needed to put 10 small cubes with 1.7-cm sides in a box, one at a time. This test was used because the time aspect was focused on some of the fine motor goals. For the children with hemiplegia, only the affected hand was tested. For the child with quadriplegia, the preferred hand was tested. The fine motor speed test was not administered for the child with diplegia, as there were no fine motor goals. Because of the many goals related to bilateral hand function, the Assisting Hand Assessment (AHA), a Rasch-built standardized criterion–referred test, measuring and describing how effective children with unilateral impairments use the affected hand in bimanual activity performance,31,32 was used for the children with hemiplegia. A few studies showed promising results concerning validity, reliability, and responsiveness.31,33 The children were observed when playing in a semistructured way, and raw scores were assigned on a 4-point ordinal scale and converted to interval-level scores using the manual's Excel program. The outcome measures were administered at the habilitation center according to the manuals by 4 experienced external assessors (OTs, physical therapist [PT], and a social worker) blinded to the design. The same assessors tested each child all 4 times. The assessors were in no other way involved in the study. The parents gave written information in a log after every group session. They also completed a questionnaire after the intensive period and attended a group interview a week after the last group session, focusing on feasibility, whether the children enjoyed themselves, and about the children's progress. Back to Top | Article Outline Intervention The intensive training period ran for 6 weeks, 5 days per week with alternating days of group and individual training sessions, 3 days of group training 1 week and 2 days the next week, with a total of approximately 10 hours of training per week. The intervention could mainly be characterized as intensive goal-directed functional therapy but with some activities designed to give the children a basic experience in the motor requirement necessary to reach the goals. The intervention was designed by a group of local professionals including special teachers, music teachers, crafts teachers, OTs, PTs, and the staff from the habilitation center, including a special teacher, OT, and PT. At least one person who knew the child well was in the planning group. The planning of intervention started after the goal areas for the children were known and was completed after the detailed goals for each child were set and the children's interests were known. The PTs and OTs would work with the teachers to provide information about each child's specific goals and motor skills that need to be practiced in the group sessions. The teachers would then, for example, compose new movement songs or find crafts activities with the goals in mind. Multidisciplinary group sessions lasted for 3 hours including 2.5 hours of group activity and 0.5 hours of individual goal-directed training in convenient smaller groups. Group sessions were held at suitable premises where physiotherapy services were usually offered from 1 to 4 in the afternoon, directly after the oldest children had finished their school hours. The same professionals who planned the intervention carried it out. Parents were invited to join in whenever they wanted. This provided at least 1 adult per child during the group activities. Most of the group activities were led by a music teacher or a crafts teacher, but the gross motor play and the outdoor activities were led by the OTs and PTs. While the music teacher or crafts teacher led the group activities, the PTs and OTs would work directly with the children using therapy-specific strategies, if needed. This would include the use of guidance techniques such as handling or supportive touch, verbal cuing, simplification of the task, or distributing the feedback according to the needs of the individual child. The group sessions started with wardrobe activities such as removing winter clothes, putting on suitable clothes and shoes for training, a welcome song, and schedule presentation. Thereafter, the children were engaged in activities such as movement songs, playing rhythmical instruments, playing with plastic clay, painting, gross motor play (eg, African dance or obstacle course), and outdoor activities. The individually adapted activities were designed to be fun and interesting and to give variable practice related to the movement problems inherent in the children's goals. For example, several of the children with hemiplegia had different goals including bilateral activities, and therefore the music instruments that they were to play required 2 hands but with different degrees of difficulty depending on the child's skills. Some children would stand while playing the instruments because they had goals including standing balance, whereas others would sit in a wheelchair or walk. If the child had goals regarding dressing or undressing, these goals would be addressed when arriving and leaving. Because of the goals regarding walking on uneven terrain, wheelchair mobility, and skiing skills, some of the group sessions were held outdoors. The group sessions always included a meal, and because several of the children had goals of using a knife and a fork or spoon, we prepared meals for which a knife and a fork or spoon were needed. After the meal, the children had individual goal-directed training geared toward their own specific goals. At that time, the local therapist worked with the specialist from the habilitation center and was thereby able to do the individual training the next day. Individual sessions held at the school/kindergarten or at home were integrated into the children's everyday activities, lasting for approximately 1 hour each time. The individual sessions used task-oriented principles of motor learning and were designed to enhance motor learning related to the children's specific goals. This included problem-solving activities and goal-directed practicing of the goal functions in relevant contexts. An example would be child 3, who did not have a strategy for tying shoelaces (Figure 3). In the first individual sessions, he would work with the PT to search for a strategy to solve the movement problem. The PT would use handling techniques, simplification of task, or verbal cuing if necessary in the beginning. Thereafter, he would practice tying his shoelaces shielded from disturbances for a period, before he would progress to tying his shoelaces in the wardrobe while having a conversation with the other children. The same strategies used in the individual sessions were used in the final part of the group sessions. Fig. 3. GAS forms were used to see what the next level of function was, to record new levels of function, and to enhance motivation by marking each new level with a stick- on label (Figure 3). A separate log was used to ensure that all goals were addressed at every session. Back to Top | Article Outline Data analysis Because of the small number of participants in this study, data were mainly analyzed on an individual basis. The data points were plotted in graphs for each child, showing changes during the intervals T1 to T2, T2 to T3, and T3 to T4. The graphs were then visually analyzed with respect to level and trend. The insensitivity of visual analysis to weak treatment effects34 was interpreted as an advantage, ensuring that only large treatment effects with obvious clinical significance were detected. The small number of observations in the different periods and the skewed data excluded the use of parametric statistical methods. The nonparametric Wilcoxon matched pairs signed rank sum test was used to get an indication of the change in function in the different periods by group level. A 1-tailed test was chosen because we did not expect any decline in function, and P values less than .05 were considered significant. Group effect was analyzed for the data of children classified at GMFCS levels I and II. The data of the child classified at GMFCS level IV were analyzed separately because of less expected change for children of her age and functional level.23 The statistical analyses were done using SPSS. Interview data and data from parents' logs and questionnaires will be thoroughly analyzed with statistical and qualitative methods are reported in another publication. Back to Top | Article Outline RESULTS During the 6-week training period there were 14 days of group training and 16 days of individual training, with approximately 58 total hours of training. Children 1, 2, 3, 4, 5, and 6 attended 22, 25, 24, 31, 28, and 26 days, respectively. In general, a high level of goal attainment was seen. Of 35 goals, 29 were attained, 9 of which with a greater than expected outcome and 15 of which with much greater than expected outcome, as recorded