Here I have included 2 discussion posts; one is about Deafness and the other one is about Cerebral Palsy. Please answer to these two discussion posts.

1. I have also included a reply example to deafness discussion to give you some idea about how to write your reply.

First Discussion: Cerebral palsy (CP) is a group of disorders characterized by motor dysfunction that results in permanent impairment in muscle tone and function. CP is caused by an insult to the developing brain in utero or shortly after birth. The severity of CP varies and can be further categorized into three main subtypes: 1) spastic, 2) dyskinetic, and 3) ataxic. Each of these subtypes are based on the predominant type of motor impairment present, however, it is important to know that features of all these subtypes may be present in a single individual. It is also important to understand that it is not a neurodegenerative disorder like ALS or MS, but the clinical features of the disease may change over time. Because the subtype and severity of CP varies widely between individuals, the healthcare needs of each patient can be vastly different. While one child may only have mild spastic features and require physical therapy or low dose anti-spastic agents to keep their symptoms under control, another may have hemi-, di-, para-, or full quadriplegia and therefore require a wheelchair to move about their environment. In addition to physical disability, CP is associated with a variety of other conditions including intellectual disabilities, epilepsy, and hearing and vision abnormalities (just to name a few). This presents a variety of healthcare challenges as there is no clear and straightforward approach to managing these patients. One of the most obvious challenges becomes the type and amount of care required for these patients to succeed. With isolated motor dysfunction, the primary goal is on rehabilitation and management of symptoms with physical and occupational therapy, behavior modifications, and medications. With the addition of intellectual or neurological conditions like epilepsy, you expand these goals to include specialty care with neurology, psychiatry, behavioral health, etc. (Ballantyne, 2015). The burden of healthcare costs, appointment load, and physical and mental stress on caregivers suddenly increases as the complexity of the disease unfolds. To further complicate this picture, there are well documented health disparities among children with CP that include socioeconomic status, gender, race, as well as maternal education, age, and prenatal care (Wu, 2011). With the addition of these disparities, children with CP are now fighting for access against even more complex barriers like structural racism and social class (Flanagan, 2021). These disparities are especially noteworthy when considering the direct effect they play in maternal health and prenatal care, when fetal development (and the potential development of CP) is at its most vulnerable point. Because CP is a complex disorder that encompasses a variety of clinical manifestations and comorbidities, it requires a specialized, multidisciplinary approach to patient care. As future healthcare providers, it is a good reminder of the importance of practicing patient-centered care that takes into account their individualized needs, while also addressing the barriers that may affect them from receiving it. References: 1. Oguntade, H. A., Nishath, T., Owusu, P. G., Papadimitriou, C., & Sakyi, K. S. (2022). Barriers to providing healthcare to children living with cerebral palsy in Ghana: A qualitative study of healthcare provider perspectives. PLOS Global Public Health, 2(12), e0001331. https://doi.org/10.1371/journal.pgph.0001331 Please provide your answer to this discussion: Bring more idea and information Deafness or hard of hearing is defined as a full or partial loss of the ability to perceive and discriminate sounds. The Mayo Clinic identifies three different types of hearing loss: conductive (involving the outer or middle ear), sensorineural (involving inner ear), and mixed (combination of conductive and sensorineural).1 Within these different categories of hearing loss, there is also a variety of degrees of loss. Some people might lose specific frequencies of sound; some do not have the ability to hear quiet sounds. Others have complete hearing loss. There are many causes of hearing loss including genetics, aging, loud noises, damage to the inner ear, abnormal bone growth, medication side effects, and some illnesses. Many causes of hearing loss are irreversible, but some, such as medication side effects, can be reversed if identified soon enough. Communication with patients about their health is one of the most important things we can do as providers. It allows patients to make informed decisions and allows them to be active participants in their own health. However, with deaf or hard of hearing patients, communication is often one of the aspects that makes healthcare inaccessible to them.2 In our PA program, we often talk about the importance of establishing a strong relationship with your patients, especially if you are their primary care provider. Unfortunately, due to communication barriers, many individuals who are deaf are unable to establish that strong and effective patient-provider relationship. Without effective communication, the patient is left with inadequate comprehension of their disease or the appropriate management, which can, in turn, result in poor treatment adherence and higher utilization of emergency services.2 This is similar to findings in linguistic minority groups. One concept that I did not realize previously is that signing deaf communities have Sign language as their first language, and Sign language is not a written language. That means that note writing is not a sufficient way to communicate with deaf people because you cannot assume that they are fluent in the written language of the region.3 Furthermore, I found it interesting that there might be a lack of appropriate sign terminology to explain a medical concept. For example, a U.K. study found that British Sign language does not have a sign for the word “cholesterol”.3 The National Association of the Deaf identifies some guidelines for health care providers when interacting with deaf patients.2 First, it clearly identifying individuals who are at risk for poor communication with clearly visible indicators on their chart. Second, the use of visual medical aids can be helpful in explaining and reinforcing certain medical concepts and basic anatomy. This can also be used in conjunction with the Teach-Back method to ensure the patient has full understanding. Third, having office staff ask, identify, and document what a deaf person’s communication needs are will allow them to facilitate appropriate communication moving forward. Fourth is having providers or interpreters available for the appropriate form of communication for that patient, particularly a Certified Deaf Interpreter. This is a person who is credentialed not just to speak sign, but particularly sign in a medical setting. They note that some patients might prefer American Sign Language, while others might need tactile communication if their vision is also affected. References: 1. Mayo Foundation for Medical Education and Research. (2021, April 16). Hearing loss. Mayo Clinic. Retrieved January 29, 2023, from https://www.mayoclinic.org/diseasesconditions/hearing-loss/symptoms-causes/syc-20373072 2. Position statement on Health Care Access for deaf patients. www.nad.org. (n.d.). Retrieved January 29, 2023, from https://www.nad.org/about-us/position-statements/position-statement-onhealth-care-access-for-deaf-patients/ Please provide your reply to this above discussion: An example of discussion Reply: You make a great point in how the barriers in communication within the deaf community can lead to a lack of trust between the patient and provider. As you mentioned, this lack of communication can lead to poor patient outcomes and is a patient safety issue. An area that I found also interesting is the lack of access to health-specific information to those within the deaf community. Deaf sign language users do not have access to incidentally occurring information about health issues in tramways, or on the radio or TV, and there is a general lack of health information and education materials provided in sign language ( Pollard, Dean, O’Hearn, & Haynes, 2009 ). Among a sample of 203 deaf adults in the United States, over 60% could not list any stroke symptoms, whereas in hearing adults only 30% are not able to list any stroke symptoms; only 49% of the deaf sample could list chest pain/pressure as a heart attack symptom, whereas 90% in a U.S. population-based survey could do so ( Margellos-Anast, Estarziau, & Kaufman, 2006 ). With that being said, I think more can be done to help increase health literacy within the deaf and hard of hearing community either by outreach programs or integrating this in specialized school systems. As you mentioned being able to explain complex medical procedures and consents can be very challenging within the deaf community and as future providers we should be knowledgeable on the appropriate ways of communication within this population. Citations. Margellos-Anast H. Estarziau M. Kaufman G. ( 2006). Cardiovascular disease knowledge among culturally deaf patients in Chicago. Preventive Medicine, 42, 235 – 239 . doi: 10.1016/j.ypmed.2005.12.012