Nurses ans other Professionals

As with doctors, there are many types of nurses

Registered Nurses

Registered nurses( R.N.s) are often found in leadership role in both inpatent and outpatient settings, such as MDA clinics.

Registered nurses generally have a bachelor's or master's degree in nursing; the "registered" part comes from a state licensing exam and isn't an academic degree. The initials B.S.N. and M.S.N. stand for bachelor of science in nursing and master of science in nursing.

These nurses generally knowa fair amount about the physiology underlying your son's illness and th medications and other therapies being used. They have a good grounding in psychology and sociology and (in an ideal world, anyway) should be able to take the time to talk with you and your son about coping with chroniic illness and disability.

Many registered nurses today have a specialty requiring extra training and education; ffor example, pediatrics or neuroscience are options for nursing specialization.

Nurse Practitioners

A nurse practitioner NP is a registered burse with advanced academic and clinical experience in a specialty, such as adult health, children's health, women's health, mental health or home care. Most NPprograms involve master's degree acadmic work and an extensive period of supervised practice. NP are certified by their states, which determine their precise scope of practice.

Nurse practitioners overlap with doctors in some functions, including diagnosing some disorders and prescribing some medications. However, their focus is somewhat different from that of physicians. Nurse practitioners focus more on health maintenance, patient and family education, and strengthening physical and psychololical  mechanisms to copewith disease. If you encounter an NP she;s most likely to be a neuromuscular disease clinic, cardiology clinic or rehabilitation unit.

Licensed Practical ( Vocational) Nurses

Licensed practical (vocational) nurses (LPN or LVN) have less education than registered nurses and have a smaller scope of practice. Yoday's practical nurses are usually prepared at community colleges with 2 year associate degrees in nursing. A few vocationall oriented high schools may still offer programs in practical nursing. The licenseing is done by the state, bases on an exam.

L.P.N.s do much of the routine nursing care in some hospitals today. They have a rudimentary understanding of the physical and psychological aspects of a person's ilness and the medications he's taking. Yoo may see L.P.N.s in the clinic, where they may take blood pressure, measure heights and weights, and set up rooms for the doctors (although these task assignments vary in different institutions).

Medical Assistants, Nursing Assistants, Patient Care Technicians

These days, you may run across a lot of people in the clinic who seems to be doing a variety of things, ranging from taking your son's blood pressure and asking about his diet to answering the phone and making the coffee. They may even be called "nurses," but chnaces are belong to the new army of semi-professional staff known as medical assistants or nursing assistants or patient care technicians. Most of these staff members are trained in less than a year t technical schools that specialize in this sort of training. Certification requirements vary from state to state.

Semi-Professional staff are generally skilled in med ical terminology, certaintechnical skills (which may included blood drawing and other fairly complex tasks) and office management, depending on the emphasis n their particular program. They usually aren't well grounded in disease physiology or psychosocial aspects of disorders, although most schools prepare their students in a gerenal way for understanding the perspective of a patient and his family.

Physical Therapists

Physical therapists are professionals who deal with problems related to mobility and strength through manipulation of muscles and joints. In DMD, there is progressive weakness of muscles, which leads eventually to muscle s shortening and therefore to contracted joints (joints that are fixed in a position dictated by weakness, use and gravity).

Physical therapists prescribe exercise plans and make recommendations about wheelchairs, braces and other mobility aids. They may also make recommendations about breathing aids, since it's muscle weakness that's responsible for loss of respiratory function in DMD. They generally work in conjunction with neurologists or other referring doctors.

Physical therapy (P.T.) can't cure DMD, but it can help maintain strenght in muscles that are still strong and can help postpone the development of contracted joints. Therefore, physical therapists are people you definitely need to see; you can get a referral to one from your MDA clinic doctor.

State and federal laws generally require schools to provide physical therapy for children who are eligible for special education. your child's therapy needs can be written into his educational program.

Physical therapists have bachelor's or master's degrees in physical therapy and are licensesed by their states. A licensed, or registered, Physical therapist the initials R.P.T.

Physical Therapy Technicians and Aides

Physical therapy, like nursing, now has different levels of preparation. You may encounter semi-professionals such as physical therapy technicians or physical therapy aides. These staff members have far less preparation ( usually less thana year at a technical school): their job is to assist the physical therapist.

Occupational Therapists

The field of occupational therapy (O.T.) overlaps a bit with physical therapy, but here the emphasis is on small muscles, such as those of the nabd, while in physical therapy, it's generallu on the large muscles, such as those in the arms and legs.

Occupational therapists are concerned with a person's ability to perform hand movements needed for work ( for example, computer operation), activites of daily living ( for example, eating, brushing one's teeth), and recreation ( for example, drawing).