using GAS. Children 1, 2, 3, 4, 5, and 6 attained 100%, 75%, 80%, 87.5%, 100%, and 40% of their goals at expected level of outcome or better, respectively. Mean goal attainment was 80.4%. Six weeks later, most of the goals were still maintained (Figure 1). Results from GMFM-66, PEDI, functional hand grips, and AHA for each child are presented graphically in Figure 4. Only results showing change are presented. Fig. 4. Child 1 (Figure 4A) reached all of his goals. Except for the change in GMFM-66 scores, all change in standardized instruments took place during the intervention period. His new ability to walk up and down stairs was reflected in the scores of the corresponding items in the GMFM-66 and in the PEDI FS mobility domain. He learned to put on both a jacket and a sweater. The gains in the FS and CA scales in the self-care domain of the PEDI came in items related to dressing and undressing. A goal related to playing a memory game focused on fine motor ability; and both the functional hand grips and fine motor speed test clearly showed a change during the intervention period. Child 2 (Figure 4B) reached 3 of 4 goals and had a remarkable rate of change in the standardized instruments. He even changed his GMFCS level. GMFM-66 showed change in all periods, as did the FS scale of the self-care domain in PEDI. However, functional hand grips, fine motor speed, and the CA scales in the mobility, self-care, and social domains of PEDI changed after the intensive training period. Child 3 (Figure 4C) reached 4 of 5 goals. He was highly motivated to reach his gross motor goals and showed improvement already during the goal-setting period. His new abilities in soccer ball, standing on 1 leg, and putting on winter shoes were directly reflected in corresponding items of the GMFM-66, in the PEDI FS mobility domain, and in the FS and CA scales of the self-care domain of PEDI. He also changed GMFCS level. Child 4 (Figure 4D) reached 7 of 8 goals. Except for the GMFM-66 scores, the change in standardized instruments occurred in the intervention period. Her new abilities in self-care goals were directly reflected in relevant items of the PEDI FS self-care domain, in the functional hand grips assessment, and in the fine motor speed test. After the intervention, her walking pattern and 1-leg balance were better, which were reflected in the PEDI FS mobility domain. Child 5 (Figure 4E) had 5 self-care goals with fine motor focus, which she reached during the intervention period. The change in functional hand grips, fine motor speed, and the AHA, mainly after the intervention, reflected this goal attainment, as did the change in the PEDI CA self-care domain. She also reached her 2 gross motor goals, which were reflected in the GMFM-66 scores. She was the only child for whom the change in GMFM-66 scores happened during the intervention period. Child 6 (Figure 4F) was the oldest and most affected. She reached 2 of 5 goals. The progress in head stability was reflected in the GMFM-66 items of sitting. The progress in GMFM-66 scores started in the intervention period and continued in the follow-up period. In addition to functional training, the intervention focused more on modifying the task, which was not reflected in scores on the standardized instruments. Table 3 shows mean change on standardized instruments in the different periods for the children on levels I and II. Table 4 shows change in GMFM percentiles for each child. TABLE 3 TABLE 4 Multiple standardized instruments showed substantial change during the whole period (T1–T4) for the children at levels I and II, reaching a significant level in GMFM-66, PEDI FS self-care and mobility domains, PEDI CA self-care domain, and the functional hand grips test (Table 3). Four of the 6 domains in the PEDI showed the greatest change in the intervention period, reaching a significant difference in the FS mobility domain, and an almost significant level (P = .0545) for the CA self-care domain for children at levels I and II. Child 6 showed no change in the PEDI except in the FS social functioning domain, where the change score was 6.9. In addition, in the functional hand grips test, significantly greater gains in the intervention phase were seen compared with the A phases. In the fine motor speed test, all the children declined from T1 to T2 and improved in the training period. This trend continued in the follow-up period, leaving a total mean change of 6.7 seconds (standard deviation, 0.98) from T1 to T4 for the children on GMFCS levels I and II, and a total change of 25 seconds from T1 to T4 for child 6. Despite a large difference between the B phase and the A phases, the difference did not reach a significant level (P = .0545). In the AHA, no significant differences were seen between phases, and in GMFM-66 scores, significantly greater gains in the A phases compared with the intervention period were observed. Preliminary data from interviews, parent's logs, and questionnaires show some promising results, which will be presented in future reports. All the parents thought that the children greatly benefited from the intensive period, and all of them were proud of their children who bravely attempted new challenges. They also underlined the importance of being goal directed. When a child reached his or her own goal, the child would practice the newly learned skills in natural settings without further requests, thereby maintaining the goal functions throughout the nontreatment period. All the parents preferred intensive periods compared with less frequent therapy sessions over a long time because there were visible gains for the children in the intensive period, and they could look forward to a subsequent period with no treatment. The obvious positive effect on the children caused all parents, except those of child 1, to wish that their children could participate again, despite the fact that they all also experienced the intensive period as tiring and stressful. Back to Top | Article Outline DISCUSSION The purpose of this study was to describe a multidisciplinary intensive intervention, with a combination of group and individual sessions, for a heterogeneous group of children with CP and assess whether the intervention would lead to change in motor function. In this article, we describe an intervention based on a thorough assessment and goal-setting period in which the children's specific goals and interests were directly used to design the intervention. The intervention led to high attendance, high level of goal attainment, positive gains on relevant standardized instruments, and positive feedback from parents. A high level of goal attainment was seen in which only 6 of the 35 goals were not achieved at the expected level. One of the 2 goals with no change can probably be explained by unfavorable weather conditions at T3 (child 3: walk downhill). For the other goal with no change (child 6: eat with a spoon) in fact some progression was seen but not enough to reach the next GAS level. The goal-setting period was considered very important. We emphasized the child's or the parents' identified goal area for the training period as a starting point. Bower et al9 demonstrated the positive effects of having specific goals compared with general aims, and during the many steps of the goal-setting process in this program, we secured a transition from the more or less general aims presented by the child or parents to specific achievable goals. Once decided on, the goals together with the list of each child's interests acted as a guide to design the intervention, thereby securing a great amount of practice directly focused on the goals. The nicely decorated loose-leaf notebooks with the goals in them, which were actively used multiple times daily, added to motivation and goal directedness of the practice—factors described to enhance goal attainment.7,9,15,16 One could argue that the goals were set at a very easy level. On the other hand, some of the standardized instruments also showed large gains, suggesting that some of the children in some areas experienced large and clinically relevant improvements. The mean change of 10.8 in GMFM-66 scores during the whole period (T1-T4) for the children on GMFCS levels I and II was substantial, and greater than or at the same levels as other intervention programs.7,13–16,35 Children 2 and 3 even moved from GMFCS level II to I, and the 3 children at level I moved 15 to 37 reference percentiles for the GMFM-66. Hanna et al4 found that the variability in the amount of change in (GMFM-66) percentiles was ±20 percentiles when the median time between assessments was 1 year for GMFCS levels I and II. Our results far exceed the expected variability, thereby reducing the chances that the gains in this study represent maturation and therefore indicate relevant change in gross motor function. However, only children 2, 5, and 6 experienced the greatest gain in GMFM-66 in the intervention period. The limited progress in GMFM-66 for child 6 is expected, considering her age and GMFCS level.17 Mean changes in the PEDI scores from T1 to T4 for the children at GMFCS levels I and II were on the same level as other studies, except for FS self-care domain (8.3) and CA self-care domain (10.3), where this study showed greater gains.7,15,16 This may reflect that most of the children in the study had goals in the areas of self-care activities. This hypothesis is further strengthened by the attainment of self-care goals being reflected in corresponding items in the FS and CA scales of the self-care domain. GMFM-66 showed some positive changes in the assessment and goal-setting period (T1–T2) for all the children except for child 6. Even though the majority of gains in the PEDI scores took place in the intervention period (T2-T3), positive changes on the PEDI were also shown from T1 to T2 for children 2, 3, 5, and 6 in the self-care and social domains. Based on a study by Bower and McLellan,8 we suggest that the T1 to T2 period might represent a kind of intervention for some of the children. Both the children and the parents reacted positively to the testing and goal-setting procedures, and the attention associated with them may have acted like indirect teaching to both parents and children. Furthermore, the results might be explained by parents starting to reduce their help in skills that they thought that the children might master in a short time. For child 3, this might even be the most important intervention. However, he was ill with a fever at T3, and this may camouflage the progression not credited before T4. Similar to the study by Bower and McLellan,8 we also assume that the children continued to develop their newly learned functions in daily life activities in the T3 to T4 period. As a result, all the children, except child 5, had accomplished more test items than expected on the GMFM-66, and children 2, 3, and 5 had accomplished more test items than expected on the PEDI at T4. Maturation might have been a factor both in the T1 to T2 and T3 to T4 periods. However, this is not likely because of the short duration of the periods. On the other hand, testing variability could account for change in the T1 to T2 period because the children were familiar with tests, testing procedures, and testers at T2. Also, fatigue associated with the high intensity intervention could probably explain some gains not recorded until T4. The tendency to start changing during the goal-setting period (T1-T2) was not seen in functional hand grips or in fine motor speed tests. In those outcome measures, almost all change can be attributed to the intervention period. Perhaps the reason for this is that the fine motor goals were so difficult for the children that they were not able to start the problem-solving process on their own, nor did the parents start reducing their assistance. It is also likely that it is more difficult to practice those tasks in a natural setting without specific intervention. A surprising result was that even though the children with hemiplegia reached their fine motor goals and had a large change in the functional hand grips and fine motor speed tests, no changes in the AHA scores were seen. This result may underscore the task-related factors in learning new motor skills. Mastering new skills does not automatically lead to generalization and more use of the affected hand in other situations. The high attendance, the high rate of goal attainment, and the positive change in relevant standardized outcome measures may be due to several factors in the intervention, such as intensity, goal directedness, functional training, motivation, and integrated interdisciplinary programming. Each of these factors is discussed below. Intensity: A lot of intervention programs have attributed success to high intensity7–14 as do we. In this intervention, we not only had high frequency of treatment (5 days per week) but also a high total amount of intervention (10 hours per week). Goal directedness: Like other authors,7,9,15,16 we are convinced that a proper goal-setting period contributes substantially to the results. We also like to highlight the importance of being family- and child-centered in the goal-setting process, as elaborated by Law et al16 among others. Functional training: Multiple authors7,15,16 have described functional training. In this intervention, we chose to view functional training both directly and indirectly. For example, the goal to put on winter shoes was practiced directly by practicing putting on shoes with gradually less assistance from an adult, both in the group sessions and individual sessions. However, we also had movement songs and gross motor play in the group sessions where the children had to practice 1-leg balance and play with a range of other balance challenges. Motivation: We enhanced motivation by focusing on the children's own goals and interests. Integrated interdisciplinary programming: Through multidisciplinary effort, we found it possible to create joint activities based on common denominators of the children's interests, music, painting, or outdoor gross motor play, and then modify the way each child participated in the joint activity to be directed to individual goals. Through this way of planning the intervention with the goals in mind, the children had the opportunity to draw on all the positive effects of being in a group, doing activities they liked, while still securing high-intense goal-directed functional therapy. The combination of group sessions, as described, and individual sessions may account for the high attendance, the high rate of goal attainment, and the positive changes on standardized instruments. Feedback from parents also suggests that high amounts of training are well tolerated when organized as described. To our knowledge, this is not described for heterogeneous groups before and may be of significant relevance for practitioners in rural areas. Back to Top | Article Outline Limitations We realize that having a longer baseline period before the assessment and goal-setting period would make the conclusions sounder. In planning the study, this was taken into consideration along with our wish to administer a broad range of standardized instruments and lessen the testing burden on the children and the parents. Back to Top | Article Outline CONCLUSIONS This study shows that it is possible to run a successful intensive intervention program combining group sessions in which the children work toward their individual goals within a joint social activity, with individual goal-directed training even if the children's age, functional levels, and goal areas differ. All the children reached most of their functional goals, which were maintained 6 weeks later, suggesting that clinically significant learning had occurred. The positive results on relevant outcome measures further strengthen that suggestion.Back to Top | Article Outline REFERENCES 1. Bax M, Goldstein M, Rosenbaum P, et al. Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol. 2005;47:571–576. Cited Here... | PubMed | CrossRef 2. Surveillance of Cerebral Palsy in Europe (SCPE). Prevalence and characteristics of children with cerebral palsy in Europe. Dev Med Child Neurol. 2002;44:633–640. Cited Here... | PubMed | CrossRef 3. Siebes RC, Wijnroks L, Vermeer A. Qualitative analysis of therapeutic motor intervention programmes for children with cerebral palsy: an update. Dev Med Child Neurol. 2002;44:593–603. Cited Here... | PubMed | CrossRef 4. Hanna SE, Bartlett DJ, Rivard LM, et al. 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Bower E, McLellan DL, Arney J, et al. A randomised controlled trial of different intensities of physiotherapy and different goal-setting procedures in 44 children with cerebral palsy. Dev Med Child Neurol. 1996;38:226–237. Cited Here... | PubMed | CrossRef 10. Eliasson AC, Bonnier B, Krumlinde-Sundholm L. Clinical experience of constraint induced movement therapy in adolescents with hemiplegic cerebral palsy—a day camp model. Dev Med Child Neurol. 2003;45:357–359. Cited Here... | PubMed | CrossRef 11. Naylor CE, Bower E. Modified constraint-induced movement therapy for young children with hemiplegic cerebral palsy: a pilot study. Dev Med Child Neurol. 2005;47:365–369. Cited Here... | PubMed | CrossRef 12. Taub E, Ramey SL, DeLuca S, et al. Efficacy of constraint-induced movement therapy for children with cerebral palsy with asymmetric motor impairment. Pediatrics 2004;113:305–312. Cited Here... | PubMed | CrossRef 13. Trahan J, Malouin F. Intermittent intensive physiotherapy in children with cerebral palsy: a pilot study. Dev Med Child Neurol. 2002;44:233–239. Cited Here... | PubMed | CrossRef 14. Tsorlakis N, Evaggelinou C, Grouios G, et al. Effect of intensive neurodevelopmental treatment in gross motor function of children with cerebral palsy. Dev Med Child Neurol. 