They make recommendations about adaptive aids ranging from hand splints to specially designed taableware to computer systems. In some institutions they also help people learn to use wheelchairs and other equipment.

Occupational therapists are prepared in bachelor's or master's degree programs and certified by the states where they practice. Registered therapists carry the initials O.T.R

As in mursing and other areas, there are less skilled practitioners known as occupational therapy assistants or aides. They work under the direction of professional occupaitonal therapists.

Respiratory Therapists

Respiratory therapists ( also known as respiratory care practitioners) are professionals who specialize in maintainine or improving a person's ability to breathe and exchange oxygen and carbon dioxide in so doing.

As chest muscles weaken in DMD, breathing and gas exchnage suffer. Your doctor may refer you to a pulmonologist who may then refer you to a respiratory therapist, or you may be referred directly to the respiratory therapist. ( Institutions differ in their procedures.)

Respiratory therapists generally have at least associate degrees from two-year community colleges. They're well grounded in respiratory physiology, disorders of respiration and treatments for these disorders. Certication is through the states.

The respiratory therapist, in conjunction with the referring doctor, will evaluate respiratory function and perform tests to determine what interventions would be best for your son. He can then begin helping your son use various forms of mechanical adis and monitoring equipment if necessary, and can help you and your son perform exercises to help keep the respiratory system functioning as effectively as possible, if these are indicated. As in other fields, there are multiple levels of trainin and expertise. A respiratory therapy technician doesn't have as much training as a respiratory therapis.

Dietitians, Nutritionists, Nutrition Counselors

All medical centers have specialists in nutrition who can help you plan a diet for your child. You may need help with diet planning and food preparation if your son needs to limit calories or sodium, or if the doctor has suggested some other alteration in average food intake . Registered dietitians (R.D.s) have bachelor's or master's degrees in the field of nutrition and have completed internships and certifying exams. The terms nutritionist and nutrition counselor are often used in medical centers and other health-care settings. These terms imply no specific training. A nutritionist or nutrition counselor may be a nurse or other health professional with special expertise and interest in nutrition.You can ask your MDA clinic doctor for a referral for nutrition counseling.

Genetic Counselors

DMD, like many other neuromuscular conditions, is a genetic disorder. Therefore, you and your family may be interested in the services of a genetic counselor, a health professional whose specialty is interpreting information about genetic disorders to families.

A certified genetic counselor has completed a master's degree in genetic counseling, which includes courses in counseling as well as in genetics. Most have undergraduate degrees in either biology, nursing, psychology or public health. At major medical centers, genetic counselors will almost certainly be certified by the American Board of Genetic Counseling.

A genetic counselor can coordinate genetic testing for family members who are suspected of either having or carrying a gene for a genetic disorder, and can interpret results for the family. This professional normally keeps up with developments in genetic testing, which is a rapidly changing field. You can ask your MDA clinic doctor for a referral to a genetic counselor.

Psychologists

Psychologists come in several varieties. Those you're likely to meet in a medical center are known as clinical psychologists or counseling psychologists.

Both have doctoral degrees in psychology and have also completed internships and periods of supervised practice, and have met state licensing requirements. They usually have Ph.D. or Psy.D. after their names.

Clinical psychologists deal with mental, emotional and behavioral issues. Counseling psychologists overlap with clinical psychologists but focus more on helping people adjust to unwanted changes in their lives, such as physical illness, or helping them make desired changes, such as getting a job. Some psychologists treat individuals and others specialize in treating families or children.

In general, psychologists don't prescribe medications, but some states allow them to do some prescribing with supervision. The focus in psychology is more on supporting coping mechanisms and existing mental health, while in psychiatry it's more on diagnosing and treating illness.

Social Workers

Like many other health professionals, social workers come in many stripes. Those you're most likely to meet in the medical center are medical social workers and clinical social workers.

A professional social worker has a social work degree -- a bachelor's, master's or doctorate -- and has met the state's legal requirements for the practice of social work. The initials B.S.W., M.S.W. and D.S.W. indicate a bachelor's, master's and doctoral degree in social work, respectively. States have different initials to indicate certification.

The initials A.C.S.W. mean that a social worker is certified by the Academy of Certified Social Workers, which requires a master's or doctoral degree, specific work experience, references and an exam.

Clinical social workers share many functions with psychologists, in that they focus on counseling to mobilize a person's resources and coping skills.

Medical social workers and general social workers usually focus more on practical matters, such as helping with finances, including insurance and disability payments, housing adaptations, access to needed equipment, and connections with other agencies at the community, state or federal level. However, they too cross over into counseling and supporting coping skills.

Social workers try to "pull all the strands together" when a family has a child with a disability or serious illness. These strands may be financial, social, emotional or circumstantial. Many school districts also have social workers to assist with issues of adjusting to school.All medical centers have social workers,