2004;46:740–745. Cited Here... | PubMed | CrossRef 15. Ketelaar M, Vermeer A, Hart H, et al. Effects of a functional therapy program on motor abilities of children with cerebral palsy. Phys Ther. 2001;81:1534–1545. Cited Here... | PubMed | CrossRef 16. Law M, Rosenbaum P, Piper M, et al. Family-centred functional therapy for children with cerebral palsy. Phys Occup Ther Pediatr 1998;18:83–102. Cited Here... | PubMed | CrossRef 17. Palisano R, Rosenbaum P, Walter S, et al. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39:214–223. Cited Here... | PubMed | CrossRef 18. Zancolli EA, Zancolli ER Jr. Surgical management of the hemiplegic spastic hand in cerebral palsy. Surg Clin North Am 1981;61:395–406. Cited Here... | PubMed | CrossRef 19. House JH, Gwathmey FW, Fidler MO. A dynamic approach to the thumb-in palm deformity in cerebral palsy. J Bone Joint Surg Am 1981;63:216–225. Cited Here... | View Full Text | PubMed | CrossRef 20. King GA, McDougall J, Palisano R, et al. Goal Attainment Scaling: its use in evaluating pediatric therapy programs. Phys Occup Ther Pediatr 1999;19:31–51. Cited Here... | PubMed | CrossRef 21. Palisano RJ, Haley SM, Brown DA. Goal attainment scaling as a measure of change in infants with motor delays. Phys Ther. 1992;72:432–437. Cited Here... | PubMed | CrossRef 22. Palisano RJ. Validity of goal attainment scaling in infants with motor delays. Phys Ther. 1993;73:651–658. Cited Here... | PubMed | CrossRef 23. Russell D, Rosenbaum P, Avery L, et al. Gross Motor Function Measure (GMFM-66 & GMFM-88) User's Manual. London: Mac Keith Press; 2002. Cited Here... 24. Russell DJ, Avery LM, Rosenbaum PL, et al. Improved scaling of the gross motor function measure for children with cerebral palsy: evidence of reliability and validity. Phys Ther. 2000;80:873–885. Cited Here... | PubMed 25. Eliasson AC, Ekholm C, Carlstedt T. Hand function in children with cerebral palsy after upper-limb tendon transfer and muscle release. Dev Med Child Neurol. 1998;40:612–621. Cited Here... | PubMed | CrossRef 26. Sollerman C, Ejeskar A. Sollerman hand function test. A standardised method and its use in tetraplegic patients. Scand J Plast Reconstr Surg Hand Surg. 1995;29:167–176. Cited Here... | PubMed | CrossRef 27. Sollerman C. Assessment of grip function. Evaluation of a new test method (Thesis). In: Sollerman C, ed. Handens Greppfunction. Gøteborg, Sweden: University of Gøteborg; 1980. Cited Here... 28. Haley SM, Coster WJ, Ludlow LH, et al. Pediatric Evaluation of Disability Inventory (PEDI). Development, Standardization and Administration Manual. Boston, MA: Boston University; 1992. Cited Here... 29. Vos-Vromans DC, Ketelaar M, Gorter JW. Responsiveness of evaluative measures for children with cerebral palsy: the Gross Motor Function Measure and the Pediatric Evaluation of Disability Inventory. Disabil Rehabil. 2005;27:1245–1252. Cited Here... | PubMed | CrossRef 30. Jahnsen R, Berg M, Dolva AS, et al. Pediatric Evaluation of Disability Inventory (PEDI). Norsk tillegg til den amerikanske manualen. Oslo: Norsk Psykologforening; 2000. Cited Here... 31. Eliasson AC, Krumlinde-Sundholm L, Shaw K, et al. Effects of constraint-induced movement therapy in young children with hemiplegic cerebral palsy: an adapted model. Dev Med Child Neurol. 2005;47:266–275. Cited Here... | PubMed | CrossRef 32. Krumlinde-Sundholm L, Holmefur M, Eliasson AC. Assisting Hand Assessment Manual, Svensk forskningsversion 4.1. Stockholm: Karolinska Institutet, Neuropediatric Research Unit, Astrid Lindgren Children's Hospital; 2004. Cited Here... 33. Krumlinde-Sundholm L, Eliasson AC. Development of the assisting hand assessment: a Rasch-built measure intended for children with unilateral limb impairments. Scand J Occup Ther. 2003;10:16–26. Cited Here... | CrossRef 34. Nourbakhsh MR, Ottenbacher KJ. The statistical analysis of single-subject data: a comparative examination. Phys Ther. 1994;74:768–776. Cited Here... | PubMed | CrossRef 35. Bower E, Michell D, Burnett M, et al. Randomized controlled trial of physiotherapy in 56 children with cerebral palsy followed for 18 months. Dev Med Child Neurol. 2001;43:4–15. Cited Here... | PubMed | CrossRef Keywords:activities of daily living/classification; cerebral palsy; child; goal; motor skills/training; physical therapy/methods; outcome and process assessment (health care); teaching/methods; time factors © 2010 Lippincott Williams & Wilkins, Inc. Article Outline Abstract INTRODUCTION METHODS Participants Design Outcome Measures Intervention Data analysis RESULTS DISCUSSION Limitations CONCLUSIONS REFERENCES Source Intensive Motor Skills Training Program Combining Group and Individual Sessions for Children With Cerebral Palsy Pediatric Physical Therapy22(2):150-159, Summer 2010. Full-Size Email + Favorites Export View in Gallery Email to a Colleague Colleague's E-mail is Invalid Your Name: (optional) Your Email: Colleague's Email: Separate multiple e-mails with a (;). Message: Thought you might appreciate this item(s) I saw at Pediatric Physical Therapy. Send a copy to your email Your message has been successfully sent to your colleague. Some error has occurred while processing your request. Please try after some time. Email to a Colleague Colleague's E-mail is Invalid Your Name: (optional) Your Email: Colleague's Email: Separate multiple e-mails with a (;). 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Pledge To Vote
The Canadian Broadcast Corporation (CBC), the national public radio and television broadcaster in Canada, wanted an interactive application on their news site that lets viewers make their voices heard while motivating others to vote in the upcoming Canadian federal election. Left Field Labs developed an online experience for the CBC that provided Canadian voters a place to pledge to vote, personalize it with what matters most to them, and share it with others.
In order to provide users with ways to categorize their interests, we developed the application to allow users to select a category: Civic duty, Leadership, The economy, Taxes, Energy, Education, Environment, Public safety, Health care, Social policy, International affairs, or Other and add a sentence or two elaborating on what issues are important to them. Once submitted, their pledge shows up on a map of Canada in the postal code they were pledging from, along with others' submissions. Viewers can browse the map of pledges and filter by categories that are of interest to them. In addition, the application helps voters spread awareness and motivate others by sharing Facebook, Twitter, G+, LinkedIn, or email links announcing that they #PledgetoVote.
Created frontend application using Closure framework.

subset: commoncrawl


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Clarron House Hotel2
22 Leopold Grove,, Blackpool, FY1 4LD
Price FromView Rooms
- Very Good
- 1 guest reviews
"Clarron House Hotel...."
About the hotel
The Opera House, Winter Gardens, Empress Ballroom and Grand Theatre are all close by which makes Clarron House an ideal base for theatregoers, conference delegates and dancers.
The Promenade and Tower are both less than a 5 minutes' walk away as is the North Pier. Pleasure Beach is only a short tram journey away.
We have a pleasant dining room where we offer full English Breakfasts with choice menu, diet request in advance. A comfortable Lounge for guest's use, with comfy sofa's, and a digital television.
All Bedrooms Tastefully decorated, cotton sheets, most rooms are en suite, colour Digital televisions, complementary refreshments, replenished daily. Bedrooms are serviced daily.
All rooms are fully heated and personal keys are given.
Sorry we do not accept stag or hen groups. Or groups of girls and boys.
Close by buses can be reached taking you to Fleetwood, Clevleys, Bispham, Freeport, Stanley Park and Zoo, all within walking distance of Clarron House
Standard terms & conditions of booking will apply.
Refunds may not always be offered, we recommend adequate travel insurance is in place before travelling anywhere. .
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- Hotel Non-Smoking Throughout, Wake Up Call Available
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- Wi-Fi Available In Public Areas
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- Tennis Courts
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- From 12:00 hours
- By 10:00 hours
- Up to 17 years old
- The price shown is based on the occupancy and dates you have searched for. Prices and availability are subject to change based on the arrival date, number of nights and occupancy searched for. All prices are inclusive of all local taxes.
- Pets are not allowed
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Very Good
100% would recommend it to a friend
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Clarron House Hotel
Clarron House Hotel....


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HI all,
This is just a little demo of something that I set up for a particular song (not to try to put together a whole light-based system or anything that ambitious). I thought it might interest some people here so it was perhaps worth posting. The other reason for posting this is as a preliminary introduction to the "Betweener" which is a project that I have been working on with collaborators here in Chicago for about a year now. Betweener is a Teensy-based MIDI/CV and CV/MIDI controller retaining flexibility to do all the other stuff Teensy can do. We are hoping to have the project (hardware and a simple arduino library) stable enough to share publicly to the DIY community in a few months, and I suspect it would be of interest to Axoloti folks, so I will definitely post here about it if that comes to pass.
For me, as a guitar-player, the thing that Betweener adds is an interesting layer of interaction to couple Axoloti-based guitar effects to other systems. Although I'm not really much of a synth person, I picked up a Moog mother 32 a couple of months back and I have been using the Betweener to do a lot of fun programmable modulation of it.
In this demo (extremely crude - just showing the ideas here, very quickly), I've got Betweener taking input from an RGB color/light sensor and converting it simultaneously to a set of CV signals to modulate my Moog and a MIDI signal to control a synchronized tremolo layered over a couple of Axoloti guitar effects. I am really liking the way it sounds to have the guitar and synthesizer synchronized as it is pretty confusing to the ear (although you really can't tell that from the crude video).
Update: here's the actual song that I made out of this thing:


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Description Edit
Ingredients Edit
- 1 tsp. olive oil
- 1 tsp. minced garlic
- 1/4 cup finely chopped onions
- 1/4 cup finely chopped green peppers
- 1/4 cup finely diced carrots
- 3 oz. lean ground Beef(or Italian Sausage or Turkey etc)
- 1/2 cup tomato Pasta sauce
- 1/2 cup grated mozzarella Cheese
- 1 Tbsp. grated Parmesan cheese
- 9 egg roll wrppers(5 1/2 inches square)
Directions Edit
- in non-stick skillet sprayed with vegetable spray, heat oil over medium heat.
- add garlic, carrots and onions; cook for 8 minutes or until softened and browned.
- add peppers and continue cooking 2 minutes longer.
- add meat, stirring to break it up and cook until no longer pink.
- remove from heat and stir in tomato sauce and mozzarella and parmesan cheeses.
- keeping the rest of the wrappers covered with a cloth to prevent drying out, put one wrapper on work surface with a corner pointing towards you.
- put 2 tbps. of the filling in the center.
- fold the lower corner up over the filling, fold the two side corners in over the filling and roll the bundle away from you.
- use water to seal the seams. put on a prepared pan and repeat until all the wrappers are filled.
- bake for 14 minutes, until browned, turning the pizza rolls at the halfway mark!
Contributed by Edit
This Y-group is international. Good food from all parts of the world. A place where we can share the wonderful food from all over the world.
Community content is available under CC-BY-SA unless otherwise noted.


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Like most mobile tech enthusiasts, my thoughts are on what will transpire at the Apple Media Event this morning. Since wearbles are a hot topic in mobile, and the wrist worn list of devices is either anorexic or described with monikers like 'The Terrible Wearable', I'm very curious if Apple will be able to pull off Watch not being a flopper. I was honored that Apple has reserved the best seat in the house for me…
That was certainly nice of them. Their generosity will have no effect on my opinion of the device. They have already failed me given the fact that I don't wear watches and they still went forward with the release of Watch. Despite that important piece of information, Apple has had quite a bit of success in recent years. The last couple of fails…genuine product issues, were Maps and Antenna-gate. No one can be this lucky. How much longer can the Technology-gods smile down on them? Are they due for a fail?
While I do like the concept of an Apple wrist wearable to re-enable some of the one-handed operation that was marginalized when the i6 was embiggened, I'm not a watch wearer. While fact isn't compelling enough for me not to make the investment for the mod/hack value that will certainly flourish in jailbreak community, I have some personal reservations with the capability of Watch. Unlike the Terrible Wearable, it does have a wifi radio. It is combined with the bluetooth radio logic. But like the Motorola 360, it won't have connectivity capability to anything other than the handset it belongs to. The Watch will eventually. Either when Apple says it can, or the profile that restricts a connection gets modified. It will get modified. That is the one thing I do know for sure about Watch.
My Opinions and reflections
The last time I remember liking watches was in Jr. High with those disgusting plastic/rubber things called Swatch. If I remember correctly, it was more the infinite number of ways one could configure it that made it entertaining.
I bought a Movado in my 20's and the only reason why I remember that is because of the ridiculous price/function ratio. For what an unlocked iPhone 6 costs…it pointed at where numbers were supposed to be…so I could guess what time it was. That's it. Since then I have had 2 events with watches in my life. My wife bought me a couple of watches from Fossil which I love, because they were from her…but I won't wear. I ran over one of them with a motorcycle, but its box still sits in a drawer next to the box with the other watch inside of it. It has close to the same dimensions as the smaller Watch. They really should have done a better job with the packaging. Finally I bought my Wife a watch she fell in love with after watching a Sandra Bullock movie. It actually has nice packaging, but sure as Google loves ad revenue, the band is made of plasticky-plastic. Why put that in such a nice box?
If I do decide to buy another watch, it won't be because I need to know to even want to know what time it is. Because I have absolutely zero concept of time, all a wearing watch would do is make me look at it to see how late I am. But the Watch isn't just a watch. We aren't only talking about fashion. Many people, myself included could really care less about the fashion aspect of it. While I appreciate the industrial design, the hard and soft controls and even the almost cheesy marketing gloss for functions like 'taptic engine' and 'force touch', I'm looking for functionality and extension in biometrics, datapoint presentation and innovative things that make it a plausible solution for not having to un-pocket my iPhone.
How the Watch will fail:
- If I have to hold it up to my pie-hole for it to hear voice commands, this is a fail. I don't have to do this with my handset so I shouldn't have to with the Watch.
- If I have to hold it up to one of the holes in the side of my head to hear acknowledgements. I can hear alerts with the iPhone in my pocket, so I should be able to hear alerts when the Watch is at arm's length.
- If the timing execution of the alerts isn't configured so both devices disseminate them simultaneously, (unless I have set one of them for no alert) I will have a problem with that. I don't need an alert from my handset and then 5 seconds later have the wearable alert me again as if I was too stupid to understand the first time.
- If I have to provide input on both the Watch and the iPhone to generate any singular useful capability. Especially if it needs to happen simultaneously. Having to operate two devices for functions that one can do by itself is just silly.
- If Apple even considers the super-dumb idea of graffiti-like single character input for quick responses, that's when we will know Steve Jobs legacy has left Apple. It was fine for the Newton. I loved my MessagePad, but graffiti needs to stay dead.
This isn't Apples first Rodeo
You may not know this, but the Watch is not Apples first consideration on a wearable device. The first one they considered was a stand alone computer, back when John Sculley was the boss. They called it Time Band:
Thank goodness this isn't the design they are going to run with. Could you imagine the flood of yuck that would ensue from Samsung if this were the form factor Apple chose?
Hmm…that's close, don't you think? Something isn't quite right though…,
There we go.
Nailed it.


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Tag Archives: Parliament← Older posts
First Female Black Rod Appointed By Queen Elizabeth II
At Buckingham Palace on Tuesday, Queen Elizabeth II presented the first female Black Rod with her ceremonial staff during an official audience. Sarah Clarke, a former championships director at the All-England Lawn Tennis Club, was appointed Lady Usher of the Black Rod in November by a special selection panel. She is the first female to hold the position in the Black Rod's 650-year history. The Black Rod is responsible for … Continue readingPosted in The United Kingdom | Tagged Elizabeth II of the United Kingdom, Parliament | Leave a comment
Jordanian Royals Mark The Opening of Parliament
Jordan's King Abdullah II has inaugurated on Sunday the eighteenth Parliament session and delivered a speech from the throne. Upon his arrival to the parliament complex in the capital Amman, the King was accompanied by his eldest son, Crown Prince Hussein bin Abdullah II. Following the official welcoming ceremony, His Majesty moved to the Parliament Hall where he addressed senators, representatives and the government, urging them to be self-reliant. His Majesty added, … Continue readingPosted in Jordan | Tagged Abdullah II of Jordan, Crown Prince Hussein of Jordan, Parliament, Princess Muna Al Hussein of Jordan, Queen Rania al-Abdullah of Jordan | 1 Comment
King of Norway Opens 162nd Session of Stortinget
The King of Norway has opened the 162nd session of the Stortinget, the Norwegian parliament, on Monday October 9th. In his one and only visit to the Stortinget for the year, King Harald delivered the government's aims for the coming year from the throne before declaring the session open. He spoke of the government's aim to "develop a society that is sustainable in economic, social and environmental terms", while also discussing … Continue readingPosted in Norway | Tagged Crown Prince Haakon of Norway, Harald V of Norway, Parliament, Queen Sonja of Norway | Leave a comment
Prinsjesdag 2017
On Tuesday September 19, the Dutch Royal Family celebrated the traditional opening of Parliament, Prinsjesdag. King Willem-Alexander was joined by his wife, Queen Máxima, his brother Prince Constantijn and his sister-in-law, Princess Laurentien. The Dutch Royals left Noordeinde Palace at around 13:00 heading to the Knight's Hall in the Glass Carriage through the streets of The Hague. Princess Beatrix saw the procession of the carriages from the window of the Royal … Continue readingPosted in The Netherlands | Tagged King Willem-Alexander of The Netherlands, Parliament, Prince Constantijn of the Netherlands, Princess Laurentien of the Netherlands, Prinsjesdag, Queen Máxima of the Netherlands | Leave a comment
Spanish State Visit to The United Kingdom: Welcoming Ceremony
King Felipe and Queen Letizia of Spain began their state visit to the United Kingdom on Wednesday, with the customary welcome at Horse Guards Parade in the presence of Queen Elizabeth, the Duke of Edinburgh, the Prince of Wales and the Duchess of Cornwall. After greeting each other, the King and Prince Philip inspected a guard of honour before the royal party traveled to Buckingham Palace in a carriage procession, … Continue readingPosted in Spain, The United Kingdom | Tagged Elizabeth II of the United Kingdom, Felipe VI of Spain, Parliament, Queen Letizia of Spain, State Visit, The Duchess of Cornwall, The Duke of Edinburgh, The Prince of Wales | 1 Comment
Felipe and Letizia Mark Forty Years Since Spain's Cortes Generales Elected
King Felipe VI and Queen Letizia attended events marking the fortieth anniversary of Spain's 1977 general elections, the first election since prior to the Spanish Civil War. The royal couple were present for a solemn session of the Cortes Generales at the Palacio de las Cortes in Madrid on Wednesday. They were joined by Prime Minister Mariano Rajoy, the President of the Congress of Deputies, Ana María Pastor, and the President of the Senate, Pio García-Escudero. "Recalling … Continue readingPosted in Spain | Tagged Anniversary, Felipe VI of Spain, Government, Parliament, Prime Minister Rajoy of Spain, Queen Letizia of Spain | 1 Comment
Watered-Down State Opening of Parliament Held in London
There was less pomp, less circumstance for the 2017 State Opening of Parliament in London on Wednesday, which saw Queen Elizabeth forego the traditional robes and crown she has worn in years past for a simple day frock and matching hat. Arriving by car instead of carriage, the Queen was accompanied by the Prince of Wales, who stood in for the Duke of Edinburgh (the Duke was admitted to hospital on … Continue readingPosted in The United Kingdom | Tagged Elizabeth II of the United Kingdom, Parliament, Prime Minister May of the United Kingdom, The Prince of Wales | Leave a comment
Crown Princess Margareta Addresses the Romanian Parliament
Her Royal Highness Crown Princess Margareta of Romania yesterday addressed a solemn session of the Romanian Parliament in connection with the jubilee celebration of "Iasi – Capital of the Kingdom of Romania 1916-1918 and the City Of the Great Union". It was 100 years ago in 1917 that the Romanian Senate and Assembly of Deputies met in the city of Iasi and adopted the reforming laws of the Romanian State … Continue readingPosted in Romania | Tagged Anniversary, Crown Princess Margareta of Romania, Parliament, Prince Radu of Romania, Princess Maria of Romania | Leave a comment
Order of the Garter Service Cancelled In Favour of State Opening of Parliament
Buckingham Palace today announced that the Order of the Garter service will not take place in 2017, as the June 19 date is required for the State Opening of Parliament following the June 8 snap election. Queen Elizabeth presides over the State Opening of Parliament. However, this year, it is reported that the Opening will have "reduced ceremonial elements" – there will be no carriage procession, a limited amount of ceremonial … Continue readingPosted in The United Kingdom | Tagged Elizabeth II of the United Kingdom, Order of the Garter, Parliament, The Duchess of Cornwall, The Prince of Wales | Leave a comment
MPs To Debate Whether Queen Elizabeth's Sapphire Jubilee Deserves Public Holiday
Whether or not the Sapphire Jubilee of Queen Elizabeth II should be honoured with a bank holiday across Britain will be debated in the Commons later this month after Tory MP Andrew Rosindell brought up the motion on Tuesday. "Just as previous jubilees have been celebrated far and wide, it must surely be right that the Sapphire Jubilee is too. In fact, I say to this House that Her Majesty's Sapphire … Continue readingPosted in The United Kingdom | Tagged Elizabeth II of the United Kingdom, Jubilee, Parliament | 1 Comment
King Abdullah Meets With British Prime Minister
The King of Jordan had a meeting with Britain's Prime Minister Theresa May at 10 Downing Street on Wednesday March 1. Both expressed the desire for the relationship between Jordan and the UK to continue to grow in the years to come, as there is a "long tradition of working together" according to Prime Minister May. King Abdullah also met with members of the Houses of Lords and Commons, with whom … Continue readingPosted in Jordan | Tagged Abdullah II of Jordan, Audience, Bilateral Relations, England, Parliament, Prime Minister May of the United Kingdom | 3 Comments
Luxembourg's Grand Ducal Family Hosts New Year Reception
At the Grand Ducal Palace today, the Luxembourg Grand Duke and Grand Duchess welcomed members of Parliament and government for their annual New Year's reception. Hereditary Grand Duke Guillaume and Hereditary Grand Duchess Stéphanie, wearing an orange shift dress with floral embellishments, were also present to greet the guests, including Prime Minister Xavier Bettel and the Parliamentary President Mars Di Bartolomeo. A second reception will be held tomorrow for members of … Continue readingPosted in Luxembourg | Tagged Government, Grand Duchess Maria Teresa of Luxembourg, Grand Duke Henri of Luxembourg, Hereditary Grand Duchess Stéphanie of Luxembourg, Hereditary Grand Duke Guillaume of Luxembourg, New Year, Parliament, Prime Minister Bettel of Luxembourg | Leave a comment
King Abdullah II Addresses Parliament
His Majesty King Abdullah II opened the 1st Ordinary Session of the 18th Parliament session in Amman, Jordan. Upon arrival at the Parliament, His Majesty reviewed the guard of honor then the national anthem was played. An artillery unit fired a 21-gun salute welcoming the King. Embed from Getty Images During the opening, His Majesty gave a speech infant of the newly elected members and members of the Jordanian royal … Continue readingPosted in Jordan | Tagged Abdullah II of Jordan, Parliament, Queen Rania al-Abdullah of Jordan | 1 Comment
Danes Attend Opening of Parliament
The 2016-2017 Parliamentary Session has been opened today in Denmark, with members of the royal family in attendance. Greeted on the stairs of Christiansborg Palace by the Presidium of the Parliament, Queen Margrethe was escorted into parliament by its Speaker, Pia Kjærsgaard. The Queen looked lovely in a red ensemble, while both her daughters-in-law Crown Princess Mary and Princess Marie stuck to neutral tones (though Mary accessorised with navy blue). Princess … Continue readingPosted in Denmark | Tagged Crown Prince Frederik of Denmark, Crown Princess Mary of Denmark, Margrethe II of Denmark, Parliament, Prince Joachim of Denmark, Princess Benedikte of Denmark, Princess Marie of Denmark | 1 Comment
Prinsjesdag 2016 Marked In The Hague
The Dutch Royal Family has celebrated today, Tuesday September 19, the official opening of the parliament, Prinsjesdag. His Majesty King Willem-Alexander was accompanied by his wife, Her Majesty Queen Maxima, his brother Prince Constantijn and his sister-in-law, Princess Laurentien. The Dutch Royals left the Noordeinde Palace at 13:00 heading to the Knight's Hall in horse-drawn carriages through the streets of The Hague. This year was used the Glass Carriage that was … Continue readingPosted in The Netherlands | Tagged King Willem-Alexander of The Netherlands, Parliament, Prince Constantijn of the Netherlands, Princess Laurentien of the Netherlands, Prinsjesdag, Queen Máxima of the Netherlands | 1 Comment
The Swedes Attend Opening of Parliament
The Swedish Parliament was opened for the 2016/2017 session today, with the royal family in attendance at the Riksdaghuset. Arriving by horse drawn carriage, they were greeted by Prime Minister Stefan Löfven and the Parliamentary Speaker Urban Ahlin. King Carl Gustaf gave a speech during the opening, saying that "we live in a globalised world" and that "it was clearer than ever that what happens outside Sweden also concerns us." The … Continue readingPosted in Sweden | Tagged Carl XVI Gustaf of Sweden, Concert, Crown Princess Victoria of Sweden, Parliament, Prime Minister Löfven of Sweden, Prince Carl Philip of Sweden, Prince Daniel of Sweden, Princess Madeleine of Sweden, Princess Sofia of Sweden, Queen Silvia of Sweden | Leave a comment
Queen Elizabeth Advises All to 'Stay Calm' During Opening of Scottish Parliament
Speaking at the opening of the Fifth Session of Scottish Parliament in Edinburgh today, Queen Elizabeth spoke of the benefits of keeping calm "in an increasingly complex and demanding world", a statement of particular relevance considering the aftermath of last week's 'Brexit' vote. "Retaining the ability to stay calm and collected can at times be hard. As this Parliament has successfully demonstrated over the years, one hallmark of leadership in such a fast-moving world … Continue readingPosted in The United Kingdom | Tagged Elizabeth II of the United Kingdom, Parliament, Scotland, The Duke of Edinburgh | 2 Comments
Saga Around Beatrix Sailboat Continues: Maintenance Will Stay With Defence Department
The maintenance costs of Princess Beatrix' sailboat have been a topic of debate in Dutch parliament since 2007. Due to an electorate that lost all sense of direction and a hysterical press, the debate about the costs has become a perfect tool for a group of politicians to get their faces on television and to scratch the varnish of the throne. Princess Beatrix received the 'Groene Draeck' (Green Dragon) from … Continue readingPosted in The Netherlands | Tagged Finances, Groene Draeck, Parliament, Princess Beatrix of the Netherlands | Leave a comment
Queen Elizabeth II Opens State Parliament
Britain's State Opening of Parliament took place at the Palaces of Westminster by Queen Elizabeth II today, in the traditional glittering ceremony that sees the Queen arrive by horse-drawn coach and don the Robe of State and the Imperial State Crown as she delivers the Queen's Speech. The 90-year-old monarch used the lift up to the Sovereign's Entrance for the first time, for each of the 63 previous years she has opened … Continue readingPosted in The United Kingdom | Tagged Elizabeth II of the United Kingdom, Parliament, The Duchess of Cornwall, The Duke of Edinburgh, The Prince of Wales | Leave a comment
Was It Something I Said? David Cameron's Blunder In Front of Queen
Yesterday, Queen Elizabeth II hosted a reception for UK Parliament representatives on the occasion of her 90th birthday. In attendance were Prime Minister David Cameron, Speaker of the House John Bercow, Leader of the House Chris Grayling and The Archbishop of Canterbury, Justin Welby. Whilst being led round the room by the Speaker of the House Her Majesty stumbles upon Mr Cameron and Chris Grayling, "the great axis of powers". Mr Cameron … Continue readingPosted in The United Kingdom | Tagged Elizabeth II of the United Kingdom, Parliament, Prime Minister Cameron of the United Kingdom | 1 Comment


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Interesting article today on troubleshooting replication errors.
A few weeks ago, on production, we received an alert with on replication failures. Upon further inspection the error looks like this:
Command attempted: if @@trancount > 0 rollback tran (Transaction sequence number: 0x001031C200001B06000700000000, Command ID: 1) Error messages: The row was not found at the Subscriber when applying the replicated command. (Source: MSSQLServer, Error number: 20598) Get help: http://help/20598 The row was not found at the Subscriber when applying the replicated command. (Source: MSSQLServer, Error number: 20598) Get help: http://help/20598
Identify Root Cause:
To understand the course of action, we need to first understand the underlying issues. Go to Replication Monitor >> Open Details Window on the subscription that has errors. Go to 'Distributor to Subscriber' tab for more details. See the image below:
Now we see that, replication is attempting to perform an action on the Subscriber, but the row does not exist. So, lets find out more.
Find the exact command that is being replicated (or executed on Subscriber as part of replication) that throws this error. Use replication procedure sp_browsereplcmds for that.
Query the Distribution agent ID from dbo.MSdistribution_agents and use it in the query below.
-- -- Uncover the replication command throwing error -- EXEC sp_browsereplcmds @xact_seqno_start = '0x001031C200001A620004000000000000' , @xact_seqno_end = '0x001031C200001A620004000000000000' , @agent_id = 49 , @publisher_database_id = 3 GO
You'll see something like this:
Under the command column, we'll see the exact command that is running into this error.
-- -- Error 20598 occurring in -- {CALL [mtx_rpldel_ReportCriterion] (908236,71357,250,-1)}
Now, lets go to that stored procedure 'mtx_rpldel_ReportCriterion' and see what tables are involved in manipulation. In my scenario, the table ReportCriterion does not have the record with ID = 908236
Once you understand the root cause, we have a few options.
- Data Integrity: Looks like we have synchronization issues between Publisher and Subscriber. If it is a non-production environment or an environment where reinitializing is an option, then we could take that route to sync up the data first.
- Once data integrity issues are resolved, all subsequent replication commends would be successful.
- Manual fix: Manually insert the missing record at Subscriber and then allow replication to perform its operations on the new record.
- With this option, the more records we uncover as missing, the more manual operation would be required. Its not ideal, but it is a workaround to get things going again.
- Ignore, for now: In some situations, until further solution is identified, we may need to ignore this one record and move forward with rest of the replication commands.
- Take necessary precautions to make sure there are no more such missing records. Or gather a list of all missing ones.
- Configure replication to ignore error 20598 using skiperrors parameter. There are a couple of ways to achieve this; here we'll look at one.
- Go to the Agent Profile for this particular Distributor Agent. One of the profiles allows us to skip certain errors. See the image below.
For more information, please refer to Microsoft Support article on similar issue.


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318 Lewis St, Culpeper VA 22701 – Farm House & Land (Cancelled)
318 Lewis St, Culpeper VA, is a 1930's Farm House on 2.75 acres (in 2 parcels) in the town of Culpeper, VA, and is now being offered for sale after being in the same family for over 45 years. The lot and home are located within town limits, close to schools, shopping, restaurants, businesses, and commuter routes and just blocks away from Historic Downtown Culpeper. What a perfect location!
Farm House
Several generations of one family have called this home; the home is sturdy and livable and has had some recent updates, including a new roof in 2015 and the chimney replaced in 2015. It needs some work but with a little TLC can be restored into a great home for its new owner. As you enter the home through the original front of the home, you are greeted with a beautiful wooden staircase with all the craftsmanship of days gone by. The living room features original wood floors and a fireplace which has now been closed off. Pass through a doorway into a small sunroom/enclosed porch. Through another door you find the dining room, also with original wood floors, featuring a wood burning stove with a newer chimney installed in 2015. The kitchen has enough room for all the cooks. Through the kitchen is the main entry to the home, along with a full bath and laundry room. The home features 3 bedrooms and 1 bathroom upstairs. Each bedroom originally had either a fireplace or wood burning stove, all of which have now been closed off. The owners have retained the original wood floors and wood molding throughout the bedrooms and hallway.
This is an excellent opportunity to own a fine old home; restore it for yourself or to sell, or rent it for current income. The property itself can potentially be subdivided, subject to town approval. Per the zoning ordinance, 10,000 sf lots are permitted; we estimate approximately 6-10 lots are possible, depending on the site plan, and subject to town approval. A great opportunity for a small builder!
Vacant Lot
The vacant lot is a 2.11 acres, being offered together with 318 Lewis St., and is situated directly behind the house, extending over to Griffith Drive, then left down to a creek. The two parcels, totalling 2.75 acres and including the home , and are being offered together at a combined price of $313,000. The lot is open & surrounded by mature trees, sloping gently to the creek. Subject to town zoning and planning restrictions and requirements, the lot can potentially be subdivided into several lots, each a minimum size of 10,000 sf. Town water and sewer are available to the lot from Lewis Street. There is a proposed, but undeveloped street, Smith Street, which will provide future access for the property. Interested buyers are encouraged to speak with the Planning Director regarding development of this street.
This is a quaint neighborhood with a mix of older and newer homes and tree-lined streets, yet it is only a few blocks from Historic Downtown Culpeper, named "The Best Small Town in Virginia" and "One of America's Top 10 Small Towns" by Norman Crampton, author of "The 100 Best Small Towns in America."
PLEASE NOTE: DO NOT USE GRIFFITH DRIVE TO ACCESS THIS PROPERTY. The lot currently can only be accessed via 318 Lewis Street and is located directly behind the house.
(All information herein believed to be accurate but should be independently verified. Prospective buyers should contact the town Zoning & Planning Departments to verify allowable uses, requirements and conditions.)


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Bathroom Curtain Ideas for High Class Bathroom Decoration
In this way, you're looking for the high-class and soigné bathroom assistants to improve your bathroom. However don't be overwhelmed by the adornment work. Accompany steps and partition the assignment with the goal that it comes to be straightforward and achievable. Notwithstanding bathroom is an exceptionally individual place so to make it the more particular retreat you have to design it as per your taste and put all the most recent and sharp bathroom adornments that extend from bathroom curtain ideas, vanities to shower floor coverings, shower tangles and ground surface.
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In this segment of bathroom enhancing plans, you will have knowledge into mirrors, bathroom sinks, space cabinets, bathroom vanities, bathtubs, walled in areas and shower heads & sections. Right away to give an in number effect, purchase these as per the accessible bathroom space. Like, provided that you have a restricted shower space then vanity for space could be utilized under the sink any other way you can put it independently. Likewise check the mirror measure and size of bathtub before acquiring them. It is better to take the estimations of your bathroom before shopping.
The bathroom curtain ideas that can alter your bathroom are the bathroom outfitting thing. The determination of all these may as well additionally be carried out specifically where it is significant to think about the fabric, shade, plan & shape.


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From what we can see Chinese company is already working on new action camera. From available information it should be called SJCAM SJ8, and it will have many advanced features like 4K at 60fps. Therefore if you know this is not in the first [email protected] action camera in the world. Because of that they are working on some other really cool features which other action cameras in the same class does not have.
SJCAM SJ8 views have 2.33 inch touchscreen, and at the same time it will have 0.96 inch screen on the front side. The same as SJCAM SJ6 Legend. At this moment we Information that it will have GPS, and would be optional. So according to your needs you will able to choose GPS option or not.
The SJ8 will also support EIS up to maximum resolution [email protected] Also below you can see tech specs which are at this moment not confirmed yet.
Ambarella H22 Chipset
Sony IMX377 Sensor
Dual Screen – 2.33″ Touchscreen + 0.96″ Front
GPS (External)
FPV Mode (PWM)
RAW Support
Live Streaming
24fps / 25fps
Voice Control
Dual Microphones
2.4GHz/5GHz WiFi
Distortion Correction
USB Type-C
External Mic Support
2.4GHz Remote Support
Slow Motion
EIS (Gyro) up to 4K30Fps
source: poshgadgets


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At CNY Healing Arts we recognize the "mother" in everyone. That caring, nurturing essence that helps make the world what it is and that we all need in our lives. As Mother's Day approaches we'd like to invite you to join us at one or more of our special events created for the sole purpose of honoring you and providing an opportunity for wellness, renewal and nurturing of self. You deserve it! Call us with any questions 518.724.5750
Meditation with Suzanne Maguire
May 3rd & 17th
Join Suzanne in the CNY Fertility Reception Area for an evening of relaxation and meditation.
RSVP to 518-724-5750, Fee $15
Mother's Day Wellness Retreat
May 12, 9:00-12:30pm
*RSVP to 518-724-5750 by May 10th
Vinyasa Yoga (all-levels welcome), Brunch, Reflexology, and Chair Massage. Come Celebrate! Honor & Give Back to yourself for all the amazing, selfless work you do as a mom. Come show gratitude to the amazing moms out there who have touched your life in some way! Fee: $30
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Date - Jul 16th 2019
Rundholz Mainline Collection
VAT FREE outside European Union
The Rundholz Mainline Collection is always a joy, stunning fabrics, original design and the very finest production. This Rundholz Mainline Spring Summer 2019 collection is no exception to this.
The Rundholz Mainline Collection for Spring Summer 2019 offers complex fabrics, original prints and wonderful combinations of fabrics. Once again, Carsten and Lenka Rundholz have created a strong, unique and exceptional collection of clothing for this Summer 2018 season.